The application of AI in public health surveillance presents a transformative potential for more efficient work methodologies, offering new capabilities for the detection, notification, and response to public health threats. However, it is important to be aware of the associated risks and the ethical and legal challenges linked to AIs use in such a sensitive area as public health. The general objective of this study was to explore the application of AI in public health surveillance in Portugal, as viewed by Portuguese experts. The methodological approach employed was a qualitative study, utilising a descriptive and exploratory investigation. A content analysis was performed on 28 anonymised semi-structured interviews. This process identified concepts, themes, key ideas, and emergent patterns. The findings were then grouped into categories and subcategories, which allowed us to highlight significant consensuses and meaningful insights. Experts recognised AIs transformative potential in enhancing predictive capacity, automating data processes, and supporting decision-making. However, they highlighted critical limitations of the Portuguese system, notably entrenched reactivity, fragmented infrastructures, under-utilisation of primary care and personal device data, and insufficient surveillance of non-communicable diseases. Key barriers include poor data quality and interoperability, absence of comprehensive data governance, shortage of AI-skilled professionals, resistance to organisational change, and limited financial sustainability. Ethical concerns, privacy, algorithmic bias, and explainability were emphasised as central to AIs legitimacy. Comparisons with international experiences revealed that progress depends less on technological readiness than on systemic reform, data harmonisation, and strong governance aligned with European Union (EU) and World Health Organization (WHO) frameworks. AI can shift Portuguese public health surveillance from reactive to predictive, but only if supported by robust data ecosystems, clear governance, and investment in human capital. A national roadmap is required, prioritising interoperability, sustainable financing, and ethical implementation, to ensure that AI serves as a complement to, rather than a replacement for, human judgement in protecting population health. The application of AI tools in public health surveillance presents a transformative potential for more efficient work methodologies, offering new capabilities for the detection, notification, and response to public health threats. The aim of this study was to explore the view of experts about the application of AI tools in public health surveillance. 28 experts were interviewed and shared their views. Addressing Portugal’s current public health surveillance system, they described its problems such as outdated information systems and issues with data quality and access. Experts believe AI could significantly improve how public health is monitored and acted upon. However, they also raised important concerns about data security and privacy, potential bias in AI systems, and the need for transparency in how AI operates. This highlights the importance of new legislation and ethical guidelines, like those proposed in the AI Act, to guide AI use. Key challenges include managing data effectively, ensuring system interoperability and training healthcare professionals. For AI to be used successfully, it requires human oversight, robust data systems, specific legislation, investment in new technologies and collaboration between several organisations. In conclusion, while AI can offer considerable benefits to public health surveillance, it is constrained by current limitations in data and information systems. Portugal needs a digital transformation in health, making sure that new technology is introduced while also supporting the people involved. Training professionals and having strong ethical and legal regulations are crucial for using AI responsibly and effectively in public health in Portugal. A aplicação da IA na vigilância em saúde pública apresenta um potencial transformador para metodologias de trabalho mais eficientes, oferecendo novas capacidades para a deteção, notificação e resposta a ameaças em saúde pública. No entanto, é importante reconhecer os riscos associados e os desafios éticos e legais inerentes à utilização da IA numa área tão sensível como a saúde pública. O objetivo geral deste estudo foi explorar a aplicação da IA na vigilância em saúde pública em Portugal, a partir da perspetiva de especialistas portugueses. A abordagem metodológica foi um estudo qualitativo, numa investigação descritiva e exploratória. Foi realizada a análise de conteúdo a 28 entrevistas semiestruturadas anónimas que permitiu identificar conceitos, temas, ideias-chave e padrões emergentes. Os resultados foram agrupados em categorias e subcategorias, possibilitando identificar consensos significativos e contributos relevantes. Os especialistas reconheceram o potencial transformador da IA para reforçar a capacidade preditiva, automatizar processos de dados e apoiar a tomada de decisão. No entanto, destacaram limitações críticas do sistema português, nomeadamente a reatividade enraizada, infraestruturas fragmentadas, subutilização de dados dos cuidados de saúde primários e de dispositivos pessoais e uma vigilância insuficiente das doenças não transmissíveis. Entre as principais barreiras identificadas encontram-se a fraca qualidade e interoperabilidade dos dados, a ausência de uma governação abrangente dos dados, a resistência à mudança organizacional, a sustentabilidade financeira limitada e a escassez de profissionais com competências em IA. As preocupações éticas, privacidade, enviesamento algorítmico e explicabilidade foram enfatizadas como centrais para a legitimidade da IA. A comparação com experiências internacionais revelou que o progresso depende menos da prontidão tecnológica do que da reforma sistémica, da harmonização de dados e de uma governação robusta alinhada com os referenciais da União Europeia e da Organização Mundial da Saúde. A IA pode transformar a vigilância em saúde pública em Portugal de um modelo reativo para um modelo preditivo, mas apenas se for sustentada por ecossistemas de dados robustos, uma governação clara e investimento em capital humano. É necessário um roteiro nacional que priorize a interoperabilidade, o financiamento sustentável e a implementação ética, de modo a garantir que a IA funcione como complemento, e não como substituto, do juízo humano na proteção da saúde da população.
Assessing and understanding communicative health literacy (COM-HL) in healthcare settings is essential, as it constitutes a fundamental tool of public health and health promotion. Despite its importance, COM-HL remains an underinvestigated topic in Africa. Consequently, the development and validation of a Portuguese COM-HL scale could be regarded as a significant contribution to the assessment of the COM-HL in Portuguese-speaking African countries. Therefore, the aims of this study were to assess the psychometric properties of the Portuguese COM-HL instruments, to describe the COM-HL of Angolan adults and investigate its determinants. Cross-sectional survey. Purposively selected recruitment sites within the municipality/district in seven provinces of Angola across the North, South and East regions. 1839 Angolan adults from 3041 invited persons, predominantly females (53.6%). Quota sampling was used to ensure representation across key sociodemographic strata. Within each quota, recruitment sites, data collection time points and participants were randomly selected. The inclusion criteria were age 18 years or above, Angolan nationality, permanent residence in Angola, the ability to speak the language of the questionnaire and the absence of mental disabilities or any other incapacity to perform the interview. Measurement properties of the six-item and 11-item versions of the COM-HL instrument assessed through Cronbach's alpha and Spearman-Brown coefficient, construct validity of the questionnaire investigated by principal component analysis (PCA), the relationship between COM-HL and independent variables measured with linear regression analyses. The Cronbach's alpha of the 11-item COM-HL scale was 0.92, and the Spearman-Brown correlation was 0.89. The items belonged to one factor, and 56.7% of the total variance was explained by this factor based on the PCA. The mean score was 52.4 (95% CI 51.42 to 53.45). For the six-item version, the Cronbach's alpha was 0.86, and the Spearman-Brown correlation was 0.83. The items belonged to one factor, and 58.1% of the total variance was explained by this factor based on the PCA. The mean score was 49.9 (95% CI 48.83 to 50.97). In both versions of the scale, getting enough time in the consultation with your doctor was rated as the most difficult task. The absence of financial deprivation (p<0.001), the location of residence within an urban area (p<0.001) and the possession of at least a fair health status (p<0.02) were identified as positive determinants of COM-HL. The questionnaires can be characterised by good internal consistency and seem to be an appropriate tool to assess COM-HL in Portuguese-speaking countries. Angolan adults scored relatively low for COM-HL. People found it difficult to get enough time during consultations. Therefore, it is recommended to improve the communication skills of physicians and facilitate communication among healthcare users.
To analyze the perceptions of Primary Health Care (PHC) professionals regarding Covid-19 testing in basic health units (BHUs). This qualitative study, part of a formative research project, involved 22 semi-structured interviews and 4 focus groups with professionals working in PHC in a Brazilian capital city. Among other criteria, the professional most directly involved in pandemic response measures in each BHU was selected. Content analysis was performed using a deductive analytical approach, in which the findings were organized into categories defined based on the components of the health system (population; infrastructure; organization of services; service delivery or care model; and management). Reports commonly referred, in the population component, to the challenges arising from the limitations of PHC coverage; in the infrastructure component, the insufficiency of human resources and physical infrastructure was highlighted, which in turn required changes in the organization and provision of services, with repercussions on the care model. The contributions also revealed that at some points during the pandemic there was a disruption of the work process, especially in family health teams. In the management component, weaknesses in communication flows between the health secretariat and the BHU were identified, although this was less frequently mentioned. The perception that expanding and decentralizing testing in BHUs was necessary was confirmed. The findings point to the importance of coordinating the pandemic response and effectively decentralizing the actions adopted, of preparedness plans and strengthening PHC and its professionals, as well as investments in infrastructure and team training, and advances in actions aimed at occupational health. The pandemic revealed the importance of advancing the health economic-industrial complex and, fundamentally, strengthening and defending the Brazilian Unified Health System. Analisar percepções de profissionais da Atenção Primária à Saúde (APS) sobre a testagem para Covid-19 em unidades básicas de saúde (UBS). Estudo qualitativo, integrante de pesquisa formativa, envolvendo 22 entrevistas semiestruturadas e 4 grupos focais com profissionais que atuavam na APS de uma capital brasileira. Selecionou-se, entre outros critérios, o profissional de cada UBS mais diretamente envolvido com ações de enfrentamento à pandemia. Foi realizada análise de conteúdo com abordagem analítica dedutiva em que os achados foram organizados em categorias definidas com base nos componentes do sistema de saúde (população; infraestrutura; organização dos serviços; prestação dos serviços ou modelo de atenção; gestão). Relatos comumente referiram, no componente população, os desafios procedentes dos limites de cobertura da APS; na infraestrutura, destacou-se a insuficiência de recursos humanos e infraestrutura física que, por sua vez, exigiram mudanças na organização e na prestação de serviços, com reflexos no modelo de atenção. As contribuições revelaram, ainda, que em alguns momentos da pandemia houve descaracterização do processo de trabalho, especialmente nas equipes de saúde da família. Pouco identificado, no componente gestão foram apontadas fragilidades nos fluxos de comunicação entre secretaria de saúde e UBS. Constatou-se a percepção de que a ampliação e capilarização dos testes nas UBS eram necessárias. Os achados apontam para a importância da coordenação da pandemia e descentralização efetiva das ações adotadas, de planos de preparo e fortalecimento da Atenção Primária à Saúde e dos seus profissionais, bem como investimentos em infraestrutura e capacitação das equipes e avanços nas ações voltadas à saúde do trabalhador. A pandemia desvelou a importância de avançar no complexo econômico-industrial da saúde e, fundamentalmente, fortalecer e defender o Sistema Único de Saúde brasileiro.
Person-centered practice has increasingly become a key structural component of health systems, driving the progressive reformulation of public health policies internationally. Despite broad consensus regarding its importance, its integration into clinical practice continues to face significant challenges. The Person-Centred Practice Framework identifies the macro context as a critical domain for sustainable implementation, as it encompasses the structural and strategic factors that shape healthcare delivery. To characterize the person-centered practice framing within the macro context of the Portuguese healthcare system. Qualitative, descriptive, and retrospective documentary study. A systematic literature search was conducted on the websites of entities responsible for defining, guiding, and regulating healthcare in Portugal. Using predefined eligibility criteria, 40 documents were selected. Textual analysis was performed using IRAMUTEQ® software and guided by the constructs of the macro context domain of the Person-Centred Practice Framework. The lexicometric analysis identified five classes, grouped into two thematic fields: i) Structural and organizational determinants of person-centered practice, comprising the classes Systemic vision and integrated response, Organizational culture and participation, Digital transformation and information management, and Political vision and governance structures; and ii) Operationalization of person-centered practice, represented solely by the class Care approach, reflecting its thematic specificity. Factorial analysis revealed distinct and poorly connected discursive patterns associated with different action levels within the healthcare system. Similarity analysis highlighted a discourse centered on the health-care-person nucleus, showing relations with service organization, care integration, and person participation, albeit with word dispersion suggesting misalignment between organizational and practice levels. The macrocontextual framing of person-centered practice in the Portuguese healthcare system demonstrates significant political and strategic advances, as seen in the emphasis on humanized care, investment in health literacy and digitalization, and the introduction of Integrated Care Pathways. However, implementation remains limited due to the absence of clear formative guidelines, biomedical paradigm persistence, and lack of evaluation mechanisms sensitive to care experience.
The 2023 iteration of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) estimated prevalence, incidence, and health burden for 375 diseases and injuries, including 12 mental disorders. We assess past, current, and emerging trends in the prevalence and burden of mental disorders across sexes and age groups, for 21 regions, 204 countries and territories, and by Socio-demographic Index (SDI) quintile, from 1990 to 2023. Mental disorders included in GBD 2023 were anxiety disorders, major depressive disorder, dysthymia, bipolar disorder, schizophrenia, autism spectrum disorders, conduct disorder, attention-deficit hyperactivity disorder, anorexia nervosa, bulimia nervosa, idiopathic developmental intellectual disability, and a residual category of other mental disorders. A literature review identified epidemiological data for each disorder. These were analysed via a Bayesian meta-regression to estimate prevalence by disorder, sex, age, location, and year. Disorder-specific prevalence was multiplied by disability weights representing the severity of health loss associated with each disorder to estimate years lived with disability (YLDs). Deaths due to anorexia nervosa were assessed with a Cause of Death Ensemble modelling strategy to estimate deaths by sex, age, location, and year, and then multiplied by the standard life expectancy at age of death to estimate years of life lost (YLLs). YLDs equalled disability-adjusted life-years (DALYs) for all mental disorders except anorexia nervosa (the only mental disorder considered as an underlying cause of death in GBD), for which DALYs represented the sum of YLDs and YLLs. We presented prevalence, deaths, YLDs, YLLs, and DALYs as counts, age-specific rates per 100 000 population, and age-standardised rates per 100 000 population. We estimated 1·17 billion (95% uncertainty interval 1·06-1·31) prevalent cases of mental disorders globally in 2023, equivalent to an age-standardised prevalence rate of 14 210·7 cases (12 849·5-15 940·1) per 100 000 population. These estimates represented a 95·5% (75·0-121·2) increase in prevalent cases and 24·2% (11·4-41·4) increase in age-standardised prevalence rate between 1990 and 2023. All mental disorders showed increases in prevalent cases between 1990 and 2023, while notable increases were seen in age-standardised prevalence rates for anxiety disorders, major depressive disorder, dysthymia, anorexia nervosa, bulimia nervosa, schizophrenia, and conduct disorder. There were an estimated 171 million (127-228) DALYs due to mental disorders globally across sex and age in 2023, equivalent to an age-standardised DALY rate of 2070·5 DALYs (1519·1-2750·5) per 100 000 population. Mental disorders contributed to 6·1% (4·8-7·6) of all-cause DALYs in 2023, making them the fifth leading cause of global DALYs (up from 12th in 1990). DALYs were almost entirely composed of YLDs. Mental disorders were the leading cause of YLDs in 2023 (up from second in 1990), explaining 17·3% (14·8-20·6) of all-cause global YLDs. Leading causes of mental disorder DALYs were anxiety disorders (ranked 11th among the 304 diseases and injuries at Level 4 of the GBD cause hierarchy), major depressive disorder (15th), and schizophrenia (41st). Globally in 2023, mental disorder age-standardised DALY rates were higher among females (2239·6 [1643·7-3014·1] per 100 000) than among males (1900·2 [1399·8-2510·8] per 100 000), and peaked in the 15-19 years age group (2617·3 [1850·6-3696·8] per 100 000). All locations showed increased mental disorder DALY rates in 2023 compared with 1990, ranging across countries and territories from 1302·4 (952·7-1683·7) per 100 000 in Viet Nam to 3555·8 (2661·9-4715·0) per 100 000 in the Netherlands. Across SDI quintiles, DALY rates ranged from 1853·0 (1352·1-2469·3) per 100 000 for middle SDI to 2184·1 (1606·1-2890·3) per 100 000 for high SDI. A significant health burden was imposed by mental disorders in all countries and territories in 2023, irrespective of the health resources available. In some instances, this burden has increased over time and is unevenly distributed across populations. Stronger surveillance systems, particularly in low-income and middle-income countries, are required. Additionally, we need more coordinated and inclusive policies to reduce the burden through early treatment and prevention, tailored to sex and age differences across locations. Responding to the mental health needs of our global population, especially those most vulnerable, is an obligation, not a choice. Gates Foundation, Queensland Health, and University of Queensland.
Obesity is a serious public health problem and is associated with activation of the sympathetic nervous system and the development of resistant or refractory hypertension. To estimate the prevalence of obesity in the population of outpatients with refractory or resistant hypertension and its relationship between body mass index and hypertension severity. A cross-sectional study was carried out in a referral outpatient clinic for severe arterial hypertension. Patients with resistant and refractory hypertension were included. Information related to demographic characteristics, anthropometric measurements, systolic and diastolic blood pressure, comorbidities, alcoholism, smoking, and sedentary lifestyle was collected. Continuous variables were compared using the Student's t-test or Mann Whitney, and categorical variables were compared using the chi-square test. Pearson's correlation test was used for anthropometric measurements and blood pressure. A significance level of p < 0.05 was adopted. A total of 138 patients were collected, of whom 74.7% had resistant hypertension and 25.3% had refractory hypertension. There was a predominance of females and black ethnicities, representing 79.7% (p=0.307) and 91.3% (p=0.315), respectively. The mean age was 64.7± 10.8 (p=0.566). Obesity (BMI ≥ 30 kg/m2) was present in 42% (p=0.379), being higher in refractory hypertension (51.4% vs. 38.8%). Higher body mass index values were directly associated with an increased number of antihypertensive medications required for blood pressure control (r = 0.45; p < 0.01). Additionally, 74.6% of the patients had dyslipidemia (p=0.400). In our population of patients with severe hypertension, obesity was prevalent and significantly influenced both the presentation and the control of blood pressure levels. A obesidade é um grave problema de saúde pública e está associada à ativação do sistema nervoso simpático e ao desenvolvimento de hipertensão resistente ou refratária. Estimar a prevalência de obesidade na população de pacientes ambulatoriais com hipertensão refratária ou resistente e sua relação entre índice de massa corporal e gravidade da hipertensão. Foi realizado um estudo transversal em um ambulatório de referência para hipertensão arterial grave. Foram incluídos pacientes com hipertensão resistente e refratária. Foram coletadas informações relacionadas às características demográficas, medidas antropométricas, pressão arterial sistólica e diastólica, comorbidades, alcoolismo, tabagismo e sedentarismo. As variáveis contínuas foram comparadas utilizando o teste t de Student ou Mann-Whitney, e as variáveis categóricas foram comparadas pelo teste do qui-quadrado. O teste de correlação de Pearson foi utilizado para medidas antropométricas e pressão arterial. Foi adotado nível de significância de p < 0,05. Um total de 138 pacientes foi incluído, dos quais 74,7% apresentavam hipertensão resistente e 25,3% hipertensão refratária. Houve predominância de mulheres e de indivíduos de etnia negra, representando 79,7% (p = 0,307) e 91,3% (p = 0,315), respectivamente. A média de idade foi de 64,7 ± 10,8 anos (p = 0,566). A obesidade (IMC ≥ 30 kg/m2) esteve presente em 42% (p = 0,379), sendo mais frequente na hipertensão refratária (51,4% vs. 38,8%). Valores mais elevados de IMC estiveram diretamente associados a um maior número de medicamentos anti-hipertensivos necessários para o controle da pressão arterial (r = 0,45; p < 0,01). Além disso, 74,6% dos pacientes apresentavam dislipidemia. Em nossa população de pacientes com hipertensão grave, a obesidade foi prevalente e impactou tanto na apresentação quanto no controle dos níveis de pressão arterial. Obesity is a serious public health problem and is associated with activation of the sympathetic nervous system and the development of resistant or refractory hypertension. To estimate the prevalence of obesity in the population of outpatients with refractory or resistant hypertension and its relationship between body mass index and hypertension severity. A cross-sectional study was carried out in a referral outpatient clinic for severe arterial hypertension. Patients with resistant and refractory hypertension were included. Information related to demographic characteristics, anthropometric measurements, systolic and diastolic blood pressure, comorbidities, alcoholism, smoking, and sedentary lifestyle was collected. Continuous variables were compared using the Student’s t-test or Mann Whitney, and categorical variables were compared using the chi-square test. Pearson’s correlation test was used for anthropometric measurements and blood pressure. A significance level of p < 0.05 was adopted. A total of 138 patients were collected, of whom 74.7% had resistant hypertension and 25.3% had refractory hypertension. There was a predominance of females and black ethnicities, representing 79.7% (p=0.307) and 91.3% (p=0.315), respectively. The mean age was 64.7± 10.8 (p=0.566). Obesity (BMI ≥ 30 kg/m2) was present in 42% (p=0.379), being higher in refractory hypertension (51.4% vs. 38.8%). Higher body mass index values were directly associated with an increased number of antihypertensive medications required for blood pressure control (r = 0.45; p < 0.01). Additionally, 74.6% of the patients had dyslipidemia (p=0.400). In our population of patients with severe hypertension, obesity was prevalent and significantly influenced both the presentation and the control of blood pressure levels.
Limited information is available on the impact of the COVID-19 pandemic on supported accommodations (SAs) for people with serious mental disorders. A quantitative study recently conducted in Portugal showed that these services struggled with a more challenging environment, residents' fears, and a lack of support from community services. We now aim to complement it by reporting qualitative data on the experiences of residents and professionals of SAs for people with serious mental disorders during the pandemic. A purposive sample of 11 residents and 11 professionals from 11 different organisations responsible for SAs in Portugal was included. Data were collected through semi-structured interviews. The interview guide included questions regarding changes in the functioning of SAs and implemented measures during COVID-19 and the impact of the pandemic on the well-being of residents and professionals. Thematic analysis was used. Some SAs had to close or relocate, and several procedures were changed. Residents felt that the most impactful changes included not being able to go outside or see loved ones. Despite some residents reporting anxiety or sadness, almost none relapsed. However, some professionals noted an impact on the autonomy and cognition of residents. Despite reporting a negative impact of the pandemic on their own well-being, professionals struggled to maintain the functioning of SAs and the well-being of residents. Residents recognised the effort made by professionals and felt supported by them during COVID-19. The COVID-19 pandemic significantly impacted the functioning of SAs. In line with our findings, some actions seem fundamental to improve SAs' resilience in the future. These relate to human resources, training, structural conditions, new technologies, and professionals' well-being. A informação sobre o impacto da pandemia de COVID-19 em residências apoiadas (RAs) para pessoas com doença mental grave é limitada. Um estudo quantitativo realizado recentemente em Portugal mostrou que estes serviços enfrentaram dificuldades devido a um ambiente mais desafiador, aos medos dos residentes e à falta de apoio por parte dos serviços comunitários. Pretendemos agora complementar o mesmo estudo reportando dados qualitativos sobre as experiências de residentes e profissionais de RAs durante a pandemia. Foi incluída uma amostra intencional de 11 residentes e 11 profissionais de 11 organizações diferentes responsáveis por RAs em Portugal. Os dados foram colhidos através de entrevistas semiestruturadas. O guião de entrevista incluiu perguntas sobre as mudanças no funcionamento das RAs e medidas implementadas durante a pandemia de COVID-19 e o impacto da pandemia no bem-estar dos residentes e profissionais. Foi posteriormente realizada análise temática. Algumas RAs tiveram de fechar ou se mudar e vários procedimentos foram alterados. Os residentes sentiram que as mudanças mais impactantes incluíram não poder sair de casa ou ver os seus entes queridos. Apesar de alguns residentes relatarem ansiedade ou tristeza, quase nenhum teve recaída. Contudo, alguns profissionais notaram impacto na autonomia e cognição dos residentes. Apesar de relatarem um impacto negativo da pandemia no seu próprio bem-estar, os profissionais lutaram para manter o funcionamento das RAs e o bem-estar dos residentes. Os residentes reconheceram o esforço dos profissionais e sentiram-se apoiados por eles durante a pandemia. A pandemia de COVID-19 teve um impacto significativo no funcionamento das RAs. Algumas ações parecem fundamentais para melhorar a resiliência das RAs no futuro. Estas dizem respeito aos recursos humanos, à formação, às condições estruturais, às novas tecnologias e ao bem-estar dos profissionais.
In the Brazilian Unified Health System (SUS), social participation is a fundamental principle. With Law 8.142 of 1990, this participation was established through health councils and conferences, but these are not the only means for society to participate in the management of the SUS. The objective was to identify forms of social participation in the SUS and what are the challenges and potentialities of this principle. A scoping review with the research question: what are the forms of user participation in the management of the SUS? The research was conducted in Portuguese, English, and Spanish, in the PubMed, BVS, Scopus, Embase, and Web of Science databases. Forty-six articles were selected for analysis. Seven categories of community participation in the SUS were identified: health councils, user service evaluation research, popular health education, health-related social movements, public consultation, health conferences, and ombudsman offices. The seven mechanisms of social participation in the SUS form a mapping from which it is possible to think of ways to overcome the barriers of each of the mechanisms and how to strengthen them. It also allows for reflection on the reinvention and creation of new models of participation. No SUS, a participação social é um princípio fundamental. Com a Lei 8.142, de 1990, essa participação foi instituída por meio dos conselhos e das conferências de saúde, mas esses não são os únicos meios de a sociedade participar da gestão do SUS. Objetivou-se identificar formas de participação social no SUS e quais são os desafios e potencialidades desse princípio. Trata-se de uma revisão de escopo com a pergunta de pesquisa: quais as formas de participação dos usuários na gestão do SUS? Pesquisa realizada em português, inglês e espanhol nas bases de dados PubMed, BVS, Scopus, Embase e Web of Science. Quarenta e seis artigos foram selecionados para leitura na íntegra e análise, com sete categorias de participação da comunidade no SUS: conselhos de saúde, pesquisa de avaliação do serviço pelo usuário, educação popular em saúde, movimentos sociais ligados à saúde, consulta pública, conferências de saúde, ouvidorias. Os sete mecanismos de participação social no SUS formam um mapeamento a partir do qual é possível pensar formas de superar as barreiras de cada um dos mecanismos e como fortalecê-los. Também possibilita a reflexão sobre a reinvenção e criação de novos modelos de participação. En el Sistema Único de Salud (SUS) de Brasil, la participación social es un principio fundamental. Con la Ley 8.142 de 1990, esta participación se instituyó por los consejos y las conferencias de salud, pero estos no son los únicos medios para que la sociedad participe en la gestión del SUS. El objetivo fue identificar formas de participación social en el SUS y cuáles son los desafíos y potencialidades de este principio. Revisión de escopo con la pregunta: ¿cuáles son las formas de participación de los usuarios en la gestión del SUS? La investigación se realizó en portugués, inglés y español, en las bases de datos PubMed, BVS, Scopus, Embase y Web of Science. Cuarenta y seis artículos seleccionados. Se identificaron siete categorías de participación: consejos de salud, investigación de evaluación del servicio por el usuario, educación popular en salud, movimientos sociales, consulta pública, conferencias de salud y oficinas de atención al usuario. Los siete mecanismos de participación social en el SUS forman un mapeo a partir del cual es posible pensar en formas de superar las barreras de cada uno y cómo fortalecerlos, y posibilita la reflexión sobre la reinvención y creación de nuevos modelos de participación.
To critically analyze the potential, challenges, and ethical implications of incorporating artificial intelligence (AI) into Brazilian public health, in light of the principles of the Unified Health System (SUS), also considering its interfaces with epidemiological practice. This is a theoretical-analytical paper based on national and international literature, which articulates core AI concepts with political-epistemological reflections from Public Health. The approach includes discussions on machine learning, deep learning, natural language processing, and large language models, focusing on applications within the SUS context. Multiple opportunities for using AI to strengthen the SUS are identified, including prediction of health events, diagnostic support, service regulation, and public policy development. However, structural barriers such as fragmented information systems, regional inequalities, and gaps in professional training are highlighted. Issues such as algorithmic fairness, explainability, technological sovereignty, and digital literacy emerge as key dimensions for the responsible adoption of AI. AI is not neutral, and its integration into the SUS must be guided by democratic principles and sensitivity to social vulnerabilities, or it risks reinforcing technocratic and exclusionary models. The struggle over the meaning of innovation is, therefore, also a struggle over the future of public health in Brazil. Analisar de forma crítica as potencialidades, os desafios e as implicações éticas da incorporação da Inteligência Artificial (IA) à saúde pública brasileira, à luz dos princípios do Sistema Único de Saúde (SUS), considerando também suas interfaces com a prática epidemiológica. Trata-se de um artigo de natureza teórico-analítica, fundamentado em literatura nacional e internacional, que articula conceitos centrais da IA e reflexões político-epistemológicas da Saúde Coletiva. A abordagem contempla discussões sobre aprendizado de máquina, aprendizado profundo, processamento de linguagem natural e grandes modelos de linguagem, com foco em aplicações no contexto do SUS. Identifica-se múltiplas possibilidades de uso da IA para o fortalecimento do SUS, incluindo predição de eventos em saúde, apoio ao diagnóstico, regulação de serviços e formulação de políticas públicas. No entanto, destacam-se barreiras estruturais, como a fragmentação dos sistemas de informação, desigualdades regionais e lacunas na formação profissional. Questões como equidade e justiça algorítmica, explicabilidade, soberania tecnológica e letramento digital emergem como dimensões essenciais para a adoção responsável da IA. A IA não é neutra, e sua integração ao SUS deve ser guiada por princípios democráticos e sensibilidade às vulnerabilidades sociais, sob pena de reforçar modelos tecnocráticos e excludentes. A disputa pelo sentido da inovação é, portanto, também uma disputa pelo futuro da saúde pública no Brasil.
To evaluate the association between the pulp involvement, ulceration, fistula, abscess (PUFA) index and oral health-related quality of life (OHRQoL) of 5-year-old Brazilian children. This was a cross-sectional, population-based study using data from the oral health survey SB Brasil 2023. A total of 7,198 children examined by trained teams were included. The exposure variable was the presence of clinical consequences of untreated caries in primary teeth, assessed by PUFA. OHRQoL was assessed using the SOHO-5 instrument for 5-year-olds. The analysis considered a complex sampling design, using Poisson regression to estimate prevalence ratios (PR) and linear regression. The prevalence of clinical consequences of untreated caries (PUFA≥1) was 41.1%, with a higher prevalence among Black, Brown, Asian, and Indigenous children compared to White children. Attending school (PR 0.69; 95%CI 0.53-0.90) and a family income above R$ 4,000.00 (PR 0.59; 95%CI 0.42-0.84) showed a protective effect. The North and Central-West regions had higher prevalence rates than the Southeast. and OHRQoL was worse among children of mixed race and indigenous descent compared to those of white skin color. Furthermore, children with dental caries had a 1.44-point higher OHRQoL score (β=1.44; 95%CI 1.01-1.86), which indicates a worse OHRQoL. The clinical consequences of untreated dental caries have a negative impact on the OHRQoL of Brazilian children, influenced by social and racial determinants. These findings reinforce the need for public policies aimed at reducing regional inequalities and expanding oral health promotion and prevention actions. Avaliar a associação entre Envolvimento Pulpar, Ulceração, Fístula e Abscesso (PUFA) e Qualidade de Vida Relacionada à Saúde Bucal (QVRSB) de crianças brasileiras de 5 anos de idade. Estudo transversal, de base populacional, utilizando dados da Pesquisa Nacional de Saúde Bucal (SB Brasil) 2023. Foram incluídas 7.198 crianças examinadas por equipes treinadas. A variável de exposição foi a presença de consequências clínicas da cárie não tratada em dentes decíduos, avaliada pelo índice PUFA. A QVRSB foi avaliada pelo instrumento Scale of Oral Health Outcomes for 5-year-old children (SOHO-5). As análises consideraram o delineamento amostral complexo, utilizando regressão de Poisson para estimar Razões de Prevalência (RP) e regressão linear. A prevalência de consequências clínicas da cárie não tratada (PUFA≥1) foi de 41,1%, sendo maior entre crianças negras, pardas, amarelas e indígenas, quando comparadas às brancas. Frequentar a escola (RP 0,69; IC95% 0,53-0,90) e renda familiar acima de R$ 4.000 (RP 0,59; IC95% 0,42-0,84) mostraram efeito protetor. As regiões Norte e Centro-Oeste apresentaram maiores prevalências em relação à Sudeste. A qualidade de vida relacionada à saúde bucal foi pior entre crianças pardas e indígenas comparadas às de cor de pele branca. Além disso, crianças com cárie tiveram 1,44 ponto a mais no escore de QVRSB (β=1,44; IC95% 1,01-1,86), o que significa pior QVRSB. As consequências clínicas da cárie dentária não tratada trazem impacto negativo na QVRSB de crianças brasileiras, sendo influenciada por determinantes sociais e raciais. Os achados reforçam a necessidade de políticas públicas voltadas à redução das desigualdades regionais e ampliação das ações de promoção e prevenção em saúde bucal.
Tuberculosis (TB) remains a major public health problem in South America, disproportionately affecting vulnerable populations, such as the homeless population (HP). To synthesize, through a systematic review with meta-synthesis, the scientific evidence on the relationship between tuberculosis and its social, individual, and programmatic determinants in the HP in South America, highlighting factors associated with treatment abandonment and mortality. Scientific articles were searched in PubMed, EMBASE, LILACS, SciELO, Web of Science, and Cochrane databases, published in Portuguese, English, or Spanish between 2013 and 2023. Study selection was conducted independently by three reviewers, with consensus reached by a fourth when necessary. The process followed the protocols of the Cochrane Collaboration and the PRISMA flowchart, resulting in the inclusion of 27 studies. The most frequent determinants were lack of social protection (85%) and extreme poverty (75%), both associated with high rates of treatment abandonment (average of 36%) and mortality (average of 14%). Reduced use of Directly Observed Therapy (DOT) and regional inequalities emerged as critical factors. The meta-synthesis indicated that alcohol and drug users had a 2.3 times higher risk of treatment abandonment, while TB-HIV coinfection increased mortality by up to threefold. The vulnerability of the HP to TB is strongly linked to social and programmatic factors. Intervention strategies should prioritize social protection, expansion of DOT, intersectoral policies, and approaches tailored to regional contexts in order to reduce inequalities and promote health equity. A tuberculose (TB) continua sendo um importante problema de saúde pública na América do Sul, afetando desproporcionalmente populações vulneráveis, como a população sem-teto (PST). Sintetizar, por meio de uma revisão sistemática com metassíntese, as evidências científicas sobre a relação entre tuberculose e seus determinantes sociais, individuais e programáticos no Sistema de Saúde da América do Sul, destacando os fatores associados ao abandono do tratamento e à mortalidade. Foram pesquisados artigos científicos nas bases de dados PubMed, EMBASE, LILACS, SciELO, Web of Science e Cochrane, publicados em português, inglês ou espanhol entre 2013 e 2023. A seleção dos estudos foi realizada de forma independente por três revisores, sendo que, quando necessário, um quarto revisor chegou a um consenso. O processo seguiu os protocolos da Colaboração Cochrane e o fluxograma PRISMA, resultando na inclusão de 27 estudos. Os determinantes mais frequentes foram a falta de proteção social (85%) e a pobreza extrema (75%), ambos associados a altas taxas de abandono do tratamento (média de 36%) e mortalidade (média de 14%). A redução no uso da Terapia Diretamente Observada (TDO) e as desigualdades regionais emergiram como fatores críticos. A metassíntese indicou que usuários de álcool e drogas apresentaram um risco 2,3 vezes maior de abandono do tratamento, enquanto a coinfecção por TB-HIV aumentou a mortalidade em até três vezes. A vulnerabilidade das PST à tuberculose está fortemente ligada a fatores sociais e programáticos. As estratégias de intervenção devem priorizar a proteção social, a expansão do TDO, políticas intersetoriais e abordagens adaptadas aos contextos regionais, a fim de reduzir as desigualdades e promover a equidade em saúde.
Primary Health Care (PHC) is responsible for organizing the care networks of the Unified Health System (SUS), and with advances in digital health and investments from the Ministry of Health, tools have been developed to support PHC management. This article presents the "PHC Teams and Facilities Map" a publicly accessible tool developed by the Monitoring and Evaluations Coordination of the Secretariat of Primary Health Care of the Ministry of Health. The platform allows visualization of the territorial distribution of Basic Health Units and teams through five thematic maps: demography, teams, coverage, rurality, and dengue. Public data from the Health Information System for Primary Care; the National Registry of Health Establishments; the Brazilian Institute of Geography and Statistics; as well as geological risk information from the Geological Survey of Brazil, and information on areas from the National Foundation for Indigenous Peoples and the National Institute for Colonization and Agrarian Reform were used. The initiative seeks to promote greater transparency and support in decision-making, and could become a valuable strategy in the primary health care planning process. A Atenção Primária à Saúde (APS) é responsável pela organização das redes de atenção do Sistema Único de Saúde, e com os avanços da saúde digital e investimentos do Ministério da Saúde, ferramentas vêm sendo desenvolvidas para apoiar a gestão da APS. Este artigo apresenta o “Mapa das Unidades Básicas de Saúde da APS”, ferramenta de acesso público, elaborada por uma Coordenação Geral da Secretaria de Atenção Primária à Saúde do Ministério da Saúde. A plataforma permite a visualização da distribuição territorial das Unidades Básicas de Saúde e das equipes por meio de cinco mapas temáticos: demografia, equipes, cobertura, ruralidade e dengue. Foram utilizados dados públicos do Sistema de Informação em Saúde para Atenção Básica; do Cadastro Nacional de Estabelecimentos de Saúde; do Instituto Brasileiro de Geografia e Estatística; além de informações de riscos geológicos do Serviço Geológico do Brasil, e sobre áreas da Fundação Nacional dos Povos Indígenas e do Instituto Nacional de Colonização e Reforma Agrária. A iniciativa busca promover maior transparência e apoio na tomada de decisões, e pode se tornar uma estratégia valiosa no processo de planejamento em saúde da APS. La Atención Primaria de Salud (APS) es responsable de organizar las redes de atención del Sistema Único de Salud (SUS). Gracias a los avances en salud digital y a las inversiones del Ministerio de Salud, se han desarrollado herramientas para apoyar su gestión. Este artículo presenta el “Mapa de Unidades Básicas de Salud de la APS”, una herramienta de acceso público desarrollada por la Coordinación General de la Secretaría de Atención Primaria de Salud del Ministerio de Salud. La plataforma permite visualizar la distribución territorial de las Unidades Básicas de Salud y los equipos mediante cinco mapas temáticos: demografía, equipos, cobertura, ruralidad y dengue. Se utilizaron datos públicos del Sistema de Información en Salud para la Atención Primaria; el Registro Nacional de Establecimientos de Salud; el Instituto Brasileño de Geografía y Estadística; así como información sobre riesgos geológicos del Servicio Geológico de Brasil e información sobre áreas de la Fundación Nacional para los Pueblos Indígenas y el Instituto Nacional de Colonización y Reforma Agraria. La iniciativa busca promover una mayor transparencia y apoyo en la toma de decisiones, y podría convertirse en una estrategia valiosa en el proceso de planificación de la atención primaria de salud. Palabras clave: Atención Primaria de Salud, Unidad Básica de Salud, Salud Digital, Cartografía Geográfica.
This article describes the digital transformation trajectory of the Municipal Health Department of Rio de Janeiro (SMS-Rio), leading to the creation of minhasaude.rio application. The study was divided into two phases: document analysis and systematization of the app's development process, which was structured into three stages: information digitization, integration and construction of the health data lake, and creation of the app. Since its launch, the number of registered users has increased, with information on regulatory information, appointment scheduling, exams, and vaccination history being the most widely accessed. Integration with the federal government's gov.br for first-time access now accounts for 25% of new users. The users are predominantly black/brown, women, between the ages of 18 and 69 years. In 2025, 39.2% of the users reported being extremely satisfied. The case illustrates the digital maturity and modernization of healthcare services, featuring local solutions that enable personalized care and seamless data integration. The updates and public involvement are key elements for the success of the implemented technology. O artigo descreve a trajetória da transformação digital da Secretaria Municipal de Saúde do Rio de Janeiro (SMS-Rio) até a concepção do aplicativo minhasaude.rio. O estudo foi dividido em dois momentos: análise documental e sistematização do processo de construção do aplicativo, estruturado em três etapas - digitalização das informações, integração e construção do data lake da saúde e criação do aplicativo. Desde o lançamento, houve aumento no número de usuários cadastrados, sendo as informações de regulação, agendamento de consultas, exames e histórico de vacinas as mais acessadas. A integração com gov.br, do governo federal, para cadastramento ao aplicativo passou a representar 25% dos novos usuários. Os usuários são, majoritariamente, mulheres na faixa etária de 18 a 69 anos e pretos/pardos. Em 2025, 39,2% dos usuários estavam altamente satisfeitos. O caso revela maturidade digital e modernização dos serviços de saúde com soluções locais para personalização do cuidado e integração dos dados. A atualização de funcionalidades e o engajamento da população são elementos-chave para o sucesso da tecnologia implementada. El artículo describe la trayectoria de transformación digital de la Secretaría Municipal de Salud de Río de Janeiro (SMS-Rio) hasta la creación de la aplicación minhasaude.rio. El estudio se dividió en dos fases: análisis documental y sistematización del proceso de desarrollo de la aplicación, estructurado en tres etapas: digitalización de la información, integración y construcción del data lake de salud, y la creación de la aplicación. Desde su lanzamiento, el numero de usuarios registrados aumentó. La información sobre regulación de acceso, programación de citas, exámenes y historial de vacunaciones son las más consultadas. La integración con el sitio web gov.br del gobierno federal para el primer acceso representa el 25% de los nuevos usuarios. Los usuarios son predominantemente negro/mestizo, mujeres de entre 18 y 69 años. En 2025, 39,2 % de los usuarios estaban altamente satisfechos. El caso ilustra la madurez digital y la modernización de los servicios de salud, con soluciones locales para la atención personalizada y la integración de datos. Las actualizaciones de las funcionalidades y la participación ciudadana son elementos clave para el éxito de la tecnología implementada.
The myth of racial democracy has contributed to the invisibility of racism as a determinant of social and health inequalities in Brazil. Despite the influence of racism on illness and mortality, there are still few studies that address it as a social determinant of health, and it is often treated as a secondary factor. This study conducted a scoping review to identify racism theories that explain its effects on the health of the Brazilian population. Four theories that position racism as a social determinant were identified: structural, institutional, vicarious, and anti-Black racism. These theories operate through historical, social, and symbolic processes that structure inequalities in interpersonal and institutional relationships. The findings show that racism negatively impacts the health of the Black population and reinforce the need for scientific production and formulation of public policies that address racial inequities, promote equity, and ensure human rights in the field of health. No Brasil, o mito da democracia racial contribuiu para a invisibilização do racismo como determinante das desigualdades sociais e de saúde no Brasil. Apesar da influência do racismo em adoecimentos e mortalidade, ainda são escassos os estudos que o abordam como determinante social da saúde, sendo frequentemente tratado como fator secundário. Este estudo realizou uma revisão de escopo com o objetivo de identificar teorias do racismo que expliquem seus efeitos sobre a saúde da população brasileira. Foram identificadas quatro teorias que posicionam o racismo como determinante social: racismo estrutural, institucional, vicário e antinegro. Tais teorias operam por meio de processos históricos, sociais e simbólicos que estruturam desigualdades nas relações interpessoais e institucionais. Os achados evidenciam que o racismo impacta negativamente a saúde da população negra e reforçam a necessidade de produção científica e formulação de políticas públicas que enfrentem as iniquidades raciais, promovam a equidade e assegurem os direitos humanos no campo da saúde. En Brasil, el mito de la democracia racial contribuyó a la invisibilidad del racismo como determinante de las desigualdades sociales y de salud en Brasil. A pesar de la influencia del racismo en la enfermedad y la mortalidad, todavía hay pocos estudios que lo aborden como determinante social de la salud y a menudo se le trata como un factor secundario. Este estudio realizó una revisión exploratoria con el objetivo de identificar teorías del racismo que expliquen sus efectos sobre la salud de la población brasileña. Se identificaron cuatro teorías que posicionan al racismo como un determinante social: el racismo estructural, el institucional, el vicario y el anti-negro. Estas teorías operan a través de procesos históricos, sociales y simbólicos que estructuran las desigualdades en las relaciones interpersonales e institucionales. Los hallazgos muestran que el racismo impacta negativamente la salud de la población negra y refuerzan la necesidad de producción científica y formulación de políticas públicas que aborden las inequidades raciales, promuevan la equidad y garanticen los derechos humanos en el campo de la salud.
Up to one-third of people living with psoriasis develop psoriatic arthritis (PsA), and the majority have active psoriasis prior to the development of arthritis. Clinical risk factors, such as nail involvement, in conjunction with novel blood biomarkers, could improve PsA risk monitoring and early diagnosis. The aim of the HIPPOCRATES Prospective Observational Study (HPOS-www.hpos.study) is to follow a cohort living with psoriasis and identify risk factors for the development of PsA. HPOS is a patient-driven online prospective European observational cohort. Adult participants with psoriasis but with no prior diagnosis of PsA are eligible. Participants are invited to provide consent and join the study online. They complete a semi-structured questionnaire to collect data on demographics, psoriasis, comorbidities, risk factors for PsA, and the Psoriasis Epidemiology Screening Tool screening questionnaire. Follow-up is conducted through a questionnaire every 6 months. The primary outcome is the new onset of PsA confirmed by a diagnosis from their doctor. The study will also collect peripheral blood samples from a subset of participants for biomarker identification. This study follows the principles of the Declaration of Helsinki. To date, ethical approval has been granted by independent ethical committees in 10 countries. Studying a cohort of individuals with psoriasis will allow us to identify risk factors for arthritis development and to develop a risk calculator. This can support focused efforts on screening, patient education, and even studies looking to delay or prevent the onset of arthritis. This study, run via remote online data collection, provides an efficient way to recruit a large cohort (25,000) across multiple countries. However, challenges have had to be addressed with some key changes in study design, ethical review, and recruitment strategies required for each individual country. HPOS, Clinicaltrials.gov ID: NCT05858528, IRAS number 325080; https://clinicaltrials.gov/study/NCT05858528?locStr=United%20Kingdom&country=United%20Kingdom&cond=Psoriasis&term=HPOS&aggFilters=status%3Anot%20rec&rank=1. The HIPPOCRATES prospective observational study (HPOS) The HPOS Study, part of the HIPPOCRATES project, aims to find out what signs or factors can show which people with psoriasis might later develop Psoriatic Arthritis (PsA). PsA is a type of inflammatory arthritis that is related to the skin condition psoriasis. It occurs in about 1–2% of the general population but can develop in up to 30% of people who already have skin or nail psoriasis. Diagnosing PsA early can be difficult because symptoms can be vague or inconsistent, which means treatment often starts only after joint damage has already happened. By learning more about how psoriasis develops into PsA, researchers hope to find new ways to treat the disease earlier—or even prevent or delay it. The HPOS Study is an observational study that uses online questionnaires. Adults (aged 18 or older) who have psoriasis but not PsA can take part. Participants fill out a questionnaire every six months for three years. These questionnaires collect information about age, psoriasis details, lifestyle and health factors, early joint symptoms (using the PEST questionnaire), daily function, treatment satisfaction, disease impact, fatigue, and mental health. If early signs of PsA appear, participants are advised to contact a doctor for assessment. The study plans to recruit 25,000 people across 14 European countries (including the UK, Ireland, France, Germany, and others) and expects that around 675 participants will develop PsA each year. A smaller group of 3,000 participants will also provide a small finger-prick blood sample, which will help researchers look for blood markers that might predict PsA development. HPOS is the first large-scale European study to track how psoriasis progresses to PsA. The findings could lead to a “risk calculator” that helps doctors identify people at high risk of developing PsA earlier.
Healthcare workers (HCWs) faced a heightened risk of SARS-CoV-2 infection compared to the general population. The Bacillus Calmette-Guérin (BCG) vaccine, used for over a century, is known to modulate immune responses to various pathogens, including the SARS-CoV-2. This study examines the association between lifetime BCG vaccination and the risk of SARS-CoV-2 infection among HCWs in Cape Verde. We conducted a case-control study among HCWs in Cape Verde in 2021. Cases were HCWs, 18 years or older who tested positive for SARS-CoV-2 via PCR or Rapid Antigen Test, identified by Public Health Authorities, while controls were HCWs, 18 years or older with no reported or suspected SARS-CoV-2 infection, confirmed by POC Rapid Antigen Test. Both were selected from HCWs of three hospitals on Santiago and São Vicente islands in Cape Verde. The primary outcome measured was the status of SARS-CoV-2 infection (yes/no), and the primary exposure examined was BCG vaccination status (yes/no). The study also considered sociodemographic, epidemiological, and employment variables. Data collection was conducted using an electronic questionnaire applied to all participants, and analysis employed a maximum likelihood forward selection logistic regression model to assess the impact of BCG vaccination on the odds of SARS-CoV-2 infection. The study included 215 cases and 250 controls. Most cases of SARS-CoV-2 infection that occurred before completion of COVID-19 vaccination were identified through epidemiological surveillance or among people who reported being quarantined and/or absent from work after diagnosis. Hospitalization for COVID-19 was required for 7.7% of the cases. Persistent symptoms following COVID-19 were reported in fewer than 1% of cases. Having at least one child in the house, not having double employment, and being of normal weight were more likely to be observed among cases than controls. BCG vaccination showed no association with SARS-CoV-2 infection (aOR of BCG-vaccinated vs. not BCG-vaccinated = 0.76 [0.48; 1.20]). Completing the COVID-19 vaccination regimen was associated with reduced odds of SARS-CoV-2 infection, but there was likely some reversed causation, as vaccination was postponed for 6 months post-COVID-19 infection for cases. Lifetime BCG vaccination did not reduce the likelihood of SARS-CoV-2 infection among HCWs. Os profissionais de saúde (PS) enfrentaram um risco acrescido de infeção por SARS-CoV-2 em comparação com a população em geral. A vacina BCG, utilizada há mais de um século, é conhecida por modular as respostas imunitárias a vários agentes patogénicos, incluindo o SARS-CoV-2. Este estudo analisa a associação entre a vacinação com BCG ao longo da vida e o risco de infeção por SARS-CoV-2 entre profissionais de saúde em Cabo Verde. Foi realizado um estudo caso-controlo entre profissionais de saúde em Cabo Verde, em 2021. Os casos foram definidos como PS com idade igual ou superior a 18 anos, que testaram positivo para SARS-CoV-2 através de teste PCR ou teste rápido de antigénio, identificados pela Autoridade de Saúde Pública, enquanto os controlos foram PS, com idade igual ou superior a 18 anos, sem infeção por SARS-CoV-2 reportada ou suspeita, confirmada por teste rápido de antigénio à altura do recrutamento. O principal desfecho avaliado foi o estado de infeção por SARS-CoV-2 (sim/não), e a principal exposição analisada foi o estado vacinal relativamente à BCG (sim/não). O estudo considerou ainda variáveis sociodemográficas, epidemiológicas e laborais. A recolha de dados foi feita através de um questionário eletrónico, e a análise utilizou um modelo de regressão logística com seleção progressiva por máxima verosimilhança para avaliar o impacto da vacinação BCG nas probabilidades de infeção por SARS-CoV-2. O estudo incluiu 215 casos e 250 controlos. A maioria dos casos de infeção por SARS-CoV-2 que ocorreram antes da conclusão da vacinação contra a COVID-19 foram identificados através de vigilância epidemiológica ou entre pessoas que reportaram ter estado em quarentena e/ou ausentes do trabalho após o diagnóstico. A hospitalização por COVID-19 foi necessária em 7,7% dos casos. Sintomas persistentes após a COVID-19 foram reportados em menos de 1% dos casos. Ter pelo menos um filho em casa, não ter duplo emprego e ter peso normal foram características mais frequentes entre os casos do que entre os controlos. A vacinação com BCG não mostrou associação com a infeção por SARS-CoV-2 (aOR vacinados com BCG vs. Não vacinados com BCG = 0.76 [0.48;1.20]).). A conclusão do esquema vacinal contra a COVID-19 esteve associada a uma redução das probabilidades de infeção por SARS-CoV-2, embora possa haver causalidade inversa, dado que a vacinação foi adiada por 6 meses após a infeção nos casos. A vacinação com BCG ao longo da vida não reduziu a probabilidade de infeção por SARS-CoV-2 entre os profissionais de saúde.
The aim of this article was to describe the prevalence of self-perceived discrimination and to identify associations with sociodemographic factors and the evaluation of care in health services in Brazil. This study used data from the 2013 National Health Survey, analyzing information from 44.001 adults were analyzed. The prevalence of discrimination in health services was 11.4% (95% CI 10.8-12.0). Discrimination was significantly higher in women (12.2%), in people with yellow skin color or indigenous people (13.3%), in those living with a partner (11.9%), individuals with lower economic status (13.6%), those with poor self-rated health (21,7%) and those with a shorter interval since their last medical consultation (12.2%). A higher prevalence of discrimination was also observed among respondents who rated health services as "fair, poor, or very poor" regarding medical care, reception, and waiting times. Discrimination may be associated with worse health outcomes and more negative perceptions of care quality. As such, discrimination in health services should be recognized as a public health issue requiring targeted interventions to ensure equitable and high-quality care, particularly for vulnerable populations. O objetivo do artigo foi descrever a prevalência de discriminação autopercebida e identificar associações com fatores sociodemográficos e de avaliação dos atendimentos em estabelecimentos de saúde no Brasil. O estudo utilizou dados da Pesquisa Nacional de Saúde de 2013 e foram analisados dados de 44.001 adultos. A prevalência de discriminação em serviços de saúde foi de 11,4% (IC95% 10,8-12,0). A discriminação foi significativamente maior nas mulheres (12,2%), em pessoas de raça/cor de pele amarela ou indígenas (18,2%), em quem vivia com companheiro (11,9%), em quem apresentava menor classificação econômica (13,6%), entre quem percebia sua saúde como muito ruim (21,7%) e naqueles que estiveram em consulta em um período menor de três meses (12,2%). Foram observadas maiores prevalências de discriminação nos grupos que avaliaram o atendimento como “regular, ruim ou muito ruim” quanto às características do atendimento médico, à recepção no serviço de saúde e ao tempo de espera para ser atendido. A discriminação pode estar associada a piores resultados de saúde e percepções negativas do paciente sobre a qualidade da assistência. Deve ser vista como um problema de saúde pública e necessita de ações de combate visando garantir a qualidade da atenção à saúde, principalmente de grupos vulneráveis. Este artículo tuvo como objetivo describir la prevalencia de la discriminación autopercibida e identificar su asociación con factores sociodemográficos y la evaluación de la atención en centros de salud en Brasil. El estudio utilizó datos de la Encuesta Nacional de Salud de 2013 y analizó información de 44.001 adultos. La prevalencia de discriminación en los servicios de salud fue del 11,4% (IC del 95%: 10,8-12,0). La discriminación fue significativamente mayor entre las mujeres (12,2%), las personas de ascendencia asiática o indígena (18,2%), quienes viven en pareja (11,9%), las personas con menor nivel socioeconómico (13,6%), quienes percibían su salud como muy mala (21,7%) y quienes habían acudido a consulta en los últimos tres meses (12,2%). Se observaron mayores prevalencias de discriminación en los grupos que calificaron la atención como “regular, mala o muy mala” en cuanto a las características de la atención médica, la recepción en el centro de salud y el tiempo de espera para ser atendido. La discriminación puede asociarse con peores resultados de salud y percepciones negativas de la calidad de la atención por parte de los pacientes. Debe considerarse un problema de salud pública y requiere acciones para combatirlo con el fin de garantizar la calidad de la atención sanitaria, especialmente para los grupos vulnerables.
To unveil strategies for tackling fake news in the context of health and nursing from nursing professionals' perspective. This qualitative research, whose theoretical and methodological frameworks were, respectively, Complexity Theory and Grounded Theory, involved 25 nursing professionals from a public hospital and a Family Clinic in the city of Rio de Janeiro. Semi-structured interviews were conducted between 2021 and 2023. The meanings revealed by nursing professionals considered the complexity of tackling fake news, highlighting that the dissemination of this information occurs through multiple channels and is embedded in social, political, and technological dynamics. The results indicated the importance of developing institutional fact-checking mechanisms and promoting educational campaigns as strategies to minimize the impacts of fake news on healthcare. The study's complex perspective indicates that tackling fake news in health and nursing requires multidimensional approaches that combine education, regulation, and the valuing of science in the construction of reliable knowledge. Desvelar as estratégias para o enfrentamento de fake news no contexto da saúde e da enfermagem sob a perspectiva dos profissionais de enfermagem. Pesquisa qualitativa, cujos referenciais teórico e metodológico foram, respectivamente, a Teoria da Complexidade e a Grounded Theory. Participaram 25 profissionais de enfermagem de um hospital público e de uma Clínica da Família da cidade do Rio de Janeiro. Foram empregadas entrevistas semiestruturadas entre 2021 e 2023. Os significados desvelados pelos profissionais de enfermagem consideraram a complexidade do combate às fake news, evidenciando que a disseminação dessas informações ocorre por múltiplas vias e está inserida em dinâmicas sociais, políticas e tecnológicas. Os resultados sinalizaram a importância do desenvolvimento de mecanismos institucionais de checagem e promoção de campanhas educativas como estratégias para minimizar os impactos das fake news no cuidado em saúde. A perspectiva complexa do estudo sinaliza que o enfrentamento das fake news na saúde e na enfermagem exige abordagens multidimensionais que combinem educação, regulamentação e valorização da ciência na construção do conhecimento confiável. Revelar las estrategias para hacer frente a las fake news en el contexto de la salud y la enfermería desde la perspectiva de los profesionales de enfermería. Investigación cualitativa, cuyos marcos teórico y metodológico fueron, respectivamente, la Teoría de la Complejidad y la Grounded Theory. Participaron 25 profesionales de enfermería de un hospital público y de una Clínica de Familia de la ciudad de Río de Janeiro. Se realizaron entrevistas semiestructuradas entre 2021 y 2023. Los significados revelados por los profesionales de enfermería pusieron de manifiesto la complejidad de la lucha contra las fake news (noticias falsas), evidenciando que la difusión de esta información ocurre por múltiples vías y está insertada en dinámicas sociales, políticas y tecnológicas. Los resultados señalaron la importancia del desarrollo de mecanismos institucionales de verificación y la promoción de campañas educativas como estrategias para minimizar los impactos de las noticias falsas en la atención de la salud. La perspectiva compleja del estudio señala que la lucha contra las noticias falsas en la salud y la enfermería exige enfoques multidimensionales que combinen educación, regulación y valoración de la ciencia en la construcción de conocimiento confiable.
Modern health systems require physicians to not only provide high-quality clinical care but also understand, navigate, and lead complex healthcare organizations. However, undergraduate medical education in Portugal remains predominantly focused on clinical skills, with minimal exposure to health policy and management (HPM). This study aimed to assess Portuguese medical students' exposure to, attitudes toward, and preferences for HPM education. We conducted a cross-sectional survey of 483 medical students across 10 Portuguese medical schools. The questionnaire assessed prior exposure to HPM education, self-perceived knowledge of the national health system, curricular preferences, and civic participation. Only 29.2% of participants (n = 141; 95% CI 25.1-33.2) reported any previous HPM training, and those with exposure were more likely to demonstrate higher institutional literacy and greater confidence in understanding health system governance. Overall, 94.8% supported the inclusion of HPM in the medical curriculum, and 64.4% supported making it compulsory, with stronger support among civically engaged students. Portuguese medical students had limited formal exposure to HPM but expressed strong demand for structured training in this area. These findings highlight a misalignment between current curricula and students' perceived needs and support the introduction of a mandatory HPM course in Portuguese medical schools to better prepare future physicians for leadership and governance roles within the health system.
eConsult is considered a strategic digital health tool for expanding access to specialized care and improving Primary Health Care. This article aims to present an analytical model for assessing the implementation of eConsults in municipalities of Santa Catarina, Brazil. This is a methodological study, without the empirical application of the model. The model was developed based on Implementation Science theoretical-methodological frameworks: i-PARIHS (Integrated-Promoting Action on Research Implementation in Health Services), ORCA (Organizational Readiness to Change Assessment), and RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance). The proposed implementation analysis model is structured into three main dimensions (Intervention/Innovation, Implementation, and Maintenance), ten analytical subdimensions, and 41 indicators. It is considered a tool for understanding the multiple factors that influence the adoption, effectiveness, and sustainability of teleconsultations within Brazil's Unified Health System at the municipal level. The model represents a methodological advancement by integrating different theoretical frameworks, allowing for an in-depth understanding of the complexity involved in implementing digital health innovations. A teleconsultoria é considerada uma ferramenta de saúde digital estratégica na ampliação do acesso à atenção especializada e na qualificação da Atenção Primária à Saúde. O objetivo deste artigo é apresentar modelo de análise da implementação das teleconsultorias nos municípios catarinenses. Trata-se de estudo metodológico, sem a realização de aplicação empírica do modelo. A construção do modelo foi fundamentada nos referenciais teórico-metodológicos da Ciência de Implementação: i-PARIHS (integrated-Promoting Action on Research Implementation in Health Services), ORCA (Organizational Readiness to Change Assessment) e RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance). O modelo de análise da implementação proposto está estruturado em 3 dimensões principais (Intervenção/Inovação, Implementação e Manutenção), 10 subdimensões analíticas e 41 indicadores. É considerado uma ferramenta para compreender os múltiplos fatores que influenciam a adoção, eficácia e sustentabilidade das teleconsultorias no Sistema Único de Saúde, a nível municipal. O modelo representa um avanço metodológico ao articular diferentes referenciais teóricos, permitindo captar com profundidade a complexidade do processo de implementação de inovações em saúde digital. La teleconsulta asincrónica se considera una herramienta estratégica de la salud digital para ampliar el acceso a la atención especializada y calificar la Atención Primaria de Salud. El objetivo de este artículo es presentar modelo de análisis de implementación de las teleconsultas asincrónicas en los municipios de Santa Catarina. Se trata de estudio metodológico, sin la realización de aplicación empírica del modelo. La construcción se fundamentó en marcos teórico-metodológicos de la Ciencia de la Implementación: i-PARIHS (Integrated-Promoting Action on Research Implementation in Health Services), ORCA (Organizational Readiness to Change Assessment) y RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance). El modelo de análisis de implementación propuesto está estructurado en 3 dimensiones (Intervención/Innovación, Implementación y Mantenimiento), 10 subdimensiones analíticas y 41 indicadores. Se considera una herramienta para comprender los múltiples factores que influyen en la adopción, efectividad y sostenibilidad de las teleconsultorías en el Sistema Único de Salud. El modelo avanza al articular diferentes marcos teóricos, permitiendo captar en profundidad la complejidad del proceso de implementación de innovaciones en salud digital.