Background/Objectives: Water pollution caused by human activities disrupts ecosystems and promotes the spread of antimicrobial resistance genes (ARGs), posing a public health threat. This study investigated the presence of resistant Gram-negative bacteria and resistance genes in water from two sites occasionally exposed to domestic and hospital effluents, the Carioca River (CR) and Rodrigo de Freitas Lagoon (RFL), both used for recreation. Methods: Physicochemical parameters and coliform levels were measured. Bacterial isolates were identified by Matrix-Assisted Laser Desorption Ionization-Time-of-Flight Mass Spectrometry (MALDI-TOF MS) and tested for antimicrobial susceptibility using disk diffusion. The Minimum Inhibitory Concentration (MIC) was determined using the E-test® and broth microdilution methods. PCR was used to detect carbapenem resistance and other ARGs from the DNA of bacterial isolates obtained from water samples. Results: CR presented signs of environmental degradation, with low dissolved oxygen and high coliform counts. One Citrobacter braakii isolate showed resistance to all tested antimicrobials, raising concern for untreatable infections. Carbapenem-resistant isolates accounted for 49.4% of the total, harboring blaKPC (20%), blaTEM (5%), blaVIM (5%), and blaSPM (5%). The intl1 gene was found in 10% of isolates, indicating potential horizontal gene transfer. Conclusions: The findings from a one-day sampling reveal the presence of multidrug-resistant bacteria that carry antimicrobial resistance genes in polluted aquatic systems. These highlight the connection between water contamination and antimicrobial resistance. The evidence underscores the urgent need for environmental monitoring and effective management strategies to reduce public health risks.
Oropouche virus (OROV), an arbovirus endemic to the Amazon region, has recently expanded into non-endemic areas including Rio de Janeiro State, Brazil. To characterise the spatio-temporal dynamics and ecological factors associated with OROV transmission in Rio de Janeiro during 2024-2025. We analysed OROV case-associated ecological factors and performed a phylodynamic analysis on 40 viral genomes, comprising 35 new and five published sequences, sampled from 15 municipalities across the state during 2024-2025. OROV cases showed significant positive correlations with forest area (r = 0.50, p < 0.0001), banana harvest area (r = 0.39, p < 0.01), and cassava harvest area (r = 0.29, p < 0.05); but these factors were autocorrelated, suggesting a confounded relationship. We identified two OROV sub-clades circulating in the Rio de Janeiro State. The OROVRJ/ES sub-clade was likely introduced into the Southern Fluminense region around January 2024, spread primarily by short (> 2 km, 50% of events) and mid-distance movements (2-9 km; 30%) with a mean dispersal rate of 0.3 km/day, and seed outbreaks in Metropolitan and Northwest Fluminense regions in 2025. The OROVES-I clade was likely introduced into Central Fluminense and Coastal Lowlands regions, later spreading to the Northern Fluminense region. Following its introduction in early 2024, OROV persisted in Rio de Janeiro State by spreading through short-distance movements among municipalities with high forest cover and agricultural areas. The sustained multi-year OROV transmission in the Atlantic Forest biome highlights the potential for establishment of endemic cycles beyond the Amazon region and the need for enhanced surveillance in extra-Amazonian areas, where OROV will evolve in a different ecosystem.
[This corrects the article DOI: 10.1371/journal.pone.0313240.].
The following paper is centred on an analysis of comparative studies of the human pelvis developed over the 19th century by mostly French natural scientists, physical anthropologists, students of the human anatomy and doctors engaged in the initial stages of the emerging fields of gynaecology and obstetrics. As this paper will argue, there was considerable overlap between these specialisations, producing a fundamentally masculine, Eurocentric and racialised knowledge that had an enormous impact in establishing racially informed gynaecological and obstetric practices. This paper argues that comparative pelvic anatomy studies originated from the belief that African and Black women had specifically different pelves and genitalia and served to stratify women of different races and promoted racially oriented obstetric and gynaecological treatments. Despite their European origins, these French publications had profound repercussions across various regions of the Atlantic world and directly influenced the medical care provided to women of African descent in both slave and postemancipation societies, particularly in Brazil. In 1887, a doctoral candidate from the Rio de Janeiro Medical School (Brazil) wrote a dissertation in which he advocated and justified the racialised treatments offered to enslaved, free and soon-to-be-free women of African descendent who delivered their offspring at the medical school's maternity ward. In his advocacy for such practices, the author drew connections between the prevailing methods at Rio de Janeiro's Medical School to a long lineage of French medical thought on the racialised comparative anatomy of women's pelvises throughout the 19th century.
The spread of invasive species in marine ecosystems is a growing global concern, particularly in regions with high economic and ecological importance. Sun corals (Tubastraea spp.) are native scleractinians from the Pacific Ocean that have spread along most of the Brazilian coast. This invasive species initially established populations in Rio de Janeiro state, SE Brazil, reaching high levels of abundance. Although the ecological aspects and impacts caused by this organism have been studied in detail, the natural mechanisms that drive its dispersal have attracted little attention. In this research, we focus on the coastal dispersion of sun coral larvae between Cabo de São Tomé and Ilha Grande Bay, and the offshore transport of sun coral larvae, investigating how submesoscale oceanographic features such as filaments, fronts and eddies influence connectivity among different sites. A high-resolution numerical model was used to simulate the coastal dynamics, incorporating the influence of the Brazil Current, wind-driven circulation, and submesoscale structures. Larval dispersal was examined under different wind scenarios, including northeasterly winds that drive southward currents and enhance offshore transport via submesoscale filaments. Results show that submesoscale features, particularly filaments emerged from upwelling regions, play a significant role on sun coral larvae dispersion. These features act as pathways that connect larvae from coastal to offshore oil exploration areas, highlighting the importance of both natural and anthropogenic processes for the dispersal of this invasive species. This research provides critical insights into the mechanisms governing the spread of invasive marine species, emphasizing the need for integrated coastal management strategies. Understanding how physical processes drive larval transport is essential for developing targeted control measures to mitigate the impact of invasive species like sun coral on native ecosystems and local economies. Furthermore, the study underscores the importance of monitoring both natural and anthropogenic influences on marine bioinvasions, particularly in regions with significant offshore industrial activities.
Brazilian scientific production on the subject of Public-Private Partnerships (PPP) in health is still scarce. In the state of Rio de Janeiro, the first PPP initiative was launched in 2023 for the Souza Aguiar Municipal Hospital Complex (Complexo Hospitalar Municipal Souza Aguiar - CHMSA) involving three SUS units in the capital: a maternity hospital, a general emergency hospital operating 24/7, and a regional emergency center (Centro de Emergência Regional - CER). We sought to characterize the unit, analyze the decision-making processes of the PPP implemented in this Complex, based on the experience of its key players during its formulation, implementation, and follow-up. Our study also highlighted the fundamental role of the permanent health education (Educação Permanente em Saúde - EPS) process, which was key to sustaining the change in the adopted management model. The results show that after the first year of the PPP's implementation, several adjustments have been necessary to make it possible to measure the indicators agreed upon with the concessionaire. By contrast, the Souza Aguiar OTICS Station has stood out as a major training center for Rio de Janeiro's SUS, with more than 2,500 workers trained in its first year of implementation by the SMS-RJ. A produção científica brasileira em relação à temática das Parcerias Público-Privadas (PPP) na saúde ainda é escassa. No estado do Rio de Janeiro, a primeira iniciativa de PPP foi lançada no ano de 2023 para o Complexo Hospitalar Municipal Souza Aguiar (CHMSA) envolvendo três unidades do SUS da capital: uma maternidade, um hospital geral de emergência com portas abertas 24h, e um Centro de Emergência Regional (CER). Buscamos caracterizar a unidade, analisar os processos de tomada de decisão e adoção da PPP implantada nesse Complexo, a partir da experiência de seus atores-chaves durante a formulação, implementação e acompanhamento e destacamos também o papel fundamental do processo de Educação Permanente em Saúde (EPS), fundamental para sustentar a mudança do modelo de gestão implantado. Os resultados demonstram que após o primeiro ano de implantação da PPP, diversos ajustes vêm sendo necessários para viabilizar a medição dos indicadores pactuados com a concessionária. Por outro lado, a Estação OTICS Souza Aguiar vem se destacando com grande centro de formação para o SUS carioca, com mais de 2.500 trabalhadores capacitados em seu primeiro ano de implantação pela SMS-RJ. La producción científica brasileña sobre el tema de las Colaboración Público-Privadas (CPP) en salud es aún escasa. En el estado de Río de Janeiro, la primera iniciativa de CPP fue lanzada en 2023 para el Complejo Hospitalario Municipal Souza Aguiar (CHMSA), que involucra tres unidades del SUS en la capital: una maternidad, un hospital general de urgencias con puertas abiertas las 24 horas del día y un Centro Regional de Urgencias (CRU). Buscamos caracterizar la unidad, analizar los procesos de decisión y adopción del CPP implementado en este Complejo, a partir de la experiencia de sus actores clave durante su formulación, implementación y seguimiento, y destacamos también el papel fundamental del proceso de Educación Permanente en Salud (EPS), que fue clave para sostener el cambio en el modelo de gestión implementado. Los resultados muestran que, tras el primer año de implementación de la CPP, han sido necesarios varios ajustes para hacer posible la medición de los indicadores acordados con el concesionario. Por otro lado, la Estación de OTICS Souza Aguiar se ha destacado como un importante centro de formación para el SUS de Río, con más de 2.500 trabajadores formados en su primer año de implantación por la SMS-RJ.
Military Police officers of Rio de Janeiro's State have been considered the most lethal security forces in Brazil, corresponding to 52.35% of deaths in policing actions. The main aim of this study was to identify occupational stress among military police officers in Rio de Janeiro State and its relationship with the psychosocial environment, sleep quality, and daytime sleepiness. Two hundred and forty-two military policemen, divided into two groups (elite and non-elite), were evaluated occupational stress by the Lipp's Stress Symptoms Inventory (LSSI), daytime sleepiness (DS) by the Epworth Sleepiness Scale and sleep quality (SQ) by the Pitsburgh Sleep Quality Index. Military police officers (entire sample) showed dissatisfaction related to psychological support from the military institution (p = 0.004), about the inefficiency of the judicial system (p < 0.001) and their low popularity towards society (p = 0.009). The group of elite police officers slept significantly less (p = 0.026) and, in general, suffered more from severe daytime sleepiness, had poorer SQ and showed lower levels of occupational stress than their peers. It was possible to identify that stress can be detected, developed, and intensified in military police officers as a result of the environment in which they are exposed and this interferes significantly in sleep and daytime sleepiness (p < 0.05). Through this study, it is hoped that measures can be implemented to enhance the work environment and thereby improve the quality of life for this military population. Furthermore, it is intended to stimulate more comprehensive and longitudinal studies, particularly inclusive of female military personnel.
To evaluate the Cost-Efficiency of Atraumatic Restorative Treatment (ART) with a chemical-mechanical caries removal agent (CMCRA, Papacárie Duo GelⓇ) compared to conventional ART, based on pain perceived and time for selective removal of carious tissue, from the perspective of the Brazilian Unified Health System (SUS). The Cost-Efficiency analysis was conducted using TreeAgePro software, considering a 12-month horizon and a hypothetical cohort based on Monte Carlo microsimulation. ART + CMCRA was compared to ART in deciduous teeth, based on 26,700 treatments performed on children attended by SUS in Rio de Janeiro. Direct costs were calculated in Brazilian currency using the microcosting technique. Efficiency measures related to pain and caries removal time were extracted from a high-quality randomized clinical trial. Probabilistic simulation considered a 95% confidence interval and a 5% variation in parameters, generating acceptability curves to estimate the probability of treatment choice. ART + CMCRA proved superior (p < 0,001) in terms of benefit. For pain perceived efficiency, ART + CMCRA resulted in a cost increase of R$ 0.23 per procedure, with an additional benefit of 47.53%. For time efficiency, there was a cost increase of R$ 0.24 per procedure, with an additional benefit of 14.19%. ART + CMCRA is a cost-efficient option for SUS. The implementation of this technique in Rio de Janeiro's public health system can be recommended due to the reduced pain, despite requiring a higher willingness to pay for the additional benefits. The adoption of ART + CMCRA in SUS can significantly improve the experience of pediatric patients by reducing pain, making dental treatment more efficient and humane.
Bivalve mollusks face a crisis due to infectious diseases, resulting in high mortality and economic losses. The need for continuous monitoring to prevent contamination from sewage and rainwater in aquaculture is evident. The recent mass mortality of scallops in Ilha Grande Bay (IGB), Rio de Janeiro's largest scallop producer, due to environmental contaminants underscores the need for further research. This study aims to investigate the recent collapse of the scallop population and assess the human impact by analyzing the circulation of pathogens. Mollusks were collected from three sites in Ilha Grande Bay (IGB), a region known for its significant scallop production, and from scallop farms in Angra dos Reis, RJ. A total of 216 gill and adductor tissue samples from lion's foot scallops were analyzed. Bacterial contamination was identified using MALDI-TOF, while antimicrobial susceptibility and carbapenem production were assessed via disk diffusion tests. Mollusks were contaminated with V. alginolyticus, V. fluvialis, V. harveyi, Pseudomonas putida, and Pseudomonas monteilii. All isolates were sensitive to meropenem, but P. putida showed higher resistance to ciprofloxacin. The presence of these pathogenic and resistant bacteria in scallop adductor tissues is a concern for the aquaculture industry and a significant public health risk. The potential for these bacteria to enter the human food chain through consuming contaminated seafood or recreational activities such as bathing is a serious issue that needs to be addressed.
Fundamentals: Bullous fixed drug eruption (BFDE) is defined by the recurrence of bullous eruptions caused by medications, with a predilection for the same site. We report a rare association of BFDE with atenolol, with only two cases described in the literature. Case Report: An elderly woman presented with bullous and erythematous-violaceous plaques disseminated across her body, along with painful ulcers in the oral cavity. She was using atenolol, analgesics, and anti-inflammatory drugs (NSAIDs). After a biopsy compatible with BFDE, NSAIDs and analgesics were discontinued, and topical corticosteroids were started, but without improvement. The condition only showed improvement after the substitution of atenolol, supporting the suspicion. Discussion: The main drugs involved in BFDE are NSAIDs, analgesics, and antibiotics. Atenolol is a selective β-1 blocker, widely used, which rarely causes bullous skin reactions, including drug-induced pemphigoid, erythema multiforme, and BFDE. We also discuss the classic dermatopathology of FDE and its bullous variant.
This essay examines the urban atmospheres of terror in the favelas of Rio de Janeiro, Brazil, from the perspective of women residents. Drawing on two ethnographic projects conducted in various favelas in 2016 and 2019, I argue that terror, as an urban atmosphere, is deeply rooted in a long history of racialized and gendered violence, and that its persistence in the contemporary urban landscape is a consequence of the coloniality of power. The analysis begins by exploring the layers, textures, and complexities of urban atmospheres of terror, providing a deeper understanding of their racialized and gendered nature. It further examines the transformative power of the body in reshaping these urban atmospheres, focusing on how favela women cultivate alternative affective atmospheres within their communities. Drawing on Afrodiasporic and decolonial feminist thinking, I show how Afrodescendant women in the favelas resist and transform these atmospheres, creating spaces that challenge the coloniality of power and its spatial manifestations, such as urban borders. I conclude that a key aspect of favela women's urban politics and resistance to coloniality is rooted in the body and the affective dimensions of urban life.
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Non-human primates (NHPs) are reported as exclusive hosts of Trypanosoma minasense, whose transmission cycle remains unknown. We investigated trypanosomatid infections in 194 NHPs of nine species from the Brazilian Southeast region. We evaluated the impact of landscape composition and forest fragmentation on T. minasense infection. In the Atlantic Forest areas, Sapajus nigritus presented a higher positivity for T. minasense on the blood slides (60.9%) compared to Callithrix spp. (24.6%) and Alouatta guariba clamitans (20.7%); molecular analysis revealed higher infection prevalences in S. nigritus (87.0%) and A. g. clamitans (78.8%) than Callithrix spp. (50.8%). Callithrix spp. from the Cerrado and bordering areas showed higher infection prevalences by T. minasense on the blood slides (51.8%) and molecular diagnosis (77.6%). Eight (7.8%) positive hemocultures were obtained, but in only one (from A. g. clamitans) parasites were isolated and characterized as Crithidia mellificae. Trypanosoma cruzi TcII and T. rangeli lineage A were identified in Leontopithecus rosalia and C. penicillata, respectively. The results indicate that Alouatta, Callithrix, and Sapajus genera are highly exposed to T. minasense in the study area and landscape analysis revealed that these infections were inversely correlated with the proportion of forest and directly correlated with the forest fragmentation.
This article examines the general characteristics of how the invertebrate paleontology collection at the National Museum [Museu Nacional] in Rio de Janeiro took shape and the stages in its trajectory, considering the institution's own journey from the perspective of museology and heritage studies. It addresses the reach of the collection within the context of the department and the procedures and practices involved, namely research, education, and exhibitions. The collection's trajectory reflects the contexts that formed the backdrop for the museum, domestically and globally, between the mid-1900s and the early twenty-first century. O artigo analisa os aspetos gerais da formação da coleção de paleoinvertebrados do Museu Nacional, no Rio de Janeiro, e as etapas da sua trajetória, tendo em consideração o próprio percurso da instituição, sob a perspetiva da museologia e dos estudos sobre o património. São abordados o alcance da coleção no contexto do departamento, os procedimentos por que passou e as práticas em que esteve envolvida, nomeadamente a pesquisa, o ensino e as exposições. A trajetória da coleção reflete os contextos em que o museu se moveu no país e no mundo, desde meados do século XIX até o início do século XXI.
The COVID-19 pandemic has resulted in widespread reflection in medical communities about the role of professional stakeholders in public health interventions. Health professionals, including mental health clinicians, should question how, when, and why they should intervene to address the obstacles and objections to these interventions.
This interview with Leo Salo aims to understand how methods to foster interaction in excluded territories were created through the active listening of the community in actions developed as part of the Passeio Brabo project, designed to highlight the work undertaken in Rio de Janeiro's Manguinhos community. With its clown parades, Experimentalismo Brabo endeavors to apprehend the realities of the community by listening to its demands inside its own territory, alleys, and favelas, reaching out to the homes and individuals in the community space to create environments for interaction, active listening, and collaboration. A entrevista com Leo Salo busca compreender a criação dos instrumentos de interação no território, promovidos por ações de escuta da comunidade por meio do projeto Passeio Brabo, com o intuito de trazer os trabalhos desenvolvidos na comunidade de Manguinhos, no Rio de Janeiro. As ações do grupo Experimentalismo Brabo procuram, por meio dos cortejos de palhaçaria, apreender realidades da comunidade pela escuta de suas demandas, que ocorrem dentro do território, dos becos e das favelas, chegando às casas e às pessoas no espaço de favela, a fim de criar cenários de interação, escuta e colaboração.
The Herlyn-Werner-Wunderlich syndrome (HWWS) is characterized by the triad of uterus didelphys, obstructed hemivagina, and renal agenesis. The typical clinical presentation involves chronic pelvic pain, dysmenorrhea, and palpable abdominal mass, related to hematocolpos/hematometra. It is a rare disease, with a challenging clinical and radiological diagnosis. Surgery is the definitive treatment. Complications such as endometriosis, infertility and chronic pelvic pain occur more frequently and severely when diagnosis and treatment are delayed. This is a case report of a twelve-year-old patient admitted to the Gynecology Department of the Federal University of Rio de Janeiro's General Hospital (HUCFF/UFRJ), in March 2021, with progressive symptoms of dysmenorrhea and abdominal distention due to palpable abdominal mass. She had a previous history of congenital solitary kidney. Magnetic Resonance Imaging (MRI) showed a double uterus with hematometra and hematocolpos on the left side, pelvic endometriosis and left renal agenesis. Conservative clinical treatment with inhibition of the hypothalamic-pituitary-ovarian (H-P-O) axis was initiated while a definitive surgical approach was being defined. In June 2022, the patient underwent left hemi-hysterectomy and salpingectomy, achieving full remission of symptoms. Given the rarity of this syndrome and its potential complications, our report aims to familiarize clinicians with it, mostly those who work with children and adolescents, so that more patients have access to early diagnosis and adequate treatment. Consequently, future fertility can be effectively preserved.
Heat waves are becoming more intense and extreme as a consequence of global warming. Epidemiological evidence reveals the health impacts of heat waves in mortality and morbidity outcomes, however, few studies have been conducted in tropical regions, which are characterized by high population density, low income and low health resources, and susceptible to the impacts of extreme heat on health. The aim of this paper is to estimate the effects of heat waves on cardiovascular and respiratory mortality in the city of Rio de Janeiro, Brazil, according to sex, age, and heat wave intensity. We carried out a time-stratified case-crossover study stratified by sex, age (0-64 and 65 or above), and by sex for the older group. Our analyses were restricted to the hot season. We included 42,926 participants, 29,442 of whom died from cardiovascular and 13,484 from respiratory disease, between 2012 and 2017. The death data were obtained from Rio de Janeiro's Municipal Health Department. We estimated individual-level exposure using the inverse distance weighted (IDW) method, with temperature and humidity data from 13 and 12 stations, respectively. We used five definitions of heat waves, based on temperature thresholds (90th, 92.5th, 95th, 97.5th, and 99th of individual daily mean temperature in the hot season over the study period) and a duration of two or more days. Conditional logistic regression combined with distributed lag non-linear models (DLNM) were used to estimate the short-term and delayed effects of heat waves on mortality over a lag period (5 days for cardiovascular and 10 for respiratory mortality). The models were controlled for daily mean absolute humidity and public holidays. The odds ratios (OR) increase as heat waves intensify, although some effect estimates are not statistically significant at 95% level when we applied the most stringent heat wave criteria. Although not statistically different, our central estimates suggest that the effects were greater for respiratory than cardiovascular mortality. Results stratified by sex and age were also not statistically different, but suggest that older people and women were more vulnerable to the effects of heat waves, although for some heat wave definitions, the OR for respiratory mortality were higher among the younger group. The results also indicate that older women are the most vulnerable to heat wave-related cardiovascular mortality. Our results show an increase in the risk of cardiovascular and respiratory mortality on heat wave days compared to non-heat wave ones. These effects increase with heat wave intensity, and evidence suggests that they were greater for respiratory mortality than cardiovascular mortality. Furthermore, the results also suggest that women and the elderly constitute the groups most vulnerable to heat waves.
Few community-based interventions addressing the transmission control and clinical management of COVID-19 cases have been reported, especially in poor urban communities from low-income and middle-income countries. Here, we analyse the impact of a multicomponent intervention that combines community engagement, mobile surveillance, massive testing and telehealth on COVID-19 cases detection and mortality rates in a large vulnerable community (Complexo da Maré) in Rio de Janeiro, Brazil. We performed a difference-in-differences (DID) analysis to estimate the impact of the multicomponent intervention in Maré, before (March-August 2020) and after the intervention (September 2020 to April 2021), compared with equivalent local vulnerable communities. We applied a negative binomial regression model to estimate the intervention effect in weekly cases and mortality rates in Maré. Before the intervention, Maré presented lower rates of reported COVID-19 cases compared with the control group (1373 vs 1579 cases/100 000 population), comparable mortality rates (309 vs 287 deaths/100 000 population) and higher case fatality rates (13.7% vs 12.2%). After the intervention, Maré displayed a 154% (95% CI 138.6% to 170.4%) relative increase in reported case rates. Relative changes in reported death rates were -60% (95% CI -69.0% to -47.9%) in Maré and -28% (95% CI -42.0% to -9.8%) in the control group. The case fatality rate was reduced by 77% (95% CI -93.1% to -21.1%) in Maré and 52% (95% CI -81.8% to -29.4%) in the control group. The DID showed a reduction of 46% (95% CI 17% to 65%) of weekly reported deaths and an increased 23% (95% CI 5% to 44%) of reported cases in Maré after intervention onset. An integrated intervention combining communication, surveillance and telehealth, with a strong community engagement component, could reduce COVID-19 mortality and increase case detection in a large vulnerable community in Rio de Janeiro. These findings show that investment in community-based interventions may reduce mortality and improve pandemic control in poor communities from low-income and middle-income countries.
This article analyzed the activity of Social Health Organizations (OSS) in the Brazilian Unified National Health System (SUS) and the use of management contracts and contract addenda as instruments of privatization. The article aimed to understand the processes that legitimize privatization, based on quantification of the amounts transferred through management contracts and contract addenda to organizations that signed contracts with the Rio de Janeiro Municipal Health Department, Rio de Janeiro, Brazil, from 2009 to 2018. A descriptive, exploratory, mixed-methods study was developed to analyze the amounts transferred to the OSS. The study used secondary public data available on the Health Department's websites and other official documents. A total of 268 documents were identified, 61 of which were contracts and 207 addenda, related to 15 institutions. The funds transferred to these organizations totaled BRL 15.94 billion (USD 2.9 billion). The OSS that received the most public funds was IABAS (Institute of Primary and Advanced Health Care), with a total of BRL 4.021 billion (USD 731 million). In 2014, Rio de Janeiro's total health budget was approximately BRL 4 billion (USD 727 million), of which BRL 2.5 billion (USD 455 million) was transferred to OSS, representing 62% of the municipal health budget. The data show that management contracts and contract addenda serve as instruments for privatization of the SUS. This privatization does not employ the conventional model but a functional and fluctuating one. Este artigo analisou a atuação das Organizações Sociais de Saúde (OSS) no Sistema Único de Saúde (SUS) e o uso dos contratos de gestão e dos termos aditivos como instrumentos de privatização. O objetivo foi compreender os processos que legitimam a privatização, a partir da quantificação dos valores financeiros repassados por meio de contratos de gestão e termos aditivos para as organizações que firmaram contratos com a Secretaria Municipal de Saúde do Rio de Janeiro (SMS-RJ), Brasil, entre 2009 e 2018. Foi desenvolvido um estudo descritivo e exploratório com abordagem mista para analisar os valores repassados às OSS. Trabalhou-se com dados secundários públicos e disponíveis nos portais eletrônicos da SMS-RJ, além de outros documentos oficiais. Foram identificados 268 documentos, sendo 61 contratos e 207 aditivos, relacionados a 15 instituições. O volume financeiro total repassado a essas organizações foi de BRL 15,94 bilhões. A OSS IABAS (Instituto de Atenção Básica e Avançada à Saúde) foi a que mais recebeu recursos públicos, somando BRL 4,021 bilhões. Em 2014, o orçamento total da saúde do município do Rio de Janeiro foi de aproximadamente BRL 4 bilhões, sendo que desse montante BRL 2,5 bilhões foram repassados para as OSS, representando 62% do orçamento da saúde. Com base nos dados, podemos afirmar que os contratos de gestão e os termos aditivos são instrumentos de privatização do SUS. Essa privatização não se dá no modelo convencional, mas em um tipo funcional e flutuante. Este artículo analizó la actuación de las Organizaciones Sociales de Salud (OSS) en el Sistema Único de Salud (SUS), así como el uso de los contratos de gestión y anexos como instrumentos de privatización. El objetivo fue comprender los procesos que legitiman la privatización, a partir de la cuantificación de los valores financieros transferidos mediante contratos de gestión y anexos a organizaciones que firmaron contratos con la Secretaría Municipal de Salud de Río de Janeiro (SMS-RJ), Brasil, entre 2009 y 2018. Se desarrolló un estudio descriptivo y exploratorio con un abordaje mixto para analizar los valores transferidos a las OSS. Se trabajó con datos secundarios públicos y disponibles en los portales electrónicos de la SMS-RJ, además de otros documentos oficiales. Se identificaron 268 documentos, siendo 61 contratos y 207 anexos, relacionados con 15 instituciones. El volumen financiero total transferido a esas organizaciones fue de BRL 15,94 mil millones. La OSS IABAS fue la que más recursos públicos recibió, sumando BRL 4,021 mil millones. En 2014, el presupuesto total de salud del municipio de Río de Janeiro fue de aproximadamente BRL 4 mil millones, siendo que de ese montante BRL 2,5 mil millones fueron transferidos a las OSS, representando un 62% del presupuesto de la salud. En base a estos datos, podemos afirmar que los contratos de gestión y los anexos son instrumentos de privatización del SUS. Esa privatización no se produce en el modelo convencional, sino en un tipo funcional y fluctuante.