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Progressos e desafios para alcançar a cobertura universal de saúde no Peru, 2011-2019: um estudo de caso

2026-07-15T16:49:26Z

Título: Progressos e desafios para alcançar a cobertura universal de saúde no Peru, 2011-2019: um estudo de caso Autor(es): Bonzano, Cesar Manuel Velazco Abstract: The Peruvian health system demonstrated significant fragility during the COVID-19 pandemic, evidenced by the enormous number of deaths associated with the disease, despite health coverage for approximately 90% of the population being reported in the years before the pandemic. In the second decade of the 21st century, Peru conceived and implemented a "new" health reform, led by a government that promised social changes. The reform is based on the Universal Health Insurance model, a mixed insurance model, built during two previous decades — years of hegemonic neoliberal discourse and practices in the health sector. This reform is also framed in the discourse of Universal Health Coverage, hegemonic on regional and global levels, with vague definitions, interpretations and diverse strategies, and involving a dispute between two opposing models of construction of the health system: the market or residual model and the universal or health-directed model. This dissertation describes the health reform process in Peru, from 2011 to 2019, from a historical-contextual perspective, analyzing its trajectory and context, as well as some of the results of its implementation. It uses theoretical references, such as historical institutionalism, to try to understand the changes or continuities in public policies. The research strategy is a case study, mainly employing documentary and bibliographic analysis. After analyzing the health reform package and the changes implemented during the study period, it is evident that the main measures aim to strengthen the mixed health insurance model; This includes things like the separation of functions and the specialization of entities, within a market governance structure. Furthermore, it is noted that there is a lack of emphasis on measures to improve the provision of services and to overcome the fragmentation and segmentation of the health system. Finally, we believe that the opportunity for health reform was brief, given the context, and stressed, among other reasons, by the opposition of professional and civil society associations. Furthermore, it is worth highlighting the significant number of policies that have not been implemented or are only partially implemented, or that may be related to institutional fragility. Tipo: Dissertação

Itinerário terapêutico de mulheres idosas com câncer de colo de útero: perspectivas das usuárias e dos(as) cuidadores(as)

2026-07-15T13:32:01Z

Título: Itinerário terapêutico de mulheres idosas com câncer de colo de útero: perspectivas das usuárias e dos(as) cuidadores(as) Autor(es): Vieira, Gabriela Holanda Abstract: Introduction: Cervical cancer (CC) is emerging as a serious public health problem in Brazil. Older women constitute a highly vulnerable group for this condition, as current guidelines do not provide specific recommendations for screening in postmenopausal women, limiting themselves to evaluating past cytopathological history without establishing inclusion criteria that raise awareness among this group regarding the importance of the Pap test. Consequently, these women become more vulnerable due to gaps in care, the functional decline inherent to aging, and the accumulated disadvantages in their life trajectories. Objective: To understand the therapeutic journey of older women with cervical cancer from the time of diagnosis, from the perspective of the patient and the caregiver. Methodological Approach: A qualitative, exploratory, and descriptive study conducted in Fortaleza, Ceará. Data collection involved documentary research, semi-structured interviews with 6 patients and 3 informal caregivers, as well as the administration of the Zarit Caregiver Burden Scale to the caregivers. The analysis followed the principles of Thematic Content Analysis, supported by the literature on therapeutic pathways. The research was approved by the Research Ethics Committee of the Federal University of Ceará (Opinion No. 7.354.462). Presentation of findings: From an empirical perspective, strengths were identified in Primary Health Care (PHC), such as initial reception, ease in requesting tests, multidisciplinary care, strong patient-provider relationships, and follow-up measures. However, weaknesses in the network emerged, such as: delays in scheduling specialist appointments; failures in referral coordination; prolonged wait times for biopsy results; scarcity of high-tech diagnostic tests; fragmented care; and a lack of information regarding patient flow and prognosis. This situation leads to financial hardship, social isolation, and the invisibility of caregiving work. The results of the Zarit Scale indicated moderate burden for two caregivers (19 and 20 points) and severe burden for the third (over 22 points), confirming the strain resulting from daily caregiving demands. Commuting by public transportation revealed significant geographical barriers, with an estimated average travel time of 35 to 80 minutes to reach specialized oncology centers. It was not possible to conduct a quantitative analysis of SISCAN data due to chronic data entry failures in the SUS information systems. Final considerations: The study revealed a disconnect between the regulatory frameworks advocated by public policies and the actual experiences of service users and caregivers, demonstrating that weaknesses in the healthcare system directly contribute to family burden. In the context of primary health care marked by the coexistence of initial responsiveness and attitudinal barriers, preventive screening was often performed late in women who were already symptomatic, resulting in a diagnosis of cervical cancer predominantly at advanced stages. Tipo: Dissertação

Perfil clínico-epidemiológico de pacientes com tuberculose com e sem infecção por HIV de centros de referência em Fortaleza

2026-06-26T14:01:20Z

Título: Perfil clínico-epidemiológico de pacientes com tuberculose com e sem infecção por HIV de centros de referência em Fortaleza Autor(es): Araújo, Luiz Wilson de Abstract: Tuberculosis (TB) has for centuries challenging public policy worldwide. Disease of ancient occurrence nas been reinvigorated with the onset of acquired immunodeficiency syndrome (AIDS) in the early 80's, occupying the position of second most common opportunistic disease in AIDS patients and those with transferable characteristic of increased morbidity and mortality. The purpose of this research was to better understand the characteristics of the manifestation of TB and treatment response in patients with HIV treated in hospitais of Reference of Ceará State. For that reason a cohort study was performed for patients with TB and compared the symptoms and complications of treatment among those with co-infection HIV / TB and without HIV (HIV-/TB), from July 2007 to May 2009 , in the hospitais São José (HSJ) and Hospital Universitário Walter Cantídio (HUWC). We included 106 patients with HIV / TB and 53 patients HIV-/TB. Data were collected during hospitalization and outpatient follow-up through completion of forms and the data analyzed by the program EPI.INFO 6.0. Predominated in both groups, men (HIV + / TB: 70.8% and HIV-/TB: 62.3%) and aged 26 to 35 years (HIV + / TB: 41.5% and HIV-/TB: 35.8%). Over 85% of patients in both groups had family income less than two minimum month salaries. Group patients HIV + / TB showed a statistically significant difference (p <0.05) for the location of nodes extrapulmonary TB (14.2% versus 1.9%) for daily fever (87.6% versus 72.5%), anorexia (90.5% versus 74.0%), dry cough (47.5% versus 25.7%) and negative tuberculin test reactor (68.9% versus 28.12%). Hemoglobin <10g / 1 (56% versus 21.1%), leukocytes <4500 cél/mm3 (35.5% versus 15.8%), platelets <150,000 cél/mm3 (30.4% versus 2%) and albumin <3.0 g / dl (46% versus 17.4%) showed a statistically significant difference between groups HIV + and HIV-, respectively. HIV-/TB patients had more episodes of hemoptysis (41.7% versus 12.3%) and greater duration of symptoms prior to treatment (average of 101.98 days versus 71.44 days). The groups were similar in frequency of adverse effects to treatment for TB, but when analyzed the types of effects, HIV-/TB patients had significantly (p = 0.04) more complaints of gastrointestinal intolerance (26.4% versus 13, 2%) of peripheral neuropathy (3.8% versus 0%) and dizziness (3.8% versus 0%). The group HIV + / TB had higher incidence of hospitalization (63% versus 35.8%). The groups were similar in the form of TB diagnosis and outcome of cases. Among the patients HIV + / TB, 80% had CD4 + lymphocyte count of less than <350 cél/mm3. Symptoms related to tuberculosis had evidence. Tipo: Dissertação

Estudo da composição corporal por absorciometria de dupla emissão de raios X (DEXA) em pacientes com Lipodistrofia Generalizada Congênita

2026-05-05T15:50:24Z

Título: Estudo da composição corporal por absorciometria de dupla emissão de raios X (DEXA) em pacientes com Lipodistrofia Generalizada Congênita Autor(es): Lopes, Fábia Karine de Moura Abstract: Congenital Generalized Lipodystrophy (CGL) is a rare autosomal recessive disorder, characterized by the almost total absence of adipose tissue since birth or childhood, resulting in the accumulation of ectopic fat and the development of metabolic complications. This is a cross- sectional study that analyzed 23 patients with LGC at the Walter Cantídio University Hospital in the city of Fortaleza, Ceará, which aimed to describe the body composition of these individuals by dual-emission X-ray absorptiometry and compare with a healthy control group. matched by sex, age, and body mass index (BMI). Socioeconomic data, measurements of circumference and skinfold thickness, body composition data by dual emission X-ray absorptiometry (DEXA), clinical parameters, and laboratory tests were collected. Continuous variables were described using mean, standard deviation, and median (minimum-maximum), and categorical variables were described using relative and absolute frequencies. To compare variables between groups, the Mann-Whitney test was used. A significance level of 5% was adopted. Among anthropometric parameters, the majority of patients with LGC had a normal BMI, while neck circumference was significantly greater compared to the control group. When analyzing body composition in adults and the pediatric population with LGC, it was observed that adults had a higher muscle mass index. This finding suggests a possible association with the progression of muscular steatosis or hypertrophy secondary to hyperinsulinemia. A higher relative skeletal muscle mass index was also observed in patients with LGC, compared to healthy individuals. From the fat shadow images, residual pubic fat was evident in all women with lipodystrophy. LGC is an important biological model for studying the relationship between adipose tissue distribution and susceptibility to metabolic diseases. Although this study addresses a significant case series from Brazil, the need for additional studies is highlighted to deepen the understanding of the findings of this research and the mechanisms involved. Tipo: Dissertação