Abstract This article aims to reflect on the concept of domestic service from a historical perspective, having as reference the history of labor carried out in urban households by female and male slaves and free workers, especially in the capital of Brazil, between approximately 1850 and 1950. For this purpose, the text discusses, based on various documentary sources and studies on the subject, notions that are usually associated with the definitions of domestic labor, in terms of providing services, such as those that comprise the nature of work activities, the spaces in which they were carried out and the type of workers involved. The hypothesis defended is the historical existence of a great complexity in the work relationship established in the context of domesticity, especially regarding the integration of class, gender, and race determinants, as well as the characteristics of the organization of social reproduction in contexts such as the transition from slave/servile labor to free/paid labor in the constitution of capitalism in Brazil. perspective Brazil 185 1950 purpose discusses subject services activities involved domesticity class gender determinants slaveservile slave servile freepaid paid 18 195 1 19

Resumo Este artigo tem como objetivo refletir sobre o conceito de serviço doméstico a partir de uma perspectiva histórica, tendo como referência a história do trabalho realizado nos domicílios urbanos por trabalhadoras e trabalhadores escravizados e livres, especialmente na cidade do Rio de Janeiro, então capital brasileira, entre aproximadamente 1850 e 1950. Para isso, o texto problematiza, a partir de diversas fontes documentais e estudos sobre o tema, noções que costumam estar associadas às definições do trabalho doméstico, em sua face de prestação de serviços, como as que compreendem a natureza das atividades laborais, os espaços em que eram realizadas e o tipo de trabalhadores envolvidos. A hipótese defendida é a da existência histórica de uma grande complexidade nas relações de trabalho estabelecidas no âmbito da domesticidade, sobretudo no que se refere à integração de determinantes de classe, gênero e raça, bem como às características da organização da reprodução social em contextos como os da passagem do trabalho escravo/servil ao trabalho livre/remunerado na constituição do capitalismo no Brasil livres Janeiro brasileira 185 1950 isso problematiza tema serviços laborais envolvidos domesticidade classe raça escravoservil escravo servil livreremunerado livre remunerado 18 195 1 19

ABSTRACT The Pan American Health Organization (PAHO) and its Member States have been leading the efforts to eradicate wild poliovirus in the Region of Americas since smallpox's successful elimination in 1971. The region became the first to be certified free of wild poliovirus in 1994. However, in July 2022, an unvaccinated patient with no recent travel history was diagnosed with poliomyelitis in the United States of America. In response to the emergence of a circulating vaccine-derived poliovirus in the United States, PAHO established the Polio Incident Management Support Team. This team has been coordinating response efforts, focusing on: coordination, planning, and monitoring; risk communication and community engagement; surveillance and case investigation; vaccination; and rapid response. In this paper, we identified and documented best practices observed following establishment of the Incident Management Support Team (September 2022–2023) through a comprehensive review and analysis of various data sources and country-specific data from the polio surveillance dashboard. The aim was to share these best practices, highlighting technical support and implementation of polio measures by Member States. Despite several challenges, the Americas region remains polio-free. Polio risk is declining, with a July 2023 assessment showing fewer countries at medium, high, and very high risk. This progress reflects improved immunization coverage, surveillance, containment, health determinants, and outbreak preparedness and response. The PAHO Polio Incident Management Support Team has played a key role in supporting these efforts.

RESUMEN La Organización Panamericana de la Salud (OPS) y sus Estados Miembros han liderado los esfuerzos para erradicar el poliovirus salvaje en la Región de las Américas desde la eliminación exitosa de la viruela en 1971. En 1994, la Región fue la primera en obtener la certificación de libre del poliovirus salvaje. Sin embargo, en julio del 2022, se diagnosticó poliomielitis a un paciente de Estados Unidos de América no vacunado y sin antecedentes de viajes recientes. Para responder a la aparición de un poliovirus circulante derivado de la vacuna en ese país, la OPS creó el equipo de apoyo a la gestión de incidentes de poliomielitis. Este equipo ha asumido la coordinación de los esfuerzos de respuesta y se ha centrado en la coordinación, la planificación y seguimiento; la comunicación de riesgos y la participación de la comunidad; la vigilancia e investigación de casos; la vacunación; y la respuesta rápida. En este artículo, se determinan y documentan las mejores prácticas observadas después de la creación del equipo de apoyo a la gestión de incidentes (septiembre del 2022-2023) mediante una revisión y un análisis pormenorizados de datos procedentes de diversas fuentes y de datos específicos de los países del panel de vigilancia de la poliomielitis. El objetivo fue poner en común estas mejores prácticas y resaltar el apoyo técnico y la aplicación de medidas contra la poliomielitis por parte de los Estados Miembros. A pesar de los diversos desafíos, la Región de las Américas se mantiene libre de poliomielitis. El riesgo de esta enfermedad es cada vez menor, y la evaluación de julio del 2023 muestra una disminución del número de países con un riesgo medio, alto o muy alto. Este progreso refleja la mejora de la cobertura de inmunización, la vigilancia, la contención, los determinantes de la salud y la preparación y respuesta ante brotes. El equipo de apoyo a la gestión de incidentes relacionados con la poliomielitis de la OPS ha desempeñado un papel fundamental para brindar apoyo a estas iniciativas.

RESUMO Desde a eliminação bem-sucedida da varíola em 1971, a Organização Pan-Americana da Saúde (OPAS) e seus Estados Membros têm estado à frente de iniciativas para erradicar o poliovírus selvagem na Região das Américas. Em 1994, a região foi a primeira do mundo a ser certificada como livre do poliovírus selvagem. Entretanto, em julho de 2022, um paciente não vacinado e sem histórico de viagens recentes foi diagnosticado com poliomielite nos Estados Unidos da América. Em resposta ao surgimento de um poliovírus derivado de vacina circulante nos Estados Unidos, a OPAS criou a Equipe de Apoio à Gestão de Incidentes de Poliomielite. A equipe vem administrando os esforços de resposta, concentrando-se em: coordenação, planejamento e monitoramento; comunicação de risco e envolvimento da comunidade; vigilância e investigação de casos; vacinação; e resposta rápida. Neste documento, identificamos e documentamos as melhores práticas observadas após a criação da Equipe de Apoio à Gestão de Incidentes (setembro de 2022 a 2023) por meio de uma revisão e análise abrangentes de diversas fontes de dados e dados específicos de cada país fornecidos por meio do painel de vigilância da poliomielite. O objetivo foi compartilhar essas melhores práticas, destacando o apoio técnico e a implementação de medidas contra a poliomielite pelos Estados Membros. Apesar de vários desafios, a Região das Américas continua livre da poliomielite. Um levantamento de julho de 2023 demonstrou que o risco da poliomielite vem diminuindo, com menos países com risco médio, alto ou muito alto. Essa evolução é resultado de melhoras na cobertura vacinal, vigilância, contenção, preparação, determinantes de saúde e resposta a surtos. A Equipe de Apoio à Gestão de Incidentes de Poliomielite da OPAS foi fundamental para apoiar esses esforços.

Abstract This essay elucidates the Healthcare and Intersectionality notions to prompt reflections on the interaction between healthcare professionals and individuals referred to as Nanás: elderly, poor, and Black women who represent a historically marginalized profile throughout Brazilian history. By delving into the arguments about the concept of Intersectionality and the multifaceted Care dimensions, it becomes apparent that there is a pressing need to broaden the perspective on women who access healthcare services, as they are inherently shaped by their life experiences. Moreover, it is imperative to acknowledge how the intersecting factors inherent in their profiles can influence the approach taken by those providing Care, which underscores the essentiality of an intersectional agency on the part of the agents involved in this encounter, namely the Nanás and healthcare workers, to effectively uphold the principles of comprehensiveness and equity within the Unified Health System (SUS).

Resumo O presente ensaio articula os conceitos de Cuidado em Saúde e Interseccionalidade para suscitar reflexões sobre o encontro entre o/a trabalhador/a de saúde e aquelas que aqui denominamos uma Naná: uma mulher, negra, idosa e periférica, perfil historicamente vulnerabilizado ao longo da história brasileira. Considerando as argumentações que envolvem o conceito de Interseccionalidade e as diferentes vertentes acerca do Cuidado, observamos a necessidade de se ampliar o olhar sobre estas que buscam os serviços de saúde já atravessadas por suas histórias de vida, e ponderar sobre os atravessamentos que seu perfil pode acionar em quem exerce o Cuidado. Aponta ser primordial uma agência interseccional por parte das/os agentes deste encontro, Nanás e profissionais de saúde, para que se concretizem os princípios de integralidade e equidade no Sistema Único de Saúde (SUS).

Resumo O presente ensaio articula os conceitos de Cuidado em Saúde e Interseccionalidade para suscitar reflexões sobre o encontro entre o/a trabalhador/a de saúde e aquelas que aqui denominamos uma Naná: uma mulher, negra, idosa e periférica, perfil historicamente vulnerabilizado ao longo da história brasileira. Considerando as argumentações que envolvem o conceito de Interseccionalidade e as diferentes vertentes acerca do Cuidado, observamos a necessidade de se ampliar o olhar sobre estas que buscam os serviços de saúde já atravessadas por suas histórias de vida, e ponderar sobre os atravessamentos que seu perfil pode acionar em quem exerce o Cuidado. Aponta ser primordial uma agência interseccional por parte das/os agentes deste encontro, Nanás e profissionais de saúde, para que se concretizem os princípios de integralidade e equidade no Sistema Único de Saúde (SUS). oa trabalhadora trabalhador Naná mulher negra periférica brasileira vida dasos das SUS. SUS . (SUS) (SUS

Abstract This essay elucidates the Healthcare and Intersectionality notions to prompt reflections on the interaction between healthcare professionals and individuals referred to as Nanás: elderly, poor, and Black women who represent a historically marginalized profile throughout Brazilian history. By delving into the arguments about the concept of Intersectionality and the multifaceted Care dimensions, it becomes apparent that there is a pressing need to broaden the perspective on women who access healthcare services, as they are inherently shaped by their life experiences. Moreover, it is imperative to acknowledge how the intersecting factors inherent in their profiles can influence the approach taken by those providing Care, which underscores the essentiality of an intersectional agency on the part of the agents involved in this encounter, namely the Nanás and healthcare workers, to effectively uphold the principles of comprehensiveness and equity within the Unified Health System (SUS). elderly poor history dimensions services experiences Moreover encounter workers SUS. SUS . (SUS) (SUS

Abstract Background: Social determinants interfere in the health-disease process of the riverside population, associated with territorial isolation and restricted access to health goods and services. Objective: The objective of this study was to identify factors associated with the health conditions of children and adolescents and their mothers, from two riverside communities on the Madeira River, Amazonas, Brazil. Method: A cross-sectional study was carried out in April and August 2017 in two riverside communities in the Amazon, with mothers, children, and adolescents up to 19 years old. Sociodemographic conditions and maternal and health characteristics of children and adolescents were evaluated. Poisson regression analysis was performed using Stata 13. Results: Of the 94 participating mothers, 56.4% declared their children’s health conditions as fair to bad. The regular and poor health condition of children and adolescents was associated with the place of residence, number of appliances, daily consumption of snacks, sweets, and artificial juice, having a chronic disease, and having a history of hospitalization once in a lifetime (p<0.05). In the adjusted model, only hospitalization had a statistically significant association (PR=1.60; 1.13–2.26) with regular and poor health. Conclusion: Children and adolescents in the evaluated communities are vulnerable to illness due to precarious socioeconomic factors, sanitary conditions, and low access to health services. Background healthdisease disease population services Objective mothers River Amazonas Brazil Method crosssectional cross sectional 201 Amazon 1 old 13 Results 9 564 56 4 56.4 childrens s bad residence appliances snacks sweets juice p<0.05. p005 p p<0.05 . 0 05 (p<0.05) model PR=1.60 PR160 PR 60 (PR=1.60 1.13–2.26 113226 2 26 Conclusion 20 5 56. p00 p<0.0 (p<0.05 PR=1.6 PR16 6 (PR=1.6 1.13–2.2 11322 p0 p<0. (p<0.0 PR=1. PR1 (PR=1. 1.13–2. 1132 p<0 (p<0. PR=1 (PR=1 1.13–2 113 p< (p<0 PR= (PR= 1.13– 11 (p< (PR 1.13 (p 1.1 1.

Resumo Introdução: Os determinantes sociais interferem no processo saúde-doença de população ribeirinha, associados ao isolamento territorial, acesso restrito de bens e serviços de saúde. Objetivo: Identificar fatores associados às condições de saúde de crianças e adolescentes e suas mães, de duas comunidades ribeirinhas no rio Madeira, Amazonas, Brasil. Método: Estudo transversal, realizado em abril e agosto de 2017 em duas comunidades ribeirinhas amazônica, com mães, crianças e adolescentes até 19 anos. Foi avaliada as condições sociodemográficas, características maternas, de saúde, das crianças e adolescentes. Foi realizada análise de regressão de Poisson por meio do Stata 13. Resultados: Das 94 mães participantes, 56,4% declararam condições de saúde de seus filhos como regulares a ruins. A condição regular e ruim de saúde de crianças e adolescentes foi associada ao local de moradia, número de eletrodomésticos, consumo diário de salgadinhos, doces e suco artificial, ter doença crônica e ter histórico de internação hospitalar uma vez na vida (p<0,05). No modelo ajustado, apenas a internação hospitalar teve associação estatisticamente significativa (PR=1.60; 1,13–2,26) com a condição regular e ruim em saúde. Conclusão: As crianças e adolescentes das comunidades avaliadas são vulneráveis ao adoecimento pelas precárias condições socioeconômicas, sanitárias e baixo acesso aos serviços de saúde. Introdução saúdedoença ribeirinha territorial Objetivo Madeira Amazonas Brasil Método transversal 201 amazônica 1 anos sociodemográficas maternas 13 Resultados 9 participantes 564 56 4 56,4 ruins moradia eletrodomésticos salgadinhos artificial p<0,05. p005 p p<0,05 . 0 05 (p<0,05) ajustado PR=1.60 PR160 PR 60 (PR=1.60 1,13–2,26 113226 2 26 Conclusão socioeconômicas 20 5 56, p00 p<0,0 (p<0,05 PR=1.6 PR16 6 (PR=1.6 1,13–2,2 11322 p0 p<0, (p<0,0 PR=1. PR1 (PR=1. 1,13–2, 1132 p<0 (p<0, PR=1 (PR=1 1,13–2 113 p< (p<0 PR= (PR= 1,13– 11 (p< (PR 1,13 (p 1,1 1,

Abstract Introduction: Cesarean delivery on maternal request, which occurs without maternal or fetal medical indication, has increased in recent years. Reasons for patients to request it have been described, such as emotional experiences, social norms, and the interrelationship with the healthcare team. Methodology: The objective was to determine possible determinants for cesarean request. An observational study was conducted with cases (patients who requested cesarean delivery without medical indication) and controls (spontaneous vaginal delivery), non-matched, in a 2:1 ratio. A pre-designed survey was used to determine possible determinants, including fear of childbirth through a W-DEQ adapted questionnaire, social support, concern for fetal-neonatal safety, and the influence of the treating physician. Results: A total of 171 patients were included. Among patients with cesarean delivery on maternal request, 52.5% reported choosing cesarean due to high concern for fetal-neonatal safety, 32.8% due to some influence from the treating physician, 31.7% due to its predictability (better home organization or the anxiety of uncertainty about the timing of delivery), and 42.6% due to personal concern about the consequences of vaginal delivery. The W-DEQ variable, categorized into tertiles, showed a statistically significant association for requesting cesarean delivery. Previous traumatic history showed an association of 4.17. Conclusions: The factors that influenced the decision to request a cesarean delivery were previous traumatic history, the influence of the treating physician, and the existence of tocophobia. What connects all these factors is that they are all modifiable.

Resumen Introducción: La cesárea por solicitud materna, aquella sin indicación médica materna ni fetal, ha aumentado en los últimos años. Se han descrito motivos para que la paciente solicite la misma, como experiencias emocionales, normas sociales, y la interrelación con el equipo de salud. Metodología: El objetivo fue determinar posibles determinantes para la solicitud de cesárea. Se realizó un estudio observacional de casos (pacientes que solicitaron cesárea sin indicación médica) y controles (parto vaginal espontáneo), no pareados, en una relación 2:1. Se utilizó una encuesta prediseñada para determinar los posibles determinantes, incluyendo el miedo al parto mediante cuestionario adaptado de W-DEQ, soporte social, preocupación por la seguridad fetoneonatal y la influencia del médico tratante. Resultados: Se incluyeron 171 pacientes. Dentro de las pacientes con cesárea por requerimiento materno, el 52,5% manifestó la elección de cesárea por preocupación por la alta seguridad fetoneonatal, el 32,8% por alguna influencia del médico tratante, el 31,7 % por su predictibilidad (mejor organización del hogar o por la angustia de la falta de certeza del momento del parto) y el 42,6% por preocupación personal por las consecuencias debidas al parto vaginal. La variable WDEQ, categorizada en terciles, mostró una asociación para solicitar cesárea con significancia estadística. La historia traumática previa mostró una asociación de 4,17. Conclusiones: Los factores que influyeron en la decisión de solicitar una cesárea fueron la historia traumática previa, la influencia del médico tratante y la existencia de tocofobia. Lo que une a todos estos factores es que son todos modificables.

Resumo Introdução: A cesárea por solicitação materna, aquela realizada sem indicação médica materna ou fetal, aumentou nos últimos anos. Motivos para que a paciente solicite a mesma foram descritos, como experiências emocionais, normas sociais e a inter-relação com a equipe de saúde. Metodologia: O objetivo foi determinar possíveis determinantes para a solicitação de cesárea. Foi realizado um estudo observacional de casos (pacientes que solicitaram cesárea sem indicação médica) e controles (parto vaginal espontâneo), não pareados, em uma relação 2:1. Utilizou-se uma pesquisa pré-desenhada para determinar os possíveis determinantes, incluindo o medo do parto por meio de um questionário adaptado do W-DEQ, suporte social, preocupação com a segurança fetoneonatal e a influência do médico responsável. Resultados: Foram incluídas 171 pacientes. Entre as pacientes com cesárea por requerimento materno, 52,5% manifestaram escolher a cesárea por preocupação com a alta segurança fetoneonatal, 32,8% por alguma influência do médico responsável, 31,7% por sua previsibilidade (melhor organização do lar ou pela angústia da falta de certeza sobre o momento do parto) e 42,6% por preocupação pessoal com as consequências do parto vaginal. A variável W-DEQ, categorizada em tercis, mostrou uma associação para solicitar cesárea com significância estatística. A história traumática anterior mostrou uma associação de 4,17. Conclusões: Os fatores que influenciaram a decisão de solicitar uma cesárea foram a história traumática anterior, a influência do médico responsável e a existência de tocofobia. O que une todos esses fatores é que todos são modificáveis.

ABSTRACT Introduction: Adequate psychomotor development is basic to various physical, cognitive, and socialization processes in children. Several factors can affect this process, among them hospitalization, due to its relationship with stressful experiences and the disruption of the environment surrounding the infant. Objective: To analyze possible factors related to psychomotor development in hospitalized children. Methods: A cross-sectional and analytical study was carried out in a pediatric hospitalization service in Cali, Colombia, which mainly attends a population of low socioeconomic level. We included 100 children between 0 and 5 years of age, with hemodynamic and clinical stability. On the day of hospital discharge, psychomotor development was assessed with the Abbreviated Developmental Scale and nutritional status. Socioeconomic data, prenatal, perinatal and postnatal history were inquired. Results: The majority of the population was classified at a medium level of psychomotor development, with a normal body mass index and weight for age. Sixty-five percent had a low socioeconomic level. Hospital stay was 3.9 ± 2 days with no significant relationship with psychomotor development. Lower Abbreviated Developmental Abbreviated Scale scores were related to malnutrition status (p = 0.011) and low socioeconomic status (p = 0.001). Conclusions: The risk of psychomotor developmental delays in hospitalized pediatric patients was related to malnutrition and low socioeconomic status. This demonstrates the impact of social determinants and reaffirms the importance of primary care in socially disadvantaged groups.

RESUMEN Introducción: El adecuado desarrollo psicomotor es básico para diversos procesos físicos, cognitivos y de socialización de los niños. Varios factores pueden afectar dicho proceso, entre ellos la hospitalización, por su relación con experiencias estresantes y la ruptura de los ambientes que rodean al infante. Objetivo: Analizar posibles factores relacionados con el desarrollo psicomotor de niños hospitalizados. Métodos: Se realizó un estudio transversal y analítico en un servicio de hospitalización pediátrica de Cali, Colombia, que atiende mayormente a una población de bajo nivel socioeconómico. Se incluyeron 100 niños entre 0 y 5 años, con estabilidad hemodinámica y clínica. El día del egreso hospitalario se evaluaron el desarrollo psicomotor, con la Escala Abreviada del Desarrollo, y el estado nutricional. Se indagaron datos socioeconómicos, antecedentes prenatales, perinatales y posnatales. Resultados: La mayoría de la población se clasificó en nivel medio de desarrollo psicomotor, con un índice de masa corporal y peso para la edad normales. El 65 % tenía un bajo nivel socioeconómico. La estancia hospitalaria fue de 3,9 ± 2 días sin relación significativa con el desarrollo psicomotor. Las puntuaciones más bajas de la Escala Abreviada del Desarrollo se relacionaron con el estado de malnutrición (p= 0,011) y el bajo nivel socioeconómico (p= 0,001). Conclusiones: El riesgo de retrasos del desarrollo psicomotor en pacientes pediátricos hospitalizados se relacionó con la malnutrición y el bajo nivel socioeconómico. Esto demuestra el impacto de los determinantes sociales y reafirma la importancia de la atención primaria en grupos con desventaja social.

Abstract: Objective: To examine disparities in the use of mental health services (MHS) in adolescents according to sociodemographic factors. Subjects and Method: 2,022 adolescents aged 13-19 years in Santiago, Chile, participated in the study. Between April and May 2008, they answered a self-report survey that assessed lifetime (history of treatment for depression) and current (psychological or pharmacological treatment) use of MHS, sociodemographic variables, and psychopathology as symptoms of depression, symptoms of generalized anxiety disorder, and risk of problematic substance use. Data were analyzed using logistic regression. Results: 16.5% of participants reported lifetime use of MHS due to depression, 9.7% were on current psychological treatment, and 2.7% were on current pharmacological treatment. Among those meeting criteria for a mental health problem, only 14.9% to 18.9% were currently on treatment. Males, younger participants, and those who had immigrants’ parents reported lower lifetime use of MHS due to depression. Those with parents with 9 to 12 years of education and who had immigrants’ parents reported lower current MHS use. Youth not living with both parents reported higher lifetime and current MHS use. Conclusions: We observe a high treatment gap in those with mental health needs as well as differences in MHS use based on socio-demographic variables. These results may be useful for planning interventions that favor access to and use of MHS, especially in the most disadvantaged groups of adolescents.

Resumen: Objetivo: Examinar las disparidades en la utilización de servicios de salud mental (SSM) en adolescentes según factores sociodemográficos. Sujetos y Método: Participaron 2.022 adolescentes entre 13 y 19 años, en Santiago, Chile. Entre abril y mayo de 2018 respondieron una encuesta de autorreporte que evaluó la utilización de SSM durante la vida (historia de tratamiento por depresión) y actual (tratamiento psicológico o farmacológico), variables sociodemográficas y psicopatología correspondientes a síntomas de depresión, síntomas de trastorno de ansiedad generalizada y riesgo de consumo problemático de sustancias. Los datos se analizaron mediante regresión logística. Resultados: El 16,5% de los participantes reportó haber utilizado SSM por depresión durante la vida, 9,7% estaba en tratamiento psicológico actual y el 2,7% en tratamiento farmacológico actual. Entre quienes cumplen criterios para algún problema de salud mental, solo entre el 14,9% y el 18,9% estaba en algún tratamiento actual. Reportaron menor uso de SSM por depresión durante la vida los hombres, quienes tienen menor edad, e hijos de migrantes, y menor uso de SSM actuales quienes tienen padres con 9 a 12 años de educación e hijos de migrantes. Los jóvenes que no viven con ambos padres reportaron mayor uso de SSM durante la vida y actuales. Conclusiones: Se observa una alta brecha de tratamiento en quienes presentan necesidades de salud mental y diferencias en el uso SSM a partir de variables sociodemográficas. Estos resultados pueden ser útiles para la planificación de intervenciones que favorezcan el acceso y uso de SSM, especialmente en los grupos de adolescentes más desfavorecidos.

ABSTRACT Background: Besides traditional risk factors (RF), non-conventional determinants (NCD) of cardiovascular (CV) health are additional risk factors in women. Therefore, they should be explored to establish their prevalence and association with the female gender. Objective: The aim of this study is to know the prevalence of socioeconomic (SE) and psychosocial (PS) factors as NCD in CV health in Latin American (LATAM) women. Methods: We conducted an observational, cross-sectional study using an anonymous survey distributed among LATAM women between May and June 2022. The information gathered included SE and PS NCD, traditional RF and cardiovascular disease (CVD). Results: A total of 4915 women participated; mean age was 49 ± 13 years. Most respondents (49.6%) lived in Argentina, 55.8% in large cities; 94.4% reported adequate access to healthcare services and 89% had access to some level of education. Although 79.9% had a paid job, more than half reported their salary was not commensurate (59.5%) and 26.7% reported exposure to violence at the workplace. The most prevalent PS factors were low to moderate level of satisfaction (68.3%), anxiety or irritability (51.9%), apathy, negative thoughts, or unhappiness (41.7%). Age >45 years was significantly associated with overweight, obesity, unemployment, and violence at the workplace. On multivariate analysis, sleep disorders (OR 1.7; p = 0.001), living in a city with low population density (OR 0.5; p <0.001), violence at the workplace (OR 1.8; p = 0.001), anxiety (OR 1.5; p = 0.001) and a history of pregnancy complications (OR 1.6; p = 0.022) were independently associated with CVD. Conclusion: The prevalence of PS and SE factors affecting the CV health of LATAM women was significant. Variables such as violence at the workplace, anxiety, or irritability, living in cities with low population density, sleep disorders and pregnancy complications were independently associated with CVD. This survey shows the impact of SE and PS factors as NCD on the cardiometabolic burden and CV health of women in LATAM, mainly in those > 45 years.

RESUMEN Introducción: Más allá de los factores de riesgo (FR) tradicionales, hay determinantes no convencionales (DnoC) de la salud cardiovascular (CV) que operan en las mujeres como factores de riesgo adicional. Es por ello necesario explorarlos y establecer su prevalencia y vínculo con el género femenino. Objetivo: conocer la prevalencia de los DnoC socioeconómicos (SE) y psicosociales (PS) y su impacto en la salud CV de la mujer en Latinoamérica (LATAM). Material y métodos: estudio observacional, de corte transversal realizado a través de una encuesta anónima en mujeres de LATAM entre mayo y junio de 2022. Se recabaron datos sobre DnoC (SE y PS), FR convencionales y enfermedad cardiovascular (ECV). Resultados: participaron 4915 mujeres con edad media de 49 ± 13 años. El 49,6% residía en Argentina, el 55,8% en grandes ciudades, el 94,4% declaró acceso adecuado a la salud y el 89% tuvo acceso a algún nivel de educación. Si bien el 79,9% expresó tener trabajo remunerado, más de la mitad refirió percibir un salario no acorde (59,5%) y una exposición a la violencia en el ámbito laboral (26,7%). Los determinantes PS más prevalentes fueron el bajo a moderado nivel de satisfacción (68,3%), la ansiedad o irritabilidad (51,9%), el desinterés, los pensamientos negativos o la infelicidad (41,7%). El grupo de edad mayor de 45 años se asoció significativamente a más sobrepeso, obesidad, desempleo y violencia laboral. En el análisis multivariado se encontró asociación independiente con ECV para el trastorno del sueño (OR 1,7; p = 0,001), residir en una ciudad de baja densidad poblacional (OR 0,5; p <0,001), la violencia laboral (OR 1,8; p = 0,001), la ansiedad (OR 1,5; p = 0,001) y al haber padecido complicaciones del embarazo (OR 1,6; p = 0,022). Conclusión: se demostró una importante prevalencia de factores PS y SE que impactan en la salud CV de las mujeres en LATAM. Variables como la violencia laboral, la ansiedad o la irritabilidad, residir en ciudades de baja densidad poblacional, así como los trastornos del sueño y complicaciones del embarazo se asociaron de forma independiente con la ECV. Esta encuesta muestra el impacto de los DnoC SE y PS en la carga cardiometabólica (CCM) y la salud CV de las mujeres en LATAM, principalmente en aquellas mayores de 45 años.

The construction of public policies for the prevention and treatment of HIV/AIDS in Brazil is a history of struggle that unites sanitarians, researchers and activists since the 1980s. An important part of this path is linked to the production and distribution of antiretroviral drugs (ARV), initiatives to reduce the price of ARVs and civil society mobilizations for the guarantee of rights, which contributed to create one of the most successful programs to combat the disease in the country. world. Based on this history, this study aimed to analyze government spending on the acquisition of selected ARVs in the period between 2005 and 2020, making a comparison with international prices, in the light of determinants related to patent disputes, voluntary licensing, PDPs and ARV price reduction initiatives. Among other results, it was possible to observe that there was no immediate relationship between the end of the patent concession and the reduction of prices. Filings of other patent applications and the lack of nationally registered competitors, even after patent expiration, can be significant factors in maintaining high prices.

A construção de políticas públicas para a prevenção e tratamento do HIV/Aids no Brasil é uma história de luta que une sanitaristas, pesquisadores e ativistas desde os anos 1980. Parte importante desse caminho está ligado à produção e distribuição de medicamentos antirretrovirais (ARV), iniciativas de redução do preço dos ARV e mobilizações da sociedade civil pela garantia de direitos, que contribuíram para criar um dos programas mais bem-sucedidos de combate à doença no mundo. Com base nesse histórico, este trabalho teve por objetivo analisar os gastos governamentais na aquisição de ARV selecionados no período entre 2005 e 2020, fazendo uma comparação com preços internacionais, à luz dos determinantes relacionados às disputas patentárias, ao licenciamento voluntário, às PDPs e às iniciativas para redução de preços de ARVs. Entre outros resultados, foi possível observar que não houve uma relação imediata entre o fim da concessão patentária e a redução de preços. Depósitos de outros pedidos de patente e a inexistência de concorrentes registrados nacionalmente, mesmo após a expiração da patente, podem ser fatores significativos para a manutenção de altos preços.

Resumen Introducción: Existen dos formas de presentación clínica de los síndromes coronarios agudos (SCA): con elevación del segmento ST (SCACEST) y sin elevación (SCASEST). Los mecanismos que determi nan ambas presentaciones no se conocen completamente. El objetivo del estudio fue definir la asociación entre factores de riesgo cardiovascular y otras variables clínicas con la presentación de los SCA como SCACEST o SCASEST. Métodos: Analizamos información de pacientes incluidos prospectivamente en el Registro Epi-Cardio con diagnóstico de SCA desde abril de 2006 a abril de 2018.Se incluyeron un total de 10 019 pacientes. Resul tados: En el análisis multivariado, el sexo masculino (OR 1.5) y el tabaquismo activo (OR 1.71) se asociaron positivamente con el SCACEST. Contrariamente, la hipertensión (OR 0.71), las dislipidemias (OR 0.74), la edad (OR 0.97 por quintilo), historia de infarto (OR 0.57), angina crónica (OR 0.44), presencia de comorbilidades (OR 0.64), y la extensión de enfermedad coronaria (OR 0.84) se asociaron negativamente con el SCACEST. Las mujeres presentaron mayor incidencia de SCASEST, debido a una mayor proporción de SCA sin obstrucción coronaria significativa. Conclusión: Concluimos que algunos factores de riesgo cardiovascular y otras variables clínicas se asociaron independientemente con la presentación clínica como SCACEST o SCASEST, confirmando su influencia en la fisiopatología y en la presentación clínica y electrocardiográfica de los SCA.

Abstract Introduction: Two clinical presentations of acute coronary syndrome (ACS) have been defined: ST- segment elevation ACS (STEACS) or non-ST-segment elevation ACS (NSTEACS). The mecha nism that determines the clinical presentation of ACS is not clearly understood. The aim of this study was to define the association between cardiovascular risk factors and other clinical variables with the clinical presentation of ACS as STEACS or NSTEACS. Methods: We analyzed data of patients prospectively included in the Epi-Cardio Registry with a diagnosis of ACS from April 2006 to April 2018. A total of 10 019 patients were included in the study. Results: In the multivariate analysis, male sex (OR 1.5) and active smoking (OR 1.71) were positively associated with STEACS presentation. Conversely, hypertension (OR 0.71), dyslipidemia (OR 0.74), age (OR 0.97 per quintile), history of myocardial infarction (OR 0.57), chronic angina (OR 0.44), presence of comorbidities (OR 0.64), and extension of coronary heart disease (OR 0.84) were negatively associated with STEACS. Women differed from men by presenting a higher incidence of NSTEACS, due to a greater proportion of ACS without obstructive coronary heart disease. Conclusion: Some cardiovascular risk factors and other clinical variables are independently associated with the presentation of ACS as ST EACS or NSTEACS. These findings confirm the influence of risk factors and clinical history on the pathophysiology, clinical and electrocardiographic presentation of ACS.

ABSTRACT Background: Intersectoral health promotion initiatives in Chile to address obesity and non- communicable diseases have had a long history in Chile, but also a high degree of changes in their design, implementation, and financing. Aim: To analyze the “Choose a Healthy Lifestyle” enacted by Law 20,670 under Sabatier's “Advocacy Coalition Framework” (ACF), addressing the political discussion and its execution in the subsequent governing coalitions (2011-2022). Material and Methods: The ACF components are the following: external events, coalitions, policy subsystem (health promotion), and policy brokers. Policy change and learning occurs when a certain level of conflict exists between coalitions. We carried out a bibliographic and literature review, including history of the Law and notes in the media. Results: We identified two coalitions. The first is pro-individual freedom and aims to solve the problem with education and health promotion. The second one defines the problem as structural and related to social determinants and health inequity. The first coalition launched the “Choose Healthy Liferstyle” program in 2011 when they were in executive power. After criticism from the opposition and the participation of policy brokers, the Program was institutionalized with an intersectoral vision. The lack of permanent financing affected the continuity of the policy, especially after a change in the governing coalition. Conclusions: Law 20,670 falls within the ACF. However, policy learning slowed down because the problem involved social aspects, conflict between deep beliefs of both coalitions, and lack of permanent funding, thus affecting the continuity of the policy.

Antecedentes: Las iniciativas intersectoriales de promoción de salud en Chile han tenido una larga historia en el país, pero también un alto grado de cambios en su diseño, implementación y financiamiento. Objetivos: Analizar el “Sistema Elige Vivir Sano” (Ley 20.670) bajo el marco de “Coaliciones de Causa” (ACF), abordando la discusión política y su ejecución durante cambios de coaliciones gobernantes (2011-2022). Material y Métodos: Los componentes de ACF incluyen eventos externos, coaliciones, subsistema de políticas (promoción de salud) e intermediarios de políticas. El cambio y aprendizaje de políticas ocurre cuando existe cierto nivel de conflicto entre coaliciones. Realizamos una revisión de literatura, incluyendo historia de la Ley y notas en los medios de comunicación. Resultados: Identificamos dos coaliciones. La primera es pro-libertad individual y pretende resolver el problema con educación y promoción de la salud. La segunda es pro-determinantes sociales y define el problema como estructural. La primera coalición lanzó el programa “Elige Vivir Sano” en 2011 cuando estaban en el poder ejecutivo. Luego de las críticas de la oposición y la participación de intermediarios de políticas, el Programa se institucionalizó con una visión intersectorial. La falta de financiamiento permanente afecta la continuidad de la política, especialmente luego de un cambio en la coalición gobernante. Conclusiones: La Ley 20.670 se enmarca dentro de la ACF. Sin embargo, el aprendizaje de políticas se ralentizó porque el problema involucra aspectos sociales, conflicto entre creencias profundas de ambas coaliciones y falta de financiamiento permanente, afectando la continuidad de la política.

The systematic assessment of cognitive performance of older people without cognitive complaints is controversial and unfeasible. Identifying individuals at higher risk of cognitive impairment could optimize resource allocation. We aimed to develop and test machine learning models to predict cognitive impairment using variables obtainable in primary care settings. In this cross-sectional study, we included 8,291 participants of the baseline assessment of the ELSA-Brasil study, who were aged between 50 and 74 years and were free of dementia. Cognitive performance was assessed with a neuropsychological battery and cognitive impairment was defined as global cognitive z-score below 2 standard deviations. Variables used as input to the prediction models included demographics, social determinants, clinical conditions, family history, lifestyle, and laboratory tests. We developed machine learning models using logistic regression, neural networks, and gradient boosted trees. Participants' mean age was 58.3±6.2 years, 55% were female. Cognitive impairment was present in 328 individuals (4%). Machine learning algorithms presented fair to good discrimination (areas under the ROC curve between 0.801 and 0.873). Extreme Gradient Boosting presented the highest discrimination, high specificity (97%), and negative predictive value (97%). Seventy-six percent of the individuals with cognitive impairment were included among the highest ranked individuals by this algorithm. In conclusion, we developed and tested a machine learning model to predict cognitive impairment based on primary care data that presented good discrimination and high specificity. These characteristics could support the detection of patients who would not benefit from cognitive assessment, facilitating the allocation of human and economic resources. unfeasible settings crosssectional cross sectional study 8291 8 291 8,29 ELSABrasil ELSA Brasil 5 7 dementia zscore z score deviations demographics determinants conditions history lifestyle tests regression networks trees Participants 58362 58 3 6 58.3±6. 55 female 32 4%. 4 4% . (4%) areas 0801 0 801 0.80 0.873. 0873 0.873 873 0.873) 97%, 97 97% , (97%) 97%. Seventysix Seventy six algorithm conclusion resources 829 29 8,2 5836 58.3±6 (4% 080 80 0.8 087 0.87 87 9 (97% 82 8, 583 58.3± (4 08 0. (97 58.3 ( (9 58.

Abstract Perceptions of the importance of the role of psychological trauma in the origins of psychiatric problems have oscillated throughout the history of psychiatry. However, since the conception of post-traumatic stress disorder (PTSD), western societies have witnessed a marked expansion of the discourse of trauma in the interpretation of devastating human experiences like catastrophes, genocides, disasters, and epidemics. Through an integrative literature review, this article analyzes some of the historical and epistemological determinants behind the emergence of traumatic memory and the establishment of trauma as a semantic field that orients clinical responses and political strategies in the field of the humanities and the health sciences. psychiatry However posttraumatic post PTSD, PTSD , (PTSD) catastrophes genocides disasters epidemics review sciences (PTSD

Resumo A percepção do papel do trauma psicológico na origem de problemas psiquiátricos aumentou e diminuiu ao longo da história da psiquiatria. Com a concepção do transtorno de estresse pós-traumático (TEPT), entretanto, as sociedades ocidentais presenciaram uma profunda expansão do discurso do traumatismo na interpretação de experiências humanas devastadoras, como catástrofes, genocídios, desastres e epidemias. A partir de revisão bibliográfica integrativa, este artigo analisa alguns dos determinantes históricos e epistemológicos que fundamentam o surgimento da memória traumática e o estabelecimento do trauma como campo semântico que orienta respostas clínicas e estratégias políticas no campo das ciências humanas e da saúde. psiquiatria póstraumático pós traumático TEPT, TEPT , (TEPT) entretanto devastadoras catástrofes genocídios epidemias integrativa saúde (TEPT

Alcohol and other substance use disorders are complex problems with multiple variables and determinants, requiring a multidimensional approach to prevention and treatment. A robust body of research shows that religiosity and spirituality (R/S) play a prominent role in these disorders; however, how to apply this knowledge remains unclear. We present practical guidelines on how to integrate R/S into substance use prevention and treatment in an ethical, evidence-based manner. These guidelines have been endorsed by prominent academic leaders in these topics and by health associations affiliated with the three major Brazilian religions. The integration of R/S is part of a respectful, person-centered, interdisciplinary approach, which imposes neither religious beliefs nor secular worldviews. The most critical interventions include collecting a history of spiritual and religious beliefs, practices, and experiences and evaluating how these may be used positively in treatment. It is also essential that health professionals are encouraged to value and respect the R/S of patients, and that religious groups recognize that professional and technical interventions can make a valuable contribution to preventing and treating these disorders. determinants RS R S (R/S however unclear ethical evidencebased evidence based manner religions respectful personcentered, personcentered person centered, centered person-centered worldviews practices patients