Resumen Existe un corpus de investigación, aún incipiente pero prometedor, en el ámbito de las actividades grupales vocales, y su impacto en la salud y el bienestar de las personas, que se sintetiza en este trabajo. En este, se aportan las evidencias más relevantes y ponen el foco en los coros amateurs de personas adultas. Se hace especial énfasis en los mecanismos generativos que relacionan el canto coral con la salud y el bienestar en las personas adultas desde cuatro perspectivas: emocional, mental, social y fisiológica. Se argumenta que un grupo coral funciona como un equipo, que existen diferencias entre hombres y mujeres en las respuestas emocionales a las actividades corales, y se aborda el canto coral amateur como una actividad de ocio formativo para la que se precisa aplicar estrategias didácticas adecuadas a un colectivo de adultos desde un enfoque andragógico. Finalmente, se presenta una reflexión crítica sobre las fortalezas y debilidades de las investigaciones realizadas hasta el momento, como la falta de sinergias entre los estudios realizados, cierto sesgo positivista que elude visualizar y analizar también los contras de la práctica coral, y la falta de indicadores musicales, de liderazgo y relacionales que podrían explicar parte de los resultados obtenidos e, incluso, limitarlos.

Resumo Existe um conjunto de investigação, ainda incipiente mas promissor, no domínio das actividades de grupos vocais e do seu impacto na saúde e bem-estar das pessoas, que é sintetizado neste documento. Este documento fornece as provas mais relevantes e centra-se nos coros amadores para adultos. É dada especial ênfase aos mecanismos generativos que relacionam o canto coral com a saúde e o bem-estar dos adultos em quatro perspectivas: emocional, mental, social e fisiológica. Defende-se que um grupo coral funciona como uma equipa, que existem diferenças entre homens e mulheres nas respostas emocionais às actividades corais e que o canto coral amador é abordado como uma atividade formativa de lazer para a qual é necessário aplicar estratégias didácticas adequadas a um grupo de adultos a partir de uma abordagem andragógica. Por fim, é apresentada uma reflexão crítica sobre os pontos fortes e fracos da investigação realizada até à data, como a falta de sinergias entre os estudos efectuados, um certo viés positivista que evita também visualizar e analisar os contras da prática coral, e a falta de indicadores musicais, de liderança e relacionais que poderiam explicar parte dos resultados obtidos e até limitá-los.

Abstract There is a body of research, still incipient but promising, in the field of vocal group activities, and their impact on the health and well-being of people, that is synthesized in this work. Here I provide the most relevant evidence and focuson amateur choirs of adult people. Special emphasis is placed on the generative mechanisms that relate choral singing to health and well-being in adults from four perspectives: emotional, mental, social and physiological. It is argued that a choral group functions as a team, that there are differences between men and women in the emotional responses to choral activities, and amateur choral singing is approached as a formative leisure activity for which it is necessary to apply adequate didactic strategies to a group of adults from an andragogic approach. Finally, a critical reflection is presented on the strengths and weaknesses of the research carried out so far, such as the lack of synergies between the studies carried out, a certain positivist bias that avoids visualizing and also analyzing the cons of choral practice, and the lack of musical, leadership and relational indicators that could explain part of the results obtained and even limit them.

Abstract: This article analyzes discourses on the protection of children, maternity and the family that were developed in academic medical circles and their influence on the reports of social workers at the Central Board of the Quito Public Welfare Office in the nineteen forties; these reports constituted a reading of the reality of single mothers and the illegitimacy of their children through imaginaries of how mothers and married women ought to be.

Resumen: En este artículo se analizan los discursos sobre la protección de la infancia, la maternidad y la familia que se desarrollaron en los círculos académicos de la medicina y la influencia que éstos tuvieron en los informes de las trabajadoras sociales de la Junta Central de Asistencia Pública de Quito en los años cuarenta del siglo XX; en estos informes se hace una lectura de la realidad de las madres solteras y la ilegitimidad de sus hijos desde imaginarios del deber ser de las madre y las mujeres casadas.

Abstract This article takes up the concept of surplus labor force as understood in Latin American economic thought, due to its importance in pointing out the difficulties of capitalism in incorporating people into quality jobs and explaining the reproduction of inequalities. To contribute to the study of women’s labor exclusion in the region, two objectives are pursued. The first objective is to construct a theoretical-methodological proposal to study the surplus of the labor force by re-reading the structuralist approach from a feminist economics perspective. The second objective is to analyze with this adapted framework the evolution of the surplus of the labor force, as well as the Argentine welfare policy that aims to regulate it and its link with the reproduction of gender inequalities at the national level between 2003 and 2019. For this purpose, a documentary and statistical analysis of different sources is carried out. The results show the structural persistence of exclusion and gender inequality as a result of the articulation between the labor features of the Argentine development style and the consolidated welfare policy pattern. This pattern is based on conditional cash transfers and was functional to the feminization of the surplus of the labor force during the first two decades of the 21st century.

Resumen En este artículo se retoma el concepto de excedente de la fuerza de trabajo tal como se entiende desde el pensamiento económico latinoamericano, por su importancia al señalar las dificultades del capitalismo para incorporar a las personas en empleos de calidad y explicar la reproducción de las desigualdades. A fin de contribuir al estudio de la exclusión laboral de las mujeres dentro de la región, se persiguen dos objetivos. El primero: construir una propuesta teórico-metodológica para estudiar el excedente de la fuerza de trabajo mediante la relectura del abordaje estructuralista desde la economía feminista. Con el segundo se propone analizar, a partir de este marco adaptado, la evolución del excedente de la fuerza de trabajo, así como la política asistencial argentina que pretende regularlo y su vínculo con la reproducción de las desigualdades de género en el ámbito nacional entre 2003 y 2019. Para ello se realiza un análisis documental y estadístico de distintas fuentes. Los resultados permiten constatar la persistencia estructural de la exclusión y la desigualdad de género producto de la articulación entre los rasgos laborales del estilo de desarrollo argentino y el patrón de política asistencial consolidado. Dicho patrón se apoya en las transferencias monetarias condicionadas y resulta funcional a la feminización del excedente de la fuerza de trabajo durante las dos primeras décadas del siglo XXI.

RESUMEN Introducción: A nivel mundial, la cobertura de vacunación contra el COVID-19, así como contra la influenza es baja tanto en la población general como en los profesionales de la salud a pesar de que la vacuna es gratuita y obligatoria en el personal sanitario. Objetivo: Describir la cobertura de vacunación contra el COVID -19, y la influenza en personal de salud y administrativo de un hospital de referencia del Ministerio de Salud Pública y Bienestar Social en el periodo 2021-2022. Metodología: Estudio observacional descriptivo de corte trasverso. Se hizo la revisión de los registros del personal sanitario y administrativo del centro vacunatorio del Hospital Nacional de Itauguá de la campaña vacunal contra el COVID-19 y de anti-influenza en el periodo 2021- 2022. Resultados: De los 3.586 funcionarios, 999 (27,9 %) eran médicos, 1494 (41,7 %) personal de enfermería, 366 (10,2 %) otra categoría de personal sanitario, y 727 (20,3 %) personal administrativo. En forma global, el 86,5 % de los funcionarios recibió por lo menos las dos dosis que constituyen el esquema primario y el 73 % la dosis de refuerzo. El 2,1 % del personal no recibió ninguna dosis de vacuna anti covid-19, la cifra fue mayor en el personal administrativo (4,8 %). La cobertura de vacunación contra la influenza fue de 20 % en el 2021 y 25 % en el 2022. Discusión: Si bien cobertura de vacunación anti-COVID-19 fue comparable a otros países, la vacunación contra la influenza fue muy baja. Es urgente implementar estrategias dirigidas a aumentar la percepción de riesgo y aceptabilidad de las vacunas obligatorias para el personal sanitario.

ABSTRACT Introduction: Worldwide, vaccination coverage against COVID-19, as well as against influenza, is low both in the general population and in health professionals, despite the fact that the vaccine is free and mandatory for health personnel. Objective: To describe the COVID -19 and influenza vaccination coverage in health and administrative personnel of a reference hospital of the Ministry of Public Health and Social Welfare in the period 2021-2022. Methods: Cross-sectional descriptive observational study. Charts of the health and administrative personnel of the vaccination center of the Itauguá National Hospital of the COVID-19 and influenza vaccination campaign in the period 2021-2022 were reviewed. Results: Of the 3,586 personnel, 999 (27.9%) were medical personnel, 1,494 (41.7%) nursing personnel, 366 (10.2%) other category of health personnel, and 727 (20.3%) administrative personnel. Overall, 86.5% of the employees received at least the two doses that constitute the primary schedule and 73% the booster dose; 2.1% of the staff did not receive any dose of the anti COVID-19 vaccine, which was higher in the administrative staff (4.8%). Influenza vaccination coverage was 20% in 2021 and 25% in 2022. Discussion: Even though the vaccination coverage of anti-COVID-19 was comparable to other countries, vaccination anti-influenza was very low. It is urgent to implement strategies aimed at increasing the perception of risk and acceptability of mandatory vaccines for health personnel.

Resumo Este artigo discute o RBI como política que promove a reciprocidade na sociedade, olhando para os dados disponíveis sobre experiências sociais de transferências monetárias, em particular experiências de rendimento mínimo garantido e de rendimento básico. Os resultados destas experiências mostram que com a atribuição do rendimento incondicional os indivíduos não deixam de investir o seu tempo num emprego mas antes diversificam as suas atividades, investindo no cuidado prestado a familiares ou em atividades na comunidade. As experiências indicam também que, contrariamente a propostas de rendimento mínimo condicional (ex. rendimento social de inserção), o rendimento básico promove a redução do estigma social. Estes resultados permitem-nos expandir a nossa ideia de contribuição produtiva para além do emprego, e discutir o papel do RBI como um mecanismo que, ao invés de violar a norma de reciprocidade, funciona como política essencial para a sua promoção numa sociedade mais justa.

Abstract This article explores the idea that a UBI might be a superior mechanism in promoting reciprocity in society, looking at available data from social experiments with cash transfers. The results of these experiments show that when people receive an unconditional grant, they don’t usually stop working. Instead, they tend to diversify their time-use, opting to invest in caring for family members or in community activities. Experiences also shows that unlike conditional cash transfers, basic income is less stigmatizing to beneficiaries. These results and their interpretation allow us to expand our idea of productive contribution beyond paid employment. It also allows us to discuss the role of basic income as an essential policy for promoting reciprocity in a fairer society, instead of a mechanism that violates the norm of reciprocity.

ABSTRACT This paper analyzes the expansion of social policies in South Korea during the context of globalization, by linking two theoretical approaches: social investment and the New Developmental State. Applying the case study method, I endorse the hypothesis of complementarily between the welfare state and the developmental state. The article shows that between the 1990s and the 2010s, South Korea expanded all sectors of social policies analyzed. Beyond the expansion of passive policies, active policies (including education) were reshaped in an integrated manner with the industrial policy to promote innovation, pursuing the transition to the knowledge-based society; also the family policy became one of the most generous among OECD countries.

RESUMO Este artigo analisa a expansão das políticas sociais na Coreia do Sul, durante o contexto da globalização, articulando duas abordagens teóricas: investimento social e Novo Estado desenvolvimentista. Por meio do método de estudo de caso, defende-se a hipótese da complementariedade entre Estado de bem-estar e estado desenvolvimentista. O artigo demonstra que, entre os anos 1990 e os anos 2010, a Coreia do Sul ampliou todos os setores das políticas sociais analisados. Para além da expansão das políticas passivas, as políticas ativas (incluindo a educação) foram reformuladas de forma articulada com a política industrial de fomento à inovação, buscando a transição para a sociedade baseada no conhecimento; além disso, a política familiar tornou-se uma das mais generosas entre os países da OCDE.

ABSTRACT The study sought to understand the experience and expectations of doulas who worked or worked in two municipalities in the border region: Foz do Iguaçu and Cascavel, Paraná, Brazil. This was a qualitative research based on the framework of Social Phenomenology. The collection of information took place through interviews with a semi-structured script in Portuguese. The interviews were done online. The results were classified into six categories: motivated to become a doula, knowledge about the role of the doula, the daily life of the doulas, covering the subcategories of successful experiences and challenges of the activity in the border region, the invisibility of the doula, the expectations as doulas facing the obstetric scenario and what is expected of their professional performance. The study made it possible to understand the experience of doulas and knowledge of the role of their role in the Unified Health System (SUS), in the private sector and in home births, highlighting the importance of multidisciplinary action. Resistance in the obstetric scenario was considered due to the lack of knowledge on the part of care professionals about the role of the doula. Regarding work in the border region, the doulas reported accompanying Paraguayan women in Brazil and, less frequently, in Paraguay. Cultural and linguistic barriers were highlighted as reasons that make professional practice in another country unfeasible.

RESUMO O estudo buscou compreender a vivência e as expectativas das doulas que atuam ou atuaram em dois municípios de região de fronteira: Foz do Iguaçu e Cascavel, Paraná, Brasil. Tratou-se de uma pesquisa qualitativa pautada no referencial da Fenomenologia Social. A coleta das informações deu-se por entrevistas com roteiro semiestruturado em língua portuguesa. As entrevistas foram feitas on-line. Os resultados foram classificados em seis categorias: motivação para tornar-se doula, conhecimento sobre o papel da doula, o cotidiano das doulas, abarcando as subcategorias de experiências exitosas e desafios da atividade na região de fronteira, a invisibilidade da doulagem, as expectativas enquanto doulas frente ao cenário obstétrico e o esperado da sua atuação profissional. O estudo permitiu compreender a vivência das doulas e o conhecimento do papel da sua função no Sistema Único de Saúde (SUS), no setor privado e em partos domiciliares, evidenciando a importância da atuação multiprofissional. Foram ponderadas resistências no cenário obstétrico por desconhecimento dos profissionais da assistência sobre o papel da doula. Em relação à atuação na região de fronteira, as doulas relataram o acompanhamento de mulheres paraguaias no Brasil e, com menos frequência, no Paraguai. As barreiras culturais e linguísticas foram destacadas como obstáculos para o exercício profissional em outro país.

ABSTRACT This article examines the development of Brazilian unemployment insurance from 1986 to 2019. First, it discusses legal changes, considering the economic conditions and sociopolitical conflicts of each period. Second, it presents the main indicators of the insurance’s effectiveness, notably coverage, duration and wage replacement. Finally, it presents a calculation of the Decommodification Index of the unemployment insurance, following Esping-Andersen’s (1990) proposal. The goal is to analyze Brazilian unemployment insurance from 1996 to 2017 and compare it with current models in OECD countries. The results reveal the weakening of unemployment protection in 2017, a year that ranks second worst in the historical series due to the labor market disruption and a restrictive reform of unemployment insurance in 2015. Furthermore, Brazil has the lowest Index in the database, owing to its residual effective coverage due to the distance between insurance rules – designed for structured labor markets – and the characteristics of the national workforce.

RESUMEN Este artículo discute la trayectoria del seguro de desempleo brasilero en el periodo 1986-2019. Inicialmente, son debatidos los cambios legales del seguro a la luz de la coyuntura económica y de las disputas sociopolíticas de cada período. Luego, el artículo analiza los indicadores de efectividad del seguro, especialmente la cobertura, la duración del beneficio y la reposición salarial. Finalmente, se calcula el Índice de Desmercantilización ( Decommodification Index ) del seguro de desempleo, siguiendo la propuesta de Esping-Andersen (1990). El objetivo es analizar el seguro desempleo brasilero en el periodo 1996-2017 y, luego, compararlo con los modelos existentes de la OCDE. Los resultados demuestran el debilitamiento reciente de la protección al desempleo, lo que coloca el año 2017 en la segunda peor posición de la serie histórica, como resultado de la desestructuración del mercado de trabajo y de una reforma restrictiva del seguro de desempleo en 2015. Además, el Índice de Desmercantilización del seguro brasilero es el menor entre los países analizados, sobre todo debido a una cobertura efectiva residual, dada la distancia entre las reglas del seguro (pensadas para mercados de trabajo estructurados) y las características de la fuerza de trabajo nacional.

RÉSUMÉ Cet article traite de la trajectoire de l’Assurance Chômage brésilienne sur la période 1986-2019. Dans un premier temps, les évolutions juridiques de l’assurance sont discutées à la lumière de la conjoncture économique et des contestations socio-politiques de chaque période. Ensuite, l’article analyse les indicateurs d’efficacité de l’assurance, notamment la couverture, la durée des prestations et le remplacement du salaire. Enfin, je calcule l’indice de démarchandisation de l’Assurance Chômage, suivant la proposition d’Esping-Andersen (1990). L’objectif est d’analyser l’Assurance Chômage brésilienne sur la période 1996-2017, puis de la comparer aux modèles existants de l’OCDE. Les résultats attestent de l’affaiblissement récent de la protection contre le chômage, qui place 2017 dans la deuxième pire position de la série historique, en raison de la perturbation du marché du travail et d’une réforme restrictive de l’Assurance Chômage en 2015. Par ailleurs, l’Indice de la démarchandisation de l’assurance brésilienne est le plus bas parmi les pays analysés, principalement en raison d’une couverture d’efficace résiduelle, compte tenu de la distance entre les règles d’assurance (conçues pour des marchés du travail structurés) et les caractéristiques de la force de travail nationale.

RESUMO Este artigo discute a trajetória do seguro-desemprego brasileiro no período 1986-2019. De início, as mudanças legais do seguro são debatidas à luz da conjuntura econômica e das disputas sociopolíticas de cada período. Em seguida, o artigo analisa os indicadores de efetividade do seguro, notadamente a cobertura, a duração do benefício e a reposição salarial. Por fim, calculo o Índice de Desmercantilização ( Decommodification Index ) do seguro-desemprego, seguindo a proposta de Esping-Andersen (1990). O objetivo é analisar o seguro-desemprego brasileiro no período 1996-2017 e, em seguida, compará-lo com os modelos existentes na OCDE. Os resultados atestam o enfraquecimento recente da proteção ao desemprego, o que coloca o ano de 2017 na segunda pior posição da série histórica, em decorrência da desestruturação do mercado de trabalho e de uma reforma restritiva do seguro-desemprego em 2015. Ademais, o Índice de Desmercantilização do seguro brasileiro é o menor dentre os países analisados, sobretudo devido a uma cobertura efetiva residual, dada a distância entre as regras do seguro (pensadas para mercados de trabalho estruturados) e as características da força de trabalho nacional.

Resumen: Cada vez con mayor naturalidad reconocemos a niños, niñas y adolescentes (NNA) como actores sociales capaces de agenciar por sí mismos, según su edad y nivel de desarrollo, aspectos específicos de su vida; espacios en los cuáles correlativamente y de manera gradual vamos otorgándoles mayores márgenes de actuación personal. Este cambio paradigmático en la comprensión de NNA ha estado influenciado por la adopción de la Convención sobre los Derechos del Niño (CDN), en 1989. Ella supuso avanzar desde una mirada hasta entonces asistencialista que observaba a NNA como objetos de protección sometidos, en tanto sujetos pasivos, a la tutela de adultos responsables (doctrina de la protección tutelar), a su consideración como sujetos de derecho, esto es, como titulares y principales agentes en el ejercicio de sus derechos, respecto de los cuales cabe a los adultos deberes de orientación y guía (doctrina de la protección integral). Revisando los términos de la Convención y las adecuaciones experimentadas por el marco jurídico nacional, esta actualidad explora el modo como este nuevo modelo, fundamentado en los derechos humanos, se hace extensible y en qué términos, al espacio sanitario.

Abstract: More and more naturally we recognize children and adolescents (NNA) as social actors capable of managing for themselves, according to their age and level of development, specific aspects of their lives; spaces in which we gradually and correlatively grant them greater scope for personal action. This paradigmatic change in the understanding of children and adolescents has been influenced by the adoption of the Convention on the Rights of the Child (CRC) in 1989. It meant moving forward from a until then welfare perspective that observed children and adolescents as subject objects of protection, as passive subjects, to the guardianship of responsible adults (doctrine of guardianship protection), to their consideration as subjects of law, that is, as holders and main agents in the exercise of their rights, with respect to which adults have duties of protection. orientation and guidance (doctrine of comprehensive protection). Reviewing the terms of the Convention and the adjustments made to the national legal framework, this article explores how this new model, based on human rights, is extended and in what terms, to the healthcare space.

This opinion article argues that it may not be appropriate to regard the Covid-19 pandemic as a traumatic stressor. Persons diagnosed with Covid-19 have typically been concerned about events that might have occurred in the future such as severe illness, hospitalisation and death, access to treatment, the welfare of dependents, and stigma and discrimination. Their concerns are thus future-oriented rather than anchored to a past traumatic event, which is the requirement for a diagnosis of PTSD. If the criteria for what is considered a traumatic stressor are widened, there is a risk that the concept of trauma may become so diluted that many events, even mildly distressing ones, may be regarded as traumatic. Social workers and other health professionals should take these matters into account when attending to the emotional and psychological needs of persons affected by the Covid-19 pandemic.

BACKGROUND: Robust results-based monitoring and evaluation (M) systems allow government to track the progress and impact of development programmes. This article focused on the current M system as adopted for the Child Support Grant (CSG) programme of the Ministry of Gender Equality, Poverty Eradication and Social Welfare (MGEPESW) in Namibia. OBJECTIVES: The article examined whether the adopted M processes and arrangements for the MGEPESW sufficiently track the outcomes for beneficiaries of the CSG programme to enable strategic decisions by the MGEPESW. METHOD: A desktop review of available literature on M systems was complemented by a review of strategic reports and programme documentation of the MGEPESW that sets out the current M arrangements. Further interviews with senior, middle and programme managers responsible for the implementation of the CSG programme assessed the suitability and gaps of these arrangements as well as the proposed recommendations to strengthen the existing M arrangements. RESULTS: The research found several gaps in current practice that hinders the MGEPESW and decision-makers in assessing the outcomes for child beneficiaries. CONCLUSION: Recommendations were offered to improve the current M system to better track the outcomes of the CSG programme. This included a refined theory of change, revised indicators and strengthened institutional arrangements. CONTRIBUTION: The improved results-based M system for the MGEPESW offers a comparative base for the implementation of results-based M systems for child-focused cash transfer programmes in similar contexts.

Modern capitalism has shaped the world, but for many scholars, its principles have disproportionately favoured the prosperity of a minority while neglecting the prospects of the majority, particularly in Southern Africa. The recent COVID-19 pandemic combined with significant inequalities of wealth has put the social policies of countries in Southern Africa to the test. It exposed the inadequacies of the current capitalist order in many countries in the global south, hindering their ability to protect their populations from the pandemic's impact. In contrast, the global north, with stronger social policies and economic flexibility, managed to cushion the severity of pandemic's economic impact on their populations in many ways, even though they suffered the most deaths. In this article, I establish how COVID-19 and neoliberal capitalism made it difficult to achieve the social developmental objectives in Southern Africa. While scholars have documented the medical and economic harms caused by the pandemic, I highlight ways that it, along with considerable inequalities of wealth, impaired social development more broadly. I conclude by establishing how the COVID-19 pandemic has underscored the shortcomings of neoliberal capitalism in Southern Africa's social policies, emphasising the need for re-evaluating and re-alignment of these policies-to foster more equitable and resilient societies.

This article explores how the Western theology often employed by European explorers sought to deify 'whiteness'. Whiteness as an ideological construction found the ideal tool in Christianity and through supersessionism detached Jesus of Nazareth from his Jewish roots and clothed him in whiteness, thus making white maleness the idol that all creatures must aspire towards. In defiance, liberation theologians, in particular James Cone, coined the possibility that 'Jesus is black'. Thus, the possibility of Jesus being anything to anyone becomes conceivable. Such a usurpation of the Jesus of Nazareth on either side opens the possibility of recreating Jesus in one's image. This is the coin of idolatry that this article will argue sits at the heart of modern theology. Assuming a dialectical hermeneutic of suspicion, this article explores the problem of modern theology and how some liberation theologies may continue to play second fiddle to the whiteness perpetuated by western theologies like pruning a bonsai tree. Notwithstanding the challenges of decolonising theology, this search conceives the possibility of a non-ideological Christianity that may be confronting the whiteness of western theology and its associated atrocities. Such a quest may lead to a framing of a transformative theology based on honest and interrogative encounter between modern theology and cultural and traditional spiritualities. CONTRIBUTION: This article explores how liberation theology can become a major player in the theology arena without always playing second fiddle to Western theologies. Exploring decoloniality confronts whiteness in terms of political theology that interlinks anthropology, economics and social welfare.

RESUMEN Con la sanción de la Constitución Nacional en 1992 de la República del Paraguay, se declara en sus artículos 68 y 69 "que el Estado protegerá y promoverá el derecho a la salud como fundamental, proveyendo las condiciones dentro del Sistema Nacional de Salud, recursos, planes y políticas integradas al desarrollo". Este marco constitucional ha sido la base y el fundamento de la Ley 1.032/96, que crea el Sistema Nacional de Salud, el cual está compuesto por los subsectores públicos, mixtos y privados, caracterizado por un modelo segmentado y fragmentado, reglamentado por el Decreto Ley N°21.376 del año 1998 bajo la rectoría del Ministerio de Salud Pública y Bienestar Social, actualmente la salud paraguaya está fundamentada en los ejes estratégicos basados en la creación e implementación de unidades de salud familiar y se define con un enfoque basado en la atención primaria de la salud.

ABSTRACT With the enactment of the National Constitution of the Republic of Paraguay in 1992, articles 68 and 69 state that "the State will protect and promote the right to health as fundamental, providing the conditions within the National Health System, resources, plans and policies integrated to development". This constitutional framework has been the basis and foundation of Law 1.032/96, which creates the National Health System, which is composed of public, mixed and private subsectors, characterized by a segmented and fragmented model, regulated by the Decree Law No. 21,376 of 1998, under the Ministry of Public Health and Social Welfare, Paraguayan health is currently based on strategic axes based on the creation and implementation of family health units and is defined with an approach based on primary health care.

ABSTRACT Objective To analyze the survival of patients with Chagas disease, beneficiaries of social security and social assistance, in Brazil, from 1942 to 2016. Methods This is a retrospective cohort study with data from the Brazilian Ministry of Social Security. The event of interest was death, and the survival functions were estimated by the Kaplan-Meier and Cox regression methods. Results In the period “onset of the disease until death”, women (HR=0.54; 95%CI 0.43–0.53) and receiving social security benefits (HR=0.13; 95%CI 0.11–0.23) were associated with longer survival. Lower survival was associated with the cardiac form of the disease (HR=2.64; 95%CI 2.23–3.12), living in a rural area (HR=1.23; 95%CI 1.14–1.21), and manifestation of the disease between the years 2000 and 2016 (HR=5.32; 95%CI 4.74–5.93). Likewise, in the period “work disability until death”, women (HR=0.51; 95%CI 0.41–0.52) and receiving social security benefits (HR=0.24; 95%CI 0,14–0.45) were associated with longer survival, as well as the cardiac form of the disease (HR=1.95; 95%CI 1.83–2.13), living in a rural area (HR=1.31; 95%CI 1.21–1.54), and manifestation of the disease between 2000 and 2016 (HR=1.53; 95%CI 1.33–1.71) were associated with lower survival. Conclusion The main predictors of mortality and survival of patients with Chagas disease who receive social security and assistance benefits in Brazil were presented. These findings can guide the definition of priorities for follow-up actions by Primary Health Care, currently recommended for the longitudinal management of the disease.

RESUMO Objetivo Analisar a sobrevida de portadores da doença de Chagas, beneficiários da previdência e da assistência social no Brasil, 1942-2016. Métodos Estudo de coorte retrospectivo com dados do Ministério da Previdência Social. O evento de interesse foi o óbito, e as funções de sobrevida foram estimadas pelos métodos Kaplan-Meier e de regressão de Cox. Resultados No período “início da doença até o óbito”, o sexo feminino (HR=0,54; IC95% 0,43–0,53) e recebimento de benefícios previdenciários (HR=0,13; IC95% 0,11–0,23) foram associados a maior sobrevida. A menor sobrevida esteve associada à forma cardíaca da doença (HR=2,64; IC95% 2,23–3,12), residência em zona rural (HR=1,23; IC95% 1,14–1,21) e manifestação da doença entre os anos de 2000 e 2016 (HR=5,32; IC95% 4,74–5,93). Da mesma forma, no período “incapacidade laboral até o óbito”, o sexo feminino (HR=0,51; IC95% 0,41–0,52) e o recebimento de benefícios previdenciários (HR=0,24; IC95% 0,14–0,45) foram associados a maior sobrevida, assim como forma cardíaca da doença (HR=1,95; IC95% 1,83–2,13), residência em zona rural (HR=1,31; IC95% 1,21–1,54) e manifestação da doença entre os anos de 2000 e 2016 (HR=1,53; IC95% 1,33–1,71) associaram-se a menor sobrevida. Conclusão Os principais preditores de mortalidade e sobrevida de portadores de doença de Chagas que recebem benefícios previdenciários e assistenciais no Brasil foram apresentados. Estes achados podem nortear a definição de prioridades de ações de acompanhamento pela atenção primária à saúde, preconizada atualmente para o manejo longitudinal da doença.