RESUMO Objetivo: Analisar os padrões espaciais da hanseníase em Pernambuco no período de 2011 a 2021. Métodos: Trata-se de um estudo epidemiológico ecológico, realizado com dados do Sistema de Informações de Agravos de Notificação com base nos casos novos de hanseníase em residentes de Pernambuco, entre 2011–2021. Foi realizada uma análise bayesiana empírica local e de dependência espacial com os índices de Moran global e local. Resultados: Foram registrados 25.008 casos novos de hanseníase com coeficiente médio anual de detecção de casos novos na população geral de 16,51 casos/100 mil habitantes — classificado como alto. Na população menor de 15 anos, ocorreu 5,16 casos/100 mil habitantes (muito alto) e 0,89/100 mil habitantes com grau II de incapacidade física (baixo) com aglomerados de alto risco para ocorrência com índice global de Moran de 0,33 (p<0,001), transmissão ativa (0,26; p<0,001) e diagnóstico tardio da doença (0,12; p<0,006), localizados na macrorregião 1 e na macrorregião 4. Conclusão: Houve uma distribuição espacial heterogênea no estado, evidenciando dois panoramas, o primeiro, a presença de municípios com alto risco de transmissão da doença e, o segundo, aglomerados de municípios silenciosos reforçando o caráter de negligência da hanseníase como grande problema de saúde pública. Este estudo traz reflexões para ações de controle da hanseníase, dada a identificação de áreas prioritárias para o enfrentamento dess\a doença em Pernambuco.

ABSTRACT Objective: To analyze the spatial patterns of leprosy in Pernambuco from 2011 to 2021. Methods: This is an ecological epidemiological study, carried out with data from the Notifiable Diseases Information System, based on new cases of leprosy among inhabitants of Pernambuco, between 2011–2021. An empirical Bayesian analysis of local and spatial dependence was performed with the global and local Moran indices. Results: 25,008 new cases of leprosy were registered with an annual case detection rate in the general population of 16.51 cases/100,000 inhabitants — which is considered high. Among those younger than 15 years of age, there were 5.16 cases/100,000 inhabitants (high) and 0.89/100,000 inhabitants with degree II of physical disability (low); there were also many high-risk cases with an overall Moran index of 0.33 (p<0.001), active transmission (0.26; p<0.001), and subsequent diagnosis of the disease (0.12; p<0.006), as well as distribution in macro-region 1 and macro-region 4. Conclusion: There was a heterogeneous spatial distribution in the state, showing two overviews, the first being the presence of municipalities with high risk of disease transmission and the second with clusters of silent municipalities, reinforcing the character of leprosy neglect as a major public health problem. This study brings reflections for leprosy control actions, due to the identification of priority areas to combat this disease in Pernambuco.

RESUMO Objetivo: Analisar os padrões espaciais da hanseníase em Pernambuco no período de 2011 a 2021. Métodos: Trata-se de um estudo epidemiológico ecológico, realizado com dados do Sistema de Informações de Agravos de Notificação com base nos casos novos de hanseníase em residentes de Pernambuco, entre 2011–2021. Foi realizada uma análise bayesiana empírica local e de dependência espacial com os índices de Moran global e local. Resultados: Foram registrados 25.008 casos novos de hanseníase com coeficiente médio anual de detecção de casos novos na população geral de 16,51 casos/100 mil habitantes — classificado como alto. Na população menor de 15 anos, ocorreu 5,16 casos/100 mil habitantes (muito alto) e 0,89/100 mil habitantes com grau II de incapacidade física (baixo) com aglomerados de alto risco para ocorrência com índice global de Moran de 0,33 (p<0,001), transmissão ativa (0,26; p<0,001) e diagnóstico tardio da doença (0,12; p<0,006), localizados na macrorregião 1 e na macrorregião 4. Conclusão: Houve uma distribuição espacial heterogênea no estado, evidenciando dois panoramas, o primeiro, a presença de municípios com alto risco de transmissão da doença e, o segundo, aglomerados de municípios silenciosos reforçando o caráter de negligência da hanseníase como grande problema de saúde pública. Este estudo traz reflexões para ações de controle da hanseníase, dada a identificação de áreas prioritárias para o enfrentamento dess\a doença em Pernambuco.

ABSTRACT Objective: To analyze the spatial patterns of leprosy in Pernambuco from 2011 to 2021. Methods: This is an ecological epidemiological study, carried out with data from the Notifiable Diseases Information System, based on new cases of leprosy among inhabitants of Pernambuco, between 2011–2021. An empirical Bayesian analysis of local and spatial dependence was performed with the global and local Moran indices. Results: 25,008 new cases of leprosy were registered with an annual case detection rate in the general population of 16.51 cases/100,000 inhabitants — which is considered high. Among those younger than 15 years of age, there were 5.16 cases/100,000 inhabitants (high) and 0.89/100,000 inhabitants with degree II of physical disability (low); there were also many high-risk cases with an overall Moran index of 0.33 (p<0.001), active transmission (0.26; p<0.001), and subsequent diagnosis of the disease (0.12; p<0.006), as well as distribution in macro-region 1 and macro-region 4. Conclusion: There was a heterogeneous spatial distribution in the state, showing two overviews, the first being the presence of municipalities with high risk of disease transmission and the second with clusters of silent municipalities, reinforcing the character of leprosy neglect as a major public health problem. This study brings reflections for leprosy control actions, due to the identification of priority areas to combat this disease in Pernambuco.

Abstract Understanding the dynamic behavior of soils is essential to the study of the influence of seismic loads on the instability of submarine slopes, an important issue in Brazil and other countries. The shear modulus and the damping ratio are two fundamental parameters for the study of this behavior. Determining these parameters for Speswhite kaolin clay is the object of the present study using resonant column tests and dynamic centrifuge tests with accelerometers and pairs of bender elements. The curves obtained in the laboratory are compared with empirical curves and comparable data in the literature. Good agreement was observed between experimental data and the empirical prediction for the degradation curve of the normalized shear modulus. The damping curve for very low strains, obtained with resonant column tests, was consistent with the empirical curve. However, consistent with a trend observed in the literature, the centrifuge test results presented considerable scatter (dispersion), attributable to the difficulty in modelling damping dissipation mechanisms in the centrifuge.

Abstract Objective: Galvanic vestibular stimulation has been evaluated in the context of vestibular rehabilitation. The objective was to identify evidence in the scientific literature about the clinical applications of galvanic vestibular stimulation. Methods: In this systematic review, the articles describing the applications of galvanic vestibular stimulation were extracted from PubMed, Web of Science, MEDLINE, Scopus, LILACS and SciELO databases. The survey was limited to articles published in English, Portuguese and Spanish. All the articles about the clinical applications of galvanic vestibular stimulation were compiled. Repeated articles in the databases, literature review articles, case reports, letters and editorials were excluded. The descriptors included: galvanic vestibular stimulation, postural balance, central nervous system diseases, vestibular diseases, spinal cord diseases and cognition. Results: The search strategy resulted in the initial selection of 994 articles; the reading of titles and abstracts was accomplished in 470 articles and the complete reading in 23 articles. Clinical applications of galvanic vestibular stimulation included Ménière’s disease, vestibular neuritis, bilateral vestibular disorders, vestibular schwannoma, Parkinson’s disease, ischemic central lesions, motor myelopathies, anxiety disorders, cognition and memory. Conclusion: Galvanic vestibular stimulation has been considered a potentially useful strategy for balance rehabilitation, since it has the effect of stimulating the central connections related to the postural balance, favoring new neuronal synapses that allow the partial or total recovery of postural imbalance.

Abstract Objective To evaluate the relationship between asthma control, family income and family costs of asthma in a population of children-adolescents; to detail the family costs of asthma in this age range; and to compare asthma costs for the families of children-adolescents and adults. Methods The authors invited asthmatic subjects who attended a scheduled spirometry test at the Jundiaí School of Medicine (FMJ). The FMJ performs all spirometry tests requested by staff physicians who serve at the public healthcare system in the municipality. Volunteers responded to the ACQ, the Asthma Family Costs Questionnaire and underwent a spirometry test. Results The authors included 342 children-adolescents. Families of children-adolescents taking maintenance therapy and families of those reporting uncontrolled asthma symptoms were more likely to report any expenditure with asthma during the preceding month. In this age range, the smallest expenditures were on diagnostic tests and medical consultations, while home expenditures to avoid asthma triggers were the highest ones. As compared to adults’ families, the children and adolescents families reported a greater proportion of income committed with asthma. Expenditures with transportation to healthcare facilities for asthma care were greater in the families of children-adolescents as compared to the values reported by the adults’ families; in contrast, loss of income due to asthma was smaller in the families of children-adolescents. Conclusions Children-adolescents’ asthma affects the household economy. The authors believe researchers should assess this outcome when designing studies about asthma. Finally, the study's data support the necessity of public policies in low-resource communities to minimize the economic impact of children and adolescents’ asthma.

Resumo Objetivo Comparar a violência sexual sofrida por vítimas no início e no final da adolescência, as reações desencadeadas após a agressão, e o cuidado de saúde dispensado. Métodos Estudo retrospectivo, em que foram revisados os prontuários de 521 mulheres adolescentes atendidas por equipe multiprofissional em hospital de referência em Campinas, São Paulo, Brasil. As variáveis foram sociodemográficas, e aquelas relativas às características da violência, ao atendimento de emergência, e às reações físicas e psicológicas observadas durante o seguimento nos grupos de adolescentes de idade precoce (10a 14 anos) e tardia (15 a 18 anos). Utilizamos os testes do Qui-quadrado/Exato de Fisher, Mann-Whitney e Kruskal-Wallis para comparar os grupos; adotamos o nível de significância de 5%. Resultados O grupo precoce (n= 242) continha maior número de estudantes (p< 0,001), que sofreram mais agressões diurnas (p= 0,031), em suas residências (p< 0,001), por agressor conhecido (p< 0,001), tiveram maior necessidade de proteção legal (p= 0,001), e demoraram mais a procurar atendimento (p= 0,048). Sentimentos de culpa, vergonha e a percepção da violência foram similares entre os grupos. No grupo tardio (n= 279) houve maior consumo de álcool durante a agressão (p= 0,005); as adolescentes receberam significativamente mais tratamentos de profilaxia; relataram mais sintomas físicos (p= 0,033), distúrbios do sono (p= 0,003), sintomas de ansiedade (p= 0,045), e sentimentos de angústia (p= 0,011); e receberam mais prescrições de psicotrópicos (p= 0,005). Apenas 52% completaram o seguimento de 6 meses, sem diferenças entre os grupos. Conclusão Os grupos apresentaram diferenças nas características da violência; as adolescentes precoces chegaram mais tardiamente ao serviço, e o grupo tardio apresentou maior sintomatologia e piora psicológica no seguimento. São necessárias medidas de prevenção e cuidados específicos voltados a essa população.

Abstract Objective To compare the sexual violence suffered by women in early and late adolescence, the reactions triggered after the aggression, and the care provided. Methods A retrospective study in which we reviewed the medical records of 521 female adolescents treated by a multidisciplinary team at a reference hospital in the city of Campinas, state of São Paulo, Brazil. We analyzed sociodemographic variables, and those pertainin to the characteristics of the episodes of violence, the emergency care, and the physical and psychological reactions observed during the follow-up. For the analysis, the sample was divided into groups of early (10 to 14 years) and late (15 to 18 years) adolescence. We used the Chi-squared/Fisher Exact, Mann-Whitney, and Kruskal-Wallis tests to compare the groups; the level of significance adopted was 5%. Results The early group (n= 242) contained more adolescents who were enrolled in school (p< 0.001), suffered more daytime aggressions (p= 0.031), in their residences (p< 0.001), by an aggressor with whom they were acquainted (p< 0.001), had greater need of legal protection (p= 0.001), and took longer to seek care (p= 0.048). Feelings of guilt, shame, and the perception of violence were similar between the groups. In the late group (n= 279), there was greater consumption of alcohol during the aggression (p= 0,005); they received significantly more prophylaxis treatments; reported more physical symptoms (p= 0.033), sleep disorders (p= 0.003), symptoms of anxiety (p= 0.045), and feelings of anguish (p= 0.011); and had more prescriptions of psychotropics (p= 0.005). Only 52% completed the 6-month follow-up, with no differences between the groups. Conclusion The age groups showed differences in the characteristics of the episodes of violence; early adolescents took longer to seek help, and the late group presented more intense symptoms and psychological worsening during the follow-up. Measures of prevention and specific care aimed at this population are needed.

Resumo Realizou-se um estudo transversal com participantes do projeto CUME (n = 289) que moravam em Viçosa, Brasil. A unidade de vizinhança adotada foi o buffer (200 metros), considerando a residência do participante como ponto central. Foi contabilizado o número de instalações públicas e privadas dentro do buffer, bem como as ocorrências criminais. Os estabelecimentos alimentares foram categorizados em estabelecimentos com venda predominante de alimentos naturais ou minimamente processados, estabelecimentos mistos e estabelecimentos com venda predominante de alimentos ultraprocessados. Os participantes que compareceram à entrevista presencial, preencheram duas escalas de percepção do ambiente. No total, 33,6% dos participantes apresentaram excesso de peso. Foi observada uma maior concentração de indivíduos próximos à região central da cidade. O acesso a diferentes estabelecimentos, ambientes alimentares e ocorrências criminais diferiram entre indivíduos com eutrofia e com excesso de peso. Os grupos diferiram na percepção da localização de praças, espaços públicos abertos, clubes e campos de futebol. Os resultados indicam a associação entre as características ambientais e o excesso de peso em adultos brasileiros.

Abstract A cross-sectional study enrolled participants from the CUME project (n = 289) who lived in Viçosa, Brazil. The neighborhood unit adopted was the buffer (200 meters), considering the participant’s residence as central point. We measure the number of public and private facilities inside the buffer as well as violent criminal occurrences. Food establishments were categorized into establishments with predominant sale of natural or minimally processed foods, mixed establishments, and establishments with predominant sale of ultra-processed foods. Those who attended the face-to-face interview filled two scales of perception of the environment. Overall, 33.6% of participants reported overweight. We observed a higher concentration of individuals close to the central region of the city. Access to different establishments, food environments, and criminal occurrences differed between normal-weight and overweight individuals. The groups deferred in the perception of the location of squares, open public spaces, clubs, and soccer fields. The results indicate the association between environmental characteristics and overweight in Brazilian adults.

Resumo Objetivo Investigar a prevalência de síndrome pré-menstrual (SPM) e do transtorno disfórico pré-menstrual (TDPM) em alunas universitárias, os fatores associados à SPM, os sintomasmais prevalentes e a interferência dos sintomas nas atividades acadêmicas, familiares, sociais e de trabalho. Métodos Este estudo transversal incluiu 1.115 estudantes universitárias ≥18 anos da Universidade de Rio Verde, Goiás. Síndrome pré-menstrual e TDPM foram identificados por meio do Premenstrual Symptoms Screening Tool. As associações com fatores sociodemográficos, comportamentais, reprodutivos, nutricionais e de saúde foram investigadas utilizando-se a regressão de Poisson. Resultados A prevalência de SPM foi de 46,9% (intervalo de confiança [IC] de 95% 44,0-49,8) e de TDPM, 11,1% (IC 95% 9,3-13,0). Os sintomas mais prevalentes foram físicos, como sensibilidade mamária, distensão abdominal e ganho de peso (73%); seguidos por psicológicos, como comer demais/desejos por comida, chorar/mais sensível à rejeição (> 60%). Mais de 30% relataram que os sintomas interferiam de forma moderada a grave em suas atividades sociais e acadêmicas. Após análise ajustada, a SPM foi mais prevalente naquelas que estava cursando o 1°/2° semestre da faculdade (razão de prevalência [RP] 1,44; IC 95% 1,14-1,80), as que haviam consumido álcool nos últimos 30 dias (RP 1,23; IC 95% 1,04-1,47), e as que tinha depressão (RP 1,49; IC 95% 1,30-1,71). Conclusão Quase metade das universitárias tinha SPM e cerca de 11%, TDPM. Os sintomas físicos foram os mais comuns e interferiram de forma moderada a grave em vários aspectos da vida. Frequentar os primeiros semestres, consumir álcool e ter depressão foram fatores de risco para SPM. A identificação dos fatores de risco para a SPM é essencial para prevenir os sintomas e reduzir o impacto da síndrome.

Abstract Objective To investigate the prevalence of premenstrual syndrome (PMS) and premenstrual dysphoric disorder (PMDD) in university students, the factors associated with PMS, the most prevalent symptoms, and the interference of symptoms in academic, family, social, and work activities. Methods This cross-sectional study included 1,115 university students aged ≥ 18 years from the University of Rio Verde, Goiás. Premenstrual syndrome and PMDD were identified using the Premenstrual Symptoms Screening Tool. Associations with sociodemographic, behavioral, reproductive, nutritional, and health factors were investigated using the Poisson regression. Results The prevalence of PMS was 46.9% (95% confidence interval [CI] 44.0-49.8), and of PMDD, 11.1% (95% CI 9.3-13.0). The most prevalent symptoms were physical, such as breast tenderness, bloating, e weight gain (73%); followed by psychological ones such as overeating/food cravings, tearful/more sensitive to rejection (> 60%). More than 30% of the patients reported that the symptoms interfered in a moderate-tosevere way in their social and academic activities. After adjusted analysis, PMS was more prevalent in those who were attending the 1st/2nd semester of college (prevalence ratio [PR] 1.44; 95% CI 1.14-1.80), those who consumed alcohol in the last 30 days (PR 1.23; 95% CI 1.04-1.47), and those who had depression (PR 1.49; 95% CI 1.30-1.71). Conclusion Almost half of the university students had PMS and ~ 11%, PMDD. Physical symptoms were themost common and interfered in amoderate-to-severe way in various aspects of life. Attending the first semesters, consuming alcohol, and having depression were risk factors for PMS. The identification of risk factors for PMS is essential to prevent symptoms and reduce the impact of the syndrome.

Abstract Objective: To describe and compare the results of the main risk and protective factors for chronic non-communicable diseases, in the 26 Brazilian capitals and the Federal District, obtained through the National Health Survey (PNS) and the Surveillance System for Risk and Protective Factors for Chronic Diseases by Telephone Survey (VIGITEL) in 2019. Methods: Cross-sectional study, in which the difference in prevalence between health behavior indicators investigated by PNS and VIGITEL was calculated. Results: The largest discrepancy between the surveys, PNS (n = 32,111) and VIGITEL (n = 52,443), were observed in relation to leisure-time physical activity (6.8 in percentage points - p.p.), recommended physical activity in the transport domain (7.4 p.p.), and high screen time (21.8 p.p.). Both surveys presented similar prevalence regarding nutritional status, food consumption, smoking, alcohol abuse and negative self-rated health. Conclusion: Prevalence in both surveys presented small differences, but point to results in the same direction.

Resumo Objetivo: Descrever e comparar os resultados dos principais fatores de risco e proteção para doenças crônicas não transmissíveis, nas 26 capitais brasileiras e no Distrito Federal, obtidos pela Pesquisa Nacional de Saúde (PNS) e pelo Sistema de Vigilância de Fatores de Risco e Proteção para Doenças Crônicas por Inquérito Telefônico (Vigitel) em 2019. Métodos: Estudo transversal, no qual se calculou a diferença na prevalência entre os indicadores de comportamentos de saúde investigados pela PNS e Vigitel. Resultados: As maiores discrepâncias entre os inquéritos, PNS (n = 32.111) e Vigitel (n = 52.443), foram observadas para prática de atividade física no lazer (6,8 pontos percentuais - p.p.), prática recomendada no deslocamento (7,4 p.p.) e tempo elevado de tela (21,8 p.p.). Foram semelhantes nos dois inquéritos as prevalências do estado nutricional, consumo alimentar, tabagismo, consumo abusivo de álcool e de autoavaliação negativa do estado de saúde. Conclusão: Os inquéritos apresentaram prevalências com pequenas diferenças, mas que apontam resultados na mesma direção.

Resumen Objetivo: Describir y comparar los resultados de los principales factores de riesgo y protección de enfermedades crónicas no transmisibles, en las 26 capitales brasileñas y el Distrito Federal, obtenido por la Encuesta Nacional de Salud (PNS) y el Sistema de Vigilancia para Factores de Riesgo y Protección de Enfermedades Crónicas por Encuesta Telefónica (Vigitel) en 2019. Métodos: Estudio transversal, que calculó la diferencia de prevalencia entre los indicadores investigados por PNS y Vigitel. Resultados: Las mayores discrepancias entre las encuestas, PNS (n = 32.111) y Vigitel (n = 52.443), fueron práctica de actividad física en el tiempo libre (6,8 puntos porcentuales - p.p.), práctica recomendada de desplazamientos (7,4 p.p.) y tiempo de pantalla elevado (21,8 p.p.). La prevalencia del estado nutricional, consumo de alimentos, tabaquismo, abuso de alcohol y la autoevaluación negativa de la salud fueron similares en ambas encuestas. Conclusión: Las encuestas presentaron prevalencias con pequeñas diferencias, pero que apuntan resultados en la misma dirección.

The literature evidences the growing central coordinating role played by the federal government in health policy. However, there is little research on the role of subnational entities, especially state governments. This article analyzes the institutional arrangement for the implementation of the More Doctors for Brazil Project in the state of Minas Gerais. The study drew on data from a documentary analysis of 31 minutes of meetings of the State Coordinating Commission and eight interviews with key actors responsible for the implementation of the project. The results highlight: (i) Centralized Project decision-making at federal level; (ii) Lack of clarity with regard to the role of the state government in the implementation arrangement; (iii) A state government funding crisis; and (iv) Political instability, which result in (v) Changes in the state and federal government. These combined factors had a negative impact on project implementation capacity in Minas Gerais.

La literatura endosa el creciente papel central de coordinación del gobierno federal en las políticas de salud. No obstante, hay pocos estudios sobre el papel de los entes subnacionales, en especial de los estados. Por lo tanto, este artículo analizó la organización institucional de implementación del proyecto Más Médicos para Brasil (PMMB) en el estado de Minas Gerais. El trabajo se realizó con base en el análisis documental de 31 actas de reuniones de la Comisión de Coordinación Estatal y ocho entrevistas con actores-clave responsables por su implementación. Los resultados pusieron en evidencia: (i) la centralidad de decisión del Proyecto en el ámbito federal; (ii) la poca claridad del papel del gobierno estatal en la organización de la implementación; (iii) la crisis presupuestaria del gobierno del Estado de Minas Gerais y (iv) la inestabilidad política, lo que resultó en (v) cambios de gobierno estatal y federal. Tales factores, en conjunto, tuvieron impacto sobre la capacidad de implementación del Proyecto en Minas Gerais.

A literatura endossa o crescente papel central de coordenação do governo federal nas políticas de saúde. Porém, há poucos estudos sobre o papel dos entes subnacionais, em especial, dos estados. Assim, este artigo analisou o arranjo institucional de implementação do Projeto Mais Médicos para o Brasil (PMMB) no estado de Minas Gerais. O trabalho foi realizado com base em análise documental de 31 atas de reuniões da Comissão de Coordenação Estadual e oito entrevistas com atores-chave responsáveis por sua implementação. Os resultados evidenciaram a (i) centralidade decisória do projeto no âmbito federal, a (ii) pouca clareza do papel do governo estadual no arranjo de implementação, a (iii) crise orçamentária do governo mineiro e a (iv) instabilidade política, que resultaram em (v) trocas de governo estadual e federal. Tais fatores, em conjunto, impactaram na capacidade de implementação do projeto em Minas Gerais.

ABSTRACT: Objective: This study aimed to identify the prevalence of multimorbidity and its associated factors in women in southern Brazil. Methods: We conducted a cross-sectional, population-based study with a sample of 1,128 women (age 20–69 years), living in São Leopoldo, southern Brazil. Multimorbidity was defined as two or more chronic conditions measured using the therapeutic and chemical anatomical classification of continuous use medications prescribed by a physician. Poisson regression model with robust variance was used to assess the association between sociodemographic and lifestyle variables and multimorbidity. Results: The prevalence of multimorbidity was 21.7% (95%CI 19.3–24.2), and 26 chronic conditions were identified. A direct linear association was observed with age and income and an inverse association with education. Being unemployed was a risk factor for multimorbidity (PR 1.95; 95%CI 1.51–2.52). Alcohol consumption (moderate or excessive) had a protective effect. Overweight and obese women were 53% (PR 1.53; 95%CI 1.09–2.15) and 76% (PR 1.76; 95%CI 1.27–2.45) more likely to have multimorbidity than eutrophic women. Conclusion: Over 20% of the adult women had multimorbidity, and its occurrence was strongly associated with socioeconomic characteristics, such as fewer years of schooling, higher income, and not having an occupation. The results regarding alcohol consumption are still insufficient to propose a public policy for the prevention of multimorbidity. Excess weight was an independent risk factor and should be addressed in public health policies for the prevention and management of multimorbidity.

A literatura endossa o crescente papel central de coordenação do governo federal nas políticas de saúde. Porém, há poucos estudos sobre o papel dos entes subnacionais, em especial, dos estados. Assim, este artigo analisou o arranjo institucional de implementação do Projeto Mais Médicos para o Brasil (PMMB) no estado de Minas Gerais. O trabalho foi realizado com base em análise documental de 31 atas de reuniões da Comissão de Coordenação Estadual e oito entrevistas com atores-chave responsáveis por sua implementação. Os resultados evidenciaram a (i) centralidade decisória do projeto no âmbito federal, a (ii) pouca clareza do papel do governo estadual no arranjo de implementação, a (iii) crise orçamentária do governo mineiro e a (iv) instabilidade política, que resultaram em (v) trocas de governo estadual e federal. Tais fatores, em conjunto, impactaram na capacidade de implementação do projeto em Minas Gerais.

The literature evidences the growing central coordinating role played by the federal government in health policy. However, there is little research on the role of subnational entities, especially state governments. This article analyzes the institutional arrangement for the implementation of the More Doctors for Brazil Project in the state of Minas Gerais. The study drew on data from a documentary analysis of 31 minutes of meetings of the State Coordinating Commission and eight interviews with key actors responsible for the implementation of the project. The results highlight: (i) Centralized Project decision-making at federal level; (ii) Lack of clarity with regard to the role of the state government in the implementation arrangement; (iii) A state government funding crisis; and (iv) Political instability, which result in (v) Changes in the state and federal government. These combined factors had a negative impact on project implementation capacity in Minas Gerais.

La literatura endosa el creciente papel central de coordinación del gobierno federal en las políticas de salud. No obstante, hay pocos estudios sobre el papel de los entes subnacionales, en especial de los estados. Por lo tanto, este artículo analizó la organización institucional de implementación del proyecto Más Médicos para Brasil (PMMB) en el estado de Minas Gerais. El trabajo se realizó con base en el análisis documental de 31 actas de reuniones de la Comisión de Coordinación Estatal y ocho entrevistas con actores-clave responsables por su implementación. Los resultados pusieron en evidencia: (i) la centralidad de decisión del Proyecto en el ámbito federal; (ii) la poca claridad del papel del gobierno estatal en la organización de la implementación; (iii) la crisis presupuestaria del gobierno del Estado de Minas Gerais y (iv) la inestabilidad política, lo que resultó en (v) cambios de gobierno estatal y federal. Tales factores, en conjunto, tuvieron impacto sobre la capacidad de implementación del Proyecto en Minas Gerais.

Resumo A nova normativa do saneamento básico no Brasil, Lei nº 14.026/2020, abriu caminho para um modelo mais agressivo de inserção do capital privado no chamado “negócio do saneamento”, ao alterar a forma de organização do serviço nos estados, pela imposição da regionalização em blocos de municípios, e ao modificar as regras contratuais de concessão praticadas até então com as companhias estatais de água e esgoto. Neste artigo, os autores analisam as alterações legais pelo viés da consideração preliminar de que, nesse setor, arranjos de poder multiescalares e multiníveis, visíveis ou não, suplantam os interesses locais e distorcem a realidade por meio de narrativas falaciosas. O problema de pesquisa é investigar se, de acordo com o novo marco, água e saneamento são considerados direitos humanos fundamentais ou simples serviços regulados, questionando a regionalização adotada como instrumento de promoção de desenvolvimento regional ou como mero pretexto para a privatização do setor. A opção metodológica abrange análises de tipo conjuntural, histórica, crítica e comparativa da realidade nacional, para verificar, ao fim e ao cabo, que a Lei promove grave mudança na correlação de forças econômicas públicas e privadas no setor de saneamento, no âmbito dos estados federados, com impacto conceitual no papel do Banco Nacional de Desenvolvimento (BNDES), responsável pela modelagem do processo, que, sem problematização das consequências, como risco de aumento da tarifa, falta de acesso aos serviços pelas camadas mais vulneráveis da população e privatização ilegal de um monopólio natural em sua essência, se transforma de banco de fomento em leiloeiro facilitador da venda.

Abstract The latest Brazilian Basic Sanitation Act, Federal Low No. 14.026/2020, paved the way for a more aggressive model of inserting private capital into the so-called “sanitation market” by altering the way in which the service is organized within the federal states; by imposing the regionalization according to blocks of municipalities; and by modifying the contractual concession rules practiced until then with State-level water and sewage companies. In this essay, the authors analyze those legal modifications departing from the premise that, in this sector, multi-scale and multi-level power arrangements, visible or not, supplant local interests and distort reality through fallacious narratives. The research problem is to investigate whether, according to the new framework, water and sanitation are considered basic human rights or simply regulated services, questioning whether the model of regionalization serves as an instrument to promote regional development or as a pretext for the sector’s privatization. The methodological option covers conjunctural, historical, critical and comparative analysis of the national reality, in order to confirm that the recent Act promotes a grave change in the correlation of public and private economic forces in the sanitation sector, within the scope of the federated states and the role of the Brazilian National Development Bank (BNDES), responsible for modeling those deals, which risks mutating itself from a development bank into an auctioneer that facilitates sales, so long as it does not question potential consequences of these deals, such as the risk of tariff increases, restriction of access to services by the most vulnerable strata of the population and illegal privatization of a natural monopoly in its essence.