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KeywordsAntenatal care. Women's health. Unified Health System (SUS-Br). Maternal health services. Pregnant women. Program evaluation. Quality of health care. Abstract ObjectiveTo assess antenatal care in health care units, so as to obtain a baseline for future evaluation studies. Methods A self-applied inquiry was conducted among municipal health managers within a probabilistic stratified random sample of 627 municipalities which, through expansion technique, extended the analysis to 5,507 municipalities. Data was collected from October 2003 to April 2004. The survey appraised information about the priority granted by the managers to each modality of care, as well as data concerning characteristics of the assistance provided and the declared estimate of the demand being covered. The Chi-square test and Student's t-test were performed in order to verify independence among the qualitative variables and mean differences, respectively. Results Almost half (43.8%; n=2,317) of the municipalities did not attend gestational risk; 81% (n=4,277) and 30.1% (n=1,592) reported that they attend over 75% of the demand for low and high risk antenatal respectively; 30.1% (n=1,592) attend over 75% of the demand for high risk care. Care for low risk (χ 2 =282,080; P<0.001 n=4,277) and for high risk pregnancies (χ 2 =267.924; P<0.001 n=5,280) were associated to geographic region, municipality's size and management modality within the Unified Health System. The guarantee of vacancy for labour and birth was also associated to management modality. Conclusions There were gaps related to the provision and the quality of antenatal care within the Unified Health System. Municipal based health care extends the provision of antenatal care, but there are inequalities among regions and among municipalities according to demographic size.services are sufficient to control the identified risks. 10The principal objectives of antenatal care are: to assure the normal development of pregnancy; to prepare the pregnant woman for normal childbirth, for the postpartum period and for normal lactation; to identify risk situations, as quickly as possible. These measures make it possible to prevent the most frequent complications that occur during pregnancy and the postpartum period.

Introduction. We evaluated the association between components of the renin-angiotensin system and the development of breast cancer in a case-control study by means of angiotensinconverting enzyme (ACE) insertion/deletion (I/D) and angiotensin II type 1 (AT 1 )-receptor A1166C polymorphisms. Methods. Genotyping was performed by PCR-RFLP (restriction fragment length polymorphism) or PCR (polymerase chain reaction) using genomic DNA extracted from buccal cells of subjects with (101 cases) or without (307 controls) breast cancer. Results. The frequencies of genotypes for ACE were: DD, ID and II (in %: cases: 60; 20; 20; controls: 46; 37; 17; p=0.019, χ 2 ); and for AT 1 -receptor were: AA, AC and CC (in %: cases: 65; 30; 5; controls: 51; 44; 5; p=0.114, χ 2 ). The results suggested that the A1166C polymorphism was not associated with breast cancer risk. On the other hand, for the ACE (I/D), there seemed to be different risks for cancer between cases and controls. Conclusions. The ID genotype was less frequently associated with the disease than were the DD or II; that is, women with the ID genotype were 3.1 times less likely to develop breast cancer than those with the other genotypes. The ID genotype might be protective against breast cancer and the ACE (I/D) polymorphism a possible target for developing genetic markers for breast cancer.

We designed the present study in order to evaluate the eventual role of polymorphisms in the genes encoding cytochrome P450c17alpha (CYP17) and the progesterone receptor (PROGINS) as risk factors for endometriosis development. Eligible cases consisted of 121 women with surgically confirmed endometriosis who underwent treatment in a hospital in São Paulo, Brazil during the period from September 2003 to September 2005. The 281 controls were participants with normal gynecological as well as pelvic ultrasound evaluation, who did not have any gynecological conditions during their reproductive lives such as pelvic pain and/or dyspareunia nor infertility history. Genomic DNA was obtained from buccal cells and processed for DNA extraction using the GFX DNA extraction kit (GE Healthcare). The CYP17 (-34T-->C) polymerase chain reaction-restriction fragment length polymorphism assay has been described previously, as has the progesterone receptor polymorphism (PROGINS) detection assay. PROGINS heterozygosis genotype frequencies were shown to be statistically higher in endometriosis cases compared with controls. On the other hand, differences in the CYP17 polymorphism (-34T-->C) frequencies were not even close to significance (p = 0.278) according to our findings.

ResumoEste ensaio apresenta uma discussão sobre a Integralidade em saúde. Apoiado na constatação de que a perda do equilíbrio da saúde nos processos de adoecimento não constituiu apenas fator médico-biológico, mas também um processo vinculado à história de vida do indivíduo, da família e da sociedade, elege como ponto de partida para a reflexão os poderes e limites de atuação dos profissionais de saúde, em especial o médico. Discute a fragmentação da ciência médica e a especialização de sua prática resultante da separação dos objetos em compartimentos estanques, obrigando o esforço interdisciplinar para a apreensão da totalidade da saúde. Analisa as relações de desigualdade entre médico e paciente, defendendo o diálogo como alternativa de redução desta desigualdade. A integralidade surge como discurso contra hegemônico na formação e nas práticas médicas, adotada pelo movimento sanitário brasileiro como um conjunto de atitudes desejáveis, em especial a valorização da associação entre as práticas de saúde e as práticas sociais. Finalmente destaca caminhos para a conquista de mais integralidade, partindo da delimitação das demandas e necessidades, em interação com os recursos tecnológicos de saúde disponíveis. Nesse contexto, discute, ainda, o acesso, alertando sobre a necessidade de enfrentamento do campo da micropolítica de saúde e suas articulações, fluxos e circuitos, baseada na lógi-ca das necessidades dos usuários do sistema e na incorporação de valores éticos e técnicos. Palavras-chave: Cuidado integral à saúde; Humanização na relação médico-paciente; Integralidade. Integralidade na atenção e no cuidado a saúde Integral Healthcare Abstract This paper discusses Integral Healthcare. Based on the realization that health imbalances stemming from diseases are due not only to medical-biological reasons, but also to processes related to the individual's life history, family, and society, this paper begins by discussing the capabilities and limitations of healthcare professionals, especially physicians. It then discusses the fragmentation of medical science and the specialization of medical practice into rigidly compartmentalized subject areas, and defends the need for interdisciplinary efforts in an integral approach to healthcare. It goes on to analyze the inequalities in doctor-patient relationships, championing dialogue as an alternative route for reducing these inequalities. Integral healthcare emerged as a way of curbing hegemony in medical training and practice, and has been adopted by the Brazilian health movement as a set of desirable attitudes, especially that of valuing the association between healthcare and social practices. In conclusion, the paper outlines ways forward to bring about more integral healthcare, starting with a discussion on user demands and needs with regard to available healthcare technological resources. It also discusses access issues within micro-level healthcare policies, systems, and flows, which need to be based on an understanding of the logic behind user needs, while also incorp...

This article reflects on the future of the Brazilian Unified Health System (SUS, acronym in Portuguese), based on the foresight exercises conducted by the Brasil Saúde Amanhã initiative of the Oswaldo Cruz Foundation. The text briefly reviews some paths followed by the SUS as referred to in the Federal Constitution of 1988. It highlights the movement towards the decentralization of care and the constraint of health financial resources that reduced policies of increasing public expenditures. It examines the public and private arrangements for financing and provision of services that have resulted in sectoral privatization, mainly from economic policies articulated with concession of fiscal benefits. It analyzes the changes in the public sector financing through successive constitutional amendments that resulted in the weakening of established social protection policies, particularly of the health sector. For the future, the text considers population aging and analyzes trends in the epidemiological profile, with consequent changes in the health care paradigm. The article concludes by pointing out the consequences of fiscal strangling in the organization of the healthcare system and the need to reverse legal provisions that hamper the fulfillment of the constitutional mandate for equity and universality.

AT THE TIME OF WRITING THIS EDITORIAL, 122 days have passed since the first Covid-19 case was registered in Brazil, confirmed in São Paulo, on February 25, 2020 1. The pandemic found the nation with a militarized, ultra-right government, bewildered and submerged in a political crisis, aggravated by a low performance of the economy with growth of the Gross Domestic Product (GDP), in 2019, of only 1.1% and adding up to approximately 13 million unemployed citizens. This combination of factors and crises has deepened political instability and has proved to be tragic from all points of view, making the country seem like a ship with no direction, ready to sink. Today, we have 928,985 confirmed cases of infected with Sars-CoV-2, although the estimates warn to figures at least 8 to 10 times higher due to the low testing practiced in our territory. In a pace of accelerated growth, more than 20 thousand new diagnosed cases are registered daily, regrettably accumulating 53,895 deaths, of which 1,185 in the last 24 hours 2. With these data, Brazil becomes the second country in number of deaths, surpassed, at the moment, only by the United States. The pandemic has hit the core of society's narcissism, always fueled by satisfaction with the denial of reality. The abysmal social inequality is now wide opened as scandalously exposed as it had previously been denied. The Brazil that will emerge from this health crisis will no longer be able to hide from itself the image that revealed its millions of poor and miserable people without minimum conditions for complying with the sanitary standards recommended for the control of the pandemic: staying at home, maintaining social distance, washing hands, and eating properly. This mirror, if not broken again-and the uncomfortable image, once again forgotten-, will require radical changes in the development model and in economic policy. The transformations involve admitting that a fairer and less unequal country is only possible through the adoption of an unorthodox economic policy that institutionalizes universal social protection mechanisms, guaranteeing a basic citizenship income and promoting an effective increase in public investment to expand the labor market and absorb the Brazilians who are found completely abandoned today 3. The R$ 600 emergency aid, approved by the National Congress, instead of the R$ 200 proposed by the federal government, has already been requested by 43% of the Brazilian population; and of these, only 60% received at least a portion of the money 4. The result is in the 'disobedience' to health recommendations, reflected in the extremely low isolation rates found in large Brazilian cities and states which, even in a lockdown situation, are unable to reach the desirable levels of social distance. Without the support of

The universal and equitable access to health is established in the Brazilian Federal Constitution of 1988 and must be guaranteed by the Brazilian Unified Health System -the Sistema Único de Saúde (SUS). The lack of professionals and the large regional differences in the distribution of human resources, mainly physicians, are factors that contribute to the nonfulfillment of the SUS principles. This article reports the experience of evaluation of the More Doctors Program (PMM) by a multidisciplinary team composed of 28 researchers, based on field work in 32 municipalities with 20% or more of the population in extreme poverty selected in all regions of Brazil (remote areas, far from capitals, and rural maroon communities), as well as analyzes of the 5,570 Brazilian municipalities based on the Ministry of Health databases. The research resulted in a vast scientific production, pointing out important results, such as broadening of access to health and reducing of avoidable hospitalizations. The reflections brought here show that the PMM contributed to the implementation and consolidation of the SUS principles and guidelines, and guaranteed access to health, especially for the poorest populations, small municipalities and remote and distant regions. KEYWORDS Health manpower. Health services. Primary Health Care. National health programs.RESUMO O acesso à saúde de forma universal e equitativa está preconizado na Constituição Federal de 1988, devendo ser garantida pelo Sistema Único de Saúde (SUS). Dentre os diversos fatores que contribuem para a não efetivação dos princípios do SUS, destacam-se a insuficiência de profissionais e as disparidades regionais na distribuição de recursos humanos, principalmente médicos. Este artigo relata a experiência de avaliação do Programa Mais Médicos (PMM) por uma equipe multidisciplinar composta por 28 pesquisadores, a partir de trabalho de campo em 32 municípios com 20% ou mais da população em extrema pobreza selecionados em todas as regiões do Brasil (áreas remotas, distantes das capitais e comunidades quilombolas rurais), além de análises sobre os 5.570 municípios brasileiros baseadas em bancos de dados do Ministério da Saúde. A pesquisa resultou em vasta produção científica, apontando importantes resultados, como ampliação do acesso à saúde e redução de internações evitáveis. As reflexões aqui trazidas permitem concluir que o PMM contribuiu para a efetivação e consolidação dos princípios e diretrizes do SUS e garantiu acesso à saúde, especialmente para as populações mais pobres, municípios pequenos e regiões remotas e longínquas. PALAVRAS-CHAVE Recursos humanos em saúde. Serviços de saúde. Atenção Primária a Saúde. Programas nacionais de saúde.