The present study aims at analyzing the regionalization of the services carried out by the Psychosocial Care Network (RAPS in Portuguese) in the state of Minas Gerais (MG) in Brazil, yielding indicators that may enhance the SUS strategic management towards the strengthening of the psychosocial care provided by the state. It is a cross-sectional study, based on the data collected in May 2019 from government websites, considering the state’s Macro-Regions and Health Regions as units of analysis. Indicators of service coverage in relation to the population in accordance to normative parameters determined by the Ministry of Health for a better understanding of the effective coverage were produced, and a general indicator (iRAPS) of the supply of services in this network in Minas Gerais state was validated. The outcomes allow a detailed analysis of the structural aspect of the RAPS in MG and unveil the development of a robust network. However, important regional heterogeneities were noticed and also a lack of services aiming at specific populations providing assistance 24 hours a day, which weakens the proper access to RAPS in several parts of the state. Higher values of iRAPS were found in health regions with low socioeconomic development and low general offer of health services, a fact that differs from the national scenario, which may imply state policy investments aiming at offering RAPS within the state hinterland areas.

Objetivo: Analisar os dados da COVID-19 entre as regiões do Brasil, comparando as realidades distintas, levando em consideração as taxas de mortalidade, letalidade, incidência e isolamento social. Métodos: Trata-se de um estudo observacional analítico. Foram analisadas a partir da densidade demográfica, as taxas de incidência, mortalidade, letalidade e isolamento social. Ademais, foram levantados dados referentes ao número de leitos público e privados disponíveis para COVID-19 em cada estado do país. Para análise das associações foi utilizado a correlação de Spearman entre as variáveis densidade populacional, número de casos, número de leitos e quantidade de óbitos nos estados brasileiros. Resultados: O estudo avaliou 3.817.904 casos confirmados e 120.530 óbitos em todo o Brasil, sendo que a letalidade geral foi de 3,15. A Região Norte apresentou as maiores taxas de incidência e a região Sul apresentou as menores taxas de incidência. Com esses dados, foi possível verificar a existência de uma relação positiva entre as taxas de incidência e mortalidade. Conclusão: O estudo demonstrou uma enorme discrepância epidêmica e socioeconômica entre as regiões brasileiras, implicando diretamente na incidência e mortalidade por COVID-19.

Resumo Objetivou-se analisar a regionalização dos serviços da Rede de Atenção Psicossocial (RAPS) em Minas Gerais (MG), Brasil, gerando indicadores que possam potencializar a gestão estratégica do SUS no fortalecimento da atenção psicossocial do estado. É um estudo transversal, realizado a partir de dados coletados em maio de 2019 em sites governamentais, tendo as Macrorregiões e Regiões de Saúde do estado como unidades de análise. Foram produzidos indicadores da cobertura de serviços em relação à população, de acordo com parâmetros normativos estipulados pelo Ministério da Saúde, para melhor compreensão da cobertura efetivada e validou-se um indicador geral (iRAPS) da oferta dos serviços dessa rede em MG. Os resultados encontrados possibilitam uma análise detalhada do aspecto estrutural da RAPS em MG e demonstram a implantação de uma rede robusta. Entretanto, percebem-se importantes heterogeneidades regionais e também uma carência de serviços voltados para populações específicas e com funcionamento 24 horas, o que fragiliza o adequado acesso à RAPS em diversos territórios do estado. Foram encontrados maiores valores do iRAPS nas regiões de saúde com baixo desenvolvimento socioeconômico e baixa oferta geral de serviços de saúde, fato que difere do cenário nacional.

In recent decades, public policies of the Unified Health System (SUS) in Brazil have structured a community mental health care network (RAPS) based on various community actions and services. This study carried out evaluative research on the implementation of the structure and process dimensions of this care network in Minas Gerais, the second most populous state of Brazil, generating indicators that can enhance the strategic management of the public health system in the strengthening the psychosocial care in the state. The application of a multidimensional instrument, previously validated (IMAI-RAPS), in 795 of the 853 municipalities in Minas Gerais was carried out between June and August 2020. Regarding the structural dimension, we noticed an adequate implementation of services like ‘Family Health Strategy,’ ‘Expanded Family Health Center,’ and ‘Psychosocial Care Centers’ but a lack of ‘Beds in General Hospitals’ destinated to mental health care, ‘Unified Electronic Medical Records’ and ‘Mental Health Training Activities for Professionals.’ In the process dimension, adequate implementation of actions such as ‘Multidisciplinary and Joint Care,’ ‘Assistance to Common Mental Disorders by Primary Health Care,’ ‘Management of Psychiatric Crises in Psychosocial Care Centers,’ ‘Offer of Health Promotion Actions,’ and ‘Discussion of Cases by Mental Health Teams’ point to a form of work consistent with the guidelines. However, we detected difficulties in the implementation of ‘Psychosocial Rehabilitation Actions,’ ‘Productive Inclusion,’ ‘User Protagonism,’ ‘Network Integration,’ and practical activities for the effectiveness of collaborative care. We found a better implementation of the mental health care network in more populous, demographically dense, and socioeconomically developed cities, which shows the importance of regional sharing of services that are not possible for small cities. The evaluation practices of mental health care networks are scarce throughout the Brazilian territory, a fact also found in Minas Gerais, highlighting the need for its expansion not only in the scientific sphere but also in the daily life of the various levels of management.

In recent decades, public policies of the Unified Health System (SUS) in Brazil have structured a mental health care network (RAPS) based on various community actions and services. This study carried out evaluative research on the implementation of the structure and process dimensions of the RAPS in Minas Gerais (MG), the second most populous state of Brazil, generating indicators that can enhance the strategic management of the SUS in the strengthening the psychosocial care in the state. The application of a multidimensional instrument, previously validated (IMAI-RAPS), in 795 of the 853 municipalities in Minas was carried out between June and August 2020. Regarding the structural dimension, we noticed an adequate implementation of ‘Family Health Strategy (ESF),’ ‘Expanded Family Health Center (NASF),’ and ‘Psychosocial Care Centers (CAPS)’ but a lack of ‘Beds in General Hospitals (LHG),’ ‘Unified Electronic Medical Records’ and ‘Mental Health Training Activities for Professionals’. In the process dimension, adequate implementation of actions such as ‘Multidisciplinary and Joint Care,’ ‘Assistance to Common Mental Disorders by Primary Health Care,’ ‘Management of Psychiatric Crises in CAPS,’ ‘Offer of Health Promotion Actions,’ and ‘Discussion of Cases by Mental Health Teams’ point to a form of work consistent with the guidelines. However, we detected difficulties in the implementation of ‘Psychosocial Rehabilitation Actions,’ ‘Productive Inclusion,’ ‘User Protagonism,’ ‘Network Integration,’ and practical activities for the effectiveness of collaborative care. We found a better implementation of RAPS in more populous, demographically dense, and socioeconomically developed cities, which shows the importance of regional sharing of services that are not possible for small cities. The evaluation practices of RAPS are scarce throughout the Brazilian territory, a fact also found in MG, highlighting the need for its expansion not only in the scientific sphere but also in the daily life of the various levels of management.

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INTRODUCTION: Urethral prolapse can be characterized by a circular protrusion of the urethra distally to the external urethral meatus, and its diagnosis is entirely clinical. The etiology is still not completely defined, but there are some hypotheses of clinical causes. Urethral prolapse is also one of the findings in child sexual abuse, however, as a rare condition, health professionals have little experience in diagnosing and distinguish it from other events that occur in childhood. OBJECTIVE: To demonstrate the importance of the differential diagnosis of clinical conditions that can also characterize suspected child sexual abuse. MATERIALS AND METHODS: This is a descriptive study, which presents the report of three cases of urethral prolapse, in which suspicions of sexual abuse were raised in a medium-sized city in Minas Gerais. DISCUSSION: Urethral prolapse is an uncommon condition, but it should be considered in the differential diagnosis in cases of urogenital hemorrhage in prepubertal children. CONCLUSION: It is essential to correctly characterize the urethral prolapse, its probable etiology and, in the case of suspected sexual abuse, to be investigated by the expert medical authority.