This field research aimed to identify healthcare integration among four twin cities in Paraná State, Brazil, the determinants of cross-border movements of foreigners, and the obstacles to such integration. Data were collected through in-depth interviews with key informants that were analyzed with thematic content analysis. The results showed that asymmetries in the structure, resources, supply, and quality of the network's health services are determinants of cross-border movements. The experiences with integration are limited basically to emergency measures in health surveillance. Working groups are formed with limited case-resolution capacity, depending on personal, non-institutionalized initiatives. Public underfinancing is a limiting factor for access to health services. Municipal health services managers play a leading role in border areas, and they should be acknowledged as international political actors.

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RESUMO: Trata-se de pesquisa realizada com o objetivo de construir um instrumento de avaliação para idosos. A pesquisa foi desenvolvida entre março e setembro de 2007 por meio de revisão de literatura, identificação e análise de diferentes instrumentos/escalas propostos para avaliação funcional. A partir da análise de nove escalas, construiu-se o Instrumento de Avaliação Sócio-funcional em Idosos, que se compõe de duas partes, a primeira visa obter dados de identificação, representação do estado de saúde e desempenho social dos idosos; a segunda busca realizar a avaliação funcional propriamente dita. O instrumento foi avaliado por quatro juízes e posteriormente aplicado em 10 idosos com diferentes graus de dependência. Mostrou-se de fácil aplicação e útil na identificação dos fatores que interferem na saúde do idoso e na avaliação do grau de dependência, fornecendo subsídios para o planejamento do trabalho em saúde e para a assistência à pessoa idosa.ABSTRACT:The objective of this study is to build a socio-functional evaluation instrument for elderly people. The research was developed between March and September of 2007 through a literature review, identification, and analysis of different instruments/scales proposed for functional evaluation. From the analysis of nine scales, the Socio-Functional Evaluation Instrument for Elderly was constructed. It is composed of two parts. The first one seeks to obtain identification information, representation of their health states, and social performance of the elderly. The second seeks to complete the functional evaluation per se. The instrument was evaluated by four judges and was then applied to ten elderly people with different levels of dependency. Its easy application and use in identifying factors that interfere in elderly health, as well as evaluating dependency levels were proven, providing sources for planning elderly health care work. RESUMEN:Se trata de una investigación realizada con el objetivo de construir un instrumento de evaluación para ancianos. La investigación fue desarrollada entre marzo y septiembre de 2007, por medio de la revisión de literatura, identificación y análisis de diversos instrumentos/escalas propuestos para la evaluación funcional. A partir del análisis de nueve escalas, se construyó el Instrumento de Evaluación Socio-funcional en Ancianos, que se compone de dos partes: la primera, cuyo objetivo es obtener datos de identificación, representación del estado de salud y desempeño social de los ancianos; la segunda busca realizar la evaluación funcional propiamente dicha. El instrumento fue evaluado por cuatro jueces y después fue aplicado a diez ancianos con diversos grados de dependencia. Se reveló de fácil aplicación y útil en la identificación de los factores que intervienen en la salud de la persona anciana, así como, en la evaluación del grado de dependencia, ofreciendo subsidios para la planificación del trabajo en salud y asistencia a los ancianos.

This essay has the aim of updating discussions on the political perspective and the role played by the World Bank in the development of public health policies in Brazil, seeking to identify continuities and changes in the way this institution acts and suggest hypotheses about action strategies in this new century. To do this, we analyzed a 2007 and a 2013 document published by that institution, and gather data on projects funded by the World Bank from 2000 to 2015 in Brazil, with emphasis on the healthcare industry. We concluded that the traditional mechanisms of action have not changed from those used in the 1980s and 1990s, as well as the guiding principles; what we observed is that the World Bank's actions have shifted from the national level to the state and municipal level. We indicate the need for specific studies of the agreements between the Bank and subnational governments, since the Brazilian federative model and the national health system itself allow implementing decentralized management mechanisms that can alter the setting of the Unified Health System. Keywords: Inter-American Development Bank; Health Care Reform; Brazilian National Health System; Right to Health. Maria Lucia Frizon Rizzotto

This essay consists of a reflection on the theme proposed on the 63rd Brazilian Nursing Week. It was initially elaborated for a conference, which would be presented in a commemorative nursing event. The essay relates the theme "humanization and work: reason and signification in nursing" to the current health policies implemented in Brazil. It discusses the consequences of these policies, and approaches strategies for the humanization of assistance.

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

RESUMO Pesquisa com abordagem qualitativa que objetivou analisar as mudanças nos processos de adesão, avaliação externa e organização do processo de trabalho de 21 equipes na 10a Região de Saúde do Paraná, as quais participaram dos dois primeiros ciclos do Programa de Melhoria do Acesso e da Qualidade da Atenção Básica (PMAQ). Os resultados apontaram melhor organização e registro das informações; planejamento a partir da autoavaliação e a avaliação externa como estratégia de mobilização da gestão e das equipes. Todavia, é necessário maior envolvimento das equipes na contratualização e monitoramento dos indicadores do PMAQ, assim como melhor uso das ferramentas da autoavaliação no planejamento local.

Murofuse NT, Rizzotto MLF, Muzzolon ABF, Nicola AL. Diagnosis of the situation of health workers and the training process at a regional center for professional health education. Rev Latino-am Enfermagem 2009 maio-junho; 17(3):314-20.