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Introduction: Integration in health and care can improve quality and outcomes, but it is challenged by expansion of medical knowledge, social pressures on patient needs, and demands to deliver critical information. In Latin American and in other lower and middle-income countries integrated care remains in development. This paper examined the available literature on integrated care to understand how Latin American countries identify and measure integration, and what factors influence success. Methods: This integrative literature review included systematic searches in Global Health, PubMed, SciELO and BVSPsi databases for articles on integrated care in Spanish, Portuguese, and English in the period from January of 1999 to December 2020. The articles were screened for selection and assessed independently by five reviewers that used the inclusion criteria of papers about integration in health care systems. The sample excluded articles that did not deal with the integration of health care, which addressed issues related to public health campaigns, programs to control endemics and epidemics, reports on the experience of implementing health services, health promotion guidelines, food safety, oral health, and books evaluation. Results: 24 articles were included: qualitative (75%), quantitative (12,5%), and mixed-method research (4%) published between 2000 and 2017. All studies were undertaken in Brazil, and two of them were also conducted in Latin American countries. In 15 articles there was an interchangeable use between concepts of integration of services and integrated care, while nine studies did not define integration. Barriers to integration included absence of shared understanding of knowledge among members of interprofessional teams, lack of clarity on professional roles, missing consensus on a definition and measurement of integrated care, power struggles between professionals, poor institutional support, insufficient team preparation and training and unequal valuation of professions by society. Conclusion: Several types of integration and factors contributing to the success of implementation of integrated care in various contexts in Brazil were identified. The concept of integration reflected the varied local and regional realities including different health settings and levels of health and care, suggesting a need for further clarifications on its objective and components especially in LMIC contexts. [ABSTRACT FROM AUTHOR]

Internationally, there is a large body of scientific evidence concerning the benefits of integrating health and social care to ensure that frail older people living in the community receive the assistance they need to maintain independence. In the Brazilian city of Belo Horizonte, located in the state of Minas Gerais, an integrated care intervention has been developed: the Programa Maior Cuidado - Older Adult Care Programme (PMC). This programme represents a pioneering example in Brazil of the provision of carers for highly vulnerable older people, through integrated action between public health and social service agencies. This paper draws on the first phase of a mixed method evaluation of PMC, including data from documentary sources, focus groups, empirical observation and expert workshops, to examine the processes that led to the establishment of programme. The origins of the PMC are discussed and its operational processes, with a particular emphasis on integrated activities and the roles of different actors. The paper situates PMC within comparable international experiences of integrated provision for older people and considers how it has been affected by unique context and challenging of a middle-income country. [ABSTRACT FROM AUTHOR]

Effective mitigation of greenhouse gas (GHG) emissions in the buildings sector requires a full understanding of the factors influencing emissions over the life-cycle of buildings, particularly in places where large additions to the building stock are expected. Currently, little is known about what affects the GHG emissions of buildings located in warmer climates, a typical situation for many emerging economies. This paper presents a study of emissions from Brazilian office buildings using building archetypes. A sensitivity analysis explores possible parameter ranges, various contributions to life-cycle impacts and their key drivers. For each of the 1000 building variations in the sample, the emissions were calculated using a life-cycle assessment. Multivariate regression analysis enabled the study of the results' sensitivity to 10 parameters, influencing building operation, design and others. The emissions ranged from 20 to 106 kg CO2-eq/m² gross floor area and year. Electricity mix, climate and cooling efficiency were the most impactful parameters, but building component service time was also significant. [ABSTRACT FROM AUTHOR]

Introduction: Despite the lack of evidence supporting its practice, antipsychotic polypharmacy (APP), is widely used1,2,3,. To change the outcomes that are directly related to doctors' decisions, it is important to understand the decision-making process and the factors which affect it. Behavioral Economics is a field that blends social psychology and economics, and it seeks to understand how biases affecting the human decision-making process. Strategies based on Behavioral Economics principles have been successful in addressing many issues in healthcare. This paper describes a quality improvement project designed with the aim of reducing APP prescribing behavior in a large psychiatric hospital in Brazil. Aims Objectives Theory or Methods: Nineteen units participated in this case study. The intervention targeted all prescribers and it involved the use of norms and peer comparison, behavioral economics principles which indicate that individuals are more likely to adjust their behavior if they perform below the average performance of their peers. After baseline, where the APP prescribing rate for the whole hospital and for each unit in particular were assessed, a weekly email was sent to each prescriber with information about the hospital-wide APP prescribing rate, feedback related to the APP prescribing rates in their units, and how they compared to other units. Highlights or Results or Key Findings: The intervention was successful in reducing hospital-wide APP prescribing rate. After the second e-mail, we observed a steep drop in the APP prescribing rate, and the rate never returned to preintervention levels. The weekly emails with feedback and peer comparisons yielded an average statistically significant difference of about 8.02% (t(10) = 4.7491, p < 0.008) over a brief 11-week period. This study demonstrated that e-mails designed according to a Behavioral Economics strategy can affect prescribing behavior. Conclusions: Information about the lack of evidence for the use of antipsychotic combinations, about the rates in other parts of the world, and information about the rates in hospitals with a similar population within their own state was enough to yield statistically significant results.. Implications for applicability/transferability sustainability and limitations: Future quality improvement projects targeting prescribing behavior should consider a combined use of guidelines and training with norms and peer comparison. [ABSTRACT FROM AUTHOR]

Citizen science networks can provide support and visibility to existing initiatives. Although citizen science is a growing practice in Brazil, several challenges still exist. A network can play an important role in overcoming these challenges, helping with the exchange of knowledge between initiatives or raising funding, for example. The Brazilian Citizen Science Network was created to advance citizen science in the country. The launch took place in March 2021 at a two-day online workshop focused on topics such as financial sustainability, technology, data quality, inter- and transdisciplinary infrastructure, engagement, and good practices. Based on the contents of the presentations and comments during the event, the authors of this report held follow-up meetings to identify favourable and unfavourable factors that can foster or constrain citizen science in Brazil. Afterwards, an open letter expressing these factors was produced and shared with the network members to register the status of challenges and opportunities we have discussed so far, to be used as a guide for future actions. This report provides an overview of the workshop. Despite depicting a local perspective, the challenges and opportunities discussed during the workshop and summarised in this report may also apply to fostering citizen science in other countries or establishing global practices. We consider that the Brazilian Citizen Science Network can play an important role in promoting the establishment of collaborative actions across the country. [ABSTRACT FROM AUTHOR]

Brazilian social housing is used to address the country's housing deficit through government programs with the massive production of standardised affordable housing. This non-systemic approach is shown to neglect residents' changing needs over time and results in inflexible housing in relation to environmental, constructive, and social issues. The use of inappropriate spatial patterns fails to account for residents' current socioeconomic and spatial realities. Quantitative/qualitative methods involving residents (n = 162) and two case studies are used to assess resilience in social housing. The costs and implications arising from a lack of housing adaptability are identified. An 'impact assessment' tool is employed to document the shocks and tensions experienced by residents along with the negative effects on the house and its occupants. These impacts increase the vulnerability of families and hinder their adaptive capacity. The identification of major impacts and residents' perceptions can be used to establish priorities for action. [ABSTRACT FROM AUTHOR]

The year 2014 marked the centenary of the birth of Roman-born Brazilian architect Lina Bo Bardi. Among the best known of Lina's many contributions to Brazilian modernism is Museu de Arte de São Paulo (MASP). Begun in 1957 and opened in 1968, MASP flouted European museological and museographical conventions, dissolving structural, temporal and hierarchical boundaries. Lina's expressive architectonic forms and revolutionary exhibition scheme allowed the works in the MASP collection to literally stand on their own as objects liberated completely from chronological, connoisseurial and scholarly classification systems. Lina designed MASP to provoke 'reactions of curiosity and investigation' by redefining notions of space and form within and beyond the context of the museum as mausoleum, archive and treasury. This collaborative analysis examines the philosophical, theoretical, practical and formal elements of what John Cage purportedly characterized as 'the architecture of freedom'. Toward that end, this article situates MASP and its collections within broader historical discourses of museum practice to reveal the transgressive genius of Lina's architectural and museal gestures. We conclude with a discussion of current debates surrounding the conventionalization of MASP's exhibition protocols, considered in the contexts of conservation and proposed changes to the structure and its immediate urban setting. [ABSTRACT FROM AUTHOR]

Background: Hypertension awareness and control are understudied among older adults in middle-income countries, with limited work contextualizing awareness and control across layers of influence (individual to the community). Research on hypertension in Latin America is acknowledged as insufficient., Objectives: This study applies the socioecological model (SEM) to examine individual, interpersonal, institutional, and community factors related to hypertension awareness and control in older adults residing in Brazil and Colombia. It identifies groups of older adults more likely to be unaware of their condition and/or to have challenges achieving hypertension control., Methods: We analyzed International Mobility in Aging Study data of 803 community-dwelling adults 65-74 years from study sites in the two most populous countries in South America. The study framework was the socioecological model. Logistic regression models identified factors associated with hypertension awareness and control., Conclusions: Hypertension was prevalent in both samples (>70%), and awareness was high (>80%). Blood pressure control among diagnosed respondents was low: 30% in Brazil and 51% in Colombia. Factors across the socioecological model were associated with awareness and control, with notable differences across countries. Those with diabetes (OR 4.19, 95%CI 1.64-10.71) and insufficient incomes (OR: 1.85, 95%CI 1.03-3.31) were more likely to be aware of their hypertension. In Colombia, those reporting no community activity engagement were less likely to be aware compared to those reporting community activities. In Brazil, it was the opposite. Women (OR 1.66, 95%CI 1.12-2.46) and those reporting strolling shops and stores (OR 1.80, 95% CI 1.09-3.00) were significantly more likely to have their hypertension under control. In Brazil, those 70-75 were significantly less likely to have their hypertension under control compared to their younger counterparts. In Colombia, this was not observed. This paper highlights the importance of theory-based studies within unique Latin American contexts on hypertension and suggests novel opportunities for intervention., Competing Interests: The authors have no competing interests to declare., (Copyright: © 2023 The Author(s).)

Background/objective: As a developing country, Brazil presents a wide range of environmental risks that can constitute hazards to child health. The country also presents different socio-economic-cultural conditions that could be responsible for determining different vulnerability and susceptibility levels for the population, which can potentiate the effects of the environmental pollutants. The Rio Birth Cohort Study (PIPA project) is a prospective maternal-infant health study, hosted in the city of Rio de Janeiro (Southeastern Brazil), designed to investigate separate and combined effects of environmental chemical pollutants, as well as the interactions between these exposures and sociocultural environment and epigenetic patterns. This paper presents the learned lessons and strategies to address the shortcomings detected from this pilot study., Methods: The study population will be all children born at the Federal University of Rio de Janeiro Maternity Hospital from July 1st, 2020 to June 30th, 2021. The estimated population is of 2,500 children. The study will collect social, demographic, and health information from pregnant women and their children up to four years of age. Biological samples from both mothers and newborns will be collected to assess metal, pesticide and plasticizer exposure. All newborns will have their landmarks of physical, neurological, psychological, and cognitive development recorded at specific ages., Findings: A pilot study was carried out between September 2017 and August 2018, totaling 142 enrolled pregnant women, leading to 135 (95%) births and the collection of umbilical cord (126-93%,) and mother (139-98%) blood samples, as well as both mother (142-100%) and newborn (54-40%) urine samples and newborn meconium samples (117-86.7%)., Conclusions: The study proposes a comprehensive assessment of pre- and postnatal exposure to environmental chemicals at multiple time points in a population living in a highly urbanized developing country. As far as we know, this is the only birth cohort in Brazil specifically designed for this purpose., Competing Interests: The authors have no competing interests to declare., (Copyright: © 2020 The Author(s).)

Background: Some specific groups, such as immigrants, are considered at significantly high risk of developing poor sexual health (SH), specifically in relation to sexually transmitted infections (STIs). However, despite the high number of Haitian immigrants living in southern Brazil, a study that assessed the SH of these immigrants has not been conducted yet., Objective: This study aimed to assess the sexual health of Haitian immigrants in southern Brazil., Methods: This was a cross-sectional study conducted in 201 adult Haitian immigrants of both sexes, living in southern Brazil. A self-applied questionnaire containing sociodemographic questions and SH and behaviors was used to collect data. Data were collected on paper or through online form., Findings: Of the 201 immigrants included in the study, the majority were men (58.06%). There was no difference in the mean age (30 years) between both sexes. More than half were married with a partner (a) (53.29%), and 69.89% had an average educational level. Although an association between the reported STIs and the variables considered as risk factors or behaviors for STIs was not reported, women reported a frequency of 33.80% for self-declared active STIs and a frequency of 66.20% for lifelong STIs; these frequencies are highly superior in women compared to men. Additionally, 55.33% of women also reported not using a condom in their last sexual intercourse, and 35.10% reported changing their sexual behaviors after immigrating., Conclusions: The high frequency of STIs reported by Haitian immigrant women indicates the need to implement STI tracking strategies in that population. This study can assist in the development of comprehensive healthcare policies for Haitian immigrants., Competing Interests: The authors have no competing interests to declare., (Copyright: © 2020 The Author(s).)

Background: Some scholars and global health advocates argue that litigation is a strategy to advance public health care, especially in those countries that do not have specific legislation to guarantee access to basic health care services. However, strategic litigation has another side, known as judicialization of the right to health, particularly present in the Latin American region where most countries incorporate the right to health into their constitutions, but their citizens still struggle with health disparities., Objectives: Considering these two perspectives on litigation in health care, this paper examines the phenomenon of litigation in health care and its impact on public health in Brazil, where there is an ambiguous process of litigation in health care., Methods: Comparing the literature of both the use of strategic litigation for advancing public health and the judicialization of the right to health, this paper develops an ethical analysis of the impacts of strategic litigation for individuals and societies, using Brazil's public health care system and its policies as case-study of the impact of court decisions on the management of the system., Findings: Supporters of strategic litigation present experiences in African countries using this strategy to access a specific medical service led to enforce the creation of health-related policies by authorities and policymakers. However, in Brazil, a country with the right to health guaranteed by its Constitution, strategic litigation creates access to health care for some individuals, but also results in complex sociomedical challenges with significant impact for public administration and distributive justice., Conclusions: Strategic litigation can lead to ambiguous results, which will depend on the local context and the existence or not of public health services and health-related policies. When this strategy is considered, ethical analysis helps to understand how litigation can both benefit and damage individuals' health and the public health system in the complex context and diverse reality of Brazil. As a result, strategic litigation must be considered from an ethical perspective of prudence and discernment in a close interaction with the local reality, its particular circumstances, culture, policies, and laws., Competing Interests: The authors have no competing interests to declare., (Copyright: © 2020 The Author(s).)