Medicine graduates intentions in the face of establishment predictors: Bahia’s Mais Médicos Program

Introduction: The quantitative deficit and inequalities in the distribution of doctors exacerbate the global health workforce crisis. Many policies have been adopted to face the problem, with the ‘Mais Médicos’ Program standing out due to its scope.Objective: This study aimed to characterize, among undergraduate medical students in the state of Bahia, the intentions of future medical specialty and professional retention in priority areas defined by the More Doctors Program (PMM), according to the predictors indicated in the literature.Methods: This is a cross-sectional exploratory study conducted with medical students from four federal universities in the state of Bahia.Results: The study predominantly included students aged 20 to 24 years, with a lower socioeconomic profile in relation to previous studies, born in small and medium-sized municipalities in the state of Bahia, who mostly stated their option for medical residency in specialties other than the basic areas after graduation. An inequality was observed between the percentage of students who intended to work in Primary Care and those who wanted basic specialties, with the option for Family and Community Medicine being even lower. Female students clearly predominated among those who desired basic specialties and who envisioned a future employment in Primary Care in this state. Conversely, male students mostly chose specialties in other areas, especially those who had financial aspects as the main motivation for career choice.Final considerations: The study added knowledge to the body of literature on changes in medical training in the country and the effects of policies leading to a generalist professional profile that meets the social needs of the population

A Dimensão da Formação no Programa Mais Médicos.pdf

Introdução: A carência e as desigualdades na distribuição geográfica de médicos desafiam a consolidação do direito à saúde e criam fluxos migratórios que acirram iniquidades em saúde. Devido ao seu caráter complexo e multidimensional, demandam abordagens políticas multissetoriais, considerando vários fatores relativos à disponibilidade e à área de atuação de médicos, bem como à vulnerabilidade social das populações consideradas.Objetivo: Esteestudo teve como objetivo analisar os resultados do eixo Formação do Programa Mais Médicos no Brasil.Métodos: Realizou-se uma pesquisa documental, especificamente relativa à localização e à natureza pública ou privada das novas vagas de graduação em Medicina, no período de 2013 a 2017, em que se confrontaram os resultados obtidos com as metas e estratégias pactuadas nos documentos oficiais do programa.Resultados: O eixo Formação alcançou resultados importantes, apesar da resistência de alguns atores institucionais. O programa expandiu em 7.696 vagas de graduação, sendo 22,48% em instituições públicas e 77,52% em instituições privadas. A distribuição das novas vagas priorizou cidades do interior do Brasil e aprovou mudanças regulatórias importantes para os cursos de Medicina. No entanto, as disputas políticas com atores sociais representativos da classe médica e aqueles interessados no favorecimento do setor privado na educação e assistência à saúde ficaram expressas nos discursos e documentos oficiais. Tais aspectos fragilizaram o corpo normativo do programa e criaram um hiato entre os seus objetivos e a implementação. Evidências referentes à concentração de vagas no Sudeste do país favorecem a manutenção das desigualdades, a despeito de um crescimento proporcionalmente maior nas Regiões Centro-Oeste, Nordeste e Norte.Conclusão: A prevalência de vagas em instituições privadas e a fragilização de instrumentos de monitoramento dos novos cursos podem comprometer a mudança no perfil dos egressos, necessária para a fixação de médicos em áreas estratégicas e na atenção primária à saúde

Utilization of the Brazilian public health system by privately insured individuals: a literature review

Abstract: More than one in four Brazilians have private health insurance (PHI), even thought it covers mostly the same procedures as the Brazilian Unified National Health System (SUS). This literature review included articles and monographs published since 1990 about the utilization of SUS by privately insured individuals. Considering outpatient care and hospitalization, privately insured people in Brazil use SUS in approximately 13% of the times they receive health care, and approximately 7% of people receiving care paid by SUS are privately insured; these findings vary depending on the type of service studied and on study methods. Utilization of SUS is more frequent in less developed regions, by people with more restricted PHI plans and by people with worse health status. Privately insured people report the limitations of PHI plans as their reasons for resorting to SUS. Sometimes, beneficiaries of PHI plans owned by nonprofit hospitals (which also provide health care financed by SUS) have easier access to care than uninsured people financed by SUS. Anecdotally, privately insured people are satisfied with SUS, but not to the point of adopting SUS as their preferred source of care. In short, for privately insured people, SUS only plays a secondary role in their health care. Despite PHI taking over part of the SUS’s health care demand, PHI represents a restriction of the universal, equitable character of the SUS

Σ(1385)± resonance production in Pb–Pb collisions at √sNN = 5.02 TeV

Hadronic resonances are used to probe the hadron gas produced in the late stage of heavy-ion collisions since they decay on the same timescale, of the order of 1 to 10 fm/c, as the decoupling time of the system. In the hadron gas, (pseudo)elastic scatterings among the products of resonances that decayed before the kinetic freeze-out and regeneration processes counteract each other, the net effect depending on the resonance lifetime, the duration of the hadronic phase, and the hadronic cross sections at play. In this context, the Σ(1385)± particle is of particular interest as models predict that regeneration dominates over rescattering despite its relatively short lifetime of about 5.5 fm/c. The first measurement of the Σ(1385)± resonance production at midrapidity in Pb-Pb collisions at sNN−−−√=5.02 TeV with the ALICE detector is presented in this Letter. The resonances are reconstructed via their hadronic decay channel, Λπ, as a function of the transverse momentum (pT) and the collision centrality. The results are discussed in comparison with the measured yield of pions and with expectations from the statistical hadronization model as well as commonly employed event generators, including PYTHIA8/Angantyr and EPOS3 coupled to the UrQMD hadronic cascade afterburner. None of the models can describe the data. For Σ(1385)±, a similar behaviour as K∗(892)0 is observed in data unlike the predictions of EPOS3 with afterburner

Measurement of ψ (2S) production as a function of charged-particle pseudorapidity density in pp collisions at √s = 13 TeV and p–Pb collisions at √sNN = 8.16 TeV with ALICE at the LHC

Production of inclusive charmonia in pp collisions at center-of-mass energy of √s = 13 TeV and p–Pb collisions at center-of-mass energy per nucleon pair of √sNN = 8.16 TeV is studied as a function of charged-particle pseudorapidity density with ALICE. Ground and excited charmonium states (J/ψ, ψ(2S)) are measured from their dimuon decays in the interval of rapidity in the center-of-mass frame 2.5 < ycms < 4.0 for pp collisions, and 2.03 < ycms < 3.53 and −4.46 < ycms < −2.96 for p–Pb collisions. The charged-particle pseudorapidity density is measured around midrapidity (|η| < 1.0). In pp collisions, the measured charged-particle multiplicity extends to about six times the average value, while in p-Pb collisions at forward (backward) rapidity a multiplicity corresponding to about three (four) times the average is reached. The ψ(2S) yield increases with the charged-particle pseudorapidity density. The ratio of ψ(2S) over J/ψ yield does not show a significant multiplicity dependence in either colliding system, suggesting a similar behavior of J/ψ and ψ(2S) yields with respect to charged-particle pseudorapidity density. Results for the ψ(2S) yield and its ratio with respect to J/ψ agree with available model calculations

Investigation of K+K− interactions via femtoscopy in Pb-Pb collisions at √sNN = 2.76 TeV at the CERN Large Hadron Collider

Femtoscopic correlations of non-identical charged kaons (K+K−) are studied in Pb−Pb collisions at a center-of-mass energy per nucleon−nucleon collision sNN−−−√=2.76 TeV by ALICE at the LHC. One-dimensional K+K− correlation functions are analyzed in three centrality classes and eight intervals of particle-pair transverse momentum. The Lednický and Luboshitz interaction model used in the K+K− analysis includes the final-state Coulomb interactions between kaons and the final-state interaction through a0(980) and f0(980) resonances. The mass of f0(980) and coupling were extracted from the fit to K+K− correlation functions using the femtoscopic technique for the first time. The measured mass and width of the f0(980) resonance are consistent with other published measurements. The height of the ϕ(1020) meson peak present in the K+K− correlation function rapidly decreases with increasing source radius, qualitatively in agreement with an inverse volume dependence. A phenomenological fit to this trend suggests that the ϕ(1020) meson yield is dominated by particles produced directly from the hadronization of the system. The small fraction subsequently produced by FSI could not be precisely quantified with data presented in this paper and will be assessed in future work

Two-particle transverse momentum correlations in pp and p-Pb collisions at energies available at the CERN Large Hadron Collider

Two-particle transverse momentum differential correlators, recently measured in Pb-Pb collisions at LHC energies, provide an additional tool to gain insights into particle production mechanisms and infer transport properties, such as the ratio of shear viscosity to entropy density, of the medium created in Pb-Pb collisions. The longitudinal long-range correlations and the large azimuthal anisotropy measured at low transverse momenta in small collision systems, namely pp and p-Pb, at LHC energies resemble manifestations of collective behaviour. This suggests that locally equilibrated matter may be produced in these small collision systems, similar to what is observed in Pb-Pb collisions. In this work, the same two-particle transverse momentum differential correlators are exploited in pp and p-Pb collisions at s√=7 TeV and sNN−−−√=5.02 TeV, respectively, to seek evidence for viscous effects. Specifically, the strength and shape of the correlators are studied as a function of the produced particle multiplicity to identify evidence for longitudinal broadening that might reveal the presence of viscous effects in these smaller systems. The measured correlators and their evolution from pp and p-Pb to Pb-Pb collisions are additionally compared to predictions from Monte Carlo event generators, and the potential presence of viscous effects is discussed

Symmetry plane correlations in Pb–Pb collisions at √sNN = 2.76 TeV

A newly developed observable for correlations between symmetry planes, which characterize the direction of the anisotropic emission of produced particles, is measured in Pb-Pb collisions at sNN−−−√=2.76 TeV with ALICE. This so-called Gaussian Estimator allows for the first time the study of these quantities without the influence of correlations between different flow amplitudes. The centrality dependence of various correlations between two, three and four symmetry planes is presented. The ordering of magnitude between these symmetry plane correlations is discussed and the results of the Gaussian Estimator are compared with measurements of previously used estimators. The results utilizing the new estimator lead to significantly smaller correlations than reported by studies using the Scalar Product method. Furthermore, the obtained symmetry plane correlations are compared to state-of-the-art hydrodynamic model calculations for the evolution of heavy-ion collisions. While the model predictions provide a qualitative description of the data, quantitative agreement is not always observed, particularly for correlators with significant non-linear response of the medium to initial state anisotropies of the collision system. As these results provide unique and independent information, their usage in future Bayesian analysis can further constrain our knowledge on the properties of the QCD matter produced in ultrarelativistic heavy-ion collisions

Measurement of the radius dependence of charged-particle jet suppression in Pb–Pb collisions at sNN=5.02\sqrt{s_{\rm NN}} = 5.02 TeV

The ALICE Collaboration reports a new differential measurement of inclusive jet suppression using pp and Pb–Pb collision data at center-of-mass energy per nucleon–nucleon collision $\sqrt{s_{\rm NN}} = 5.02$ TeV. Charged-particle jets are reconstructed using the anti-$k_{\rm T}$ algorithm with resolution parameters $R$ = 0.2, 0.3, 0.4, 0.5, and 0.6 in pp collisions and $R$ = 0.2, 0.4, 0.6 in central (0–10\%), semi-central (30–50\%), and peripheral (60–80\%) Pb–Pb collisions. The analysis uses a novel approach based on machine learning to mitigate the influence of jet background in central heavy-ion collisions, which enables measurements of inclusive jet suppression for jet $p_{\rm T} \ge 40$ GeV/$c$ in central collisions at a resolution parameter of $R$ = 0.6. This is the lowest value of jet $p_{\rm T}$ achieved for inclusive jet measurements at $R$ = 0.6 at the LHC, and is an important step for discriminating different models of jet quenching in the quark-gluon plasma. The transverse momentum spectra, nuclear modification factors, and derived cross section and nuclear modification factor ratios for different jet resolution parameters of charged-particle jets are presented and compared to model predictions. A mild dependence of the nuclear modification factor ratios on collision centrality and resolution parameter is observed. The results are compared to a variety of jet quenching models with varying levels of agreement, demonstrating the effectiveness of this observable to discriminate between models.The ALICE Collaboration reports a new differential measurement of inclusive jet suppression using pp and Pb$-$Pb collision data at center-of-mass energy per nucleon-nucleon collision $\sqrt{s_{\rm NN}} = 5.02$ TeV. Charged-particle jets are reconstructed using the anti-$k_{\rm T}$ algorithm with resolution parameters $R =$ 0.2, 0.3, 0.4, 0.5, and 0.6 in pp collisions and $R =$ 0.2, 0.4, 0.6 in central (0$-$10%), semi-central (30$-$50%), and peripheral (60$-$80%) Pb$-$Pb collisions. The analysis uses a novel approach based on machine learning to mitigate the influence of jet background in central heavy-ion collisions, which enables measurements of inclusive jet suppression for jet $p_{\rm T} \geq 40$ GeV/$c$ in central collisions at a resolution parameter of $R = 0.6$. This is the lowest value of jet $p_{\rm T}$ achieved for inclusive jet measurements at $R=0.6$ at the LHC, and is an important step for discriminating different models of jet quenching in the quark-gluon plasma. The transverse momentum spectra, nuclear modification factors, and derived cross section and nuclear modification factor ratios for different jet resolution parameters of charged-particle jets are presented and compared to model predictions. A mild dependence of the nuclear modification factor ratios on collision centrality and resolution parameter is observed. The results are compared to a variety of jet quenching models with varying levels of agreement, demonstrating the effectiveness of this observable to discriminate between models