Junqueira, Virgínia; Mendes, Áquilas N
This article examines some political and economic facts that led to an intensification of austerity measures by the Brazilian government, including ones against the Unified Health System (SUS) and its progressive dismantling. In a country where fundamental human rights were never fully respected, nowadays social and labor rights are under severe attacks. The deepening of the capital crisis and the rise of interest-bearing capital dominance have been causing unemployment, social insecurity growth, and resulting public fund appropriation by the private capital. The Brazilian governments in the 1990s and 2000s have implemented deeper cuts in social policy expenditure, freezing security benefits, privatizing services, and prioritizing the payment of public debt interests. The right wing's project involves the demoralization of not only the Workers' Party but also the left as a whole, so that the adoption of austerity measures could be achieved without popular resistance. It is the duty of the Brazilian left wing to denounce such a project and to provoke firm initiatives to rebuild its bonds with the working class.
Cuenca, Angela Maria Belloni; Barbosa, Milena Maria de Araújo Lima; de Oliveira, Karoline; Quinta, Fernanda Paranhos; Alvarez, Maria do Carmo Avamilano; França, Ivan
ABSTRACT Here, we describe the percentage of non-citation in Brazilian public health journals, a field that, until now, had not been investigated nationally or internationally. We analyzed articles, published between 2008 and 2012, of eight public health journals indexed in the scopus database. The percentage of non-citation differs between journals (from 5.7% to 58.1%). We identified four statistically distinct groups: História, Ciência, Saúde – Manguinhos (58% uncited articles); Physis: Revista de Saúde Coletiva, Interface, and Saúde e Sociedade (32% to 37%); Ciência & Saúde Coletiva and Revista Brasileira de Epidemiologia (16% to 17%); and Cadernos de Saúde Pública and Revista de Saúde Pública (6%). The non-citation in the first three years post-publication also varies according to journal. Four journals have shown a clear decline of non-citation: Cadernos de Saúde Pública, Ciência & Saúde Coletiva, Revista Brasileira de Epidemiologia, and Physis. Another three (Revista de Saúde Pública, Saúde e Sociedade, and Interface) presented an oscillation in non-citation, but the rates of 2008 and 2012 are similar, with different magnitudes. In turn, the journal História, Ciência, Saúde – Manguinhos maintains high rates of non-citation. Multidisciplinary journals attract more citation, but a comprehensive citation model still needs to be formulated and tested. PMID:29211202
Cuenca, Angela Maria Belloni; Barbosa, Milena Maria de Araújo Lima; Oliveira, Karoline de; Quinta, Fernanda Paranhos; Alvarez, Maria do Carmo Avamilano; França, Ivan
Here, we describe the percentage of non-citation in Brazilian public health journals, a field that, until now, had not been investigated nationally or internationally. We analyzed articles, published between 2008 and 2012, of eight public health journals indexed in the scopus database. The percentage of non-citation differs between journals (from 5.7% to 58.1%). We identified four statistically distinct groups: História, Ciência, Saúde - Manguinhos (58% uncited articles); Physis: Revista de Saúde Coletiva, Interface, and Saúde e Sociedade (32% to 37%); Ciência & Saúde Coletiva and Revista Brasileira de Epidemiologia (16% to 17%); and Cadernos de Saúde Pública and Revista de Saúde Pública (6%). The non-citation in the first three years post-publication also varies according to journal. Four journals have shown a clear decline of non-citation: Cadernos de Saúde Pública, Ciência & Saúde Coletiva, Revista Brasileira de Epidemiologia, and Physis. Another three (Revista de Saúde Pública, Saúde e Sociedade, and Interface) presented an oscillation in non-citation, but the rates of 2008 and 2012 are similar, with different magnitudes. In turn, the journal História, Ciência, Saúde - Manguinhos maintains high rates of non-citation. Multidisciplinary journals attract more citation, but a comprehensive citation model still needs to be formulated and tested.
Avelino, George; Barberia, Lorena G; Biderman, Ciro
This study contributes to the health governance discussion by presenting a new data set that allows for comparisons of the management of health resources among Brazilian municipalities. Research on Brazil is particularly important as the provision of health services was decentralized in 1988 and since then municipalities have been given greater responsibilities for the management of fiscal resources for public health service provision. Based on detailed information on corruption practices (such as over-invoicing, illegal procurement and fake receipts) from audit reports of health programmes in 980 randomly selected Brazilian municipalities, this study deepens understanding of the relationship between health governance institutions and the incidence of corruption at the local level by exploring the extent to which horizontal and vertical accountabilities contribute to reducing the propensity of municipal government officials to divert public health resources for private gain. The results of our multiple regression analysis suggest that the experience of health municipal councils is correlated with reductions in the incidence of corruption in public health programmes. This impact is significant over time, with each additional year of health council experience reducing corruption incidence levels by 2.1% from baseline values. The findings reported in this study do not rely on the subjectivity of corruption measures which usually conflate the actual incidence of corruption with its perception by informants. Based on our results, we provide recommendations that can assist policy makers to reduce corruption. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine © The Author 2013; all rights reserved.
Full Text Available Abstract Congenital anomalies are already the second cause of infant mortality in Brazil, as in many other middle-income countries in Latin America. Birth defects are a result of both genetic and environmental factors, but a multifactorial etiology has been more frequently observed. Here, we address the environmental causes of birth defects – or teratogens – as a public health issue and present their mechanisms of action, categories and their respective maternal-fetal deleterious effects. We also present a survey from 2008 to 2013 of Brazilian cases involving congenital anomalies (annual average of 20,205, fetal deaths (annual average of 1,530, infant hospitalizations (annual average of 82,452, number of deaths of hospitalized infants (annual average of 2,175, and the average cost of hospitalizations (annual cost of $7,758. Moreover, we report on Brazilian cases of teratogenesis due to the recent Zika virus infection, and to the use of misoprostol, thalidomide, alcohol and illicit drugs. Special attention has been given to the Zika virus infection, now proven to be responsible for the microcephaly outbreak in Brazil, with 8,039 cases under investigation (from October 2015 to June 2016. From those cases, 1,616 were confirmed and 324 deaths occurred due to microcephaly complications or alterations on the central nervous system. Congenital anomalies impact life quality and raise costs in specialized care, justifying the classification of teratogens as a public health issue.
Mazzu-Nascimento, Thiago; Melo, Débora Gusmão; Morbioli, Giorgio Gianini; Carrilho, Emanuel; Vianna, Fernanda Sales Luiz; da Silva, André Anjos; Schuler-Faccini, Lavinia
Abstract Congenital anomalies are already the second cause of infant mortality in Brazil, as in many other middle-income countries in Latin America. Birth defects are a result of both genetic and environmental factors, but a multifactorial etiology has been more frequently observed. Here, we address the environmental causes of birth defects – or teratogens – as a public health issue and present their mechanisms of action, categories and their respective maternal-fetal deleterious effects. We also present a survey from 2008 to 2013 of Brazilian cases involving congenital anomalies (annual average of 20,205), fetal deaths (annual average of 1,530), infant hospitalizations (annual average of 82,452), number of deaths of hospitalized infants (annual average of 2,175), and the average cost of hospitalizations (annual cost of $7,758). Moreover, we report on Brazilian cases of teratogenesis due to the recent Zika virus infection, and to the use of misoprostol, thalidomide, alcohol and illicit drugs. Special attention has been given to the Zika virus infection, now proven to be responsible for the microcephaly outbreak in Brazil, with 8,039 cases under investigation (from October 2015 to June 2016). From those cases, 1,616 were confirmed and 324 deaths occurred due to microcephaly complications or alterations on the central nervous system. Congenital anomalies impact life quality and raise costs in specialized care, justifying the classification of teratogens as a public health issue. PMID:28534929
Paula, Ana Patrícia de; Giozza, Silvana Pereira; Pereira, Michelle Zanon; Boaventura, Patrícia Souza; Santos, Leonor Maria Pacheco; Sachetti, Camile Giaretta; Tamayo, César Omar Carranza; Kowalski, Clarissa Campos Guaragna; Elias, Flavia Tavares Silva; Serruya, Suzanne Jacob; Guimarães, Reinaldo
Scientific and technological development is crucial for advancing the Brazilian health system and for promoting quality of life. The way in which the Brazilian Ministry of Health has supported clinical research to provide autonomy, self-sufficiency, competitiveness and innovation for the healthcare industrial production complex, in accordance with the National Policy on Science, Technology and Innovation in Healthcare, was analyzed. Descriptive investigation, based on secondary data, conducted at the Department of Science and Technology, Ministry of Health. The Ministry of Health's research management database, PesquisaSaúde, was analyzed from 2002 to 2009, using the key word "clinical research" in the fields "primary sub-agenda" or "secondary sub-agenda". The 368 projects retrieved were sorted into six categories: basic biomedical research, preclinical studies, expanded clinical research, clinical trials, infrastructure support and health technology assessment. From a structured review on "clinical research funding", results from selected countries are presented and discussed. The amount invested was R$ 140 million. The largest number of projects supported "basic biomedical research", while the highest amounts invested were in "clinical trials" and "infrastructure support". The southeastern region had the greatest proportion of projects and financial resources. In some respects, Brazil is ahead of other BRICS countries (Russia, India, China and South Africa), especially with regard to establishing a National Clinical Research Network. The Ministry of Health ensured investments to encourage clinical research in Brazil and contributed towards promoting cohesion between investigators, health policies and the healthcare industrial production complex.
Signorelli, Marcos Claudio; Taft, Angela; Pereira, Pedro Paulo Gomes
Domestic violence creates multiple harms for women's health and is a 'wicked problem' for health professionals and public health systems. Brazil recently approved public policies to manage and care for women victims of domestic violence. Facing these policies, this study aimed to explore how domestic violence against women is usually managed in Brazilian primary health care, by investigating a basic health unit and its family health strategy. We adopted qualitative ethnographic research methods with thematic analysis of emergent categories, interrogating data with gender theory and emergent Brazilian collective health theory. Field research was conducted in a local basic health unit and the territory for which it is responsible, in Southern Brazil. The study revealed: 1) a yawning gap between public health policies for domestic violence against women at the federal level and its practical application at local/decentralized levels, which can leave both professionals and women unsafe; 2) the key role of local community health workers, paraprofessional health promotion agents, who aim to promote dialogue between women experiencing violence, health care professionals and the health care system.
Ana Patrícia de Paula
Full Text Available CONTEXT AND OBJECTIVE: Scientific and technological development is crucial for advancing the Brazilian health system and for promoting quality of life. The way in which the Brazilian Ministry of Health has supported clinical research to provide autonomy, self-sufficiency, competitiveness and innovation for the healthcare industrial production complex, in accordance with the National Policy on Science, Technology and Innovation in Healthcare, was analyzed. DESIGN AND SETTING: Descriptive investigation, based on secondary data, conducted at the Department of Science and Technology, Ministry of Health. METHODS: The Ministry of Health's research management database, PesquisaSaúde, was analyzed from 2002 to 2009, using the key word "clinical research" in the fields "primary sub-agenda" or "secondary sub-agenda". The 368 projects retrieved were sorted into six categories: basic biomedical research, preclinical studies, expanded clinical research, clinical trials, infrastructure support and health technology assessment. From a structured review on "clinical research funding", results from selected countries are presented and discussed. RESULTS: The amount invested was R$ 140 million. The largest number of projects supported "basic biomedical research", while the highest amounts invested were in "clinical trials" and "infrastructure support". The southeastern region had the greatest proportion of projects and financial resources. In some respects, Brazil is ahead of other BRICS countries (Russia, India, China and South Africa, especially with regard to establishing a National Clinical Research Network. CONCLUSION: The Ministry of Health ensured investments to encourage clinical research in Brazil and contributed towards promoting cohesion between investigators, health policies and the healthcare industrial production complex.
Celeste, Roger Keller; Warmling, Cristine Maria
The scope of this paper is to describe characteristics of the scientific output in the area of public oral health in journals on public health and dentistry nationwide. The Scopus database of abstracts and quotations was used and eight journals in public health, as well as ten in dentistry, dating from 1947 to 2011 were selected. A research strategy using key words regarding oral health in public health and key words about public health in dentistry was used to locate articles. The themes selected were based on the frequency of key words. Of the total number of articles, 4.7% (n = 642) were found in oral health journals and 6.8% (n = 245) in public health journals. Among the authors who published most, only 12% published in both fields. There was a percentile growth of public oral health publications in dentistry journals, though not in public health journals. In dentistry, only studies indexed as being on the topic of epidemiology showed an increase. In the area of public health, planning was predominant in all the phases studied. Research to evaluate the impact of research and postgraduate policies in scientific production is required.
Suzely Adas Saliba Moimaz
Full Text Available Introduction: work healthy conditions are essential for a great professional performance. Objective: To verify the perception of dentists regarding structural and healthy conditions of dental offices in the Brazilian Public Health System (SUS and their satisfaction with work and public job. Material and Method: In this cross-sectional study, type inquiry, 24 Brazilian dentists were interviewed. The follow variables were asked: cleaning and asepsis; maintenance and time of use of dental equipment; satisfaction with work and public job. Results: The professionals were "satisfied" or "very satisfied" with cleaning and asepsis (66.67%; Dental equipment (54.17%, reflectors (54.17% and the dental chairs (54.17% had more than 24 years of use; 20% of all professionals said that the equipment had maintenance but only to fix them. Of total, 58.33% had already given no attendance for patients and broken equipment was the most frequent cause (92.86%. It was observed satisfaction with work (79.1% and public job (95.83%. It was concluded that dentists who worked in SUS were satisfied with public job, although they had said the need for improvement on structural and healthy work conditions.
Onocko-Campos, Rosana Teresa; Furtado, Juarez Pereira
This article presents a preliminary discussion of potential methodological tools for qualitative research on the Network of Referral Centers for Psycho-Social Care (CAPS) in the Brazilian Unified Health System (SUS). The relevance of mental health within the field of public health is examined. The study focuses on the high prevalence of mental disorders and the disproportionate lack of studies on the interface between mental health and public health. The establishment of an interdisciplinary field between public health and mental health is proposed to meet common needs by achieving similar perspectives in knowledge and practice. A particular group of tools is proposed, emphasizing the importance of reclaiming and guaranteeing the roles of various social actors to shape the assessment process, the need for collecting and standardizing academic studies on the topic, and the importance of promoting a new research field focusing on public health policies to support policymakers, managers, and health teams in reshaping their practices.
de Castro-Santos, L A
Since George Herbert Mead studied "the social self" and the interactionists went further in distinguishing "images of self", a lecture on the building up of a Brazilian medical identity should try to focus on the patterns of self-images, presented images, and aspired-to images among the Brazilian medical elites during the First Republic (1889-1930). In no other period of Brazilian history were those "images" of professional identity so close--in contrast, later periods of Brazilian history witnessed an almost permanent "collision" or the clashing of such images among public health specialists. Oswaldo Cruz, Carlos Chagas, Artur Neiva and Belisário Pena are perhaps the best examples of successful careers as "sanitarians" (to recall John Duffy's historical work on luminaries before and after the "New Public Health" in the United States), and as important political actors during Brazil's First Republic. In light of the prominent political, policy-oriented, and scientific roles public health professionals played in Brazil, it is interesting to suggest that in large part such prominence resulted from the symbolic impact of the ideologies of sanitary reform on the political agenda of that period of Brazilian history. Where many studies look for personal rivalries and disputes around Chagas and Neiva as public figures, we may also see the importance of finding identity-building processes among public health specialists as an integrated group (e.g., trying to appear as "significant others" for the new generations of medical graduates in the country), regardless of existing rivalries. Cruz and Chagas, especially, were names with great impact in the Brazilian press (pro and con), a circumstance made possible largely by their easy and direct access to the Brazilian presidents Rodrigues Alves and Epitácio Pessoa, and, most clearly, by public health being one of Brazil's political priorities to find a place among the "civilized nations" of the world. A task that further
de Oliveira, Pedro Keller; Cavalli, Richard Souto; Kunert Filho, Hiran Castagnino; Carvalho, Daiane; Benedetti, Nadine; Rotta, Marco Aurélio; Peixoto Ramos, Augusto Sávio; de Brito, Kelly Cristina Tagliari; de Brito, Benito Guimarães; da Rocha, Andréa Ferretto; Stech, Marcia Regina; Cavalli, Lissandra Souto
Aquaculture has many occupational hazards, including those that are physical, chemical, biological, ergonomic, and mechanical. The risks in aquaculture are inherent, as this activity requires particular practices. The objective of the present study was to show the risks associated with the aquaculture sector and present a critical overview on the Brazilian public policies concerning aquaculture occupational health. Methods include online research involved web searches and electronic databases including Pubmed, Google Scholar, Scielo and government databases. We conducted a careful revision of Brazilian labor laws related to occupational health and safety, rural workers, and aquaculture. The results and conclusion support the idea that aquaculture requires specific and well-established industry programs and policies, especially in developing countries. Aquaculture still lacks scientific research, strategies, laws, and public policies to boost the sector with regard to occupational health and safety. The establishment of a safe workplace in aquaculture in developing countries remains a challenge for all involved in employer-employee relationships.
Kátia Bones Rocha
Full Text Available This study aims to describe how transgender people perceive services offered by the Brazilian Public Health System (SUS. This qualitative study, using the phenomenological technique, is based on eight semi-structured interviews conducted with individuals whose gender identity and/or gender expression differs from the sex they were assigned at birth. Each interview was evaluated by two interviewers and a content analysis performed by all members of the research group. The analysis identified the following categories as having high relevance to the participants’ experiences: homophobia, receptiveness, and humanization, access to health care, and suggestions to improve the SUS. Information shared by participants emphasized their belief that health care professionals are not adequately prepared to assist transgendered individuals and that health care providers should use a more sensitive approach towards them. A recurrent theme was the need to use appropriate and socially acceptable terminology when providing health care services in order to facilitate transgendered individuals' inclusive treatment. Despite the effort of Brazilian authorities, there is a need for significant improvement in health care practices in order to comply with SUS quality standards. This study highlights the importance of qualitative investigations to improve planning and to help define public health policies with the goal of including the most vulnerable and marginalized groups of the population. URN: urn:nbn:de:0114-fqs0902281
Mendez, L C; Moraes, F Y; Fernandes, G Dos S; Weltman, E
Radiotherapy plays a fundamental role in the treatment of cancer. Currently, the Brazilian public health system cannot match the national radiotherapy demand and many patients requiring radiotherapy are never exposed to this treatment. This study estimated the number of preventable deaths in the public health system if access to radiotherapy was universal. Incidence rates for the year 2016 provided by Instituto Nacional de Cancer were used in this analysis. The number of untreated patients requiring radiotherapy was obtained through the difference between the total number of patients requiring radiotherapy and the total amount of delivered radiotherapy treatments in the public health system. The number of deaths for the three most common cancers in each gender due to radiotherapy shortage was calculated. Initially, the total number of patients per cancer type was divided in stages using Brazilian epidemiological data. Subsequently, previously published tree arm diagrams were used to define the rate of patients requiring radiotherapy in each specific clinical setting. Finally, the clinical benefit of radiotherapy in overall survival was extracted from studies with level 1 evidence. Over 596 000 cancer cases were expected in Brazil in 2016. The public health system covers more than 75% of the Brazilian population and an estimated 111 432 patients who required radiotherapy in 2016 did not receive this treatment. Breast, colorectal and cervix cancers are the most frequent malignant tumours in women and prostate, lung and colorectal in men. The number of deaths due to a radiotherapy shortage in the year 2016 for these types of cancer were: (i) breast: 1011 deaths in 10 years; (ii) cervix: 2006 deaths in 2 years; (iii) lung: 1206 deaths in 2 years; (iv) prostate, intermediate risk: 562 deaths in 13 years; high risk: 298 deaths in 10 years; (v) colorectal: 0 deaths, as radiotherapy has no proven benefit in overall survival. Thousands of cancer patients requiring
Marmitt, Diorge Jônatas; Bitencourt, Shanna; Silva, Amanda do Couto E; Rempel, Claudete; Goettert, Márcia Inês
The aim of this study was to conduct a systematic review of the healing potential of medicinal plants belonging to the Brazilian National List of Medicinal Plants of Interest to the Unified Health System (RENISUS). PubMed and ScienceDirect databases were searched for relevant articles, regardless of the language, from 2010 to June 2016. Two reviewers independently assessed study eligibility. Articles were included if they presented evidence of healing potential of medicinal plants. Only those available as full and open access texts were considered. A total of 1381 articles met the inclusion criteria. Of these, 156 studies were considered eligible and were reviewed as full text. Following full analysis, 64 studies were included in this review. The studies covered 27 of the 71 plants belonging to RENISUS, nine of which are native to Brazil. In addition, two species are currently available in the Brazilian public health system as herbal medicine. This review may encourage and contribute to the appropriate use of medicinal plants in the public health system in Brazil.
Elinton Adami CHAIM
Full Text Available ABSTRACT BACKGROUND Bariatric surgery has become the gold standard treatment for morbid obesity, but access to surgery remains difficult and low compliance to postoperative follow-up is common. To improve outcomes, enable access and optimize follow-up, we developed a multidisciplinary preoperative approach for bariatric surgery. OBJECTIVE To determine the impact of this program in the outcomes of bariatric surgery in the Brazilian public health system. METHODS A prospective evaluation of the individuals who underwent a preoperative multidisciplinary program for bariatric surgery and comparison of their surgical outcomes with those observed in the prospectively collected historical database of the individuals who underwent surgery before the beginning of the program. RESULTS There were 176 individuals who underwent the multidisciplinary program and 226 who did not. Individuals who underwent the program had significantly lower occurrence of the following variables: hospital stay; wound dehiscence; wound infection; pulmonary complications; anastomotic leaks; pulmonary thromboembolism; sepsis; incisional hernias; eventrations; reoperations; and mortality. Both loss of follow-up and weight loss failure were also significantly lower in the program group. CONCLUSION The adoption of a comprehensive preoperative multidisciplinary approach led to significant improvements in the postoperative outcomes and also in the compliance to the postoperative follow-up. It represents a reproducible and potentially beneficial approach within the context of the Brazilian public health system.
de Castro, Ricardo Dias; Rangel, Marianne de Lucena; da Silva, Marcos André Azevedo; de Lucena, Brunna Thaís Lucwu; Cavalcanti, Alessandro Leite; Bonan, Paulo Rogério Ferreti; Oliveira, Julyana de Araújo
The Specialized Dental Clinics (SDCs) represent the first government initiative in Latin America aimed at providing specialized oral health services. This study sought to evaluate the organizational accessibility to specialized oral health care services in Brazil and to understand the factors that may be associated with accessibility from the user’s perspective. This epidemiological, cross-sectional and quantitative study was conducted by means of interviews with individuals who sought specialized public oral health services in the city of João Pessoa, Paraíba, Brazil, and consisted of a sample of 590 individuals. Users expressed a favorable view of the classification and resolutive nature of specialized services offered by Brazilian public health. The binary logistic regression analysis revealed weak points highlighting the difficulty involved in obtaining such treatments leading to unfavorable evaluations. In the resolutive nature item, difficulty in accessing the location, queues and lack of materials and equipment were highlighted as statistically significant unfavorable aspects. While many of the users considered the service to be resolutive, weaknesses were mentioned that need to be detected to promote improvements and to prevent other health models adopted worldwide from reproducing the same flaws. PMID:27775584
Carolina Vieira de Freitas
Full Text Available OBJECTIVE: To identify the prevalence and the severity of malocclusions and to analyze factors associated with the need for orthodontic treatment of Brazilian adolescents. METHODS: This exploratory, cross-sectional study was carried out based on secondary data from the national epidemiological survey on oral health in Brazil (2002-2003. Socio-demographic conditions, self-perception, and the existence and degree of malocclusion, using the Dental Aesthetic Index, were evaluated in 16,833 adolescent Brazilians selected by probabilistic sample by conglomerates. The dependent variable need orthodontic treatment was estimated from the severity of malocclusion. The magnitude and direction of the association in bivariate and multivariate analyzes from a Robust Poisson regression was estimated. RESULTS: The majority of the adolescents needed orthodontic treatment (53.2%. In the multivariate analysis, the prevalence of the need for orthodontic treatment was larger among females, non-whites, those that perceived a need for treatment, and those that perceived their appearance as normal, bad, or very bad. The need for orthodontic treatment was smaller among those that lived in the Northeast and Central West macro-regions compared to those living in Southeast Brazil and it was also smaller among those that perceived their chewing to be normal or their oral health to be bad or very bad. CONCLUSIONS: There was a high prevalence of orthodontic treatment need among adolescents in Brazil and this need was associated with demographic and subjective issues. The high prevalence of orthodontic needs in adolescents is a challenge to the goals of Brazil's universal public health system.
Maurílio de Souza Cazarim
Full Text Available ABSTRACT Human insulin is provided by the Brazilian Public Health System (BPHS for the treatment of diabetes, however, legal proceedings to acquire insulin analogs have burdened the BPHS health system. The aim of this study was to perform a cost-effectiveness analysis to compare insulin analogs and human insulins. This is a pharmacoeconomic study of cost-effectiveness. The direct medical cost related to insulin extracted from the Ministry of Health drug price list was considered. The clinical results, i.e. reduction in glycated hemoglobin (HbA1c, were extracted by meta-analysis. Different scenarios were structured to measure the uncertainties regarding the costs and reduction in HbA1c. Decision tree was developed for sensitivity of Incremental Cost Effectiveness Ratio (ICER. A total of fifteen scenarios were structured. Given the best-case scenario for the insulin analogs, the insulins aspart, lispro, glargine and detemir showed an ICER of R$ 1,768.59; R$ 3,308.54; R$ 11,718.75 and R$ 2,685.22, respectively. In all scenarios in which the minimum effectiveness was proposed, lispro, glargine and detemir were dominant strategies. Sensitivity analysis showed that the aspart had R$ 3,066.98 [95 % CI: 2339.22; 4418.53] and detemir had R$ 6,163.97 [95% CI: 3919.29; 11401.57] for incremental costs. We concluded there was evidence that the insulin aspart is the most cost-effective.
FERNANDA DOS SANTOS
Full Text Available ABSTRACT Objective: to analyze the profile of appendectomies performed in the Brazilian Public Health System (SUS and to compare the laparoscopic and laparotomic techniques of appendectomy. Methods: This work used information from DataSus from 2008 to 2014 (http://datasus.saude.gov.br. We compared the data of patients submitted to laparotomic appendectomy with those submitted to laparoscopic one. Results: when comparing the total growth of appendectomies, the laparoscopic route increased 279.7%, while the increase in laparotomic surgery was 25% (p <0.001 in the study period. With regard to medical and hospital costs, laparoscopic appendectomy accounted for only 2.6% of the total expenditure on appendectomies performed by the Unified Health System (SUS hospitals, with an average cost 7.6% lower than that of laparotomy procedures, but without statistical significance. The mortality rate was 57.1% lower in the laparoscopic approach when compared with laparotomy. Conclusion: there has been a significant increase in the laparoscopic route in the treatment of appendicitis, but the method is still rarely used in SUS patients. The costs of laparoscopic appendectomy were similar to those observed in laparotomic access.
João Porto de Albuquerque
Full Text Available This article evaluates social implications of the "SIGA" Health Care Information System (HIS in a public health care organization in the city of São Paulo. The evaluation was performed by means of an in-depth case study with patients and staff of a public health care organization, using qualitative and quantitative data. On the one hand, the system had consequences perceived as positive such as improved convenience and democratization of specialized treatment for patients and improvements in work organization. On the other hand, negative outcomes were reported, like difficulties faced by employees due to little familiarity with IT and an increase in the time needed to schedule appointments. Results show the ambiguity of the implications of HIS in developing countries, emphasizing the need for a more nuanced view of the evaluation of failures and successes and the importance of social contextual factors.
Carlos Cezar Flores Vidotti
Full Text Available OBJECTIVES: To describe the new drugs marketed in Brazil during the period 2000-2004, compare the description to the country's burden of disease, and suggest initiatives capable of addressing the situation from the perspective of a developing country. METHODS: Records of new drugs were surveyed in an official drug registration database. The new drugs were categorized by Anatomical Therapeutic Chemical classification, indication, and innovation, and compared with the needs of the country's burden of disease. Data on the morbidity and mortality rates of selected diseases (diabetes, Hansen's disease, hypertension, tuberculosis were retrieved from official documents and the literature. RESULTS: During the period investigated, 109 new drugs were launched. Most were general anti-infectives for systemic use (19, followed by antineoplastic and immunomodulating agents (16. The number of new drugs launched in 2004 was roughly one-third that of 2000. Of 65 new drugs, only one-third can be classified as innovative. Most new drugs were intended to treat noninfectious diseases that typically affect developed countries, diseases that constitute only a fraction of the country's challenges. CONCLUSIONS: A mismatch occurs between public health needs and the new drugs launched on the Brazilian market. Not only did the number of new drugs decrease in the study period, but only a few were actually new in therapeutic terms. Developing countries must acquire expertise in research and development to strengthen their capacity to innovate and produce the drugs they need.
Palmero, Edenir I; Galvão, Henrique C R; Fernandes, Gabriela C; Paula, André E de; Oliveira, Junea C; Souza, Cristiano P; Andrade, Carlos E; Romagnolo, Luis G C; Volc, Sahlua; C Neto, Maximiliano; Sabato, Cristina; Grasel, Rebeca; Mauad, Edmundo; Reis, Rui M; Michelli, Rodrigo A D
The identification of families at-risk for hereditary cancer is extremely important due to the prevention potential in those families. However, the number of Brazilian genetic services providing oncogenetic care is extremely low for the continental dimension of the country and its population. Therefore, at-risk patients do not receive appropriate assistance. This report describes the creation, structure and management of a cancer genetics service in a reference center for cancer prevention and treatment, the Barretos Cancer Hospital (BCH). The Oncogenetics Department (OD) of BCH offers, free of charge, to all patients/relatives with clinical criteria, the possibility to perform i) genetic counseling, ii) preventive examinations and iii) genetic testing with the best quality standards. The OD has a multidisciplinary team and is integrated with all specialties. The genetic counseling process consists (mostly) of two visits. In 2014, 614 individuals (371 families) were seen by the OD. To date, over 800 families were referred by the OD for genetic testing. The support provided by the Oncogenetics team is crucial to identify at-risk individuals and to develop preventive and personalized behaviors for each situation, not only to the upper-middle class population, but also to the people whose only possibility is the public health system.
Ângelo Zambam de MATTOS
Full Text Available ABSTRACT Background - Terlipressin and noradrenaline are the best studied treatments for hepatorenal syndrome, and there is no evidence of superiority of one over the other regarding to efficacy. While the former drug is more costly, the latter requires admission into an intensive care unit. Objective - The aim of this study was to perform an economic evaluation, comparing treatments for hepatorenal syndrome with terlipressin and noradrenaline. Methods - For the economic evaluation, a cost-minimization analysis was performed. Direct medical costs of the two treatment strategies were compared under the perspective of the Brazilian Public Health System as the third-party payer. A probabilistic sensitivity analysis was performed. Results - The costs of treatments with terlipressin or noradrenaline were 287.77 and 2,960.45 International Dollars (Int$ respectively. Treatment using terlipressin would save Int$2,672.68 for the Public Health System for each hospital admission related to hepatorenal syndrome. In the probabilistic sensitivity analysis, it was verified that the cost of the treatment with noradrenaline could vary between Int$2,326.53 and Int$3,644.16, while costs related to the treatment using terlipressin are not variable. Conclusion - The treatment strategy using terlipressin was more economical than that using noradrenaline under the perspective of the Brazilian Public Health System as the third-party payer.
Ravioli, Antonio Franco; Soárez, Patrícia Coelho De; Scheffer, Mário César
The current study aimed to systematically analyze trends and priorities in the theoretical and conceptual approaches and empirical studies on specific health services management modalities in the Brazilian Unified National Health System. A narrative review of the literature identified, in 33 publications, the location and nature of services, management models, methodological procedures, and study outcomes. The research deals mainly with the models' conceptual and legal characteristics and management practices, in addition to addressing contracts, procurement, human resources, financing, and control mechanisms. In conclusion, the literature is limited and concentrated in the State of São Paulo, showing little theoretical diversity and methodological weaknesses, while it is nonconclusive as to the superiority of one management model over another. New evaluation studies are needed that are capable of comparing different models and assessing their performance and their effects on the quality of health services' provision, the population's health, and the health system's organization.
Ana Luiza d'Ávila Viana
Full Text Available Abstract: Technological innovations play a decisive role in societies' development by contributing to economic growth and the population's welfare. The state has a key role in this process by inducing innovative behavior, strategies, and decisions. This study addresses Brazil's current policy for development of the health industry and its effects on qualification of national public laboratories by contextualizing different cycles of interaction between health policy and the industrial base, discussing the government's development strategy and the transfer and absorption of health technology (through Industrial Development Partnerships, and presenting two current partnerships involving public laboratories in the production of medicines and vaccines.
Luciana Ribeiro Bahia
Full Text Available OBJECTIVE: To perform a cost-effectiveness analysis of medical treatment of benign prostatic hyperplasia (BPH under Brazilian public health system perspective (Unified Health System - "Sistema Único de Saúde (SUS". MATERIAL AND METHODS: A revision of the literature of the medical treatment of BPH using alpha-blockers, 5-alpha-reductase inhibitors and combinations was carried out. A panel of specialists defined the use of public health resources during episodes of acute urinary retention (AUR, the treatment and the evolution of these patients in public hospitals. A model of economic analysis(Markov predicted the number of episodes of AUR and surgeries (open prostatectomy and transurethral resection of the prostate related to BPH according to stages of evolution of the disease. Brazilian currency was converted to American dollars according to the theory of Purchasing Power Parity (PPP 2010: US$ 1 = R$ 1.70. RESULTS: The use of finasteride reduced 59.6% of AUR episodes and 57.9% the need of surgery compared to placebo, in a period of six years and taking into account a treatment discontinuity rate of 34%. The mean cost of treatment was R$ 764.11 (US$449.78 and R$ 579.57 (US$ 340.92 per patient in the finasteride and placebo groups, respectively. The incremental cost-effectiveness ratio (ICERs was R$ 4.130 (US$ 2.429 per episode of AUR avoided and R$ 2.735 (US$ 1.609 per episode of surgery avoided. The comparison of finasteride + doxazosine to placebo showed a reduction of 75.7% of AUR episodes and 66.8% of surgeries in a 4 year time horizon, with a ICERs of R$ 21.191 (US$ 12.918 per AUR episodes avoided and R$ 11.980 (US$ 7.047 per surgery avoided. In the sensitivity analysis the adhesion rate to treatment and the cost of finasteride were the main variables that influenced the results. CONCLUSIONS: These findings suggest that the treatment of BPH with finasteride is cost-effective compared to placebo in the Brazilian public health system
David Provenzale Titinger
Full Text Available Abstract Background: Heart surgery has developed with increasing patient complexity. Objective: To assess the use of resources and real costs stratified by risk factors of patients submitted to surgical cardiac procedures and to compare them with the values reimbursed by the Brazilian Unified Health System (SUS. Method: All cardiac surgery procedures performed between January and July 2013 in a tertiary referral center were analyzed. Demographic and clinical data allowed the calculation of the value reimbursed by the Brazilian SUS. Patients were stratified as low, intermediate and high-risk categories according to the EuroSCORE. Clinical outcomes, use of resources and costs (real costs versus SUS were compared between established risk groups. Results: Postoperative mortality rates of low, intermediate and high-risk EuroSCORE risk strata showed a significant linear positive correlation (EuroSCORE: 3.8%, 10%, and 25%; p < 0.0001, as well as occurrence of any postoperative complication EuroSCORE: 13.7%, 20.7%, and 30.8%, respectively; p = 0.006. Accordingly, length-of-stay increased from 20.9 days to 24.8 and 29.2 days (p < 0.001. The real cost was parallel to increased resource use according to EuroSCORE risk strata (R$ 27.116,00 ± R$ 13.928,00 versus R$ 34.854,00 ± R$ 27.814,00 versus R$ 43.234,00 ± R$ 26.009,00, respectively; p < 0.001. SUS reimbursement also increased (R$ 14.306,00 ± R$ 4.571,00 versus R$ 16.217,00 ± R$ 7.298,00 versus R$ 19.548,00 ± R$935,00; p < 0.001. However, as the EuroSCORE increased, there was significant difference (p < 0.0001 between the real cost increasing slope and the SUS reimbursement elevation per EuroSCORE risk strata. Conclusion: Higher EuroSCORE was related to higher postoperative mortality, complications, length of stay, and costs. Although SUS reimbursement increased according to risk, it was not proportional to real costs.
Viana, Ana Luiza d'Ávila; Silva, Hudson Pacifico da; Ibañez, Nelson; Iozzi, Fabíola Lana
Technological innovations play a decisive role in societies' development by contributing to economic growth and the population's welfare. The state has a key role in this process by inducing innovative behavior, strategies, and decisions. This study addresses Brazil's current policy for development of the health industry and its effects on qualification of national public laboratories by contextualizing different cycles of interaction between health policy and the industrial base, discussing the government's development strategy and the transfer and absorption of health technology (through Industrial Development Partnerships), and presenting two current partnerships involving public laboratories in the production of medicines and vaccines. Resumo: As inovações tecnológicas jogam papel decisivo no processo de desenvolvimento das sociedades, visto que contribuem para gerar crescimento econômico e bem-estar da população. O Estado possui grande importância e centralidade nesse processo, pois pode induzir fortemente o comportamento, as estratégias e as decisões relativas à inovação. O presente artigo tem por objetivo investigar a atual política de desenvolvimento produtivo em saúde no Brasil e seus reflexos sobre a capacitação dos laboratórios públicos nacionais. Para essa finalidade, contextualiza os diferentes ciclos de interação entre a política de saúde e a sua base produtiva, discute a estratégia do governo brasileiro para o desenvolvimento, a transferência e a absorção de tecnologia na área da saúde (as parcerias para o desenvolvimento produtivo) e apresenta duas parcerias vigentes envolvendo laboratórios públicos para a produção de medicamentos e vacinas.
A discourse analysis carried out on basic operating standard Norma Operacional Básica do Sistema Unico de Saúde (NOB-SUS 01/96) of the Brazilian public health care system aiming at locating signs that could allow to identify lines of thought which have influenced health care policies prioritized by the federal administration. The author points out a peculiarity in the kind of discourse employed by the ministry directive: its structure is based on isolated aspects of legislation and on ideas advocated by other discourse communities, articulated with redefined legal principles - an effort towards authorizing the official reasoning in favor of the relevance in keeping the decentralization process under the control of the federal administration. The analysis concludes that an infra-legal standard can neither grant state and federal administrations a hierarchical superiority (mediation function) over municipal administrations, nor can it transfer the legal responsibilities pertaining to Health Councils over to inter-administration commissions (Comissões Intergestores) , thus making the former mere decision ratifiers. This study found that granting privileges not contemplated in the legislation to state and federal administrations surfaced again and more strongly so in 2001 in yet another operating standard.
Varela, Patrícia Louise Rodrigues; de Oliveira, Rosana Rosseto; Melo, Emiliana Cristina; Mathias, Thais Aidar de Freitas
ABSTRACT Objective: to analyze the prevalence of pregnancy complications and sociodemographic profile of puerperal patients with complications, according to the form of financing of the childbirth service. Method: cross-sectional study with interview of 928 puerperal women whose childbirth was financed by the Unified Health System, health plans and private sources (other sources than the Unified Health System). The sample was calculated based on the births registered in the Information System on Live Births, stratified by hospital and form of financing of the childbirth service. Data were analyzed using the chi-square and Fisher’s exact tests. Results: the prevalence was 87.8% for all puerperal women, with an average of 2.4 complications per woman. In the case of deliveries covered by the Unified Health System, urinary tract infection (38.2%), anemia (26.0%) and leucorrhea (23.5%) were more frequent. In turn, vaginal bleeding (26.4%), urinary tract infection (23.9%) and leucorrhoea (23.7%) were prevalent in deliveries that were not covered by the Unified Health System. Puerperal women that had their delivery covered by the Unified Health System reported a greater number of intercurrences related to infectious diseases, while women who used health plans and private sources reported intercurrences related to chronic diseases. A higher frequency of puerperal adolescents, non-white women, and women without partner among those assisted in the Unified Health System (p < 0.001). Conclusion: the high prevalence of complications indicates the need for monitoring and preventing diseases during pregnancy, especially in the case of pregnant women with unfavorable sociodemographic characteristics. PMID:29319740
Patrícia Louise Rodrigues Varela
Full Text Available ABSTRACT Objective: to analyze the prevalence of pregnancy complications and sociodemographic profile of puerperal patients with complications, according to the form of financing of the childbirth service. Method: cross-sectional study with interview of 928 puerperal women whose childbirth was financed by the Unified Health System, health plans and private sources (other sources than the Unified Health System. The sample was calculated based on the births registered in the Information System on Live Births, stratified by hospital and form of financing of the childbirth service. Data were analyzed using the chi-square and Fisher’s exact tests. Results: the prevalence was 87.8% for all puerperal women, with an average of 2.4 complications per woman. In the case of deliveries covered by the Unified Health System, urinary tract infection (38.2%, anemia (26.0% and leucorrhea (23.5% were more frequent. In turn, vaginal bleeding (26.4%, urinary tract infection (23.9% and leucorrhoea (23.7% were prevalent in deliveries that were not covered by the Unified Health System. Puerperal women that had their delivery covered by the Unified Health System reported a greater number of intercurrences related to infectious diseases, while women who used health plans and private sources reported intercurrences related to chronic diseases. A higher frequency of puerperal adolescents, non-white women, and women without partner among those assisted in the Unified Health System (p < 0.001. Conclusion: the high prevalence of complications indicates the need for monitoring and preventing diseases during pregnancy, especially in the case of pregnant women with unfavorable sociodemographic characteristics.
Ciulla, Leandro; Lopes Nogueira, Eduardo; da Silva Filho, Irenio Gomes; Tres, Guilherme Levi; Engroff, Paula; Ciulla, Veronica; Cataldo Neto, Alfredo
Examine prevalence and level of suicide risk, and its associations with sociodemographic factors and mood disorders. A cross-sectional study with a random sample of 530 individuals aged 60 years or more from Family Health Strategy of Porto Alegre, Brazil. Diagnosis was made by psychiatrists using the Mini International Neuropsychiatric Interview plus (MINIplus). Suicide risk was found in 15.7% of the sample. Female gender, elderly with no income or with no paid activity and those who have lost one or more of his sons presented association with suicide risk. Bipolar disorder shows association with suicide risk for those with or without current episode. For unipolar depression only elderly with a current episode shows association with suicide risk. The cross-sectional design limits the examination of causative relationships. The MINIplus questions are not broad enough to assess other important self-destructive behaviors. A high rate of suicide risk was found. As expected an increased rate of mood disorders were related to the risk of suicide. The loss of sons may partly explain a subtype of late-life risk of suicide or mood disorders especially in the oldest-old. These findings can be a useful to generate other research hypothesis and for health professionals who care older persons. Detecting characteristics linked to suicide, therefore opening up the possibility of preventing tragic outcomes providing a proper treatment. Crown Copyright © 2013 Published by Elsevier B.V. All rights reserved.
Leite, Valéria Rodrigues; Lima, Kenio Costa; de Vasconcelos, Cipriano Maia
This article investigates the issue of funding and the decentralization process in order to examine the composition, application and management of resources in the healthcare area. The sample surveyed involved 14 municipalities in the state of Rio Grande do Norte, Brazil. The research involved data gathering of financial transfers, the municipality's own resources and primary healthcare expenses. Management analysis included a survey of local managers and counselors. It was seen that the Unified Health System is funded mainly by federal transfers and municipal revenues and to a far lesser extent by state resources. Funds have been applied predominantly in primary healthcare. The management process saw centralization of actions in the city governments. Municipal secretarial offices and councils comply partially with legislation, though they have problems with autonomy and social control. The results show that planning and management instruments are limited, due to the contradictions inherent to the institutional, political and cultural context of the region.
Full Text Available Abstract Background Obesity is a major global epidemic and a burden to society and health systems. It is well known risk factor for a number of chronic medical conditions with high morbidity and mortality. This study aimed to provide an estimate of the direct costs associated to outpatient and inpatient care of overweight and obesity related diseases in the perspective of the Brazilian Health System (SUS. Methods Population attributable risk (PAR was calculated for selected diseases related to overweight and obesity and with the following parameters: Relative risk (RR ≥ 1.20 or RR ≥1.10 and Results The estimated total costs in one year with all diseases related to overweight and obesity are US$ 2,1 billion; US$ 1,4 billion (68.4% of total costs due to hospitalizations and US$ 679 million due to ambulatory procedures. Approximately 10% of these cost is attributable to overweight and obesity. Conclusion The results confirm that overweight and obesity carry a great economic burden for Brazilian health system and for the society. The knowledge of these costs will be useful for future economic analysis of preventive and treatment interventions.
Pinho, Natália de Alencar; Pierin, Angela Maria Geraldo, E-mail: firstname.lastname@example.org [Universidade de São Paulo, Escola de Enfermagem, São Paulo, SP (Brazil)
Hypertension is a major public health problem due to its high prevalence and cardiovascular complications. Its treatment is aimed at reducing cardiovascular morbidity and mortality, its goal being to maintain blood pressure levels below 140/90 mm Hg. Hypertension control in Brazil is low, and nationwide rates are unknown. The objective of this review was to provide an overview on hypertension control in Brazil from publications in a database. We identified 45 publications. In population-based studies, the highest control rate (57.6%) was reported in a multicenter study in 100 municipalities and the city of São José do Rio Preto, São Paulo state (52.4%), while the lowest rates (around 10%) were identified in microregions of the Rio Grande do Sul state and in the city of Tubarão, Santa Catarina state. In conclusion, the studies assessed showed a wide variation in hypertension control rates. It is worth noting that the comparison between studies was a major limiting factor, because of the different methods used.
Pinho, Natália de Alencar; Pierin, Angela Maria Geraldo
Hypertension is a major public health problem due to its high prevalence and cardiovascular complications. Its treatment is aimed at reducing cardiovascular morbidity and mortality, its goal being to maintain blood pressure levels below 140/90 mm Hg. Hypertension control in Brazil is low, and nationwide rates are unknown. The objective of this review was to provide an overview on hypertension control in Brazil from publications in a database. We identified 45 publications. In population-based studies, the highest control rate (57.6%) was reported in a multicenter study in 100 municipalities and the city of São José do Rio Preto, São Paulo state (52.4%), while the lowest rates (around 10%) were identified in microregions of the Rio Grande do Sul state and in the city of Tubarão, Santa Catarina state. In conclusion, the studies assessed showed a wide variation in hypertension control rates. It is worth noting that the comparison between studies was a major limiting factor, because of the different methods used
Bosi, Maria Lúcia Magalhães
This article analyzes some challenges for knowledge output in the human and social sciences in the public health field, under the current academic assessment model in Brazil. The article focuses on the qualitative research approach in human and social sciences, analyzing its status in comparison to the other traditions vying for hegemony in the public health field, conjugating the dialogue with the literature, especially the propositions pertaining to the social fields present in the work of Pierre Bourdieu, with elements concerning the field's dynamics, including some empirical data. Challenges identified in the article include hurdles to interdisciplinary dialogue and equity in the production of knowledge, based on recognition of the founding place of human and social sciences in the public health field. The article discusses strategies to reshape the current correlation of forces among centers of knowledge in public health, especially those capable of impacting the committees and agendas that define the accumulation of symbolic and economic capital in the field.
Fontes, Maria Lucineide Andrade
this article presents the results of research to monitor the Brazilian printed media in order to identify the stance of the abortion issue during the period from July 6 to October 29, 2010, which was the period of the official presidential campaign in Brazil. based on the monitoring of 28 printed media vehicles (newspapers and magazines) with nationwide circulation, the research selected 464 texts, of which 434 were considered valid for the study. The media studied included stories, reports, notes, opinion columns, interviews and letters from readers. although abortion was widely mentioned in Brazilian news coverage of the presidential campaign in 2010, with an average of four texts published per day, the stance adopted for the issue was not from the standpoint of public health. Among the 434 texts analyzed, only one report explicitly addressed epidemiological data linking abortion to women's health. In the other texts, the positioning of abortion was guided by the electoral stance that associated it with the dispute for the votes of the religious communities and conservative voters.
Full Text Available Marcio Machado,1 Thomas R Einarson21GlaxoSmithKline Brasil Ltd, Rio de Janeiro, Brazil; 2Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, CanadaObjective: To evaluate, from the perspective of the Brazilian public health care system, the cost-effectiveness of lapatinib plus capecitabine (LAP/CAP versus capecitabine alone (CAP or trastuzumab plus capecitabine (TRAST/CAP in the treatment of women with human epidermal growth factor receptor-2-positive metastatic breast cancer previously treated with trastuzumab.Methods: An economic model was developed to compare costs and clinical outcomes over a 5-year time horizon. Both costs and outcomes were discounted at a 5% rate, in accordance with Brazilian pharmacoeconomic guidelines. Clinical inputs were determined using indirect treatment comparisons. Costs were derived from public reimbursement databases and reported in 2010 Brazilian real (R$1 = USD$0.52. Clinical outcomes included progression-free survival years (PFYs, life-years (LYs and quality-adjusted life-years (QALYs. The economic outcome was the incremental cost per LY, PFY, or QALY gained. The impact of variations in individual inputs (eg, drug cost, drug effectiveness was examined using one-way sensitivity analyses. Overall model robustness was tested using probabilistic sensitivity analyses, varying the ranges of all input parameters within their standard distributions.Results: Expected cost per patient was R$41,195 for CAP, R$95,256 for LAP/CAP, and R$113,686 for TRAST/CAP. Respective LYs were 1.406, 1.695, and 1.465; PFYs were 0.473, 0.711, and 0.612; and QALYS were 0.769, 0.958, and 0.827. LAP/CAP dominated TRAST/CAP for all outcomes. Incremental cost-effectiveness ratios of LAP/CAP over CAP were R$186,563 for LYs, R$226,403 for PFYs, and R$284,864 for QALYs. Results remained unchanged in one-way sensitivity analyses. In probabilistic analyses, LAP/CAP was dominant over TRAST/CAP in 93.5% of simulations.Conclusion: LAP
Berg, van den A.E.
Agnes van den Berg wrote an essay about human health and nature, establishing that subject as an important policy argument in developing (urban) nature in the Netherlands. She studied the public balance of fear and fascination for nature, summarising benefits on human health. In this chapter, she
Full Text Available The aim of this paper is to determine whether it is necessary to increase available resources to local governments or if better use of these funds is sufficient. The paper contributes to the literature by looking both at the supply and demand for public health services. If the demand is estimated correctly, one can compare its expected value to actual health expenditures. Even if actual expenditures are lower than the estimated demand, it is not certain that additional spending is necessary. If the efficiency scores (supply side indicate that local governments can simply “save” resources to make up for the difference, then it is possible to reduce (or bring to zero new resources only by requiring local governments to efficiently manage their expenditures. Since municipalities in Brazil are very heterogeneous, we estimate their efficiency using the metafrontier approach (O’Donnell et al., 2008, while we estimate the demand through an equation derived from the median voter theorem model. Using 2010 data, we find evidence that efficient management of spending is sufficient to meet excess demand for goods and services in the health sector.
Martins, Aline de Carvalho; Barros, Geiza Martins
ABSTRACT BACKGROUND AND OBJECTIVES: The study aimed at providing further visibility to discussions about obstetric violence suffered by Brazilian women in public health institutions. CONTENTS: This was an integrative review of the last decade, where 100 articles were evaluated to identify how Obstetric Violence is in Brazilian public health units. CONCLUSION: Identified obstetric violences were: institutional violence, moral violence, physical violence, sexual violence, psychological and v...
Fabiola Sulpino Vieira
Full Text Available This article deals with the organization of pharmaceutical assistance within the Brazilian Public Unified Health System (Sistema Único de Saúde, SUS by analyzing the progress made so far and the challenges that still must be faced to ensure the right to universal therapeutic and pharmaceutical coverage in Brazil. Among the improvements, the article discusses the National List of Essential Drugs and its role to guide the supply, prescription, and dispensing of drugs within SUS. The structure of federal funding and the existing pharmaceutical programs are described, as well as the responsibilities of the Federal Government, states, and municipalities concerning allocation of financial resources. Despite the progress made, the model of access to SUS drugs has not been successful in securing universal therapeutic assistance. It is essential to consider a type of funding and organization of pharmaceutical assistance that is driven by a notion of regionalization, with financing based on health care flows rather than on the population circumscribed to a given territory. It is also essential to qualify pharmaceutical management by hiring pharmacists and support personnel, professionalizing workers, and setting up facilities with appropriate information systems and equipment.
Dias, Marcos Augusto Bastos; Domingues, Rosa Maria Soares Madeira; Schilithz, Arthur Orlando Corrêa; Nakamura-Pereira, Marcos; do Carmo Leal, Maria
The rate of cesarean delivery (CD) in Brazil has increased over the past 40 years. The CD rate in public services is three times above the World Health Organization recommended values. Among strategies to reduce CD, the most important is reduction of primary cesarean. This study aimed to describe factors associated with CD during labor in primiparous women with a single cephalic pregnancy assisted in the Brazilian Public Health System (SUS). This study is part of the Birth in Brazil survey, a national hospital-based study of 23,894 postpartum women and their newborns. The rate of CD in primiparous women was estimated. Univariate and multivariable logistic regression was performed to analyze factors associated with CD during labor in primiparous women with a single cephalic pregnancy, including estimation of crude and adjusted odds ratios and their respective 95 % confidence intervals. The analyzed data are related to the 2814 eligible primiparous women who had vaginal birth or CD during labor in SUS hospitals. In adjusted analyses, residing in the Southeast region was associated with lower CD during labor. Occurrence of clinical and obstetric conditions potentially related to obstetric emergencies before delivery, early admission with women cared for by at least one nurse midwife. The CD rate in primiparous women in SUS in Brazil is extremely high and can compromise the health of these women and their newborns. Information and support for vaginal birth during antenatal care, avoiding early admission, and promoting the use of good practices during labor assistance can reduce unnecessary CD. Considering the experience of other countries, incorporation of nurse midwives in childbirth care may increase the use of good practices during labor.
Nine Brazilian scientists with an outstanding profile of international publications were invited to publish an original article in the same issue of a Brazilian Journal (Anais da Academia Brasileira de Ciências). The objective was to measure the impact of the papers on the number of citations to the articles, the assumption being that these authors would carry their international prestige to the Brazilian periodical. In a 2-year period there was a larger number of citations of these articles compared to others published in the same journal. Nevertheless, the number of citations in Brazilian journals did not equal the number of citations obtained by the other papers by the same authors in their international publications within the same 2-year period. The reasons for this difference in the number of citations could be either that less significant invited articles were submitted or that it was due to the intrinsic lack of visibility of the Brazilian journals, but this could not be fully determined with the present data. Also relevant was a comparison between the citations of Brazilian journals and the publication in Brazilian journals by these selected authors. A clear imbalance due to a remarkable under-citation of Brazilian authors by authors publishing in Brazilian journals raises the possibility that psychological factors may affect the decision of citing Brazilian journals.
Tatiana de Cássia Nakano
Full Text Available The definition of giftedness is related to the existence of high abilities in several and different fields and involves the study of process as intelligence, motivation, creativity and leadership. Due to the lack of research in this area, the present study aimed to review researches about giftedness on Brazilian periodic publications, in two databases: Scielo and Pepsic. The results pointed to the existence of 19 theorical and empiric articles, published between 2002 and 2009, that approached distinct dimensions of giftedness: conceptual definitions, models and forms of identification, models of attendance, Brazilian laws to guide the performance, researches with teachers, family and school environment, studies of cognitive, social and emotional dimension, finally behaviors and emotional disorders related to the giftedness. The articles analysis allowed concluding the recent interest for the theme, it was observed divergences in the definition of the concept, the lack of specific tests, with validity and standards, beyond the recognition of the importance of the school environment and the psychologis
Rocha, Luiz Roberto Martins; Veiga, Daniela Francescato; e Oliveira, Paulo Rocha; Song, Elaine Horibe; Ferreira, Lydia Masako
The Health Service Quality Scale is a multidimensional hierarchical scale that is based on interdisciplinary approach. This instrument was specifically created for measuring health service quality based on marketing and health care concepts. The aim of this study was to translate and culturally adapt the Health Service Quality Scale into Brazilian Portuguese and to assess the validity and reliability of the Brazilian Portuguese version of the instrument. We conducted a cross-sectional, observational study, with public health system patients in a Brazilian university hospital. Validity was assessed using Pearson's correlation coefficient to measure the strength of the association between the Brazilian Portuguese version of the instrument and the SERVQUAL scale. Internal consistency was evaluated using Cronbach's alpha coefficient; the intraclass (ICC) and Pearson's correlation coefficients were used for test-retest reliability. One hundred and sixteen consecutive postoperative patients completed the questionnaire. Pearson's correlation coefficient for validity was 0.20. Cronbach's alpha for the first and second administrations of the final version of the instrument were 0.982 and 0.986, respectively. For test-retest reliability, Pearson's correlation coefficient was 0.89 and ICC was 0.90. The culturally adapted, Brazilian Portuguese version of the Health Service Quality Scale is a valid and reliable instrument to measure health service quality.
Background The Health Service Quality Scale is a multidimensional hierarchical scale that is based on interdisciplinary approach. This instrument was specifically created for measuring health service quality based on marketing and health care concepts. The aim of this study was to translate and culturally adapt the Health Service Quality Scale into Brazilian Portuguese and to assess the validity and reliability of the Brazilian Portuguese version of the instrument. Methods We conducted a cross-sectional, observational study, with public health system patients in a Brazilian university hospital. Validity was assessed using Pearson’s correlation coefficient to measure the strength of the association between the Brazilian Portuguese version of the instrument and the SERVQUAL scale. Internal consistency was evaluated using Cronbach’s alpha coefficient; the intraclass (ICC) and Pearson’s correlation coefficients were used for test-retest reliability. Results One hundred and sixteen consecutive postoperative patients completed the questionnaire. Pearson’s correlation coefficient for validity was 0.20. Cronbach's alpha for the first and second administrations of the final version of the instrument were 0.982 and 0.986, respectively. For test-retest reliability, Pearson’s correlation coefficient was 0.89 and ICC was 0.90. Conclusions The culturally adapted, Brazilian Portuguese version of the Health Service Quality Scale is a valid and reliable instrument to measure health service quality. PMID:23327598
Marcos Augusto Bastos Dias
Full Text Available Abstract Background The rate of cesarean delivery (CD in Brazil has increased over the past 40 years. The CD rate in public services is three times above the World Health Organization recommended values. Among strategies to reduce CD, the most important is reduction of primary cesarean. This study aimed to describe factors associated with CD during labor in primiparous women with a single cephalic pregnancy assisted in the Brazilian Public Health System (SUS. Methods This study is part of the Birth in Brazil survey, a national hospital-based study of 23,894 postpartum women and their newborns. The rate of CD in primiparous women was estimated. Univariate and multivariable logistic regression was performed to analyze factors associated with CD during labor in primiparous women with a single cephalic pregnancy, including estimation of crude and adjusted odds ratios and their respective 95 % confidence intervals. Results The analyzed data are related to the 2814 eligible primiparous women who had vaginal birth or CD during labor in SUS hospitals. In adjusted analyses, residing in the Southeast region was associated with lower CD during labor. Occurrence of clinical and obstetric conditions potentially related to obstetric emergencies before delivery, early admission with < 4 cm of dilatation, a decision late in pregnancy for CD, and the use of analgesia were associated with a greater risk for CD. Favorable advice for vaginal birth during antenatal care, induction of labor, and the use of any good practices during labor were protective factors for CD. The type of professional who attended birth was not significant in the final analyses, but bivariate analysis showed a higher use of good practices and a smaller proportion of epidural analgesia in women cared for by at least one nurse midwife. Conclusions The CD rate in primiparous women in SUS in Brazil is extremely high and can compromise the health of these women and their newborns
Thiago Vinícius Nadaleto Didone
Full Text Available Objectives: To uncover reasons why patients missed pharmaceutical care (PC appointments, identify predictive factors to miss at least one appointment and to reschedule after a miss, and compare the rescheduling behavior of patients receiving different types of PC. Methods: All elderly patients who had at least one scheduled appointment in the PC service of a health setting of São Paulo city, Brazil, from January to December/2011 were included. Chi-square analysis compared categorical data between groups; multivariate logistic regression models predicted attendance and rescheduling behavior. Results: We identified 421 patients, being 221 (52.5% non-attenders. Forgetting the appointment was the most common patient-related reason (56.3%. Illiteracy was a risk factor to be a non-attender [OR(95%CI=2.27(1.17:4.40, p=0.015]. Patients having previous knowledge of the pharmacist presented more chance to rescheduled an appointment after the first miss compared to those who had not [OR(95%CI=3.57(1.90:6.71, p<0.001]. Further, non-attenders who had knowledge of the pharmacist and received Medication Review with Follow-up rescheduled more than the ones receiving other types of PC (p=0.035. Conclusion: Illiteracy predicted non-attendance in PC to aged outpatients and forgetfulness was the main reason for that. The previous acquaintance of the pharmacist and the provision of pharmaceotherapeutic follow-up explained the rescheduling behavior, which indicates the establishment of a patient-centered patient-pharmacist relationship plays a pivotal role in the continuity of the PC.
Fabiola Sulpino Vieira
Full Text Available Objetivos. Descrever e discutir a evolução do financiamento da assistência farmacêutica no Sistema Único de Saúde - SUS. Métodos. Foram identificados os valores alocados para aquisição de medicamentos, para o Programa Farmácia Popular e para estruturação de serviços farmacêuticos públicos. Os valores referentes ao financiamento da União, por meio do Ministério da Saúde, foram obtidos do sistema Siga Brasil e, dos Estados, do Distrito Federal e dos municípios, do Sistema de Informações sobre Orçamentos Públicos em Saúde - SIOPS. Resultados. Entre 2005 e 2009 houve aumento de 65,3% nos recursos financeiros da União para aquisição de medicamentos. No mesmo período, ampliou-se o volume de transferências feitas às esferas subnacionais. Verificou-se que os Estados e o Distrito Federal aumentaram em 112,4% o volume de recursos próprios alocados no financiamento de medicamentos e que para os municípios este crescimento foi de 22,7%. Em 2008, a participação das despesas com medicamentos em relação às despesas com saúde foi de 7,8%. O gasto total com medicamentos em 2009 foi de 8,9 bilhões de reais. Observou-se aumento de 20,6 vezes no valor alocado no Programa Farmácia Popular e, no caso dos recursos destinados à estruturação de serviços, crescimento de 41,6%, chegando a 10,1 milhões de reais em 2009. Conclusão: Houve ampliação do financiamento de medicamentos no SUS entre 2005 e 2009.Objectives. To describe and discuss developments in the financing of pharmaceutical services in the Brazilian public health system - SUS. Methods. The amounts allocated for drug procurement, for the Farmácia Popular Program and for structuring of public pharmaceutical services were identified. The values regarding the financing of the Federal government were obtained from the Siga Brasil database. Data regarding states, Federal District and municipalities were obtained from Information System on Public Health Budget - SIOPS
Loureiro, Luiz Victor Maia; Callegaro, Donato; Rocha, Altieres de Arruda; Prado, Bernard Lobato; Mutão, Taciana Sousa; Donnarumma, Carlos del Cistia; del Giglio, Auro
ABSTRACT Objective: To investigate whether Brazilian articles on cancer are published in journals with an impact factor and/or repercussion (measured by the number of citations) inferior to those that come from foreign organizations. Methods: A search was carried out in PubMed for the MeSH term “neoplasm” with the limits clinical trial, affiliation of the Brazilian author(s), and interval from July 1st, 2009 to June 30, 2010. Selected for matching were non-Brazilian related articles published from three months prior to three months after the date of publication of the Brazilian study. The numbers of citations were obtained from two databases, as well as the impact factor for the journals in which the articles were published. Results: Fortythree national and 876 related international articles were identified. The Brazilian publications had a mean impact factor of 3.000 versus 3.430 of the international ones (p=0.041). There was no statistically significant difference as to the number of citations between the two groups. The affiliation of the first author with a Brazilian or foreign organization did not significantly influence the number of citations or the impact factor. Conclusion: Brazilian articles are significantly less accepted in journals with higher impact factors, although it does not compromise its repercussion on the scientific community. PMID:23579739
ian health ministry, and the Canadian. International ... Tanzanian and Canadian researchers began work on ... information on the major causes of death ... The effects have been dramatic. Accord- ... destroy mosquito breeding grounds, such.
Ribeiro, Rodrigo Antonini; Duncan, Bruce Bartholow; Ziegelmann, Patricia Klarmann; Stella, Steffan Frosi; Vieira, Jose Luiz da Costa; Restelatto, Luciane Maria Fabian; Polanczyk, Carisi Anne
Statins have proven efficacy in the reduction of cardiovascular events, but the financial impact of its widespread use can be substantial. To conduct a cost-effectiveness analysis of three statin dosing schemes in the Brazilian Unified National Health System (SUS) perspective. We developed a Markov model to evaluate the incremental cost-effectiveness ratios (ICERs) of low, intermediate and high intensity dose regimens in secondary and four primary scenarios (5%, 10%, 15% and 20% ten-year risk) of prevention of cardiovascular events. Regimens with expected low-density lipoprotein cholesterol reduction below 30% (e.g. simvastatin 10mg) were considered as low dose; between 30-40%, (atorvastatin 10mg, simvastatin 40mg), intermediate dose; and above 40% (atorvastatin 20-80mg, rosuvastatin 20mg), high-dose statins. Effectiveness data were obtained from a systematic review with 136,000 patients. National data were used to estimate utilities and costs (expressed as International Dollars - Int$). A willingness-to-pay (WTP) threshold equal to the Brazilian gross domestic product per capita (circa Int$11,770) was applied. Low dose was dominated by extension in the primary prevention scenarios. In the five scenarios, the ICER of intermediate dose was below Int$10,000 per QALY. The ICER of the high versus intermediate dose comparison was above Int$27,000 per QALY in all scenarios. In the cost-effectiveness acceptability curves, intermediate dose had a probability above 50% of being cost-effective with ICERs between Int$ 9,000-20,000 per QALY in all scenarios. Considering a reasonable WTP threshold, intermediate dose statin therapy is economically attractive, and should be a priority intervention in prevention of cardiovascular events in Brazil
Rodrigo Antonini Ribeiro
Full Text Available Background: Statins have proven efficacy in the reduction of cardiovascular events, but the financial impact of its widespread use can be substantial. Objective: To conduct a cost-effectiveness analysis of three statin dosing schemes in the Brazilian Unified National Health System (SUS perspective. Methods: We developed a Markov model to evaluate the incremental cost-effectiveness ratios (ICERs of low, intermediate and high intensity dose regimens in secondary and four primary scenarios (5%, 10%, 15% and 20% ten-year risk of prevention of cardiovascular events. Regimens with expected low-density lipoprotein cholesterol reduction below 30% (e.g. simvastatin 10mg were considered as low dose; between 30-40%, (atorvastatin 10mg, simvastatin 40mg, intermediate dose; and above 40% (atorvastatin 20-80mg, rosuvastatin 20mg, high-dose statins. Effectiveness data were obtained from a systematic review with 136,000 patients. National data were used to estimate utilities and costs (expressed as International Dollars - Int$. A willingness-to-pay (WTP threshold equal to the Brazilian gross domestic product per capita (circa Int$11,770 was applied. Results: Low dose was dominated by extension in the primary prevention scenarios. In the five scenarios, the ICER of intermediate dose was below Int$10,000 per QALY. The ICER of the high versus intermediate dose comparison was above Int$27,000 per QALY in all scenarios. In the cost-effectiveness acceptability curves, intermediate dose had a probability above 50% of being cost-effective with ICERs between Int$ 9,000-20,000 per QALY in all scenarios. Conclusions: Considering a reasonable WTP threshold, intermediate dose statin therapy is economically attractive, and should be a priority intervention in prevention of cardiovascular events in Brazil.
Ribeiro, Rodrigo Antonini, E-mail: email@example.com [Programa de Pós-Graduação em Epidemiologia da Universidade Federal do Rio Grande do Sul, Porto Alegre, RS (Brazil); Instituto de Avaliação de Tecnologia em Saúde, Porto Alegre, RS (Brazil); Duncan, Bruce Bartholow [Programa de Pós-Graduação em Epidemiologia da Universidade Federal do Rio Grande do Sul, Porto Alegre, RS (Brazil); Instituto de Avaliação de Tecnologia em Saúde, Porto Alegre, RS (Brazil); Programa de Pós-Graduação em Cardiologia da Universidade Federal do Rio Grande do Sul, Porto Alegre, RS (Brazil); Ziegelmann, Patricia Klarmann [Instituto de Avaliação de Tecnologia em Saúde, Porto Alegre, RS (Brazil); Departamento de Estatística da Universidade Federal do Rio Grande do Sul, Porto Alegre, RS (Brazil); Stella, Steffan Frosi [Instituto de Avaliação de Tecnologia em Saúde, Porto Alegre, RS (Brazil); Programa de Pós-Graduação em Cardiologia da Universidade Federal do Rio Grande do Sul, Porto Alegre, RS (Brazil); Vieira, Jose Luiz da Costa [Instituto de Cardiologia / Fundação Universitária de Cardiologia, Porto Alegre, RS (Brazil); Restelatto, Luciane Maria Fabian [Serviço de Medicina Interna do Hospital de Clínicas de Porto Alegre, Porto Alegre, RS (Brazil); Polanczyk, Carisi Anne [Programa de Pós-Graduação em Epidemiologia da Universidade Federal do Rio Grande do Sul, Porto Alegre, RS (Brazil); Instituto de Avaliação de Tecnologia em Saúde, Porto Alegre, RS (Brazil); Programa de Pós-Graduação em Cardiologia da Universidade Federal do Rio Grande do Sul, Porto Alegre, RS (Brazil)
Statins have proven efficacy in the reduction of cardiovascular events, but the financial impact of its widespread use can be substantial. To conduct a cost-effectiveness analysis of three statin dosing schemes in the Brazilian Unified National Health System (SUS) perspective. We developed a Markov model to evaluate the incremental cost-effectiveness ratios (ICERs) of low, intermediate and high intensity dose regimens in secondary and four primary scenarios (5%, 10%, 15% and 20% ten-year risk) of prevention of cardiovascular events. Regimens with expected low-density lipoprotein cholesterol reduction below 30% (e.g. simvastatin 10mg) were considered as low dose; between 30-40%, (atorvastatin 10mg, simvastatin 40mg), intermediate dose; and above 40% (atorvastatin 20-80mg, rosuvastatin 20mg), high-dose statins. Effectiveness data were obtained from a systematic review with 136,000 patients. National data were used to estimate utilities and costs (expressed as International Dollars - Int$). A willingness-to-pay (WTP) threshold equal to the Brazilian gross domestic product per capita (circa Int$11,770) was applied. Low dose was dominated by extension in the primary prevention scenarios. In the five scenarios, the ICER of intermediate dose was below Int$10,000 per QALY. The ICER of the high versus intermediate dose comparison was above Int$27,000 per QALY in all scenarios. In the cost-effectiveness acceptability curves, intermediate dose had a probability above 50% of being cost-effective with ICERs between Int$ 9,000-20,000 per QALY in all scenarios. Considering a reasonable WTP threshold, intermediate dose statin therapy is economically attractive, and should be a priority intervention in prevention of cardiovascular events in Brazil.
Department of Homeland Security — State and Local Public Health Departments in the United States Governmental public health departments are responsible for creating and maintaining conditions that...
Souza-Leal, Bruno; de-Carvalho, Carlos-Alberto; Antunes, Elton
This paper explores the capacity of the media to incorporate controversies in circulation in the public sphere. For that, it is based on the analysis of a set of 607 news stories about violence against women in context of gender relations and proximity, collected in nine Brazilian media during the years of 2013 and 2014. Recognized as one of the…
Fonseca, Franciele Fagundes; Sena, Ramony Kris R; dos Santos, Rocky Lane A; Dias, Orlene Veloso; Costa, Simone de Melo
To review and discuss childhood and adolescence vulnerabilities, as well as Brazilian public policies of intervention. A narrative review was performed, considering studies published between 1990 and 2012, found in the Virtual Health Library databases (Biblioteca Virtual em Saúde - BVS). A combination of the following descriptors was used in the search strategy: "Adolescent Health", "Child Health", "Health Public Politics" and "Vulnerability". In addition, Brazilian official documents, the Statute of the Child and the Adolescent, Guardianship Council, Bolsa Família and Saúde na Escola Programs were evaluated. The results were divided into five categories of analysis: Vulnerability of Children and Adolescents in Brazil, Public Politics of Intervention to Risk Factors in Childhood and Adolescence, the Statute of the Child and the Adolescent and Guardianship Council, Bolsa Família Program and Saúde na Escola Program. The studies show that children and adolescents are vulnerable to environmental and social situations. Vulnerabilities are exhibited in daily violence within families and schools, which results in the premature entrance of children and adolescents in the work environment and/or in the drug traffic. To deal with these problems, the Brazilian Government established the Statute of the Child and the Adolescent as well as social programs. Literature exposes the risks experienced by children and adolescents in Brazil. In the other hand, a Government endeavor was identified to eliminate or minimize the suffering of those in vulnerable situations through public policies targeted to this population group.
Felipe Peres Calheiros
Extension Assistance (Pnater, this article examines the relation of power between public policies and ethnic identities. It discusses how the reformulated concept of development influences government activity in rural contexts and the adoption of compensatory actions for excluded portions of the population. It briefly presents the social, legal and conceptual trajectory of the quilombos, localizing the dynamics of power in the construction of quilombola identity, a project in constant re-elaboration by Brazilian society.
Mermelstein, Claudia; Costa, Manoel Luis
The enormous amount of information available in cell biology has created a challenge in selecting the core concepts we should be teaching our undergraduates. One way to define a set of essential core ideas in cell biology is to analyze what a specific cell biology community is teaching their students. Our main objective was to analyze the cell biology content currently being taught in Brazilian universities. We collected the syllabi of cell biology courses from public universities in Brazil and analyzed the frequency of cell biology topics in each course. We also compared the Brazilian data with the contents of a major cell biology textbook. Our analysis showed that while some cell biology topics such as plasma membrane and cytoskeleton was present in ∼100% of the Brazilian curricula analyzed others such as cell signaling and cell differentiation were present in only ∼35%. The average cell biology content taught in the Brazilian universities is quite different from what is presented in the textbook. We discuss several possible explanations for these observations. We also suggest a list with essential cell biology topics for any biological or biomedical undergraduate course. The comparative discussion of cell biology topics presented here could be valuable in other educational contexts. © 2017 The Authors. Cell Biology International Published by John Wiley & Sons Ltd on behalf of International Federation of Cell Biology.
Rodolpho Repullo Junior
Full Text Available CONTEXT: Many authors have emphasized the importance of worker strength through unionized organizations, in relation to the improvement of working procedures, and have reported on the decisiveness of labor movement actions in achieving modifications within the field of work and health. OBJECTIVE: To describe the ways in which Brazilian unions have tried to intervene in health-illness and work processes, identifying the existence of commonality in union actions in this field. TYPE OF STUDY: Qualitative study. SETTING: Postgraduate Program, Environmental Health Department, Faculdade de Saúde Pública, Universidade de São Paulo, São Paulo, Brazil. METHODS: Union health advisers and directors were interviewed. Documents relating to union action towards protecting workers' health were collected and analyzed. RESULTS: Unions articulate actions regarding workers' health of a technical and political nature that involve many aspects and high complexity. These have been divided into thematic categories for better analysis. DISCUSSION: Union actions regarding workers' health in Brazil are restricted to some unions, located mainly in the southern, southeastern and northeastern regions of the country. Nonetheless, the unions undertaking such actions represent many professions of great economic and political importance. CONCLUSIONS: The recent changes in health and safety at work regulations, recognition of professional diseases, creation of workers' health services and programs within the unified health system, and operational improvements in companies' specialized safety and occupational medicine services, all basically result from union action. There is commonality of union action in this field in its seeking of technical and political strengthening for all workers and their general and local representation. This has the objective of benefiting collective bargaining between employers and workers. Inter-institutional action on behalf of workers' rights
Lokschin, F; Barros, F C
Tobacco plays a key role in both disease and the economy in Brazil. In 1981 about 135 billion cigarettes were smoked, and cigarette-related diseases far outnumber infections as the leading cause of death. Brazil is the 4th largest world producer and the 2nd largest exporter of tobacco. 2.1% of the total population -- 2.5 million people -- are maintained by tobacco-related activities. Cigarette sales taxes provide 11.6% of the country's total taxes. Involved in a deep economic crisis, Brazil depends on this revenue and has not introduced any measures to control or counteract the high pressure marketing of cigarette manufacturers. Ischemic heart disease is the leading cause of death in Brazil, taking 90,000 lives in 1979. Based on World Health Organization estimates, at least 25% of these deaths could be ascribed to smoking. Cancer is the 2nd largest cause of death. In 1979, 10% of 60,000 cancer deaths were from lung cancer. Based on estimate that 30% of cancer deaths are provoked by smoking, more than 20,000 of those deaths were caused by tobacco. In Brazil, lung cancer is the 2nd highest cause of death from cancer in men and 3rd among women. Smoking in Brazil is definitely associated with low birth weight, the single most important predictive factor of perinatal and infant mortality. Rural workers giving up subsistence crops to grow tobacco may also affect their children's health. Also in such low-income populations, expenditures for cigarettes leave less money for essential goods. As a result of the high tax rate and the enormous number of cigarettes sold, 11.6% of all the country's revenue comes from the tobacco industry. The Brazilian Association of Tobacco Industries has been trying to link cigarette sales to Brazilian social development but does not mention the cost of disease, disability, and early death provoked by smoking. In Brazil tobacco companies have a huge market free of constraints, and the country lacks consistent smoking control policies. Recently
Teresa Rodriguez Cao
Full Text Available This paper investigates changes in long-term operational and financial performance for a sample of Brazilian companies made initial public offerings (IPO's shares, in the period 2002-2008. This period showed a historically high number of IPOs, a heavily discontinued phenomenon with the international financial crisis of 2008. As performance measures were chosen six financial indicators usually adopted in the literature in periods of three years pre-IPO, year of listing and three years post-IPO. The indicators evaluated were size, growth rate, profitability, financial leverage, investment level and investment rate. The results show evidence that, on average, there were statistically significant improvements in size, profitability, investment level and investment rate. But there was no evidence statistically significant changes in the growth rate and financial leverage after the IPO of Brazilian firms.
Rafael Felipe Schiozer
Full Text Available This paper investigates the determinants of trade credit supply by Brazilian publicly traded companies between the years of 2005 and 2008. International literature (both theoretical and empirical documents that the main determinants of trade credit supply are the size of the firm and the size of its debt. Both indicate that the availability of resources to the firm is an important factor for the supply of trade credit. In addition, the literature confirms strategic uses of trade credit such as those for price discrimination purposes. The results obtained using a sample of 157 Brazilian companies do not support that size and indebtedness are relevant determinants for trade credit supply, but they confirm the supply of trade credit as a strategic tool for the firms. Additionally we observed a significant decrease in trade credit supply in 2008, the year in which a severe international financial crisis took place.
Maria Aparecida Gonçalves Melo Cunha
Full Text Available Objectives. To describe dental prosthesis provision in the Brazilian public health service and report the performance of dental prosthesis procedures according to the Brazilian macroregions. Methods. A structured interview was conducted with senior-level health professionals from each of the 18,114 oral health teams (OHT. The dependent variables were performance of removable prostheses and prosthesis procedures, including provision of fixed prostheses by OHT. Descriptive statistics were produced together with performing a cluster analysis using SPSS version 19.0. Results. The manufacture of any type of prosthesis was done by a minority of OHT (43%. The most commonly provided types of dental prosthesis were removable full and partial dentures. Cluster 1 (teams that performed prosthesis procedures the most was composed of a smaller number of teams (n = 5,531, and Cluster 2 (composed of teams that do not perform prosthetics or that perform them in small amounts consisted of 12,583 teams. The geographic distribution of clusters reveals that the largest proportion of Cluster 1 teams is located in the Northeast (33.9% and Southeast (33.6%. Conclusions. A minority of OHT produce dental prostheses. There is an unequal geographical distribution of clusters.
Débora Gomes Machado
Full Text Available The goal of this study is to identify characteristics, from the perspective of social networks, of the scientific literature on earning management in Brazilian accounting journals. Specifically, were identified: a authors and their social networks of scientific production; b researched topics, models for accruals detection, authors’ networks and the period studied; c methodological procedures used. A bibliometric survey, with a quantitative approach was performed through the analysis of 17 Brazilian accounting journals, since their first edition until the year 2010. Out of them, 10 published articles having the theme earning management in the title, abstract or keywords. The 32 identified articles were submitted to content analysis and then the data were presented from the perspective of social networks. The survey results show that: the authors and their social networks of production originates mostly from Universidade de São Paulo (USP; the most researched theme was the methods or means to conduct earnings management, and accruals measurement models, with emphasis on Kang and Sivaramakrishnan Model; the descriptive research, based on document and quantitative approach were the most commonly used forms in the articles researched. It is noteworthy that structural gaps are the topics, such as compensation plans, political costs and earnings management in different contractual environments. The research results can contribute to academia to highlight some features of the earnings management theme and its researchers, in the field of publications in Brazilian accounting journals.
Leite, Valéria Rodrigues; de Vasconcelos, Cipriano Maia; Lima, Kenio Costa
This article discusses the implications of decentralization in the light of international and Brazilian federalism, and its effects on public health policy. In a comparative analysis among countries, the authors find there is no single model; rather, each country has a unique structure of institutions and norms that have important implications for the operation of its health system. Brazil shares some similarities with other countries that have adopted a decentralized system and is assuming features ever closer to U.S. federalism, with a complex web of relationships. The degree of inequality among Brazilian municipalities and states, along with the budgetary imbalances caused by the minimal levels of resource utilization, undermines Brazil's constitutional principles and, consequently, its federalism. To ensure the constitutional mandate in Brazil, it is essential, as in other countries, to create a stable source of funds and increase the volume and efficiency of spending. Also important are investing in the training of managers, improving information systems, strengthening the principles of autonomy and interdependence, and defining patterns of cooperation within the federation.
Svendsen, Mette N.
of public health, made me re-evaluate both what ‘public’ and what ‘health’ means in public health. In this commentary I provide a short personal account of that intellectual journey. I argue that entanglements between species make it urgent that public health scholars investigate the moral, socio......Animals are rare topics in public health science texts and speech despite the fact that animal bodies and lives are woven into the health of human populations, and vice versa. Years of ethnographic and documentary research – following pigs and their humans in and out of biomedical research – made......-economic, material, and bacterial passages between humans and animals that constitute the various publics of public health and profoundly shape the health of human and animal populations in a globalized world....
This article investigates various ways that transportation policy and planning decisions affect public health and better ways to incorporate public health objectives into transport planning. Conventional planning tends to consider some public health impacts, such as crash risk and pollution emissions measured per vehicle-kilometer, but generally ignores health problems resulting from less active transport (reduced walking and cycling activity) and the additional crashes and pollution caused by increased vehicle mileage. As a result, transport agencies tend to undervalue strategies that increase transport system diversity and reduce vehicle travel. This article identifies various win-win strategies that can help improve public health and other planning objectives.
First page Back Continue Last page Graphics. Challenges to Public Health. Tracing of the infection. Isolation of patients to stop spread. Laboratory diagnosis. Hospitalization &Treatment. Stock pile & supply of drugs. Planning & mitigation. Information to public. Support to SEARO countries.
Ierland, J. van & Schreuder, D.A.
The following topics; are discussed with respect to public health: - the effect of visible and ultraviolet radiation upon man. - vision with respect to lighting. interior lighting. - artificial lighting of work environments. - day light and windows. - recommendations for lighting. public lighting. -
In this podcast series, CDC scientists address frequently asked questions about the National Environmental Public Health Tracking Network, including using and applying data, running queries, and much more.
"Despite children making up around a quarter of the population, the first edition of this book was the first to focus on a public health approach to the health and sickness of children and young people...
EDITORIAL. Enabling local health departments to save more lives: A public ... promoting health through the organized efforts of society” (1) ... and synergistic with achieving the sustainable development goals because its furtherance brings a ...
Roberto Midoguti Joia
Full Text Available In 2007, Brazil adopted the International Financial Reporting Standards (IFRS. Studies involving publicly traded companies in different countries around the world indicate that these new standards tend to improve the information quality and make it more comparable and transparent. This study was aimed at verifying any changes in the earnings management levels after 2010 and whether this happened in function of the full adoption of the IFRS by the Brazilian publicly traded companies (except for financial institutions. The data were extracted from the three-monthly financial statements of the databases from Economática and the Brazilian Securities Commission for the period from 2006 till 2011. To achieve the research objectives, two tests were applied. The first showed that the average discretionary accruals, calculated through the Modified Jones Model, were lower after 2010. Next, the regression analysis was elaborated, using panel data with Newey-West’s correction. The results did not confirm the hypothesis that the adoption of the IFRS affected the earnings management level in the period under analysis, but showed that the size and indebtedness significantly explain the discretionary accruals, independently of the adoption of the IFRS. The results suggest that larger companies with a large proportion of own capital tend to produce higher quality reports, independently of the adoption of the IFRS.
Juliana Pinhata Sanches do Vale
Full Text Available ABSTRACT Law n. 11,638/2007 legitimized the International Financial Reporting Standards (IFRS adoption process in Brazil and introduced an accounting system detached from tax purposes in the country. This law aims to reduce the influence of tax law on accounting standards and improve the quality of financial reporting, as IFRS are considered to be higher quality standards. International literature shows a reduction in earnings quality in environments where accounting and tax rules are strongly linked. Moreover, the influence of tax legislation on financial accounting is seen to encourage unconditional conservatism, a bias with no advantages for financial market efficiency. Thus, tax neutrality is expected to provide a more favorable institutional environment for quality financial reporting by detaching corporate accounting from tax accounting. In light of the above, this study aims to verify whether the advent of tax neutrality influences unconditional conservatism in Brazilian public companies. The methodology used involves panel data regressions. The sample consists of non-financial publicly-traded companies with information published in Economática® covering 2002 to 2014. The results show differences in the relationship between taxation and financial reporting between firms that are subject to different levels of monitoring in the Brazilian stock market. Evidence of unconditional conservatism is only found in companies that are subject to greater market monitoring. In this group, it is observed that taxation does not induce unconditional conservatism in reported earnings, which is expected in a tax neutrality context.
Maria Alves Barbosa
Full Text Available ABSTRACT: This research is a part of CIPESC (Classification of Nursing Practice in Public Health project, with national coordination by ABEn (Brazilian Nursing Association witch purpose was to elaborate an inventory of activities developed by Public Health Nurses. It sough to analyze the contribution of the nurses in public health in the South Sanitary District in the city of Goiânia (GO – Brazil, and to identify the meaning of nurses work contribution at Public Health Services, by users and managers. The study was developed by a descriptive-analytical investigation in a qualitative approach. The subjects were managers and users of the Public Health System. Data was collected by individual semi-structured interview directed to the managers and controlling and the Technique of Focal Group. The results had been grouped in three categories: "Performance of the professional", "Education Perspective of Nurses Work”, and "Health-care attendance". As conclusion was found that the nurses give great contribution in the implantation and maintenance of the health politics; that it has concern with the professional formation, that many times is responsible for the incompatibility between the service and the expected potential; it is stand out performance of the nurse as health education professional in the inserted activities in the public health, being intense its contact with the community. KEY WORDS: Public Health; Nursing; Public Health Nursing.
Terrill, Jr, J G [Consumer Protection and Environmental Health Service, U.S. PubIic Health Service, Washington, DC (United States)
The protection of public health and safety is a principal area of concern in any application of nuclear energy. A health and safety analysis must be conducted and reviewed by appropriate agencies and the final results made available to interested agencies and groups, both public and private, prior to the application. This is especially important for the Plowshare Program - the peaceful uses of nuclear explosives - where the public is to be the ultimate beneficiary. Because public health must be a primary concern in the Plowshare Program, it is essential that the potential risk be weighed against the expected benefits to the public. Public health agencies must play an increasingly important role in the planning and operational stages of the peaceful applications of nuclear explosives and in the final stage of consumer use of Plowshare-generated products. There are many long term and long distance ramifications of the Plowshare Program, such a the potential radiological contamination of consumer products that may reach the consumer at long times after the event or at great distances from the site of the event. Criteria for evaluating public exposure to radiation from these products need to be developed based on sound scientific research. Standards for radioactivity in consumer products must be developed in relation to potential exposure of the public. Above all, a clear benefit to the public with a minimum of risk must be shown. The major purpose of this Symposium on the Public Health Aspects of Peaceful Uses of Nuclear-Explosives is to focus attention on the health and safety aspects, present the results of safety analyses accomplished to date and other information necessary to an understanding of the public health aspects, and to identify areas where additional research is required. A general overview of the total symposium content is presented with emphasis on the relationship of the topics to public health. (author)
Terrill, J.G. Jr.
The protection of public health and safety is a principal area of concern in any application of nuclear energy. A health and safety analysis must be conducted and reviewed by appropriate agencies and the final results made available to interested agencies and groups, both public and private, prior to the application. This is especially important for the Plowshare Program - the peaceful uses of nuclear explosives - where the public is to be the ultimate beneficiary. Because public health must be a primary concern in the Plowshare Program, it is essential that the potential risk be weighed against the expected benefits to the public. Public health agencies must play an increasingly important role in the planning and operational stages of the peaceful applications of nuclear explosives and in the final stage of consumer use of Plowshare-generated products. There are many long term and long distance ramifications of the Plowshare Program, such a the potential radiological contamination of consumer products that may reach the consumer at long times after the event or at great distances from the site of the event. Criteria for evaluating public exposure to radiation from these products need to be developed based on sound scientific research. Standards for radioactivity in consumer products must be developed in relation to potential exposure of the public. Above all, a clear benefit to the public with a minimum of risk must be shown. The major purpose of this Symposium on the Public Health Aspects of Peaceful Uses of Nuclear-Explosives is to focus attention on the health and safety aspects, present the results of safety analyses accomplished to date and other information necessary to an understanding of the public health aspects, and to identify areas where additional research is required. A general overview of the total symposium content is presented with emphasis on the relationship of the topics to public health. (author)
José Carlos Barbieri
Full Text Available This paper deals with environmental issues from the perspective of Supply Chain Management. With the incorporation of environmental concerns in a systematic manner the concept of Green Supply Chain Management (GSCM has emerged. The subject GSCM interests not only to academics but also to professional audience especially with regard to new legal obligations, and social pressures of various types of stakeholders, as well as issues related to the competitiveness of enterprises and their supply chains. However, the way in which this knowledge is being produced in Brazil is not clear, hence the need for a mapping which areas and sub-areas of GSCM has been studied most frequently. Thus, this work can be characterized as a desk research that aims to analyze the Brazilian academic publications on green supply chain management. In order to delimit the scope of the research, we collected articles published from 2006 to 2010 in specific Brazilian congresses of Management and Production Engineering, as EnANPAD, SIMPOI and SIMPEP. 110 papers were collected and analyzed.The area of Green Operations represents 81% of published articles and 45% of these focus on Reverse Logistics. 70% of total papers are empirical and 77% use a qualitative approach, while 57% of the total are case studies
Leandro Luiz Giatti
Full Text Available Embora a Amazônia ostente grandioso patrimônio ambiental e abundância de recursos hídricos, é na região Norte do Brasil, contida neste notável bioma, que se verificam os piores índices de acesso a serviços de saneamento e respectivos indicadores de saúde pública. Por meio de estudo de caso efetuado na cidade de São Gabriel da Cachoeira, localizada à noroeste do Estado do Amazonas, com aproximadamente 18.000 habitantes e substancial parcela de população indígena, verificou-se a complexidade de fatores relacionados ao provimento de água e à melhoria da saúde pública para núcleos urbanos da Amazônia. A ausência de políticas concisas, as peculiaridades ambientais, as dificuldades logísticas e financeiras somam-se a questões socioculturais, a aspectos migratórios e a processo de urbanização desordenada, associada a impactos ambientais. Para melhoria da saúde pública nessas circunstâncias torna-se necessária uma abordagem interdisciplinar, que possibilite a gestão dos recursos hídricos, a implementação de saneamento básico e, não obstante, a promoção de adesão dos habitantes.Even though Amazonia displays magnificent environmental heritage and abundance of water resources, it is exactly in the Brazilian northern region, contained in this remarkable biome, that the worst indices of access to sanitation services and respective public health indicators are found. A case study carried out in the town of São Gabriel da Cachoeira, located to the northwest in the State of Amazonas, with nearly 18,000 inhabitants, a large portion of whom are Indians, revealed a complexity of factors related to water supply and public health improvement for urban centers in Amazonia. Lack of proper policies, environmental peculiarities, logistic and financial difficulties, are added to socio-cultural matters, migratory processes, and unorganized urbanization associated with environmental impacts. In order to improve the public health
Luiz Antonio de Castro-Santos
Full Text Available A contribuição do médico sanitarista Belisário Penna (1868-1939 à história da saúde pública no Brasil constitui o tema central do texto. Belisário Penna é retratado aqui a partir de sua militância, dos combates que travou em defesa do saneamento rural e pela melhoria das condições de saúde de toda a população brasileira. O propósito também é situá-lo em meio aos debates de sua época, esclarecendo, por exemplo, como as ideias de Belisário - tão bem apresentadas em suas eloquentes palestras - primavam por se contrapor ao pensamento racista dominante entre as elites do País. Belisário argumentava que os obstáculos ao progresso nacional residiam na precariedade tanto da saúde quanto da instrução pública. Nessa medida, os problemas referidos à questão da eugenia no País eram interpretados sob um prisma otimista: no lugar de determinismos raciais intangíveis, a presença do Estado, por meio de programas de higiene e educação cívica, traria o progresso desejado. O "otimismo sanitário" do combatente mineiro não consistiu em um atributo só dele, mas era compartilhado por outros médicos e intelectuais em torno de movimentos como a Liga Pró-Saneamento, cujas bandeiras acenavam a necessidade de mudanças sociais e alcançaram significativa ressonância popular.The contribution of the sanitarian Belisário Penna (1868-1939 to the history of public health in Brazil constitutes the central topic of this text. The intellectual, professional, and political profile of Belisário Penna is here reconsidered, in the light of his entrenched defense of rural sanitation, his militancy in favor of the improvement of living conditions in the backlands of Brazil, and his criticism of oligarchical power. The intention is also to point out how he opposed, through a series of speeches of great eloquence, the climate of opinion in Brazil's early Republic. He took in the preoccupations of Brazilian elite with "eugenics," discussing
Sim, Fiona; McKee, Martin
..., there is increasing understanding of the inevitable limits of individual health care and of the need to complement such services with effective public health strategies. Major improvements in people's health will come from controlling communicable diseases, eradicating environmental hazards, improving people's diets and enhancing the availability ...
Freitas Brandao Bittencourt, C.
Four decades of the Brazilian nuclear history have been analysed with special emphasis placed on government policy and its repercussion on public opinion. The implications of the new constitutional regulations which rule the issue are discussed. it is also studied the change in the nuclear program structure, enforced in August 1988. At different times, the government decisions on nuclear energy could be classified as miser, extravagant, dissimulated and frank, successively. Their aftermaths, which show little consistency with the expectations laid on them, have led to discredit by part of the society, which is controlled by a scientific - intellectual elite. However, recent successes are likely to reverse this trend, if the government explores them properly. (author) [pt
Sandra Mara Campos Alves
Full Text Available The research was conducted in 27 Brazilian courts of law. We aimed to know the legal demands on health and the arguments made by the patient, the defense, and the judge in judicial hearings. For this, we used the method of case law research. The research unit was Brazilian judicial processes with the material object of health demands, decided between 2012 and 2013. The results showed reliance on constitutional arguments for both the request and the decision, while the defense was based on diverse and obsolete legal points. It was concluded that judges have decided questions about health using purely legal arguments and reproducing points made by the patient. The defense of the Brazilian health system is fragile due to the lack of an adequate legal rationale.
Laaser, Ulrich; Donev, Donco; Bjegović, Vesna; Sarolli, Ylli
The modern concept of public health, the New Public Health, carries a great potential for healthy and therefore less aggressive societies. Its core disciplines are health promotion, environmental health, and health care management based on advanced epidemiological methodologies. The main principles of living together in healthy societies can be summarized as four ethical concepts of the New Public Health essential to violence reduction equity, participation, subsidiarity, and sustainability. The following issues are discussed as violence determinants: the process of urbanization; type of neighborhood and accommodation, and consequent stigmatization; level of education; employment status; socialization of the family; women's status; alcohol and drug consumption; availability of the firearms; religious, ethnic, and racial prejudices; and poverty. Development of the health systems has to contribute to peace, since aggression, violence, and warfare are among the greatest risks for health and the economic welfare. This contribution can be described as follows: 1) full and indiscriminate access to all necessary services, 2) monitoring of their quality, 3) providing special support to vulnerable groups, and 4) constant scientific and public accountability of the evaluation of the epidemiological outcome. Violence can also destroy solidarity and social cohesion of groups, such as family, team, neighborhood, or any other social organization. Durkheim coined the term anomie for a state in which social disruption of the community results in health risks for individuals. Health professionals can make a threefold contribution to peace by 1) analyzing the causal interrelationships of violence phenomena, 2) curbing the determinants of violence according to the professional standards, and 3) training professionals for this increasingly important task. Because tolerance is an essential part of an amended definition of health, monitoring of the early signs of public intolerance is
Each title has a brief description and link for downloading the full text. Includes the publications catalog, the Child Health Champion resource guide, student curriculum materials, reports, fact sheets, and booklets/brochures of advice and tools.
Alonso, Nivaldo; Massenburg, Benjamin B; Galli, Rafael; Sobrado, Lucas; Birolini, Dario
to analyze demographic Brazilian medical data from the national public healthcare system (SUS), which provides free universal health coverage for the entire population, and discuss the problems revealed, with particular focus on surgical care. data was obtained from public healthcare databases including the Medical Demography, the Brazilian Federal Council of Medicine, the Brazilian Institute of Geography and Statistics, and the National Database of Healthcare Establishments. Density and distribution of the medical workforce and healthcare facilities were calculated, and the geographic regions were analyzed using the public private inequality index. Brazil has an average of two physicians for every 1,000 inhabitants, who are unequally distributed throughout the country. There are 22,276 board certified general surgeons in Brazil (11.49 for every 100,000 people). The country currently has 257 medical schools, with 25,159 vacancies for medical students each year, with only around 13,500 vacancies for residency. The public private inequality index is 3.90 for the country, and ranges from 1.63 in the Rio de Janeiro up to 12.06 in Bahia. A significant part of the local population still faces many difficulties in accessing surgical care, particularly in the north and northeast of the country, where there are fewer hospitals and surgeons. Physicians and surgeons are particularly scarce in the public health system nationwide, and better incentives are needed to ensure an equal public and private workforce. analisar dados demográficos do Sistema Único de Saúde (SUS) brasileiro, que promove cobertura de saúde universal a toda população, e discutir os problemas revelados, com particular ênfase nos cuidados cirúrgicos. os dados foram obtidos a partir dos bancos de dados de saúde pública da Demografia Médica, do Conselho Federal de Medicina, do Instituto Brasileiro de Geografia e Estatística e do Cadastro Nacional dos Estabelecimentos de Saúde. A densidade e a
Full Text Available This Special Issue on GIS and public health is the result of a highly selective process, which saw the participation of some 20 expert peer-reviewers and led to the acceptance of one half of the high-quality submissions received over the past year. Many threads link these papers to each other and, indeed, to our original call for papers, but the element that most clearly emerges from these works is the inextricable connection between public health and the environment. Indeed, GIS analysis of public health simply cannot disregard the geospatial dimension of environmental resources and risks. What consistently emerges from these analyses is that current geospatial research can only scratch the surface of the complex interactions of spatial resources, risks, and public health. In today’s world, or at least in the developed world, researchers and practitioners can count on virtually endless data, on inexpensive computational power, and on seamless connectivity. In this research environment, these papers point to the need for improved analytical tools, covering concepts, representation, modeling and reliability. These works are important contributions that help us to identify what advances in geospatial analysis can better address the complex interactions of public health with our physical and cultural environment, and bridge research and practice, so that geospatial analyses can inform public health policy making. [...
de Lima, Luciana Dias
In the Brazilian society's context of meager financial resources for health care, associated with structural features of fiscal federalism and with the current model of funding transfers for the Unified Health System's (SUS), important inequities directly impact political negotiations and the deployment of federal financing alternatives which are not directly linked to the supply and production of health care activities and services by states and municipalities. We observed that health policies, since the second half of the nineties, have developed their own mechanisms that, in the above mentioned context, tend to accommodate different interests and federative conflicts generated by structural factors and by institutional rules. However, the absence of an integrated planning program between the criteria to establish resource redistribution for financing the Unified Health System and the Brazilian Federation's fiscal sharing system, end up reinforcing certain asymmetric patterns and generating new imbalances, making the compensation of inequities difficult in public health spending at the sub-national domain.
Perfil dos pesquisadores com bolsa de produtividade em pesquisa do CNPq da área de saúde coletiva A profile of researchers in public health with productivity grants from the Brazilian National Research Council (CNPq
Rita Barradas Barata
Full Text Available O artigo analisa, com base nas informações do currículo Lattes, o perfil dos pesquisadores com bolsa de produtividade em pesquisa do CNPq na área de Saúde Coletiva. A análise levou em conta a formação graduada e pós-graduada, área de atuação, produção e divulgação científica. As comparações são feitas entre as classes de pesquisadores e com dados do diretório de grupos de pesquisa. A maioria dos pesquisadores (70% são formados em Ciências da Saúde, principalmente em Medicina, ou em Ciências Humanas (18%, principalmente Sociologia. Sessenta por cento fizeram mestrado e doutorado em Saúde Coletiva, mas há entre 20 e 30% de pesquisadores, dependendo da classe, sem formação específica na área. A maioria atua em Epidemiologia. A produção científica, expressa em produtos bibliográficos, varia de 10,56 produtos/ano de obtenção do doutorado para os pesquisadores 2C a 6,60 produtos/ano para os pesquisadores 1A. Para artigos completos publicados em periódicos os valores são 3,56 e 2,87, respectivamente. A produção é divulgada principalmente em periódicos A internacional e, A e B nacional. Os periódicos que concentram a publicação são Cadernos de Saúde Pública e Revista de Saúde Pública.Based on information provided by the Lattes curriculum, this study analyzes the profile of researchers in public health with productivity grants from the Brazilian National Research Council (CNPq. The analysis considered the researcher’s undergraduate and graduate degrees, field of expertise, scientific output, and publications. The article discusses comparisons between different categories of researchers and data provided by the CNPq Research Group Directory. Most of the researchers (70% received their undergraduate degrees either in health sciences, mainly medicine, or the humanities (18%, mainly sociology. 60% have Master’s or PhDs in collective health, but some 20 to 30% of researchers, depending on the category
The Program of Health Section / Brazilian Cnen, which was elaborated to promote the use of ionizing radiations (nuclear and x-ray techniques) in benefit of Brazilian health, with safety assurance of patients, personnels, population and environment, is presented. The Ministry of Health, industries, Medical and Physicist Associations, Universities and Research Centers are participants of this program. The activities involved in the program are: production of isotopes and radiopharmaceuticals; radiation detectors and nuclear instrumentation; radiation protection and dosimetry; education and training of human resources; applied research and new technologies. The guiding and actions that the section will adopt to attend the growing necessities of Brazilian society, considering technological powers, management, available substructure and associated difficulties are defined. (M.C.K.) [pt
Dias, Patricia Camacho; Henriques, Patrícia; Anjos, Luiz Antonio Dos; Burlandy, Luciene
The study analyzes national strategies for dealing with obesity in Brazil in the framework of the Brazilian Unified National Health System (SUS) and the Food and Nutritional Security System (SISAN). Based on the document analysis method, we examined government documents produced in the last 15 years in the following dimensions: definitions of obesity, proposed actions, and strategies for linkage between sectors. In the SUS, obesity is approached as both a risk factor and a disease, with individual and social/environmental approaches aimed at changing eating practices and physical activity. In the SISAN, obesity is also conceived as a social problem involving food insecurity, and new modes of producing, marketing, and consuming foods are proposed to change eating practices in an integrated way. Proposals in the SUS point to an integrated and intra-sector approach to obesity, while those in SISAN emphasize the problem's inter-sector nature from an expanded perspective that challenges the prevailing sector-based institutional structures.
Suzely Adas Saliba Moimaz
Full Text Available The fluoridation of public water supplies is considered the most efficient public health measure for dental caries prevention. However, fluoride levels in the public water supply must be kept constant and adequate for the population to gain preventive benefit. The aim of this study was to analyze fluoride levels in the public water supply of 29 Brazilian municipalities during a 48-month period from November 2004 to October 2008. Three collection sites were defined for each source of municipal public water supply. Water samples were collected monthly and analyzed at the Research Laboratory of the Nucleus for Public Health (NEPESCO, Public Health Postgraduate Program, Araçatuba Dental School (UNESP. Of the 6862 samples analyzed, the fluoride levels of 53.5% (n = 3671 were within the recommended parameters, those of 30.4% (n = 2084 were below these parameters, and those of 16.1% (n = 1107 were above recommended values. Samples from the same collection site showed temporal variability in fluoride levels. Variation was also observed among samples from collection sites with different sources within the same municipality. Although 53.5% of the samples contained the recommended fluoride levels, these findings reinforce the importance of monitoring to minimize the risk of dental fluorosis and to achieve the maximum benefit in the prevention of dental caries.
Fernando de Holanda Barbosa
Full Text Available This paper attempts to explain why the Brazilian inter-bank interest rate is so high compared with rates practiced by other emerging economies. The interplay between the markets for bank reserves and government securities feeds into the inter-bank rate the risk premium of the Brazilian public debt.
Gabriela S. S. Chaves
Full Text Available ABSTRACT Background Cardiovascular Disease (CVD is the leading burden of disease worldwide. Moreover, CVD-related death rates are considered an epidemic in low- and middle-income countries (LMICs. Research shows that cardiac rehabilitation (CR participation reduces death and improves disability and quality of life. Given the growing epidemic of CVD in LMICs and the insufficient evidence about CR programs in these countries, a Randomized Control Trial (RCT in Latin America is warranted. Objective To investigate the effects of comprehensive CR on functional capacity and cardiovascular risk factors. Method The design is a single-blinded RCT with three parallel arms: comprehensive CR (exercise + education versus exercise-based CR versus wait-list control (no CR. The primary outcome will be measured by the Incremental Shuttle Walk Test. Secondary outcomes are risk factors (blood pressure, dyslipidemia, dysglycemia, body mass index and waist circumference; tertiary outcomes are heart health behaviors (exercise, medication adherence, diet, and smoking, knowledge, and depressive symptoms. The CR program is six months in duration. Participants randomized to exercise-based CR will receive 24 weeks of exercise classes. The comprehensive CR group will also receive 24 educational sessions, including a workbook. Every outcome will be assessed at baseline and 6-months later, and mortality will be ascertained at six months and one year. Conclusion This will be the first RCT to establish the effects of CR in Latin America. If positive, results will be used to promote broader implementation of comprehensive CR and patient access in the region and to inform a larger-scale trial powered for mortality.
Lindert, Jutta; Bilsen, Johan; Jakubauskiene, Marija
Public mental health (PMH) is a major challenge for public health research and practice. This article is organized in six parts. First, we will highlight the significance of PMH; second, we will define mental health and mental disorders; third, we identify and describe determinants of mental health and mental disorders on which we worked in the past 10 years since the establishment of the PMH section such as social determinants and violence. Fourth, we will describe the development of the EUPHA PMH section and provide details on vulnerable groups in the field of PMH, on violence as a main determinant and on suicide as an outcome which affects all countries in the European region. Fifth, we describe policy and practice implications of the development of PMH and highlight the European dimension of PMH. We will conclude this article by providing an outlook on potential further development of PMH as regards research and policy and practice. Finally, we hope that the EUPHA PMH section will contribute to public health in the next 25 years and we can contribute to improvement of PMH in Europe. © The Author 2017. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved.
Letícia de Oliveira Cardoso
Full Text Available Abstract: The food consumption of 15,071 public employees was analyzed in six Brazilian cities participating in the baseline for Brazilian Longitudinal Study of Adult Health (ELSA-Brasil, 2008-2010 with the aim of identifying eating patterns and their relationship to socio-demographic variables. Multiple correspondence and cluster analysis were applied. Four patterns were identified, with their respective frequencies: "traditional" (48%; "fruits and vegetables" (25%; "pastry shop" (24%; and "diet/light" (5% The "traditional" and "pastry shop" patterns were more frequent among men, younger individuals, and those with less schooling. "Fruits and vegetables" and "diet/light" were more frequent in women, older individuals, and those with more schooling. Our findings show the inclusion of new items in the "traditional" pattern and the appearance of the "low sugar/low fat" pattern among the eating habits of Brazilian workers, and signal socio-demographic and regional differences.
Cardoso, Letícia de Oliveira; Carvalho, Marilia Sá; Cruz, Oswaldo Gonçalves; Melere, Cristiane; Luft, Vivian Cristine; Molina, Maria Del Carmen Bisi; Faria, Carolina Perim de; Benseñor, Isabela M; Matos, Sheila Maria Alvim; Fonseca, Maria de Jesus Mendes da; Griep, Rosane Harter; Chor, Dóra
The food consumption of 15,071 public employees was analyzed in six Brazilian cities participating in the baseline for Brazilian Longitudinal Study of Adult Health (ELSA-Brasil, 2008-2010) with the aim of identifying eating patterns and their relationship to socio-demographic variables. Multiple correspondence and cluster analysis were applied. Four patterns were identified, with their respective frequencies: "traditional" (48%); "fruits and vegetables" (25%); "pastry shop" (24%); and "diet/light" (5%) The "traditional" and "pastry shop" patterns were more frequent among men, younger individuals, and those with less schooling. "Fruits and vegetables" and "diet/light" were more frequent in women, older individuals, and those with more schooling. Our findings show the inclusion of new items in the "traditional" pattern and the appearance of the "low sugar/low fat" pattern among the eating habits of Brazilian workers, and signal socio-demographic and regional differences.
Dourado, Daniel de Araujo; Elias, Paulo Eduardo Mangeon
The implications from the Brazilian federal structure on the regionalization of health actions and services in the National Unified Health System (SUS) were analyzed, considering that the regional health planning in Brazil takes place within the context of intergovernmental relations as an expression of cooperative federalism in health. The analysis was based on a historical approach to Brazilian health federalism, recognizing two development periods, decentralization and regionalization. Regional health planning of SUS was explored in light of the theoretical framework of federalism. It is concluded that relative centralization of the process is needed in intergovernmental committees to actualize federal coordination and that it is essential to consider formalizing opportunities for dissent, both in regional management boards and in the intergovernmental committees, so that the consensus decision-making can be accomplished in healthcare regionalization.
Jackson Filho, José Marçal; Algranti, Eduardo; Saito, Cézar Akiyoshi; Garcia, Eduardo Garcia
The Revista Brasileira de Saúde Ocupacional (RBSO) - Brazilian Journal of Occupational Health - is an academic peer-reviewed journal in the field of Workers' Health that has been published by Fundacentro since 1973. Its historical trajectory, current performance, challenges and future perspectives were approached, in this paper, from a documental analysis. The journal's history can be divided into three periods, starting during the military government. At the beginning, the journal was the official vehicle for the Brazilian occupational accidents prevention policy, in which Fundacentro played a central role. The early 1980s opens space for technical-scientific publications and the field of Workers' Health emerges on the journal's pages. In 2005-6, a restructuring process is implemented, ensuring independent editorial policy and structures. Since 2006, 139 original papers and 9 thematic issues have been published. The journal is indexed in 9 bibliographic databases, has been ranked B1 in the field of interdisciplinary studies and B2 in the field of public health by CAPES, has an upward trend in the SciELO Impact Factor, and has an h-index of 5 in Google Scholar. Nevertheless, the low scientific production in the field and the high rate of rejection of manuscripts may jeopardize the survival of the journal, which is the main locus for scientific publications in the field of Workers' Health.
Perfil socioeconômico, nutricional e de saúde de adolescentes recém-ingressos em uma universidade pública brasileira Socioeconomic, nutritional and health profile of adolescents recently admitted to a Brazilian public university
Valéria Cristina Ribeiro VIEIRA
Full Text Available Objetivou-se delinear o perfil socioeconômico, nutricional e de saúde de adolescentes recém-ingressos em uma universidade pública brasileira. As variáveis comportamentais foram obtidas por meio de questionário, o percentual de gordura corporal (%GC pelo somatório das dobras cutâneas e o estado nutricional pelo Índice de Massa Corporal. A maioria dos adolescentes era do sexo feminino (57,3%, não residia com familiares (89,8%, consumia bebida alcoólica (73,5%, omitia alguma refeição principal (57,3% e rejeitava um ou mais alimentos do grupo das hortaliças (79,5%. Cerca de 57,0% não realizavam atividade física e 7,0% fumavam. Em torno de 72,0% e 25,0%, respectivamente, consumiam hortaliça e fruta cinco ou mais vezes na semana. Os eutróficos predominavam, mas 58,7% destes apresentavam %GC elevado. Concluiu-se que considerável parcela dos indivíduos estudados residia sem os familiares e apresentava, além de inadequação da composição corporal e do comportamento alimentar, outros fatores de risco à saúde, como o consumo de álcool e a inatividade física.The objective of this work was to describe the socioeconomic, nutritional and health profile of adolescents recently admitted to a Brazilian public university. The behavioral variables were obtained by interview, the body fat percentage (BF% by the sum of the four skinfold thicknesses and the nutritional status by body mass index. Most of the students were female (57.3%, lived away from their families (89.8%, drank alcohol (73.5%, skipped a main meal (57.3% and rejected one or more types of vegetables (79.5%. About 57.0% did not practice any physical activity and 7.0% smoked. About 72.0% and 25.0%, respectively, consumed vegetable and fruit five times or over during the week. The eutrophic subjects predominated, but 58.7% of them presented a high BF%. The results showed that a considerable number of the subjects lived away from their families and had inadequate body
de Assis, Simone Gonçalves; Avanci, Joviana Quintes; Pesce, Renata Pires; Ximenes, Liana Furtado
This article reflects about the situation of mental health and violence against Brazilian children and adolescents, proposing a discussion about the need for public health policies including these extremely relevant issues in their priority agenda. In Brazil, the debate about this problem has occurred in a fragmented and not very consistent way. This article presents a non-systematic selection of epidemiological investigations on this subject conducted in Brazilian schools and communities. The great variety and prevalence of familiar and community violence and of mental health problems is pointed out and the methodological differences between the studies and the concentration of studies in the South and Southeastern regions of the country are emphasized. The article still highlights to the scarce service network for dealing with this kind of problem and the lack of concern with the prevention of mental disorders and promotion of mental health.
in the theoretical as well as the practical potential of the public health professional. Thus, he and she must be able to perform, what WHO Europe has developed as Essential Public Health Operations (EPHOs).3 This, in turn, implies that the public health professional possesses the set of intellectual (knowledge...... endorsed by WHO Europe’s member states as the basis for the public health education in Europe.5 The sections of the lists include: Public health methods; Population health and: Its social and economic determinants, and: Its material environmental determinants; Man-made interventions and systems, namely...... Health policy, health economics, organizational theory, health legislation, and public health leadership and management; Health promotion—health education, health protection, disease prevention; public health ethics. This should form the central part of the basis for all public health professionals...
Victor Placeres Borges
Full Text Available The studies on the determinants of audit fees in Brazil became possible with the mandatory disclosure of audit expenses in 2009. Thus, the objective of this research was to identify the determinants of the fees paid by Brazilian publicly traded companies to independent auditors in 2010 to 2014. The analysis took place through regression with data arranged in panel. Size, performance, complexity, audit firm size, adoption of corporate governance practices, audit rotation, industry and litigation risks have all been found to have an impact on the fees. Therefore, the aspects that can be used by companies for the purpose of information management or that require more auditing timefor signaling points of greater risks are highlighted. In addition, understanding the determinants allows companies to plan future expenditures with audit fees and assists regulators and inspectors in defining and comparing key determinants of firms for identifying abnormal payments. These results complement the research in Brazil, Australia, Bangladesh, Norway, Bahrain, England, Jordan, Kuwait, USA, Malaysia, Nigeria, Abu Dhabi, Italy and Indonesia.
Samantha Alflen Banin
Full Text Available This article discusses the view of man as a gender category in public policies and national laws, especially those focused on violence against women. With this objective, it contextualizes the studies of feminisms and masculinities as theories and epistemology that guide the analysis of 17 official Brazilian documents selected for this study. This analysis seeks to clarify how the gendered man has been understood in various documents over the years. It discusses how the formulation of laws can provide a new accountability approach beyond the punishment of these men. It also investigates the regulation of some of the existing groups of men who have used violence against women in the country. It finalizes claiming the importance of these reflections for the debate on gender and masculinities in pursuit of a more effective system of prevention and eradication of violence against women. It discusses and argues in favor of both changing the way this category is addressed in official documents, and formalizing spaces for reflection for men who have used violence against women.
Bonde, Lars Ole; Juel, Knud; Ekholm, Ola
Background: ‘Music and public health’ is a new field of study. Few scientific studies with small samples have documented health implications of musical participation. Research questions in this epidemiological study were: 1) Is there an association between self-rated health and active use of musi......: 57%. Multiple logistic regression analyses were performed to investigate associations between musical background/activities and health-related indicators. Discussion: The study documents that a majority of informants use music to regulate physical and psychological states......Background: ‘Music and public health’ is a new field of study. Few scientific studies with small samples have documented health implications of musical participation. Research questions in this epidemiological study were: 1) Is there an association between self-rated health and active use of music...... in daily life? 2) What associations can be observed between musical background, uses and understanding of music as a health factor, and self-reported health? Method: Data came from the Danish Health and Morbidity Survey 2013, based on a simple random sample of 25.000 adult Danes (16+ years). Response rate...
Cromley, Ellen K
Authoritative and comprehensive, this is the leading text and professional resource on using geographic information systems (GIS) to analyze and address public health problems. Basic GIS concepts and tools are explained, including ways to access and manage spatial databases. The book presents state-of-the-art methods for mapping and analyzing data on population, health events, risk factors, and health services, and for incorporating geographical knowledge into planning and policy. Numerous maps, diagrams, and real-world applications are featured. The companion Web page provides lab exercises w
Ramona Fernanda Ceriotti Toassi
Full Text Available The aim of this study was to analyze the role of teaching at primary healthcare services within the Brazilian National Health System (SUS in dentists' training, at a public university in the south of Brazil. A qualitative methodological approach (case study was used. Interviews were conducted with 12 dentistry students, six dentists who were preceptors working in public primary healthcare services and three teachers connected with this curricular training. Our findings showed that the curricular training in SUS primary healthcare services had an impact on the dentists' education through establishment of bonds, autonomy in problem-solving and multiprofessional teamwork. It was seen that they learned about how healthcare services function, about healthcare and about development of cultural competence. There is a need to maintain constant questioning regarding these practices, and to ensure the presence of infrastructure and qualified professionals for teaching at these services.
Bettcher, D; Lee, K
At the dawn of the 21st century, globalisation is a word that has become a part of everyday communication in all corners of the world. It is a concept that for some holds the promise of a new and brighter future, while for others it represents a threat that needs to be confronted and counteracted. In the area of public health, a wide range of claims have been made about the various impacts, both positive and negative, that can be attributed to globalisation. In the ever expanding literature on globalisation and health, it has become apparent that considerable confusion is emerging in both the ways that terminology is applied and concepts are defined. The determinants of health are increasingly multisectoral, and in tackling these challenges it is necessary to take a multidisciplinary approach that includes policy analyses in such areas as trade, environment, defence/security, foreign policy, and international law. In assembling the terms for this glossary, we have attempted to demonstrate the richness of the globalisation and public health debate, and in so doing have selected some of the core terms that require definition. We hope that this glossary will help to clarify this interesting and challenging area, and will also serve as a useful entry point to this new debate in public health.
Pamela Barreto Lang
Full Text Available In order to map Brazilian institutions’ web presence in an international network of health research institutions, a study was conducted in 2009, including 190 institutions from 42 countries. The sample was based on WHO (World Health Organization collaborating centers, and the methodology used webometric analyses and techniques, especially interlinks, and social network analysis. The results showed the presence of five Brazilian institutions, featuring the Oswaldo Cruz Foundation (Fiocruz, showing links to 20 countries and 42 institutions. Through the interface between the health field and the web, the study aims to contribute to future analyses and a plan for strategic repositioning of these institutions in the virtual world, as well as to the elaboration of public policies and recognition of webometrics as an area to be explored and applied to various other fields of knowledge.
T-Ping, Cheng; Weckx, Luc Louis Maurice
The data base of ENT care in the Brazilian public health system (Sistema Unico de Saude - SUS) will help organize public health programs. The following items were investigated in patients aged up to 17 years attended in public health system outpatient units in the city of Mariana, in the ENT screening unit, UNIFESP-EPM, and in CISMISEL: 1) The main otorhinolaryngological diagnoses; 2) The most frequently required exams, drugs, and surgical procedures and their indications; 3) The jobs of parents; the number of siblings; and 4) A statistical analysis and comparison of data in each location. We undertook a prospective study and a statistical analysis of variables that were gathered during the first visit. The age, the parents' salary, the number of siblings aged below 18 years, the presence of rhinitis, ears diseases, the exams, drugs and otological surgeries that were indicated were all statistically significant. The most common diagnosis was mouth breathing. The most common surgery was adenotonsillectomy. The most frequently requested exam was a lateral cranial radiograph. The number of unemployed parents, their poor salaries, and the number of siblings make it difficult for these patients to be treated in any facility other than the public heath system.
Teixeira, Renan Kleber Costa; Botelho, Nara Macedo; Petroianu, Andy
To assess whether there is a preference for international journal citation to the detriment of national ones in ten Brazilian medical journals, in two different periods. All references in the articles published in Arquivos Brasileiros de Oftalmologia, Revista Brasileira de Cirurgia Cardiovascular, Revista da Associação Médica Brasileira, São Paulo Medical Journal, Arquivos Brasileiros de Endocrinologia e Metabologia, Clinics, Jornal Brasileiro de Pneumologia, Revista da Sociedade Brasileira de Medicina Tropical, Revista Brasileira de Psiquiatria e Acta Ortopédica Brasileira in the years 2011 and 2007 were analyzed, assessing the number of articles published in national and international journals. A total of 36,125 references from 1,462 articles published in the 10 aforementioned journals were analyzed. Of the total number, 4.242 (11.74%) were from Brazilian journals. There was no significant difference between the two analyzed periods. A total of 453 (30,98%) of the articles studied non-cited brazilian papers,and 81 (5.54%) articles had more Brazilian than international references. Of total references analyzed, 11.74% were related to articles published in Brazilian journals. This number, when compared to the percentage of Brazilian articles published in the medical area, demonstrates a good number of citations of national articles. Copyright © 2012 Elsevier Editora Ltda. All rights reserved.
Gerlack, Letícia Farias; Karnikowski, Margô Gomes de Oliveira; Areda, Camila Alves; Galato, Dayani; Oliveira, Aline Gomes de; Álvares, Juliana; Leite, Silvana Nair; Costa, Ediná Alves; Guibu, Ione Aquemi; Soeiro, Orlando Mario; Costa, Karen Sarmento; Guerra, Augusto Afonso; Acurcio, Francisco de Assis
To identify limiting factors in the management of pharmaceutical services in the primary health care provided by the Brazilian Unified Health System (SUS). This study was based on the data from the Pesquisa Nacional sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos no Brasil (PNAUM - National Survey on Access, Use and Promotion of Rational Use of Medicines), and it was conducted by interviews with professionals responsible for pharmaceutical services in Brazilian cities, in 2015. To identify the management limiting factors, we considered the organizational, operational, and sustainability indicators of the management. For the analyses, we included the weights and structure of analysis plan for complex samples. The results were expressed by frequencies and measures of central tendency with 95% confidence interval, considering the Brazilian geographic regions. We identified the following limiting factors: lack of pharmaceutical services in the Municipal Health Secretariat organization chart (24%) and in the health plan (18%); lack of participation of managers in the Health Board and the absence of reference to this topic in the agenda of meetings (58.4%); lack of financial autonomy (61.5%) and lack of knowledge on the available values (81.7%); lack of adoption of operational procedures (about 50%) for selection, scheduling, and acquisition; and the fact that most professionals evaluate the organization of pharmaceutical services as good and great (58.8%), despite the worrisome indicators. Pharmaceutical services management is currently supported by a legal and political framework that should guide and contribute to improve the pharmaceutical services in the Brazilian Unified Health System primary health care. However, there is a mismatch between the goals established by these guidelines and what is actually happening.
Calvasina, Paola; Lawrence, Herenia P.; Hoffman-Goetz, Laurie; Norman, Cameron D.
Background Inadequate functional health literacy is a common problem in immigrant populations. The aim of this study was to investigate the association between oral (dental) health literacy (OHL) and participation in oral health care among Brazilian immigrants in Toronto, Ontario, Canada. Methods The study used a cross-sectional design and a convenience sample of 101 Brazilian immigrants selected through the snowball sampling technique. Data were analyzed using descriptive statistics and logi...
Full Text Available This article looks at the evolution of bioethics a discipline from its initial focus, concerned with issues of personal autonomy and the conflicts around the use of complex technology in medicine, to where it is now; focused on major population issues in public health, with a focus on equality, justice and the right to health. As part of this it considers the 18 guiding principles and issues in bioethics contained in the Universal Declaration of Bioethics and Human Rights of UNESCO.
Straton, Nadiya; Vatrapu, Ravi; Mukkamala, Raghava Rao
This paper reports on a survey about the perceptions and practices of social media managers and experts in the area of public health. We have collected Facebook data from 153 public health care organizations and conducted a survey on them. 12% of organizations responded to the questionnaire....... The survey results were combined with the findings from our previous work of applying clustering and supervised learning algorithms on big social data from the official Facebook walls of these organizations. In earlier research, we showed that the most successful strategy that leads to higher post engagement...... is visual content. In this paper, we investigated if organisations pursue this strategy or some other strategy that was successful and has not been uncovered by the machine learning algorithms. Performance of each organisation on Facebook is based on the number of posts (volume share) and the number...
Jaishankar, R; Jhonson, C P
Geomatics technology has tremendous potential to address public health issues particularly under the present circumstances of global climate change and climate or technology induced human migration, which result in an increase in the geographical extent and re-emergence of vector-borne diseases. The authors present an overview of the science of geomatics, describe the potential impacts of climate change on vector-borne diseases and review the applications of remote sensing for disease vector surveillance.
Christiansen, Ask Vest
rad av världens främsta idrottsvetare och dopningsexperter hade mött upp för att presentera papers till en intresserad och engagerad publik. Temat för konferensen var "Doping and Public Health", och den aspekten behandlades också; dock tolkade flera presentatörer temat på sina egna vis, och hela...
Garcia, Jonathan; Parker, Richard G
Brazil's national response to AIDS has been tied to the ability to mobilize resources from the World Bank, the World Health Organization, and a variety of donor agencies. The combination of favorable political economic opportunities and the bottom-up demands from civil society make Brazil a particularly interesting case. Despite the stabilization of the AIDS epidemic within the general Brazilian population, it continues to grow in pockets of poverty, especially among women and blacks. We use resource mobilization theories to examine the role of Afro-Brazilian religious organizations in reaching these marginalized populations. From December 2006 through November 2008, we conducted ethnographic research, including participant observation and oral histories with religious leaders (N = 18), officials from the National AIDS Program (N = 12), public health workers from Rio de Janeiro (N = 5), and non-governmental organization (NGO) activists who have worked with Afro-Brazilian religions (N = 5). The mobilization of resources from international donors, political opportunities (i.e., decentralization of the National AIDS Program), and cultural framings enabled local Afro-Brazilian religious groups to forge a national network. On the micro-level, in Rio de Janeiro, we observed how macro-level structures led to the proliferation of capacity-building and peer educator projects among these religious groups. We found that beyond funding assistance, the interrelation of religious ideologies, leadership, and networks linked to HIV can affect mobilization. Copyright © 2010 Elsevier Ltd. All rights reserved.
Full Text Available Considering the long tradition of discussing health in the Brazilian school curriculum, it is important to investigate how this topic is addressed by the textbooks, the main resource used by most schools in the country. In particular, it is relevant to verify if this content is presented in a manner that contributes to the development of the students as active and critical members of the society. We analyze how health is treated in the textbook Biology, by Laurence (2005, which has been the high school Biology textbook most chosen by public school teachers among those certified by the National Program for High School Textbooks (PNLEM/2007, sponsored by the Brazilian Ministry of Education (MEC. We used categorical content analysis techniques, involving the decomposition of the texts into units of analysis, the categories, which were built in this work through analogical regroupings, by using semantic criteria. In order to investigate the treatment given to health, we applied an analytical table to the units of recording, which consist of sentences, paragraphs, and sections of the textbook that discuss contents related to health and disease. This table systematizes eight health indicators, seeking to identify three health approaches: biomedical, behavioral, and socioecological. We found 267 units of recording in the textbook and, based on their analysis, it was possible to categorize the textbook as one in which the biomedical approach prevails. Our findings are consistent with other works that indicate the prevalence of this approach in Brazilian education, and Brazilian and international textbooks. Another important finding of the work is that the behavioral approach does not hold, at least for the analyzed textbook, as a view of health different from the biomedical and socioecological approaches. After all, when the book mentions behaviors and habits of life associated with health, it generally emphasizes biological dimensions, aligning with a
Luiz Carlos Romero
sistemática de trabalho no âmbito das comissões técnicas e da consultoria técnica do Senado.The objective of this study was to identify and describe the actions of Brazilian senators in the field of public health in 1995 and 1996. We also sought to determine if profession, regional background, or political party influenced the senators' actions. The actions were divided into three types: legislative (proposal and review of bills and petitions; supervisory (information requests to the executive branch and the establishment of inquiry committees and other special committees; and parliamentary (speeches. The data were collected from two databases maintained by the Senate, namely MATE and DISC. Of the 89 senators who were in office during the study period, 76 were involved with public health issues. Of the total of 667 actions studied, there was a predominance of speeches (43% of all actions, most of them responding to news reported by regional or national media. Supervisory activities were limited (5% of all actions were information requests. The subjects dealt with most frequently were health policies (30%, drugs (9%, regulation of health professions (8%, disease control (7%, and worker health (6%. Concerning the professions of the senators, the most frequent categories were physicians, teachers, and journalists. The senators representing the North and Northeast regions performed 62% of the actions and were involved with almost all the health subjects. Although 43% of the actions were carried out by liberal and right-wing senators, the senators from socialist and labor parties had a stronger proportional participation (both in terms of senators involved and actions performed. It is interesting to note that socialist and labor senators showed minimal involvement in the issue of worker health. The predominance of speeches as a prevalent type of action, the limited and disjointed scope of legislative actions, and, especially, the poor monitoring and control show the need
Anna Silvia Penteado Setti da Rocha
Full Text Available This paper aims to reflect on human dignity and misthanasia in the public health system in Brazil. For this, concepts, document reviews and public data about the condition of the Brazilian population’s access to public health were all used. The indicators show the health inequalities in the country, with the north and northeast at a disadvantage both in terms of access to health and the number of available professionals. Thus, the most underserved population tends to continue to be excluded from society and impaired with respect to their human dignity.
Túlio Batista Franco
Full Text Available Throughout Brazilian Public Health System's (Centralized Health System - SUS construction history there has been a reasonable investment in the education for the sector. However, it has been frequently noticed by health professionals and managers the fact that this investment in educational programs has not converted into change of healthcare practices. Assuming that education can be used as a tool for changes in health, the text suggests that the pedagogical practices should be directed towards the production of individuals implied with the care production. Hence it proposes to work on a field of subjectivity in addition to cognition. This work reveals the management of the Brazilian public health system and its flows of permanent education, focusing "micromanagement" to think about the context on which they structuralize the diverse scenarios of care production, treating them as Pedagogical Production Units where it would be possible to develop entailed educational methodologies to a general idea of permanent education in health.
Day, Matthew; Shickle, Darren; Smith, Kevin; Zakariasen, Ken; Moskol, Jacob; Oliver, Thomas
Public health leaders have been criticized for their policy stances, relationships with governments and failure to train the next generation. New approaches to the identification and training of public health leaders may be required. To inform these, lessons can be drawn from public health 'superheroes'; public health leaders perceived to be the most admired and effective by their peers. Members and Fellows of the UK Faculty of Public Health were contacted via e-newsletter and magazine and asked to nominate their 'Public Health Superhero'. Twenty-six responses were received, nominating 40 different people. Twelve semi-structured interviews were conducted. Thematic analysis, based on 'grounded theory', was conducted. Five leadership 'talents' for public health were identified: mentoring-nurturing, shaping-organizing, networking-connecting, knowing-interpreting and advocating-impacting. Talent-based approaches have been effective for leadership development in other sectors. These talents are the first specific to the practice of public health and align with some aspects of existing frameworks. An increased focus on identifying and developing talents during public health training, as opposed to 'competency'-based approaches, may be effective in strengthening public health leadership. Further research to understand the combination and intensity of talents across a larger sample of public health leaders is required. © The Author 2014. Published by Oxford University Press on behalf of Faculty of Public Health. All rights reserved. For permissions, please e-mail: firstname.lastname@example.org.
Actions towards closing the health equity gap: A global public health imperative. Tewabech ... global health development. With only two ... of himself and of his family; including food, clothing .... impact on health equity and in the end issued the.
Penteado, Silvio Pires; Ramos, Sueli de Lima; Battistella, Linamara Rizzo; Marone, Silvio Antonio Monteiro; Bento, Ricardo Ferreira
Summary Introduction: Currently, the Brazilian government has certificated nearly 140 specialized centers in hearing aid fittings through the Brazilian National Health System (SUS). Remote fitting through the Internet can allow a broader and more efficient coverage with a higher likelihood of success for patients covered by the SUS, as they can receive fittings from their own homes instead of going to the few and distant specialized centers. Aim: To describe a case of remote fitting between 2 cities, with revision of the literature. Method: Computer gears, a universal interface, and hearing aids were used. Case study: An audiologist located in a specialized center introduced a new hearing aid and its fitting procedure to a remote center (200 km away). The specialized center helped the remote center in fitting a hearing aid in 2 patients, and performed fitting in one of its own patients. The whole process was done through the Internet with audio and video in real time. Results: Three patients were fitted remotely. Three audiologists were remotely trained on how to fit the hearing aids. Conclusions: Remote fitting of hearing aids is possible through the Internet, as well as further supplying technical training to a remote center about the fitting procedures. Such a technological approach can help the government advance public policies on hearing rehabilitation, as patients can be motivated about maintaining their use of hearing aids with the option to ask for help in the comfort of their own homes. PMID:25991960
Nunes Maria F
Full Text Available Abstract Background Follow-up studies of former students are an efficient way to organize the entire process of professional training and curriculum evaluation. The aim of this study was to identify professional profile subgroups based on job-related variables in a sample of former students of a Brazilian public dental school. Methods A web-based password-protected questionnaire was sent to 633 registered dentists who graduated from the Federal University of Goias between 1988 and 2007. Job-related information was retrieved from 14 closed questions, on subjects such as gender, occupational routine, training, profits, income status, and self-perception of professional career, generating an automatic database for analysis. The two-step cluster method was used for dividing dentists into groups on the basis of minimal within-group and maximal between-group variation, using job-related variables to represent attributes upon which the clustering was based. Results There were 322 respondents (50.9%, predominantly female (64.9% and the mean age was 34 years (SD = 6.0. The automatic selection of an optimal number of clusters included 289 cases (89.8% in 3 natural clusters. Clusters 1, 2 and 3 included 52.2%, 30.8% and 17.0% of the sample respectively. Interpretation of within-group rank of variable importance for cluster segmentation resulted in the following characterization of clusters: Cluster 1 - specialist dentists with higher profits and positive views of the profession; Cluster 2 - general dental practitioners in small cities; Cluster 3 - underpaid and less motivated dentists with negative views of the profession. Male dentists were predominant in cluster 1 and females in cluster 3. One-way Anova showed that age and time since graduation were significantly lower in Cluster 2 (P Conclusions Cluster analysis was a valuable method for identifying natural grouping with relatively homogeneous cases, providing potentially meaningful information for
Full Text Available Nanotechnology is a new revolution in technology; being used in different parts of life such as self-cleaning paints, dirt repellent fabrics, the destruction of cancer cells without harming the person, biosensors that can detect even a single bacterium, odorless socks due to the destruction of bacteria, germ-free refrigerators, disinfection etc. In this article, we consider in the perspective of public health the possible risks of this new technology, which is starting to appear in all areas of our daily lives.
Holt, R D
Dental public health has been defined as 'the science and art of preventing oral diseases, promoting oral health and improving the quality of life through the organised efforts of society'. Dental practitioners most often have the oral health of individual patients as their primary focus but the aim of public health is to benefit populations. Early developments in dental public health were concerned largely with demonstrating levels of disease and with treatment services. With greater appreciation of the nature of oral health and disease, and of their determinants has come recognition of the need for wider public health action if the effects of prevention and oral health promotion are to be maximized.
Guimarães, Cristian Fabiano; da Silva, Rosane Azevedo Neves
This paper presents a theoretical review of how the public health concept has been perceived in health practices, based on the problematic field introduced in Italian and Brazilian health reforms, in order to understand the construction of public health and the meanings that this term acquires in the health arena. The main goal is to understand how public health appears in the context of health movements in Italy and Brazil, as well as its movement of variation. In this sense, an attempt is made to identify elements that contribute to the composition of a genealogy of public health. From the investigation of public health practices, the tensions produced by this concept are analyzed, giving visibility to those practices that demonstrate the public health experience as a force in the world of health.
David, Helena Maria Scherlowski Leal; Bonetti, Osvaldo Peralta; da Silva, Maria Rocineide Ferreira
This essay discusses the role of Brazilian nursing as a socially committed practice, in the political and pedagogic plan. The concepts of popular participation, representative and participatory democracy, and education in health are recovered, enlightened by the recent history of the constitution of social network of practices and reflections called Popular Education and Health. The construction process and the ethical-political principles of a National Policy of Popular Education in Health are presented, discussing the participation of nursing in the changes of educational practices, in spaces of political representation and formulation of public policies, with a perspective of achieving a fair and equal social order.
Little, Ruth Gaskins; Greer, Annette; Clay, Maria; McFadden, Cheryl
Public health leaders play pivotal roles in ensuring the population health for our nation. Since 2000, the number of schools of public health has almost doubled. The scholarly credentials for leaders of public health in academic and practice are important, as they make decisions that shape the future public health workforce and important public health policies. This research brief describes the educational degrees of deans of schools of public health and state health directors, as well as their demographic profiles, providing important information for future public health leadership planning. Data were extracted from a database containing information obtained from multiple Web sites including academic institution Web sites and state government Web sites. Variables describe 2 sets of public health leaders: academic deans of schools of public health and state health directors. Deans of schools of public health were 73% males and 27% females; the PhD degree was held by 40% deans, and the MD degree by 33% deans. Seventy percent of deans obtained their terminal degree more than 35 years ago. State health directors were 60% males and 40% females. Sixty percent of state health directors had an MD degree, 4% a PhD degree, and 26% no terminal degree at all. Sixty-four percent of state health directors received their terminal degree more than 25 years ago. In addition to terminal degrees, 56% of deans and 40% of state health directors held MPH degrees. The findings call into question competencies needed by future public health professionals and leadership and the need to clarify further the level of public health training and degree type that should be required for leadership qualifications in public health.
Misuse and Addiction Prevention Finance & Management Services Health Care Services Juvenile Justice , Alaska 99752 Phone: 442-7144 Fax: 442-7292 e-mail: Josephine Oke, Program Manager [back to top] North Phone: 852-0270 Fax: 852-2855 email: Andrey Boskhomdzhiev [back to top] Municipality of Anchorage P.O
Green, Judith; Labonte, Ronald N
... the contemporary roles of 'critical voices' in public health research and practice from a range of disciplines and contexts. The book covers many of the pressing concerns for public health practitioners and researchers, including: * * * * * the implications of new genetic technologies for public health; the impact of globalisation on local practice...
Carlos Cezar Flores Vidotti
Full Text Available OBJECTIVES: To describe the new drugs marketed in Brazil during the period 2000-2004, compare the description to the country's burden of disease, and suggest initiatives capable of addressing the situation from the perspective of a developing country. METHODS: Records of new drugs were surveyed in an official drug registration database. The new drugs were categorized by Anatomical Therapeutic Chemical classification, indication, and innovation, and compared with the needs of the country's burden of disease. Data on the morbidity and mortality rates of selected diseases (diabetes, Hansen's disease, hypertension, tuberculosis were retrieved from official documents and the literature. RESULTS: During the period investigated, 109 new drugs were launched. Most were general anti-infectives for systemic use (19, followed by antineoplastic and immunomodulating agents (16. The number of new drugs launched in 2004 was roughly one-third that of 2000. Of 65 new drugs, only one-third can be classified as innovative. Most new drugs were intended to treat noninfectious diseases that typically affect developed countries, diseases that constitute only a fraction of the country's challenges. CONCLUSIONS: A mismatch occurs between public health needs and the new drugs launched on the Brazilian market. Not only did the number of new drugs decrease in the study period, but only a few were actually new in therapeutic terms. Developing countries must acquire expertise in research and development to strengthen their capacity to innovate and produce the drugs they need.OBJETIVOS: Describir los nuevos medicamentos lanzados al mercado en Brasil durante el período 2000-2004, comparar su descripción con la carga de enfermedades del país y recomendar iniciativas que permitan enfrentar la situación desde la perspectiva de un país en desarrollo. MÉTODOS: Se buscaron los nuevos medicamentos en una base de datos oficial de registro de medicamentos. Los nuevos medicamentos
Rogers, W A
This paper sketches an account of public health ethics drawing upon established scholarship in feminist ethics. Health inequities are one of the central problems in public health ethics; a feminist approach leads us to examine not only the connections between gender, disadvantage, and health, but also the distribution of power in the processes of public health, from policy making through to programme delivery. The complexity of public health demands investigation using multiple perspectives and an attention to detail that is capable of identifying the health issues that are important to women, and investigating ways to address these issues. Finally, a feminist account of public health ethics embraces rather than avoids the inescapable political dimensions of public health.
Le Loup, G; Fleury, S; Camargo, K; Larouzé, B
The sustainability of successful public health programmes remains a challenge in low and middle income settings. These programmes are often subjected to mobilization-demobilization cycle. Indeed, political and organizational factors are of major importance to ensure this sustainability. The cooperation between the World Bank and the Brazilian AIDS programme highlights the role of international institutions and global health initiatives (GHI), not only to scale up programmes but also to guarantee their stability and sustainability, at a time when advocacy is diminishing and vertical programmes are integrated within health systems. This role is critical at the local level, particularly when economic crisis may hamper the future of public health programmes. Political and organizational evolution should be monitored and warnings should trigger interventions of GHI before the decline of these programmes.
Padoveze, Maria Clara; Fortaleza, Carlos Magno Castelo Branco; Kiffer, Carlos; Barth, Afonso Luís; Carneiro, Irna Carla do Rosário Souza; Giamberardino, Heloisa Ilhe Garcia; Rodrigues, Jorge Luiz Nobre; Santos Filho, Lauro; de Mello, Maria Júlia Gonçalves; Pereira, Milca Severino; Gontijo Filho, Paulo; Rocha, Mirza; de Medeiros, Eduardo Alexandrino Servolo; Pignatari, Antonio Carlos Campos
Minimal structure is required for effective prevention of health care-associated infection (HAI). The objective of this study was to evaluate the structure for prevention of HAI in a sample of Brazilian hospitals. This was a cross-sectional study from hospitals in 5 Brazilian regions (n = 153; total beds: 13,983) classified according to the number of beds; 11 university hospitals were used as reference for comparison. Trained nurses carried out the evaluation by using structured forms previously validated. The evaluation of conformity index (CI) included elements of structure of the Health Care-Associated Prevention and Control Committee (HAIPCC), hand hygiene, sterilization, and laboratory of microbiology. The median CI for the HAIPCC varied from 0.55-0.94 among hospital categories. Hospitals with >200 beds had the worst ratio of beds to sinks (3.9; P hospitals with hospitals (3.3; P hospitals were more likely to have their own laboratory of microbiology than other hospitals. This study highlights the need for public health strategies aiming to improve the structure for HAI prevention in Brazilian hospitals. Copyright © 2016 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.
Shaw, David; Elger, Bernice S
In this article, we describe and analyse three issues in publication ethics that are raised when conducting research in emergencies and disasters. These include reluctance to share data and samples because of concerns about publications, loss of individual authorship in high high-profile multi-entity publications, and the deaths of authors during dangerous research projects. An emergency research pledge may be useful in avoiding some of these issues. © The Author 2016. Published by Oxford University Press on behalf of Faculty of Public Health. All rights reserved. For permissions, please e-mail: email@example.com.
Springston, Jeffrey K; Weaver Lariscy, Ruth Ann
This article explores public relations effectiveness in public health institutions. First, the two major elements that comprise public relations effectiveness are discussed: reputation management and stakeholder relations. The factors that define effective reputation management are examined, as are the roles of issues and crisis management in building and maintaining reputation. The article also examines the major facets of stakeholder relations, including an inventory of stakeholder linkages and key audiences, such as the media. Finally, methods of evaluating public relations effectiveness at both the program level and the institutional level are explored.
Objective: To identify and describe the parameters of the Frontal Power of Concentration (C). Method: Systematic review of EEG- and fMRI-studies from a neuroeconomic point of view. Results: C is a quadripartite executive integrator depending on: 1) Limbic system (L) generates emotions and cogni...... + εI → 1 Discussion: How to reinforce volitional flexibility (c)? Firstly, cognitive predictions are improved by open-mindedness. Secondly, emotional control is best maintaining an appropriate level of physical fitness. Thirdly, our imagination is directly facilitated by in...... predicts that well-organized stress-management integrating LowTech-interventions as exercise (L↓ and c↑), in-depth-relaxation (c↓) and diet (integrating L, R and c) tailored to the individual would improve public health (national life expectancy) significantly...
Reichert, Felipe Fossati; Domingues, Marlos Rodrigues; Hallal, Pedro C; Azevedo, Mario Renato; Siqueira, Fernando Vinholes; Barros, Aluísio J D
We aimed to evaluate how Brazilian adults rank seven well-known health-related factors in terms of importance for health. A population-based study was undertaken in Pelotas, Rio Grande do Sul State, Brazil (N = 3,100; response rate: 96.5%). Individuals ranked three out of seven factors that, in their opinion, were the most important for health. The factors investigated were: "controlling stress", "practicing physical activity regularly", "avoiding drinking in excess", "avoiding smoking", "visiting a doctor regularly", "keeping the ideal weight", and "having a healthy diet". Healthy diet (73.9%), physical activity (59.9%), and visiting a doctor regularly (45.7%) were the most frequently reported factors. Younger subjects and those with higher socioeconomic status were more likely to report physical activity and stress as important factors for health than their counterparts. The importance attributed to health-related factors changes markedly among population subgroups.
Bertoldi Andréa D
Full Text Available Abstract Background In a country where comprehensive free health care is provided via a public health system (SUS, an unexpected high frequency of catastrophic out-of-pocket expenditure has been described. We studied how deliveries were financed among mothers of a birth cohort and whether they were an important source of household out-of-pocket expenditure. Methods All deliveries occurring in the city of Pelotas, Brazil, during 2004, were recruited for a birth cohort study. All mothers were interviewed just after birth and three months later. Comprehensive data on the pregnancy, delivery, birth conditions and newborn health were collected, along with detailed information on expenses related to the delivery. Results The majority of the deliveries (81% were financed by the public health system, a proportion that increased to more than 95% among the 40% poorest mothers. Less than 1% of these mothers reported some out-of-pocket expenditure. Even among those mothers covered by a private health plan, nearly 50% of births were financed by the SUS. Among the 20% richest, a third of the deliveries were paid by the SUS, 50% by private health plans and 17% by direct payment. Conclusion The public health system offered services in quantity and quality enough to attract even beneficiaries of private health plans and spared mothers from the poorest strata of the population of practically any expense.
Full Text Available Public health policies continue to play important roles in national and international health reforms. However, the influence and legacies of the public health eras during which such policies are formulated remain largely underappreciated. The limited appreciation of this relationship may hinder consistent adoption of public health policies by nation-states, and encumber disinvestment from ineffective or anachronistic policies. This article reviews seven public health eras and highlights how each era has influenced international policy formulation for leprosy control—“the fertile soil for policy learning”. The author reiterates the role of health leadership and health activism in facilitating consistency in international health policy formulation and implementation for leprosy control.
Sabrina Destri Emmerick Campos
Full Text Available There is increasing interaction between man and pathogens transmitted by arthropods, especially by ticks. It is on this background that a holistic approach stands out, for the sake of Public Health. Brazilian Spotted Fever is an endemic disease at the country’s southeast, with Amblyomma sculptum as its major contributor, followed by A. aureolatum and potentially Rhipicephalus sanguineus. Dogs have been considered sentinels, and in some areas the disease in dogs can precede human disease. Considering the importance of this disease for human health, the serological evidence in dogs, and the transmission of ticks between dogs and their owners, this review aimed to elucidate the importance of the epidemiological investigation, the diagnosis in dogs, and the role of veterinarians in Public Health to control vector-borne zoonotic diseases. We encourage veterinarians to include this rickettsial infection in the diagnosis of febrile diseases of common occurrence in dogs.
Nascimento, Renata Cristina Rezende Macedo do; Álvares, Juliana; Guerra, Augusto Afonso; Gomes, Isabel Cristina; Costa, Ediná Alves; Leite, Silvana Nair; Costa, Karen Sarmento; Soeiro, Orlando Mario; Guibu, Ione Aquemi; Karnikowski, Margô Gomes de Oliveira; Acurcio, Francisco de Assis
To characterize the availability of tracer medicines in pharmaceutical services in primary health care of the Brazilian Unified Health System (SUS). This is a cross-sectional and evaluative study, part of the Pesquisa Nacional Sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos - Serviços, 2015 (PNAUM - National Survey on Access, Use and Promotion of Rational Use of Medicines - Services, 2015). To analyze the availability of medicines, we verified 50 items selected from the Relação Nacional de Medicamentos Essenciais (Rename - National List of Essential Medicines) of 2012. Observation scripts were applied to medicine dispensing services in the primary health care. Interviews were carried out with patients, health care professionals, and public managers, using semi-structured questionnaires. The availability index was presented as the percentage of health units where the medicines were available. For statistical analysis, absolute, relative, and mean frequencies were presented (with 95% confidence intervals). The comparison of groups was carried out by Pearson Chi-square tests or variance analysis, when needed. One thousand, one hundred, and seventy-five observation scripts were filled in a national representative sample composed by 273 cities. Statistically significant differences were observed regarding the type of unit, infrastructure, and presence of a pharmacist between regions of Brazil. The average availability of tracer medicines in primary health care was 52.9%, with differences between regions and sampling strata. This index increased to 62.5% when phytotherapic medicines were excluded. We found limited availability of medicines for treatment of chronic and epidemiological diseases, such as tuberculosis and congenital syphilis. The low availability of essential medicines purchased centrally by the Brazilian Ministry of Health indicates deficiencies in supply chain management. The different views on the availability of tracer
Renata Cristina Rezende Macedo do Nascimento
Full Text Available ABSTRACT OBJECTIVE To characterize the availability of tracer medicines in pharmaceutical services in primary health care of the Brazilian Unified Health System (SUS. METHODS This is a cross-sectional and evaluative study, part of the Pesquisa Nacional Sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos – Serviços, 2015 (PNAUM – National Survey on Access, Use and Promotion of Rational Use of Medicines – Services, 2015. To analyze the availability of medicines, we verified 50 items selected from the Relação Nacional de Medicamentos Essenciais (Rename – National List of Essential Medicines of 2012. Observation scripts were applied to medicine dispensing services in the primary health care. Interviews were carried out with patients, health care professionals, and public managers, using semi-structured questionnaires. The availability index was presented as the percentage of health units where the medicines were available. For statistical analysis, absolute, relative, and mean frequencies were presented (with 95% confidence intervals. The comparison of groups was carried out by Pearson Chi-square tests or variance analysis, when needed. RESULTS One thousand, one hundred, and seventy-five observation scripts were filled in a national representative sample composed by 273 cities. Statistically significant differences were observed regarding the type of unit, infrastructure, and presence of a pharmacist between regions of Brazil. The average availability of tracer medicines in primary health care was 52.9%, with differences between regions and sampling strata. This index increased to 62.5% when phytotherapic medicines were excluded. We found limited availability of medicines for treatment of chronic and epidemiological diseases, such as tuberculosis and congenital syphilis. CONCLUSIONS The low availability of essential medicines purchased centrally by the Brazilian Ministry of Health indicates deficiencies in supply chain
Riveros, Maribel; Ochoa, Theresa J
Diarrhea remains the third leading cause of death in children under five years, despite recent advances in the management and prevention of this disease. It is caused by multiple pathogens, however, the prevalence of each varies by age group, geographical area and the scenario where cases (community vs hospital) are recorded. The most relevant pathogens in public health are those associated with the highest burden of disease, severity, complications and mortality. In our country, norovirus, Campylobacter and diarrheagenic E. coli are the most prevalent pathogens at the community level in children. In this paper we review the local epidemiology and potential areas of development in five selected pathogens: rotavirus, norovirus, Shiga toxin-producing E. coli (STEC), Shigella and Salmonella. Of these, rotavirus is the most important in the pediatric population and the main agent responsible for child mortality from diarrhea. The introduction of rotavirus vaccination in Peru will have a significant impact on disease burden and mortality from diarrhea. However, surveillance studies are needed to determine the impact of vaccination and changes in the epidemiology of diarrhea in Peru following the introduction of new vaccines, as well as antibiotic resistance surveillance of clinical relevant bacteria.
This commentary describes how the Brazilian Ministry of Health's (MoH) research support policy fulfilled the National Agenda of Priorities in Health Research (NAPHR). In 2003, the MoH started a democratic process in order to establish a priority agenda in health research involving investigators, health managers and community leaders. The Agenda was launched in 2004 and is guiding budget allocations in an attempt to reduce the gap between scientific knowledge and health practice and activities, aiming to contribute to improving Brazilian quality of life. Many strategies were developed, for instance: Cooperation Agreements between the Ministry of Health and the Ministry of Science and Technology; the decentralization of research support at state levels with the participation of local Health Secretariats and Science and Technology Institutions; Health Technology Assessment; innovation in neglected diseases; research networks and multicenter studies in adult, women's and children's health; cardiovascular risk in adolescents; clinical research and stem cell therapy. The budget allocated by the Ministry of Health and partners was expressive: US$419 million to support almost 3,600 projects. The three sub-agenda with the higher proportion of resources were "industrial health complex", "clinical research" and "communicable diseases", which are considered strategic for innovation and national development. The Southeast region conducted 40.5% of all projects and detained 59.7% of the resources, attributable to the concentration of the most traditional health research institutes and universities in the states of São Paulo and Rio de Janeiro. The second most granted region was the Northeast, which reflects the result of a governmental policy to integrate and modernize this densely populated area and the poorest region in the country. Although Brazil began the design and implementation of the NAPHR in 2003, it has done so in accordance with the 'good practice principles
Full Text Available Abstract This commentary describes how the Brazilian Ministry of Health's (MoH research support policy fulfilled the National Agenda of Priorities in Health Research (NAPHR. In 2003, the MoH started a democratic process in order to establish a priority agenda in health research involving investigators, health managers and community leaders. The Agenda was launched in 2004 and is guiding budget allocations in an attempt to reduce the gap between scientific knowledge and health practice and activities, aiming to contribute to improving Brazilian quality of life. Many strategies were developed, for instance: Cooperation Agreements between the Ministry of Health and the Ministry of Science and Technology; the decentralization of research support at state levels with the participation of local Health Secretariats and Science and Technology Institutions; Health Technology Assessment; innovation in neglected diseases; research networks and multicenter studies in adult, women's and children's health; cardiovascular risk in adolescents; clinical research and stem cell therapy. The budget allocated by the Ministry of Health and partners was expressive: US$419 million to support almost 3,600 projects. The three sub-agenda with the higher proportion of resources were "industrial health complex", "clinical research" and "communicable diseases", which are considered strategic for innovation and national development. The Southeast region conducted 40.5% of all projects and detained 59.7% of the resources, attributable to the concentration of the most traditional health research institutes and universities in the states of São Paulo and Rio de Janeiro. The second most granted region was the Northeast, which reflects the result of a governmental policy to integrate and modernize this densely populated area and the poorest region in the country. Although Brazil began the design and implementation of the NAPHR in 2003, it has done so in accordance with the 'good
This paper suggests that current models of public health are no longer sufficient as a means for understanding the health challenges of the anthropogenic age, and argues for an alternative based upon an ecological model. The roots of this perspective originated within the Victorian era, although it found only limited expression at that time. Ecological thinking in public health has only been revived relatively recently. Derived from an analysis of obesity, this paper proposes the development of an approach to ecological public health based on four dimensions of existence: the material, the physiological, the social and the cultural-cognitive. The implications for public policy are considered.
It is clear that the public health community is concerned about the human health impacts of climate change, but are we inadvertently underestimating the scope of the problem and obfuscating potentially useful interventions by using a narrow intellectual frame in our discussions with policy makers? If we take a more holistic approach, we see that the public health impacts of climate change are only one subset of the enormous public health impacts of fossil fuel burning. This broader perspective can provide a more accurate and comprehensive assessment that is more useful for decision making in public policy settings.
Freire, Maria do Carmo Matias; Jordão, Lidia Moraes Ribeiro; Malta, Deborah Carvalho; Andrade, Silvânia Suely Caribé de Araújo; Peres, Marco Aurelio
OBJECTIVE To analyze oral health behaviors changes over time in Brazilian adolescents concerning maternal educational inequalities. METHODS Data from the Pesquisa Nacional de Saúde do Escolar (Brazilian National School Health Survey) were analyzed. The sample was composed of 60,973 and 61,145 students from 26 Brazilian state capitals and the Federal District in 2009 and 2012, respectively. The analyzed factors were oral health behaviors (toothbrushing frequency, sweets consumption, soft drink consumption, and cigarette experimentation) and sociodemographics (age, sex, race, type of school and maternal schooling). Oral health behaviors and sociodemographic factors in the two years were compared (Rao-Scott test) and relative and absolute measures of socioeconomic inequalities in health were estimated (slope index of inequality and relative concentration index), using maternal education as a socioeconomic indicator, expressed in number of years of study (> 11; 9-11; ≤ 8). RESULTS Results from 2012, when compared with those from 2009, for all maternal education categories, showed that the proportion of people with low toothbrushing frequency increased, and that consumption of sweets and soft drinks and cigarette experimentation decreased. In private schools, positive slope index of inequality and relative concentration index indicated higher soft drink consumption in 2012 and higher cigarette experimentation in both years among students who reported greater maternal schooling, with no significant change in inequalities. In public schools, negative slope index of inequality and relative concentration index indicated higher soft drink consumption among students who reported lower maternal schooling in both years, with no significant change overtime. The positive relative concentration index indicated inequality in 2009 for cigarette experimentation, with a higher prevalence among students who reported greater maternal schooling. There were no inequalities for
... a variety of comprehensive classroom and curriculum resources. Framing The Future Faculty Resources Educational Models and Reports ... research, and regulate health systems to achieve these goals. Its reach is global. The public health field ...
Taira, Deborah; Sentell, Tetine; Albright, Cheryl; Lansidell, Doug; Nakagawa, Kazuma; Seto, Todd; Stevens, Joel Mark
Hypertension is one of the leading causes of death and disability worldwide. Blood pressure reduction and control are associated with reduced risk of stroke and cardiovascular disease. To achieve optimal reduction and control, reliable and valid methods for blood pressure measurement are needed. Office based measurements can result in ‘white coat’ hypertension, which is when a patient's blood pressure in a clinical setting is higher than in other settings, or ‘masked’ hypertension, which occurs when a patient's blood pressure is normal in a clinical setting, but elevated outside the clinical setting. In 2015, the US Preventative Services Task Force recommended Ambulatory Blood Pressure Monitoring (ABPM) as the “best method” for measuring blood pressure, endorsing its use both for confirming the diagnosis of hypertension and for excluding ‘white coat’ hypertension. ABPM is a safe, painless and non-invasive test wherein patients wear a small digital blood pressure machine attached to a belt around their body and connected to a cuff around their upper arm that enables multiple automated blood pressure measurements at designated intervals (typically every 15 to 30 minutes) throughout the day and night for a specified period (eg, 24 hours). Patients can go about their typical daily activities wearing the device as much as possible, except when they are bathing, showering, or engaging in heavy exercise. Given the importance of blood pressure monitoring and control to population public health, this article provides details on the relevance and challenges of blood pressure measurement broadly then describes ABPM generally and specifically in the Hawai‘i context. PMID:29164016
Turi, Bruna Camilo; Codogno, Jamile S; Fernandes, Romulo A; Sui, Xuemei; Lavie, Carl J; Blair, Steven N; Monteiro, Henrique Luiz
Hypertension is one of the most common noncommunicable diseases worldwide, and physical inactivity is a risk factor predisposing to its occurrence and complications. However, it is still unclear the association between physical inactivity domains and hypertension, especially in public healthcare systems. Thus, this study aimed to investigate the association between physical inactivity aggregation in different domains and prevalence of hypertension among users of Brazilian public health system. 963 participants composed the sample. Subjects were divided into quartiles groups according to 3 different domains of physical activity (occupational; physical exercises; and leisure-time and transportation). Hypertension was based on physician diagnosis. Physical inactivity in occupational domain was significantly associated with higher prevalence of hypertension (OR = 1.52 [1.05 to 2.21]). The same pattern occurred for physical inactivity in leisure-time (OR = 1.63 [1.11 to 2.39]) and aggregation of physical inactivity in 3 domains (OR = 2.46 [1.14 to 5.32]). However, the multivariate-adjusted model showed significant association between hypertension and physical inactivity in 3 domains (OR = 2.57 [1.14 to 5.79]). The results suggest an unequal prevalence of hypertension according to physical inactivity across different domains and increasing the promotion of physical activity in the healthcare system is needed.
Marilisa Berti de Azevedo Barros
Full Text Available ABSTRACT OBJECTIVE To evaluate the prevalence of health-related behaviors according to presence and type of depression in Brazilian adults. METHODS Based on a sample of 49,025 adults (18 to 59 years from the National Survey on Health 2013 (PNS 2013, we estimated the prevalence of health-related behaviors (smoking; passive smoking; frequent or risky alcohol consumption; leisure time physical activity; time watching TV; and eating pattern indicators, according to the presence of depression (minor and major, evaluated by the Patient Health Questionnaire – 9 (PHQ-9, and the report of depressive mood (in up to seven days or more than seven days over a two-week period. Prevalence ratios were estimated by Poisson regression. RESULTS Evaluated by the PHQ-9 scale, 9.7% of the Brazilian adults had depression and 3.9% presented major depression. About 21.0% reported depressive mood and, in 34.9% of them, that feeling has been present for more than seven days. In individuals with major depression (PHQ-9, higher prevalence was found in almost all unhealthy behaviors analyzed, in particular, smoking (PR = 1.65, passive smoking (PR = 1.55, risk alcohol consumption (PR = 1.72, TV for ≥ 5 hours/day (PR = 2.13, consumption of fat meat (PR = 1.43 and soft drink (PR = 1.42. The prevalence ratios tended to be lower in those with minor depression. Similar results were observed in adults with depressive mood. CONCLUSIONS This study detected relevant association between depression and health behaviors, in particular for smoking and physical activity. The associations found with the PHQ were similar to those observed with the application of a single question about depressive mood. Our results indicate the importance of assessing the presence of depression and the frequency and severity of symptoms when implementing actions for the promotion of healthy behaviors.
Soares, Catharina Leite Matos
This paper addresses the construction of public oral health policies in Brazil by reviewing the available literature. It includes a discussion of the social responses given by the Brazilian State to oral health policies and the relationship of these responses with the ideological oral health movements that have developed globally, and that have specifically influenced oral health policies in Brazil. The influence of these movements has affected a series of hegemonic practices originating from both Market Dentistry and Preventive and Social Dentistry in Brazil. Among the state activities that have been set into motion, the following stand out: the drafting of a law to regulate the fluoridation of the public water supply, and the fluoridation of commercial toothpaste in Brazil; epidemiological surveys to analyze the status of the Brazilian population's oral health; the inclusion of oral health in the Family Health Strategy (Estratégia de Saúde da Família - ESF); the drawing up of the National Oral Health Policy, Smiling Brazil (Brasil Sorridente). From the literature consulted, the progressive expansion of state intervention in oral health policies is observed. However, there remains a preponderance of hegemonic "dental" practices reproduced in the Unified Public Health Service (Sistema Único de Saúde - SUS) and the Family Health Strategy.
Many public health dilemmas involve a tension between the promotion of health and the rights of individuals. This article suggests that we should resolve the tension using our familiar liberal principles of government. The article considers the common objections that (i) liberalism is incompatible with standard public health interventions such as anti-smoking measures or intervention in food markets; (2) there are special reasons for hard paternalism in public health; and (3) liberalism is incompatible with proper protection of the community good. The article argues that we should examine these critiques in a larger methodological framework by first acknowledging that the right theory of public health ethics is the one we arrive at in reflective equilibrium. Once we examine the arguments for and against liberalism in that light, we can see the weaknesses in the objections and the strength of the case for liberalism in public health. © 2015 John Wiley & Sons Ltd.
Meldonian, Nelson Leon; Mattos, Luis Antonio Terribile de
The Brazilian society is against applications of nuclear energy, mainly respecting to construction of new nuclear power plants, believing that they are harmful to population's welfare and the environment. By this reason, Brazilian nuclear sector would promote a more intensive program of public discussion, not limited to technical and scientific community. Intending to contribute to a better judgment by society about the differences between diverse employment of nuclear energy, arguments concerned to its benefits are presented, pointing out that adverse accounts to nuclear electricity based on Goiania radiological accident, are not justified
Adelman, Howard S; Taylor, Linda
Health policy and practice call for health and mental health parity and for a greater focus on universal interventions to promote, prevent, and intervene as early after problem onset as is feasible. Those in the public health field are uniquely positioned to help promote the mental health of young people and to reshape how the nation thinks about and addresses mental health. And schools are essential partners for doing the work.
Claudia Hausman Silveira
Full Text Available The article makes reference to the three models that have inspired the construction of the Program of Family Health in Brazil (Cuban, English and Canadian, observing their differences and similarities and comparing them with the Brazilian case. Therefore, an associative line is also constructed between the Only System of Health (SUS and the necessity of a practice which allows the functioning of its lines of direction and organization principles. Thus, we reach the conclusion that the Program of Family Health in Brazil, for its multi professional work proposal in interdisciplinary teams, in accordance with the SUS, can help keep the law of health in the Country. Key-words: SUS; Program of Family Health; Interdisciplinary; Medical care model; Sanitary practice
Arcos González, Pedro; Castro Delgado, Rafael; Cuartas Alvarez, Tatiana; Pérez-Berrocal Alonso, Jorge
Today the terrorism is a problem of global distribution and increasing interest for the international public health. The terrorism related violence affects the public health and the health care services in an important way and in different scopes, among them, increase mortality, morbidity and disability, generates a context of fear and anxiety that makes the psychopathological diseases very frequent, seriously alters the operation of the health care services and produces important social, political and economic damages. These effects are, in addition, especially intense when the phenomenon takes place on a chronic way in a community. The objective of this paper is to examine the relation between terrorism and public health, focusing on its effects on public health and the health care services, as well as to examine the possible frames to face the terrorism as a public health concern, with special reference to the situation in Spain. To face this problem, both the public health systems and the health care services, would have to especially adapt their approaches and operational methods in six high-priority areas related to: (1) the coordination between the different health and non health emergency response agencies; (2) the reinforcement of the epidemiological surveillance systems; (3) the improvement of the capacities of the public health laboratories and response emergency care systems to specific types of terrorism as the chemical or biological terrorism; (3) the mental health services; (4) the planning and coordination of the emergency response of the health services; (5) the relations with the population and mass media and, finally; (6) a greater transparency in the diffusion of the information and a greater degree of analysis of the carried out health actions in the scope of the emergency response.
Kass-Hout, Taha A; Alhinnawi, Hend
While social media interactions are currently not fully understood, as individual health behaviors and outcomes are shared online, social media offers an increasingly clear picture of the dynamics of these processes. Social media is becoming an increasingly common platform among clinicians and public health officials to share information with the public, track or predict diseases. Social media can be used for engaging the public and communicating key public health interventions, while providing an important tool for public health surveillance. Social media has advantages over traditional public health surveillance, as well as limitations, such as poor specificity, that warrant additional study. Social media can provide timely, relevant and transparent information of public health importance; such as tracking or predicting the spread or severity of influenza, west nile virus or meningitis as they propagate in the community, and, in identifying disease outbreaks or clusters of chronic illnesses. Further work is needed on social media as a valid data source for detecting or predicting diseases or conditions. Also, whether or not it is an effective tool for communicating key public health messages and engaging both, the general public and policy-makers.
Broeder, Den Lea; Devilee, Jeroen; Oers, Van Hans; Schuit, A.J.; Wagemakers, Annemarie
Community engagement in public health policy is easier said than done. One reason is that public health policy is produced in a complex process resulting in policies that may appear not to link up to citizen perspectives. We therefore address the central question as to whether citizen engagement in
Den Broeder, Lea; Devilee, Jeroen; Van Oers, J.A.M.; Schuit, A.J.; Wagemakers, Annemarie
Community engagement in public health policy is easier said than done. One reason is that public health policy is produced in a complex process resulting in policies that may appear not to link up to citizen perspectives. We therefore address the central question as to whether citizen engagement in
Cromley, Ellen K; McLafferty, Sara
...s. The book presents state-of-the-art methods for mapping and analyzing data on population, health events, risk factors, and health services, and for incorporating geographical knowledge into planning and policy...
... like Saba are about three to four times… https://www.nytimes.com/2017/11/13/health/colombia- ... often be overlooked as a cause of death": https://insideclimatenews.… Environmental health matters: https://www.theatlantic.com/ ...
Johnson, Claire; Rubinstein, Sidney M; Côté, Pierre
The purpose of this collaborative summary is to document current chiropractic involvement in the public health movement, reflect on social ecological levels of influence as a profession, and summarize the relationship of chiropractic to the current public health topics of: safety, health issues...... disorders? How can chiropractic use cognitive behavioral therapy to address chronic low back pain as a public health problem? What opportunities exist for doctors of chiropractic to more effectively serve the aging population? What is the role of ethics and the contribution of the chiropractic profession...
Full Text Available INTRODUCTION: At a time when a great number of diseases can be prevented by changing one's habits and life style, investigations have focused on understanding what adults and children believe to be desirable health practices and uncovering the factors associated with successful adherence to such practices. For these, causal attributions for health and illness were investigated among 96 Brazilian elementary school students. METHODS: Ninety six subjects, aged 6 to 14, were interviewed individually and their causal attributions were assessed through 14 true-false items (e.g. people stay well [healthy] because they are lucky. The relationship between the children's causal attributions and demographic characteristics were also examined. RESULTS: Overall, the results were consistent with previous researches. "Taking care of oneself" was considered the most important cause of good health. "Viruses and germs" and "lack of self-care" were the most selected causes of illness. Analyses revealed significant relationship between subjects' causal attribution and their age, school grade level, socioeconomic status and gender. CONCLUSIONS: The study findings suggest that there may be more cross-cultural similarities than differences in children's causal attributions for health and illness. Finding ways to help individuals engage in appropriate preventive-maintenance health practices without developing an exaggerated notion that the individuals can control their own health and illness is a challenge which remains to be addressed by further research.
Hollederer, A; Wildner, M
There is a great need for health services research in the public health system and in the German public health service. However, the public health service is underrepresented in health services research in Germany. This has several structural, historical and disciplinary-related reasons. The public health service is characterised by a broad range of activities, high qualification requirements and changing framework conditions. The concept of health services research is similar to that of the public health service and public health system, because it includes the principles of multidisciplinarity, multiprofessionalism and daily routine orientation. This article focuses on a specified system theory based model of health services research for the public health system and public health service. The model is based on established models of the health services research and health system research, which are further developed according to specific requirements of the public health service. It provides a theoretical foundation for health services research on the macro-, meso- and microlevels in public health service and the public health system. Prospects for public health service are seen in the development from "old public health" to "new public health" as well as in the integration of health services research and health system research. There is a significant potential for development in a better linkage between university research and public health service as is the case for the "Pettenkofer School of Public Health Munich". © Georg Thieme Verlag KG Stuttgart · New York.
The issues raised in this editorial and exemplified within a number of the studies reported in this issue indicate new directions for public health, directions which take feminist scholarship, both outside and within the medical framework, into account. The changing potential of feminist public health, as derived from the articles in this issue, can be summarised within the following issues: new research areas, positioning women as actors, development of theoretical frameworks, reflexive theory of science, interplay between sex and gender, gender-sensitive methods, diversities among women/men, pro-feminist research on men's health and using the results for change. Thus, feminist public health represents a shift towards the new public health, with holistic and multidisciplinary activities, based on theoretical pluralism, multiple perspectives and collective actions with the aim of improving the health of gender-subordinated groups.
Silveira, Cíntia Botelho; Pantoja, Ivaneida Kzarina Olaia Ribeiro; Silva, Allan Roberto Marques; Azevedo, Rômulo Nina de; Sá, Nayara Bandeira de; Turiel, Marck Gregório Pereira; Nunes, Mário Barbosa Guedes
End-stage chronic kidney disease (CKD) requiring dialysis affects the quality of life sometimes more severely than other chronic diseases, such as rheumatoid arthritis, heart failure, coronary artery disease, and chronic obstructive pulmonary disease, exerting a negative effect on the energy and vitality levels, limiting social interactions, and hindering psychic health. To evaluate the quality of life of patients with CKD on hemodialysis in a public Brazilian Amazonian hospital. Data were collected through interview based on the Brazilian version of the SF-36 questionnaire. The study was conducted on 50 patients (mean age, 48 ± 16 years; mean hemodialysis time, 3 ± 2.9 years). The most affected domain was role limitations due to physical health, with a mean score of 36 ± 36, and 58% of the patients in the lowest quartile, while mental health and social functioning were relatively preserved, with most patients in the highest quartile. Men obtained poorer scores than women did for role limitations due to physical health and vitality. Age correlated negatively with physical functioning. Patients on hemodialysis for more than one year had better scores in the social functioning domain, with a positive correlation between dialysis time and physical functioning. The domains assessed were globally impaired in the population studied, especially regarding role limitations due to physical health, suggesting that chronic disease with prolonged treatment has a negative influence on those domains.
Full Text Available The bioethics study method concerns the duties and values that must be fulfilled for respect for life. The aim of this article is to provide a reflection on bioethics in public health actions. It is a review article that includes authors with different positions. Bioethics, despite its apparent individual focus, is vital to fulfil essential functions in public health, and to guarantee the right to health and respect for human dignity.
ABSTRACT Environmental modification by anthropogenic actions, disordered urban growth, globalization of international exchange and climate change are some factors that help the emergence and dissemination of human infectious diseases transmitted by vectors. This review discusses the recent entry of three arboviruses in Brazil: Chikungunya, West Nile, and Zika virus, focusing on the challenges for the Country’s public health. The Brazilian population is exposed to infections caused by th...
Dr. Katrin Kohl, a medical officer at the CDC, discusses the World Health Organizationâs International Health Regulations for assessing and reporting on public health events across the world. Created: 6/21/2012 by National Center for Emerging and Zoonotic Infectious Diseases (NCEZID). Date Released: 6/21/2012.
Frontier Learn what marijuana means for Alaska and you It's your health - Teen Health Autism: Learn the Outbreak of Life-threatening Coagulopathy Associated with Synthetic Cannabinoids Use Friday, May 25, 2018 Impacts of Climate Change in Alaska PDF Monday, January 8, 2018 Breastfeeding mothers reporting marijuana
Considers how communication researchers have developed a solid body of knowledge in the health field but know little about the activities of public relations practitioners in public health bodies. Suggests that public relations scholarship and practice have much to offer the field of public health in helping public health bodies meet their…
.... It combined clinical and academic perspectives to explore the current state of health of our children, the historical roots of the speciality and the relationship between early infant and child...
Uno, Hideo; Zakariasen,Kenneth
Hideo Uno, Kenneth ZakariasenDepartment of Public Health Sciences, School of Public Health, University of Alberta, Edmonton, AB, CanadaAbstract: Public health leadership is one of the priority disciplines public health professionals need to learn well if they are to deal with demanding public health issues effectively and efficiently. This article looks at the trends in public health leadership education by reviewing the literature and using the Internet to explore the public health leadershi...
Douglas Fernando Dias
Full Text Available ABSTRACT OBJECTIVE To evaluate if perceived occupational factors are associated with insufficient free-time physical activity in Brazilian public school teachers. METHODS The relationship between insufficient physical activity (< 150 minutes/week and variables related to work was analyzed in 978 elementary and high school teachers calculating the prevalence ratio (PR and 95% confidence interval (95%CI in Poisson regression models, adjusted for sociodemographic and health variables. RESULTS The prevalence of insufficient physical activity was 71.9%, and this condition was associated independently with the perception of bad or regular balance between personal and professional life (PR = 1.09; 95%CI 1.01–1.18, perception that standing time affects the work (PR = 1.16; 95%CI 1.01–1.34, low or very low perception of current ability for the physical requirements of work (PR = 1.21; 95%CI 1.08–1.35, and temporary employment contract (PR = 1.13; 95%CI 1.03–1.25. The teaching of physical education was associated with lower prevalence of insufficient physical activity (PR = 0.78; 95%CI 0.64–0.95. CONCLUSIONS The perception of adverse working conditions is associated with increased prevalence of insufficient physical activity in teachers and should be considered for the promotion of physical activity in this population.
Guilherme Luz Tortorella
Full Text Available During the last decade, there has been a demand for public services to enhance management practices and attain results comparable to those experienced in the private sector. The need for achieving higher quality standards in public services has highlighted the importance of exploring new management techniques to account for the obsolescence in those organizations’ administrative models, with particular emphasis on healthcare services. This paper reports the application of one such new management technique, named Value Stream Mapping (VSM, in the sterilized unit of a public healthcare organization. We present here the benefits of analyzing healthcare processes using VSM, contributing to the existing body of knowledge on Lean management by examining the validity of applying its principles and practices in contexts other than manufacturing.
Gormaz, Juan G; Fry, Jillian P; Erazo, Marcia; Love, David C
Nearly half of all seafood consumed globally comes from aquaculture, a method of food production that has expanded rapidly in recent years. Increasing seafood consumption has been proposed as part of a strategy to combat the current non-communicable disease (NCD) pandemic, but public health, environmental, social, and production challenges related to certain types of aquaculture production must be addressed. Resolving these complicated human health and ecologic trade-offs requires systems thinking and collaboration across many fields; the One Health concept is an integrative approach that brings veterinary and human health experts together to combat zoonotic disease. We propose applying and expanding the One Health approach to facilitate collaboration among stakeholders focused on increasing consumption of seafood and expanding aquaculture production, using methods that minimize risks to public health, animal health, and ecology. This expanded application of One Health may also have relevance to other complex systems with similar trade-offs.
To provide an overview of the history of electronic health policy and identify significant laws that influence health informatics. US Department of Health and Human Services. The development of health information technology has influenced the process for delivering health care. Public policy and regulations are an important part of health informatics and establish the structure of electronic health systems. Regulatory bodies of the government initiate policies to ease the execution of electronic health record implementation. These same bureaucratic entities regulate the system to protect the rights of the patients and providers. Nurses should have an overall understanding of the system behind health informatics and be able to advocate for change. Nurses can utilize this information to optimize the use of health informatics and campaign for safe, effective, and efficient health information technology. Copyright © 2018 Elsevier Inc. All rights reserved.
Rocha, T A H; da Silva, N C; Amaral, P V; Barbosa, A C Q; Rocha, J V M; Alvares, V; de Almeida, D G; Thumé, E; Thomaz, E B A F; de Sousa Queiroz, R C; de Souza, M R; Lein, A; Toomey, N; Staton, C A; Vissoci, J R N; Facchini, L A
Studies of health geography are important in the planning and allocation of emergency health services. The geographical distribution of health facilities is an important factor in timely and quality access to emergency services; therefore, the present study analyzed the emergency health care network in Brazil, focusing the analysis at the roles of small hospitals (SHs). Cross-sectional ecological study. Data were collected from 9429 hospitals of which 3524 were SHs and 5905 were high-complexity centers (HCCs). For analytical purposes, we considered four specialties when examining the proxies of emergency care capability: adult, pediatrics, neonatal, and obstetric. We analyzed the spatial distribution of hospitals, identifying municipalities that rely exclusively on SHs and the distance of these cities from HCCs. More than 14 and 30 million people were at least 120 km away from HCCs with an adult intensive care unit (ICU) and pediatric ICU, respectively. For neonatal care distribution, 12% of the population was more than 120 km away from a health facility with a neonatal ICU. The maternities situation is different from other specialties, where 81% of the total Brazilian population was within 1 h or less from such health facilities. Our results highlighted a polarization in distribution of Brazilian health care facilities. There is a concentration of hospitals in urban areas more developed and access gaps in rural areas and the Amazon region. Our results demonstrate that the distribution of emergency services in Brazil is not facilitating access to the population due to geographical barriers associated with great distances. Copyright © 2017 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.
Full Text Available In public health ethics, as in bioethics, utilitarian approaches usually prevail, followed by Kantian and communitarian foundations. If one considers the nature and core functions of public health, which are focused on a population perspective, utilitarianism seems still more applicable to public health ethics. Nevertheless, faulting additional protections towards the human person, utilitarianism doesn't offer appropriate solutions when conflicts among values do arise. Further criteria must be applied to protect the fundamental principles of respect for human life. Personalism offers similar advantages to utilitarianism but warrants more protection to the human person. We suggest a possible adaptation of personalism in the specific field of public health by means of four principles: absolute respect for life or principle of inviolability; subsidiarity and the "minimum" mandatory principle; solidarity; justice and non discrimination.
Petrini, Carlo; Gainotti, Sabina; Requena, Pablo
In public health ethics, as in bioethics, utilitarian approaches usually prevail, followed by Kantian and communitarian foundations. If one considers the nature and core functions of public health, which are focused on a population perspective, utilitarianism seems still more applicable to public health ethics. Nevertheless, faulting additional protections towards the human person, utilitarianism doesn't offer appropriate solutions when conflicts among values do arise. Further criteria must be applied to protect the fundamental principles of respect for human life. Personalism offers similar advantages to utilitarianism but warrants more protection to the human person. We suggest a possible adaptation of personalism in the specific field of public health by means of four principles: absolute respect for life or principle of inviolability; subsidiarity and the "minimum" mandatory principle; solidarity; justice and non discrimination.
Arruda, Marco A; Querido, Cícero Nardini; Bigal, Marcelo E; Polanczyk, Guilherme V
To assess the prevalence of ADHD, mental health status, and risk factors in a sample of Brazilian children. Target sample consisted of all children from 5 to 13 years registered in the public elementary school. Children with ADHD were compared with those without ADHD for sociodemographic, risk factors, and Child Behavior Checklist (CBCL) symptom dimensions. Multivariate models estimated determinants of ADHD diagnosis. Of the target sample, consents and complete information were obtained from 1,830 children (91.8%). The prevalence rate of ADHD was 5.1% (95% confidence interval [CI] = [4.2, 6.2]). In contrast to controls, children with ADHD presented higher levels of symptoms in the CBCL dimensions. In multivariate analyses, the diagnosis of ADHD was significantly influenced by maternal educational status (p = .019), income class (p = .012), and prenatal exposure to tobacco (p = .032). Prevalence and demographic features of ADHD in Brazil are similar to what has been reported worldwide. © 2012 SAGE Publications.
Torheim, Liv Elin; Birgisdottir, Bryndis Eva; Robertson, Aileen
, Oslo, Norway, 2Unit for Nutrition Research, Landspitali University Hospital , 3Department of Food Science and Nutrition, University of Iceland, Reykjavik, Iceland, 4Global Nutrition and Health, Metropolitan University College, Copenhagen, Denmark, 5School of Hospitality, culinary arts and meal science...
This paper analyzes the present processes, products and needs of post-graduate public health education for the health programming, implementation and oversight responsibilities at field level and suggests some solutions for the institutes to adopt or adapt for improving the quality of their scholars. Large number of institutions has cropped up in India in the recent years to meet the growing demand of public health specialists/practitioners in various national health projects, international development partners, national and international NGOs. Throwing open MPH courses to multi-disciplinary graduate's is a new phenomenon in India and may be a two edged sword. On one hand it is advantageous to produce multi-faceted Public health postgraduates to meet the multi tasking required, on the other hand getting all of them to a common basic understanding, demystifying technical teaching and churning out products that are acceptable to the traditional health system. These Institutions can and must influence public health in the country through producing professionals of MPH/ MD degree with right attitude and skill-mix. Engaging learners in experimentation, experience sharing projects, stepping into health professionals' roles and similar activities lead to development of relatively clear and permanent neural traces in the brain. The MPH institutes may not have all efficient faculties, for which they should try to achieve this by inviting veterans in public health and professionals from corporate health industry for interface with students on a regular basis. The corporate and public health stalwarts have the capacities to transmit the winning skills and knowledge and also inspire them to adopt or adapt in order to achieve the desired goals.
Bastos, José Alexandre; Cecato, Angela Maria Traldi; Martins, Marielza Regina Ismael; Grecca, Kelly Regina Risso; Pierini, Rafael
The goal of the study was to assess public school children at the end of the first stage of elementary school. We used a protocol applied concurrently with a writing test in the form of an unexpected activity in 28 public schools; 2,893 children assessed, 687 exhibited performance below 58 points, 184 were excluded due to change of address or lack of consent; 503 children subjected to a test of intellectual capacity and reading assessment and 71 considered intellectually disabled were excluded. 226 (7.8%) children, who could read, write, and had normal intellectual level, met the criteria of developmental dyscalculia (DD), 98 female and 128 male. The most influential factors in the prevalence were socioeconomic levels of the schools neighborhood, education level of parents, and being male, as demonstrated by the odds ratio and multiple logistic regression analysis. Further studies should be done so that educational policies are taken.
José Alexandre Bastos
Full Text Available ABSTRACT The goal of the study was to assess public school children at the end of the first stage of elementary school. We used a protocol applied concurrently with a writing test in the form of an unexpected activity in 28 public schools; 2,893 children assessed, 687 exhibited performance below 58 points, 184 were excluded due to change of address or lack of consent; 503 children subjected to a test of intellectual capacity and reading assessment and 71 considered intellectually disabled were excluded. 226 (7.8% children, who could read, write, and had normal intellectual level, met the criteria of developmental dyscalculia (DD, 98 female and 128 male. The most influential factors in the prevalence were socioeconomic levels of the schools neighborhood, education level of parents, and being male, as demonstrated by the odds ratio and multiple logistic regression analysis. Further studies should be done so that educational policies are taken.
VanderVoort, Debra J
The following article addresses the nature of and problems with the public mental health system in Hawaii. It includes a brief history of Hawaii's public mental health system, a description and analysis of this system, economic factors affecting mental health, as well as a needs assessment of the elderly, individuals with severe mental illness, children and adolescents, and ethnically diverse individuals. In addition to having the potential to increase suicide rates and unnecessarily prolong personal suffering, problems in the public mental health system such as inadequate services contribute to an increase in social problems including, but not limited to, an increase in crime rates (e.g., domestic violence, child abuse), divorce rates, school failure, and behavioral problems in children. The population in need of mental health services in Hawaii is under served, with this inadequacy of services due to economic limitations and a variety of other factors.
Freudenberg, Nicholas; Klitzman, Susan; Diamond, Catherine; El-Mohandes, Ayman
In this article, we compared the characteristics of public and private accredited public health training programs. We analyzed the distinct opportunities and challenges that publicly funded schools of public health face in preparing the nation's public health workforce. Using our experience in creating a new, collaborative public school of public health in the nation's largest urban public university system, we described efforts to use our public status and mission to develop new approaches to educating a workforce that meets the health needs of our region and contributes to the goal of reducing health inequalities. Finally, we considered policies that could protect and strengthen the distinct contributions that public schools of public health make to improving population health and reducing health inequalities.
Eduardo Angeli Malavolta
Full Text Available ABSTRACT OBJECTIVE: To assess the historical trend of rotator cuff repairs in Brazil between 2003 and 2015, using the database of the Brazilian Unified Health System's (Sistema Único de Saúde [SUS] Department of Informatics (DataSUS. METHODS: Historical series using DataSUS. Surgeries performed between 2003 and 2015 were included and data relating to cuff tear repair were assessed, including decompression procedures were included. The numerator was the total number of rotator cuff repair and the denominator, the total population of the assessed locality. Population data were based on information from the Instituto Brasileiro de Geografia e Estatística (IBGE. RESULTS: During the period, 50,207 surgeries were performed. The rate was presented as number of procedures per 100,000 inhabitants, and increased from 0.83 to 2.81, a growth of 238%. In 2015, the South region had the highest rate, 6.32, followed by the Southeast, 3.62, while the North had the lowest rate, 0.13. The growing trend can be observed in the Southeast, South, and Midwest, while the rate is stable in the North and Northeast. CONCLUSION: The rate of rotator cuff repairs in Brazil performed through the SUS increased from 0.83 to 2.81 between 2003 and 2015, representing a growth of 238%, but remains lower than that of developed countries. A trend of growth can be observed in the Southeast, South, and Midwest, while the rate is stable in the North and Northeast.
Sergio Miranda Freire
Full Text Available AbstractIntroductionThis paper's aim is to develop a data warehouse from the integration of the files of three Brazilian health information systems concerned with the production of ambulatory and hospital procedures for cancer care, and cancer mortality. These systems do not have a unique patient identification, which makes their integration difficult even within a single system.MethodsData from the Brazilian Public Hospital Information System (SIH-SUS, the Oncology Module for the Outpatient Information System (APAC-ONCO and the Mortality Information System (SIM for the State of Rio de Janeiro, in the period from January 2000 to December 2004 were used. Each of the systems has the monthly data production compiled in dbase files (dbf. All the files pertaining to the same system were then read into a corresponding table in a MySQL Server 5.1. The SIH-SUS and APAC-ONCO tables were linked internally and with one another through record linkage methods. The APAC-ONCO table was linked to the SIM table. Afterwards a data warehouse was built using Pentaho and the MySQL database management system.ResultsThe sensitivities and specificities of the linkage processes were above 95% and close to 100% respectively. The data warehouse provided several analytical views that are accessed through the Pentaho Schema Workbench.ConclusionThis study presented a proposal for the integration of Brazilian Health Systems to support the building of data warehouses and provide information beyond those currently available with the individual systems.
Christiane de Holanda Camilo
Full Text Available This article is a presentation of preliminary results of the data collected in the "Research Project Violence, Conflict and Crime: Subsidies for the Formulation of UFG Security Policy" held between 2014-2015. The objective is to analyze policies to prevent violence in universities. The methodology used was an exploratory and documental research and are based public information available on institutional websites. The five universities surveyed were: UFSC, USP, UFMT, UFMG and UNILA. The results allowed certain approximation and divergence on the concepts of security on campuses, as the statistical record and the presence of military police at the university.
Borges, Carolina Marques; Cascaes, Andreia Morales; Fischer, Tatiana Konrad; Boing, Antonio Fernando; Peres, Marco Aurélio; Peres, Karen Glazer
The aim of this study was to estimate the prevalence of dental and gingival pain and associated factors among Brazilian adolescents (15-19 years of age). Data from 16,126 adolescents who participated in the Brazilian Oral Health Survey SB-Brazil 2002-2003 were used. The outcome measured was dental and gingival pain in the last six months. Independent variables were per capita income, schooling, school enrollment, gender, skin color, age, area of residence, time since last dental appointment, type of dental service, DMFT index and its components, dental calculus, and Dental Aesthetic Index. Simple and multiple Poisson regression analyses were performed. Prevalence of dental and gingival pain was 35.6% (95%CI: 34.8-36.4). Increased prevalence of pain was associated with: female gender, low income, non-students, students enrolled in public schools, and grade-for-age lag. In addition, adolescents with high levels of dental caries and dental calculus also reported higher prevalence of dental pain. Dental and gingival pain can be considered a relevant public health problem, suggesting the need for preventive measures.
Fountain, Jane E
Digital government is typically defined as the production and delivery of information and services inside government and between government and the public using a range of information and communication technologies. Two types of government relationships with other entities are government-to-citizen and government-to-government relationships. Both offer opportunities and challenges. Assessment of a public health agency's readiness for digital government includes examination of technical, managerial, and political capabilities. Public health agencies are especially challenged by a lack of funding for technical infrastructure and expertise, by privacy and security issues, and by lack of Internet access for low-income and marginalized populations. Public health agencies understand the difficulties of working across agencies and levels of government, but the development of new, integrated e-programs will require more than technical change - it will require a profound change in paradigm.
Calvasina, Paola; Lawrence, Herenia P; Hoffman-Goetz, Laurie; Norman, Cameron D
Inadequate functional health literacy is a common problem in immigrant populations. The aim of this study was to investigate the association between oral (dental) health literacy (OHL) and participation in oral health care among Brazilian immigrants in Toronto, Ontario, Canada. The study used a cross-sectional design and a convenience sample of 101 Brazilian immigrants selected through the snowball sampling technique. Data were analyzed using descriptive statistics and logistic regression modeling. Most of the sample had adequate OHL (83.1 %). Inadequate/marginal OHL was associated with not visiting a dentist in the preceding year (OR = 3.61; p = 0.04), not having a dentist as the primary source of dental information (OR = 5.55; p < 0.01), and not participating in shared dental treatment decision making (OR = 1.06; p = 0.05; OHL as a continuous variable) in multivariate logistic regressions controlling for covariates. A low average annual family income was associated with two indicators of poor participation in oral health care (i.e., not having visited a dentist in the previous year, and not having a dentist as regular source of dental information). Limited OHL was linked to lower participation in the oral health care system and with barriers to using dental services among a sample of Brazilian immigrants. More effective knowledge transfer will be required to help specific groups of immigrants to better navigate the Canadian dental care system.
Grier, Sonya A; Kumanyika, Shiriki
Targeted marketing techniques, which identify consumers who share common needs or characteristics and position products or services to appeal to and reach these consumers, are now the core of all marketing and facilitate its effectiveness. However, targeted marketing, particularly of products with proven or potential adverse effects (e.g., tobacco, alcohol, entertainment violence, or unhealthful foods) to consumer segments defined as vulnerable raises complex concerns for public health. It is critical that practitioners, academics, and policy makers in marketing, public health, and other fields recognize and understand targeted marketing as a specific contextual influence on the health of children and adolescents and, for different reasons, ethnic minority populations and other populations who may benefit from public health protections. For beneficial products, such understanding can foster more socially productive targeting. For potentially harmful products, understanding the nature and scope of targeted marketing influences will support identification and implementation of corrective policies.
Miguel Barbosa Fontes
Full Text Available This study assessed the main determinants of sexual and reproductive health of Brazilian youth. It was approved by the Ethics Committee of the Medicine Faculty of the University of Brasília, and it received support from Paho and Brazilian Ministry of Health. 1.208 youngsters (18 to 29 years old in 15 states and Federal District were interviewed at their residences, during the second semester of 2011. Margin of error, adjusted regional and nationally, was 2.8% (CI: 95%, regarding the assessed sample. A KAP scale (knowledge, attitudes, and practices with 17 questions (-17 to +17 points was generated. A questionnaire was pre-tested for consistency and validity analysis was performed. KAP scale was used as dependent variable in adjusted linear regression models. Mean KAP score was 5.65 points. Gaps in KAP were: 70% of the youth do not know when the fertility period of a woman is. 42% of youth do not recognize condoms as a method to prevent unwanted pregnancy and STDs. The main factors associated to explaining variances in KAP are gender, education, religion, access to health services, having had sexual intercourse in the last 12 months, and having friends as the main personal reference (p < 0.05. Youngsters with higher education, women, non-Protestant, who claim to know where to find health services have better KAP level of reproductive health. Studies are necessary to support public policies that increase the KAP levels in sexual and reproductive health of the most vulnerable groups, such as the segment comprising low education, men and Protestants.
Much work in public health ethics is shaped by an 'autonomy first' view, which takes it to be axiomatic that it is difficult to justify state interference in the lives of competent adults unless the behaviours interfered with are compromised in terms of their autonomy, or would wrongfully infringe on the autonomy of others. However, such an approach is difficult to square with much of traditional public heath practice. Recent years have seen running battles between those who assume that an 'autonomy first' approach is basically sound (and so much the worse for public health practice) and those who assume that public health practice is basically sound (and so much the worse for the 'autonomy first' approach). This paper aims to reconcile in a normatively satisfying way what is best about the 'autonomy first' approach with what is best about a standard public health approach. It develops a positive case for state action to promote and protect health as a duty that is owed to each individual. According to this view, the state violates individuals' rights if it fails to take cost-effective and proportionate measures to remove health threats from the environment. It is thus a mistake to approach public health in the way that 'autonomy first' accounts do, as primarily a matter of individual entitlements versus the common good. Too little state intervention in the cause of improving population health can violate individuals' rights, just as too much can. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/
Eliany Nazaré Oliveira
Full Text Available Background: Immigrants face many challenges when settling in a foreign country, numerous factors influence this immigrant experience including the resources they bring with them and those they find in the host society. The literature has indicated that a significant number of individuals migrate in search of a better quality of life. In this context, the objective of the study was to analyze the quality of life and health of Brazilian immigrants living in Portugal, using the "Medical Outcomes Study: 36-Item Short Form Survey" (SF-36. Methods and Results: A cross-sectional study with a quantitative approach developed under the project titled: Health status and quality of life of Brazilian immigrants in Portugal conducted in the first half of 2016, with 682 Brazilian immigrant women over 18 living in Portugal. This study adopted as reference SF-36, a generic instrument for the evaluation of Quality of Life. It can be affirmed that the quality of life and health of Brazilian immigrants living in Portugal is good, since all dimensions presented values above 50%. It was evidenced that Brazilian immigrants who live alone have lower levels of quality of life and health than those who live with someone and, that Brazilian immigrants who are unemployed, have low levels of quality of life and health compared to those who are in another employment situation, and Brazilian immigrants entering the labor market with a workload of more than 40 hours per week present similar levels of quality of life and health compared to those who work fewer hours. Conclusion: In general, one can affirm that the quality of life and health of Brazilian immigrants living in Portugal is good, but due to the particularities of the migration process in the current political and international context, a systematic monitoring of living conditions and health of this population is necessary. Keywords: Emigrants and Immigrants; Quality of life; Women, Mental health
Den Broeder, Lea; Devilee, Jeroen; Van Oers, Hans; Schuit, A Jantine; Wagemakers, Annemarie
Community engagement in public health policy is easier said than done. One reason is that public health policy is produced in a complex process resulting in policies that may appear not to link up to citizen perspectives. We therefore address the central question as to whether citizen engagement in knowledge production could enable inclusive health policy making. Building on non-health work fields, we describe different types of citizen engagement in scientific research, or 'Citizen Science'. We describe the challenges that Citizen Science poses for public health, and how these could be addressed. Despite these challenges, we expect that Citizen Science or similar approaches such as participatory action research and 'popular epidemiology' may yield better knowledge, empowered communities, and improved community health. We provide a draft framework to enable evaluation of Citizen Science in practice, consisting of a descriptive typology of different kinds of Citizen Science and a causal framework that shows how Citizen Science in public health might benefit both the knowledge produced as well as the 'Citizen Scientists' as active participants. © The Author 2016. Published by Oxford University Press.
Souto, Rayone Moreira Costa Veloso; Barufaldi, Laura Augusta; Nico, Lucélia Silva; Freitas, Mariana Gonçalves de
Injuries and deaths resulting from violence constitute a major public health problem in Brazil. The article aims to describe the profile of calls for violence in emergency departments and emergency Brazilian capitals. This is a descriptive study of Violence and Accident Surveillance System (VIVA), carried out in public emergencies Brazilian cities, from September to November 2014, a total of 4406 calls for aggression. We considered the following categories of analysis: 1) sociodemographic characteristics (gender, age, race / skin color, education, place of residence, vulnerability, alcohol intake); 2) Event feature (probable author, nature and means of aggression); and characteristics of care (getting to the hospital, prior service, evolution). Of the total calls for violence (n = 4406), the highest prevalence was among young people 20-39 years (50.2%), male, black and low education. As for the event characteristics it stands out that 87.8% were physical assaults; 46.3% cut/laceration and 13.7% involved a firearm. The results point to the need to strengthen intersectoral actions to expand the network of care and protection.
Petersen, Poul E; Baehni, Pierre C
Chronic diseases are a growing burden to people, to health-care systems and to societies across the world. The rapid increase in the burden of chronic diseases is particularly prevalent in the developing countries. Periodontal disease is one of the two most important oral diseases contributing...... to the global burden of chronic disease. In addition to social determinants, periodontal health status is related to several proximal factors. Modifiable risk factors, such as tobacco use, excessive alcohol consumption, poor diet and nutrition, obesity, psychological stress and insufficient personal....../oral hygiene, are important and these principal risk factors for periodontal disease are shared by other chronic diseases. The present monograph is devoted to the existing evidence on the practice of public health related to periodontal health. Public health is defined as the process of mobilizing and engaging...
Padrões e mudanças no financiamento e regulação do Sistema de Saúde Brasileiro: impactos sobre as relações entre o público e privado Patterns and changes in the financing and regulation of Brazilian Health System: impacts on public and private relationships
Full Text Available O trabalho sistematiza as matrizes interpretativas envolvidas no debate sobre o sistema de saúde brasileiro e avança hipóteses sobre as extensas e dinâmicas fronteiras de interseção público-privadas que o caracterizam. Considerando que o hiato entre as concepções sobre o sistema de saúde baseadas em modelos puros e a realidade brasileira, na qual predominam as formas híbridas de prestação e organização de redes de serviços, constitui, per se, um foco permanente de tensões, o estudo destaca e dimensiona: a utilização de fontes públicas de financiamento à demanda e a oferta dos planos de saúde; o afluxo de clientes de planos a uma capacidade instalada de recursos físicos e humanos constituída e reproduzida com recursos públicos; a inserção público-privada de profissionais de saúde e as franquias para dirigentes de empresas privadas assumirem cargos públicos e vice-versa. Os reflexos da estrutura e formas de articulação entre o público e o privado nas agendas dos mais importantes fóruns de debate e formulação de diretrizes para o sistema de saúde, as Conferências de Saúde (previstas pela Lei 8142-90 como instâncias de avaliação e elaboração de diretrizes para a saúde nas três esferas de governo, e das instituições governamentais relacionadas diretamente com o SUS são analisados. Conclui-se que as tensões, conflitos e proposições, sobre o considerado componente público do sistema de saúde, estão direcionadas a arenas específicas de debate. Paralelamente renovaram-se e constituíram-se outros fóruns de negociação sobre o componente privado. Portanto, a segmentação das demandas reflete-se, de maneira quase automática, no âmbito setorial, na definição de "pautas especializadas" - ou no público ou no privado.This article systematizes the interpretative matrixes used in the debate about the Brazilian Unified Health System and formulates hypothesis about the extensive and dynamic frontiers
Barnes, Christopher M; Drake, Christopher L
The schedules that Americans live by are not consistent with healthy sleep patterns. In addition, poor access to educational and treatment aids for sleep leaves people engaging in behavior that is harmful to sleep and forgoing treatment for sleep disorders. This has created a sleep crisis that is a public health issue with broad implications for cognitive outcomes, mental health, physical health, work performance, and safety. New public policies should be formulated to address these issues. We draw from the scientific literature to recommend the following: establishing national standards for middle and high school start times that are later in the day, stronger regulation of work hours and schedules, eliminating daylight saving time, educating the public regarding the impact of electronic media on sleep, and improving access to ambulatory in-home diagnostic testing for sleep disorders. © The Author(s) 2015.
Novaes, Hillegonda Maria Dutilh; Elias, Flávia Tavares Silva
Policies for scientific development and knowledge production in health have increased in recent decades. In Brazil, incentives for research, development, and innovation have been part of the National Health Act since 1990, and science and technology policies for health, including health technology assessment (HTA), have been implemented since 1994, as in many other countries. The emphasis is now on impact evaluation of HTA policies in the incorporation of technologies by health services and systems. The article presents a case study of HTA utilization in decision-making processes in the Brazilian Ministry of Health, analyzing participation by the Department of Science and Technology (DECIT), responsible for the production of assessments used in the Commission on Technology Incorporation (CITEC) of the Ministry of Health from 2008 to 2010. CITEC used 103 assessments in its decisions during this period, of which DECIT produced 80%. Nearly all were literature reviews on therapeutic technologies. An increase in knowledge production was observed. A methodological and political learning process appears to have occurred in the use of HTA, but its impact on Brazilian Unified National Health System remains unclear.
Alethele de Oliveira Santos
Full Text Available This paper has the aim to revisit the theme of the brazilian public health system from the perspective of its operation and funding of its actions and services, analyzing some of the main obstacles to its effectiveness. Endowed with its own logic of organization, planning and funding of its actions and services, the Brazilian Unified Health System (SUS finds barriers to its sustainability when it comes to funding and the judicialization of health. Historical under-funding worsened by the economic and political crisis the country currently faces plus the increase in casuistic judicial decisions that prioritize the individual logic over the collective right have produced serious shocks in the system. These are just some of the challenges to an effective public health system. This is why the work of public bodies must be responsible and always take into consideration the collective dimension of the right to health under penalty of causing the collapse of the public health system altogether.
Brabham, Daren C; Ribisl, Kurt M; Kirchner, Thomas R; Bernhardt, Jay M
Crowdsourcing is an online, distributed, problem-solving, and production model that uses the collective intelligence of networked communities for specific purposes. Although its use has benefited many sectors of society, it has yet to be fully realized as a method for improving public health. This paper defines the core components of crowdsourcing and proposes a framework for understanding the potential utility of crowdsourcing in the domain of public health. Four discrete crowdsourcing approaches are described (knowledge discovery and management; distributed human intelligence tasking; broadcast search; and peer-vetted creative production types) and a number of potential applications for crowdsourcing for public health science and practice are enumerated. © 2013 American Journal of Preventive Medicine Published by American Journal of Preventive Medicine All rights reserved.
Honoré, Peggy A; Costich, Julia F
The absence of appropriate financial management competencies has impeded progress in advancing the field of public health finance. It also inhibits the ability to professionalize this sector of the workforce. Financial managers should play a critical role by providing information relevant to decision making. The lack of fundamental financial management knowledge and skills is a barrier to fulfilling this role. A national expert committee was convened to examine this issue. The committee reviewed standards related to financial and business management practices within public health and closely related areas. Alignments were made with national standards such as those established for government chief financial officers. On the basis of this analysis, a comprehensive set of public health financial management competencies was identified and examined further by a review panel. At a minimum, the competencies can be used to define job descriptions, assess job performance, identify critical gaps in financial analysis, create career paths, and design educational programs.
Glass, Thomas A; Goodman, Steven N; Hernán, Miguel A; Samet, Jonathan M
Causal inference has a central role in public health; the determination that an association is causal indicates the possibility for intervention. We review and comment on the long-used guidelines for interpreting evidence as supporting a causal association and contrast them with the potential outcomes framework that encourages thinking in terms of causes that are interventions. We argue that in public health this framework is more suitable, providing an estimate of an action's consequences rather than the less precise notion of a risk factor's causal effect. A variety of modern statistical methods adopt this approach. When an intervention cannot be specified, causal relations can still exist, but how to intervene to change the outcome will be unclear. In application, the often-complex structure of causal processes needs to be acknowledged and appropriate data collected to study them. These newer approaches need to be brought to bear on the increasingly complex public health challenges of our globalized world.
Scott J. N McNabb
Full Text Available Over the past decade, the world has radically changed. New advances in information and communication technologies (ICT connect the world in ways never imagined. Public health informatics (PHI leveraged for public health surveillance (PHS, can enable, enhance, and empower essential PHS functions (i.e., detection, reporting, confirmation, analyses, feedback, response. However, the tail doesn't wag the dog; as such, ICT cannot (should not drive public health surveillance strengthening. Rather, ICT can serve PHS to more effectively empower core functions. In this review, we explore promising ICT trends for prevention, detection, and response, laboratory reporting, push notification, analytics, predictive surveillance, and using new data sources, while recognizing that it is the people, politics, and policies that most challenge progress for implementation of solutions.
Fountain, Jane E.
Digital government is typically defined as the production and delivery of information and services inside government and between government and the public using a range of information and communication technologies. Two types of government relationships with other entities are government-to-citizen and government-to-government relationships. Both offer opportunities and challenges. Assessment of a public health agencys readiness for digital government includes examination of technical, manage...
Claudia Maffini Griboski
Full Text Available This paper focuses on the front of the Brazilian higher education practices of evaluation, highlighting the importance of its use in academic management and institutional guarantee for the permanent monitoring of the quality of supply. With this objective discusses the trajectory of the evaluation policy of higher education with an emphasis on construction of the current National Assessment of Higher Education (Sinaes. From this perspective, conducts exploratory research with a descriptive analysis of the constituent elements of Sinaes, instruments and indicators, and evaluation results of the cycle in 2004, 2007 and 2010 in order to characterize and compare the evolution of courses in health and design improvements in its development. Finally, the comparison of these results, especially the nursing courses, the remarkable expansion in the period, shows its importance as an inducer of changing personal and professional attitudes of teachers and others involved in the educational process. It also enables the IES, proposing changes to the curriculum to meet the prospect of improving the training of students, contributing to the establishment of the evaluation culture in higher education to society to ensure reliable results on the quality and credibility of the courses offered.
Heiko T. Santana
Full Text Available Summary: The World Health Organization (WHO created the WHO Surgical Safety Checklist to prevent adverse events in operating rooms. The aim of this study was to analyze WHO checklist implementation in three operating rooms of public hospitals in the Brazilian Federal District. A prospective cross-sectional study was performed with pre- (Period I and post (Period II-checklist intervention evaluations. A total of 1141 patients and 1052 patients were studied in Periods I and II for a total of 2193 patients. Period I took place from December 2012 to March 2013, and Period II took place from April 2013 to August 2014. Regarding the pre-operatory items, most surgeries were classified as clean-contaminated in both phases, and team attire improved from 19.2% to 71.0% in Period II. Regarding checklist adherence in Period II, “Patient identification” significantly improved in the stage “Before induction of anesthesia”. “Allergy verification”, “Airway obstruction verification”, and “Risk of blood loss assessment” had low adherence in all three hospitals. The items in the stage “Before surgical incision” showed greater than 90.0% adherence with the exception of “Anticipated critical events: Anesthesia team review” (86.7% and “Essential imaging display” (80.0%. Low adherence was noted in “Instrument counts” and “Equipment problems” in the stage “Before patient leaves operating room”. Complications and deaths were low in both periods. Despite the variability in checklist item compliance in the surveyed hospitals, WHO checklist implementation as an intervention tool showed good adherence to the majority of the items on the list. Nevertheless, motivation to use the instrument by the surgical team with the intent of improving surgical patient safety continues to be crucial. Keywords: Surgical checklist, Adverse events, Patient safety, Surgical team, Infection control
The nuclear power industry has always emphasized the health and safety aspects of the various stages of power production. Nevertheless, the question of public acceptance is becoming increasingly important in the expansion of nuclear power programmes. Objections may arise partly from the tendency to accept familiar hazards but to react violently to unfamiliar ones such as radiation, which is not obvious to the senses and may result in delayed adverse effects, sometimes manifested only in the descendants of the individuals subjected to the radiation. The public health authorities therefore have an important role in educating the public to overcome these fears. However, they also have the duty to reassure the public and convince it that proper care has been taken to protect man and his environment. This duty can be fulfilled by means of independent evaluation and control to ensure that safe nuclear facilities are built, care is taken with their siting, they are operated safely, and the effects of possible accidents are minimized. The selection and development of a nuclear power facility should be carried out with a sound understanding of the factors involved. WHO has collaborated with the International Atomic Energy Agency (IAEA) in the preparation of a booklet summarizing the available information on the subject. It deals with the role of atomic energy in meeting future power needs, radiation protection standards, the safe handling of radioactive materials, disturbances of the environment arising from plant construction and ancillary operations, and the public health implications
The nuclear power industry has always emphasized the health and safety aspects of the various stages of power production. Nevertheless, the question of public acceptance is becoming increasingly important in the expansion of nuclear power programmes. Objections may arise partly from the tendency to accept familiar hazards but to react violently to unfamiliar ones such as radiation, which is not obvious to the senses and may result in delayed adverse effects, sometimes manifested only in the descendants of the individuals subjected to the radiation. The public health authorities therefore have an important role in educating the public to overcome these fears. However, they also have the duty to reassure the public and convince it that proper care has been taken to protect man and his environment. This duty can be fulfilled by means of independent evaluation and control to ensure that safe nuclear facilities are built, care is taken with their siting, they are operated safely, and the effects of possible accidents are minimized. The selection and development of a nuclear power facility should be carried out with a sound understanding of the factors involved. WHO has collaborated with the International Atomic Energy Agency (IAEA) in the preparation of a booklet summarizing the available information on the subject. It deals with the role of atomic energy in meeting future power needs, radiation protection standards, the safe handling of radioactive materials, disturbances of the environment arising from plant construction and ancillary operations, and the public health implications.
Marcia Regina Martins Alvarenga
Full Text Available Diferentes estudios recientes demuestran que el envejecimiento de la población brasileña es irreversible. Evaluar las necesidades de salud de este segmento poblacional para gestionar los recursos disponibles es imprescindible para los profesionales de la salud. Ese artículo tiene como objetivo presentar el Sistema único de Salud en Brasil y las políticas públicas para las personas mayores. El país brasileño no dispone de una red de servicios articulados y dedicados a la asistencia de las necesidades específicas de las personas mayores, a pesar de que la legislación brasileña está avanzando en cuanto a la promoción y la protección de la salud de estas personas.Recent different studies show that Brazilian population aging is irreversible. Evaluation of the elderly health care needs by health professionals is essential to the management of the available resources. The aim of this article is to describe the Brazilian Unified Health Care System and the public policies for elderly. In spite of the lack of an integrated health care network to provide health care to meet the needs of the elderly population, Brazilian legislation is improving, foreseeing the health promotion and protection of older people.
Greer, Scott L; Bekker, Marleen; de Leeuw, Evelyne; Wismar, Matthias; Helderman, Jan-Kees; Ribeiro, Sofia; Stuckler, David
If public health is the field that diagnoses and strives to cure social ills, then understanding political causes and cures for health problems should be an intrinsic part of the field. In this article, we argue that there is no support for the simple and common, implicit model of politics in which scientific evidence plus political will produces healthy policies. Efforts to improve the translation of evidence into policy such as knowledge transfer work only under certain circumstances. These circumstances are frequently political, and to be understood through systematic inquiry into basic features of the political economy such as institutions, partisanship and the organization of labour markets. © The Author 2017. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved.
Janmille Valdivino da Silva
Full Text Available ABSTRACT OBJECTIVE To analyze how individual characteristics and the social context, together, are associated with self-perception of the oral health. METHODS A multilevel cross-sectional study with data from the Brazilian National Health Survey 2013, the United Nations Development Program, and the National Registry of Health Establishments. The explanatory variables for the “oral health perception” outcome were grouped, according to the study framework, into biological characteristics (sex, color, age, proximal social determinants (literacy, household crowding, and socioeconomic stratification, and distal (years of schooling expectancy at age 18, GINI, Human Development Index, and per capita income. The described analysis was performed, along with bivariate Poisson analysis and multilevel Poisson analysis for the construction of the explanatory model of oral health perception. All analyzes considered the sample weights. RESULTS Both the biological characteristics and the proximal and distal social determinants were associated with the perception of oral health in the bivariate analysis. A higher prevalence of bad oral health was associated to lower years of schooling expectancy (PR = 1.31, lower per capita income (PR = 1.45, higher income concentration (PR = 1.41, and worse human development (PR = 1.45. Inversely, oral health services in both primary and secondary care were negatively associated with oral health perception. All the biological and individual social characteristics, except reading and writing, made up the final explanatory model along with the distal social determinants of the Human Development Index and coverage of basic care in the multilevel analysis. CONCLUSIONS Biological factors, individual and contextual social determinants were associate synergistically with the population’s perception of oral health. It is necessary to improve individual living conditions and the implementation of public social policies to improve
Silva, Janmille Valdivino da; Oliveira, Angelo Giuseppe Roncalli da Costa
To analyze how individual characteristics and the social context, together, are associated with self-perception of the oral health. A multilevel cross-sectional study with data from the Brazilian National Health Survey 2013, the United Nations Development Program, and the National Registry of Health Establishments. The explanatory variables for the "oral health perception" outcome were grouped, according to the study framework, into biological characteristics (sex, color, age), proximal social determinants (literacy, household crowding, and socioeconomic stratification), and distal (years of schooling expectancy at age 18, GINI, Human Development Index, and per capita income). The described analysis was performed, along with bivariate Poisson analysis and multilevel Poisson analysis for the construction of the explanatory model of oral health perception. All analyzes considered the sample weights. Both the biological characteristics and the proximal and distal social determinants were associated with the perception of oral health in the bivariate analysis. A higher prevalence of bad oral health was associated to lower years of schooling expectancy (PR = 1.31), lower per capita income (PR = 1.45), higher income concentration (PR = 1.41), and worse human development (PR = 1.45). Inversely, oral health services in both primary and secondary care were negatively associated with oral health perception. All the biological and individual social characteristics, except reading and writing, made up the final explanatory model along with the distal social determinants of the Human Development Index and coverage of basic care in the multilevel analysis. Biological factors, individual and contextual social determinants were associate synergistically with the population's perception of oral health. It is necessary to improve individual living conditions and the implementation of public social policies to improve the oral health of the population.
Ricardo R.G. Avelino
Full Text Available This paper examines the underwriters' treatment of information throughout the IPO pricing process based on a sample of Brazilian companies that went public between 2004 and 2011. There is evidence that the offer price partially incorporates the information contained into the Bovespa index during the book-building period, reacting symmetrically to upward and downward movements. The first-day return, as a result, is predictable on the basis of this information. Positive private information disclosed during the book-building period is also partially incorporated into the offer price. Issues priced above the midpoint of the initial price range are associated with higher initial returns.
Moema de Rezende Vergara
Full Text Available In the recent works about Brazilian public understanding of science, gender has been poorly used as an analytical category. This paper has as its main goal to bridge this gap by analyzing a section called ‘Letters for a Lady‘, in the journal O Vulgarizador that sought to teach all about Darwinism to women in the Brazil of the 19th century. So the notion of gender will help us understand the tension between masculinity and femininity in the text written by the literary critic Rangel S. Paio.
Thula Rafaela de Oliveira Pires
Full Text Available Schools have been a privileged place of violence for blacks in Brazil. Starting from the contingent treatment of religious freedom, this article aims to denounce the perverse relationship between religious intolerance and racism, and how it has impacted the routine of children and adolescents in public schools in Brazil. The analysis of the systematization of the normative framework against religious discrimination in schools intends to reaffirm the commitment of Brazilian democracy with freedom and an education oriented towards respect, autonomy and emancipation.
Garnica, Guilherme Besse; Barriga, Gladys Dorotea Cacsire
Abstract Paper aims To determine main barriers to the implementation of occupational health and safety management systems OHSMS in the context of small Brazilian enterprises from the perspectives of owners/managers, labor auditors, and OHS consultants. Originality: Survey with three different perspectives on small Brazilian enterprises. Research method: Survey conducted with stakeholders who influence the safety culture in small enterprises to identify the main barriers to the implementati...
Lilian Ribeiro de Oliveira
Full Text Available The Brazilian Unified National Health System (Sistema Único de Saúde [SUS] is in a prominent position compared to the existing social policies. One of the new tools used by SUS is known as Performance Index of the Unified Health System (Índice de Desempenho do Sistema Único de Saúde [IDSUS], which is intended to measure the performance of each municipality. Therefore, the aim of this study was to propose a model of cost-effectiveness to compare IDSUS performance against total revenues achieved in Homogeneous Group 2, consisting of 94 municipalities and analysed using data from IDSUS and the System Information of the Public Budget for Health Care (Sistema de Informação do Orçamento Público em Saúde [SIOPS] for the year 2011. After structuring this data, we carried out descriptive statistical and cluster analysis in order to group similar municipalities in accordance with established variables: IDSUS performance, population and total revenue in health per capita. Even with the division of municipalities into homogeneous groups and after using variables such as population and revenue to regroup them, the results showed there are municipalities with heterogeneous characteristics. Another finding is in the use and intersection of two distinct databases (IDSUS and SIOPS, which allowed for visualizing the impact of health care revenue on the municipalities performance.
Zander Neves, Camila; Devicari Bueno, Claudine; Pires Felden, Giovana; Costa Irigaray, Mariane; Rivadeneira, María Fernanda; Oenning, Nágila Soares Xavier; Goulart, Bárbara N G
To study the association between aspects of mental health and the family context with tobacco experimentation and consumption among Brazilian schoolchildren. A cross-sectional study using data from the National Survey of Schoolchildren's Health in Brazil conducted on 109,104 schoolchildren from the ninth year of elementary school, day scholars in public and private schools in all Brazilian state capitals and the Federal District. Descriptive analysis of variables, bivariate and multivariate analyses were performed with logistic regression estimates, adjusted for socioeconomic variables, obtaining the odds ratio (OR) and 95% confidence interval (95%CI). Among the participants, 52.2% were female. Twenty point nine percent of the students reported having experimented with cigarettes at least once. Adolescents who experienced more often feelings of loneliness (OR: 2.07; 95%CI: 1.98-2.16), difficulty sleeping (OR: 2.37; 95%CI: 2.52-2.48) and lower social interaction (OR: 1.27; 95%CI: 1.26-1.32), were more likely to smoke, regardless of socioeconomic status. The schoolchildren of parents or caregivers (OR: 2.39; 95%CI: 2.29-2.49) who did not know what their children did in their free time (OR: 1.52; 95%CI: 1.46-1.59) were associated with more frequent cigarette smoking. An association was seen between aspects of mental health and the family context with the experimentation and consumption of tobacco in adolescents enrolled in the study in Brazil. These associations are independent of school type, sex and skin colour. It is important that programmes for the prevention of tobacco use in adolescence emphasise these findings. Copyright © 2017 SESPAS. Publicado por Elsevier España, S.L.U. All rights reserved.
Costa, Cassia Kely Favoretto; Balbinotto Neto, Giácomo; Sampaio, Luciano Menezes Bezerra
The objective of this study was to evaluate the efficiency of Brazilian States and the Federal District in the public kidney transplant system and their productivity trends from 2006 to 2011. The authors used Data Envelopment Analysis (DEA) with slack and the Malmquist index with slack. Inputs included spending on hospital services and health professionals in the system. The output was the number of kidney transplants performed in each State. The data showed a significant discrepancy between States in the number of kidney transplants. The transplant system's inefficiency may result from inadequate management, failure to comply with national guidelines, inactive hospital transplant committees, and overburdened hospital staff. Institutional changes promoted by the Brazilian Ministry of Health (procedures improvement and standardization) failed to increase productivity in most States during this period.
Arcaro, P; Mannocci, A; Saulle, R; Miccoli, S; Marzuillo, C; La Torre, G
Social marketing uses the principles and techniques of commercial marketing by applying them to the complex social context in order to promote changes (cognitive; of action; behavioral; of values) among the target population in the public interest. The advent of Internet has radically modified the communication process, and this transformation also involved medical-scientific communication. Medical journals, health organizations, scientific societies and patient groups are increasing the use of the web and of many social networks (Twitter, Facebook, Google, YouTube) as channels to release scientific information to doctors and patients quickly. In recent years, even Healthcare in Italy reported a considerable application of the methods and techniques of social marketing, above all for health prevention and promotion. Recently the association for health promotion "Social marketing and health communication" has been established to promote an active dialogue between professionals of social marketing and public health communication, as well as among professionals in the field of communication of the companies involved in the "health sector". In the field of prevention and health promotion it is necessary to underline the theme of the growing distrust in vaccination practices. Despite the irrefutable evidence of the efficacy and safety of vaccines, the social-cultural transformation together with the overcoming of compulsory vaccination and the use of noninstitutional information sources, have generated confusion among citizens that tend to perceive compulsory vaccinations as needed and safe, whereas recommended vaccinations as less important. Moreover, citizens scarcely perceive the risk of disease related to the effectiveness of vaccines. Implementing communication strategies, argumentative and persuasive, borrowed from social marketing, also for the promotion of vaccines is a priority of the health system. A typical example of the application of social marketing, as
Zafar, Syed Nabeel; McQueen, K A Kelly
Surgical healthcare is rapidly gaining recognition as a major public health issue. Surgical disparities are large, with poorest populations receiving the least amount of emergency and essential surgical care. In light of recent evidence, developing countries, such as Pakistan, must acknowledge surgical disease as a major public health issue and prioritize research and intervention accordingly. We review information from various sources and describe the current situation of surgical health care in Pakistan and highlight areas of neglect. Pakistan suffers an annual deficit of 17 million surgeries. Surgical disease kills more people than infectious diseases inclusive of tuberculosis, HIV/AIDS, diarrheal disease, and childhood infections. The incidence of trauma and maternal mortality ratio are staggeringly high. There is a severe dearth of surgical and anesthesia-related epidemiological data. Important information that would help to drive policy and planning is not available. Corruption and neglect have led to a dilapidated health care infrastructure. Surgical care is largely inaccessible to the poor, especially those living in rural areas. The country faces a dearth of healthcare professionals, especially paramedics, anesthetists, and surgeons. Unsafe surgery and anesthesia poses a significant risk to patients. There is no national policy on surgical illness and the preventive aspects of surgery are nonexistent. Consistent with other underdeveloped countries, surgical care in Pakistan is dismal. Neglecting surgery and safe anesthesia has led to countless deaths and disability. Physicians, researchers, policy makers, and the government health care system must engage and commit to provide access to emergency, essential, and safe surgical care.
Bruna de Oliveira Ascef
Full Text Available ABSTRACT OBJECTIVE To analyze the Health-Related Quality of Life (HRQoL of patients of the primary health care of the Brazilian Unified Health System (SUS and its associated factors. METHODS This is a cross-sectional study with data from the Pesquisa Nacional sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos – Serviços, 2015 (PNAUM – National Survey on Access, Use and Promotion of Rational Use of Medicines – Services, 2015. Data were collected with a questionnaire that included the EuroQol 5 Dimensions (EQ-5D instrument. Patients from the five regions of Brazil were interviewed. Multiple linear regression was used to analyze their Health-Related Quality of Life and its associated factors. RESULTS Of the total of 8,590 patients, the most frequent dimensions were pain/discomfort (50.7% and anxiety/depression (38.8%. About 10% of the patients reported extreme problems in these dimensions. The following factors were significantly associated with a worse quality of life: being female; having arthritis, osteoarthritis, or rheumatism; cerebrovascular accident; heart disease; depression; health self-assessment as poor or very poor; drinking alcoholic beverages once or more per month; dieting to lose weight, avoiding salt consumption, and reducing fat intake. Significant association was observed between a better quality of life and: living in the North and Southeast regions of Brazil; practicing physical activities; and having a higher educational level. No association was observed with factors related to the health services. CONCLUSIONS The Health-Related Quality of Life of patients was influenced by demographic and socioeconomic factors that were related to health conditions and lifestyle, being useful to guide specific actions for promoting health and the integral care to patients of the Brazilian Unified Health System.
Curtis, Valerie A.; Garbrah-Aidoo, Nana; Scott, Beth
Skill in marketing is a scarce resource in public health, especially in developing countries. The Global Public–Private Partnership for Handwashing with Soap set out to tap the consumer marketing skills of industry for national handwashing programs. Lessons learned from commercial marketers included how to (1) understand consumer motivation, (2) employ 1 single unifying idea, (3) plan for effective reach, and (4) ensure effectiveness before national launch. After the first marketing program, 71% of Ghanaian mothers knew the television ad and the reported rates of handwashing with soap increased. Conditions for the expansion of such partnerships include a wider appreciation of what consumer marketing is, what it can do for public health, and the potential benefits to industry. Although there are practical and philosophical difficulties, there are many opportunities for such partnerships. PMID:17329646
Cristiane S Paula
Full Text Available Worldwide, a minority of disordered children/adolescents receives mental health assistance. In order to improve service access, it is important to investigate factors that influence the process leading to receiving care. Data on frequency and barriers for mental health service use (MHSU among Brazilian children/adolescents are extremely scarce and are needed to guide public policy.To establish the frequency of MHSU among 6-to-16-year-old with psychiatric disorders from four Brazilian regions; and to identify structural/psychosocial/demographic barriers associated with child/adolescent MHSU.Multicenter cross-sectional-study involving four towns from four out of five Brazilian regions. In each town, a representative sample of elementary public school students was randomly selected (sample: 1,721. Child/adolescent MHSU was defined as being seen by a psychologist/psychiatrist/neurologist in the previous 12 months. Standardized instruments measured: (1 children/adolescent characteristics [(1.1 Schedule for Affective Disorders and Schizophrenia for School-Age Children (K-SADS-PL-psychiatric disorders; (1.2 Ten Questions Screen-neurodevelopment problems; (1.3 two subtests of WISC-III-estimated IQ; (1.4 Academic Performance Test-school performance], (2 factors related to mothers/main caregivers (Self-Reporting Questionnaire-anxiety/depression, (3 family (Brazilian Research-Companies-Association's Questionnaire-SES.Only 19.8% of children/adolescents with psychiatric disorder have used mental health services in the previous 12 months. Multiple logistic regression modeling identified five factors associated with lower rates of MHSU (female gender, adequate school performance, mother/main caregiver living with a partner, lower SES, residing in deprived Brazilian regions regardless of the presence of any psychiatric disorders/neurodevelopmental problems.Only a small proportion of children/adolescents with psychiatric disorders had been seen by a mental
Paulo Roberto Lima Carreiro
Full Text Available OBJECTIVE: Show the steps of a Trauma Registry (TR implementation in a Brazilian public hospital and evaluate the initial data from the database.METHODS: Descriptive study of the a TR implementation in João XXIII Hospital (Hospital Foundation of the state of Minas Gerais and analysis of the initial results of the first 1,000 patients.RESULTS: The project was initiated in 2011 and from January 2013 we began collecting data for the TR. In January 2014 the registration of the first 1000 patients was completed. The greatest difficulties in the TR implementation were obtaining funds to finance the project and the lack of information within the medical records. The variables with the lowest completion percentage on the physiological conditions were: pulse, blood pressure, respiratory rate and Glasgow coma scale. Consequently, the Revised Trauma Score (RTS could be calculated in only 31% of cases and the TRISS methodology applied to 30.3% of patients. The main epidemiological characteristics showed a predominance of young male victims (84.7% and the importance of aggression as a cause of injuries in our environment (47.5%, surpassing traffic accidents. The average length of stay was 6 days, and mortality 13.7%.CONCLUSION: Trauma registries are invaluable tools in improving the care of trauma victims. It is necessary to improve the quality of data recorded in medical records. The involvement of public authorities is critical for the successful implementation and maintenance of trauma registries in Brazilian hospitals.
João Eudes de Souza Calado
Full Text Available The objective of this paper is to identify the perception of the developers of the financial statements of public sector in respect to their difficulties in producing and disseminating such information, after the convergence of Brazil to the international standards IPSAS. Our methodological approach used multivariate descriptive techniques. Data was obtained through a survey, applied to professionals involved in the process of preparing the financial statement in the Brazilian public sector. The sample had 69 respondents, which corresponds to the perception of 85% of states and 46% of Brazilian cities. Data analysis was conducted using exploratory factor analysis. Results indicated that two perceptions of difficulties stood out: 1 the relevance of the information - its quality was not considered as being able to guide the internal user (decision-making or external user; 2 and the process of adaptation to the new standards - relationship between time and cost for adaptation. They also indicated the predominant focus on the Budget and the low adhesion to the Cash Flow Statement.
Carreiro, Paulo Roberto Lima; Drumond, Domingos André Fernandes; Starling, Sizenando Vieira; Moritz, Mônica; Ladeira, Roberto Marini
Show the steps of a Trauma Registry (TR) implementation in a Brazilian public hospital and evaluate the initial data from the database. Descriptive study of the a TR implementation in João XXIII Hospital (Hospital Foundation of the state of Minas Gerais) and analysis of the initial results of the first 1,000 patients. The project was initiated in 2011 and from January 2013 we began collecting data for the TR. In January 2014 the registration of the first 1000 patients was completed. The greatest difficulties in the TR implementation were obtaining funds to finance the project and the lack of information within the medical records. The variables with the lowest completion percentage on the physiological conditions were: pulse, blood pressure, respiratory rate and Glasgow coma scale. Consequently, the Revised Trauma Score (RTS) could be calculated in only 31% of cases and the TRISS methodology applied to 30.3% of patients. The main epidemiological characteristics showed a predominance of young male victims (84.7%) and the importance of aggression as a cause of injuries in our environment (47.5%), surpassing traffic accidents. The average length of stay was 6 days, and mortality 13.7%. Trauma registries are invaluable tools in improving the care of trauma victims. It is necessary to improve the quality of data recorded in medical records. The involvement of public authorities is critical for the successful implementation and maintenance of trauma registries in Brazilian hospitals.
Luciana B. Mattos
Full Text Available The Health and Education Ministries of Brazil launched the Health in School Program (Programa Saúde na Escola - PSE in 2007. The purpose of the PSE is two-fold: articulate the actions of the education and health systems to identify risk factors and prevent them; and promote health education in the public elementary school system. In the health field, the self-regulation (SR construct can contribute to the understanding of life habits which can affect the improvement of individuals' health. This research aims to present a program that promotes SR in health (SRH. This program (PSRH includes topics on healthy eating and oral health from the PSE; it is grounded on the social cognitive framework and uses story tools to train 5th grade Brazilian students in SRH. The study consists of two phases. In Phase 1, teachers and health professionals participated in a training program on SRH, and in Phase 2, they will be expected to conduct an intervention in class to promote SRH. The participants were randomly assigned into three groups: the Condition I group followed the PSE program, the Condition II group followed the PSRH (i.e., PSE plus the SRH program, and the control group (CG did not enroll in either of the health promotion programs. For the baseline of the study, the following measures and instruments were applied: Body Mass Index (BMI, Simplified Oral Hygiene Index (OHI-S, Previous Day Food Questionnaire (PFDQ, and Declarative Knowledge for Health Instrument. Data indicated that the majority are eutrophic children, but preliminary outcomes showed high percentages of children that are overweight, obese and severely obese. Moreover, participants in all groups reported high consumption of ultraprocessed foods (e.g., soft drinks, artificial juices, and candies. Oral health data from the CI and CII groups showed a prevalence of regular oral hygiene, while the CG presented good oral hygiene. The implementation of both PSE and PSRH are expected to help
Suellen R. Mendes
Full Text Available The aim of this study was to examine the procedures of primary dental health care performed by oral health teams (OHTs adhering to the second cycle of the ‘National Programme for Improving Access and Quality of Primary Care’ (PMAQ-AB in Brazil. A cross-sectional descriptive analysis was performed, across 23 dental procedures comprising preventive, restorative/prosthetic, surgical, endodontic and oral cancer monitoring. Descriptive analysis shows that most of the oral health teams carry out basic dental procedures. However, most of the time, they do not keep adequate records of suspected cases of oral cancer, diagnosis tests or follow-ups, and do not perform dental prosthetic procedures. Data also showed disparities in the average number of procedures performed in each Brazilian geographical region in 2013–2014, ranging from 13.9 in the northern to 16.5 in the southern and south-eastern regions, reinforcing the great social disparities between them. Brazilian regions with the highest volume of dental need deliver the lowest number of dental procedures. The need to tackle inequalities and further shape the supply of appropriate primary health care (PHC is evident.
Full Text Available This work proposes an anthropological reflection on the images and discourses of the body and the sexuality in the Brazilian society, focusing on a particular social phenomenon: the emergence of the Viagra in the national public scenario. This article explores the connotations constructed and confirmed by the Brazilian media press about this drug. Two Brazilian newspapers belonging to the same publisher but aimed at different publics were analyzed from April 1998 to April 1999, period that corresponds to the beginning – and apex – of the debate on the Viagra in the country. The discussion focuses on the symbolism and discursive strategies utilized by the newspapers when presenting this medication to the general public. This article also draws the attention to an appeal to traditional logics of gender, despite a contemporary scenario of issues concerning the relationships among the sexes and the sexuality.
Camelo, Lidyane do Valle; Rodrigues, Jôsi Fernandes de Castro; Giatti, Luana; Barreto, Sandhi Maria
The objective of this paper was to investigate whether sedentary leisure time was associated with increased regular consumption of unhealthy foods, independently of socio-demographic indicators and family context. The analysis included 59,809 students from the Brazilian National School-Based Adolescent Health Survey (PeNSE) in 2009. The response variable was sedentary leisure time, defined as watching more than two hours of TV daily. The target explanatory variables were regular consumption of soft drinks, sweets, cookies, and processed meat. Odds ratios (OR) and 95% confidence limits (95%CI) were obtained by multiple logistic regression. Prevalence of sedentary leisure time was 65%. Regular consumption of unhealthy foods was statistically higher among students reporting sedentary leisure time, before and after adjusting for sex, age, skin color, school administration (public versus private), household assets index, and household composition. The results indicate the need for integrated interventions to promote healthy leisure-time activities and healthy eating habits among young people.
Full Text Available Brazilian scientific output exhibited a 4-fold increase in the last two decades because of the stability of the investment in research and development activities and of changes in the policies of the main funding agencies. Most of this production is concentrated in public universities and research institutes located in the richest part of the country. Among all areas of knowledge, the most productive are Health and Biological Sciences. During the 1998-2002 period these areas presented heterogeneous growth ranging from 4.5% (Pharmacology to 191% (Psychiatry, with a median growth rate of 47.2%. In order to identify and rank the 20 most prolific institutions in these areas, searches were made in three databases (DataCAPES, ISI and MEDLINE which permitted the identification of 109,507 original articles produced by the 592 Graduate Programs in Health and Biological Sciences offered by 118 public universities and research institutes. The 20 most productive centers, ranked according to the total number of ISI-indexed articles published during the 1998-2003 period, produced 78.7% of the papers in these areas and are strongly concentrated in the Southern part of the country, mainly in São Paulo State.
Barros, Marilisa Berti de Azevedo; Lima, Margareth Guimarães; Azevedo, Renata Cruz Soares de; Medina, Lhais Barbosa de Paula; Lopes, Claudia de Souza; Menezes, Paulo Rossi; Malta, Deborah Carvalho
To evaluate the prevalence of health-related behaviors according to presence and type of depression in Brazilian adults. Based on a sample of 49,025 adults (18 to 59 years) from the National Survey on Health 2013 (PNS 2013), we estimated the prevalence of health-related behaviors (smoking; passive smoking; frequent or risky alcohol consumption; leisure time physical activity; time watching TV; and eating pattern indicators), according to the presence of depression (minor and major), evaluated by the Patient Health Questionnaire - 9 (PHQ-9), and the report of depressive mood (in up to seven days or more than seven days) over a two-week period. Prevalence ratios were estimated by Poisson regression. Evaluated by the PHQ-9 scale, 9.7% of the Brazilian adults had depression and 3.9% presented major depression. About 21.0% reported depressive mood and, in 34.9% of them, that feeling has been present for more than seven days. In individuals with major depression (PHQ-9), higher prevalence was found in almost all unhealthy behaviors analyzed, in particular, smoking (PR = 1.65), passive smoking (PR = 1.55), risk alcohol consumption (PR = 1.72), TV for ≥ 5 hours/day (PR = 2.13), consumption of fat meat (PR = 1.43) and soft drink (PR = 1.42). The prevalence ratios tended to be lower in those with minor depression. Similar results were observed in adults with depressive mood. This study detected relevant association between depression and health behaviors, in particular for smoking and physical activity. The associations found with the PHQ were similar to those observed with the application of a single question about depressive mood. Our results indicate the importance of assessing the presence of depression and the frequency and severity of symptoms when implementing actions for the promotion of healthy behaviors. Avaliar a prevalência de comportamentos relacionados à saúde segundo a presença e tipo de depressão em adultos brasileiros. Com base em amostra de 49
Full Text Available Research in public health is a range that includes from fundamental research to research in clinical practice, including novel advances, evaluation of results and their spreading. Actually, public health research is considered multidisciplinary incorporating numerous factors in its development. Establishing as a mainstay the scientific method, deepens in basic research, clinical epidemiological research and health services. The premise of quality and relevance is reflected in international scientific research, and in the daily work and good biomedical practices that should be included in the research as a common task. Therefore, the research must take a proactive stance of inquiry, integrating a concern planned and ongoing development of knowledge. This requires improve international coordination, seeking a balance between basic and applied research as well as science and technology. Thus research cannot be considered without innovation, weighing up the people and society needs. Acting on knowledge of scientific production processes requires greater procedures thoroughness and the effective expression of the results. It is noted as essential to establish explicit principles in review and evaluation of the adjustments of actions, always within the standards of scientific conduct and fairness of the research process. In the biomedical scientific lines it have to be consider general assessments that occur related to the impact and quality of health research, mostly leading efforts to areas that require further attention. However, other subject areas that may be deficient or with lower incidence in the population should not be overlook. Health research as a source of new applications and development provides knowledge, improving well-being. However, it is understandable without considering the needs and social demands. Therefore, in public health research and to improve the health of the population, we must refine and optimize the prevention and
Full Text Available This paper presents a critical review of 47 articles published between 2006 and 2011 to identify how case studies have been applied in Brazilian research on public administration. In addition to their theoretical and methodological characteristics, four further specific topics of interest were addressed: (a what is meant by case study; (b the relationship between the phenomenon of interest and the case under investigation; (c the possibility of replication; and (d how the supposed method contributes towards the development of the field of public administration. The main inconsistencies found were: the methodological descriptions are confusing; the results are inconsistent compared with data gathering procedures and data analysis techniques; a lack of information about the number of interviewed individuals; and no descriptions of research variables. The results suggest the reviewed case studies present methodological inconsistencies and limitations, which undermine their scientific value and relevance to academic work in Brazil.
Gallagher, Jennifer E.; Alajbeg, Ivan; Buechler, Silvia; Carrassi, Antonio; Hovius, Marjolijn; Jacobs, Annelies; Jenner, Maryan; Kinnunen, Taru; Ulbricht, Sabina; Zoitopoulos, Liana
The tobacco epidemic presents a major public health challenge, globally, and within Europe. The aim of the Public Health Work Stream at the 2nd European Workshop on Tobacco Use Prevention and Cessation for Oral Health Professionals was to review the public health aspects of tobacco control and make
Full Text Available Recent years have witnessed much progress in the incorporation of economic considerations into the evaluation of public health interventions. In England, the Centre for Public Health Excellence within the National Institute for Health and Care Excellence works to develop guidance for preventing illness and assessing which public health interventions are most effective and provide best value for money...
Faleiros, Daniel Resende; Acurcio, Francisco de Assis; Álvares, Juliana; Nascimento, Renata Cristina Rezende Macedo do; Costa, Ediná Alves; Guibu, Ione Aquemi; Soeiro, Orlando Mario; Leite, Silvana Nair; Karnikowski, Margô Gomes de Oliveira; Costa, Karen Sarmento; Guerra, Augusto Afonso
To discuss factors related to the financing of the Basic Component of Pharmaceutical Services within the municipal management of the Brazilian Unified Health System. The Pesquisa Nacional sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos no Brasil - Serviços (PNAUM - National Survey on Access, Use and Promotion of Rational Use of Medicines - Services) is a cross-sectional, exploratory, and evaluative study that performed an information survey in a representative sample, stratified by Brazilian regions It considered different study populations in the sampling plan, which represent primary health care services in the cities. Data were collected in 2015 by two methods: in person, by applying direct observation scripts and interviews with users, physicians, and professionals responsible for the dispensing of medicines in primary care services; by telephone interviews with municipal health managers and municipal professionals responsible for Pharmaceutical Services. The results were extracted from the questionnaires applied by telephone. Of the sample of 600 eligible cities, we collected 369 interviews (61.5%) with secretaries and 507 (84.5%) with pharmaceutical services managers. 70.8% of the cities have a computerized management system; and 11.9% have qualification/training of professionals. More than half (51.3%) of the cities received funds for the structuring of pharmaceutical services, and almost 60% of these cities performed this type of spending. In 35.4% of cases, municipal secretaries of health said that they use resources of medicines from the Componente Básico da Assistência Farmacêutica (CBAF - Basic Component of Pharmaceutical Services) to cover demands of other medicines, but only 9.7% believed that these funds were sufficient to cover the demands. The existence of a permanent bidding committee exclusively for acquiring medicines was reported in 40.0% of the cities. We found serious deficiencies in the public financing of
The legend about Parmentier is quite reductive when it limits his activity to the promotion of potato. This military pharmacist intended mainly to make science serve human being, whatever could be his various activities. Actor of the foundation of food chemistry, reorganizer of military pharmacy, he has always been highly concerned with hygiene and public health. He then studied the quality of water, particularly in the case of river Seine, or the purity of air, especially in hospitals. The affair of Dunkerque exhumations or that of cesspools, or the utilisation of human excrements in agriculture were parts of the occurrences for which he had the opportunity to find a scientific approach allowing to solve the difficult questions that were asked to him, for the best benefit of public health. The exhaustive study he published in "Bulletin de pharmacie" for the conservation of meat shows that he did not ignore anything about freezing of food in order to preserve it. It is necessary not to forget the important role he played, as soon as he were informed of Jenner's discovery, for the diffusion of vaccination in France. It is simply astounding to observe how modern were the questions he solved and how intense was his spirit of dedication to the public good, when exerting his functions in "Comité de Salubrité de la Seine" or "Conseil de Santé des Armées", as well as outside these prestigious institutions. Copyright © 2014 Elsevier Masson SAS. All rights reserved.
Prospecções para desenvolvimento de políticas públicas de formação de profissionais de saúde a partir da análise do cenário brasileiro de competências Prospections for development of public policies for health professionals training from the analysis of the Brazilian scenario of competencies
Thaís Branquinho Oliveira Fragelli
Full Text Available Quando se refere à Saúde Coletiva, a literatura aponta para a necessidade de profissionais que sejam capazes de atuar em diferentes contextos. Nesta perspectiva, o tema “competência” emerge do contexto administrativo para a saúde, de maneira a promover debates no campo de desenvolvimento de recursos humanos e formação profissional. Este artigo tem por objetivo apresentar um panorama do cenário brasileiro sobre competências profissionais em saúde para melhor entendimento do constructo em nível nacional e propor futuras prospecções. O estudo utilizou dados do Diretório de Grupos de Pesquisa do Conselho Nacional de Pesquisa (CNPq, da base de dados do Departamento de Ciência e Tecnologia do Ministério da Saúde (Sistema Pesquisa em Saúde, do Banco de Teses e de Dissertações da Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES e SciELO. Observou-se desigualdade na distribuição de pesquisadores e produção científica pouco incentivada. Indica-se, assim, a necessidade de maiores esforços gerenciais no campo de saúde para a construção do tema.When referring to Public Health, literature points to the need for professionals who are able to work in different contexts. In this perspective, the theme of "competency" emerges from the administrative context for health in order to promote debates in the field of human resource development and training. This paper aims to present an overview of the Brazilian scene on professional skills in health for better understanding the construct at the national level and propose future research. The study used data from the Directory of Research Groups of the National Research Council (CNPq, the database of the Department of Science and Technology of the Ministry of Health (Health Research System, Bank of Theses and Dissertations of the Coordination for Higher Education Personnel (CAPES and SciELO database. We observed inequality in the distribution of scientific
Angell, C; Hemingway, A; Hartwell, H
To identify public health open educational resources (OER) available online, map the identified OER to The Public Health Skills and Career Framework (PHSCF), and triangulate these findings with public health practitioners. Systematic online search for public health OER. An online search was undertaken using a pre-defined set of search terms and inclusion/exclusion criteria. Public health OER were then mapped against the UK PHSCF. The findings of the search were discussed with public health specialists to determine whether or not they used these resources. A number of public health OER were identified, located on 42 websites from around the world. Mapping against the UK PHSCF demonstrated a lack of coverage in some areas of public health education. It was noted that many of the OER websites identified were not those generally used in practice, and those sites preferred by public health specialists were not identified by the online search. Public health OER are available from a number of providers, frequently universities and government organizations. However, these reflect a relatively small pool of original OER providers. Tagging of websites does not always identify their public health content. In addition, users of public health OER may not use search engines to identify resources but locate them using other means. Copyright © 2011 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.
Paulo Afonso de André
Full Text Available OBJECTIVE: Due to their toxicity, diesel emissions have been submitted to progressively more restrictive regulations in developed countries. However, in Brazil, the implementation of the Cleaner Diesel Technologies policy (Euro IV standards for vehicles produced in 2009 and low-sulfur diesel with 50 ppm of sulfur was postponed until 2012 without a comprehensive analysis of the effect of this delay on public health parameters. We aimed to evaluate the impact of the delay in implementing the Cleaner Diesel Technologies policy on health indicators and monetary health costs in Brazil. METHODS: The primary estimator of exposure to air pollution was the concentration of ambient fine particulate matter (particles with aerodynamic diameters <2.5 μm, [PM2.5]. This parameter was measured daily in six Brazilian metropolitan areas during 2007-2008. We calculated 1 the projected reduction in the PM2.5 that would have been achieved if the Euro IV standards had been implemented in 2009 and 2 the expected reduction after implementation in 2012. The difference between these two time curves was transformed into health outcomes using previous dose-response curves. The economic valuation was performed based on the DALY (disability-adjusted life years method. RESULTS: The delay in implementing the Cleaner Diesel Technologies policy will result in an estimated excess of 13,984 deaths up to 2040. Health expenditures are projected to be increased by nearly US$ 11.5 billion for the same period. CONCLUSIONS: The present results indicate that a significant health burden will occur because of the postponement in implementing the Cleaner Diesel Technologies policy. These results also reinforce the concept that health effects must be considered when revising fuel and emission policies.
Patrick, C.H.; Loebl, A.S.; Miller, F.L.; Ritchey, P.N. Jr.
The purpose of this program is to assess the methodology and available data sources appropriate for use in analytical studies and environmental impact statements concerning the health effects of nuclear power plants. The techniques developed should be applicable as well to evaluation of the known risks of high levels of radiation exposure and of conflicting evidence on low-level effects, such as those associated with the normal operations of nuclear power plants. To accomplish this purpose, a two-pronged approach has been developed. The first involves a determination of the public health and demographic data sources of local, state, and federal origin that are available for use in analyses of health effects and environmental impact statements. The second part involves assessment of the methods used by epidemiologists, biostatisticians, and other scientists as found in the literature on health effects. This two-pronged approach provides a means of assessing the strength and shortcomings of studies of the impact of nuclear facilities on the health of the general population in a given locality
de Almeida Filho, Naomar Monteiro
An introductory comment is made on the historical background, institutional impasses and curriculum challenges for training Public Health workers in Brazil. Initially, a thesis is proposed, namely that the Brazilian state has not fulfilled its responsibility to ensure quality public services for the population, with access and equity, shaping "the four perversions of Brazilian education." Secondly, it analyzes the public health system, which is theoretically universal, but being underfunded and with acknowledged shortcomings, contributes to the increase in social exclusion. Lastly, it highlights the need for new models for training people who are technologically competent, suitable for teamwork, creative, autonomous, problem-solving, engaged in health promotion, open to social participation and committed to the humanization of health.
Juliane Madeira Leitão
Full Text Available Materiality in private sector financial audit is a topic that has been relatively well developed in the literature. Specific research in this regard in public sector auditing, on the other hand, is scarce at the international level and absent in Brazil. In view of this, the purpose of this study was to identify the parameters used to determine materiality in public sector financial audit. To this end, we sent questionnaires to the 192 Supreme Audit Institutions that are members of INTOSAI and to 36 Brazilian public auditors, specialists in financial audit, who are staff members of the TCU or the CGU seeking information with respect to the Institutions’ guidelines and the auditors’ perceptions about materiality. Results reveal that expenditures, revenues and total assets are the benchmarks most recommended by respondents for defining materiality in the public sector. In addition, they recommended the adoption of percentages of up to 2% for each of these parameters in defining what is material. It was observed, as well, especially with respect to the effectiveness of internal control and to public expectations or interests, that qualitative aspects should be also taken into account in determining materiality, although a lesser degree of importance is attributed to this than to the quantitative aspects,. The study contributes to the accounting literature on the development of audits, particularly with respect to the use of a concept, materiality, that is always emphasized in professional standards, but about which there are few objective guidelines.
Public health focuses on health of the population and it is concerned with threats to health based on population health analysis. Anthropology covers most aspects that concern human beings. Both sciences converge on community and this fact represents a foundation for the partnership between public health and anthropology. Biological/medical anthropology is one of the highly developed fi elds of anthropology and the most important for public health.
Paulo Roberto Dutra Leão
postpartum women, attended in two hospitals of the Public Health System (SUS in Cuiabá, and its correlation with age, previous abortion and women's knowledge of the disease. METHODS: a cross-sectional study including 205 women with ages from 14 to 43 (mean 22.4 years old, attended in these hospitals for two months, in the first or second days postpartum. Each woman answered a short questionnaire and had peripheral blood sample collected. Blood samples were stored at 20°C until assay. The seroprevalence was determined by quantitative detection of specific IgG antibody against Toxoplasma gondii, using a microparticle enzyme immunoassay. All samples were assayed at the same time. RESULTS: The average number of pregnancies in the women included in this study was 2.2, and the majority of them was pregnant for the first time. The seroprevalence found was 70.7% (165 of 205 women. No statistical correlation was found between seroprevalence and age (p = 0.967 or previous abortion (p = 0.82. Most of the women in this study (78% did not know about toxoplasmosis and no statistical correlation was found between this condition and seroprevalence (p = 0.49. CONCLUSION: the high seroprevalence found in the present study is in accordance with surveys previously reported in our country and other developing countries. Among the women included in this study, an expressive number (29.3% is still under risk of contamination. The lack of statistical correlation between seroprevalence and women's age, lack of knowledge about the disease and report of previous abortion is in accordance with some previous studies and in disagreement with others.
Tiago Villac Adde
Full Text Available The history of Brazilian accounting has not been explored at length. Through a historical survey, this article presents the history of the Double-entry Bookkeeping Committee of 1914. After the Proclamation of the Republic was announced in 1889, the government started to expand its administrative bodies, necessitating the introduction of a bureaucracy able to perform new functions. In the same period, Brazil experienced a strong economic development with the development of its coffee industry. In 1905, under the leadership of Carlos de Carvalho, São Paulo State Treasury bookkeeping tasks were introduced under a double-entry bookkeeping system and through accrual and financial accounting. Double-entry bookkeeping practices in the federal public accounting system, although enshrined in law since 1808, were only fully realized after the creation of the Double-entry Bookkeeping Committee in 1914. In that same year, due to the negotiation of a second funding loan, English creditor bank auditors requested a balance of the National Treasury from the Minister of Finance Rivadávia Corrêa. Because the balance had not been prepared in eight years, the Double-entry Bookkeeping Committee was established in June of 1914, and this body completed a technical audit of Revenues and Expenditures. The committee also conducted the state administration's first Asset and Liability audit since the colonial era. The Double-entry Bookkeeping Committee of 1914 spearheaded changes to the Brazilian public accounting system, including the creation of the Public Accounting Code in 1922 and the approval of Central Accounting Office of the Republic regulation in 1924, strengthening and ascribing perpetuity to practices adopted after 1914.
Milton de Abreu Campanario
Full Text Available The text is the part of public policy of a larger research project on Brazilian Outward ForeignDirect Investment - OFDI. The text analyses the viability to adopt policies to enhance FDI,particularly outward. Based on statistical data and on literature review, the policy agenda framesthe underling questions surrounding the theme. There is not yet a theoretical framework to dealwith emergent countries’ FDI and related policies. There exist strong evidences that capital flowsthrough FDI generate externalities in the following domains: macroeconomics, microeconomicsand foreign relations particularly in areas related to industrial organization and innovation. Thetheoretical proposition is that international capital flows are compatible to monetary stability,commercial openness, investment promotion and industrial innovation policies. A betterpositioning of national enterprises internationally may result in growing partnership within theforeign environment. Brazil has not a set of policies to deal with inward and outward BrazilianFDI flows. These policies do not necessarily jeopardize macroeconomic policy and the relatedmonetary and currency stabilization goals. It contends that FDI stimulus by means of publicpolicies may contribute not just to a better competitiveness and innovation of Brazilianenterprises, but also assure a balanced growing and economic structural change.
Author Guidelines; » Copyright Notice; » Privacy Statement ... and noncommunicable diseases, health leadership and management issues. ... current scientific and policy debates, including methodological issues in public health research.
Hunter, David J; Marks, Linda; Smith, Katherine E
.... The Public Health System in England offers a wide-ranging, provocative and accessible assessment of challenges confronting a public health system, exploring how its parameters have shifted over time...
Salinsky, Eileen; Gursky, Elin A
Changing threats to the public's health necessitate a profound transformation of the public health enterprise. Despite recent attention to the biodefense role of public health, policymakers have not developed a clear, realistic vision for the structure and functionality of the governmental public health system. Lack of leadership and organizational disconnects across levels of government have prevented strategic alignment of resources and undermined momentum for meaningful change. A transformed public health system is needed to address the demands of emergency preparedness and health protection. Such transformation should include focused, risk-based resource allocation; regional planning; technological upgrades; workforce restructuring; improved integration of private-sector assets; and better performance monitoring.
Schaffer, Marjorie A.; Anderson, Linda J. W.; Rising, Shannon
School nurses (SNs) use public health nursing knowledge and skills to provide nursing services to school populations. The Public Health Intervention Wheel is a practice framework that can be used to explain and guide public health nursing interventions. SNs who were also members of the National Association of School Nurses completed an electronic…
Public health has burgeoned over the past 100 years, from the study of tropical diseases in the 19th century to national public health systems after World War One and, more recently, to include international public health. Education has kept up with these trends, and today there are hundreds of schools around the world, many flourishing in developing countries.
Casarin, Fabíola Schwengber; Wong, Cristina Elizabeth Izábal; Parente, Maria Alice de Mattos Pimenta; de Salles, Jerusa Fumagalli; Fonseca, Rochele Paz
Neuropsychological assessment reveals that certain cognitive changes that take place during the neural development process may be associated with biopsychosocial issues. A substantial body of research has focused on cognitive development in children and adults, but few such studies have been carried out on adolescents. Therefore, research into the processing of neuropsychological functions in adolescents, taking into account the role of major socio-cultural factors such as school type (public vs. private), is highly relevant. The present study sought to assess whether differences in neuropsychological development exist between adolescent students of public (government-funded) and private schools. A total of 373 grade-matched students between the ages of 12 and 18, 190 from public schools and 183 from private schools, took part in the study. All subjects had no self-reported neurologic or psychiatric conditions and sensory disorders. The NEUPSILIN Brazilian Brief Neuropsychological Assessment Battery was administered to this sample. Comparison of mean scores (one-way ANCOVA with socioeconomic score and age as covariates) showed that adolescents attending private schools generally outperformed their public-school peers in tasks involving sustained attention, memory (working and visual), dictated writing, and constructional and reflective abilities. We conclude that school type should be taken into account during standardization of neuropsychological assessment instruments for adolescent and, probably, child populations.
Marcella Costa RADAEL
Full Text Available Reproduction is a fundamental part of life being and studies related to fish reproduction have been much accessed. The aim of this study was to perform a bibliometric analysis in intend to identify trends in this kind of publication. During June 2013, were performed searches on Scopus Database, using the term “fish reproduction”, being compiled and presented information related to the number of publications per year, number of publications by country, publications by author, by journal, by institution and most used keywords. Based on the study, it was possible to obtain the following results: Brazil occupies a highlight position in number of papers, being that the Brazilian participation compared to worldwide publishing production is having an exponential increase; in Brazil, there is a high concentration of articles when concerning the top 10 authors and institutions. The present study allows verifying that the term “fish reproduction” has been focused by many scientific papers, being that in Brazil there is a special research effort related to this subject, especially in the last few years. The main contribution concerns to the use of bibliometric methods to describe the growth and concentration of researches in the area of fishfarm and reproduction.
Today, a substantial reorientation of the Public Health services in the Federal Republic of Germany is broadly seen necessary. Patterns of functional and organisational restructuring of Public Health services on the regional and the communal level are closely linked with concepts of prevention and health promotion. Hence, a number of agencies have already adopted new tasks and functions like comprehensive and transorganizational planning, coordination and evaluation as well as the establishment of new reporting systems. Presently, the transformation process from the bureaucratic mode of administering matters of health to a new Public Health orientation receives new impacts from the international "New Public Management" movement. Comparatively late, with the beginning of the 1990s, a growing number of German municipalities has introduced new concepts of administration. Local government administrations, of which the Public Health services are a part, follow the model of modern service organizations producing services in a more efficient, professionalized and consumer-oriented way. Specific elements of economising modernisation programmes like re-distribution of tasks, de-centralisation, extension of managerial capacities, setting of stimulating working conditions that provide employees with greater independence of action as well as career opportunities, are at the same time prerequisites for innovative strategies of health protection and coordination policies of Public Health services.
Serikawa, Simoni S; Albieri, Ana Carolina S; Bonugli, Gustavo P; Greghi, Marina F
During the last decades there have been many changes in the banking sector organization. It has been also observed the mutual growing of musculoskeletal and mental disorders. This study investigated the workload of bank tellers at a Brazilian public institution. It was performed the Ergonomic Work Analysis (EWA). Three employees participated in this study. During the analysis process, three research instruments were applied: Inventory of Work and Risk of Illness, Yoshitake Fatigue Questionnaire and Nordic Musculoskeletal Questionnaire, beyond the realization of footage recordings and the self-confrontation. The results indicated the existence of an excess of workload on the evaluated workstations, mainly in relation to mental order constraints, that overlaps the physical aspects. Thereby it was found that the employees tend to adopt strategies trying to reduce the impacts of the excess of workload, in order to regulate it.
Tavares, Ana Paula Cardoso; Leite, Bruna Silva; Silveira, Isabelle Andrade; Santos, Thayane Dias Dos; Brito, Willian de Andrade Pereira de; Camacho, Alessandra Conceição Leite Funchal
To analyze the publications that focus on distance education in nursing in Brazil from 2010 to 2016. Integrative review of the literature with data collection in June 2016 in the following databases: LILACS, MEDLINE via PUBMED, CINAHL and SCOPUS. For the data analysis and interpretation, the thematic categorization was chosen. We selected 18 articles for discussion, whose textual analysis permitted the construction of three thematic categories: use of virtual technologies for distance education in nursing; construction of virtual learning environments with the aid of virtual technologies for distance education in nursing; and evaluation of the learning process through virtual technologies for distance education of nurses. Distance Education stands out as an effective teaching-learning strategy in this type of education in Brazilian nursing, focused mainly on the improvement and complement of traditional teaching.
This master thesis is trying to describe the situation of private sector in public health care systems. As a private sector we understand patients, private health insurance companies and private health care providers. The focus is placed on private health care providers, especially in ambulatory treatment. At first there is a definition of health as a main determinant of a health care systems, definition of public and private sectors in health care systems and the difficulties at the market o...
Alexander, Mandi M.; Santo, Jonathan B.; Da Cunha, Josafa; Weber, Lidia; Russell, Stephen T.
This study investigated homophobic victimization, teacher support, and school commitment in Brazilian schools. Participants were 339 students, ages 11 to 18 years old, in two public schools in Brazil. Data were obtained using the Brazil Preventing School Harassment Survey. Structural equation modeling revealed that both homophobic and…
doctors, nurses, lawyers, and architects can enjoy the benefits of the 2005/36/EC Directive amended by 2013/55/EU Directive on the recognition of professional qualifications, public health professionals are left out from these influential (elite professions. Firstly, we use the profession traits theory as a framework in arguing whether public health can be a legitimate profession in itself; secondly, we explain who public health professionals are and what usually is required for shaping the public health profession; and thirdly, we attempt to sketch the road to the authorisation or licensing of public health professionals. Finally, we propose some recommendations.
The East African Journal of Public Health is a multi-disciplinary journal publishing scientific research work from a range of public health related disciplines including community medicine, epidemiology, nutrition, behavioural sciences, health promotion, health education, communicable and non-communicable disease.
Teixeira, C. A.; Gallo, P. R.
Introduction - The elaboration process of public policies for science and technology in knowledge societies should include not only experts, but all society members. There are studies on lay people's perception of science and technology. However, what is the scientists' perspective on public communication of science? Objectives - To describe and characterize the concepts that coordinators of Brazilian public health graduate programs have about public communication of science. Methods - This is an analytical and descriptive report of an exploratory research (doctoral study). The answers of fifty-one coordinators to two questionnaires were submitted for content analysis. The categories were transformed into variables that allowed the data processing by the Hiérarchique Classificatoire et Cohésitive (CHIC®) software. Results - Similarity analysis strongly suggested (0,99) that coordinators understand public communication as a communication directed to academic peers and students, also as a form of participation in scientific events and communication by scientific papers. Likewise, the implication analysis suggested a strong implication (0,98) between scientific communication understood as public communication. Conclusion - The notion of public communication of science as a social right and as a commitment and responsibility of researchers and research centers is not explicitly present in the narrative of the coordinators, although in general the coordinators conceive it as a relevant activity. This study thus contributes to a reflection on the role of scientists, researchers and research centers in public communication of science and technology.
... 42 Public Health 1 2010-10-01 2010-10-01 false Public health advisory. 90.9 Section 90.9 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES HEALTH ASSESSMENTS AND HEALTH... PROCEDURES § 90.9 Public health advisory. ATSDR may issue a public health advisory based on the findings of a...
Reviews of public health emergency responses have identified a need for crisis leadership skills in health leaders, but these skills are not routinely taught in public health curricula. To develop criteria for crisis leadership in public health, published sources were reviewed to identify attributes of successful crisis leadership in aviation, public safety, military operations, and mining. These sources were abstracted to identify crisis leadership attributes associated with those disciplines and compare those attributes with crisis leadership challenges in public health. Based on this review, the following attributes are proposed for crisis leadership in public health: competence in public health science; decisiveness with flexibility; ability to maintain situational awareness and provide situational assessment; ability to coordinate diverse participants across very different disciplines; communication skills; and the ability to inspire trust. Of these attributes, only competence in public health science is currently a goal of public health education. Strategies to teach the other proposed attributes of crisis leadership will better prepare public health leaders to meet the challenges of public health crises.
Joana Portugal Mota et al.
Full Text Available II Luso-Brazilian Symposium - Hair Care and Health II Simpósio Luso-Brasileiro - Cuidados e Saúde do Cabelo 24 October | 24 Outubro Lisboa - Universidade Lusófona Honor Commitee /Comissão de Honra Magnífico Reitor da Universidade Lusófona, Mário Moutinho Presidente do Conselho de Administração da Universidade Lusófona, Manuel de Almeida Damásio Presidente do Infarmed, Eurico Castro Alves. Bastonário da Ordem dos Farmacêuticos, Carlos Maurício Barbosa Presidente da Associação Industriais Cosmética, Ana Maria Couras. Presidente da SPCC, Luís Monteiro Rodrigues (Presidente do Simpósio Presidente da ABC, João Hansen (Presidente do Simpósio Scientific Commitee /Comissão Científica Alberto Keidi Kurebayashi Catarina Fialho Rosado Celso Martins Júnior Joana Portugal Mota João Hansen Luís Monteiro Rodrigues Maria Lídia Palma Organizing Commitee /Comissão Organizadora SPCC Escola de Ciências e Tecnologias da Saúde (ECTS da U. Lusófona de Humanidades e Tecnologias ALIES – Associação Lusófona para o Desenvolvimento do Ensino e Investigação das Ciências da Saúde CBIOS – Centro de Investigação em Biociências e Tecnologias da Saúde Programa Open Session | Sessão de abertura Bastonário da Ordem dos Farmacêuticos, Carlos Maurício Barbosa Direcção da SPCC, Manuel Fitas Direcção da ABT, Celso Martins Júnior 1st Session | Sessão 1 HOT TOPICS (Tecnologia das Formulações Charmain | Moderador - Joana Portugal Mota Speakers | Prelectores Celso Martins Júnior Michelli Dario Key-note Speakers | Prelectores Bruno A. Bernard Nelson Tavares 2st Session | Sessão 2 HOT TOPICS (Saúde do Cabelo e Imagem Charmain | Moderador - André Rolim Baby Speakers | Prelectores Celso Martins Júnior Roundtable - Debate | Mesa Redonda - Debate Flávio Roques Catarina Rosado Previous speakers | Prelectores anteriores 1st Session | Sessão 1 HOT TOPICS (Formulation Technology | HOT TOPICS (Tecnologia das Formulações Chairman
Priscila Reinaldo Marson
Full Text Available The intention of this article is to present a case study on the adoption and use of new channels of internal communication in a federal public autarchy. The study was conducted at the National Institute of Social Security, in São Paulo, between July 2008 and July 2009, and aimed to monitor the period in which a new internal communication plan was developed and implemented in its initial phase. The research methodology used was the case study, consisting of documentary analysis, field research and in-depth interviews conducted with the institution’s public employees. As a result, it was possible to observe the internal resistance and the difficulties encountered in the management of the new plan. Among its conclusions, the study highlights the need for a previous study on the conditions of relationships and practices developed in a public service unit at the adoption of new communication tools. It also highlights the importance of planning and management actions in the implementation of the intended communication actions, including internal marketing efforts to sensitize users about the meaning and importance of internal communication in promoting greater agility and efficiency in the workplace, in order to offer best public services to users.
U.S. Department of Health & Human Services — A set of seven (7) public use files containing information on health insurance issuers participating in the Health Insurance Marketplace and certified qualified...
"This text has a large emphasis on mixed methods, examples relating to health research, new exercises pertaining to health research, and an introduction on qualitative and mixed methods in public health...
Elisa Elaine Moreira Teixeira
Full Text Available DOI: http://dx.doi.org/10.5007/2175-8077.2012v14n33p79 This paper describes the results of a twofold study that compared the performance of Initial Public Offering (IPOs in the Brazilian stock market with that of incorporated company in 2004 and 2005 and also checked if these IPOs were included in the Bovespa Index (IBOV in this period. We first collected data on stock price variations every year subsequent to the public offering. Thereafter, we compared the IPOs’ rates with those of the public corporations. The results show that 81.25% of the IPOs had positive returns in the first and the second years of anniversary, and only 50% of them had positive return in the third year. The youngest companies had the highest returns, and 45% of them were included in the IBOV in the period under scrutiny. The comparison of the ratios showed that IPOs of any age are more valued than the comparison companies. As a conclusion, we can say that the IPOs’ performance was significantly better than that of the comparison companies in the period studied.
Messias, Alexandre Augusto; Reichelt, Angela J; Dos Santos, Edson F; Albuquerque, Galton C; Kramer, José S P; Hirakata, Vania N; Garcia, Valter D
Return to work is an objective parameter used worldwide to evaluate the success of organ transplantation and is especially feasible after renal transplantation. This study sought to describe the frequency of return to work after renal transplantation and related characteristics. Retrospective cohort of 511 isolated kidney transplant recipients was recruited from a Brazilian referral center from January 2005 to December 2009; all were matched to the public social security database to determine inclusion and benefit awards, as well as the rate of resumption of contributions to the public social security system, a surrogate marker of work rehabilitation. Characteristics associated with work return were analyzed. No social security records were found for 28 subjects. The remaining 483 subjects had a mean age of 45±13 years; 62% were male; 401 (83%) received some public social security benefit; 298 were paying dues and could, therefore, receive temporary or permanent disability benefits. Of these, 78 subjects made social security payments after transplantation, resulting in a work return rate of 26% (95% confidence interval, 21-32). Younger age, living donor graft, and chronic glomerulonephritis were significantly associated with return to work. In Brazil, most renal transplant recipients are on social security benefits, but only a small proportion return to work after surgery. Clinical characteristics may help define work resumption trends.
This mixed methods study examined the relationship between the motivations for attending college of undergraduate students with a focus on students with a public health major, and their desire to pursue graduate training in public health and subsequently, public health careers. The study highlighted the current public health workforce shortage and…
David A. Sleet
Full Text Available Injuries are one of the most under-recognized public health problems facing the world today. With more than 5 million deaths every year, violence and injuries account for 9% of global mortality, as many deaths as from HIV, Malaria and Tuberculosis combined. Eight of the 15 leading causes of death for people ages 15 to 29 years are injury-related: road traffic injuries, suicides, homicides, drowning, burns, war injuries, poisonings and falls. For every death due to war, there are three deaths due to homicide and five deaths due to suicide. However, most violence happens to people behind closed doors and results not in death, but often in years of physical and emotional suffering . Injuries can be classified by intent: unintentional or intentional. Traffic injuries, fire-related injuries, falls, drowning, and poisonings are most often classified as unintentional injuries; injuries due to assault, selfinflicted violence such as suicide, and war are classified as intentional injuries, or violence. Worldwide, governments and public and private partners are increasingly aware of the strains that unintentional injuries and violence place on societies. In response they are strengthening data collection systems, improving services for victims and survivors, and increasing prevention efforts .
The thesis introduces a new conceptual model of organizational health and discusses its implications for public health management and leadership. It is developed with reference to organizational theories and ideologies, including New Public Management, the use of which has coincided with increasing workplace health problems in health care organizations. The model is based on empirical research and theories in the fields of public health, health care organization and management, and institutio...
Climate change has been identified as a serious threat to human health, associated with the sustainability of current practices and lifestyles. Nurses should expand their health promotion role to address current and emerging threats to health from climate change and to address ecological public health. This article briefly outlines climate change and the concept of ecological public health, and discusses a 2012 review of the role of the nurse in health promotion.
Cavalcante, Ricardo Bezerra; Kerr-Pinheiro, Marta Macedo; Guimarães, Eliete Albano de Azevedo; Miranda, Richardson Machado
The This qualitative study aimed to analyze the development and implementation of the Brazilian National Policy on Health Data and Information Technology (NPIIH). We analyzed documents and applied an online questionnaire to the experts involved in developing the policy. The data were submitted to content analysis using the categorical thematic modality. The PNIIS is the target of debate and proposals at various levels. Provisions have appeared in parallel to regulate measures on health data and information technology. Community participation in developing this policy and the convergence of laws, standards, resolutions, and policy-making levels in a common and broadly acknowledged and enforced policy are challenges, in addition to linking the public and private sectors. The study concludes that the National Policy on Health Data and Information Technology is making gradual progress, predominantly in theoretical debates, revisions, and updates. There are numerous challenges for its implementation and a prevailing need for legitimation.
Many public health practitioners and organizations view themselves as engaged in the promotion or achievement of equity. However, discussions around public health frequently assume that practitioners and policy-makers take a utilitarian approach to this work. I argue that public health is better understood as a social justice endeavor. I begin by presenting the utility view of public health and then discuss the equity view. This is a theoretical argument, which should help public health to justify interventions for communicable and non-communicable diseases equally, and which contributes to breaking down the 'old/new' public health divide. This argument captures practitioners' views of the work they are engaged in and allows for the moral and policy justification of important interventions in communicable and non-communicable diseases. Systemic interventions are necessary to remedy high rates of disease among certain groups and, generally, to improve the health of entire populations. By viewing diseases as partly the result of failures of health protective systems in society, public health may justify interventions in communicable and non-communicable diseases equally. Public health holds a duty to improve the health of the worst-off in society; by prioritizing this group, the health of the whole community may improve. © The Author(s) 2017. Published by Oxford University Press on behalf of Faculty of Public Health. All rights reserved. For permissions, please e-mail: firstname.lastname@example.org
Bendo Cristiane B
Full Text Available Abstract Background Oral and orofacial problems may cause a profound impact on children’s oral health-related quality of life (OHRQoL because of symptoms associated with these conditions that may influence the physical, psychological and social aspects of their daily life. The OHRQoL questionnaires found in the literature are very specific and are not able to measure the impact of oral health on general health domains. Consequently, the objective of this study was to evaluate the psychometric properties of the Portuguese version for Brazilian translation of the Pediatric Quality of Life Inventory™ (PedsQL™ Oral Health Scale in combination with the PedsQL™ 4.0 Generic Core Scales. Methods The PedsQL™ Oral Health Scale was forward-backward translated and cross-culturally adapted for the Brazilian Portuguese language. In order to assess the feasibility, reliability and validity of the Brazilian version of the instrument, a study was carried out in Belo Horizonte with 208 children and adolescents between 2 and 18 years-of-age and their parents. Clinical evaluation of dental caries, socioeconomic information and the Brazilian versions of the PedsQL™ Oral Health Scale, PedsQL™ 4.0 Generic Core Scales, Child Perceptions Questionnaire (CPQ11-14 and CPQ8-10 and Parental-Caregiver Perception Questionnaire (P-CPQ were administered. Statistical analysis included feasibility (missing values, confirmatory factor analysis (CFA, internal consistency reliability, and test-retest intraclass correlation coefficients (ICC of the PedsQL™ Oral Health Scale. Results There were no missing data for both child self-report and parent proxy-report on the Brazilian version of the PedsQL™ Oral Health Scale. The CFA showed that the five items of child self-report and parent proxy-report loaded on a single construct. The Cronbach's alpha coefficients for child/adolescent and parent oral health instruments were 0.65 and 0.59, respectively. The test
Moreira, Tiago Ricardo; Giatti, Luana; Cesar, Cibele Comini; Andrade, Eli Iola Gurgel; Acurcio, Francisco de Assis; Cherchiglia, Mariângela Leal
ABSTRACT OBJECTIVE To examine whether the level of complexity of the services structure and sociodemographic and clinical characteristics of patients in hemodialysis are associated with the prevalence of poor health self-assessment. METHODS In this cross-sectional study, we evaluated 1,621 patients with chronic terminal kidney disease on hemodialysis accompanied in 81 dialysis services in the Brazilian Unified Health System in 2007. Sampling was performed by conglomerate in two stages and a structured questionnaire was applied to participants. Multilevel multiple logistic regression was used for data analysis. RESULTS The prevalence of poor health self-assessment was of 54.5%, and in multivariable analysis it was associated with the following variables: increasing age (OR = 1.02; 95%CI 1.01–1.02), separated or divorced marital status (OR = 0.62; 95%CI 0.34–0.88), having 12 years or more of study (OR = 0.51; 95%CI 0.37–0.71), spending more than 60 minutes in commuting between home and the dialysis service (OR = 1.80; 95%CI 1.29–2.51), having three or more self-referred diseases (OR = 2.20; 95%CI 1.33–3.62), and reporting some (OR = 2.17; 95%CI 1.66–2.84) or a lot of (OR = 2.74; 95%CI 2.04–3.68) trouble falling asleep. Individuals in treatment in dialysis services with the highest level of complexity in the structure presented less chance of performing a self-assessment of their health as bad (OR = 0.59; 95%CI 0.42–0.84). CONCLUSIONS We showed poor health self-assessment is associated with age, years of formal education, marital status, home commuting time to the dialysis service, number of self-referred diseases, report of trouble sleeping, and also with the level of complexity of the structure of health services. Acknowledging these factors can contribute to the development of strategies to improve the health of patients in hemodialysis in the Brazilian Unified Health System. PMID:27143610
Tiago Ricardo Moreira
Full Text Available ABSTRACT OBJECTIVE To examine whether the level of complexity of the services structure and sociodemographic and clinical characteristics of patients in hemodialysis are associated with the prevalence of poor health self-assessment. METHODS In this cross-sectional study, we evaluated 1,621 patients with chronic terminal kidney disease on hemodialysis accompanied in 81 dialysis services in the Brazilian Unified Health System in 2007. Sampling was performed by conglomerate in two stages and a structured questionnaire was applied to participants. Multilevel multiple logistic regression was used for data analysis. RESULTS The prevalence of poor health self-assessment was of 54.5%, and in multivariable analysis it was associated with the following variables: increasing age (OR = 1.02; 95%CI 1.01–1.02, separated or divorced marital status (OR = 0.62; 95%CI 0.34–0.88, having 12 years or more of study (OR = 0.51; 95%CI 0.37–0.71, spending more than 60 minutes in commuting between home and the dialysis service (OR = 1.80; 95%CI 1.29–2.51, having three or more self-referred diseases (OR = 2.20; 95%CI 1.33–3.62, and reporting some (OR = 2.17; 95%CI 1.66–2.84 or a lot of (OR = 2.74; 95%CI 2.04–3.68 trouble falling asleep. Individuals in treatment in dialysis services with the highest level of complexity in the structure presented less chance of performing a self-assessment of their health as bad (OR = 0.59; 95%CI 0.42–0.84. CONCLUSIONS We showed poor health self-assessment is associated with age, years of formal education, marital status, home commuting time to the dialysis service, number of self-referred diseases, report of trouble sleeping, and also with the level of complexity of the structure of health services. Acknowledging these factors can contribute to the development of strategies to improve the health of patients in hemodialysis in the Brazilian Unified Health System.
Cohen, Neal L; Galea, Sandro
... on population mental health with public mental health policy and practice. Issues covered in the book include the influence of mental health policies on the care and well- being of individuals with mental illness, the interconnectedness of physical and mental disorders, the obstacles to adopting a public health orientation to mental health/mental ill...
CDCâs Office of Public Health Preparedness and Response funds Preparedness and Emergency Response Research Centers (PERRCs) to examine components of the public health system. This podcast is an overview of mental and behavioral health tools developed by the Johns Hopkins PERRC. Created: 8/29/2011 by Emergency Risk Communication Branch (ERCB)/Joint Information Center (JIC); Office of Public Health Preparedness and Response (OPHPR). Date Released: 8/30/2011.
Winder, A.E.; Stanitis, M.A.
Twenty-three public health schools and 492 university schools of nursing were surveyed to gather specific information on educational programs related to nuclear war. Twenty public health schools and 240 nursing schools responded. Nuclear war-related content was most likely to appear in disaster nursing and in environmental health courses. Three schools of public health report that they currently offer elective courses on nuclear war. Innovative curricula included political action projects for nuclear war prevention
Valéria Rodrigues Leite
Full Text Available O artigo aborda a temática do financiamento e o processo de descentralização tendo como objetivo examinar a composição, a direção e a gestão dos recursos na área da saúde. A amostra investigada foi constituída por 14 municípios do Estado do Rio Grande do Norte. A pesquisa envolveu coleta de dados referente às transferências, recursos próprios municipais e gastos com atenção básica. Na análise da gestão foi realizado um levantamento junto aos dirigentes locais e conselheiros. Observa-se que o financiamento do Sistema Único de Saúde se faz às expensas das transferências federais e receitas municipais, com pequena participação dos recursos estaduais. A direção dos gastos tem privilegiado a atenção básica. No processo de gestão, verifica-se centralização das ações nas prefeituras. As secretarias municipais e os conselhos cumprem em parte a legislação e apresentam dificuldades na autonomia e o controle social. Os resultados mostram que os instrumentos de planejamento e gestão são limitados em função das contradições presentes no contexto institucional, político e cultural no âmbito regional.This article investigates the issue of funding and the decentralization process in order to examine the composition, application and management of resources in the healthcare area. The sample surveyed involved 14 municipalities in the state of Rio Grande do Norte, Brazil. The research involved data gathering of financial transfers, the municipality's own resources and primary healthcare expenses. Management analysis included a survey of local managers and counselors. It was seen that the Unified Health System is funded mainly by federal transfers and municipal revenues and to a far lesser extent by state resources. Funds have been applied predominantly in primary healthcare. The management process saw centralization of actions in the city governments. Municipal secretarial offices and councils comply partially with
Senna, Kátia Marie Simões e; Sarti, Flavia Mori; Costa, Márcia Gisele Santos da; Nita, Marcelo Eidi; Santos, Marisa da Silva; Tura, Bernardo Rangel; Correia, Marcelo Goulart
The aim of this study was to perform a budget impact analysis on the adoption of percutaneous occlusion of ostium secundum atrial septal defects in the Brazilian Unified National Health System. Costs were collected using micro-costing technique from medical records for each treatment technique (conventional surgery versus percutaneous septal occluder) at a public federal hospital specialized in high-complexity cardiology. The analysis showed that expenditures associated with percutaneous occlusion were lower than with conventional surgery, and sensitivity analysis confirmed the cost reduction in several scenarios, showing a significant budget impact with a 30% adoption rate for the percutaneous occluder (savings of approximately 1.5 million dollars per year). The study indicates that the adoption of the percutaneous septal occluder would mean cost savings of approximately 3.5 million dollars for the Brazilian public health system.
Himmelstein, David U; Woolhandler, Steffie
We examined trends in US public health expenditures by analyzing historical and projected National Health Expenditure Accounts data. Per-capita public health spending (inflation-adjusted) rose from $39 in 1960 to $281 in 2008, and has fallen by 9.3% since then. Public health's share of total health expenditures rose from 1.36% in 1960 to 3.18% in 2002, then fell to 2.65% in 2014; it is projected to fall to 2.40% in 2023. Public health spending has declined, potentially undermining prevention and weakening responses to health inequalities and new health threats.
Jacobson, Peter D; Wasserman, Jeffrey; Wu, Helen W; Lauer, Johanna R
We assessed the feasibility and desirability of public health entrepreneurship (PHE) in governmental public health. Using a qualitative case study approach with semistructured interview protocols, we conducted interviews between April 2010 and January 2011 at 32 local health departments (LHDs) in 18 states. Respondents included chief health officers and senior LHD staff, representatives from national public health organizations, health authorities, and public health institutes. Respondents identified PHE through 3 overlapping practices: strategic planning, operational efficiency, and revenue generation. Clinical services offer the strongest revenue-generating potential, and traditional public health services offer only limited entrepreneurial opportunities. Barriers include civil service rules, a risk-averse culture, and concerns that PHE would compromise core public health values. Ongoing PHE activity has the potential to reduce LHDs' reliance on unstable general public revenues. Yet under the best of circumstances, it is difficult to generate revenue from public health services. Although governmental public health contains pockets of entrepreneurial activity, its culture does not sustain significant entrepreneurial activity. The question remains as to whether LHDs' current public revenue sources are sustainable and, if not, whether PHE is a feasible or desirable alternative.
Leipert, B D
It is a well-known fact that nursing and feminism have enjoyed an uneasy alliance. In recent years, however, nursing has begun to recognize the importance of feminism. Nevertheless, the literature still rarely addresses the relevance of feminism for public health nursing. In this article, I articulate the relevance of feminism for public health nursing knowledge and practice. First, I define and describe feminism and public health nursing and then I discuss the importance of feminism for public health nursing practice. The importance of feminism for the metaparadigm concepts of public health nursing is then reviewed. Finally, I examine several existing challenges relating to feminism and public health nursing research, education, and practice. The thesis of this article is that feminism is vitally important for the development of public health nursing and for public health care.
Annas, George J; Mariner, Wendy K
Public health's reliance on law to define and carry out public activities makes it impossible to define a set of ethical principles unique to public health. Public health ethics must be encompassed within--and consistent with--a broader set of principles that define the power and limits of governmental institutions. These include human rights, health law, and even medical ethics. The human right to health requires governments not only to respect individual human rights and personal freedoms, but also, importantly, to protect people from harm from external sources and third parties, and to fulfill the health needs of the population. Even if human rights are the natural language for public health, not all public health professionals are comfortable with the language of human rights. Some argue that individual human rights--such as autonomy and privacy--unfairly limit the permissible means to achieve the goal of health protection. We argue that public health should welcome and promote the human rights framework. In almost every instance, this will make public health more effective in the long run, because the goals of public health and human rights are the same: to promote human flourishing. Copyright © 2016 by Duke University Press.
Inhorn, Stanley L; Astles, J Rex; Gradus, Stephen; Malmberg, Veronica; Snippes, Paula M; Wilcke, Burton W; White, Vanessa A
This article describes the development since 2000 of the State Public Health Laboratory System in the United States. These state systems collectively are related to several other recent public health laboratory (PHL) initiatives. The first is the Core Functions and Capabilities of State Public Health Laboratories, a white paper that defined the basic responsibilities of the state PHL. Another is the Centers for Disease Control and Prevention National Laboratory System (NLS) initiative, the goal of which is to promote public-private collaboration to assure quality laboratory services and public health surveillance. To enhance the realization of the NLS, the Association of Public Health Laboratories (APHL) launched in 2004 a State Public Health Laboratory System Improvement Program. In the same year, APHL developed a Comprehensive Laboratory Services Survey, a tool to measure improvement through the decade to assure that essential PHL services are provided.
Full Text Available The current global economic crisis seriously threatens the health of the public. Challenges include increases in malnutrition; homelessness and inadequate housing; unemployment; substance abuse, depression, and other mental health problems; mortality; child health problems; violence; environmental and occupational health problems; and social injustice and violation of human rights; as well as decreased availability, accessibility, and affordability of quality medical and dental care. Health professionals can respond by promoting surveillance and documentation of human needs, reassessing public health priorities, educating the public and policymakers about health problems worsened by the economic crisis, advocating for sound policies and programs to address these problems, and directly providing necessary programs and services.
.... Covering important works from legal, moral, and political theory, public health, public health law and ethics, and bioethics, this is a foundational text for scholars, practitioners and policy bodies interested in freedoms, rights and responsibilities relating to health"--
Greene, D; Healton, C; Hamburg, M; Rosenfield, A; Cagan, E; Van Wie, W; Haviland, M L
In response to several reports issued by the federal government and private foundations on the under-training of public health practitioners, Joseph L. Mailman School of Public Health of Columbia University (SPH) and the New York City Department of Health (NYC DOH) initiated the Public Health Scholars program (SPH-PHS) to make degree-level public health training available to NYC DOH employees. Public Health Scholars receive a 50% tuition scholarship and enroll part-time while working full-time at NYC DOH. Sixteen scholars have enrolled during the past three years. The SPH-PHS program is considered a success by both SPH and NYC DOH. This article details the history of the collaboration between the two agencies and the structure of the program and provides a critical analysis of the SPH-PHS program based on interviews with 16 scholars. It also examines the cost and benefit to other schools of public health of implementing such a program.
Bryan, Ralph T; Schaefer, Rebecca McLaughlin; DeBruyn, Lemyra; Stier, Daniel D
American Indian/Alaska Native tribal governments are sovereign entities with inherent authority to create laws and enact health regulations. Laws are an essential tool for ensuring effective public health responses to emerging threats. To analyze how tribal laws support public health practice in tribal communities, we reviewed tribal legal documentation available through online databases and talked with subject-matter experts in tribal public health law. Of the 70 tribal codes we found, 14 (20%) had no clearly identifiable public health provisions. The public health-related statutes within the remaining codes were rarely well integrated or comprehensive. Our findings provide an evidence base to help tribal leaders strengthen public health legal foundations in tribal communities.
Ivanov, Luba L; Oden, Tami L
Public health nursing has a code of ethics that guides practice. This includes the American Nurses Association Code of Ethics for Nurses, Principles of the Ethical Practice of Public Health, and the Scope and Standards of Public Health Nursing. Human rights and Rights-based care in public health nursing practice are relatively new. They reflect human rights principles as outlined in the Universal Declaration of Human Rights and applied to public health practice. As our health care system is restructured and there are new advances in technology and genetics, a focus on providing care that is ethical and respects human rights is needed. Public health nurses can be in the forefront of providing care that reflects an ethical base and a rights-based approach to practice with populations. © 2013 Wiley Periodicals, Inc.
Dias, Douglas Fernando; Loch, Mathias Roberto; González, Alberto Durán; Andrade, Selma Maffei de; Mesas, Arthur Eumann
To evaluate if perceived occupational factors are associated with insufficient free-time physical activity in Brazilian public school teachers. The relationship between insufficient physical activity (work was analyzed in 978 elementary and high school teachers calculating the prevalence ratio (PR) and 95% confidence interval (95%CI) in Poisson regression models, adjusted for sociodemographic and health variables. The prevalence of insufficient physical activity was 71.9%, and this condition was associated independently with the perception of bad or regular balance between personal and professional life (PR = 1.09; 95%CI 1.01-1.18), perception that standing time affects the work (PR = 1.16; 95%CI 1.01-1.34), low or very low perception of current ability for the physical requirements of work (PR = 1.21; 95%CI 1.08-1.35), and temporary employment contract (PR = 1.13; 95%CI 1.03-1.25). The teaching of physical education was associated with lower prevalence of insufficient physical activity (PR = 0.78; 95%CI 0.64-0.95). The perception of adverse working conditions is associated with increased prevalence of insufficient physical activity in teachers and should be considered for the promotion of physical activity in this population. Analisar se fatores ocupacionais percebidos estão associados à atividade física insuficiente no tempo livre em professores de escolas públicas. A relação entre atividade física insuficiente (< 150 minutos/semana) e variáveis relacionadas ao trabalho foi analisada em 978 professores do ensino fundamental e médio mediante o cálculo da razão de prevalência (RP) e intervalo de confiança de 95% (IC95%) em modelos de regressão de Poisson, ajustados por variáveis sociodemográficas e de saúde. A prevalência de atividade física insuficiente foi de 71,9%, e essa condição associou-se de maneira independente com percepção de equilíbrio entre vida pessoal e profissional ruim ou regular (RP = 1,09; IC95% 1,01-1,18), percepção de
SUS, política pública de Estado: seu desenvolvimento instituído e instituinte e a busca de saídas The Brazilian Unified Health System (SUS, State Public Policy: Its institutionalized and future development and the search for solutions
Nelson Rodrigues dos Santos
Full Text Available O texto resgata significados do movimento da reforma sanitária e do movimento municipal de saúde no contexto dos anos 70 e 80, sua força social, política e inovadora na reconstrução democrática na época. A seguir constata que a implementação das diretrizes constitucionais, regulamentadas em 1.990 pelas Leis 8080/90 e 8142/90, vem sendo marcada nos últimos 22 anos por quatro pesados e crescentes obstáculos impostos pela política de Estado a todos os governos: subfinanciamento federal, subsídios federais ao mercado de planos privados de saúde, resistência à reforma da estrutura gerencial estatal da prestação de serviços e, entrega do gerenciamento de estabelecimentos públicos a entes privados. O SUS incluiu no sistema público de saúde metade da população antes excluída, mas estes obstáculos mantêm a cobertura da atenção básica focalizada abaixo da linha de pobreza e com baixa resolutividade. Conclui que a real política de Estado para a saúde nesses 22 anos vem priorizando a criação e a expansão do mercado dos planos privados de saúde para os direitos do consumidor, e secundarizando a efetivação das diretrizes constitucionais para os direitos humanos de cidadania.This paper redeems the significance of the health reform movement and the municipal healthcare movement in the context of the 1970s and 1980s, and its social, politic and innovative power in the democratic reconstruction of the day. It then notes that the implementation of the constitutional guidelines, regulated in 1990 by Laws 8080/90 and 8142/90, has been characterized in the last 22 years by four major and mounting obstacles imposed by State policy on all governments: federal underfunding; federal subsidies to the private health plan market; resistance to reform of the State management structure of service provision; and the handing over of administration of public facilities to private entities. The Brazilian Unified Health System (SUS included
E. Talamini; H. Dewes
The purpose of this study is to identify the macro-environmental dimensions through which Brazilian scientists and government officials have framed issues surrounding liquid biofuels over a period of time. This study analyzes scientific papers published by researchers affiliated with Brazilian institutions and official documents of the Brazilian government related to liquid biofuels. Documents published during a ten-year period (1997--2006) were collected from electronic sources. Text-mining ...
da Silva-Júnior, Ivam Freire; Hartwig, Andréia Drawanz; Stüermer, Vanessa Müller; Demarco, Giulia Tarquínio; Goettems, Marília Leão; Azevedo, Marina Sousa
This study aims to assess and compare Oral Health-Related Quality of Life (OHRQoL) in child abuse victims and non-abused children in a Southern Brazilian city. The study compared two independent samples of children aged 8-10 years: 48 child abuse victims recruited from a centre for Child and Adolescent Psychological Support (NACA) for abused children, and 144 public and private school students. Data collection consisted of administration of the Child Perceptions Questionnaire 8-10 (CPQ 8-10 ) to measure OHRQoL (dependent variable), clinical examination (dental caries), and collection of socioeconomic and demographic information (age, sex, skin colour, family income, and type of school). Multiple linear regression models were used to assess the association between presence of abuse and OHRQoL and subscales. After adjustment for clinical and sociodemographic variables, child abuse victims were found to exhibit higher CPQ scores on the overall scale and on the oral symptoms and functional limitations subscales. In conclusion, child abuse victims have a higher impact on OHRQoL. Based on the results, it is possible to suggest that greater care should be taken of these children, not only in providing treatment for oral disorders, but also in providing interdisciplinary care. Copyright © 2017 Elsevier Ltd. All rights reserved.
Marco W. Lentini
Full Text Available Logging in natural forests is a vital economic activity in the Brazilian Amazon. However, illegal and unplanned logging is exhausting forests rapidly. In 2006, a new forestry law in Brazil (Lei 11,284/2006 established the legal framework to develop state and national public forests for multiple uses. To support public forest planning efforts, we combine spatially explicit data on logging profits, biodiversity, and potential for community use for use within a forest planning optimization model. While generating optimal land use configurations, the model enables an assessment of the market and nonmarket tradeoffs associated with different land use priorities. We demonstrate the model's use for Faro State Forest, a 636,000 ha forest embedded within a large mosaic of conservation units recently established in the state of Pará. The datasets used span the entire Brazilian Amazon, implying that the analysis can be repeated for any public forest planning effort within the region.
Barcellos, Christovam; Feitosa, Patrícia; Damacena, Giseli N; Andreazzi, Marco A
Abstract Background Economic development is often evoked as a driving force that has the capacity to improve the social and health conditions of remote areas. However, development projects produce uneven impacts on local communities, according to their different positions within society. This study examines the spatial distribution of three major health threats in the Brazilian Amazon region that may undergo changes through highway construction. Homicide mortality, AIDS incidence and malaria ...
Full Text Available Background: Global public health today faces new challenges and is impacted by a range of actors from within and outside state boundaries. The diversity of the actors involved has created challenges and a complex environment that requires a new context-tailored global approach. The World Federation of Public Health Associations has embarked on a collaborative consultation with the World Health Organization to encourage a debate on how to adapt public health to its future role in global health. Design: A qualitative study was undertaken. High-level stakeholders from leading universities, multilateral organizations, and other institutions worldwide participated in the study. Inductive content analyses were performed. Results: Stakeholders underscored that global public health today should tackle the political, commercial, economic, social, and environmental determinants of health and social inequalities. A multisectoral and holistic approach should be guaranteed, engaging public health in broad dialogues and a concerted decision-making process. The connection between neoliberal ideology and public health reforms should be taken into account. The WHO must show leadership and play a supervising and technical role. More and better data are required across many programmatic areas of public health. Resources should be allocated in a sustainable and accountable way. Public health professionals need new skills that should be provided by a collaborative global education system. A common framework context-tailored to influence governments has been evaluated as useful. Conclusions: The study highlighted some of the main public health challenges currently under debate in the global arena, providing interesting ideas. A more inclusive integrated vision of global health in its complexity, shared and advocated for by all stakeholders involved in decision-making processes, is crucial. This vision represents the first step in innovating public health at the
Lomazzi, Marta; Jenkins, Christopher; Borisch, Bettina
Background Global public health today faces new challenges and is impacted by a range of actors from within and outside state boundaries. The diversity of the actors involved has created challenges and a complex environment that requires a new context-tailored global approach. The World Federation of Public Health Associations has embarked on a collaborative consultation with the World Health Organization to encourage a debate on how to adapt public health to its future role in global health. Design A qualitative study was undertaken. High-level stakeholders from leading universities, multilateral organizations, and other institutions worldwide participated in the study. Inductive content analyses were performed. Results Stakeholders underscored that global public health today should tackle the political, commercial, economic, social, and environmental determinants of health and social inequalities. A multisectoral and holistic approach should be guaranteed, engaging public health in broad dialogues and a concerted decision-making process. The connection between neoliberal ideology and public health reforms should be taken into account. The WHO must show leadership and play a supervising and technical role. More and better data are required across many programmatic areas of public health. Resources should be allocated in a sustainable and accountable way. Public health professionals need new skills that should be provided by a collaborative global education system. A common framework context-tailored to influence governments has been evaluated as useful. Conclusions The study highlighted some of the main public health challenges currently under debate in the global arena, providing interesting ideas. A more inclusive integrated vision of global health in its complexity, shared and advocated for by all stakeholders involved in decision-making processes, is crucial. This vision represents the first step in innovating public health at the global level and should lead
CDCâs Office of Public Health Preparedness and Response funds Preparedness and Emergency Response Research Centers (PERRCs) to examine components of the public health system. This podcast is an overview of mental and behavioral health tools developed by the Johns Hopkins PERRC.
Bunton, Robin; Petersen, Alan R., Ph. D
...; discusses the role of the media in framing debate about genetics, health and medicine. The New Genetics and the Public's Health addresses the emerging social and political consequences of the new genetics and provides a stimulating critique of current research and practice in public health. Alan Petersen is Professor in Sociolo...
Stein, Richard; Davis, Devra Lee
Evaluating the potential health impacts of chemical, physical, and biological environmental factors represents a challenging task with profound medical, public health, and historical implications. The history of public health is replete with instances, ranging from tobacco to lead and asbestos, where the ability to obtain evidence on potential…
Smith, Jason A; Vargo, Jason; Hoverter, Sara Pollock
Climate change poses real and immediate impacts to the public health of populations around the globe. Adverse impacts are expected to continue throughout the century. Emphasizing co-benefits of climate action for health, combining adaptation and mitigation efforts, and increasing interagency coordination can effectively address both public health and climate change challenges.
Carla Aparecida Arena Ventura
Full Text Available OBJECTIVES: to identify the agreement of faculty affiliated with Brazilian higher education institutions about the global health competencies needed for undergraduate nursing students' education and whether these competencies were covered in the curriculum offered at the institution where they were teaching.METHOD: exploratory-descriptive study, involving 222 faculty members who answered the Brazilian version of the "Questionnaire on Core Competencies in Global Health", made available electronically on the website Survey Monkey.RESULTS: participants predominantly held a Ph.D. (75.8%, were women (91.9% and were between 40 and 59 years of age (69.3%. The mean and standard deviation of all competencies questioned ranged between 3.04 (0.61 and 3.88 (0.32, with scores for each competency ranging from 1 "strongly disagree" to 4 "strongly agree". The results demonstrated the respondents' satisfactory level of agreement with the global health competencies.CONCLUSIONS: the study demonstrated a high mean agreement level of the nursing faculty from Brazilian HEI with the global health competencies in the questionnaire. The curricula of the HEI where they teach partially address some of these. The competencies in the domain "Globalization of health and health care" are the least addressed.
The sources and levels of natural and manmade radiation are discussed in this report, and the resulting risks of radiation-induced cancer and hereditary diseases are estimated. The medical uses of X-rays currently increase the average population exposure by something like 35 per cent above natural background radiation. At a future time when nuclear generators will produce one kilowatt of electricity per person it is expected that the additional exposure from this source will not exceed 6 per cent of that from natural background. Acceptability of the risks that these exposures represent must depend upon the benefits with which they are associated, and upon the risks associated with other options open to society including alternative ways of obtaining similar benefits. The public health impact of the radiation from nuclear power generation, for example, is believed to be considerably less than that from the combustion products associated with the production of an equivalent amount of electrical power by conventional coal-fired stations. (author)
The sources and levels of natural and manmade radiation are discussed in this report, and the resulting risks of radiation-induced cancer and hereditary diseases are estimated. The medical uses of X-rays currently increase the average population exposure by something like 35 per cent above natural background radiation. At a future time when nuclear generators will produce one kilowatt of electricity per person it is expected that the additional exposure from this source will not exceed 6 per cent of that from natural background. Acceptability of the risks that these exposures represent must depend upon the benefits with which they are associated, and upon the risks associated with other options open to society including alternative ways of obtaining similar benefits. The public health impact of the radiation from nuclear power generation, for example, is believed to be considerably less than that from the combustion products associated with the production of an equivalent amount of electrical power by conventional coal-fired stations. (author)
Expert consensus (SBC/SBHCI) on the use of drug-eluting stents: recommendations of the Brazilian society of interventional cardiology/ Brazilian society of cardiology for the Brazilian public single healthcare system.
Lima, Valter C; Mattos, Luiz Alberto P; Caramori, Paulo R A; Perin, Marco A; Mangione, José A; Machado, Bruno M; Coelho, Wilson M C; Bueno, Ronaldo R L
National Health Surveillance Agency (ANVISA). During this stage the interested company submits to the regulatory agency, results from clinical studies that demonstrate the efficacy and safety of the new device or pharmaceutical product. Frequently, in addition to clinical studies, approval records for clinical use from the regulatory agencies of other countries, mainly the United States of America and the European Community are also submitted. The successful completion of this stage means that the medication or device may be prescribed or used by the physicians in Brazil. The second stage in the incorporation of new healthcare technology involves the reimbursement or financing of the treatment that was approved in the previous stage based on its efficacy and safety. This stage can be more complex than the first one since the new technology, whether a substitution for established treatment methods or the introduction of a new treatment concept, are usually more expensive. The incorporation of new technology requires a cost-effectiveness analysis so that fund administrators can make decisions based on the universal scenario of limited resources to finance healthcare with treatments that are more and more burdensome. The difficulties of funding management are aggravated by medical and social ethical implications that arise when a treatment is approved based on its efficacy and safety but is not made available to patients who could benefit greatly from it. In Brazil, assessment methods for the incorporation of new technology based on reimbursement or financing have not been fully developed for either the private healthcare plans or the Brazilian Public Healthcare System (SUS). The implementation of new technology in both healthcare systems is a slow process and frequently the implementation is a result of the requirements of patients or the organizations that represent them and at times is the result of legal proceedings or political pressure imposed by physicians and their
Eide, Melody J; Weinstock, Martin A
Sunscreens are a popular choice for protection from ultraviolet radiation, and hence, important components in the public health campaign to reduce the burden of skin cancer. Public health messages in skin cancer prevention have been used effectively in educational campaigns. The benefits of sunscreen extend beyond skin cancer prevention into other aspects of health and disease prevention: sunscreen decreases the risk for sunburn during physical activity outdoors and seems not to increase the risk for osteoporosis. Public health efforts have laid a solid foundation on which to face the continuing challenge of promoting and developing effective public health campaigns and health policies that encourage sunscreen use, sun protection, and the primary prevention of skin cancer. In this article, the controversies, concerns, and challenges of sunscreen use as it relates to public health are discussed.
Younger, David S
A network of family-based community-oriented primary health programs, or Programa Agentes Communita˙rios de Saúde, and family health programs, or Programa Saúde da Família, introduced almost 2 decades ago were the Brazilian government's health care models to restructure primary care under the Unified Health System, or Sistema Único de Saúde. The latter offers comprehensive coverage to all, although it is used by those of lower income, and despite achievement in the last quarter century, access to health services and gradients of health status continue to persist along income, educational background, racial, and religious lines. Copyright © 2016 Elsevier Inc. All rights reserved.
Full Text Available This paper focuses the Health Services wastes management of 70 Brazilian hospitals. As the outcome of a distance course, in 2003, each hospital was required to describe its existing Health Services wastes system and its Plan for improvement.The project was administered by an association of two leading Brazilian educational entities, the Fundação Getulio Vargas and the Universidade Federal de Santa Catarina. Data concerning collection, disposal and final treatment of infectious, hazardous, chemical, radioactive and common wastes were tabulated and analysed. Water supply, liquid effluents and gaseous emissions were also investigated..Their technical and economical aspects were appraised. The research indicates that the sampled hospitals are still in an incipient stage of wastes management. An extensive gap exists between the present situation and the legal and acceptable requirements they should comply with, both on health care and on environmental standpoints.
Bhabani Prasad Acharya
Full Text Available Public health emergencies in urban India can be caused by natural or man-made disasters. Occurrence of a public health emergency adds to the already stretched health system. This paper looks into the public health emergency conditions in urban India, and our preparedness to tackle them. To address this composite threat to nation’s health and development, a concerted public health response is needed, that can ensure efficient delivery in emergency situations Public health emergency is an occurrence or eminent threat of an illness or health condition caused by bio-terrorism, epidemic or pandemic disease, or novel and highly fatal infectious agent or biological toxin, that possess a substantial risk of a significant number of human facilities or incidents or permanent or long–term disability (1. It is a condition that requires the government to declare a state of public health emergency. The declaration of a state of public health emergency permits the government to suspend state regulations,and change the functions of state agencies (2. Term “Urban” refers to perplexing variety of environments. Health circumstances of small cities and town differ in many ways from larger cities and metros. Within cities, change in lifestyle of residents is observed. The urban system is often present with full array of health providers ranging from traditional healer, street drug seller to highly –trained surgeons (3.
... initiative About this book Further reading and resources Principles of public health The emergence of public health genetics The human genome project and 'genomic medicine' Community genetics Current developments in public health genetics Genomics and global health 2 Genetic science and technology Basic molecular genetics Genes and the geno...
Menezes, Renata de Miranda; Andrade, Mônica Viegas; Noronha, Kenya Valéria Micaela de Souza; Kind, Paul
This study explores the use of EQ-5D-3L as a measure of population health status in a Brazilian region with significant socioeconomic, demographic, and epidemiological heterogeneity. Data came from a study of 3363 literate individuals aged between 18 and 64 years living in urban areas of the state of Minas Gerais. Descriptive analysis and logistic and OLS regression models were performed to analyze the relationship between EQ-5D-3L (descriptive system and EQ VAS) and other health (self-assessed health status and 8 self-reported diagnosed chronic diseases), socioeconomic (educational level and economic class), and demographic (gender and age) measures. Additionally, a grade of membership (GoM) analysis was performed to identify multidimensional health profiles. A total of 76 health statuses were identified in the Brazilian population. The most prevalent one is full health (44 % of the sample). Elderly people, women, and individuals with poor health and lower socioeconomic conditions generally report more health problems in the EQ-5D-3L dimensions. The GoM analysis demonstrated that health status of older individuals is associated with the socioeconomic condition. Arthritis exhibited the strongest association with the EQ-5D-3L instrument. The results indicate that EQ-5D-3L is a good measure of health status for the Brazilian population. The instrument has a good discriminatory capacity in terms of demographic, socioeconomic, and health measures. The high prevalence of individuals with full health may indicate the presence of ceiling effect. However, this prevalence is smaller than that in other countries.
Ribeiro, Amanda Gomes; Mill, José Geraldo; Cade, Nágela Valadão; Velasquez-Melendez, Gustavo; Matos, Sheila Maria Alvim; Molina, Maria Del Carmen Bisi
Recent studies have suggested the possible effect of dairy product intake on cardiovascular risk markers, including arterial stiffness. Our aim was to investigate whether dairy food intake is associated with arterial stiffness, which we assessed by carotid-femoral pulse wave velocity (cfPWV) and pulse pressure (PP) in a cross-sectional analysis of baseline data (2008⁻2010; n = 12,892) of the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). Dairy consumption was evaluated with a validated food-frequency questionnaire (FFQ) by computing servings per day for total and subgroups of dairy products. Dairy consumption was described in four categories (≤1 serving/day to >4 servings/day). Covariance analysis (ANCOVA) was used to compare cfPWV across increasing intake of dairy food, adjusting for confounding factors, including non-dairy food groups. The intake of total dairy was inversely associated with cfPWV and PP (-0.13 m/s and -1.3 mmHg, from the lowest and to the highest category of dairy intake). Low-fat dairy, fermented dairy and cheese showed an inverse relationship with cfPWV and PP. These findings suggest a beneficial effect of dairy consumption to reduce arterial stiffness. However, further evidence from longitudinal studies or long-term intervention is needed to support reduction of cfPWV and PP mediating the beneficial effects of dairy products on cardiovascular health.
Amanda Gomes Ribeiro
Full Text Available Recent studies have suggested the possible effect of dairy product intake on cardiovascular risk markers, including arterial stiffness. Our aim was to investigate whether dairy food intake is associated with arterial stiffness, which we assessed by carotid-femoral pulse wave velocity (cfPWV and pulse pressure (PP in a cross-sectional analysis of baseline data (2008–2010; n = 12,892 of the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil. Dairy consumption was evaluated with a validated food-frequency questionnaire (FFQ by computing servings per day for total and subgroups of dairy products. Dairy consumption was described in four categories (≤1 serving/day to >4 servings/day. Covariance analysis (ANCOVA was used to compare cfPWV across increasing intake of dairy food, adjusting for confounding factors, including non-dairy food groups. The intake of total dairy was inversely associated with cfPWV and PP (−0.13 m/s and −1.3 mmHg, from the lowest and to the highest category of dairy intake. Low-fat dairy, fermented dairy and cheese showed an inverse relationship with cfPWV and PP. These findings suggest a beneficial effect of dairy consumption to reduce arterial stiffness. However, further evidence from longitudinal studies or long-term intervention is needed to support reduction of cfPWV and PP mediating the beneficial effects of dairy products on cardiovascular health.
Full Text Available Abstract Background The Brazilian health reform process, following the establishment of the Unified Health System (SUS, has had a strong emphasis on decentralization, with a special focus on financing, management and inter-managerial agreements. Brazil is a federal country and the Ministry of Health (MoH, through the Secretary of Labour Management and Health Education, is responsible for establishing national policy guidelines for health labour management, and also for implementing strategies for the decentralization of management of labour and education in the federal states. This paper assesses whether the process of decentralizing human resources for health (HRH management and organization to the level of the state and municipal health departments has involved investments in technical, political and financial resources at the national level. Methods The research methods used comprise a survey of HRH managers of states and major municipalities (including capitals and focus groups with these HRH managers - all by geographic region. The results were obtained by combining survey and focus group data, and also through triangulation with the results of previous research. Results The results of this evaluation showed the evolution policy, previously restricted to the field of 'personnel administration', now expanded to a conceptual model for health labour management and education-- identifying progress, setbacks, critical issues and challenges for the consolidation of the decentralized model for HRH management. The results showed that 76.3% of the health departments have an HRH unit. It was observed that 63.2% have an HRH information system. However, in most health departments, the HRH unit uses only the payroll and administrative records as data sources. Concerning education in health, 67.6% of the HRH managers mentioned existing cooperation with educational and teaching institutions for training and/or specialization of health workers. Among them
Pierantoni, Celia Regina; Garcia, Ana Claudia P
The Brazilian health reform process, following the establishment of the Unified Health System (SUS), has had a strong emphasis on decentralization, with a special focus on financing, management and inter-managerial agreements. Brazil is a federal country and the Ministry of Health (MoH), through the Secretary of Labour Management and Health Education, is responsible for establishing national policy guidelines for health labour management, and also for implementing strategies for the decentralization of management of labour and education in the federal states. This paper assesses whether the process of decentralizing human resources for health (HRH) management and organization to the level of the state and municipal health departments has involved investments in technical, political and financial resources at the national level. The research methods used comprise a survey of HRH managers of states and major municipalities (including capitals) and focus groups with these HRH managers - all by geographic region. The results were obtained by combining survey and focus group data, and also through triangulation with the results of previous research. The results of this evaluation showed the evolution policy, previously restricted to the field of 'personnel administration', now expanded to a conceptual model for health labour management and education-- identifying progress, setbacks, critical issues and challenges for the consolidation of the decentralized model for HRH management. The results showed that 76.3% of the health departments have an HRH unit. It was observed that 63.2% have an HRH information system. However, in most health departments, the HRH unit uses only the payroll and administrative records as data sources. Concerning education in health, 67.6% of the HRH managers mentioned existing cooperation with educational and teaching institutions for training and/or specialization of health workers. Among them, specialization courses account for 61.4% and short
Leider, Jonathon P
Accurate information on how much the United States spends on public health is critical. These estimates affect planning efforts; reflect the value society places on the public health enterprise; and allows for the demonstration of cost-effectiveness of programs, policies, and services aimed at increasing population health. Yet, at present, there are a limited number of sources of systematic public health finance data. Each of these sources is collected in different ways, for different reasons, and so yields strikingly different results. This article aims to compare and contrast all 4 current national public health finance data sets, including data compiled by Trust for America's Health, the Association of State and Territorial Health Officials (ASTHO), the National Association of County and City Health Officials (NACCHO), and the Census, which underlie the oft-cited National Health Expenditure Account estimates of public health activity. In FY2008, ASTHO estimates that state health agencies spent $24 billion ($94 per capita on average, median $79), while the Census estimated all state governmental agencies including state health agencies spent $60 billion on public health ($200 per capita on average, median $166). Census public health data suggest that local governments spent an average of $87 per capita (median $57), whereas NACCHO estimates that reporting LHDs spent $64 per capita on average (median $36) in FY2008. We conclude that these estimates differ because the various organizations collect data using different means, data definitions, and inclusion/exclusion criteria--most notably around whether to include spending by all agencies versus a state/local health department, and whether behavioral health, disability, and some clinical care spending are included in estimates. Alongside deeper analysis of presently underutilized Census administrative data, we see harmonization efforts and the creation of a standardized expenditure reporting system as a way to
The Key Word in Context (KWIC) index to the publications of the Bureau of Radiological Health was prepared to aid in the retrieval and identification of publications originated or authored by Bureau staff or published by the Bureau. These publications include journal articles, government publications and technical reports, selected staff papers, and Bureau news releases issued by HEW. For convenience, the document is divided into four sections, KWIC Index, Author Index, Bibliography Index, and BRH Publications Subject Index
In 31 August 2016, Brazilian president Dilma Rousseff was impeached and replaced by her vice president Michel Temer. Herein, we examine how the conservative agenda of Mr Temer and his supporters is influencing key decisions in the human rights and public health arena in Brazil. The government's austerity agenda includes severe cuts in critical areas such as health, education and science, jeopardising well-known strategies such as the Brazilian Public Health System (SUS) and nationwide cash transfer program, 'Bolsa Familia' - both benefited millions and were the largest of their kind in the world. Mr Temer's decisions show not only severe cuts in critical areas but also a political agenda that clearly demonstrates a broad shift away from the progressivism and social agenda presented and supported by its predecessors. Most vulnerable groups such as the LGBTQ community, women, people who use drugs and disenfranchised communities have been severely affected. Mr Temer's administration is putting Brazil far from its once nationwide goal to foster free and universal health care access and social equity for all its citizens. The near future for Brazil is unknown, but both national and international communities anticipate severe problems within the national human rights arena, if nothing changes. CCT: Conditional Cash Transfer; LGBTQ: Lesbian, Gay, Bisexual, Transgender and Queer (and/or Questioning); SUS: Brazilian Public Health System.
Evans, W Douglas; Blitstein, Jonathan; Hersey, James C; Renaud, Jeanette; Yaroch, Amy L
Brands build relationships between consumers and products, services, or lifestyles by providing beneficial exchanges and adding value to their objects. Brands can be measured through associations that consumers hold for products and services. Public health brands are the associations that individuals hold for health behaviors, or lifestyles that embody multiple health behaviors. We systematically reviewed the literature on public health brands; developed a methodology for describing branded health messages and campaigns; and examined specific branding strategies across a range of topic areas, campaigns, and global settings. We searched the literature for published studies on public health branding available through all relevant, major online publication databases. Public health branding was operationalized as any manuscripts in the health, social science, and business literature on branding or brands in health promotion marketing. We developed formalized decision rules and applied them in identifying articles for review. We initially identified 154 articles and reviewed a final set of 37, 10 from Africa, Australia, and Europe. Branded health campaigns spanned most of the major domains of public health and numerous communication strategies and evaluation methodologies. Most studies provided clear information on planning, development, and evaluation of the branding effort, while some provided minimal information. Branded health messages typically are theory based, and there is a body of evidence on their behavior change effectiveness, especially in nutrition, tobacco control, and HIV/AIDS. More rigorous research is needed, however, on how branded health messages impact specific populations and behaviors.
Nunes, Maria A; Pinheiro, Andréa P; Bessel, Marina; Brunoni, André R; Kemp, Andrew H; Benseñor, Isabela M; Chor, Dora; Barreto, Sandhi; Schmidt, Maria I
To assess the prevalence of common mental disorders (CMD) and the association of CMD with sociodemographic characteristics in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) cohort. We analyzed data from the cross-sectional baseline assessment of the ELSA-Brasil, a cohort study of 15,105 civil servants from six Brazilian cities. The Clinical Interview Schedule-Revised (CIS-R) was used to investigate the presence of CMD, with a score ≥ 12 indicating a current CMD (last week). Specific diagnostic algorithms for each disorder were based on the ICD-10 diagnostic criteria. Prevalence ratios (PR) of the association between CMD and sociodemographic characteristics were estimated by Poisson regression. CMD (CIS-R score ≥ 12) was found in 26.8% (95% confidence intervals [95%CI] 26.1-27.5). The highest burden occurred among women (PR 1.9; 95%CI 1.8-2.0), the youngest (PR 1.7; 95%CI 1.5-1.9), non-white individuals, and those without a university degree. The most frequent diagnostic category was anxiety disorders (16.2%), followed by depressive episodes (4.2%). The burden of CMD was high, particularly among the more socially vulnerable groups. These findings highlight the need to strengthen public policies aimed to address health inequities related to mental disorders.
Gerbase, A.C.; Roman, G.; Zemouri, C.; Rangel Bonamigo, R.; Torres Dornelles, S.I.
Structured strategies to tackle skin diseases and related infections provide a framework and direct actions against their burden. The World Health Organization (WHO) develops, updates, advocates, and disseminates international public health strategies and implementation tools including guidelines.
... human health and well-being. The author covers a wealth of topics including foundations, the joint history of public health and urban planning, transportation and land use, infrastructure and natural disasters, assessment tools...
"This text combines an examination of how the physical environment affects our health with a description of how public health and urban planning can work together to create environments that improve...
This paper explores the consequences of the oft ignored fact that public health insurance must actually be supplied by the state. Depending how the state is modeled, different health insurance outcomes are expected. The benevolent model of the state does not account for many actual features of public health insurance systems. One alternative is to use a standard public choice model, where state action is determined by interaction between self-interested actors. Another alternative--related to a strand in public choice theory--is to model the state as Leviathan. Interestingly, some proponents of public health insurance use an implicit Leviathan model, but not consistently. The Leviathan model of the state explains many features of public health insurance: its uncontrolled growth, its tendency toward monopoly, its capacity to buy trust and loyalty from the common people, its surveillance ability, its controlling nature, and even the persistence of its inefficiencies and waiting lines.
Policy is an important feature of public and private organizations. Within the field of health as a policy arena, public health has emerged in which policy is vital to decision making and the deployment of resources. Public health practitioners and students need to be able to analyze public health policy, yet many feel daunted by the subject's complexity. This article discusses three approaches that simplify policy analysis: Bacchi's "What's the problem?" approach examines the way that policy represents problems. Colebatch's governmentality approach provides a way of analyzing the implementation of policy. Bridgman and Davis's policy cycle allows for an appraisal of public policy development. Each approach provides an analytical framework from which to rigorously study policy. Practitioners and students of public health gain much in engaging with the politicized nature of policy, and a simple approach to policy analysis can greatly assist one's understanding and involvement in policy work.
O mix público-privado na utilização de serviços de saúde: um estudo dos itinerários terapêuticos de beneficiários do segmento de saúde suplementar brasileiro The public-private mix and health service utilization: a study of the therapeutic itineraries of Brazilian supplementary care beneficiaries
Eleonor Minho Conill
Full Text Available O trabalho analisou a experiência de saúde-doença-cuidados referida por usuários do segmento suplementar com situações ou necessidades de saúde nas áreas de cuidado cardiovascular, oncológico, saúde mental e obstétrico, no município de Florianópolis, capital de Santa Catarina. Discute-se o processo de escolha das situações marcadoras nessas áreas, o infarto agudo do miocárdio; o câncer de mama, o alcoolismo e o parto, além dos procedimentos sugeridos para explorar contribuições da socioantropologia no campo da gestão. Os resultados revelam a procura de recursos nos subsistemas de saúde profissional, informal e popular, sendo os dois últimos importantes nas áreas da saúde mental e oncologia. O uso combinado dos serviços públicos e da assistência suplementar aparece no cuidado cardiovascular e oncológico. Diversos arranjos se estabelecem no cotidiano assistencial dos usuários quando procuram superar lacunas do acesso e da integralidade da atenção através de suas próprias escolhas, caminhos ou estratégias. A abordagem socioantropológica mostra-se útil para uma compreensão mais abrangente do significado de público e privado no sistema de saúde, bem como dos modelos de cuidados empreendidos pelos usuários.This study analyzes the health-disease-care experience reported by users of the Brazilian supplementary system in cardiovascular, oncological, mental health and obstetric care in Florianópolis, capital of the state of Santa Catarina. It discusses the selection of indicators in these areas such as myocardial infarction, breast cancer, alcoholism and childbirth besides exploring socio-anthropological contributions to the management field. The results show a search for solutions in three interconnected sub-sectors of the system - the professional sector, the popular sector and the folk sector, the two latter being of greatest importance in mental and oncological care. Combined use of public and private
de Andrade, Fabíola Bof; Lebrão, Maria Lúcia; Santos, Jair Lício Ferreira; da Cruz Teixeira, Doralice Severo; de Oliveira Duarte, Yeda Aparecida
To assess the impact of oral health on quality of life in elderly Brazilians and to evaluate its association with clinical oral health measures and socioeconomic and general health factors. Cross-sectional study. Population-based cohort study on health, well-being, and aging. Eight hundred fifty-seven participants representing 588,384 community-dwelling elderly adults from the city of São Paulo, Brazil. Self-perceived impact of oral health on quality of life was measured using the Geriatric Oral Health Assessment Index (GOHAI), with scores categorized as good, moderate, or poor, indicating low, moderate, and high degrees of negative impact on quality of life, respectively. Nearly half of the individuals had good GOHAI scores (44.7% of overall sample, 45.9% of dentate participants, and 43.4% of edentulous participants). In the overall sample, those with poor self-rated general health and a need for dental prostheses were more likely to have poor and moderate GOHAI scores. Individuals with depression were significantly more likely to have poor GOHAI scores. No socioeconomic variables were related to the outcome, except self-perception of sufficient income, which was a protective factor against a poor GOHAI score in dentate participants. Moderate and high degrees of negative impact of oral health on quality of life were associated with general health and clinical oral health measures, independent of socioeconomic factors. © 2012, Copyright the Authors Journal compilation © 2012, The American Geriatrics Society.
SCHMINSKI VIEIRA, Roseli
Full Text Available The Brazilian National Health Policy for Elderly Persons (PNSPI – in Portuguese was formulated by the Ministry of Health through Ordinance No. 2.528/2006 in line with the 1988 Brazilian Constitution. The study investigated whether municipalities from the South region of the State of Santa Catarina had knowledge and applied the PNSPI, on the performed actions in basic healthcare, especially on the Units of Family Healthcare Services based on what the Constitution and the Statute of the Elderly comprise. A deductive method with a qualitative approach and a descriptive research were used. As a result, some difficulties experienced by the research subjects related to two important points of policies and strategies of PNSPI were identified: the lack of a planned policy and of a continuous health education for the elderly; and the lack of a stimulating exercise of social control, whether in the health sector, or in the Municipal Council of Elderly People.
In this presentation author deals with the role of the Public Health Authority of the Slovak Republic in radiation protection in the Slovak Republic. Public Health Authority is budgetary organization, which depends on the funding of the Ministry of Health. As the state administration authority performs execution of state regulatory activities in the field of health protection in Slovak republic and radiation protection as well. Radiation Protection Supervision is performed according to the act on public health protection. Organization scheme of radiation protection in the Slovak Republic is presented
Full Text Available In recent years, increasing concerns about toxicity residues in agricultural products have stimulated an increased interest in new agricultural strategies. While considering new strategies, the question arises if homeopathic preparations could be of use in plants. Homeopathy was born as an experimental discipline, and, generally, plants are able to react to homeopathic substances. In this paper, we conduct an up-to-date review of the existing in literature on Brazilian basic research in homeopathy applied in plants and agroecosystems to raise the profiles of Brazilian publications, according QUALIS methods and H index of Journals. The results of this research are useful not only for those who are interested in the homeopathy itself, but also to analyze the expanding that through experiments attending mainly agroecological production, aimed at improving on the level of publications.
Erwin, Paul Campbell; Brownson, Ross C
The requisite capacities and capabilities of the public health practitioner of the future are being driven by multiple forces of change, including public health agency accreditation, climate change, health in all policies, social media and informatics, demographic transitions, globalized travel, and the repercussions of the Affordable Care Act. We describe five critical capacities and capabilities that public health practitioners can build on to successfully prepare for and respond to these forces of change: systems thinking and systems methods, communication capacities, an entrepreneurial orientation, transformational ethics, and policy analysis and response. Equipping the public health practitioner with the requisite capabilities and capacities will require new content and methods for those in public health academia, as well as a recommitment to lifelong learning on the part of the practitioner, within an increasingly uncertain and polarized political environment.
Zimmerman, Frederick J
The ethical principle of autonomy is among the most fundamental in ethics, and it is particularly salient for those in public health, who must constantly balance the desire to improve health outcomes by changing behavior with respect for individual freedom. Although there are some areas in which there is a genuine tension between public health and autonomy-childhood vaccine mandates, for example-there are many more areas where not only is there no tension, but public health and autonomy come down to the same thing. These areas of overlap are often rendered invisible by a thin understanding of autonomy. Better integrating newer theoretical insights about autonomy into applied ethics can make discussions of public health ethics more rigorous, incisive, and effective. Even more importantly, bringing modern concepts of autonomy into public health ethics can showcase the many areas in which public health and autonomy have the same goals, face the same threats, and can be mutually advanced by the same kinds of solutions. This article provides a schema for relational autonomy in a public health context and gives concrete examples of how autonomy can be served through public-health interventions. It marshals insights from sociology, psychology, and philosophy to advance a theory of autonomy and coercion that recognizes three potential threats to autonomy: threats to choice sets, threats to knowledge, and threats to preferences. © 2017 The Hastings Center.
Armando Henrique Norman; Charles Dalcanale Tesser
The objective of this paper is to present a proposal for a gradual and systemic incorporation of midwives and obstetric nurses into the Brazilian Unified Health System (SUS) and Primary Health Care (PHC). The proposal was born from contact with the British experience, based on midwives, which is briefly described. In Brazil, these professionals would progressively take over the prenatal, delivery and postpartum care for pregnant women of usual risk in a region, in partnership with the PHC tea...
Mesquita, Gabriela Campos; Soares, Priscilla Barbosa Ferreira; Moura, Camilla Christian Gomes; Roscoe, Marina Guimarães; Paiva, Saul Martins; Soares, Carlos José
This study assessed the epidemiological characteristics and management of the permanent teeth avulsion cases attended in a Brazilian dental trauma service from December 2005 to August 2016. A retrospective study was conducted of case records of 93 patients involving 139 avulsed teeth. Data included sex, age, trauma etiology, location of the accident, number and position of avulsed teeth, and presence and type of associated traumatic lesions. Management of the avulsed teeth was addressed as: time elapsed until teeth were retrieved from the accident's location; teeth's cleaning method and storage media; time elapsed until seeking treatment and replantation. The majority of the patients were children from 6-10 (31.2%) and 11-15 years old (26.9%). Male patients were more affected than female. Bicycle accident was the main etiological factor (31.2%). In 56 (60.2%) cases, traumatic lesions to neighboring teeth were present. In 55 (59.1%) cases, lesions to adjacent soft tissues were reported. In 82 (88.2%) cases, patients requested treatment at the same day of the accident. Sixty-four teeth (46.0%) were immediately retrieved and 28 (20.1%) were not found. Forty-two teeth (30.2%) were kept dry. Only one tooth (0.7%) was immediately replanted at the accident's site, while 51 teeth (36.7%) were not replanted. Numerous avulsed teeth were inappropriately managed and immediate replantation was not frequent. Public policies must be created to raise awareness towards the particularities of avulsion cases.
Alexandre André Feil
Full Text Available The Higher Education Institutions (HEIs are being pressured by changes towards sustainability and thus awakening to environmental management, they are considered as a leader in promoting sustainability through actions and environmental management practices. Following this logic, this study aims to identify the environmental management practices used in Brazilian HEIs and correlations exist that influence the implementation of Environmental Management Systems (EMS. The quantitative approach is applied through documentary research with secondary data published in proceedings, journals, books and portal Scientific Electronic Library (SciELO. The data analysis occurred through meta-analysis using descriptive statistics and Spearman correlation. The results of 34 scientific studies 23 IES referencing models and practices of waste management published from 2001 to 2012 were identified. The Spearman correlation analysis expressed that HEIs with programs in environmental education performed better ranking General Index of Courses. It is recommended that HEIs that have a waste management deployed, share your experience through scientific publications to disseminate their adaptation practices regarding the SGA.
Guilherme Busch Rocha
Full Text Available Abstract In the present global scenario of strong competitive edge, the Human factor had its relevance enhanced, presenting itself as a key element to enhance organizations' flexibility and performance. Since the 1990s, one of the most widespread and studied Human Resources practices has consisted of the Management Model by Competency, that innovated by changing the "position" reference to the "people" element. Therefore, this paper tries to investigate what are the elements that influence the employees' perception of social gain within an establishment that had taken on the competency management model. This is a quantitative work with survey methodology. The sample consists of 422 employees of a Brazilian public university that had implanted the competency model in 2011. The questionnaire, available in an online environment, used the dimensions developed by Sarsur (2007. The relationships between the actions on corporate education, wage move, career move, managerial positions held, workplace and seniority (independent variables with the perception employees have of social gain (dependent variables were analyzed through non parametric statistical techniques. The results indicate that the employees' perception of social competency gains in the model displays an essentially utilitarian nature. Namely, just the benefited employees demonstrated higher rankings of perception regarding the new proposal.
Marcelino José Jorge
Full Text Available Budgetary restrictions have become much more binding for the Brazilian Navy and both users’ access to health services provided by the Navy Health Service as well as hospitals’ access to new technologies appears to be endangered. This paper aims to evaluate the efficiency of naval hospitals in the light of these concerns, with a view toward designing better managerial tools to enhance health services in the Brazilian Navy. The paper presents an application of Data Envelopment Analysis (DEA to the study of productive efficiency in selected hospital units of the Brazilian Navy in order to suggest improvements on the use of productive resources by the Navy Health Service. Productive efficiency of hospital units located throughout the country are measured and compared. Data Envelopment Analysis models were used to calculate an efficient frontier for the seven naval hospitals assessed and to identify the group of relatively efficient naval hospitals which were used as benchmarks for calculating the pro-efficiency operation plans for the inefficient units.
There is a well-known quotation by the nineteenth-century sociologist Virchow (quoted in Ref. 1) that aptly captures the dilemma that has confronted public health medicine since the specialty was created as a discrete entity in 1848. Virchow said: 'Medicine is politics and social medicine is politics writ large!' What does this mean in relation to effective public health medicine practice and how is it likely to affect its future? There is increasingly limited freedom of expression within the current context of political correctness, central control and a rapidly burgeoning litigious climate. The purpose of this paper is to explore these issues and to propose a means of maintaining public health medicine integrity within a working environment where action is becoming rapidly constrained by political rigidity. An additional factor to be included in the dialogue is the current context within which public health physicians work. Because the majority of public health doctors are employed within the National Health Service (NHS), they are finding themselves being expected to take on tasks and responsibilities marginal to their essential purpose and function. For example, public health physicians spend a great deal of time involved in detailed deliberations about health service provision. Although there is a great deal of evidence to show that good quality health care provision positively affects the health of the individual, there is no evidence to show that this activity has any effect on the population's health status. The essence of public health medicine practice is the prevention of ill-health and the promotion of the health of the population and, consequently, attention needs to be focused on the root causes of disease. However, as these are outside the aegis of the NHS, public health medicine involvement in such issues as education, nutrition, housing, transport and poverty is regarded as marginal to the NHS corporate agenda.
Ramos Junior, Helio Santiago; Galiotto, Simone
This paper presents some initiatives of government-to-business in Brazil: The Sped and its project called eSocial. The Sped Fiscal is the Brazilian Public Digital Bookkeeping System and it can be considered an innovation in the relation between the government and the corporate taxpayers, especially in the informatization area. In this research, we explain how it works and its regulatory legislation. After that, we show some benefits of this system. The eSocial Project is the Digital Bookkeepi...
Kierkegaard, Patrick; Kaushal, Rainu; Vest, Joshua R
Increased information availability, timeliness, and comprehensiveness through health information exchange (HIE) can support public health practice. The potential benefits to disease monitoring, disaster response, and other public health activities served as an important justification for the US' investments in HIE. After several years of HIE implementation and funding, we sought to determine if any of the anticipated benefits of exchange participation were accruing to state and local public health practitioners participating in five different exchanges. Using qualitative interviews and template analyses, we identified public health efforts and activities that were improved by participation in HIE. HIE supported public health activities consistent with expectations in the literature. However, no single department realized all the potential benefits of HIE identified. These findings suggest ways to improve HIE usage in public health.
Káren Mendes Jorge de Souza
Full Text Available ABSTRACT Objective: Analyze the perceptions of undergraduate nursing students about the contributions of public health to nursing practice in the Unified Health System. Method: Qualitative Descriptive Study. Data collection was carried out through semi-directed interviews with 15 students. The language material was analyzed according to content and thematic analysis. Results: Thematic categories were established, namely: "Perceptions about Public Health" and "Contribution of Public Health to nursing practice in the Unified Health System". Final considerations: Perceptions about Public Health are diversified, but converge to the recognition of this field as the basis for training nurses qualified to work in the SUS with technical competence, autonomy and focusing on the integrality in health care.
Puhl, Rebecca M; Heuer, Chelsea A
Stigma and discrimination toward obese persons are pervasive and pose numerous consequences for their psychological and physical health. Despite decades of science documenting weight stigma, its public health implications are widely ignored. Instead, obese persons are blamed for their weight, with common perceptions that weight stigmatization is justifiable and may motivate individuals to adopt healthier behaviors. We examine evidence to address these assumptions and discuss their public health implications. On the basis of current findings, we propose that weight stigma is not a beneficial public health tool for reducing obesity. Rather, stigmatization of obese individuals threatens health, generates health disparities, and interferes with effective obesity intervention efforts. These findings highlight weight stigma as both a social justice issue and a priority for public health.
Lucchetti, Giancarlo; Lucchetti, Alessandra L G; Peres, Mario F P; Moreira-Almeida, Alexander; Koenig, Harold G
This study aims to analyze the association between religious attendance, self-reported religiousness, depression, and several health factors in 170 older adults from a Brazilian outpatient setting. A comprehensive assessment was conducted including sociodemographic characteristics, religious attendance, self-reported religiousness, functional status, depression, pain, hospitalization, and mental status. After adjusting for sociodemographics, (a) higher self-reported religiousness was associated with lower prevalence of smoking, less depressive symptoms, and less hospitalization and (b) higher religious attendance was only associated with less depressive symptoms. Religiousness seems to play a role in depression, smoking, and hospitalization in older adults from a Brazilian outpatient setting. Self-reported religiousness was associated with more health characteristics than religious attendance.
Pittas, Tiago Mocellin; Dri, Clarissa Franzoi
Mother's milk is the primary source of nourishment in early infancy. When this source is unavailable, secondary sources may be used, such as human milk banks. The first milk bank in Brazil was created in 1943, and they have been used ever since. A national model was developed through a number of phases, culminating in the Brazilian Network of Human Milk Banks. This gave rise to a number of international cooperation projects, with the Brazilian model particularly relevant for developing nations. The main objective of this analysis is to understand what drives Brazil to promote milk banks internationally. To do this we tried to understand the relationship between health and foreign policy, expressed here as soft power, as here the two areas dialog with one another. The results include gains in both areas and the affirmation of health as a central goal of the national interest cluster of the case.
Wild, V; Dawson, A
In this article, we outline the link between migration, public health and ethics. Discussing relevant arguments about migration from the perspective of public health and public health ethics. Critical review of theories and frameworks, case-based analysis and systematic identification and discussion of challenges. Migration is a core issue of public health ethics and must take a case-based approach: seeking to identify the specific ethical dimensions and vulnerabilities in each particular context. Public health as a practice, built upon the core value of justice, requires the protection and promotion of migrants' well-being (even if this produces tension with immigration services). Ethical analysis should take all phases of migration into account: before, during and after transit. We argue that migration policies, at least as they relate to migrants' well-being, should be founded upon a shared humanity, respect for human rights and on the idea that effective public health cannot and should not be confined within the borders and to the citizens of any host country. We make the case for migration to be seen as a core issue of public health ethics. Copyright © 2018 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.
This podcast discusses bullying as a public health problem, and provides information and resources for public health practitioners. Created: 1/19/2012 by National Center for Injury Prevention and Control (NCIPC). Date Released: 1/19/2012.
Parker, Richard G; Sommer, Marni
... processes such as the growth of inequalities between the rich and the poor in countries around the world, the globalisation of trade and commerce, new patterns of travel and migration, as well as a reduction in resources for the development and sustainability of public health infrastructures. The Routledge Handbook of Global Public Health explores ...
The powers vested in the Commonwealth Government by the Constitution contain the basis of much public health law in Australia. Yet this is not often recognised; public health law is generally, and historically, seen as the states' responsibility. This article surveys the broad range of constitutional powers that the Commonwealth Government can rely upon to make public health laws. It considers areas of power specified in the Constitution, such as those with respect to external affairs and corporations. Decisions of the High Court have interpreted the various heads of power very broadly and have significantly enhanced the potential of the Commonwealth to pass detailed and far-reaching public health law. To this fact must be added the taxation arrangements in Australia and, with these, the very extensive control that the Commonwealth can exercise through its monopoly of major taxation sources. Its power to make financial arrangements can tie dependent states into specific policies (including public health policies) as a condition of the grants made to them. However, these broad powers may be limited in some important respects: the High Court is increasingly identifying rights and freedoms in the Constitution that may increasingly bring both state and Commonwealth public health law under challenge. Despite this possibility, the Commonwealth may prove to be our most significant source of public health law, and public health policy makers should recognise the full potential of its power to make such laws.
More than 100 people gathered in Birmingham on April 23 for the third joint conference of the Veterinary Public Health Association and the Association of Government Vets. With the theme of 'VPH hands on - making a difference together', the meeting considered the role vets play in society through their work on public health and sustainability. Kathryn Clark reports. British Veterinary Association.
Friel, Sharon; Hattersley, Libby; Townsend, Ruth
Twenty-first-century trade policy is complex and affects society and population health in direct and indirect ways. Without doubt, trade policy influences the distribution of power, money, and resources between and within countries, which in turn affects the natural environment; people's daily living conditions; and the local availability, quality, affordability, and desirability of products (e.g., food, tobacco, alcohol, and health care); it also affects individuals' enjoyment of the highest attainable standard of health. In this article, we provide an overview of the modern global trade environment, illustrate the pathways between trade and health, and explore the emerging twenty-first-century trade policy landscape and its implications for health and health equity. We conclude with a call for more interdisciplinary research that embraces complexity theory and systems science as well as the political economy of health and that includes monitoring and evaluation of the impact of trade agreements on health.
Mental illness affects the majority of prisoners. Mental health issues are beginning to take a central position in the development of prison health services, reflecting this burden of disease. This change in focus is not before time. But prison mental health services cannot exist in isolation. Public health systems should lead provision of care for patients with acute and severe illness. A whole prison approach to health and, specifically, mental health will offer the greatest likelihood that offenders will thrive, benefit from imprisonment, and lead law-abiding lives after release. Public awareness of the scale and commitment of prisons to mental health and illness, and understanding of prisons' role in society, are necessary developments that would protect and enhance public mental health, as well as creating a healthier and safer society. This article draws on recent reviews, information and statements to set out a public health agenda for mental health in prisons.
Guyon, Ak'ingabe; Perreault, Robert
Public health is currently being weakened in several Canadian jurisdictions. Unprecedented and arbitrary cuts to the public health budget in Quebec in 2015 were a striking example of this. In order to support public health leaders and citizens in their capacity to advocate for evidence-informed public health reforms, we propose a knowledge synthesis of elements of public health systems that are significantly associated with improved performance. Research consistently and significantly associates four elements of public health systems with improved productivity: 1) increased financial resources, 2) increased staffing per capita, 3) population size between 50,000 and 500,000, and 4) specific evidence-based organizational and administrative features. Furthermore, increased financial resources and increased staffing per capita are significantly associated with improved population health outcomes. We contend that any effort at optimization of public health systems should at least be guided by these four evidence-informed factors. Canada already has existing capacity in carrying out public health systems and services research. Further advancement of our academic and professional expertise on public health systems will allow Canadian public health jurisdictions to be inspired by the best public health models and become stronger advocates for public health's resources, interventions and outcomes when they need to be celebrated or defended.
DiPietro Mager, Natalie A; Ochs, Leslie; Ranelli, Paul L; Kahaleh, Abby A; Lahoz, Monina R; Patel, Radha V; Garza, Oscar W; Isaacs, Diana; Clark, Suzanne
To collect data on public health collaborations with schools of pharmacy, we sent a short electronic survey to accredited and preaccredited pharmacy programs in 2015. We categorized public health collaborations as working or partnering with local and/or state public health departments, local and/or state public health organizations, academic schools or programs of public health, and other public health collaborations. Of 134 schools, 65 responded (49% response rate). Forty-six (71%) responding institutions indicated collaborations with local and/or state public health departments, 34 (52%) with schools or programs of public health, and 24 (37%) with local and/or state public health organizations. Common themes of collaborations included educational programs, community outreach, research, and teaching in areas such as tobacco control, emergency preparedness, chronic disease, drug abuse, immunizations, and medication therapy management. Interdisciplinary public health collaborations with schools of pharmacy provide additional resources for ensuring the health of communities and expose student pharmacists to opportunities to use their training and abilities to affect public health. Examples of these partnerships may stimulate additional ideas for possible collaborations between public health organizations and schools of pharmacy.
In this podcast, Erin Edgerton, CDC, and Eric Holman, President of SmartReply, discuss why mobile technologies are an important communications tool for disseminating health messages. Created: 9/5/2008 by National Center for Health Marketing (NCHM), Division of eHealth Marketing (DeHM). Date Released: 1/12/2009.
Tamara Nunes Lima-Camara
Full Text Available ABSTRACT Environmental modification by anthropogenic actions, disordered urban growth, globalization of international exchange and climate change are some factors that help the emergence and dissemination of human infectious diseases transmitted by vectors. This review discusses the recent entry of three arboviruses in Brazil: Chikungunya, West Nile, and Zika virus, focusing on the challenges for the Country’s public health. The Brazilian population is exposed to infections caused by these three arboviruses widely distributed on the national territory and associated with humans. Without effective vaccine and specific treatment, the maintainance and integration of a continuos entomological and epidemiological surveillance are important so we can set methods to control and prevent these arboviruses in the Country.
Maria Auristela Magalhães Coelho
Full Text Available Objective: To assess the relationship between the functional health literacy of Unified Heath System users and the understanding of food servings in the pocket version of the Brazilian Food Guide. Methods: Functional health literacy was assessed by the Brief Test of functional health literacy. Two dialogue rounds were conducted with patients with adequate functional health literacy (Group 1 and inadequate functional health literacy (Group 2. The dialogues were recorded and analyzed according to the discourse of the collective subject. Results: Most (58.0% users had inadequate functional health literacy. Five core areas were identified: understands serving sizes; does not understand serving sizes; serving sizes are confusing; unfamiliar/uncommon foods; small letters. Group 2 had more trouble understanding. Conclusion: Difficulty understanding hinders health promotion. Individuals need to have access to educational materials that are easier to understand and developed taking their functional health literacy into account.
Ulinski, Karla Giovana Bavaresco; do Nascimento, Mariele Andrade; Lima, Arinilson Moreira Chaves
The aim of this cross-sectional study was to assess the factors associated with the impact of oral health on the quality of life in a sample of 504 Brazilian independent elderly. Data collection included oral examinations and structured interviews. The simplified form of the Oral Health Impact...... Profile (OHIP-14) was used to measure OHRQoL. Information on sociodemographic characteristics, use of dental services, and subjective measures of health was collected. Poisson regression within a hierarchical model was used to data analyses. The following variables were associated with a negative impact...
Medeiros, Katia Rejane de; Albuquerque, Paulette Cavalcanti de; Tavares, Ricardo Antônio Wanderley; Souza, Wayner Vieira de
The limits for expenditure on personnel that were imposed by the Fiscal Responsibility Act (FRA) have been considered by local health managers as an obstacle to health sector policies. This paper analyzes the linear trend for the personnel expenses indicators and the correlation of this with the profile of spending on health care personnel in 5,356 Brazilian municipalities from 2004 to 2009. The study of the time series used data from the 'Finanças do Brasil' (Finbra) and data from the Information System on Public Health Budgets (SIOPS). There was a trend towards an increase of 1.3% in the annual average of total personnel expenditure in the municipalities, but the cost of health care staff did not follow that growth. There were no correlations between the indicators, and this result is contrary to the arguments given by the health managers. They attribute the problems with hiring workers and the expansion of health systems to the FRA. The availability of data from the Finbra and the Siops system is associated with a lack of knowledge on these issues. This makes it an opportune time for conducting new research.
Full Text Available The study of threat and fear appeal arguments has given rise to a sizeable literature. Even within a public health context, much is now known about how these arguments work to gain the public’s compliance with health recommendations. Notwithstanding this level of interest in, and examination of, these arguments, there is one aspect of these arguments that still remains unexplored. That aspect concerns the heuristic function of these arguments within our thinking about public health problems. Specifically, it is argued that threat and fear appeal arguments serve as valuable shortcuts in our reasoning, particularly when that reasoning is subject to biases that are likely to diminish the effectiveness of public health messages. To this extent, they are rationally warranted argument forms rather than fallacies, as has been their dominant characterization in logic.
Coughlin, Steven S.
General moral (ethical) principles play a prominent role in certain methods of moral reasoning and ethical decision-making in bioethics and public health. Examples include the principles of respect for autonomy, beneficence, nonmaleficence, and justice. Some accounts of ethics in public health have pointed to additional principles related to social and environmental concerns, such as the precautionary principle and principles of solidarity or social cohesion. This article provides an overview of principle-based methods of moral reasoning as they apply to public health ethics including a summary of advantages and disadvantages of methods of moral reasoning that rely upon general principles of moral reasoning. Drawing upon the literature on public health ethics, examples are provided of additional principles, obligations, and rules that may be useful for analyzing complex ethical issues in public health. A framework is outlined that takes into consideration the interplay of ethical principles and rules at individual, community, national, and global levels. Concepts such as the precautionary principle and solidarity are shown to be useful to public health ethics to the extent that they can be shown to provide worthwhile guidance and information above and beyond principles of beneficence, nonmaleficence, and justice, and the clusters of rules and maxims that are linked to these moral principles. Future directions likely to be productive include further work on areas of public health ethics such as public trust, community empowerment, the rights of individuals who are targeted (or not targeted) by public health interventions, individual and community resilience and wellbeing, and further clarification of principles, obligations, and rules in public health disciplines such as environmental science, prevention and control of chronic and infectious diseases, genomics, and global health. PMID:20072707
Full Text Available Antimicrobial resistance and emerging infectious diseases, including avian influenza, Ebola virus disease, and Zika virus disease have significantly affected humankind in recent years. In the premodern era, no distinction was made between animal and human medicine. However, as medical science developed, the gap between human and animal science grew deeper. Cooperation among human, animal, and environmental sciences to combat emerging public health threats has become an important issue under the One Health Initiative. Herein, we presented the history of One Health, reviewed current public health threats, and suggested opportunities for the field of public health through better understanding of the One Health paradigm.
Myers, Julie; Frieden, Thomas R; Bherwani, Kamal M; Henning, Kelly J
Public health agencies increasingly use electronic means to acquire, use, maintain, and store personal health information. Electronic data formats can improve performance of core public health functions, but potentially threaten privacy because they can be easily duplicated and transmitted to unauthorized people. Although such security breaches do occur, electronic data can be better secured than paper records, because authentication, authorization, auditing, and accountability can be facilitated. Public health professionals should collaborate with law and information technology colleagues to assess possible threats, implement updated policies, train staff, and develop preventive engineering measures to protect information. Tightened physical and electronic controls can prevent misuse of data, minimize the risk of security breaches, and help maintain the reputation and integrity of public health agencies.
Johnson, Barry L. (Barry Lee)
... or the consequences of their use. The authors and publishers have attempted to trace the copyright holders of all material reproduced in this publication and apologize to copyright holders if permission ...
The thesis introduces a new conceptual model of organizational health and discusses its implications for public health management and leadership. It is developed with reference to organizational theories and ideologies, including New Public Management, the use of which has coincided with increasing...... as the disintegration of such values. Possible implications for public health management and leadership include four different forms. The application of the conceptual model can potentially draw attention to value conflicts and help to clarify contradictory, institutional logics. It can also potentially support health...... workplace health problems in health care organizations. The model is based on empirical research and theories in the fields of public health, health care organization and management, and institutional theory. It includes five dimensions and defines organizational health in terms of how an organization...
Moore, R T [Bureau of Radiological Health, RockviIle, MD (United States)
The Public Health Service must assume the role of the overall Public Health Coordinator, seeking to afford the highest level of health protection both to the nearby population as well as to the more distant groups. Data will be given relative to the limited experience the PHS has had in the removal of populations from areas of suspected hazards. Problems inherent in the evacuation of civilians of all ages will be discussed. (author)
The Public Health Service must assume the role of the overall Public Health Coordinator, seeking to afford the highest level of health protection both to the nearby population as well as to the more distant groups. Data will be given relative to the limited experience the PHS has had in the removal of populations from areas of suspected hazards. Problems inherent in the evacuation of civilians of all ages will be discussed. (author)
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In this special issue the four articles focus on population health in terms of primary care and preventive medicine. This critical area of health often receives less attention than health care issues (more so in the popular press but also in academic analyses.Upon reviewing these very interesting and illuminating articles it was striking that despite significant cultural, economic, geographic and historical differences there are many commonalities which exist throughout the Americas.
Cohen, Emma R M; Masum, Hassan; Berndtson, Kathryn; Saunders, Vicki; Hadfield, Tom; Panjwani, Dilzayn; Persad, Deepa L; Minhas, Gunjeet S; Daar, Abdallah S; Singh, Jerome A; Singer, Peter A
Experience with public engagement activities regarding the risks and benefits of science and technology (S&T) is growing, especially in the industrialized world. However, public engagement in the developing world regarding S&T risks and benefits to explore health issues has not been widely explored. This paper gives an overview about public engagement and related concepts, with a particular focus on challenges and benefits in the developing world. We then describe an Internet-based platform, which seeks to both inform and engage youth and the broader public on global water issues and their health impacts. Finally, we outline a possible course for future action to scale up this and similar online public engagement platforms. The benefits of public engagement include creating an informed citizenry, generating new ideas from the public, increasing the chances of research being adopted, increasing public trust, and answering ethical research questions. Public engagement also fosters global communication, enables shared experiences and methodology, standardizes strategy, and generates global viewpoints. This is especially pertinent to the developing world, as it encourages previously marginalized populations to participate on a global stage. One of the core issues at stake in public engagement is global governance of science and technology. Also, beyond benefiting society at large, public engagement in science offers benefits to the scientific enterprise itself. Successful public engagement with developing world stakeholders will be a critical part of implementing new services and technologies. Interactive engagement platforms, such as the Internet, have the potential to unite people globally around relevant health issues.
In the light of recent very prominent studies, especially that of Mukherjee and Krieckhaus (), one should be initially tempted to assume that nowadays globalization is a driver of a good public health performance in the entire world system. Most of these studies use time series analyses based on the KOF Index of Globalization. We attempt to re-analyze the entire question, using a variety of methodological approaches and data. Our re-analysis shows that neoliberal globalization has resulted in very important implosions of public health development in various regions of the world and in increasing inequality in the countries of the world system, which in turn negatively affect health performance. We use standard ibm/spss ordinary least squares (OLS) regressions, time series and cross-correlation analyses based on aggregate, freely available data. Different components of the KOF Index, most notably actual capital inflows, affect public health negatively. The "decomposition" of the available data suggests that for most of the time period of the last four decades, globalization inflows even implied an aggregate deterioration of public health, quite in line with globalization critical studies. We introduce the effects of inequality on public health, widely debated in global public health research. Our annual time series for 99 countries show that globalization indeed leads to increased inequality, and this, in turn, leads to a deteriorating public health performance. In only 19 of the surveyed 99 nations with complete data (i.e., 19.1%), globalization actually preceded an improvement in the public health performance. Far from falsifying globalization critical research, our analyses show the basic weaknesses of the new "pro-globalization" literature in the public health profession. Copyright © 2015 John Wiley & Sons, Ltd. Copyright © 2015 John Wiley & Sons, Ltd.
Frenk, J.; Coutre, le J.; Bladeren, van P.J.; Blum, S.
The relationship between health and the economy is complex and hardly a matter of unidirectional cause and consequence. With health increasingly being understood as a stimulus for the economy, nutrition directly assumes the status of an economic identifier. This paper discusses the growing
Limberger, Leo Francisco; Faria, Fernanda Pacheco; Campos, Luciana Silveira; Anzolch, Karin Marise Jaeger; Fornari, Alexandre
Surgical treatment of urinary incontinence progressed significantly with the introduction of synthetic slings. However, in some public Brazilian hospitals, the costs of these materials prevent their routine use. To compare the costs of ambulatory synthetic sling surgery with an historical series of patients submitted to Burch surgery in a Brazilian public hospital. Twenty nine incontinent patients were selected to synthetic sling surgery. Demographic data were prospectively collected and also the costs of the procedure, including drugs and materials, use of surgical and recovery wards, medical staff and hospitalization. These data were compared to the costs of 29 Burch surgeries performed before the introduction of synthetic slings. Demographic data were similar, although median age was lower in the group submitted to Burch surgery (46.3±8.6 versus 56.2±11.3 (pCost was significantly lower in patients submitted to sling in all items, except for time spent in recovery ward. Total value of 29 Burch surgeries was R$ 217.766.12, and of R$ 68.049.92 of 29 patients submitted to sling surgery (pcost of the synthetic sling was considered. Copyright® by the International Brazilian Journal of Urology.
Chieffi, Ana Luiza; Barata, Rita Barradas
The supply of medicines in response to court orders or injunctions has become a common practice in the State of São Paulo, Brazil. This 'judicialization' of the health system clashes with basic principles of the Brazilian Unified National Health System (SUS), such as equal opportunity to access health services. The aim of this paper is to analyze the legal action used to obtain medicines through the São Paulo State Health Department, from two main angles: judicialization of public policies and breach of the equity principle. This is a descriptive study of legal action taken to obtain medicines through the São State Health Department, as listed in the Electronic Court Docket System for the year 2006. Most cases were filed through private attorneys; 47% of the patients had obtained their prescriptions through private care; and 73% of the cases involved patients from the three wealthiest areas in the city of São Paulo. The data demonstrate that such legal action violates key principles of the SUS such as equity, thereby privileging individuals with higher purchasing power and more access to information.
25 oct. 2010 ... For four decades, IDRC has supported research across the developing world that has saved lives and reduced illness by tackling threats to public health such as infections diseases, tobacco, dilapidated health systems, and degraded environments.
Parker, Cindy L.; Caine, Virginia A.; McKee, Mary; Shirley, Lillian M.; Links, Jonathan M.
Recognition of petroleum as a finite global resource has spurred increasing interest in the intersection between petroleum scarcity and public health. Local health departments represent a critical yet highly vulnerable component of the public health infrastructure. These frontline agencies currently face daunting resource constraints and rely heavily on petroleum for vital population-based health services. Against this backdrop, petroleum scarcity may necessitate reconfiguring local public health service approaches. We describe the anticipated impacts of petroleum scarcity on local health departments, recommend the use of the 10 Essential Public Health Services as a framework for examining attendant operational challenges and potential responses to them, and describe approaches that local health departments and their stakeholders could consider as part of timely planning efforts. PMID:21778471
In this podcast, Erin Edgerton, CDC, and Craig Lefebvre, George Washington University discuss social media, blogs, and mobile technologies and how they can be used for public health. Created: 5/15/2009 by National Center for Health Marketing (NCHM), Division of eHealth Marketing (DeHM). Date Released: 6/30/2009.
Community health educators are well versed in the behavior sciences, including intervention theories. However, most public health professionals are not familiar with the policy theories related to political advocacy. Because health educators are engaging in policy advocacy more frequently, and as a result of the profession including policy…
Hahn, Robert A; Truman, Benedict I
This article describes a framework and empirical evidence to support the argument that educational programs and policies are crucial public health interventions. Concepts of education and health are developed and linked, and we review a wide range of empirical studies to clarify pathways of linkage and explore implications. Basic educational expertise and skills, including fundamental knowledge, reasoning ability, emotional self-regulation, and interactional abilities, are critical components of health. Moreover, education is a fundamental social determinant of health - an upstream cause of health. Programs that close gaps in educational outcomes between low-income or racial and ethnic minority populations and higher-income or majority populations are needed to promote health equity. Public health policy makers, health practitioners and educators, and departments of health and education can collaborate to implement educational programs and policies for which systematic evidence indicates clear public health benefits. © The Author(s) 2015.
The goal of this presentation is to explore how HIA can help inform hazardous waste permitting regulations and incorporate community vulnerability and cumulative impacts to their potential health risks into permitting decision making by the California Department of Toxic Substances Control. Presented the Health Impact Assessment (HIA) at the State of California Cumulative Impacts and Community Vulnerability Symposium on July 27 in Diamond Bar, CA.
The book brings together experts working in public health and multi-disciplinary areas to present recent issues in statistical methodological development and their applications. This timely book will impact model development and data analyses of public health research across a wide spectrum of analysis. Data and software used in the studies are available for the reader to replicate the models and outcomes. The fifteen chapters range in focus from techniques for dealing with missing data with Bayesian estimation, health surveillance and population definition and implications in applied latent class analysis, to multiple comparison and meta-analysis in public health data. Researchers in biomedical and public health research will find this book to be a useful reference, and it can be used in graduate level classes.
Full text of publication follows: over the last 25 years, the traditional command-and-control, chemical-by-chemical environmental medium-by-environmental medium, risk-by-risk approach to protecting public health from environmental risks has worked well to greatly improve the quality of our food, air, water, and workplaces, but we are now left with the more complex problems, like urban air pollution or personal dietary behavior, that a chemical-by-chemical approach is not going to solve. Because current environmental regulatory programs have curbed the 'low-hanging fruit' and because of today's emphasis on achieving risk reductions cost-effectively, new and creative public health-based approaches to risk management are needed. Since public concern about pollution-related disease become serious in the 1960's and 1970's and regulatory agencies and laws began to proliferate, the public health goals of environmental protection have been obscured. As a society, we have made a tradeoff between environmental health and public health. The public health foundation of environmental health protection has been obscured by legalistic, technical, centralized decision-making processes that have often mistaken hazard for risk. A greater focus on public health would help us to assess aggregate risks and to target risk management resources by focusing on a problem and then identifying what is causing the problem as a guide to determining how best to solve it. Most of our current approaches start with a cause and then try to eliminate it without determining the extent to which it actually may contribute to a problem, making it difficult to set priorities among risks or to evaluate the impact of risk management actions on public health. (author)
Esther Império Hamburger
Full Text Available This paper revisits the wide range of critical literature that, from a variety of theoretical perspectives and with an emphasis on different historical periods and countries, deals with the relationships between mass media and representations of gender relations. This review of the literature focuses on works that are particularly suggestive for our ensuing discussion on the major conventions of Brazilian telenovela, a television genre that blends elements of documentary and fiction and treats the nation in melodramatic terms. Analysis of relevant programs that were exhibited during the 70s and the 80s suggests that these soaps constructed the Brazilian public space in terms that expanded what the industry had conventionally defined as "woman's domain".
Ricardo R.G. Avelino
Full Text Available This paper examines the underwriters' treatment of information throughout the IPO pricing process based on a sample of Brazilian companies that went public between 2004 and 2011. There is evidence that the offer price partially incorporates the information contained into the Bovespa index during the book-building period, reacting symmetrically to upward and downward movements. The first-day return, as a result, is predictable on the basis of this information. Positive private information disclosed during the book-building period is also partially incorporated into the offer price. Issues priced above the midpoint of the initial price range are associated with higher initial returns.Este artigo examina o tratamento da informação pelo coordenador líder durante o processo de apreçamento do IPO baseado em uma amostra de firmas brasileiras que abriram o capital entre 2004 e2011. O preço de oferta incorpora parcialmente a informação contida no Ibovespa durante o período de book-building, reagindo simetricamente a movimentos de alta e baixa. O retorno inicial, como resultado, pode ser previsto com base nesta informação. Informação privada positiva revelada durante o período de book-building também é parcialmente incorporada no preço de oferta. Ofertas com preço acima do ponto médio do intervalo inicialmente estabelecido produzem maiores retornos iniciais.
de Barros Reis, Carla; Knust, Renata Erthal; de Aguiar Pereira, Claudia Cristina; Portela, Margareth Crisóstomo
The present study estimated the cost of advanced non-small cell lung cancer care for a cohort of 251 patients enrolled in a Brazilian public hospital and identified factors associated with the cost of treating the disease, considering sociodemographic, clinical and behavioral characteristics of patients, service utilization patterns and survival time. Estimates were obtained from the survey of direct medical cost per patient from the hospital's perspective. Data was collected from medical records and available hospital information systems. The ordinary least squares (OLS) method with logarithmic transformation of the dependent variable for the analysis of cost predictors was used to take into account the positive skewness of the costs distribution. The average cost of NSCLC was US$ 5647 for patients, with 71% of costs being associated to outpatient care. The main components of cost were daily hospital bed stay (22.6%), radiotherapy (15.5%) and chemotherapy (38.5%). The OLS model reported that, with 5% significance level, patients with higher levels of education, with better physical performance and less advanced disease have higher treatment costs. After controlling for the patient's survival time, only education and service utilization patterns were statistically significant. Individuals who were hospitalized or made use of radiotherapy or chemotherapy had higher costs. The use of these outpatient and hospital services explained most of the treatment cost variation, with a significant increase of the adjusted R 2 of 0.111 to 0.449 after incorporation of these variables in the model. The explanatory power of the complete model reached 62%. Inequities in disease treatment costs were observed, pointing to the need for strategies that reduce lower socioeconomic status and population's hurdles to accessing cancer care services.
Antunes, José Leopoldo; Peres, Marco Aurélio; Jahn, Graciela Medeiros Jabôr; Levy, Bárbara Bianca da Silva
To appraise the association between dental care utilisation and gingival status in the Brazilian context, controlling for covariates on socio-demographic characteristics and dentofacial anomalies (12-year-old children). A survey of oral health comprising 5780 schoolchildren in 35 towns of the state of São Paulo, Brazil, provided primary information regarding the assessment of the community periodontal index. The survey also provided information on socio-demographic characteristics and the dental aesthetic index of participants. The utilization of dental services was measured at the town-level, in terms of the dental care index (F/DMFT ratio). Multilevel models of logistic regression fitted the adjustment of covariates for gingival bleeding on probing and calculus. Almost 32% of the children examined presented unhealthy gingival conditions, with a significantly poorer profile for boys, black children and those enrolled in public schools than for their counterparts. Several dentofacial anomalies associated with unhealthy gingival status: crowding of the incisal segments, maxillary and mandibular irregularity, antero posterior molar relation, maxillary overjet and vertical anterior openbite. Towns with a higher dental care index presented a lower proportion of children with gingival bleeding and calculus. This study confirmed previous observations of boys, blacks and children enrolled in public schools as presenting poorer oral health status than their counterparts in the Brazilian context. The utilization of dental services was significantly associated with improved profile of gingival status of participating towns, and this association is unlikely to be due to insufficient control of confounding on socio-demographic characteristics and dentofacial anomalies.
Paumgartten, Francisco José Roma
In the US, where registration of lobbyists is mandatory, the pharmaceutical industry and private health-care providers spend huge amounts of money seeking to influence health policies and government decisions. In Brazil, where lobbying lacks transparency, there is virtually no data on drug industry expenditure to persuade legislators and government officials of their viewpoints and to influence decision-making according to commercial interests. Since 1990, however, the Associação da Indústria Farmacêutica de Pesquisa (Interfarma - Pharmaceutical Research Industry Association), Brazilian counterpart of the Pharmaceutical Research and Manufacturers of America (PhRMA), main lobbying organization of the US pharmaceutical industry, has played a major role in the advocacy of interests of major drug companies. The main goals of Interfarma lobbying activities are: shortening the average time taken by the Brazilian regulatory agency (ANVISA) to approve marketing authorization for a new drug; making the criteria for incorporation of new drugs into SUS (Brazilian Unified Health System) more flexible and speeding up technology incorporation; changing the Country's ethical clearance system and the ethical requirements for clinical trials to meet the need of the innovative drug industry, and establishing a National Policy for Rare Diseases that allows a prompt incorporation of orphan drugs into SUS. Although lobbying affects community health and well-being, this topic is not in the public health research agenda. The impacts of pharmaceutical lobbying on health policies and health-care costs are of great importance for SUS and deserve to be investigated.
Guilherme Besse Garnica
Full Text Available Abstract Paper aims To determine main barriers to the implementation of occupational health and safety management systems OHSMS in the context of small Brazilian enterprises from the perspectives of owners/managers, labor auditors, and OHS consultants. Originality: Survey with three different perspectives on small Brazilian enterprises. Research method: Survey conducted with stakeholders who influence the safety culture in small enterprises to identify the main barriers to the implementation of OHSMS. Main findings: Owners/managers tend to blame employees and the government for difficulty in implementing OHSMS, and external actors tend to blame management and resource allocation. Opinions converge on inappropriate management behavior, ineffective information and communication and production prioritization. Implications for theory and practice: These barriers should be overcome not only to facilitate the implementation of OHSMS but also to improve the conditions for the management of all small business operations.
Kierkegaard, Patrick; Kaushal, Rainu; Vest, Joshua R.
Health information exchange (HIE) can support several aspects of public health practice by increasing the availability, timeliness, and comprehensiveness individual-level patient information. The potential benefits to disease monitoring, disaster response, and other public health activities served...... as an important justification for the US’ investments in HIE. After several years of HIE implementation and funding, we sought to determine if any of the anticipated benefits of exchange participation were accruing to state and local public health practitioners participating in five different exchanges. Using...... qualitative interviews and template analyses, we identified public health efforts and activities that were improved by participation in HIE. We derived the codes for the template analysis through a literature review. HIE supported public health activities consistent with expectations in the literature...
Bayer, Ronald; Colgrove, James
The controversy over the Model State Emergency Health Powers Act has underscored the enduring tension in public health between guarding the common welfare and respecting individual liberty. The current version of the act, crafted in response to extensive public commentary, attempts to strike a balance between these values but has failed to allay the concerns of many civil libertarians and privacy advocates. Although the debates over the model act have been triggered by the threat of bioterrorism, they illustrate broader philosophical differences, with profound implications for all realms of public health policy.
Kennedy, Virginia C
The purpose of this study was to describe the number and distribution of 26 administrative, professional, and technical public health occupations across the array of US governmental and nongovernmental industries. This study used data from the Occupational Employment Statistics program of the US Bureau of Labor Statistics. For each occupation of interest, the investigator determined the number of persons employed in 2006 in five industries and industry groups: government, nonprofit agencies, education, healthcare, and all other industries. Industry-specific employment profiles varied from one occupation to another. However, about three-fourths of all those engaged in these occupations worked in the private healthcare industry. Relatively few worked in nonprofit or educational settings, and less than 10 percent were employed in government agencies. The industry-specific distribution of public health personnel, particularly the proportion employed in the public sector, merits close monitoring. This study also highlights the need for a better understanding of the work performed by public health occupations in nongovernmental work settings. Finally, the Occupational Employment Statistics program has the potential to serve as an ongoing, national data collection system for public health workforce information. If this potential was realized, future workforce enumerations would not require primary data collection but rather could be accomplished using secondary data.
Rosenbaum, Sara; Skivington, Skip; Praeger, Sandra
The relationship between insurance and public health is an enduring topic in public health policy and practice. Insurers share certain attributes with public health. But public health agencies operate in relation to the entire community that they are empowered by public law to serve and without regard to the insurance status of community residents; on the other hand, insurers (whether managed care or otherwise) are risk-bearing entities whose obligations are contractually defined and limited to enrolled members and sponsors. Public insurers such as Medicare and Medicaid operate under similar constraints. The fundamental characteristics that distinguish managed care-style insurance and public health become particularly evident during periods of public health emergency, when a public health agency's basic obligations to act with speed and flexibility may come face to face with the constraints on available financing that are inherent in the structure of insurance. Because more than 70% of all personal health care in the United States is financed through insurance, public health agencies effectively depend on insurers to finance necessary care and provide essential patient-level data to the public health system. Critical issues of state and federal policy arise in the context of the public health/insurance relations during public health emergencies. These issues focus on coverage and the power to make coverage decisions, as well as the power to define service networks and classify certain data as exempt from public reporting. The extent to which a formal regulatory approach may become necessary is significantly affected by the extent to which private entities themselves respond to the problem with active efforts to redesign their services and operations to include capabilities and accountability in the realm of public health emergency response.
Bjerregaard, Peter; Curtis, Tine
research. Two health surveys have been carried out in Greenland by the National Institute of Public Health, and a follow-up is being planned together with the Directorate of Health. The results have been widely used by politicians, administrators, and health care professionals.......In 1992, the Greenland Home Rule Government took over the responsibility for health care. There has since been a growing cooperation between the Directorate of Health and researchers in Denmark and Greenland, for instance by the Directorate supporting workshops and funding a chair in health...
Ferreira Neto, João Leite; Kind, Luciana; Resende, Maria Carolina Costa; Colen, Natália Silva
We investigated the processes involved in the construction of the Brazilian National Health Promotion Policy (PNPS) through the analysis of three documents produced by the Ministry of Health from 2002 to 2005 and the final text of the National Health Promotion Policy, approved in 2006. We interviewed five subjects who participated in drafting the PNPS, three of whom were Ministry of Health administrators, plus two researchers. The documents were explored with discourse analysis. The article contributes to the debate on the development of the PNPS. Health promotion showed various points of disagreement, which led to the delay in the document's final approval. International induction via funding proved to be a crucial element for defining the final wording of the PNPS, reestablishing the emphasis (subject to criticism) on lifestyle changes in its "Actions". The article highlights the negotiated consensus that led to the creation of the PNPS Management Committee, with participation by various sub-sectors, an innovative structure within the Ministry of Health.
Costa, Ediná Alves; Araújo, Patrícia Sodré; Pereira, Marcelo Tavares; Souto, Ana Cristina; Souza, Gisélia Santana; Guerra, Augusto Afonso; Acurcio, Francisco de Assis; Guibu, Ione Aquemi; Alvares, Juliana; Costa, Karen Sarmento; Karnikowski, Margô Gomes de Oliveira; Soeiro, Orlando Mario; Leite, Silvana Nair
ABSTRACT OBJECTIVE To characterize the technical issues and conditions of medicines conservation in Primary Health Care of Brazilian regions, responsible for pharmacy/dispensing unit profile; environmental, storage, and dose fractioning conditions; inventory control and waste management; fire and electrical failure safety items; transportation problems; advertising regulation; and pharmacovigilance. METHODS This article is part of the Pesquisa Nacional sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos – Serviços (National Survey on Access, Use and Promotion of Rational Use of Medicines – Services)–, a cross-sectional and exploratory study, of evaluative nature, consisting of an information survey within a representative sample of municipalities, stratified by Brazilian regions, which constitute the study domains, and a sample of Primary Health Care services. Pharmaceutical services (PS) were directly observed with photographic record and face-to-face interviews with those responsible for the dispensing of medicines and over the telephone with those responsible for pharmaceutical services. Data were processed with the SPSS® software version 21. RESULTS The investigated dimensions showed relevant deficiencies and inequalities between the regions, generally more favorable in the Southeast and Midwest regions and weaker in the Northeast and North regions. We verified non-compliance with technical requirements and conditions essential to the conservation of medicines, which may interfere with the maintenance of stability and, thus, on their quality, efficacy, and safety. The regulation of advertising/promotion of medicines is still incipient and there is some progress in the structuring of mechanisms regarding pharmacovigilance. CONCLUSIONS The sanitary situation of medicines in Brazilian Primary Health Care is alarming due to the violation of the specific sanitary legislation for dispensing establishments and due to a wide range of
Preventing adverse health impacts from exposures to environmental chemicals is fundamental to protecting individual and public health. When done efficiently and properly, chemical risk assessment enables risk management actions that minimize the incidence and impacts of environmentally-induced diseases related to chemical exposure. However, traditional chemical risk assessment is faced with multiple challenges with respect to predicting and preventing disease in human populations, and epidemiological studies increasingly report observations of adverse health effects at exposure levels predicted from animal studies to be safe for humans. This discordance reinforces concerns about the adequacy of contemporary risk assessment practices (Birnbaum, Burke, & Jones, 2016) for protecting public health. It is becoming clear that to protect public health more effectively, future risk assessments will need to use the full range of available data, draw on innovative methods to integrate diverse data streams, and consider health endpoints that also reflect the range of subtle effects and morbidities observed in human populations. Given these factors, there is a need to reframe chemical risk assessment to be more clearly aligned with the public health goal of minimizing environmental exposures associated with disease. Preventing adverse health impacts from exposures to environmental chemicals is fundamental to protecting individual and public health. Chemical risk assessments
Roslind Preethi George
Full Text Available The use of Qualitative Research (QR methods are now getting common in various aspects of health and healthcare research and they can be used to interpret, explore, or obtain a deeper understanding of certain aspects of human beliefs, attitudes, or behavior through personal experiences and perspectives. The potential scope of QR in the field of dental public health is immense, but unfortunately, it has remained underutilized. However, there are a number of studies which have used this type of research to probe into some unanswered questions in the field of public health dentistry ranging from workforce issues to attitudes of patients. In recent health research, evidence gathered through QR methods provide understanding to the social, cultural, and economic factors affecting the health status and healthcare of an individual and the population as a whole. This study will provide an overview of what QR is and discuss its contributions to dental public health research.
De Jesus, Maria; Earl, Tara R
Mental health providers are increasingly coming into contact with large and growing multi-racial/ethnic and immigrant patient populations in the United States. Knowledge of patient perspectives on what constitutes quality mental health care is necessary for these providers. The aim of this study was to identify indicators of quality of mental health care that matter most to two underrepresented immigrant patient groups of Portuguese background: Brazilians and Cape Verdeans. A qualitative design was adopted using focus group discussions. Six focus groups of patients (n=24 Brazilians; n=24 Cape Verdeans) who received outpatient mental health treatment through public safety net clinics in the northeast region of the United States were conducted. The Consensual Qualitative Research analytic method allowed us to identify three quality of care domains: provider performance, aspects of mental health care environment, and effectiveness of mental health care treatment. Provider performance was associated with five categories: relational, communication, linguistic, cultural, and technical competencies. Aspects of mental health care environment were linked to two categories: psychosocial and physical environment. Effectiveness of mental health care treatment was related to two categories: therapeutic relationship and treatment outcomes. Study findings provide useful data for the development of more culturally appropriate and effective patient-centered models and policies in mental health care.
Kottow, Miguel H
Genetics research has shown enormous developments in recent decades, although as yet with only limited clinical application. Bioethical analysis has been unable to deal with the vast problems of genetics because emphasis has been put on the principlism applied to both clinical and research bioethics. Genetics nevertheless poses its most complex moral dilemmas at the public level, where a social brand of ethics ought to supersede the essentially interpersonal perspective of principlism. A more social understanding of ethics in genetics is required to unravel issues such as research and clinical explorations, ownership and patents, genetic manipulation, and allocation of resources. All these issues require reflection based on the requirements of citizenry, consideration of common assets, and definition of public policies in regulating genetic endeavors and protecting the society as a whole Bioethics has privileged the approach to individual ethical issues derived from genetic intervention, thereby neglecting the more salient aspects of genetics and social ethics.
... Prevention and Health Promotion, Division of Reproductive Health, Attn: National Public Health Action Plan... Disease Prevention and Health Promotion, Division of Reproductive Health, 4770 Buford Highway NE... topic's public health importance, existing challenges, and opportunities for action to decrease the...
Yoon, Jangho; Bernell, Stephanie; Tynan, Michael; Alvarado, Carla Sarai; Eversole, Tom; Mosbaek, Craig; Beathard, Candice
The Oregon Public Health Policy Institute (PHPI) was designed to enhance public health policy competencies among state and local health department staff. The Oregon Health Authority funded the College of Public Health and Human Sciences at Oregon State University to develop the PHPI curriculum in 2012 and offer it to participants from 4 state public health programs and 5 local health departments in 2013. The curriculum interspersed short instructional sessions on policy development, implementation, and evaluation with longer hands-on team exercises in which participants applied these skills to policy topics their teams had selected. Panel discussions provided insights from legislators and senior Oregon health experts. Participants reported statistically significant increases in public health policy competencies and high satisfaction with PHPI overall. PMID:26066925
Review Human Oesophagostomiasis: A Serious Public Health Problem in Tropical ... Historical events were described from its first record in Ethiopia in 1905. ... information on patterns of distribution and relation of transmission to seasons and ...
Magnuson, J A
In a revised edition, this book covers all aspects of public health informatics, and discusses the creation and management of an information technology infrastructure that is essential in linking state and local organizations in their efforts to gather data.
... Navigation Bar Home Current Issue Past Issues Celebrating Leadership in Public Health and Medicine Friends of the ... a Distinguished Medical Science Award for his global leadership in cancer research and the development of combination ...
Cancer is the leading cause of death from disease among Americans under 85. Learn how NCI advances public health by conducting research to improve the delivery of quality cancer prevention, screening, and treatment to all Americans.
Vermont Center for Geographic Information — What is Environmental Public Health Tracking?Tracking is an ongoing national effort to better understand how environmental hazards can contribute to certain...
EPA and the Centers for Disease Control and Prevention (CDC) issued a joint statement on the public health impacts of bed bugs, which are blood-sucking ectoparasites (external parasites). EPA also has a pesticide registration notice on this topic.
García-Goñi, Manuel; Maroto, Andrés; Rubalcaba, Luis
Innovations in public health services promote increases in the health status of the population. Therefore, it is a major concern for health policy makers to understand the drivers of innovation processes. This paper focuses on the differences in behaviour of managers and front-line employees in the pro-innovative provision of public health services. We utilize a survey conducted on front-line employees and managers in public health institutions across six European countries. The survey covers topics related to satisfaction, or attitude towards innovation or their institution. We undertake principal components analysis and analysis of variance, and estimate a multinomial ordered probit model to analyse the existence of different behaviour in managers and front-line employees with respect to innovation. Perception of innovation is different for managers and front-line employees in public health institutions. While front-line employees' attitude depends mostly on the overall performance of the institution, managers feel more involved and motivated, and their behaviour depends more on individual and organisational innovative profiles. It becomes crucial to make both managers and front-line employees at public health institutions feel participative and motivated in order to maximise the benefits of technical or organisational innovative process in the health services provision.
Weed, Douglas L; McKeown, Robert E
Epidemiologists and environmental health researchers have a joint responsibility to acquire scientific knowledge that matters to public health and to apply the knowledge gained in public health practice. We examine the nature and source of these social responsibilities, discuss a debate in the epidemiological literature on roles and responsibilities, and cite approaches to environmental justice as reflective of them. At one level, responsibility refers to accountability, as in being responsible for actions taken. A deeper meaning of responsibility corresponds to commitment to the pursuit and achievement of a valued end. Epidemiologists are committed to the scientific study of health and disease in human populations and to the application of scientific knowledge to improve the public's health. Responsibility is also closely linked to reliability. Responsible professionals reliably perform the tasks they set for themselves as well as the tasks society expects them to undertake. The defining axiom for our approach is that the health of the public is a social good we commit ourselves to pursue, thus assuming an obligation to contribute to its achievement. Epidemiologists cannot claim to be committed to public health as a social good and not accept the responsibility of ensuring that the knowledge gained in their roles as scientists is used to achieve that good. The social responsibilities of environmental health researchers are conspicuous in the environmental justice movement, for example, in community-based participatory research. Responsibility is an ethical concept particularly well suited to frame many key aspects of the ethics of our profession. PMID:14602514
Public health communication aims to influence health practices of large populations, including maternal health care providers (traditional birth attendants, (TBAs), nurse-midwives, other indigenous practitioners, and physicians). A quality assurance process is needed to give public sector health providers feedback. Computerized record keeping is needing for quality assurance of maternal health programs. The Indian Rural Medical Association has trained more than 20,000 rural indigenous practitioners in West Bengal. Training of TBAs is expensive and rarely successful. However, trained health professional leading group discussions of TBAs is successful at teaching them about correct maternity care. Health education messages integrated into popular songs and drama is a way to reach large illiterate audiences. Even though a few donor agencies and governments provide time and technical assistance to take advantage of the mass media as a means to communicate health messages, the private sector has most of the potential. Commercial advertisements pay for Video on Wheels, which, with 100 medium-sized trucks each fitted with a 100-inch screen, plays movies for rural citizens of India. They are exposed to public and family planning messages. Jain Satellite Television (JST) broadcasts 24 hours a day and plans to broadcast programs on development, health and family planning, women's issues, and continuing education for all health care providers (physicians, nurses, TBAs, community workers, and indigenous practitioners). JST and the International Federation for Family Health plan to telecast courses as part of an Open University of Health Sciences.
Passchier-Vermeer, W.; Passchier, W.F.
Exposure to noise constitutes a health risk. There is sufficient scientific evidence that noise exposure can induce hearing impairment, hypertension and ischemic heart disease, annoyance, sleep disturbance, and decreased school performance. For other effects such as changes in the immune system and
Judith W. Leavitt
Full Text Available Review of: Launching Global Health: The Caribbean Odyssey of the Rockefeller Foundation. Steven Palmer. Ann Arbor: University of Michigan Press, 2010. xi + 301 pp. (Cloth US$ 70.00 Partner to the Poor: A Paul Farmer Reader. Paul Farmer, edited by Haun Saussy. Berkeley: University of California Press, 2010. xii + 660 pp. (Paper US$ 27.50
The radioactivity have been existing everywhere in the nature for the night of times. The most radioactive places such Guarapari in Brazil or Ramsar in Iran or springs of Bad Gastein in Austria do not reveal more cancers linked to radioactivity than everywhere else. Only the important radiation doses over 100 MSv received in one time are dangerous for health. (N.C.)
There has been substantial discussion of globalization in the scholarly and popular press yet limited attention so far among public health professionals. This is so despite the many potential impacts of globalization on public health. Defining public health broadly, as focused on the collective health of populations requiring a range of intersectoral activities, globalization can be seen to have particular relevance. Globalization, in turn, can be defined as a process that is changing the nature of human interaction across a wide range of spheres and along at least three dimensions. Understanding public health and globalization in these ways suggests the urgent need for research to better understand the linkages between the two, and effective policy responses by a range of public health institutions, including the UK Faculty of Public Health Medicine. The paper is based on a review of secondary literature on globalization that led to the development of a conceptual framework for understanding potential impacts on the determinants of health and public health. The paper then discusses major areas of public health in relation to these potential impacts. It concludes with recommendations on how the UK Faculty of Public Health Medicine might contribute to addressing these impacts through its various activities. Although there is growing attention to the importance of globalization to public health, there has been limited research and policy development in the United Kingdom. The UK Faculty of Public Health Medicine needs to play an active role in bringing relevant issues to the attention of policy makers, and encourage its members to take up research, teaching and policy initiatives. The potential impacts of globalization support a broader understanding and practice of public health that embraces a wide range of health determinants.
Coughlin, Steven S.
General moral (ethical) principles play a prominent role in certain methods of moral reasoning and ethical decision-making in bioethics and public health. Examples include the principles of respect for autonomy, beneficence, nonmaleficence, and justice. Some accounts of ethics in public health have pointed to additional principles related to social and environmental concerns, such as the precautionary principle and principles of solidarity or social cohesion. This article provides an overview...
Kempker, Jordan A; Wang, Henry E; Martin, Greg S
There is a paradigm shift happening for sepsis. Sepsis is no longer solely conceptualized as problem of individual patients treated in emergency departments and intensive care units but also as one that is addressed as public health issue with population- and systems-based solutions. We offer a conceptual framework for sepsis as a public health problem by adapting the traditional model of primary, secondary, and tertiary prevention.
Bonde, Lars Ole; Theorell, Töres
Introduction to Music and Public Health as a new research field. The history of the field in the Nordic countries is presented, and the 13 contributions to the book are briefly reviewed.......Introduction to Music and Public Health as a new research field. The history of the field in the Nordic countries is presented, and the 13 contributions to the book are briefly reviewed....
In this brief review, Dr. Jonathan Borak comments on five seminal papers that helped shape the fields of epidemiology and public health. These papers include Hill?s criteria for inferring causality; the first proof of the multistage theory of cancer; the first evidence that subclinical lead exposures can cause neurobehavioral impairment in children; a simple yet robust study that had a major influence on setting current air pollution policies; and a landmark review of the general public?s per...
Morris, George P
The fact that health and disease are products of a complex interaction of factors has long been recognized in public health circles. More recently, the term 'ecological public health' has been used to characterize an era underpinned by the paradigm that, when it comes to health and well-being, 'everything matters'. The challenge for policy makers is one of navigating this complexity to deliver better health and greater equality in health. Recent work in Scotland has been concerned to develop a strategic approach to environment and health. This seeks to embrace complexity within that agenda and recognize a more subtle relationship between health and place but remain practical and relevant to a more traditional hazard-focused environmental health approach. The Good Places, Better Health initiative is underpinned by a new problem-framing approach using a conceptual model developed for that purpose. This requires consideration of a wider social, behavioural etc, context. The approach is also used to configure the core systems of the strategy which gather relevant intelligence, subject it to a process of evaluation and direct its outputs to a broad policy constituency extending beyond health and environment. This paper highlights that an approach, conceived and developed to deliver better health and greater equality in health through action on physical environment, also speaks to a wider public health agenda. Specifically it offers a way to help bridge a gap between paradigm and policy in public health. The author considers that with development, a systems-based approach with close attention to problem-framing/situational modelling may prove useful in orchestrating what is a necessarily complex policy response to mitigate and adapt to climate change.
Straton, Nadiya; Hansen, Kjeld; Mukkamala, Raghava Rao
In recent years, social media has offered new opportunities for interaction and distribution of public health information within and across organisations. In this paper, we analysed data from Facebook walls of 153 public organisations using unsupervised machine learning techniques to understand...
Jones, Timothy F; Grimm, Karen
Foodborne diseases cause 76 million illnesses in the U.S. each year, and almost half of all money spent on food is spent in restaurants. Restaurant inspections are a critical public health intervention for the prevention of foodborne disease. A telephone survey of randomly selected Tennessee residents aged > or =18 was performed. Data were collected on respondents' demographics, knowledge, attitudes, and expectations regarding restaurant inspections. Of 2000 respondents, 97% were aware that restaurants are inspected regularly by the health department. More than half of the respondents believed that inspections should be performed at least 12 times per year; only one third were aware that inspections currently occur only twice per year in Tennessee. More than one third of the respondents considered an inspection score of > or =90 acceptable for a restaurant at which they would eat; the mean score in Tennessee is 82. When presented with a variety of scenarios, an overwhelming number of respondents felt that public health responses to safety violations should be far more draconian than they actually are. Survey answers did not differ consistently based on respondents' race, gender, or history of having worked in a restaurant. This study identified a number of public misconceptions and unrealistically high expectations of the public health restaurant-inspection system. It is important to improve consumers' understanding of inspection scores and the limitations of regulatory inspections, as well as the role of such inspections in disease prevention.
Yeager, Valerie A; Wisniewski, Janna M; Amos, Kathleen; Bialek, Ron
The public health workforce is critical to the functioning of the public health system and protection of the population's health. Ensuring a sufficient workforce depends on effectively recruiting and retaining workers. This study examines factors influencing decisions to take and remain in jobs within public health, particularly for workers employed in governmental public health. This cross-sectional study employed a secondary data set from a 2010 national survey of US public health workers. Survey respondents were included in this study if they responded to at least 1 survey item related to recruitment and retention. A total of 10 859 survey responses fit this criterion. Data examined demographics of public health workers and factors that influenced decisions to take jobs in and remain in public health. Job security (β = 0.42; 95% confidence interval [CI], 0.28-0.56) and competitive benefits (β = 0.49; 95% CI, 0.28-0.70) were significantly and positively associated with governmental employees' decisions to take positions with their current employers compared with public health workers employed by other types of organizations. The same finding held with regard to retention: job security (β = 0.40; 95% CI, 0.23-0.57) and competitive benefits (β = 0.53; 95% CI, 0.24-0.83). Two personal factors, personal commitment to public service (β = 0.30; 95% CI, 0.17-0.42) and wanted a job in the public health field (β = 0.44; 95% CI, 0.18-0.69), were significantly and positively related to governmental employees deciding to remain with their current employers. It is important to recognize the value of competitive benefits for both current and potential employees. Public health agencies should maintain these if possible and make the value of these benefits known to policy makers or other agencies setting these benefit policies. Job security associated with governmental public health jobs also appears to offer public health an advantage in recruiting and retaining employees.
Public health institutions, as ancient as civilizations itself, are intrinsically connected with soils. The massive body of the empirical knowledge about this connection has been accumulated. Recently unraveling the underlying mechanisms of this link has begun, and many of them appear to have the microbiological origin. The impressive progress in understanding the nexus between soil and health has been achieved by experimentation with preserved soil microbial systems functioning along with the metagenomic characterization. The objective of this work is to present an overview of some recent onsets. In the food safety arena, survival of human pathogens in soils has been related to the degree of soil eutrophication and/or related structure of soil microbial communities. Soil microbial systems affect the affinity of plants to internalizing pathogenic organisms. Pharmaceutical arsenals benefit from using field soil environment for developing antibiotics. Enzyme production by soil bacteria is used as the signal source for drug activation. Sanitary functions of sols are dependent on soil microbial system workings. The healthy living can be enhanced by the human immune system training received from direct contact with soils. The hygiene hypothesis considers the microbial input due to exposure to soil as the essential ecosystem service. The invisible links between soil and public health result in large-scale consequences. Examples of concurrent degradation of soil and public health are worth scrutinizing. Public health records can provide valuable sources of 'soil-public health' interactions. It may be worthwhile to examine current assessments of soil health from the public health standpoint. Soil management can be an efficient instrument of public health control.
Pernick, M S
Supporters of eugenics, the powerful early 20th-century movement for improving human heredity, often attacked that era's dramatic improvements in public health and medicine for preserving the lives of people they considered hereditarily unfit. Eugenics and public health also battled over whether heredity played a significant role in infectious diseases. However, American public health and eugenics had much in common as well. Eugenic methods often were modeled on the infection control techniques of public health. The goals, values, and concepts of disease of these two movements also often overlapped. This paper sketches some of the key similarities and differences between eugenics and public health in the United States, and it examines how their relationship was shaped by the interaction of science and culture. The results demonstrate that eugenics was not an isolated movement whose significance is confined to the histories of genetics and pseudoscience, but was instead an important and cautionary part of past public health and a general medical history as well.
Souza, Gisélia Santana; Costa, Ediná Alves; Barros, Rafael Damasceno de; Pereira, Marcelo Tavares; Barreto, Joslene Lacerda; Guerra, Augusto Afonso; Acurcio, Francisco de Assis; Guibu, Ione Aquemi; Álvares, Juliana; Costa, Karen Sarmento; Karnikowski, Margô Gomes de Oliveira; Soeiro, Orlando Mario; Leite, Silvana Nair
To characterize the current stage of the institutionalization of pharmaceutical services in Brazilian cities. This study is part of the Pesquisa Nacional sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos (PNAUM - National Survey on Access, Use and Promotion of Rational Use of Medicines), a cross-sectional, exploratory, and evaluative study composed by an information survey in a representative sample of cities, stratified by Brazilian regions. We interviewed municipal secretaries of health, responsible for pharmaceutical services, and pharmacists responsible for the dispensing of medicines. The variables selected from the interviews were grouped into five dimensions that defined three stages of pharmaceutical services institutionalization: incipient (0%-34.0%), partial (35.0%-69.0%), and advanced (70.0%-100%), estimated based on the interviewees' answers. Frequencies were estimated with 95% confidence intervals. For the statistical association analysis, the Chi-square test was applied, with significance level of pautonomy in the management of financial resources. Indispensable items related to the structure expressed disparities between the regions, with statistically significant differences. The study showed a partial and heterogeneous process of institutionalization of pharmaceutical services in Brazilian cities, showing regional disparities. Variables related to the normative aspects of institutionalization were positively highlighted in all dimensions; however, it is necessary to conduct new studies to evaluate the institutionalization of pharmaceutical services' finalistic activities.
Matjasko, Jennifer L.; Cawley, John H.; Baker-Goering, Madeleine M.; Yokum, David V.
Behavioral economics provides an empirically informed perspective on how individuals make decisions, including the important realization that even subtle features of the environment can have meaningful impacts on behavior. This commentary provides examples from the literature and recent government initiatives that incorporate concepts from behavioral economics in order to improve health, decision making, and government efficiency. The examples highlight the potential for behavioral economics to improve the effectiveness of public health policy at low cost. Although incorporating insights from behavioral economics into public health policy has the potential to improve population health, its integration into government public health programs and policies requires careful design and continual evaluation of such interventions. Limitations and drawbacks of the approach are discussed. PMID:27102853
Spengler, J.D.; Sexton, K.
Although official efforts to control air pollution have traditionally focused on outdoor air, it is now apparent that elevated contaminant concentrations are common inside some private and public buildings. Concerns about potential public health problems due to indoor air pollution are based on evidence that urban residents typically spend more than 90 percent of their time indoors, concentrations of some contaminants are higher indoors than outdoors, and for some pollutants personal exposures are not characterized adequately by outdoor measurements. Among the more important indoor contaminants associated with health or irritation effects are passive tobacco smoke, radon decay products, carbon monoxide, nitrogen dioxide, formaldehyde, asbestos fibers, microorganisms, and aeroallergens. Efforts to assess health risks associated with indoor air pollution are limited by insufficient information about the number of people exposed, the pattern and severity of exposures, and the health consequences of exposures. An overall strategy should be developed to investigate indoor exposures, health effects, control options, and public policy alternatives
Costa, Nilson do Rosário; Siqueira, Sandra Venâncio; Uhr, Deborah; Silva, Paulo Fagundes da; Molinaro, Alex Alexandre
This study examines the relationships between Brazilian psychiatric reform, the adoption of the Centers for Psychosocial Care (CAPS) and the development of the Unified Health System (SUS). The adherence of municipal governments was a variable determinant for the spread of reform, especially due to the continental scale and fragmentation of the Brazilian federation. The article demonstrates the institutional stability of psychiatric reform in Brazil over two decades. The institutional nature of the decision-making process in the public arena has permitted the implementation of new organizational formats through imitation and financial incentives. The psychiatric reform was successful in defending the advantages of CAPS in relation to the asylum and hospital model dominant in past decades. The inductive policies, strengthened and upheld by Law 10.216/2001, transformed the agenda of psychiatric reform, limited to pioneering cities in a national public policy.
The Constitution of the World Health Organization (1946) states that the "enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being without distinction of race, religion, political belief, economic or social position." The international legal framework for this right was laid by the Universal Declaration of Human Rights (1948) and reaffirmed in the International Covenant on Economic, Social, and Cultural Rights (1966) and the Declaration of Alma-Ata (1978). In recent years, the framework has been developed on 10 key elements: national and international human rights, laws, norms, and standards; resource constraints and progressive realization; obligations of immediate effect; freedoms and entitlements; available, accessible, acceptable, and good quality; respect, protect, and fulfill; non-discrimination, equality, and vulnerability; active and informed participation; international assistance and cooperation; and monitoring and accountability. Whereas public health law plays an essential role in the protection and promotion of the right to health, the emergence of SARS (2003) highlighted the urgent need to reform national public health laws and international obligations relating to public health in order to meet the new realities of a globalized world, leading to the WHO Framework Convention on Tobacco Control (2003) and the revision of the WHO International Health Regulations (2005). The Asian Institute for Bioethics and Health Law, in conjunction with the Republic of Korea's Ministry of Health and Welfare and the WHO International Digest of Health Legislation, conducted a comparative legal analysis of national public health laws in various countries through a project entitled Domestic Profiles of Public/Population Health Legislation (2006), which underscored the importance of recognizing the political and social contexts of distinct legal cultures, including Western, Asian, Islamic, and African.
Monitoramento externo da qualidade dos exames citopatológicos cervicais realizados pelo Sistema Único de Saúde (SUS no Estado de Mato Grosso do Sul External quality control for cervical cytology exams performed in the Brazilian Public Health System of Mato Grosso do Sul State
Hilda Guimarães de Freitas
Full Text Available OBJETIVO: Analisar a concordância de diagnósticos citopatológicos de laboratórios credenciados e os verificados no monitoramento. MÉTODOS: Foram calculados o coeficiente de concordância global e o coeficiente Kappa de Cohen de uma amostra de conveniência dos exames selecionados mensalmente pelo Sistema de Informação do Câncer do Colo do Útero (SISCOLO para monitoramento externo da qualidade (MEQ dos 15 laboratórios que realizaram exames citopatológicos para o SUS entre 2002 e 2011 no Estado do Mato Grosso do Sul (região central do Brasil. A comparação entre os valores de concordância (coeficiente de concordância global e coeficiente Kappa dos anos inicial e final foi computada por meio da variação absoluta (delta e variação percentual relativa (VPR. RESULTADOS: Foram encaminhadas para releitura 15.989 esfregaços, dos quais 48,1% apresentavam laudo normal/alteração benigna, seguidos de atipia/lesão de baixo grau (36,3%, lesão de alto grau/carcinoma/adenocarcinoma (4,2% e insatisfatórios para leitura (11,4%. O coeficiente de concordância global oscilou entre 0,2 e 1,0, sendo que o valor mediano passou de 0,7 em 2002 para 1,0 em 2011 (VPR=+36,6%. Nesse mesmo período, os valores medianos do coeficiente Kappa aumentaram de 0,5 para 0,9 (VPR=+80,8%. CONCLUSÕES: Conclui-se pela exequibilidade do MEQ dos exames citopatológicos na esfera estadual e que sua implementação resulta em melhoria nos diagnósticos realizados na rede SUS.PURPOSE: To evaluate the diagnostic agreement between the cytopathology reports issued by accredited laboratories and those obtained by quality control. METHODS: We calculated the overall agreement and Cohen's kappa coefficients of a convenience sample of smears selected monthly by the Information System of Cervical Cancer (SISCOLO for External Quality Control of the 15 laboratories that performed cytopathological PAP tests for the Brazilian Public Health System (SUS between 2002 and 2011 in
Elias, Flávia Tavares Silva; Araújo, Denizar Vianna
The universal access to a health care system for the Brazilian population was established in 1990. Brazil is a country with no tradition in the production and use of health economic evaluation (HEE) to guide decision making in the public health system. It is only within the last two decades that HEEs using a microeconomic approach have appeared in the academic field. On a national level, HEE and Health Technology Assessment (HTA), in a wider sense, were first taken into account in 2003. Two policies deserve to be mentioned - (i) the regulation of medicines in the Brazilian market, and (ii) science, technology and innovation policy. The latter required the fostering of applied research to encourage the application of methods which employ systematic reviews and economic analyses of cost-effectiveness to guide the incorporation of technologies in the Brazilian health care system. The Ministry of Health has initiated the process of incorporating these new technologies on a federal level during the last ten years. In spite of the improvement of HEE methods at Brazilian universities and research institutes, these technologies have not yet reached the governmental bodies. In Brazil, the main challenge lies in the production, interpretation and application of HEE to all technologies within the access scheme(s), and there is limited capacity building. Setting priorities can be the solution for Brazil to be able to perform HEE for relevant technologies within the access scheme(s) while the universal coverage system struggles with a triple burden of disease. Copyright © 2014. Published by Elsevier GmbH.
Sestelo, José Antonio de Freitas; Souza, Luis Eugenio Portela Fernandes de; Bahia, Lígia
This article draws on a previous review of 270 articles on private health plans published from 2000 to 2010 and selects 17 that specifically address the issue of the relationship between the public and private healthcare sectors. Content analysis considered the studies' concepts and terms, related theoretical elements, and predominant lines of argument. A reading of the argumentative strategies detected the existence of a critical view of the modus operandi in the public/private relationship based on Social Medicine and the theoretical tenets of the Brazilian Health Reform Movement. The study also identified contributions based on neoliberal business approaches that focus strictly on economic issues to discuss private health insurance. Understanding the public/private link in healthcare obviously requires the development of a solid empirical base, analyzed with adequate theoretical assumptions due to the inherent degree of complexity in the public/private healthcare interface.
The Institute of Medicine has stated that legal structures and the authority vested in health agencies and other partners within the public health system are essential to improving the public's health. Variation between the laws of different jurisdictions within the United States allows for natural experimentation and research into their…
Marina Salgado Borges; Gilberto José Miranda; Sheizi Calheira Freitas
The aim of this study was analyzing the relations between academic performance and motivation of Accounting students in a Brazilian public university based on Self-determination Theory. Methodologically, in order to reach that, structured questionnaires were applied in classrooms with the Brazilian version of the Academic Motivation Scale (AMS), in a sample of 316 students enrolled from second to tenth periods of that course, equivalent to 37.2% of the total number of students. Data were anal...
Griep, Rosane Härter; Nobre, Aline Araújo; Alves, Márcia Guimarães de Mello; da Fonseca, Maria de Jesus Mendes; Cardoso, Letícia de Oliveira; Giatti, Luana; Melo, Enirtes Caetano Prates; Toivanen, Susanna; Chor, Dóra
Unhealthy lifestyle choices, such as smoking and sedentary behavior, are among the main modifiable risk factors for chronic non-communicable diseases. The workplace is regarded as an important site of potential health risks where preventive strategies can be effective. We investigated independent associations among psychosocial job strain, leisure-time physical inactivity, and smoking in public servants in the largest Brazilian adult cohort. We conducted a cross-sectional analysis of baseline data from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil)-a multicenter prospective cohort study of civil servants. Our analytical samples comprised 11,779 and 11,963 current workers for, respectively, analyses of job strain and leisure-time physical activity and analyses of job strain and smoking. Job strain was assessed using the Brazilian version of the Swedish Demand-Control-Support Questionnaire; physical activity was evaluated using a short form of the International Physical Activity Questionnaire. We also examined smoking status and number of cigarettes smoked per day. The association reported in this paper was assessed by means of multinomial and logistic regression, stratified by sex. Among men, compared with low-strain activities (low demand and high control), job strain showed an association with physical inactivity (odds ratio [OR] = 1.34; 95% confidence interval [CI] = 1.09-1.64) or with the practice of physical activities of less than recommended duration (OR = 1.44; 95% CI = 1.15-1.82). Among women, greater likelihood of physical inactivity was identified among job-strain and passive-job groups (OR = 1.47; 95% CI = 1.22-1.77 and OR = 1.42; 95% CI = 1.20-1.67, respectively). Greater control at work was a protective factor for physical inactivity among both men and women. Social support at work was a protective factor for physical inactivity among women, as was smoking for both genders. We observed no association
Smeesters, Patrick; Pinak, Miroslav
Full text: This paper summarizes the scope of activities, ongoing experience and current results of the Expert Group on the Public Health Perspective in Radiological Protection (EGPH) of the Committee of Radiological Protection and Public Health, OECD Nuclear Energy Agency. While the prime and general task of the EGPH group is looking at how the public health and radiation protection can better take an advantage of their respective perspectives, the following four areas have been explored in detail: a) Exposure to radon; b) Justification of medical exposures; c) Public health judgement and decision making based on new scientific evidence; and d) Management of individual differences. In most of these areas, a targeted telephone survey on public policies in selected countries was used for collecting information from stake holders (public, consumers groups, public health and radiation protection regulators, governmental bodies, medical practitioners, patients, scientific communities, NGOs, etc.). The presented paper also highlights key issues of collected information and summarises existing approaches and policies. The case study on exposure to radon collects national information on approaches to the management of domestic radon risks, focusing on the integration of radiation protection and public health aspects (quality of dwellings, overall quality of indoor air, perception of radon levels, position of radon risk in the pool of other risks). In the case of justification of medical exposures, the Group studies the applications of the justification principle in opportunistic screenings (responsibilities, management of the situation, risk assessment). The precautionary principle and its impact on policy judgement in the light of significant scientific uncertainties can have a large influence on radiological-protection decision making. The case study on public health judgement and decision making based on new scientific evidence is exploring how these uncertainties and
McBride, J R [Southwestern Radiological Health Laboratory, Las Vegas, NV (United States)
Off-Site Radiological Safety Programs conducted on past Plowshare experimental projects by the Southwestern Radiological Health Laboratory for the AEC will be presented. Emphasis will be placed on the evaluation of the potential radiation hazard to off-site residents, the development of an appropriate safety plan, pre- and post-shot surveillance activities, and the necessity for a comprehensive and continuing community relations program. In consideration of the possible wide use of nuclear explosives in industrial applications, a new approach to off-site radiological safety will be discussed. (author)
Off-Site Radiological Safety Programs conducted on past Plowshare experimental projects by the Southwestern Radiological Health Laboratory for the AEC will be presented. Emphasis will be placed on the evaluation of the potential radiation hazard to off-site residents, the development of an appropriate safety plan, pre- and post-shot surveillance activities, and the necessity for a comprehensive and continuing community relations program. In consideration of the possible wide use of nuclear explosives in industrial applications, a new approach to off-site radiological safety will be discussed. (author)
Minhas Gunjeet S
Full Text Available Abstract Background Experience with public engagement activities regarding the risks and benefits of science and technology (S&T is growing, especially in the industrialized world. However, public engagement in the developing world regarding S&T risks and benefits to explore health issues has not been widely explored. Methods This paper gives an overview about public engagement and related concepts, with a particular focus on challenges and benefits in the developing world. We then describe an Internet-based platform, which seeks to both inform and engage youth and the broader public on global water issues and their health impacts. Finally, we outline a possible course for future action to scale up this and similar online public engagement platforms. Results The benefits of public engagement include creating an informed citizenry, generating new ideas from the public, increasing the chances of research being adopted, increasing public trust, and answering ethical research questions. Public engagement also fosters global communication, enables shared experiences and methodology, standardizes strategy, and generates global viewpoints. This is especially pertinent to the developing world, as it encourages previously marginalized populations to participate on a global stage. One of the core issues at stake in public engagement is global governance of science and technology. Also, beyond benefiting society at large, public engagement in science offers benefits to the scientific enterprise itself. Conclusion Successful public engagement with developing world stakeholders will be a critical part of implementing new services and technologies. Interactive engagement platforms, such as the Internet, have the potential to unite people globally around relevant health issues.
Illness Disease Reporting and Surveillance Bureau of Public Health Laboratories Environmental Health Air Air Monitoring Carbon Monoxide Indoor Air Quality Mold Radon Water Aquatic Toxins Beach Water Quality purification, testing, treatment, and disinfection procedures. To ensure that the pool technicians are
Robertson, Peter J.
Career guidance may have the potential to promote public health by contributing positively to both the prevention of mental health conditions and to population level well-being. The policy implications of this possibility have received little attention. Career guidance agencies are well placed to reach key target groups. Producing persuasive…
Freudenberg, Nicholas; Galea, Sandro; Vlahov, David
... and urban renewal on health, and the challenges facing cities in the developing world. It also examines conditions such as infectious diseases, violence and disasters, and mental illness. Nicholas Freudenberg is Distinguished Professor of Public Health and Social Psychology, Hunter College and the Graduate Center, City University of New York. Sandro G...
and comedians, there is a lot of serious introspection by health professionals and where possible remedial corrective measures are ... The public perception of health professionals is heavily influenced by greatly skewed media reporting. ... because of the resulting intense itch and could hardly sleep at night. The tourist ...
May 2, 2014 ... Health promotion has three main ethical issues: (i) what are the ultimate goals for public .... construction of new norms, the shaping of existing norms, the .... despite the fact that we know they are bad for people's health. There.
Bevc, Christine A; Retrum, Jessica H; Varda, Danielle M
Inter-organizational networks represent one of the most promising practice-based approaches in public health as a way to attain resources, share knowledge, and, in turn, improve population health outcomes. However, the interdependencies and effectiveness related to the structure, management, and costs of these networks represents a critical item to be addressed. The objective of this research is to identify and determine the extent to which potential partnering patterns influence the structure of collaborative networks. This study examines data collected by PARTNER, specifically public health networks (n = 162), to better understand the structured relationships and interactions among public health organizations and their partners, in relation to collaborative activities. Combined with descriptive analysis, we focus on the composition of public health collaboratives in a series of Exponential Random Graph (ERG) models to examine the partnerships between different organization types to identify the attribute-based effects promoting the formation of network ties within and across collaboratives. We found high variation within and between these collaboratives including composition, diversity, and interactions. The findings of this research suggest common and frequent types of partnerships, as well as opportunities to develop new collaborations. The result of this analysis offer additional evidence to inform and strengthen public health practice partnerships.
Christine A. Bevc
Full Text Available Inter-organizational networks represent one of the most promising practice-based approaches in public health as a way to attain resources, share knowledge, and, in turn, improve population health outcomes. However, the interdependencies and effectiveness related to the structure, management, and costs of these networks represents a critical item to be addressed. The objective of this research is to identify and determine the extent to which potential partnering patterns influence the structure of collaborative networks. This study examines data collected by PARTNER, specifically public health networks (n = 162, to better understand the structured relationships and interactions among public health organizations and their partners, in relation to collaborative activities. Combined with descriptive analysis, we focus on the composition of public health collaboratives in a series of Exponential Random Graph (ERG models to examine the partnerships between different organization types to identify the attribute-based effects promoting the formation of network ties within and across collaboratives. We found high variation within and between these collaboratives including composition, diversity, and interactions. The findings of this research suggest common and frequent types of partnerships, as well as opportunities to develop new collaborations. The result of this analysis offer additional evidence to inform and strengthen public health practice partnerships.
Bevc, Christine A.; Retrum, Jessica H.; Varda, Danielle M.
Inter-organizational networks represent one of the most promising practice-based approaches in public health as a way to attain resources, share knowledge, and, in turn, improve population health outcomes. However, the interdependencies and effectiveness related to the structure, management, and costs of these networks represents a critical item to be addressed. The objective of this research is to identify and determine the extent to which potential partnering patterns influence the structure of collaborative networks. This study examines data collected by PARTNER, specifically public health networks (n = 162), to better understand the structured relationships and interactions among public health organizations and their partners, in relation to collaborative activities. Combined with descriptive analysis, we focus on the composition of public health collaboratives in a series of Exponential Random Graph (ERG) models to examine the partnerships between different organization types to identify the attribute-based effects promoting the formation of network ties within and across collaboratives. We found high variation within and between these collaboratives including composition, diversity, and interactions. The findings of this research suggest common and frequent types of partnerships, as well as opportunities to develop new collaborations. The result of this analysis offer additional evidence to inform and strengthen public health practice partnerships. PMID:26445053
Precision public health is an emerging practice to more granularly predict and understand public health risks and customize treatments for more specific and homogeneous subpopulations, often using new data, technologies, and methods. Big data is one element that has consistently helped to achieve these goals, through its ability to deliver to practitioners a volume and variety of structured or unstructured data not previously possible. Big data has enabled more widespread and specific research and trials of stratifying and segmenting populations at risk for a variety of health problems. Examples of success using big data are surveyed in surveillance and signal detection, predicting future risk, targeted interventions, and understanding disease. Using novel big data or big data approaches has risks that remain to be resolved. The continued growth in volume and variety of available data, decreased costs of data capture, and emerging computational methods mean big data success will likely be a required pillar of precision public health into the future. This review article aims to identify the precision public health use cases where big data has added value, identify classes of value that big data may bring, and outline the risks inherent in using big data in precision public health efforts.
Florindo, Alex Antonio; Barrozo, Ligia Vizeu; Cabral-Miranda, William; Rodrigues, Eduardo Quieroti; Turrell, Gavin; Goldbaum, Moisés; Cesar, Chester Luiz Galvão; Giles-Corti, Billie
Access to public open space is important to increase leisure-time walking (LTW) in high-income countries, but there is little evidence in middle-income countries. We conducted a cross-sectional analysis to examine the relationship between LTW and the presence of different public open spaces (parks, bike paths, and squares) and the mix of these recreational destinations near the homes of adults participating in the Sao Paulo Health Survey ( n = 3145). LTW was evaluated by a questionnaire. We delineated buffers (500, 1000, and 1500 m) from the geographic coordinates of the adults' residential addresses using a geographic information system. We used multilevel logistic regression taking account of clustering by census tracts and households, and with adjustment for social, demographics, and health characteristics. The main results showed that the presence of at least two recreational destinations within a 500-m buffer of participants' homes were associated with an increased odds of LTW compared with no destinations present (OR = 1.65; 95% CI 1.09-2.55). No associations were found for destinations further away. These results support actions outlined in the new urban plan for Sao Paulo city and could be used to highlight the importance access to a mix of public open spaces to promote physical activity in megacities of middle-income countries.
Alex Antonio Florindo
Full Text Available Access to public open space is important to increase leisure-time walking (LTW in high-income countries, but there is little evidence in middle-income countries. We conducted a cross-sectional analysis to examine the relationship between LTW and the presence of different public open spaces (parks, bike paths, and squares and the mix of these recreational destinations near the homes of adults participating in the Sao Paulo Health Survey (n = 3145. LTW was evaluated by a questionnaire. We delineated buffers (500, 1000, and 1500 m from the geographic coordinates of the adults’ residential addresses using a geographic information system. We used multilevel logistic regression taking account of clustering by census tracts and households, and with adjustment for social, demographics, and health characteristics. The main results showed that the presence of at least two recreational destinations within a 500-m buffer of participants’ homes were associated with an increased odds of LTW compared with no destinations present (OR = 1.65; 95% CI 1.09–2.55. No associations were found for destinations further away. These results support actions outlined in the new urban plan for Sao Paulo city and could be used to highlight the importance access to a mix of public open spaces to promote physical activity in megacities of middle-income countries.
Lotufo, Paulo Andrade; Malta, Deborah Carvalho; Szwarcwald, Celia Landmann; Stopa, Sheila Rizzato; Vieira, Maria Lucia; Bensenor, Isabela Martins
To estimate the prevalence of angina pectoris in the Brazilian adult population with the use of the Rose questionnaire for angina in the National Health Survey (PNS 2013). Population survey representing the Brazilian population aged 18 years and older, with probability carried out sampling in three stages. The interview records of 60,202 individuals were obtained in the country. The respondent was presented with the short Rose questionnaire with three questions, adapted by Lawlor in 2003 and validated in Brazil, to identify angina pectoris grade I (mild) and II (moderate/severe). The prevalence rate was calculated with a 95% confidence interval (95%CI) according to sex, age, education, and race/color. The prevalence of mild angina (grade I) was of 7.6% (95%CI 7.2 - 8.0) for the entire population, more frequently in women - 9.1% (95%CI 8.5 - 9.7) - than in men - 5.9% (95%CI 5.3 - 6.4). The frequency of moderate/severe angina (grade II) was of 4.2 (95%CI 3.9 - 4.5), also more common in women - 5.2% (95%CI 4.7 - 5.6) - than in men - 3.0% (95%CI 2.7 - 3.4). The prevalence of angina by age group increased progressively with age. The prevalence of angina of any sort was inverse to years of formal study. Despite the higher value of the presence of angina in black people, there was no significant difference by race/skin color. The high prevalence rate of angina pectoris in the population aged 18 years and above was consistent with studies in other countries, revealing the importance of coronary heart disease as a public health problem.
Viegas Andrade, Mônica; Noronha, Kenya; Kind, Paul; Maia, Ana Carolina; Miranda de Menezes, Renata; De Barros Reis, Carla; Nepomuceno Souza, Michelle; Martins, Diego; Gomes, Lucas; Nichele, Daniel; Calazans, Julia; Mascarenhas, Tamires; Carvalho, Lucas; Lins, Camila
To elicit preference weights for a subset of EuroQol five-dimensional (EQ-5D) questionnaire health states from a representative sample for the state of Minas Gerais, Brazil, using a time trade-off (TTO) method and to analyze these data so as to estimate social preference weights for the complete set of 243 states. Data came from a valuation study with 3362 literate individuals aged between 18 and 64 years living in urban areas. The present study was based on quota sampling by age and sex. Face-to-face interviews were conducted in participants' own homes. A total of 99 EQ-5D questionnaire health states were selected, presorted into 26 blocks of six unique health states. Each participant valued one block together with the full health, worst health, and dead states. Each health state was evaluated by more than 100 individuals. TTO data were modeled at both individual and aggregate levels by using ordinary least squares and random effects methods. Values estimated by different models yielded very similar results with satisfactory goodness-of-fit statistics: the mean absolute error was around 0.03 and fewer than 25% of the states had a mean absolute error greater than 0.05. Dummies coefficients for each level within the EQ-5D questionnaire dimensions of health displayed an internally consistent ordering, with the mobility dimension demonstrating the largest value decrement. The values of mean observed transformed TTO values range from 0.869 to-0.235. The study demonstrates the feasibility of conducting face-to-face interviews using TTO in a Brazilian population setting. The estimated values for EQ-5D questionnaire health states based on this Minas Gerais survey represent an important first step in establishing national Brazilian social preference weights for the EQ-5D questionnaire. Copyright © 2013 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.
Kaste, L M; Sadler, Z E; Hayes, K L; Narendran, S; Niessen, L C; Weintraub, J A
The purpose of this study was to assess the representation of academically based diplomates of the American Board of Dental Public Health (ABDPH) and to identify their perceptions on the training of dental public health predoctoral faculty. Data were collected by a mailed, self-administered, 13-item questionnaire. The population was the 48 diplomates of the ABDPH as of March 1997 associated with academic institutions. Twenty of the 55 US dental schools had a diplomate of the ABDPH with a mean of 1.8 diplomates per school with a diplomate. An average of 4.5 full-time faculty members per school were associated with teaching dental public health. A master's degree in public health (MPH) was the most frequently suggested educational requirement for dental public health faculty. Continuing education courses were training needs perceived for dental public health faculty. The lack of time, money, and incentives, along with perceived rigidity of requirements for board certification, were reported as major barriers for faculty becoming dental public health board certified. Numerous challenges confront the development of a strong dental public health presence in US dental schools. These challenges include, among others, insufficient numbers of academic dental public health specialists and insufficient motivations to encourage promising candidates to pursue specialty status.
Soils sustain life. They affect human health via quantity, quality, and safety of available food and water, and via direct exposure of individuals to soils. Throughout the history of civilization, soil-health relationships have inspired spiritual movements, philosophical systems, cultural exchanges, and interdisciplinary interactions, and provided medicinal substances of paramount impact. Given the climate, resource, and population pressures, understanding and managing the soil-health interactions becomes a modern imperative. We are witnessing a paradigm shift from recognizing and yet disregarding the 'soil-health' nexus complexity to parameterizing this complexity and identifying reliable controls. This becomes possible with the advent of modern research tools as a source of 'big data' on multivariate nonlinear soil systems and the multiplicity of health metrics. The phenomenon of suppression of human pathogens in soils and plants presents a recent example of these developments. Evidence is growing about the dependence of pathogen suppression on the soil microbial community structure which, in turn, is affected by the soil-plant system management. Soil eutrophication appears to create favorable conditions for pathogen survival. Another example of promising information-rich research considers links and feedbacks between the soil microbial community structure and structure of soil physical pore space. The two structures are intertwined and involved in the intricate self-organization that controls soil services to public health. This, in particular, affects functioning of soils as a powerful water filter and the capacity of this filter with respect to emerging contaminants in both 'green' and 'blue' waters. To evaluate effects of soil services to public health, upscaling procedures are needed for relating the fine-scale mechanistic knowledge to available coarse-scale information on soil properties and management. More needs to be learned about health effects of soils
Mendes, Luciano; Dos Santos, Heliani Berlato; Ichikawa, Elisa Yoshie
The objective of this article is to make some analysis on the process of work and accidents occurring in slaughterhouses, evidenced in the Brazilian documentary film called Flesh and Bone . As such, it was necessary to discuss an alternative theoretical concept in relation to theories about health and safety at work. This alternative discussion focuses on the concepts of biopower and biopolitics. The use of audiovisual elements in research is not new, and there is already a branch of studies with methodological and epistemological variations. The Brazilian documentary Flesh and Bone was the basis for the research. The analysis of this documentary will be carried out from two complementary perspectives: "textual analysis" and "discourse analysis." Flesh and Bone presents problems related to health and safety at work in slaughterhouses because of the constant exposure of workers to knives, saws, and other sharp instruments in the workplace. The results show that in favor of higher production levels, increased overseas market sales, and stricter quality controls, some manufacturers resort to various practices that often result in serious injuries, disposal, and health damages to workers. Flesh and Bone , by itself, makes this explicit in the form of denunciation based on the situation of these workers. What it does not make clear is that, in the context of biopolitics, the actions aimed at solving these problems or even reducing the negative impacts for this group of workers, are not efficient enough to change such practices.
Mota, Daniela Belchior; Ronzani, Telmo Mota
One of the challenges with respect to public health and the abuse of alcohol and other drugs is to implement policies in support of greater co-ordination among various levels of government. In Brazil, policies are formulated by the Secretaria Nacional de Políticas sobre Drogas (SENAD - State Department for Policies on Drugs) and the Ministério da Saúde (MS - Ministry of Health). This study aims to compare implementation of policies adopted by SENAD and MS at the municipal level. Three municipalities were intentionally selected: Juiz de Fora having a larger network of treatment services for alcohol and drug users; Lima Duarte, a small municipality, which promotes the political participation of local actors (COMAD - Municipal Council on Alcohol and Drugs); and São João Nepomuceno, also a small municipality, chosen because it has neither public services specialised to assist alcohol and other drugs users, nor COMAD. Data collection was conducted through interviews with key informants (n = 19) and a review of key documents concerned with municipal policies. Data analysis was performed using content analysis. In Juiz de Fora, there are obstacles regarding the integration of the service network for alcohol and other drug users and also the articulation of local actors, who are predominant in the mental health sector. In Lima Duarte, while there is a link between local actors through COMAD, their actions within the local service network have not been effective. In São João Nepomuceno, there were no public actions in the area of alcohol and drugs, and consequently insufficient local debate. However, some voluntary, non-governmental work has been undertaken. There were weaknesses in the implementation of national-level policies by SENAD and the MS, due to the limited supply of available treatment, assistance and the lack of integration among local actors. © 2015 John Wiley & Sons Ltd.
Grove, Natalie J; Zwi, Anthony B
This paper uses 'othering' theory to explore how forced migrants are received in developed countries and considers the implications of this for public health. It identifies a variety of mechanisms by which refugees, asylum seekers and irregular migrants are positioned as 'the other' and are defined and treated as separate, distant and disconnected from the host communities in receiving countries. The paper examines how this process has the potential to affect health outcomes both for individuals and communities and concludes that public health must engage with and challenge this othering discourse. It argues that public health practitioners have a critical role to play in reframing thinking about health services and health policies for forced migrants, by promoting inclusion and by helping shape a narrative which integrates and values the experiences of this population.
Birnbaum, David; Gretsinger, Kathryn; Ellis, Ursula
Purpose The aim of this paper is to describe the experience and educational benefits of a course that has several unique educational design features. Design/methodology/approach This includes narrative description of faculty and student experience from participants in a flipped-instructional-design inter-professional education course. Findings "Improving Public Health - An Interprofessional Approach to Designing and Implementing Effective Interventions" is an undergraduate public health course open to students regardless of background. Its student activities mirror the real-life tasks and challenges of working in a public health agency, including team-building and leadership; problem and project definition and prioritization; evidence-finding and critical appraisal; written and oral presentation; and press interviews. Students successfully developed project proposals to address real problems in a wide range of communities and settings and refined those proposals through interaction with professionals from population and public health, journalism and library sciences. Practical implications Undergraduate public health education is a relatively new endeavor, and experience with this new approach may be of value to other educators. Originality/value Students in this course, journalism graduate students who conducted mock interviews with them and instructors who oversaw the course all describe unique aspects and related personal benefit from this novel approach.
Meagher, Karen M
As bioethicists increasingly turn their attention to the profession of public health, many candidate frameworks have been proposed, often with an eye toward articulating the values and foundational concepts that distinguish this practice from curative clinical medicine. First, I will argue that while these suggestions for a distinct ethics of public health are promising, they arise from problems within contemporary bioethics that must be taken into account. Without such cognizance of the impetus for public health ethics, we risk developing a set of ethical resources meant exclusively for public health professionals, thereby neglecting implications for curative medical ethics and the practice of bioethics more broadly. Second, I will present reasons for thinking some of the critiques of dominant contemporary bioethics can be met by a virtue ethics approach. I present a virtue ethics response to criticisms that concern (1) increased rigor in bioethics discourse; (2) the ability of normative theory to accommodate context; and (3) explicit attention to the nature of ethical conflict. I conclude that a virtue ethics approach is a viable avenue for further inquiry, one that leads us away from developing ethics of public health in a vacuum and has the potential for overcoming certain pitfalls of contemporary bioethics discourse. © 2011 Blackwell Publishing Ltd.
Costa, Karen Sarmento; Nascimento, José Miguel do
To analyze results of the Horus Information System, comparing elements of this system with some international experiences. Horus is a technological innovation introduced in 2009 in the Pharmaceutical management information system of the Sistema Único de Saúde (Brazilian Unified Health System). In 2011, local managers and health professionals of 1,247 municipalities (16 states) that adhered to Horus answered questionnaires on pharmaceutical assistance in primary care and about the Horus system. This is a descriptive and exploratory study, developed with the use of quantitative and qualitative methods of research. Multivariate tools were used for data collection and interpretative support of the statistical inference and thematic analysis. The main changes identified after the implementation of this system were: improvement on technical and scientific quality control of Pharmaceutical Assistance, improvement on the supply of medications and health care; training of human resources and knowledge management; improvement on the relationship health managers/users; development in the administrative management and greater inter-state management; and improvement on the technological infrastructure. In terms of health information systems, these categories are consistent with programs and obstacles observed in international experiences. The biggest gap identified was the fact that Horus was not included in a national policy of health information systems, which is in a process of consolidation in Brazil. The national database of actions and services within the Pharmaceutical Assistance will enable the collection, analysis and dissemination of information regarding integrated pharmaceutical assistance in the Brazilian context. The Horus System is a technological innovation that enables the management of the Pharmaceutical Assistance. The national base will enable the definition and agreement on national indicators of Pharmaceutical Assistance, aiming to produce evidence of
Puchalski, Krzysztof; Korzeniowska, Elzbieta
In this paper the author analyses how far in Poland the idea of workplace health promotion (WHP) does exist in the area of public health understood in its broadest sense. The analysis encapsulates the following issues: (a) the national legislative policy, (b) strategies, programs and projects concerning health issues launched or coordinated by the state or local administration, (c) grassroots initiatives for health promotion supported by local and regional administration, (d) civic projects or business strategies for health. In addition, the author emphasizes the marginalization of workplace health promotion and lack of cohesive policy in this field as well as, the fact that health problems of the working population arising from current demographic, technological, economic and social changes that could be dealt with through developing and implementing WHP projects are not yet fully perceived by public health policy makers.
Heidary, F; Rahimi, A; Gharebaghi, R
Visual sciences have been progressing quickly in recent decades through globalization phenomenon. An enormous change has taken place in ocular health issues, however, there are various problems facing ophthalmic public health worldwide. In the previous years, the World Health Organization and the International Agency for the Prevention of Blindness in partnership launched the global initiative to eradicate avoidable blindness by the year 2020, VISION 2020 the Right to Sight. It has concentrated on the prevention of blindness disability and recognized a health issue-sight as a human right. In view of challenges ahead of visual sciences, close collaboration between international agencies at the global level to implement new strategies and monitor the progress will be mandatory. In these circumstances non-governmental organizations should not be neglected. World Sight Day 2012 would be a great opportunity to be a focus on importance of visual impairment as an important public health issue and discovering new challenges ahead.
The European Public Health Law Network was established in 2007 as part of the European Union (EU) co-funded Public Health Law Flu project. The aims of the website consisted of designing an interactive network of specialist information and encouraging an exchange of expertise amongst members. The website sought to appeal to academics, public health professionals and lawyers. The Public Health Law Flu project team designed and managed the website. Registered network members were recruited through publicity, advertising and word of mouth. Details of the network were sent to health organizations and universities throughout Europe. Corresponding website links attracted many new visitors. Publications, news, events and a pandemic glossary became popular features on the site. Although the website initially focused only on pandemic diseases it has grown into a multidisciplinary website covering a range of public health law topics. The network contains over 700 publications divided into 28 public health law categories. News, events, front page content, legislation and the francophone section are updated on a regular basis. Since 2007 the website has received over 15,000 views from 156 countries. Newsletter subscribers have risen to 304. There are now 723 followers on the associated Twitter site. The European Public Health Law Network has been a successful and innovative site in the area of public health law. Interest in the site continues to grow. Future funding can contribute to a bigger site with interactive features and pages in a wider variety of languages to attract a wider global audience. Copyright © 2011 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.
Gisélia Santana Souza
Full Text Available ABSTRACT OBJECTIVE To characterize the current stage of the institutionalization of pharmaceutical services in Brazilian cities. METHODS This study is part of the Pesquisa Nacional sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos (PNAUM – National Survey on Access, Use and Promotion of Rational Use of Medicines, a cross-sectional, exploratory, and evaluative study composed by an information survey in a representative sample of cities, stratified by Brazilian regions. We interviewed municipal secretaries of health, responsible for pharmaceutical services, and pharmacists responsible for the dispensing of medicines. The variables selected from the interviews were grouped into five dimensions that defined three stages of pharmaceutical services institutionalization: incipient (0%-34.0%, partial (35.0%-69.0%, and advanced (70.0%-100%, estimated based on the interviewees’ answers. Frequencies were estimated with 95% confidence intervals. For the statistical association analysis, the Chi-square test was applied, with significance level of p<0.05. RESULTS Our results show a partial and heterogeneous process of institutionalization of pharmaceutical services in Brazil, and an advanced stage in formal structures, such as the municipal health plans and the existence of a standardized list of medicines. The analysed variables in the “organization, structure, and financing” dimension configured stages that range from partial to advanced. The management presented partial institutionalization, positively showing the existence of computerized system, but also disparate results regarding the autonomy in the management of financial resources. Indispensable items related to the structure expressed disparities between the regions, with statistically significant differences. CONCLUSION The study showed a partial and heterogeneous process of institutionalization of pharmaceutical services in Brazilian cities, showing regional
Fox, Marie; Thomson, Michael
Law has played an important, but largely constitutive, role in the development of the public health enterprise. Thus, law has been central to setting up the institutions and offices of public health. The moral agenda has, however, been shaped to a much greater extent by bioethics. While social justice has been placed at the heart of this agenda, we argue that there has been little place within dominant conceptions of social justice for gender equity and women's interests which we see as crucial to a fully realised vision of social justice. We argue that, aside from particular interventions in the field of reproduction, public health practice tends to marginalise women-a claim we support by critically examining strategies to combat the HIV pandemic in sub-Saharan Africa. To counter the marginalisation of women's interests, this article argues that Amartya Sen's capabilities approach has much to contribute to the framin