Factors related to the resignation and migration of physicians in public health administration agencies using nationwide survey data in Japan.

BACKGROUND: Physicians in public health administration agencies (public health physicians: PHP) play important roles in public health; however, there are not enough such physicians in Japan. This study aimed to elucidate the factors related to the resignation and migration of PHPs using nationwide survey data. METHODS: Data from the Survey of Physicians, Dentists, and Pharmacists (2010, 2012, 2014, and 2016) were analyzed. The outcome was the resignation of PHPs or migration to public health administration agencies. The explanatory variables in the resignation analysis were age, sex, workplace, and board certification status. The type of work was added as an explanatory variable in the migration analysis, and clinical specialty was added to the clinical doctor-restricted analysis. The odds ratios (ORs) of the explanatory variables were calculated using generalized estimation equations. RESULTS: In the resignation analysis among PHPs, women had a significantly lower OR, whereas younger PHPs and those with board certifications had significantly higher ORs. In the migration to public health administration agencies analysis among medical doctors, women and those aged between 35 and 39 years had significantly higher ORs, but those with board certifications had significantly lower ORs. Hospital/clinic founders or directors had significantly lower ORs, but the clinic staff and 'others/not working' had significantly higher ORs. In the migration to public health administration agencies analysis among clinical physicians, those aged between 35 and 39 years had significantly higher ORs. Still, those with two or more board certifications had significantly lower ORs. Hospital/clinic founders or directors had significantly lower ORs, but the clinic staff had significantly higher ORs. Clinical doctors specializing in surgery and other specialties had significantly lower ORs, but those specializing in pediatrics and psychiatry/psychosomatic medicine had significantly higher ORs. CONCLUSIONS: Having board certifications were significantly related to the resignation of PHPs and migration to public health administration agencies. Women migrated to public health administration agencies more than men and younger PHPs were more likely to resign. However, medical doctors aged between 35 and 39 years were more likely to migrate to public health administration agencies. Similarly, clinic staff, non-clinical physicians, and those whose specialties were pediatrics and psychiatry/psychosomatic medicine were more likely to migrate to public health administration agencies.

Plano EVA-TO: plano de enfrentamento à violência autoprovocada do Estado do Tocantins com ênfase na atenção integral à saúde / EVA-TO Plan: plan to face self-inflicted violence in the State of Tocantins with an emphasis on comprehensive health care

O Plano de Enfrentamento à Violência Autoprovocada do Estado do Tocantins com Ênfase na Atenção Integral à Saúde foi desenvolvido para fortalecer a rede de atenção psicossocial, em colaboração com o Sistema Único de Saúde (SUS) e o Sistema Único de Assistência Social (SUAS). Elaborado pelo Grupo de Trabalho "Flor de Pequi", o plano tem como objetivo qualificar a Rede de Atenção à Saúde, orientando gestores e profissionais de saúde na prevenção da violência autoprovocada, automutilação e suicídio, além de promover o acolhimento e compartilhamento do cuidado na rede de atenção à saúde. O documento foi elaborado em resposta a demandas relacionadas aos dados de violência autoprovocada, solicitações do Conselho Estadual de Defesa de Direitos da Criança e do Adolescente e do Conselho Regional de Psicologia. A metodologia, discussão, metas, ações e monitoramento também são abordados no plano.

The Plan for Confronting Self-Inflicted Violence in the State of Tocantins with an Emphasis on Comprehensive Health Care was developed to strengthen the psychosocial care network in collaboration with the Unified Health System (SUS) and the Unified Social Assistance System (SUAS). Elaborated by the "Flor de Pequi" Working Group, the plan aims to enhance the Health Care Network by providing guidance to managers and health professionals in the prevention of self-inflicted violence, self-harm, and suicide, while promoting care and support within the health care system. The document was created in response to demands related to self-inflicted violence data, requests from the State Council for the Defense of the Rights of Children and Adolescents, and the Regional Psychology Council. The plan also addresses methodology, discussion, goals, actions, and monitoring.

El Plan de Enfrentamiento a la Violencia Autoinfligida en el Estado de Tocantins con Énfasis en la Atención Integral de Salud fue desarrollado para fortalecer la red de atención psicosocial en colaboración con el Sistema Único de Salud (SUS) y el Sistema Único de Asistencia Social (SUAS). Elaborado por el Grupo de Trabajo "Flor de Pequi", el plan tiene como objetivo calificar la Red de Atención a la Salud, brindando orientación a los gestores y profesionales de la salud en la prevención de la violencia autoinfligida, la automutilación y el suicidio, además de promover el cuidado y apoyo dentro de la red de atención sanitaria. El documento fue elaborado en respuesta a demandas relacionadas con datos de violencia autoinfligida, solicitudes del Consejo Estatal para la Defensa de los Derechos de la Niñez y la Adolescencia y del Consejo Regional de Psicología. El plan también aborda la metodología, la discusión, las metas, las acciones y el monitoreo

Abordagem de narrativas como método de pesquisa em saúde pública: aproximações conceituais e contribuições da psicanálise / Narrative research in public health: conceptual approximations and contributions from psychoanalysis / Enfoque en narrativas como método de investigación en salud pública: aproximaciones conceptuales y aportaciones del psicoanálisis

Este artigo refere-se à parte de uma pesquisa de doutorado, realizada em hospital de alta complexidade do Sistema Único de Saúde, cujos participantes são os profissionais de saúde. O objetivo deste artigo é analisar o potencial da abordagem das narrativas como método de pesquisa e intervenção nos serviços de saúde, traçando aproximações com a teoria psicanalítica. Sua relevância no campo da Saúde Pública está calcada no reconhecimento do papel do sujeito como agente de mudanças. O texto divide-se em duas partes: na primeira, explora as especificidades do trabalho na área da saúde, o paradigma da saúde pública no que concerne à gestão e possíveis contribuições da clínica ampliada para esse modelo. Na segunda parte, analisa o uso das narrativas como método de pesquisa nesse campo e as aproximações conceituais entre a narrativa em Walter Benjamin e a psicanálise em Freud. Busca na literatura referências sobre experiências análogas que fundamentem a proposta ora realizada e conclui pela importância de, no momento atual, apostar na força germinativa das narrativas como fonte criativa de novas formas de cuidar.(AU)

This article derives from a PhD research conducted with health professionals at a high-complexity public hospital from the Brazilian Unified Health System (SUS). It analyzes the potential of the narrative as a research and intervention method in health services, outlining approximations with psychoanalysis. In the field of Public Health, the narrative approach acknowledges the individual as an agent of change. The text is divided into two parts. The first presents an overview of the peculiarities involved in healthcare, the Public Health paradigm regarding service management and possible contributions from the expanded clinic to this model. The second analyzes the use of narratives as a research method in this field and the conceptual approximations between Benjamin's narrative and Freud's psychoanalysis. It searches the literature for references on similar experiences to support the present proposal and concludes by highlighting the importance of betting on the creative power of narratives as a source for new ways to care.(AU)

Este artículo es parte de una investigación doctoral, realizada con los profesionales de la salud de un hospital de alta complejidad del Sistema Único de Salud de Brasil. Su propósito es analizar el potencial del enfoque en narrativas como método de investigación e intervención en los servicios de salud, esbozando aproximaciones entre las narrativas y la teoría del psicoanálisis. Su relevancia en el campo de la salud pública se basa en el reconocimiento del rol del sujeto como agente de cambio. El texto se divide en dos partes: La primera investiga las especificidades del trabajo en el área de la salud, el paradigma de la salud pública en la gestión de los servicios y las posibles contribuciones de la clínica ampliada a este modelo. En la segunda parte, analiza el uso de narrativas como método de investigación en este campo y las aproximaciones conceptuales entre la narrativa de Walter Benjamin y el psicoanálisis de Freud. Este estudio busca en la literatura referencias sobre experiencias similares que apoyen la propuesta ahora realizada y concluye con la importancia de, en el momento actual, apostar por el poder de las narrativas como fuente creadora de nuevas formas de cuidar.(AU)

Nos bastidores da gestão da Saúde Pública: Ensaio-discussão sobre um itinerário por lugares onde habita o poder gestionário / Behind the scenes of Public Health Management: essay-discussion on an itinerary where management power resides

O gerenciamento da Saúde pública refere-se a um lugar que lida diretamente com os recursos para a promoção, prevenção e recuperação da vida humana. Esse movimento representa a prática de um direito constitucionalmente garantido. Todavia, ao fazer parte dos seus microprocessos, experienciando o agir daqueles que os impulsionam (ou não), tanto no aspecto individual como coletivo, compreendi a necessidade de apresentar minha vivência nos bastidores da gestão nas esferas governamentais que atuei. Assim, tornou-se urgente descrever a rotina instaurada pelo poder gestionário, bem como a forma que se geraram/geram tomadas de decisões nas políticas públicas. Para tanto, parto do pressuposto de que o Estado hesita em propiciar o bem-estar e a qualidade de vida para o seu povo, fazendo com que o seu poder (constitucionalizado) institucionalize o controle e a administração da governança sob o seu território, submetendo-os aos interesses que não estão associados às necessidades sociais. Na intenção de construir um espaço de reflexão, emerge a hipótese de que as instituições que representam a governança estatal se apresentam funcional e intencionalmente abstratas, indiferentes ao seu real dever constitucional, fomentando a regulamentação e a manutenção do caos, produzindo uma fragilidade no sistema e, como consequência, permitindo os privilégios dos amantes do poder, promovendo o vazio assistencial e a morte de seu povo. Portanto, com o propósito de elaborar uma narrativa de todo esse processo vivido, elaboro um pout-pourri de ideias propostas por autores com os quais me identifico metodologicamente, balizando os contornos que considero necessários, sendo o mais fidedigna possível nos relatos. Nesse processo, destaco o arcabouço do método de Richard Sennett e a experiência de campo de Simone Weil. Ademais, realizo um diálogo acerca dos sentidos de gestão, dos seus impactos estabelecidos no universo das relações do trabalho em saúde e das necroses ­ tanto emocionais quanto físicas ­ produzidas nas vidas abaladas pelo descuidado em saúde. Dessa forma, aproprio-me do saber constituído pela prática, exemplificando por intermédio da narrativa, o ato de sentir na pele a magnitude do vigor amoral da gestão, na intenção de expor elementos que são cruciais à execução e à manutenção de seu poder. Por fim, reconhecendo o conhecimento estabelecido pelas experiências, aponto as sequelas no âmbito do trabalho da Saúde pública, revelando os seus ilimitados ditames que ocasionam a morte em suas diferentes versões. Diante das críticas lançadas ao longo deste trabalho, sobre a forma de fazer a gestão, entendendo a necessidade de pensarmos em outras maneiras de construirmos esse lugar, lamento não ser capaz de produzir argumentos e direções possíveis. A conjuntura não permite que eu ocupe outra posição, a não ser a da incredulidade. Não acredito em possibilidades concretas de modificação do nosso cenário. Contudo, não deixa de ser urgente a necessidade de encontrar outras formas possíveis de se fazer gestão em prol, de fato, da vida coletiva. É imprescindível que, ainda assim, haja firmeza de caráter o suficiente para manter o propósito focado no cuidado em saúde do usuário, assim como uns dos outros, também, ao longo desse processo. (AU)

Public Health Management refers to a place that directly deals with resources to promote, prevent and recover human life. This movement represents the practice of a constitutionally guaranteed right. However, by being part of their microprocesses, experiencing the actions of those who drive them (or not), both individually and collectively, I understood the need to show my experience behind the scenes of management in the government fields in which I worked. Thus, it became urgent to describe the routine established by the management power, as well as the way in which decision-making in public policies was generated. Then, I assume that the Government hesitates to provide well-being and quality of life to the people. Besides that, it has the power to institutionalize the control and administration of governance under its territory, subjecting them to interests that are not associated with social needs. In order to build a space for reflection, the hypothesis states that the institutions which represent state governance are functionally and intentionally abstract. So, they are indifferent to their real constitutional duty, encouraging regulation and the maintenance of chaos, producing fragility in the system and, as a consequence, allowing the privileges of lovers of power, promoting a vacuum in assistance and the death of people. Therefore, with the purpose of elaborating a narrative of this process, I elaborate a mix of ideas proposed by authors connected to my thoughts, so defining the contours that I consider necessary, being as reliable as possible in the reports. In this process, I highlight the framework of Richard Sennett's method and Simone Weil's field experience. Furthermore, I carry out a dialogue about the meanings of management, its impacts established in the field of health work relationships and the damages ­ both emotional and physical ­ produced in lives shaken by carelessness in health. In this way, I receive the knowledge constituted by practice, exemplifying through narrative, the act of feeling firsthand the magnitude of the amoral vigor of management. So, as a consequence, I am exposing elements that are crucial to the execution and maintenance of government's power. Finally, recognizing the knowledge established by experiences, I pointed out the consequences in the scope of public health work, revealing its unlimited dictates which cause death in different versions. In view of the criticisms launched throughout this work about the way of managing and thinking of other ways of building this place, I regret not being able to produce possible arguments and directions. This situation does not allow me to occupy any other position than that of disbelief. I do not believe in real possibilities of changing our reality. However, it is still urgent to understand the need to find other possible ways of managing for the benefit, in fact, of collective life. It is essential that, even so, there must be enough firmness of character to maintain the purpose to focus on the health care of the user, as well as each other, throughout this process. (AU)

Reflexiones acerca del desempeño del ministro de Salud de Colombia en el manejo de la pandemia de COVID-19, la salud sexual y reproductiva, y la salud pública / Reflections on the performance of the Colombian Minister of Health regarding the management of the COVID-19 pandemic, sexual and reproductive health and public health

Objetivos: hacer una evaluación crítica de la gestión del ministro de Salud en ejercicio al terminar el gobierno de Iván Duque en el manejo de la pandemia, la salud sexual y reproductiva, y la salud pública en Colombia. Materiales y métodos: a partir de la descripción de situaciones problemáticas enfrentadas en ese periodo se presenta evidencia sobre los resultados de la gestión que, sumados a la opinión del autor, proveen un balance de la gestión realizada. Conclusiones: la gestión del ministro de Salud fue deficiente en el manejo de la pandemia y, en especial, en su atención a la salud sexual y reproductiva, y la salud pública.

Objectives: To offer a critical assessment of the incumbent Health Minister's performance at the end of the Ivan Duque administration regarding the management of the pandemic, sexual and reproductive health, and public health in Colombia. Material and methods: Based on the description of challenges faced during this time period, we present evidence regarding performance results which, together with the author's opinion, offer an assessment of the work done. Conclusions: The Health Minister's performance in managing the pandemic fell short, in particular as concerns sexual and reproductive health, as well as public health.

Is Avoidable Hospitalization Experienced Prior to Infection Associated With COVID-19-Related Deaths?

Objectives: This study aimed to determine the effect of the presence or absence of avoidable hospitalization before acquiring coronavirus disease (COVID-19) on COVID-19-related deaths. Methods: This study used the total NHIS-COVID-19 dataset comprising domestic COVID-19 patients, provided by the National Health Insurance Service (NHIS) in South Korea. We conducted logistic regression and double robust estimation (DRE) to confirm the effect of avoidable hospitalization on COVID-19-related deaths. Results: Logistic regression analysis confirmed that the odds ratio (OR) of death due to COVID-19 was high in the group that experienced avoidable hospitalization. DRE analysis showed a higher OR of death due to COVID-19 in the group that experienced avoidable hospitalization compared to the group that did not experience avoidable hospitalization, except in the subgroup aged ≤69 years. Conclusion: The effect of avoidable hospitalization on COVID-19-related deaths was confirmed. Therefore, continued health care, preventive medicine, and public health management are essential for reducing avoidable hospitalizations despite the COVID-19 pandemic. Clinicians need to be informed about the importance of continuous disease management.

The power of partnerships: state public health department multisector collaborations in major chronic disease programme areas in the United States.

BACKGROUND: Multisector collaboration between state public health departments (SHDs) and diverse community partners is increasingly recognized as important for promoting positive public health outcomes, addressing social determinants of health, and reducing health inequalities. This study investigates collaborations between SHDs in the United States and different types of organizations addressing chronic disease in and outside of the health sector. METHODS: SHD employees were randomly selected from the National Association of Chronic Disease Directors membership list for participation in an online survey. Participants were asked about their primary chronic disease work unit (cancer, obesity, tobacco, diabetes, cardiovascular disease, and others), as well as their work unit collaborations (exchange of information/cooperation in activities) with organizations in health and non-health sectors. As a measure of the different organizations SHDs collaborated with in health and non-health sectors, a collaboration heterogeneity score for each programme area was calculated. One-way analysis of variance (ANOVA) with Tukey's post hoc tests were used to assess differences in collaborator heterogeneity between programme areas. RESULTS: A total of 574 participants were surveyed. Results indicated that the cancer programme area, along with diabetes and cardiovascular disease, had significantly less collaboration heterogeneity with organizations outside of the health sector compared to the obesity and tobacco programme areas. CONCLUSIONS: While collaborations with health sector organizations are commonly reported, public health departments can increase collaboration with sectors outside of health to more fully address chronic disease prevention.

Sofrimento sociopolítico, silenciamento e a clínica psicanalítica / Socio-political suffering, silencing, and the psychoanalytic clinic / El sufrimiento sociopolítico, el silenciamiento y la clínica psicoanalítica

O campo da Psicologia produz saberes e discursos que referenciam as políticas públicas que alteram ou sedimentam o lugar social atribuído ao sujeito. Este artigo considera que há modalidades de gestão política, controle e exploração que incluem em sua estratégia de dominação promover a experiência do sofrimento, seja composta pela angústia, culpa, vergonha ou humilhação social. Tendo em vista essa premissa, formulamos as vicissitudes e especificidades da escuta de sofrimento sociopolítico advindo de posições socialmente desqualificadas devido a fatores econômicos, raciais, culturais, religiosos, de gênero, entre outros. A vicissitude clínica que nos norteia é o silenciamento derivado desse sofrimento. A escuta clínica de sujeitos sob o desamparo discursivo se ancora na constatação de que o sofrimento sociopolítico desarvora o sujeito de seu lugar de fala, promovendo o abalo narcísico e a eclosão da dimensão traumática - questão diagnóstica que deve ser levada em conta -, e pondo em jogo um possível conflito de lealdades quanto ao pacto social daquele que pratica a psicanálise, o que pode gerar sua resistência à escuta. Essas considerações clínicas não seriam possíveis sem superar uma dicotomia e um recalque: a questão da política na psicanálise. Tais concepções supõem repensar dimensões táticas, estratégicas e éticas no atendimento clínico psicanalítico. Abordaremos as artimanhas do poder que produzem o desamparo discursivo e a dimensão traumática, chegando finalmente a algumas considerações sobre o tratamento a ser dado ao sofrimento sociopolítico e as especificidades da escuta nesses contextos.(AU)

The field of psychology produces knowledge and discourses that guide public policies and alter or consolidate the social place attributed to the subject. This article considers that there are modalities of political management, control, and exploitation which include in their own strategy of domination promoting the experience of suffering, whether comprising anguish, guilt, shame or social humiliation. In view of this premise, we formulate the vicissitudes and specificities of listening to socio-political suffering arising from socially disqualified positions due to economic, racial, cultural, religious and gender factors, among others. The clinical vicissitude that will guide us will be the silencing derived from this suffering. The clinical listening to subjects under discursive helplessness is anchored on the observation that sociopolitical suffering takes the subject out of his or her place of speech, promoting narcissistic shock and the emergence of the traumatic dimension - a diagnostic issue that should be considered - and raising a possible conflict of loyalties regarding the psychoanalyst's social pact that can generate his or her resistance to listening. These clinical considerations would not be possible without overcoming a dichotomy and a repression: the question of politics in psychoanalysis. Such conceptions suppose rethinking tactical, strategic and ethical dimensions in psychoanalytic clinical care. We will approach the tricks of power that produce the discursive helplessness and the traumatic dimension, finally reaching some considerations about the treatment to be given to socio-political suffering and the specifics of listening in these contexts.(AU)

El campo de la Psicología produce conocimiento y discursos que son decisivos para las políticas públicas y para alterar o consolidar el lugar social atribuido al sujeto. Este artículo considera la existencia de modalidades de gestión política, control y explotación que incluyen, en su estrategia de dominación, promover la experiencia del sufrimiento, ya sea compuesta por angustia, culpa, vergüenza o humillación social. En vista de esta premisa, formulamos las vicisitudes y especificidades de escucha del sufrimiento sociopolítico que surge de posiciones socialmente descalificadas debido a factores económicos, raciales, culturales, religiosos y de género, entre otros. La vicisitud clínica que nos guiará es el silenciamiento derivado de este sufrimiento. La escucha clínica de los sujetos bajo impotencia discursiva está anclada en la observación de que el sufrimiento sociopolítico saca al sujeto de su lugar de discurso promoviendo el shock narcisista y la aparición de la dimensión traumática -un problema de diagnóstico que debe tenerse en cuenta-, y pone en juego un posible conflicto de lealtades con respecto al pacto social del psicoanalista, lo que puede generar su resistencia a la escucha. Estas consideraciones clínicas no serían posibles sin superar una dicotomía y una represión: la cuestión de la política en el psicoanálisis. Dichas concepciones suponen repensar las dimensiones tácticas, estratégicas y éticas en la atención clínica psicoanalítica. Se abordarán los trucos del poder para producir la impotencia discursiva y la dimensión traumática, llegando finalmente a algunas consideraciones sobre el tratamiento que se dará al sufrimiento sociopolítico y los detalles específicos de la escucha en estos contextos.(AU)

Indicadores de saúde mental para a Rede de Atenção Psicossocial brasileira: uma proposta / Mental Health Indicators for the Brazilian Psychosocial Care Network: A proposal / Indicadores de salud mental para la Red Brasileña de Atención Psicosocial: una propuesta

Resumo Objetivo: propor indicadores de saúde mental destinados a gestão da Rede de Atenção em saúde mental, a começar da convergência da sua utilização, em países com organização pública de saúde. Método: análise exploratória dos indicadores, adotados e utilizados nesses países, a partir da análise detalhada dos seus respectivos documentos normativos, considerando as orientações da Organização Mundial de Saúde. Após a seleção dos indicadores, adotou-se a Matriz de Saúde Mental como sugestão para seu desenvolvimento e aplicação na Rede de Atenção Psicossocial brasileira. Respeitando os critérios de inclusão e exclusão dos indicadores estudados, a matriz foi construída, em duas dimensões: geográfica: (nacional/regional, local, individual) e temporal (entrada, processo e resultados). Resultados: a análise aponta 41 indicadores que apresentaram evidências quanto ao seu uso. Todos foram posicionados na Matriz de Saúde Mental, contribuindo como uma métrica para analisar a finalidade dos serviços de saúde mental, nos níveis e fases de cada dimensão. Conclusão: os indicadores selecionados, distribuídos nas diferentes dimensões da Matriz de Saúde Mental, estão sendo disponibilizados para uso, para a gestão e na prática clínica, bem como para estudos científicos e, num horizonte futuro, para uso como definidor de políticas de saúde mental.

Abstract Objective: to propose Mental Health Indicators aimed at management of the Mental Health Care Network, starting with convergence of their use, in countries with public health organization. Method: an exploratory analysis of the indicators adopted and used in these countries, from the detailed analysis of their respective normative documents, considering the World Health Organization guidelines. After selection of the indicators, the Mental Health Matrix was adopted as a suggestion for their development and application in the Brazilian Psychosocial Care Network. The matrix was prepared in two dimensions, respecting the inclusion and exclusion criteria for the indicators studied, as follows: geographical (national/regional, local, individual), and time (entry, process and results). Results: the analysis indicates 41 indicators that presented diverse evidence regarding their use. All were allocated in the Mental Health Matrix, contributing as a metric to analyze the purpose of the Mental Health services, in the levels and phases of each dimension. Conclusion: the indicators selected, distributed in the different Mental Health Matrix dimensions, are being made available for their use in management and in the clinical practice, as well as for scientific studies and, in the future, to be used as definers of Mental Health policies.

Resumen Objetivo: proponer indicadores de salud mental para la gestión de la Red de Atención en Salud Mental, a partir de la convergencia de uso en países con organización pública de salud. Método: análisis exploratorio de los indicadores que adoptan y utilizan estos países, a partir del análisis detallado de sus respectivos documentos normativos, considerando las directrices de la Organización Mundial de la Salud. Después de seleccionar los indicadores, se sugirió adoptar la Matriz de Salud Mental para desarrollarlos y aplicarlos en la Red Brasileña de Atención Psicosocial. Respetando los criterios de inclusión y exclusión de los indicadores estudiados, la matriz fue construida en dos dimensiones: geográfica (nacional/regional, local, individual) y temporal (entrada, proceso y resultados). Resultados: el análisis indica que 41 indicadores presentaron evidencia de uso. Todos fueron posicionados en la Matriz de Salud Mental, y contribuyeron como métrica para analizar la finalidad de los servicios de salud mental, en los niveles y fases de cada dimensión. Conclusión: los indicadores seleccionados, distribuidos en diferentes dimensiones de la Matriz de Salud Mental, están disponibles para ser utilizados tanto en la gestión y en la práctica clínica, como en estudios científicos y, en un horizonte futuro, para definir políticas de salud mental.

Gestão em foco / Management in focus

Este e-book tem como objetivo trazer um compêndio de relatos de experiência relacionados à gestão de saúde do Estado de Goiás. Cada capítulo traz a descrição dos projetos desenvolvidos no âmbito da Secretaria de Estado da Saúde de Goiás, que são vinculados aos objetivos estratégicos do órgão. Estes projetos têm como objetivo fortalecer as ações estratégicas para otimizar o planejamento do Sistema Único de Saúde

This e-book aims to bring a compendium of experience reports related to health management in the State of Goiás. Each chapter brings a description of the projects developed within the scope of the State Department of Health of Goiás, which are linked to the strategic objectives of the agency. These projects aim to strengthen strategic actions to optimize the planning of the Unified Health System

Cardiometabolic syndrome and associated factors among Ethiopian public servants, Addis Ababa, Ethiopia.

Non-communicable diseases (NCDs) are increasingly becoming the global cause of premature death encompassing cardiovascular diseases (CVDs), cancer, respiratory diseases and diabetes mellitus. However, cardiometabolic risk factors in the general population, especially among the high-risk groups have rarely been assessed in Ethiopia. The study aimed to assess the prevalence of metabolic syndrome, its components and associated factors among staff in the Ethiopian Public Health Institute (EPHI). An institutional-based cross-section study was conducted from March to June 2018 among EPHI staff members. A total of 450 study participants were involved in the study, and the World Health Organization NCD STEPS survey instrument version 3.1 was used for the assessment. The biochemical parameters were analyzed by using COBAS 6000 analyzer. Statistical package for the social science (SPSS) version 20 was used for data analysis. Both bivariate and multivariate logistic regression analyses were used to identify associated risk factors. p value < 0.05 was considered for statistical significance. The overall prevalence of metabolic syndrome was 27.6% and 16.7% according to IDF and NCEP criteria respectively, with males having greater prevalence than females (35.8% vs 19.4%). Central obesity, low high-density lipoprotein (HDL) and hypertension had a prevalence of 80.2%, 41.3%, and 23.6%, respectively. In multivariate analysis increasing age and having a higher body mass index (25-29.9) were significantly associated with metabolic syndromes. The magnitude of metabolic syndrome was relatively high among public employees. Preventive intervention measures should be designed on the modification of lifestyle, nutrition and physical activities, and early screening for early identification of cardiometabolic risks factors should be practised to reduce the risk of developing cardiovascular diseases.

Scientific research and product development in the United States to address injuries from a radiation public health emergency.

The USA has experienced one large-scale nuclear incident in its history. Lessons learned during the Three-Mile Island nuclear accident provided government planners with insight into property damage resulting from a low-level release of radiation, and an awareness concerning how to prepare for future occurrences. However, if there is an incident resulting from detonation of an improvised nuclear device or state-sponsored device/weapon, resulting casualties and the need for medical treatment could overwhelm the nation's public health system. After the Cold War ended, government investments in radiation preparedness declined; however, the attacks on 9/11 led to re-establishment of research programs to plan for the possibility of a nuclear incident. Funding began in earnest in 2004, to address unmet research needs for radiation biomarkers, devices and products to triage and treat potentially large numbers of injured civilians. There are many biodosimetry approaches and medical countermeasures (MCMs) under study and in advanced development, including those to address radiation-induced injuries to organ systems including bone marrow, the gastrointestinal (GI) tract, lungs, skin, vasculature and kidneys. Biomarkers of interest in determining level of radiation exposure and susceptibility of injury include cytogenetic changes, 'omics' technologies and other approaches. Four drugs have been approved by the US Food and Drug Administration (FDA) for the treatment of acute radiation syndrome (ARS), with other licensures being sought; however, there are still no cleared devices to identify radiation-exposed individuals in need of treatment. Although many breakthroughs have been made in the efforts to expand availability of medical products, there is still work to be done.

System and capability of public health response to nuclear or radiological emergencies in China.

In order to respond to nuclear or radiological emergencies effectively and protect the physical and mental health of the public, the national-, provincial-, municipal- and county-level public health response systems for nuclear or radiological emergencies had been established in China by the end of twentieth century. The health administrative departments at all levels have established professional emergency response teams, continue to improve their own level of emergency response systems and operating mechanisms, enhance the capabilities of radiation injury treatment, radiation monitoring and protection through training and exercises and also pay attention to the logistical support for emergency response. In this article the organizations, management system and capabilities of public health response to nuclear or radiological emergencies in China are briefly introduced. We try to strengthen information exchange and cooperation with foreign counterparts in this field in the future, so as to jointly promote the development of preparedness and response for nuclear or radiological emergencies.

HPV vaccine promotion: Snapshot of two health departments during the COVID-19 pandemic.

The COVID-19 pandemic has impacted routine health care services including immunization delivery. The most common sexually transmitted infection in the United States is the human papillomavirus (HPV), and its sequelae may be prevented by vaccination. Sequelae that can develop if one's immune system is not able to clear the infection include warts, precancerous lesions, and cancer. The American College of Obstetricians & Gynecologists (ACOG) reports almost everyone who is sexually active will encounter the virus at some time during their life. Most of the estimated 79 million infections occur among people who are in their late teens or early 20s. Since 2006, there has been a vaccine available to prevent HPV infections in both males and females; however, administration of this vaccine has only been about half the rate of other vaccines and vaccine hesitancy may play a role. Public health nurses are vital in providing accurate and nonjudgmental vaccine education to their clients, especially unaccompanied minors seeking care in public health department clinics. This paper will explore the recommendations for providing this vaccine as well as a snapshot of current practice in two health departments in the Southeast region of the United States during the COVID-19 pandemic.

The COVID-19-designated hospitals in China: preparing for public health emergencies.

The designated hospitals are another health approach besides Fangcang shelter hospitals and newly built temporary hospitals for responding to COVID-19 epidemic in China. Faced with the emergency situation, about 1512 hospitals from 363 cities have been designated in China to tackle the spread of COVID-19. They were local hospitals repurposed by the Chinese government as a regional public health response. Their comprehensive services mainly include: "fever-clinics" to screen patients, COVID-19 department for higher-levels of medical care, and makeshift wards for emergencies. As the only COVID-19 designated hospital in Shanghai, we documented three characters (Centralized response and action system, Comprehensive functions, Closed-Loop Management System) and three strategies (Resource allocation, Prevention of nosocomial infection, Management during the post-COVID-19 pandemic stage) from the experience in responding to COVID-19 pandemic. Lastly, learning the lessons from COVID-19 pandemic, a more efficacy and rapid national response to public health emergencies is required. Serving as an essential component of public health system, the COVID-19-designated hospitals should be always prepared for future emergencies.