RESUMO
BACKGROUND: Bariatric surgery is proven to be the most effective strategy for management of obesity and its related comorbidities. However, in Canada, patients awaiting bariatric surgery can be subjected to prolonged wait times, thereby subjecting them to increased morbidity and mortality, as well as decreased psychosocial well-being. OBJECTIVE: To assess the factors associated with prolonged wait times for bariatric surgery within a publicly funded, provincial bariatric network. METHODS: This was a retrospective population-based study of all patients aged > 18 years who were referred for bariatric surgery from April 2009 to May 2015 using linked administrative databases to capture patient demographic data, socioeconomic variables, healthcare utilization, and institutional factors. The main outcome of interest was a wait time greater than 18 months. Multivariate logistic regression modeling was used to estimate odds ratios (OR) and 95% confidence intervals (CI). RESULTS: A total of 18,854 patients underwent bariatric surgery from April 2009 to December 2016, of which 2407 patients experienced wait times of > 18 months. On average, yearly wait times have increased for patients receiving surgery with wait times of 10.98 months (SD 5.48) in 2010 and 13.09 (SD 6.69) in 2016 (p < 0.001). Increasing age (OR 1.12, 95% CI 1.05-1.19, p = 0.0004), BMI (OR 1.08, 95% CI 1.04-1.11, p < 0.001), and male gender (OR 1.47, 95% CI 1.28-1.70, p < 0.001) were significantly associated with increased bariatric surgery wait times. Additionally, smoking status (OR 1.46, 95% CI 1.09-1.97, p = 0.0118) and obesity-related comorbidities particularly diabetes (OR 1.29, 95% CI 1.14-1.44, p < 0.001) and heart failure (OR 1.72, 95% CI 1.43-2.07, p < 0.001) were correlated with prolonged wait times for surgery. Socioeconomic variables including disability (OR 1.64, 95% CI 1.38-1.92, p < 0.001) and immigration status (OR 1.35, 95% 1.11-1.64, p = 0.003) were correlated with increased odds of longer wait times, as were regions with regionalized assessment and treatment centres (RATC) when referenced against centers of excellence (COEs) in number of days added with 20.45 (95% CI 13.20-27.70, p < 0.001). CONCLUSION: Wait times for bariatric surgery in a publicly funded, regionalized bariatric program are influenced by certain patient characteristics, socioeconomic variables, and institutional factors. This warrants further intervention and study to help improve these inequities when encountering potentially vulnerable populations awaiting bariatric surgery.
Assuntos
Cirurgia Bariátrica , Acessibilidade aos Serviços de Saúde , Obesidade Mórbida/epidemiologia , Obesidade Mórbida/cirurgia , Listas de Espera , Adolescente , Adulto , Idoso , Cirurgia Bariátrica/estatística & dados numéricos , Canadá/epidemiologia , Comorbidade , Feminino , Acessibilidade aos Serviços de Saúde/organização & administração , Acessibilidade aos Serviços de Saúde/normas , Acessibilidade aos Serviços de Saúde/estatística & dados numéricos , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Obesidade Mórbida/psicologia , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Administração em Saúde Pública/métodos , Administração em Saúde Pública/normas , Administração em Saúde Pública/estatística & dados numéricos , Encaminhamento e Consulta/organização & administração , Encaminhamento e Consulta/estatística & dados numéricos , Regionalização da Saúde/organização & administração , Regionalização da Saúde/normas , Regionalização da Saúde/estatística & dados numéricos , Estudos Retrospectivos , Tempo para o Tratamento/estatística & dados numéricos , Adulto JovemRESUMO
Introdução: É consenso no meio jurídico que os resultados referentes às atividades médicas sejam obrigação de meio, e não de resultado. Contudo, há grande discussão quando se trata de procedimentos estéticos. A Resolução nº 1621/2001, do Conselho Federal de Medicina, define que o objetivo do ato médico na cirurgia plástica também constitui obrigação de meio. O estudo avaliou, entre novembro de 2015 a novembro de 2017, 106 casos, para verificar se o entendimento do Judiciário se alinha à Resolução do CFM [Conselho Federal de Medicina]. Foram quantificados o número de processos e a porcentagem dos casos julgados como procedentes ou improcedentes, além de verificar as principais posições doutrinárias e jurisprudenciais que embasaram as sentenças admitidas como procedentes. Foi, ainda, quantificado o número de casos cuja decisão do magistrado foi relacionada com o posicionamento do laudo pericial médico. Métodos: Foi feita busca no banco de sentenças do site do Tribunal de Justiça do Estado de São Paulo (SP), por meio da palavra-chave "Cirurgia Plástica", de todos os processos de indenização relacionados a cirurgias plásticas estéticas. Resultados: Foram sentenciados como improcedentes 61 casos (58%). Foram sentenciados como procedentes 45 casos (42%). Em 96% dos casos (102) a sentença relacionou-se positivamente com a análise pericial. Conclusão: Foram 102 sentenças concordantes aos laudos periciais e apenas quatro casos cuja sentença divergiu do entendimento do laudo. Estes dados mostram a importância crucial da análise pericial para a definição das sentenças judiciais. Analisando todas as sentenças, observou-se que em nenhum caso os juízes levaram em conta a Resolução do CFM [Conselho Federal de Medicina].
Introduction: There is a legal consensus that the results of medical activities represent obligations of means, not results. However, there is ample discussion when it comes to aesthetic procedures. Resolution 1621/2001 of the Federal Council of Medicine also defines the objective of a medical act in plastic surgery as an obligation of means. This study evaluated 106 cases between November 2015 and November 2017 to verify whether the decisions of the Judicial Power agree with the Resolution of the Federal Council of Medicine. The number of lawsuits and the percentage of claims granted or denied were quantified, and the opinions of jurists and courts that supported the claims granted were verified. The number of cases in which the judge's decision was related to the opinion of a medical expert was also quantified. Methods: The authors searched the judgment database located on the website of the Court of Justice of the State of São Paulo (SP) for damage related to aesthetic plastic surgery, using the keyword "Plastic Surgery" for all actions. Results: A total of 61 claims (58%) were denied, and 45 (42%) were granted. In 96% of cases (102) the judgment was positively related to the expert report. Conclusion: There were 102 cases in which the judgment agreed with the expert reports and only four cases in which the judgment did not agree with the reports. These data show the crucial importance of experts' reports in defining judicial judgments. The analyses of all judgments showed that there were no cases in which the judge considered the Resolution of the Federal Council of Medicine.
Assuntos
Humanos , História do Século XXI , Administração em Saúde Pública , Cirurgia Plástica , Erros Médicos , Decisões Judiciais , Estética , Medicina Legal , Jurisprudência , Administração em Saúde Pública/legislação & jurisprudência , Administração em Saúde Pública/métodos , Administração em Saúde Pública/estatística & dados numéricos , Cirurgia Plástica/legislação & jurisprudência , Erros Médicos/legislação & jurisprudência , Medicina Legal/estatística & dados numéricosRESUMO
OBJECTIVE: The health system in Spain rests mostly in the Autonomous Communities (similar to the states in the US). The public health activities of many local governments are little studied. The objective of this work was to bring knowledge about the public health activities of the municipalities, providing information obtained from a recent survey in Catalonia. METHODS: Descriptive study based on a survey to public health officers in the 119 municipalities above 10,000 population in Catalonia, excluding the city of Barcelona. The survey was conducted between May and October 2016, with 103 municipalities (86.6%) reporting on their services in 2015, prior to the survey. Data were collected and descriptive analyses performed. RESULTS: A consolidation of both political and professional public health structures of the municipalities was observed. Most frequent activities in health protection were related to legionella control, the control of urban pests and the management of complaints and requests by citizens. Most frequent activities in the field of health promotion were related to physical activity and health, prevention in tobacco and alcohol, food and nutrition. There were relatively few changes reported in public health structures and their officers, as well as in human resources. CONCLUSIONS: In Catalonia, municipalities above 10,000 population have a remarkable level of activity in public health. Both the areas of health protection (with mandatory minimum services for local governments) and of health promotion show high levels of activity. The system seems stable regarding political changes and budget constraints. There are opportunities for improvement in the training of professionals and service accreditation. It would be desirable to find ways to improve coordination among these services.
OBJETIVO: El sistema sanitario en España pivota sobre las Comunidades Autónomas. La salud pública gestionada por muchos gobiernos locales está poco estudiada. El objetivo de este trabajo fue contribuir al conocimiento de las actividades de salud pública de los municipios con una encuesta reciente. METODOS: Estudio descriptivo basado en cuestionario a los responsables de salud pública de los 119 municipios mayores de 10,000 habitantes de Catalunya, excluyendo la ciudad de Barcelona. Se realizó entre mayo y octubre de 2016, respondiendo 103 municipios (86,6 %) sobre la situación en 2015, anterior a la encuesta. Los datos se tabularon y sometieron a análisis descriptivos. RESULTADOS: Se apreció una consolidación de las estructuras políticas y técnicas de los municipios en salud pública. Las actuaciones más frecuentes en protección de la salud eran las referidas a la legionelosis, el control de plagas urbanas y la gestión de quejas y denuncias de la ciudadanía; en el ámbito de la promoción de la salud fueron actividad física y salud, prevención en tabaco y alcohol, alimentación y nutrición. Se refirieron relativamente pocos cambios recientes en las estructuras de salud pública, de sus responsables, y de los recursos humanos. CONCLUSIONES: Los municipios catalanes de más de 10.000 habitantes tienen un notable nivel de actividad en salud pública. Tanto los ámbitos de protección de la salud (con servicios mínimos obligatorios para los gobiernos locales) como los de promoción de la salud muestran niveles altos de actividad. El sistema parece estable respecto a cambios políticos y restricciones presupuestarias. Hay oportunidades de mejora en formación de profesionales y acreditación de servicios. Sería deseable mejorar la coordinación entre estos servicios.
Assuntos
Serviços de Saúde/estatística & dados numéricos , Governo Local , Administração em Saúde Pública/estatística & dados numéricos , Prática de Saúde Pública/estatística & dados numéricos , Serviços Urbanos de Saúde/provisão & distribuição , Pesquisas sobre Atenção à Saúde , Promoção da Saúde/organização & administração , Promoção da Saúde/estatística & dados numéricos , Humanos , Espanha , Serviços Urbanos de Saúde/organização & administraçãoRESUMO
A gestão do trabalho é o foco deste livro, que apresenta um diagnóstico sobre o funcionamento dos Setores de Gestão do Trabalho das Secretarias Estaduais de Saúde no Brasil, sendo a relevância deste trabalho ressaltada pela perspectiva de fortalecer a capacidade de gestão desses setores analisados. Ao apresentar os resultados da pesquisa realizada, os autores optaram pela descrição detalhada dos achados tendo em vista que eles podem ser usados para reflexão e análise das equipes estaduais, servindo de subsídio para impulsionar o aprimoramento da gestão do trabalho e, consequentemente, do serviço assistencial. Resultado de convênio assinado entre o Ministério da Saúde e a Universidade Federal do Rio Grande do Norte (UFRN), esta publicação faz parte de um conjunto de produtos acordado entre as citadas instituições no âmbito do Projeto de Apoio ao Desenvolvimento Institucional e Fortalecimento das Estruturas de Gestão do Trabalho das Secretarias Estaduais de Saúde. O ponto de partida do projeto consistiu em compreender o funcionamento e as fragilidades dos setores que têm como atribuição a gestão do trabalho. A realização deste projeto reforça a parceria entre o Departamento de Gestão do Trabalho em Saúde (DEGTS) da Secretaria de Gestão do Trabalho e da Educação na Saúde (SGTES) do Ministério da Saúde com o Observatório de Recursos Humanos, com o Departamento de Saúde Coletiva e com o Núcleo de Estudos em Saúde Coletiva da UFRN. Considerando que é de reponsabilidade do DEGTS propor, incentivar, acompanhar e elaborar políticas de gestão e planejamento e regulação do trabalho em saúde, esperamos que este trabalho não alcance apenas as secretarias estaduais de saúde com este projeto, pois acreditamos que os desafios apresentados para a gestão do trabalho estadual são compartilhados com as gestões das secretarias municipais de saúde.
Assuntos
Humanos , Masculino , Feminino , Admissão e Escalonamento de Pessoal/organização & administração , Administração em Saúde Pública/estatística & dados numéricos , Conselhos de Saúde/organização & administração , Gestor de Saúde , Planejamento , BrasilRESUMO
BACKGROUND: Health impact assessment (HIA) provides a structured process for examining the potential health impacts of proposed policies, plans, programs, and projects. This study systematically reviewed HIAs conducted in the United States on prekindergarten, primary, and secondary education-focused decisions. METHODS: Relevant HIA reports were identified from web sources in late 2015. Key data elements were abstracted from each report. Four case studies were selected to highlight diversity of topics, methods, and impacts of the assessment process. RESULTS: Twenty HIAs completed in 2003-2015 from 8 states on issues related to prekindergarten through secondary education were identified. The types of decisions examined included school structure and funding, transportation to and from school, physical modifications to school facilities, in-school physical activity and nutrition, and school discipline and climate. Assessments employed a range of methods to characterize the nature, magnitude, and severity of potential health impacts. Assessments fostered stakeholder engagement and provided health-promoting recommendations, some of which were subsequently incorporated into school policies. CONCLUSIONS: Health impact assessment is a promising tool that education, health, and other stakeholders can use to maximize the health and well-being of students, families, and communities.
Assuntos
Avaliação do Impacto na Saúde , Política de Saúde , Promoção da Saúde/organização & administração , Promoção da Saúde/estatística & dados numéricos , Administração em Saúde Pública/estatística & dados numéricos , Instituições Acadêmicas/organização & administração , Instituições Acadêmicas/estatística & dados numéricos , Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Estados UnidosRESUMO
BACKGROUND: Posterior cranial fossa tumours (PCF) comprise 54-70% of childhood brain tumours. The clinical profile and outcomes of these tumours differ in area of the world. The aim of this study is to describe clinical characteristics, treatment and outcome of posterior cranial fossa tumours in Sudan. MATERIAL AND METHODS: A retrospective study of children diagnosed with posterior cranial fossa tumours and treated between January 1998 and December 2015 at National Cancer Institute, Sudan. RESULTS: A total of 31 paediatric patients with a posterior cranial fossa brain tumour were identified over the study period. The mean age was 7.9 years (standard deviation (SD) = 3.37). Females were slightly more affected (51%) than males (49%), and the majority of patients were from rural areas (71%). Brainstem tumours were the most frequent tumour type (48%) followed by medulloblastoma (36%). The mean pre-diagnostic symptomatic interval was 3.6 months (SD = 3.95). Overall survival rate of our total study population at 1, 2 and 5 years was 23, 19 and 13%, respectively. CONCLUSION: Overall, this study draws attention to the situation of paediatric brain tumours in Sudan. Late presentation, misdiagnosis and limited diagnostic and treatment resources are challenges that may contribute to poor outcome in these patients.
Assuntos
Neoplasias do Sistema Nervoso Central/epidemiologia , Fossa Craniana Posterior/patologia , Neoplasias Infratentoriais/epidemiologia , Adolescente , Criança , Pré-Escolar , Feminino , Órgãos Governamentais/organização & administração , Humanos , Lactente , Masculino , Administração em Saúde Pública/estatística & dados numéricos , Estudos Retrospectivos , Sudão/epidemiologiaRESUMO
CONTEXT: Local health departments (LHDs) have historically not prioritized policy development, although it is one of the 3 core areas they address. One strategy that may influence policy in LHD jurisdictions is the formation of partnerships across sectors to work together on local public health policy. DESIGN: We used a network approach to examine LHD local health policy partnerships across 15 large cities from the Big Cities Health Coalition. SETTING/PARTICIPANTS: We surveyed the health departments and their partners about their working relationships in 5 policy areas: core local funding, tobacco control, obesity and chronic disease, violence and injury prevention, and infant mortality. OUTCOME MEASURES: Drawing on prior literature linking network structures with performance, we examined network density, transitivity, centralization and centrality, member diversity, and assortativity of ties. RESULTS: Networks included an average of 21.8 organizations. Nonprofits and government agencies made up the largest proportions of the networks, with 28.8% and 21.7% of network members, whereas for-profits and foundations made up the smallest proportions in all of the networks, with just 1.2% and 2.4% on average. Mean values of density, transitivity, diversity, assortativity, centralization, and centrality showed similarity across policy areas and most LHDs. The tobacco control and obesity/chronic disease networks were densest and most diverse, whereas the infant mortality policy networks were the most centralized and had the highest assortativity. Core local funding policy networks had lower scores than other policy area networks by most network measures. CONCLUSION: Urban LHDs partner with organizations from diverse sectors to conduct local public health policy work. Network structures are similar across policy areas jurisdictions. Obesity and chronic disease, tobacco control, and infant mortality networks had structures consistent with higher performing networks, whereas core local funding networks had structures consistent with lower performing networks.
Assuntos
Redes Comunitárias/tendências , Política de Saúde/tendências , Governo Local , Administração em Saúde Pública/métodos , Serviços Urbanos de Saúde/organização & administração , Redes Comunitárias/estatística & dados numéricos , Humanos , Formulação de Políticas , Administração em Saúde Pública/estatística & dados numéricos , Administração em Saúde Pública/tendências , Estados Unidos , Serviços Urbanos de Saúde/estatística & dados numéricosRESUMO
OBJECTIVES: We examined geographic differences in Early Periodic Screening, Diagnosis, and Treatment (EPSDT) visits as the South Carolina Department of Health and Environmental Control (SCDHEC) transitioned from direct service provision (DSP) to assuring delivery within the larger health care system. METHODS: We examined infant cohorts with continuous Medicaid coverage and normal birth weights from 1995 to 2010. Outcome variables included any EPSDT visit and the ratio of observed to expected visits. Change in SCDHEC market share over time by residence was the primary variable of interest. We used growth curve models to examine changes in EPSDT visits by rural areas and levels of DSP over time. RESULTS: A small proportion of the study population (10%) resided in rural counties that were more dependent on SCDHEC for DSP. The trajectory of not having visits among counties with high DSPs was steeper in rural areas (0.208; P = .001) compared with urban areas (0.145; P = .002). In counties with high DSPs, the slope of the predicted ratio in rural areas (-0.033; P < .001) was steeper than that of urban areas (-0.013; P < .001). CONCLUSIONS: Health departments operations continue to transition from DSP, which might decrease access to well-child care in rural communities. Health care reform provides opportunities for health departments to work with community partners to facilitate DSP from public to private sectors.
Assuntos
Serviços de Saúde da Criança/organização & administração , Serviços de Saúde da Criança/estatística & dados numéricos , Administração em Saúde Pública/estatística & dados numéricos , Prática de Saúde Pública/estatística & dados numéricos , População Rural/estatística & dados numéricos , Acessibilidade aos Serviços de Saúde , Humanos , Lactente , Recém-Nascido , Programas de Rastreamento , Medicaid , Características de Residência , South Carolina , Estados UnidosRESUMO
OBJECTIVES: We examined associations between local health department (LHD) spending, staffing, and services and community health outcomes in North Carolina. METHODS: We analyzed LHD investments and community mortality in North Carolina from 2005 through 2010. We obtained LHD spending, staffing, and services data from the National Association of City and County Health Officials 2005 and 2008 profile surveys. Five mortality rates were constructed using Centers for Disease Control and Prevention mortality files, North Carolina vital statistics data, and census data for LHD service jurisdictions: heart disease, cancer, diabetes, pneumonia and influenza, and infant mortality. RESULTS: Spending, staffing, and services varied widely by location and over time in the 85 North Carolina LHDs. A 1% increase in full-time-equivalent staffing (per 1000 population) was associated with decrease of 0.01 infant deaths per 1000 live births (P < .05). Provision of women and children's services was associated with a reduction of 1 to 2 infant deaths per 1000 live births (P < .05). CONCLUSIONS: Our findings, in the context of other studies, provide support for investment in local public health services to improve community health.
Assuntos
Tomada de Decisões , Governo Local , Administração em Saúde Pública/estatística & dados numéricos , Prática de Saúde Pública/estatística & dados numéricos , Humanos , Mortalidade , North Carolina , Admissão e Escalonamento de Pessoal , Administração em Saúde Pública/economia , Administração em Saúde Pública/normas , Prática de Saúde Pública/economia , Prática de Saúde Pública/normas , Estudos RetrospectivosRESUMO
OBJECTIVES: New York, like many other states, provides county-level health statistics for use in local priority settings but does not provide any data on public views about priority health issues. This study assessed whether health department priorities are notably different from community concerns about health, and how both groups' priorities compare with local health statistics. METHOD: Data from a 2009 rural survey on community health concerns were compared to priorities named by the seven area county health departments, and to local health indicator data. RESULTS: Health care/insurance cost (60%), obesity (53%), and prescription cost (41%) were leading community concerns, regardless of age, education, sex, or Internet in the home. Six of seven county health departments selected access to quality health care (which includes health care/insurance cost) as a leading public health priority, but only three identified obesity. The following leading local health issues were suggested by health indicators: Physical activity and nutrition, Smoking, and Unintentional injury. CONCLUSIONS: Health departments diverged from community priorities, from health indicator data, and from one another in choosing priorities. Adding a question about community health priorities to existing state telephone surveys on health behavior and lifestyle would provide an important tool to local health departments.
Assuntos
Prioridades em Saúde/estatística & dados numéricos , Administração em Saúde Pública/estatística & dados numéricos , Opinião Pública , Características de Residência/estatística & dados numéricos , População Rural , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Comportamentos Relacionados com a Saúde , Nível de Saúde , Humanos , Governo Local , Masculino , Pessoa de Meia-Idade , New York , Fatores SocioeconômicosRESUMO
Market research data complement traditional epidemiologic data by allowing users to examine health behavior and patterns by census block or census tract. Market research data can identify products and behaviors that align or do not align with public health program goals. Illinois is a recipient of an award from the Directors of Health Promotion and Education to use industry market research data collected by The Nielsen Company for public health purposes. Illinois creates customized community profiles using market research data on tobacco use characteristics to describe the demographics, habits, and media preferences of smokers in certain locations. Local agencies use profiles to plan and target marketing initiatives, reach disparate groups within overall community populations, and restructure program objectives and policy initiatives. Local market research data provide detailed information on the characteristics of smokers, allowing Illinois communities to design public health programs without having to collect data on their own.
Assuntos
Doença Crônica/prevenção & controle , Marketing/estatística & dados numéricos , Administração em Saúde Pública/estatística & dados numéricos , Humanos , Illinois/epidemiologia , Estilo de Vida , NicotianaRESUMO
BACKGROUND: A limitation of previous research on mobbing at work was that the individual consequences of the phenomenon were often assessed on 'clinical' samples of victims. Studies in organizations are less numerous and those available rarely evaluated the potential effect of mobbing over and above that of other psychosocial factors which provided robust evidence of adverse health effects. OBJECTIVES: The relationship between exposure to mobbing and stress-related psychophysical conditions was investigated taking in consideration the possible concomitant exposure to job strain and effort-reward imbalance. METHODS: Cross-sectional study on public administration administrative employees (No. = 538, 48% women). The psychosocial factors considered were assessed by means of well known and validated scales. The four health outcomes considered were psychological caseness (as operationalized by means of the general health questionnaire-12-item version), depression, gastritis and colitis/irritable colon syndrome as indicated by having reported a medical diagnosis of such conditions. Covariates: gender, age, body mass index, smoking habits and experience of a traumatic event in the last year. Analysis consisted of a series of logistic regressions. RESULTS: Exposure to mobbing was significantly associated with all the outcomes considered over and above the covariates. The inclusion in the models of job strain and effort-reward imbalance did not substantially alter the results. CONCLUSIONS: The relationship between mobbing at work and health outcomes is not confounded by concomitant exposure to job strain and effort-reward imbalance. These results offer further confirmation of the uniqueness of mobbing as a psychosocial risk factor.
Assuntos
Bullying , Doenças Profissionais/psicologia , Administração em Saúde Pública , Estresse Psicológico/psicologia , Local de Trabalho/psicologia , Adulto , Distribuição por Idade , Índice de Massa Corporal , Estudos Transversais , Depressão/psicologia , Feminino , Gastrite/psicologia , Humanos , Síndrome do Intestino Irritável/psicologia , Itália/epidemiologia , Modelos Logísticos , Masculino , Doenças Profissionais/epidemiologia , Doenças Profissionais/etiologia , Administração em Saúde Pública/estatística & dados numéricos , Fatores de Risco , Distribuição por Sexo , Fumar/efeitos adversos , Estresse Psicológico/epidemiologia , Estresse Psicológico/etiologia , Inquéritos e QuestionáriosRESUMO
Maternal mortality has been falling significantly in Cambodia since 2005 though it had been stagnant for at least 15 years before that. This paper analyzes the evolution of some major societal and health system factors based on recent national and international reports. The maternal mortality ratio fell from 472 per 100,000 live births in 2000-2005 to 206 in 2006-2010. Background factors have included peace and stability, economic growth and poverty reduction, improved primary education, especially for girls, improved roads, improved access to information on health and health services via TV, radio and cellphones, and increased ability to communicate with and within the health system. Specific health system improvements include a rapid increase in facility-based births and skilled birth attendance, notably investment in midwifery training and numbers of midwives providing antenatal care and deliveries within an expanding primary health care network, a monetary incentive for facility-based midwives for every live birth conducted, and an expanding system of health equity funds, making health care free of cost for poor people. Several major challenges remain, including post-partum care, family planning, prevention and treatment of breast and cervical cancer, and addressing sexual violence against women, which need the same priority attention as maternity care.
Assuntos
Acessibilidade aos Serviços de Saúde/organização & administração , Serviços de Saúde Materna/organização & administração , Mortalidade Materna/tendências , Administração em Saúde Pública/estatística & dados numéricos , Aborto Legal , Camboja/epidemiologia , Cesárea/estatística & dados numéricos , Comunicação , Serviços Médicos de Emergência/organização & administração , Serviços de Planejamento Familiar/organização & administração , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Tocologia/educação , Tocologia/organização & administração , Gravidez , Fatores Socioeconômicos , Saúde da MulherRESUMO
This study outlines the diagnosis stage of 201 Municipal Pharmaceutical Assistance Plans sent to the Directorate of Pharmaceutical Assistance of the State Secretariat for Health of Santa Catarina (DIAF-SES/SC) between November 12, 2005 and July 6, 2006. Multiple Correspondence Analysis was used in conjunction with SPAD 3.5 software, followed by hypothesis testing. The variables "pharmacist presence" and "population" were those which most contributed to the formation of the three clusters of municipalities observed. The number of drugs contained in the Municipal Lists of Essential Drugs (REMUMEs) ranged from 15 to 413. A total of 67 towns had between 101 and 200 drugs- a range considered ideal in this study according to the 2006 National List of Essential Drugs. No tendency toward correlation between number of drugs listed in the REMUMES and municipality population size was found. Results confirmed the known disparity in Pharmaceutical Assistance among municipalities of different sizes and highlighted the need for structuring the activities of Pharmaceutical Assistance in the municipalities studied. There is also a need for greater commitment from all management spheres so that activities of Pharmaceutical Assistance at a local level ensure access to quality drugs and services, while fostering rational use.
Este estudo retrata a etapa de diagnóstico de 201 Planos Municipais de Assistência Farmacêutica enviados entre 12 de novembro de 2005 a 06 de julho de 2006 à Diretoria de Assistência Farmacêutica da Secretaria de Estado da Saúde de Santa Catarina (DIAF-SES/SC). Utilizou-se a Análise de Correspondência Múltipla, através do programa SPAD 3.5 e posteriormente realizou-se teste de hipótese. As variáveis "presença de farmacêutico" e "população" foram as que mais contribuíram para a formação dos três agrupamentos de municípios evidenciados. O número de medicamentos constantes das Relações Municipais de Medicamentos Essenciais (REMUMEs) variou entre 15 e 413, sendo que 67 municípios possuem entre 101 e 200 medicamentos, considerado neste estudo como o intervalo ideal, de acordo com a Relação Nacional de Medicamentos Essenciais de 2006. Não se verificou tendência à correlação entre o número de medicamentos nas REMUMEs e a população do município. Os resultados confirmam a conhecida disparidade em relação à Assistência Farmacêutica entre municípios de diferentes portes e ressaltam a necessidade de estruturação das atividades de Assistência Farmacêutica nos municípios estudados. Há ainda a necessidade de maior comprometimento de todas as esferas de gestão para que as atividades de Assistência Farmacêutica no nível local garantam o acesso a medicamentos e serviços de qualidade, visando o uso racional.
Assuntos
Administração em Saúde Pública/estatística & dados numéricos , Assistência Farmacêutica/estatística & dados numéricos , Assistência Farmacêutica/organização & administração , Brasil , Atenção Primária à Saúde/estatística & dados numéricos , Atenção à Saúde , Acessibilidade aos Serviços de Saúde , Planos de Sistemas de SaúdeRESUMO
OBJECTIVES: Through a long history of cancer policies, public health has a foundation for cancer research and data to use in applying technological advancements for U.S. cancer control efforts. Geographic information systems (GIS) are one technology enabling the visualization of cancer risk patterns associated with incidence, mortality, and accessibility to care. METHODS: U.S. Comprehensive Cancer Control (CCC) program directors were interviewed from 49 of 50 states to assess use and function of GIS tools for mapping data related to cancer control policies and practices. Interviews were coded to obtain frequencies of response associated with content domains mapped using GIS tools and the perceived relative advantages. RESULTS: Significant relationships were found between the mapping of behavioral risk factors, health care services, transportation access, and policy advantages identified by program managers. The mapping of cancer incidence, mortality, and staging, transportation access, and multiple layers of content were found to have significant associations with perceived research advantages. CONCLUSIONS: U.S. CCC program managers recognize several important advantages relating to health policy and research for use of GIS tools in cancer control efforts. The application of GIS in U.S. cancer control efforts is employed unevenly, suggesting the need for innovative policies to support accessibility.
Assuntos
Atitude do Pessoal de Saúde , Sistemas de Informação Geográfica/estatística & dados numéricos , Neoplasias/epidemiologia , Administração em Saúde Pública , Informática em Saúde Pública/estatística & dados numéricos , Sistema de Registros/estatística & dados numéricos , Análise por Conglomerados , Demografia , Exposição Ambiental , Controle de Formulários e Registros , Política de Saúde , Acessibilidade aos Serviços de Saúde , Humanos , Incidência , Entrevistas como Assunto , Estadiamento de Neoplasias , Neoplasias/prevenção & controle , Administração em Saúde Pública/educação , Administração em Saúde Pública/estatística & dados numéricos , Medição de Risco , Assunção de Riscos , Estados Unidos/epidemiologiaRESUMO
Se ha identificado a la mortalidad materna como un problema grave de salud pública en el país.Con este antecedente se realiza una revisión general de mortalidad materna a nivel mundial y se detecta que las altas tasas afectan a laos países en vías de desarrollo.A lo largo de todo el estudio se intenta identificar los factores que más influyen en esta mortalidad y se observa que son múlitiples y diversos, sin embargo, se logra precisar que hay factores económicos, sociales y culturales que repercuten en la salud de las mujeres. Pero aparte de ellos existen elementos importantes como la educación a la comunidad, la capacitación al personal, el marco jurídico y la calidad de los servicios de salud que están incidiendo en las altas tasas de mortalidad materna.Se realiza un estudio de la evolución de esta mortalidad en el país en el transcurso de varias décadas pasadas y se observa que si bien es irregular, la tendencia se proyecta a la baja, sin embargo, sigue siendo en alta en comparación con otros países de América y el Caribe
Assuntos
Gravidez , Administração em Saúde Pública/estatística & dados numéricos , Administração em Saúde Pública/métodos , Administração em Saúde Pública , Mortalidade Materna/tendências , Estatísticas de Saúde , Serviços de Saúde/normas , Serviços de Saúde/provisão & distribuição , Serviços de Saúde , Serviços de Saúde/tendências , Serviços de SaúdeRESUMO
OBJECTIVES: We collected data on a national sample of existing community-based tobacco cessation programs for youths to understand their prevalence and overall characteristics. METHODS: We employed a 2-stage sampling design with US counties as the first-stage probability sampling units. We then used snowball sampling in selected counties to identify administrators of tobacco cessation programs for youths. We collected data on cessation programs when programs were identified. RESULTS: We profiled 591 programs in 408 counties. Programs were more numerous in urban counties; fewer programs were found in low-income counties. State-level measures of smoking prevalence and tobacco control expenditures were not associated with program availability. Most programs were multisession, school-based group programs serving 50 or fewer youths per year. Program content included cognitive-behavioral components found in adult programs along with content specific to adolescence. The median annual budget was 2000 dollars. Few programs (9%) reported only mandatory enrollment, 35% reported mixed mandatory and voluntary enrollment, and 56% reported only voluntary enrollment. CONCLUSIONS: There is considerable homogeneity among community-based tobacco cessation programs for youths. Programs are least prevalent in the types of communities for which national data show increases in youths' smoking prevalence.
Assuntos
Serviços de Saúde Comunitária/provisão & distribuição , Pesquisas sobre Atenção à Saúde , Promoção da Saúde/provisão & distribuição , Administração em Saúde Pública/estatística & dados numéricos , Abandono do Uso de Tabaco/estatística & dados numéricos , Tabagismo/prevenção & controle , Adolescente , Adulto , Orçamentos , Criança , Serviços de Saúde Comunitária/economia , Serviços de Saúde Comunitária/organização & administração , Feminino , Programas Governamentais/organização & administração , Programas Governamentais/estatística & dados numéricos , Promoção da Saúde/organização & administração , Necessidades e Demandas de Serviços de Saúde , Humanos , Governo Local , Masculino , População Rural , Estudos de Amostragem , Serviços de Saúde Escolar , População Suburbana , Abandono do Uso de Tabaco/economia , Tabagismo/epidemiologia , Estados Unidos/epidemiologia , População UrbanaRESUMO
Esta edição do "CONASS Documenta" traz informações sobre o impacto da violência na saúde da população, em seus diversos aspectos impacto sobre a mortalidade, morbidade, custos para o sistema de saúde, com atenção especial a questão do gênero e ciclos de vida mais vulneráveis, além de trazer sugestões de diretrizes e ações que podem ser implementadas pelo setor com vistas não só ao atendimento das vítimas, mas também para sua prevenção e promoção da saúde e qualidade de vida.