Contemporary Trends and End-Results of National Institutes of Health Grant Funding to Departments of Urology in the United States: A 10-year Analysis.

PURPOSE: We explored the patterns and distribution of National Institutes of Health grant funding for urological research in the United States. MATERIALS AND METHODS: The National Institutes of Health RePORTER database was queried for all grants awarded to urology departments between 2010 and 2019. Information regarding the value of the grant, funded institution, successful publication of the research, and the category of urological subspecialty were collected. Data on principal investigators were extracted from publicly available information. RESULTS: There were 509 grants awarded to Urology between 2010 and 2019 for a total value of $640,873,867, and a median per-project value of $675,484 (IQR 344,170-1,369,385). Over the study period, total funding decreased by 15.6% and was lower compared to other surgical subspecialties. Most grants were awarded by the National Cancer Institute and National Institute of Diabetes and Digestive and Kidney Diseases (85%) to Western or North Central institutions (52.5%), and had principal investigators specialized in urologic oncology (56.4%), followed by general urologists (21.5%). Female principal investigators led 21.6% of Urology grants and were more likely PhD basic scientists than males (64.4% vs 38.2%, p=0.001). In total, 10,404 publications linked to the 509 grants were produced, of which 28.5% were published in journals with an impact factor ≥10. CONCLUSIONS: Urology is underrepresented in National Institutes of Health grant funding compared to other surgical fields. During the past decade there was a further decrease in the total budget of National Institutes of Health grants to Urology.

Prescribed Drug Spending in Canada, 2019: A Focus on Public Drug Programs.

Public drug program spending accounts for 43.1% of prescribed drug spending in Canada. This report provides an in-depth look at public drug program spending in Canada, using the Canadian Institute for Health Information's (CIHI) National Prescription Drug Utilization Information System. Public drug program spending does not include spending on drugs dispensed in hospitals or on those funded through cancer agencies and other special programs.

Crise econômica, austeridade e seus efeitos sobre o financiamento e acesso a serviços públicos e privados de saúde bucal / Economic crisis, austerity and its effects on the financing of oral health and access to public and private services

Resumo O presente estudo analisou os efeitos da austeridade e crise econômica sobre o financiamento da saúde bucal, oferta e utilização de serviços públicos e acesso a planos exclusivamente odontológicos no Brasil, no período de 2003 a 2018. Foi realizado um estudo retrospectivo, descritivo, com abordagem quantitativa. Foram coletados dados da base do Fundo Nacional de Saúde, da Agência Nacional de Saúde Suplementar, da Sala de Apoio à Gestão Estratégica, do Sistema e-gestor. Observou-se que o repasse federal fundo a fundo apresentou tendência crescente de 2003 a 2010 e estável de 2011 a 2018. A oferta decresceu ao final do período com redução da cobertura da primeira consulta odontológica programática, média da escovação dental supervisionada e número de tratamentos endodônticos. Na contramão da crise financeira pública, as empresas de planos exclusivamente odontológicos expandiram o mercado de 2,6 milhões de usuários em 2000 para 24,3 milhões em 2018, com lucro de mais de R$240 milhões. A austeridade fiscal tem forte influência sobre a utilização de serviços públicos odontológicos no Brasil, que pode beneficiar o mercado privado e ampliar as desigualdades.

Abstract The present study analyzed the effects of austerity and economic crisis on the financing of oral health, provision and use of public services and access to exclusively dental plans in Brazil, from 2003 to 2018. A retrospective, descriptive study was carried out, with a quantitative approach. Data were collected from the National Health Funding database, the National Supplementary Health Agency, the Strategic Management Support Room, and from the e-manager system. The federal fund-to-fund transfer was increasing from 2003 to 2010 and remained stable from 2011 to 2018. The supply decreased at the end of the period, with reduced coverage of the first programmatic dental appointment, average supervised tooth brushing and number of endodontic treatments. Against the background of the public financial crisis, exclusively dental plan companies expanded the market from 2.6 million users in 2000 to 24.3 million in 2018, with a profit of more than R$ 240 million. Fiscal austerity has a strong influence on the use of public dental services in Brazil, which can benefit the private market and widen inequalities.

Crise e federalismo: tendências e padrões regionais das receitas e despesas em saúde dos estados brasileiros / Crisis and federalism: trends and regional patterns of health revenues and expenditures in the brazilian states

Resumo O estudo tem como objetivo analisar as tendências e os padrões regionais das receitas e despesas em saúde dos estados brasileiros no período de 2006 a 2016. Trata-se de estudo exploratório e descritivo com base em dados secundários de abrangência nacional e indicadores selecionados. Verificou-se crescimento da receita corrente líquida per capita para o conjunto dos estados e regiões, com quedas em anos específicos associadas às crises de 2008-2009 e de 2015-2016. A despesa em saúde per capita apresentou tendência de crescimento, mesmo em momentos de crise econômica e queda da arrecadação. Observou-se diversidade de fontes e heterogeneidade de receitas e despesas em saúde, e impactos diferenciados da crise sobre os orçamentos estaduais das regiões. Os resultados sugerem o efeito protetor relacionado à vinculação constitucional da saúde, aos compromissos e prioridades de gastos, e aos mecanismos de compensação de fontes de receitas do federalismo fiscal nas despesas em saúde dos estados. Contudo, permanecem desafios para a implantação de um sistema de transferências que diminua as desigualdades e estabeleça maior cooperação entre os entes, em um contexto de austeridade e fortes restrições ao financiamento público da saúde no Brasil.

Abstract This study aims to analyze regional trends and patterns of health revenues and expenditure in the Brazilian states from 2006 to 2016. This is an exploratory and descriptive study based on secondary national data and selected indicators. Higher per capita net current revenues for all states and regions, with decreasing levels in specific years associated with the crises of 2008-2009 and 2015-2016 were observed. Per capita health expenditure showed an increasing trend, even in times of economic crisis and declining collection. Diversity of sources and heterogeneity of health revenues and expenditures, as well as different impacts of the crisis on the regional budgets, were observed. The results suggest the protective effect of constitutional health linkage, spending commitments and priorities, and compensation mechanisms of fiscal federalism revenue sources in state health expenditures. However, challenges remain for the implementation of a transfer system that reduces inequalities and establishes greater cooperation among entities, in a context of austerity and strong public health financing constraints in Brazil.

HIV Prevention Practices and Non-Federal Funding Among U.S. States and Non-State Regions: A Survey of HIV/AIDS Directors.

We surveyed U.S. HIV/AIDS directors or designees in states and non-state regions, regarding factors influencing HIV viral suppression: (1) non-federal prevention funding; (2) contacting newly reported patients and providers, for care linkage and partner services; (3) follow-up of non-received viral load reports, to identify untreated patients; and (4) genotype/phenotype surveillance, to monitor drug resistance. The survey was conducted April-July 2015; 50 (87.7%) participated. Eighty percent of jurisdictions contacted all newly reported patients; 60% contacted all providers. HIV resistance tests were reportable in 38%; 66% contacted providers and/or patients about missed viral loads. Non-federal funding was significantly associated with annual diagnoses (p = .0001) and population (p = .0002), but not with other factors studied. Many jurisdictions lacked non-federal funding (28%), or experienced unrestored reductions since 2008 (33%). Jurisdictions' funding and preventive practices varied greatly. HIV viral suppression could be enhanced by restoring (or establishing) non-federal prevention funding, and by more standardized surveillance/outreach practices.

Obligation and the Changing Nature of Publicly Funded Healthcare.

This article explores the relationship between obligation and publicly funded healthcare. Taking the National Health Service (NHS) as the focal point of discussion, the article presents a historical analysis of the shifting nature and function of obligation as it relates to this institution. Specifically, and drawing inspiration from recent literature that takes seriously the notion of the tie or bond at the core of obligation, the article explores how the forms of social relation and bonds underpinning a system like the NHS have shifted across time. This is undertaken via an analysis of Aneurin Bevan's vision of the NHS at its foundation, the importance today of the patient (and the individual generally) within publicly funded healthcare, and the role of contract as a contemporary governance mechanism within the NHS. A core feature of the article is its emphasis on the impact that a variety of economic factors-including privatisation, marketisation, and the role of debt and finance capital-are having on previously settled understandings of obligation and the forms of social relation underpinning them associated with the NHS. It is therefore argued that an adequate analysis of obligation in healthcare law and related fields must extend beyond the doctor-patient relationship and that of state-citizen of the classical welfare state in order to incorporate new forms of relation, such as that between creditor and debtor, and new actors, including private healthcare providers and financial institutions.

The future of the Brazilian Health System: a short review of its pathways towards an uncertain and discouraging horizon. / Notas sobre o futuro do SUS: breve exame de caminhos e descaminhos trilhados em um horizonte de incertezas e desalentos.

This article reflects on the future of the Brazilian Unified Health System (SUS, acronym in Portuguese), based on the foresight exercises conducted by the Brasil Saúde Amanhã initiative of the Oswaldo Cruz Foundation. The text briefly reviews some paths followed by the SUS as referred to in the Federal Constitution of 1988. It highlights the movement towards the decentralization of care and the constraint of health financial resources that reduced policies of increasing public expenditures. It examines the public and private arrangements for financing and provision of services that have resulted in sectoral privatization, mainly from economic policies articulated with concession of fiscal benefits. It analyzes the changes in the public sector financing through successive constitutional amendments that resulted in the weakening of established social protection policies, particularly of the health sector. For the future, the text considers population aging and analyzes trends in the epidemiological profile, with consequent changes in the health care paradigm. The article concludes by pointing out the consequences of fiscal strangling in the organization of the healthcare system and the need to reverse legal provisions that hamper the fulfillment of the constitutional mandate for equity and universality.

Este artigo apresenta uma reflexão sobre o futuro do SUS, baseada em exercícios prospectivos desenvolvidos pela iniciativa Brasil Saúde Amanhã da Fundação Oswaldo Cruz. O texto faz uma breve revisão de caminhos e descaminhos percorridos pelo SUS, tendo como marco a Constituição Federal de 1988. Destaca os movimentos pela descentralização e a subtração de recursos da saúde que reduziu a política de incremento de gastos; e acentua os arranjos públicos e privados de financiamento e provisão de serviços que resultaram na privatização setorial decorrente, principalmente, de políticas econômicas articuladas com a concessão de benefícios e tributos. Analisa o financiamento do setor público através das sucessivas emendas constitucionais que resultaram na destruição da proteção social e no enfraquecimento do setor Saúde. Para o futuro, o texto considera o envelhecimento populacional e analisa tendências no perfil epidemiológico, com as consequentes mudanças no modelo de cuidados de atenção à saúde. O artigo conclui apontando os resultados do estrangulamento fiscal na organização do sistema de cuidados e a necessidade da reversão de dispositivos legais que obstaculizam o mandamento constitucional.

[Give the due value to the end of life: the systematic underfunding of specialised palliative care in the Swiss DRG system]. / Der Wert des Lebensendes: am Beispiel der Finanzierung der stationären spezialisierten Palliative Care in der Schweiz.

Give the due value to the end of life: the systematic underfunding of specialised palliative care in the Swiss DRG system Abstract. Palliative care is an integral part of modern medicine, improving quality of life, treatment satisfaction, and reducing the costs of care in severe disease. Patients' access should be early, regardless of age, diagnosis and setting, when incurable or advanced disease has been diagnosed. The public expenditure for specialised palliative care units in hospitals can be seen as yardstick for an appropriate palliative care supply, but in Switzerland only a mere fraction of revenues is dedicated to the palliative care units. Every year, 66'000 patients die in Switzerland, 38 % of them in a hospital. Health care costs for the last year of life account for 1.9 billion Swiss francs, but palliative care units receive only estimated 51 million Swiss francs per year. Reasons are a too little number of palliative care units, a systemic underfunding of their services and a fragmentary supply chain for severely ill or dying patients. This leads to ethically conflicting situations for clinicians. They have to deal with shortage of supply and, due to economic reasons, are forced to transfer severely ill or dying patients into inadequate settings. Based on international recommendations, Switzerland is in need of further 500 beds for specialised palliative care (actually 335), and at least 11'000 patients per year need access to a specialised palliative care service (actually about 3'500). Under the actual tariffing system, units for palliative care in hospitals are endangered in their existence. Corrections of the remuneration system are urgently warranted. On the long run, a national legal basis should be elaborated to safeguard adequate palliative care supply for all patients in need and as a base for monitoring, formation and research in palliative care.

Notas sobre o futuro do SUS: breve exame de caminhos e descaminhos trilhados em um horizonte de incertezas e desalentos / The future of the Brazilian Health System: a short review of its pathways towards an uncertain and discouraging horizon

Resumo Este artigo apresenta uma reflexão sobre o futuro do SUS, baseada em exercícios prospectivos desenvolvidos pela iniciativa Brasil Saúde Amanhã da Fundação Oswaldo Cruz. O texto faz uma breve revisão de caminhos e descaminhos percorridos pelo SUS, tendo como marco a Constituição Federal de 1988. Destaca os movimentos pela descentralização e a subtração de recursos da saúde que reduziu a política de incremento de gastos; e acentua os arranjos públicos e privados de financiamento e provisão de serviços que resultaram na privatização setorial decorrente, principalmente, de políticas econômicas articuladas com a concessão de benefícios e tributos. Analisa o financiamento do setor público através das sucessivas emendas constitucionais que resultaram na destruição da proteção social e no enfraquecimento do setor Saúde. Para o futuro, o texto considera o envelhecimento populacional e analisa tendências no perfil epidemiológico, com as consequentes mudanças no modelo de cuidados de atenção à saúde. O artigo conclui apontando os resultados do estrangulamento fiscal na organização do sistema de cuidados e a necessidade da reversão de dispositivos legais que obstaculizam o mandamento constitucional.

Abstract This article reflects on the future of the Brazilian Unified Health System (SUS, acronym in Portuguese), based on the foresight exercises conducted by the Brasil Saúde Amanhã initiative of the Oswaldo Cruz Foundation. The text briefly reviews some paths followed by the SUS as referred to in the Federal Constitution of 1988. It highlights the movement towards the decentralization of care and the constraint of health financial resources that reduced policies of increasing public expenditures. It examines the public and private arrangements for financing and provision of services that have resulted in sectoral privatization, mainly from economic policies articulated with concession of fiscal benefits. It analyzes the changes in the public sector financing through successive constitutional amendments that resulted in the weakening of established social protection policies, particularly of the health sector. For the future, the text considers population aging and analyzes trends in the epidemiological profile, with consequent changes in the health care paradigm. The article concludes by pointing out the consequences of fiscal strangling in the organization of the healthcare system and the need to reverse legal provisions that hamper the fulfillment of the constitutional mandate for equity and universality.

Diabetes research in Mexico: a map of 13 years of public funding / La investigación en diabetes en México: un mapa de 13 años de financiamiento público / Pesquisa em diabetes no México: um mapa de 13 anos de financiamento público

Abstract: In Mexico, diabetes represents a serious public health problem and a high-cost disease for the health system. Health research is essential for generating new knowledge to combat such a serious issue, however, there is not enough information on how to generate and use it. This paper examines the public funding of 303 diabetes research projects, granted by the National Council of Science and Technology in Mexico between 2002 and 2014. The projects were systematized and classified according to their type of research, discipline or subject, and aim of knowledge. Considering these information, an econometric model that links the funding with the characteristics of the projects was prepared. The results show that the funding is focused on the basic and biomedical areas, particularly on genetic research, and also that diabetes research resources have increased over time, not steadily, but rather cyclically. In diabetes research projects there is a high level of concentration at several dimensions: research areas, topics, objects, institutions conducting research, and regions. The analysis of the resource allocation suggests that Mexico needs a stronger and oriented diabetes research agenda, including in its bases discussions about balance between basic and applied research, and about oriented research towards practical implementations. The importance of promoting health systems research to improve diabetes care is also discussed, as well as implementing mechanisms to assess the impact of diabetes research in short, medium and long term, as part of Mexico's science and technology policy.

Resumen: En México la diabetes es un grave problema de salud pública y es una enfermedad de alto costo para el sistema de salud. La investigación en salud es esencial para generar nuevo conocimiento para combatir este problema, pero existe escasa información sobre su generación y uso. Este trabajo examina el financiamiento público de 303 proyectos de investigación sobre diabetes, otorgados por el Consejo Nacional de Ciencia y Tecnología en México, entre 2002 y 2014. Los proyectos fueron sistematizados y clasificados de acuerdo con el tipo de investigación, disciplina o temática, y objetivo de generación de conocimiento. Con estos datos, se elaboró un modelo econométrico que relacional el financiamiento con las características de los proyectos. Los resultados muestran que el financiamiento está centrado en áreas básica y biomédica, particularmente en investigación genética, y que los recursos destinados a la investigación en diabetes se han incrementado en el tiempo pero no de manera constante, sino coyuntural. En los proyectos de investigación sobre diabetes hay un alto nivel de concentración en varias dimensiones: áreas de investigación, temáticas, objeto de estudio, instituciones que realizan la investigación, y regiones. El análisis de la asignación de recursos sugiere que México necesita una agenda de investigación en diabetes más fuerte y orientada, con fundamento en discusiones sobre el equilibrio entre investigación básica y aplicada, y sobre investigación orientada hacia implementaciones de tipo práctico. SE discute también la importancia de promover investigación sobre el sistema de salud para mejorar el cuidado a los pacientes con diabetes, así como la de implementar mecanismos para evaluar el impacto de la investigación en diabetes a corto, mediano y largo plazo, como parte de la política de ciencia y tecnología en México.

Resumo: No México, o diabetes representa um grave problema de saúde pública e uma doença de custo elevado para o sistema de saúde. A pesquisa em saúde é essencial para gerar novos conhecimentos para combater o problema, mas não há informação suficiente para gerar e utilizá-los. O artigo examina o financiamento público de 303 projetos de pesquisa em diabetes, através do Conselho Nacional de Ciência e Tecnologia do México entre 2002 e 2014. Os projetos foram sistematizados e classificados de acordo com o tipo de pesquisa, disciplina ou assunto e o objetivo do conhecimento. Com base nessa informação, foi preparado um modelo econométrico que associa o financiamento às características dos projetos. Os resultados mostram que o financiamento está concentrado nas áreas de pesquisa básica e biomédica, principalmente em pesquisa genética, e que os recursos para pesquisa em diabetes aumentaram ao longo do tempo, não continuamente, mas ciclicamente. Os projetos de pesquisa em diabetes mostram uma forte concentração em diversas dimensões: área de pesquisa, tema, objeto, instituição que realiza a pesquisa e região do país. A análise da alocação de recursos sugere que o México precisa de uma agenda de pesquisa mais forte e orientada, com bases que incluam discussões sobre o equilíbrio entre pesquisa básica e aplicada, e para pesquisa voltada para implementações práticas. O artigo também discute a importância de promover pesquisas em sistemas de saúde para melhorar os cuidados em diabetes, além de implementar mecanismos para avaliar o impacto da pesquisa em diabetes no curto, médio e longo prazo como parte da política de ciência e tecnologia do país.

[Old and New Public Health Structures in Germany - Plenary Lecture of the Forum Future Public Health, Berlin 2016]. / Alte und neue Strukturen von Public Health in Deutschland.

Basic structures serving public health in Germany in the second decade of the 21st century are described. They are related to the governmental public health grant programs of the late 20th century and the successful re-introduction of public health competencies and capacities at universities and colleges. Structures under direct governmental responsibility, public law self-government and in the non-governmental for-profit and not-for-profit sector are described. Future challenges are sketched and a networked, three-dimensional model of research and development, politics and practice is suggested.

Federal financing of health surveillance in Brazil from 2005 to 2012: an analysis of distribution of resources. / Financiamento federal da Vigilância Sanitária no Brasil de 2005 a 2012: análise da distribuição dos recursos.

Health Surveillance carries out a set of actions to prevent health risks related to the consumption of products and the provision of services under the Unified Health System (SUS). The implementation of Health Surveillance actions relies heavily on the federal funding policy, which induces its decentralization. This text aims to analyze the federal funding of Health Surveillance to States and Municipalities from the scheduled onlendings in the period 2005-2012. Among the main results are the increase of per capita values, steady at around the mean value of R$ 1.25/inhabitant/year; the increased number of municipalities that agreed to carry out strategic actions; and a stable trend in the proportions of each federated entity at around 50% to Municipalities, 25% to state federated entities and 20% to the Central Public Health Laboratories (LACENs). Results show that the adoption of unified nationwide per capita values caused distortions that indicate inequity among state territories, pointing to the need to clarify the concept of equity in financing under the National Health Surveillance System and to broaden the discussion on the currently used allocation criteria.

Resumo A Vigilância Sanitária realiza um conjunto de ações de prevenção de riscos à saúde relacionados ao consumo de produtos e à prestação de serviços no âmbito do Sistema Único de Saúde. A realização das ações de Vigilância Sanitária depende fortemente da política de financiamento federal, que é indutora da sua descentralização. O objetivo deste texto é analisar o financiamento federal da Vigilância Sanitária para estados e municípios, a partir dos repasses programados, no período entre 2005-2012. Entre os principais resultados estão o aumento nos valores per capita, com manutenção em torno do valor médio de R$ 1,25/hab/ano; o aumento no número de municípios que pactuaram a realização de ações estratégicas; e uma tendência de estabilização nos percentuais atinentes a cada ente federado em torno de 50% aos Municípios, 25% aos entes federados Estado e 20% aos Laboratórios Centrais de Saúde Pública. Os resultados evidenciam que a adoção de valores per capita unificados para todo o país provocou distorções que indicam iniquidade entre territórios estaduais, apontando a necessidade de tornar mais preciso o conceito de equidade no financiamento no âmbito do Sistema Nacional de Vigilância Sanitária e de ampliar a discussão sobre os critérios de alocação atualmente utilizados.

Financiamento federal da Vigilância Sanitária no Brasil de 2005 a 2012: análise da distribuição dos recursos / Federal financing of health surveillance in Brazil from 2005 to 2012: an analysis of distribution of resources

Resumo A Vigilância Sanitária realiza um conjunto de ações de prevenção de riscos à saúde relacionados ao consumo de produtos e à prestação de serviços no âmbito do Sistema Único de Saúde. A realização das ações de Vigilância Sanitária depende fortemente da política de financiamento federal, que é indutora da sua descentralização. O objetivo deste texto é analisar o financiamento federal da Vigilância Sanitária para estados e municípios, a partir dos repasses programados, no período entre 2005-2012. Entre os principais resultados estão o aumento nos valores per capita, com manutenção em torno do valor médio de R$ 1,25/hab/ano; o aumento no número de municípios que pactuaram a realização de ações estratégicas; e uma tendência de estabilização nos percentuais atinentes a cada ente federado em torno de 50% aos Municípios, 25% aos entes federados Estado e 20% aos Laboratórios Centrais de Saúde Pública. Os resultados evidenciam que a adoção de valores per capita unificados para todo o país provocou distorções que indicam iniquidade entre territórios estaduais, apontando a necessidade de tornar mais preciso o conceito de equidade no financiamento no âmbito do Sistema Nacional de Vigilância Sanitária e de ampliar a discussão sobre os critérios de alocação atualmente utilizados.

Abstract Health Surveillance carries out a set of actions to prevent health risks related to the consumption of products and the provision of services under the Unified Health System (SUS). The implementation of Health Surveillance actions relies heavily on the federal funding policy, which induces its decentralization. This text aims to analyze the federal funding of Health Surveillance to States and Municipalities from the scheduled onlendings in the period 2005-2012. Among the main results are the increase of per capita values, steady at around the mean value of R$ 1.25/inhabitant/year; the increased number of municipalities that agreed to carry out strategic actions; and a stable trend in the proportions of each federated entity at around 50% to Municipalities, 25% to state federated entities and 20% to the Central Public Health Laboratories (LACENs). Results show that the adoption of unified nationwide per capita values caused distortions that indicate inequity among state territories, pointing to the need to clarify the concept of equity in financing under the National Health Surveillance System and to broaden the discussion on the currently used allocation criteria.

Current trends in disability claims due to fibromyalgia syndrome.

Fibromyalgia syndrome (FMS) affects 0.4-8% of the general population predominantly in the female population with a F:M ratio of 3-9:1. It is characterised by persistent widespread pain and other associated clinical conditions such as chronic fatigue, irritable bowel syndrome (IBS), temporomandibular joint dysfunction (TMJD), sleep disorders and cognitive impairment. FMS diagnosis at present is purely clinical because no medical or laboratory examinations are able to identify it with certainty. FMS is not fully recognised worldwide, and patients often do not receive the treatment and disability benefits planned for other chronic diseases even though it gives rise to a very significant social burden due to direct and indirect healthcare costs and the loss of productivity and work. This article describes the medico-legal situation of FMS patients around the world, particularly issues related to the recognition of the disease by health institutions and the provision of disability benefits. We also discuss the current means of assessing disabilities in the medico-legal context, and their possible future improvements.

Making the Case for Investment in Rural Cancer Control: An Analysis of Rural Cancer Incidence, Mortality, and Funding Trends.

Estimates of those living in rural counties vary from 46.2 to 59 million, or 14% to 19% of the U.S. POPULATION: Rural communities face disadvantages compared with urban areas, including higher poverty, lower educational attainment, and lack of access to health services. We aimed to demonstrate rural-urban disparities in cancer and to examine NCI-funded cancer control grants focused on rural populations. Estimates of 5-year cancer incidence and mortality from 2009 to 2013 were generated for counties at each level of the rural-urban continuum and for metropolitan versus nonmetropolitan counties, for all cancers combined and several individual cancer types. We also examined the number and foci of rural cancer control grants funded by NCI from 2011 to 2016. Cancer incidence was 447 cases per 100,000 in metropolitan counties and 460 per 100,000 in nonmetropolitan counties (P < 0.001). Cancer mortality rates were 166 per 100,000 in metropolitan counties and 182 per 100,000 in nonmetropolitan counties (P < 0.001). Higher incidence and mortality in rural areas were observed for cervical, colorectal, kidney, lung, melanoma, and oropharyngeal cancers. There were 48 R- and 3 P-mechanism rural-focused grants funded from 2011 to 2016 (3% of 1,655). Further investment is needed to disentangle the effects of individual-level SES and area-level factors to understand observed effects of rurality on cancer. Cancer Epidemiol Biomarkers Prev; 26(7); 992-7. ©2017 AACR.

Política de Saúde Bucal no Brasil 2003-2014: cenário, propostas, ações e resultados / Oral health policy in Brazil between 2003 and 2014: scenarios, proposals, actions, and outcomes

Resumo Este estudo analisou a implementação da Política de Saúde Bucal no Brasil de 2003 a 2014, caracterizando cenários, ações institucionais do poder executivo nos componentes do sistema de saúde em três governos. Realizou-se análise documental das tomadas de decisão da Coordenação Geral de Saúde Bucal do Ministério da Saúde através de documentos de setores estratégicos do governo disponíveis nos sítios da internet, como portal da transparência e Instituto Brasileiro de Geografia e Estatística. Este estudo apontou crescimento na oferta e cobertura potencial de serviços públicos odontológicos entre 2003 e 2006 e certa manutenção nos períodos 2007-2010 e 2011-2014. Houve ampliação do financiamento nominal, infraestrutura e recursos humanos. Os recursos repassados para estados e municípios passaram de 83,4 milhões em 2003 para 916 milhões em 2014, aumento de 10,9 vezes no período. O uso dos serviços odontológicos no SUS entre 2003-2008 manteve-se constante em torno de 30%. Houve aumento do uso dos serviços odontológicos privados (64,4% em 2003, 69,6% em 2008 e 74,3% em 2013). O componente do modelo de atenção foi o menos abordado nos três governos, constituindo-se em lacuna com repercussões nos resultados requerendo adoção de medidas futuras por parte dos gestores.

Abstract This study examined the implementation of Brazil’s National Oral Health Policy by the three governments during the period 2003 to 2014. It provides a general overview of oral health care scenarios and examines institutional proposals and actions developed by the executive branch based on the components of the health care system. A documental analysis was conducted using documents produced by key government agencies. The findings show that there was an increase in the provision and coverage of public dental services between 2003 and 2006 and that rates were maintained to a certain degree in subsequent periods (2007 to 2010 and 2011 to 2014). There was an expansion in government funding, human resources and infrastructure. The amount of funds transferred to state and local governments increased from 83.4 million in 2003 to 916 million in 2014, equivalent to a 10.9 fold increase. However, the use of public dental services remained stable, with only a slight increase from 29.7% in 2003 to 30.7% in 2008, while private service utilization increased from 64.4% in 2003 to 74.3% in 2013. The care model component was given lowest priority by the three governments. This shortcoming influences policy effectiveness and requires the adoption of future measures by healthcare managers and officials to correct the situation.

Crafting AIDS policy in Brazil and Russia: State-civil societal ties, institutionalised morals, and foreign policy aspiration.

During the 1990s, Brazil and Russia diverged in their policy response to AIDS. This is puzzling considering that both nations were globally integrated emerging economies transitioning to democracy. This article examines to what extent international pressures and partnerships with multilateral donors motivated these governments to increase and sustain federal spending and policy reforms. Contrary to this literature, the cases of Brazil and Russia suggest that these external factors were not important in achieving these outcomes. Furthermore, it is argued that Brazil's policy response was eventually stronger than Russia's and that it had more to do with domestic political and social factors: specifically, AIDS officials' efforts to cultivate a strong partnership with NGOs, the absence of officials' moral discriminatory outlook towards the AIDS community, and the government's interest in using policy reform as a means to bolster its international reputation in health.