EUROCOURSE lessons learned from and for population-based cancer registries in Europe and their programme owners: Improving performance by research programming for public health and clinical evaluation.

UNLABELLED: Population-based cancer registries (CRs) in Europe have played a supportive, sometimes guiding, role in describing geographic variation of cancer epidemics and comparisons of oncological practice and preventive interventions since the 1950s for all types of cancer, separate and simultaneously. This paper deals with historical and longitudinal developments of the roughly 160 CRs and their programme owners (POs) that emerged since 1927 and accelerating since the late 70s especially in southern and continental Europe. About 40 million newly diagnosed patients were recorded since the 1950s out of a total of 100 million of whom almost 20 million are still alive and about 10% annually dying from cancer. The perception of unity in diversity and suboptimal comparability in performance and governance of CRs was confirmed in the EUROCOURSE (EUROpe against cancer: Optimisation of the Use of Registries for Scientific Excellence in research) European Research Area (ERA)-net coordination FP7 project of the European Commission (EU) which explored best practices, bottlenecks and future challenges of CRs. Regional oncologic and public health changes but also academic embedding of CRs varied considerably, although Anno 2012 optimal cancer surveillance indeed demanded intensive collaboration with professional and institutional stakeholders in two major areas (public health and clinical research) and five minor overlapping cancer research domains: aetiologic research, mass screening evaluation, quality of care, translational prognostics and survivorship. Each of these domains address specific study questions, mixes of disciplines, methodologies, additional data-sources and funding mechanisms. POs tended to become more and more public health institutes, Health ministries, but also comprehensive cancer centres and cancer societies through more and more funding at project or programme basis. POs were not easy to pin down because of their multiple, sometimes competitive (funding) obligations and increasing complexity of cancer surveillance. But they also rather seemed to need guiding principles for Governance of 'their' CR(s) as well as to appreciate value of collaborative research in Europe and shield CRs against unreasonable data protection in case of linkages. Despite access to specialised care related shortcomings, especially of survival cohort studies, European databases for studies of incidence and survival (such as ACCIS and EUREG on the one hand and EUROCARE and RARECARE on the other hand) have proved to be powerful means for comparative national or regional cancer surveillance. Pooling of comparable data will exhibit much instructive variation in time and place. If POs of CRs would consider multinational European studies of risk and prognosis of cancer more to serve their own regional or national interest, then progress in this field will accelerate and lead to more consistent funding from the EU. The current 20 million cancer survivors and their care providers are likely to appreciate more feedback. CONCLUSION: Most CRs remain uniquely able to report on progress against cancer by studies of variation in incidence (in time and place), detection and survival, referral and treatment patterns and their (side) effects in unselected patients, the latter especially in the (very) elderly. Programming and profiling its multiple and diverse clinical and prevention research is likely to promote involvement of public health and clinical stakeholders with a population-based research interest, increasingly patient groups and licensed 'buyers' of oncologic services.

7° Encuentro de la Red de Unidades de Investigación en Enfermería ENEO/UNAM, Instituciones e Institutos Nacionales de Salud / 7th Meeting of the Network of Nursing Research Units ENEO/UNAM, Institutions, and National Institutes of Healt

El término red tiene dos usos como un campo social constituido por relaciones entre personas. La palabra campo hace referencia a un concepto espacial que va asociado a cada punto o “integrante” como un valor determinado.

A percepção dos usuários sobre a oferta de programas de promoção da saúde e prevenção de doenças: o caso de uma operadora de autogestão / The users' perception of a health promotion and prevention program offer: a self-management operator case

A coexistência do setor público e privado de saúde no Brasil é antiga e os arranjos percorridos têm contribuído para a construção de um sistema fragmentado e complexo. Na busca por estabelecer políticas setoriais em harmonia com o Sistema Único de Saúde, a Agência Nacional de Saúde Suplementar tem estimulado o desenvolvimento de programas de promoção da saúde e prevenção de doenças no setor. Essas ações são consideradas como um conjunto heterogêneo de estratégias na consolidação de políticas que visem à saúde da população. Este é um estudo de caráter qualitativo que objetiva analisar esses programas em uma operadora de autogestão, com o intuito de compreender se eles produzem dispositivos biopolíticos. Foram coletados os discursos dos usuários dos programas por meio de um roteiro semiestruturado e utilizou-se a técnica de análise de conteúdo. Os resultados mostram que se encontram em curso alguns processos de reestruturação da produção do cuidado, e os aspectos relacionais têm sido priorizados nesses programas. Essas ações configuram-se em dispositivos biopolíticos conduzindo formas de viver. É importante a existência de equilíbrio entre as práticas desses poderes e a produção de liberdade, atentando para que não haja intervenções biopolíticas arbitrárias e autoritárias na produção das ações de saúde.

The coexistence of public and private health care systems in Brazil is old and their arrangements have contributed to the construction of a fragmented system. In seeking to establish policies in agreement with the Brazilian Unifed Health System, the National Agency of Supplemental Health insurance has encouraged the development of programs for health promotion and disease prevention on the private sector. These actions are a heterogeneous set of strategies to consolidate policies aiming at the population's health. This is a qualitative study that analyzes these preventive programs in a private health insurance agency, to understand whether they produce bio-political devices. Speeches were collected from users of the programs through a semi-structured script using the technique of content analysis. The results show that some restructuring processes of care production are ongoing, and relational aspects have been targeted in these programs. These actions are configured in devices leading biopolitical forms of life. It is important to have balance between these powers and the production practices of freedom, noting that there is no arbitrary and authoritarian biopolitical interventions in the production of health actions.

[The "Instituto de Salud Carlos III" and the public health in Spain. Origin of laboratory medicine and of the central laboratories and research in public health]. / El instituto de Salud Carlos III y la sanidad española. Origen de la medicina de laboratorio, de los Institutos de salud pública y de la investigación sanitaria.

The "Instituto de Salud Carlos III" is the Central Public Health Laboratory in Spain with an important component of scientific research in health related areas, such as cancer, cardiovascular diseases, infectious diseases and environmental health. The article describes the development of the Public Health Institutes. arising from the introduction and development of scientific and laboratory based medicine and the introduction of vaccination and sanitation with the control of water and food. At about the same time, the discoveries in microbiology and immunology were produced, being the research activities incardinated with the practical advances in the control of products. To cope with the practical needs, Institutions were created with the responsibility of providing smallpox vaccine but incorporating very soon production of sera and other vaccines and water and sanitation control and foods control. At the same time. colonization of countries specially in Africa, South East Asia and explorations in Central America confront the Europeans with new diseases and the need of laboratories where to study them. These circumstances gave rise to the birth of the Central Public Health Laboratories and the National institutes of Health at the beginning of the XX century in many countries. In Spain, the Spanish Civil War was a breaking point in the development of such an institution that finally was reinvented with the creation of the Instituto de Salud Carlos III, in 1986, incorporating research and epidemiological surveillance and control of diseases and also the responsibilities of the Food and Drug Control, lately separated from it.

Rural community and health care interdependence: an historical, geographical study.

The relationships between rural health care and community development were examined over time, for the case-study area of Huron and Perth counties in Southwestern Ontario. The underlying premises were that an historical-geographic study could provide both a perspective on the development of rural health services and explore the interdependent relationship between rural community and health care. The research concentrated on examinations of the 2 key elements of rural health care, namely the rural practitioner and the community hospital. Detailed reconstruction revealed that, over time, both physicians and hospitals moved from a marginal to a central position and identity within the community, in parallel with the stages of community development in the 19th and 20th centuries, with hospitals emerging as major foci of rural sustainability. In the last 2 decades, the strength of the area's rural community health system was successfully marshalled to offset the potentially negative aspects of provincial health care restructuring. This reinforced both the perception and the reality of the interdependence of health services and communities in the predominantly rural area.

Unloading the trunk: neurasthenia, CFS and race.

The aetiologies of both chronic fatigue syndrome (CFS) and its predecessor neurasthenia, have been linked to technological advances in 'developed' countries. This paper discusses how this has led to a form of race thinking within discussions about fatigue which has persisted for more than a century. We review the historical development of this race thinking from neurasthenia to CFS and describe how it is manifested in both the lay- and medical literature. We also review the epidemiological literature on CFS and ethnicity to better understand the relatively low percentage of non-white patients seen in tertiary referral clinics for CFS. The aim of this paper is to act as a starting point for a debate on race and CFS.

Trabajo comunitario en la compañia Cañadita I Y II Itauguá

Presenta investigación sobre la tención primaria de salud

Historical and methodological perspectives on cancer outcomes research.

Outcomes research is the study of the net effects of the health care process on the health and well-being of individuals and populations. It encompasses a wide breadth of issues, including measurement of patient preferences and health status, broadly referred to as quality of life. Evaluation of health-related quality of life in research studies has been facilitated by the development of a number of measurement tools. In addition to general health tools, cancer-related tools are available, some of which include cancer site-specific or symptom-specific measures. Preference assessment, from the perspective of the patient or general population, is necessary to incorporate quality of life into economic analyses. Various techniques are available to assign preference values to outcomes; metrics such as quality-adjusted life-years (QALYs) are then used to combine quality and quantity of life into a usable value for economic analyses. In the future, quality of life and economic measurements should be incorporated into phase III trials, effectiveness trials, and observational studies.

Creating an agenda for research and evaluation: HIV service delivery, the Ryan White CARE Act, and beyond.

HRSA, AHCPR and NCAP convened a working meeting in November 1992, to discuss creation of a national agenda for research and evaluation on HIV service delivery systems that are cost-effective, responsive to the needs of the diverse populations affected by the epidemic, and reflective of the lessons learned so far. In this article, the interests and goals of the conveners are described, the meeting's process and outcomes are discussed, and the nine key study areas that were identified and chosen by the meeting participants are presented. It is hoped that this article will stimulate further interest among private and public funders and among the research community in fostering the implementation of HIV service delivery-related research and evaluation studies. If this is accomplished, decision-makers will be better enabled to make informed and responsive policy decisions.

Nota sobre los trabajos iniciales de investigación en salud pública en México / Commencement of public health research in Mexico

Se hace revisión histórica de los hitos que han marcado el desarrollo científico de la Salud Pública en México, desde las investigaciones personales del doctor Jiménez en 1866 sobre el absceso hepático, y la búsqueda del germen causante del tifo iniciada por el doctor Otero y continuada con el estímulo de la Academia Nacional de Medicina, que también apoyó los estudios sobre fiebre amarilla del doctor Alvarado y sobre la rabia, del doctor Liceaga. Entre las otras activiades mencionadas se incluyen la formación de los Institutos Nacionales de Medicina, Patología y Bacteriología, que continuaron su encomienda hasta la consolidación del gobierno revolucionario. Concluye esta nota con las investigaciones sobre las rickettsias y sus transmisores, llevadas a cabo por los doctores Ruiz Castañeda, Mooser, Zinzer y Varela, en la tercera década del siglo XX

Investigación y enseñanza en salud pública: historia de las relaciones entre las universidades y el gobierno / Research and teaching in public health: history of the relations between universities adn government

Para ubicar los inicios del pensamiento sanitario en el país, se revisan las relaciones entre el gobierno y las universidades mexicanas desde la Colonia. Un primer periodo va del siglo XVI a 1804, cuando llegó a México la Expedición Filantrópica del doctor Balmis. El segundo periodo en las relaciones universitarias y gubernamenteles comprende todo el siglo XIX, y el tercero principia en 1910 con la creación de la Universidad Nacional. Después, el autor analiza los avances cientificos a lo largo de los últimos cuatro siglos, que resultan no siempre originados en recintos universitarios, dado el carácter pragmático de las investigaciones biológicas y sanitarias. Los estudios sobre los recursos naturales del país hechos por Francisco Hernández, marcan el inicio de la ciencia mexicana, que lo mismo produciría trabajos teóricos que las importantes obras de ingeniería hechas por Henrico en el Valle de México. Por otra parte, se mencionan las aportaciones de Bartolache, Alzate y los humanistas jesuitas, que sentaron las bases del pensamiento científico posterior a la Independencia. En el periodo comtemporáneo se consolida la Universidad Nacional y adquiere autonomía y las relaciones con el gobierno se estabilizan en beneficio de la investigación y la enseñanza, mediante un desarrollo continuo que llega hasta nuestros dias