Coping strategies of food insecure households with children and adolescents in Uruguay, a high-income Latin American country: A qualitative study through the lens of Bourdieu's theories of capitals and practice.

Food insecurity has been associated with negative short, medium, and long-term health consequences, which are more detrimental for children and adolescents. These effects may depend on the coping strategies developed to deal with food shortages. The present research aimed at exploring coping strategies in food insecure households with children and adolescents in Uruguay, incorporating sociological theoretical insights from Bourdieu. A qualitative approach based on individual semi-structured interviews was used. A total of 40 interviews were conducted with adults who had parental responsibilities of children and adolescents and who received different types of food assistance, between July and December 2022, in four cities. Results showed that adults tend to develop a wide range of coping strategies aimed at: reducing food expenditure, increasing the availability of money for purchasing food, increasing food availability and/or rationing the food available in the household. Some of the strategies were implemented regardless of the severity of food insecurity, whereas others were characteristic of the moderate and severe levels of the construct. Evidence to support the mediation effect of coping strategies on health outcomes was found. Discourses suggested that lower accumulation of economic and cultural capital may be aligned with the adoption of less socially accepted mechanisms to access to food. Expressions of a specific habitus aimed at securing food were identified among participants with more deprivations. Taken together, the findings suggest that coping strategies may not be a universal or invariant sequence according to the severity of food insecurity and stress the importance of considering households' resources and local context for the development of strategies to improve access to food.

An assessment of the owned canine and feline demographics in Chile: registration, sterilization, and unsupervised roaming indicators.

The global rise in companion animal populations, particularly dogs and cats, is driven by emotional and social benefits for owners, and their population management is becoming critically important to avoid a plethora of adverse effects on themselves, humans, and wildlife. We estimated the size and density of the owned canine and feline population in Chile and evaluated the status of microchipping, registration, sterilization rates, and the proportion of owned animals that roam unsupervised. A cross-sectional household survey in 36 districts was conducted and standard inferential statistics was employed to analyze differences between cats and dogs, sexes within each species, and between rural and urban areas. Additionally, two negative binomial models with mixed effects were developed to predict the number of dogs and cats per households. Two methods were used to compare population size estimates at the country level, multiplying: (1) the estimated mean number of companion animals per household by the estimated number of households at the country level, and (2) the estimated human:dog and human:cat ratios by the total human population. The study involved 6333 respondents, of which 76% (74% urban; 83% rural) owned companion animals (dogs and/or cats). Individuals in rural multi-person households increase the probability of owning dogs and/or cats. Additionally, women exhibit a greater inclination towards cat and dog ownership compared to men, while those over 30 years old demonstrate lower rates of companion animal ownership in contrast to the 18-30 age group for both species. The overall human:dog and human:cat ratios estimated were 2.7:1, and 6.2:1, respectively. The estimated total number of owned dogs and cats in Chile ranged from 9.6 to 10.7 million, depending on the methodological approach, while national median density of companion animals was 12 dogs per km2 (ranging from 0.02 to 7232) and 5 cats per km2 (ranging from 0.01 to 3242). This nationwide study showed one of the highest percentages of households with companion animals in Latin America and relatively low registration and sterilization rates, highlighting the need to strength long-term public policies to control populations of companion animals and promote responsibility in pet ownership.

Air, land, and water pollutants and public health expenditures: Empirical data from selected EU countries in the transport sector.

The increase in economic activity, particularly in transport, leads to a significant increase in emissions of pollutants, such as ammonia, arsenic and cadmium, at the European Union (EU) level. This can seriously impact human health and, consequently, public health spending. Based on data from 15 European Union countries from 1992 to 2020, a panel co-integration approach is used to study these pollutants' short- and long-term co-movements and per capita health expenditure. The results show a long-term relationship between ammonia, arsenic and cadmium emissions and per capita health spending, as they are panel-cointegrated. Ammonia and cadmium emissions exert a statistically significant positive effect on health expenditure in the short run, and arsenic emissions have a statistically significant positive impact in the long run. The forecast assessment of reductions in health spending resulting from policies to reduce emissions of air, land and water pollutants, such as ammonia, arsenic and cadmium, from the transport sector supports investments in its policies that reduce pressure on health spending. The reduction in annual healthcare expenditure is greater when these reductions are made sooner and more severely. Indeed, varying the reduction in emissions for each pollutant by 10% and 100%, respectively, from the first year for all countries over a 3-year period results in an average annual reduction in health spending of 2.05% and 51.02%, respectively. However, if we wait until the third year, the annual reduction is only 0.77% and 17.63% respectively.

Simple economics of vaccination: public policies and incentives.

This paper focuses on the economics of vaccination and, more specifically, analyzes the vaccination decision of individuals using a game-theoretic model combined with an epidemiological SIR model that reproduces the infection dynamics of a generic disease. We characterize the equilibrium individual vaccination rate, and we show that it is below the rate compatible with herd immunity due to the existence of externalities that individuals do not internalize when they decide on vaccination. In addition, we analyze three public policies consisting of informational campaigns to reduce the disutility of vaccination, monetary payments to vaccinated individuals and measures to increase the disutility of non-vaccination. If the public authority uses only one type of policy, herd immunity is not necessarily achieved unless monetary incentives are used. When the public authority is not limited to use only one policy, we find that the optimal public policy should consist only of informational campaigns if they are sufficiently effective, or a combination of informational campaigns and monetary incentives otherwise. Surprisingly, the requirement of vaccine passports or other restrictions on the non-vaccinated are not desirable.

Long-term care needs and the risk of household poverty across Europe: a comparative secondary data study.

PURPOSE: Population ageing and rising poverty are two of the most pressing issues today, even in Western European nations, growing as a result of the recent global economic crisis and the COVID-19 containment measures. This study explores the relationship between long-term care (LTC) needs and risk of poverty at household level in eight European countries, representing the different European care regimes. METHODS: The main international databases were scoured for study variables, categorized according to the following conceptual areas: home care, residential care, health expenditure, service coverage, cash benefits, private services, population, family, education, employment, poverty, disability and care recipients, and life expectancy. We initially identified 104 variables regarding 8 different countries (Austria, Finland, Germany, the Netherlands, Italy, Spain, Poland, Romania). Statistical analyses were conducted as described hereafter: analysis of the Pearson's Bivariate Correlation between the dependent variable and all other variables; a Multivariable Linear Regression Model between the Poverty Index (dependent variable) and the covariates identified in the preceding step; a check for geographical clustering effects and a reduced Multivariable Linear Regression Model for each identified European cluster. RESULTS: The variables that addressed the risk of poverty pertained to the area of policy intervention and service provision. Rising private out-of-pocket health expenditures and proportion of "poor" couples with at least one child are two factors that contributed significantly to poverty increasing. Moreover, rising private out-of-pocket health expenditures for covering LTC needs (even in presence of public financial contribution to the family) is the main contributor to household poverty increasing in presence of ADL disability. CONCLUSION: The results reveal the existence of a clear correlation between the need for LTC and the risk of poverty in households across Europe. These results highlight the central relevance of LTC policies, which are often still treated as marginal and sectoral, for the future sustainability of integrated care strategies.

Intersectorality in a conditional cash transfer programme: Actors, convergences and conflicts.

This study aimed to analyse intersectoral arrangements among the health, education and social assistance sectors in the operationalization of the Bolsa Família Program (BFP). A qualitative approach was carried out, in a peripheral region of a large urban centre of Southeast Brazil. Data content analysis was performed on the basis of reference in the Actor-Network Theory (ANT) using statements by the actors and considering ideas in dispute and work processes in the geopolitical territorial context. Seventeen managers of Municipal Secretariats of Health, Education and Social Assistance were interviewed, as were basic education, primary health care and social assistance professionals. One-off, episodic and discontinuous intersectoral actions were identified, with limited integration among sectors. Convergences and conflicts were found with respect to the institutional processes of BFP. The convergences referred to the conceptions shared among the actors about the role of intersectoral collaboration, as they recognize themselves as providing care to the same vulnerable population. Considering the multiple vulnerabilities of these families, the convergence of actions from different sectors can impact factors that condition inequalities. The conflicts were related to institutional conditions, to sectorized work processes and to a lack of understanding by professionals about the duties of their respective sectors.

The INFORMAS healthy food environment policy index in Brazil: Benchmarking, current policies, and determining priorities for the future.

INTRODUCTION: Obesity and non-communicable diseases are the most important cause of death and inability in Brazil and worldwide. Public policies are an important strategy to prevent obesity. This study analysed the scope of Brazilian public policies for preventing and controlling obesity using the INFORMAS/Food-EPI protocol. METHODS: The public policies evaluation was conducted based on the INFORMAS/Food-EPI protocol. Experts from academia, civil society, and government assessed the level of implementation of food policies compared with international best practices and proposed new actions to be developed nationally. The protocol consisted of five phases: (1) A comprehensive review of the implementation of food environment-related public policies; (2) validation with experts; (3) comparison of the national actions with the international best practice and due to the level of implementation; (4) list a set of actions to improve the current policies; and (5) evaluation of the actions due to their importance and achievability. RESULTS: Brazilian actions were focused on monitoring, leadership, governance, and resources and financing domains. CONCLUSION: The results will provide elements to support and improve the national policies that aim at the promotion of a healthy food environment and obesity prevention.

Determinantes Sociais da Saúde dentro e fora de casa: captura de uma nova abordagem / The Social Determinants of Health inside and outside the household: capturing a new approach

RESUMO Este artigo teve como objetivo compreender os Determinantes Sociais da Saúde (DSS), em área periférica de uma capital brasileira, sob a perspectiva de atores sociais e políticos da região. Baseou-se na abordagem qualitativa, com 45 participantes, entre trabalhadores do setor saúde; de sede administrativa regional; vereadores, líderes religiosos e representantes de entidades organizadas do Grande Bom Jardim, Fortaleza (CE). Utilizou-se de análise documental, de grupo focal e de entrevista semiestruturada. Realizou-se análise de conteúdo, englobando as categorias dos DSS e os temas gerais 'dentro e fora de casa', analisados com base nas representações sociais. As mudanças positivas se evidenciaram no tema 'dentro das casas' dos moradores: alimentação, melhorias advindas de benefícios da política de assistência social, aumento do abastecimento de água e de energia elétrica. No tema 'fora das casas', a influência negativa na saúde destacou-se com baixo índice de cobertura de saneamento básico, insuficiência na oferta de transporte público e insegurança. Propõe-se a inclusão de temas sobre segurança, energia elétrica, mobilidade urbana, assistência social e saneamento básico para subsidiar novos estudos sobre determinação social e elaboração de medidas que contribuam para a promoção da saúde e equidade social nos territórios urbanos.

ABSTRACT The aim was to understand the Social Determinants of Health (SDH) in the outskirts of a Brazilian capital, from the perspective of social and political actors in the region. It was based on the qualitative methodological approach, with 45 participants including health workers of the regional administrative headquarter, councilors, religious leaders, and representatives of organized entities from Grande Bom Jardim - Fortaleza (CE). We used document analysis, focus group, and semi-structured interview. The content analysis was carried out, encompassing the SDH categories and the general themes 'inside the household' and 'outside the household', analyzed based on social representations. In the results, the positive changes were evident on the theme 'inside the household' of residents: nourishment, improvements resulting from benefits of social assistance policies, an increase in water and electricity supply. On the theme 'outside the household', the negative influence on health was evidenced by the low level of basic sanitation coverage, insufficient supply of public transport, and insecurity. It is proposed to include the themes of security, electricity, urban mobility, social assistance, and basic sanitation to support new studies on social determination and the development of measures that contribute to the promotion of health and social equity in urban territories.

Políticas sociais e orçamento público em um estado de exceção permanente (2013-2021) / Social policies and public budget in a state of permanent exception (2013-2021)

Resumo: Escrito sob a forma de um ensaio teórico, o artigo levanta reflexões sobre o modo de gestão do orçamento público no Brasil e sua articulação com dois eixos temáticos: tratamento da dívida pública e promoção de políticas sociais. As considerações finais apontam para a possibilidade de associar as práticas na gestão do orçamento federal brasileiro e um estado de exceção econômica perpetuado ao longo do tempo e, como desdobramento, limitante da promoção de direitos de proteção social.

Abstract: Written in the form of a theoretical essay, the article raises reflections on the way the public budget is managed in Brazil and its articulation with two thematic axes: austerity, treatment of public debt and promotion of social policies. Final considerations point to the possibility of associating practices in the management of the Brazilian federal budget and a state of economic exception perpetuated over time and, as a result, limiting the promotion of social protection rights.

Estudo da população com Transtorno do Espectro Autista atendida em clínica suplementar de Belo Horizonte no ano de 2023 / Study of the population with Autism Spectrum Disorder treated at a supplementary clinic in Belo Horizonte in 2023

O Transtorno do Espectro Autista (TEA) tem seus critérios diagnósticos atuais baseados no Manual de Diagnóstico e Estatístico de Transtornos Mentais (DSM 5). Sendo um transtorno global do neurodesenvolvimento, da reciprocidade social e da comunicação, com comportamentos repetitivos, interesses restritos e inflexibilidade comportamental. O diagnóstico do TEA vem aumentando em todo o mundo trazendo uma nova realidade para a família, modificando a sua dinâmica emocional, social e financeira. Esse estudo teve por objetivo delinear um perfil e demonstrar as principais dificuldades e repercussões do cuidado da pessoa com diagnóstico de Transtorno do Espectro Autista (TEA) e suas famílias. Tratou-se de um estudo realizado através da coleta de dados nos meses de setembro e outubro de 2023 em quatro clínicas multidisciplinares de tratamento do TEA da saúde suplementar. Foram coletados dados quantitativos e qualitativos de 208 famílias, sendo os quantitativos apresentados percentuais em tabelas contendo: idade atual do paciente, idade no início das terapias e idade dos cuidadores; raça dos pacientes, sexo do paciente e dos cuidadores, idade dos pais na concepção, escolaridade dos cuidadores, tipo de parto, renda familiar, formação escolar do cuidador, presença ou não de fé declarada e estado civil do cuidador (os últimos dois considerados enquanto fatores de resiliência familiar). Os dados qualitativos foram trabalhados através da análise de conteúdo de Bardin, ilustrando e auxiliando no melhor entendimento das demandas familiares e suas dinâmicas. Os resultados encontrados concordam, em parte, com o perfil da população TEA relatada em literatura, mas com particularidades como, por exemplo, em referência a idade dos pais na concepção da criança TEA e a quantidade de diagnósticos no sexo feminino. Conseguiu-se, também, identificar fatores de resiliência familiar, como uma estrutura da dinâmica familiar e a presença de uma religião / fé. A partir da hipótese que a presença de um membro com TEA traz impacto em toda família, a autora espera, assim, contribuir na construção de políticas públicas e instituições de apoio ao TEA, norteando condutas mais assertivas frente ao atendimento às necessidades desta população; minimizando os impactos da violência sofrida através da exclusão, suas dificuldades econômicas e sociais.

The current diagnostic criteria of Autism Spectrum Disorder (ASD) is based on the Diagnostic and Statistical Manual of Mental Disorders (DSM 5). Being a global disorder of neurodevelopment, social reciprocity and communication, with repetitive behaviors, restricted interests and behavioral inflexibility. The diagnosis of ASD has been increasing throughout the world, bringing a new reality to families, changing their emotional, social and financial dynamics. This study aimed to outline a profile and demonstrate the main difficulties and repercussions of caring for people diagnosed with Autism Spectrum Disorder (ASD) and their families. This was a study carried out through data collection in the months of September and October 2023 in four multidisciplinary ASD treatment clinics in supplementary health. Quantitative and qualitative data were collected from 208 families, with the quantitative data presented in percentages in tables containing: current age of the patient, age at the beginning of therapies and age of caregivers; race of patients, sex of patient and caregivers, age of parents at conception, education of caregivers, type of birth, family income, educational background of the caregiver, presence or absence of declared faith and marital status of the caregiver (the last two considered as family resilience factors). The qualitative data were worked through Bardin's content analysis, illustrating and helping to better understand family demands and their dynamics. The results found agree, in part, with the profile of the ASD population reported in the literature, but with particularities such as, for example, in reference to the age of the parents at the conception of the ASD child and the number of diagnoses in females. It was also possible to identify factors of family resilience, such as the structure of family dynamics and the presence of a religion/faith. Based on the hypothesis that the presence of a member with ASD has an impact on the entire family, the author hopes to contribute to the construction of public policies and institutions to support ASD, guiding more assertive behaviors in meeting the needs of this population; minimizing the impacts of violence suffered through exclusion, economic and social difficulties.

Mortalidade materno-infantil em um estado nortista brasileiro: coerência e discrepância entre instrumentos de gestão e agenda 2030 / Addressing maternal and child mortality in a northern brazilian state: coherence and discrepancy between management instruments and the 2030 agenda / Abordando la mortalidad materno-infantil en un estado del norte de brasil: coherencia y discrepancia entre los instrumentos de gestión y la agenda 2030

Introdução:As mortes maternas e infantis refletem as condições de vida de uma determinada população e são marcadores importantes de desenvolvimento de uma nação, reduzi-las tornou-se prioridade na Agenda 2030 de desenvolvimento sustentável. Políticas públicas devem ser formuladas, executadas e monitoradas em escalas nacionais, estaduais e locais para melhorar a qualidade de vida e cumprir os compromissos pactuados nacional e internacionalmente.Objetivo:identificar o alinhamento dos indicadores e os resultados alcançados nas metas para redução de mortalidades materna e infantil do Plano de Desenvolvimento Sustentável e Plano Estadual de Saúde do Estado de Rondônia com Agenda 2030.Metodologia:Trata-se de uma pesquisa documental e bibliográficacomanálise crítica de indicadores referentes à redução da mortalidade materno-infantil na Agenda 2030 e respectivos ações e metas alcançadas ou não contempladas no Plano de Desenvolvimento Sustentável de Rondônia (2015-2030) e Planos Estaduais de Saúde (2016-2019 e 2020-2021). Verificou-se os resultados alcançados em relatórios da sociedade civil e anual de gestão.Resultados:Constatou-se que a redução das mortes materna e infantil são destacadas nos planejamentos analisados, contudo a mortalidade infantil contida nos planosconsidera somente as mortes em menores de um ano de vida e há incompletudes nos escopos selecionados para o monitoramento, assim como diferentes indicadores de verificação, dificultando análise das metas pactuadas na Agenda 2030.Conclusões:Os relatóriosdos resultados alcançados apontaram retrocessos para o alcance das metas. Instrumentos de gestão e planejamento são imprescindíveis para nortear ações e estabelecer prioridades, porém para que haja avanços é necessário coerência não somente em metas pactuadas, mas nos indicadores e meios de verificação a fim de corroborar para análise e retroalimentação do planejamento (AU).

Introduction:Maternal and infant deaths reflect the living conditions of a given population and are important markers of a nation's development, reducing them has become a priority in the 2030 Agenda for sustainable development. Public policies must be formulated, implemented and monitored at national, state and local scales to improve the quality of life and meet the commitments agreed nationally and internationally. Objective:To identify the alignment of indicators and the results achieved in the goals for reducing maternal and child mortality of the Sustainable Development Plan and State Health Plan of the State of Rondônia with Agenda 2030. Methodology:This is a documentary and bibliographical research with critical analysis of indicators related to the reduction of maternal and child mortality in the 2030 Agenda and respective actions and goals achieved or not contemplated in the Sustainable Development Plan of Rondônia (2015-2030) and State Health Plans (2016-2019 and 2020-2021). It was verified the results achieved in reports of civil society and annual management. Results:It was found that the reduction of maternal and infant deaths are highlighted in the however the infant mortality contained in the plans considers only deaths in children under one year of age and there are incompleteness in the scopes selected for monitoring, as well as different verification indicators, making it difficult to analyze the goals agreed in the 2030 Agenda. Conclusions:The reports of the achieved results pointed setbacks to the achievement of the goals. Management and planning tools are essential to guide actions and establish priorities, but for there to be progress it is necessary coherence not only in agreed indicators and means of verification in order to corroborate for analysis and feedback of planning (AU).

Introducción: Las muertes maternas e infantiles reflejan las condiciones de vida de una determinada poblacióny son marcadores importantes del desarrollo de una nación, su reducción se ha convertido en prioridad en la Agenda 2030 de desarrollo sostenible. Las políticas públicas deben ser formuladas, ejecutadas y monitoreadas a escala nacional, estatal y local para mejorar la calidad de vida y cumplir con los compromisos pactados a nivel nacional e internacional. Objetivo: Identificar la alineación de los indicadores y los resultados alcanzados en las metas para reducción de mortalidades materna e infantil del Plande Desarrollo Sostenible y Plan Estadual de Salud del Estado de Rondônia com Agenda 2030.Metodología: Se trata de una investigación documental y bibliográfica con análisis crítico de indicadores referentes a la reducción de la mortalidad materno-infantilen la Agenda 2030 y respectivos acciones y metas alcanzadas o no contempladas en el Plan de Desarrollo Sostenible de Rondônia (2015-2030) y Planes Estatales de Salud (2016-2019 y 2020-2021). Se han verificado los resultados obtenidos en informes de la sociedad civil y anual de gestión.Resultados: Se constató que la reducción de las muertes materna e infantil son destacadas en los planeamientos analizados, sin embargo, la mortalidad infantil contenida en los planes considera solamente las muertes en menores de un año de vida y hay incompletudes en los ámbitos seleccionados para el monitoreo, así como diferentes indicadores de verificación, dificultando el análisis de las metas pactadas en laAgenda 2030.Conclusiones: Los informes de los resultados alcanzados apuntaron retrocesos para el alcance de las metas. Instrumentos de gestión y planificación son imprescindibles para orientar acciones y establecer prioridades, pero para que haya avances es necesaria coherencia no solo en metas pactadas, pero en los indicadores y medios de verificación con el fin de corroborar el análisis y retroalimentación de la planificación (AU).

New choreographies of inequalities in reproduction: an overview of assisted reproduction market.

Brazil follows the trend of countries that went from high fertility to below replacement level; in many countries, fertility rates continue to fall, often to levels well below population replacement, especially in Europe and Eastern Asia. Since 2006, Brazil has presented rates below the population replacement level, with regional variations. The shift to a pattern of late motherhood is central to understanding this phenomenon, as well as the increased use of reproductive technologies and the global market for assisted reproduction. Demand for services based on Assisted Reproductive Technologies (ART) has increased in European countries and the United States. Also, in Brazil, there is a growing demand for assisted reproduction services, which private clinics offer at a significantly high cost. This article provides an overview of these issues. It raises new questions and dimensions of analysis by problematizing the socio-demographic, legal, and ethical aspects of assisted reproduction, which need to be explored in future population studies.

Mathematical Modeling for the Assessment of Public Policies in the Cancer Health-Care System Implemented for the Colombian Case.

The incidence of cancer has been constantly growing worldwide, placing pressure on health systems and increasing the costs associated with the treatment of cancer. In particular, low- and middle-income countries are expected to face serious challenges related to caring for the majority of the world's new cancer cases in the next 10 years. In this study, we propose a mathematical model that allows for the simulation of different strategies focused on public policies by combining spending and epidemiological indicators. In this way, strategies aimed at efficient spending management with better epidemiological indicators can be determined. For validation and calibration of the model, we use data from Colombia-which, according to the World Bank, is an upper-middle-income country. The results of the simulations using the proposed model, calibrated and validated for Colombia, indicate that the most effective strategy for reducing mortality and financial burden consists of a combination of early detection and greater efficiency of treatment in the early stages of cancer. This approach is found to present a 38% reduction in mortality rate and a 20% reduction in costs (% GDP) when compared to the baseline scenario. Hence, Colombia should prioritize comprehensive care models that focus on patient-centered care, prevention, and early detection.

The Potential of Social Policies in Preventing Dementia: An Ecological Study Using Systematic Review and Meta-Analysis.

Social policies determine the distribution of factors (e.g. education, cardiovascular health) protecting against the development of dementia in Alzheimer's disease (AD). However, the association between social policies and the likelihood of AD without dementia (ADw/oD) has yet to be evaluated. We estimated this association in an ecological study using systematic review and meta-analysis. Four reference databases were consulted; 18 studies were included in the final analysis. ADw/oD was defined as death without dementia in people with clinically significant AD brain pathology. The indicators of social policy were extracted from the Organisation for Economic Co-operation and Development database (OECD). The probability of ADw/oD with moderate AD brain pathology was inversely associated with the Gini index for disposable income, poverty rate, and certain public expenditures on healthcare. ADw/oD with advanced AD brain pathology was only associated with public expenditures for long-term care. Social policies may play a role in maintaining and sustaining cognitive health among older people with AD.

Efficiency and productivity of the Chilean public health system between 2010 and 2019. / Evolución de la eficiencia y la productividad del sistema de salud público chileno entre 2010 y 2019.

Introduction: In view of the strong increase in health expenditure, it is necessary to investigate whether proportional increases in healthcare production for the beneficiaries of the National Health Fund have corresponded to this increase. Methods: In this observational, descriptive, and retrospective longitudinal research, we estimate the technical efficiency of the National Health Services System through the average cost of production and average labor productivity in the period from 2010 to 2019. Results: During the studied decade, production has increased by approximately 6% annually; the number of workers increased (mostly physicians) by 61%; spending on salaries increased by 106% in real terms; spending on consumer goods and services has increased by 25% in real terms; the efficiency of spending has decreased by 21%, and productivity is the least dynamic element of the system with an average annual growth rate of 0.6%. After subtracting the diagnostic tests component, this scenario worsens. Conclusions: The results show that higher health expenditure has not been matched by commensurate increases in output, translating into a fall in the efficiency of healthcare expenditure and meager increases or falls in productivity, depending on how the output is measured. This means that the public sector's growth strategy depends mainly on increases in the number of workers. This low productivity is a serious constraint to improving healthcare access for National Health Fund beneficiaries and contributes to increasing waiting lists. Special attention should be paid to average production costs and average labor productivity in a scenario of less dynamic growth in public health spending and health system reform.

Introducción: Frente al fuerte incremento del gasto en salud, es necesario indagar si ha venido acompañado de aumentos proporcionales en la producción de atenciones de salud dirigidas a los beneficiarios del Fondo Nacional de Salud. Métodos: En esta investigación observacional, descriptiva y longitudinal retrospectiva estimamos la eficiencia técnica del Sistema Nacional de Servicios de Salud a través del costo medio de producción y la productividad media del trabajo en el periodo de 2010 a 2019. Resultados: Durante la década estudiada, la producción ha aumentado en torno al 6% anual; la dotación de trabajadores aumentó (mayormente en el estamento médico) 61%; el gasto en remuneraciones aumentó 106% real; el gasto en bienes y servicios de consumo ha aumentado 25% real; la eficiencia del gasto ha disminuido 21% y la productividad es el elemento menos dinámico del sistema con 0,6% de crecimiento medio anual. Tras sustraer el componente de exámenes diagnósticos, el escenario empeora. Conclusiones: Los resultados muestran que el mayor gasto en salud no ha venido aparejado de aumentos proporcionales en producción, traduciéndose en una caída en la eficiencia del gasto sanitario y aumentos magros o caídas en productividad, según cómo se mida la producción. Esto hace que la estrategia de crecimiento del sector público dependa principalmente de aumentos en la dotación de trabajadores. Esta baja productividad constituye una limitante seria para mejorar el acceso de los beneficiarios del Fondo Nacional de Salud a las atenciones de salud y contribuye a incrementar las listas de espera. Especial atención debiera brindarse a los costos medios de producción y a la productividad media del trabajo en un escenario de menor dinamismo en el crecimiento del gasto público en salud y de reforma del sistema de salud.

Evolución de la eficiencia y la productividad del sistema de salud público chileno entre 2010 y 2019 / Efficiency and productivity of the Chilean public health system between 2010 and 2019

INTRODUCCIÓN: Frente al fuerte incremento del gasto en salud, es necesario indagar si ha venido acompañado de aumentos proporcionales en la producción de atenciones de salud dirigidas a los beneficiarios del Fondo Nacional de Salud. MÉTODOS: En esta investigación observacional, descriptiva y longitudinal retrospectiva estimamos la eficiencia técnica del Sistema Nacional de Servicios de Salud a través del costo medio de producción y la productividad media del trabajo en el periodo de 2010 a 2019. RESULTADOS: Durante la década estudiada, la producción ha aumentado en torno al 6% anual; la dotación de trabajadores aumentó (mayormente en el estamento médico) 61%; el gasto en remuneraciones aumentó 106% real; el gasto en bienes y servicios de consumo ha aumentado 25% real; la eficiencia del gasto ha disminuido 21% y la productividad es el elemento menos dinámico del sistema con 0,6% de crecimiento medio anual. Tras sustraer el componente de exámenes diagnósticos, el escenario empeora. CONCLUSIONES: Los resultados muestran que el mayor gasto en salud no ha venido aparejado de aumentos proporcionales en producción, traduciéndose en una caída en la eficiencia del gasto sanitario y aumentos magros o caídas en productividad, según cómo se mida la producción. Esto hace que la estrategia de crecimiento del sector público dependa principalmente de aumentos en la dotación de trabajadores. Esta baja productividad constituye una limitante seria para mejorar el acceso de los beneficiarios del Fondo Nacional de Salud a las atenciones de salud y contribuye a incrementar las listas de espera. Especial atención debiera brindarse a los costos medios de producción y a la productividad media del trabajo en un escenario de menor dinamismo en el crecimiento del gasto público en salud y de reforma del sistema de salud.

INTRODUCTION: In view of the strong increase in health expenditure, it is necessary to investigate whether proportional increases in healthcare production for the beneficiaries of the National Health Fund have corresponded to this increase. METHODS: In this observational, descriptive, and retrospective longitudinal research, we estimate the technical efficiency of the National Health Services System through the average cost of production and average labor productivity in the period from 2010 to 2019. RESULTS: During the studied decade, production has increased by approximately 6% annually; the number of workers increased (mostly physicians) by 61%; spending on salaries increased by 106% in real terms; spending on consumer goods and services has increased by 25% in real terms; the efficiency of spending has decreased by 21%, and productivity is the least dynamic element of the system with an average annual growth rate of 0.6%. After subtracting the diagnostic tests component, this scenario worsens. CONCLUSIONS: The results show that higher health expenditure has not been matched by commensurate increases in output, translating into a fall in the efficiency of healthcare expenditure and meager increases or falls in productivity, depending on how the output is measured. This means that the public sector's growth strategy depends mainly on increases in the number of workers. This low productivity is a serious constraint to improving healthcare access for National Health Fund beneficiaries and contributes to increasing waiting lists. Special attention should be paid to average production costs and average labor productivity in a scenario of less dynamic growth in public health spending and health system reform.

Alinhamento partidário e oferta de políticas públicas no Brasil / Alineación partidaria y provisión de políticas públicas en Brasil / Partisan alignment and public policies provision in Brazil

Resumo Municípios partidariamente alinhados com o presidente ofertam mais políticas públicas? A entrega de serviços públicos é uma das atividades centrais dos governos. Uma vez que são os partidos políticos que controlam o Poder Executivo tanto no Governo Federal quanto no governo local, é razoável esperar que seus interesses partidários e eleitorais influenciem o curso da implementação de serviços. Neste artigo, analiso a cobertura da atenção básica à saúde como indicador de oferta. Dado o forte compartilhamento de responsabilidades entre os entes federados, argumento que o Governo Federal implementa políticas públicas de forma estratégica, aumentando a oferta de serviços em municípios partidariamente alinhados. Para testar empiricamente essa relação, estimo o efeito causal do alinhamento por meio de um desenho de regressão descontínua para eleições acirradas. Os resultados indicam que os municípios partidariamente alinhados com a Presidência da República têm cobertura da atenção básica à saúde, em média, 3% maior que outros governados por partidos oposicionistas. Em uma cidade com 10 mil habitantes, por exemplo, isso significaria 300 pessoas a mais sendo adequadamente atendidas por equipes de saúde.

Resumen ¿Los municipios alineados partidariamente con el presidente ofrecen más políticas públicas? La prestación de servicios públicos es una de las actividades centrales de los gobiernos. Dado que son los partidos políticos los que controlan el Poder Ejecutivo tanto en el Gobierno federal como en el local, es razonable esperar que sus intereses partidistas y electorales influyan en el curso de la implementación. En este artículo analizo la cobertura de la atención primaria de salud como indicador de provisión. Dada la fuerte compartición de responsabilidades entre las entidades federativas, argumento que el Gobierno federal implementa las políticas públicas de manera estratégica, aumentando la provisión de servicios en los municipios alineados partidariamente. Para probar empíricamente esta relación, estimo el efecto causal del alineamiento utilizando un diseño de regresión discontinua para elecciones reñidas. Los resultados indican que los municipios partidariamente alineados tienen, en promedio, una cobertura de atención primaria un 3% más alta que otros gobernados por partidos de oposición. En una ciudad de 10.000 habitantes, por ejemplo, esto significaría 300 personas más adecuadamente atendidas por los equipos de salud.

Abstract This research examines whether local governments politically aligned with the president's party offer more public policies. The delivery of public services is one of the central activities of governments. Since the political parties control the executive branch in both federal and local government, it is reasonable to expect that their partisan and electoral interests will influence policy implementation. This study analyzes the coverage of primary healthcare as an indicator of policy delivery. Given the strong sharing of responsibilities among federated entities, I argue that the federal government implements public policies strategically, increasing the supply of services in partisan-aligned municipalities. To empirically test this relationship, I estimate the causal effect of alignment using a regression-discontinuity design for close elections. The results indicate that partisan-aligned municipalities have, on average, 3% higher coverage of primary healthcare than others governed by opposition parties. In a city with 10,000 inhabitants, for example, this would mean 300 more people receiving healthcare.

Causation between energy consumption and climate change in the countries with the highest global climate risk.

The study aims to examine if there is causation between "energy consumption" and "climate change" through the data of ten countries with the highest Climate Risk Index (CRI) scores. The ten highest CRI score countries include Puerto Rico, Myanmar, Haiti, Philippines, Mozambique, The Bahamas, Bangladesh, Pakistan, Thailand, and Nepal. The annual data for the years 2005-2019 was used because of the data constraints. CRI is selected as the dependent variable. As for the independent variables, the ratios of the energy consumption of the key sectors indicated by the International Energy Agency (IEA) to the total energy consumption are chosen. These key sectors in energy consumption are industry (IND), transportation (TRA), trade and public services (TPS), and housing (HOU). Economic growth (EG), which is one of the main factors affecting climate change in the literature, is included in the model as the control variable. According to the results of the Dumitrescu-Hurlin causality test, there is one-way causality from transportation towards CRI, but not any causality between others. It is evaluated that since the transportation sector is heavily dependent on fossil fuels, it has a strong effect on the amount of CO2 emissions and a significant determining role on climate change.

University sport and scholarship funding for student-athletes: possibilities and limitations to sports performance / Esporte universitário e financiamento de bolsas à estudantes-atletas: possibilidades e limitações ao rendimento esportivo / Deportes universitarios y financiación de becas para estudiantes-deportistas: posibilidades y limitaciones al rendimiento deportivo

ABSTRACT The study investigated the policy of funding sports scholarships to student-athletes linked to the Federal University of Mato Grosso do Sul, Brazil. This is exploratory and documentary research, with an analysis of the opening and results edicts of the Athlete Scholarship Program (2010-2021). The institution has the Athlete Scholarship Program. Scholarships were paid R$400.00, with an annual duration of 9 and 7 months, with emphasis on individual sports, especially wrestling, athletics, and swimming. It is concluded that the university presents a policy that favors the sport of institutional representation, however, not the high performance, given the low value of the scholarship and the non-payment of it in the first quarter of all the years analyzed.

RESUMO O estudo investigou a política de financiamento de bolsas esportivas à estudantes-atletas vinculados à Universidade Federal de Mato Grosso do Sul, Brasil. Trata-se de pesquisa exploratória e documental, com análise de editais de abertura e de resultados do Programa Bolsa Atleta (2010-2021). A instituição conta com o Programa Bolsa Atleta. Foram pagas bolsas de R$400,00, com duração anual de 9 e 7 meses, com destaque para modalidades individuais, sobretudo, lutas, atletismo e natação. Conclui-se que a universidade apresenta política que favorece o esporte de representação institucional, porém, não o de alto rendimento, dado ao baixo valor da bolsa e o não pagamento da mesma no primeiro trimestre de todos os anos analisados.

RESUMEN El estudio investigó la política de financiamiento de becas deportivas para estudiantes-atletas vinculados a la Universidad Federal de Mato Grosso do Sul, Brasil. Se trata de una investigación exploratoria y documental, con análisis de convocatorias de apertura y resultados del Programa Bolsa Atleta (2010-2021). La institución cuenta con el Programa Bolsa Atleta. Se pagaron becas por valor de R$ 400,00, con duración anual de 9 y 7 meses, con énfasis en las modalidades individuales, sobre todo, lucha, atletismo y natación. Se concluye que la universidad tiene una política que favorece el deporte de representación institucional, sin embargo, no el deporte de alto rendimiento, dado el bajo valor de la beca y el impago de la misma en el primer trimestre de todos los años analizados.

Condições de vida de pessoas vivendo com HIV em um município do Estado do Rio de Janeiro, Brasil / Life conditions of people living with HIV in a city of the state of Rio de Janeiro, Brazil / Condiciones de vida de las personas que viven con el VIH en un municipio del estado de Río de Janeiro, Brasil

Objetivo: discorrer sobre as condições de vida das pessoas vivendo com HIV em um município do estado do Rio de Janeiro, Brasil. Método: estudo do tipo transversal, descritivo, de natureza qualitativa. A coleta de dados foi através de entrevistas, sendo os achados submetidos à técnica de análise de conteúdo. A amostra foi composta por pessoas vivendo com HIV que eram abordados no momento que compareciam ao serviço de assistência especializada, sendo definida uma amostra de 20 participantes por técnica de saturação. Resultado: emergiram categorias com base nos temas abordados na entrevista relacionados à qualidade de vida (condição de alimentação, atividade física, lazer, religião e satisfação com a vida sexual) e à experiência de viver com HIV. Conclusão: as pessoas vivendo com HIV, em tratamento antirretroviral, podem usufruir de boas condições de vida tendo como principal fator impeditivo o medo de vivenciar situações de estigma e discriminação.

Objectives: investigate the implications for the life conditions of people living with HIV in a city of the State of Rio de Janeiro, Brazil. Method: cross-sectional, descriptive, and qualitative study. Data collection was conducted through interviews, and the findings were subjected to the content analysis technique. The sample comprised people living with HIV that were approached at the time they attended the specialized assistance service, and a sample of 20 participants was defined by saturation technique. Result: categories emerged based on the topics addressed in the interview related to quality of life (food condition, physical activity, leisure, religion, and satisfaction with sexual life) and the experience of living with HIV. Conclusion: people living with HIV in antiretroviral treatment can enjoy good living and the preventing potential factor is the fear of experiencing situations of stigma and discrimination.

Objetivos: conocer las implicaciones para las condiciones de vida de las personas que viven con el VIH en un municipio del Estado de Río de Janeiro, Brasil. Método: estudio de tipo transversal, descriptivo, de naturaleza cualitativa. La recolección de datos se realizó a través de entrevistas, y los hallazgos fueron sometidos a la técnica de análisis de contenido. La muestra se compuso por personas que viven con el VIH que fueron abordadas en el momento en que vinieron al servicio de asistencia especializada, y se definió una muestra de 20 participantes por la técnica de saturación. Resultado: emergieron categorías basadas en los temas abordados en la entrevista relacionados con la calidad de vida (condición alimentaria, actividad física, ocio, religión, y satisfacción con la vida sexual) y la experiencia de vivir con VIH. Conclusión: las personas que viven con el VIH en tratamiento antirretroviral pueden disfrutar de buenas condiciones de vida y salud, y el principal impedimento y el temor de experimentar situaciones de estigma y discriminación.