[Human rights and transgender surgery]. / Droits de la personne humaine et chirurgie de la transidentité.

René Sève recalls that Contemporary Law in the Western World is based on autonomy of equal subjects, mutually recognizing the right to each carry out their own life project. The LGBTQIA+ person therefore exercises their ability to be their own species, according to Kirkegaard's word. It remains that "life project" also implies a constraint of stability and rationality. The author then shows, using Canadian and French statistical data, the difficulties of achieving this ideal for minors and, for adults, the other medical, paramedical and social conditions required. The rights of LGBT people cannot be considered independently of the physical and financial limits of the health system and therefore of the public debate on its priorities.

On the nexus of air pollution and health expenditures: new empirical evidence.

OBJECTIVE: To analyse the impact of per capita income and environmental air quality variables on health expenditure determinants. METHOD: In this study, we analyse the relationship between air pollution and health expenditure in 29 OECD countries over the period 1995-2014. In addition, we test whether our findings differ between countries with higher or lower incomes. RESULTS: The econometric results show that per capita income has a positive effect on health expenditure, but is not as statistically significant as expected when lag-time is incorporated. In addition, an anchorage effect is observed, which implies that about 80%-90% of previous expenditure explain current expenditure. Our empirical results are quite consistent between groups and when compared with the full sample. Nevertheless, there appear to be some differences when broken down by financing scheme (total, public, and private). CONCLUSIONS: Overall, our findings could be used to clarify the appropriate health expenditure level or to obtain better environmental quality and social well-being. That is, empirical support is provided on how health management and policy makers should include more considerations for the use of cleaner fuels in developed countries.

Panorama OCDE sobre el rol de la salud oral en las estrategias nacionales y politicas para el manejo y control de diabetes mellitus tipo 2: Una revisión sistemática / OECD overview on the role of oral health in national strategies and policies for the management and control of type 2 diabetes mellitus: A systematic review

RESUMEN: Objetivo: Describir el rol de la Salud Oral en las estrategias nacionales y políticas sanitarias para el manejo integral y control de Diabetes Mellitus Tipo 2 (DM2) en los 38 Estados miembros de la Organización para la Cooperación y Desarrollo Económico (OCDE). Materiales y Método: Se realizó una revisión sistemática exploratoria, siguiendo la pauta PRISMA-ScR. Se incluyeron reportes gubernamentales, guías de práctica clínica, documentos oficiales OMS y OCDE, y artículos identificados en PubMED y LiLACS hasta diciembre de 2020. Se sintetizó: 1) Inclusión de la Salud Oral en planes nacionales o guías clínicas de DM2, 2) Prestaciones y cobertura odontológica para DM2 y 3) Indicadores de salud asociados al control de DM2. Resultados: 84 documentos fueron incluidos. 1) La Salud Oral está incorporada en los planes nacionales de 22 países OCDE para el control de DM2. 2) De estos, 8 garantizan la atención odontológica con alta cobertura para DM2. 3) Países OCDE con alta cobertura odontológica presentan los mejores indicadores de control metabólico de DM2. Conclusiones: En el marco de la Salud Global, países que no tienen integrada la salud oral podrían beneficiarse si incorporan la atención odontológica con cobertura universal en el manejo integral y control de la DM2.

ABSTRACT: Aim: To describe the role of Oral Health in national strategies and health policies for the comprehensive management and control of Type 2 Diabetes Mellitus (T2DM) in the 38 member states of the Organization for Economic Cooperation and Development (OECD). Method: A scoping review was carried out, according to the PRISMA-ScR guideline. Government reports, clinical practice guidelines, official WHO and OECD documents, and review articles identified in PubMED and LiLACS were included up to December 2020. The following were synthesized: 1) Inclusion of Oral Health in national plans or clinical guidelines for DM2, 2) Dental benefits and coverage for DM2 and 3) Health indicators associated with the control of DM2. Results: 84 documents were included. 1) Oral Health is incorporated in the national plans of 22 OECD countries for the control of DM2. 2) Of these, 8 provide dental care with high coverage for DM2. 3) OECD countries with high dental coverage have the best indicators of metabolic control of DM2. Conclusions: In the framework of Global Health, countries that do not have Oral Health integrated could benefit if they add dental care in the comprehensive management and control of DM2.

Association between cardiovascular disease and socioeconomic level in Portugal.

INTRODUCTION: Cardiovascular disease is the leading cause of morbidity, mortality and disability in Portugal. Socioeconomic level is known to influence health status but there is scant evidence on socioeconomic inequalities in cardiovascular disease in Portugal. AIM: To analyze the distribution of cardiovascular disease in the Portuguese population according to socioeconomic status. METHODS: We conducted a cross-sectional study using data from the fourth National Health Survey on a representative sample of the Portuguese population. Socioeconomic inequalities in cardiovascular disease, risk factors and number of medical visits were analyzed using odds ratios according to socioeconomic status (household equivalent income) in the adult population (35-74 years). Comparisons focused on the top and bottom 50% and 10% of household income distribution. RESULTS: Of the 21 807 individuals included, 53.3% were female, and mean age was 54 ± 11 years. Cardiovascular disease, stroke, ischemic heart disease, hypertension, diabetes, obesity and physical inactivity were associated with lower socioeconomic status, while smoking was associated with higher status; number of medical visits and psychological distress showed no association. When present, inequality was greater at the extremes of income distribution. CONCLUSIONS: The results reveal an association between morbidity, lifestyle and socioeconomic status. They also suggest that besides improved access to effective medical intervention, there is a need for a comprehensive strategy for health promotion and disease prevention that takes account of individual, cultural and socioeconomic characteristics.

Pruebas normalizadas para la evaluación de la biodegradabilidad de sustancias químicas. una revisión

La biodegradabilidad es una propiedad de las sustancias químicas que determina su persistencia ambiental. Diversos organismos han estandarizado métodos para la evaluación de esta propiedad, entre los que destacan, por su amplio uso a nivel internacional, las pruebas de la Organización para la Cooperación y el Desarrollo Económico (OCDE). En este trabajo se presenta una descripción general de estas pruebas, y se discuten sus principales ventajas e inconvenientes. Para tal efecto, se utiliza la estructura propuesta por dicha organización, que distingue tres niveles sucesivos de ensayo: las pruebas de biodegradabilidad inmediata, de biodegradabilidad intrínseca y de simulación. La complejidad de las condiciones experimentales empleadas aumenta en el mismo orden, por lo que dicho esquema permite evaluar a bajo costo el potencial de biodegradación de cualquier molécula orgánica. En este artículo se sugieren algunas mejoras a los métodos, tales como la aplicación de modelos cinéticos para la expresión de los resultados y el uso de la sustancia de prueba como fuente de N, P o S. Se revisan en particular las pruebas de simulación, que permiten conocer el comportamiento de las sustancias en medios naturales o industriales específicos, y se destaca la importancia de normalizar nuevos métodos de simulación y de optimizar los existentes para hacerlos más accesibles a los posibles usuarios. Entre los medios naturales susceptibles de ser normalizados destacan los anóxicos en presencia de distintos aceptores externos de electrones (i.e., nitratos, sulfatos o hierro). Finalmente, se presentan aplicaciones recientes de estas pruebas, así como algunas áreas de investigación futura.

As knowledge of the biodegradability of organic compounds is essential to determine their environmental fate, several standardized biodegradability tests have been proposed by regulatory agencies. This paper presents an overview of the most commonly used standardized methods for biodegradability assessment of chemicals, those of the Organization for Economic Cooperation and Development (OECD). A general description is given of these tests and of their most important advantages and disadvantages. The tests presentation follows the OECD strategy, which classifies the assays in three successive levels: ready, inherent and simulation tests. Since experimental complexity increases in the same order, this strategy permits the biodegradability assessment of any organic compound in a cost-effective way. Some improvements to the tests are suggested, such as the application of kinetic models for the expression of test results and the use of the test compound as a source of N, P or S. The simulation tests, which allow the study of the behavior of chemicals in specific natural or industrial environments, are reviewed. The need of both new simulation methods and the optimization of available ones in order to extend their use is emphasized. A relevant simulation test to be standardized is the anoxic medium with external electron acceptors (i.e., nitrates, sulfates or iron). Finally, some recent applications of these tests as well as some proposals for future research in the field are presented.

A biodegradabilidade é uma propriedade das substâncias químicas que determina sua persistência ambiental. Diversos organismos tem estandardizado métodos para a avaliação desta propriedade, entre os que destacam, por seu amplo uso a nível internacional, as provas da Organização para a Cooperação e o Desenvolvimento Econômico (OCDE). Neste trabalho apresenta-se uma descrição geral destas provas, e discutem-se suas principais vantagens e inconvenientes. Para tal efeito, utiliza-se a estrutura proposta por dita organização, que distingue três níveis sucessivos de ensaios: as provas de biodegradabilidade imediata, de biodegradabilidade intrínseca e de simulação. A complexidade das condições experimentais empregadas aumenta na mesma ordem, pelo que dito esquema permite avaliar a baixo custo o potencial de biodegradação de qualquer molécula orgânica. Neste artigo se sugerem algumas melhoras aos métodos, tais como a aplicação de modelos cinéticos para a expressão dos resultados e o uso da substância de prova como fonte de N, P ou S. Revisam-se em particular as provas de simulação, que permitem conhecer o comportamento das substâncias em meios naturais ou industriais específicos, e se destaca a importância de normalizar novos métodos de simulação e de melhorar os existentes para fazê-los mais acessíveis aos possíveis usuários. Entre os meios naturais susceptíveis de ser normalizados destacam os anóxicos na presença de distintos aceptores externos de elétrons (i.e., nitratos, sulfatos ou ferro). Finalmente, se apresentam aplicações recentes destas provas, assim como algumas áreas de investigação futura.

Os seguros privados de saúde no Brasil: uma análise taxonômica a partir da OCDE

O objetivo deste trabalho é descrever o papel dos seguros privados de assistência à saúde dentro do sistema de saúde brasileiro, à luz da proposta de taxonomia desenvolvida pela Organização para a Cooperação e Desenvolvimento Econômico (OCDE). A utilização dessa proposta contribui para um melhor entendimento do desenho institucional do sistema de saúde. Noções como "suplementar", "complementar" e a própria designação do nosso "seguro público nacional de saúde" como Sistema Único de Saúde (SUS) dificultam a interpretação do arranjo institucional do sistema, de seu financiamento misto e do papel desempenhado pelos SPS em relação ao SUS. Para que a taxonomia da OCDE contemple particularidades do caso brasileiro, propomos como novas categorias explicativas, os conceitos de "duplicado-reduzido" e "suplementar-hoteleiro" para representar o papel dos SPS no Brasil