Saúde, desenvolvimento e factores institucionais: o caso de moçambique / Health, development and institutional factors: the case of mozambique

Este trabalho tem por objectivo central mostrar o impacto que as instituições têm no desempenho do sector da Saúde em Moçambique. Demonstra-se que, de entre os Determinantes Sociais da Saúde, as instituições têm um papel central no desempenho do sector da Saúde ­ e, por seu intermédio, no desenvolvimento económico e social dos moçambicanos, em especial dos mais pobres e mais vulneráveis, como são as crianças, as mulheres, as pessoas com deficiência e os idosos. Argumenta-se também que as deficiências e ineficiências do funcionamento do sector da Saúde em Moçambique resultam em larga medida do facto de as instituições com influência no sector da Saúde serem controladas por uma minoria de privilegiados que não dá a prioridade devido às necessidades básicas em saúde da maioria da população. Finalmente, argumenta-se que as medidas de carácter institucional mais importantes para a melhoria do estado de saúde dos moçambicanos são a revisão da Constituição da República, o reforço do Sistema Nacional de Saúde (em particular do Serviço Nacional de Saúde), bem como a redução da pobreza e das iniquidades económica e socia.

Política prisional e garantia de atenção integral à saúde da criança que coabita com mãe privada de liberdade, Moçambique / Prison policy and guarantee of comprehensive care to the health of the child who lives together with mother deprived of freedom, Mozambique

RESUMO A provisão dos cuidados de saúde implica o princípio dos direitos fundamentais do homem, enfatizado por Moçambique, uma nação emergente, ao considerar a saúde como um bem para o desenvolvimento sustentável previsto na Constituição da República, e garantida de forma equânime. Contudo, observa-se o ingresso preocupante no sistema prisional de mulheres com crianças pequenas que carecem de garantia do acesso a cuidados de saúde especiais. O estudo teve como objetivo fundamental analisar e descrever de que maneira a política de atenção integral à saúde da criança dos 0-5 anos, estabelecida pelo Serviço Nacional de Saúde em Moçambique, está incorporada no Serviço de Cuidados Sanitários Penitenciários. A abordagem qualitativa incidiu sobre as mães de crianças pequenas que vivem no presídio de Ndlavela, tendo em conta as variáveis que descreveram as condições socioeconômicas, demográficas e as relativas às condições biológicas da mulher com crianças. Participaram do estudo, por meio de entrevistas, duas gestantes e cinco mães em coabitação com crianças. Os dados coletados foram tratados por meio da análise de conteúdo segundo Bardin. Essas mulheres são jovens, solteiras, com baixa escolaridade, sem suporte nutricional e de saúde adequados e foram abandonadas pelas suas famílias de origem ou de formação, as quais realizavam atividades domésticas e de comércio informal. Observou-se que esse grupo é duplamente vulnerável e socialmente marginalizado, por ser pouco favorecido pelas políticas públicas de saúde. Conclui-se que a política de saúde necessita ser desdobrada, voltar-se para a necessidade e a importância de uma atenção à saúde mais igualitária, adequada e resolutiva, independentemente da situação legal, razão por que sublinha-se que essa realidade ainda está distante do preconizado sobre a assistência sanitária nos estabelecimentos penitenciários.

ABSTRACT The provision of health care implies the principle of fundamental human rights, emphasized by Mozambique, an emerging nation, when considering health as a good for the sustainable development provided for the Constitution of the Republic, and assured in an equitable manner. However, there is a worrying entrance into the prison system of women with young children who lack access guarantee and special health care. The main objective of this study was to analyze and describe how the comprehensive health care policy for children aged 0-5 years, established by the National Health Service in Mozambique, is incorporated into the Prison Health Care Service. The qualitative approach focused on mothers with small children residing in the Ndlavela prison, taking into account the variables that only described the socioeconomic, demographic conditions and the ones related to biological conditions of women with children. Two pregnant women and five mothers in cohabitation with children participated in the study, through interviews. The data collected were treated by the Bardin content analysis. These women are young, single, low schooling, without adequate nutritional and health support and were abandoned by their families of origin or formed, and who were engaged in domestic activities and informal trade activities. It was observed that this group is doubly vulnerable and socially marginalized, because it is not favored by public health policies. It is concluded that the health policy needs to be unfolded, turning to the need and importance of a more egalitarian, adequate and resolutive health care, regardless of the legal situation, which is why it is emphasized that this reality is still far from the one recommended for health care in prisons.

Defensa de los derechos adquiridos: luchas y albures del ejercicio de la homeopatía en Colombia (1905-1950) / Defending entitlement: struggles and fate of the practice of homeopathy in Colombia (1905-1950)

El artículo analiza la práctica y el estatuto profesional de los homeópatas colombianos en el siglo XX, según las solicitudes de licencia de la serie “Teguas” del Archivo General de la Nación. Desde el contexto histórico del ejercicio de la medicina en Colombia, se estudia la práctica homeopática en su inserción en el debate entre medicina diplomada y medicina permitida. Ahí aparece la homeopatía como un campo subordinado a la medicina universitaria y los homeópatas como conjunto de practicantes no homogéneo ni organizado, pero caracterizado por compartir la lucha por el “derecho adquirido” a ejercer y por la defensa de un estatuto profesional mediante la judicialización constante de la reprobación oficial.

Social representations of health councilors regarding the right to health and citizenship. / Representações sociais de conselheiros de saúde acerca do direito à saúde e da cidadania.

OBJECTIVE: To know the structure of the social representations of right to health and citizenship of health municipal councilors. METHOD: This is a qualitative study, based on the central nucleus theory of social representations, carried out in eight municipalities of the Integrated Region for the Development of the Surroundings of the Federal District, Brazil. The intentional sample consisted of municipal health councilors. Between June and December 2012, free recall questionnaires were used, of which 68 were answered with the inducing term health, and 64 with the inducing term citizenship. Data were analyzed using EVOC software and Bardin's content analysis. RESULTS: The representational field of the right to health is associated with the idea of universal law guaranteed by the Constitution and the Unified Health System (SUS), and of citizenship linked to rights and duties. CONCLUSIONS: The conceptions of right to health are understood as a condition for reaching citizenship, and citizenship as social protection.

A efetivação jurídico-política do direito à saúde no Supremo Tribunal Federal: a referência paradigmática da sl 47-agr/pe / The legal-political realization of the right to health in the Brazilian Supreme Court: the paradigmatic reference of SL 47-AgR/PE

A saúde é direito fundamental, essencial à proteção e à manutenção da vida, pressuposto da dignidade da pessoa humana, possuindo papel de destaque na complexa realidade social que integramos. Como tal, deve ser incansavelmente protegido, respeitado e garantido mediante políticas sociais e econômicas, em prol do interesse de cada indivíduo e da própria sociedade, consoante, inclusive, previsto na ordem constitucional. Nesse contexto, instado a se pronunciar, o Supremo Tribunal Federal, na qualidade de guardião da Constituição, tem a incumbência de proferir respostas capazes de proporcionar o bem-estar físico, mental e social devido a todos, em sintonia com o constitucionalmente previsto, no intuito de garantir adequado alcance jurídico e/ou político em suas decisões. Por isso, mostra-se relevante avaliar se a atuação da Corte, frente a casos concretos, efetivamente consegue respeitar a boa técnica jurídica e/ou política e, com essa finalidade, por enquadrá-la na condição de paradigma, optou-se por eleger o decisum prolatado no âmbito da Suspensão de Liminar 47 ­ Agravo Regimental do Estado de Pernambuco

Health is a fundamental right, essential for protection and maintenance of life, assuming the dignity of the human person, having an important role in the complex social reality of which we are a part. As such, the right to health should be constantly protected, respected and guaranteed through social and economic politics, in favor of the interest of each individual and his or her own community. In this context, when called upon to rule, the Brazilian Supreme Court, as guardian of the Constitution, has the duty to deliver responses capable of providing physical, mental and social well-being to all, aligned with the provisions of the Constitution, in order to ensure appropriate legal and/or political significance in its decisions. Therefore, it is relevant to assess if the activities of the Court, in concrete cases, can effectively respect the best legal practices and/or policy and, for this purpose, and to fit it into this paradigm, it was selected a specific decisum .

Representações sociais de conselheiros de saúde acerca do direito à saúde e da cidadania / Representaciones sociales de concejales de salud sobre el derecho a la salud y a la ciudadanía / Social representations of health councilors regarding the right to health and citizenship

RESUMO Objetivo Conhecer a estrutura das representações sociais de direito à saúde e cidadania de conselheiros municipais de saúde. Método Estudo qualitativo, fundamentado nas Teorias das Representações Sociais e do Núcleo Central, realizado em oito municípios da Região Integrada de Desenvolvimento do Entorno do Distrito Federal, Brasil. A amostra intencional foi composta por conselheiros municipais de saúde. Entre junho e dezembro de 2012 aplicaram-se questionários de evocação livre, dos quais foram respondidos 68 com o termo indutor Direito à Saúde e 64 com o termo indutor Cidadania. Os dados foram analisados por meio do software EVOC e da análise de conteúdo de Bardin. Resultados O campo representacional de direito à saúde está associado à ideia de direito universal garantido pela Constituição e pelo SUS e de cidadania vinculado aos direitos e deveres. Conclusões As concepções de direito à saúde são entendidas enquanto condição para alcance da cidadania e cidadania como proteção social.

RESUMEN Objetivo Conocer la estructura de las representaciones sociales de la salud y el derecho a la ciudadanía de la salud de concejales. Estudio cualitativo basado en la teoría de las representaciones sociales y el núcleo central, realizado en los municipios de la región que rodea el Desarrollo Integrado del Distrito Federal, Brasil. Una muestra intencional fue compuesta por consejeros municipales de salud. Entre junio y diciembre de 2012 aplicaron cuestionarios de recuerdo libre, de los cuales fueron contestados 68 con el inductor del término derecho a la salud y 64 con el término ciudadanía inductor. Los datos fueron analizados utilizando el software EVOC y el análisis de contenido de Bardin. s El campo representacional derecho a la salud se asocia con la idea del derecho universal garantizado por la Constitución y el SUS y la ciudadanía vinculada a los derechos y deberes. El derecho de los conceptos de salud se entiende como condición para el logro de la ciudadanía y ciudadanía como protección social.

ABSTRACT Objective To know the structure of the social representations of right to health and citizenship of health municipal councilors. Method This is a qualitative study, based on the central nucleus theory of social representations, carried out in eight municipalities of the Integrated Region for the Development of the Surroundings of the Federal District, Brazil. The intentional sample consisted of municipal health councilors. Between June and December 2012, free recall questionnaires were used, of which 68 were answered with the inducing term health, and 64 with the inducing term citizenship. Data were analyzed using EVOC software and Bardin’s content analysis. Results The representational field of the right to health is associated with the idea of universal law guaranteed by the Constitution and the Unified Health System (SUS), and of citizenship linked to rights and duties. Conclusions The conceptions of right to health are understood as a condition for reaching citizenship, and citizenship as social protection.

Reflexiones sobre multiculturalidad, grupos étnicos, prácticas terapéuticas y movimientos de reindigenización en Colombia / Reflections on Multiculturalism, Ethnic Groups, Therapeutic Practices and Movements of Reindigenización in Colombia / Reflexões sobre o multiculturalismo, grupos étnicos, práticas terapêuticas e movimentos de reindigenización na Colômbia

Introducción: El presente ensayo busca aproximarse a la comprensión de las prácticas terapéuticas indígenas haciendo un análisis comparativo y una revisión crítica inicial sobre los referentes epistémicos colonialistas desde los cuales se han descrito las prácticas culturales y las prácticas medicinales indígenas; seguidamente, se enfatiza en el cambio político y epistemológico que sucede a finales del siglo XX (especialmente, en Colombia, desde la Constitución de 1991), y en cómo se desarrolla así una transformación en la manera como estos grupos étnicos se identifican a sí mismos y como se muestran al exterior de sus comunidades; este es el caso del cabildo indígena muisca de Cota, en Colombia, en el cual la medicina, la música y otros elementos culturales puestos en la escena han constituido la mimesis que le otorga identidad hoy día como grupo étnico con características propias. Métodos: Se hizo un análisis comparativo entre distintas fuentes; una primaria y otras secundarias. Se usó la fuente primaria de información del estudio desarrollado desde 2012 hasta 2014 con la comunidad indígena muisca de Cota, y como fuentes secundarias, los escritos narrativos del periodo colonial del siglo XVI. Conclusión: La medicina tradicional indígena promueve la cultura y la reetnización del grupo resignificando sus propias historias y sus narrativas, como un elemento esencial en sus relaciones comunitarias, en el establecimiento de redes, al igual que en la manera como son identificados, observados y utilizados por la sociedad mayoritaria

Introduction: This essay seeks to approach to the understanding of indigenous therapeutic practices making a comparative analysis and a critical initial review on the related epistemic colonialist from which described the cultural practices and indigenous medicinal practices; then she emphasizes on the epistemological and political change that happens at the end of the last century, especially in Colombia since the 1991 Constitution, develop thus a transformation in the way in which these ethnic groups identify themselves and on the way how are displayed on the outside of their communities; This is the case of the indigenous cabildo Muisca of Cota, in Colombia in which medicine, music and other cultural positions in the scene have been mimesis that gives you identity today as an ethnic group with their own characteristics. Methods: It makes a comparative analysis between different sources, one primary and the other secondary. Using the primary source of study information developed from the year 2012 to 2014 with the indigenous community Muisca dimension and as secondary sources the narrative writings from the colonial period of the 16th century. Conclusion: The indigenous traditional medicine promotes culture and the reethnization of the group, resignifying their own stories and narratives, as an essential element in their community relations, networking, as well as the way they are identified, observed and used by the majority society.

O presente ensaio procura aproximar ao entendimento das práticas terapêuticas indígenas fazendo uma análise comparativa e uma revisão crítica inicial sobre os referentes epistémicos colonialistas desde os quais se descreveram as práticas culturais e práticas medicinales indígenas; depois enfatiza-se sobre a mudança política e epistemológico que sucede no final do século passado, especialmente em Colômbia desde a Constituição de 1991, desenvolvendo-se assim uma transformação na maneira na qual estes grupos étnicos se identificam a si mesmos e na maneira como se mostram ao exterior de suas comunidades; este é o caso do cabildo indígena Muisca de Cota, em Colômbia no qual a medicina, a música e outros elementos culturais postos na cena têm constituído a mimesis que lhe outorga identidade hoje em dia como grupo étnico com características próprias. Método: Faz-se uma análise comparativa entre diferentes fontes, uma primária e outras secundárias. Uso-se a fonte primária de informação do estudo desenvolvido desde o ano 2012 a 2014 com a comunidade indígena Muisca de Cota e como fontes secundárias os escritos narrativos do período colonial do século XVI. Conclusão: A medicina tradicional indígena promove a cultura e a reetnización do grupo, resignificando suas próprias histórias e narrativas, como um elemento essencial em suas relações comunitárias, no estabelecimento de redes, bem como na maneira em que são identificados, observados e utilizados pela sociedade maioritária.

Research by Psychiatrists of Chosun Chongdokbu Hospital and Keijo Imperial University in Korea during Japanese Colonial Rule / 신경정신의학

Eighty-three of 114 original articles and abstracts of research published by neuropsychiatrists of Chosun Chongdokbu Hospital (the Japanese colonial government hospital in Korea) and Keijo (Seoul) Imperial University Hospital during the Japanese colonial period (1910-1945) in journals including Shinkeigaku-zassi (Neurologia), Seishin-shinkei-gaku zassi (Psychiatria Et Neurologia Japonica), and The Journal of Chosun (Korea) Medical Association were reviewed. Most articles were on clinical research based on descriptive and biological psychiatry while only 4 articles were on dynamic psychiatry, probably because Japanese pioneers in psychiatry had introduced German psychiatry into Japan during the 1880s. The first paper was written by Dr. Shim Ho-sub. Professor Kubo of Keijo (Seoul) Imperial University published most articles, followed by Dr. Hikari, Dr. Hattori, and Dr. Sugihara. There were more articles on symptomatic psychosis and morphine addiction, followed by general paralysis, schizophrenia, neurological diseases, narcolepsy, epilepsy, and neurasthenia. The meaningful articles even for today were comparative studies between Japanese and Koreans and articles on opioid use disorder in Korea. Authors reported a markedly lower rate of psychotic inpatients in the population of Koreans compared with Japanese. Japanese researchers argued that, because of simpleness in social life in Korea and less violence or excitement in symptoms, Korean mental patients could be cared for by family or members of the community, or be treated by shamanism rather than bringing them to a public mental hospital, and poverty also prohibited hospital care. Finding of higher ratio of schizophrenia to manic-depressive psychosis among Koreans than Japanese was discussed in relation to delayed cultural development of Korea compared to Japan. In addition, traditional customs prohibiting marriage between relatives in Korea was related to low prevalence of manic-depressive psychosis, local endemic malaria was related to low prevalence of general paresis, and poor general hygiene was related to high prevalence of epilepsy. Unclear (undifferentiated) form of psychotic symptoms including hallucination and delusion was reported in more Koreans than Japanese. Also Korean patients showed a more atypical form in diagnosis. Authors added that they had found no culture-specific mental illness in Korea. However, no Korean psychiatrists were included as author in such comparative studies. Comparative studies on constitution between Koreans and Japanese mental patients and prisoners were also unique. However, no Korean psychiatrists participated in such comparative studies. In studies on morphine addiction in Koreans, Japanese researchers argued that such studies were necessary to prevent introduction of morphine-related criminal phenomena to Japan. Meanwhile, Dr. Kubo had left a notion on adaptation problems of Japanese living in the foreign country, Korea. Nevertheless he reported nothing about psychosocial aspects of mental illness in relation to political, cultural, and economic difficulties Koreans were experiencing under the colonial rule of Japan. These general trends of studies based on German biological and descriptive psychiatry and policies of colonial government to isolate "dangerous" mental patients in hospital appeared to reflect colonial or ethnopsychiatry of those days. These policy and research trends seem to have worsened stigma attached to mental disorders. Japanese tradition of psychiatric research was discontinued by return home of Japanese scholars with the end of WWII and colonial rule.

[Study on the correlation between chronic asymptomatic HBV carriers of yin asthenia constitution and genotypes of HLA-DRB1 and HLA DQA1 alleles].

OBJECTIVE: To study on the correlation between chronic asymptomatic HBV carriers (ASC) of yin asthenia constitution and genotypes of HLA-DRB1 and HLA DQA1 alleles. METHODS: Totally 105 ASC were assigned to two groups according to their constitutions, i.e., the yin asthenia group (47 cases) and the non-yin asthenia group (58 cases). The genotypes of HLA-DRB1 and HLA DQA1 alleles were determined using PCR-SSP. RESULTS: The gene frequency of HLA-DRB1 * 09 allele and HLA-DQA1 * 0301 allele (being 12.1% and 19.1%) were obviously lower in the yin asthenia group than in the non-yin asthenia group (being 27.8% and 39.7%, P < 0.05). The gene frequency of HLA-DRB1 * 11 allele and HLA-DQA1 * 0501 allele were obviously higher in the yin asthenia group (being 12.1% and 28.7%) than in the non-yin asthenia group (4.3% and 9.5%), showing statistical difference (P < 0.05, P < 0.01). CONCLUSIONS: HLA-DRB1 * 09 allele and HLA-DQA1 * 0301 allele might be the molecular bases for non-yin asthenia patients with ASC. HLA-DRB1 * 11 allele and HLA-DQA1 * 0501 allele might be the molecular bases for yin asthenia patients with ASC.

A Comparative Study on the Applied Effects of Auricular Acupressure Therapy on Insomnia in the Elderly by Sasangin Constitution: Based on Tae Yin In, So Yang In, and So Yin In

PURPOSE: This study was to compare and examine the effects of auricular acupressure therapy on insomnia in the elderly by Sasangin constitution. METHODS: This study was designed to compare three groups according to Sasangin constitution (Tae Yin In, So Yang In, and So Yin In) in terms of the changeful effects of auricular acupressure therapy on insomnia in the elderly. The subjects were 81 (Tae Yin In: 28, So Yang In: 26, and So Yin In: 27) persons aged over 65 years who were living in Seoul or Gyunggi Province. Data were collected from May, 2007 to July, 2008, and analyzed by SPSS/WIN 16.0. RESULTS: 1. The effect of auricular acupressure on insomnia in Tae Yin In was higher than that in So Yang In, and its effect in So Yang In was higher than that in So Yin In. 2. The effect was highest after the 4th treatment in Tae Yin In, after the 5th treatment in So Yang In, and after the 6th treatment in So Yin In. CONCLUSIONS: The use of auricular acupressure therapy in consideration of individual elders' Sasangin constitution can maximize its effect to relieve insomnia in the elderly.

Investigation of Genetic Evidence for Sasang Constitution Types in South Korea

In Sasang constitutional medicine, both disease susceptibility and drug response are considered to be related to the characteristics of an individual's physiology and psychology: a theory which is central to traditional Korean medicine. Based on such observable characteristics, Sasang constitutional medicine classifies people into four constitutional types. Genetic studies of Sasang constitution would help reveal the inheritance patterns and models of the typological traits and, moreover, help with traditional medical diagnosis and treatment. To investigate the heritable aspect of Sasang constitution, we collected various pedigrees from South Korea. The study population has 101 pedigrees composed of 593 individuals. The determination of the Sasang constitution type of each individual was performed by doctors who diagnose the Sasang constitutional type of individuals as part of their professional practice. We calculated estimates of familial correlation and heritability. Parent-Offspring pairs showed the strongest familial correlation of Sasang constitutional type, with the correlation values of 0.21 and 0.28, followed by sibling pairs with the value ranging between 0.14 and 0.25. From the heritability analysis conducted with the Variance-Component method, the heritability of TE (Tae-Eum) type, SY (So-Yang) type, and SE (So-Eum) type were 55%, 41%, and 47%, respectively. This pattern of heritability was consistent with different set of analyses, which suggest the robustness of our result. Our result clearly shows that the Sasang constitution type is heritable, and further genetic analysis based on our result will shed light on the biological mechanism of Sasang constitution.

El concepto legal de persona en Colombia: ¿razones biológicas para modificarlo?

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