Qual família e qual comunidade? Reconfigurações da Medicina de Família e Comunidade na saúde suplementar / ¿Qué familia y qué comunidad? Reconfiguraciones de la Medicina Familiar y Comunitaria en salud complementaria / Which family and which community? Reconfigurations of Family and Community Medicine in supplementary health

RESUMO: Trata-se de um estudo cartográfico que buscou analisar a atuação de médicos(as) de família e comunidade na Atenção Primária da saúde suplementar, realizado por meio de diários e entrevistas cartográficas entre março de 2021 e janeiro de 2022, processados semanalmente em reuniões de pesquisa. Tal estudo se deu com base nos analisadores: 'território', 'família' e 'comunidade'. Notou-se que a territorialização e a abordagem familiar ganham outros contornos na Medicina de Família e Comunidade praticada na saúde suplementar. Além disso, verificou-se que algumas das ferramentas típicas da Atenção Básica - como visita domiciliar, educação em saúde, genograma, ecomapa e vigilância em saúde - não eram utilizadas na atenção suplementar ou tiveram outras aplicabilidades dissonantes do modelo preconizado. Concluiu-se que a Medicina de Família e Comunidade na saúde suplementar se aproxima de uma atuação mais clínica, com perda da potência das linhas de força que constituem tal especialidade, tendendo a uma medicina menos familiar e comunitária.

RESUMEN: Se trata de un estudio cartográfico que buscó analizar el desempeño de los médicos de familia y comunidad en atención primaria de salud complementaria, realizado a través de diarios y entrevistas cartográficas entre marzo de 2021 y enero de 2022, que fueron procesados semanalmente en reuniones de investigación. Este estudio se basó en los analizadores: 'territorio', 'familia' y 'comunidad'. Se observó que la territorialización y el enfoque familiar adquieren otros contornos en la Medicina Familiar y Comunitaria practicada en salud complementaria. Además, se encontró que algunas de las herramientas típicas de la atención básica, como las visitas domiciliarias, la educación sanitaria, el genograma, el ecomap y la vigilancia sanitaria, no se utilizaron en la atención complementaria o tenían otra aplicabilidad disonante del modelo recomendado. Se concluyó que la Medicina Familiar y Comunitaria en salud complementaria se aproxima a una práctica más clínica, con pérdida de potencia de las líneas eléctricas que constituyen dicha especialidad, tendiendo a una medicina menos familiar y comunitaria.

ABSTRACT: This is a cartographic study that sought to analyze the performance of family and community physicians in primary care of supplementary health, carried out through diaries and cartographic interviews between March 2021 and January 2022, which were weekly processed in research meetings. This study was based on the analyzers: 'territory', 'family' and 'community'. It was noticed that territorialization and family approach gain other contours in Family and Community Medicine practiced in supplementary health. In addition, it was found that some of the typical tools of basic care - such as home visits, health education, genogram, ecomap and health surveillance - were not used in supplementary care or had other dissonant applicabilities of the recommended model. It was concluded that Family and Community Medicine in supplementary health approaches a more clinical practice, with loss of power from the power lines that constitute such specialty, tending to a less familiar and community medicine.

O papel da(o) psicóloga(o) na saúde indígena / The role of the psychologist in indigenous health / El papel del psicólogo en la salud indígena

Este trabalho apresenta contribuições ao papel dos profissionais em Psicologia na Atenção Diferenciada à Saúde Indígena, destacando o entre-lugar teórico-prático ocupado junto aos povos Guarani, Kaiowá e Terena, e demonstrando a relação entre a Política Pública de Saúde, com suas exigências normativas e disciplinares, e a ordem cósmica, refletidas nos saberes em Saúde das diferentes figurações sociais e grupos-sujeitos com que trabalhamos. A partir dos diferentes ethos e estilos dos grupos indígenas e não indígenas e suas acepções de saúde, nos deparamos com a complexidade desse cenário-contexto, representada pela multiculturalidade/interculturalidade e pelas relações de poder e saber no cuidado em saúde. Assim, a Psicologia e demais profissões de saúde se veem desafiadas a produzirem uma Atenção à Saúde que cumpra sua função e tenha a eficácia simbólico-material necessária aos povos indígenas. Nesse sentido, a Cartografia como recurso metodológico nos permite acompanhar o processo, adentrar os textos e contextos de produção de Atenção à Saúde Indígena e compreender a emergência do pensamento limiar com a participação dos conhecimentos e saberes indígenas no cuidado em Saúde. A Psicologia Decolonial surge como alternativa, não como uma nova receita de atuação, mas provendo uma orientação teórico-prática que viabiliza a coexistência dos saberes indígenas e não indígenas no cuidado em Saúde. A supervisão das lideranças tradicionais e a entrada na cosmologia e nas epistemologias indígenas se tornam imprescindíveis para a atuação da Psicologia, possibilitando novos enlaces afetivo-intelectuais e políticos no cuidado em Saúde.(AU)

This work presents contributions to the role of professionals in Psychology in Differentiated Indigenous Healthcare, highlighting the theoretical-practical in-between occupied by indigenous people Guarani, Kaiowá, and Terena and demonstrating the relationship between the Public Health Politics, with its normative and disciplinary requirements, and the cosmic order, reflected in the knowledge of Health of the different social representations and subject-groups we work with. From the different ethos and styles of indigenous and non-indigenous groups and their meanings of health, we faced the complexity of this scenario-context, represented by multiculturalism/interculturalism and the relations of power and knowledge in healthcare. With this, the Psychology and other health professions are challenged to produce a Healthcare that fulfills its function and has the symbolic-material effectiveness necessary to the indigenous peoples. In this sense, the Cartography, as a methodological resource, allows us to follow the process, get into the texts and contexts of production in Indigenous Healthcare and understand the emergence of the threshold thought with the participation of indigenous knowledge and wisdom in the Healthcare. The Decolonial Psychology is an alternative, not as a new performance recipe, but as a theoretical-practical guideline that enables the coexistence of indigenous and non-indigenous knowledge in Healthcare. The supervision of traditional leaderships and the entry in the indigenous cosmology and epistemology became indispensable to the performance of Psychology, enabling new affective-intellectual and political links in Healthcare.(AU)

Este trabajo presenta contribuciones al papel de los profesionales en Psicología en la Atención Diferenciada a la Salud Indígena, destacando el entre-lugar teórico-práctico ocupado junto a los pueblos Guaraní, Kaiowá y Terena, y demostrando el tránsito entre la Política Pública de Salud, con sus requisitos normativas y disciplinarias, y el orden cósmico, reflejadas en los saberes en Salud de las diferentes figuraciones sociales y grupos-sujetos con los que trabajamos. Desde los diferentes ethos y estilos de los grupos indígenas y no indígenas y sus acepciones de Salud, nos encontramos con la complejidad de este escenario-contexto representada por la multiculturalidad / interculturalidad y por las relaciones de poder y conocer en el cuidado en Salud. Así, la Psicología y demás profesiones de salud se ven desafiadas a producir una Atención a la Salud que cumpla su función y tenga eficacia simbólico-material necesaria para los pueblos indígenas. En ese sentido, la Cartografía, como recurso metodológico, nos permite acompañar el proceso, adentrar a los textos y contextos de producción de Atención a la Salud Indígena y comprender la emergencia del pensamiento umbral con la participación de los conocimientos y saberes indígenas en el cuidado en Salud. La Psicología Decolonial surge como alternativa, no como una nueva receta de actuación, sino como orientadora teórico-práctica que viabiliza la coexistencia de los saberes indígenas y no indígenas en el cuidado en Salud.(AU)

Triangulation supports agricultural spread of the Transeurasian languages.

The origin and early dispersal of speakers of Transeurasian languages-that is, Japanese, Korean, Tungusic, Mongolic and Turkic-is among the most disputed issues of Eurasian population history1-3. A key problem is the relationship between linguistic dispersals, agricultural expansions and population movements4,5. Here we address this question by 'triangulating' genetics, archaeology and linguistics in a unified perspective. We report wide-ranging datasets from these disciplines, including a comprehensive Transeurasian agropastoral and basic vocabulary; an archaeological database of 255 Neolithic-Bronze Age sites from Northeast Asia; and a collection of ancient genomes from Korea, the Ryukyu islands and early cereal farmers in Japan, complementing previously published genomes from East Asia. Challenging the traditional 'pastoralist hypothesis'6-8, we show that the common ancestry and primary dispersals of Transeurasian languages can be traced back to the first farmers moving across Northeast Asia from the Early Neolithic onwards, but that this shared heritage has been masked by extensive cultural interaction since the Bronze Age. As well as marking considerable progress in the three individual disciplines, by combining their converging evidence we show that the early spread of Transeurasian speakers was driven by agriculture.

A map of the extent and year of detection of oil palm plantations in Indonesia, Malaysia and Thailand.

In recent decades, global oil palm production has shown an abrupt increase, with almost 90% produced in Southeast Asia alone. To understand trends in oil palm plantation expansion and for landscape-level planning, accurate maps are needed. Although different oil palm maps have been produced using remote sensing in the past, here we use Sentinel 1 imagery to generate an oil palm plantation map for Indonesia, Malaysia and Thailand for the year 2017. In addition to location, the age of the oil palm plantation is critical for calculating yields. Here we have used a Landsat time series approach to determine the year in which the oil palm plantations are first detected, at which point they are 2 to 3 years of age. From this, the approximate age of the oil palm plantation in 2017 can be derived.

Mapping colocation: Using national provider identified data to assess primary care and behavioral health colocation.

INTRODUCTION: Evidence supports that integrated behavioral health care improves patient outcomes. Colocation, where health and behavioral health providers work in the same physical space, is a key element of integration, but national rates of colocation are unknown. We established national colocation rates and analyzed variation by primary care provider (PCP) type, practice size, rural/urban setting, Health and Human Services region, and state. METHOD: Data were from the Centers for Medicare & Medicaid Services' 2018 National Plan and Provider Enumeration System data set. Practice addresses of PCPs (family medicine, general practitioners, internal medicine, pediatrics, and obstetrician/gynecologists), social workers, and psychologists were geocoded to latitude and longitude coordinates. Distances were calculated; those < 0.01 miles apart were considered colocated. Bivariate and multivariate analyses were conducted, and maps were generated. RESULTS: Of the 380,690 PCPs, > 44% were colocated with a behavioral health provider. PCPs in urban settings were significantly more likely to be colocated than rural providers (46% vs. 26%). Family medicine and general practitioners were least likely to be colocated. Only 12% of PCPs who were the sole PCP at an address were colocated compared with 48% at medium-size practices (11-25 PCPs). DISCUSSION: Although colocation is modestly expanding in the United States, it is most often occurring in large urban health centers. Efforts to expand integrated behavioral health care should focus on rural and smaller practices, which may require greater assistance achieving integration. Increased colocation can improve access to behavioral health care for rural, underserved populations. This work provides a baseline to assist policymakers and practices reach behavioral health integration. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Distribution of midwives in Mongolia: A secondary data analysis.

INTRODUCTION: Midwives are at the core of strengthening the health system, especially in the crucial period around pregnancy, childbirth, and the early weeks of life. In 2016, the national-level maternal mortality ratio in Mongolia was 48.6 deaths per 100,000 live births, but this was much higher (up to 212.9 deaths/100,000) in some rural provinces of the country. The wide variation in maternal mortality between urban and rural areas of Mongolia might be related to the distribution of midwives and equity of access to maternity care. OBJECTIVES: In the present study, we aimed to determine the distribution of midwives in each province of Mongolia and to examine inequality in the distribution of midwives nationwide. DESIGN: A secondary data analysis. METHODS: Data from the Centre of Health Development and the National Statistical Office of Mongolia were obtained and analysed. First, we assessed the distribution of midwives at provincial and regional levels, along with the association between these distributions and the maternal mortality ratio in 2016. We then calculated the inequality of these distributions using the Gini coefficient and examined trends for the years 2010-2016. We compared results for urban, suburban, and rural provinces. Rural areas are sparsely populated and enormous in size, so it may be difficult access to basic healthcare services. It was considered important, therefore, to assess the number of midwives per 1000 km2 as well as the commonly used indicator of per 10,000 population. RESULTS: When the land area in each province was taken into consideration rather than only the population, wider variations between urban, suburban, and rural provinces became apparent. Provinces varied according to the number of midwives per 10,000 population by a factor of three (range 2.0-6.2/midwives); while provinces varied according to the number of midwives per 1000 km2 by a factor of approximately 300 (range 0.2-61.2/midwives). The Gini coefficient for the number of midwives per 10,000 population in 2016, R = 0.201, revealed "relative" equality. This was slightly reduced from R = 0.305 in 2010 and indicated a shift toward equality. However, the Gini coefficient for the number of midwives per 1000 km2 area indicated "severe" inequality of R = 0.524 in 2016. This was increased from R = 0.466 in 2010, indicating that no improvement has been seen over these years. CONCLUSIONS: Our study suggests that two different measures of midwifery distribution should be used as indicators: number of midwives "per 10,000 population" and "per 1000 km2 area". In rural areas such as parts of Mongolia, geographical features and population density are important features of the local context. To deliver healthcare services in a timely manner and within a reasonable distance for pregnant women who need care, the indicator of per 1000 km2 area would be more suitable for rural and sparsely populated areas than the indicator of per 10,000 population, which is commonly used for urban and settled areas. Based on our findings, to reduce the wide gap in MMR between rural and urban areas, we recommend at least one midwife per 1000 km2 area in rural regions of Mongolia.

A Bivariate Mapping Tutorial for Cancer Control Resource Allocation Decisions and Interventions.

Bivariate choropleth mapping is a straightforward but underused method for displaying geographic health information to use in public health decision making. Previous studies have recommended this approach for state comprehensive cancer control planning and similar efforts. In this method, 2 area-level variables of interest are mapped simultaneously, often as overlapping quantiles or by using other classification methods. Variables to be mapped may include area-level (eg, county level) measures of disease burden, health care use, access to health care services, and sociodemographic characteristics. We demonstrate how geographic information systems software, specifically ArcGIS, can be used to develop bivariate choropleth maps to inform resource allocation and public health interventions. We used 2 types of county-level public health data: South Carolina's Behavioral Risk Factor Surveillance System estimates of ever having received cervical cancer screening, and a measure of availability of cervical cancer screening providers that are part of South Carolina's Breast and Cervical Cancer Early Detection Program. Identification of counties with low screening rates and low access to care may help inform where additional resources should be allocated to improve access and subsequently improve screening rates. Similarly, identifying counties with low screening rates and high access to care may help inform where educational and behavioral interventions should be targeted to improve screening in areas of high access.

Origin identification of Panax notoginseng by multi-sensor information fusion strategy of infrared spectra combined with random forest.

Traditional Chinese medicine Panax notoginseng is a valuable geo-authentic herbal material. The difference of growth environment in different producing areas has significant influence on the quality of traditional Chinese medicine, and origin identification is an important part of the quality assessment of P. notoginseng. In this study, Fourier transform mid-infrared (FT-MIR) and near infrared (NIR) sensor technologies combined with single spectra analysis and multi-sensor information fusion strategy (low-, mid- and high-level) for the origin identification of 210 P. notoginseng samples from five cities in Yunnan Province, China. FT-MIR spectra were considered to play a greater role in data analysis than NIR spectra. Random forest (RF) was used to establish classification models. The result of the random forest Boruta (RF-Bo) model and the random forest variable selection (RF-Vs) model based on high-level multi-sensor information fusion strategy was satisfactory. In addition, the RF-Bo model based on high-level multi-sensor information fusion strategy was faster and simpler in data analysis and the accuracy was 95.6%.

Spatial distribution of hospitalization rates of children due to pneumonia in the Unified Health System, in the municipalities of the state of São Paulo. / Distribuição espacial das taxas de internação de crianças por pneumonia no Sistema Único de Saúde, nos municípios do estado de São Paulo.

OBJECTIVE: To identify spatial patterns in the distribution of hospitalization rates of children with pneumonia in the state of São Paulo, Brazil from 2009 to 2013. METHODS: This was an exploratory ecological study with data obtained from DATASUS of hospitalizations of children with pneumonia in the municipalities in São Paulo from 2009 to 2013/ Data on maternal education and family income were obtained and rates per thousand children were calculated and inserted in a database of municipalities obtained from IBGE. Thematic, kernel and Moran maps were constructed for the hospitalization rates and the Moran indices were calculated. The TerraView program was used for spatial analysis. RESULTS: A total of 43,809 children were hospitalized in the study period, with a minimum of zero and a maximum of 69,072. The mean rate per municipality was 11.51 ± 8.62 (SD). The Moran index was 0.21 (p = 0.01). The thematic map showed clusters in the northern, northwestern, midwestern and southwestern regions of the state; the kernel map showed a higher density of rates in the northwestern and midwestern areas, and the Moran map identified 39 municipalities that deserve the attention of municipal and regional managers. CONCLUSIONS: Geoprocessing identifies regions with higher hospitalization rates for pneumonia and also municipalities that deserve a high intervention priority.

OBJETIVO: Identificar padrões espaciais na distribuição das taxas de internação de crianças por pneumonia no estado de São Paulo, no período de 2009 a 2013. MÉTODOS: Estudo ecológico exploratório com dados obtidos do Departamento de Informática do Sistema Único de Saúde (DATASUS) de internações por pneumonia em crianças relativas aos municípios do estado de São Paulo de 2009 a 2013, dados de escolaridade materna e renda familiar; e foram criadas taxas por mil crianças e inseridas numa base digital de municípios obtida do Instituto Brasileiro de Geografia e Estatística. Foram construídos mapas temáticos, de Kernel e de Moran para as taxas de internação e calculados os índices de Moran. Foi utilizado o programa TerraView para a análise espacial. RESULTADOS: Foram internadas 43.809 crianças no período. A taxa média por município foi de 11,51 (DP = 8,62). O índice de Moran foi de 0,21 (p = 0,01). Há aglomerados nas regiões norte, noroeste, centro-oeste e sudoeste; o mapa de Kernel mostra densidade maior de taxas no noroeste e centro-oeste do estado; e o mapa de Moran identificou 39 municípios que merecem atenção por parte dos gestores municipais e regionais. CONCLUSÕES: O geoprocessamento permitiu identificar regiões com maiores taxas de internação por pneumonia e também municípios que merecem prioridade de intervenção.

Spatial clustering of people with memories and responses six years after an earthquake in Cauquenes, Chile.

The occurrence of earthquakes can cause psychiatric problems expressed as unpleasant and uncontrollable memories of the event termed post-traumatic stress disorder (PTSD). Mapping the location of people and identifying their exposure and reactions to an earthquake can be extremely valuable from a public, mental health point of view. The main objective of this study was to examine people with respect to PTSD and healthy post-traumatic growth (PTG) after an earthquake searching for expression of geographic clustering that could be useful for a better understanding of mental health conditions. Geographic information systems analyses were performed to detect global and local geographic clustering. Investigating 171 randomly selected adults from Cauquenes, Chile, we demonstrated spatially clustered variables related to PTSD and PTG in Cauquenes six years after an earthquake. Urban and peri-urban areas had clear differences (hotspots/coldspots). The spatial identifications found should facilitate exploring the impact of mental health programmes in communities exposed to disasters like earthquakes, thereby improving their quality of life as well as reducing overall costs.

Malaria risk map for India based on climate, ecology and geographical modelling.

Mapping the malaria risk at various geographical levels is often undertaken considering climate suitability, infection rate and/or malaria vector distribution, while the ecological factors related to topography and vegetation cover are generally neglected. The present study abides a holistic approach to risk mapping by including topographic, climatic and vegetation components into the framework of malaria risk modelling. This work attempts to delineate the areas of Plasmodium falciparum and Plasmodium vivax malaria transmission risk in India using seven geo-ecological indicators: temperature, relative humidity, rainfall, forest cover, soil, slope, altitude and the normalized difference vegetation index using multi-criteria decision analysis based on geographical information system (GIS). The weight of the risk indicators was assigned by an analytical hierarchical process with the climate suitability (temperature and humidity) data generated using fuzzy logic. Model validation was done through both primary and secondary datasets. The spatio-ecological model was based on GIS to classify the country into five zones characterized by various levels of malaria transmission risk (very high; high; moderate; low; and very low. The study found that about 13% of the country is under very high malaria risk, which includes the malaria- endemic districts of the states of Chhattisgarh, Odisha, Jharkhand, Tripura, Assam, Meghalaya and Manipur. The study also showed that the transmission risk suitability for P. vivax is higher than that for P. falciparum in the Himalayan region. The field study corroborates the identified malaria risk zones and highlights that the low to moderate risk zones are outbreak-prone. It is expected that this information will help the National Vector Borne Disease Control Programme in India to undertake improved surveillance and conduct target based interventions.

Convergent estimates of marine nitrogen fixation.

Uncertainty in the global patterns of marine nitrogen fixation limits our understanding of the response of the ocean's nitrogen and carbon cycles to environmental change. The geographical distribution of and ecological controls on nitrogen fixation are difficult to constrain with limited in situ measurements. Here we present convergent estimates of nitrogen fixation from an inverse biogeochemical and a prognostic ocean model. Our results demonstrate strong spatial variability in the nitrogen-to-phosphorus ratio of exported organic matter that greatly increases the global nitrogen-fixation rate (because phytoplankton manage with less phosphorus when it is in short supply). We find that the input of newly fixed nitrogen from microbial fixation and external inputs (atmospheric deposition and river fluxes) accounts for up to 50 per cent of carbon export in subtropical gyres. We also find that nitrogen fixation and denitrification are spatially decoupled but that nevertheless nitrogen sources and sinks appear to be balanced over the past few decades. Moreover, we propose a role for top-down zooplankton grazing control in shaping the global patterns of nitrogen fixation. Our findings suggest that biological carbon export in the ocean is higher than expected and that stabilizing nitrogen-cycle feedbacks are weaker than previously thought.

Use of hospital palliative care according to the place of death and disease one year before death in 2013: a French national observational study.

BACKGROUND: Only limited data are available concerning the diseases managed before death and hospital palliative care (HPC) use according to place of death in France. We therefore conducted an observational study based on administrative health data in a large population to identify the diseases treated one year before death in 2013, the place of stay with or without hospital palliative care, and the place of death. METHODS: French health insurance general scheme beneficiaries were identified in the National Health data Information System (Snds) with a selection of information. Diseases were identified by algorithms from reimbursement data recorded in the Snds database. RESULTS: 347,253 people were included in this study (61% of all people who died in France). Place of death was short stay hospital for 51%, Rehab (7%), hospital at home (3%), skilled nursing home (13%) and other (26%). Chronic diseases managed in 2013 before death were cardiovascular/neurovascular diseases (56%), cancers (42%), and neurological and degenerative diseases (25%). During the year before death, 84% of people were hospitalized at least once, and 29% had received HPC. HPC was used by 52% of cancer patients (lung cancer: 62%; prostate cancer: 41%). In the absence of cancer, the use of HPC varied according to the disease: acute stroke: 24%, heart failure: 17%, dementia: 17%, multiple sclerosis: 23%. CONCLUSIONS: Health administrative data can refine the knowledge of the care pathway prior to death and the HPC utilisation and can be useful to evaluate heath policies and improve monitoring and assessment of HPC use.

Fire frequency drives decadal changes in soil carbon and nitrogen and ecosystem productivity.

Fire frequency is changing globally and is projected to affect the global carbon cycle and climate. However, uncertainty about how ecosystems respond to decadal changes in fire frequency makes it difficult to predict the effects of altered fire regimes on the carbon cycle; for instance, we do not fully understand the long-term effects of fire on soil carbon and nutrient storage, or whether fire-driven nutrient losses limit plant productivity. Here we analyse data from 48 sites in savanna grasslands, broadleaf forests and needleleaf forests spanning up to 65 years, during which time the frequency of fires was altered at each site. We find that frequently burned plots experienced a decline in surface soil carbon and nitrogen that was non-saturating through time, having 36 per cent (±13 per cent) less carbon and 38 per cent (±16 per cent) less nitrogen after 64 years than plots that were protected from fire. Fire-driven carbon and nitrogen losses were substantial in savanna grasslands and broadleaf forests, but not in temperate and boreal needleleaf forests. We also observe comparable soil carbon and nitrogen losses in an independent field dataset and in dynamic model simulations of global vegetation. The model study predicts that the long-term losses of soil nitrogen that result from more frequent burning may in turn decrease the carbon that is sequestered by net primary productivity by about 20 per cent of the total carbon that is emitted from burning biomass over the same period. Furthermore, we estimate that the effects of changes in fire frequency on ecosystem carbon storage may be 30 per cent too low if they do not include multidecadal changes in soil carbon, especially in drier savanna grasslands. Future changes in fire frequency may shift ecosystem carbon storage by changing soil carbon pools and nitrogen limitations on plant growth, altering the carbon sink capacity of frequently burning savanna grasslands and broadleaf forests.

Interpolated mapping and investigation of environmental radioactivity levels in soils and mushrooms in the Middle Black Sea Region of Turkey.

The activity concentration of natural (238U, 232Th, and 40K) and artificial (137Cs) radionuclides was determined in 50 samples (obtained from the same station) from various species of mushrooms and soil collected from the Middle Black Sea Region (Turkey). The activities of 238U, 232Th, 40K, and 137Cs were found as 84 ± 16, 45 ± 14, 570 ± 28, and 64 ± 6 Bq kg-1 (dry weight), respectively, in the mushroom samples and as 51 ± 6, 41 ± 6, 201 ± 11, and 44 ± 4 Bq kg-1, respectively, in the soil samples for the entire area of study. The results of all radionuclide activity measurements, except those of 238U and 232Th in the mushroom samples, are consistent with previous studies. In the soil samples, the mean values of 238U and 232Th are above the world mean, and the activity mean of 40K is below the world mean. Finally, the activity estimation was made with both the soil and mushroom samples for unmeasured points within the study area by using the ordinary kriging method. Radiological distribution maps were generated.

Mapping midwifery and obstetric units in England.

OBJECTIVE: to describe the configuration of midwifery units, both alongside&free-standing, and obstetric units in England. DESIGN: national survey amongst Heads of Midwifery in English Maternity Services SETTING: National Health Service (NHS) in England PARTICIPANTS: English Maternity Services Measurements descriptive statistics of Alongside Midwifery Units and Free-standing Midwifery Units and Obstetric Units and their annual births/year in English Maternity Services FINDINGS: alongside midwifery units have nearly doubled since 2010 (n = 53-97); free-standing midwifery units have increased slightly (n = 58-61). There has been a significant reduction in maternity services without either an alongside or free-standing midwifery unit (75-32). The percentage of all births in midwifery units has trebled, now representing 14% of all births in England. This masks significant differences in percentage of all births in midwifery units between different maternity services with a spread of 4% to 31%. KEY CONCLUSIONS: In some areas of England, women have no access to a local midwifery unit, despite the National Institute for Health&Clinical Excellence (NICE) recommending them as an important place of birth option for low risk women. The numbers of midwifery units have increased significantly in England since 2010 but this growth is almost exclusively in alongside midwifery units. The percentage of women giving birth in midwifery units varies significantly between maternity services suggesting that many midwifery units are underutilised. IMPLICATIONS FOR PRACTICE: Both the availability and utilisation of midwifery units in England could be improved.

Shrinking risk profiles after deworming of children in Port Elizabeth, South Africa, with special reference to Ascaris lumbricoides and Trichuris trichiura.

Risk maps facilitate discussion among different stakeholders and provide a tool for spatial targeting of health interventions. We present maps documenting shrinking risk profiles after deworming with respect to soil-transmitted helminthiasis among schoolchildren from disadvantaged neighbourhoods in Port Elizabeth, South Africa. Children were examined for soil-transmitted helminth infections using duplicate Kato-Katz thick smears in March 2015, October 2015 and May 2016, and subsequently treated with albendazole after each survey. The mean infection intensities for Ascaris lumbricoides were 9,554 eggs per gram of stool (EPG) in March 2015, 4,317 EPG in October 2015 and 1,684 EPG in March 2016. The corresponding figures for Trichuris trichiura were 664 EPG, 331 EPG and 87 EPG. Repeated deworming shrank the risk of soil-transmitted helminthiasis, but should be complemented by other public health measures.

Protocol for a scoping review to identify and map the global health personnel considered skilled attendants at birth in low and middle-income countries between 2000 and 2015.

INTRODUCTION: Despite progress towards the Millennium Development Goals (MDG), maternal mortality remains high in countries where there are shortages of skilled personnel able to manage and provide quality care during pregnancy and childbirth. The 'percentage of births attended by skilled health personnel' (SAB, skilled attendants at birth) was a key indicator for tracking progress since the MDGs and is part of the Sustainable Development Goal agenda. However, due to contextual differences between and within countries on the definition of SAB, a lack of clarity exists around the training, competencies, and skills they are qualified to perform. In this paper, we outline a scoping review protocol that poses to identify and map the health personnel considered SAB in low and middle-income countries (LMIC). METHODS AND ANALYSIS: A search will be conducted for the years 2000-2015 in PubMed/MEDLINE, EMBASE, CINAHL Complete, Cochrane Database of Systematic Reviews, POPLINE and the WHO Global Health Library. A manual search of reference lists from identified studies or systematic reviews and a hand search of the literature from international partner organisations will be done. Original studies conducted in LMIC that assessed health personnel (paid or voluntary) providing interventions during the intrapartum period will be considered for inclusion. ETHICS AND DISSEMINATION: A scoping review is a secondary analysis of published literature and does not require ethics approval. This scoping review proposes to synthesise data on the training, competency and skills of identified SAB and expands on other efforts to describe this global health workforce. The results will inform recommendations around improved coverage measurement and reporting of SAB moving forward, allowing for more accurate, consistent and timely data able to guide decisions and action around planning and implementation of maternal and newborn health programme globally. Data will be disseminated through a peer-reviewed manuscript, conferences and to key stakeholders within international organisations.

Dialectics of a medical provision policy in priority areas in Brazil.

INTRODUCTION:: The people living in vulnerable areas that are difficult to access in Brazil represent a portion of the population that has proven very sensitive to lack of medical and health services. The government, seeking to solve the situation urgently, implemented the More Doctors Program [Programa Mais Médicos, in the Portuguese original] in 2013. OBJECTIVE:: To discuss the More Doctors Program, with the purpose of contributing to the debate on the provision of medical policies in Brazil. METHOD:: Study based on the review of official documents: Programa Mais Médicos - dois anos: mais saúde para os brasileiros, 2015 [More Doctors Program - two years: more health for Brazilians, 2015]; Operational Audit Report, TC Nº 005391/2014-8, the Court of Auditors of Brazil; and Medical Demography in Brazil 2015. RESULTS:: The import of exchange physicians without diploma revalidation has cast a shadow on the technical quality of services offered to the population. In terms of infrastructure, the reduction of resources paralyzed works and made the care network maintenance projects impossible. The creation of new medical schools has created uncertainty about the possibility of quality education being offered, with minimum and sufficient structure including laboratories, clinics and teaching hospitals indispensable to medical training. CONCLUSION:: The regional inequalities of concentration and dispersion of physicians, showed by studies on medical demography in Brazil, stem from several factors, including the lack of a career path and working conditions. There is no point in having physicians if they do not have safe and ethical conditions to establish the diagnosis and a treatment plan, as well as to monitor the rehabilitation of the patient.

Specific targeted quantification combined with non-targeted metabolite profiling for quality evaluation of Gastrodia elata tubers from different geographical origins and cultivars.

Gastrodia elata tuber (GET) has been widely used as a famous herbal medicine in China and other East Asian countries. In this work, we developed a comprehensive strategy integrating targeted and non-targeted analyses for quality evaluation and discrimination of GET from different geographical origins and cultivars. Firstly, 43 batches of GET samples of five cultivars from three regions in China were efficiently quantified by a "single standard to determine multi-components" (SSDMC) method. Six marker compounds were simultaneously determined within 11min using gastrodin as the internal standard. It showed that samples from different regions and cultivars could not be differentiated by the contents of six marker compounds. Secondly, a non-targeted metabolite profiling analysis was performed by ultrahigh-performance liquid chromatography quadrupole time-of-flight mass spectrometry (UHPLC-QTOF/MS). Samples from different geographical origins and cultivars were clearly discriminated by principal component analysis (PCA) and partial least-squares discriminant analysis (PLS-DA). 147 discriminant ions contributing to the group separation were selected from 1194 aligned variables. Furthermore, based on the relative intensities of discriminant ions, support vector machines (SVM) was employed to predict the geographical origins of GET. The obtained SVM model showed excellent prediction performance with an average prediction accuracy of 100%. These results demonstrated that the UHPLC-QTOF/MS-based non-targeted metabolite profiling analysis, as a vital supplement to targeted analysis, can be used to discriminate the geographical origins and cultivars of GET.