Plantas medicinais e políticas públicas de saúde: novos olhares sobre antigas práticas / Medicinal plants and public health policies: new perspectives on old practices

Resumo As plantas medicinais são utilizadas nos cuidados a saúde desde a Antiguidade, mas apenas na década de 1970 a OMS se manifestou sobre sua importância para a saúde da população. Este artigo teve por objetivo identificar a sequência temporal e evolução dos marcos legais associados às políticas públicas de plantas medicinais, discutindo as implicações dessa evolução, bem como sua inserção no sistema de saúde, e apresentar essa evolução no Brasil. Foram identificados e analisados os conteúdos de Leis, Decretos, Resoluções, Políticas, Portarias e Instruções Normativas relacionadas ao tema. Apesar do longo histórico de uso da flora nacional, as primeiras legislações sobre seu emprego no campo da saúde são recentes. O Brasil, país com maior biodiversidade do planeta, aprovou, apenas em 2006, a Política Nacional de Práticas Integrativas e Complementares e a Política Nacional de Plantas Medicinais e Fitoterápicos. Necessita-se, entretanto, ampliar o investimento em pesquisas científicas para que haja segurança, qualidade e eficácia no seu uso.

Abstract Medicinal plants have been used in health care since Antiquity, but it was only in the 1970s that the WHO expressed its importance for the health of the population. This article aimed to identify the temporal sequence and evolution of legal frameworks associated with public policies on medicinal plants, discussing the implications of this evolution, as well as its insertion in the health system, and to present this evolution in Brazil. The contents of Laws, Decrees, Resolutions, Policies, Ordinances and Normative Instructions related to the topic were identified and analyzed. Despite the long history of using the national flora, the first legislation on its use in the health field is recent. Only in 2006, Brazil, the country with the greatest biodiversity on the planet, approved the National Policy on Integrative and Complementary Practices and the National Policy on Medicinal Plants and Phytotherapeutics. It is necessary, however, to increase investment in scientific research so that there is safety, quality and effectiveness in its use.

Diagnóstico situacional do programa academia da saúde no estado de Mato Grosso do Sul: relatório técnico 2022 / Situational diagnosis of the health academy program in the state of Mato Grosso do Sul: technical report 2022

O Programa Academia na Saúde (PAS) é considerado como um programa estratégico para a execução das Política Nacional de Promoção da Saúde (PNPS) e da Política Nacional de Atenção Básica (PNAB), e o programa é apontado como uma das ações de prevenção e controle que integram o Plano de Ações Estratégicas para o Enfrentamento das Doenças Crônicas Não Transmissíveis (DCNT).

The evidence for the impact of policy on physical activity outcomes within the school setting: A systematic review.

BACKGROUND: Despite the well-established health benefits of physical activity (PA) for young people (aged 4-19 years), most do not meet PA guidelines. Policies that support PA in schools may be promising, but their impact on PA behavior is poorly understood. The aim of this systematic review was to ascertain the level and type of evidence reported in the international scientific literature for policies within the school setting that contribute directly or indirectly to increasing PA. METHODS: This systematic review is compliant with Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines. Six databases were searched using key concepts of policy, school, evaluation, and PA. Following title and abstract screening of 2323 studies, 25 progressed to data synthesis. Methodological quality was assessed using standardized tools, and the strength of the evidence of policy impact was described based on pre-determined codes: positive, negative, inconclusive, or untested statistically. RESULTS: Evidence emerged for 9 policy areas that had a direct or indirect effect on PA within the school setting. These were whole school PA policy, physical education, sport/extracurricular PA, classroom-based PA, active breaks/recess, physical environment, shared use agreements, active school transport, and surveillance. The bulk of the evidence was significantly positive (54%), 27% was inconclusive, 9% was significantly negative, and 11% was untested (due to rounding, some numbers add to 99% or 101%). Frequency of evidence was highest in the primary setting (41%), 34% in the secondary setting, and 24% in primary/secondary combined school settings. By policy area, frequency of evidence was highest for sport/extracurricular PA (35%), 17% for physical education, and 12% for whole school PA policy, with evidence for shared use agreements between schools and local communities rarely reported (2%). Comparing relative strength of evidence, the evidence for shared use agreements, though sparse, was 100% positive, while 60% of the evidence for whole school PA policy, 59% of the evidence for sport/extracurricular PA, 57% of the evidence for physical education, 50% of the evidence for PA in classroom, and 50% of the evidence for active breaks/recess were positive. CONCLUSION: The current evidence base supports the effectiveness of PA policy actions within the school setting but cautions against a "one-size-fits-all" approach and emphasizes the need to examine policy implementation to maximize translation into practice. Greater clarity regarding terminology, measurement, and methods for evaluation of policy interventions is needed.

A critical review of national physical activity policies relating to children and young people in England.

BACKGROUND: There has been an increasing focus on the importance of national policy to address population levels of physical inactivity. It has been suggested that the 4 cornerstones of policy comprise (1) national guidelines on physical activity (PA), (2) setting population goals and targets, (3) surveillance or health-monitoring systems, and (4) public education. The current study aimed to review the policy actions that have addressed each of these elements for children and youth in England and to identify areas of progress and remaining challenges. METHODS: A literature search was undertaken to identify past and present documents relevant to PA policy for children and youth in England. Each document was analyzed to identify content relevant to the 4 cornerstones of policy. RESULTS: Physical activity guidelines (Cornerstone 1) for children and youth have been in place since 1998 and reviewed periodically. Physical activity targets (Cornerstone 2) have focussed on the provision of opportunities for PA, mainly through physical education in schools rather than in relation to the proportion of children meeting recommended PA levels. There has been much surveillance (Cornerstone 3) of children's PA, but this has been undertaken infrequently over time and with varying inclusions of differing domains of activity. There has been only 1 campaign (Cornerstone 4) that targeted children and their intermediaries, Change4Life, which was an obesity campaign focussing on dietary behavior in combination with PA. Most recently, a government infographic supporting the PA guidelines for children and young people was developed, but details of its dissemination and usage are unknown. CONCLUSION: There have been many developments in national PA policy in England targeted to children and young people. The area of most significant progress is national PA guidelines. Establishing prevalence targets, streamlining surveillance systems, and investing in public education with supportive policies, environments, and opportunities would strengthen national policy efforts to increase PA and reduce sedentary behavior.

Health policy versus kava (Piper methysticum): Anxiolytic efficacy may be instrumental in restoring the reputation of a major South Pacific crop.

ETHNOPHARMACOLOGICAL RELEVANCE: Kava (Piper methysticum G. Forst. f.) is by far the most important plant used in the islands of Melanesia, Polynesia and Micronesia for its relaxing effects. Kava drinking is a pillar of South Pacific societies and is also the foundation of their economies. Preparations of kava extract as herbal medicinal drugs were banned in Germany in 2002 and again in 2019, with dramatic consequences for the South Pacific economies. In 2002, the major regulatory argument for the ban of kava was safety issues. In 2019, the assessment report of the European Medicines Agency's Herbal Medicinal Product Committee (HMPC) justified a negative benefit-to-risk ratio by a supposed lack of efficacy of ethanolic extracts for an indication of which kava extract preparations never had an approval. In this HMPC report the efficacy in the approved indications 'nervous anxiety, tension and restlessness' was attributed to the extract branded as 'WS 1490', which was assumed to have been prepared with acetone as an extraction solvent. In addition to this change of indication and the attribution of efficacy to acetone kava extract alone, the German health authorities and the HMPC still refuse to discuss quality issues as a likely factor impacting drug safety. The first case reports of liver toxicity were observed with an acetone extract in a timely relationship with the introduction of 'two-day kava' instead of 'noble kava' as used in ethanolic kava extracts. AIM OF THE STUDY: The correlation between clinical benefits and the type of extract preparation was examined. METHODS: In order to identify the types of kava material and extracts used in clinical trials, the respective publications were compared with regulatory databases and protocols of a German regulatory advisory board. RESULTS AND CONCLUSIONS: The comparison reveals inconsistencies in the regulatory decisions. In all studies with WS 1490, the evidence points to the use of an ethanolic extract. The efficacy of kava extract for the approved indication was clearly demonstrated. The HMPC report and the recent renewed German regulatory ban of kava therefore require major revision, which should include the impact of the use of "two-day kava" on drug safety. Such a revision could contribute to restoring the reputation of "noble kava" on the international markets.

Atenção à Saúde do bebê na Rede Cegonha: um diálogo com a teoria de Winnicott sobre as especificidades do desenvolvimento emocional / Baby's healthcare in Rede Cegonha: a dialogue with Winnicott's theory on the specificities of emotional development

Resumo O Ministério da Saúde instituiu, em 2011, a Rede Cegonha através da Portaria no 1.459, visando assegurar um atendimento integral e integrado, da gestação até os 24 meses de vida do bebê. A partir desse importante avanço, este artigo tem como objetivo promover uma análise crítica da Portaria da Rede Cegonha a partir de um diálogo com a teoria do amadurecimento pessoal de Winnicott. Os resultados são apresentados a partir de quatro eixos norteadores: Características integradoras do cuidado, em que discutimos características da Rede Cegonha favorecedoras de um cuidado integrador; Cuidar do cuidador, em que salientamos a possibilidade de essa rede colaborar com a sustentação da dupla mãe-bebê; Especificidades do cuidado à saúde materno-infantil, em que atentamos às especificidades do processo de desenvolvimento emocional inicial; e Ética do cuidado, em que destacamos a necessidade de uma postura ética implicada no cuidado. Este artigo indicou as potencialidades e fragilidades da Rede Cegonha, trazendo novas proposições, que visem aprimorar a atenção à saúde materno-infantil, sobretudo nos dois primeiros anos de vida. Por fim, salientamos que apesar de a portaria não garantir como o cuidado é operacionalizado, reiteramos o importante potencial que a Rede Cegonha possui para um cuidado integrador na atenção à saúde materno-infantil.

Abstract In 2011, the Ministry of Health established the Rede Cegonha ("Stork Network"), to ensure full and integrated care, from pregnancy to 24 months of life. On this important advance, this article aims to promote a critical analysis of the Stork Network Ordinance from a dialogue with Winnicott's theory of personal maturity. The results of our analysis are presented from four guiding axes: Integrative characteristics of care, in which we discuss characteristics of the Rede Cegonha that favor an integrative care; Caring for the caregiver, in which we emphasize the possibilities of this network to support of the double mother-baby; Specificities of maternal and child health care, in which we discuss the attention to the specifics of the initial emotional development process; and Ethics of care, in which we highlight the need for an ethical posture implied in the care. This article indicated the potentialities and weaknesses of the Rede Cegonha, bringing new perspectives to improve maternal and child health care especially in the first two years of life. Finally, we emphasize that although policy does not guarantee the way how care is operationalized, we reiterate the Rede Cegonhas's potential for an integrator maternal and child health care.

Breast cancer in Thailand: policy and health system challenges to universal healthcare.

Thailand has successfully implemented Universal Health Coverage (UHC) and embedded the 2030 Agenda for Sustainable Development into its Thailand 4.0 policy. Breast cancer is a growing challenge in Thailand, as it is globally. It serves as a perfect medium through which to interrogate UHC and demonstrate areas of the health system which require further strengthening if UHC is to be sustainable in the longer term. We conducted a situation analysis and used a Systemic Rapid Assessment (SYSRA) framework to examine the challenges posed to UHC through the lens of breast cancer. We identified a number of challenges facing UHC including (1) continued political commitment; (2) the need for coordinated scale-up of strategic investments involving increased financing and fine-tuning of the allocation of resources according to health needs; (3) reducing inequities between health insurance schemes; (4) investing in innovation of technologies, and more critically, in technology transfer and capacity building; (5) increasing capacity, quality and confidence in the whole primary healthcare team but especially family medicine doctors. This would subsequently increase both efficiency and effectiveness of the patient pathway, as well as allow patients wherever possible to be treated close to their homes, work and family; (6) developing and connecting information systems to facilitate understanding of what is working, where needs are and track trends to monitor improvements in patient care. Our findings add to an existing body of evidence which suggest, in light of changing disease burden and increasing costs of care, a need for broader health system reforms to create a more enabling platform for integrated healthcare as opposed to addressing individual challenging elements one vertical system at a time. As low- and middle-income countries look to realize the 2015 Sustainable Development Goals and sustainable UHC this analysis may provide input for policy discussion at national, regional and community levels and have applicability beyond breast cancer services alone and beyond Thailand.

The pervasiveness and policy consequences of medical folk wisdom in the U.S.

Medical folk wisdom (MFW) refers to widely held, but factually inaccurate, beliefs about disease, immunity, pregnancy, and other medically-relevant topics. Examples include the idea that fasting when feverish ("starving a fever") can increase the pace of recovery, or that showering after sex can prevent pregnancy. The pervasiveness of MFW, and whether or not it-like other forms of medically-relevant misinformation-shapes Americans' health behaviors and policy preferences is an important and under-studied question. We begin this research by proposing and validating a novel measure of MFW; including a short-form scale suitable for administration in public opinion surveys. We find that nearly all Americans-irrespective of socio-economic status, political orientation, and educational background-endorse at least some aspects of MFW. Concerningly, and consistent with the idea that folk wisdom challenges scientific expertise, we additionally find that those highest in MFW tend to place less value on medical expertise and the role experts play in shaping health policy. However, this skepticism does not appear to translate to peoples' health actions, as MFW appears to have an inconsistent effect on public participation in healthy behaviors.

Vaccine Policy in the United States.

In an era when the success of the US vaccination policies to date is threatened by vaccine hesitancy, it is important for clinicians to have a working understanding of how vaccines are developed and recommended for use in the United States and how federal and state governments are coordinated to ensure a safe and effective vaccine supply. This article discusses the federal agencies involved in vaccine development and recommendation, other organizations involved in vaccine policy, and the role of vaccine-related public health law in promoting universal vaccination.

New problems of a new health system: the creation of a national public policy of rare diseases care in Brazil (1990s-2010s). / Nuevos problemas de un nuevo sistema de salud: la creación de una política pública nacional de atención de enfermedades raras en Brasil (1990-2014).

This study discusses actors and institution movements leading to the disclosure in 2014 of Resolution 199 by the Brazilian Ministry of Health, which establishes the National Policy for the Comprehensive Care of Persons with Rare Diseases. Taking as sources the mainstream newspapers, drafts law, and secondary literature on the subject, we begin our analysis in the early 1990s when the first patient associations were created in Brazil - mainly for claiming more funds for research on genetic diseases - and arrive at the late 2010s when negotiations for a national policy are taking place in the National Congress. Resolution 199 is part of an ongoing process and the path towards its disclosure and the complications that followed have given us elements to discuss contemporary aspects of the Brazilian public health. Based on the references of the history of the present time and the social studies of science, we argue that two aspects have been fundamental to creating a national policy: framing different illnesses within the terminology "rare diseases" and the construction of a public perception about the right of health which is guaranteed by the 1988 Brazilian Constitution.

En este trabajo se analizan los movimientos de actores e instituciones que llevaron a la promulgación, en 2014, de la Resolución 199 del Ministerio de Salud de Brasil, que establece la Política Nacional de Atención Integral a las Personas con Enfermedades Raras. Tomando como fuentes los principales periódicos, proyectos de ley y bibliografía secundaria sobre el tema, comenzamos nuestro análisis a principios de la década de 1990 con la creación de las primeras asociaciones de pacientes en Brasil, para reclamar fundamentalmente más fondos para la investigación de enfermedades genéticas, y llegamos a fines de la década de 2010 con las negociaciones para una política nacional. La Resolución 199 es parte de un proceso en curso, en el que el camino hacia la promulgación y las complicaciones posteriores nos dan elementos para discutir aspectos actuales de la salud pública brasileña. Sobre la base de la historia del tiempo presente y los estudios sociales de la ciencia, argumentamos que hay dos aspectos que han sido fundamentales para crear una política nacional: enmarcar diferentes enfermedades en la terminología "enfermedades raras" y la construcción de una percepción pública sobre el derecho a la salud, que se garantiza en la Constitución brasileña de 1988.

A regulatory take on cannabis and cannabinoids for medicinal use in the European Union.

The discovery of the endocannabinoid system has raised public interest in the medicinal use of cannabis, phytocannabinoids, and synthetic cannabinoids, which has always been closely regulated due to their psychotropic effects and potential abuse. The review takes a quick look at the current legal framework in the European Union, which regulates cannabis use and cultivation for medicinal purposes in line with the United Nations Conventions on the production, trade, and use of cannabis, phytocannabinoids, and synthetic cannabinoids. And while the EU legislation precisely defines requirements and marketing authorisation procedures for medicinal products for all EU member states, there is no common regulatory framework for magistral and officinal preparations containing cannabinoids, as they are exempt from marketing authorisation. Instead, their regulation is left to each member state, and it is quite uneven at this point, mainly due to cultural and historical differences between the countries, leading to different access to non-authorised medicinal products. Therefore, to meet great public interest, harmonised approaches on cannabinoid-containing products without marketing authorisation would be welcome to level the playing field in the EU.

Lessons from the Field: The Traditional Monarch of Kitti in Pohnpei Addresses the High Rates of Non-Communicable Diseases through Local Policy.

Almost a quarter of Pohnpei's population is overweight or obese, a major factor influencing a 2010 non-communicable diseases (NCD) emergency declaration. The Racial and Ethnic Approaches to Community Health (REACH) project in Pohnpei is implementing a culturally tailored policy, systems, and environmental (PSE) intervention to reduce NCDs through healthy nutrition projects. Through collaboration with traditional leaders and using traditional protocols, REACH succeeded in soliciting formal approval from a Traditional Monarch to serve only healthy beverages during events at all traditional houses in the municipality. The Governor, in turn, also supported this initiative. This project cultivated relationships with traditional and government leaders to implement a culturally appropriate healthy nutrition PSE change intervention.

Lessons from the Field: Lessons from Yap - Changing Government and Cultural Practice Through Public Health Policy.

The heavy burden of non-communicable diseases (NCD) in Yap State, Federated States of Micronesia overwhelms the resources of this small population. Traditional cultural practices strongly influence all aspects of life, especially in the remote outer islands. The traditional Chiefs must grant permission to perform any type of health outreach or services for about one-third of the population. One key cultural practice promotes tobacco and alcohol use. The Yap Comprehensive Cancer Control Program, in collaboration with other entities in public health, systematically engaged the traditional Chiefs, resulting in a landmark policy that paved the way for other system and environmental interventions to reduce the risks of developing NCD.

Global landscape analysis of no-fault compensation programmes for vaccine injuries: A review and survey of implementing countries.

To update the landscape analysis of vaccine injuries no-fault compensation programmes, we conducted a scoping review and a survey of World Health Organization Member States. We describe the characteristics of existing no-fault compensation systems during 2018 based on six common programme elements. No-fault compensation systems for vaccine injuries have been developed in a few high-income countries for more than 50 years. Twenty-five jurisdictions were identified with no-fault compensation programmes, of which two were recently implemented in a low- and a lower-middle-income country. The no-fault compensation programmes in most jurisdictions are implemented at the central or federal government level and are government funded. Eligibility criteria for vaccine injury compensation vary considerably across the evaluated programmes. Notably, most programmes cover injuries arising from vaccines that are registered in the country and are recommended by authorities for routine use in children, pregnant women, adults (e.g. influenza vaccines) and for special indications. A claim process is initiated once the injured party or their legal representative files for compensation with a special administrative body in most programmes. All no-fault compensation programmes reviewed require standard of proof showing a causal association between vaccination and injury. Once a final decision has been reached, claimants are compensated with either: lump-sums; amounts calculated based on medical care costs and expenses, loss of earnings or earning capacity; or monetary compensation calculated based on pain and suffering, emotional distress, permanent impairment or loss of function; or combination of those. In most jurisdictions, vaccine injury claimants have the right to seek damages either through civil litigation or from a compensation scheme but not both simultaneously. Data from this report provide an empirical basis on which global guidance for implementing such schemes could be developed.