GLOBAL ENDOCRINOLOGY: Global perspectives in endocrinology: coverage of iodized salt programs and iodine status in 2020.

Iodine deficiency has multiple adverse effects on growth and development. Diets in many countries cannot provide adequate iodine without iodine fortification of salt. In 2020, 124 countries have legislation for mandatory salt iodization and 21 have legislation allowing voluntary iodization. As a result, 88% of the global population uses iodized salt. For population surveys, the urinary iodine concentration (UIC) should be measured and expressed as the median, in µg/L. The quality of available survey data is high: UIC surveys have been done in 152 out of 194 countries in the past 15 years; in 132 countries, the studies were nationally representative. The number of countries with adequate iodine intake has nearly doubled from 67 in 2003 to 118 in 2020. However, 21 countries remain deficient, while 13 countries have excessive intakes, either due to excess groundwater iodine, or over-iodized salt. Iodine programs are reaching the poorest of the poor: of the 15 poorest countries in the world, 10 are iodine sufficient and only 3 (Burundi, Mozambique and Madagascar) remain mild-to-moderately deficient. Nigeria and India have unstable food systems and millions of malnourished children, but both are iodine-sufficient and population coverage with iodized salt is a remarkable 93% in both. Once entrenched, iodine programs are often surprisingly durable even during national crises, for example, war-torn Afghanistan and Yemen are iodine-sufficient. However, the equity of iodized salt programs within countries remains an important issue. In summary, continued support of iodine programs is needed to sustain these remarkable global achievements, and to reach the remaining iodine-deficient countries.

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.

From Alma-Ata to Astana: the path of Primary Health Care in Portugal, 1978-2018 and the genesis of Family Medicine. / De Alma-Ata a Astana: o percurso dos Cuidados de Saúde Primários em Portugal,1978-2018 e a génese da Medicina Familiar.

Throughout the twentieth century, the profound changes that have taken place in Medicine can only be wholly explained if observed from a historical perspective, for they have always occurred in response to external influences, some scientific and technological, others of a social nature. Modern Family Medicine is one of the many new disciplines that have developed during medical history, and we critically discuss the last 40 years of primary health care in Portugal, which started in 1971, long before the Alma-Ata Declaration (1978). Along the way, in 2005, the Primary Health Care Reform emerges in Portugal, along with the new family health facilities, which until September 2019, attended about 94 % of Portuguese citizens, i.e., 9,5 million people. At the end of this course, in solidarity and voluntarily, this Reform inspired another one in Brazil, in Rio de Janeiro, in 2009. Finally, we present the challenges pointed out in the 2018 Astana Declaration, among them, the issue of the workforce in primary health care as an essential factor for the performance and sustainability of health systems.

Ao longo século XX, as profundas alterações que ocorreram na Medicina apenas podem ser completamente esclarecidas se forem observadas numa perspectiva histórica, pois elas sempre ocorreram em resposta a influências externas, umas científicas e tecnológicas, outras de ordem social. A moderna Medicina Familiar é uma das muitas disciplinas novas que se desenvolveram durante o curso da história da Medicina e aqui debatemos de forma crítica, os últimos 40 anos dos cuidados primários em saúde em Portugal, começando em 1971, mesmo antes da Declaração de Alma-Ata (1978). Ao longo do percurso, em 2005, surge a Reforma dos Cuidados Primários em Saúde em Portugal e as novas unidades de saúde familiar, que até setembro de 2019 atendiam cerca de 94% dos cidadãos portugueses, ou seja, mais de nove milhões e meio de pessoas. No final dessa trajetória, de forma solidária e voluntária, esta Reforma serviu de inspiração para outra, no Brasil, na cidade do Rio de Janeiro, em 2009. Por fim, apresentamos os desafios apontados na Declaração de Astana de 2018, dentre elas, a questão da força de trabalho nos cuidados de saúde primários, como fator essencial para o desempenho e a sustentabilidade dos sistemas de saúde.

De Alma-Ata a Astana: o percurso dos Cuidados de Saúde Primários em Portugal, 1978-2018 e a génese da Medicina Familiar / From Alma-Ata to Astana: the path of Primary Health Care in Portugal, 1978-2018 and the genesis of Family Medicine

Resumo Ao longo século XX, as profundas alterações que ocorreram na Medicina apenas podem ser completamente esclarecidas se forem observadas numa perspectiva histórica, pois elas sempre ocorreram em resposta a influências externas, umas científicas e tecnológicas, outras de ordem social. A moderna Medicina Familiar é uma das muitas disciplinas novas que se desenvolveram durante o curso da história da Medicina e aqui debatemos de forma crítica, os últimos 40 anos dos cuidados primários em saúde em Portugal, começando em 1971, mesmo antes da Declaração de Alma-Ata (1978). Ao longo do percurso, em 2005, surge a Reforma dos Cuidados Primários em Saúde em Portugal e as novas unidades de saúde familiar, que até setembro de 2019 atendiam cerca de 94% dos cidadãos portugueses, ou seja, mais de nove milhões e meio de pessoas. No final dessa trajetória, de forma solidária e voluntária, esta Reforma serviu de inspiração para outra, no Brasil, na cidade do Rio de Janeiro, em 2009. Por fim, apresentamos os desafios apontados na Declaração de Astana de 2018, dentre elas, a questão da força de trabalho nos cuidados de saúde primários, como fator essencial para o desempenho e a sustentabilidade dos sistemas de saúde.

Abstract Throughout the twentieth century, the profound changes that have taken place in Medicine can only be wholly explained if observed from a historical perspective, for they have always occurred in response to external influences, some scientific and technological, others of a social nature. Modern Family Medicine is one of the many new disciplines that have developed during medical history, and we critically discuss the last 40 years of primary health care in Portugal, which started in 1971, long before the Alma-Ata Declaration (1978). Along the way, in 2005, the Primary Health Care Reform emerges in Portugal, along with the new family health facilities, which until September 2019, attended about 94 % of Portuguese citizens, i.e., 9,5 million people. At the end of this course, in solidarity and voluntarily, this Reform inspired another one in Brazil, in Rio de Janeiro, in 2009. Finally, we present the challenges pointed out in the 2018 Astana Declaration, among them, the issue of the workforce in primary health care as an essential factor for the performance and sustainability of health systems.

State Hygiene School as a Department of Education in the National Institute of Hygiene in Warsaw

The article presents the history of the establishment of the State School of Hygiene (PSH) in Poland after the First World War. The difficulties faced by the public health service in a country destroyed by war and created after the reunification of the lands, which for over 150 years remained under the control of three powers, were pointed out. It discusses how the foundations of modern teaching in the field of public health were created in the National Institute of Hygiene (PZH) in Warsaw, an institution to which the Ministry of Public Health entrusted tasks related to health education in the country. The State School of Hygiene was built by the Polish Government with a significant financial contribution from the John Davison Rockefeller Foundation. The official opening ceremony took place on 20 April 1926. The State School of Hygiene in Warsaw was the first such school in Europe. It educated professional staff for the health service in Poland, especially sanitary physicians, sanitary inspectors, nurses and staff to work in health offices. The importance and scope of influence of the State School of Hygiene as the Department of Education in the National Institute of Hygiene was constantly increasing, as evidenced by the number of students (about 800 per year) participating in courses, especially in the first years after its establishment. By the end of 1935, 6,389 students had completed the courses, including 1,900 physicians. Apart from the teaching activities, the State School of Hygiene also carried out research work. The State School of Hygiene was supported by the Rockefeller Foundation, which funded scholarships for the employees of the National Institute of Hygiene at university centers in the USA

Atuação do enfermeiro na reconfiguração do cuidado paliativo em uma unidade de referência nacional (2004) / Nursing performance in the reconfiguration of palliative care in a national reference unit (2004)

No Brasil, o século XX, alcançou políticas públicas voltadas para a oncologia, que influenciaram diretamente na organização e estrutura do Instituto Nacional de Câncer (INCA) e na assistência ao paciente em cuidados paliativos. Esse cenário contribuiu diretamente para o desenvolvimento de iniciativas voltadas à reconfiguração da assistência desses cuidados no Hospital do Câncer IV (HCIV). Esta pesquisa tem como objeto de estudo: reconfiguração do cuidado paliativo do enfermeiro em uma unidade de referência nacional, com vistas a obter a acreditação hospitalar. Os objetivos: descrever as circunstâncias que ensejaram a reconfiguração do cuidado paliativo oncológico do enfermeiro no HCIV; analisar as estratégias empreendidas pelo enfermeiro para reconfigurar o cuidado paliativo oncológico frente ao processo de acreditação hospitalar no HCIV; e discutir os primeiros efeitos simbólicos da reconfiguração do cuidado paliativo oncológico do enfermeiro no HCIV, visando o processo de acreditação hospitalar. Metodologia: trata-se de um estudo histórico-social, de abordagem qualitativa, na perspectiva da História do Tempo Presente, cujo cenário foi o Hospital de Câncer IV (HCIV). As fontes históricas foram: diretas (escritas: relatório, manuais, folderes, entre outros; e depoimentos orais temáticos com sete participantes) e as indiretas (artigos científicos e livros sobre o tema). Os resultados evidenciaram que, para se reconfigurar o cuidado de enfermagem em uma unidade de referência nacional para cuidados paliativos em pacientes oncológicos, iniciou-se, em 2004, um grande investimento institucional, empreendido pela unidade e pelos enfermeiros, tais como a implantação do novo modelo de gestão, centrado em eixos específicos de trabalho, entre eles a acreditação hospitalar. Além disso, foram criados a Divisão de Enfermagem, o regimento interno da unidade, o Núcleo de Assistência de Enfermagem e o ambulatório de curativos tumorais e ostomizados, bem como ocorreu o desenvolvimento do Fórum do 5.o Sinal Vital. Também foram consolidadas a educação continuada e a humanização em âmbito institucional por meio do Projeto de Humanização, vinculado à Política Nacional de Humanização (PNH). Concluiu-se que os enfermeiros, apoiados por uma aliança pactuada com a direção da instituição, contribuíram para que a unidade atendesse aos critérios e objetivos determinados. Destarte, se destacaram, empreenderam eficazes estratégias e alcançaram significativos avanços no cuidado de enfermagem a pacientes oncológicos em estágio avançado, à medida que participavam desse investimento, se transformavam em porta-vozes legítimos de um discurso autorizado no campo da enfermagem oncológica no Brasil.

In Brazil, the 20th century was an increase in public policies focused on oncology, which directly influenced the organization and structure of the National Cancer Institute (INCA) and patient care in palliative care. This scenario has directly contributed to the development of initiatives aimed at the reconfiguration of health services in Cancer Hospital IV (HCIV). The research has as object of study the reconfiguration of the palliative care nursing support in a national unit of reference, in order to establish the hospital accreditation program. Objectives: to describe the circumstances that led to the reconfiguration of the palliative care nursing support in HCIV; to analyze the strategies undertaken by nurses to reconfigure oncologic palliative care in the HCIV accreditation program and to discuss the first symbolic effects that the process produced among the participating nurses professionals. Methods: This is a historical-social study with a qualitative approach from the perspective of the History of Present Time, whose scenario was Cancer Hospital IV (HCIV). The historical sources were direct as reports, manuals, folders and thematic oral statements with 7 participants and indirect sources as scientific articles and books. The results showed that in order to reconfigure nursing care in a national referral unit in palliative care for cancer patients, a major institutional investment was initiated in 2004, conducted by the council and nurses to implement a new management model, centred in specific working areas, seeking for a hospital accreditation. In addition, the Nursing Management Services, the unit's internal regiment, the Nursing Station and tumour and ostomy dressing outpatient clinic were created and the 5th Vital Sign Forum was held. Continued education and institutional humanization were also consolidated through the Humanization Project linked to the National Humanization Policy (PNH). It was concluded that the nurses, supported by an alliance with the institution's management, contributed to achieving the determined objectives that the unit pursued. In addition, they have held a prominent position, undertook effective strategies and achieved significant advances in nursing care for advanced cancer patients. As they participated in this investment, they became legitimate spokespersons for an authorized discourse in the field of oncology nursing in Brazil.

Interlaced strands: Health psychology in Brazil from an autobiographic perspective.

The presence of psychology in Brazilian Health Settings is closely related to two socio-political movements: for the creation of the Brazilian Unified Health System in 1990 and for Psychiatric Reform. Each had a multidisciplinary stance closely associated with a socially committed approach to healthcare delivery and connected with prior experiences that influenced its policies, among them the National AIDS Programme. These developments are told as a tale that interlaced autobiographical data and the long road to a universal healthcare system that shaped the relationship between psychology and health in the country.

Health and health care in Israel: an introduction.

Starting well before Independence in 1948, and over the ensuing six decades, Israel has built a robust, relatively efficient public system of health care, resulting in good health statistics throughout the life course. Because of the initiative of people living under the British Mandate for Palestine (1922-48), the development of many of today's health services predated the state's establishment by several decades. An extensive array of high-quality services and technologies is available to all residents, largely free at point of service, via the promulgation of the 1994 National Health Insurance Law. In addition to a strong medical academic culture, well equipped (albeit crowded) hospitals, and a robust primary-care infrastructure, the country has also developed some model national projects such as a programme for community quality indicators, an annual update of the national basket of services, and a strong system of research and education. Challenges include increasing privatisation of what was once largely a public system, and the underfunding in various sectors resulting in, among other challenges, relatively few acute hospital beds. Despite substantial organisational and financial investment, disparities persist based on ethnic origin or religion, other socioeconomic factors, and, regardless of the country's small size, a geographic maldistribution of resources. The Ministry of Health continues to be involved in the ownership and administration of many general hospitals and the direct payment for some health services (eg, geriatric institutional care), activities that distract it from its main task of planning for and supervising the whole health structure. Although the health-care system itself is very well integrated in relation to the country's two main ethnic groups (Israeli Arabs and Israeli Jews), we think that health in its widest sense might help provide a bridge to peace and reconciliation between the country and its neighbours.

Los primeros pasos en la organización de la lucha contra el cáncer en la Argentina: el papel del Instituto de Medicina Experimental, 1922-1947 / The begginings of teh fight against cancer in Argentina: the role of the Instituto de Medicina Experimental, 1922-1947

El artículo analiza iniciativas para organizar la lucha contra el cáncer en la Argentina entre comienzos de la década de 1920 y mediados de la década de 1940. En particular, hace eje en las acciones del Instituto de Medicina Experimental, un hospital-instituto de investigación dependiente de la Facultad de Ciencias Médicas de la Universidad de Buenos Aires que tuvo un papel central en este proceso. Se presta atención a la organización de la atención médica en el establecimiento, a las campañas de difusión de conocimiento a la población, a los intentos por incorporar esta cuestión a la formación profesional, a la articulación de las actividades con organismos estatales para dar mayor alcance territorial a la lucha contra el cáncer y a las investigaciones científicas que apuntaron a vincular el desarrollo del cáncer con estilos de vida (AU)

This article analyses initiatives to organize the fight against cancer in Argentina between the early 1920s to mid 1940s. Specifically, it focuses on the initiatives of the Instituto de Medicina Experimental, a hospital-research institute dependent on the Facultad de Ciencias Médicas of the Universidad de Buenos Aires that played a key role in this process. This paper considers the organization of the medical attention within the establishment, knowledge awareness campaigns, and the intents to incorporate cancer as a topic in the professional curricula and scientific research linking cancer and life styles (AU)

Psychologists in public health: Historical aspects and current challenges.

This article presents the historical context of the insertion of psychology, as a profession, in health policies in Brazil, in order to understand its current challenges. Analysis was based on a non-systematic literature review about professional training, practice, and research in psychology. Three challenges were identified: working in high social vulnerability contexts, practice in multidisciplinary teams and the need to expand the research agenda. We conclude that dealing with these challenges will depend on the area's capacity to reinvent itself and become more permeable to interdisciplinary dialogue.

Adapting the forms of yesterday to the functions of today and the needs of tomorrow: a genealogical case study of clinical teaching units in Canada.

Emergent discourses of social responsibility and accountability have in part fuelled the expansion of distributed medical education (DME). In addition to its potential for redressing physician maldistribution, DME has conferred multiple unexpected educational benefits. In several countries, its recent rise has occurred around the boundaries of traditional medical education practices. Canada has been no exception, with DME proliferating against a backdrop of its longstanding central node, the clinical teaching unit (CTU). The CTU first appeared just over 50 years ago with its position in Canadian health care largely taken-for-granted. Given the increasing prominence of DME, however, it is timely to reconsider what the place of tertiary centre-based practices such as the CTU might be in shifting medical education systems. From a genealogical perspective, it becomes clear that the CTU did not just "happen". Rather, its creation was made possible by multiple interrelated cultural, social, and political changes in Canadian society that, while subtle, are powerfully influential. Making them visible offers a better opportunity to harmonize the benefits of longstanding entities such as the CTU with novel practices such as DME. In so doing, the medical education field may sidestep the pitfalls of investing significant resources that may only produce superficial changes while unwittingly obstructing deeper transformations and improvements. Although this work is refracted through a Canadian prism, reconceptualizing the overall design of medical education systems to take advantage of both tradition and innovation is a persistent challenge across the international spectrum, resistant to tests of time and constraints of context.

[Health technology assessment agencies in the xxi century]. / Las agencias de evaluación de tecnología médica en el siglo xxi.

The origins of the health technology assessment (HTA) agencies date back to the 70s in the United States; in the European context, the current Agency for Quality and Health Assessment of Catalonia was among the pioneers in 1991. Epidemiological, social, technological and economic changes of recent years have led to the incorporation, by the agencies, of new functions, activities and projects that can offer better services (information and knowledge) to the various players in the healthcare system (patients, professionals, providers, insurers and policy-makers) in order to increase healthcare quality and preserve the sustainability of the health system.

A historical perspective on malaria control in Brazil.

Malaria has always been an important public health problem in Brazil. The early history of Brazilian malaria and its control was powered by colonisation by Europeans and the forced relocation of Africans as slaves. Internal migration brought malaria to many regions in Brazil where, given suitable Anopheles mosquito vectors, it thrived. Almost from the start, officials recognised the problem malaria presented to economic development, but early control efforts were hampered by still developing public health control and ignorance of the underlying biology and ecology of malaria. Multiple regional and national malaria control efforts have been attempted with varying success. At present, the Amazon Basin accounts for 99% of Brazil's reported malaria cases with regional increases in incidence often associated with large scale public works or migration. Here, we provide an exhaustive summary of primary literature in English, Spanish and Portuguese regarding Brazilian malaria control. Our goal was not to interpret the history of Brazilian malaria control from a particular political or theoretical perspective, but rather to provide a straightforward, chronological narrative of the events that have transpired in Brazil over the past 200 years and identify common themes.

A historical perspective on malaria control in Brazil

Malaria has always been an important public health problem in Brazil. The early history of Brazilian malaria and its control was powered by colonisation by Europeans and the forced relocation of Africans as slaves. Internal migration brought malaria to many regions in Brazil where, given suitableAnopheles mosquito vectors, it thrived. Almost from the start, officials recognised the problem malaria presented to economic development, but early control efforts were hampered by still developing public health control and ignorance of the underlying biology and ecology of malaria. Multiple regional and national malaria control efforts have been attempted with varying success. At present, the Amazon Basin accounts for 99% of Brazil’s reported malaria cases with regional increases in incidence often associated with large scale public works or migration. Here, we provide an exhaustive summary of primary literature in English, Spanish and Portuguese regarding Brazilian malaria control. Our goal was not to interpret the history of Brazilian malaria control from a particular political or theoretical perspective, but rather to provide a straightforward, chronological narrative of the events that have transpired in Brazil over the past 200 years and identify common themes.

Israel's Long-Term Care Social Insurance Scheme After a Quarter of a Century.

Long-term care social insurance schemes exist in a number of countries, while the introduction of such schemes enjoys some support in others. Israel's long-term care social insurance scheme has been operating since 1988. This article examines the emergence, goals, design, and impacts of this scheme and draws out some of the lessons that can be learned from Israel's quarter century experience of long-term care social insurance.