The evolution of the Italian National Health Service.

40 years ago, Italy saw the birth of a national, universal health-care system (Servizio Sanitario Nazionale [SSN]), which provides a full range of health-care services with a free choice of providers. The SSN is consistently rated within the Organisation for Economic Co-operation and Development among the highest countries for life expectancy and among the lowest in health-care spending as a proportion of gross domestic product. Italy appears to be in an envious position. However, a rapidly ageing population, increasing prevalence of chronic diseases, rising demand, and the COVID-19 pandemic have exposed weaknesses in the system. These weaknesses are linked to the often tumultuous history of the nation and the health-care system, in which innovation and initiative often lead to spiralling costs and difficulties, followed by austere cost-containment measures. We describe how the tenuous balance of centralised versus regional control has shifted over time to create not one, but 20 different health systems, exacerbating differences in access to care across regions. We explore how Italy can rise to the challenges ahead, providing recommendations for systemic change, with emphasis on data-driven planning, prevention, and research; integrated care and technology; and investments in personnel. The evolution of the SSN is characterised by an ongoing struggle to balance centralisation and decentralisation in a health-care system, a dilemma faced by many nations. If in times of emergency, planning, coordination, and control by the central government can guarantee uniformity of provider behaviour and access to care, during non-emergency times, we believe that a balance can be found provided that autonomy is paired with accountability in achieving certain objectives, and that the central government develops the skills and, therefore, the legitimacy, to formulate health policies of a national nature. These processes would provide local governments with the strategic means to develop local plans and programmes, and the knowledge and tools to coordinate local initiatives for eventual transfer to the larger system.

"The barbarous glebes of Central Brazil:" the hinterlands of Mato Grosso and Goiás in the travel narratives of Hermano Ribeiro da Silva, 1935-1936. / "As glebas bárbaras do Brasil Central": os sertões de Mato Grosso e Goiás nas narrativas de viagem de Hermano Ribeiro da Silva, 1935-1936.

The article analyzes the travel narratives to the hinterlands of the states of Mato Grosso and Goiás published in 1935 and 1936 by the São Paulo-based explorer Hermano Ribeiro da Silva, which proved a great publishing success and had a considerable impact on lettered society in Brazil. The analysis focuses on his ideas about the relationship between the environment in Central Brazil and the man who inhabited it, the potential economic exploitation of the region, and the role of the State in orchestrating initiatives capable of promoting its effective incorporation into the nationhood. It also seeks to understand how he grounded his discourse on generic scientific concepts and schemas endowed with rhetorical and argumentative power.

O artigo analisa as narrativas de viagem ao interior de Mato Grosso e Goiás publicadas em 1935 e 1936 pelo explorador paulista Hermano Ribeiro da Silva, que obtiveram considerável sucesso editorial e impacto no meio letrado brasileiro. Concentramo-nos em suas ideias sobre a relação entre o ambiente do Brasil Central e o homem sertanejo, sobre as potencialidades de exploração econômica da região e sobre o papel do Estado na condução de iniciativas capazes de promover sua incorporação efetiva à nacionalidade. Buscamos também compreender a fundamentação de seu discurso em conceitos e esquemas científicos genéricos dotados de poder retórico e argumentativo.

"As glebas bárbaras do Brasil Central": os sertões de Mato Grosso e Goiás nas narrativas de viagem de Hermano Ribeiro da Silva, 1935-1936 / "The barbarous glebes of Central Brazil: " the hinterlands of Mato Grosso and Goiás in the travel narratives of Hermano Ribeiro da Silva, 1935-1936

Resumo O artigo analisa as narrativas de viagem ao interior de Mato Grosso e Goiás publicadas em 1935 e 1936 pelo explorador paulista Hermano Ribeiro da Silva, que obtiveram considerável sucesso editorial e impacto no meio letrado brasileiro. Concentramo-nos em suas ideias sobre a relação entre o ambiente do Brasil Central e o homem sertanejo, sobre as potencialidades de exploração econômica da região e sobre o papel do Estado na condução de iniciativas capazes de promover sua incorporação efetiva à nacionalidade. Buscamos também compreender a fundamentação de seu discurso em conceitos e esquemas científicos genéricos dotados de poder retórico e argumentativo.

Abstract The article analyzes the travel narratives to the hinterlands of the states of Mato Grosso and Goiás published in 1935 and 1936 by the São Paulo-based explorer Hermano Ribeiro da Silva, which proved a great publishing success and had a considerable impact on lettered society in Brazil. The analysis focuses on his ideas about the relationship between the environment in Central Brazil and the man who inhabited it, the potential economic exploitation of the region, and the role of the State in orchestrating initiatives capable of promoting its effective incorporation into the nationhood. It also seeks to understand how he grounded his discourse on generic scientific concepts and schemas endowed with rhetorical and argumentative power.

A Short History of Occupational Safety and Health in the United States.

As this short history of occupational safety and health before and after establishment of the Occupational Safety and Health Administration (OSHA) clearly demonstrates, labor has always recognized perils in the workplace, and as a result, workers' safety and health have played an essential part of the battles for shorter hours, higher wages, and better working conditions. OSHA's history is an intimate part of a long struggle over the rights of working people to a safe and healthy workplace. In the early decades, strikes over working conditions multiplied. The New Deal profoundly increased the role of the federal government in the field of occupational safety and health. In the 1960s, unions helped mobilize hundreds of thousands of workers and their unions to push for federal legislation that ultimately resulted in the passage of the Mine Safety and Health Act of 1969 and the Occupational Safety and Health Act of 1970. From the 1970s onward, industry developed a variety of tactics to undercut OSHA. Industry argued over what constituted good science, shifted the debate from health to economic costs, and challenged all statements considered damaging.

George Deacon and the circulation of homeopathic therapies in Lima (1880-1915).

Homeopathy arrived from the United States to Peruvian soil in the last decades of the nineteenth century, broadening the repertoire of existing medical knowledge, which included an emerging medical profession, Chinese herbalists, and indigenous practitioners. This article examines the circulation and use of homeopathic therapies and medicines in Lima from the time when the American homeopath George Deacon initiated his practice, in the 1880s, until his death, in 1915. Although homeopathy was not the most widely used medical therapy in the country, it nevertheless posed a threat to professional medicine and the School of Medicine's desired monopoly of the field of medicine.

George Deacon and the circulation of homeopathic therapies in Lima (1880-1915) / George Deacon e a circulação de tratamentos homeopáticos em Lima (1880-1915)

Abstract Homeopathy arrived from the United States to Peruvian soil in the last decades of the nineteenth century, broadening the repertoire of existing medical knowledge, which included an emerging medical profession, Chinese herbalists, and indigenous practitioners. This article examines the circulation and use of homeopathic therapies and medicines in Lima from the time when the American homeopath George Deacon initiated his practice, in the 1880s, until his death, in 1915. Although homeopathy was not the most widely used medical therapy in the country, it nevertheless posed a threat to professional medicine and the School of Medicine's desired monopoly of the field of medicine.

Resumo A homeopatia originária dos EUA adentrou solo peruano nas últimas décadas do século XIX, ampliando o repertório de conhecimento médico existente até então, o qual incluía uma profissão médica em ascensão, herbolários chineses e médicos locais. Este artigo analisa a circulação e o uso de tratamentos e medicamentos homeopáticos em Lima desde o período em que o homeopata norte-americano George Deacon iniciou sua prática, nos anos 1880, até sua morte, em 1915. Embora a homeopatia não fosse o tratamento médico mais disseminada no país, ela representou uma ameaça à medicina profissional e ao monopólio do campo da medicina almejado pela escola tradicional.

Health as an independent predictor of the 2017 French presidential voting behaviour: a cross-sectional analysis.

BACKGROUND: It has been suggested that poor health has influenced vote for Brexit and the US presidential election. No such research has been published regarding the 2017 French presidential election. METHODS: We performed a cross-sectional analysis using a comprehensive set of socioeconomic and health indicators, to be compared with voting outcome at the first round of the 2017 French presidential election. The 95 French departments were selected as the unit of analysis. Data were obtained from publicly available sources. The linear model was used for both univariate and multivariate analysis to investigate the relation between voting patterns and predictors. Sensitivity analyses were done using the elastic-net regularisation. RESULTS: Emmanuel Macron and Marine Le Pen arrived ahead. When projected on the first factorial plane (~ 60% of the total inertia), Emmanuel Macron and Marine Le Pen tended to be in opposite directions regarding both socioeconomic and health factors. In the respective multivariate analyses of the two candidates, both socio-economic and health variables were significantly associated with voting patterns, with wealthier and healthier departments more likely to vote for Emmanuel Macron, and opposite departments more likely to vote for Marine Le Pen. Mortality (p = 0.03), severe chronic conditions (p = 0.014), and diabetes mellitus (p < 0.0001) were among the strongest predictors of voting pattern for Marine Le Pen. Sensitivity analyses did not substantially change those findings. CONCLUSIONS: We found that areas associated with poorer health status were significantly more likely to vote for the far-right candidate at the French presidential election, even after adjustment on socioeconomic criteria.

Anopheles gambiae in Brazil: the background to a "silent spread," 1930-1932. / Anopheles gambiae no Brasil: antecedentes para um "alastramento silencioso", 1930-1932.

The article analyzes the arrival and identification of the African mosquito Anopheles gambiae in Brazil in 1930, and the initial reactions of scientists and public health authorities against the epidemics of malaria caused by this species. Although this mosquito was recognized as a dangerous vector of malaria, its presence in Brazil was neglected after initial emergency actions in the city of Natal in 1932; this encouraged it to spread silently, resulting in a major malaria epidemic in 1938. This article examines scientific and political issues which caused the fight against mosquitoes to be pushed into the background until 1937 in cooperative efforts between the Rockefeller Foundation's International Health Division and the Brazilian authorities.

O artigo analisa a chegada e identificação do mosquito africano Anopheles gambiae no Brasil em 1930 e as primeiras reações de cientistas e autoridades de saúde pública contra as epidemias de malária causadas por essa espécie. Apesar de ter sido reconhecido como perigoso vetor da malária, sua presença em território nacional foi negligenciada a partir de 1932, após ações emergenciais na capital do Rio Grande do Norte, favorecendo um alastramento silencioso que resultou em uma grande epidemia de malária em 1938. São abordadas questões científicas e políticas que contribuíram para que o combate ao mosquito fosse colocado em segundo plano nas articulações entre a Divisão Sanitária Internacional da Fundação Rockefeller e autoridades brasileiras até 1937.

Anopheles gambiae no Brasil: antecedentes para um " alastramento silencioso ", 1930-1932 / Anopheles gambiae in Brazil: the background to a " silent spread, " 1930-1932

Resumo O artigo analisa a chegada e identificação do mosquito africano Anopheles gambiae no Brasil em 1930 e as primeiras reações de cientistas e autoridades de saúde pública contra as epidemias de malária causadas por essa espécie. Apesar de ter sido reconhecido como perigoso vetor da malária, sua presença em território nacional foi negligenciada a partir de 1932, após ações emergenciais na capital do Rio Grande do Norte, favorecendo um alastramento silencioso que resultou em uma grande epidemia de malária em 1938. São abordadas questões científicas e políticas que contribuíram para que o combate ao mosquito fosse colocado em segundo plano nas articulações entre a Divisão Sanitária Internacional da Fundação Rockefeller e autoridades brasileiras até 1937.

Abstract The article analyzes the arrival and identification of the African mosquito Anopheles gambiae in Brazil in 1930, and the initial reactions of scientists and public health authorities against the epidemics of malaria caused by this species. Although this mosquito was recognized as a dangerous vector of malaria, its presence in Brazil was neglected after initial emergency actions in the city of Natal in 1932; this encouraged it to spread silently, resulting in a major malaria epidemic in 1938. This article examines scientific and political issues which caused the fight against mosquitoes to be pushed into the background until 1937 in cooperative efforts between the Rockefeller Foundation's International Health Division and the Brazilian authorities.

Two more nurses enter parliament.

The nursing presence in parliament increased last month after two nurses were elected to the House of Commons.

Unit 731 and moral repair.

Unit 731, a biological warfare research organisation that operated under the authority of the Imperial Japanese Army in the 1930s and 1940s, conducted brutal experiments on thousands of unconsenting subjects. Because of the US interest in the data from these experiments, the perpetrators were not prosecuted and the atrocities are still relatively undiscussed. What counts as meaningful moral repair in this case-what should perpetrators and collaborator communities do decades later? We argue for three non-ideal but realistic forms of moral repair: (1) a national policy in Japan against human experimentation without appropriate informed and voluntary consent; (2) the establishment of a memorial to the victims of Unit 731; and (3) US disclosure about its use of Unit 731 data and an apology for failing to hold the perpetrators accountable.

[An approach to research in the political agendas of the health sector in Colombia between 1990 and 2010]. / Una aproximación a la investigación en las agendas políticas del sector salud en Colombia entre 1990 y 2010.

OBJECTIVE: To understand health research in Colombia in the context of governmental and legislative agendas related to the health sector between 1990 and 2010. METHODS: Official sources were used such as development plans, bills and institutional documents. RESULTS: The National Government, the Ministry of Health and Social Protection (MSPS by its acronym in Spanish) and the Colombian Congress have focused their attention on health research as a public concern at certain presidential periods due to their interest in reducing the gap between research and health needs. In the 1990s, government plans showed greater interest in formulating a Science and Technology (S&T) policy in health led by the Ministry, an entity that had directorates, commissions and committees responsible for promoting and planning health research. In Congress, some health system reform projects included initiatives to formulate a health research policy that were not approved. DISCUSSION: Health research is recognized as a fundamental tool to help solve health problems. However, said recognition by governmental and legislative actors has not been constant and the institutionality in the health sector has been precarious considering that there is no permanent interest in formulating an S&T policy in health.

OBJETIVO: Entender la investigación en salud en Colombia como parte de agendas gubernamentales y legislativas relacionadas con el sector salud entre 1990 y 2010. MÉTODOS: Se usaron fuentes documentales oficiales como planes de desarrollo, proyectos de ley y otras publicaciones institucionales. RESULTADOS: El Gobierno Nacional, el Ministerio de Salud y Protección Social (MSPS) y el Congreso colombiano han puesto la atención a la investigación en salud como un problema público en diferentes periodos presidenciales debido al interés de reducir la brecha entre la investigación y las necesidades en salud. En los planes gubernamentales durante los años noventa se presentó mayor interés en la formulación de una política de Ciencia y Tecnología (CyT) en salud liderado por el MSPS, entidad que contaba con direcciones, comisiones y comités encargados de promover y planear la investigación en salud. En el Congreso, algunos proyectos de reforma al sistema de salud incluyeron iniciativas para formular una política de investigación en salud que no fueron aprobadas. DISCUSIÓN: La investigación en salud es reconocida como fundamental para contribuir a solucionar los problemas de salud. Sin embargo, este reconocimiento no ha sido constante por parte de los actores gubernamentales y legislativos, la institucionalidad en el sector salud ha sido precaria y no hubo insistente interés por formular una política de CyT en salud.