The moderating effect of perceived punishment on the relationship between the Dark Triad and corruption

The present study aimed to investigate the moderating effect of perceived punishment on the relationship between the Dark Triad personality traits and corruption in Brazil (N = 118) and the United Kingdom (N = 130). Participants answered the Dark Triad Dirty Dozen Scale, as well as measures of corruption and perceived punishment. It was found that punishment predicts corruption in both countries. Regarding the Dark Triad traits, a relationship between Machiavellianism and corruption was identified in Brazil and the United Kingdom, although an interaction with punishment was identified only in Brazil. Moreover, psychopathy had no relationship with corruption or punishment in either country. A direct relationship was found only in Brazil on narcissism, although the interaction term was significant in both countries. In general, it was identified that perceived punishment and the dark triad traits contribute to the understanding of corruption, despite some differences in the results between Brazil and the United Kingdom.

O presente estudo tem como objetivo investigar o papel moderador da percepção de punição na relação entre Tríade Sombria da personalidade e corrupção no Brasil (N = 118) e no Reino Unido (N = 130). Participantes responderam à Escala Dark Triad Dirty Dozen, bem como a medidas de corrupção e percepção de punição. Foi encontrado que a punição prediz a corrupção em ambos os países. Em relação à Tríade Sombria, o relacionamento entre maquiavelismo e corrupção foi identificado no Brasil e no Reino Unido, embora a interação com a punição tenha sido identificada apenas no Brasil. Adicionalmente, a psicopatia não teve relação com a corrupção ou com a punição em nenhum dos países. Um efeito direto do narcisismo foi encontrado apenas no Brasil, apesar do termo de interação ter sido significativo em ambos os países. De forma geral, foi identificado que a percepção de punição e a tríade sombria contribuíram com a compreensão da corrupção, apesar de algumas diferenças nos resultados entre Brasil e Reino Unido.

El presente estudio tuvo como objetivo investigar el efecto moderador del castigo percibido sobre la relación entre los rasgos de personalidad de la tríada oscura y la corrupción en Brasil (N = 118) y en el Reino Unido (N = 130). Los participantes respondieron a la Escala de la Docena Sucia de la Triada Oscura, así como a medidas de corrupción y castigo percibido. Se encontró que el castigo predice la corrupción en ambos países. En cuanto a los rasgos de la tríada oscura, se identificó una relación entre el maquiavelismo y la corrupción en Brasil y en el Reino Unido, aunque se identificó una interacción con el castigo solo en Brasil. Además, la psicopatía no tuvo relación con la corrupción o el castigo en ninguno de los dos países. Se encontró una relación directa solo en Brasil con el narcisismo, aunque la interacción fue significativa en ambos países. En general, se identificó que el castigo percibido y los rasgos de la tríada oscura contribuyen a la comprensión de la corrupción, a pesar de algunas diferencias en los resultados entre Brasil y el Reino Unido.

Consumers' beef purchasing behavior across countries.

In 2022, the value of United States (US) beef and beef product exports was $11.7 billion, and the US was the world's largest beef producer and second-largest beef exporter by volume. Therefore, we conducted surveys to evaluate beef purchasing behavior among consumers in important and emerging US beef export markets, including Japan, the United Kingdom (UK), Germany, and Mexico. Results reveal differences in consumers' beef purchasing behavior across countries. Most Mexican consumers purchase beef two-to-three times a week, while consumers in other countries typically purchase it once a week. Using ordered probit models, we examined the factors associated with beef purchase frequency in each country. Japanese consumers who consider price to be an important factor when purchasing beef are less likely to purchase it frequently. German consumers, for whom brands are important when buying beef, are more likely to buy it frequently. British consumers, who consider hormone-free production to be important when purchasing beef, are less likely to buy it frequently. Mexican consumers, who consider grass-fed production to be an important factor when purchasing beef, are less likely to buy it frequently. Across all countries, individuals who purchase beef at supermarkets and from butchers are more likely to purchase it more often. Results also indicate that various consumer demographics are associated with beef purchase frequency across countries. The findings provide valuable insights for stakeholders regarding international consumer beef purchasing behavior.

Genomic Diversity and Zoonotic Potential of Brucella neotomae.

After reports in 2017 of Brucella neotomae infections among humans in Costa Rica, we sequenced 12 strains isolated from rodents during 1955-1964 from Utah, USA. We observed an exact strain match between the human isolates and 1 Utah isolate. Independent confirmation is required to clarify B. neotomae zoonotic potential.

'No-one knows how to care for LGBT community like LGBT do': LGBTQIA+ experiences of COVID-19 in the United Kingdom and Brazil.

The coronavirus pandemic and responses to it have had uneven impacts on different segments of societies. This study analysed the experiences of LGBTQIA+2 people during the COVID-19 emergency, based on interviews in the United Kingdom and Brazil in 2020. The two countries are instructive cases, given the different social, cultural, economic, and political contexts. Pre-existing marginalisation shaped COVID-19 experiences in both settings, influencing the challenges faced, such as isolation or disruption to transgender healthcare, and coping strategies, including the important role of LGBTQIA+ volunteer and mutual aid groups. This paper argues that despite commonalities, there is no single LGBTQIA+ experience, and that disaster strategies will be ineffective until they recognise intersectionality and support the diversity of LGBTQIA+ populations. It concludes with a call for more inclusive disaster research, policy, and practice, which requires scrutinising the dominant cisgender-heteronormative structures that produce and reproduce LGBTQIA+ marginalisation.

Deaths, infections, and herd immunity in the COVID-19 pandemic: A comparative study of the strategies for disease containment implemented in Peru and the United Kingdom / Muertes, infecciones e inmunidad de rebaño en la pandemia por COVID-19: un estudio comparativo de las estrategias de control de la pandemia implementadas en Perú y Reino Unido

Abstract Introduction: In light of the threat posed by the COVID-19 pandemic, most countries have implemented several containment and prevention measures to slow down the rapid spread of the disease. Objectives: To compare the COVID-19 pandemic containment strategies implemented in Peru [World Health Organization (WHO) - confinement and social distancing] and the United Kingdom [herd immunity (HI)] in terms of morbidity and mortality, and to simulate the implementation of HI in Peru during the initial stage of the pandemic. Materials and methods: Exploratory study with a simulation model based on official data obtained from both countries at the beginning of the pandemic. Mortality, case fatality, and infection rates documented within the first 55 days after the first COVID-19 case report in the United Kingdom and the start of the WHO-recommended containment and prevention strategy implementation in Peru were evaluated. Additionally, the impact of applying HI, according to WHO guidelines, as the initial strategy in Peru was simulated. The Paired-samples t-test was used to determine the differences between the two strategies at both stages of the study. Results: During the follow-up period, 15 034 and 33 931 COVID-19 cases were reported in the United Kingdom and Peru, respectively. The case fatality rate was higher in the United Kingdom (7.82% vs. 2.74%), while the cumulative mortality rate was higher in Peru (2.89 vs. 1.74x100 000 inhabitants p= 0.0001). Regarding the simulation, a minimum critical population of 60% (>19 million positive cases) was established for Peru to achieve HI, with 1 223 473.1 deaths and a hospitalization rate of 44 770x100 000 patients. Conclusions: During the follow-up period (55 days), the United Kingdom's strategy resulted in a higher case fatality rate, while the Peruvian strategy in over twice as many COVID-19 cases. The HI simulation strategy in Peru showed a sharp increase in all unfavorable indicators of the pandemic.

Resumen Introducción. Ante la amenaza de la pandemia por COVID-19, la mayoría de los países han establecido diversas medidas de control y prevención para disminuir la rápida propagación de esta enfermedad. Objetivos. Comparar las estrategias de control de la pandemia por COVID-19 implementadas en Perú (de confinamiento y distanciamiento social de la Organización Mundial de la Salud (OMS)) y Reino Unido (de inmunidad de rebaño (IR)) en términos de morbimortalidad, y simular la implementación de la IR en Perú durante la etapa inicial de la pandemia. Materiales y métodos. Estudio exploratorio con un modelo de simulación basado en datos oficiales de ambos países registrados al inicio de la pandemia. Se evaluaron las tasas de mortalidad, letalidad e infección en Reino Unido (IR) y Perú (confinamiento y distanciamiento social) dentro de los 55 días posteriores al reporte del primer caso de COVID-19 en Reino Unido y al inicio de la implementación de la estrategia de control y prevención recomendada por la OMS en Perú. Además, se simuló el impacto de haber aplicado la IR, según pautas de la OMS, como estrategia inicial en Perú. Se utilizó la prueba t-Student para muestras relacionadas para determinar las diferencias entre ambas estrategias en las dos etapas del estudio. Resultados. En el periodo de seguimiento se registraron 15 034 y 33 931 casos de COVID-19 en Reino Unido y Perú, respectivamente. La tasa de letalidad fue mayor para Reino Unido (7.82% vs. 2.74%), y la tasa de mortalidad acumulada fue mayor en Perú (2.89 vs. 1.74x100 000 habitantes; p=0.0001). Respecto a la simulación, se estableció una población crítica mínima de 60% (>19 millones de casos positivos) para que Perú logre la IR, con 1 223 473.1 muertes y una tasa de hospitalización de 44 770x100 000 pacientes. Conclusiones. Durante el periodo de seguimiento (55 días), la estrategia de Reino Unido resultó en una mayor letalidad y la peruana, en más del doble de casos de COVID-19. La simulación de la IR en Perú mostró un dramático incremento de todos los indicadores desfavorables de la pandemia.

Advanced Practice Nursing Roles: A Comparison Between Mexico and the United Kingdom.

The COVID-19 pandemic has placed nursing at the forefront of public attention across the globe and has highlighted the critical role of nursing in healthcare service provision. Advanced practice nursing has been recognized for more than 50 years, but the rate of its growth and development varies significantly across the world. One of the key aims of the Better Health Programme Mexico, which commenced in 2019, was to develop advanced practice nursing in Mexico. The Programme was based on the United Kingdom model, where advanced practice nursing has been in place-though not subject to statutory regulation-for more than 40 years. The aim of this article is to compare the frameworks that underpin advanced practice nursing in the United Kingdom and in Mexico. In the present article, current practice in both countries was researched, and the structure, systems, and processes relating to nursing regulation and the frameworks to support advanced practice nursing were examined. A gap analysis report undertaken as part of the Better Health Programme identified challenges in developing advanced practice nursing in Mexico and the United Kingdom and highlighted the need for stakeholders to agree on an approach toward a rigorous regulatory framework in both settings. In summary, this article highlights the issues facing nurses and regulators in both countries in terms of advanced practice nursing and identifies strategies that can be used to strengthen the advanced practice nurse role.

Práticas clínicas relacionadas a cânulas nasais de alto fluxo em terapia intensiva pediátrica no Brasil em comparação com as de outros países: um inquérito brasileiro / Clinical practices related to high-flow nasal cannulas in pediatric critical care in Brazil compared to other countries: a Brazilian survey

RESUMO Objetivo: Descrever as práticas clínicas atuais relacionadas à utilização de cânula nasal de alto fluxo por intensivistas pediátricos brasileiros e compará-las com as de outros países. Métodos: Para o estudo principal, foi administrado um questionário a intensivistas pediátricos em países das Américas do Norte e do Sul, Ásia, Europa e Austrália/Nova Zelândia. Comparou-se a coorte brasileira com coortes dos Estados Unidos, Canadá, Reino Unido e Índia. Resultados: Responderam ao questionário 501 médicos, dos quais 127 eram do Brasil. Apenas 63,8% dos participantes brasileiros tinham disponibilidade de cânula nasal de alto fluxo, em contraste com 100% dos participantes no Reino Unido, no Canadá e nos Estados Unidos. Coube ao médico responsável a decisão de iniciar a utilização de uma cânula nasal de alto fluxo segundo responderam 61,2% dos brasileiros, 95,5% dos localizados no Reino Unido, 96,6% dos participantes dos Estados Unidos, 96,8% dos médicos canadenses e 84,7% dos participantes da Índia; 62% dos participantes do Brasil, 96,3% do Reino Unido, 96,6% dos Estados Unidos, 96,8% do Canadá e 84,7% da Índia relataram que o médico responsável era quem definia o desmame ou modificava as regulagens da cânula nasal de alto fluxo. Quando ocorreu falha da cânula nasal de alto fluxo por desconforto respiratório ou insuficiência respiratória, 82% dos participantes do Brasil considerariam uma tentativa com ventilação não invasiva antes da intubação endotraqueal, em comparação com 93% do Reino Unido, 88% dos Estados Unidos, 91,5% do Canadá e 76,8% da Índia. Mais intensivistas brasileiros (6,5%) do que do Reino Unido, Estados Unidos e Índia (1,6% para todos) afirmaram utilizar sedativos com frequência concomitantemente à cânula nasal de alto fluxo. Conclusão: A disponibilidade de cânulas nasais de alto fluxo no Brasil ainda não é difundida. Há algumas divergências nas práticas clínicas entre intensivistas brasileiros e seus colegas estrangeiros, principalmente nos processos e nas tomadas de decisão relacionados a iniciar e desmamar o tratamento com cânula nasal de alto fluxo.

ABSTRACT Objective: To describe current clinical practices related to the use of high-flow nasal cannula therapy by Brazilian pediatric intensivists and compare them with those in other countries. Methods: A questionnaire was administered to pediatric intensivists in North and South America, Asia, Europe, and Australia/New Zealand for the main study. We compared the Brazilian cohort with cohorts in the United States of America, Canada, the United Kingdom, and India Results: Overall, 501 physicians responded, 127 of which were in Brazil. Only 63.8% of respondents in Brazil had a high-flow nasal cannula available, in contrast to 100% of respondents in the United Kingdom, Canada, and the United States. The attending physician was responsible for the decision to start a high-flow nasal cannula according to 61.2% respondents in Brazil, 95.5% in the United Kingdom, 96.6% in the United States, 96.8% in Canada, and 84.7% in India. A total of 62% of respondents in Brazil, 96.3% in the United Kingdom, 96.6% in the United States, 96.8% in Canada, and 84.7% in India reported that the attending physician was responsible for the decision to wean or modify the high-flow nasal cannula settings. When high-flow nasal cannula therapy failed due to respiratory distress/failure, 82% of respondents in Brazil would consider a trial of noninvasive ventilation before endotracheal intubation, compared to 93% in the United Kingdom, 88% in the United States, 91.5% in Canada, and 76.8% in India. More Brazilian intensivists (6.5%) than intensivists in the United Kingdom, United States, and India (1.6% for all) affirmed using sedatives frequently with high-flow nasal cannulas. Conclusion: The availability of high-flow nasal cannulas in Brazil is still not widespread. There are some divergences in clinical practices between Brazilian intensivists and their colleagues abroad, mainly in processes and decision-making about starting and weaning high-flow nasal cannula therapy.

How did the UK government face the global COVID-19 pandemic? / Como o governo do Reino Unido enfrentou a pandemia global da COVID-19? / ¿Cómo hizo frente el gobierno del Reino Unido a la pandemia mundial de COVID-19?

Abstract This paper aims to analyse the coordination and cooperation in Primary Health Care (PHC) measures adopted by the British government against the spread of the COVID-19. PHC is clearly part of the solution founded by governments across the world to fight against the spread of the virus. Data analysis was performed based on coordination, cooperation, and PHC literature crossed with documentary analysis of the situation reports released by the World Health Organisation and documents, guides, speeches and action plans on the official UK government website. The measures adopted by the United Kingdom were analysed in four periods, which helps to explain the courses of action during the pandemic: pre-first case (January 22- January 31, 2020), developing prevention measures (February 1 -February 29, 2020), first Action Plan (March 1- March 23, 2020) and lockdown (March 24-May 6, 2020). Despite the lack of consensus in essential matters such as Brexit, the nations in the United Kingdom are working together with a high level of cooperation and coordination in decision-making during the COVID-19 pandemic.

Resumo Este artigo tem o objetivo de analisar a coordenação e cooperação nas medidas de atenção básica à saúde adotadas pelo governo britânico no combate a evolução da COVID-19. A atenção básica à saúde é parte da solução adotada pelos governos no mundo para combater o vírus. Foi utilizada da análise de dados baseada na literatura de coordenação, cooperação e atenção básica à saúde, de forma cruzada com a análise documental dos relatórios elaborados pela Organização Mundial da Saúde e documentos, guias, discursos e planos de ação nos sites oficiais do governo britânico. As medidas adotadas pelo governo britânico foram analisadas em 4 períodos, de forma a ajudar na explicação das ações durante a pandemia: pré-primeiro caso (22 a 31 de janeiro), desenvolvendo medidas de prevenção (01 a 29 de fevereiro), primeiro plano de ação (1 a 23 de março) e lockdown (24 de março a 6 de maio). Apesar da falta de consenso em temas essenciais como o Brexit, as nações no Reino Unido estão trabalhando juntas com um alto nível de cooperação e coordenação na tomada de decisão durante o surto do coronavírus.

Resumen Este artículo tiene como objetivo analizar la coordinación y cooperación en las medidas de atención primaria de salud adoptadas por el gobierno británico para combatir la evolución de la COVID-19. Una crisis sin precedentes exige soluciones de políticas públicas y una gobernanza única en el desafío más importante del siglo XXI. La atención primaria de salud es claramente parte de la solución adoptada por los gobiernos de todo el mundo para combatir el virus. Se utilizó el análisis de datos ‒basado en la literatura sobre coordinación, cooperación y atención primaria de salud‒ cruzado con el análisis documental de informes elaborados por la Organización Mundial de la Salud y documentos, guías, discursos y planes de acción de los sitios web oficiales del gobierno británico. Las medidas adoptadas por el gobierno británico se analizaron en 4 periodos con el fin de ayudar a explicar las acciones durante la pandemia: pre-primer caso (22 a 31 de enero), desarrollo de medidas preventivas (01 a 29 de febrero), primer plan de acción (01 a 23 de marzo) y confinamiento (24 de marzo a 6 de mayo). A pesar de la disparidad en el consenso sobre temas clave como el Brexit, las naciones del Reino Unido están trabajando juntas con un alto nivel de cooperación y coordinación en la toma de decisiones durante el brote de coronavirus.

Use of Cost-Effectiveness Analyses for Decisions About Vaccination Programs for Meningococcal Disease in the United States, United Kingdom, The Netherlands, and Canada.

INTRODUCTION: Meningococcal vaccines to protect against invasive meningococcal disease (IMD) vary in terms of vaccine technology and serogroup coverage (Polysaccharide MnACWY, conjugated C and ACWY, outer membrane vesicle-based or protein-based B vaccines), and the national recommendations for each of them vary in terms of target population and number of doses. We sought to understand factors associated with the evolution of meningococcal vaccination program recommendations in four countries with formal evaluation processes: the UK, US, the Netherlands, and Canada. AREAS COVERED: A targeted review of published literature and internet sources for the four countries relating to meningococcal vaccination decision-making was conducted. The review focused on the impact of cost-effectiveness analyses on vaccine policy decisions and the extent to which variation in incidence of IMD and its potential catastrophic consequences influenced policy decisions.The evolution of meningococcal vaccine recommendations in the four countries was mainly driven by changes in vaccine availability and changes in serogroup incidence. Public pressure due to the catastrophic nature of IMD influenced recommendations. The role of cost-effectiveness analyses varied across the 4 countries. EXPERT OPINION: The value of implementing meningococcal vaccination programs should be assessed using factors beyond those included in traditional cost-effectiveness analyses.

Ultra-processed food consumption and risk of obesity: a prospective cohort study of UK Biobank.

OBJECTIVE: The objective of this study was to examine the associations between ultra-processed food consumption and risk of obesity among UK adults. METHODS: Participants aged 40-69 years at recruitment in the UK Biobank (2006-2019) with dietary intakes collected using 24-h recall and repeated measures of adiposity--body mass index (BMI), waist circumference (WC) and percentage of body fat (% BF)--were included (N = 22,659; median follow-up: 5 years). Ultra-processed foods were identified using the NOVA classification and their consumption was expressed as a percentage of total energy intake. Multivariable Cox proportional hazards regression models were used to estimate hazard ratios (HR) of several indicators of obesity according to ultra-processed food consumption. Models were adjusted for sociodemographic and lifestyle characteristics. RESULTS: 947 incident cases of overall obesity (BMI ≥ 30 kg/m2) and 1900 incident cases of abdominal obesity (men: WC ≥ 102 cm, women: WC ≥ 88 cm) were identified during follow-up. Participants in the highest quartile of ultra-processed food consumption had significantly higher risk of developing overall obesity (HR 1.79; 95% CI 1.06─3.03) and abdominal obesity (HR 1.30; 95% CI 1.14─1.48). They had higher risk of experiencing a ≥ 5% increase in BMI (HR 1.31; 95% CI 1.20─1.43), WC (HR 1.35; 95% CI 1.25─1.45) and %BF (HR 1.14; 95% CI 1.03─1.25), than those in the lowest quartile of consumption. CONCLUSIONS: Our findings provide evidence that higher consumption of ultra-processed food is strongly associated with a higher risk of multiple indicators of obesity in the UK adult population. Policy makers should consider actions that promote consumption of fresh or minimally processed foods and reduce consumption of ultra-processed foods.

Estimating virtual water and land use transfers associated with future food supply: A scalable food balance approach.

Virtual water or land use is the volume of water or area of land, respectively, used to produce a unit food commodity that is traded. Estimates of future virtual water or land use (as potential mechanisms for mitigating against food insecurity due to resource scarcity) are limited by the need for complex modelling and data requirements regarding trade, for which the data or expertise might be rare or unavailable. This paper presents a simple food balance approach for estimating the status quo food demand and supply and associated virtual water or land use transfers under future conditions. The method is spatially-scalable, accessible to a wider range of users, and illustrated using UK feed barley supply. Key features of the method are: ● Proportionate distribution of a target food item over utilization components is estimated from the FAO Food Balance Sheet of the country of analysis and used to distribute future supply over utilization components. ● The balance between demand and supply is used to estimate the direction and magnitude of virtual water or land use transfers. ● The method can be scaled up from national to regional and global levels and to cover multiple food items.

Ultra-processed foods and excessive free sugar intake in the UK: a nationally representative cross-sectional study.

OBJECTIVES: To describe dietary sources of free sugars in different age groups of the UK population considering food groups classified according to the NOVA system and to estimate the proportion of excessive free sugars that could potentially be avoided by reducing consumption of their main sources. DESIGN AND SETTING: Cross-sectional data from the UK National Diet and Nutrition Survey (2008-2014) were analysed. Food items collected using a 4-day food diary were classified according to the NOVA system. PARTICIPANTS: 9364 individuals aged 1.5 years and above. MAIN OUTCOME MEASURES: Average dietary content of free sugars and proportion of individuals consuming more than 10% of total energy from free sugars. DATA ANALYSIS: Poisson regression was used to estimate the associations between each of the NOVA food group and intake of free sugars. We estimated the per cent reduction in prevalence of excessive free sugar intake from eliminating ultra-processed foods and table sugar. Analyses were stratified by age group and adjusted for age, sex, ethnicity, survey year, region and equivalised household income (sterling pounds). RESULTS: Ultra-processed foods account for 56.8% of total energy intake and 64.7% of total free sugars in the UK diet. Free sugars represent 12.4% of total energy intake, and 61.3% of the sample exceeded the recommended limit of 10% energy from free sugars. This percentage was higher among children (74.9%) and adolescents (82.9%). Prevalence of excessive free sugar intake increased linearly across quintiles of ultra-processed food consumption for all age groups, except among the elderly. Eliminating ultra-processed foods could potentially reduce the prevalence of excessive free sugar intake by 47%. CONCLUSION: Our findings suggest that actions to reduce the ultra-processed food consumption generally rich in free sugars could lead to substantial public health benefits.

Mercantilização nas reformas dos sistemas de saúde alemão, francês e britânico / Commodification in the reforms of the German, French and British health systems

Resumo Desde os anos 1980, os sistemas de saúde europeus vêm passando por várias reformas, com ênfase à tendência de sua mercantilização. O objetivo deste artigo é evidenciar formas de implementação de mecanismos de mercado no funcionamento desses sistemas, alemão, britânico e francês - a partir da década de 1980. As reformas "mercantis" eram justificadas a partir da premissa de que a inserção da lógica de mercado poderia tanto diminuir a necessidade de gastos públicos como aumentar a eficiência dos existentes. O trabalho apresenta diferentes formas de mercantilização implementadas nas reformas, com a distinção entre os processos de mercantilização explícita, em que há efetivo aumento da presença privada, e implícita, em que ocorre a incorporação de princípios advindos do setor privado no sistema público, tanto no financiamento como na prestação de serviços de saúde. Além do detalhamento das diferentes maneiras em que este fenômeno se expressa, o artigo apresenta brevemente os potenciais efeitos negativos desse processo para os sistemas de saúde, principalmente em termos de acesso e equidade, explicitando que as premissas iniciais em torno da mercantilização (redução de gastos e melhora na eficiência) parecem ser falsas.

Abstract Since the 1980s, European health systems have undergone several reforms, with emphasis on the tendency of their commodification. The objective of this article is to demonstrate how market mechanisms were implemented in the functioning of these systems, german, british and french - from the 1980s. The "mercantile" reforms were justified on the premise that the insertion of market logic could both reduce the need for public spending and increase the efficiency of existing expenditure. The work presents different forms of commodification implemented in the reforms, with the distinction between processes of explicit commodification, in which there is an effective increase in private, and implicit presence, in which there is incorporation of principles from the private sector in the public system, both in financing and in the provision of health services. In addition to detailing the different ways in which this phenomenon is expressed, the article briefly presents the potential negative effects of this process for health systems, especially in terms of access and equity, stating that the initial assumptions surrounding commodification (cost reduction and efficiency improvement) appear to be false.

Ultra-Processed Food Consumption and Chronic Non-Communicable Diseases-Related Dietary Nutrient Profile in the UK (2008⁻2014).

We described the contribution of ultra-processed foods in the U.K. diet and its association with the overall dietary content of nutrients known to affect the risk of chronic non-communicable diseases (NCDs). Cross-sectional data from the U.K. National Diet and Nutrition Survey (2008⁻2014) were analysed. Food items collected using a four-day food diary were classified according to the NOVA system. The average energy intake was 1764 kcal/day, with 30.1% of calories coming from unprocessed or minimally processed foods, 4.2% from culinary ingredients, 8.8% from processed foods, and 56.8% from ultra-processed foods. As the ultra-processed food consumption increased, the dietary content of carbohydrates, free sugars, total fats, saturated fats, and sodium increased significantly while the content of protein, fibre, and potassium decreased. Increased ultra-processed food consumption had a remarkable effect on average content of free sugars, which increased from 9.9% to 15.4% of total energy from the first to the last quintile. The prevalence of people exceeding the upper limits recommended for free sugars and sodium increased by 85% and 55%, respectively, from the lowest to the highest ultra-processed food quintile. Decreasing the dietary share of ultra-processed foods may substantially improve the nutritional quality of diets and contribute to the prevention of diet-related NCDs.

Media coverage of the 'UK flooding crisis': a social panorama.

A disaster referred to by the press as the 'UK flooding crisis' occurred between December 2015 and January 2016. This study employed three different levels of analysis to identify a multidimensional perspective adopted in the disaster reporting of the British Broadcasting Corporation (BBC). These levels revealed details about the social actors and their interactions. The set of news exposed diverse viewpoints on the crisis, from loss and damage to distinct affected subgroups to the various social engagement actions of aid and the multiplicity of technical response measures. The conclusions highlight considerable social amplitude in the BBC's coverage; however, owing to the reductionist approach of this media communicator, the field of action involving different social actors was not very clear in the content of the news, particularly with regard to cohesion, conflict/obstruction, and concernthe concept of crisis in its essence. In addition, the paper suggests new questions for future reports.

The National Health Services of Brazil and Northern Europe: Universality, Equity, and Integrality-Time Has Come for the Latter.

In 1990 the national health services in the United Kingdom and Sweden started to split up in internal markets with purchasers and providers. It was also the year when Brazil started to implement a national health service (SUS) inspired by the British national health service that aimed at principles of universality, equity, and integrality. While the reform in Brazil aimed at improving equity and effectiveness, reforms in Europe aimed at improving efficiency in order to contain costs. The European reforms increased supply and utilization but never provided the large increase in efficiency that was hoped for, and inequities have increased. The health sector reform in Brazil, on the other hand, contributed to great improvements in population health but never succeeded in changing the fact that more than half of health care spending was private. Demographic and epidemiological changes, with more elderly people having chronic disorders and very unequal comorbidities, bring the issue of integrality in the forefront in all 3 countries, and neither the public purchaser provider markets nor the 2-tier system in Brazil delivers on that front. It will demand political leadership and strategic planning with population responsibility to deal with such challenges.

Biochemical and molecular modulation of CCl4-induced peripheral and central damage by Tilia americana var. mexicanaextracts.

Around the world, species from the genus Tilia are commonly used because of their peripheral and central medicinal effects; they are prepared as teas and used as tranquilizing, anticonvulsant, and analgesic agents. In this study, we provide evidence of the protective effects of organic and aqueous extracts (100 mg/kg, i.p.) obtained from the leaves of Tilia americana var. mexicana on CCl4-induced liver and brain damage in the rat. Protection was observed in the liver and brain (cerebellum, cortex and cerebral hemispheres) by measuring the activity of antioxidant enzymes and levels of malondialdehyde (MDA) using spectrophotometric methods. Biochemical parameters were also assessed in serum samples from the CCl4-treated rats. The T. americana var. mexicana leaf extracts provided significant protection against CCl4-induced peripheral and central damage by increasing the activity of antioxidant enzymes, diminishing lipid peroxidation, and preventing alterations in biochemical serum parameters, such as the levels of aspartate aminotransferase (AST), alanine aminotransferase (ALT), alkaline phosphatase (ALP), γ-globulin (γ-GLOB), serum albumin (ALB), total bilirubin (BB), creatinine (CREA) and creatine kinase (CK), relative to the control group. Additionally, we correlated gene expression with antioxidant activity in the experimental groups treated with the organic and aqueous Tilia extracts and observed a non-statistically significant positive correlation. Our results provide evidence of the underlying biomedical properties of T. americana var. mexicana that confer its neuro- and hepatoprotective effects.

Identity in a medicine cabinet: Discursive positions of Andean migrants towards their use of herbal remedies in the United Kingdom.

This study explores different rationales for using herbal remedies among people from Andean descent in the United Kingdom, using positioning theory as a conceptual framework. By analysing processes of positioning in narratives about healthcare choices conducted with 40 Bolivian and Peruvian migrants in London (between 2005 and 2009), we examine in which ways talking about personal preferences for herbal medicine can be constitutive of one's health identity. The results reveal three distinct discursive repertoires that frame the use of herbal remedies either as a tradition, a health-conscious consumer choice, or as a coping strategy, each allowing specific health identity outcomes. An enhanced understanding of how people make sense of their use of traditional, plant-based medicines enables healthcare professionals to better assist patients in making meaningful decisions about their health. Through illustrating how treatment choices are discursively linked with identity, the present results debunk the tendency to perceive patients with a migration background as one homogenous group and thus urge for a patient centred approach.

A review of the quality of current diabetes clinical practice guidelines / Examen de la calidad de las directrices actuales de práctica clínica sobre la diabetes / Uma revisão da qualidade das diretrizes atuais para a prática clínica em casos de diabetes

Objective To obtain an evaluation of current type 2 diabetes mellitus (T2DM) clinical practice guidelines. Methods Relevant guidelines were identified through a systematic search of MEDLINE/PubMed. Pan American Health Organization (PAHO) country offices were also contacted to obtain national diabetes guidelines in use but not published/available online. Overall, 770 records were identified on MEDLINE/PubMed for citations published from 2008 to 2013. After an initial screening of these records, 146 were found to be guidelines related to diabetes. Inclusion and exclusion criteria were used to further refine the search and obtain a feasible number of guidelines for appraisal. Guideline evaluation was conducted by health professionals using the Appraisal of Guidelines for Research and Evaluation (AGREE) II instrument, which was developed to address the issue of variability in guideline quality and assesses the methodological rigor and transparency in which a guideline is developed. A total of 17 guidelines were selected and evaluated. Results Ten guidelines scored ≥ 70% and seven guidelines scored ≥ 80%. The range was 21%-100%. The mean scores for Latin America and the Caribbean (LAC) country guidelines (n = 6) were compared to the mean scores for non-LAC country guidelines (n = 11). International guidelines consistently scored notably higher in all domains and overall quality than LAC guidelines. Conclusions Based on this study's findings, it is clear that T2DM clinical practice guideline development requires further improvements, particularly with regard to the involvement of stakeholders and editorial independence. This issue is most apparent for LAC country guidelines, as their quality requires major improvement in almost all aspects of the AGREE II criteria. Continued efforts should be made to generate and update high-quality guidelines to improve the management of increasingly prevalent noncommunicable diseases, such as T2DM.

RESUMEN Objetivo Evaluar las directrices de práctica clínica sobre la diabetes mellitus de tipo 2 que se utilizan en la actualidad. Métodos Se realizó una búsqueda sistemática en MEDLINE/PubMed con el fin de localizar las directrices pertinentes. Asimismo, se solicitó a las oficinas de la Organización Panamericana de la Salud (OPS) en los países que facilitaran las directrices nacionales sobre la diabetes utilizadas en cada país que no estuvieran accesibles ni publicadas en línea. Se obtuvieron 770 registros de trabajos publicados del 2008 al 2013 en MEDLINE/PubMed. Tras un tamizaje inicial, se localizaron 146 directrices relacionadas con la diabetes. Se aplicaron criterios de inclusión y exclusión para perfeccionar aún más la búsqueda y obtener un número viable de directrices para realizar la evaluación. La evaluación estuvo a cargo de profesionales de la salud, quienes utilizaron el instrumento AGREE II (Appraisal of Guidelines for Research and Evaluation), creado para abordar el problema de la variabilidad en cuanto a la calidad de las directrices, que evalúa el rigor metodológico y la transparencia del proceso de formulación. Se seleccionaron y evaluaron 17 directrices. Resultados Diez directrices recibieron una puntuación  70% y siete directrices,  80%. El margen de las puntuaciones asignadas fue de 21-100 %. Se comparó la media de las puntuaciones asignadas a las directrices provenientes de países de América Latina y el Caribe (n = 6) con la media de aquellas provenientes de otros países (n = 11). Las directrices internacionales recibieron una puntuación notablemente mayor que las de América Latina y el Caribe en todos los criterios evaluados y en la calidad general. Conclusiones Dados los resultados de este estudio, está claro que es preciso mejorar la formulación de directrices de práctica clínica sobre la diabetes mellitus de tipo 2, en particular con respecto a la participación de los interesados directos y la independencia editorial. Esta cuestión es sumamente evidente en las directrices de los países de América Latina y el Caribe, puesto que son necesarias mejoras considerables de la calidad en casi todos los aspectos de los criterios evaluados con el instrumento AGREE II. Es fundamental continuar con los esfuerzos destinados a formular directrices de excelente calidad y actualizarlas para mejorar el diagnóstico y el tratamiento de las enfermedades no transmisibles que son cada vez más prevalentes, como es el caso de la diabetes mellitus de tipo 2.

RESUMO Objetivo Avaliar as diretrizes atuais para a prática clínica em casos de diabetes mellitus do tipo 2 (DMT2). Métodos Identificamos diretrizes relevantes por meio de uma pesquisa sistemática na base de dados MEDLINE/PubMed. As representações da Organização Pan-Americana da Saúde (OPAS) nos países também foram contatadas para que pudéssemos obter diretrizes para diabetes utilizadas nos países, mas não publicadas/disponíveis on-line. Ao todo, foram encontrados 770 resultados na MEDLINE/PubMed para citações publicadas entre 2008 e 2013. Depois de uma triagem inicial destes resultados, constatou-se que 146 eram diretrizes relacionadas ao diabetes. Utilizamos critérios de inclusão e exclusão para refinar ainda mais a pesquisa e obter um número viável de diretrizes a serem avaliadas. A avaliação das diretrizes foi feita por profissionais da saúde usando o instrumento AGREE II (Avaliação de Diretrizes para Pesquisa e Avaliação), desenvolvido para abordar a questão da variabilidade na qualidade de diretrizes e avaliar o rigor metodológico e a transparência no desenvolvimento de uma diretriz. No total, foram selecionadas e avaliadas17 diretrizes. Resultados Dez diretrizes tiveram pontuação 70%, e sete diretrizes tiveram pontuação 80%. A variação foi de 21% a 100%. As pontuações médias das diretrizes de países da América Latina e Caribe (ALC) (n=6) foram comparadas às de países não pertencentes a esta região (n=11). As diretrizes internacionais tiveram pontuações consistentemente mais altas em todos os domínios e uma qualidade global mais elevada que as diretrizes da ALC. Conclusões Com base nos resultados deste estudo, está claro que o desenvolvimento de diretrizes para a prática clínica em casos de DMT2 precisa ser aperfeiçoado, especialmente no que diz respeito à participação dos interessados diretos e à independência editorial. Este problema fica muito evidente no caso das diretrizes de países da ALC, cuja qualidade precisa melhorar muito em quase todos os aspectos dos critérios AGREE II. É preciso fazer esforços contínuos para desenvolver e atualizar diretrizes de alta qualidade a fim de melhorar a gestão de doenças não transmissíveis cada vez mais prevalentes, como o DMT2.