Economic performance and cost-effectiveness of using a DEC-salt social enterprise for eliminating the major neglected tropical disease, lymphatic filariasis.

BACKGROUND: Salt fortified with the drug, diethylcarbamazine (DEC), and introduced into a competitive market has the potential to overcome the obstacles associated with tablet-based Lymphatic Filariasis (LF) elimination programs. Questions remain, however, regarding the economic viability, production capacity, and effectiveness of this strategy as a sustainable means to bring about LF elimination in resource poor settings. METHODOLOGY AND PRINCIPAL FINDINGS: We evaluated the performance and effectiveness of a novel social enterprise-based approach developed and tested in Léogâne, Haiti, as a strategy to sustainably and cost-efficiently distribute DEC-medicated salt into a competitive market at quantities sufficient to bring about the elimination of LF. We undertook a cost-revenue analysis to evaluate the production capability and financial feasibility of the developed DEC salt social enterprise, and a modeling study centered on applying a dynamic mathematical model localized to reflect local LF transmission dynamics to evaluate the cost-effectiveness of using this intervention versus standard annual Mass Drug Administration (MDA) for eliminating LF in Léogâne. We show that the salt enterprise because of its mixed product business strategy may have already reached the production capacity for delivering sufficient quantities of edible DEC-medicated salt to bring about LF transmission in the Léogâne study setting. Due to increasing revenues obtained from the sale of DEC salt over time, expansion of its delivery in the population, and greater cumulative impact on the survival of worms leading to shorter timelines to extinction, this strategy could also represent a significantly more cost-effective option than annual DEC tablet-based MDA for accomplishing LF elimination. SIGNIFICANCE: A social enterprise approach can offer an innovative market-based strategy by which edible salt fortified with DEC could be distributed to communities both on a financially sustainable basis and at sufficient quantity to eliminate LF. Deployment of similarly fashioned intervention strategies would improve current efforts to successfully accomplish the goal of LF elimination, particularly in difficult-to-control settings.

Proceso de trabajo y salud docente. Un abordaje socio-antropológico de las relaciones entre los riesgos organizacionales y psicosociales del trabajo en contextos de pobreza urbana de Rosario (Argentina) / Work process and teacher's health. A socio-anthropological approach to the relationship between the organizational and psychosocial workplace risk factors in the context of urban poverty in Rosario (Argentina)

El presente escrito aborda las relaciones entre el proceso de trabajo y los procesos de salud-enfermedad de docentes de Nivel Medio de la ciudad de Rosario (Argentina), en el contexto de las reformas educativas de la denominada posconvertibilidad. El objetivo específico de este artículo es analizar los riesgos organizacionales y psicosociales presentes en una escuela secundaria ubicada en un contexto barrial de creciente fragmentación, diferenciación socioeconómica y pobreza. El estudio se realiza a partir de un enfoque propio de la Antropología del Trabajo y retoma asimismo los aportes de la Medicina Social. En este sentido, entendemos los procesos productivos a partir de su condición sociohistórica y a los procesos de salud-enfermedad a estos asociados como expresión del conflicto entre capital y trabajo (Grimberg, 1991). Se privilegió el desarrollo del denominado enfoque etnográfico, el cual implicó optar por estrategias intensivas de construcción de la información, tales como la observación participante y las entrevistas semiestructuradas. A partir de un referente empírico acotado se identificaron riesgos psicosociales vinculados con la condición social de los alumnos y sus familias, los cuales forman parte de la dinámica escolar en el contexto específico. Asimismo, se profundizó la identificación y análisis de los riesgos organizacionales vinculados a las formas de contratación; tiempo de trabajo, salario y exigencias de capacitación. El enfoque propuesto que vincula analíticamente los riesgos psicosociales y organizacionales es plausible de ser retomado para abordar la relación trabajo-salud de docentes en otros contextos escolares similares(AU)

In this article, we analyze the relationships between the work process, psychosocial risk factors and the health-disease processes of secondary level school teachers in Rosario (Argentina), in the context of the so-called "postconvertibility educational reforms". The main objective was to analyze organizational and psychosocial risk factors, based on a case study of a school located in an urban area affected by increasing fragmentation, socioeconomic differentiation and poverty. We used an approach based on the anthropology of work, with some contributions from the field of social medicine. In this sense, we understand productive processes as based on their socio-historical condition, and the associated health-disease processes as the expression of the conflict between capital and work. We prioritized the implementation of the ethnographic approach, which led us to select intensive strategies to construct the information, such as participant observation and semi-structured surveys. Based on a limited empirical reference, we were able to identify psychological risks attached to the students and the social conditions of their family. These risks reflect the different dimensions of school dynamics within this general context. Moreover, we went further by identifying and analyzing the organizational risks connected to hiring, working time, wages and training demands. We consider that this approach, which connects psychological and the organizational risk factors, has been scarcely researched in studies in this area. Thus, it is plausible that it can be used to further investigate relationships between work and health among teachers in similar school contexts(AU)

Saúde Pública e Colonização da Natureza / Public Health and Colonization of Nature

Este trabalho apresenta algumas questões sobre as quais o campo da Saúde Pública/Coletiva no Brasil precisa se reposicionar. Tomando por referência a concepção de biológico e social que se consolidou no campo a partir da década de 1970, discute-se a concepção de natureza e cultura que subsidiou o debate. Mostra como esse debate foi circunstanciado historicamente, por isso mesmo merecendo uma revisão, tendo em vista o contexto das sociedades modernas contemporâneas. As práticas biotecnológicas são objeto da análise na medida em que, além do seu uso intensivo pela saúde, carregam consigo as características de articular o biológico e o social num mesmo objeto, de transformar e criar seres vivos e de atuar na diversidade biológica. Este cenário coloca, à Saúde Pública/Coletiva, a imperiosa necessidade de rever seus marcos teórico-epistemológicos.

This paper presents some issues on which the field of Public/Collective Health in Brazil needs to reposition. Based on the design of biological and social consolidated in the field from the 1970s, it discusses the concept of nature and culture that has supported the debate. It shows how this debate has been historically positioned, so it deserves to be reviewed, given the context of contemporary modern societies. Biotechnology practices are the subject of analysis in that, in addition to their intensive use by health, hold the characteristics of joining biological and social factors in the same object, transforming and creating living beings and working in the biodiversity. This scenario requires from the Public/Collective Health the urgent need to review their theoretical and epistemological marks.

Research on health inequalities in Latin America and the Caribbean: bibliometric analysis (1971-2000) and descriptive content analysis (1971-1995).

We conducted a bibliometric and content analysis of research on health inequalities produced in Latin American and Caribbean countries. In our bibliometric analysis (n = 576), we used indexed material published between 1971 and 2000. The content analysis (n = 269) covered the period 1971 to 1995 and included unpublished material. We found recent rapid growth in overall output. Brazil, Chile, and Mexico contributed mostly empirical research, while Ecuador and Argentina produced more conceptual studies. We found, in the literature reviewed, a relative neglect of gender, race, and ethnicity issues. We also found remarkable diversity in research designs, however, along with strong consideration of ecological and ethnographic methods absent in other research traditions.

La medicina socialista

Se hace un análisis de los antecedentes teóricocientíficos del surgimiento de la Medicina Socialista, lo que permite ganar en claridad con respecto a sus cualidades y significado. Se fundamentan las necesidades económicas y propósitos sociales que en el seno del capitalismo han originado diferentes interpretaciones de las enfermedades y su valoración social, que nos remiten a la necesidad de profundizar en la determinación de los rasgos esenciales de la Medicina Socialista relacionada con la salud y la calidad de vida (AU)

Comunidad andina y sistemas de salud formal y no formal / Andean community and systems of formal and not formal health

Este trabajo se realiza porque la Salud Rural constituye uno de los problemas fundamentales de los ecuatorianos.Entre la búsqueda y propuesta de muchas y distintas respuestas al crítico problema de salud-enfermedad entre campesinos-indígenas, se pueden observar leves cambios en esa situación.Ante tan dura realidad, a la par de las soluciones ofrecidas, se ha abierto un debate que aunque no es generalizado (amplio) todavía, sin embargo representa una preocupación científica y teórica de importantes sectores sensibles del área médica. Además, tras los indicadores de salud-enfermedad, se siente el clamor de miles de campesinos-indígenas y se siente su laboriosa paciencia, que no es quietud sino la constante preparación de un mañana mejor, de futuro propio