Language: the ignored determinant of health.

Canada is one of the most multicultural countries in the world, with growing numbers of families who do not speak English or French as a first language. However, providing language-concordant services for patients with non-official language preference (NOLP) is not a standardized or measured component of our healthcare system, reflecting the historical marginalization of minority groups in our society. Existing evidence from other countries demonstrates the importance of language as a social determinant of health, and illustrates improved healthcare outcomes for patients with NOLP with the use of medical interpretation. This commentary proposes that a change in our approach to patients with NOLP needs to be accomplished through concerted efforts at the policy, research, and institutional levels in healthcare.

A global survey of national oral health policies and its coverage for young children.

Background: There is no accessible information on countries with oral health policies. The purpose of this study was to identify World Dental Federation (FDI) member countries with oral health policies and their scope and extent of coverage of oral health care for young children. Methods: This international survey recruited chief dental officers, oral health advisors to national ministries of health, and other key informants of the 158 FDI member countries between December 2020 and December 2021. The survey tool was administered online to the study participants. Key questions explored the following outcome measures: countries with oral health policies; the thrusts of the oral health policies; policy thrusts targeting young children; and dental care plans as a component of a universal health care plan. Descriptive statistics were conducted to determine the number of countries with any of the study outcome measures and coverage per country. Results: Sixty (38%) of the 158 FDI member-countries responded to the survey. Forty-eight (55.2%) of the 60 countries had a national oral health policy document or position statement on oral health; 54 (62.1%) countries had plans on universal health care, and 42 (48.3%) included dental care within their universal health care plan. The most common policy thrusts addressing the oral health needs of children were the promotion of oral hygiene (71.7%), provision of fluoride products for children (53.3%), collaboration with primary care providers (35%), and prenatal oral health education (50%). There were differences in the scope of oral health care coverage and the coverage for young children between continents as well as between countries. Europe had many countries with children-friendly oral health policy coverage. Conclusions: About half of the surveyed countries had a national oral health policy. There were variations in the scope of oral health care coverage, particularly for young children, both between continents and among individual countries. These findings underscore the importance of understanding the landscape of oral health policies globally. Such insights can help inform targeted interventions to enhance oral health policies, thereby contributing to improved oral health outcomes on a global level.

National Sporting Organisation policies: A health promotion opportunity?

ISSUE ADDRESSED: The objective was to identify whether National Sporting Organisations (NSOs) have policy documentation on healthy behaviours (smokefree, sun-protection, healthy food/beverages and alcohol) and, for organisations with such documentation, whether this was in-line with current scientific evidence of past best practice in cancer prevention. METHODS: This cross-sectional policy analysis study was performed September to December 2018 in Aotearoa/New Zealand. A content analysis was undertaken using NSO policy documents matched against a framework of key indicators for best practice within health behaviours of interest. Data analysis of the policy process was undertaken through key informant telephone interviews with NSO staff using semi-structured qualitative interviews. RESULTS: Of 96 NSOs, nearly half (49%) mentioned smokefree at least once in one of their policy documents, and 47% had an alcohol policy, although in both instances the policies lacked comprehensiveness. Two NSOs had a reasonably comprehensive sun protection policy. Seventeen had at least one specific nutrition policy/guideline. The contents of the latter were primarily related to short-term athletic performance rather than non-communicable disease prevention, specifically promoting hydration during sports participation, and food and nutrition to support sporting performance. Two NSOs had policies relating to the promotion of healthy food/nutrition more widely. For some NSOs, the lack of health-related policies was not a conscious choice but just not considered previously. Other NSOs reported they lacked resources or had other priorities. CONCLUSIONS: Although this study clearly demonstrates that many NSOs lack adequate health-related policies, this is not necessarily a conscious choice, but the result of a lack of resources, other priorities, or just that they had not considered developing policies in these areas. A number expressed support for these types of policies although it was apparent that some, particularly smaller NSOs, would require assistance in policy template development. It seems probable that the development of health-related policies will only occur if partner agencies become involved.

Immediate or Delayed Sequential Bilateral ICL Surgery: a Survey of Chinese Ophthalmologists.

INTRODUCTION: In China, the demand for implantable collamer lens (ICL) surgery is booming. Immediate sequential bilateral ICL surgery (ISBICLS) benefits patients and clinics, but it remains controversial and lacks standardization. We aim to investigate the prevalence of, factors for, and surgeon attitudes toward ISBICLS. METHODS: In this cross-sectional survey study, an electronic questionnaire about the practice and attitudes toward performing ISBICLS or delayed sequential bilateral ICL surgery (DSBICLS) was distributed to 792 qualified ICL surgeons in Mainland China, between 4 April and 22 April 2022. RESULTS: A total of 531 surgeons (66.79%) from 30 provinces in Mainland China responded. Among them, 374 (67.23%) were currently performing ISBICLS. Fifty-two percent (277) of surgeons reported performing ISBICLS more than 50% of the time, while 85.05% of surgeons chose to perform the second eye surgery 1 day after the first eye surgery. Seventy percent (248) of surgeons performing ISBICLS chose to perform the second eye surgery less than 30 min after the first eye surgery. Surgeons who started ICL surgery earlier (before 2010, OR = 2.772, 95% CI = 1.290-5.957, P = 0.009; 2011-2013, OR = 2.479, 95% CI = 1.060-5.800, P = 0.036), completed one-eye ICL surgery faster (< 3 min, OR = 3.936, 95% CI = 1.505-10.293, P = 0.005) and modified the second eye ICL selection less frequently (1-25%, OR = 0.203, 95% CI = 0.054-0.771, P = 0.019; 26-50%, OR = 0.173, 95% CI = 0.041-0.726, P = 0.017; 51-75%, OR = 0.299, 95% CI = 0.041-0.726, P = 0.123; 76-100%, OR = 0.163, 95% CI = 0.039-0.688, P = 0.014) tended to perform ISBICLS. No significant association was found among clinical settings, preoperative measurement devices, and hospital policies with performing ISBICLS. Regarding their attitudes toward ISBICLS, 54.63% preferred ISBICLS and 45.37% preferred DSBICLS. The main supporting reasons were patient convenience (98.64%), faster vision rehabilitation (73.56%), and improved perioperative compliance (73.22%). The concerns regarding ISBICLS included the risk of endophthalmitis (62.22%), lack of recommendation in expert consensus (61.67%), and decreased vault predictability (60.93%). The most common desires for further adoption were expert consensus on surgical criteria and patient indicators for ISBICLS (82.3%). CONCLUSIONS: ISBICLS has been gradually adopted in Mainland China, but has not been widely accepted as a routine procedure. Surgeons' experience and skills mainly influence whether ISBICLS is performed. Further research is needed to explore standardized protocols to prevent endophthalmitis, the appropriate time interval of two eye surgery, and requisitions for surgeon skills.

The benefits and challenges of taxing sugar in a small island state: an interrupted time series analysis.

BACKGROUND: Beverage and food taxes have become a popular 'best buy' public health intervention in the global battle to tackle noncommunicable diseases. Though many countries have introduced taxes, mainly targeting products containing sugar, there is great heterogeneity in tax design. For taxes levied as import tariffs, there is limited evidence of effectiveness in changing the price and sale of taxed products, while the evidence base is stronger for excise taxes levied as a fixed amount per quantity of product. This paper examines the effect of the Bermuda Discretionary Foods Tax, which was based on import tariff changes, on retail prices and sales of sugar-sweetened beverages (SSBs), and on selected fruits and vegetables that benefited from a tariff reduction. METHODS: We used weekly electronic point-of-sale data from a major food retailer in Bermuda. We assessed historical weekly sales and price data using an interrupted time series design on 2,703 unique products between the dates of January 2018 through January 2020, covering 103 weeks. RESULTS: By January 2020, the average price per ounce of SSBs increased by 26.0%, while the price of untaxed beverages (including waters and non-added sugar drinks) remained constant. The increasing price of SSBs was the sole observable structural driver of SSB market share, responsible for a decrease in the market share by nearly eight percentage points by the end of the study period. The subsidy on fruits and vegetables was ineffective in changing prices and sales, due to the relatively small 5% import tax decrease. CONCLUSIONS: The tax was largely passed through to consumers. However, several factors mitigated the impact of the tax on the prices paid for SSBs by consumers, including the specific design of the tax, price promotions and consumer responses. The experience of Bermuda provides important lessons for the planning of similar taxes in the future.

Intersectoral Action for Addressing NCDs through the Food Environment: An Analysis of NCD Framing in Global Policies and Its Relevance for the African Context.

Noncommunicable diseases contribute the greatest to global mortality. Unhealthy diet-a prominent risk factor-is intricately linked to urban built and food environments and requires intersectoral efforts to address. Framings of the noncommunicable disease problem and proposed solutions within global and African regional diet-related policy documents can reveal how amenable the policy landscape is for supporting intersectoral action for health in low-income to middle-income countries. This study applied a document analysis approach to undertake policy analysis on global and African regional policies related to noncommunicable disease and diet. A total of 62 global and 29 African regional policy documents were analysed. Three problem frames relating to noncommunicable disease and diet were identified at the global and regional level, namely evidence-based, development, and socioeconomic frames. Health promotion, intersectoral and multisectoral action, and evidence-based monitoring and assessment underpinned proposed interventions to improve education and awareness, support structural changes, and improve disease surveillance and monitoring. African policies insufficiently considered associations between food security and noncommunicable disease. In order to effectively address the noncommunicable disease burden, a paradigm shift from 'health for development' to 'development for health' is required across non-health sectors. Noncommunicable disease considerations should be included within African food security agendas, using malnutrition as a possible intermediary concept to motivate intersectoral action to improve access to nutritious food in African low-income to middle-income countries.

Who or what is to blame? Examining sociodemographic relationships to beliefs about causes, control, and responsibility for cancer and chronic disease prevention in Alberta, Canada.

BACKGROUND: Beliefs about causes and responsibility for chronic diseases can affect personal behaviour and support for healthy policies. In this research we examined relationships between socio-demographics (sex, age, education, employment, political alignment, perceived health, household income, household size) and perceptions of causes and responsibility for health behaviour, chronic disease correlates, and attitudes about cancer prevention and causes. METHODS: Using data from the 2016 Chronic Disease Prevention survey in which participants (N = 1200) from Alberta, Canada responded to items regarding how much they believed personal health behaviours, prevention beliefs, and environmental factors (i.e., healthy eating, physical activity, alcohol, smoking, and where a person lives or works) are linked to getting cancer. Participants also responded to questions about causes and responsibility for obesity, alcohol, and tobacco (i.e., individual or societal). Relationships were examined using multinomial logistic regression on socio-demographics and survey items of interest. RESULTS: Men (compared to women) were less likely to link regular exercise, or drinking excessive alcohol, to reducing or increasing cancer risk. Similarly, men were less likely to link environmental factors to cancer risk, and more likely to agree that cancer was not preventable, and that treatment is more important than prevention. Finally, men were more likely to believe that alcohol problems are an individual's fault. Left and central voters were more likely to believe that society was responsible for addressing alcohol, tobacco, and obesity problems compared to right voters. Those with less than post-secondary education were less likely to believe that regular exercise, maintaining a healthy body weight, or eating sufficient fruits and vegetables were linked to cancer - or that society should address obesity - compared to those with more education. Households making above the median income (versus below) were more likely to link a balanced diet with cancer and were less likely to think that tobacco problems were caused by external circumstances. CONCLUSIONS: These results provide insight into the importance of health literacy, message framing, and how socio-demographic factors may impact healthy policy. Men, those with less education, and those with less income are important target groups when promoting health literacy and chronic disease prevention initiatives.

Otolaryngology burden of disease and surgical case triage in resource-limited settings: An example from Cameroon.

OBJECTIVES: Otolaryngology services worldwide faced an unprecedented demand for case triage during the SARS-CoV-2 pandemic. We propose and apply a novel case-leveling schema in a resource-limited setting. Describing the surgical burden of otolaryngologic disease in this setting may critically inform resource planning to address global surgical disparities. METHODS: This is a retrospective study of otolaryngology cases performed over a 28-month period (1/2016-4/2018) at a hospital in rural Cameroon. Case details were collated and categorized as a surrogate measure of otolaryngologic disease in resource-limited settings. A case-levelling schema based on temporal urgency and anticipated impact on health was proposed and applied. RESULTS: 1277 cases took place during the study. The largest proportion of cases were head and neck (517, 40%), followed by pediatrics (316, 25%). A four-tiered leveling system was generated: level 1 cases were immediately life-saving; level 2 cases were expected to result in a significant return to functions of daily living, or would prevent future death from cancer; level 3 cases aimed to significantly improve quality of life; level 4 cases were purely elective. Upon application of the schema, most cases were deemed to be level 2 (661, 52%). CONCLUSION: We use our experience in a resource-limited setting to generate and apply a novel schema to be used for otolaryngology case triage in services facing unprecedented states of emergency such as the SARS-CoV-2 pandemic. This is the first study describing the surgical otolaryngologic disease burden in a resource-limited setting, data which may be used for future resource allocation. LEVEL OF EVIDENCE: 4.

The Relationship between Written District Policies and School Practices among High-Need Districts in New York State.

BACKGROUND: This study tested the hypothesis that written district wellness policies are associated with higher rates of implementation of nutrition and physical activity practices. METHODS: Written wellness policies and building level practices were assessed for schools (N = 295) within high-need districts (N = 70) in New York State. The relationship between policies and practices was measured using multi-level mixed-effects logistic regressions. RESULTS: Overall, stronger written district policies significantly increase the likelihood of practice implementation in schools. This relationship is strongest for physical education and physical activity items, followed by nutrition standards for competitive foods in middle and high schools. Most elementary schools implemented nutrition practices with or without a policy and there were differences in implementation rates between elementary and middle/high schools. When examined separately, policies were for the most part not significantly associated with implementation of corresponding practices. CONCLUSIONS: Strong and comprehensive written policies are associated with higher rates of practice implementation overall, but the consistency of this relationship varies by policy-practice domain. The newer policy topics areas of school wellness promotion and marketing were less frequently included in written policies. Future research should examine whether districts that strengthen their written policies achieve greater implementation over time.

Moving an Evidence-Based Policy Agenda Forward: Leadership Tips From the Field.

Advancing evidence-based policy change is a leadership challenge that nurses should embrace. Key tips to ensure that evidence-based policy changes are successful at the individual, community, and population levels are offered to help nurses through the change process. The public trust in the nursing profession is a leverage point that should be used to advance the use of evidence, expedite change, and improve health for students and across communities.

Pharmacists detecting atrial fibrillation (PDAF) in primary care during the influenza vaccination season: a multisite, cross-sectional screening protocol.

INTRODUCTION: Atrial fibrillation (AF) affects >6% of people aged 65 years or older. Left undetected and untreated, patients may develop significant cardiovascular complications and have a fivefold increased risk of suffering a stroke. For 40% of all sufferers, AF can be asymptomatic. Every year in the UK, £2.2 billion is spent on AF-related strokes, so there is an urgent need to improve early detection of AF. This study aims to determine the feasibility of using trained clinical pharmacists based in general practices, to screen for AF, using pulse palpation and a single-lead ECG device on participants aged 65 years or older, attending influenza vaccination clinics. METHODS AND ANALYSIS: Seven clinical pharmacists will be trained by a cardiologist to pulse palpate and record single-lead ECGs using the AliveCor Kardia Mobile device. Quantitative analysis will assess the accuracy and ability of the clinical pharmacist to identify pulse irregularities using pulse palpation and to record and interpret a single-lead ECG. The level of agreement of pulse irregularities detected by pulse palpation will be compared with those detected by the single-lead ECG device, as will the level of agreement between the cardiologist and the device's interpretation of the ECG. The proportion of people identified with AF (confirmed by the cardiologist) will be determined. Additional demographic data will be obtained from all participants through a questionnaire. Qualitative data will be captured from the participants, from the clinical pharmacists and from the general practitioners and practice staff to determine their views on this method of AF screening. We aim to recruit 600 participants across general practices within Kent. ETHICS AND DISSEMINATION: This protocol was approved by the London-Riverside Research Ethics committee. The findings of this study will be disseminated through forums including, but not limited to, peer-reviewed journals, national and international conferences.

A contribuição da Naturologia para a implementação da política nacional de práticas integrativas e complementares na concepção dos naturólogos que atuam no Sistema Único de Saúde / Contribution of naturology in regard to the implementation of the National Policy of Integrative and Complementary practices into the conception of naturology who work for brazilian Unique Health System

Introdução: Organização Mundial de Saúde (OMS) demonstrou a valorização das Medicinas Tradicionais e Medicinas Alternativas/Complementares como forma de melhorar resultados no campo da saúde. O Brasil atendeu as recomendações da OMS e instituiu a Política Nacional de Práticas Integrativas e Complementares (PNPIC). A PNPIC legitimou a institucionalização destas práticas inaugurando novas perspectivas com foco na saúde e em sua complexidade, visando garantir a integralidade na atenção à saúde. Objetivo: compreender a contribuição da Naturologia para a implementação da PNPIC na concepção de naturólogos que atuam no Sistema Único de Saúde (SUS). Percurso metodológico: realizou-se, no primeiro semestre de 2015, um estudo de campo com abordagem qualitativa, exploratória e descritiva, aprovado pelo Comitê de Ética em Pesquisa da Universidade do Sul de Santa Catarina. Os dados foram coletados através de entrevista semi estruturada com oito naturólogos atuantes em quatro estados brasileiros e tratados por meio da análise do conteúdo de Bardin. Resultados: foram descritos cinco categorias temáticas: (1) O naturólogo em equipe multidisciplinar de saúde, (2) Abordagem do naturólogo no SUS, (3) A implementação da PNPIC nos municípios de atuação, (4) Princípios da Naturologia que contribuem com a implementação da PNPIC e (5) Estratégias para a inserção dos naturólogos no SUS. Considerações finais: Considera-se que a atuação dos naturólogos em equipe multiprofissional contribui com a implementação da PNPIC no SUS, cooperando para que as práticas abarcadas pela PNPIC sejam incorporadas em sua potencialidade desmedicalizante. Esta pesquisa contribui também para refletir a inserção da Naturologia no contexto da saúde pública.(AU)

Introduction: World Health Organization (WHO) has demonstrated the appreciation of Traditional Medicines and Alternative / Complementary Medicines as a way to improve health outcomes. Brazil complied with WHO recommendations and instituted the National Policy on Integrative and Complementary Pratices (PNPIC). The PNPLIClegitimized the institutionalization of these pratices, opening new perspectives with a focus on health and its complexity, aiming to guarantee integrality on health care. Objective: to understand the contribution of Naturology to the implementation of PNPIC in the conception of naturologists who work in the Unified Health System (SUS). Results: five thematic categories were described: (1) The naturologist in a multidisciplinary health team, (2) The naturologist´s approach to the SUS, (3) The implementation of the PNPIC in the minicipalities of operation, (4) Naturology principles that contribute to Implementation of PNPIC and (5) Strategies for the insertion of naturologists in SUS. Final considerations: It is considered that the performance of the naturologists in a multiprofessional team contributes to the implementation of the PNPIC in the SUS, cooperating so that the pratices covered by the PNPIC are incorporated in its demedicalizing potential. This research also contributes to reflect the insertion of Naturology in the context of public health.(AU)

A Cross-Sectional Assessment of the Quality of Physician Quality Reporting System Measures.

BACKGROUND: Starting in 2015, the Center for Medicare and Medicaid Services (CMS) requires all Medicare providers to report quality measures through Physician Quality Reporting System (PQRS) or incur a 1.5 % financial penalty. Research indicates that physicians believe this reporting does not lead to high quality care; however, little research has examined what PQRS actually measures, which is reflective of the physicians and patient disease populations being assessed. OBJECTIVES: (1) Identify the proportion of measures that apply to different medical specialties, types of quality measurement, and National Quality Strategy (NQS) priorities. (2) Identify how different specialties are required to measure quality and NQS priorities. (3) Compare the 2011 and 2015 measures. DESIGN AND MAIN MEASURES: This was a categorical qualitative analysis of 2011 and 2015 PQRS measures. One hundred and ninety-eight and 254 individual measures, respectively, were analyzed by three domains: medical specialty measured, type of measure, and NQS priority category. KEY RESULTS: Between 2011 and 2015, the type of measures changed significantly, with fewer processes (85.4 % vs. 66.5 %, p < 0.001) and more outcomes (12.6 % vs. 29.1 %, p < 0.001). The measures showed no significant specialty or NQS category differences. For subcategories within each specialty in 2015, differences in measure type were statistically significant: surgery had the highest percentage of outcomes (61.1 %) compared to 21.7 % of internal medicine and 5.9 % of obstetrics/gynecology. For NQS categories, internal medicine had the highest percentage of effective clinical care measures (68.5 %), compared to 22.2 % in surgery. Surgery had the highest percentage of patient safety (31.9 %) and communication and care coordination measures (27.8 %) compared with internal medicine (5.4 % and 6.5 %). CONCLUSIONS: Our study shows that PQRS measures include many medical specialties and significantly more outcomes in recent years, particularly for surgery. PQRS still lacks sufficient measures for half of NQS priorities and sufficient outcomes to assess internal medicine and obstetrics/gynecology. CMS must continue to improve PQRS measures to better assess and encourage high-quality care for all Americans.

As representações sociais da judicialização da saúde para profissionais de saúde / The social representations of the health litigation for health professionals

A judicialização da saúde é uma expressão cada vez mais presente nos cenários de assistência à saúde no Brasil materializada, principalmente, pelos mandados judiciais para a realização de procedimentos diagnósticos e terapêuticos, consultas, internações e dispensação de insumos médico-cirúrgicos. Como objetivo geral o estudo visa analisar o processo de judicialização da saúde no Brasil, no âmbito do SUS, a partir dos profissionais de saúde envolvidos nesse processo. Foram definidos como objetivos específicos descrever a estrutura e os conteúdos das representações sociais da judicialização da saúde no âmbito do SUS para gestores, reguladores e profissionais de saúde envolvidos no processo de atendimento às demandas geradas pela prática da ação judicial; comparar as Representações Sociais sobre a judicialização da saúde destes grupos sociais; discutir os conteúdos dessas representações no processo de judicialização da saúde compreendendo o campo social no qual esta questão se insere, as relações de poder que as perpassam e as construções simbólicas que as especificam. Trata-se de um estudo qualitativo, desenvolvido à luz da Teoria das Representações Sociais, realizado com 152 profissionais, em um hospital universitário e na central de regulação de procedimentos e leitos na cidade do Rio de Janeiro. Aplicou-se a Técnica de Evocação Livre através do termo indutor “judicialização da saúde”, sendo essas analisadas com a técnica de quadro de quatro casas e 40 entrevistas semiestruturadas analisadas através da análise de conteúdo temático-categorial instrumentalizada pelo software NVivo. Na análise estrutural foram evocadas 761 palavras, com média das ordens médias de evocação de três, com frequência máxima de 17 e mínima de 10, já a análise processual resultou em seis categorias, com 2257 unidades de registro, distribuídas em 85 temas...

The health litigation is an expression increasingly present in the public institutions of health care in Brazil materialized mainly by warrants for performing diagnostic and therapeutic procedures, consultations, hospitalizations and dispensation of medical and surgical supplies. The study aims to analyze the process of legalization of health in Brazil, under the Unified Health System, from the health professionals involved in this process. Were defined as specific goals the description of the structure and content of the social representations of litigation of health activities and services within the managers, regulators and health professionals involved in the process of legalization of health; the comparison of the social representations about the legalization of that social group and the discussion of the contents of these representations in the legalization of health process. This is a qualitative study, based on the Theory of Social Representations, conducted with 152 subjects in a university hospital and the central of regulation of procedures and beds in the city of Rio de Janeiro. We applied the free word association technique by the inducing term "health litigation", that were analyzed with the technique of four-digit chart and also 40 semi-structured interviews that were analyzed through thematic content analysis, instrumentalized by NVivo software. 761 words were evoked with average sized orders recall of 3, with maximum and minimum frequency of 17 and 10. The procedural analysis resulted in six categories, with 2257 units of analysis, distributed in 85 themes...

O processo de trabalho na alta complexidade no contexto das políticas de controle do câncer no Brasil / The process of working in high complexity in the context of cancer control policies in Brazil

INTRODUÇÃO: Foco do trabalho sobre a organização do processo de controle de câncer. OBJETIVO: Esta dissertação examina em que medida as políticas nacionais para o controle do câncer no Brasil organizam o processo de trabalho na alta complexidade oncológica (ACO), por meio dos recursos humanos em saúde (RHS) oncologistas clínicos, radioterapeutas e físicos médicos vinculados às Redes Estaduais de ACO, a partir das definições estabelecidas pela Portaria SAS/MS N. 741/2005. MATERIAL E MÉTODO: Trata-se de um estudo de caso exploratório. Nele foi realizado um sucinto panorama da oncologia dentro da conjuntura histórica da saúde; apresentadas as três portarias ministeriais direcionadas ao controle câncer no País, e exemplificado, através de relato técnico e referencial teórico baseado nas três dimensões que permeiam os RHS propostas por Pierantoni: estrutural, gerencial e regulatória, de como aconteceu a divulgação das políticas para o controle do câncer no país, e os primeiros desenhos estaduais das redes de serviços de saúde de ACO. Algumas situações observadas sinalizam que, enquanto alguns dos instrumentos existentes na área da oncologia ainda são poucos utilizados pelos gestores no seu processo de planejamento e gestão, outros precisam ser aprimorados. O estudo de caso foi sobre a Rede de Atenção Oncológica do Município do Rio de Janeiro de 2008, composta por hospitais federais, estaduais, municipais, universitários e filantrópicos, todos na gestão municipal. No plano das análises destacam-se três elementos: a caracterização desses serviços de saúde; os parâmetros de cobertura assistencial e produção ambulatorial de quimioterapia e radioterapia e o número e carga horária dos RHS. O Cadastro Nacional de Estabelecimentos de Saúde do Departamento de Informação do SUS (DATASUS) e o Sistema de Informação Ambulatorial são utilizados como fontes de dados por representarem um banco de dados que podem contribuir para a gestão da área oncológica, ampliando, assim, sua utilidade para o SUS. CONCLUSÃO: Por fim, os achados possibilitam uma reflexão tanto pela ótica da gestão do trabalho quanto da gestão da educação em saúde, de como está se configurando a alta complexidade oncológica e quais os atuais limites e possibilidades para incluir o dimensionamento das categorias profissionais estudadas nos instrumentos normativos ministeriais.

INTRODUCTION: Focus work on the organization of the cancer control process. OBJECTIVE: This dissertation examines at which level the national policies for cancer control in Brazil organize the work process in oncological high complexity, through human resources in health (HRH) - clinical oncologists, radiotherapists and medical physicists - bound to the State oncological high complexity network, from the definitions established by the SAS/MS Order # 741/2005. MATERIAL AND METHOD: It is an exploratory case study, which brings a brief overview of Oncology in the historical context of health. The three ministerial resolutions directed to the control of cancer in the country are presented and, through technical report and theoretical referential based on the three dimensions that permeate the HRH proposed by Pierantoni (structural, management and regulatory), exemplify how the dissemination of the cancer control policies in the country and the first State sketches of the oncological high complexity network came to be. Some situations encountered indicate that while some of the instruments in the area of oncology are still little used by the managers in their planning and management process, others need to be improved. The case study was on the Oncological Care Network in Rio de Janeiro 2008, composed of federal, state, municipal, university and philanthropic hospitals, all under municipal management. In terms of analysis, three elements stand out: the characterization of these health services, the parameters of care coverage and ambulatorial production of chemotherapy and radiotherapy and the number and workload hours of the human resources in health. The National Registry of Health Facilities of the SUS Information Department (DATASUS) and the Ambulatorial Information System are used as data sources, as they represent a data bank that may contribute to the management of the oncological area, this way widening its utility to the SUS. CONCLUSÃO: Finally, the findings allow a reflection from both the perspectives of work management and management education in health, on how is the oncological cancer care configuring itself and what are the actual limits and possibilities to have the dimensioning of the studied professional categories included in the ministerial normative instruments.