Political factors, entrepreneurship and female employment vulnerability in sub-Saharan Africa.

This study examines the relationship between political factors, entrepreneurship, and female employment vulnerability in sub-Saharan Africa. Using data from the World Development Indicators (WDI) and World Governance Indicators (WGI) of the World Bank for the period 2001 - 2022, the study employs the Generalised Method of Moments to control for endogeneity. The results show that there exists an elastic relationship between voice and accountability and female vulnerability to employment in these sub-regions. It implies that a percentage increase in voice and accountability will result in a 11.9%, 3.07%, 1.08% decrease in female vulnerability to employment in Central, East, West and Southern Africa, respectively. These findings suggest that improving political institutions and reducing corruption could help to promote female entrepreneurship and reduce vulnerability in Sub-Saharan Africa.

Cette étude examine la relation entre les facteurs politiques, l'entrepreneuriat et la vulnérabilité de l'emploi des femmes en Afrique subsaharienne. Utilisant les données des Indicateurs de développement dans le monde (WDI) et des Indicateurs de gouvernance mondiale (WGI) de la Banque mondiale pour la période 2001-2022, l'étude utilise la méthode généralisée des moments pour contrôler l'endogénéité. Les résultats montrent qu'il existe une relation élastique entre la voix et la responsabilité et la vulnérabilité des femmes à l'emploi dans ces sous-régions. Cela implique qu'une augmentation en pourcentage de la voix et de la responsabilité entraînera une diminution de 11,9 %, 3,07 % et 1,08 % de la vulnérabilité des femmes à l'emploi en Afrique centrale, orientale, occidentale et australe, respectivement. Ces résultats suggèrent que l'amélioration des institutions politiques et la réduction de la corruption pourraient contribuer à promouvoir l'entrepreneuriat féminin et à réduire la vulnérabilité en Afrique subsaharienne.

Neighbourhood sociodemographic factors and COVID-19 vaccine uptake in the Netherlands: an ecological analysis.

BACKGROUND: While overall COVID-19 vaccine uptake is high in the Netherlands, it lags behind in certain subpopulations. AIM: We aimed to explore the characteristics of groups with lower COVID-19 vaccine uptake at neighbourhood level to inform the strategy to improve uptake and guide research into barriers for vaccination. METHODS: We performed an ecological study using national vaccination register and socio-demographic data at neighbourhood level. Using univariate and multivariable generalized additive models we examined the (potentially non-linear) effect of each determinant on uptake. We focused on those aged 50 years and older, since they are at highest risk of severe disease. RESULTS: In those over 50 years of age, a higher proportion of individuals with a non-Western migration background and higher voting proportions for right-wing Christian and conservative political parties were at neighbourhood level univariately associated with lower COVID-19 vaccine uptake. In contrast, higher socioeconomic status and higher voting proportions for right-wing liberal, progressive liberal and Christian middle political parties were associated with higher uptake. Multivariable results differed from univariate results in that a higher voting proportion for progressive left-wing political parties was also associated with higher uptake. In addition, with regard to migration background only a Turkish background remained significant. CONCLUSION: We identified determinants associated with COVID-19 vaccine uptake at neighbourhood level and observed heterogeneity in uptake between different subpopulations. Since the goal of vaccination is not only to reduce suffering and death by improving the average uptake, but also to reduce health inequity, it is important to focus on subpopulations with lower uptake.

Determinants of COVID-19 Vaccine Uptake in The Netherlands: A Nationwide Registry-Based Study.

By September 2022, the uptake of at least one dose of COVID-19 vaccine in the Dutch adult population was 84%. Ecological studies have indicated a lower uptake in certain population groups. We aimed to investigate determinants of COVID-19 vaccine uptake in the Netherlands at individual level to evaluate and optimize implementation of the vaccination program and generate hypotheses for research on drivers of, and barriers to, vaccination. A retrospective database study was performed including the entire Dutch population ≥ 18. Vaccination data (5 January 2021-18 November 2021) were at individual levels linked to sociodemographic data. Random forest analyses ranked sociodemographic determinants of COVID-19 vaccine uptake. The most important determinant was age; uptake increased until the age of 80 (67% in 18-35 years, 92% in 67-79 years, and 88% in those > 80). Personal income and socioeconomic position ranked second and third, followed by migration status. Uptake was lower among individuals in the lowest income group (69%), those receiving social benefits (56%), and individuals with two parents born abroad (59%). Our finding that age is the most important determinant for uptake likely reflects the prioritisation of elderly in the programme and the general understanding of their increased vulnerability. However, our findings also reveal important other disparities in vaccine uptake. How to best address this inequity in future vaccination campaigns requires further research.

The pervasive association between political ideology and COVID-19 vaccine uptake in Brazil: an ecologic study.

BACKGROUND: Despite the unequivocal benefits of vaccination, vaccine coverage has been falling in several countries in the past few years. Studies suggest that vaccine hesitancy is an increasingly significant phenomenon affecting adherence to vaccines. More recently, during the COVID-19 pandemic, political views have emerged as an additional influencing factor for vaccine hesitancy. METHODS: In this ecologic study, we used information from publicly available databases to investigate the association between political ideology, depicted by the percentage of votes for the right-wing candidate Jair Bolsonaro in the presidential elections of 2018 and 2022, and COVID-19 vaccination in Brazilian municipalities. The primary endpoint was the COVID-19 vaccination index, calculated as the number of COVID-19 vaccine doses administered up to September 2022 divided by the number of inhabitants in each municipality. The analysis was conducted using Pearson correlation coefficients and linear regression models adjusted for HDI, the percentage of male voters, the percentage of voters who were older than 50 years old, and the percentage of voters with a middle school education or less. In addition, we explored whether the effect of the percentage of Bolsonaro voters on the COVID-19 vaccination index was modified in different quartiles of HDI using an interaction term. RESULTS: Five thousand five hundred sixty-three Brazilian municipalities were included in the analysis. For both the 2018 and 2022 elections, the percentage of votes for Jair Bolsonaro was significantly and inversely associated with COVID-19 vaccine uptake after adjustment for the sociodemographic characteristics of the voters (change in mean vaccination index in 2018 for each 1% increase in Bolsonaro voters -0.11, 95% confidence interval [CI] -0.13 to -0.08, p < 0.001; change in mean vaccination index in 2022 for each 1% increase in Bolsonaro voters -0.09, 95% CI -0.11 to -0.07, p < 0.001). We also found a statistically significant interaction between the primary predictor of interest and HDI scores, with a more significantly detrimental effect of the right-wing political stance in municipalities in the lower HDI quartiles (interaction p < 0.001 for the first HDI quartile; p = 0.001 for the second HDI quartile). CONCLUSION: Our findings suggest that political ideologies have influenced COVID-19 vaccine hesitancy in Brazilian municipalities, affecting communities inequitably. The politicization of vaccines is a new challenge for vaccine programs. Strategies to face these challenges should include joint efforts from governments and civil society for a common public health goal.

[ROWING AGAINST THE CURRENT]. / REMANDO A CONTRACORRIENTE.

At Lalonde we know that the determinants that most influence the health of the population are lifestyle, genetics and the environment. Health represents only 10% and is the determinant that consumes the most resources. It has been shown that a salutogenic approach focused on the social determinants of health and the support of public policies to improve the environment are more efficient in the long term than medicine focused on hospitals, technology and super-specialization. Primary Care (PC) that has an approach centered on the person and families with a community vision, is the ideal level to provide health care, and to influence lifestyles. However it is not invested in PC. In this article we review the socioeconomic and political factors that globally influence the lack of interest in the development of PC.

Remando a contracorriente / Rowing against the current

At Lalonde we know that the determinants that most influence the health of the population are lifestyle, genetics and the environment. Health represents only 10% and is the determinant that consumes the most resources. It has been shown that a salutogenic approach focused on the social determinants of health and the support of public policies to improve the environment are more efficient in the long term than medicine focused on hospitals, technology and super-specialization. Primary Care (PC) that has an approach centered on the person and families with a community vision, is the ideal level to provide health care, and to influence lifestyles. However it is not invested in PC. In this article we review the socioeconomic and political factors that globally influence the lack of interest in the development of PC.(AU)

Desde Lalonde sabemos que los determinantes que más influyen en la Salud de la población son el estilo de vida, la genética y el entorno. La sanidad representa solo el 10% y es el determinante que más recursos consume. Está demostrado que un enfoque salutogénico centrado en los determinantes sociales de la salud y el apoyo de políticas públicas para mejorar el entorno, son más eficientes a largo plazo que la medicina centrada en los hospitales, la tecnología y la superespecialización. La Atención Primaria (AP) que tiene un enfoque centrado en la persona y las familias con una visión comunitaria, es el nivel idóneo para proveer atención sanitaria, y para influir en los estilos de vida. Sin embargo no se invierte en AP. En este artículo revisamos los condicionantes socioeconómicos y políticos que influyen de manera global en la falta de interés en el desarrollo de la AP.(AU)

A COVID-19 Lesson: Better Health Emergency Preparedness Standards Are Needed.

This article reports on an assessment of the value of 4 widely recognized standards of health sector emergency preparedness as predictors of effective preparedness for, and response to, the COVID-19 pandemic in the United States. The standards are sponsored by the National Health Security Preparedness Index (NHSPI), the Trust for America's Health (TFAH), the Emergency Management Accreditation Program (EMAP), and the Public Health Accreditation Board (PHAB). The measure of effectiveness was states' cumulative COVID-19 deaths per 100,000 population, from January 21, 2020, through January 20, 2022. Linear regression analysis found no statistically significant associations when controlling for 3 intervening variables. Cross-tabulation of states' preparedness status with their COVID-19 death rates found that high NHSPI and TFAH preparedness scores were generally, but not uniformly, associated with lower death rates. EMAP and PHAB accreditation had negligible association with low or high death rates. Lack of accreditation was associated with lower death rates. Higher prior state public health spending related to COVID-19 preparedness and higher state household income, an indicator of state economic strength, were associated with lower death rates. States with Democratic control of the legislative and executive branches of government generally had substantially lower death rates than states with Republican control. A science-based, practice-oriented research initiative is recommended to improve the predictive power of health sector preparedness standards and to enhance protection for US residents from large-scale future health threats.

Comparing the magnitude of oral health inequality over time in Canada and the United States.

OBJECTIVES: To assess the magnitude of, and changes in, absolute and relative oral health inequality in Canada and the United States, from the 1970s till the first decade of the new millennium. METHODS: Data were obtained from four national surveys; two Canadian (NCNS 1970-1972 and CHMS 2007-2009) and two American (HANES 1971-1974 and NHANES 2007-2008). The slope and relative index of inequality were used to measure absolute and relative inequality, respectively. Percentage change in inequality was also calculated. RESULTS: Relative inequality for untreated decay increased by 91% in Canada and 189% in the United States, while for filled teeth it declined by 63% in Canada and 16% in the United States. Relative inequality in edentulism rose by 200% and 78% in Canada and United States, respectively. Absolute inequality declined in both countries. CONCLUSIONS: There was persistent absolute and relative inequality in Canada and the United States. An increase in relative inequality for adverse outcomes suggests that improvements in oral health were occurring primarily among the rich, while reductions in relative inequality for filled teeth indicate higher utilization of restorative services among the poor. These results point to the necessity of tackling the sociopolitical determinants of health to mitigate oral health inequality in Canada and the United States.

Coalizão partidária, aporte financeiro e desempenho da assistência médica e odontológica em duas regiões de saúde brasileiras / Party coalitions, budget outlay, and performance of medical and dental care in two health regions of Brazil / Coalición partidaria, aporte financiero y desempeño de la asistencia médica y odontológica en dos regiones de salud brasileñas

Coalizações de governo distintas encontram limites para produzir mudanças na orientação de políticas. O objetivo foi descrever a orientação política dos partidos de coalização, o aporte financeiro, a estrutura e o desempenho da assistência médica e odontológica em duas regiões de saúde brasileiras distintas socioeconomicamente e na oferta de serviços. Utilizaram-se indicadores a partir de dados oficiais relativos ao período de 2007 a 2014 e caraterísticas da coalização partidária definidas pelas preferências eleitorais municipais e de intensidade da competição eleitoral em cada estado da respectiva região. Maior aporte financeiro per capita e maior porcentagem de população potencialmente coberta pela atenção básica e pelas equipes de saúde bucal da Estratégia Saúde da Família estavam relacionados com o município-polo da região de coalização partidária mais à esquerda, ao passo que o município-polo da região de coalização partidária mais à direita mostrou aumento expressivo na porcentagem de população potencialmente coberta por médicos. Em ambos os municípios-polo, a efetividade melhorou. Os achados confirmaram a noção de que as coalizações mais à esquerda aportam mais recursos em políticas sociais, mas encontram limites para superar desigualdades estruturais e converter suas preferências programáticas em políticas efetivas.

Various government coalitions encounter limits when attempting to implement policy changes. The study aimed to describe the policy orientation of party coalitions, budget outlay, and the structure and performance of medical and dental care in two health regions of Brazil with different socioeconomic conditions and supplies of services. The indicators used were based on official data from 2007 and 2014 and characteristics of the party coalition defined by municipal electoral preferences and the intensity of electoral competition in each state of the respective major geographic region. Higher per capita budget outlay and higher percentage of the population potentially covered by primary care and by the oral health teams under the Family Health Strategy were related to the regional hub municipality with a more left-leaning party coalition, while the regional hub municipality with the more right-leaning party coalition showed an important increase in the percentage of the population potentially covered by physicians. The effectiveness improved in both hub municipalities. The findings confirmed the notion that more left-leaning coalitions tend to earmark more budget resources for social policies but encounter limits for overcoming structural inequalities and for converting their platform preferences into actual policies.

Coaliciones de gobierno distintas encuentran límites para producir cambios en la orientación de políticas. El objetivo fue describir la orientación política de los partidos de coalición, el aporte financiero, la estructura y desempeño de la asistencia médica y odontológica en dos regiones de salud brasileñas, distintas socioeconómicamente y en la oferta de servicios. Se utilizaron indicadores a partir de datos oficiales relacionados con el período de 2007 a 2014 y características de la coalición partidaria, definidas por las preferencias electorales municipales y de intensidad en la competición electoral en cada estado de la respectiva región. Mayor aporte financiero per cápita y mayor porcentaje de población potencialmente cubierta por la atención básica y por los equipos de salud bucal de la Estrategia Salud de la Familia estaban relacionados con el municipio polo de la región de la coalición partidaria más a la izquierda, mientras que el municipio polo de la región de coalición partidaria más a la derecha mostró un aumento expresivo en el porcentaje de población potencialmente cubierta por médicos. En ambos municipios polo, la efectividad mejoró. Los resultados confirmaron la noción de que las coaliciones más a la izquierda aportan más recursos en políticas sociales, pero encuentran límites para superar desigualdades estructurales y convertir sus preferencias programáticas en políticas efectivas.

Catalizando cambios sociales y bioculturales sobre el cáncer. Diseño de acciones transdisciplinarias contra la pandemia / Catalyzing biocultural and social changes about cancer. Design of transdisciplinary actions against the pandemic

RESUMEN Objetivo Diseñar y analizar una experiencia de formación y organización transdisciplinaria sobre el cáncer, en la que expertos de múltiples disciplinas y actores con diferentes horizontes convergen en un diagnóstico y un panorama de intervención en múltiples escalas. Método Se diseñó e implementó un diplomado de 140 horas con más de 60 ponentes y 50 actores relevantes en torno al cáncer. Se llevó a cabo un taller transversal de 20 horas, usando como mediación las metodologías del diseño para la transición, que proponen estrategias para la construcción de diagnósticos e intervenciones en problemáticas complejas y conflictivas. Resultados Se logró construir un mapa de actores, preocupaciones, conflictos, causas-raíces, escenarios ideales y modelos potenciales de intervención con base en un trabajo colegiado. Se generaron recursos visuales que funcionan como mapas y estructuras donde se ubican los factores bioculturales que facilitan o impiden la efectiva implementación de estrategias de intervención. Las infografías y tablas funcionaron como mediaciones transdisciplinarias en tanto que posibilitaron que el espacio político (múltiples actores) fuera también un espacio pedagógico (múltiples epistemologías) situado en un contexto económico y ecológico concreto (interdependencia material de actores y ambientes). Conclusión Con la metodología del diseño para la transición se logró catalizar un trabajo transdisciplinario entre expertos y actores sociales en torno al cáncer. A través de las mediaciones visuales como mapas, infografías y tablas, se logró sintetizar y usar un diagnóstico compartido y avanzar así en intervenciones más incluyentes que reconozcan la complejidad biocultural de esta pandemia.(AU)

ABSTRACT Objective Design and analyze a transdisciplinary training and organization experience on cancer, where experts from multiple disciplines and actors with different horizons converge on a diagnosis and intervention horizon on multiple scales. Method A 140-hour diploma course with more than 60 speakers and 50 relevant actors around cancer was designed and implemented. A 20-hour transversal workshop was developed, using the Design for Transition methods as mediation of collaborative strategies for the construction of diagnoses and interventions in complex and conflict situations. Results It was possible to build a series of maps with a common view of stakeholders, concerns, conflicts, root causes, ideal scenarios and potential models of intervention, based on diverse participant's input. The visual resources generated were able to function as guides and structures that made possible the identification of biocultural factors that facilitate or impede implementation of strategies and interventions. Infographic material functioned as transdisciplinary mediations that enabled a diverse political (multiple-actors) and pedagogical (multiple-epistemologies) space to act upon an economic and ecological context (material interdependence of actors and environments). Conclusion The Design for Transition methodology catalized transdisciplinary work by enabling cancer experts and social actors interactions. Through visual mediations such as maps, infographics and tables, it was possible to synthesize and use a shared diagnosis and thus advance towards more inclusive interventions that recognize the biocultural complexity of this pandemic.(AU)

Fatores críticos de sucesso das Parcerias Público-Privadas: aspetos político-institucionais. Estudo de caso das rodovias em Portugal / Factores críticos de rendimiento de los Consorcios Público-Privados: aspectos político-institucionales. Estudio de caso de infraestructura vial en Portugal / Critical success factors of Public-Private Partnerships: political and institutional Aspects. Case study of highways in Portugal

Resumo As Parcerias Público-Privadas (PPP) são arranjos institucionais que envolvem atores públicos e privados numa relação contratual de longa duração. Assumindo-se como contratos incompletos, propendem para o aumento dos custos de transação e estão associadas aos problemas típicos das relações de principal-agente. Neste contexto, a academia tem dedicado atenção ao estudo dos fatores críticos para o bom desempenho das PPP, entre os quais, os fatores de natureza política e institucional, a que dedicamos o artigo. Por meio de uma metodologia qualitativa, assente na realização de entrevistas em profundidade e numa criteriosa análise documental, o artigo propõe-se estudar o caso das PPP de infraestruturas rodoviárias em Portugal, com falhas já identificadas e atualmente sob forte escrutínio público.

Resumen Los Consorcios Público-Privados (CPP) son arreglos institucionales donde participen agentes públicos y privados en una relación contractual de larga duración. Como contratos incompletos, os CPP tienden a un aumento de los costos de transacción y están asociados con los problemas típicos de las relaciones de principal-agente. En este contexto, la academia ha dedicado atención al estudio de los factores críticos para el rendimiento del CPP, incluyendo los factores políticos y institucionales, al que dedicamos el artículo. A través de una metodología cualitativa, basada en la realización de entrevistas en profundidad y un análisis exhaustivo de los documentos, el artículo propone estudiar el caso de CPP de infraestructura vial en Portugal, con deficiencias ya identificadas y actualmente bajo un intenso escrutinio público.

Abstract Public-Private Partnerships (PPPs) can be defined as institutional arrangements involving public and private actors in long-term contracts. Considered incomplete contracts, PPPs tend to have increased transaction costs and are associated with the typical problems of principal-agent relationships. In this context, the academy has devoted attention to the study of the critical factors to the performance of PPPs, including political and institutional factors, which is also the focus of this article. Through a qualitative study, based on in-depth interviews and intensive documental analysis, this article aims to study the case of PPPs of highways in Portugal, which have flaws and are currently under great public scrutiny.

Despesas de Campanha e Sucesso Eleitoral nos Pleitos Legislativos Brasileiros / Campaign Expenses and Candidate Success in Brazilian Legislative Elections / Dépenses de Campagne et Succès Électoraux Lors des Scrutins Législatifs Brésiliens / Los Gastos de Campaña y el Éxito Electoral en las Elecciones Legislativas Brasileñas

RESUMO Este artigo contribui para a crescente literatura nacional sobre os determinantes do sucesso em pleitos legislativos por meio da mensuração do impacto eleitoral de fatores financeiros, políticos e pessoais associados aos candidatos à Assembleia Legislativa do Ceará em 2010. Escolheu-se um estado de porte mediano para minimizar o potencial problema de endogeneidade e maximizar a homogeneidade da amostra, de modo a se obterem resultados estatísticos mais robustos. Da aplicação empírica baseada em modelos com dados contáveis, destacam-se as seguintes constatações: 1) os impactos na votação diferem drasticamente de acordo com a localização geográfica dos municípios; 2) características pessoais dos candidatos são relevantes para a obtenção de votos, sobressaindo a condição de casado; 3) dentre as variáveis políticas, a filiação a um partido que integra a coligação do governador é importante apenas para candidatos eleitos com votos obtidos na região metropolitana, não tendo nenhuma delas se revelado significante para os não eleitos; 4) candidatos incumbentes possuem vantagem significativa na obtenção de votos; 5) as despesas declaradas de campanha são decisivas para o desempenho eleitoral dos candidatos. Essa última verificação empírica revela um grave problema relativo ao funcionamento das instituições representativas de um país profundamente desigual do ponto de vista socioeconômico.

ABSTRACT The following article contributes to the growing body of national literature on the drivers of success in legislative elections by gauging the electoral impact of financial, political, and personal factors associated with the candidates running for Ceará Legislative Assembly in 2010. Medium in size, the state was chosen in order to minimize any potential issues of endogeneity and to maximize the homogeneity of the sample, in order to obtain more robust statistical results. A subsequent empirical application based on models for discrete data was carried out, highlighting the following facets: 1) the impacts of the vote varied dramatically according to the geographical location of the municipalities; 2) the candidates' personal characteristics were relevant to their obtaining of votes, particularly their marital status; 3) within the political variables, an affiliation to a party in the governor's coalition was only significant for the candidates elected via votes from the metropolitan region, with none of these variables proving significant for those not to have been elected; 4) incumbent candidates enjoyed a significant advantage in the obtaining of votes; 5) the campaign expenses declared influenced the candidates' electoral performance. The final empirical finding reveals a grave problem in the workings of representative institutions in a country profoundly unequal from a socioeconomic perspective.

RÉSUMÉ Cet article veut contribuer à l'essor de la littérature nationale sur les déterminants des succès électoraux grâce à la mesure de l'impact électoral des facteurs financiers, politiques et personnels associés aux candidats aux élections législatives de l'État du Ceará en 2010. Nous avons choisi un État de taille moyenne pour minimiser le problème potentiel de l'endogénéité et potentialiser l'homogénéité de l'échantillon, et ce afin d'obtenir des résultats statistiques les plus fiables possibles. L'application empirique basée sur des modèles pour données discrètes nous a permis de faire les constatations suivantes: 1) les impacts sur le vote diffèrent drastiquement en fonction de la localisation géographique des communes; 2) les caractéristiques personnelles des candidats sont pertinentes pour l'obtention de voix, et en particulier le fait d'être marié; 3) parmi les variables politiques, la filiation à un parti intégrant la coalition du gouverneur n'est importante que pour les candidats élus avec des voix obtenues dans la région métropolitaine de la capitale, et n'est significative pour aucun des candidats non élus; 4) les candidats sortants disposent d'un avantage significatif dans l'obtention des voix; 5) les dépenses de campagne déclarées ont une influence décisive sur la performance électorale des candidats. Cette dernière vérification empirique révèle un grave problème de fonctionnement des institutions représentatives d'un pays profondément inégal du point de vue socio-économique.

RESUMEN Este artículo contribuye a la creciente literatura nacional sobre los aspectos determinantes del éxito en las elecciones legislativas por medio de la medición del impacto electoral de factores financieros, políticos y personales asociados a los candidatos a la Cámara Legislativa del Estado de Ceará en 2010. Se optó por un estado de medianas dimensiones para minimizar el potencial problema de endogeneidad y maximizar la homogeneidad de la muestra, con objeto de obtener unos resultados estadísticos más fiables. De la aplicación empírica basada en modelos con datos contables, destacan las siguientes constataciones: 1) los impactos en la votación difieren drásticamente en función de la localización geográfica de los municipios; 2) las características personales de los candidatos son relevantes para obtener votos, y destaca sobre todo el hecho de que estén casados o no; 3) entre las variables políticas, la afiliación a un partido que integra la coalición del gobernador es importante solo para los candidatos elegidos con votos obtenidos en la región metropolitana, pero ninguna de ellas se reveló significativa para los no elegidos; 4) los candidatos en el poder tienen una gran ventaja en la obtención de votos; 5) los gastos declarados de la campaña son decisivos para los resultados electorales de los candidatos. Esta última confirmación empírica revela un grave problema en lo relativo al funcionamiento de las instituciones representativas de un país profundamente desigual desde el punto de vista socioeconómico.

Influences on GP coping and resilience: a qualitative study in primary care.

BACKGROUND: 'Neoliberal' work policies, austerity, NHS restructuring, and increased GP consultation rates provide the backdrop against increasing reports of GP burnout and an impending shortage of GPs. AIM: To explore GPs' experiences of workplace challenges and stresses, and their coping strategies, particularly focusing on understanding the impact of recent NHS workplace change. DESIGN AND SETTING: Study design was qualitative, with data collected from two focus groups and seven one-to-one telephone interviews. METHOD: Focus groups and one-to-one telephone interviews explored the experiences of GPs currently practising in England, recruited through convenience sampling. Data were collected using a semi-structured interview approach and analysed using thematic analysis. RESULTS: There were 22 GP participants recruited: focus groups (n = 15) and interviews (n = 7). Interviewees understood GPs to be under intense and historically unprecedented pressures, which were tied to the contexts in which they work, with important moral implications for 'good' doctoring. Many reported that being a full-time GP was too stressful: work-related stress led to mood changes, sleep disruption, increases in anxiety, and tensions with loved ones. Some had subsequently sought ways to downsize their clinical workload. Workplace change resulted in little time for the things that helped GP resilience: a good work-life balance and better contact with colleagues. Although some GPs were coping better than others, GPs acknowledged that there was only so much an individual GP could do to manage their stress, given the external work issues they faced. CONCLUSION: GPs experience their emotional lives and stresses as being meaningfully shaped by NHS factors. To support GPs to provide effective care, resilience building should move beyond the individual to include systemic work issues.

Introducing modern technology to promote transparency in health services.

PURPOSE: Quantitative indicators show that Bangladeshi maternal and child healthcare is progressing satisfactorily. However, healthcare quality is still inadequate. It is hypothesised that modern technology enhances healthcare quality. Therefore, the purpose of this paper is to investigate how modern technology such as electronic record keeping and the internet can contribute to enhancing Bangladeshi healthcare quality. This study also explores how socio-economic and political factors affect the healthcare quality. DESIGN/METHODOLOGY/APPROACH: This paper is based on a qualitative case study involving 68 in-depth interviews with healthcare professionals, elected representatives, local informants and five focus group discussions with healthcare service users to understand technology's effect on health service quality. The study has been conducted in one rural and one urban service organisations to understand how various factors contribute differently to healthcare quality. FINDINGS: The findings show that modern technology, such as the internet and electronic devices for record keeping, contribute significantly to enhancing health service transparency, which in turn leads to quality health and family planning services. The findings also show that information and communication technology (ICT) is an effective mechanism for reducing corruption and promoting transparency. However, resource constraints impact adversely on the introduction of technology, which leads to less transparent healthcare. Progress in education and general socio-economic conditions makes it suitable to enhance ICT usage, which could lead to healthcare transparency, but political and bureaucratic factors pose a major challenge to ensure transparency. PRACTICAL IMPLICATIONS: This paper can be a useful guide for promoting governance and healthcare quality in developing countries including Bangladesh. It analyses the ICT challenges that healthcare staff face when promoting transparent healthcare. ORIGINALITY/VALUE: This paper provides a deeper understanding of transparency and healthcare quality in an ICT context using empirical data, which has not been explored in Bangladesh. This critical thinking is useful for policy makers and healthcare practitioners for promoting health service quality.

The future of medical dosimetry.

The world of health care delivery is becoming increasingly complex. The purpose of this manuscript is to analyze current metrics and analytically predict future practices and principles of medical dosimetry. The results indicate five potential areas precipitating change factors: a) evolutionary and revolutionary thinking processes, b) social factors, c) economic factors, d) political factors, and e) technological factors. Outcomes indicate that significant changes will occur in the job structure and content of being a practicing medical dosimetrist. Discussion indicates potential variables that can occur within each process and change factor and how the predicted outcomes can deviate from normative values. Finally, based on predicted outcomes, future opportunities for medical dosimetrists are given.

Raising the priority of chronic noncommunicable diseases in the Caribbean / Aumentar la prioridad de las enfermedades crónicas no transmisibles en el Caribe

The Caribbean's long history of cooperation in health now focuses on noncommunicable diseases (NCDs), given that Caribbean Community (CARICOM) countries have the highest NCD burden in the Americas. The heads of government convened a first in the world one-day summit on NCDs, largely due to advocacy by George Alleyne and others, on the health, social, and economic impact of NCDs; the need for upstream multisectoral interventions to address the common, multifactoral risks; and the need for increased global attention to NCDs. Implementation of the NCD Summit Declaration mandates was most effective in larger countries with greater capacity, but countries of all sizes performed well, when they had regional or global support. Progress was limited in regional approaches to food security, labeling, and elimination of trans fats. Inadequate funding stymied several resource-dependent interventions. Monitoring mechanisms were established, but more concrete goals are needed, especially for actions of nonhealth government agencies.

La larga trayectoria de cooperación de los países del Caribe en materia de salud se centra ahora en las enfermedades no transmisibles (ENT), puesto que los países integrantes de la Comunidad del Caribe (CARICOM) soportan la mayor carga de estas enfermedades en la Región de las Américas. Los jefes de gobierno convocaron una cumbre de un día, la primera del mundo, sobre las ENT, en gran parte gracias a la tarea de concientización llevada a cabo por George Alleyne y otros, con objeto de tratar las repercusiones sanitarias, sociales y económicas de las ENT; la necesidad de intervenciones multisectoriales tempranas para abordar los riesgos comunes y multifactoriales; y la necesidad de que se conceda mayor atención a las ENT a escala mundial. La ejecución de los mandatos de la Declaración de la Cumbre sobre las ENT fue más eficaz en los países más grandes y con mayor capacidad, pero países de distintos tamaños actuaron satisfactoriamente cuando contaron con la ayuda regional o mundial. En los enfoques regionales, el progreso se limitó a la seguridad alimentaria, la rotulación y la eliminación de las grasas trans. El financiamiento insuficiente obstaculizó diversas intervenciones que dependían del aporte de recursos. Se establecieron mecanismos de vigilancia, pero es preciso establecer metas más concretas, especialmente en lo referente a las actividades de los organismos gubernamentales de ámbitos ajenos a la salud.

Factores económicos relacionados con los Objetivos de Desarrollo del Milenio en salud: una revisión bibliográfica / Economic factors related to the Millennium Development Goals: a literature review

OBJETIVOS: Sistematizar la información publicada sobre la situación y los avances en el logro de los Objetivos de Desarrollo del Milenio relacionados con la salud (ODMS), así como analizar su asociación con algunos factores económicos y los pronósticos de cumplimiento. MÉTODOS: Se realizó una búsqueda de los artículos científicos sobre los Objetivos de Desarrollo del Milenio en general publicados entre el 1 de enero de 2000 y el 31 de agosto de 2006 en las bases bibliográficas electrónicas EBSCO, CSA Illumina, Thomson Gale, SwetsWise y BIREME. Se seleccionaron los artículos originales en inglés o español que evaluaran la situación de los ODMS o sus avances y se refirieran a factores determinantes. Se analizó la distribución de los factores determinantes de la situación de los ODMS o sus avances, los ODMS referidos, el tipo de evaluación, la relación entre los indicadores económicos y la salud, el lugar estudiado, y la situación y los pronósticos del cumplimiento de los ODMS. Se valoró la calidad de los artículos. RESULTADOS: Se identificaron 304 artículos originales, de ellos 114 (37,5 por ciento) se ocupaban de uno o varios ODMS. Los objetivos relacionados con la mortalidad infantil y materna fueron los más frecuentemente abordados. De los 39 artículos que evaluaban los ODMS y su relación con los factores económicos, en 13 se consideraban factores económicos relacionados con la equidad, la política o la globalización. Los factores económicos y políticos fueron los más frecuentemente asociados con la situación de los ODMS o sus avances. CONCLUSIONES: Existe una tendencia a utilizar variables económicas vinculadas con las condiciones de la población para analizar la situación de los ODMS y sus avances. Falta información sobre la relación con el gasto gubernamental, el comercio exterior, la ayuda externa y las políticas económicas mundiales. Los pronósticos para lograr los ODMS en los países pobres son desfavorables.

OBJECTIVES: To systematize all the information published on the status of and progress made toward the Health-related Millennium Development Goals (HMDGs), as well as to understand associations with certain economic factors and the potential for success. METHODS: A search was conducted for all scientific articles covering the Millennium Development Goals in general, published from 1 January 2000 to 31 August 2006, in the electronic databases of the EBSCO, CSA Illumina, Thomson Gale, SwetsWise, and BIREME. All original articles in English or Spanish that evaluated HMDG status, progress, and determinants were selected. The analysis evaluated the distribution of determinants of HMDG status or progress, the HMDGs referred to, the study type, the relationship between economic indicators and health, the study location, and the status and potential for attaining the HMDGs. The quality of the articles was also rated. RESULTS: Of the 304 original articles found, 114 (37.5 percent) covered one or more HMDGs. The most frequently addressed goals were those concerning infant and maternal mortality. Of the 39 articles that evaluated HMDGs and their association with economic variables, 13 dealt with economic factors related to equity, policy, or globalization. Economic and policy factors were most frequently associated with HMDG status or progress. CONCLUSIONS: There is a definitive trend toward measuring HMDG status and progress according to economic factors that reflect the population's condition. There is an information gap regarding government spending, international commerce, international aid, and global economic policy. The potential for achieving HMDGs in poor countries is low.

AIDS activists take South African government to court.

PIP: In South Africa, AIDS activists are taking legal action against their government because of its refusal to provide HIV-positive women with drugs to prevent mother-to-child transmission of HIV. The Treatment Action Campaign gave the health department an ultimatum to make moves to change policy on treating infected mothers; however, since the department had not responded, the legal process was set to begin. Mark Heywood, the Campaign's spokesman, said that the campaign is pushing for the implementation of programs on a phased basis to provide zidovudine or nevirapine at facilities where it is possible. It is noted that the government has remained steadfast in its opposition to an expansion of the program to all HIV-positive women attending state health services. Although Health Minister Mantho Tshabalala Msimang said that the drug regulatory authority is reviewing results of studies on nevirapine use, with a view to possible registration of the drug, Heywood argues that such an action continues to question the efficacy of antiretrovirals since these tests have already been done.^ieng

Public protests as Nigeria bans use of untested HIV vaccine.

PIP: In Nigeria, further use of an untested HIV vaccine was banned until investigations on its claimed efficacy are completed. Developed by controversial surgeon Jeremiah Abalaka, the Nigerian's Vice-President noted that the vaccine has killed more than it has cured. In addition, the government has also suspended the use of all similar locally developed HIV/AIDS therapies, which health officials fear may worsen Nigeria's HIV/AIDS burden. The presidential order was announced in response to medical professionals voicing their deep concerns about the methods used by the surgeon. In view of such, the government received protests from Abalaka's patients and the general public. More than 150 students from the University of Abuja staged a peaceful demonstration, calling on President Obasanjo to sack the Minister of Health for colluding with the international community to sabotage Abalaka's vaccine program. However, despite the banning, Abalaka has vowed to continue with his program, saying he had not received a formal letter from the government on the decision.^ieng