Mathematical Modeling for the Assessment of Public Policies in the Cancer Health-Care System Implemented for the Colombian Case.

The incidence of cancer has been constantly growing worldwide, placing pressure on health systems and increasing the costs associated with the treatment of cancer. In particular, low- and middle-income countries are expected to face serious challenges related to caring for the majority of the world's new cancer cases in the next 10 years. In this study, we propose a mathematical model that allows for the simulation of different strategies focused on public policies by combining spending and epidemiological indicators. In this way, strategies aimed at efficient spending management with better epidemiological indicators can be determined. For validation and calibration of the model, we use data from Colombia-which, according to the World Bank, is an upper-middle-income country. The results of the simulations using the proposed model, calibrated and validated for Colombia, indicate that the most effective strategy for reducing mortality and financial burden consists of a combination of early detection and greater efficiency of treatment in the early stages of cancer. This approach is found to present a 38% reduction in mortality rate and a 20% reduction in costs (% GDP) when compared to the baseline scenario. Hence, Colombia should prioritize comprehensive care models that focus on patient-centered care, prevention, and early detection.

New choreographies of inequalities in reproduction: an overview of assisted reproduction market.

Brazil follows the trend of countries that went from high fertility to below replacement level; in many countries, fertility rates continue to fall, often to levels well below population replacement, especially in Europe and Eastern Asia. Since 2006, Brazil has presented rates below the population replacement level, with regional variations. The shift to a pattern of late motherhood is central to understanding this phenomenon, as well as the increased use of reproductive technologies and the global market for assisted reproduction. Demand for services based on Assisted Reproductive Technologies (ART) has increased in European countries and the United States. Also, in Brazil, there is a growing demand for assisted reproduction services, which private clinics offer at a significantly high cost. This article provides an overview of these issues. It raises new questions and dimensions of analysis by problematizing the socio-demographic, legal, and ethical aspects of assisted reproduction, which need to be explored in future population studies.

The concept of informal care: ambiguities and controversies on its scientific and political uses.

Starting from an analysis of the scientific and political uses of the concept of informal care, this paper raises questions and launches the debate on the causes and effects of its uses. Recognizing the diversity and the contradictions found across the use of the term, it explains how its predominant use in Europe can be problematic. First, although it is widely recognized that care is provided primarily by women, this gender dimension is not emphasized in a concept that obscures the sexual division. Second, it does not render explicit that informal care is work, despite being unpaid. Third, the allusion to informality is likely to generate confusion with informal employment of care workers. Finally, studies often focus exclusively on care provided by family members, without distinguishing the spaces in which the work takes place and the social relationships it involves, namely the family or community. In Europe, where documents from (non)governmental organizations focus mainly on long-term care related to demographic aging, it is the care crisis of formal care provision systems, faced with financial fragility, reduction in funds and insufficient supply to meet the demand, that brings informal care to the political and scientific agendas. This paper argues that it is necessary to define conceptual boundaries that allow international studies on the dimension and value of this care work to be compared. It also advocates the importance of making visible that this is work, unpaid and female-dominated, since this view supports action guidelines more focused on social transformation and empowerment.

The Potential of Social Policies in Preventing Dementia: An Ecological Study Using Systematic Review and Meta-Analysis.

Social policies determine the distribution of factors (e.g. education, cardiovascular health) protecting against the development of dementia in Alzheimer's disease (AD). However, the association between social policies and the likelihood of AD without dementia (ADw/oD) has yet to be evaluated. We estimated this association in an ecological study using systematic review and meta-analysis. Four reference databases were consulted; 18 studies were included in the final analysis. ADw/oD was defined as death without dementia in people with clinically significant AD brain pathology. The indicators of social policy were extracted from the Organisation for Economic Co-operation and Development database (OECD). The probability of ADw/oD with moderate AD brain pathology was inversely associated with the Gini index for disposable income, poverty rate, and certain public expenditures on healthcare. ADw/oD with advanced AD brain pathology was only associated with public expenditures for long-term care. Social policies may play a role in maintaining and sustaining cognitive health among older people with AD.

Electronic cigarettes: a new social practice and the challenge of tobacco control policies / Cigarros eletrônicos: uma nova prática social e o desafio das Políticas de controle do tabagismo

O tabagismo é uma doença crônica e é considerado um grave problema de saúde pública e tem sido alvo ao longo do tempo de muitas ações preventivas e de promoção à saúde. O produto do tabaco mais consumido entre adultos e jovens é o cigarro convencional, entretanto, o consumo de tabaco sem fumaça ou outros produtos do tabaco fumado, como os cigarros eletrônicos, tem sido observado de forma crescente no mundo. Os dispositivos eletrônicos para fumar (DEF), que têm despertado cada vez mais a atenção de consumidores jovens, envolvem diferentes equipamentos e tecnologias. Fundamentado no princípio da precaução, desde 2009, o Brasil proibiu a comercialização, importação e propaganda de todos os tipos de DEF que oferecessem a substituição de cigarro, cigarrilha, charuto, cachimbo e similares ou que objetivem alternativa ao tratamento do tabagismo, por meio da RDC n 46, de 28 de agosto de 2009. Mesmo proibido no Brasil, evidencia-se o uso dos cigarros eletrônicos como uma alternativa, revelando um novo desafio a ser enfrentado pelas políticas de controle do tabagismo. As lacunas de conhecimento inerentes a uma prática social nova, bem como da necessidade de construção de referenciais que contribuam para a melhor tomada de decisões, seja no âmbito da intervenção profissional ou da gestão das políticas públicas, com vistas a proteger a saúde da população, por si só já torna relevante a ampliação de conhecimentos acerca desta temática. Contudo, é necessário a compreensão de que as ações de prevenção, promoção e controle devem ser compreendidas de forma transversal e interdisciplinar, a fim de que se possa refletir sobre os processos que envolvem aspectos políticos, socioeconômicos e culturais que interagem diretamente com o processo saúde-doença. Deste modo, com base na problemática apresentada e considerando a relevância da temática em questão, como campo pouco enfrentado deste âmbito, destaca-se que a ampliação de investigações e o aprofundamento de discussões sobre ela, possibilitarão uma melhor compreensão e visibilidade do problema

Smoking is a chronic disease and is considered a serious public health problem and has been the target of many preventive and health promotion actions over time. The most consumed tobacco product among adults and young people is the conventional cigarette, however, the consumption of smokeless tobacco or other smoked tobacco products, such as electronic cigarettes, has been observed on an increasing basis in the world. Electronic smoking devices (EFD), which have increasingly attracted the attention of young consumers, involve different equipment and technologies. Based on the precautionary principle, since 2009, Brazil has prohibited the sale, importation and advertising of all types of DEF that offer the replacement of cigarettes, cigarillos, cigars, pipes and the like or that aim at an alternative to the treatment of smoking, through RDC n 46, of August 28, 2009. Even though it is prohibited in Brazil, the use of electronic cigarettes as an alternative is evident, revealing a new challenge to be faced by tobacco control policies. The knowledge gaps inherent to a new social practice, as well as the need to build references that contribute to better decision-making, whether in the scope of professional intervention or the management of public policies, with a view to protecting the health of the population, for itself already makes the expansion of knowledge about this theme relevant. However, it is necessary to understand that prevention, promotion and control actions must be understood in a transversal and interdisciplinary way, so that one can reflect on the processes that involve political, socioeconomic and cultural aspects that interact directly with the health process -illness. Thus, based on the problem presented and considering the relevance of the issue in question, as a field little faced in this area, it is emphasized that the expansion of investigations and the deepening of discussions about it, will allow a better understanding and visibility of the problem.

Payment for Environmental Services: A critical review of schemes, concepts, and practice in Brazil.

The Payment for Environmental Services (PES) is often conceived through complex schemes without a clear definition of all concepts involved. This study presents the results of a systematic literature review on PES schemes in Brazil, accompanied by a critical assessment of their efficacy for potential environmental gains. The PES approaches were grouped into six categories based on the research focus, and those that were focused on PES policies were identified as the most studied. A particular emphasis has been given to the Amazon and Atlantic Forest biomes, where the ecosystem services studied were mostly centered on issues related to carbon and water, respectively. Approximately one-third of all schemes provided no clear definition of which ecosystem services are proposed for payment. In addition, the review showed no consensus among studies on the definition of services in similar schemes. Most schemes presented no payment system conditioned on the provision of environmental services. Furthermore, the review showed that the absence of clarity in the application of concepts may hinder the development of public policies to properly implement PES in Brazil. The conclusion is that standardizing terms used in the literature and in PES schemes is critical; therefore, the use of the Common International Classification of Ecosystem Services (CICES) as a reference is recommended to ensure clarity, objectivity and, more importantly, the expected environmental efficacy.

Evolución de la eficiencia y la productividad del sistema de salud público chileno entre 2010 y 2019 / Efficiency and productivity of the Chilean public health system between 2010 and 2019

Introducción Frente al fuerte incremento del gasto en salud, es necesario indagar si ha venido acompañado de aumentos proporcionales en la producción de atenciones de salud dirigidas a los beneficiarios del Fondo Nacional de Salud. Métodos En esta investigación observacional, descriptiva y longitudinal retrospectiva estimamos la eficiencia técnica del Sistema Nacional de Servicios de Salud a través del costo medio de producción y la productividad media del trabajo en el periodo de 2010 a 2019. Resultados Durante la década estudiada, la producción ha aumentado en torno al 6% anual; la dotación de trabajadores aumentó (mayormente en el estamento médico) 61%; el gasto en remuneraciones aumentó 106% real; el gasto en bienes y servicios de consumo ha aumentado 25% real; la eficiencia del gasto ha disminuido 21% y la productividad es el elemento menos dinámico del sistema con 0,6% de crecimiento medio anual. Tras sustraer el componente de exámenes diagnósticos, el escenario empeora. Conclusiones Los resultados muestran que el mayor gasto en salud no ha venido aparejado de aumentos proporcionales en producción, traduciéndose en una caída en la eficiencia del gasto sanitario y aumentos magros o caídas en productividad, según cómo se mida la producción. Esto hace que la estrategia de crecimiento del sector público dependa principalmente de aumentos en la dotación de trabajadores. Esta baja productividad constituye una limitante seria para mejorar el acceso de los beneficiarios del Fondo Nacional de Salud a las atenciones de salud y contribuye a incrementar las listas de espera. Especial atención debiera brindarse a los costos medios de producción y a la productividad media del trabajo en un escenario de menor dinamismo en el crecimiento del gasto público en salud y de reforma del sistema de salud.

Introduction In view of the strong increase in health expenditure, it is necessary to investigate whether proportional increases in healthcare production for the beneficiaries of the National Health Fund have corresponded to this increase. Methods In this observational, descriptive, and retrospective longitudinal research, we estimate the technical efficiency of the National Health Services System through the average cost of production and average labor productivity in the period from 2010 to 2019. Results During the studied decade, production has increased by approximately 6% annually; the number of workers increased (mostly physicians) by 61%; spending on salaries increased by 106% in real terms; spending on consumer goods and services has increased by 25% in real terms; the efficiency of spending has decreased by 21%, and productivity is the least dynamic element of the system with an average annual growth rate of 0.6%. After subtracting the diagnostic tests component, this scenario worsens. Conclusions The results show that higher health expenditure has not been matched by commensurate increases in output, translating into a fall in the efficiency of healthcare expenditure and meager increases or falls in productivity, depending on how the output is measured. This means that the public sector's growth strategy depends mainly on increases in the number of workers. This low productivity is a serious constraint to improving healthcare access for National Health Fund beneficiaries and contributes to increasing waiting lists. Special attention should be paid to average production costs and average labor productivity in a scenario of less dynamic growth in public health spending and health system reform.

Soil potentially toxic element contents in an area under different land uses in the Brazilian Amazon.

Soil pollution with potentially toxic elements (PTE) from incipient basic sanitation, dumps and industrial activities developed in the Amazon has been of international interest due to health and environmental issues. This study aimed to evaluate the concentration of PTE in five adjacent land occupations (a dump, a alumina refinery area and three residential centers) in the municipality of Barcarena, Amazon Region, Brazil. In a total area of 912 ha, 274 soil samples were collected at a depth of 0-0.2 m. Afterwards, the concentrations of As, Ba, Pb, Co, Cu, Cr, Hg, Ni and Zn were determined. The results were explored using descriptive and multivariate statistics, as well as geostatistical. Considering the data by location, maximum concentrations exceeding the prevention values of Brazilian soils were found for Cu, Ni and Zn in Dump (148; 42.8 and 356 mg kg-1), for Cu and Hg in Bom Futuro (333 and 1.99 mg kg-1) and for Cu in Itupanema (91.2 mg kg-1). Cu, Hg, Pb and Zn were grouped in the same principal component and showed the highest similarity measure in the cluster analysis. The interpolation point maps of the two principal components and of the individual concentrations of the PTEs showed the area of influence of the dump as the main reason for the increase in soil contamination. These results show the need for public policies aimed at the proper disposal of solid waste, in order to promote the reduction of pollutants in the soil, health and well-being for the local population, and also the environmental quality of the study area.

Efficiency and productivity of the Chilean public health system between 2010 and 2019. / Evolución de la eficiencia y la productividad del sistema de salud público chileno entre 2010 y 2019.

Introduction: In view of the strong increase in health expenditure, it is necessary to investigate whether proportional increases in healthcare production for the beneficiaries of the National Health Fund have corresponded to this increase. Methods: In this observational, descriptive, and retrospective longitudinal research, we estimate the technical efficiency of the National Health Services System through the average cost of production and average labor productivity in the period from 2010 to 2019. Results: During the studied decade, production has increased by approximately 6% annually; the number of workers increased (mostly physicians) by 61%; spending on salaries increased by 106% in real terms; spending on consumer goods and services has increased by 25% in real terms; the efficiency of spending has decreased by 21%, and productivity is the least dynamic element of the system with an average annual growth rate of 0.6%. After subtracting the diagnostic tests component, this scenario worsens. Conclusions: The results show that higher health expenditure has not been matched by commensurate increases in output, translating into a fall in the efficiency of healthcare expenditure and meager increases or falls in productivity, depending on how the output is measured. This means that the public sector's growth strategy depends mainly on increases in the number of workers. This low productivity is a serious constraint to improving healthcare access for National Health Fund beneficiaries and contributes to increasing waiting lists. Special attention should be paid to average production costs and average labor productivity in a scenario of less dynamic growth in public health spending and health system reform.

Introducción: Frente al fuerte incremento del gasto en salud, es necesario indagar si ha venido acompañado de aumentos proporcionales en la producción de atenciones de salud dirigidas a los beneficiarios del Fondo Nacional de Salud. Métodos: En esta investigación observacional, descriptiva y longitudinal retrospectiva estimamos la eficiencia técnica del Sistema Nacional de Servicios de Salud a través del costo medio de producción y la productividad media del trabajo en el periodo de 2010 a 2019. Resultados: Durante la década estudiada, la producción ha aumentado en torno al 6% anual; la dotación de trabajadores aumentó (mayormente en el estamento médico) 61%; el gasto en remuneraciones aumentó 106% real; el gasto en bienes y servicios de consumo ha aumentado 25% real; la eficiencia del gasto ha disminuido 21% y la productividad es el elemento menos dinámico del sistema con 0,6% de crecimiento medio anual. Tras sustraer el componente de exámenes diagnósticos, el escenario empeora. Conclusiones: Los resultados muestran que el mayor gasto en salud no ha venido aparejado de aumentos proporcionales en producción, traduciéndose en una caída en la eficiencia del gasto sanitario y aumentos magros o caídas en productividad, según cómo se mida la producción. Esto hace que la estrategia de crecimiento del sector público dependa principalmente de aumentos en la dotación de trabajadores. Esta baja productividad constituye una limitante seria para mejorar el acceso de los beneficiarios del Fondo Nacional de Salud a las atenciones de salud y contribuye a incrementar las listas de espera. Especial atención debiera brindarse a los costos medios de producción y a la productividad media del trabajo en un escenario de menor dinamismo en el crecimiento del gasto público en salud y de reforma del sistema de salud.

Violencia contra personas con discapacidad que viven en un contexto rural: perspectivas de los gestores de salud / Violência contra pessoas com deficiência que vivem em contexto rural: perspectivas de gestores em saúde / Violence against people with disabilities living in rural context: perspectives of health managers

Objetivo: Analizar las perspectivas de gestores de salud sobre la violencia vivida por personas con discapacidad que viven en un contexto rural. Material y método: Estudio descriptivo-exploratorio com abordaje cualitativo, desarrollado em nueve municipios de la región norte/noroeste del Estado de Rio Grande do Sul, en el cual participaron 18 gestores de salud. Resultados: La primeira categoría revela la concepción de la violencia por parte de los participantes, que se caracteriza por el matrato, abandono, negligencia y falta de atención. La segunda categoría aborda las debilidades em la realización de acciones y formas de calificación del trabajo en salud, asociadas a la planificación em salud, la formación profesional y el trabajo a través de la Red de Atención a la Salud. Conclusiones: Considerando las concepciones, se evidenció que la violencia permanece invisibilizada em el contexto rural. Con esto, se destaca la importancia de la intregralidad y las acciones de salud para la implementación de políticas públicas para las víctimas de violencia que viven em el contexto rural. (AU)

Objetivo: Analisar as perspectivas de gestores em saúde acerca das violências vividas pelas pessoas com deficiência que residem em contexto rural. Material e método: Estudo descritivo-exploratório de abordagem qualitativa, desenvolvido em nove municípios da região norte/noroeste do Estado do Rio Grande do Sul, no qual participaram 18 gestores de saúde. Resultados: A primeira categoria revela a concepção da violência pelos participantes, que se caracteriza pelos maus-tratos, abandono, negligência e falta de atendimento. A segunda categoria aborda as fragilidades na condução de ações e as formas para qualificar o trabalho em saúde, associadas ao planejamento em saúde, capacitação profissional e ao trabalho por meio da Rede de Atenção à Saúde. Conclusões: Diante das concepções, evidenciou-se que a violência permanece invisibilizada no contexto rural. Com isso, destaca-se a importância da integralidade e das ações de saúde para a implementação de políticas públicas para as vítimas de violência que vivem no contexto rural. (AU)

Objective: To analyze the perspectives of health managers about the violence experienced by people with disabilities living in a rural context. Material and method: A descriptive-exploratory study with a qualitative approach, developed in nine municipalities in the north/northwest region of the State of Rio Grande do Sul, in which 18 health managers participated. Results: The first category reveals the conception of violence by participants, which is characterized by maltreatment, abandonment, neglect and lack of care. The second category addresses the weaknesses in the conduct of actions and the ways to qualify health work, associated with health planning, professional training and work through the Health Care Network. Conclusions: Faced with the conceptions, it was evidenced that violence remains invisible in the rural context. This highlights the importance of comprehensiveness and health actions for the implementation of public policies for victims of violence living in the rural context. (AU)

COVID-19 vaccination and governance in the case of low, middle and high-income countries.

BACKGROUND: Global crises, regardless of the place where they started to spread or of the factors that triggered them, require a comprehensive approach, primarily based on good communication, cooperation and mutual support. No individual and no institution should remain indifferent to crises but, on the contrary, be fully aware that any involvement in curbing them matters. Although humanity can be affected by various types of crises, in this paper we refer to the one related to COVID-19 pandemic. There are certain reasons that come to justify our choice: first of all, being a shock with a strong impact on people, its analysis should be performed from several angles; this may bring to light an image with its disparate propagation and measures to counteract it both in developed countries, and especially in those with a shortage of resources. Secondly, in the context of the emergence of vaccines against COVID-19, it is helpful to have an overview of COVID-19 through the lens of the relationship between the vaccination process and the elements that characterize governance, with a differentiated dashboard by country categories worldwide: low, middle and high-income countries. Our study is far from capturing the complexity arising from such social problem, but rather aims to outline the defining role of governance when it comes to providing firm reactions to the COVID-19 crisis. METHODS: Given that our sample consists of a large number of countries, namely 170, first, examined all together, and then, split into three groups (high, middle and low-income), it is challenging to address governance in association with COVID-19 vaccination, in order to see how much they interact and how each of the six aggregate governance indicators of the World Bank (Worldwide Governance Indicators) is reflected in this process. Even if they do not oscillate strongly over relatively short periods of time, reporting on health issues requires a sequential inventory, considering closer time intervals, so as to be able to act promptly. Thus, to better distinguish how the COVID-19 vaccination process evolved in low, middle and high-income countries, but also how it was imprinted by governance, we present the situation quarterly (March, June, September and December), in 2021, the year when the immunization campaigns were the most intense at the global level. Regarding the applied methods, we mention both OLS regressions with robust estimators and a panel model, used to investigate the determinants of COVID-19 vaccination, some of them describing the good governance, as well as other dimensions. RESULTS: The findings point out that the influence of governance on COVID-19 vaccination differs depending on whether a country belongs to high, middle or low-income typology: the strongest determinism of governance on vaccination is encountered in high-income countries, and the weakest in low-income ones; in some cases, governance does not matter significantly. However, exploring the three groups of states included in the research, it is observed that the most relevant factors in this relationship are government effectiveness, regulatory quality and control of corruption. CONCLUSIONS: Besides the order of importance of governance indicators on COVID-19 vaccination, our study indicates that, overall, governance positively shapes the vaccination rate at the level of the chosen sample. In normative terms, these findings can be translated particularly by the fact that they can serve as information to raise awareness on the relevance of the existence of an institutional framework that allows the formulation of strategies according to the patterns of each country, especially since the actionable tools depend on the available resources. As a general conclusion, public policies should be designed in such a way as to strengthen trust in vaccination regulations and in governments, to reduce the multifaceted negative effects of this health crisis and to hope for its total end.

Public assistance, survival, and household trust during the containment period of the first wave of the SARS-CoV-2 pandemic in Togo.

This paper analyzes the impact of public assistance during the first wave of the SARS-CoV-2 pandemic with regard to household survival, using data from a two-round survey of 1274 respondents in Togo conducted by the National Institute of Statistics, Economic and Demographic Studies. The analysis uses the propensity score matching method, the probit model, and the discrete endogenous regressor. The first result shows that more than two thirds of respondents experienced income shocks due to the health crisis. The second result shows that public assistance programs have enabled the beneficiary populations to overcome the impact of shocks.

Evolution of nutritional status and associated factors among formula-fed infants with cow's milk protein allergy in a government program.

BACKGROUND: Cow's milk protein allergy (CMPA) is a common allergy in infants and can affect proper growth and development. This study verified factors associated with the evolution of the nutritional status (NS) among infants with CMPA fed with hypoallergenic formulas (HF). METHODS: This is a longitudinal study of infants (n = 1036) participating on a governmental program in Brazil. Researchers assessed Nutritional status before HF treatment (T1) and after HF treatment (T2). The causality of exposure variables on the evolution of NS was verified by Multinomial Logistic Regression (MLR). RESULTS: We observed an increase in anthropometric indexes analyzed with statistically significant results (p < 0.01). The weight/age and height/age scores showed a significant reduction in infants with nutritional deficit. The Body Mass Index (BMI) showed a decrease in the number of infants with nutritional deficit (< -2 z-score). On the other hand, there was an increase in those classified as at risk of overweight, overweight and obese. MLR showed that those who remained < 12 months in the program had a lower odds ratio (95% CI = 0.355-0.906; p = 0.018) to have inadequate NS with increasing BMI. Preterm infants were 4 times more likely (CI 95% = 1.520-10.694; p = 0.005) to have their BMI decreased and those who received nutritional counseling had a lower odds ratio (CI 95% = 0.411-0.953; p = 0.029) to maintain adequate NS. CONCLUSION: The program has a significant impact on the NS of infants with CMPA. The constant management and implementation of differentiated criteria according to the evolution of NS for the supply of HF is fundamental in the continuity of this public policy.

Implicações da Pandemia para a Psicologia nas Políticas Públicas / Implications of the Pandemic for Psychology in Public Policies / Implicaciones de la Pandemia para la Psicología en las Políticas Públicas

O artigo objetivou identificar e analisar desafios e potencialidades no trabalho de psicólogas(os) nas políticas públicas brasileiras na conjuntura pandêmica. É um estudo exploratório-descritivo de abordagem mista. A coleta de dados foi realizada por meio de questionário virtual com 123 psicólogas(os) que trabalhavam nas políticas públicas no país. A análise se deu a partir da extração de medidas de tendência central e pela Análise de Conteúdo temática, em um diálogo da psicologia com a tradição marxista. Os resultados apontaram para os efeitos deletérios objetivos e subjetivos do sucateamento das políticas às(aos) profissionais, bem como o tolhimento de suas práticas. Por outro lado, também apontaram algumas potencialidades que contradizem a si próprias(os) e à realidade. Fica a premência de responsabilização do Estado em fornecer melhores condições de trabalho e fortalecer as políticas públicas para o enfrentamento à pandemia, assim como a necessidade de reflexão e transformação da psicologia e sua práxis.

The article aimed to identify and analyze the challenges and potentialities of psychologists' work in Brazilian public policies in the pandemic context. It's an exploratory-descriptive study with a mixed approach. Data collection was carried out through a virtual questionnaire with 123 psychologists working in public policies around the country. The analysis was carried out from the extraction of central tendency measures and by Thematic Content Analysis, in a dialogue between psychology and the Marxist tradition. Results pointed to numerous deleterious effects (objective and subjective) on professionals resulting from the scrapping of public policies and the hampering of their practices. On the other hand, they also pointed out some potentialities that contradict themselves and reality. There is an urgent need for state responsibility to offer better working conditions and to strengthen public policies to fight the pandemic, together with the need for reflection and transformation of psychology and its own praxis.

El artículo objetivó identificar y analizar desafíos y potencialidades del trabajo de psicólogas/os en las políticas públicas brasileñas en el contexto de la pandemia. Es un estudio exploratorio-descriptivo con enfoque mixto. La recolección de datos se realizó a través de un cuestionario virtual con 123 psicólogos que trabajaban en políticas públicas en el país. El análisis se realizó a partir de la extracción de medidas de tendencia central, y por Análisis de Contenido temática, en un diálogo entre psicología y tradición marxista. Los resultados apuntaron los efectos deletéreos (objetivos y subjetivos) del desguace de políticas a los profesionales y la obstaculización de sus prácticas. Por otro lado, también señalaron potencialidades que contradicen a sí mismos y a la realidad. Existe una necesidad urgente de rendición de cuentas del Estado para mejorar las condiciones laborales y el fortalecimiento de las políticas para combatir la pandemia y la necesidad de reflexión y transformación de la psicología y de su praxis.

A social method to address the interplay between protected areas and land use policies.

During the last decade, several authors have supported the need to integrate protected areas (PAs) with land use planning (LUP) policies to improve nature conservation and promote sustainable and just cities and territories. However, this process presents multiple challenges in different parts of the world. This article introduces and develops a method of analysis for the articulation between protected areas (PAs) and land use planning (LUP) policies from the perspective of social sciences. This combines a diagnostic first stage of content analysis of land use plans at a provincial/regional/statal scale, with a second stage of an in-depth political analysis in some study cases at municipal scale. The first stage involve the spatial identification of all the municipal districts of a selected study area with provincial, national or international PAs and land use plans. Seven questions guide the analysis of those plans in terms of the degree and quality of PAs nominal articulation. This information, in addition to previous normative data, allows for the development of a formula for the comparative analysis and mapping of the institutional vulnerability and risk of those municipal districts. In the second stage, a synchronous substantive (content) and institutional (network of stakeholders) analysis of land use policies in selected municipal cases is carried out. To this end, interviews, surveys, media analysis and public documents are conducted. Thus, this method combined different focus scales and quali-quantitative techniques to advance the knowledge of key variables intended for improving political coordination in the promotion of nature conservation. This model was tested in the case of the province of Buenos Aires (Argentina).•A social sciences' method for studying land use planning and protected areas coordination is introduced.•The method combines two stages and scales: diagnostic content analysis of land use plans in a provincial/regional/statal scale plus an in-depth political analysis in study cases at a municipal scale.•This method is useful for estimating normative vulnerability and risk, identifying key political variables for coordination, and making public policy recommendations according to the current conservation paradigm.

Public policy interventions for preventing and treating obesity: scoping review.

CONTEXT: Obesity is a multicausal social problem and a pandemic, and it presents a public health challenge in many countries. Hence, public health interventions have been used in an endeavour to prevent and/or control increased obesity among populations. OBJECTIVE: This review study aimed to provide an overview of the academic literature and to analyze the strategies involved in the main public policies focused on preventing and controlling obesity in a number of countries. DATA SOURCES: MEDLINE/PubMed, Web of Science, and LILACS databases were searched. DATA EXTRACTION: Original studies were included for which the core objective was related to real-life public policy interventions for obesity. DATA ANALYSIS: The studies were organized according to their characteristics, and the qualitative analysis was based on the categorization proposed by the author Poulain. The review included 41 studies and identified 15 types of interventions focused on obesity; the largest proportion of actions were developed in school and city environments and were geared toward behavioral change, supported by direct or indirect government action. It was observed that many strategies focused on environmental line through regulatory and legislative measures, and health promotion geared toward the individual was based on the dissemination of information as a means for behavioral change. A smaller focus was given to individual care and treatment, and participative actions in the community. CONCLUSION: The design of public health strategies applicable to obesity as proposed by Poulain provides a valid model for evaluating interventions. The behavioral approach involving guidance through health education toward a healthy lifestyle prevails in public policies, indicating a movement toward accountability of individuals. However, it is necessary to deepen the debate on the social structures that determine obesity (and which limit possibilities of choice), aligned with cultural change regarding its occurrence, and to employ care strategies based on scientific evidence and which focus on the needs of the subjects.

[Profile and indicators of long-stay establishments for older adults in Chile]. / Perfil e indicadores de los establecimientos de larga estancia para adulto mayor en Chile.

BACKGROUND AND OBJECTIVE: In this article we sought to characterize the Long Stay Establishments for the Elderly in Chile, besides presenting the services offered in the public and private. MATERIAL AND METHODS: It is a quantitative, cross-sectional descriptive study, with secondary information source. We analyze all establishments in the country registered with the National Service of the Elderly. As of November 2015, a total of 724 establishments were registered and distributed in 169 neighborhoods throughout the country in which 16,985 adults aged 60 and over were institutionalized. RESULTS: Most of the establishments (65.9% [n=246/724]) are private, 47.5% of them (n=344/724) are located in the metropolitan region of Santiago. Of the residents' health, only 26.5% are considered functional brave, 28.3% are physically handicapped and 8.8% are mentally handicapped. Most establishments offer manual activities, physical exercises, memory classes, cultural classes and recreational or touristic tours. Proportionally of the activities offered were mostly private ones. CONCLUSIONS: In Chile, most of the establishments are private, located in the metropolitan region where there is the largest supply deficit of this type of service, with an occupancy rate of 90.7%, with 72.4% women and almost half 47.7% with some physical or psychic dependence.

Perfil e indicadores de los establecimientos de larga estancia para adulto mayor en Chile / Profile and indicators of long-stay establishments for older adults in Chile

Antecedentes y objetivo: En este artículo sé buscó caracterizar los establecimientos de larga estancia para adultos mayores (ELEAM) de Chile, además de presentar los servicios ofrecidos en lo público y en lo privado. Material y métodos: Se trata de un estudio cuantitativo, transversal descriptivo, a través de fuente de información secundaria. Analizamos todos los ELEAM del país registrados en el Servicio Nacional del Adulto Mayor (SENAMA). Hasta noviembre de 2015 un total de 724 ELEAM estaban registrados y distribuidos en 169 comunas alrededor del país, en los cuales estaban institucionalizados 16.985 adultos con edad a partir de los 60años. Resultados: La mayoría de los ELEAM (65,9% [n=344/724]) son privados. Entre ellos, el 47,5% (n=246/724) están localizados en la región metropolitana de Santiago. De la salud de los residentes, apenas el 26,5% son considerados autosuficientes funcionales, el 28,3% son deficientes físicos y el 8,8%, deficientes psíquicos. La mayoría de los establecimientos ofrecen actividades manuales, ejercicios físicos, clases de memoria, clases culturales y paseos recreativos o turísticos. Proporcionalmente, la mayoría de las actividades ofrecidas eran privadas. Conclusiones: En Chile la mayor parte de los establecimientos son de carácter privado, ubicados en la región metropolitana, donde se encuentra un mayor déficit de oferta de este servicio, con una tasa de ocupación del 90,7%, siendo el 72,4% mujeres, y casi la mitad (47,7%) con alguna dependencia física o psíquica. (AU)

Background and objective: In this article we sought to characterize the Long Stay Establishments for the Elderly in Chile, besides presenting the services offered in the public and private. Material and methods: It is a quantitative, cross-sectional descriptive study, with secondary information source. We analyze all establishments in the country registered with the National Service of the Elderly. As of November 2015, a total of 724 establishments were registered and distributed in 169 neighborhoods throughout the country in which 16,985 adults aged 60 and over were institutionalized. Results: Most of the establishments (65.9% [n=246/724]) are private, 47.5% of them (n=344/724) are located in the metropolitan region of Santiago. Of the residents’ health, only 26.5% are considered functional brave, 28.3% are physically handicapped and 8.8% are mentally handicapped. Most establishments offer manual activities, physical exercises, memory classes, cultural classes and recreational or touristic tours. Proportionally of the activities offered were mostly private ones. Conclusions: In Chile, most of the establishments are private, located in the metropolitan region where there is the largest supply deficit of this type of service, with an occupancy rate of 90.7%, with 72.4% women and almost half 47.7% with some physical or psychic dependence. (AU)

Children and adolescents continue to be exposed to early work in Brazil.

2 million children and adolescents between 11 and 19 years old have not yet finished basic education and had left school. The current Brazilian scenario reflects the reality in which these children and adolescents are inserted, without sufficient resources for the continuity of basic or elementary education, and often the parents' lack of income leads these young people to seek work, as can be seen in several capitals and inland cities: children selling food at traffic lights, bars, restaurants, and similar situations5. According to a study carried out by Abrinq Foundation (Fundação Abrinq), in the last quarter of 2021, there were about 2.36 million adolescents aged between 14 and 17 years old in the labor market or looking for a job, of which 1.2 million were in child labor in disagreement with Brazilian legislation, including work similar to slavery, and activities harmful to health, development, and morality.

Relationship between Burden, Quality of Life and Difficulties of Informal Primary Caregivers in the Context of the COVID-19 Pandemic: Analysis of the Contributions of Public Policies.

The study aimed to characterize and understand the difficulties experienced by informal caregivers from a bio-psychosocial and environmental perspective, taking into account the socio-demographic and health characteristics of the informal caregiver and the person cared for, quality of life, perceived burden, social support, and the impact of the COVID-19 pandemic on the informal caregiver and the person cared for. The participants were 371 informal primary caregivers, 80.9% female, aged between 25 and 85 years, mean 53.17 (SD = 11.45) years. Only 16.4% of the informal caregivers benefited from monitoring and training for informal caregiver skills; 34.8% received information on the rights of the person being cared for; 7.8% received advice or guidance on the rights and duties of the informal caregiver; 11.9% of the caregivers benefited from psychological support; and 5.7% participated in self-help groups. A convenience sample was used, and data were collected via an online questionnaire. The main findings show that the major difficulties experienced by caregivers are related to social constraints, the demands of caring, and the reactions of the person cared for. The results reveal that the burden of the main informal caregivers is explained by the level of education, quality of life, level of dependence of the person cared for, level of difficulties, and social support. The COVID-19 pandemic impacted caregiving by increasing the perceived difficulty of accessing support services, such as consultations, services, and support; causing distress feelings in the caregiver, such as, anxiety and worry; increasing the needs and symptoms of the person cared for; and increasing the degree of isolation, for both, the informal caregiver and the person cared for.