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1.
J. Health NPEPS ; 6(2): 1-23, dez. 2021.
Artigo em Inglês | LILACS, BDENF - Enfermagem, Coleciona SUS | ID: biblio-1291053

RESUMO

Objective: to analyze epidemic curves based on mathematical models for the state of Mato Grosso do Sul and the impacts of population density on COVID-19 transmission. Method: the linear, polynomial and exponential regression model was used to make the numerical adjustment of the respective curves empirical. Result: it was found that the models used describe very well the empirical curves in which they were tested. In particular, the polynomial model is able to identify with reasonable reliability the appearance of the inflection point in the accumulated curves, which corresponds to the maximum point of the respective daily curves. The analysis indicates a weak positive correlation between infection, mortality, lethality and deaths from COVID-19 with population density, as revealed by the correlation and analysis of R2 . Conclusion: the models are very effective in describing the COVID-19 and epidemic curves in the estimation of important epidemiological parameters, such as peak case curves and daily deaths, allowing practical and efficient monitoring of the evolution of the epidemic.


Objetivo: analizar curvas epidémicas basadas en modelos matemáticos para el estado de Mato Grosso do Sul y los impactos de la densidad de población en la transmisión de COVID-19. Método: se utilizó el modelo de regresión lineal, polinomial y exponencial para hacer el ajuste numérico valor de las respectivas curvas empíricas. Resultados: se encontró que los modelos utilizados describen muy bien las curvas empíricas en las que fueron probados. En particular, el modelo polinomial es capaz de identificar con razonable fiabilidad la aparición del punto de inflexión en las curvas acumuladas, que corresponde al punto máximo de las respectivas curvas diarias. El análisis indica una correlación positiva débil entre la infección, la mortalidad, la letalidad y las muertes por COVID-19 con la densidad de población, según lo revelado por la correlación y el análisis de R2 .Conclusión: los modelos son muy efectivos para describir el COVID-19 y curvas epidémicas en la estimación de parámetros epidemiológicos importantes, como las curvas de casos máximos y las muertes diarias, lo que permite un seguimiento práctico y eficaz de la evolución de la epidemia.


Objetivo: analisar as curvas epidêmicas com base em modelos matemáticos para o estado de Mato Grosso do Sul e os impactos da densidade populacional na transmissão da COVID-19. Método: o modelo de regressão linear, polinomial e exponencial foi utilizado para fazer o ajuste numérico das respectivas curvas empíricas. Resultados: verificou-se que os modelos utilizados descrevem muito bem as curvas empíricas nas quais foram testados. Em particular, o modelo polinomial é capaz de identificar com razoável confiabilidade o aparecimento do ponto de inflexão nas curvas acumuladas, que corresponde ao ponto máximo das respectivas curvas diárias. A análise indica uma correlação positiva fraca entre infecção, mortalidade, letalidade e mortes por COVID-19 com a densidade populacional, conforme revelado pela correlação e análise de R 2. Conclusão: os modelos são muito eficazes na descrição das curvas epidêmicas de COVID19 e na estimativa de parâmetros epidemiológicos importantes, como curvas de casos de pico e óbitos diários, permitindo um monitoramento prático e eficiente da evolução da epidemia


Assuntos
Modelos Epidemiológicos , COVID-19 , Política de Saúde
2.
Cad Saude Publica ; 37(8): e00206620, 2021.
Artigo em Português | MEDLINE | ID: mdl-34495093

RESUMO

Two theoretical definitions are central to the discussion on hearing impairment and deafness: the organic/biological definition and the social/anthropological definition. They differ essentially in the definition of a hypothetical boundary of normality and in the understanding of deaf individuals as a linguistic minority. This study aimed to identify how these definitions were expressed in the health policies for persons with hearing impairment/deafness in the Brazillian Unified National Health System (SUS). A document survey was performed with a focus on health policies for hearing impairment/deafness from 1990 to 2019. The documents (n = 185) were identified through the Virtual Health Library and Health Legislation System, 11 of which were selected that dealt with rulings on technological implementation or practical action in care with a focus on hearing impairment/deafness (the rest dealt with specific administrative issues). The results show that all 11 policies were based on the organic/biological conception, since no reference was found to deaf individuals' linguistic and cultural specificities. The logic may hinder access by this population to the health system, especially by increasing the communication barrier. In order to meet the principles of the SUS in practice, it is essential for health policies to incorporate sociocultural aspects, respecting deaf individuals as citizens who interact with the world mainly through their visual experiences, where sign language is a central element.


Assuntos
Surdez , Perda Auditiva , Pessoas com Deficiência Auditiva , Brasil , Política de Saúde , Perda Auditiva/diagnóstico , Humanos , Línguas de Sinais
3.
Cien Saude Colet ; 26(suppl 2): 3423-3434, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34468639

RESUMO

The paper aims to contribute as a reflection on the public production of medicines in Brazil. Public producers present themselves as strategic in Brazil, either as price regulators, in meeting the demands of the Ministry of Health (MoH) on neglected products and those at risk of shortage to SUS. The study used the official bases of the MoH, National Health Surveillance Agency (ANVISA) and Website of Official Pharmaceutical Laboratories (OPL). Thirty-three OPL were identified, 16 with active production of drug registration at ANVISA. For the remaining 17 LFOs, no one identified active portfolio in the bases surveyed. There are 80% of the OPL portfolio concentrated in the first level of the Anatomical Therapeutic Chemical Classification, such as alimentary tract and metabolism, blood and blood forming organs, cardiovascular system, anti-infective for systemic use and nervous system. The OPL participation in the health complex is 48.6% of its portfolio dedicated to the strategic component, 30.6% for primary care and 20.7% for the specialized. It concludes the relevance of the OPL for the Brazilian health policy, with the better realignment of their potential in the face of technological advancement, health legislation, drug dependence and new treatment protocols.


Assuntos
Política de Saúde , Brasil , Humanos
4.
Cien Saude Colet ; 26(suppl 2): 3467-3479, 2021.
Artigo em Português, Inglês | MEDLINE | ID: mdl-34468643

RESUMO

Public policies are based on categories that have a double effect: build eligibility for rights and generate symbolic effects, reproducing or fighting social stigmas. This article aims to analyze the historical setup of categories targeted in mental health policies in Brazil. Based in a study of the legislation from 1841 to 2017, we observed how was the processes of constructing the political categories of mental health - passing from users to citizens or mentally ill. The processes of control of public policies were selected for the respect of users of mental health policy, the social framework of data and the criteria for access to policies and the construction of social stigmas. The analysis shows important changes in these categories over time that tried to remove stigmas based on new conceptions proposed by social movements of mental health, international policies and social changes, such as Brazilian re-democratization. However, we also highlight the difficulty of effectively coping with stigmas due to the lack of consensus in the field itself, resistance to changes in social categories, family members and health professionals.


Assuntos
Pessoas Mentalmente Doentes , Brasil , Política de Saúde , Humanos , Saúde Mental , Política Pública
5.
Cien Saude Colet ; 26(suppl 2): 3481-3492, 2021.
Artigo em Português, Inglês | MEDLINE | ID: mdl-34468644

RESUMO

OBJECTIVE: to discuss strategic challenges in complex health organizations sustained by an analysis in a Medical Genetics Center at a National Health Research Institute in Brazil. METHOD: Démarche Stratégique adapted for use with research institutes, including the policy formulation function. The study used institution's databases and workshops with key actors between Dec/2014 and Jun/2015. RESULTS: Were defined the segments: clinical diagnosis, lysosomal diseases, osteogenesis imperfecta, genetic counseling, cytogenetics, biochemistry, and genomics. The findings reveal that the segments are aligned with the Institute's mission when it comes to referral care, although investment is required in strategic areas. The clinical diagnosis, lysosomal diseases, and genomics segments stood out in the scientific output portfolio. The findings show that progress needs to be made with policy implementation and planning to improve access to new technologies, together with investment in training and development, and the strengthening of coordination and collaboration between research institutes and referral services and between the wider healthcare network and research, care, and teaching. The inclusion of the policy formulation dimension was essential to highlight the unique role medical genetics plays in Brazil's public health system and the importance of developing action plans in the field of public health.


Assuntos
Genética Médica , Saúde Pública , Academias e Institutos , Brasil , Programas Governamentais , Política de Saúde , Humanos
6.
Cien Saude Colet ; 26(suppl 2): 3555-3566, 2021.
Artigo em Português, Inglês | MEDLINE | ID: mdl-34468651

RESUMO

The structure and performance of medical and dental care were analyzed in two health regions that differed socioeconomically and in the provision of services, through case study in the Norte-Barretos (São Paulo) and Juazeiro (Bahia) regions from 2007 and 2014, taking into account political, organizational and structural dimensions and structure and performance indicators. The results showed that the regionalization was positively recognized, the distribution of services did not meet the population demand, and the installed capacity of the health care network was not adequate for the health needs of the population. Norte-Barretos stood out regarding structure (except for potential coverage of oral health teams in the Family Health Strategy) and effectiveness, while Juazeiro stood out concerning efficiency; e.g. although with fewer resources, the use of services was relatively higher. The observed pattern seems to reflect aspects related to the regionalization and the political path of each care provided, the so-called "silos effect". The results may support the design of health policies aimed at overcoming the undersized structure of public health services in regions of lower socioeconomic development and search for parameters and coordination mechanisms to balance performance indicators better.


Assuntos
Atenção à Saúde , Política de Saúde , Brasil , Assistência Odontológica , Humanos , Saúde Bucal
7.
Pan Afr Med J ; 39: 93, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34466195

RESUMO

Widespread vaccination provides a means for countries to lift strict COVID-19 restrictions previously imposed to contain the spread of the disease. However, to date, Africa has secured enough COVID-19 vaccine doses for less than 5% of its population. With widespread vaccination not on the horizon for Africa, there is a strong emphasis on non-pharmaceutical interventions which include movement restrictions (lockdowns). This general COVID-19 pandemic response of imposing lockdowns, however, neglects to factor in non-fatal consequences leading to disruption socio-economic wellbeing of the society at large. The economy in most African countries can no longer sustain lockdown restrictions. Some studies have indicated that a hard lockdown statistical value of the extra lives saved would be dwarfed by its long-term cost. At the same time not responding to the threat of the pandemic will cost lives and disrupts the social fabric. This paper proffers ways to mitigate the both and advocate for better policymaking that addresses specific challenges in defined communities thus yield higher population welfare.


Assuntos
Vacinas contra COVID-19/provisão & distribuição , COVID-19/prevenção & controle , Tecnologia Digital , Política de Saúde , África , COVID-19/economia , Humanos , Formulação de Políticas , Quarentena/economia , Fatores Socioeconômicos , Vacinação/estatística & dados numéricos
9.
Bone Joint J ; 103-B(9): 1541-1549, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34465152

RESUMO

AIMS: While a centralized system for the care of patients with a sarcoma has been advocated for decades, regional variations in survival remain unclear. The aim of this study was to investigate regional variations in survival and the impact of national policies in patients with a soft-tissue sarcoma (STS) in the UK. METHODS: The study included 1,775 patients with a STS who were referred to a tertiary sarcoma centre. The geographical variations in survival were evaluated according to the periods before and after the issue of guidance by the National Institute for Health and Care Excellence (NICE) in 2006 and the relevant evolution of regional management. RESULTS: There had been a significant difference in survival between patients referred from the North East, North West, East Midlands, West Midlands, South West, and Wales in the pre-NICE era (five-year disease-specific survival (DSS); South West, 74% vs North East, 47% (p = 0.045) or West Midlands, 54% (p = 0.049)), which was most evident for patients with a high-grade STS. However, this variation disappeared in the post-NICE era, in which the overall DSS for high-grade STS improved from 47% to 68% at five years (p < 0.001). Variation in the size of the tumour closely correlated with the variation in DSS, and the overall size of the tumour and incidence of metastasis at the time of diagnosis also decreased after the national policies were issued. CONCLUSION: The survival of patients with a STS improved and regional variation corrected after the introduction of national policies, as a result of a decreasing size of tumour and incidence of metastasis at the time of diagnosis, particularly in patients with a high-grade STS. This highlights the positive impact of national guidelines on regional variation in the presentation, management, and outcome in patients with a STS. Cite this article: Bone Joint J 2021;103-B(9):1541-1549.


Assuntos
Extremidades , Política de Saúde , Sarcoma/mortalidade , Neoplasias de Tecidos Moles/mortalidade , Neoplasias Torácicas/mortalidade , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Feminino , Humanos , Incidência , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Gradação de Tumores , Metástase Neoplásica , Características de Residência , Estudos Retrospectivos , Medicina Estatal , Taxa de Sobrevida , Reino Unido/epidemiologia
10.
South Med J ; 114(9): 597-602, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-34480194

RESUMO

OBJECTIVES: Coronavirus disease 2019 (COVID-19) threatens vulnerable patient populations, resulting in immense pressures at the local, regional, national, and international levels to contain the virus. Laboratory-based studies demonstrate that masks may offer benefit in reducing the spread of droplet-based illnesses, but few data are available to assess mask effects via executive order on a population basis. We assess the effects of a county-wide mask order on per-population mortality, intensive care unit (ICU) utilization, and ventilator utilization in Bexar County, Texas. METHODS: We used publicly reported county-level data to perform a mixed-methods before-and-after analysis along with other sources of public data for analyses of covariance. We used a least-squares regression analysis to adjust for confounders. A Texas state-level mask order was issued on July 3, 2020, followed by a Bexar County-level order on July 15, 2020. We defined the control period as June 2 to July 2 and the postmask order period as July 8, 2020-August 12, 2020, with a 5-day gap to account for the median incubation period for cases; longer periods of 7 and 10 days were used for hospitalization and ICU admission/death, respectively. Data are reported on a per-100,000 population basis using respective US Census Bureau-reported populations. RESULTS: From June 2, 2020 through August 12, 2020, there were 40,771 reported cases of COVID-19 within Bexar County, with 470 total deaths. The average number of new cases per day within the county was 565.4 (95% confidence interval [CI] 394.6-736.2). The average number of positive hospitalized patients was 754.1 (95% CI 657.2-851.0), in the ICU was 273.1 (95% CI 238.2-308.0), and on a ventilator was 170.5 (95% CI 146.4-194.6). The average deaths per day was 6.5 (95% CI 4.4-8.6). All of the measured outcomes were higher on average in the postmask period as were covariables included in the adjusted model. When adjusting for traffic activity, total statewide caseload, public health complaints, and mean temperature, the daily caseload, hospital bed occupancy, ICU bed occupancy, ventilator occupancy, and daily mortality remained higher in the postmask period. CONCLUSIONS: There was no reduction in per-population daily mortality, hospital bed, ICU bed, or ventilator occupancy of COVID-19-positive patients attributable to the implementation of a mask-wearing mandate.


Assuntos
COVID-19/mortalidade , COVID-19/prevenção & controle , Controle de Doenças Transmissíveis/legislação & jurisprudência , Recursos em Saúde/estatística & dados numéricos , Hospitalização/estatística & dados numéricos , Controle de Doenças Transmissíveis/métodos , Implementação de Plano de Saúde , Política de Saúde , Humanos , Governo Local , Máscaras , SARS-CoV-2 , Texas/epidemiologia
11.
Pan Afr Med J ; 39: 99, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34466201

RESUMO

Introduction: the provision of basic diagnostic imaging services is pivotal to achieving universal health coverage. An estimated two-thirds of the world's population have no access to basic diagnostic imaging. Accurate data on current imaging equipment resources are required to inform health delivery strategy and policy at national level. This is an audit of Zimbabwean public sector diagnostic ultrasound resources and services. Methods: utilising the Ministry of Health and Child Care (MHCC) database, sequential interviews were conducted with provincial health authorities and local facility managers. Ultrasound equipment, personnel and services in all hospitals and clinics, nationally were recorded, collated, and analysed for the whole country, and by province. Results: of the 1798 Zimbabwean public sector healthcare facilities, sixty-six (n=66, 3.67%) have ultrasound equipment. Ninety-nine (n=99) ultrasound units are distributed across the sonar facilities, representing a national average of 8 units per million people. More than half the equipment units (n=53, 54%) are in secondary-level healthcare facilities (district and mission hospitals), and approximately one-fifth (n=22, 22%) in the central hospitals (quaternary level). The best-resourced province has twice the resources of the least resourced. One-hundred and forty-two (n=142) healthcare workers, from six different professional groups, provide the public sector ultrasound service. Most facilities with sonar equipment (n=64/66, 97%) provide obstetrics and gynaecology services, while general abdominal scanning is available at one third (n=22, 33%). Two facilities with ultrasound equipment have no capacity to offer a sonography service. Conclusion: in order to reach the WHO recommendation of 20 sonar units per million people, an estimated 140 additional sonar units are required nationally. The need is greatest in Masvingo, Midlands and Mashonaland East Provinces. Task-shifting plays a key role in the provision of Zimbabwean sonar services. Consideration should be given to formal training and accreditation of all healthcare workers involved in sonar service delivery.


Assuntos
Atenção à Saúde/estatística & dados numéricos , Pessoal de Saúde/estatística & dados numéricos , Acesso aos Serviços de Saúde , Ultrassonografia/estatística & dados numéricos , Bases de Dados Factuais , Instalações de Saúde/estatística & dados numéricos , Política de Saúde , Humanos , Setor Público , Cobertura Universal do Seguro de Saúde , Zimbábue
12.
Georgetown; PAHO; 2021-09-09. (PAHO/GUY/21-0001).
Não convencional em Inglês | PAHO-IRIS | ID: phr2-54811

RESUMO

Founded in 1902 as the independent specialized health agency of the inter-American system, the Pan American Health Organization (PAHO) has developed recognized competence and expertise, providing technical cooperation to its Member States to fight communicable and noncommunicable diseases and their causes, to strengthen health systems, and to respond to emergencies and disasters throughout the Region of the Americas. In addition, acting in its capacity as the World Health Organization’s Regional Office, PAHO participates actively in the United Nations Country Team, collaborating with other agencies, the funds and programs of the United Nations system to contribute to the achievement of the Sustainable Development Goals (SDGs) at country level. This 2020 annual report reflects PAHO’s technical cooperation in the country for the period, implementing the Country Cooperation Strategy, responding to the needs and priorities of the country, and operating within the framework of the Organization’s regional and global mandates and the SDGs. Under the overarching theme of Universal Health and the Pandemic – Resilient Health Systems, it highlights PAHO’s response to the COVID-19 pandemic as well as its continuing efforts in priority areas such as communicable diseases, noncommunicable diseases, mental health, health throughout the life course, and health emergencies. It also provides a financial summary for the year under review.


Assuntos
Cooperação Técnica , Prioridades em Saúde , Sistemas de Saúde , Programas Nacionais de Saúde , Política de Saúde , Cobertura Universal de Saúde , Acesso Universal aos Serviços de Saúde , Doenças Transmissíveis , Doenças não Transmissíveis , Fatores de Risco , Saúde Mental , Administração Financeira , Administração em Saúde , Guiana
13.
Montevideo; OPS; 2021-09-02. (OPS/URI/21-0001).
Não convencional em Espanhol | PAHO-IRIS | ID: phr2-54792

RESUMO

Establecida en 1902 como el organismo independiente especializado en salud del sistema interamericano, la Organización Panamericana de la Salud (OPS) ha desarrollado competencias y experiencia ampliamente reconocidas al brindar cooperación técnica a sus Estados Miembros para combatir las enfermedades transmisibles y no transmisibles y sus causas, fortalecer los sistemas de salud y responder a situaciones de emergencia y desastres en toda la Región de las Américas. Asimismo, en su calidad de oficina regional de la Organización Mundial de la Salud, la OPS participa activamente en los equipos de las Naciones Unidas en los países, colaborando con otros organismos, fondos y programas del sistema de las Naciones Unidas para contribuir al logro de los Objetivos de Desarrollo Sostenible (ODS) a nivel de país. En este informe anual se presenta la cooperación técnica de la OPS a nivel de país en el 2020, mediante la aplicación de la estrategia de cooperación con el país, la respuesta a las necesidades y prioridades nacionales, y el desarrollo de las actividades en el marco de los mandatos regionales y mundiales de la Organización y los ODS. En consonancia con el tema general de "la salud universal y la pandemia: sistemas de salud resilientes", se pone de relieve la respuesta de la OPS a la pandemia de COVID-19, así como sus esfuerzos continuos en esferas prioritarias como las enfermedades transmisibles, las enfermedades no transmisibles, la salud mental, la salud a lo largo del curso de vida y las emergencias de salud. También se presenta un resumen financiero del ejercicio examinado.


Assuntos
Cooperação Técnica , Sistemas de Saúde , Sistemas Nacionais de Saúde , Política de Saúde , Políticas, Planejamento e Administração em Saúde , Cobertura de Serviços de Saúde , Doenças não Transmissíveis , Doenças Transmissíveis , Fatores de Risco , Fatores Socioeconômicos , Saúde Mental , Administração em Saúde Pública , Administração Financeira , América do Sul , Uruguai
14.
Lima; Perú. Universidad Nacional Mayor de San Marcos; 1 ed; 20210900. 89 p. ilus.
Monografia em Espanhol | MINSAPERÚ | ID: biblio-1290608

RESUMO

El documento contiene una compilación ordenado y ­ a veces corregido ­ las notas que, habiendo sido presentadas a los responsables de dicho Blog, han sido publicadas en este año del bicentenario y de la pandemia. Notas en las que se presentan, para su debate crítico en aquel intercambio de ideas, algunas reflexiones y comentarios personales ­ no siempre ortodoxos ­ sobre tres temas: salud pública; política y justicia social en salud pública; y, memoria institucional.


Assuntos
Política , Justiça Social , Saúde Pública , Coronavirus , Impactos na Saúde , Sistemas Nacionais de Saúde , Pandemias , Política de Saúde , História da Medicina , Memória
15.
Nutrients ; 13(8)2021 Aug 02.
Artigo em Inglês | MEDLINE | ID: mdl-34444845

RESUMO

Rapid worldwide decreases in physical activity (PA), an increase in sedentary behaviour (SB) and poorer dietary patterns have been reported during COVID-19 confinement periods. However, as national variability has been observed, this study sought to describe PA, SB and eating patterns, and to explore their gender as well as other socio-demographic correlates and how they interrelate in a representative sample of Portuguese adults during the COVID-19 first mandatory social confinement. The survey was applied online and by telephone to 5856 adults (mean age = 45.8 years; 42.6% women). The majority reported high (46.0%) or moderate (20.5%) PA levels. Men, younger participants, those with higher education levels and a favourable perception of their financial situation reported higher PA levels, with the opposite pattern for SB. Physical fitness activities and household chores were more reported by women, with more strength training and running activities reported by men. Regarding eating behaviours, 45.1% reported changes, positive (58%) and negative (42%), with 18.2% reporting increases in consumption of fruit, vegetables, and fish and other seafood consumption, while 10.8% (most with lower educational level and less comfortable with their income) reported an increase in consumption of ready-to-eat meals, soft drinks, savoury snacks, and take-away and delivered meals. Two clusters-a health-enhancing vs. risky pattern-emerged through multiple correspondence analysis characterized by co-occurrence of high vs. low PA levels, positive vs. negative eating changes, awareness or not of the COVID-19 PA and dietary recommendations, perceived financial situation, higher vs. lower educational level and time in social confinement. In conclusion, while in social confinement, both positive and negative PA and eating behaviours and trends were displayed, highlighting the role of key sociodemographic correlates contributing to healthy vs. risky patterns. Results may inform future health interventions and policies to be more targeted to those at risk, and also advocate the promotion of PA and healthy eating in an integrated fashion.


Assuntos
COVID-19/epidemiologia , Exercício Físico , Comportamento Alimentar , Comportamento Sedentário , Adolescente , Adulto , COVID-19/psicologia , Estudos Transversais , Feminino , Comportamentos Relacionados com a Saúde , Política de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias , Portugal/epidemiologia , SARS-CoV-2/isolamento & purificação , Inquéritos e Questionários , Adulto Jovem
16.
BMC Public Health ; 21(1): 1566, 2021 08 18.
Artigo em Inglês | MEDLINE | ID: mdl-34407797

RESUMO

BACKGROUND: Schools provide an opportunity for developing strategies to create healthy food environments for children. The present study aimed to analyze the Healthy School Canteen (HSC) policy and identify challenges of its implementation to improve the school food environment in Iran. METHODS: This mixed method study included two qualitative and quantitative phases. In the qualitative phase, triangulation approach was applied by using semi-structured interviews with key informants, documents review and direct observation. Data content analysis was conducted through policy analysis triangle framework. In the quantitative phase, food items available in 64 canteens of primary schools of Tehran province were gathered. The food's nutrient data were evaluated using their nutrition facts label. The number and proportion of foods that met the criteria based on Iran's HSC guideline and the World Health Organization nutrient profile model for the Eastern Mediterranean Region (WHO-EMR) were determined. RESULTS: The main contextual factors that affected adoption of HSC policy included health (nutritional transition, high prevalence of non-communicable diseases and unhealthy food environment in and around the schools), political (upstream supportive policies and joint memorandums about health children between the Ministry of Health and Medical Education and Ministry of Education), structural (the lack of unified stewardship, inadequate human resource capacity, poor inter-sectional cooperation), economic (school financial problems, poor fiscal supportive of food policies), and socio-cultural (mothers working outside the home, the role of children's peer group, low nutrition knowledge of school principals) factors. Assessment of the school canteens showed that a large proportion of available foods did not comply with the national guidelines (54.7 ± 2.54%) and WHO-EMR model (85.6 ± 2.34%). The main reasons identified for incomplete implementation of the policy were inadequate physical and economic infrastructure to set up standard school canteens, lack of scientific criteria for food categorization, poor monitoring, high price of healthy foods, and conflict of interest among the actors. CONCLUSION: The majority of foods and beverages available in the school canteens did not comply with national and regional standards. Iran HSC policy needs to be improved by using an evidence-based approach and active interaction between all key actors.


Assuntos
Serviços de Alimentação , Instituições Acadêmicas , Criança , Política de Saúde , Promoção da Saúde , Humanos , Irã (Geográfico) , Política Nutricional
17.
BMJ Glob Health ; 6(8)2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-34353820

RESUMO

Health system resilience, known as the ability for health systems to absorb, adapt or transform to maintain essential functions when stressed or shocked, has quickly gained popularity following shocks like COVID-19. The concept is relatively new in health policy and systems research and the existing research remains mostly theoretical. Research to date has viewed resilience as an outcome that can be measured through performance outcomes, as an ability of complex adaptive systems that is derived from dynamic behaviour and interactions, or as both. However, there is little congruence on the theory and the existing frameworks have not been widely used, which as diluted the research applications for health system resilience. A global group of health system researchers were convened in March 2021 to discuss and identify priorities for health system resilience research and implementation based on lessons from COVID-19 and other health emergencies. Five research priority areas were identified: (1) measuring and managing systems dynamic performance, (2) the linkages between societal resilience and health system resilience, (3) the effect of governance on the capacity for resilience, (4) creating legitimacy and (5) the influence of the private sector on health system resilience. A key to filling these research gaps will be longitudinal and comparative case studies that use cocreation and coproduction approaches that go beyond researchers to include policy-makers, practitioners and the public.


Assuntos
COVID-19 , Emergências , Programas Governamentais , Política de Saúde , Humanos , SARS-CoV-2
18.
Bull World Health Organ ; 99(8): 593-602, 2021 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-34354314

RESUMO

The World Health Assembly has adopted the World Health Organization's (WHO) recommended target of achieving a 15% reduction in physical inactivity by 2030. The WHO Global Action Plan on Physical Activity provides a framework for countries to achieve this, using a systems-based approach to address the social and environmental determinants of physical inactivity. Lack of progress in many countries indicates a need to identify new ways of addressing this public health priority. WHO continues to highlight the importance of legislative and regulatory measures within the multicomponent and multisectoral action needed to reduce physical inactivity. Yet research into the role of law for addressing physical inactivity has been limited, in contrast to the legal approaches to other major noncommunicable disease risk factors such as smoking and alcohol use. Conceptual frameworks for public health law offer a method for mapping and understanding the determinants, mechanisms and outcomes of law-making for the promotion of physical activity within populations. We describe the development and application of a framework that aligns legal strategies with the WHO Global Plan policy objectives. This new framework - the Regulatory Approaches to Movement, Physical Activity, Recreation, Transport and Sport - can help policy-makers to use the untapped potential of legal interventions to support or strengthen a whole-system response for promoting physical activity. The framework illustrates the role of legal interventions to improve physical activity and identifies opportunities for research to advance understanding, implementation and evaluation of legal responses to this issue.


Assuntos
Exercício Físico , Saúde Global , Política de Saúde , Legislação como Assunto , Saúde da População , Prioridades em Saúde , Promoção da Saúde , Humanos
20.
Health Res Policy Syst ; 19(Suppl 2): 83, 2021 Aug 11.
Artigo em Inglês | MEDLINE | ID: mdl-34380519

RESUMO

BACKGROUND: Almost 20 million children under one year of age did not receive basic vaccines in 2019, and most of these children lived in low- and middle-income countries. Implementation research has been recognized as an emerging area that is critical to strengthen the implementation of interventions proven to be effective. As a component of strengthening implementation, WHO has called for greater embedding of research within decision-making processes. One strategy to facilitate the embedding of research is to engage decision-makers as Principal Investigators of the research. Since 2015, the Alliance for Health Policy and Systems Research within the WHO and the United Nations Children's Fund have supported decision-maker led research by partnering with Gavi, the Vaccine Alliance, in an initiative called "Decision-Maker Led Implementation Research". This synthesis paper describes the cross-cutting lessons from the initiative to further understand and develop future use of the decision-maker led strategy. METHODS: This study used qualitative methods of data collection, including a document review and in-depth interviews with decision-makers and researchers engaged in the initiative. Document extraction and thematic content analysis were applied. The individual project was the unit of analysis and the results were summarized across projects. RESULTS: Research teams from 11 of the 14 projects participated in this study, for an overall response rate of 78.6%. Most projects were carried out in countries in Africa and conducted at the sub-state or sub-district level. Seven enablers and five barriers to the process of conducting the studies or bringing about changes were identified. Key enablers were the relevance, acceptability, and integration of the research, while key barriers included unclear results, limited planning and support, and the limited role of a single study in informing changes to strengthen implementation. CONCLUSIONS: Decision-maker led research is a promising strategy to facilitate the embedding of research into decision-making processes and contribute to greater use of research to strengthen implementation of proven-effective interventions, such as immunization. We identified several lessons for consideration in the future design and use of the decision-maker led strategy.


Assuntos
Política de Saúde , Vacinas , Criança , Tomada de Decisões , Humanos , Pesquisadores , Vacinação
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