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1.
Rev Saude Publica ; 53: 102, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31800913

RESUMO

We analyzed data from the National School-based Health Survey (PeNSE) carried out in Brazil in 2015 (n = 102,072 adolescents) to estimate how much of the individual variance in the prevalence of health behaviors is attributable to the school level. Multilevel logistic regression models were calculated to estimate the variance partitional coefficient (VPC) of the use of drugs, intake of unhealthy food, leisure physical activity and weight-related behaviors. The between-schools variance was significant in all tested models. The highest VPCs were observed when the use of drugs was analyzed (15%-20% of the total variance of smoking and use of illegal drugs). Lower, but still significant, values were observed in the other outcomes. The school context plays an important role in the adolescents' health and should be considered in the design of public policies and actions in public health.


Assuntos
Saúde do Adolescente/estatística & dados numéricos , Comportamentos de Risco à Saúde , Instituições Acadêmicas/estatística & dados numéricos , Estudantes/estatística & dados numéricos , Adolescente , Peso Corporal , Brasil/epidemiologia , Feminino , Preferências Alimentares , Inquéritos Epidemiológicos , Humanos , Modelos Logísticos , Masculino , Setor Privado , Setor Público , Fatores de Risco , Fumar/epidemiologia , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Consumo de Álcool por Menores/estatística & dados numéricos
2.
Global Health ; 15(Suppl 1): 0, 2019 11 28.
Artigo em Inglês | MEDLINE | ID: mdl-31775785

RESUMO

In many African countries, hundreds of health-related NGOs are fed by a chaotic tangle of donor funding streams. The case of Mozambique illustrates how this NGO model impedes Universal Health Coverage. In the 1990s, NGOs multiplied across post-war Mozambique: the country's structural adjustment program constrained public and foreign aid expenditures on the public health system, while donors favored private contractors and NGOs. In the 2000s, funding for HIV/AIDS and other vertical aid from many donors increased dramatically. In 2004, the United States introduced PEPFAR in Mozambique at nearly 500 million USD per year, roughly equivalent to the entire budget of the Ministry of Health. To be sure, PEPFAR funding has helped thousands access antiretroviral treatment, but over 90% of resources flow "off-budget" to NGO "implementing partners," with little left for the public health system. After a decade of this major donor funding to NGOs, public sector health system coverage had barely changed. In 2014, the workforce/ population ratio was still among the five worst in the world at 71/10000; the health facility/per capita ratio worsened since 2009 to only 1 per 16,795. Achieving UHC will require rejection of austerity constraints on public sector health systems, and rechanneling of aid to public systems building rather than to NGOs.


Assuntos
Cooperação Internacional , Organizações/economia , Cobertura Universal do Seguro de Saúde/organização & administração , Infecções por HIV/tratamento farmacológico , Infecções por HIV/economia , Humanos , Moçambique , Setor Público/organização & administração , Estados Unidos
3.
Pan Afr Med J ; 34: 60, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31762925

RESUMO

Introduction: Approximately two-thirds of the world's population has no access to diagnostic imaging. Basic radiological services should be integral to universal health coverage. The World Health Organization postulates that one basic X-ray and ultrasound unit for every 50000 people will meet 90% of global imaging needs. However, there are limited country-level data on radiological resources, and little appreciation of how such data reflect access and equity within a healthcare system. The aim of this study was a detailed analysis of licensed Zimbabwean radiological equipment resources. Methods: The equipment database of the Radiation Protection Authority of Zimbabwe was interrogated. Resources were quantified as units/million people and compared by imaging modality, geographical region and healthcare sector. Zimbabwean resources were compared with published South African and Tanzanian data. Results: Public-sector access to X-ray units (11/106 people) is approximately half the WHO recommendation (20/106 people), and there exists a 5-fold disparity between the least- and best-resourced regions. Private-sector exceeds public-sector access by 16-fold. More than half Zimbabwe's radiology equipment (215/380 units, 57%) is in two cities, serving one-fifth of the population. Almost two-thirds of all units (243/380, 64%) are in the private sector, routinely accessible by approximately 10% of the population. Southern African country-level public-sector imaging resources broadly reflect national per capita healthcare expenditure. Conclusion: There exists an overall shortfall in basic radiological equipment resources in Zimbabwe, and inequitable distribution of existing resources. The national radiology equipment register can reflect access and equity in a healthcare system, while providing medium-term radiological planning data.


Assuntos
Equipamentos e Provisões/provisão & distribução , Acesso aos Serviços de Saúde , Disparidades em Assistência à Saúde/estatística & dados numéricos , Radiografia/instrumentação , Humanos , Setor Privado/estatística & dados numéricos , Setor Público/estatística & dados numéricos , Cobertura Universal do Seguro de Saúde , Zimbábue
4.
Artigo em Russo | MEDLINE | ID: mdl-31765535

RESUMO

The article determines the relevance of the research of morbidity of employees of the educational budget sphere. In the article it is noted that employees of the sphere of education are typical representatives of the system of budget financing. A wide range of parameters that can affect the health and well-being of teachers. Factors such as age, the frequency and chronic nature of diseases, work in a state of some malaise, pedagogical activity in unsatisfactory conditions, dissatisfaction with relations with colleagues and administration, loneliness, can make a different contribution to the processes of deterioration of health and state of health. Thus, the article determines that persons working in the field of education, more often than representatives of the compared groups, for the preservation and strengthening of their own health resort to walks in the fresh air, healthy eating and rest in a sanatorium. In turn, among the employees of the educational sphere is more common rejection of bad habits. The article makes an important conclusion that among the representatives of the educational sphere a quarter of the respondents experience constant malaise and fatigue after work, that is, more than half of the employees of the educational sphere are subject to significant emotional and even physical stress, leading to fatigue and further to diseases. The article presents the figures and the main conclusions of the study of medical and social factors of morbidity of employees of the educational public sector.


Assuntos
Nível de Saúde , Setor Público , Condições Sociais , Humanos , Morbidade , Federação Russa
5.
Pan Afr Med J ; 34: 16, 2019.
Artigo em Francês | MEDLINE | ID: mdl-31762885

RESUMO

Introduction: Do health facilities (HF) have basic resources needed to manage malaria? The purpose of our study was to analyze the operational capacity (OC) of first-line health facilities in Ivory Coast in the management of malaria. Methods: SARA methodology was used to conduct a descriptive cross-sectional study from 10 to 30 July 2016. The operational capacity in the management showed an average availability of 9 identification tracers divided in 3 areas: (i) staff and guidelines; (ii) capacity of diagnosis; (iii) drugs and products. This operational capacity was assessed through the calculation of an index and then compared with the health facilities according to the management authority and the geographical area using Chi-square test with p-values α fixed at 0.05. Results: Out of 818 HFs, 651(79.6%) were in the public sector and 487(59.5%) were located in the rural area. The operational capacity of first line health facilities was 74.5%. This OC was higher in the public sector (81.3%) than in the private sector (48.8%) (p < 10-3) as well as in the rural area (82.7%) compared to the urban area (62.9%) (p < 10-3). Conclusion: In 2016, first line health facilities in Ivory Coast had basic resources needed to manage malaria. It is necessary to focus on the need to strengthen health facility services in addition to prevention.


Assuntos
Assistência à Saúde/organização & administração , Instalações de Saúde/estatística & dados numéricos , Malária/terapia , Antimaláricos/administração & dosagem , Costa do Marfim , Estudos Transversais , Humanos , Setor Privado/estatística & dados numéricos , Setor Público/estatística & dados numéricos
6.
BMC Health Serv Res ; 19(1): 693, 2019 Oct 15.
Artigo em Inglês | MEDLINE | ID: mdl-31615529

RESUMO

BACKGROUND: Hypertension, itself a cardiovascular condition, is a significant risk factor for other cardiovascular diseases. Hypertension is recognized as a major public health challenge in Ghana. Beginning in 2014, a collaborative team launched the community-based hypertension improvement program (ComHIP) in one health district in Ghana. The ComHIP project, a public-private partnership, tests a community-based model that engages the private sector and utilizes information and communication technology (ICT) to control hypertension. This paper, focuses on the various challenges associated with managing hypertension in Ghana, as reported by ComHIP stakeholders. METHODS: A total of 55 informants - comprising patients, health care professionals, licensed chemical sellers (LCS), national and sub-national policymakers - were purposively selected for interview and focus group discussions (FGDs). Interviews were audio-recorded and transcribed verbatim. Where applicable, transcriptions were translated directly from local language to English. The data were then analysed using two-step thematic analysis. The protocol was approved by the two ethics review committees based in Ghana and the third, based in the United Kingdom. All participants were interviewed after giving informed consent. RESULTS: Our data have implications for the on-going implementation of ComHIP, especially the importance of policy maker buy-in, and the benefits, as well as drawbacks, of the program to different stakeholders. While our data show that the ComHIP initiative is acceptable to patients and healthcare providers - increasing providers' knowledge on hypertension and patients' awareness of same- there were implementation challenges identified by both patients and providers. Policy level challenges relate to task-sharing bottlenecks, which precluded nurses from prescribing or dispensing antihypertensives, and LCS from stocking same. Medication adherence and the phenomenon of medical pluralism in Ghana were identified challenges. The perspectives from the national level stakeholders enable elucidation of whole of health system challenges to ComHIP and similarly designed programmes. CONCLUSIONS: This paper sheds important light on the patient/individual, and system level challenges to hypertension and related non-communicable disease prevention and treatment in Ghana. The data show that although the ComHIP initiative is acceptable to patients and healthcare providers, policy level task-sharing bottlenecks preclude optimal implementation of ComHIP.


Assuntos
Hipertensão/prevenção & controle , Doenças não Transmissíveis/prevenção & controle , Pessoal Administrativo , Adulto , Conscientização , Serviços de Saúde Comunitária/organização & administração , Feminino , Grupos Focais , Gana , Programas Governamentais , Conhecimentos, Atitudes e Prática em Saúde , Pessoal de Saúde , Política de Saúde , Hospitais , Humanos , Masculino , Assistência Médica , Setor Privado , Saúde Pública , Setor Público , Parcerias Público-Privadas , Pesquisa Qualitativa , Fatores de Risco
7.
BMJ ; 367: l5766, 2019 10 23.
Artigo em Inglês | MEDLINE | ID: mdl-31645328

RESUMO

OBJECTIVE: To determine the extent to which late stage development of new drugs relies on support from public funding. DESIGN: Cohort study. SETTING: All new drugs containing one or more new molecular entities approved by the US Food and Drug Administration (FDA) between January 2008 and December 2017 via the new drug application pathway. MAIN OUTCOME MEASURES: Patents or drug development histories documenting late stage research contributions by a public sector research institution or a spin-off company, as well as each drug's regulatory approval pathway and first-in-class designation. RESULTS: Over the 10 year study period, the FDA approved 248 drugs containing one or more new molecular entities. Of these drugs, 48 (19%) had origins in publicly supported research and development and 14 (6%) originated in companies spun off from a publicly supported research program. Drugs in these groups were more likely to receive expedited FDA approval (68% v 47%, P=0.005) or be designated first in class (45% v 26%, P=0.007), indicating therapeutic importance. CONCLUSIONS: A review of the patents associated with new drugs approved over the past decade indicates that publicly supported research had a major role in the late stage development of at least one in four new drugs, either through direct funding of late stage research or through spin-off companies created from public sector research institutions. These findings could have implications for policy makers in determining fair prices and revenue flows for these products.


Assuntos
Ensaios Clínicos como Assunto/economia , Aprovação de Drogas/economia , Setor Público/economia , Pesquisa Médica Translacional/economia , Ensaios Clínicos como Assunto/estatística & dados numéricos , Estudos de Coortes , Aprovação de Drogas/legislação & jurisprudência , Aprovação de Drogas/estatística & dados numéricos , Humanos , Patentes como Assunto/estatística & dados numéricos , Setor Público/estatística & dados numéricos , Pesquisa Médica Translacional/estatística & dados numéricos , Estados Unidos , United States Food and Drug Administration/legislação & jurisprudência , United States Food and Drug Administration/estatística & dados numéricos
8.
Rev Lat Am Enfermagem ; 27: e3205, 2019.
Artigo em Inglês, Português, Espanhol | MEDLINE | ID: mdl-31664413

RESUMO

OBJECTIVE: evaluate the profile of the graduates of Nursing a public college from the perception of skills developed during graduation and the process of professional insertion. METHOD: quantitative, exploratory and descriptive study. The sample was composed of 216 graduates. The data was collected by a validated questionnaire and sent to a population of 470 egresses via electronic mail. For the analysis of the data, frequencies, mean and standard deviation were applied and, for the correlation, the chi-square test. RESULTS: the majority of the participants were female (88%) and the mean age was 29.62 years. The majority (65%) had an employment relationship, 14% worked in a single institution and 48% started working six months after graduation. Regarding the form of work, 56% work in care, with an average of 4.5 minimum wages and a weekly workload between 37 and 44 hours. The majority reported competence acquisition to practice the profession, assisting the patient in his integrality with ethics and applying technical and scientific concepts in care. CONCLUSION: the study made it possible to describe the singularities of nurses' education, their insertion in the world of work and the impact on the educational institution, as well as the presentation of specific competences from the perspective of the graduates themselves.


Assuntos
Bacharelado em Enfermagem , Emprego , Competência Profissional , Adulto , Brasil , Currículo , Feminino , Humanos , Masculino , Setor Público , Estudantes de Enfermagem , Inquéritos e Questionários , Universidades
9.
MMWR Morb Mortal Wkly Rep ; 68(39): 845-850, 2019 Oct 04.
Artigo em Inglês | MEDLINE | ID: mdl-31581164

RESUMO

Use of marijuana at an early age can affect memory, school performance, attention, and learning; conclusions have been mixed regarding its impact on mental health conditions, including psychosis, depression, and anxiety (1-3). Medical marijuana has been legal in Washington since 1998, and in 2012, voters approved the retail sale of marijuana for recreational use to persons aged ≥21 years. The first retail stores opened for business in July 2014. As more states legalize marijuana use by adults aged ≥21 years, the effect of legalization on use by youths will be important to monitor. To guide planning of activities aimed at reducing marijuana use by youths and to inform ongoing policy development, Public Health-Seattle & King County assessed trends and characteristics of past 30-day marijuana use among King County, Washington, public school students in grades 6, 8, 10, and 12. This report used biennial data for 2004-2016 from the Washington State Healthy Youth Survey. Among grade 6 students there was a decreasing trend in self-reported past 30-day marijuana use from 2004 to 2016, while the percentage of grade 8 students who had used marijuana during the past 30 days did not change during that period. Among students in grades 10 and 12, self-reported past 30-day use of marijuana increased from 2004 to 2012, then declined from 2012 to 2016. In 2016, the percentage of students with past 30-day marijuana use in King County was 0.6% among grade 6, 4.1% among grade 8, 13.9% among grade 10, and 25.5% among grade 12 students. Among grade 10 students, 24.0% of past 30-day marijuana users also smoked cigarettes, compared with 1.3% of nonusers. From 2004 to 2016 the prevalence of perception of great risk of harm from regular marijuana use decreased across all grades. Continued surveillance using consistent measures is needed to monitor the impact of marijuana legalization and emerging public health issues, given variable legislation approaches among jurisdictions.


Assuntos
Uso da Maconha/epidemiologia , Uso da Maconha/tendências , Setor Público , Instituições Acadêmicas/estatística & dados numéricos , Estudantes/psicologia , Adolescente , Criança , Comércio/legislação & jurisprudência , Feminino , Inquéritos Epidemiológicos , Humanos , Legislação de Medicamentos/estatística & dados numéricos , Masculino , Uso da Maconha/efeitos adversos , Uso da Maconha/legislação & jurisprudência , Prevalência , Medição de Risco , Estudantes/estatística & dados numéricos , Washington/epidemiologia
11.
Codas ; 31(4): e20180143, 2019 Sep 12.
Artigo em Português, Inglês | MEDLINE | ID: mdl-31531555

RESUMO

PURPOSE: To verify the effects of vocal warm-up (VWU) and vocal cool-down (VCD) strategies on teachers. METHODS: A quasi-experimental exploratory blind-evaluator study with control group that included teachers from a public secondary school. Teachers assigned to the experimental group (EG) performed VW prior to classes and VCD after classes. Teachers in the control group (CG) did not perform VWU and simply got voice rest after classes. Intergroup (EG vs. CG) and intragroup (pre-test versus post-test) comparisons were drawn from an auditory-perceptual evaluation, acoustic analysis, and self-reported discomfort. The mean acoustic and discomfort indicators and the percentage of improvement or worsening of vocal quality were calculated with a statistically significance level of p<0.05. RESULTS: EG and CG did not differ from each other in the intergroup analysis. The intragroup analysis showed that VWU improved voice quality and decreased the degree of body-related discomfort. VCD decreased both the fundamental frequency (f0) and the degree of discomfort, particularly in relation to the voice aspects. Vocal rest did not show any statistical difference. CONCLUSION: VWU showed positive effects on the auditory-perceptual evaluation and self-reported discomfort (body). VCD impacted f0 and self-reported discomfort (voice). Due to the exploratory nature of the research, the statistical power was not enough to demonstrate a difference in the comparison between EG and CG. However, the results indicate a potential for protecting teachers' voice and may be incorporated into daily work settings. Further controlled studies with random samples and greater numbers of participants should be conducted to confirm these results.


Assuntos
Doenças Profissionais/prevenção & controle , Patologia da Fala e Linguagem/métodos , Distúrbios da Voz/prevenção & controle , Treinamento da Voz , Adulto , Brasil , Método Duplo-Cego , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Setor Público , Professores Escolares , Autoavaliação , Medida da Produção da Fala , Inquéritos e Questionários , Qualidade da Voz
12.
Malar J ; 18(1): 315, 2019 Sep 18.
Artigo em Inglês | MEDLINE | ID: mdl-31533740

RESUMO

BACKGROUND: Surveillance is a core component of an effective system to support malaria elimination. Poor surveillance data will prevent countries from monitoring progress towards elimination and targeting interventions to the last remaining at-risk places. An evaluation of the performance of surveillance systems in 16 countries was conducted to identify key gaps which could be addressed to build effective systems for malaria elimination. METHODS: A standardized surveillance system landscaping was conducted between 2015 and 2017 in collaboration with governmental malaria programmes. Malaria surveillance guidelines from the World Health Organization and other technical bodies were used to identify the characteristics of an optimal surveillance system, against which systems of study countries were compared. Data collection was conducted through review of existing material and datasets, and interviews with key stakeholders, and the outcomes were summarized descriptively. Additionally, the cumulative fraction of incident infections reported through surveillance systems was estimated using surveillance data, government records, survey data, and other scientific sources. RESULTS: The landscaping identified common gaps across countries related to the lack of surveillance coverage in remote communities or in the private sector, the lack of adequate health information architecture to capture high quality case-based data, poor integration of data from other sources such as intervention information, poor visualization of generated information, and its lack of availability for making programmatic decisions. The median percentage of symptomatic cases captured by the surveillance systems in the 16 countries was estimated to be 37%, mostly driven by the lack of treatment-seeking in the public health sector (64%) or, in countries with large private sectors, the lack of integration of this sector within the surveillance system. CONCLUSIONS: The landscaping analysis undertaken provides a clear framework through which to identify multiple gaps in current malaria surveillance systems. While perfect systems are not required to eliminate malaria, closing the gaps identified will allow countries to deploy resources more efficiently, track progress, and accelerate towards malaria elimination. Since the landscaping undertaken here, several countries have addressed some of the identified gaps by improving coverage of surveillance, integrating case data with other information, and strengthening visualization and use of data.


Assuntos
Erradicação de Doenças/métodos , Malária/prevenção & controle , Vigilância da População/métodos , Humanos , Setor Privado , Setor Público
13.
Rev Saude Publica ; 53: 53, 2019 Aug 15.
Artigo em Inglês | MEDLINE | ID: mdl-31432910

RESUMO

OBJECTIVE: To evaluate the psychometric properties of the Brazilian Portuguese version of the Rapid Estimate of Adult Literacy in Dentistry (BREALD-30) administered to adolescents. METHODS: The study included 750 adolescents: 375 aged 12 years and 375 aged 15-19 years, attending public and private schools in Campina Grande, state of Paraíba, Brazil, in 2017. Reliability was measured based on internal consistency and test-retest reliability. Convergent validity was measured based on correlations between BREALD-30 and Functional Literacy Indicator scores. Divergent validity was measured by comparing BREALD-30 scores with sociodemographic variables. For predictive validity, the association between BREALD-30 scores and the presence of cavitated carious lesions was tested using a multiple logistic regression model. All statistical tests were performed with a significance level of 5%. RESULTS: BREALD-30 showed good internal consistency for the 12 year olds and 15 to19 year olds (Cronbach's alpha = 0.871 and 0.834, respectively) and good test-retest reliability [intraclass correlation coefficient (ICC) = 0.898 and 0.974; kappa = 0.804 and 0.808, respectively]. Moreover, item-total correlation was satisfactory for all items. BREALD-30 had convergent validity with the Functional Literacy Indicator for 12 year olds (rs = 0.558, p < 0.001) and for 15 to 19 year olds (rs = 0.652, p < 0.001). Participants with higher oral health literacy levels who attended private schools (p < 0.001), belonged to economic classes A and B2 (p < 0.001), and who had parents with higher education levels (p < 0.001) were included, indicating the divergent validity of the BREALD-30. Participants with lower BREALD-30 scores were more likely to have cavitated carious lesions [12 year olds: odds ratio (OR) = 2.37; 95% confidence interval (95%CI): 1.48-3.80; 15 to 19 year olds: OR = 1.96; 95%CI 1.24-3.11]. CONCLUSIONS: BREALD-30 shows satisfactory psychometric properties for use on Brazilian adolescents and can be applied as a fast, simple, and reliable measure of oral health literacy.


Assuntos
Inquéritos de Saúde Bucal/instrumentação , Inquéritos de Saúde Bucal/normas , Alfabetização em Saúde/métodos , Saúde Bucal/educação , Adolescente , Adulto , Brasil , Criança , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Masculino , Setor Privado , Psicometria , Setor Público , Instituições Acadêmicas , Estudantes , Inquéritos e Questionários/normas , Adulto Jovem
14.
An Acad Bras Cienc ; 91(supp 3): e20190097, 2019 Jul 29.
Artigo em Inglês | MEDLINE | ID: mdl-31365607

RESUMO

Peugeot-ONF Forest Carbon Sink Project, located at Fazenda São Nicolau (FSN) in Cotriguaçu Municipality, is a public-private initiative and has been supported by several French and Brazilian institutions. Its Research Program includes studies aiming Biodiversity Conservation, Ecology, Carbon Dynamics, Silvicultural Techniques. FSN comprises a high richness of species with more than 20 new species of beetles (Histeridae, Scarabaeidae e Melolonthidae) described among them one endemic genus. A quick overview of the SuperFamily Scarabaeoidea within the FSN area registered 260 species which nearly 100 species might be new to Science. One new species of fish as well as research with amphibian toxins as tools to treat cancer and malaria are also done with material collected at the FSN. Ecology of the decomposer´s fauna at reforestation sites showed that after 10 years, such places were more similar to native forest sites than pastures or abandoned pastures. Finally large mammals studies indicated that many large mammals use FSN as a refuge. We stress the importance to keep the FSN natural habitats linked with the Juruena National Park. The FSN contour is under heavy deforestation which will increase the species loss and turn FSN in one of the few major natural vegetation fragments.


Assuntos
Biodiversidade , Conservação dos Recursos Naturais/métodos , Modelos Biológicos , Brasil , Setor Privado , Setor Público
15.
Rev Saude Publica ; 53: 58, 2019 Jul 18.
Artigo em Inglês, Português | MEDLINE | ID: mdl-31340350

RESUMO

To advance in order to overcome the challenge of enabling greater autonomy in the use of financial resources in the Unified Health System (SUS), system managers agreed that transfers from the Union to other federated entities will be carried out through a financial investment account and a costing account. Over the past few years, states and municipalities managed more than 34,000 bank accounts dedicated to the Union's on-lendings, in which balance exceeded R$8 billion. However, from 2018, Ordinance 3,992/2017 unequivocally separated the budget flow from the financial flow, and the fund-to-fund transfers started to be carried out in only 11,190 bank accounts. Since then, managers have had financial autonomy in the management of financial resources received from the Union, if in accordance with the parameters established in their respective budget items at the end of each fiscal year.


Assuntos
Orçamentos/legislação & jurisprudência , Orçamentos/organização & administração , Gastos em Saúde/legislação & jurisprudência , Programas Nacionais de Saúde/economia , Programas Nacionais de Saúde/legislação & jurisprudência , Brasil , Orçamentos/estatística & dados numéricos , Gastos em Saúde/estatística & dados numéricos , Humanos , Programas Nacionais de Saúde/organização & administração , Setor Público/economia , Setor Público/legislação & jurisprudência , Setor Público/organização & administração
16.
S Afr J Surg ; 57(2): 16-19, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31342679

RESUMO

BACKGROUND: The frequency of the occurrence and type of oesophageal cancer from pathology laboratory data from the private and public sector has never been compared in KwaZulu-Natal (KZN). This study aims to compare data from the public and private pathology services in the province. METHOD: All the malignant and pre-malignant oesophageal biopsies at the academic department of histopathology and at three private laboratories in the KZN were retrieved for comparison. RESULTS: Between January 2012 and December 2014, there were a total of 1087 new diagnoses of an oesophageal malignancy or pre-malignant diagnosis. There were 613 specimens from the private laboratories in KZN and 474 from IALCH. The sex distribution was (41%) females and (59%) males. In the private sector, the mean age was 61.6 years and in the public sector it was 62.7 years. (Range 18-75 years) Africans comprised 63% of the total, Whites 28% and Indians 7%. In the public sector 89.5 % of patients were African whereas in the private sector, Africans comprised 45.7% and Whites made up 46% of the total. Eighty-eight per cent of biopsy specimens were malignant lesions of which 68% were squamous carcinoma. Squamous carcinomas accounted for 87.5% and 54% of all lesions in the public and private sectors respectively. Pre-malignant lesions accounted for 5% and 23% of diagnoses in the public and private sectors respectively. Pre-malignant lesions in the public sector showed mainly dysplastic squamous cell dysplasia whereas dysplastic Barrett's oesophagus lesions accounted for the majority in the private sector. CONCLUSION: Oesophageal cancer is a major public health problem in KZN. Although squamous carcinoma predominates, adenocarcinoma is a significant problem in the White population. It would appear that surveillance for oesophageal adenocarcinoma is taking place in the private sector albeit in a non-systematic or coordinated fashion. This does not appear to be the case in the state sector.


Assuntos
Neoplasias Esofágicas/epidemiologia , Setor Privado , Setor Público , Adulto , Idoso , Biópsia , Neoplasias Esofágicas/patologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , África do Sul/epidemiologia
17.
S Afr J Surg ; 57(2): 61, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31342686

RESUMO

SUMMARY: Access to neurosurgical care in South Africa is influenced by prevailing inequities in healthcare. It is generally perceived that the public sector performs mainly emergencies relating to trauma, and the private sector performs mainly elective spinal surgery. In March 2015, emergencies constituted 51% of cases in the public sector compared to 8% in the private sector. Trauma, paediatric hydrocephalus and intracranial sepsis constituted nearly 75% of the operative workload in the public sector. Cranial surgery accounted for the majority (95%) of operations in the public sector, whereas the majority in the private sector was spinal (75%). There is considerable disparity in the type of neurosurgery being performed in the public and private sectors in KwaZulu-Natal and with the current financial constraints, there is a potential unmet need for elective spinal surgery in the public sector.


Assuntos
Disparidades em Assistência à Saúde/estatística & dados numéricos , Procedimentos Neurocirúrgicos/estatística & dados numéricos , Setor Privado/estatística & dados numéricos , Setor Público/estatística & dados numéricos , Humanos , África do Sul
18.
Medwave ; 19(5): e7644, 2019 Jun 26.
Artigo em Espanhol, Inglês | MEDLINE | ID: mdl-31348767

RESUMO

INTRODUCTION: Dual practice (i.e. workers who work in the public and private sector) has an impact on health services in terms of quality and costs. However, the effectiveness of regulatory policies has not been proven. METHODS: We searched in Epistemonikos, the largest database of systematic reviews in health, which is maintained by screening multiple information sources, including MEDLINE, EMBASE, Cochrane, among others. We extracted data from the systematic reviews, reanalyzed data of primary studies, conducted a meta-analysis and generated a summary of findings table using the GRADE approach. RESULTS AND CONCLUSIONS: We identified three systematic reviews that included 23 primary studies overall, of which all correspond to observational studies. We concluded it is not clear whether the interventions to reduce the negative consequences of dual practice in the health system are effective because the certainty of the available evidence is very low.


Assuntos
Assistência à Saúde/organização & administração , Setor Privado , Setor Público , Bases de Dados Factuais , Assistência à Saúde/normas , Humanos , Saúde Pública
19.
Environ Sci Pollut Res Int ; 26(25): 26082-26089, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31278642

RESUMO

Proper management of biomedical waste (BMW) is required to avoid environmental and human health risks. The current study evaluated the BWM practices in public and private health care facilities of Fatehgarh Sahib District in Punjab, India. The study was conducted, using a modified World Health Organization (WHO) tool in 120 health care facilities randomly selected from rural and urban areas. At primary health care level, BMW management guidelines were followed in 67.2% of the public sector and 40.4% of the private sector facilities, whereas in secondary health care sectors both private and public sector follows 100% compliance. Health facilities were graded into different categories according to median score, i.e., scores less than < 2.5 was categorized as red (no credible BMW management system in place), scores between 2.5 to 7.5 as yellow (system present but needs major improvement) and scores > 7.5 as green (good system in place for BMW). It was observed that among primary health care facilities, 85% of the public sector and 64% of private sector facilities falls in the red category, whereas for secondary health care facilities only 8% fall in the red category. Logistic regression helped to identify the major factors that affect the performance of the health care facility, and it shows that regular training on BMW and improved infrastructure can improve the BMW management practices. Further, proper management of BMW requires multi-sectoral coordination, which can be better addressed through policies and by providing periodical training to all stakeholders.


Assuntos
Instalações de Saúde/estatística & dados numéricos , Setor Privado/economia , Setor Público/economia , Gerenciamento de Resíduos , Humanos , Índia
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