PsicoQuilombologia: escrevivência de uma psicologia das encruzilhadas em tempos pandêmicos / PsychoQuilombology: writexperience of a psychology of crossroads in pandemic times / PsicoQuilombología: escrivivencia de una psicología de la encrucijada en tiempos pandémicos

O texto é um relato de experiência da participação no Grupo de Estudos psicoQuilombologia ocorrida nos meses de setembro de 2020 a março de 2021, período atravessado pela segunda onda da pandemia de COVID-19 no Brasil. O objetivo do relato é apresentar o conceito-movimento de psicoQuilombologia como uma proposta epistemológica quilombola de agenciamento de cuidado e saúde, com base em uma escuta que se faça descolonial e inspirada no fecundo e ancestral acervo de cuidado dos povos africanos, quilombolas e pretos, preservado e atualizado em nossos quilombos contemporâneos. A metodologia utilizada é a escrevivência, método desenvolvido por Conceição Evaristo que propõe uma escrita em que as vivência e memórias estão totalmente entrelaçadas, imersas e imbricadas com a pesquisa. O resultado das escrevivências dessa pesquisa descortinam que os povos pretos desenvolveram práticas de cuidado e acolhimento às vulnerabilidades do outro, enraizadas no fortalecimento de laços e conexões coletivas de afetos e cuidado mútuos. Práticas de cuidado que articulam memória, ancestralidade, tradição, comunidade, transformação, luta, resistência e emancipação, engendrando modos coletivos de ser e viver. Nas quais cuidar do outro implica tratar suas relações e situar o cuidado como extensão de uma cura que se agencia no coletivo. O trabalho conclui apontando que o cenário pandêmico vigente acentua a pungência de se desenvolver estratégias de cuidado baseadas em epistemologias pretas e quilombolas, valorizando os sentidos de ancestralidade, comunidade, pertencimento e emancipação.(AU)

The text is an experience report of the participation in the psicoQuilombology Study Group that carried out from September 2020 to March 2021, during the second wave of the COVID-19 pandemic in Brazil. The purpose of the report is to introduce the concept-movement of psicoQuilombology as a quilombola epistemological proposal for the development of care and health, based on a decolonial listening and inspired by the rich care collection of African peoples, quilombolas and Blacks, preserved and updated in our contemporary quilombos. The methodology used is writexperience [escrevivências], a method developed by Conceição Evaristo who proposes a writing in that the experiences and memories are totally involved with the research. The result of the writability of this research show that Black people have developed practices of care and acceptance of the other's vulnerabilities, based on the strengthening of ties and collective connections of mutual affection and care. Care practices that mix memory, ancestry, tradition, community, transformation, struggle, resistance and emancipation, outlining collective ways of being and living. The core idea is that taking care of the other means treating your relationships and maintaining care as an extension of a cure that takes place in the collective. The paper concludes by pointing out that the current pandemic scenario demonstrates the urgent need to develop care strategies based on black and quilombola epistemologies, valuing the senses of ancestry, community, belonging and emancipation.(AU)

Este es un reporte de experiencia de la participación en el Grupo de Estudio psicoQuilombología que ocurrió en los meses de septiembre de 2020 a marzo de 2021, periodo en que Brasil afrontaba la segunda ola de la pandemia de la COVID-19. Su propósito es presentar el concepto-movimiento de psicoQuilombología como una propuesta epistemológica quilombola para el desarrollo del cuidado y la salud, basada en una escucha decolonial e inspirada en el rico acervo asistencial de los pueblos africanos, quilombolas y negros, conservado y actualizado en nuestros quilombos contemporáneos. La metodología utilizada es la escrivivencia, un método desarrollado por Conceição Evaristo quien propone una escrita en que las vivencias y los recuerdos están totalmente involucrados con la investigación. El resultado de la escrivivencia muestra que las personas negras han desarrollado prácticas de cuidado y aceptación de las vulnerabilidades del otro, basadas en el fortalecimiento de lazos y conexiones colectivas de afecto y cuidado mutuos. Prácticas de cuidado que mezclan memoria, ascendencia, tradición, comunidad, transformación, lucha, resistencia y emancipación, perfilando formas colectivas de ser y vivir. El cuidar al otro significa tratar sus relaciones y mantener el cuidado como una extensión de una cura que tiene lugar en lo colectivo. El trabajo concluye que el actual escenario pandémico demuestra la urgente necesidad de desarrollar estrategias de atención basadas en epistemologías negras y quilombolas, y que valoren los sentidos de ascendencia, comunidad, pertenencia y emancipación.(AU)

Escola sem partido e conservadorismo moral: instrumentalização da religião, sexualidade e gênero / School without party and moral conservatism: the instrumentalization of religion, sexuality and gender / Escuela sin partido y conservadurismo moral: la instrumentalización de la religión, sexualidad y género

Este artigo tem por objetivo identificar e discutir alguns estratagemas psicológicos utilizados por movimentos conservadores e autoritários recentemente difundidos no Brasil - em especial, pelo Movimento Escola sem Partido -, em relação a temas como sexualidade e gênero, que atualmente foram incluídos como essenciais à formação escolar. Com esse propósito, empenhamo-nos em compreender a perspectiva cultural em que se apoiam e o modo como a articulam, ideologicamente, para inviabilizar o debate sobre eles. A partir da análise dos Projetos de Lei 246/2019 e 1859/2015, identificamos estratégias conservadoras que, autoritariamente, deslegitimam sua inclusão na formação escolar. Dentre elas, pareceu-nos urgente investigar a instrumentalização da religião, pois favorece a subordinação da crença religiosa, sobretudo associada ao conservadorismo moral imbricado na tradição cristã brasileira, ao discurso político autoritário. Assim como os movimentos fascistas que, nos Estados Unidos da década de 1930, reivindicavam um ordenamento autoritário e opressor da sociedade por meio do apelo a conteúdos religiosos instrumentalizados para esse fim, atualmente, o discurso religioso também é utilizado como forma de suscitar adesão ao conservadorismo social e político e de justificar preconceitos arraigados. Constatamos que a instrumentalização da religião é uma forma de justificar a permanência de valores conservadores na escola e na sociedade, bem como de reiterar o modelo de família heterossexual monogâmica e a ordem patriarcal. Por meio de estratagemas como esses, os movimentos conservadores e autoritários, articulados em função da negação da diversidade sexual e de gênero, impedem que a escola se constitua como espaço democrático e diverso.(AU)

This paper identifies and discusses the psychological ploys employed by recent conservative and authoritarian movements in Brazil, particularly the School without Party movement, against topics like sexuality and gender, which are currently included as essential to school education. To do so, we sought to understand their cultural basis and how they are ideologically articulated to prevent school debate around these topics. By analyzing Bills 246/2019 and 1859/2015, we identified some conservative strategies that authoritatively delegitimize their inclusion in school education. Chief among them is the instrumentalization of religion, since it favors subordinating religious belief, mainly associated with traditional Christian moral conservatism, to authoritarian political discourse. Similar to the fascist movements in the 1930s United States that claimed an authoritarian and oppressive ordering of society by appealing to religious content, religious speech is currently instrumentalized to encourage social and political conservatism adherence and to justify deep-seated prejudices. Religion instrumentalization is used to justify upholding conservative values at school and in society, as well as to reiterate the monogamous heterosexual family model and patriarchy. Through such ploys, authoritarian and conservative movements, articulated around denying sexual and gender diversity, prevent the school from becoming a democratic and diverse environment.(AU)

Este artículo tiene por objetivo identificar y discutir algunas de las estratagemas psicológicas que utilizan los movimientos conservadores y autoritarios, difundidas recientemente en Brasil, en particular por el Movimiento Escuela sin Partido, con relación a temas como sexualidad y género, que actualmente se incluyeron en la formación escolar. Con este propósito, se pretende comprender la base cultural en la que se han apoyado y cómo la articulan ideológicamente para hacer inviable el debate sobre ellas. A partir de análisis de los Proyectos de Ley 246/2019 y 1859/2015, se identificaron estrategias conservadoras que, autoritariamente, deslegitiman la inclusión de estos temas en la formación escolar. Entre ellas, parece urgente analizar la instrumentalización de la religión, porque favorece la subordinación de la creencia religiosa al discurso político autoritario, sobre todo asociada al conservadurismo moral presente en las vertientes del cristianismo brasileño. Al igual que los movimientos fascistas en los Estados Unidos en los años 1930 que reivindicaban una planificación autoritaria de la sociedad mediante un llamado a contenidos religiosos instrumentalizados, actualmente se utiliza el discurso religioso como forma de promover la adhesión al conservadurismo social y político y de justificar los prejuicios. Se constata que la instrumentalización de la religión es un modo de justificar la permanencia de valores conservadores en la escuela, así como de confirmar el modelo de familia heterosexual monógama y el orden patriarcal. Estos estratagemas que son utilizados por los movimientos conservadores y autoritarios, articulados en función de la negación de la diversidad sexual y de género, impiden que la escuela sea democrática y diversa.(AU)

Perspectivas de una producción sostenible en acuicultura multitrófica integrada (IMTA): una revisión / Prospects for sustainable production in integrated multitrophic aquaculture (IMTA): a review

RESUMEN La acuicultura tradicional se enfrenta a serios problemas medioambientales, particularmente por el uso de grandes volúmenes de agua, con las consecuentes descargas de efluentes ricos en nutrientes inorgánicos y partículas orgánicas. Un ejemplo claro de esto está en que del 20 al 30% del nitrógeno presente en la proteína del alimento suministrado es aprovechado por los peces, el restante 70-80% es desechado en el cuerpo de agua producto de la excreción y el alimento no consumido, lo que favorece la eutrofización de aguas receptoras y su entorno. Por lo anterior, se requiere el desarrollo de tecnologías y prácticas de producción innovadoras, responsables, sostenibles y rentables. Una de las alternativas que está generando interés, debido a sus implicaciones ambientales, económicas y sociales, es la producción en sistemas de acuicultura multitrófica integrada (IMTA). Este concepto se basa en la integración de diferentes niveles tróficos en un mismo sistema, lo que resulta en una conversión de los residuos de cultivo de unas especies en alimentos o fertilización para otras especies. Aplicada, la producción IMTA puede mejorar la sostenibilidad de la acuicultura al reducir el impacto de los efluentes y generar mayor rentabilidad económica, debido a la producción simultanea de dos o más productos finales y al uso mínimo de fertilizantes. El objetivo de la presente revisión es presentar los fundamentos básicos de los sistemas de IMTA, como una alternativa a los sistemas de producción en piscicultura.

ABSTRACT Traditional aquaculture faces serious environmental problems, particularly due to the use of large volumes of water, with the consequent discharge of effluents rich in inorganic nutrients and organic particles. A clear example of this is that only 20 to 30% of the nitrogen present in the protein of the supplied food is used by the fish. The remaining 70 to 80% is disposed of in the water body as a result of excretion and unconsumed food, favoring the eutrophication of receiving waters and their environment. Therefore, the development of innovative, responsible, sustainable, and profitable technologies and production practices is required. One of the alternatives that is generating interest due to its environmental, economic, and social implications is the production in integrated multitrophic aquaculture systems (IMTA). This concept is based on the integration of different trophic levels in the same system, which results in a conversion of the culture residues of some species into food or fertilization for other species. Applicated, the IMTA systems can improve the sustainability of aquaculture by reducing the impact of effluents, generating greater economic profitability due to the simultaneous production of two or more end products and minimal use of fertilizers. The objective of this review is to present fundamentals basic aspects of IMTA systems, as an alternative to fish farming production systems.

Collaboration in handling COVID-19 toward people in poverty line: study case in Makassar.

OBJECTIVE: The large-scale social distancing policy conducted twice was unable to reduce the rate of development of COVID-19 widespread in Makassar, yet it increased. One of the causes was that social awareness is still lacking especially for people in the poverty line. This study attempts to describe the social behavior of people in poverty line toward COVID-19 case in Makassar. METHOD: This research is a qualitative descriptive study based on the case. The data analysis was undertaken qualitatively. RESULTS: The results revealed that the limited understanding of people in poverty line about COVID-19 and health protocols makes their behavior indifferent and disobedient to health protocols. In addition, the government's top-down approach to deal with COVID-19 pandemic was ineffective. However, bottom-up collaborative interventions need to be carried out through a group approach to gain an understanding of the COVID-19 health protocol, especially for people in poverty line and other vulnerable groups.

Fortalecimiento de los sistemas regulatorios en la Región de las Américas. Resumen de las enseñanzas obtenidas de las autoridades regulatorias nacionales de referencia regional

Mejorar el acceso a los medicamentos y otras tecnologías sanitarias seguros, eficaces y de calidad es una prioridad esencial de la salud pública y un requisito fundamental para el logro de la salud universal. Los sistemas regulatorios nacionales cumplen una función clave en el sistema de salud de un país al supervisar la seguridad, la calidad y la eficacia de todas las tecnologías sanitarias, como los fármacos, las vacunas, la sangre y los productos sanguíneos, y los dispositivos médicos. El objetivo del informe Fortalecimiento de los sistemas regulatorios en la Región de las Américas: enseñanzas obtenidas de las autoridades regulatorias nacionales de referencia regional es que se comprenda mejor el panorama regulatorio en la Región de las Américas, con un interés especial en las autoridades regulatorias nacionales de referencia en América Latina. En este resumen se presentan los datos y análisis correspondientes a las funciones regulatorias esenciales y las bases del sistema a fin de comprender las prácticas actuales, reconocer algunas cuestiones importantes y formular una serie de recomendaciones para la acción. Se proporciona además un panorama sobre las perspectivas del mercado y los mecanismos de integración económica en la Región, y su influencia sobre la política regulatoria y el comercio farmacéutico.

Reducing the Justice Gap and Improving Health through Medical-Legal Partnerships.

A recent study by the Legal Services Corporation reported that 71% of low-income U.S. households experienced at least one civil legal problem in 2017 and that 86% of these needs went unresolved. In this article, we examine the potential for medical-legal partnerships (MLPs) to address this "justice gap." We draw on qualitative interviews, conducted with 20 parents and guardians in one pediatric MLP, to identify barriers to legal access and examine how the MLP model may uniquely address these barriers. Our data suggest that MLPs can (1) identify legal needs and create awareness of legal rights among individuals who would not have sought legal services; (2) create an access point for legal services; (3) improve access to legal advice and brief intervention; (4) support ongoing relationships between patients and lawyers that allow for the timely identification of subsequent legal needs; (5) foster trust and confidence in the legal system; and (6) address affordability concerns. These findings suggest that by improving access to justice, MLPs can address critical social and legal determinants of health and, ultimately, advance health equity.

Provision of COVID-19 Convalescent Plasma in a Resource-Constrained State.

BACKGROUND: Arkansas is a rural state of 3 million people. It is ranked fifth for poverty nationally. The first case of coronavirus disease 2019 (COVID-19) in Arkansas occurred on 11 March 2020. Since then, approximately 8% of all Arkansans have tested positive. Given the resource limitations of Arkansas, COVID-19 convalescent plasma (CCP) was explored as a potentially lifesaving, therapeutic option. Therefore, the Arkansas Initiative for Convalescent Plasma was developed to ensure that every Arkansan has access to this therapy. STUDY DESIGN AND METHOD: This brief report describes the statewide collaborative response from hospitals, blood collectors, and the Arkansas Department of Health (ADH) to ensure that CCP was available in a resource-limited state. RESULTS: Early contact tracing by ADH identified individuals who had come into contact with "patient zero" in early March. Within the first week, 32 patients tested positive for COVID-19. The first set of CCP collections occurred on 9 April 2020. Donors had to be triaged carefully in the initial period, as many had recently resolved their symptoms. From our first collections, with appropriate resource and inventory management, we collected sufficient CCP to provide the requested number of units for every patient treated with CCP in Arkansas. CONCLUSIONS: The Arkansas Initiative, a statewide effort to ensure CCP for every patient in a resource-limited state, required careful coordination among key players. Collaboration and resource management was crucial to meet the demand of CCP products and potentially save lives.

Factores asociados a la integración laboral de las personas en tratamiento renal sustitutivo en España / Factors associated with the labor integration of people on renal replacement therapy in Spain

INTRODUCCIÓN: Las personas en tratamiento renal sustitutivo en edad laboral presentan tradicionalmente tasas de empleo significativamente más bajas que la población general. OBJETIVO: Describir la situación laboral de las personas con enfermedad renal crónica en tratamiento renal sustitutivo en España e identificar los factores asociados más significativos. MATERIAL Y MÉTODO: Estudio observacional descriptivo trasversal comparativo de personas en los diferentes tratamientos renales sustitutivos, en edad laboral de 16 a 64 años. Se analizó su situación laboral y otros factores socio-demográficos y socio-económicos, mediante la administración de un cuestionario ad hoc. RESULTADOS: En 437 personas con enfermedad renal crónica avanzada en tratamiento con hemodiálisis, diálisis peritoneal o trasplante. La tasa de empleo fue del 27%, un 84,21% de personas tenían certificado de discapacidad y un 46,45% de incapacidad laboral reconocida. Las personas trasplantadas presentaron mayores ingresos económicos mensuales y las que estaban en diálisis domiciliarios tenían la mayor tasa de empleo (37,64% frente al 27,89% de las personas trasplantadas y el 20,37% de las personas en hemodiálisis en centro). CONCLUSIONES: Las personas en tratamiento renal sustitutivo en edad laboral tienen importantes limitaciones en su acceso al empleo, sin embargo, existen diferencias importantes según sea la opción elegida de tratamiento. La información y toma de decisiones respecto opción del tratamiento renal sustitutivo son claves para el mantenimiento u obtención de un empleo, para su situación económica futura e incluso para el reconocimiento de la incapacidad laboral

INTRODUCTION: People on renal replacement therapy at working age traditionally have significantly lower employment rates than the general population. OBJECTIVE: To describe the employment situation of people with chronic kidney disease on renal replacement therapy in Spain and to identify the significant associated factors. MATERIAL AND METHOD: Observational, descriptive, cross-sectional and comparative study of people in the different renal replacement treatments, during the work period of 16 to 64 years. Their employment situation and other socio-demographic and socio-economic factors were analysed through the use of an ad hoc questionnaire. RESULTS: In 437 people with advanced chronic kidney disease on haemodialysis, peritoneal dialysis or transplantation. The employment rate was 27%, 84.21% of people had a certificate of disability and 46.45% had a recognized incapacity for work. The transplanted persons presented higher monthly economic income. Patients receiving home dialysis had a higher employment rate (37.64% compared to 27.89% of transplant recipients, and 20.37% of people on centre haemodialysis). CONCLUSIONS: People in renal replacement therapy at working age have significant limitations in access to employment. Although, there are important differences depending on the treatment option chosen. Information and decision-making regarding the option of renal replacement treatment are key for maintaining or obtaining a job, for the future economic situation, and even for the recognition of incapacity for work

Second meeting of the Issue-based Coalition on Health and Well-being for All at All Ages: 19–20 September 2019, Copenhagen, Denmark

The second meeting of the Issue-based Coalition on Health and Well-being for All at All Ages (IBC-Health) was held at the WHO Regional Office for Europe in Copenhagen on 19–20 September 2019. The purpose of the meeting was to review the progress of IBC-Health since 2018 and to develop a second joint work plan for 2020–2022. To facilitate the development of a joint vision and to identify workstreams and priorities for 2020–2022, IBC-Health revised the objectives in its terms of reference and the criteria guiding the identification and prioritization of areas for joint work, which now include addressing the burden of disease; leaving no one behind; cooperation to advance strategic and critical issues; and accelerate implementation by working together as one. Participants agreed to proceed with the previous workstream on coordination and the four technical workstreams (health over the life-course; communicable disease; universal health coverage, with a focus on medicines; and migration) and also to add two technical workstreams in the areas of primary health care and noncommunicable disease. The revised IBC-Health terms of reference and draft of the second IBC-Health work plan for 2020–2022 will be made available for further discussion and input at the next Regional United Nations System Meeting scheduled for November 2019.

Centro de Isótopos: acciones en beneficio de la salud pública / Center of Isotope: actions for the benefit of public health

RESUMEN En tributo a los cinco siglos de ciudad el Centro de Isótopos hace recuento de su actividad. La obtención de compuestos marcados con radionucleidos y otros trabajos radioquímicos en el Instituto de Física Nuclear, inaugurado en 1969, estimularon las aplicaciones de las fuentes radiactivas abiertas, por lo que puede considerarse el antecedente organizado más palpable del centro. Posteriormente en los años 80, la Secretaria Ejecutiva para Asuntos Nucleares aceleró, diversificó y amplió las aplicaciones, desarrolló la formación de cuadros y especialistas y la colaboración internacional. La puesta en operación del Centro de Estudios Aplicados al Desarrollo de la Energía Nuclear coincidió con la consolidación de un grupo de instituciones de investigación y producción biotecnológica y con el auge de las aplicaciones en Medicina Nuclear. Pronto se reconoció que no era posible continuar el manejo de un inventario cada vez mayor de radionucleidos, por lo que se diseñó y construyó un centro especializado a ciclo completo: investigación-desarrollo, producción y comercialización, el CENTIS. Durante su integración en 1994 a la Agencia de Energía Nuclear, se concluyó la inversión y se establecieron las metodologías de producción de los más importantes radiofármacos. En más de 20 años de labor CENTIS se ha convertido en el principal soporte de la Medicina Nuclear del país. Con sus capacidades metrológicas en la magnitud radiactividad y sus investigaciones no clínicas y clínicas, se inserta de forma cada vez más estrecha en la vida socio-económica del país y su capital. En el trabajo se detallan los principales resultados de cada etapa en lo relacionado a la misión del centro y se hace una valoración técnica de hacia dónde se encaminan acciones en favor de sus sectores destino: salud e investigación biomédica. Lustros en favor de siglos.

ABSTRACT To commemorate the 500th anniversary of the city of Havana, the Isotope Center reviews its activity since its creation. The production of radionuclidemarked compounds and other radiochemical work at the Institute of Nuclear Physics, inaugurated in 1969, stimulated the applications of open radioactive sources, which can be considered as the most tangible organized antecedent of the center. Later in the 1980s, the Executive Secretary for Nuclear Affairs accelerated, diversified and expanded nuclear applications, developed the training of highly qualified staff and experts as well as international cooperation. The creation of the Center for Applied Nuclear Development Studies coincided with the consolidation of a group of biotechnological research and production institutions and with these applications gaining importance in Nuclear Medicine. It was soon recognized that it was not possible to continue managing a growing inventory of radionuclides. As a result, CENTIS, a specialized center with a complete cycle, was designed and built, which comprised not only research and development, but also production and marketing. When in 1994 CENTIS became part of the Nuclear Energy Agency, investment was concluded and the production methodologies of the most important radiopharmaceuticals were established. In more than 20 years of work CENTIS has become the main support of Nuclear Medicine in the country. With its metrological capabilities in the magnitude of radioactivity and its non-clinical and clinical research, it is increasingly part of the socio-economic life of the country and its capital. In this paper the main results of each stage are detailed in relation to the mission of the center and a technical assessment is made regarding the actions taken to favor their target sectors: health and biomedical research. Periods of five years in favor of centuries.

An assessment of the trainability of beggars and the destitute in Abakaliki Nigeria: implication for policy on their health, vocational rehabilitation and social reintegration.

BACKGROUND: Begging and destitution constitute serious health and social problems in low and middle-income countries (LMICs). OBJECTIVES: The objective of this study was to assess the trainability of beggars and the destitute in Abakaliki Nigeria in order to provide scientific evidence required for the development of a policy on their health, vocational rehabilitation and social reintegration. METHODS: The study was a cross-sectional descriptive survey of 50 purposively selected beggars and destitute persons identified from motor parks, church cathedrals, market places etc. Data was collected using a structured interviewer-administered questionnaire. Analysis was based on mean rating (MNR), median rating (MDR), and range. Interview of each respondent lasted approximately 20 minutes. RESULTS: Of the 50 respondents who participated in this study, 17 (34%) were females. Most subjects were of age category 31-35 years (30%) and 36-40 years (34%). Fifteen (30%) admitted having sight impairment while 17 (34%) admitted that they were physically challenged. The outcome of the trainability assessment showed relatively high mean ratings (MNRs) ranging from 3.42-4.06 on a scale of 5 points. CONCLUSION: The findings of this study clearly suggest that there is a very high potential for the vocational rehabilitation and social reintegration of beggars and the destitute in the study area.

Малярия: информационный бюллетень о Целях в области устойчивого развития (ЦУР): задачи, связанные со здоровьем

Информационные бюллетени о задачах ЦУР в области здравоохранения раскрывают основные факты и цифры, текущие обязательства, стратегические рекомендации для осуществления действий и индикаторы для мониторинга прогресса – в контексте Европейского региона ВОЗ. Особое внимание в них уделяется тому, как ЕРБ ВОЗ содействует государствам-членам в достижении этих целевых ориентиров, а также ключевым аспектам ЦУР, таким как справедливость, партнерское взаимодействие и межсекторальное сотрудничество. Малярия часто рассматривается во всем мире как угроза достижениям в области здравоохранения и развития и успешной реализации Повестки дня в области устойчивого развития на период до 2030 г., поскольку число людей, подвергающихся риску заражения этой инфекцией очень велико. Европейский регион, как было объявлено ВОЗ 20 апреля 2016 г., стал первым в мире, где была успешно прервана местная передача малярии, что соответствует цели Ташкентской декларации по элиминации малярии в Регионе к 2015 г.. Тем не менее, климатические изменения и другие социальные, демографические и экологические факторы повышают риск возвращения малярии. Возвращение малярии может поставить под угрозу достижение ЦУР, оказывая негативное влияние на ситуацию в области безопасности здоровья населения, бедности, экономического роста, прогресса в сокращении неравенств, а также сохранения среды обитания и биоразнообразия. Для того чтобы сохранить этот статус региона, свободного от малярии, необходимо принятие мер во всех секторах и контекстах.

[Orthopedic surgery in Dhulikhel, Nepal]. / Unfallchirurgie in Dhulikhel/Nepal.

Nepal is one of the 20 poorest countries in the world. Thus, medical care in Nepal is dependent on significant medical and financial commitment from within and outside the country. Dhulikhel Hospital - Kathmandu University Hospital (DH-KUH) was founded in 1996 by Prof. Dr. Ram and colleagues. Collaboration and support of many people and institutions are, in contrast to the experience in other hospitals of the third world, characterized by an extraordinary sustainability. The reason for this is the spirit lived according to the motto "best service for the poor". The structures in DH-KUH are influenced by a very close cooperation with a number of international (university) hospitals. Most of the DH-KUH departments have an amazingly high technical standard. Assuming this development and progress can be continued, a splendid future for DH-KUH can be predicted.

Incremental Benefit-Cost of MOMCare: Collaborative Care for Perinatal Depression Among Economically Disadvantaged Women.

OBJECTIVE: Effectiveness of collaborative care for perinatal depression has been demonstrated for MOMCare, from early pregnancy up to 15 months postpartum, for Medicaid enrollees in a public health system. MOMCare had a greater impact on reducing depression and improving functioning for women with comorbid posttraumatic stress disorder (PTSD) than for those without PTSD. This study estimated the incremental benefit and cost and the net benefit of MOMCare for women with major depression and PTSD. METHODS: A randomized trial (September 2009 to December 2014) compared the MOMCare collaborative care depression intervention (choice of brief interpersonal psychotherapy or pharmacotherapy or both) with enhanced maternity support services (MSS-Plus) in the public health system of Seattle-King County. Among pregnant women with a probable diagnosis of major depression or dysthymia (N=164), two-thirds (N=106) met criteria for probable PTSD. Blinded assessments at three, six, 12, and 18 months postbaseline included the Symptom Checklist-20 depression scale and the Cornell Services Index. Analyses of covariance estimated gain in depression free days (DFDs) by intervention and PTSD status. RESULTS: When the analysis controlled for baseline depression severity, women with probable depression and PTSD in MOMCare had 68 more depression-free days over 18 months than those in MSS-Plus (p<.05). The additional depression care cost per MOMCare participant with comorbid PTSD was $1,312. The incremental net benefit of MOMCare was positive if a DFD was valued at ≥$20. CONCLUSIONS: For women with probable major depression and PTSD, MOMCare had significant clinical benefit over MSS-Plus, with only a moderate increase in health services cost.

Low-Income Urban Mothers' Experiences with the Supplemental Nutrition Assistance Program.

BACKGROUND: Food insecurity remains a public health concern in the United States, particularly among low-income urban ethnically diverse families, even with the Supplemental Nutrition Assistance Program (SNAP). Limited phenomenologic data exist to capture how programmatic changes to SNAP address the needs of users and why a gap in SNAP use may exist. OBJECTIVE: The primary aim of this study was to examine the experiences of low-income, Baltimore, MD, mothers in applying for and maintaining access to SNAP. Secondary aims included understanding participants' perspectives on the influence of changes in SNAP over a 3-year period and how SNAP fits into the overall system of social services for families. DESIGN: In this qualitative, phenomenologic study, in-depth interviews were conducted with 13 mothers and three focus groups with 20 mothers, for a total sample of 33 mothers receiving SNAP benefits. Ten mothers participated in the first round of data collection (January to May 2010), and 23 in the second round (February to May 2013). PARTICIPANTS/SETTING: Participants were 33 mothers receiving SNAP benefits in Baltimore City, MD. MAIN OUTCOME MEASURES: Baltimore SNAP users' experiences with applying for and maintaining access to SNAP, as well as with program changes to the SNAP program. DATA ANALYSIS: Data were analyzed using an iterative emergent design and phenomenologic approach. A constructivist perspective was implemented throughout the coding process. RESULTS: SNAP functioned as a valuable support system within the broader social safety net for mothers living in poverty, yet participants expressed frustration about the processes of applying for and maintaining benefits due to communication problems and poor integration of services. In applying for and accessing SNAP, positive interactions with caseworkers and previous knowledge of the SNAP program were important for maintaining benefits. Interviews and focus group discussions revealed the need for additional outreach and education about the implemented program changes to build trust and improve access to SNAP among participants. CONCLUSIONS: Improving communication and supporting participants' ability to maintain relationships with the same caseworkers, as well as developing better integration with other aid programs, could improve the SNAP program.

América Latina y el Caribe: Panorama de la seguridad alimentaria y nutricional. Sistemas alimentarios sostenibles para poner fin al hambre y la malnutrición, 2016

[Prólogo]: América Latina y el Caribe (ALC) se encuentra en una etapa de transición entre dos momentos clave en su desarrollo. Si bien en los últimos 20 años los países de ALC han avanzado en la prevención y control de las deficiencias nutricionales, se observa un rápido incremento en la prevalencia del sobrepeso y la obesidad que afecta a toda la población sin importar su condición económica, su lugar de residencia o su origen étnico. La coexistencia del hambre, la desnutrición, las deficiencias de micronutrientes, el sobrepeso, la obesidad se debe, entre otras causas, a la falta de acceso a una alimentación saludable que provea la cantidad de nutrientes necesarios para llevar una vida sana y activa. El crecimiento económico y la mayor integración de América Latina y el Caribe en mercados internacionales ha ocasionado cambios en los patrones de alimentación: se observa una disminución de preparaciones culinarias tradicionales basadas en alimentos frescos, preparados y consumidos en el hogar, y una presencia y consumo cada vez mayor de productos ultraprocesados con baja densidad de nutrientes pero con alto contenido de azúcares, sodio y grasas. Este cambio en el patrón alimentario ha contribuido a la persistencia de la malnutrición en todas sus formas y a la disminución de la calidad de vida [...] Esta edición del Panorama se describe la situación de la seguridad alimentaria y nutricional en América Latina y el Caribe, poniendo especial énfasis en el estado nutricional y su importancia para lograr el desarrollo económico y social de la Región. Esta publicación es el primer paso, de una serie de esfuerzos coordinados entre la FAO y la OPS para poner fin al hambre, lograr la seguridad alimentaria y mejorar de la nutrición y promover la agricultura sostenible, de suerte que nuestros Estados Miembros puedan alcanzar el Objetivo 2 de los Objetivos de Desarrollo Sostenible. Esperamos que este esfuerzo también sirva de motivación a los gobiernos, las agencias internacionales de desarrollo, los donantes, el sector privado, y la sociedad civil de coordinar acciones para poner fin al hambre y la malnutrición.

[Comparison of Costs and Revenues in Conservative and Invasive Treatment in Cardiology: a Contribution Margin Analysis]. / Vergleich der Kosten- und Erlössituation invasiver und konservativer kardiologischer Behandlungsfälle: Modell einer Deckungsbeitragsrechnung.

Aim of the study: Direct costing is a specialized form of cost analysis well suited for medical areas with DRG-orientated flat rate payments. By comparing case-related variable costs and payments, it is possible to compare the economic benefits of different medical treatments. This aim was pursued by developing a direct costing concept and by its application to invasively and non-invasively treated cardiac patients. Methods: The entire database comprised 7 330 cases of a tertiary cardiac center between 2007 and 2011. It was derived from databases of the hospital information system, the materials management department and the catheter laboratory. On the revenue side, DRG payments were included. Costs related to heart catheterization such as material, personnel and maintenance expenses were considered to be variable costs. Contribution margins and relative contribution margins were calculated by introducing the length of hospital stay as a time reference. Results: During the observation period, caseload and annual revenues increased by about 20 percent. Contribution margins were higher in invasively than in non-invasively treated patients (2 097±1 590 vs. 1 614±1 105 €; p<0,001). However, the relative relation of both patient groups was not altered during the observation period. A remarkable shortening of the duration of catheter laboratory examinations was observed between 2007 and 2011 (46,2±39,1 auf 36,7±33,5 min; p<0,001). In the same period, relative contribution margins increased from 461±306 to 530±335 € (p<0,001). Conclusions: Within existing supply structures, direct costing is a useful tool for economic comparison of different treatment services. Furthermore, temporal constraints of an economic bottleneck can be easily monitored and tackled with the help of time management tools.

Control systems engineering in continuous pharmaceutical manufacturing. May 20-21, 2014 Continuous Manufacturing Symposium.

This white paper provides a perspective of the challenges, research needs, and future directions for control systems engineering in continuous pharmaceutical processing. The main motivation for writing this paper is to facilitate the development and deployment of control systems technologies so as to ensure quality of the drug product. Although the main focus is on small-molecule pharmaceutical products, most of the same statements apply to biological drug products. An introduction to continuous manufacturing and control systems is followed by a discussion of the current status and technical needs in process monitoring and control, systems integration, and risk analysis. Some key points are that: (1) the desired objective in continuous manufacturing should be the satisfaction of all critical quality attributes (CQAs), not for all variables to operate at steady-state values; (2) the design of start-up and shutdown procedures can significantly affect the economic operation of a continuous manufacturing process; (3) the traceability of material as it moves through the manufacturing facility is an important consideration that can at least in part be addressed using residence time distributions; and (4) the control systems technologies must assure quality in the presence of disturbances, dynamics, uncertainties, nonlinearities, and constraints. Direct measurement, first-principles and empirical model-based predictions, and design space approaches are described for ensuring that CQA specifications are met. Ways are discussed for universities, regulatory bodies, and industry to facilitate working around or through barriers to the development of control systems engineering technologies for continuous drug manufacturing. Industry and regulatory bodies should work with federal agencies to create federal funding mechanisms to attract faculty to this area. Universities should hire faculty interested in developing first-principles models and control systems technologies for drug manufacturing that are easily transportable to industry. Industry can facilitate the move to continuous manufacturing by working with universities on the conception of new continuous pharmaceutical manufacturing process unit operations that have the potential to make major improvements in product quality, controllability, or reduced capital and/or operating costs. Regulatory bodies should ensure that: (1) regulations and regulatory practices promote, and do not derail, the development and implementation of continuous manufacturing and control systems engineering approaches; (2) the individuals who approve specific regulatory filings are sufficiently trained to make good decisions regarding control systems approaches; (3) provide regulatory clarity and eliminate/reduce regulatory risks; (4) financially support the development of high-quality training materials for use of undergraduate students, graduate students, industrial employees, and regulatory staff; (5) enhance the training of their own technical staff by financially supporting joint research projects with universities in the development of continuous pharmaceutical manufacturing processes and the associated control systems engineering theory, numerical algorithms, and software; and (6) strongly encourage the federal agencies that support research to fund these research areas.

UceWeb: a web-based collaborative tool for collecting and sharing quality of life data.

OBJECTIVES: This work aims at building a platform where quality-of-life data, namely utility coefficients, can be elicited not only for immediate use, but also systematically stored together with patient profiles to build a public repository to be further exploited in studies on specific target populations (e.g. cost/utility analyses). METHODS: We capitalized on utility theory and previous experience to define a set of desirable features such a tool should show to facilitate sound elicitation of quality of life. A set of visualization tools and algorithms has been developed to this purpose. To make it easily accessible for potential users, the software has been designed as a web application. A pilot validation study has been performed on 20 atrial fibrillation patients. RESULTS: A collaborative platform, UceWeb, has been developed and tested. It implements the standard gamble, time trade-off and rating-scale utility elicitation methods. It allows doctors and patients to choose the mode of interaction to maximize patients' comfort in answering difficult questions. Every utility elicitation may contribute to the growth of the repository. CONCLUSION: UceWeb can become a unique source of data allowing researchers both to perform more reliable comparisons among healthcare interventions and build statistical models to gain deeper insight into quality of life data.

“El dinero es el vehículo de interacción”: perspectivas de integración social de las personas afectadas por la lepra en e norte de Nigeria / No disponible

Objetivo: Este estudio propone un planteamiento mediante el cual la rehabilitación socio-económica (SER) puede conseguir reducir el estigma relacionado con la lepra en el norte de Nigeria, después de analizar las entrevistas llevadas a cabo para evaluar el impacto de la SER. Metodología: La evaluación combina un cuestionario cuantitativo (escala P) con entrevistas cualitativas de 20 individuos afectados de lepra, cinco grupos de discusión y 10 entrevistas a individuos considerados importantes. A partir de nuestra información desarrollamos un marco de trabajo de estigma relacionado con la lepra integrando los temas emergentes y que puedan constituir una posible amenaza para el funcionamiento de los grupos, para describir como se percibe el estigma por las personas afectadas de lepra en el norte de Nigeria. Resultados: Los resultados revelan que las personas afectadas por lepra están menos estigmatizadas por las discapacidades causadas por la enfermedad que por su incapacidad de contribuir al sostenimiento familiar/comunitario. También, se identificaron los microcréditos y la formación profesional como elementos del SER que reducen el estigma a través de un mecanismo de protección de individuos frente a la pérdida del valor social al facilitar su compromiso social continuado en las tareas sociales cotidianas de la familia/comunidad. Conclusión: Se propone que la SER estimula los cambios de actitud y la inclusión de personas afectadas por lepra al proteger a los individuos frente a la pérdida del valor social e incrementar su capacidad de participación. Se propone una mayor evaluación empírica del marco propuesto para evaluar su utilidad en otras culturas (AU)

Objective: This paper proposes a mechanism by which socio-economic rehabilitation (SER) reduces stigma in northern Nigeria following a re-analysis of the transcripts of interviews conducted to evaluate the impact of SER on leprosy-related stigma. Design: the evaluation combined quantitative questionnaire (P-scale) with qualitative interviews of 20 individuals affected by leprosy, five focus group discussions and 10 key informant interviews. Form our data, we developed a leprosy related stigma framework by integrating emerging themes with the construct of threat to group functioning to describe stigma processes experienced by people affected by leprosy in northern Nigeria. Results: Finding revealed people affected by leprosy are less likely to be stigmatized because of leprosy impairments than for their incapacity to contribute to family/community finances. We also identified micro-credit loans and vocational training as elements of SER for reducing stigma through the mechanism of protecting individuals against the loss of social value, and by facilitating their continued engagement in daily social roles in the family/community. Conclusion: We propose that SER stimulates attitudinal change towards, and inclusion of people affected by leprosy by protecting individuals against the loss of social value and increasing their contributive capacity. We recommend further empirical testing of the proposed framework to ascertain its utility in other cultures (AU)