Saúde e pesquisas domiciliares no Brasil e Inglaterra: a Pesquisa Nacional de Saúde e a Health Survey for England / Health and household surveys in Brazil and England: The National Health Survey and the Health Survey for England

Resumo O objetivo do artigo é analisar as características das pesquisas nacionais de saúde realizadas no Brasil e na Inglaterra pelos seus respectivos institutos de Estatística. No Brasil foi considerada a Pesquisa Nacional de Saúde (PNS) e na Inglaterra, a Health Survey for England (HSE). Para tanto, apresenta-se inicialmente um panorama sobre os distintos perfis populacionais dos países. Passa-se, então, a um breve histórico das pesquisas, evidenciando inclusive as temáticas comuns que são abordadas na PNS e na HSE que favorecem análises comparativas. Por fim, apresenta-se uma comparação, a título de exemplo, acerca das desigualdades no acesso e na utilização dos serviços de saúde no Brasil e na Inglaterra. Os resultados evidenciam inúmeras possiblidades de análises comparativas em temáticas como percepção de saúde, tabagismo, consumo de bebidas alcoólicas, diabetes e hipertensão. Entretanto, salienta-se a necessidade de atentar para especificidades do perfil populacional de cada país e às características metodológicas das pesquisas.

Abstract This paper aims to analyze the characteristics of national health surveys conducted in Brazil and England by their respective Statistics institutes. For Brazil, the National Health Survey (PNS) was considered, and the Health Survey for England (HSE) for England. To this end, we show a preliminary overview of the different population profiles of the two countries. Then, a brief historical background is presented, including the common themes that are addressed in the PNS and HSE that favor comparative analyses. Finally, we compared, for example, the inequalities in access to and use of Brazilian and English health services. The results show several possibilities for comparative analysis on topics such as health perception, tobacco use, alcohol consumption, diabetes, and hypertension. However, the need to consider the specificities of the population profile of each country and the methodological characteristics of the surveys is emphasized.

O que podemos aprender com a atual realidade da Atenção Primária inglesa? Considerações a partir da tradução de textos da British Journal of General Practice pela Revista Brasileira de Medicina de Família e Comunidade / What can we learn from the reality of UK's primary care? Reflections on the translation of texts from the British Journal of General Practice by the Brazilian Journal of Family and Community Medicine / ¿Qué podemos aprender de la realidad de la atención primaria del Reino Unido? Consideraciones sobre la traducción de textos del British Journal of General Practice por la Revista Brasileña de Medicina Familiar y Comunitaria

Neste editorial, apresentamos a nova sessão de textos traduzidos, fruto da parceria da Revista Brasileira de Medicina de Família e Comunidade com a British Journal of General Practice. Em 2017, optamos por traduzir textos que trouxessem para o Brasil reflexões sobre a atualidade da atenção primária inglesa, particularmente sobre a incorporação de tecnologias na prática dos médicos de família, a necessidade de maior conhecimento sobre a relação entre oferta, demanda e acesso aos serviços de saúde, bem como sobre os efeitos de políticas de pagamento por performance na prática dos profissionais de saúde. Tais reflexões são atuais para o contexto brasileiro, sugerindo a importância de maiores investimentos em inovação e produção de conhecimentos científicos para o fortalecimento da APS no país

In this editorial, we present the new session of translated texts, fruit of the partnership of the Brazilian Journal of Family and Community Medicine with the British Journal of General Practice. In 2017, we chose to translate texts that brought to Brazil reflections on the current reality of United Kingdom's primary health care, particularly on the incorporation of technologies in general practice, the need for greater knowledge about the relationship between supply, demand and access to health services, as well as the effects of pay for performance policies on the practice of health professionals. These reflections are current for the Brazilian context, suggesting the importance of greater investments in innovation and production of scientific knowledge for strengthening primary health care in the country.

En este editorial, presentamos la nova sesión de textos traducidos, fruto de la colaboración de la Revista Brasileña de Medicina Familiar y Comunidad con el British Journal of General Practice. En 2017, optamos por traducir textos que trajesen a Brasil reflexiones sobre la actualidad de la atención primaria del Reino Unido, particularmente sobre la incorporación de tecnologías en la práctica de los médicos de familia, la necesidad de un mayor conocimiento sobre la relación entre oferta, demanda y acceso a los servicios de salud, así como sobre los efectos de políticas de pago por desempeño en la práctica de los profesionales de salud. Tales reflexiones son actuales para el contexto brasileño, sugiriendo la importancia de mayores inversiones en innovación y producción de conocimientos científicos para el fortalecimiento de la atención primaria de salud en el país.

A "liberalização" do Serviço Nacional de Saúde da Inglaterra: trajetória e riscos para o direito à saúde / La "liberalización" del Servicio Nacional de Salud de la Inglaterra: trayectoria y riesgos para el derecho a la salud / "Liberalizing" the English National Health Service: background and risks to healthcare entitlement

Resumo: A recente reforma do Serviço Nacional de Saúde (NHS) inglês por meio do Health and Social Care Act de 2012 introduziu mudanças importantes na organização, gestão e prestação de serviços públicos de saúde na Inglaterra. O objetivo deste estudo é analisar as reformas do NHS no contexto histórico de predomínio de teorias neoliberais desde 1980 e discutir o processo de "liberalização" do NHS. São identificados e analisados três momentos: (i) gradativa substituição ideológica e teórica (1979-1990) - transição da lógica profissional e sanitária para uma lógica gerencial/comercial; (ii) burocracia e mercado incipiente (1991-2004) - estruturação de burocracia voltada à administração do mercado interno e expansão de medidas pró-mercado; e (iii) abertura ao mercado, fragmentação e descontinuidade de serviços (2005-2012) - fragilização do modelo de saúde territorial e consolidação da saúde como um mercado aberto a prestadores públicos e privados. Esse processo gradual e constante de liberalização vem levando ao fechamento de serviços e à restrição do acesso, comprometendo a integralidade, a equidade e o direito universal à saúde no NHS.

Resumen: La reciente reforma del Servicio Nacional de Salud (NHS) inglés a través de la Health and Social Care Act de 2012 introdujo cambios importantes en la organización, gestión y prestación de los servicios de salud pública en Inglaterra. El objetivo de este estudio es analizar las reformas del NHS en el contexto histórico del predominio de las teorías neoliberales desde 1980 y discutir el proceso de "liberalización" del NHS. Fueron identificados y se analizaron tres momentos: (i) sustitución gradual ideológica y teórica (1979-1990) -transición de la lógica profesional y de salud para una lógica de gestión/negocio; (ii) la burocracia y el mercado incipiente (1991-2004) -estructuración de la burocracia dedicada a la gestión del mercado interior y la expansión de las medidas pro-mercado; y (iii) la apertura del mercado, la fragmentación y la discontinuidad de los servicios (2005-2012) -fragilización del modelo de salud territorial y consolidación de la salud como un mercado abierto para los proveedores públicos y privados. Este proceso gradual y constante de la liberalización ha provocado el cierre de los servicios y la restricción del acceso, comprometiendo la integridad, justicia y derecho universal a la salud en el NHS.

Abstract: The recent reform of the English National Health Service (NHS) through the Health and Social Care Act of 2012 introduced important changes in the organization, management, and provision of public health services in England. This study aims to analyze the NHS reforms in the historical context of predominance of neoliberal theories since 1980 and to discuss the "liberalization" of the NHS. The study identifies and analyzes three phases: (i) gradual ideological and theoretical substitution (1979-1990) - transition from professional and health logic to management and commercial logic; (ii) bureaucracy and incipient market (1991-2004) - structuring of the bureaucracy focused on administration of the internal market and expansion of pro-market measures; and (iii) opening to the market, fragmentation, and discontinuity of services (2005-2012) - weakening of the territorial health model and consolidation of health as an open market for public and private providers. This gradual but constant liberalization has closed services and restricted access, jeopardizing the system's comprehensiveness, equity, and universal healthcare entitlement in the NHS.

Public Health Observatories in England: recent transformations and continuing the legacy / Os Observatórios de Saúde Pública na Inglaterra: mudanças recentes e continuação do legado / Los Observatorios de Salud Pública en Inglaterra: cambios recientes y continuacción del legado

Abstract Public Health Observatories (PHOs) were created in England in 2000 as an important adjunct to the public health system in the country. The observatories were networked together, which allowed pooling of expertise and rapid dissemination of methods and results. The network grew to include the whole of the UK and Ireland and was a very successful force for change until PHOs were subsumed into the new Government Agency Public Health Organization, Public Health England. This paper describes the lessons learnt from their existence in the public health system in England for fourteen years.

Resumo Os Observatórios de Saúde Pública foram criados na Inglaterra em 2000 como instâncias auxiliares importantes para o sistema de saúde pública no país. Os observatórios constituíram uma rede, que permitiu o compartilhamento de experiências e a disseminação rápida de métodos e resultados. Essa rede cresceu até cobrir todo o Reino Unido e Irlanda, servindo como força altamente bem-sucedida em favor de mudanças, até que os observatórios foram subsumidos pela nova agência governamental de saúde pública, chamada Public Health England. O artigo descreve as lições aprendidas ao longo dos 14 anos de existência dos observatórios junto ao sistema de saúde pública da Inglaterra.

Resumen Los Observatorios de Salud Pública se crearon en Inglaterra en 2000 como importantes órganos auxiliares para el sistema de salud pública en el país. Los observatorios establecieron una red, permitiendo el intercambio de experiencias y la rápida difusión de los métodos y resultados. Esta red creció hasta cubrir todo el Reino Unido e Irlanda, sirviendo como fuerza de gran éxito para el cambio, hasta que los observatorios fueron subsumidos por la nueva salud pública agencia gubernamental, la Public Health England. El artículo describe las lecciones aprendidas durante los 14 años de existencia de los observatorios en el sistema de salud pública en Inglaterra.

Atrial Fibrillation, Neurocognitive Decline and Gene Expression After Cardiopulmonary Bypass

ABSTRACT OBJECTIVE: Atrial fibrillation and neurocognitive decline are common complications after cardiopulmonary bypass. By utilizing genomic microarrays we investigate whether gene expression is associated with postoperative atrial fibrillation and neurocognitive decline. METHODS: Twenty one cardiac surgery patients were prospectively matched and underwent neurocognitive assessments pre-operatively and four days postoperatively. The whole blood collected in the pre-cardiopulmonary bypass, 6 hours after-cardiopulmonary bypass, and on the 4th postoperative day was hybridized to Affymetrix Gene Chip U133 Plus 2.0 Microarrays. Gene expression in patients who developed postoperative atrial fibrillation and neurocognitive decline (n=6; POAF+NCD) was compared with gene expression in patients with postoperative atrial fibrillation and normal cognitive function (n=5; POAF+NORM) and patients with sinus rhythm and normal cognitive function (n=10; SR+NORM). Regulated genes were identified using JMP Genomics 4.0 with a false discovery rate of 0.05 and fold change of >1.5 or <-1.5. RESULTS: Eleven patients developed postoperative atrial fibrillation. Six of these also developed neurocognitive decline. Of the 12 patients with sinus rhythm, only 2 developed neurocognitive decline. POAF+NCD patients had unique regulation of 17 named genes preoperatively, 60 named genes six hours after cardiopulmonary bypass, and 34 named genes four days postoperatively (P<0.05) compared with normal patients. Pathway analysis demonstrated that these genes are involved in cell death, inflammation, cardiac remodeling and nervous system function. CONCLUSION: Patients who developed postoperative atrial fibrillation and neurocognitive decline after cardiopulmonary bypass may have differential genomic responses compared to normal patients and patients with only postoperative atrial fibrillation, suggesting common pathophysiology for these conditions. Further exploration of these genes may provide insight into the etiology and improvements of these morbid outcomes.

Disease and weight loss: a prospective study of middle-aged and older adults in Costa Rica and England / Enfermedad y pérdida de peso: un estudio prospectivo de adultos y adultos mayores en Costa Rica e Inglaterra

Objective. To determine whether disease predicts weight loss in population-based studies, as this may confound the relationship between weight and mortality. Materials and methods. We used longitudinal data from the Costa Rican Longevity and Healthy Aging Study (CRELES) and the English Longitudinal Study of Ageing (ELSA). We defined two overlapping outcomes of measured weight loss between waves: >1.0 point of body mass index (BMI) and >2.0 BMI points. Logistic regression models estimated the associations with disease, adjusting for age (range 52-79), sex, smoking, and initial BMI. Results. In ELSA, onset of diabetes, cancer, or lung disease is associated with loss >2.0 points (respectively, OR=2.25 [95%CI: 1.34-3.80]; OR=2.70 [95%CI: 1.49-4.89]; OR=1.82 [95%CI: 1.02-3.26]). In CRELES, disease-onset reports are not associated with weight loss at 5% significance, but statistical power to detect associations is poor. Conclusion. Although it is known that some diseases cause weight loss, at the population level these associations vary considerably across samples.

Objetivo. Determinar si las enfermedades predicen pérdida de peso a partir de encuestas poblacionales, debido a que esto podría confundir la relación entre peso y mortalidad. Material y métodos. Se utilizaron datos longitudinales de Costa Rica: Estudio de Longevidad y Envejecimiento Saludable (CRELES) y Estudio Longitudinal de Envejecimiento en Inglaterra (ELSA, por sus siglas en inglés). Se definieron dos indicadores de resultado no excluyentes de pérdida de peso entre rondas: >1.0 punto de índice de masa corporal (IMC) y >2.0 puntos de IMC. Las asociaciones de interés se estimaron con modelos de regresión logística, con controles para la edad (rango 52-79), sexo, tabaquismo actual e IMC inicial. Resultados. En el ELSA, la incidencia de diabetes, cáncer o enfermedad pulmonar está asociada con pérdida de >2.0 puntos de IMC (respectivamente: OR=2.25 [IC95%: 1.34-3.80]; OR=2.70 [IC95%: 1.49-4.89]; OR=1.82 [IC95%: 1.02-3.26]). En el CRELES, el reporte de diagnóstico de enfermedades no muestra asociación significativa a 5% con pérdida de peso, pero el poder estadístico de la muestra para detectar asociaciones es limitado. Conclusión. Aunque es conocido que ciertas enfermedades causan pérdida de peso, estas asociaciones a nivel poblacional varían considerablemente entre encuestas.

Equidad en Salud y Evaluación de Tecnologías Sanitarias en Chile / Equity in Health and Health Technology Assessment in Chile

Equity has been recognized as one of the driving principles of many health systems in the world. In Latin America, Chile has led the explicit inclusion of equity in their health policies, which is reflected in its recent health reform. On the other hand, Chile faces the challenge of defining and implementing a policy for health technology assessment (HTA), which should be consistent with the equity principles that underlie the Chilean national health system. This paper reviews the equity concept emphasizing the relevance of socioeconomic inequalities. Furthermore, it examines how international HTA agencies have explicitly included this element in the evaluation and decision processes. It presents the English case, which highlights the elements of procedural justice rather than adopting a normative position regarding equity. Finally, it examines the methods that have been developed aiming to make explicit consideration of equity in HTA. It concludes that the methodological development to incorporate equity elements with empirical basis is recent and limited. The consideration of equity is, in most of the cases, left to the instances of deliberative participation.

Развитие детей в раннем возрастев Европейском регионе: потребности, тенденции и разработка политики: обзор на основе оценки пяти стран

Раннее детство - это период, требующий от родителей выполнения наиболее многочисленных (и интенсивных) обязанностей, связанных со всеми аспектами благополучия ребенка, охватываемыми Конвенцией: их выживанием, здоровьем, физической безопасности и эмоциональной защиты, качеством условий жизни иухода, возможностями участия в играх и обучении, а также свободой выражения своих взглядов. В этой связи осуществление прав детей в значительной степени зависит от благосостояния и наличия ресурсов у тех, кто отвечает за заботу о них. Признание этой взаимосвязи является важной отправной точкой в планировании помощи и услуг, предоставляемых родителям, законным опекунам и другим лицам, предоставляющим услуги по уходу за детьми. Государствам-участникам предлагается оказывать надлежащую помощь родителям, законным опекунам и расширенным семьям в выполнении ими своих обязанностей по воспитанию детей (статьи 18.2 и 18.3), в том числе помощь родителям в создании условий жизни, необходимых для развития ребенка (статья 27.2) и в обеспечении ребенку необходимой защиты и заботы (статья 3.2).

Early child development in the European Region: needs, trends and policy development: an overview based on five country assessments

Early childhood is the period of most extensive (and intensive) parental responsibilities related to all aspects of children’s well-being covered by the Convention: their survival, health, physical safety and emotional security, standards of living and care, opportunities for play and learning, and freedom of expression. Accordingly, realizing children’s rights is in large measure dependent on the well-being and resources available to those with responsibility for their care. Recognizing these interdependencies is a sound starting point for planning assistance and services to parents, legal guardians and other caregivers. State parties are required to render appropriate assistance to parents, legal guardians and extended families in the performance of their child-rearing responsibilities (arts. 18.2 and 18.3), including assisting parents in providing living conditions necessary for the child’s development (art. 27.2) and ensuring that children receive necessary protection and care (art. 3.2) (United Nations General Assembly, General Comment No.7, 2005)

O consumo de álcool segundo as gravuras Beer Street e Gin Lane de William Hogarth e as obras de John Wesley: convergências e diferenças / Alcohol consumption as portrayed in William Hogarth's prints Beer Street and Gin Lane and in the works of John Wesley: similarities and differences

Compara as gravuras Gin Lane e Beer Street, de William Hogarth, com textos do seu contemporâneo John Wesley, spiritus rector do movimento religioso metodista. Embora em algumas gravuras Hogarth tenha retratado o movimento metodista como perigosamente entusiasta, os dois defenderam uma agenda próxima quanto ao consumo de álcool. A semelhança entre as duas formas de compreender a questão é explicada por costumes culturalmente estabelecidos, e a diferença por uma perspectiva social distinta.

The article compares William Hogarth's Gin Lane and Beer Street with texts by his contemporary John Wesley, spiritus rector of the Methodist movement. Although Hogarth had portrayed the Methodist religious movement in some of his prints as dangerously enthusiastic, both men defended a similar agenda concerning alcohol consumption. The similarities in their two ways of understanding the issue can be explained by culturally established customs, while distinct social outlooks can account for their differences.