Strategic mapping of institutional frameworks and their approach to equity: mapping exercise conducted to inform the implementation of the Health Equity Status Report initiative (HESRi) of the WHO Regional Office for Europe

International organizations within the health sector, as well as in other policy areas that are of relevance to the distribution of health inequities in society, pursue different approaches towards equity and equality. For example, equity may be expressed with regards to access to services, resources and opportunities; to levels of exposure and vulnerability to risk; or as a social value in itself, and a root factor contributing to other societal benefits. This report analyses a series of selected policy frameworks that guide the work of key institutions from within and outside of the health sector, including United Nations agencies, international and regional organizations, and national governments. The analysis elucidates the position of these stakeholders with regards to equity objectives, as expressed in their institutional frameworks. In doing so, the report aims to provide an insight into the institutional policy context of health equity in the WHO European Region, highlighting factors that may potentially enable, support or hinder the establishment of collaborations among selected institutional partners for the implementation of the Health Equity Status Report initiative of the WHO Regional Office for Europe.

A relação entre o suporte organizacional no trabalho e o risco para doenças crônicas não transmissíveis em um serviço de saúde / Relationship between organizational support at work and risk of non-communicable chronic diseases in a health service

Contexto: Conhecer a relação entre o suporte organizacional e as doenças crônicas e seus fatores de risco pode contribuir no planejamento ações de prevenção e promoção à saúde integral dos trabalhadores. Objetivo: Avaliar a relação entre o suporte organizacional percebido (SOP) e os fatores de risco para as doenças crônicas não transmissíveis (DCNT) em um serviço de saúde. Métodos: Estudo transversal, observacional e descritivo, com delineamento correlacional e abordagem quantitativa, através de dados de um questionário de autopreenchimento. Resultados: A taxa de participação da pesquisa foi de 80,24%, com média etária de 36,9 anos, 52,3% com contrato de trabalho por tempo determinado, 38,5% em turno noturno e 69,3% com trabalho exclusivo no serviço. Os riscos mais prevalentes para as DCNT foram hipertensão arterial sistêmica (29,2%), tabagismo (13,8%), sedentarismo (73,8%), dislipidemia (29,2%) e mais de um fator de risco associado (61,6%). O SOP na população estudada foi favorável, principalmente devido ao salário e às relações sociais no trabalho. Não houve relação significativa do SOP, mais de um emprego, turno noturno ou contratação temporária com os riscos para DCNT. Conclusão: O suporte organizacional percebido não aumentou ou reduziu o risco para as DCNT na população estudada.

Background: Accurate knowledge on the relationship between organizational support and chronic diseases and their risk factors might contribute to the planning of prevention and promotion actions focusing on the integral health of workers. Objective: To investigate the relationship between perceived organizational support (POS) and risk factors for chronic noncommunicable diseases (NCD) in a health service. Methods: The present was a cross-sectional, observational and descriptive study, with correlational design and quantitative approach that data collected by means of a self-report questionnaire. Results: The participation rate was 80.24%; the average age of the participants was 36.9 years old; 52.3% of the sample had temporary jobs, 38.5% worked the night shift and for 69.3% this was their only job. The most prevalent risks for NCD were systemic hypertension (29.2%), smoking (13.8%), sedentary lifestyle (73.8%), dyslipidemia (29.2%) and more than one associated risk factor (61.6%). The POS score was favorable, mainly due to the salary and social relationships at the workplace. There was no significant relation between risk for NCD and POS score, more than one job, night shift or temporary job. Conclusion: The perceived organizational support did not increase or reduced the risk for chronic noncommunicable diseases in the study sample.

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.

Planejamento governamental em saúde no estado da Bahia, Brasil: atores políticos, jogo social e aprendizado institucional / Government health planning in the state of Bahia, Brazil: political actors, social interaction and institutional learning

Este artigo analisa o processo de planejamento governamental em saúde no Estado da Bahia, no período 2007-2010, a partir da formulação do Plano Estadual de Saúde. O referencial adotado partiu da adaptação do modelo teórico do ciclo da política pública, contemplando análise do contexto, caracterização dos atores envolvidos, operações realizadas na tomada de decisões e meios estratégicos utilizados. A produção de informações se deu por meio da análise de documentos institucionais organizados em portfólios e registros do processo de planejamento na organização estudada. A análise dos resultados revela que o jogo político incluiu "concessões" e "negociações" em torno de mudanças na gestão e organização do sistema de saúde, evidenciando a discussão sobre os problemas enfrentados pela gestão estadual do SUS, no período, e a busca de alternativas e soluções a esses problemas. Também evidencia o aprendizado institucional construído, envolvendo dirigentes e técnicos que ampliaram e acumularam sua capacidade de análise e formulação de propostas em torno da agenda governamental.

This article analyzes the process of government planning in health in the state of Bahia in the 2007-2010 period based on the formulation of the State Health Plan. The benchmark adopted involved adaptation of the theoretical model of the cycle of public policy, including analysis of context, characterization of the actors involved, operations conducted in decision making and the strategic means used. The production of information was through the analysis of documents organized in institutional portfolios and records of the planning process in the organization studied. The analysis of results reveals that the political game included "concessions" and "negotiations" regarding changes in the management and organization of the health system, highlighting the discussion on the problems facing the state management of the Unified Health System (SUS) during the period, and the search for alternatives and solutions to these problems. It also reveals the institutional learning acquired, involving managers and technicians who broadened and reinforced their capacity to analyze and formulate proposals around the government agenda.

Memoria anual del Seguro Integral de Salud: Enero - Diciembre 2012 / Annual Report of the Integral Health Insurance: January-December 2012

El documento describe un recuento de la gestión desarrollada por la institución durante el período Enero-Diciembre 2012, en ella se esquematiza las acciones de relevancia suscitadas en el período analizado y el logro de objetivos institucionales con las instancias internas y externas de la institución a fin de disponer de información que enfatiza los aspectos que han permitido mejorar los indicadores en el campo de salud y los logros alcanzados en materia de aseguramiento en salud

Memoria anual del Seguro Integral de Salud: Enero - Diciembre 2011 / Annual Report of the Integral Health Insurance: January-December 2011

El presente documento describe los logros y dificultades de la institución al cierre del período, considerando que la gestión se realizó en el marco de las políticas sociales que el Estado Peruano impulsa con el fin de superar la pobreza y extrema pobreza en la población más vulnerable, garantizándoles el derecho ciudadano de acceso a los servicios de salud; por lo cual el Estado con total transparencia viene promoviendo la inversión social en las zonas más pobres, así como la participación de la sociedad civil en el seguimiento, gestión y evaluación de los diversos programas y proyectos de alivio y superación de la pobreza, con la finalidad de contar con una sociedad más justa y equitativa