OBJECTIVE: Hospital systems and regulating agencies enforce strict guidelines barring personal items from entering the operating room (OR) - touting surgical site infections (SSIs) and patient safety as the rationale. We sought to determine whether or not evidence supporting this recommendation exists by reviewing available literature. BACKGROUND DATA: Rules and guidelines that are not evidence based may lead to increased hospital expenses and limitations on healthcare provider autonomy. METHODS: PubMed, Embase, Scopus, Cochrane Library, Web of Science, and CINAHL were searched in order to find articles that correlated personal items in the OR to documented SSIs. Articles that satisfied the following criteria were included: (1) studies looking at personal items in the OR, such as handbags, purses, badges, pagers, backpacks, jewelry phones, and eyeglasses, but not just OR equipment; and (2) the primary outcome measure was infection at the surgical site. RESULTS: Seventeen articles met inclusion criteria and were evaluated. Of the 17, the majority did not determine if personal items increased risk for SSIs. Only one article examined the correlation between a personal item near the operative site and SSI, concluding that wedding rings worn in the OR had no impact on SSIs. Most studies examined colonization rates on personal items as potential infection risk; however, no personal items were causally linked to SSI in any of these studies. CONCLUSION: There is no objective evidence to suggest that personal items in the OR increase risk for SSIs.

This thesis describes the development of the idea of an 'obesity epidemic' that figures prominently in contemporary public health discourse. It uses conceptual approaches from Science and Technology Studies and the history of medicine to analyse changing ideas about obesity, particularly as formulated and mobilised by British researchers from the 1960s onwards, to show how excess body weight became understood as a significant public health problem in this period. The thesis begins by describing the post-war refocusing of medical attention in developed countries from infectious diseases, the rates of which are falling, to chronic disease such as heart disease, diabetes, cancer and stroke. Heart disease, in particular, became seen as an 'epidemic'. After World War II, increase research funding by the American government made possible the development of a new research method - the long-term prospective epidemiological study - and a new way of understanding chronic diseases as caused by risk factors such as high blood pressure, cigarette smoking and high blood cholesterol. Excess body weight was includes in this list of risk factors, and so became an object in increased medical attention. The thesis then outlines how a new public health coalition was formed around obesity in the 1970s by British biomedical researchers working on topics in the fields of nutrition, diabetes and coronary heart disease. It describes the development of what I call the 'individual paradigm' of obesity which characterises the condition as an individual problem that leads to heart disease and mechanical complaints and is treatable by weight loss diets. It then describes two key features of British obesity science in the 1980s and 1990s. The first of these is the adoption of the Body Mass Index and the standard cut-off points that are used to define overweight and obesity, which together facilitate the collection and dissemination of data on changes in average body weights, The second is the energy balance model of weight regulation, which served to unify the diverse disciplinary approaches to biomedical research incorporated into this new knowledge, but which could not account for the high rates of failure acknowledged as occurring with conventional treatments such as weight loss diets, anorectic drugs and bariatric surgery. The thesis describes how researchers in the field of obesity science than extended their institutional research to participate in the production of a series of reports for the World Health Organization, including one on the global epidemic of obesity published in 2000. This new platform, combined with data produced by prospective studies, enabled them to disseminate a new understanding of obesity and overweight - what I call the 'environmental paradigm' - which characterises it as a global health problem associated with an increased risk of many diseases and caused by structural factors such as inappropriate diet and sedentary lifestyles. Despite refocusing attention of structural determinants of ill health, however, public health experts were constrained by considerations of political practicality and commercial interest when calling for preventive measures in the areas of diet and physical activity. The thesis concludes by considering the different ways in which scholars have theorised the epidemiological transition from infectious to chronic disease. Drawing on approaches from the health inequalities literature, it argues that the conventional framings of chronic disease epidemiology have tended systematically to obscure structural links between obesity and other forms of diet-related ill health on the one hand, and relative poverty on the other.

O presente trabalho consistiu em reconhecer o lugar ocupado por adolescentes concretos no discurso dominante, na área da Saúde Pública, sobre saúde integral do adolescente. Reconhecemos a visão paradigmática biomédica/médico-biológica, como tendência dominante na área de saúde do adolescente, quer na produção do conhecimento, quer na elaboração de propostas de intervenção. Assumimos, como discurso oficial/hegemônico na Saúde, aquele produzido e irradiado por agências internacionais que atuam na área, e que é explicitado no Programa de Saúde Integral do Adolescente, do Plano de AçãO sobre a Saúde do Adolescente nas Américas. Este Programa vem orientando, nesta década, as políticas específicas em países da América Latina e do Caribe, inclusive, no Brasil. Buscamos desvendar o discurso dominante, pela mediação da análise do referido Programa. Recorremos ao emprego de procedimentos metodológicos de ciências sociais, dentro de uma perspectiva histórica, apoiadas em autores que tentam romper com o positivismo - base da visão paradigmática biomédica/médico-biológica. Utilizamos como fontes documentais, além do referido Programa, outras publicações produzidas por organismos internacionais, relacionadas com o nosso objeto de estudo. O processo de desconstruçâo e reconstrução histórica do discurso em estudo, permitiu-nos estar reconhecendo os reais destinatários do Programa de Saúde Integral do Adolescente-adolescentes \"pobres\" - e o lugar, por eles ocupado - objeto, dentro de um projeto, por nós reconhecido como: legistador. ético-moral e pedagógico. / The present study describes and discusses the position held by the \"real\" adolescent in the Public Health context, particularly in the Comprehensive Health Care Program for Adolescent. The biomedical paradigm has hegemonically directed health actions as well as the building of knowledge in this domain. This official discourse is produced and disseminated by international health organizations. The Comprehensive Adolescent Health in the Region of the Americas Program has been used as guideline to determine the adolescent\'s health policies in the Latin America and the Caribbean Region, including the Brazil. The dominant discourse was analysed in order to desclose the \"real\" target population. Social sciences methods, in an historical perspective, were applied to desassemble and to rebuild the discourse, searching out the underlined \"intention\" in that Program. In this investigation, we have taken in account of authors, who disagree with the positivism approach , the basis of the biomedical paradigm. This research allowed us to enhance understandings to whom is adressed the Comprehensive Health Care Program for Adolescents in the Region of Americas. We recognize that the target population of this program are the poor adolescents and they are placed only as an object within the Project. This program contains a legislative, ethic-moral and pedagocic discourse.

Nos últimos anos observa-se o aumento da presença de um evento no Sistema Único de Saúde denominado judicialização da saúde. O crescente nu?mero de aço?es judiciais propostas para garantir o fornecimento de medicamentos tem sido motivo de preocupação, pelo seu aspecto emergencial, onerando e dificultando ações de planejamento e de controle por parte dos gestores públicos. Assim, a análise dos atores envolvidos nesse fenômeno torna-se relevante, afinal, elas atuam diretamente no perfil das ações judiciais. Desse modo, esta pesquisa propôs explorar as percepções dos médicos (prescritores) sobre a dispensação de medicamentos na Divisão Regional de Saúde - DRS XIII. Para isso, foi realizada uma busca por médicos prescritores utilizando a página do Tribunal de Justiça de São Paulo, o TJSP, o Sistema de Coordenação das Demandas Estratégicas do SUS, o S-Codes e/ou cadastro de paciente do Hospital das Clínicas de Ribeirão Preto, o HCRP. Foram selecionados aleatoriamente 72 prescritores para responderem um questionário composto por 15 questões. Dentre os principais resultados, uma constatação marcante foi a de que, na percepção dos médicos, sempre que possível, há a prescrição de medicamentos genéricos, o que consequentemente faz com que estes não prescrevam necessariamente medicamentos \"originais\", de referência e ou de marca. Por outro lado, não foi observada preocupação dos prescritores se o medicamento prescrito está incluído (ou não) na RENAME. Outra inferência interessante: médicos menos experientes (tempo de formação) não se mostraram avessos a orientar pacientes a seguir com ações judiciais, tanto quanto os médicos mais experientes. / In the last few years, there has been an increase in the occurrence of an event known as \"judicialization of health\" in the Brazilian Health Service (SUS). The increasing number of lawsuits that have been proposed to guarantee the supply of drugs has been a reason for concern because of its emergence, burdening and hindering planning and control actions by public managers. Thus, the analysis of the parts involved in this phenomenon has become relevant, as they act directly in the lawsuit profiles. Therefore, this research proposed to explore the perceptions of physicians (prescribers) in relation to the release of drugs in the Regional Health Division - DRS XIII. To do so, a search for prescribing physicians using the page of the São Paulo Court of Justice, the TJSP; the SUS Strategic Requests Coordination System; the S-Codes; and/or the patient registry of the Hospital das Clínicas of Ribeirão Preto, the HCRP, was carried out. Seventy-two prescribers were randomly selected to answer a questionnaire composed of 15 questions. Among the main results, a striking finding uncovered that in the physicians\' perception, whenever possible, there was a prescription of generic drugs, which means that they did not necessarily prescribe \"original\", reference and/or branded drugs. On the other hand, prescribers had no concern whether the prescribed drug was included in the RENAME. Another interesting inference: both the least and the most experienced physicians (by training time) were not averse to guiding patients to follow lawsuit.

O Sistema Único de Saúde (SUS), desde o seu nascimento em 1988, passa por constantes mudanças e transformações que buscam a consolidação de um sistema de saúde universal, equânime e com integralidade do cuidado em saúde. O objetivo geral desse trabalho foi avaliar a distribuição e as possíveis influências para habilitação e implantação da atenção domiciliar nos municípios brasileiros a partir da normativa 2527/2011 que redefine a atenção domiciliar no SUS até dezembro de 2013. Nesse período foram habilitados 277 municípios e destes, 166 foram implantados. As variáveis estudadas para os municípios foram o Porte Populacional (PP), Índice de Desenvolvimento do SUS (IDSUS), Produto Interno Bruto (PIB), Índice Desenvolvimento Humano Municipal (IDHM), cobertura de estratégia de saúde da família (COB-ESF) e a cobertura de saúde suplementar (COB- SS). Os dados coletados foram organizados em banco de dados do programa Statiscal Package Social Science (SPSS), versão 20 para Windows com os valores de significância p<0,05. Os resultados desta pesquisa mostraram que a distribuição da atenção domiciliar está concentrada nas regiões Sudeste e Nordeste e que as variáveis PP, PIB, IDHM, COB- ESF e COB- SS podem influenciar na habilitação da atenção domiciliar e não possuem influência na implantação, que parece estar relacionado com aspectos de gestão. Conclui-se que os municípios sem nenhuma estrutura de média e alta complexidade não tiveram grande sucesso na habilitação e implantação da atenção domiciliar no SUS e que os mecanismos de indução exclusivamente por critérios populacionais podem ser eficazes num primeiro momento na direção da política pública, mas outras vertentes, como o IDSUS, IDHM, COB- ESF dentre outras, podem ser utilizadas a fim de promover a equidade na distribuição da atenção domiciliar e outras políticas públicas de saúde no SUS. / The Unified Health System (SUS) in Brazil, established in 1988, undergoes changes and transformations seeking to consolidate a universal health system, equitable and comprehensive care in health. The research aimed to evaluate the distribution and possible Influences for accreditation and operation of Homecare in Brazilian cities from the 2527/2011 rules that redefines the home care policy in SUS until December 2013. In this period 277 accredited municipalities and 166 were in operation. The variables studied were the Population Porte (PP), SUS Development Index (IDSUS), Gross Domestic Product (PIB), Municipal Human Development Index (IDHM), Health Strategy coverage Family (COB-ESF) and coverage Supplemental Health (COB- SS). Data were organized in Program Database Statiscal Package Social Science (SPSS) version 20 for Windows with significance values p <0.05. These results showed a Homecare distribution concentrated in the Southeast and Northeast of Brazil and what variables such as PP, PIB, IDHM can influence the accreditation of Homecare and not influence the operation, which appears to be related to aspects of management. We conclude that the municipalities without Media Structure and High Complexity, have difficulties for accreditation and operation of home care in the Brazilian health system and induction mechanisms exclusively by population criteria may have been effective at first in directing policy home care for the large municipalities, but other aspects, such as IDSUS, IDHM, COB- ESF among others, can be used to promote equity in the distribution of home care and other policies in the health system of Brazil.

O presente trabalho consistiu em reconhecer o lugar ocupado por adolescentes concretos no discurso dominante, na área da Saúde Pública, sobre saúde integral do adolescente. Reconhecemos a visão paradigmática biomédica/médico-biológica, como tendência dominante na área de saúde do adolescente, quer na produção do conhecimento, quer na elaboração de propostas de intervenção. Assumimos, como discurso oficial/hegemônico na Saúde, aquele produzido e irradiado por agências internacionais que atuam na área, e que é explicitado no Programa de Saúde Integral do Adolescente, do Plano de AçãO sobre a Saúde do Adolescente nas Américas. Este Programa vem orientando, nesta década, as políticas específicas em países da América Latina e do Caribe, inclusive, no Brasil. Buscamos desvendar o discurso dominante, pela mediação da análise do referido Programa. Recorremos ao emprego de procedimentos metodológicos de ciências sociais, dentro de uma perspectiva histórica, apoiadas em autores que tentam romper com o positivismo - base da visão paradigmática biomédica/médico-biológica. Utilizamos como fontes documentais, além do referido Programa, outras publicações produzidas por organismos internacionais, relacionadas com o nosso objeto de estudo. O processo de desconstruçâo e reconstrução histórica do discurso em estudo, permitiu-nos estar reconhecendo os reais destinatários do Programa de Saúde Integral do Adolescente-adolescentes \"pobres\" - e o lugar, por eles ocupado - objeto, dentro de um projeto, por nós reconhecido como: legistador. ético-moral e pedagógico. / The present study describes and discusses the position held by the \"real\" adolescent in the Public Health context, particularly in the Comprehensive Health Care Program for Adolescent. The biomedical paradigm has hegemonically directed health actions as well as the building of knowledge in this domain. This official discourse is produced and disseminated by international health organizations. The Comprehensive Adolescent Health in the Region of the Americas Program has been used as guideline to determine the adolescent\'s health policies in the Latin America and the Caribbean Region, including the Brazil. The dominant discourse was analysed in order to desclose the \"real\" target population. Social sciences methods, in an historical perspective, were applied to desassemble and to rebuild the discourse, searching out the underlined \"intention\" in that Program. In this investigation, we have taken in account of authors, who disagree with the positivism approach , the basis of the biomedical paradigm. This research allowed us to enhance understandings to whom is adressed the Comprehensive Health Care Program for Adolescents in the Region of Americas. We recognize that the target population of this program are the poor adolescents and they are placed only as an object within the Project. This program contains a legislative, ethic-moral and pedagocic discourse.

abstract: The biohacker movement is an important and modern form of activism. This study broadly examines how positive-activist-oriented biohackers emerge, organize, and respond to social crises. Despite growing public awareness, few studies have examined biohacking's influence on prevailing notions of organizing and medicine in-context. Therefore, this study examines biohacking in the context of the 2016 EpiPen price-gouging crisis, and explores how biohackers communicatively attempted to constitute counter-narratives and counter-logics about medical access and price through do-it-yourself (DIY) medical device alternatives. Discourse tracing and critical case study analysis are useful methodological frameworks for mapping the historical discursive and material logics that led to the EpiPen pricing crisis, including the medicalization of allergy, the advancement of drug-device combination technologies, and role of public health policy, and pharmaceutical marketing tactics. Findings suggest two new interpretations for how non-traditional forms of organizing facilitate new modes of resistance in times of institutional crisis. First, the study considers the concept of "pop-up maktivism" to conceptualize activism as a type of connective activity rather than collective organizing. Second, findings illustrate how activities such as participation and co-production can function as meaningful forms of institutional resistance within dominant discourses. This study proposes “mirrored materiality” to describe how biohackers deploy certain dominant logics to contest others. Lastly, implications for contributions to the conceptual frameworks of biopower, sociomateriality, and alternative organizing are discussed. / Dissertation/Thesis / Doctoral Dissertation Communication 2019

Is public health policy based on scholarly evidence? With the manifold variables that policy makers must consider, is evidence-based policy even realistic? While strategies exist to translate research into policy, a need to understand better how that can play out in real-life remains. Using interviews from informants occupying a range of positions, and considering the atmosphere created by media reports, this study examines the case of smoking privileges at East Coast Forensic Hospital. After a patient committed murder while on leave, apparently to smoke, public pressure over public safety, a relative lack of relevant scholarship, ethical considerations, and the divergent voices of stakeholders created challenging circumstances for policy makers. Through the use of case study methodology, this project identifies the kinds of information that are employed in the creation or modification of policy and offers insights concerning how the influences exerted on policy makers determine how information is employed.

Entre 2008 et 2011, plus de 22 000 cas de rougeole ont été signalés en France. Comment la résurgence de cette « maladie du passé » peut-elle s’expliquer ? Un vaccin efficace existe pour s’en prémunir, mais il apparaît que de plus en plus de Français se méfient de cette méthode jugée dangereuse, inutile et/ou contre-nature. La résistance et l’hésitation face aux vaccinations ont gagné de nombreux pays occidentaux. La territorialisation de récentes épidémies de rougeole en Europe et en France donne à voir les espaces de sous-vaccination, corrélés à l’implantation de populations réfractaires aux vaccins. Comprendre l’inscription géographique du vaccino-scepticisme implique donc de relier les pratiques vaccinales aux contextes socio-territoriaux dans lesquels elles prennent place. L’analyse multiscalaire proposée dans ce travail permet ainsi d’articuler les modalités locales du refus vaccinal avec une approche plus globale du système de santé. Enfin, l’étude des représentations des différents acteurs (patients-citoyens, professionnels de santé, médias, experts et décideurs politiques) montre que la politique vaccinale est devenue plus qu’un investissement de santé publique, un enjeu de société. / Between 2008 and 2011, more than 22 000 cases of measles were reported in France. How can the resurgence of this “disease from the past” be explained? The existing vaccine is effective, yet it seems that more and more French people are wary of this method of protection which they consider dangerous, useless and/or unnatural.The reluctance and hostility to vaccination have spread across numerous western countries. The study of the territories affected by recent epidemics of measles in France and Europe points out spaces of sub-vaccination, correlated to vaccination-resisting populations. To understand the geographical localisation of this resistance, it is therefore necessary to connect the vaccinal practices with the social and territorial contexts of the skeptical populations. A multi-level analysis allows to articulate the local modes of vaccinal refusal with a more global approach to public health policy. Finally, a close study of the perceptions of the different actors involved (patients-citizens, healthcare professionals, media, experts and political decision makers) shows that vaccinal policy has become more than an investment of public health and is now a real societal challenge.

Made available in DSpace on 2013-01-07T15:54:59Z (GMT). No. of bitstreams: 2 license.txt: 1748 bytes, checksum: 8a4605be74aa9ea9d79846c1fba20a33 (MD5) 45.pdf: 1317474 bytes, checksum: b38b65c060b6eeefd673dfdd34c21f62 (MD5) Previous issue date: 2004 / Analisa as consequências que a reforma implantada por Pedro Ernesto Baptista na Assistência Municipal, em 1933, trouxe para o mercado de trabalho médico. Observa as manifestações da sociedade às medidas adotadas, mas sobretudo as reações provocadas no meio médico, buscando avaliar com isto as alterações no âmbito do mercado de trabalho daquela categoria profissional.