Made available in DSpace on 2013-01-07T15:59:28Z (GMT). No. of bitstreams: 2 license.txt: 1748 bytes, checksum: 8a4605be74aa9ea9d79846c1fba20a33 (MD5) 1.pdf: 1195556 bytes, checksum: 565b68c13e129d4c5d60ba7ab17c0e07 (MD5) Previous issue date: 2006 / Discute as políticas públicas contra a varíola no Brasil, centrando-se nas campanhas para o seu controle e erradicação - Campanha Nacional Contra a Varíola (1962) e Campanha de Erradicação da Varíola (1966). Inicialmente, analisa a história dessa doença no país, observando sua importância epidemiológica e seu significado simbólico como mal epidêmico de grande mortalidade em diversos momentos. A partir dessa análise, procura identificar os fatores que a transformaram em alvo de uma campanha de erradicação.

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.

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.

Health and Wellbeing Boards (HWBs) are new local government (LG) sub-committees tasked with assessing local health and social care needs, and developing strategies for promoting integration and tackling health inequalities; yet they have no statutory authority to compel action. This research explored how they approached tackling health inequalities, focussing on the role of environmental health (EH), the LG public health occupation, in the pre-shadow and shadow stages and as they went live in April 2013. Four case study sites (based around individual HWBs) were purposively sampled to ensure that a variety of HWBs were included, including unitary and two-tier authorities and urban, suburban and rural areas. Data collection at each case study site included semi-structured interviews, observation of HWB meetings, and documentary analysis and extended for 18 months from early 2012. In addition, EH practitioners and managers were interviewed from each of the English regions to provide a wider context. The data was analysed thematically both inductively and deductively using Atlas.ti. and conclusions drawn. HWBs were varied in their structures, practices and intentions and some changed considerably during the research, as would be expected at a time of new policy development and implementation. There was evident commitment and enthusiasm from HWB members to improve the health of local populations. However it is unclear what ‘success’ will be or how it will be measured and attributed to the work of the HWB, and there were some tensions between the various parties involved. There was an espoused commitment to the principles of Marmot, in particular to children, however much of the focus during HWB meetings was on integrating health and social care. Taking action on many of the social determinants of health is outside the core sphere of HWB control, however they did not generally appear to be utilising some of the readily available tools, such as EH work to improve local living and working conditions. EH was found to be largely ‘invisible’ within its own public health community and does not have a tradition of evidence based practice needed to secure funding in the new system. This, along with the decline of the regulatory role, has led to a period of reflection and adaptation. The research findings are linked by the policy approaches of ‘doodle’ and localism, including the shrinking of the state, and in particular the retreat of statutory and regulatory roles and the introduction of overt political values in policy making; shifting the focus to relationships, partnership-building, integration and the impact of individuals. The contexts in which the research has taken place, both at local and national levels, including financial austerity, major health restructuring, and high national and local expectations are all significant factors which have shaped the findings.

Background: Non-communicable diseases (NCDs) account for over two-thirds of deaths worldwide, and global efforts to address NCDs have accelerated. Current prevention and control efforts rely primarily on individual behavior/lifestyle approaches that place the onus of responsibility for health on the individual. These approaches, however, have not stopped the increasing trend of NCDs worldwide. Thus, there is urgent need for exploring alternative approaches in order to attain the aim of reducing global premature NCDs mortality by 25% by 2025, and meeting the NCD reduction objective in the Sustainable Development Goals. Discussion: We suggest the need for a structural approach to addressing the NCDs epidemic that integrates social science and public health theories. We evaluate two overarching principles (empowerment and human rights) and three social determinants of health (labor and employment, trade and industry, and macroeconomics) addressed in the 2013 Global Action Plan for the Prevention and Control of NCDs to demonstrate how a structural approach to NCDs can be incorporated into existing NCD interventions. For each area considered, theoretical considerations for structural thinking are provided and conclude with recommended actions. Conclusion: Achieving the global health agenda goals of reducing NCDs mortality will require a shift to a paradigm that embraces concerted efforts to address both behavioral/lifestyle factors and structural dimensions of NCDs.

Indiana University-Purdue University Indianapolis (IUPUI) / Neonatal abstinence syndrome (NAS), the constellation of withdrawal symptoms experienced by neonates exposed to opioids prenatally, is an epidemic affecting an estimated 23,580 infants each year with an annual cost of $720 million. The purpose of this study was to examine factors associated with the incidence and severity of NAS as measured by the need for initiation of neonatal medication, peak medication dose, hospital length of stay (LOS), and hospital costs among newborns born to opioiddependent mothers. A retrospective review of medical records was conducted with two convenience samples: 204 infants born to mothers who used opioids during pregnancy; and 121 of these infants who required treatment with morphine to control symptoms of NAS. Data from April 2011 to September 2017 were collected from medical records of a large Midwestern hospital. Exploratory analysis and descriptive statistics were performed. Associations between independent variables and outcomes were examined using correlations, chi-square, t-tests, analyses of variance, and linear regression. Of the 204 neonates who were exposed to opioids prenatally, 121 (59%) developed symptoms of NAS requiring treatment with morphine. Neonates requiring morphine had significantly higher gestational ages than those who did not (37.7 vs 36.4 weeks; p = < .001) and their mothers were present at the neonates’ bedside a lower proportion of their total hospital stay (mean = 0.5684 of days vs 0.7384 of days; p = < .001). Compared to maternal use of buprenorphine, maternal methadone use was associated with higher peak morphine doses needed to control the neonate’s withdrawal symptoms (0.089 mg/kg versus 0.054 mg/kg; p = .023), and with longer hospital length of stay when compared to maternal use of buprenorphine and other opioid analgesics (34.2 vs. 20.8 vs. 22.5 days, respectively; p=0.02). Higher visitation time from the primary caregiver was correlated with lower hospital LOS (r = -0.421; p = < .001). Future research is needed to examine these relationships prospectively in a larger and more diverse sample. An effective response to the epidemics of opioid use during pregnancy and the incidence of NAS requires ongoing coordinated research and intervention in clinical care, public health, and health policy. / 2019-11-06

No description available.

No description available.

Recent public health scholarship finds that health outcomes are explained by the social and individual determinants of health rather than the individual-level determinants alone. The individualistic perspective has dominated the 20th century institutionalization of public health in the United States where the public health system has tended to focus largely, if not exclusively, on individual factors. This persistent orientation lies in contrast to another set of perspectives that have also persisted, focused on social causes, which are currently dominant in contemporary public health academic literature and in major, international health organizations. Whether the orientation within the United States is due to a prevailing paradigm among public health officials or is the result of new ideas about health causation being dampened under organizational weight is unknown. Despite public health being central to decreasing morbidity and mortality in the 20th century, significant gaps remain in researchers' understanding of what influences practice in the American public health system. My dissertation research investigates the broad outlines of the determinants of health as understood by state public health administrators. I study how the understanding of the determinants of health affects the practice of public health through analyzing how the ideas of state public health administrators interact with the organizational dynamics of the public health organizations they lead. This mixed-methods dissertation uses survey research and in-depth interviews and quantitative and qualitative analysis. I find that state public health officials' professionalization, length of tenure, level of education, and gender affect the perspective of health causation to which they adhere. I also find that the state public health officials with a social health frame more commonly report they are situated in organizations that are learning environments. Both organizational and ideational factors influence public health practice. The interview data expand this finding to paint a complex picture of organizational and ideational factors influencing one another as well as resulting practices. This research reveals that state public health officials often have strong health frames that are only able to shape the edges of their practice due to the political and organizational dynamics interacting with state public health departments. / Ph. D.

Introdução: A fluoretação da água dos sistemas de abastecimento é reconhecida como política pública eficaz no controle da doença cárie em nível populacional. Dentre os países que adotam a política, foram observadas desigualdades na distribuição dos serviços entre seus entes federativos, levando a necessidade de pesquisas mais aprofundadas com ointuito de identificar os determinantes da sua implantação. Objetivo: Foi investigadasituação da fluoretação da água dos sistemas de abastecimento dos municípios do Brasil, explorando o papel de variáveis contextuais na oferta deste serviço. Métodos: A partir de dados primárias do Censo Demográfico para o ano 2010 e a Pesquisa Nacional de Saneamento Básico de 2008, e, utilizando as divisões político-territoriais de região de saúde/município, verificou-se a possibilidade da oferta do serviço de fluoretação exibir relação de dependência com características das empresas prestadoras dos serviços de saneamento, e, com características contextuais das regiões de saúde em que os municípios estão inseridos. A análise para ambas foi ajustada por variáveis de características municipais. Resultados: 60% dos municípios contavam com serviço de fluoretação. Em análise das características das empresas de saneamento (natureza jurídica, esfera administrativa e forma de execução), estas mantiveram-se associadas positivamente independente das características municipais. Administrações municipais e empresas privadas associadas ou não a entidades públicas estiveram associadas a ausência de provisão do serviço.A oferta de fluoretação se alterou conforme as variáveis contextuais das regiões de saúde, eram maiores as chances de o serviço estar ausente em municípios pertencentes a regiões de saúde onde eram elevadas as mortalidades infantil e ocasionadas doença diarreica aguda, onde houvesse maior a proporção de pessoas com baixa renda e nas regiões saúde pertencentes às macrorregiões Nordeste/Norte. Conclusão: Verificou-se importante relação de dependência entre provisão da fluoretação da água com as características das empresas e características contextuais das regiões de saúde / Introduction: The fluoridation of water supply systems is recognized as an effective public policy in the control of caries disease at the population level. Among the countries that adopting the policy, inequalities were observed in the distribution of services among their federative entities, leading to the need for more detailed surveys in order to identify the determinants of their implementation. Objective: It was investigated the water fluoridation of water supply systems in Brazilian municipalities, exploring the role of contextual variables in the supply of this service. Methods: Based on primary data from the Demographic Census for the year 2010 and the 2008 National Survey on Basic Sanitation, and using the political-territorial divisions health region/municipality, it was verified the possibility of offering the fluoridation service show dependency relation with characteristics of the companies that providing the sanitation services, and, with contextual characteristics of the health regions in which the municipalities are inserted. The analysis for both was adjusted by variables of municipal characteristics. Results: 60% of municipalities had fluoridation service. In an analysis of the characteristics of the sanitation companies (legal nature, administrative sphere and form of water supply service provision), they were positively associated with municipal characteristics. Municipal administrations and private companies associated or not with public entities were associated with the absence of provision of the service. The fluoridation supply changed according to the contextual variables of the health regions, the chances of the service being absent were higher in municipalities belonging to health regions where child mortality was high and mortality caused by acute diarrheal disease, where there was a greater proportion of people with low income and in the health regions belonging to the North-East / North macro-regions. Conclusion: There was an important dependence relationship between the provision of water fluoridation with the characteristics of the companies and the contextual characteristics of the health regions.