Orientador: Maria da Luz Rosário de Sousa / Dissertação (mestrado profissional) - Universidade Estadual de Campinas, Faculdade de Odontologia de Piracicaba / Made available in DSpace on 2018-08-19T03:07:37Z (GMT). No. of bitstreams: 1 Pires_OlgaMariaDiasAgostinho_M.pdf: 1645149 bytes, checksum: 0417a207e7e24f1f12216b6c58841707 (MD5) Previous issue date: 2011 / Resumo: Estimou-se o perfil dos usuários do tratamento regular e urgência no serviço público de saúde bucal no município de Embu, em adultos, participantes do Levantamento Epidemiológico realizado em 2008, constituindo-se em um estudo transversal de base populacional, composta por pessoas de 35 a 44 anos (n=345), provenientes dos setores censitários, selecionadas através de amostragem probabilística. A amostra deste estudo foi examinada e entrevistada nos domicílios. O desfecho foi ser usuário do serviço público odontológico para tratamento regular ou atendimento de urgência. As variáveis independentes foram: agravos bucais (índice CPOD, condição periodontal: índice CPI e PIP, necessidade de prótese); condições socioeconômicas (renda familiar, aglomeração domiciliar, número de filhos, escolaridade); condições demográficas (sexo, estado civil, cor da pele); hábitos (uso de cigarros); utilização dos serviços (tempo da última consulta odontológica, informações sobre como evitar problemas bucais); percepção dos problemas bucais (dor de dente nos últimos seis meses, percepção de necessidade de tratamento e se sua situação bucal afeta relacionamentos). Para análise estatística foi utilizado o programa EPIINFO6 e STATA10, empregando-se análise bivariada dos usuários de serviço de saúde público odontológico em relação às variáveis independentes, utilizando razões de prevalência (RP), com respectivos intervalos de confiança de 95% (IC95%), ajustados para modelos complexos de amostragem com ponderação populacional. Ser usuário do serviço público para tratamento regular ou urgência representou 53% da amostra, sendo que o restante era usuário do serviço privado, convênio ou serviço filantrópico. O gênero feminino foi mais prevalente no uso do serviço público, [RP=1,33; IC95%: (1,14-1,54)]. O maior número de filhos também foi mais prevalente no uso do serviço [RP=1,15; IC95%: (1,01- 1,31)]. A aglomeração domiciliar [RP=1,88; IC95%: (1,42-2,50)] e menor renda familiar [RP=2,23; IC95%: (1,33-3,66)], mostraram-se fortes preditores no uso do serviço público, assim como o relato de dor nos últimos 6 meses [RP=1,43; IC95%: (1,06-1,42)], considerar que a condição bucal afeta os relacionamentos [RP=1,31; IC95%: (1,05-1,62)], e ser fumante ou ex fumante [RP=1,61; IC95%: (1,15-2,24)]. Este estudo mostrou associação ao uso do serviço público o baixo nível econômico, considerando o princípio da Equidade no Sistema Único de Saúde, este requisito vem sendo cumprido / Abstract: It was estimated the profile of users of regular and emergency treatment in the public oral health in the city of Embu, in adults, participants of an epidemiological survey conducted in 2008, thus becoming a cross-sectional study population comprised people aged 35 to 44 years (n=345), through probability sampling, people were examined and interviewed in their homes. The outcome was to be a user of public dental treatment for regular or emergency care. The independent variables were: dental caries (DMFT, periodontal condition: CPI index and PIP, need for prostheses, need for treatment), socioeconomic (family income, household crowding, number of children, schooling), demographic conditions (gender, civil status, skin color), habits (cigarette smoking), use of services (time of last dental visit, information on preventive oral health), perception of oral health problems (toothache in the last six months, feels that she needs treatment considers that the oral situation affects relationships). For statistical analysis program was used and EPIINFO6 STATA10, using bivariate analysis of users of public dental health service for the independent variables, using prevalence ratios (PR) with confidence intervals of 95% (CI95%) adjusted for complex sampling designs weighted population. Being a user of public emergency or for regular treatment represented 53% of the sample, the remaining user of the service was private, or philanthropic service agreement. Females were more prevalent in the public service use, with PR=1.33; CI95%: (1.14-1.54). The greatest number of children was also more prevalent in service use PR= 1.15; CI95%: (1.01-1.31). The household crowding PR= 1.88; CI95%: (1.42-2.50) and lower family income RP=2.23; CI95%: (1.33-3.66), were strong predictors in the use of public service, the report pain in the last 6 months PR=1.43; CI95%: (1.06-1.42), considering that the oral condition affects relationships PR=1.31; IC95%: (1.05-1.62), being a smoker or former smoker PR=1.61; CI95%: (1.15-2.24). This study showed an association between the use of public service and the low economic level, considering the principle of Equity in Health System, this requirement has been fulfilled / Mestrado / Odontologia em Saude Coletiva / Mestre em Odontologia em Saúde Coletiva

Doctorat en Sciences / info:eu-repo/semantics/nonPublished

For her MPH thesis research, Alex Kent conducted secondary analysis of data from the Equity Lens in Public Health (ELPH) research program to explore whether and how Indigenous health equity is prioritized within one regional health authority [HA100] in British Columbia’s public health system. Her thesis addresses the question: How has Indigenous health equity been identified and prioritized within HA100 as reflected in core documents and plans as well as interviews with key decision makers in the health authority? Using the Xpey’ Relational Environments Framework, a theoretical framework designed by Drs. Charlotte Loppie and Jeannine Carriere, Alex identifies and discusses the physical and theoretical settings where Indigenous health equity is and is not manifested in the public health system. Her findings highlight a number of examples of how HA100 has implemented successful strategies aimed at enhancing Indigenous health equity as well as several areas for improvement across the relational environments. Alex concludes that improving Indigenous health equity through human, non-human and symbolic interactions in institution, system and community settings appears to be a current priority for HA100; whereas reconciling historical relationships and creating equitable social, cultural and political conditions that promote optimal health and wellbeing for Indigenous peoples is positioned as a long-term and indirect goal. / Graduate

Master of Public Health / This study aimed to contribute to the current debate around equity in health care resource allocation by measuring the current allocation of resources, relative to need in the Northern Cape. It also discussed the level of inequities in health financing expenditure and staffing at the primary health care level between different districts of the Northern Cape. / South Africa

The South African Department of Health, like the health departments of many other countries, has reviewed its policies to focus on the delivery of comprehensive Primary Health Care (PHC). The South African health care sector is undergoing major restructuring in an attempt to address the inadequacies resulting from the fragmentation and duplication of health services in apartheid South Africa. Following this restructuring, the decentralisation to health services has been adopted as the model for both the governance and management of health issues (Department of Health, 2002:7). Before 1994, local government health departments were rendering certain primary health care services in terms of the Health Act 63 of 1977. Post 1994, the Constitution of the Republic of South Africa 1996 (Act 108 of 1996) classified primary health care as a provincial function. Based on this classification, primary health care services in South Africa are now being provided by two authorities, namely local government and provincial government, in the same community. Thus, in the Nelson Mandela Bay Municipality District, primary health care services are rendered by two authorities, namely the Nelson Mandela Bay Municipality and the Nelson Mandela Health District of the Eastern Cape Department of Health. These authorities are targeting the same community, with the same PHC package, with different sets of conditions of service, salary structures, infrastructure, accountability and authority. Such differences are believed to have impeded functional integration, depleted human resource capacity in rendering an effective and efficient PHC system and resulted in inefficient budget spending by both authorities. The problems of location, duplication and fragmentation of primary health care provision in the Nelson Mandela Bay Municipality District are not conducive to optimal service rendering. This will be resolved only once a unified, single integrated health service has been established. This study was undertaken to explore and describe the views of health practitioners with respect to the location of primary health care within the Nelson Mandela Bay Municipality District. The research design of this study was a quantitative, explorative, descriptive survey. Healthcare practitioners, like management, doctors and nurses, were asked to respond to a structured questionnaire. The findings of the study indicate that while health practitioners may hold diverse views on where primary health care should be located, they agree that a unified, single PHC authority would be desirable. Although primary health care is a combination of task-orientated basic health services and the process of community development, it is important that the authority of choice should ensure the highest possible quality through an integrated process, taking into account local needs. The recommendations made by the researcher on the conclusion of this study cover the principles on which a successful strategy for implementing primary health care should be based, including the need to create sustainable communities. It is hoped that the recommendations offered, will contribute to the more effective and efficient implementation of comprehensive primary health care services in Nelson Mandela Bay and also elsewhere in South African local government.

Background: Irresponsible self-medication is a problem for health systems in developing countries. We aimed to estimate the frequency of self-medication and associated factors in users of drugstores and pharmacies in Peru. Methods: We performed a secondary data analysis of the 2015 National Survey on User Satisfaction of Health Services (ENSUSALUD), a two-stage probabilistic sample of all regions of Peru. Non self-medication (NSM), responsible self-medication (RSM) and irresponsible self-medication (ISM) were defined as the outcome categories. Demographic, social, cultural and health system variables were included as covariates. We calculated relative prevalence ratios (RPR) with their 95% confidence intervals (95%CI) using crude and adjusted multinomial logistic regression models for complex samples with NSM as the referent category. Results: 2582 participants were included. The average age was 41.4 years and the frequencies of NSM, RSM and ISM were 25.2%, 23.8% and 51.0%; respectively. The factors associated with RSM were male gender (RPR: 1.35; 95%CI: 1.06-1.72), being between 40 and 59 years old (RPR: 0.53; 95%IC: 0.39-0.72), being 60 or older (RPR: 0.39; 95%IC: 0.25-0.59), not having health insurance (RPR: 1.89; 95%CI: 1.31-2.71) and living in the Highlands region (RPR: 2.27; 95%CI: 1.23-4.21). The factors associated with ISM were male gender (RPR: 1.41; 95%CI: 1.16-1.72), being between 40 and 59 years old (RPR: 0.68; 95%IC: 0.53-0.88), being 60 or older (RPR: 0.65; 95%IC: 0.48-0.88) and not having health insurance (RPR: 2.03; 95%CI: 1.46-2.83). Conclusion: Around half of the population practiced ISM, which was associated with demographic and health system factors. These outcomes are the preliminary evidence that could contribute to the development of health policies in Peru. / Revisión por pares

No description available.

Yes / Teenage pregnancy is often a very emotive subject. The media image of pregnant teenagers and young parents can be very negative, promoting the idea that young people become pregnant for financial reasons or for want of a responsible attitude. In reality, this is seldom true and the picture is far more complex. For many young parents the decision to become pregnant is not taken lightly. Their parenting, though perhaps more challenging than for older parents, is no less caring and effective. Sadly, this is not the experience for all young parents and their children. A number of negative outcomes for teenage parent families have been identified (see Box 1).1 As well as the difficulties faced by teenage parents, many young people become pregnant without intending to be and do not continue their pregnancies. Figures from the Office for National Statistics show that in 2015 almost 50% of under 18 pregnancies ended in termination. Risk factors for teenage pregnancy include poor school experience, low educational attainment, bullying and domestic violence, use of alcohol and spending time in local authority care.

The purpose of this study was to explore HIV/AIDS client experiences with supportive services. The consumption of social services for individuals living with HIV/AIDS has assumed increasing importance. This is a crucial population that requires a multifaceted approach to treatment in order to remain active and productive for longer periods of time.

Chile has experienced great success in terms of economic growth in the last decades. This growing economy brings changes in the Chilean health care system. Its health care system was primarily funded by state sources until 1981, when a major reform was introduced that established new rules for the health insurance market. Since then, Chile has a public-private mixed health care system, both in financing and delivery of services. Citizens can choose for coverage between the Public National Health Insurance and the Private Health Insurance system. However, these systems have a common funding source coming from the mandatory contribution of employees, equivalent to 7% of their taxable income with an approximate limit of US$2,800 dollars. One of the more important Chilean health reforms towards the establishment of social guarantees was effective on July 2005, when the Regime of Explicit Health Guarantees, also known as Plan AUGE became effective. Plan AUGE is a health program that benefits all Chileans without discrimination of age, gender, economic status, health care, or place of residence. This plan includes the 69 diseases with higher impact on Chilean population in its different stages, but with feasibility of effective treatments. Changes in the health care system and its last reform brought questions about their impact on the distribution of health care services throughout country. Is Chile moving towards a better and more equitable health care system? The main purpose of this thesis is to investigate equity in health system finance and health care utilization as well as to explore alternative measurement of access to health care in Chile. The first two manuscripts examine equity issues in Chile. The purpose of the first one is to assess equity in health system finance in Chile, accounting for all finance sources. While equity in health system finance has been well studied in OECD countries, there are still few published empirical studies on Latin American health care systems, where there tends to be a wider gap in income-wealth distribution among states. This gap may increase the financial burden for people in the lower spectrum of income groups, which is the main concern in the first manuscript. It will focus on identifying policy variables that may contribute to more equitable distribution of the financial burden in health care. The equity principle we adopt for this study is the ability to pay principle. Based on this, we explore factors that contribute to inequities in the health care system finance and issues about who bears the heavier burden of out-of pocket (OOP) payment, progressivity of OOP payment, and the redistributive effect of OOP payment for health care as a source of finance in the Chilean health care system. Our analysis is based on data from the National Socioeconomic Survey (CASEN), and the 2006 National Survey on Satisfaction and OOP payments. Results from this study provide comprehensive understanding of the financial burden of health care in Chile. This study identified evidence of inequity, in spite of the progressivity of the health care system. Furthermore, our assessment of equity in health system finance identified relevant policy variables such as education, insurance system, and method of payment that should be taken into consideration in the ongoing debates and research in improving the Chilean system. Such findings will also benefit other Latin American countries that are concerned about equity in health system finance. The purpose of the second manuscript was to assess equity in health care utilization in Chile. Secondary data analyses from the National Socioeconomic Survey (CASEN) were performed to estimate the impact of different factors including AUGE in the utilization of health care services. We used a two-part model for the analysis of frequency of health care use in the country. Four other separate two-part models were also specified to estimate the frequency of use of preventive services, general practitioner services, specialty care and emergency care. An assessment of horizontal equity was also included. Results suggest the presence of pro-rich inequities in the use of medical care. The estimation of the two-part model found key factors affecting utilization of health care services such as education and the implementation of the AUGE program. These findings provide timely evidence to policy-makers to understand the current distribution and equity of health care utilization, and to strengthen availability of health services accordingly. The third manuscript was motivated by the previous findings. Its purpose was to explore an alternative measurement for health care access. The majority of studies nowadays use a single proxy to estimate access: the use of health care services. However, we saw many limitations on this approach since it only considers people that are already using the system and ignores those that are not. The final manuscript proposed a model to estimate access to health care services based on communitarian claims. The model identified barriers to health care access as well as the preferences of the community for priority settings. / Graduation date: 2012