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Resumo A Rede de Cuidado à Pessoa com Deficiência (RCPD) foi implementada no Sistema Único de Saúde (SUS) para expandir o acesso aos serviços às pessoas com deficiência (PCD). Uma vez que seu funcionamento depende de mecanismos robustos de cooperação e pactuação entre os entes federados, este artigo analisa a dinâmica da Comissão Intergestores Bipartite (CIB) de São Paulo na condução da implementação da RCPD. Realizou-se uma análise documental das atas da CIB-SP de 2011 a 2019. O referencial teórico se pautou na análise de políticas públicas, utilizando abordagem multidimensional a partir das dimensões política, estrutura e organização. Na dimensão política, as pautas centrais são referentes à responsabilidade dos entes federados e demandas originárias do Ministério da Saúde e Ministério Público. A dimensão estrutura ocorre prioritariamente por pautas protocolares de informes de credenciamento/descredenciamento. Já na dimensão organização, foram classificadas como centrais: avaliação dos serviços; necessidades populacionais; oferta, fluxos, regulação assistencial e dispensação de órteses, próteses e meios auxiliares. Conclui-se que, quando não induzida por atores externos, a discussão é protocolar, reduzida aos informes de credenciamento de ações e serviços e adquire centralidade com demandas de órgãos externos e com o surgimento de novos problemas de saúde pública. Abstract The Care Network for People with Disabilities (RCPD) was implemented in the Brazilian National Health System (SUS) to expand the access to services to people with disabilities (PWD). Since its functioning depends on robust cooperation and pact mechanisms between federated states, this article analyzes the dynamic of the Bipartite Inter-manager Commission (CIB) of São Paulo in implementing RCPD. Document analysis of the records of the CIB-SP from 2011 to 2019 was carried out. The theoretical referential was based on the analysis of public policies, using a multidimensional approach from the political, structural, and organizational dimensions. In the political dimension, the main rulings relate to the responsibilities of federated states and demands from the Ministry of Health and Public Ministry. The structural dimension comprises mainly protocol rulings regarding accreditation/de-accreditation. In the organizational dimension, at last, were classified as central: service evaluation; populational needs; offer, flow, regulation of assistance and dispensing of orthotics, prostheses, and auxiliary means. In conclusion, when it is not conducted by external actors, the discussion follows protocol, being reduced to accreditation informs of actions and services and gains centrality with demands from external organs and the emergence of new public health problems.

The application of the Italian law No. 24/2017, which focused on patient safety and medical liability, in the Italian National Health Service has been evaluated by a survey conducted five years after the promulgation of the law. The law required the establishment of healthcare risk management and patient safety centers in all Italian regions and the appointment of a Clinical Risk Manager (CRM) in all Italian public and private healthcare facilities. This study demonstrates that five years after the approval of the law, it has not yet been fully implemented. The survey revealed a lack of adequate permanent staff in all the Regional Centers, with two employees on average per Center. Few meetings were held with the Regional Healthcare System decision-makers with less than four meetings per year. This reduces the capacity to carry out functions. In addition, the role of the CRMs is weak in most healthcare facilities. More than 20% of CRMs have other roles in the same organization. Some important tasks have reduced application, e.g., assessment of the inappropriateness risk (reported only by 35.3% of CRM) and use of patient safety indicators for monitoring hospitals (20.6% of CRM). The function of the Regional Centers during the COVID-19 pandemic was limited despite the CRMs being very committed. The CRMs units undertake limited research and have reduced collaboration with citizen associations. Despite most of the CRMs believing that the law has had an important role in improving patient safety, 70% of them identified clinicians’ resistance to change and lack of funding dedicated to implementing the law as the main barriers to the management of risk.

Given the controversy over the effectiveness of age-based breast cancer (BC) screening, offering risk-stratified screening to women may be a way to improve patient outcomes with detection of earlier-stage disease. While this approach seems promising, its integration requires the buy-in of many stakeholders. In this cross-sectional study, we surveyed Canadian healthcare professionals about their views and attitudes toward a risk-stratified BC screening approach. An anonymous online questionnaire was disseminated through Canadian healthcare professional associations between November 2020 and May 2021. Information collected included attitudes toward BC screening recommendations based on individual risk, comfort and perceived readiness related to the possible implementation of this approach. Close to 90% of the 593 respondents agreed with increased frequency and earlier initiation of BC screening for women at high risk. However, only 9% agreed with the idea of not offering BC screening to women at very low risk. Respondents indicated that primary care physicians and nurse practitioners should play a leading role in the risk-stratified BC screening approach. This survey identifies health services and policy enhancements that would be needed to support future implementation of a risk-stratified BC screening approach in healthcare systems in Canada and other countries.

Objective: to know the process of kangaroo care implementation and dissemination in the state of Santa Catarina. Method: this is socio-historical research with a qualitative approach, with data collection carried out from January to November 2019, through interviews with 12 oral sources. Analysis was carried out in the light of genealogical analysis proposed by Foucault, with the help of Atlas.ti Cloud®. Results: the process of kangaroo care implementation and dissemination in Santa Catarina happened from the breaking of resistance to the light of scientific knowledge, training and awareness that gradually captivated health professionals for the incorporation of new knowledge in neonatal care practice. Conclusion: kangaroo care implementation as a public health policy configured a paradigm shift in neonatal care in Santa Catarina. Although scientifically supported, it took years to materialize in the state and still faces resistance. RESUMEN Objetivo: conozca el proceso de implementación y difusión del método canguro en el estado de Santa Catarina. Método: se trata de una investigación sociohistórica con enfoque cualitativo, con recolección de datos realizada de enero a noviembre de 2019, a través de entrevistas con 12 fuentes orales. El análisis se realizó a la luz del análisis genealógico propuesto por Foucault, con la ayuda del software Atlas.ti Cloud®. Resultados: el proceso de implantación y difusión del método canguro, en Santa Catarina, pasó por el rompimiento de resistencias a la luz del conocimiento científico, la formación y la concientización que poco a poco contagió a los profesionales de la salud para la incorporación de nuevos conocimientos en la práctica del cuidado neonatal. Consideraciones finales: la implementación del método canguro, como política de salud pública, configuró un cambio de paradigma en la atención neonatal en Santa Catarina. Aunque científicamente respaldado, tardó años en materializarse en el estado y aún enfrenta resistencia. RESUMO Objetivo: conhecer o processo de implantação e disseminação do Método Canguru no estado de Santa Catarina. Método: pesquisa sócio histórica com abordagem qualitativa, com coleta de dados realizada de janeiro a novembro de 2019, por meio de entrevistas com 12 fontes orais. A análise foi realizada à luz da análise genealógica proposta por Foucault, com o auxílio do software Atlas.ti Cloud®. Resultados: o processo de implantação e disseminação do Método Canguru, em Santa Catarina, aconteceu a partir da quebra de resistências à luz do saber científico, capacitações e sensibilizações que contagiaram aos poucos os profissionais de saúde para a incorporação dos novos saberes na prática do Cuidado Neonatal. Considerações finais: a implantação do Método Canguru, enquanto política pública de saúde configurou uma mudança de paradigma no Cuidado Neonatal em Santa Catarina. Embora cientificamente respaldado, levou anos para se concretizar no estado e ainda enfrenta resistências.

There is a well-documented scholarly discourse on how the COVID-19 outbreak adversely affects the mental health of Chinese nationals. However, there is little evidence revealing how the public health crisis negatively influenced the mental health of rural-to-urban migrants in China. The relevant literature argues that rural-to-urban migrant workers and their dependents have been experiencing discrimination, exclusion, and stigmatization in the urban labor market and social space, thereby jeopardizing their mental health to a large extent. However, whether the COVID-19 outbreak and its associated consequences further compounded rural-to-urban migrant workers' mental health has rarely been discussed. Since 2010, the Chinese government has emphasized the importance of promoting positive mental health. Without identifying how COVID-19 specifically imposed mental health challenges on rural-to-urban migrant cohorts, Chinese policymakers cannot effectively and efficiently address the dilemmas faced by such vulnerable groups. The significant rural-to-urban migrant population (i.e. 291 million), alongside their disposition to encounter social and psychological challenges, prompts the urgency to develop this narrative essay to examine whether their mental health burdens worsened during the pandemic. The author also discusses remedies for the worsened mental issues faced by migrant cohorts, and recommends policies that local Chinese governments should adopt to mitigate the mental health burdens encountered by rural-to-urban migrants.

Resumo: Este ebook, editado pelo Centro de Edições do ISPA, procura testemunhar a importância da prática em Literacia em Saúde (LS). É constituído por duas partes. A primeira composta por um conjunto de textos que visam apresentar as novas perspetivas da LS em contexto nacional e internacional. A segunda parte apresenta um conjunto de projetos aplicados que focam diferentes competências a desenvolver em LS na prática, nomeadamente: (a) Adquirir, desenvolver e consolidar competências nas metodologias e técnicas de avaliação em LS; (b) Implementação nas organizações de programas de LS, através de metodologias que permitam a conceção, elaboração, monitorização e avaliação de planos de ação; (c) Desenvolver técnicas de linguagem assertiva e comportamento positivo para mudar comportamentos e atitudes; (d) Potenciar o empowerment do cidadão, nomeadamente nas competências digitais e contribuir para melhorar a educação para a saúde; (e) Desenvolver estratégias de comunicação e informação em saúde para conseguir maior adesão terapêutica com doentes; (f) Desenvolver técnicas para melhorar o relacionamento entre profissionais de saúde e; (g) Desenvolver competências para tornar exequíveis as orientações do Programa Nacional de Saúde, em particular o reforço do papel do cidadão e as estratégias de ativação do cuidador informal. Abstract: This ebook, published by the ISPA Publishing Centre, thus seeks once again, to testify to the importance of health literacy (HL) practice. Organized in two parts. The first consists of a set of texts which aim to present new perspectives of HL in a national and international national and international context. The second part presents a set of applied projects which focus on different competences to develop in HL practice, namely: (a) Acquiring, developing and consolidating skills in methodologies and assessment techniques in HL; (b) Implementation of HL programmes in organisations, through methodologies which enable the conception, development, monitoring and evaluation of action plans; (c) Developing assertive language and positive behaviour techniques to change behaviours and attitudes; (d) To boost citizen empowerment, namely in digital skills and contribute to improve health education and contribute to improve education for health; (e) To develop communication and health information strategies in order to Develop communication and health information strategies to achieve greater therapeutic adherence with patients; (f) To develop techniques to improve the relationship between health professionals and ; (g) Develop skills to make feasible the guidelines of the Portugal National Health Program, in particular the strengthening of the role of citizen and activation strategies of the informal caregiver. info:eu-repo/semantics/publishedVersion

In the past, epidemics such as AIDS, measles, SARS, H1N1 influenza, and tuberculosis caused the death of millions of people around the world. In response, intensive research is evolving to design efficient drugs and vaccines. However, studies warn that new pandemics such as Coronavirus (COVID-19), variants, and even deadly pandemics can emerge in the future. The existing epidemic confinement approaches rely on a large amount of available data to determine policies. Such dependencies could cause an irreversible effect before proper strategies are developed. Furthermore, the existing approaches follow a one-size-fits-all control technique, which might not be effective. To overcome this, in this work, we develop a game-theory-inspired approach that considers societal and economic impacts and formulates epidemic control as a non-zero-sum game. Further, the proposed approach considers the demographic information that provides a tailored solution to each demography. We explore different strategies, including masking, social distancing, contact tracing, quarantining, partial-, and full-lockdowns and their combinations, and present demography-aware optimal solutions to confine a pandemic with minimal history information and optimal impact on the economy. To facilitate scalability, we propose a novel graph learning approach, which learns from the previously obtained COVID-19 game outputs and mobility rates of one state (region) depending on the other to produce an optimal solution. Our optimal solution is strategized to restrict the mobility between states based on the impact they are causing on COVID-19 spread. We aim to control the COVID-19 spread by more than 50% and model a dynamic solution that can be applied to different strains of COVID-19. Real-world demographic conditions specific to each state are created, and an optimal strategic solution is obtained to reduce the infection rate in each state by more than 50%.

This paper uses a difference-in-differences (DID) framework to estimate the impact of non-pharmaceutical interventions (NPIs) used to fight the 1918 influenza pandemic and control the resultant mortality in 43 US cities. The results suggest that NPIs such as school closures and social distancing, as implemented in 1918, and when applied relatively intensively, might have reduced individual and herd immunity reducing the life expectancy of people with co morbidity, thereby leading to a significantly higher number of deaths in subsequent years. It would be difficult to draw any inference regarding the predicted impact of NPIs as implemented during the Covid-19 crisis as influenza and Covid-19 are two entirely different viruses and nowadays’ pharmaceutical technologies can limit these medium-term impacts.

RESUMO O artigo apresenta uma análise comparada de dez países selecionados sobre as relações entre governança participativa, perfis socioeconômicos e sistemas de saúde com resultados sanitários e de Indicadores de Governança Global. As fontes principais foram bases de dados produzidas e/ou compiladas pelo Banco Mundial. O modelo analítico se apoia em enfoque institucionalista para tratar de proteção social e governança participativa – esta, como utilizada, recobre as noções de participação social, porosidade governamental e regulação responsiva. Os resultados mostram uma sólida convergência entre perfis socioeconômicos mais distributivos, sistemas sanitários com maior financiamento público e universalismo e melhores indicadores de governança. Esta análise reforça os argumentos sobre trajetórias institucionais socialmente virtuosas e sujeitas a reforços positivos capazes de produzir melhores resultados sociais e políticos ao longo do tempo. ABSTRACT This paper presents a comparative analysis of ten selected countries regarding the established relationships of participative governance, socioeconomic profiles, and health care systems with health outcomes and Global Governance Indicators. Significant sources were databases produced or compiled by the World Bank. The analytical model adopts an institutionalist approach to address social protection and participative governance – the latter, as used, recovers notions of societal participation, government porosity, and responsive regulation. Outcomes show a solid convergence of more distributive socioeconomic profiles, more universalist health systems with higher government financing, and better governance indicators. This analysis supports the arguments that socially virtuous institutional paths subjected to positive feedback favor better social and political outcomes over time.

This systematic study aims at analyzing the differences between the approach of the European healthcare systems to the pharmaceutical market and the American one. This paper highlights the opportunities and the limitations given by the application of managed entry agreements (MEAs) in European countries as opposed to the American market, which does not regulate pharmaceutical prices. Data were collected from the Organisation for Economic Co-operation and Development (OECD), the European Medicines Agency, and the national healthcare agencies of US and European countries. A literature review was undertaken in PubMed, Scopus, MEDLINE, and Google for a period ten years (2010–2019). The period 2020–2021 was considered to compare health expenditure before and after the SARS-CoV-2 pandemic. Scarce information from national agencies has been given in terms of MEAs related to the COVID-19 pandemic. The comparison between the United States approach and the European one shows the importance of a market access regulation to reduce the cost of therapies, increasing the efficiency of national healthcare systems and the advantages in terms of quality and accessibility to the final users: patients. Nevertheless, it seems that the golden age of MEAs for Europe was during the examined period. Except for Italy, countries will move to other forms of reimbursements to obtain higher benefits, reducing the costs of an inefficient implementation and outcomes in the medium term.

ObjectiveThe World Health Organization recognizes abortion as essential health care and has encouraged governments to ensure access to abortion services throughout the COVID-19 pandemic. However, the threat of infection combined with government responses to COVID-19 have impacted access to abortion services globally. This study explores access to abortion in Germany during the pandemic.MethodsThis study used a mixed-methods design. An analysis of data collected by Women on Web (WoW) was carried out to assess women’s reasons for choosing telemedicine abortion outside the formal health system in Germany during the pandemic. Descriptive statistics were generated for 2057 requests for telemedicine abortion received by WoW between March 2020-March 2021. Semi-structured interviews were conducted with eight healthcare professionals involved in the provision of abortion services to explore how they perceive of women’s access to abortion services in Germany during the pandemic.ResultsThe quantitative analysis found that preferences and needs for privacy (47.3%), secrecy (44.4%) and comfort (43.9%) were the most common reasons for choosing telemedicine abortion. COVID-19 was another important reason (38.8%). The thematic analysis of the interviews was organized into two overarching themes: service provision, and axes of difference.ConclusionsThe pandemic affected the provision of abortion services as well as the circumstances of women seeking abortion. The main barriers to access were financial constraints, privacy issues, and lack of abortion providers. Throughout the pandemic, accessing abortion services was more difficult for many women in Germany, especially women experiencing multiple and overlapping forms of discrimination. Objective: The World Health Organization recognizes abortion as essential health care and has encouraged governments to ensure access to abortion services throughout the COVID-19 pandemic. However, the threat of infection combined with government responses to COVID-19 have impacted access to abortion services globally. This study explores access to abortion in Germany during the pandemic. Methods: This study used a mixed-methods design. An analysis of data collected by Women on Web (WoW) was carried out to assess women's reasons for choosing telemedicine abortion outside the formal health system in Germany during the pandemic. Descriptive statistics were generated for 2057 requests for telemedicine abortion received by WoW between March 2020-March 2021. Semi-structured interviews were conducted with eight healthcare professionals involved in the provision of abortion services to explore how they perceive of women's access to abortion services in Germany during the pandemic. Results: The quantitative analysis found that preferences and needs for privacy (47.3%), secrecy (44.4%) and comfort (43.9%) were the most common reasons for choosing telemedicine abortion. COVID-19 was another important reason (38.8%). The thematic analysis of the interviews was organized into two overarching themes: service provision, and axes of difference. Conclusions: The pandemic affected the provision of abortion services as well as the circumstances of women seeking abortion. The main barriers to access were financial constraints, privacy issues, and lack of abortion providers. Throughout the pandemic, accessing abortion services was more difficult for many women in Germany, especially women experiencing multiple and overlapping forms of discrimination.

This paper is intended to be an addition to a study protocol for an online survey project to explore health care preferences in Vienna. Here I discuss the structural and institutional context of the Vienna Public Health Equity Project. Further, the key concepts and constructs of the project are introduced. These are: 1) socio-economic status, 2) individual health, 3) accessibility, affordability, and provision of health care, 4) attitudes towards social justice and fairness, 5) redistribution and policy preferences, 6) social norms of solidarity. Additionally, health (in)equity is considered.

Understanding the individual and global impact of pesticides on human physiology and the different stages of life is still a challenge in environmental health. We analyzed here whether administration of the organophosphate insecticide malathion before pregnancy could affect glucose homeostasis during pregnancy and, in addition, generate possible later consequences in mothers and offspring. For this, adult Wistar rats were allocated into two groups and were treated daily (intragastric) with malathion (14 or 140 mg/kg, body mass (bm)) for 21–25 days. Corn oil was used as vehicle in the Control group. Subgroups were defined based on the absence (nulliparous) or presence (pregnant) of a copulatory plug. Pregnant rats were followed by an additional period of 2 months after the term (post-term), without continuing malathion treatment. Fetuses and adult offspring of males and females were also evaluated. We ran an additional experimental design with rats exposed to malathion before pregnancy at a dose of 0.1 mg/kg bm. Malathion exposure resulted in glucose intolerance in the mothers during pregnancy and post-term period, regardless of the exposure dose. This was accompanied by increased visceral adipose tissue mass, dyslipidemia, unchanged pancreatic β-cell mass, and varying insulin responses to glucose in vivo. The number of total newborns and birthweight was not affected by malathion exposure. Adult offspring from both sexes also became glucose-intolerant, regardless of the pesticide dose their dams were exposed to. This alteration could be associated with changes at the epigenomic level, as reduced hepatic mRNA content of DNA methylases and demethylases was found. We demonstrated that periconceptional exposure to malathion with doses aiming to mimic from work environment to indirect contamination predisposes progenitors and offspring rats to glucose intolerance. Thus, we conclude that subchronic exposure to malathion is a risk factor for gestational diabetes and prediabetes later in life., We are indebted with the staff from the LIDoC and LAMEB. This research was partially granted by the National Council for Scientific and Technological Development (CNPq; grant number 428023/2018–5). In addition, some reagents and materials were acquired by A.R private funding or result from donations from collaborators. This work was submitted as thesis by M.A.B. M.A.B and F.N.S received a scholarship from the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - Brasil (CAPES) – Finance Code 001, and P.L.Z received a scholarship from the CNPq. A.R is funded by a CNPq research grant (grant number 304388/2020–3). IQ is funded by a grant of Generalitat Valenciana (PROMETEO/2020/006).

Background: The implementation of public health measures is a key aspect of the fight against the pandemic. However, the current literature suggests that the effectiveness of measures is influenced by various factors, and these factors are most pronounced among young people. Finding the causes and reasons for non-compliance is essential for increasing the effectiveness of measures and reducing their negative effects. Subjects and methods: We evaluated the degree of non-comopliance with epidemiological measures and the reasons for such behaviour among students attending medical colleges at four universities in Croatia (Zagreb, Split, Osijek, Rijeka) in view of altered social, academic, mental, and economic conditions during the pandemic by using an anonymous online questionnaire with 36 Likert scale based questions which was distributed to students in Croatia in March of 2021. Results: A total of 605 students filled out the questionnaire. Female students reported a higher negative impact of social distancing (3.24±1.08 vs 2.95±1.11 ; p=0.006) and were more concerned about getting infected with SARS-CoV-2 (2.81±1.06 vs. 2.46±0.94 ; p=0.0005) and about the health of their family and friends during the pandemic (3.83±1.09 vs. 3.50±1.04 ; p=0.0005). Simultaneously, they were more compliant with the mitigation measures (4.06±0.71 vs. 3.85±0.83 ; p=0.0413) and were more aware that irresponsible behaviour can place other people at risk. In contrast, male students considered COVID-19 more often as a threat affecting only the elderly (3.11±1.1 vs. 2.78±1.23 ; p=0.0036). While all students reported high responsibility levels, they did describe violating the measures at times they wanted to socialise. Conculsions: Gender, working status, care for their health, and the health of loved ones were modifying factors for young people behaviour. Assessing social, economic, and health factors must be applied when tailoring public health policies during crisis management.

Background and Objectives During the COVID-19 Pandemic, political elites in Iran have tried to use social media to express their views, influence public opinion or criticize the government's performance in managing Covid-19 disease. The aim of this study was to investigate and analyze the tweets related to this Pandemic that were tweeted by Iranian political elites. Material and Methods This qualitative study is conducted based on the method of content analysis. A list of political elites likely to run for presidency in 1400 presidential election was selected by referring to public and specialized political news websites, their Twitter accounts were identified and all their Persian and English tweets about COVID-19 until the end of 2020 were collected and reviewed. Content analysis method was used for analyzing the tweets. Results More than 2,800 tweets from 27 political elites were reviewed. About 18% of the total tweets during this period were related to health and about 84% of the health tweets had COVID-19 content. All tweets related to COVID-19 were categorized under six main themes; notices; policy recommendation; criticism of government performance; situation analysis and future forecasting; warnings and Macroeconomic, social and political issues. Conclusion In recent years, the use of Twitter among Iran's political elites has increased significantly. It seems that the tweets of the political elites can influence the public’s views and behaviors as well as the government performance in a major way, leading the government to be more accountable in responsible management of the COVID-19 pandemic. The health system can also make more use of the social network's capacity to inform programs, attract support and disseminate health and prevention perspectives Extended Abstract Background and Objectives In the field of health care, the views of political elites greatly influence the opinions of citizens and their health-related behaviors. Political leaders can use their influence on public opinion to address public health issues by disseminating evidence-based public health information. Social networks like Twitter play an important role in enabling people to stay in touch even in times of crisis. During the COVID-19 Pandemic, political elites in Iran have tried to use social media to express their views or influence public opinion or criticize the government's performance in managing COVID-19 disease. This study aims to investigate and analyze the Iranian political elites’ tweets related to this pandemic. Material and Methods This qualitative study is conducted based on the method of content analysis. According to public and specialized political news websites, we made a list of political elites who were likely to run for presidency in 1400 presidential election. The research population of this list was finalized, and all members of the research population were surveyed. The Twitter accounts of these people were identified and all the main tweets of these people -both in Persian and English about COVID-19 were collected and reviewed, starting from the beginning of the COVID-19 pandemic in late 2019 to the end of 2020. The names and positions of individuals, the number of followers, the number of health and COVID-19-related tweets, and finally the content of COVID19-related tweets were collected in tables. Content analysis method was used to theme and analyze tweets. Because all data (tweets) were retrieved from the open-access public domain, no ethical approval was required. Results More than 2,800 tweets from 27 political elites were reviewed. About 18% of all the tweets during this period were related to health and about 84% of the health tweets had COVID-19 content. All tweets related to COVID-19 were categorized under six main themes; Notices; Policy recommendations; Criticism of government performance; Status analysis and future forecasting; Warning; and macroeconomic, social, and political issues. The main topics of information included sub-topics of morbidity and mortality trends, production or purchase of vaccines, planning of national and local actions, status or sacrifice of medical staff, preparation and distribution of masks and other protective equipment, disease status in other countries, job closures, the economic, social and psychological damage caused by the covid-19 outbreak. Policy recommendations also included support for medical staff, prioritization of health to the economy, distribution of protection or vaccination equipment, self-care and attention to health advice, temporary closure of infected cities and areas, development of virtual communications and new business platforms, international cooperation and regional, avoidance of unnecessary travel, cooperation between government agencies, people's livelihood and the improvement of monitoring systems.Criticism of the government's performance, excessive inconsistency in decision-making and information, inadequate distribution of protective equipment, absence of the president in the parliament, hasty and contradictory comments, preference of the economy over public health, internal and inter-sectoral inconsistencies, indecision in decision-making, Lack of use of successful internal and external experiences in dealing with the disease and impossibility of social and physical distance in public places were classified. Situation analysis and forecasting also include the doubling of economic problems along with the COVID-19 outbreak, the lack of impact of restrictions on traffic reduction, resilience to crisis due to previous experiences, and the synergy of military devices and facilities for the present and the future.We also categorized other sub-themes, including aggravation of poverty and economic and social harms, reduction of observance of health protocols, congestion and gatherings, trips and excessive presence of travelers in tourist areas, failure of health system, security, political and religious issues and profiteering and abuses. Finally, the themes of macroeconomic, social, and political issues included themes such as political sanctions, assistance to families affected by the corona, the impact of the corona on sustainable development, and new lifestyles in the corona and post-COVID-19 eras. Conclusion In recent years, the use of Twitter among Iranian political elites has increased significantly. It seems that political elites tweets can have a dramatic effect on the attitudes and behaviors of the people or obliging the government to be more accountable and do better in the management of COVID -19 pandemic. The health system can also make more use of the social network's capacity to inform programs, attract support and disseminate health and prevention perspectives. Practical Implications of Research The present study helps to create a more comprehensive analysis of the views of political elites, and familiarizes us with their thoughts and attitudes on current issues of the health system and even the extent of their attention to health. This study helps health researchers and analysts while designing a reliable source for the analysis of attitude of officials and political elites, we might, in so doing , provide a basis for them on which to design and implement similar studies. This study helps health researchers and analysts to design and implement similar studies while obtaining a reliable source for their analysis of the attitudes of officials and political elites. This research is the first study of its kind in the Iran that can affect future studies in this regard. Ethical Considerations This study was conducted using public data on the Internet and does not require ethical approval due to public and open access to the data used. The names of the people and their tweets are openly available to the public. Conflict of Interest There is no conflict of interest in this study. Aknowledgment None declared.

Raul Patrascu,1,2 Alin Albai,2,3 Adina Braha,2,3 Laura Gaita,2,3 Sandra Lazar,3 Ovidiu Potre,4 Bogdan Timar2,3 1Department of Functional Sciences, “Victor Babes” University of Medicine and Pharmacy, Timisoara, Romania; 2“Pius Brinzeu” Emergency Hospital, Timisoara, Romania; 3Second Department of Internal Medicine, “Victor Babes” University of Medicine and Pharmacy, Timisoara, Romania; 4First Department of Internal Medicine, “Victor Babes” University of Medicine and Pharmacy, Timisoara, RomaniaCorrespondence: Alin Albai Tel +40721435829Fax +40256490626Email albai.alin@umft.roPurpose: To develop, test, and validate an instrument for assessing patients’ desirability, acceptability, and adherence to telemedicine in diabetes.Patients and Methods: A group of six experts defined the components that needed to be assessed when developing telemedicine platforms aimed at improving the care of patients with diabetes. The resulting instrument was tested for reliability and construct validity of 114 patients with diabetes and re-tested for reproducibility and consistency on a sub-group of 34 patients. Based on the analysis, the questionnaire’s syntax, phrasing, and flow were improved to obtain optimal assessment results.Results: The resulting questionnaire has three major sections: one for the main evaluated component (acceptability, desirability, and adherence to telemedicine in diabetes), one for collecting socio-economic and demographical information, and one for diabetes history-related data, respectively. The corresponding data for these sections are collected using 29 questions. The developed instrument has a good reliability (Cronbach’s alpha = 0.890), reproducibility (Total score 164 vs 166 points at re-test vs test; Mann–Whitney U p-value = 0.394) and external validity (Spearman’s rho = − 0.580; p < 0.001 for correlation with Patient’s Health Questionnaire − 9; and Spearman’s rho = − 0.516; p < 0.001 for correlation with Generalized Anxiety Disorder – 7).Conclusion: The developed questionnaire is a valid and reliable instrument in assessing the patients’ acceptability, desirability, and adherence to telemedicine use in diabetes care. In addition, the use of this instrument in the development of telemedicine platforms may improve and optimize their usage by providing valuable information regarding patients’ preferences and specific needs.Keywords: telemedicine, eHealth, diabetes, self-care, health policies, economics of care

Raul Patrascu,1,2 Alin Albai,2,3 Adina Braha,2,3 Laura Gaita,2,3 Sandra Lazar,3 Ovidiu Potre,4 Bogdan Timar2,3 1Department of Functional Sciences, “Victor Babes” University of Medicine and Pharmacy, Timisoara, Romania; 2“Pius Brinzeu” Emergency Hospital, Timisoara, Romania; 3Second Department of Internal Medicine, “Victor Babes” University of Medicine and Pharmacy, Timisoara, Romania; 4First Department of Internal Medicine, “Victor Babes” University of Medicine and Pharmacy, Timisoara, RomaniaCorrespondence: Alin Albai Tel +40721435829Fax +40256490626Email albai.alin@umft.roPurpose: To develop, test, and validate an instrument for assessing patients’ desirability, acceptability, and adherence to telemedicine in diabetes.Patients and Methods: A group of six experts defined the components that needed to be assessed when developing telemedicine platforms aimed at improving the care of patients with diabetes. The resulting instrument was tested for reliability and construct validity of 114 patients with diabetes and re-tested for reproducibility and consistency on a sub-group of 34 patients. Based on the analysis, the questionnaire’s syntax, phrasing, and flow were improved to obtain optimal assessment results.Results: The resulting questionnaire has three major sections: one for the main evaluated component (acceptability, desirability, and adherence to telemedicine in diabetes), one for collecting socio-economic and demographical information, and one for diabetes history-related data, respectively. The corresponding data for these sections are collected using 29 questions. The developed instrument has a good reliability (Cronbach’s alpha = 0.890), reproducibility (Total score 164 vs 166 points at re-test vs test; Mann–Whitney U p-value = 0.394) and external validity (Spearman’s rho = − 0.580; p < 0.001 for correlation with Patient’s Health Questionnaire − 9; and Spearman’s rho = − 0.516; p < 0.001 for correlation with Generalized Anxiety Disorder – 7).Conclusion: The developed questionnaire is a valid and reliable instrument in assessing the patients’ acceptability, desirability, and adherence to telemedicine use in diabetes care. In addition, the use of this instrument in the development of telemedicine platforms may improve and optimize their usage by providing valuable information regarding patients’ preferences and specific needs.Keywords: telemedicine, eHealth, diabetes, self-care, health policies, economics of care

In the last decade (2010–2020), more than half of European countries have improved their health policies within the primary care for type 2 diabetes mellitus. Community pharmacies have been and could continue to be essential actors in this evolution of fighting the disease by providing a set of pharmacotherapeutic follow-up services for the person with diabetes. These services, designated by the Pharmaceutical Group of the European Union as “diabetes management” and “glucose measurement”, have aimed to optimize adherence to therapy and improve health outcomes. However, to follow the European guidelines of Good Pharmacy Practice, providing these services implies having a normative framework or a legal basis. Thus, this study sought to analyze the normative and regulatory framework on which community pharmacies in 28 European countries were based on providing this health care over the last decade.

Access for disabled persons in 63 services of 12 municipalities in Vale do Paraíba and São Paulo’s North Coast was evaluated in an exploratory study, with a quali-quantitative design carried out 2008 - 2010 with observation guidelines of service reception, 63 structured interviews with the people in charge and with 596 users, 57 being disabled persons, resulting in a characterization of the service provided, personnel, assistential activities, working shifts, scheduling, transportation, disabled users, reasons for requiring the services, waiting time and reception. Access facilitators were the proximity to the homes, healthcare strategies in the families, rehabilitation professionals and reduced waiting time. Complicating factors were the mandatory presence of the users or their representatives at scheduling, the absence of or difficulties with public transportation in 41% of the municipalities, the absence of adapted transportation in 75% of them, the existence of environmental barriers and the predominance of biomedical assistance and few rehabilitation actions in the basic care services. It was concluded that it is essential for policies to take such specificities into consideration in order to guarantee the right to health care of this population group. O acesso de pessoas com deficiências em 63 serviços de 12 municípios do Vale do Paraíba e Litoral Norte de São Paulo foi avaliado em estudo exploratório, com desenho quali-quantitativo realizado entre 2008 e 2010. Foi utilizado roteiro de observação da recepção dos serviços, 63 entrevistas estruturadas com seus responsáveis e 596 com usuários, sendo 57 pessoas com deficiência, resultando na caracterização de serviços, equipes, atividades assistenciais, turnos de funcionamento, agendamento, transporte, usuários com deficiência, motivos de procura, tempo de espera e acolhimento. Constatou-se como facilitadores do acesso a proximidade do domicílio, a presença da estratégia de saúde da família, de profissionais de reabilitação e o tempo de espera reduzido. Os fatores dificultadores foram a exigência do agendamento com a presença do usuário ou representante, a ausência ou dificuldades no transporte público em 41% dos municípios, a ausência de transporte adaptado em 75% deles, a existência de barreiras ambientais e a prevalência de assistência de caráter biomédico e poucas ações reabilitacionais nos serviços de atenção básica. Conclui-se que é fundamental que as políticas considerem essas especificidades para garantir o direito à saúde desse grupo populacional.

Introduction: Various particularities and guarantees arising from the issue of LGBT rights are observed. Several public health policies have been implemented by the federal government to address the specific issues of this population. However, the disparity in treatment suffered by these individuals in the public network, added to the high rates of violence and discrimination suffered by the population, ends up remaining constant and thus creates a challenge for public institutions. The objective of the study is to carry out a critical analysis of the effectiveness of public policies for the LGBTQIA+ population in recent decades. Methodology: This is an integrative literature review carried out through the Scielo and BVS databases containing publications between 2009 and 2022. Results: For the composition of the sample, 7 scientific articles were selected following the inclusion and exclusion criteria, in addition to theoretical books and materials from the Ministry of Health obtained throughout the research. Conclusion: Despite the progress of services in meeting the demands of the LGBTQIA+ population, in practice, there are still gaps in the implementation of policies to meet them. Therefore, public health policies should be more precise and effective to reach all citizens and, consequently, promote an improvement in the health condition and vulnerability of the LGBT community. Introducción: Se observan diversas particularidades y garantías derivadas del tema de los derechos LGBT. El gobierno federal ha implementado varias políticas de salud pública para abordar los problemas específicos de esta población. Sin embargo, la disparidad de trato que sufren estas personas en la red pública, sumada a los altos índices de violencia y discriminación que sufre la población, termina por mantenerse constante y por ende genera un desafío para las instituciones públicas. El objetivo del estudio es realizar un análisis crítico de la efectividad de las políticas públicas para la población LGBTQIA+ en las últimas décadas. Metodología: Se trata de una revisión integrativa de la literatura realizada a través de las bases de datos Scielo y BVS que contienen publicaciones entre 2009 y 2022. Resultados: Para la composición de la muestra se seleccionaron 7 artículos científicos siguiendo los criterios de inclusión y exclusión, además de libros teóricos y materiales del Ministerio de Salud obtenidos a lo largo de la investigación. Conclusión: A pesar del avance de los servicios en la atención de las demandas de la población LGBTQIA+, en la práctica aún existen vacíos en la implementación de políticas para atenderlas. Por lo tanto, las políticas públicas deben ser más precisas y efectivas para llegar a todos los ciudadanos y, en consecuencia, promover una mejora en la condición de salud y vulnerabilidad de la comunidad LGBT. Introdução: São observadas variadas particularidades e garantias que decorrem da questão dos direitos LGBT. Diversas políticas de saúde pública vêm sendo implantadas pelo governo federal, para atender as questões específicas dessa população. Porém, a disparidade de tratamento sofrida por esses indivíduos na rede pública, somado a índices altos de violência e discriminação sofridas pela população acaba se mantendo constante e cria-se assim um desafio para as instituições públicas. O objetivo do estudo consiste em realizar uma análise crítica da efetividade das políticas públicas para a população LGBTQIA+ nas últimas décadas. Metodologia: Trata-se de uma revisão integrativa da literatura realizada através das bases de dados Scielo e BVS contendo publicações entre 2009 a 2022. Resultados: Para composição da amostra foram selecionados 7 artigos científicos seguindo os critérios de inclusão e exclusão, além de livros teóricos e materiais do Ministério da Saúde obtidos ao longo da pesquisa. Conclusão: Apesar do progresso dos serviços no atendimento às demandas da população LGBTQIA+, na prática, ainda existem lacunas na implementação de políticas para atendê-las. Sendo assim, as políticas públicas em saúde devem ser mais precisas e efetivas para alcançar todos os cidadãos e, consequentemente, promover melhoria da condição de saúde e vulnerabilidade da comunidade LGBT.

Resumo Os objetivos do artigo são comparar o arranjo institucional da política de saúde de Argentina e Brasil, com foco nos arranjos federativos, e os resultados da política em relação à universalização e à igualdade entre níveis de governo. Buscou-se responder à questão recorrente no debate sobre federalismo: o formato das relações federativas tem consequências sobre a produção de políticas universais e igualitárias? O estudo é assentado em fontes documentais e bibliográficas para a comparação entre os arranjos institucionais, e em dados quantitativos relativos às dimensões consideradas na análise dos resultados: cobertura, recursos, qualidade da atenção, situação de saúde. Os indicadores de saúde das unidades federadas foram comparados a partir de medidas de dispersão e desigualdade. O artigo contribui para reforçar uma linha de argumentação que enfatiza a especificidades dos arranjos federativos e sua articulação com outras dimensões institucionais para interpretar resultados de políticas e para suprir lacunas de estudos comparativos. Abstract The objectives of the article are to compare the institutional arrangements of Brazil and Argentina’s health policies while focusing on the countries’ federative arrangements, and the outcome of said policies in terms of universalization and equality between levels of government. We sought to answer a recurring question in the debate on federalism: does the format of federative relations have consequences on the making of universal and egalitarian policies? The study is based on original and bibliographic sources to compare institutional arrangements and on quantitative data of aspects addressed in the analysis of the results: coverage, resources, quality of care, and health situation. It compares the health indicators of the federated units using measures of dispersion and inequality. Finally, the article reinforces the argument emphasizing the peculiarities of federative arrangements and how they coordinate with other institutional dimensions to interpret policy results and to fill gaps in comparative studies. Résumé Les objectifs de l’article sont de comparer l’arrangement institutionnel de la politique de santé en Argentine et au Brésil, en mettant l’accent sur les arrangements fédératifs, et les résultats des politiques en matière d’universalisation et d’égalité entre les niveaux de gouvernement. Nous avons cherché à répondre à la question récurrente du débat sur le fédéralisme : le format des relations fédératives a-t-il des conséquences sur la production de politiques universelles et égalitaires ? L’étude s’appuie sur des sources documentaires et bibliographiques pour la comparaison des dispositifs institutionnels, et sur des données quantitatives liées aux dimensions considérées dans l’analyse des résultats : couverture, ressources, qualité des soins, situation sanitaire. Les indicateurs de santé des unités fédérées ont été comparés à l’aide de mesures de dispersion et d’inégalité. L’article contribue à renforcer une argumentation qui met l’accent sur les spécificités des dispositifs fédératifs et leur articulation avec d’autres dimensions institutionnelles pour interpréter les résultats des politiques et combler les lacunes des études comparatives. Resumen Los objetivos del artículo son comparar el arreglo institucional de la política de salud en Argentina y Brasil, centrándose en los arreglos federativos, y los resultados de la política en relación con la universalización y la igualdad entre niveles de gobierno. Se trató de responder a la pregunta recurrente en el debate sobre el federalismo: ¿tiene el formato de las relaciones federales consecuencias en la producción de políticas universales e igualitarias? El estudio se basa en fuentes documentales y bibliográficas para la comparación entre los arreglos institucionales, y en datos cuantitativos relacionados con las dimensiones consideradas en el análisis de los resultados: cobertura, recursos, calidad de la atención, situación sanitaria. Los indicadores de salud de las unidades federadas se compararon a partir de medidas de dispersión y desigualdad. El artículo contribuye a reforzar una línea argumental que hace hincapié en las especificidades de los arreglos federativos y su articulación con otras dimensiones institucionales para interpretar los resultados de las políticas y colmar las lagunas de los estudios comparativos.

Objective We aimed to describe, from the perspective of rheumatologists in Europe, how the coronavirus disease 2019 (COVID-19) pandemic has impacted their management of people with RA and the continuing medical education of physicians. Methods Rheumatologists participating in the Adelphi RA Disease Specific ProgrammeTM in six European countries were contacted in August and September 2020 for a telephone survey. Rheumatologists were asked seven attitudinal questions on changes to patient management, prescription behaviour and continuing education owing to COVID-19. Results were summarized with descriptive statistics. Results The telephone survey was completed by 284 rheumatologists. The most commonly reported changes to patient management were increased utilization of video/telephone consultations (66.5% of respondents), fewer visits (58.5%) and limiting physical contact (58.1%). Furthermore, 67.9% of rheumatologists who indicated that prescribing behaviour had changed switched their patients to self-administered medication, and 60.7% reported not starting patients on targeted synthetic DMARDs, biologic originator DMARDs or biosimilar DMARDs. In total, 57.6% of rheumatologists believed that changes in management would persist. Rheumatologists reported that 38.0% of patients expressed concerns about how COVID-19 would impact treatment, including access to treatment and the risk of infection. The biggest impact on rheumatologist education was a switch to online training and conferences. Conclusion All countries saw changes in patient management and prescribing behaviour, including the rapid uptake of telemedicine. It is important that the international rheumatology community learns from these experiences to prepare better for future pandemics and to address ongoing rheumatologist shortages.

Objective: To analyze the offer of telemedicine based on outpatient production in different Brazilian regional scenarios through public funding. Method: Documentary research based on data made available by the Department of Informatics of the Unified Health System (DATASUS) between the years 2020 to 2022. The codes used in the searches were: 0301010315; 0301010307; and 0301010220. The data collected refer exclusively to the application of telemedicine in the Unified Health System. Search results were manually entered into the Google Sheets tool and descriptively analyzed. The term telemedicine was used as a synonym for teleconsultation and/or teleservice and was not restricted to medical activity, except when duly indicated. Results: Code 03010100315: 982,117 telephone calls [Southeast (71.26%); Northeast (12.35%); South (10.45%); Midwest (5.10%); North (0.84%)]; total cost: R$ 6.18 million; unit value of R$ 6.30. Code 0301010307: 386,746 teleconsultations [Southeast (78.03%); South (15.45%); Midwest (2.40%); Northeast (2.34%); North (1.78%)]; total cost: R$ 3.86 million; unit value: R$ 9.99. Code 0301010220: Unpublished data. Conclusion: Telemedicine faces technical and infrastructure difficulties, which prevent its full amplification in the national territory. It is important to adapt the execution of the modality to the reality and to the public to which it will be aimed, in addition to training the population and health professionals. Objetivo: Analizar la oferta de telemedicina basada en la producción ambulatoria en diferentes escenarios regionales brasileños a través de financiación pública. Método: Investigación documental basada en datos puestos a disposición por el Departamento de Informática del Sistema Único de Salud (DATASUS) entre los años 2020 a 2022. Los códigos utilizados en las búsquedas fueron: 0301010315; 0301010307; y 0301010220. Los datos recopilados se refieren exclusivamente a la aplicación de la telemedicina en el Sistema Único de Salud. Los resultados de la búsqueda se ingresaron manualmente en la herramienta Hojas de cálculo de Google Sheets y se analizaron de forma descriptiva. El término telemedicina se utilizó como sinónimo de teleconsulta y/o teleservicio y no se restringió a la actividad médica, salvo indicación en contrario. Resultados: Código 03010100315: 982.117 llamadas telefónicas [Sureste (71,26%); Nordeste (12,35%); Sur (10,45%); Medio Oeste (5,10%); Norte (0,84%)]; costo total: R$ 6,18 millones; valor unitario de R$ 6,30. Clave 0301010307: 386.746 teleconsultas [Sureste (78,03%); Sur (15,45%); Medio Oeste (2,40%); Nordeste (2,34%); Norte (1,78%)]; costo total: R$ 3,86 millones; valor unitario: R$ 9,99. Código 0301010220: Datos no publicados. Conclusión: La Telemedicina enfrenta dificultades técnicas y de infraestructura, que impiden su plena ampliación en el territorio nacional. Es importante adecuar la ejecución de la modalidad a la realidad y al público al que se destinará, además de capacitar a la población y a los profesionales de la salud. Objetivo: Analisar a oferta da telemedicina a partir da produção ambulatorial em diferentes cenários regionais brasileiros por meio do financiamento público. Método: Pesquisa documental a partir de dados disponibilizados pelo Departamento de Informática do Sistema Único de Saúde (DATASUS) entre os anos de 2020 a 2022. Os códigos utilizados nas buscas foram: 0301010315; 0301010307; e 0301010220. Os dados coletados referem-se exclusivamente à aplicação da telemedicina no Sistema Único de Saúde. Os resultados das buscas foram inseridos manualmente na ferramenta Google Sheets e analisados de forma descritiva. O termo telemedicina foi empregado como sinônimo de teleconsulta e/ou teleatendimento não se restringindo à atividade médica, exceto quando devidamente sinalizado. Resultados: Código 03010100315: 982.117 teleatendimentos [Sudeste (71,26%); Nordeste (12,35%); Sul (10,45%); Centro-Oeste (5,10%); Norte (0,84%)]; custo total: R$ 6,18 milhões; valor unitário de R$ 6,30. Código 0301010307: 386.746 teleconsultas [Sudeste (78,03%); Sul (15,45%); Centro-Oeste (2,40%); Nordeste (2,34%); Norte (1,78%)]; custo total: R$ 3,86 milhões; valor unitário: R$ 9,99. Código 0301010220: Dados não publicados. Conclusão: A telemedicina enfrenta dificuldades de ordem técnica e de infraestrutura, o que impede sua plena amplificação no território nacional. É importante adequar a execução da modalidade à realidade e ao público ao qual será destinada, além de capacitar a população e profissionais da saúde.

The developing and changing world both locally and globally faces with a wide variety of environmental problems due to tapid population growth, excessive urbanization and excessive use of natural resources from the mid-20th century until nowadays. Excessive waste generation, excessive energy consumption and excessive use of resources that occur in modern healthcare institutions; which appears with the term “green hospital”. In this sense, it is aimed that health institutions will solve that increasing environmental problems in order to compensate for their environmental issues and develop services with less damage to the environment.By examining its contributions to health institutions and the environment; to provide information about green hospital concepts, feasible green hospital concepts put forward; at the same time drawing attention on the concept of green to the health sector in Turkey is the objective of the study.As a result; increasing the green hospital identity in both private and public sectors not only reduces the costs of health care services, but also increases the quality of health services. Considering the environmental and economic effects of the health sector, it is thought that it will contribute to both health professionals and social development in the production and delivery health services., Gelişen ve değişen dünya yerel ve küresel çapta, 20. yüzyılın yarısından günümüze kadar hızlı nüfus artışı, aşırı kentleşme, aşırı doğal kaynak kullanımına bağlı olarak çok çeşitli çevre sorunlarıyla yüzleşmektedir. Modern sağlık kurumlarında ortaya çıkan aşırı atık üretimi, aşırı enerji tüketimi ve kaynakların aşırı kullanımı ise; “yeşil hastane” terimiyle karşımıza çıkmaktadır. Bu anlamda sağlık kurumlarının çevre sorunlarını artırır nitelikteki problemlere çözümü ve çevreye daha az zararla hizmet geliştirmesi amaçlanmıştır.Sağlık kurumlarına ve çevreye sağladığı katkılar incelenerek; yeşil hastane kavramı hakkında bilgi vermek, uygulanabilir yeşil hastane kavramını ortaya koymak aynı zamanda Türkiye’de sağlık sektöründe yeşil kavramına dikkat çekmek çalışmanın amacını oluşturmaktadır. Sonuç olarak; yeşil hastane kimliğinin hem özel hem de kamu da artırılması sağlık hizmetlerinin maliyetlerini düşürmekle beraber sağlık hizmetlerinin kalitesini de artırmaktadır. Sağlık sektörünün gerek çevresel gerekse ekonomik açıdan etkileri göz önünde bulundurularak hem sağlık uzmanlarına hem de sağlık hizmetinin üretimi ve sunumunda toplumsal gelişime katkı sağlayacağı düşünülmektedir.

Summary: ⇒ Human actions have played a key role in shaping the COVID-19 pandemic patterns. While theoretically recognised, existing models of epidemics often do not endogenously capture many of the feedback loops connecting people’s choices and epidemic dynamics, for example, adoption of non-pharmaceutical interventions (NPIs) by individuals and governments shapes disease transmission, which in turn alters perceived risks and future NPI adoption. ⇒ Such ‘risk-driven response’ feedback is central to explaining important empirical puzzles of the COVID-19 pandemic, including the convergence of reproduction number to 1 across nations, multiple waves of pandemic, mortality variance and limited trade-off between economic and health outcomes in adoption of NPIs. Capturing that feedback also enhances pandemic forecasting and offers distinct and more effective vaccination strategies. ⇒ Much remains to be explored in modelling diverse behavioural feedbacks, from endogenous testing and vaccination choices to the building of infrastructure for various responses. Integrating those with epidemiological models offers promising new discoveries and enhanced policy design. Published version

The regulation of health policies within the scope of neoliberal policies caused the private sector in healthcare to be supported by the states and this led to a significant increase in the number of private hospitals. Increasing the role of private hospitals and the private sector in health services, has moved away from providing health services as a basic social policy and has transformed this area into a commercial area. By commercializing health services and transforming them into a tradable commodity that can be bought and sold, has caused many problems and causing service providers to evaluate health services through market dynamics and this brought the field away from its original purpose. The purpose of this research is to determine the changes in the service quality of health services and to reveal the reasons that transform this area into an area dominated by economic relations. The stage of the research consists of patients who were treated in private hospitals in Ağrı, Muş and Patnos and benefited from the health services of these hospitals. The patient groups who benefited health services from private hospitals in Muş, Ağrı and Patnos, which are believed to represent the stage; 10 from Ağrı, 15 from Muş and 10 from Patnos, were reached using the purposeful qualitative sampling technique. The patients who constitute the sample of the study, were asked conducted questions and interviews by using semi-structured in-depth interview technique according to the subject and purpose of the research. The findings were analyzed and interpreted according to the purpose and subject of the research by using the descriptive analysis method., Neoliberal politikalar kapsamında özel hastanelerin sağlık hizmetlerindeki rolünün artması, sağlık hizmetlerinin temel bir sosyal politika olarak verilmesinden uzaklaştırmış ve bu alanı adeta bir ticaret alanına dönüştürmüştür. Sağlık hizmetlerinin ticarileştirilmesine sebep olan bu süreç beraberinde birçok problemi doğurarak, hizmet sunucuların sağlık hizmetlerini piyasa dinamikleri üzerinden değerlendirmesine neden olmuştur. Bu araştırmanın amacını sağlık hizmetlerinin hizmet niteliğinde değişime neden olan ve bu alanı ekonomik ilişkilerin hâkim olduğu bir alana dönüştüren nedenleri ortaya koyabilmek oluşturmaktadır. Araştırmanın evrenini Ağrı, Muş ve Patnos'ta bulunan özel hastanelerde tedavi görmüş ve bu hastanelerin sağlık hizmetlerinden yararlanmış hastalar oluşturmaktadır. Evreni temsil ettiğine inanılan, Muş, Ağrı ve Patnos'ta bulunan özel hastanelerin sağlık hizmetlerinden yararlanmış Ağrı'dan 10, Muş'tan 15 ve Patnos'tan 10 kişilik hasta gruplarına, amaçlı nitel örneklem tekniği kullanılarak ulaşılmıştır. Araştırmanın örneklemini oluşturan bu hastalara, araştırmanın konusu ve amacına göre yarı yapılandırılmış derinlemesine görüşme tekniği kullanılarak sorular yöneltilmiş ve görüşmeler yapılmıştır. Elde edilen bulgular betimsel analiz yöntemi kullanılarak, araştırmanın amacı ve konusuna göre analiz edilip yorumlanmıştır. Araştırma neticesinde elde edilen temel sonuç, sağlık hizmetlerinde özel hastanelerin rolünün artması, bu alanda ekonomik ilişkilerin ve kâr anlayışının hizmet sunumunda öne çıkan temel amaç olduğudur.

Resumo O presente artigo se propõe a avaliar, a partir das informações da Pesquisa Nacional de Saúde (PNS), 2019, as desigualdades de gênero e raciais no acesso e utilização dos serviços de saúde no Brasil. O objetivo principal é compreender como homens e mulheres, brancos, pretos ou pardos, buscam atendimento médico na Atenção Primária à Saúde, porta de entrada no sistema de saúde brasileiro. As análises sob uma perspectiva de gênero mostram que padrões culturais e sociais afetam ações e escolhas individuais e, em particular, o acesso e uso dos serviços de saúde. Os resultados também indicam que homens e mulheres reproduzem o comportamento de gênero esperado, social e culturalmente construído, que impacta sua autoavaliação de estado de saúde, cuidados e suas exposições ao risco de doença e morte. A análise interseccional revela que as desigualdades raciais se combinam às observadas entre homens e mulheres, exponenciando vulnerabilidades para pessoas de cor ou raça preta ou parda e refletindo as desigualdades socioeconômicas estruturantes da sociedade brasileira. Nesse contexto, a universalidade e a integralidade preconizadas no Sistema Único de Saúde contribuem enquanto política pública para a garantia de direitos, equalização de oportunidades e efetivação do acesso ao atendimento igualitário. Abstract This paper aims to evaluate gender and racial inequalities in the access and use of health services in Brazil Based on the 2019 National Health Survey (PNS). Its main objective is to understand how white, black, or brown men and women seek medical care in Primary Health Care, the gateway to the Brazilian health system. Analyses from a gender perspective show that cultural and social patterns affect individual actions and choices and mainly access to and use of health services. The results also show that men and women reproduce the expected gender behavior, socially and culturally constructed, which impacts their self-assessment of health status, care, and their exposure to the risk of disease and death. The intersectional analysis reveals that racial inequalities are aligned with those observed between men and women, exponentiating vulnerabilities for self-identified black or brown people, reflecting the structural socioeconomic inequalities of Brazilian society. In this context, the universality and integrality recommended in the Unified Health System contribute as a public policy to the guarantee of rights, equalization of opportunities, and adequate access to equal care.

RESUMO Este trabalho analisa a evolução das despesas em saúde realizadas com receitas próprias pelos municípios brasileiros após a vigência da Emenda Constitucional 29/2000, com o intuito de verificar se cresceram de forma homogênea nas diferentes regiões do país e se eventuais desigualdades regionais diminuíram, se mantiveram ou aumentaram com o tempo. Utiliza o Índice Global e Local de Moran, buscando padrões de correlação espacial e formação de clusters. ABSTRACT This paper analyzes the evolution of health expenditures using own revenues by Brazilian municipalities after the promulgation of Constitutional Amendment 29/2000, in order to verify if they grew homogeneously in different regions of the country and if regional inequalities decreased, maintained or increased with time. It uses Moran’s Global and Local Index to look for patterns of spatial correlation and clusters formation.

الملخص: عادة ما تكون المقالات ما قبل الطباعة بمثابة مقدمة أولية لأوراق تمت مراجعتها من قِبل النظراء ويتم وضعها على الفور تقريبا، باستثناء بعض الفحص السطحي، في مستودع وصول مفتوح للجمهور للسماح للمعلومات بالوصول إلى القراء بسرعة، والتغلب على الخمول المرتبط عادة بالمعالجة بطريقة المجلات التي تعتمد على مراجعة الأقران. بالنسبة للباحثين في بداية حياتهم المهنية الذين قد يكونون متحمسين للحصول على بعض التقدير لجهودهم، أو الرغبة في الحصول على مدخلات مفتوحة وعلنية حول عملهم، فإن النشر قبل الطباعة هو بالتأكيد خيار نشر مفيد. ومع ذلك، إذا لم يتم فحص البيانات والمعلومات المتعلقة بالصحة بعناية، فقد تشكل خطرا، وقد تعمل أيضا كمصدر لمعلومات مضللة عن الصحة العامة. تشير زيادة النمو والمنافسة بين خوادم ما قبل الطباعة، إلى جانب حجم هائل من المطبوعات المسبقة المتعلقة بـ كوفيد-١٩، وخاصة على خادم ما قبل الطباعة لعلم الأحياء، وخادم ما قبل الطباعة للعلوم الطبية، بالإضافة إلى تحديد الفهرسة التي يتم اختبارها الآن على موقع بوب ميد، إلى أن المطبوعات المسبقة يتم استخدامها بشكل متزايد في العلوم الطبية الحيوية. وهناك حاجة إلى سياسات أخلاقية أقوى وأكثر قوة لفحص المطبوعات المسبقة قبل نشرها للجمهور، وحتى إذا كان هذا يعني تأخيرا طفيفا في النشر، فقد يؤدي ذلك إلى زيادة ثقة الأكاديميين في هذا الشكل من المعلومات العلمية والتواصل. يجب تقديم سياسات أخلاقية واضحة وصارمة بشكل عاجل من قبل مجموعات الأخلاقيات مثل لجنة أخلاقيات النشر، واللجنة الدولية لمحرري المجلات الطبية للمجلات الأعضاء التي تسمح بنشر مقالات ما قبل الطباعة قبل مراجعة النظراء التقليدية. ستفيد الإرشادات الأخلاقية الصارمة التي تتعامل مع سوء السلوك على قدم المساواة في مقالات ما قبل الطباعة والأبحاث التي راجعها النظراء، ستفيد نزاهة النشر الأكاديمي. Abstract: Preprints are typically crude precursors of peer-reviewed papers that are placed almost immediately, save for some superficial screening, on an open-access repository to allow the information to reach readers quickly, circumventing the long-drawn process typically associated with processing in peer-reviewed journals. For early-career researchers who might be enthusiastic about obtaining some recognition for their efforts, or wanting open and public input about their work, preprints are certainly a useful publication choice. However, if health-related data and information have not been carefully scrutinised, they may pose a risk and may even serve as a source of public health misinformation. Surging growth and competition among preprint servers, coupled with a massive volume of COVID-19-related preprints, mainly on bioRxiv and medRxiv, as well as select indexing now being tested on PubMed, suggests that preprints are being increasingly used in the biomedical sciences. Stronger and more robust ethical policies are needed to screen preprints before they are released to the public, and even if this implies a slight delay in publication, it may increase academics' trust in this form of scientific information and communication. Clear and stringent ethical policies need to be urgently introduced by ethics groups such as COPE and the ICMJE, whose many member journals allow preprints to be posted before traditional peer review. Stringent ethical guidelines that treat misconduct equally in preprints and peer-reviewed papers will boost the integrity of academic publishing.

Obezite ile mücadelede, başvurulan güncel çözüm yollarından biri obezite vergisidir. Kalorisi yüksek ancak besleyici değeri düşük gıdaların fiyatını yükselterek tüketimlerini azaltmak obezite vergisinin ana amacıdır. Obezite vergisi birçok ülkede farklı şekillerde kullanılmaktadır ve Türkiye’de uygulanması son dönemlerde tartışılan bir konudur. Bu makalede öncelikle obeziteden genel olarak bahsedilmiş, ardından obezite vergisinin olumlu ve olumsuz yönlerine yer verilmiş ve daha sonra araştırma bulguları sunulmuştur. Bu çalışmanın amacı, obezite vergisinin Türkiye’de uygulanmasına yönelik görüşleri değerlendirmektir. Araştırma evreni, Ankara’da hizmet veren bir aile sağlığı merkezine 01.04.2019-30.05.2019 tarihleri arasında başvuran 18 yaş ve üzeri hastalardan oluşmaktadır. Araştırma kapsamında gönüllülük esasıyla araştırmayı kabul eden 371 hasta ile görüşme yapılmıştır. Araştırmada, Ayyıldız ve Demirli (2015) tarafından hazırlanan anket kullanılmıştır ve elde edilen veriler SPSS programıyla analiz edilmiştir. Araştırmada kullanılan ölçüm aracının yapı geçerliliği, açıklayıcı ve doğrulayıcı faktör analizleri ile değerlendirilmiştir. Katılımcıların cinsiyetinin obezite vergisini destekleme ihtimalleri üzerinde etkili olduğu sonucuna ulaşılmıştır. Kadınların obezite vergisini destekleme olasılığının daha yüksek olduğu saptanmıştır. Katılımcıların büyük çoğunluğunun obezite vergisini desteklemediği ancak vergi dışında araçlar ve politikalarla obezite ile mücadeleyi gerekli gördükleri bulunmuştur., Obesity tax is one of the latest solutions and the main aim is to reduce the consumption of foods with high calories but low nutritional value by increasing the prices. Obesity tax is applied in different ways in many countries and its implementation in Turkey is a topic that has been discussed recently. The aim of this study is to evaluate the opinions for the implementation of the obesity tax in Turkey. The research population consists of patients aged 18 and over who applied to a family health center serving in Ankara between 01.04.2019 and 30.05.2019. Within the scope of the research, 371 patients who accepted the research on a voluntary basis were interviewed. The questionnaire prepared by Ayyıldız and Demirli (2015) was used as a measurement tool and the obtained data were analyzed by the SPSS program. The construct validity of the measurement tool used in the research was evaluated with exploratory and confirmatory factor analysis. T-test and ANOVA test as well as logistic regression analysis were used to evaluate the hypotheses. It was concluded that the gender of the participants had an effect on the probability of supporting the obesity tax. It has been found that women are more likely to support the obesity tax. It was found that the majority of the participants did not support the obesity tax, but they considered it necessary to fight obesity with tools and policies other than tax.

Esta oficina foi realizada no 59º Congresso Brasileiro de Educação Médica por membros da International Student Surgical Network of Brazil (InciSioN Brazil), Gender Equity Initiative in Global Surgery (GEIGS Brazil) e International Federation of Medical Students Associations' of Brazil (IFMSA Brazil). A oficina tem como objetivo geral promover a capacitação de discentes para exercerem liderança em prol da diminuição das desigualdades de gênero no contexto acadêmico e médico. Além disso, temos como objetivos específicos: 1) Introduzir dados do contexto atual, histórico e conceitos relacionados à desigualdade de gênero. 2) Desmistificar o feminismo, abordando suas diferentes vertentes e possíveis aplicações na sociedade e na escola médica 3) Sensibilizar quanto ao uso de mecanismos de combate à discriminação de gênero e quando utilizá-las.

Europeanization is assumed to influence health policy in the Western Balkans, but little is known about the actual impact of this process in these countries which constitute a complex geopolitical region of Europe. In this context, we used time trends to explore the Western Balkans health policies during the Europeanization through a cross-country comparative analysis of six countries. We conducted a health policy analysis by adapting the framework for globalization and population health coined by Huynen et al. in 2005. We analyzed 90 progress reports of Albania, Bosnia and Herzegovina, Croatia, Montenegro, North Macedonia and Serbia from 2005 to 2020. In particular, we considered chapter 28 on "Consumer and health protection" and other chapters that contained the words "health" or "population health". Evidence indicates that Europeanization influences Western Balkans' policies at different levels. Western Balkan countries revise national legislation in accordance with new European Union acquis as addressed in the progress reports and build cooperation with international institutions. They build national health reforms and reorganize relevant institutions to better address regulations in accordance to Europeanization. However, it is necessary to monitor law implementation so that the current legislation is enforced and further positive impact can be measured on population health.

Early diagnosis and timely and appropriate treatments positively influence the history of fibromyalgia syndrome (FM), with favourable repercussions at clinical, psychological, social and economic levels. Notwithstanding, there are still significant problems with timeliness of diagnosis, access to pharmacological therapies – particularly to innovative ones – and appropriate and effective taking in charge of patients. All the aforementioned factors have a great impact on FM patients’ quality of life. Indeed, even though the World Health Organisation recognised FM as a chronic condition in the International Classification of Diseases 10th edition (ICD-10), many countries still fail to recognise the syndrome, and this negatively influences the capability to appropriately protect and care for patients. This is the case in several European Countries. In Italy, a few Regions have started to put in place precise indications for people suffering from FM, aiming at the implementation of diagnostic-therapeutic pathways. The Diagnostic-Therapeutic Care Pathway (DTCP) provides an important tool to meet the needs of patients suffering from chronic diseases. They present the organisation of an integrated assistance network. This includes a seamless path for disease prevention, diagnosis and treatment, by means of cooperation among physicians and other healthcare professionals.

BackgroundComprehensive data is key for evidence-informed policy aiming to improve the lives of persons experiencing different levels of disability. The objective of this paper was to identify the environmental barriers — including physical, social, attitudinal, and political barriers — that might become priorities for cross-cutting policies and policies tailored to the needs of persons experiencing severe disability in Cameroon.MethodsA secondary analysis of data obtained with the WHO Model Disability Survey was completed in the Bankim Health District (N = 559) using random forest regression to determine and compare the impact of the environmental factors on the experience of disability.ResultsThe physical environment had by far the highest influence on disability, with transportation, toilet of the dwelling, and the dwelling itself being the most important factors. Factors inside one’s own home (toilet of the dwelling, and the dwelling itself) were the most important for persons with moderate and severe disability, followed by attitudes of others and issues with accessing health care.ConclusionOur study provides country policy makers with evidence for setting priorities and for the development of evidence-informed policies for the Bankim Health District in Cameroon.

The present paper reviews good practices in modern management and marketing for sports clubs, especially in the Martial Arts. Objectives: to study how modern management and especially marketing should impact the development of martial arts clubs in Romania, by comparison to good practices identified in the USA. Prior Work: most available data is from USA, and relevant literature has been thoroughly reviewed, with an emphasis on modern marketing practices; Approach: for the purpose of clearly identifying marketing and management influence, a survey has been submitted to all known martial arts clubs registered in Romania; Results: survey results highlight the importance of modern marketing in attracting new practitioners, while modern management should make the sports activity lucrative and profitable; Implications: present findings and their interpretation are meant to provide academics and researchers with a foundation for further studies, as well as to send a signal to the policy-makers in charge; Value: according to our knowledge, this is the first study on this subject in Romania, and its’ importance is relevant as a significant part of the health system and policies.

This study explored social factors that are associated with the US deaths caused by COVID‐19 after the declaration of economic reopening on May 1, 2020 by President Donald Trump. We seek to understand how county‐level support for Trump interacted with social distancing policies to impact COVID‐19 death rates. Overall, controlling for several potential confounders, counties with higher levels of Trump support do not necessarily experience greater mortality rates due to COVID‐19. The predicted weekly death counts per county tended to increase over time with the implementation of several key health policies. However, the difference in COVID‐19 outcomes between counties with low and high levels of Trump support grew after several weeks of the policy implementation as counties with higher levels of Trump support suffered relatively higher death rates. Counties with higher levels of Trump support exhibited lower percentages of mobile staying at home and higher percentages of people working part time or full time than otherwise comparable counties with lower levels of Trump support. The relative negative performance of Trump‐supporting counties is robust after controlling for these measures of policy compliance. Counties with high percentages of older (aged 65 and above) persons tended to have greater death rates, as did more populous counties in general. This study indicates that policymakers should consider the risks inherent in controlling public health crises due to divisions in political ideology and confirms that vulnerable communities are at particularly high risk in public health crises., Key Points Counties with higher levels of Trump support did not necessarily experience greater mortality rates due to COVID‐19.The predicted weekly death counts per county tend to increase over time with the implementation of several key health policies.The difference in COVID‐19 outcomes between counties with low and high levels of Trump support grew after several weeks of the policy implementation as counties with higher levels of Trump support suffered relatively higher death rates.Counties with higher levels of Trump support exhibited lower percentages of devices staying at home and higher percentages of people working part time or full time than otherwise comparable counties with lower levels of Trump support.

Background Throughout the United States, low-wage, minority workers are disproportionately affected by occupational illnesses and injuries. Chronic exposure to hazardous chemicals at work can lead to serious illnesses, contributing to health inequities. In this article, we expand on theories of ‘responsibilization’ in an occupational health context to reveal how responsibilities for workplace chemical exposures are negotiated by workers and owners in Latinx-owned small businesses. Methods We conducted semi-structured interviews with a total of 22 workers and owners in auto repair shops and beauty salons – two high-risk industries – in Southern Metropolitan Tucson. Participants were asked about their insights into workplace chemical exposures and health. A qualitative analysis team with representation from all study partner organizations collectively coded and reviewed the interview data in QSR International’s NVivo 11 and identified overarching themes across the interviews. Results We identified three primary themes: 1) ambivalence toward risks in the workplace; 2) shifting responsibilities for exposure protection at work; and 3) reflections on the system behind chemical exposure risks. Participants discussed the complexities that small businesses face in reducing chemical exposures. Conclusions Through our analysis of the interviews, we examine how neoliberal occupational and environmental policies funnel responsibility for controlling chemical exposures down to individuals in small businesses with limited resources, obscuring the power structures that maintain environmental health injustices. We conclude with a call for upstream policy changes that more effectively regulate and hold accountable the manufacturers of chemical products used daily by small business workers.

Background To design better measures to contain the Covid-19 epidemics, it is relevant to know whether socioeconomic factors are associated with a higher risk of death by Covid-19. This work estimates the effects of individual socioeconomic characteristics on the risk of death by Covid-19. Methods Logistic models were estimated to assess the effect of socioeconomic characteristics (income, race/ethnicity, schooling, occupation and economic activity) on the risk of death from Covid-19. For this purpose, Covid-19 individual death records in Rio de Janeiro state, Brazil were combined with the Annual Register of Social Information, which contains socioeconomic information about formal workers. Findings Workers employed in establishments in the health and public safety sectors present a risk of dying 2.46 and 2.25 times higher than those employed in other activities. Non-white people, men, and those who work in the Metropolitan Region are also more likely to die from Covid-19. People with higher education are 44% less likely to die from the disease. Conclusions Some population groups are more vulnerable to the Covid-19 pandemic and individual socioeconomic conditions play a relevant role in the probability of death by the disease. That should be considered in the design of prevention policies to be adopted.

The dynamics of the covid-19 pandemic has evolved according to phases marked by a higher or lower rate of infection, the different impacts on the health system and mortality. These phases were studied according to four indicators made available by the MonitoraCovid-19 system: positivity rates of diagnostic tests, number of cases, number of deaths and number of people who received at least two vaccine doses, standardized in a historical series to allow their comparison. Five phases are discerned, evidenced by the circulation of different virus variants, strategies employed to implement -or even undermine – disease control measures and the gradual vaccination of the population. These indicators can be used in the future to monitor trends and point out appropriate public policies.Monitoring; Pandemic; Indicators; Covid-19; Health policies. La dinámica de la pandemia de covid-19 ha evolucionado según fases marcadas por una mayor o menor tasa de contagios, sus diferentes impactos en el sistema de salud y mortalidad. Estas fases se estudiaron según cuatro indicadores disponibles en el sistema MonitoraCovid-19: positividad de las pruebas diagnósticas, número de casos, número de defunciones y el número de personas vacunadas con al menos dos dosis, estandarizados en una serie histórica para permitir su comparación. Se distinguen cuatro fases, marcadas por la circulación de diferentes variantes del virus, las estrategias de implementación - o mismo el boicoteo- de medidas de control y la paulatina vacunación de la población. Estos indicadores pueden utilizarse en el futuro para monitorear tendencias y señalar políticas públicas apropiadas. A dinâmica da pandemia de covid-19 vem evoluindo segundo fases marcadas por uma maior ou menor taxa de infecção, e diferentes impactos sobre o sistema de saúde e a mortalidade. Essas fases foram estudadas segundo quatro indicadores disponibilizados no sistema MonitoraCovid-19: positividade de testes de diagnóstico, número de casos, número de óbitos e o número de pessoas com ao menos duas doses de vacinas – padronizados numa série histórica para permitir sua comparação. São distinguidas cinco fases, marcadas pela circulação de diferentes variantes do vírus, estratégias de implementação – ou mesmo boicote – de medidas de controle e a vacinação gradativa da população. Esses indicadores podem ser usados no futuro para monitorar tendências e apontar políticas públicas adequadas.

In order to provide an environment with agile, creative, and effective decisions in the health system, the Felicilab laboratory has been adopting the use of innovative project management methods. This experience report aims to present how the Escola de Saúde Pública do Ceará (ESP/CE), Brazil, had managed to orchestrate, through FeliciLab, a set of people, methods, and technologies from a disruptive perspective of standards hitherto presented in the market of technologies directed to the health system, in face of the health crisis caused by the covid-19 pandemic. With the adoption of more agile methodologies for conducting work and managing crisis, the perception of the value of the Information technology (IT) used at ESP/CE was expanded, understanding that innovating is more than producing and implementing technologies: it means transforming the ways of creating and consume solutions in order to impact on personal experiences and their context. A fin de propiciar un ambiente con decisiones ágiles, creativas y efectivas en el sistema de salud, el Laboratório de Inovações no SUS do Ceará (FeliciLab) tiene adoptado el uso de métodos innovadores de gestión de proyectos. Este relato de experiencia tiene como objetivo presentar cómo la Escola de Saúde Pública do Ceará (ESP/CE), a través del FeliciLab, ha conseguido orquestar un conjunto de personas, métodos y tecnologías capaces para quebrar estándares hasta entonces presentados en el mercado de tecnologías dirigidas al sistema de salud, frente a la crisis de salud provocada por la pandemia de Covid-19. Con la adopción de metodologías más ágiles para la realización del trabajo y la gestión de crisis, se amplió la percepción del valor de la tecnología de la información (TI) ESP/CE, alimentada por el entendimiento de que innovar es más que producir e implementar tecnologías: se trata de transformar formas de crear y consumir soluciones para impactar los contextos y las experiencias de las personas. Com o fim de propiciar um ambiente que possibilite decisões ágeis, criativas e efetivas no sistema de saúde, o Laboratório de Inovações no SUS do Ceará (FeliciLab) tem adotado o uso de métodos inovadores de gestão de projetos. Este relato de experiência tem como objetivo apresentar como a Escola de Saúde Pública do Ceará (ESP/CE) conseguiu, através do FeliciLab, orquestrar um conjunto de pessoas, métodos e tecnologias capazes de provocar uma quebra em padrões até então apresentados no mercado de tecnologias direcionadas para o sistema de saúde, diante da crise sanitária ocasionada pela pandemia de covid-19. Com adoção de metodologias mais ágeis de condução de trabalho e gerenciamento de crises, ampliou-se a percepção de valor da tecnologia da informação (TI) da ESP/CE, nutrida pela compreensão de que inovar é mais do que produzir e implantar tecnologias: trata-se de transformar os modos de criar e consumir soluções, de forma a impactar os contextos e as experiências das pessoas.

The worldwide spread of SARS-CoV-2 has been responsible for an infectious pandemic, with repercussions on socio-economic aspects and on the physical and mental health of the general population. The present systematic review aimed to evaluate the data belonging to the European framework, analyzing the population by age group. Original articles and reviews on the state of mental health of the general European population have been researched starting from 2021. Initially, a total of 1764 studies were found, among which a total of 75 were selected. Youth were the age group most affected by pandemic consequences on mental health, with emotional and behavioral alterations observed from a third to more than a half of children and adolescents examined. Among both adolescents and adults, the female gender had a higher prevalence of psychopathological symptoms. The main risk factors were poor social support, economic difficulties, and, in particular, unemployment or job changes. Additional individual risk factors were the perception of loneliness, the presence of pre-pandemic mental illness/distress, and some personality traits, such as neuroticism, impulsiveness, and the use of maladaptive coping strategies. Unexpectedly, the elderly maintained good resilience towards change, even if a stress factor was represented by the feeling of loneliness and poor social contact. As regards suicidal behaviors, among adolescents, there was an increase in attempts of 25%, with a greater risk for the female gender. This risk increased also among adults, in association with symptoms of anxiety and depression, and poor socio-environmental conditions. In conclusion, some population groups were found to be at greater risk of psychological burden during pandemic waves, thus representing priority targets for socio-health interventions.

Objective The overall aim of this study was to investigate how commissioning policies for accessing clinical procedures compare in the context of the English National Health Service. Our primary objective was to compare policy wording and categorise any variations identified. Our secondary objective was to explore how any points of variation relate to national guidance. Methods This study entailed documentary analysis of commissioning policies that stipulated criteria for accessing eight elective musculoskeletal procedures. For each procedure, we retrieved policies held by regions with higher and lower rates of clinical activity relative to the national average. Policies were subjected to content and thematic analysis, using constant comparison techniques . Matrices and descriptive reports were used to compare themes across policies for each procedure and derive categories of variation that arose across two or more procedures. National guidance relating to each procedure were identified and scrutinised, to explore whether these provided context for explaining the policy variations. Results Thirty-five policy documents held by 14 geographic regions were included in the analysis. Policies either focused on a single procedure/treatment or covered several procedures/treatments in an all-encompassing document. All policies stipulated criteria that needed to be fulfilled prior to accessing treatment, but there were inconsistences in the evidence cited. Policies varied in recurring ways, with respect to specification of non-surgical treatments and management, requirements around time spent using non-surgical approaches, diagnostic requirements, requirements around symptom severity and disease progression, and use of language, in the form of terms and phrases (‘threshold modifiers’) which could open up or restrict access to care. National guidance was identified for seven of the procedures, but this guidance did not specify criteria for accessing the procedures in question, making direct comparisons with regional policies difficult. Conclusions This, to our knowledge, is the first study to identify recurring ways in which policies for accessing treatment can vary within a single-payer system with universal coverage. The findings raise questions around whether formulation of commissioning policies should receive more central support to promote greater consistency – especially where evidence is uncertain, variable or lacking.

Objective To identify and to describe the legal provisions that regulate the sale of food in Brazilian schools. Method Documentary analysis carried out in 2019, on the websites of the State, capital and Federal District Legislative Assemblies, via e-mail and/or telephone contact and publications on the subject review. The data were grouped by geographic region and a descriptive analysis was carried out. Results Data were obtained from 96% of the federative units (25 States and the Federal District). 62 legal provisions were found: 60% current, 11% revoked and 29% draft bills. Current legislation was found in 67% of States: 100% of the States in the South, Southeast and Center-West regions, 56% in the Northeast and 43% in the North. Most of the legal provisions prohibit the sale of ultra-processed foods and encourage the sale of fruits and fresh foods in the public and private school network. Conclusion Progress is observed in the school food regulatory process in this country, considering its coverage in the States and in the public and private school network, but still restricted to the South, Southeast and Midwest regions. RESUMO Objetivo Identificar e descrever os dispositivos legais que regulamentam a comercialização de alimentos em escolas brasileiras. Método Análise documental realizada em 2019, nos sites das Assembleias Legislativas dos Estados, Capitais e Distrito Federal, via e-mail e/ou contato telefônico e publicações sobre o tema. Os dados foram agrupados por região geográfica e procedeu-se análise descritiva. Resultados Obteve-se dados de 96% das unidades federativas (25 Estados/Capitais e Distrito Federal). Foram encontrados 62 dispositivos legais: 60% vigentes, 11% revogados e 29% projetos de lei. Regulamentação vigente foi encontrada em 67% dos Estados brasileiros: 100% dos Estados das Regiões Sul, Sudeste e Centro-Oeste, 56% no Nordeste e 43% no Norte. A maioria dos dispositivos legais proíbe a comercialização de alimentos ultraprocessados e incentiva a venda de frutas e alimentos in natura, na rede pública e privada. Conclusão Constata-se avanço no processo de regulamentação no país, considerando abrangência nos estados/capitais e na rede pública e privada, porém ainda restrito às Regiões Sul, Sudeste e Centro-Oeste.

Population movements have turned Chagas disease (CD) into a global public health problem. Despite the successful implementation of subregional initiatives to control vectorial and transfusional Trypanosoma cruzi transmission in Latin American settings where the disease is endemic, congenital CD (cCD) remains a significant challenge. In countries where the disease is not endemic, vertical transmission plays a key role in CD expansion and is the main focus of its control. Although several health organizations provide general protocols for cCD control, its management in each geopolitical region depends on local authorities, which has resulted in a multitude of approaches. The aims of this review are to (i) describe the current global situation in CD management, with emphasis on congenital infection, and (ii) summarize the spectrum of available strategies, both official and unofficial, for cCD prevention and control in countries of endemicity and nonendemicity. From an economic point of view, the early detection and treatment of cCD are cost-effective. However, in countries where the disease is not endemic, national health policies for cCD control are nonexistent, and official regional protocols are scarce and restricted to Europe. Countries of endemicity have more protocols in place, but the implementation of diagnostic methods is hampered by economic constraints. Moreover, most protocols in both countries where the disease is endemic and those where it is not endemic have yet to incorporate recently developed technologies. The wide methodological diversity in cCD diagnostic algorithms reflects the lack of a consensus. This review may represent a first step toward the development of a common strategy, which will require the collaboration of health organizations, governments, and experts in the field. Population movements have turned Chagas disease (CD) into a global public health problem. Despite the successful implementation of subregional initiatives to control vectorial and transfusional Trypanosoma cruzi transmission in Latin American settings where the disease is endemic, congenital CD (cCD) remains a significant challenge.

Body-size perception is an important factor in motivating people to lose weight. Study aim was to explore the perception of body image among first-generation Chinese migrants living in Italy. A sample of 1258 Chinese first-generation immigrants and of 285 native Italians living in Prato, Italy, underwent blood pressure measurements, blood tests (with measurement of glucose, cholesterol, and triglycerides), and anthropometric measurements. Body-size perception was investigated with Pulvers’ figure rating scale using logistic or linear multivariable regression adjusted for age, gender, BMI, education and years spent in Italy. Chinese migrants had lower BMI and discrepancy score (preferred minus current body size) than Italians (p < 0.05 for both). After a logistic regression analysis, the discrepancy score remained lower in the Chinese than in the Italian cohort independently from BMI and other confounders (OR 0.68; 95%CI 0.50 to 0.92). In the Chinese cohort, female gender, BMI and years spent in Italy were positive determinants of discrepancy score (desire to be thinner), while age showed negative impact (p < 0.05 for all). Overweight is an important risk factor for diabetes, a very prevalent condition among first-generation Chinese migrants. The present study offers useful information and suggests the need for prevention programs specifically addressed to men.

What sets AI systems and AI-powered medical robots apart from all other forms of advanced medical technology is their ability to operate at least to some degree autonomously from the human health care practitioner and to use machine-learning to generate new, often unforeseen, analysis and predictions. This poses challenges under the current framework of laws, regulations, and ethical guidelines applicable to health care in South Africa. The article outlines these challenges and sets out guiding principles for a normative framework to regulate the use of AI in health care. The article examines three key areas for legal reform in relation to AI in health care. First, it proposes that the regulatory framework for the oversight of software as a medical device needs to be updated to develop frameworks for adequately regulating the use of such new technologies. Secondly, it argues that the present HPCSA guidelines for health care practitioners in South Africa adopt an unduly restrictive approach centred in the outmoded semantics of telemedicine. This may discourage technological innovation that could improve access to health care for all, and as such the guidelines are inconsistent with the national digital health strategy. Thirdly, it examines the common law principles of fault-based liability for medical negligence, which could prove inadequate to provide patients and users of new technologies with redress for harm where fault cannot clearly be attributed to the healthcare practitioner. It argues that consideration should be given to developing a statutory scheme for strict liability, together with mandatory insurance, and appropriate reform of product liability pertaining to technology developers and manufacturers. These legal reforms should not be undertaken without also developing a coherent, human-rights centred policy framework for the ethical use of AI, robotics, and related technologies in health care in South Africa.

The five-year evaluation of the Global Fund to fight HIV/AIDS, TB and malaria (GFATM) was carried out by a Consortium of several universities and institutions, led by a consulting firm based in Washington DC. The evaluation focused on three study areas: (i) organizational efficiency and effectiveness of the Global Fund, (ii) effectiveness of the Global Fund partner environment, (iii) system effects of the Global Fund and impact of increased funding on the level of response to the three diseases. The findings can be summarized as follows: the Global Fund has been successful in mobilizing additional funding and attracting new players. However, the demand-driven model used for allocation of funding is poorly adapted to epidemiological profiles with regard to population, persons at highest risk, and number of persons affected by the disease. The partner environment of the Global Fund, involving UN technical partners and institutions cooperating in development, has failed to produce planned results due to the weak institutional capacity of recipients and health systems overall, as well as little synergy and coordination between international partners. Increased financial resources have allowed the rapid expansion of prevention and care services for the three diseases. Spectacular results have been achieved against malaria in Eastern African countries, but little progress has been made in the collective effort to slow down the spread of HIV/AIDS. In preparation for the upcoming Replenishment Conference of the Global Fund and prior to any further decisions to expand the use of innovative financing instruments for development, the author of this article calls the attention of policy-makers to the need to ensure the development of accompanying strategies to increase the effectiveness and impact of these instruments at country level. L’évaluation à cinq ans du Fonds mondial de lutte contre le VIH/SIDA, la tuberculose et le paludisme (GFTAM) a été menée par un consortium de plusieurs universités et institutions, piloté par un cabinet de conseil basé à Washington DC. Cette évaluation s’est concentrée sur trois domaines d’étude : (i) l’efficacité organisationnelle du Fonds mondial, (ii) l’efficacité et la performance du système de partenariats du Fonds mondial, (iii) les effets systémiques du Fonds mondial et l’impact de l’augmentation des financements sur la maîtrise des trois maladies. Les résultats se résument comme suit : le Fonds mondial a su mobiliser des financements additionnels et attirer de nouveaux acteurs. Cependant, l’allocation des financements repose sur un modèle fondé sur la demande qui n’est pas adapté aux profils épidémiologiques en termes de population, de personnes les plus exposées, ou de nombre de personnes atteintes par ces maladies. Le système de partenariats du Fonds mondial, impliquant des partenaires techniques de l’ONU et des institutions de coopération au développement, n’a pas eu les effets escomptés, en raison de la faible capacité institutionnelle des bénéficiaires et des systèmes de santé, et d'une synergie et d’une coordination insuffisante entre les partenaires internationaux. Si l’augmentation des ressources financières a permis une expansion rapide des services de prévention et de prise en charge des trois maladies, avec des résultats remarquables pour le paludisme dans les pays d’Afrique de l’Est, l’impact de l’effort collectif sur la réduction de la propagation du VIH/SIDA reste faible. En amont de la prochaine conférence de reconstitution des ressources du Fonds mondial, et à la veille de décider d’élargir l’utilisation d’instruments de financements innovants du développement, l’auteur de cet article souhaite attirer l’attention des politiques sur la nécessité d’élaborer des stratégies d’accompagnement de ces nouveaux instruments afin d’améliorer leur efficacité et leur impact au niveau des pays. La evaluación quinquenal del Fondo Mundial de lucha contra el SIDA, la tuberculosis y la malaria (FMSTM) fue realizada por un consorcio de diversas universidades e instituciones, encabezado por una asesoría con sede en Washington DC. La evaluación se centró en tres áreas de estudio: (i) eficiencia y eficacia organizativa del Fondo Mundial, (ii) eficacia del compromiso de los asociados del Fondo Mundial, (iii) efectos sistémicos del Fondo Mundial e impacto de la ampliación del financiamiento en el grado de respuesta a las tres enfermedades. Las conclusiones pueden resumirse de la manera siguiente: el Fondo Mundial ha tenido éxito a la hora de movilizar fondos adicionales y atraer a nuevos actores. Sin embargo, el modelo basado en la demanda utilizado para asignar las ayudas no está bien adaptado a los perfiles epidemiológicos con respecto a la población, las personas de más riesgo y el número de personas afectadas por la enfermedad. El entramado de asociados del Fondo Mundial, incluidos los asociados técnicos de la ONU y las instituciones de cooperación al desarrollo, no ha obtenido los resultados esperados como consecuencia de la escasa capacidad institucional de los receptores y de los sistemas de salud en general, así como por la poca sinergia y coordinación entre los asociados internacionales. La ampliación de los recursos financieros ha permitido una expansión rápida de los servicios de prevención y cuidado en las tres enfermedades. Se han conseguido resultados espectaculares contra la malaria en los países de África Oriental, pero se ha avanzado muy poco en el esfuerzo colectivo para frenar la propagación del VIH/SIDA. Ante la próxima Conferencia de Reposición del Fondo Mundial y antes de tomar ninguna otra decisión para extender el uso de los nuevos instrumentos financieros para el desarrollo, el autor de este artículo llama la atención de los responsables políticos sobre la necesidad de garantizar el desarrollo de estrategias de acompañamiento que aumenten la eficacia y el impacto de estos instrumentos a nivel de país.

ilustraciones, tablas La gestión de enfermedades es un proceso de transformación estratégica cuyo objetivo es optimizar la provisión de cuidados durante el curso natural de una enfermedad, mediante la coordinación de los recursos disponibles y basados en la mejor evidencia científica disponible. El dolor lumbar es la enfermedad musculoesquelética de mayor impacto a nivel mundial la cual genera cargas considerables en aspectos económicos, sociales y laborales en la población que la padece. La atención de esta patología requiere múltiples relaciones entre los diferentes actores del proceso; sin embargo, se han identificado discrepancias entre las indicaciones de la mejor evidencia disponible y lo que se ejecuta en la atención de estos pacientes. El objetivo de este trabajo de grado fue identificar las diferencias existentes entre lo planteado por la literatura como correcto y lo ejecutado por una IPS en la ciudad de Bogotá. Se analizaron los procesos de atención de la IPS y se realizó una revision de literatura para identificar las dificultades de coordinación ya determinados. Se identificaron 3 tipos de problemas dentro del proceso: los relacionados con la atención clínica, con la gestión de la IPS y con la configuración del sistema de salud, donde los dos últimos fueron los de mayor frecuencia. Se propone a la gestión de enfermedades como un marco acertado de trabajo para el análisis y gestión de enfermedades de este tipo, y se proponen posibles ajustes para ser aplicados al proceso de atención del dolor lumbar, con miras a la optimización del mismo. Disease management is a process of strategic transformation whose objective is to optimize the provision of care during the natural course of a disease, through the coordination of available resources and based on the best available scientific evidence. Low back pain is the musculoskeletal disease with the greatest impact worldwide, which generates considerable burdens in economic, social and labor aspects in the population that suffers from it. The attention of this pathology requires multiple relationships between the different actors of the process; however, discrepancies have been identified between the indications of the best available evidence and what is executed in the care of these patients. The objective of this degree work was to identify the differences between what is proposed by the literature as correct and what is executed by an IPS in Bogotá. The care processes of the IPS were analyzed and a literature review was carried out to identify the coordination difficulties already determined. Three types of problems were identified within the process: those related to clinical care, to the management of the IPS and to the configuration of the health system, where the last two were the most frequent. Disease management is proposed as a successful framework for the analysis and management of diseases of this type, and possible adjustments are proposed to be applied to the low back pain care process, with a view to optimizing it. Maestría Magíster en Administración Gestión de organizaciones

Resumo O artigo analisa a presença da história da saúde no periódico “Revista Ciência & Saúde Coletiva” entre 1996 e 2020. Discute as relações entre o campo disciplinar da história e a multidisciplinaridade da saúde coletiva, suas tensões, convergências e potenciais sinergias. Apresenta a trajetória do tema da história da saúde nos artigos e fascículos ao longo dos 25 anos de existência da revista, as principais iniciativas, resultados e temáticas abordadas. Faz um balanço crítico e discute caminhos para incrementar presença da história em artigos e números temáticos de “Revista Ciência & Saúde Coletiva”. Abstract The article analyzes the presence of the history of health in the “Journal Ciência & Saúde Coletiva” from 1996 to 2020, exploring relations between the disciplinary field of history and the multidisciplinary field of public health and examining their tensions, commonalities, and potential synergies. It shows how the history of health has featured in the journal’s articles and issues over the course of the journal’s twenty-five years and describes the main initiatives, results, and topics addressed in this realm. The article then offers a critical evaluation and discusses pathways for boosting the presence of history in articles and thematic issues of “Journal Ciência & Saúde Coletiva”.