Sunshine and suicide at the tropic of Capricorn, São Paulo, Brazil, 1996-2004

Several studies have confirmed seasonal variation in suicide rates according to hours of sunshine. The suicide pattern was assessed in São Paulo, southeastern Brazil, at the tropic of Capricorn from 1996 to 2004. Poisson regression was employed to estimate parameters of seasonality, as well as to verify associations for each day between daylight duration and suicide. During the nine-year study period, there were 3,984 suicides (76.9% in men; median age=38.7 years old). Seasonal averages of suicides were similar, as were monthly averages. Poisson regression did not reveal any association between suicide rates and hours of sunshine (p=0.45) for both sexes. In conclusion, no seasonal pattern was observed for suicides.

Multimedia materials for education, training, and advocacy in international health: experiences with the Schistosomiasis Control Initiative CD-ROM

We describe an innovative use of multimedia materials to support training and advocacy within a schistosomiasis control programme. The Schistosomiasis Control Initiative (SCI) at Imperial College London works with selected sub-Saharan African countries to develop schistosomiasis control programmes. Two elements of the SCI programme were supported by multimedia materials developed at the Wellcome Trust in collaboration with the SCI: (1) training of programme managers, district health officers, and those delivering practical elements of the programme; and (2) advocacy targeted at decision-makers and donors. Evaluation of the materials revealed high reported ratings for both user satisfaction and impact from use of the product. From this experience we draw out several general messages about development of multimedia materials and how these will play a growing future role in promoting training within international health.

Nursing Actions in practicing inpatient advocacy in a Burn Unit

OBJECTIVEUnderstanding nursing actions in the practice of inpatient advocacy in a burn unit.METHODA single and descriptive case study, carried out with nurses working in a referral burn center in southern Brazil. Data were collected through focus group technique, between February and March 2014, in three meetings. Data was analysed through discursive textual analysis.RESULTSThree emerging categories were identified, namely: (1) instructing the patient; (2) protecting the patient; and (3) ensuring the quality of care.CONCLUSIONSThis study identified that the nurses investigated exercised patient advocacy and that the recognition of their actions is an advance for the profession, contributing to the autonomy of nurses and the effectiveness of patients' rights and social justice.

Nursing beliefs and actions in exercising patient advocacy in a hospital context

AbstractOBJECTIVEAnalyzing beliefs and actions of nurses in exercising patient advocacy in a hospital context.METHODA quantitative cross-sectional exploratory and descriptive study, conducted with 153 nurses from two hospitals in southern Brazil, one public and one philanthropic, by applying Protective Nursing Advocacy Scale - Brazilian version. Data were analyzed using descriptive statistics and analysis of variance.RESULTSNurses believe they are advocating for patients in their workplaces, and agree that they should advocate, especially when vulnerable patients need their protection. Personal values and professional skills have been identified as major sources of support for the practice of advocacy.CONCLUSIONNurses do not disagree nor agree that advocating for patients in their working environments can bring them negative consequences. It is necessary to recognize how the characteristics of public and private institutions have helped or not helped in exercising patient advocacy by nurses.

The seasonal and ovarian status effects on in vitro production of domestic cat embryos between Equator and Tropic of Capricorn

From the Tropic of Capricorn to Equator, the seasonality of domestic cat is known to be absent, i.e., these animals are considered non-seasonal breeders at these regions. We hypothesized that this particularity might have some influence on in vitro embryo production. The aim of this experiment was to determine the percentage of cleavage and morulae and blastocyst formation produced from oocytes recovered from queen ovaries of three distinct status - follicular, luteal or inactive - during two different reproductive seasons experienced by cats in southeast of Brazil (22°53'09" S and 48°26'42" W) - non breeding season (NBS), comprehending January to March; and breeding season (BS), August to October. Thirty queens were neutered. Ovaries were classified according to their status and were sliced in PBS for cumulus oocyte complex (COC) releasing. Grade I COC were washed three times in H-MEM supplemented with BSA, glutamine, sodium pyruvate, cysteine, streptomycin and penicillin. Oocytes were incubated in groups of 20-30 in 400µL of DMEM supplemented with FSH, LH, estradiol, IGF-I and basic fibroblast growth factor under mineral oil for 30 or 36 hours at 38°C in humidified environment of 5% de O2, 5% CO2 and 90% N2. COC were fertilized in Ham's F-10 medium supplemented with BSA, cysteine, pyruvate and streptomycin/penicillin (culture medium) with fresh semen selected through swim up technique. Eighteen hours later, the presumptive zygotes were denuded, the percentage of cleavage was determined and every 10 zygotes were transferred to 100mL drops of culture medium for culture during three days. After 72 hours of culture the percentage of morulae formation was evaluated and these structures were transferred to drops of the same culture medium. At the eighth day of culture blastocyst formation was analyzed. During NBS, from a total of 272 (inactive), 162 (luteal) and 134 (follicular) fertilized oocytes, the percentage of cleaved zygotes, morulae and blastocysts derived from inactive ovaries were 24.63, 16.54 and 8.09 respectively; for those derived from luteal ovaries, the percentage was 21.6, 12.96 and 8.64, and for those from follicular ovaries, they were 24.62, 16.41 and 8.21. Considering BS, from a total of 102 (inactive), 198 (luteal) and 86 (follicular) fertilized oocytes, the relative frequency (%) of cleaved zygotes, morulae and blastocysts derived from inactive ovaries were 64.7, 41.17 and 23.53 respectively; for those derived from luteal ovaries, the percentage was 64.14, 40.41 and 23.73, and for those from follicular ovaries, they were 63.95, 39.54 and 24.41. The results of this experiment demonstrate that no statistically significant difference (P<0.05) was verified in the frequency of cleaved embryos and morulae and blastocyst formation when comparing the three ovarian conditions in the same season. However the breeding season presented better results considering cleavage and morulae and blastocyst formation.

Inovação na cooperação intermunicipal no Brasil: a experiência da Federação Catarinense de Municípios (Fecam) na construção de consórcios públicos

Este artigo analisa uma experiência inovadora de cooperação intermunicipal no Brasil, por meio da observação da atuação da Federação Catarinense de Municípios (Fecam) no fomento e na organização de consórcios públicos intermunicipais. Investiga o uso de uma estratégia singular para enfrentar determinados limites à montagem de formas de consórcio no Brasil, entre os quais a dificuldade dos municípios, sem algum estímulo externo, para construir parcerias estáveis entre si. O ponto central da análise realça a possibilidade de associações municipalistas induzirem a cooperação de forma mais duradoura e com maior sustentação técnica. Com base no estudo de caso qualitativo, observou-se a atuação da Fecam como advocacy e como estrutura institucional profissionalizada que fomenta a cooperação entre municípios.

A Política Científica e Tecnológica de Santa Catarina: análise a partir do modelo de coalizões de defesa

Este artigo utiliza o modelo de coalizões de defesa (Advocacy Coalition Framework - ACF), de Sabatier e Jenkins-Smith (1993), para analisar a prevalência da comunidade científica catarinense como ator-chave na formulação da Política Científica e Tecnológica (PCT) de Santa Catarina. A coleta de dados foi realizada a partir de relatórios e documentos oficiais das instituições, bem como de entrevistas realizadas com 10 atores do processo de formulação da PCT que ocuparam funções estratégicas no período de 1989 a 2009, assim classificados: 1) comunidade científica; 2) burocratas; 3) designados politicamente; 4) empresários; 5) políticos. A análise dos dados teve como conceitos sensíveis aqueles presentes no modelo de coalizões de defesa: a) o papel dos atores; b) sistemas de convicções e recursos; c) trajetórias da política pública; d) características da política pública; e) conteúdo da política pública. Foram identificadas as conexões entre os atores, suas convicções, estratégias, recursos e constrangimentos. A pesquisa conclui que a comunidade científica exerce um papel de destaque na formulação da política científica e tecnológica catarinense, sendo prevalente na formulação da PCT em todo o período analisado. Em relação aos empresários, políticos e burocratas, não se identificou uma atuação destacada e contínua desses atores. Entretanto, os designados politicamente, que na maioria das vezes são recrutados no seio da comunidade científica, exerceram papel importante na formulação e na reafirmação do sistema de convicções da comunidade científica. Em relação às principais trajetórias que ajudam a explicar as mudanças da PCT catarinense no período analisado, a trajetória "aprendizagem orientada pela política pública" destaca-se perante as demais.

CRM na administração pública: desenvolvimento e validação de uma Escala de Relacionamento com o Cidadão (ERCi)

As empresas utilizam a gestão de relacionamento com o cliente ou Customer Relationship Management (CRM) para estabelecer relacionamentos de longo prazo, mantendo seus clientes satisfeitos e fiéis. Neste contexto, o Citizen Relationship Management (CiRM) surge no setor público como estratégia para aprimorar o atendimento ao cidadão e incentivar a cidadania. Considerando a lacuna da literatura sobre o tema, o objetivo deste estudo multimétodo foi validar um instrumento para avaliar a percepção dos cidadãos quanto às iniciativas de CiRM na administração pública. A principal contribuição deste trabalho consistiu na validação de um instrumento, em versões completa e reduzida, com índices psicométricos muito confiáveis, que pode ser utilizado como ferramenta diagnóstica pelos gestores públicos para promover uma gestão profícua do relacionamento com os cidadãos.

Traditional knowledge for promotion of socioeconomic inclusion of local communities

This paper discusses the key role played by public research institutes for promoting socioeconomic inclusion of local communities based on traditional knowledge and traditional medicine. Nongovernmental organizations and cooperatives have had an important role in raising financial resources, being involved with advocacy of local communities and advancing legislation changes. But strict best manufacturing practices regulations imposed by the Brazilian National Health Surveillance Agency on the requirements for approval and commercialization of drugs based on herbal medicine products call for the involvement of strong public research institutes capable of supporting community-based pharmacies. Thus, public research institutes are pivotal as they can conduct scientific research studies to evidence the efficacy of herbal medicine products and help building the capacity of local communities to comply with current regulations.

Legal and health variations in drug litigation injunctions granted in Minas Gerais

OBJECTIVE To investigate the factors related to the granting of preliminary court orders [injunctions] in drug litigations. METHODS A retrospective descriptive study of drug lawsuits in the State of Minas Gerais, Southeastern Brazil, was conducted from October 1999 to 2009. The database consists of 6,112 lawsuits, out of which 6,044 had motions for injunctions and 5,167 included the requisition of drugs. Those with more than one beneficiary were excluded, which totaled 5,072 examined suits. The variables for complete, partial, and suppressed motions were treated as dependent and assessed in relation to those that were independent – lawsuits (year, type, legal representation, defendant, court in which it was filed, adjudication time), drugs (level five of the anatomical therapeutic chemical classification), and diseases (chapter of the International Classification of Diseases). Statistical analyses were performed using the Chi-square test. RESULTS Out of the 5,072 lawsuits with injunctions, 4,184 (82.5%) had the injunctions granted. Granting varied from 95.8% of the total lawsuits in 2004 to 76.9% in 2008. Where there was legal representation, granting exceeded 80.0% and in lawsuits without representation, it did not exceed 66.9%. In public civil actions (89.1%), granting was higher relative to ordinary lawsuits (82.8%) and injunctions (80.1%). Federal courts granted only 68.6% of the injunctions, while the state courts granted 84.8%. Diseases of the digestive system and neoplasms received up to 87.0% in granting, while diseases of the nervous system, mental and behavioral disorders, and diseases of the skin and subcutaneous tissue received granting below 78.6% and showed a high proportion of suspended injunctions (10.9%). Injunctions involving paroxetine, somatropin, and ferrous sulfate drugs were all granted, while less than 54.0% of those involving escitalopram, sodium diclofenac, and nortriptyline were granted. CONCLUSIONS There are significant differences in the granting of injunctions, depending on the procedural and clinical variances. Important trends in the pattern of judicial action were observed, particularly, in the reduced granting [of injunctions] over the period.

Critical analysis of the allocation policy for liver transplantation in Brazil

Liver transplantation is now the standard treatment for end-stage liver disease. Given the shortage of liver donors and the progressively higher number of patients waiting for transplantation, improvements in patient selection and optimization of timing for transplantation are needed. Several solutions have been suggested, including increasing the donor pool; a fair policy for allocation, not permitting variables such as age, gender, and race, or third-party payer status to play any role; and knowledge of the natural history of each liver disease for which transplantation is offered. To observe ethical rules and distributive justice (guarantee to every citizen the same opportunity to get an organ), the "sickest first" policy must be used. Studies have demonstrated that death has no relationship with waiting time, but rather with the severity of liver disease at the time of inclusion. Thus, waiting time is no longer part of the United Network for Organ Sharing distribution criteria. Waiting time only differentiates between equally severely diseased patients. The authors have analyzed the waiting list mortality and 1-year survival for patients of the State of São Paulo, from July 1997 through January 2001. Only the chronological criterion was used. According to "Secretaria de Estado da Saúde de São Paulo" data, among all waiting list deaths, 82.2% occurred within the first year, and 37.6% within the first 3 months following inclusion. The allocation of livers based on waiting time is neither fair nor ethical, impairs distributive justice and human rights, and does not occur in any other part of the world.

Getting ready for malaria elimination: a check list of critical issues to consider

In recent years, a renewed interest in malaria elimination and eradication has emerged and seems to be rooting in the minds of the scientific community, public health specialists, funding bodies, policy makers and politicians. Malaria eradication will certainly benefit from improved and innovative tools; notwithstanding novel knowledge in fields ranging from basic science to mathematical modelling and health systems research. However, the elimination of malaria also encompasses a broad range of essential aspects that countries and other actors need to consider when thinking of embarking on such an adventure, including the implementation of innovative strategies, the ability to incorporate the most up-to-date evidence into policy, the integration of malaria into the broader health agenda, the strengthening of surveillance and health systems, capacity building, funding, advocacy and, very importantly, research. While in some cases this enthusiasm is clearly justified, some countries are still a long way from realistically advancing towards elimination. This paper attempts to provide guidance on all the necessary issues that should be considered when initiating a malaria elimination program.

Portraying innovation in the public service of Brazil: Frameworks, systematization and characterization

ABSTRACT Innovation is essential for improving organizational performance in both the private and public sectors. This article describes and analyzes the 323 innovation experiences of the Brazilian federal public service that received prizes during the 16 annual competitions (from 1995 to 2012) of the Award for Innovation in Federal Public Management held by the Brazilian National School of Public Administration (ENAP). It is a qualitative and quantitative study in which were employed as categories for analysis the four types of innovation defined in the Copenhagen Manual: product, process, organizational and communication. The survey results allow us to affirm that there is innovation in the public sector, in spite of the skepticism of some researchers and the incipient state of theoretical research on the subject. It was possible to observe that organizational innovation was the one with the highest number of award- -winning experience, followed respectively by process, communication and product innovation, with citizen services and improvement of work processes being the main highlights. The results showed that, although the high incidence of innovation occurs at the national level, a significant number of innovations also occur at the local level, probably because many organizations of the federal government have their actions spread only at this level of government. Concerning the innovative area, health and education predominate, with almost 33% of initiatives, which can be explained by capillarity of these areas and the fact that both maintain a strong interaction with the user. The contributions of this work include the use of theoretical model of innovation analysis in the public sector in Brazil still upcoming, and the systematization of knowledge in empirical basis for this innovation. In this sense, it also contributes to the development of the theory with the presentation of evidence that the characteristics, determinants and consequences of innovation in the public sector differ not only from innovation in the industry, but also from innovation in services in the private sector.

Moral distress: challenges for an autonomous nursing professional practice

Constantly experiencing limiting situations that hinder a professional practice coherent with its principles - of autonomy and advocacy of users' interests -, and often conditioned to experience moral distress, the nursing profession plays a prominent role in the current health model because it has the characteristic of managing the care rendered to users in a perspective of social inclusion, both in the basic health network and in hospitals. Aiming at carrying out a reflection on the nursing practice and the difficulties present in its work routine, and considering its characteristics as a profession, this article sought to make a reflection between the practice of nursing and the numerous moral challenges imposed by the routine, resulting, in many cases, in a value crisis that can reverberate directly on the quality of the service rendered, and in abandonment of the ideals of advocacy for users.

Child care and health rights: perspectives of adolescent mothers

AbstractOBJECTIVETo analyze child health care and the defense of their rights from the perspective of adolescent mothers.METHODSAn exploratory study with qualitative thematic analysis of data, based on conceptual aspects of care and the right to health, from semi-structured interviews with 20 adolescent mothers ascribed by Family Health teams.RESULTSMaternal reports indicate that child health care requires responsibility and protection, with health practices that promote child advocacy. Gaps in assistance which preclude the full guarantee of the right to child health care were also highlighted.CONCLUSIONThe right to health care assumed different meanings, and the forms to guarantee them were linked to individual behavior in detriment to broader actions that consider health as a social product, connected to the guarantee of other fundamental rights.