Vasectomy within the public health services in Campinas, Sao Paulo, Brazil

Objective: To describe some of the characteristics of men who underwent a vasectomy in the public health network of Campinas, Sao Paulo, Brazil. Methods: A descriptive study including 202 men randomly selected from a list of all the men vasectomized between 1998 and 2004 in the public health network. Results: Most of the men were 30 years of age or older when vasectomized, had completed elementary school and had two or more children of both sexes. Most of the men came from the lowest income segment of the population: 47.6% in 1998-1999 and 61.3% in 2003-2004. Although the men knew various contraceptive methods, 51.2% reported that their partners were using combined oral contraceptives at the time of surgery. Most men initially sought information on vasectomy at health-care clinics where care was provided by a multidisciplinary team; most received counselling, however, 47.9% of the men waited more than 4 months for the vasectomy. Conclusions: The profile of the vasectomized men in this study appears to indicate that the low-income population from Campinas, Sao Paulo, Brazil has access to vasectomy; however, the waiting time for vasectomy reveals that difficulties exist in obtaining this contraceptive method in the public health service.

Public health risks of enterobacterial isolates producing extended-spectrum ��-lactamases or AmpC ��-lactamases in food and food-producing animals: an EU perspective of epidemiology, analytical methods, risk factors, and control options

The blaESBL and blaAmpC genes in Enterobacteriaceae are spread by plasmid-mediated integrons, insertion sequences, and transposons, some of which are homologous in bacteria from food animals, foods, and humans. These genes have been frequently identified in Escherichia coli and Salmonella from food animals, the most common being blaCTX-M-1, blaCTX-M-14, and blaCMY-2. Identification of risk factors for their occurrence in food animals is complex. In addition to generic antimicrobial use, cephalosporin usage is an important risk factor for selection and spread of these genes. Extensive international trade of animals is a further risk factor. There are no data on the effectiveness of individual control options in reducing public health risks. A highly effective option would be to stop or restrict cephalosporin usage in food animals. Decreasing total antimicrobial use is also of high priority. Implementation of measures to limit strain dissemination (increasing farm biosecurity, controls in animal trade, and other general postharvest controls) are also important.

THE EVALUATION OF PUBLIC HEALTH COMPONENTS OF INTERNATIONAL DISASTER RELIEF OPERATIONS: INDOCHINESE REFUGEES IN THAILAND, 1979-1982

Refugee populations suffer poor health status and yet the activities of refugee relief agencies in the public health sector have not been subjected previously to comprehensive evaluation. The purpose of this study was to examine the effectiveness and cost of the major public health service inputs of the international relief operation for Indochinese refugees in Thailand coordinated by the United Nations High Commissioner for Refugees (UNHCR). The investigator collected data from surveillance reports and agency records pertaining to 11 old refugee camps administered by the Government of Thailand Ministry of Interior (MOI) since an earlier refugee influx, and five new Khmer holding centers administered directly by UNHCR, from November, 1979, to March, 1982.^ Generous international funding permitted UNHCR to maintain a higher level of public health service inputs than refugees usually enjoyed in their countries of origin or than Thais around them enjoyed. Annual per capita expenditure for public health inputs averaged approximately US$151. Indochinese refugees in Thailand, for the most part, had access to adequate general food rations, to supplementary feeding programs, and to preventive health measures, and enjoyed high-quality medical services. Old refugee camps administered by MOI consistently received public health inputs of lower quantity and quality compared with new UNHCR-administered holding centers, despite comparable per capita expenditure after both types of camps had stabilized (static phase).^ Mortality and morbidity rates among new Khmer refugees were catastrophic during the emergency and transition phases of camp development. Health status in the refugee population during the static phase, however, was similar to, or better than, health status in the refugees' countries of origin or the Thai communities surrounding the camps. During the static phase, mortality and morbidity generally remained stable at roughly the same low levels in both types of camps.^ Furthermore, the results of multiple regression analyses demonstrated that combined public health inputs accounted for from one to 23 per cent of the variation in refugee mortality and morbidity. The direction of associations between some public health inputs and specific health outcome variables demonstrated no clear pattern. ^

Community pharmacists' engagement with public health in Great Britain

Objective - The objective of the research was to examine to what extent community pharmacists in Great Britain believed that their job was concerned with local public health issues. Methods - The project (Pharmacy and Public Health)received ethical approval from the Research Ethics Committee of the School of Life and Health Sciences at Aston University. After piloting, in August 2006 a self-completion postal questionnaire was sent to practicing community pharmacists in Great Britain (n=1998), with a follow-up to non-responders 4 weeks later. A final response rate of 51% (n=1023/1998) was achieved. Results - Respondents were asked to indicate their answer to the question ���to what extent is your present job concerned with local public health issues?��� on a three-point scale ��� ���highly���, ���slightly��� or ���not at all��� concerned with public health. They were also asked to indicate whether they were pharmacy owners, employee pharmacists or self-employed locum pharmacists. Less than half (43%,n=384/898) of respondents answering both questions believed that their job was highly concerned with public health. A relationship was observed between employment status and the level to which a respondent believed that their job was concerned with public health (chi-square test with P=0.001). Over half of pharmacy owners (51%, n=68/134) considered that their job was highly concerned with public health compared to44% (n=193/443) of employee pharmacists and38% (n=123/321) of locum pharmacists. Conclusion - This research suggests that community pharmacists in Great Britain are not ���fully engaged��� with public health. Pharmacy owners may feel more enfranchised in the public health movement than their employees and locums. Indeed, one-in-ten locums reported that their job was not at all concerned with public health which, as locum pharmacists constitute over a third of actively employed community pharmacists, could be limiting factor in any drive to strengthen the public health function of community pharmacists.

Methods matter: computational modelling in public health policy and planning

This work is aimed at understanding and unifying information on epidemiological modelling methods and how those methods relate to public policy addressing human health, specifically in the context of infectious disease prevention, pandemic planning, and health behaviour change. This thesis employs multiple qualitative and quantitative methods, and presents as a manuscript of several individual, data-driven projects that are combined in a narrative arc. The first chapter introduces the scope and complexity of this interdisciplinary undertaking, describing several topical intersections of importance. The second chapter begins the presentation of original data, and describes in detail two exercises in computational epidemiological modelling pertinent to pandemic influenza planning and policy, and progresses in the next chapter to present additional original data on how the confidence of the public in modelling methodology may have an effect on their planned health behaviour change as recommended in public health policy. The thesis narrative continues in the final data-driven chapter to describe how health policymakers use modelling methods and scientific evidence to inform and construct health policies for the prevention of infectious diseases, and concludes with a narrative chapter that evaluates the breadth of this data and recommends strategies for the optimal use of modelling methodologies when informing public health policy in applied public health scenarios.

Fully engaged: tackling health inequalities through public health interventions

The evolving role of Primary Care Trusts (PCTs) is currently centre stage, with fundamental debate emerging from Commissioning a patient-led NHS and Our health, our care, our say a new direction for community services. This paper argues that PCTs have a crucial role to play in the public health agenda, specifically tackling health inequalities. This responsibility will become even stronger as the present wave of reforms gains momentum. There is also a lively debate on whether these reforms will make inroads into the persistent problem of health inequality or will exacerbate them even further unless robust, additional intervention levers and mechanisms are introduced. This paper suggests that PCTs will be central to ensuring the balance of reforms is tilted towards a more rather than a less equitable NHS. One of the key responsibilities for PCTs outlined by the Department of Health1 will be to act as the anchor at local level to the increasingly diverse and potentially3fragmented NHS. By using their crucial commissioning role to provide overall coherence to the health system, acting as leading local champions of the NHS and continuing the drive for improvement in access and quality, PCTs will have to act as enforcer and guardian of the equity of the NHS at local level. There is widespread evidence of the tenacity of health inequalities in Great Britain. This report looks at the measures that a fully engaged��3 PCT has taken to grapple with the issues and draws some conclusions as to their possible wider application.refer to the resource

Workshop: Capacity building for national public health advocacy: case studies from national associations

The first statement of the EUPHA on the Future of Public Health in Europe refers to the need for going 'to policymakers, politicians and practitioners in all sectors of society and advise them on how to promote public health throughout society'. WHO-EURO Director General Marc Danzon, quoted in the second EUPHA statement on the responsibility of policy makers indicates that 'learning is not systematically applied in health policy development in our continent'. Statement 3 calls for the integration of public health into the political agenda in all sectors. The first EUPHA president, Louise Gunning-Schepers, quoted in Statement 10 called on EUPHA to become 'a powerful advocate of the public health community'. In addition to the above, the EU is now actively seeking ways to build capacity to implement its health strategy. Learning and building the capacity to achieve our aims The aims and objectives to promote the public's health as reflected in EUPHA's 10 statements are also mirrored in the national public health associations. However, many of EUPHA's national associations have little or limited experience in promoting public health policy at the national level. To assist in the learning of advocacy for public health policies, case studies presenting experiences of national public health organizations in lobbying for national public health policy will be presented and discussed. In addition to sharing experiences, the presentations will identify successful approaches to public health advocacy as well as lessons learned from unsuccessful attempts.

���All work and no play ��� ?��� : a critical investigation of an emerging public health discourse on children���s play.

Dans de nombreuses soci��t��s industrialis��es, une grande valeur est attribu��e au jeu des enfants, principalement parce que le jeu est consid��r�� comme ��tant une composante essentielle de leur d��veloppement et qu���il contribue �� leur bonheur et �� leur bien-��tre. Toutefois, des inqui��tudes ont r��cemment ��t�� exprim��es au regard des transformations qui s���op��rent dans le jeu des enfants, notamment en ce qui a trait �� la r��duction du temps de jeu en plein air. Ces transformations ont ��t�� attribu��es, en grande partie, �� une perception de risques accrus associ��s au jeu en plein air et �� des changements sociaux qui favorisent des activit��s de loisirs plus structur��es et organis��es. L���inqui��tude concernant la diminution de l���espace-temps accord�� au jeu des enfants est d���ailleurs clairement exprim��e dans le discours de la sant�� publique qui, de plus, t��moigne d���un redoublement de pr��occupations vis-��-vis du mode de vie s��dentaire des enfants et d���une volont�� affirm��e de pr��vention de l'ob��sit�� infantile. Ainsi, les organisations de sant�� publique sont d��sormais engag��es dans la promotion du jeu actif pour accro��tre l'activit�� physique des enfants. Nous assistons �� l�����mergence d���un discours de sant�� publique portant sur le jeu des enfants. �� travers quatre articles, cette th��se explore le discours ��mergeant en sant�� publique sur le jeu des enfants et analyse certains de ses effets potentiels. L'article 1 pr��sente une prise de position sur le sujet du jeu en sant�� publique. J���y d��finis le cadre d'analyse de cette th��se en pr��sentant l'argument central de la recherche, les positions que les organisations de sant�� publique adoptent vis-��-vis le jeu des enfants et les r��percussions potentielles que ces positions peuvent avoir sur les enfants et leurs jeux. La th��se permet ensuite d���examiner comment la notion de jeu est abord��e par le discours de sant�� publique. L'article 2 pr��sente ainsi une analyse de discours de sant�� publique �� travers 150 documents portant sur la sant��, l'activit�� physique, l'ob��sit��, les loisirs et le jeu des enfants. Cette ��tude consid��re les valeurs et les postulats qui sous-tendent la promotion du jeu comme moyen d���am��liorer la sant�� physique des enfants et permet de discerner comment le jeu est fa��onn��, disciplin�� et normalis�� dans le discours de sant�� publique. Notre propos r��v��le que le discours de sant�� publique repr��sente le jeu des enfants comme une activit�� pouvant am��liorer leur sant��; que le plaisir sert de v��hicule �� la promotion de l���activit�� physique ; et que les enfants seraient encourag��s �� organiser leur temps libre de mani��re �� optimiser leur sant��. ��tant donn�� l���influence potentielle du discours de sant�� publique sur la signification et l���exp��rience v��cue du jeu parmi les enfants, cette th��se pr��sente ensuite une analyse des repr��sentations qu���ont 25 enfants ��g��s de 7 �� 11 ans au regard du jeu. L���article 3 sugg��re que le jeu est une fin en soi pour les enfants de cette ��tude; qu'il rev��t une importance au niveau ��motionnel; et qu'il s���av��re intrins��quement motiv��, sans but particulier. De plus, l���amusement que procure le jeu rel��ve autant d���activit��s engag��es que d���activit��s s��dentaires. Enfin, certains enfants expriment un sentiment d'ambivalence concernant les jeux organis��s; tandis que d���autres consid��rent parfois le risque comme une composante particuli��rement agr��able du jeu. De tels r��sultats signalent une dissonance entre les formes de jeux promues en sant�� publique et le sens attribu�� au jeu par les enfants. Prenant appui sur le concept de �� biop��dagogies �� inspir�� des ��crits de Michel Foucault, le quatri��me article de cette th��se propose un croisement des deux volets de cette ��tude, soit le discours de sant�� publique sur le jeu et les constructions du jeu par les enfants. Bien que le discours de la sant�� publique exhortant au ��jeu actif�� soit reproduit par certains enfants, d'autres soulignent que le jeu s��dentaire est important pour leur bien-��tre social et affectif. D���autre part, tandis que le �� jeu actif �� apparait, dans le discours de sant�� publique, comme une solution permettant de limiter le risque d'ob��sit��, il comporte n��anmoins des contradictions concernant la notion de risque, dans la mesure o�� les enfants ont �� n��gocier avec les risques inh��rents �� l���activit�� accrue. �� terme, cet article sugg��re que le discours de sant�� publique met de l���avant certaines repr��sentations du jeu (actifs) tandis qu���il en n��glige d���autres (s��dentaires). Cette situation pourrait donner lieu �� des cons��quences inattendues, dans la mesure o�� les enfants pourraient ��ventuellement reconfigurer leurs pratiques de jeu et les significations qu���ils y accordent. Cette th��se n'a pas pour but de fournir des recommandations particuli��res pour la sant�� publique au regard du jeu des enfants. Prenant appui sur la perspective th��orique de Michel Foucault, nous pr��sentons plut��t une analyse d���un discours ��mergeant en sant�� publique ainsi que des pistes pour la poursuite de recherches sur le jeu dans le domaine de l���enfance. Enfin, compte tenu des effets potentiels du discours de la sant�� publique sur le jeu des enfants, et les perspectives contemporaines sur le jeu et les enfants, la conclusion offre des pistes de r��flexion critique.

���Public Health Protection through Air Quality Controls���

Health is an important aspect of everybody���s life. Today, there is an increasing recognition and commitment to the pursuit of health both within government and beyond. Any attempt on the part of the " State to protect and promote people���s health, in turn, must be accompanied by effective controls on air quality, as air constitutes ��� one of the important elements of man���s life and the consequences of air pollution covers a very wide spectrum ranging from material ---damage to personal discomfort and illness. The broad social and economic objectives adumbrated in the Directive Principles of State Policy including the commitment to improve public health underlying in Article 47 and the obligation to preserve and protect-the natural environment cast under Article 48A of the Constitution are being used as versatile weapons by the State to regulate the public health scenario. Preservation and maintenance of air quality is a significant area within the sphere of public health, where the regulatory arm of the law is not adequately touched and in this arena urgent State intervention through legislative and administrative action is called for in the well-being of the society. Judiciary also plays a pivotal role in this arena in the larger interest of the society and for the benefit of the present and future generations. The research study is an attempt to analyze how far the existing legal system, for maintaining air quality and in controlling air pollution, is effective in protecting public health. The study also analyzes the limitations of the control mechanisms. The study focuses on industrial air pollution, indoor and personal air pollution, vehicular pollution and noise pollution which are today appearing as the major public health hazards affecting the air quality. However, this is not to overlook the importance of controls required under other areas of public health.

Anemia and hemoglobinopathies in pregnant women attended in a public hospital

Objectives: to identify the demographic profile and frequency of anemia and hemoglobinopathies, as a basis for future implementation of actions aimed at pregnant women in the public health domain. Method: this is a cross-sectional study developed with pregnant women attended in a university hospital at Mato Grosso do Sul, Brazil. Blood samples were collected for the erythrogram analysis for detection of anemia and selective and specific tests for abnormal hemoglobin. The patients regarded as indigenous and mentally ill, as well as inmates, were excluded from the research, as they represent a vulnerable population which needs a cohort different from that of the sample. For data collection, a particular questionnaire was used. The research was approved by the Ethics Committee of Universidade Federal de Mato Grosso do Sul (UFMS), under the Protocol 873/2006. Results: of the 215 pregnant women under study, 20% were adolescents; 36.3% had incomplete primary education; 53.0% were non-Caucasian; 43.3% were from Campo Grande, Mato Grosso do Sul, Brazil; and 21.1% were of European descent. 17.7% had some type of anemia and, in the evaluation of hemoglobinopathies, 4.7% of patients were detected with some abnormal hemoglobin, with the following frequencies: 3.3% with HbAS; 0.9% with HbAC; and 0.5% with intermediate ��-thalassemia. Conclusion: the frequencies of anemia and hemoglobinopathy found in these pregnant women showed the importance of early diagnosis, revealing indicators able to provide a basis for preventive and assistance actions for adequate clinical monitoring, reducing maternal and neonatal morbimortality in the public health services. Descriptors: pregnant women; anemia; hemoglobinopathies; public health; nursing.

Public Health: Zentrale Begriffe, Disziplinen und Handlungsfelder

In diesem einfu��hrenden Kapitel lernen wir die zentralen Begriffe, Disziplinen und Handlungsfelder von Public Health kennen. Ein Blick in das 19. Jh. zeigt, dass Public Health zu Beginn u��berraschenderweise weniger mit der Medizin als mit dem Ingenieurwesen zu tun hatte. Die Geschichte macht auch verst��ndlich, warum heute der englische Begriff ,Public Health��� auch im Deutschen gebr��uchlich ist. Public Health und Medizin unterscheiden sich in ihrer Sicht auf Krankheit und Gesundheit. Anders als im medizinischen Denken steht in Public Health die Entstehung von Gesundheit (Salutogenese) und nicht die Entstehung von Krankheit (Pathogenese) im Mittelpunkt. Zu den Kernthemen von Public Health geh��rt u. a. die gesundheitliche Ungleichheit zwischen verschiedenen Bev��lkerungsgruppen, z. B. die Ungleichheit im Zusammenhang mit der sozialen Schichtzugeh��rigkeit und dem Geschlecht. Bei vielen Public-Health-Fragen spielen auch ethische Aspekte eine Rolle. W��hrend in der Medizinethik die Arzt-Patient-Beziehung im Mittelpunkt steht, ist es in der Public-Health-Ethik das Verh��ltnis zwischen den Institutionen und den Bu��rgerInnen. Wir schlie��en das Kapitel mit einem kritischen Blick auf die Public Health Genomics und ihrem Versprechen einer individualisierten Pr��vention. Schweizerische Lernziele: CPH 1���3, CPH 28���34

Texas Department of Health organizational structure changes: A reflection of public health policy and agency expansion, September 1, 1946--June 30, 1994

The premise of this study is that changes in the agency's organizational structure reflect changes in government public health policy. Based on this premise, this study tracks the changes in the organizational structure and the overall expansion of the Texas Department of Health to understand the evolution of changing public health priorities in state policy from September 1, 1946 through June 30, 1994, a period of growth and new responsibilities. It includes thirty-seven observations of organizational structure as depicted by organizational charts of the agency and/or adapted from public documents. ^ The major questions answered are, what are the changes in the organizational structure, why did they occur and, what are the policy priorities reflected in these changes in and across the various time periods. ^ The analysis of the study included a thorough review of the organizational structure of the agency for the time-span of the study, the formulation of the criteria to be used in ascertaining the changes, the delineation of the changes in the organizational structure and comparison of the observations sequentially to characterize the change, the discovery of reasons for the structural changes (financial, statutory - federal and state, social and political factors), and the determination of policy priorities for each time period and their relation to the expansion and evolution of the agency. ^ The premise that the organizational structure of the agency and the changes over time reflect government public health policy and agency expansion was found to be true. ^

Pharmacy and public health: examining the link between strategy and practice

Despite having been described by the then (2003) Chief Pharmaceutical Officer for England as ��probably the biggest untapped resource for health improvement", the development of the public health function of community pharmacists has been limited. However, devolution of healthcare budgets has led 10 differential rates of development of the public health function in each administration of the UK (England, Scotland, Wales and Northern Ireland). This is measured and reflected upon in this thesis. Two large-scale surveys were conducted, one of key strategic personnel (Directors of Public Health and Chief Pharmacists) in Primary Care Organisations (PCOs) and one of practicing community pharmacists. This research highlights the fact that community pharmacists have developed an individualistic, service-based approach to their engagement with public health that is contrary to the more collective approach adopted by the wider public health movement. The study measures the scope and level of health-improving services through community pharmacy across the UK and shows that the nature of the pharmacy contractor (independent, multiple etc.) may impact on the range and nature of services provided. Survey data also suggest that attitudes towards pharmacy involvement in the public health agenda vary markedly between Directors of Public Health, PCO Chief Pharmacists, and community pharmacists. Furthermore, within the community pharmacist population, attitudes are affected by a wide range of factors including the nature of employment (owner, employee, self-employed) and the type of employing pharmacy (independent, multiple etc.). Implications for policy and areas for further research aimed at maximising the public health function of community pharmacists are suggested.

Variables affecting the success of older applicants for employment in a public organization: An age -cued cognitive model of administrative decision-making

The dissertation takes a multivariate approach to answer the question of how applicant age, after controlling for other variables, affects employment success in a public organization. In addition to applicant age, there are five other categories of variables examined: organization/applicant variables describing the relationship of the applicant to the organization; organization/position variables describing the target position as it relates to the organization; episodic variables such as applicant age relative to the ages of competing applicants; economic variables relating to the salary needs of older applicants; and cognitive variables that may affect the decision maker's evaluation of the applicant. ^ An exploratory phase of research employs archival data from approximately 500 decisions made in the past three years to hire or promote applicants for positions in one public health administration organization. A logit regression model is employed to examine the probability that the variables modify the effect of applicant age on employment success. A confirmatory phase of the dissertation is a controlled experiment in which hiring decision makers from the same public organization perform a simulated hiring decision exercise to evaluate hypothetical applicants of similar qualifications but of different ages. The responses of the decision makers to a series of bipolar adjective scales add support to the cognitive component of the theoretical model of the hiring decision. A final section contains information gathered from interviews with key informants. ^ Applicant age has tended to have a curvilinear relationship with employment success. For some positions, the mean age of the applicants most likely to succeed varies with the values of the five groups of moderating variables. The research contributes not only to the practice of public personnel administration, but is useful in examining larger public policy issues associated with an aging workforce. ^

Production efficiency and financing of public health: an analysis of small municipalities in the state of Sao Paulo - Brazil

This paper measured the variations in performance of small municipalities in the State of Sao Paulo, Brazil, regarding the technical efficiency in the use of public funds in public primary health care actions concerning the funding profile, in a scenario of fiscal federalism. Technical efficiency is one of the parameters of evaluation of public sector performance and was measured by means of Data Envelopment Analysis (DEA). The correlation analysis of DEA score was used to verify possible associations between technical efficiency and the funding profile of expenses with health care. The results showed that 6.41% of the municipalities were considered efficient. They also showed that the level of municipality dependence to inter-governmental general purpose grants and the national health funding specific purpose grants have negative correlation with efficiency scores.