Health surveys and use of maternal and child health care services in three municipalities within the Sao Paulo metropolitan area

Objectives. To describe the changes in the use of maternal and child health care services by residents of three municipalities-Embu, Itapecerica da Serra, and Taboao da Serra-in the Sao Paulo metropolitan area, 12 years after the implementation of the Unified Health System (SUS) in Brazil, and to analyze the potential of population-based health care surveys as sources of data to evaluate these changes. Methods. Two population-based, cross-sectional surveys were carried out in 1990 and 2002 in municipalities located within the Sao Paulo metropolitan area. For children under 1 year of age, the two periods were compared in terms of outpatient services utilization and hospital admission; for the mothers, the periods were compared in terms of prenatal care and deliveries. In both surveys, stratified and multiple-stage conglomerate sampling was employed, with standardization of interview questions. Results. The most important changes observed were regarding the location of services used for prenatal care, deliveries, and hospitalization of children less than 1 year of age. There was a significant increase in the use of services in the surrounding region or hometown, and decrease in the utilization of services in the city of Sao Paulo (in 1990, 80% of deliveries and almost all admissions for children less than 1 year versus 32% and 46%, respectively, in 2002). The use of primary care units and 24-hour walk-in clinics also increased. All these changes reflect care provided by public resources. In the private sector, there was a decrease in direct payments and payments through company-paid health insurance and an increase in payments through self-paid health insurance. Conclusions. The major changes observed in the second survey occurred simultaneous to the changes that resulted from the implementation of the SUS. Population-based health surveys are adequate for analyzing and comparing the utilization of health care services at different times.

Outcomes of newborns admitted in the intensive care unit at a public hospital

Background: We evaluated the outcome of newborns admitted in the neonatal Intensive Care Unit (ICU) in Diadema, Brazil. Methods: We evaluated 72 newborns, data were extracted from research forms, newborns` hospital records, mothers interviews, domiciliary inquiry made with the responsible for the newborn care, and paediatric accompaniment cards. Results: 48.93% presented low birth weight, 48% were considered to have normal birth weight and 2% had a birth weight higher than 4000g. Concerning gestational age, 57.44% were younger than 37 weeks old. During hospitalisation, newborn had appointments with doctors from other specialties (inter-appointments), around 40% were cardiologists. After hospital discharge 82.98% were referred to local primary health care units, and the main specialities were cardiology and neurology. Among the newborns evaluated 85.11% were accompanied by paediatric health care units. Conclusion: The implementation of a specialised newborn health accompaniment program in Brazil after ICU discharge is important for positive outcomes regarding newborns growth and development.

Enhancing the distribution of Swedish tourism services on international markets : Possible export-ready criteria requisitioned by European tour operators

This paper identifies subjects which are relevant for Swedish suppliers of tourism services beforeapproaching foreign markets. Most suppliers are micro, small or medium sized companies anduse intermediaries, such as tour operators, for internationalization. The research considers theopinion of British and German tour operators, which require some criteria beforehand in orderto simplify both the initialization and the development of cooperation. Destination marketingorganizations (DMOs) are hereby the go-betweens since they not only represent small-scalesuppliers on international markets, but also initiate first encounters between suppliers and touroperators. Suppliers need to provide DMOs with accurate information in order to ensure thebest possible representation. After initializing collaboration, business relationships are sought todevelop in order to facilitate long-term cooperation. Proper preparation forms therefore the basefor strengthening the competitiveness of Swedish tourism prior approaching internationalmarkets. The enhancement of distributing Swedish tourism services on foreign markets appearedto be a profitable way to enable further growth, which is strongly limited on the domestic market.Increasing the export share therefore secures and further facilitates tourism’s valuablecontributions to the Swedish economy.

Therapeutic Discourse and the American Public Philosophy: On American Liberalism's Troubled Relationship with Psychology

I explore the main currents of postwar American liberalism. One, sociological, emerged in response to the danger of mass movements. Articulated primarily by political sociologists and psychologists and ascendant from the mid-fifties till the mid-seventies, it heralded the "end of ideology." It emphasized stability, elitism, positive science and pluralism; it recast normatively sound politics as logrolling and hard bargaining. I argue that these normative features, attractive when considered in isolation, taken together led to a vicious ad hominem style in accounting for views outside the postwar consensus. It used pseudo-scientific literature in labeling populists, Progressives, Taft conservatives, Goldwaterites, the New Left and others "pathological," viz. mentally ill. Hence, "therapeutic discourse." I argue that philosophical liberalism, which reasserts the role of political theory in working out norms and adjudicating disagreement, is a more profitable way of thinking about and defending from critics liberalism. I take the philosopher John Rawls as the tradition's modern representative. This inquiry is important because the themes of sociological liberalism are making a comeback in American public discourse, and with them perhaps the baggage of therapeutic discourse. I present a cautionary tale.

Geographical externalities and the Pacifying Police Units Program in Rio de Janeiro

The paper quantifies the effects on violence and police activity of the Pacifying Police Unit program (UPP) in Rio de Janeiro and the possible geographical spillovers caused by this policy. This program consists of taking selected shantytowns controlled by criminals organizations back to the State. The strategy of the policy is to dislodge the criminals and then settle a permanent community-oriented police station in the slum. The installation of police units in these slums can generate geographical spillover effects to other regions of the State of Rio de Janeiro. We use the interrupted time series approach proposed by Gonzalez-Navarro (2013) to address effects of a police when there is contagion of the control group and we find that criminal outcomes decrease in areas of UPP and in areas near treated regions. Furthermore, we build a model which allows to perform counterfactuals of this policy and to estimate causal effects in other areas of the State of Rio de Janeiro outside the city.

Familiares de portadores de transtorno mental: vivenciando o cuidado em um centro de atenção psicossocial

Esta investigação teve por objetivo apreender como os familiares de portadores de transtorno mental têm convivido com um serviço de saúde mental. Foi utilizado o método exploratório/descritivo, de natureza qualitativa. Como instrumento de coleta de dados, utilizou-se uma entrevista semiestruturada, sendo sujeitos dessa pesquisa seis familiares que já conviviam há mais de três anos com o adoecimento psíquico. A análise dos dados permitiu inferir que os familiares que acompanham o usuário têm de lidar com um aprendizado que adquiriram na vivência cotidiana e são sujeitos à rejeição de membros da família e da comunidade; com relação ao centro de atenção psicossocial, os familiares se sentem acolhidos em suas queixas, recebendo um atendimento singular; porém, desconhecem os mecanismos para a sua participação social, o que aponta para uma deficiência do serviço, à medida que este deve estimular formas de inserção na comunidade, e da ampliação dos direitos de cidadania dos usuários.

Health surveys and use of maternal and child health care services in three municipalities within the São Paulo metropolitan area

Objectives. To describe the changes in the use of maternal and child health care services by residents of three municipalities-Embu, Itapecerica da Serra, and Taboao da Serra-in the São Paulo metropolitan area, 12 years after the implementation of the Unified Health System (SUS) in Brazil, and to analyze the potential of population-based health care surveys as sources of data to evaluate these changes.Methods. Two population-based, cross-sectional surveys were carried out in 1990 and 2002 in municipalities located within the São Paulo metropolitan area. For children under 1 year of age, the two periods were compared in terms of outpatient services utilization and hospital admission; for the mothers, the periods were compared in terms of prenatal care and deliveries. In both surveys, stratified and multiple-stage conglomerate sampling was employed, with standardization of interview questions.Results. The most important changes observed were regarding the location of services used for prenatal care, deliveries, and hospitalization of children less than 1 year of age. There was a significant increase in the use of services in the surrounding region or hometown, and decrease in the utilization of services in the city of São Paulo (in 1990, 80% of deliveries and almost all admissions for children less than 1 year versus 32% and 46%, respectively, in 2002). The use of primary care units and 24-hour walk-in clinics also increased. All these changes reflect care provided by public resources. In the private sector, there was a decrease in direct payments and payments through company-paid health insurance and an increase in payments through self-paid health insurance.Conclusions. The major changes observed in the second survey occurred simultaneous to the changes that resulted from the implementation of the SUS. Population-based health surveys are adequate for analyzing and comparing the utilization of health care services at different times.

Summit of the Americas 1994-2009: selected indicators

Includes bibliography

Trade in services in Latin America and the Caribbean: an analysis of recent trends

Includes bibliography

Manual for completing the questionnaire on measures affecting services trade in the hemisphere

Includes bibliography

Modernization and foreign trade in the health services

Includes bibliography

Trade between Caribbean Community (CARICOM) and Central American Common Market (CACM) countries: the role to play for ports and shipping services

Includes bibliography

Intervenções farmacêuticas na atenção à saúde mental: Uma revisão

Uma revisão dirigida foi realizada nas bases de dados IBECS, LILACS e MEDLINE, até fevereiro/2011, para identificar intervenções farmacêuticas (IF) na atenção farmacêutica em saúde mental e os seus resultados. Para a busca utilizaram-se os descritores em saúde: Pharmaceutical Care, Pharmaceutical Services, Medication Adherence, Pharmacists, Mental Health, Mental Health Services, Mental Health Assistance, Community Mental Health Services, Mentally Ill Persons andMental Disorders. Identificaram-se 1686 publicações, das quais 21 contemplaram os critérios de inclusão. Após exploração do material, apenas cinco estudos tratavam-se de IF. Todos foram conduzidos no nível secundário de atenção, com abordagem individual, por meio do acompanhamento da terapia (3), intervenção educativa por cartas a médicos e pacientes (1), aconselhamento farmacêutico presencial e remoto e inserção de terapia com sistema transdérmico de nicotina (1). Os resultados, tais como promoção da adesão e resolução de problemas relacionados a medicamentos foram positivos para a terapêutica. No entanto, é necessário que as IF monitorem os parâmetros clínicos, as mudanças de hábitos, a melhora na qualidade de vida e os aspectos farmacoeconômicos a fim de avaliar os seus impactos. Palavras-chave:Atenção Farmacêutica. Assistência Farmacêutica. Adesão à Medicação. Farmacêuticos. Saúde Mental. ABSTRACT Pharmaceutical interventions in mental health services: a review A directed review was performed in IBECS, LILACS and MEDLINE databases, until February/2011, in order to identify the studies which developed pharmaceutical interventions (PI) in pharmaceutical care in mental health services and estimated their results. The search was carried out using the follow health science descriptors: Pharmaceutical Care, Pharmaceutical Services, Medication Adherence, Pharmacists, Mental Health, Mental Health Services, Mental Health Assistance, Community Mental Health Services, Mentally Ill Persons andMental Disorders. It was identified 1686 manuscripts, of whose 21 contemplated the inclusion criteria. After the content analysis of the eligible manuscripts, only five developed PI. All of them were conducted in the second level of health care, with individual approach, through: therapy follow-up (3), educational interventions by letters to physicians and patients (1), presence or remote pharmaceutical counseling and inclusion of therapy with nicotine transdermal patch (1). The data, such as adherence promotion and solving drug related problems, were positive for the therapeutic. However, it is necessary that the PI monitor the clinical parameters, the habit changes, the improvement in the quality of life and the pharmacoeconomic aspects, in order to assess their impacts. Keywords: Pharmaceutical Care. Pharmaceutical Services. Medication Adherence. Pharmacists. Mental Health. Mental Disorders.

Tourist Cruise Ships and the Trade in Services: Recent Trends in Countries of the Caribbean Basin

This issue of the Bulletin reviews the main trends of trade in goods and services for the countries of the Association of Caribbean States (ACS) in 2004. The strong recovery of trade in goods and the robust expansion of trade in services are highlighted, emphasizing the increase in services as a proportion of total exports for the smaller Caribbean economies, which may even exceed 80%.A detailed analysis of the performance of the tourism component, especially travel, showed that in 2004 there was a boom in cruise ship arrivals, a situation which poses a real challenge for some islands in terms of ensuring a permanent flow of tourists and making use of the main comparative advantages -sun, sea and beaches- and possible linkages with the rest of the economy such as the hotel industry, restaurants, business and entertainment centres, guided excursions, transport, yachting, and others. In some islands, the ratio of cruise passengers to inhabitants is particularly high, and can reach a significant factor of about 11 tourists for every inhabitant in the Bahamas, 8 in Aruba, 7 in Antigua and Barbuda and 5 in Dominica, and around 4 for a sample of eleven countries.One of the main challenges for a number of Caribbean islands is how to capitalize on such linkages by developing sustainable tourism that minimizes the possible adverse impacts on the environment and the everyday life of the citizens.

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 β-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.