Breastfeeding knowledge and practice of health professionals in public health care services

Objetivou-se avaliar conhecimentos e práticas sobre aleitamento materno de profissionais que atendem lactentes em unidades de atenção básica, ou maternidades públicas, de município do interior paulista, Brasil. É estudo epidemiológico, sendo a população composta por 89 enfermeiros e médicos. Suas respostas a um questionário estruturado foram analisadas no total e segundo o local de trabalho, aplicando-se o teste de diferença de proporções (qui-quadrado), considerando-se p<0,05 como nível crítico. Como parâmetros de acertos foram consideradas as recomendações do Ministério da Saúde. As diferenças significativas para conhecimentos e práticas, segundo o local de trabalho, foram restritas a alguns aspectos, com resultados discretamente melhores dos escores médios de acertos dos profissionais das unidades de atenção básica. Independente do local de trabalho, verificou-se desempenho regular e ruim em diferentes aspectos estudados, indicando que possíveis intervenções para a capacitação nessa temática deverão incluir profissionais de todos os níveis de atenção à saúde.

Performance of constructed wetland system for public water supply

The project is being conducted in the town of Analândia, São Paulo, Brazil. The constructed wetlands system for water supply consists of a channel with floating aquatic macrophytes, HDS system (Water Decontamination with Soil - Patent PI 850.3030), chlorinating system, filtering system and distribution. The project objectives include investigating the process variables to further optimize design and operation factors, evaluating the relation of nutrients and plants development, biomass production, shoot development, nutrient cycling and total and fecal coliforms removal, comparing the treatment efficiency among the seasons of the year; and moreover to compare the average values obtained between February and June 1998 (Salati et al., 1998) with the average obtained for the same parameters between March and June 2000. Studies have been developed in order to verify during one year the drinking quality of the water for the following parameters: turbidity, color, pH, dissolved oxygen, total of dissolved solids, COD, chloride, among others, according to the Ministry of Health's Regulation 36. This system of water supply projected to treat 15 L s-1 has been in continuous operation for 2 years, it was implemented with support of the National Environment Fund (FNMA), administered by the Center of Environmental Studies (CEA-UNESP), while the technical supervision and design were performed by the Institute of Applied Ecology. The actual research project is being supported by FAPESP.

Risk factors for low birth weight in Botucatu city, SP state, Brazil: A study conducted in the public health system from 2004 to 2008

Background: Low birth weight (LBW), defined as birth weight less than 2500 g, has a complex etiology and may be a result of premature interruption of pregnancy or intrauterine growth restriction. The objective of this study was to provide information on determinants of LBW and contribute to the understanding of the problem in Brazil. Methods. A case-control study was conducted in Botucatu city, SP state, Brazil. The study population consisted of 2 groups with 860 newborns in each group as follows: low weight newborns (LWNB) and a control group (weight ≤ 2500 g). Secondary data from 2004 to 2008 were collected using the Live Birth Certificate (LBC) and records from medical charts of pregnant women in Basic Health Units (BHU) and in the Public University Hospital (UH). Variables were as follows: maternal socio-demographic characteristics, pregnancy and birth conditions including quality of prenatal care according to 3 criteria. They were based on parameters established by the Ministry of Health (MH), one of them, the modified Kessner Index. The multivariable analysis by logistic regression was used to evaluate the association between variables and LBW. Results: According to the analysis, the factors associated with LBW were as follows: prematurity (OR = 56.98, 95% CI 29.52-109.95), twin pregnancy (OR = 20.00, 95% CI 6.25-100.00), maternal smoking (OR = 2.12, 95% CI 1.33-3.45), maternal malnourishment (OR = 2.30, 95% CI 1.08-5.00), maternal obesity (OR = 2.30, 95% IC 1.18-4.48), weight gain during pregnancy less than 5 kg (OR = 2.63, 95% CI 1.35-5.00) and weight gain during pregnancy more than 15 kg (OR = 2.26, 95% CI 1.16-4.41). Adequacy of prenatal care visits adjusted to gestational age was less frequent in the LBW group than in the control group (68.7% vs. 80.5%, x 2 p < 0.001). According to the modified Kessner Index, 64.4% of prenatal visits in the LWNB group were adequate. Conclusion: LWNB are a quite heterogeneous group of infants concerning their determinants and prevention actions against LBW and the follow-up of these infants have also been very complex. Therefore, improvement in the quality of care provided should be given priority through concrete actions for prevention of LBW. © 2012 Fonseca et al; licensee BioMed Central Ltd.

Report of the AD HOC Expert Group meeting on social exclusion, poverty, inequality, crime and violence: Towardsa research agenda for informed public policy for Caribbean SIDS

The Economic Commission for Latin America and the Caribbean (ECLAC), Subregional Headquarters for the Caribbean convened an expert group meeting on Social Exclusion, Poverty, Inequality – Crime and Violence: Towards a Research Agenda for informed Public Policy for Caribbean SIDS on Friday 4 April 2008, at its conference room in Port of Spain. The meeting was attended by 14 experts drawn from, the University of the West Indies (UWI), St. Augustine, Trinidad and Tobago; and Mona Campus, Jamaica; the St. Georges University, Grenada; the Trinidad and Tobago Crime Commission and the Ministry of Social Development, Government of Trinidad and Tobago and representative of Civil Society from Guyana. Experts from the United Nations System included representatives from the United Nations Fund for Women (UNIFEM), Barbados; the United Nations Development Programme (UNDP), Port of Spain and UNDP Barbados/SRO and the Organisation of Eastern Caribbean States (OECS). The list of participants appears as an annex to this report. The purpose of the meeting was to provide a forum in which differing theories and methodologies useful to addressing the issues of social exclusion, poverty, inequality, crime and violence could be explored. It was expected that at the end of the meeting there would be consensus on areas of research which could be pursued over a two to four-year period by the ECLAC Subregional Headquarters for the Caribbean and its partners, which would lead to informed public policy in support of the reduction of the growing violence in Caribbean society.

Private and Public Dental Care in the City of Sao Paulo in the First Decade of the XXI Century

Two concomitant movements occur in the first decade of the XXI century within the private and public dental services in Brazil: the entrance of oral health on the agenda of political priorities of the federal government and the vigorous growth of additional dental care. We analyzed the occurrence of these phenomena in the city of Sao Paulo, by seeking information in official documents and electronic databases in the Municipality of Sao Paulo, the Ministry of Health and National Health Agency (ANS), and also in scientific literature. During the studied period - January 2000 to December 2009 - and with basis on indicators such as coverage of First Consultation Program and Dental coverage Population Potential, percentages were found that characterize low public assistance and a situation far short of the constitutional principle of universal access to dental care. The growing number of beneficiaries of additional services through exclusively dental coverage insurance plans and other types of private insurance plans in the same period was significant, accounting for a major expansion of population coverage in this mode of care. It was found that, compared to the overall national framework, the city of Sao Paulo offers poor access to public dental care, with reduced supply of services to adults and aged people. Furthermore, considering the limitations of market additional services to provide dental care to all Brazilians, it reinforces the need for continuity and expansion of Brasil Sorridente, which is the programmatic expression of the National Oral Health Politics.

VVV DR1: The first data release of the Milky Way bulge and southern plane from the near-infrared ESO public survey VISTA variables in the Via Lactea

Context. The ESO public survey VISTA variables in the Via Lactea (VVV) started in 2010. VVV targets 562 sq. deg in the Galactic bulge and an adjacent plane region and is expected to run for about five years. Aims. We describe the progress of the survey observations in the first observing season, the observing strategy, and quality of the data obtained. Methods. The observations are carried out on the 4-m VISTA telescope in the ZYJHK(s) filters. In addition to the multi-band imaging the variability monitoring campaign in the K-s filter has started. Data reduction is carried out using the pipeline at the Cambridge Astronomical Survey Unit. The photometric and astrometric calibration is performed via the numerous 2MASS sources observed in each pointing. Results. The first data release contains the aperture photometry and astrometric catalogues for 348 individual pointings in the ZYJHK(s) filters taken in the 2010 observing season. The typical image quality is similar to 0 ''.9-1 ''.0. The stringent photometric and image quality requirements of the survey are satisfied in 100% of the JHK(s) images in the disk area and 90% of the JHK(s) images in the bulge area. The completeness in the Z and Y images is 84% in the disk, and 40% in the bulge. The first season catalogues contain 1.28 x 10(8) stellar sources in the bulge and 1.68 x 10(8) in the disk area detected in at least one of the photometric bands. The combined, multi-band catalogues contain more than 1.63 x 10(8) stellar sources. About 10% of these are double detections because of overlapping adjacent pointings. These overlapping multiple detections are used to characterise the quality of the data. The images in the JHK(s) bands extend typically similar to 4 mag deeper than 2MASS. The magnitude limit and photometric quality depend strongly on crowding in the inner Galactic regions. The astrometry for K-s = 15-18 mag has rms similar to 35-175 mas. Conclusions. The VVV Survey data products offer a unique dataset to map the stellar populations in the Galactic bulge and the adjacent plane and provide an exciting new tool for the study of the structure, content, and star-formation history of our Galaxy, as well as for investigations of the newly discovered star clusters, star-forming regions in the disk, high proper motion stars, asteroids, planetary nebulae, and other interesting objects.

Sudden Cardiac Death in Brazil: Study Based on Physicians' Perceptions of the Public Health Care System

Background: There are no available statistical data about sudden cardiac death in Brazil. Therefore, this study has been conducted to evaluate the incidence of sudden cardiac death in our population and its implications. Methods: The research methodology was based on Thurstone's Law of Comparative Judgment, whose premise is that the more an A stimulus differs from a B stimulus, the greater will be the number of people who will perceive this difference. This technique allows an estimation of actual occurrences from subjective perceptions, when compared to official statistics. Data were collected through telephone interviews conducted with Primary and Secondary Care physicians of the Public Health Service in the Metropolitan Area of Sao Paulo (MASP). Results: In the period from October 19, 2009, to October 28, 2009, 196 interviews were conducted. The incidence of 21,270 cases of sudden cardiac death per year was estimated by linear regression analysis of the physicians responses and data from the Mortality Information System of the Brazilian Ministry of Health, with the following correlation and determination coefficients: r = 0.98 and r2= 0.95 (95% confidence interval 0.81.0, P < 0.05). The lack of waiting list for specialized care and socioadministrative problems were considered the main barriers to tertiary care access. Conclusions: The incidence of sudden cardiac death in the MASP is high, and it was estimated as being higher than all other causes of deaths; the extrapolation technique based on the physicians perceptions was validated; and the most important bureaucratic barriers to patient referral to tertiary care have been identified. (PACE 2012; 35:13261331)

INTERNAL AUDIT AND GROWTH OF PUBLIC INSTITUTIONS

The ONATRACOM was established by the law number 08/2007 of 03/02/2007 determining the responsibilities, organization and functioning of Rwanda Public Transport Authority with function of promoting public transportation between Rwanda and other countries; participating in the implementation of the public transportation policy of Ministry in charge of transportation; perform any other activity that is directly or indirectly related to its objectives; and establish relations and collaborate with other regional and international agencies with similar attributions. In the recent days many public institutions have been listed by general auditor for being mismanaged and are on the course of deficit. This study aimed at examining internal audit growth of public institutions, case study of ONATRACOM – Rwanda. This research was conducted as a case study using ONATRACOM in NYARUGENGE District. The study was built at four specific objectives which are to determine if internal audit lead to the business growth of ONATRACOM, to find out if achieving internal audit increases the net profit and sales of ONATRACOM, to explore if there is internal sources of funds for pursuing growth opportunities in ONATRACOM, to assess whether ONATRACOM is able to obtain external sources of funds for pursuing growth opportunities as a result of internal audit impact or not. The findings were got from 27 respondents as the sample from the total target population of 96. Questionnaire was used as the technique to obtain primary data, while secondary data were obtained through examining the existing literature about the study. Chapter four presents the finding in form of descriptive statistical tables starting with the profile of the respondent and findings in line with the research objectives, It was found out that ONATRACOM was failure in its services because it was not achieve its targeted objectives and in this company, the internal audit was not effective in order to make performance of that company.

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. ^

Food, nutrition and public health in contemporary Spain, 1900-1936

Within the context of the health reforms introduced in Spain in the early 20th century and the influence of international health organisations on their development, this article analyses the growing interest that surrounded nourishment and food-related problems at that time in relation to healthcare, the diagnosis provided by hygienists of such problems, and the public health measures applied to resolve them. The issue of hygienic diet and the collective aspect of nutritional problems became priorities in the field of healthcare. Two of the most prominent initiatives involved setting up a Department of Nutrition and Food Hygiene and Bromatological Technique during the early years of the Second Republic, as part of the National School of Health, as well as a Food Hygiene Service. Spanish hygienists underlined the importance of education and the dissemination of information about food hygiene, health and nutrition, in order to overcome the qualitative and quantitative deficiencies observed in the average diet of the Spanish population.

History of health, a valuable tool in public health

The aim of this article is to highlight the importance of the history of public health for public health research and practice itself. After summarily reviewing the current great vitality of the history of collective health oriented initiatives, we explain three particular features of the historical vantage point in public health, namely the importance of the context, the relevance of a diachronic attitude and the critical perspective. In order to illustrate those three topics, we bring up examples taken from three centuries of fight against malaria, the so called “re-emerging diseases” and the 1918 influenza epidemic. The historical approach enriches our critical perception of the social effects of initiatives undertaken in the name of public health, shows the shortcomings of public health interventions based on single factors and asks for a wider time scope in the assessment of current problems. The use of a historical perspective to examine the plurality of determinants in any particular health condition will help to solve the longlasting debate on the primacy of individual versus population factors, which has been particularly intense in recent times.

Looking twice at the gender equity index for public health impact

Background: It has been shown that gender equity has a positive impact on the everyday activities of people (decision making, income allocation, application and observance of norms/rules) which affect their health. Gender equity is also a crucial determinant of health inequalities at national level; thus, monitoring is important for surveillance of women’s and men’s health as well as for future health policy initiatives. The Gender Equity Index (GEI) was designed to show inequity solely towards women. Given that the value under scrutiny is equity, in this paper a modified version of the GEI is proposed, the MGEI, which highlights the inequities affecting both sexes. Methods: Rather than calculating gender gaps by means of a quotient of proportions, gaps in the MGEI are expressed in absolute terms (differences in proportions). The Spearman’s rank coefficient, calculated from country rankings obtained according to both indexes, was used to evaluate the level of concordance between both classifications. To compare the degree of sensitivity and obtain the inequity by the two methods, the variation coefficient of the GEI and MGEI values was calculated. Results: Country rankings according to GEI and MGEI values showed a high correlation (rank coef. = 0.95). The MGEI presented greater dispersion (43.8%) than the GEI (19.27%). Inequity towards men was identified in the education gap (rank coef. = 0.36) when using the MGEI. According to this method, many countries shared the same absolute value for education but with opposite signs, for example Azerbaijan (−0.022) and Belgium (0.022), reflecting inequity towards women and men, respectively. This also occurred in the empowerment gap with the technical and professional job component (Brunei:-0.120 vs. Australia, Canada Iceland and the U.S.A.: 0.120). Conclusion: The MGEI identifies and highlights the different areas of inequities between gender groups. It thus overcomes the shortcomings of the GEI related to the aim for which this latter was created, namely measuring gender equity, and is therefore of great use to policy makers who wish to understand and monitor the results of specific equity policies and to determine the length of time for which these policies should be maintained in order to correct long-standing structural discrimination against women.

Transitioning Towards a Development Permit System: Recommendations for the Ministry of Municipal Affairs and Housing

Since 2007, Ontario Regulation 608/06 now provides all municipalities with the authority to establish a development permit system (DPS); however, much of this regulatory power and its functions are largely misunderstood by both professionals and the general public, which has led to a lack of widespread municipal implementation. One main contributor to the uncertainty is the lack of academic literature. Currently, the most comprehensive document has been produced by the Ministry of Municipal Affairs and Housing (MMAH), Development Permit System: A Handbook for Municipal Implementation. The study’s key objective is to identify, analyze, and evaluate the MMAH Handbook in order to effectively provide an updated set of recommendations within the context of Ontario.

The USSR Foreign Ministry : senior officials.

"LDA 89-10851."

A double anniversary sermon of the thirty year's episcopate of Bishop Samuel David Ferguson, June 24, 1885-1915 : fifty years of his ministry, December 31, 1865-1915, preached in St. Mark's Church, June 27, 1915 /

Cover title.