e-Health policies, programmes and projects in Mexico

Includes bibliography

Shipping suply and demand, biennium 2008 - 2009

This edition of the FAL Bulletin analyses the performance of the shipping industry during the biennium 2008-2009 in its three main markets: containers, dry-bulk cargoes and liquid bulk (oil and its derivatives).

Maritime Cabotage Services: Prospects and Challenges

This edition of the FAL Bulletin is based on the document entitled 'Serie de la CEPAL, RNI, 32: Transporte marítimo regional y de cabotaje en América Latina y el Caribe: el caso de Chile', which is available on the Internet at www.eclac.cl/transporte/perfil/cap3tranmar.asp. Information is also included on other subregions based on studies that are currently being prepared.

Changes in maritime transport supply and demand

This FAL bulletin reviews changes in water transport supply and demand in three markets: containers, dry bulk and liquid cargo (dirty and clean) over the past several years.

A influência da demanda espontânia na (des)caracterização do processo de trabalho na estratégia saúde da família

Pós-graduação em Enfermagem (mestrado profissional) - FMB

Psychometric Properties of the Oral Health Impact Profile and New Methodological Approach

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Health professionals ethical and legal liability on patient’s inadequate clarification in order to obtain free and informed consent

It is required that patients are provided information about therapeutic possibilities, showing the risks, benefits, prognosis and costs of each possible and indicated alternative. This is an ethical and legal resolution. However, health professionals possess the clinical/technical/scientific knowledge and determine what information will be (or not) provided. The patient in question decides to undergo a treatment, providing his/her free and informed consent on the basis of the data presented. Unfortunately, some professionals may not provide all the information necessary for making an informed decision or, after obtaining the consent of the patient, may provide him information that causes the patient to give up on the treatment initially accepted. Such information, if relevant, and not a supervening fact, should have been provided initially. However, the information may not be entirely true, and bring the patient, for instance, to decide based on inadequately presented risks. The craniofacial rehabilitation of the temporomandibular joint (TMJ) by means of TMJ prosthesis, is indicated in many situations. Often, patients in need of such prostheses have aesthetic and functional problems and the rehabilitation expectations run high. This work presents a case and discusses ethical and legal issues, including the liability of partial and inadequate information to a patient.

United Way and University partnerships in community-wide human services planning and plan implementation: The case of Lincoln/Lancaster County, Nebraska.

Given the similar interests of United Way organizations and universities in planning, implementation, and evaluation of human services, the two social institutions could be extensively and effectively partnering with one another. However, there is little documentation that such cooperative efforts are taking place. This article describes one such collaboration in Lincoln, Nebraska. The purpose of the article is to show the potential of such collaboration to improve community-wide coordination and outcomes by following the principles of a community-engagement model, to generate more effective use of evaluative tools that can assist in developing evidence-based practices in community planning, and to connect areas of study within the university to United Way efforts.

Implementing Human Papillomavirus Testing in a Public Health Hospital: Challenges and Opportunities

Objectives: Robust evidence now supports human papillomavirus (HPV) testing as a more effective option to screening and as more sensitive than cytology in detecting high-grade cervical intraepithelial neoplasia. Our goal was to analyze the performance of the Hybrid Capture II (HC2) assay for high-risk HPV (hrHPV) in women undergoing gynecological examination at a public health hospital as part of the evaluation of HPV screening as an alternative or complement to cytology. Study Design: This analysis is a subset of a cross-sectional study carried out at a large public hospital serving a predominantly low-resource population. A total of 705 women were enrolled; the sensitivity and specificity of each test were estimated and compared. Results: The analysis identified 272 hrHPV-positive women (mean age 36.3 years) and 433 hrHPV-negative women (mean age 41.2 years). HPV testing showed a significantly increased sensitivity of the HC2 assay versus cytology (84.5 vs. 69.7%; p < 0.0001) but a lower specificity (49.90 vs. 88.78%; p < 0.0001). Conclusion: The combination of both methods seems to be useful in improving detection of cervical lesions. Copyright (C) 2012 S. Karger AG, Basel

Saúde bucal e uso dos serviços odontológicos em função do Índice de Necessidades em Saúde: São Paulo, 2008

A Secretaria Municipal de Saúde de São Paulo desenvolveu o Índice de Necessidades em Saúde (INS) para identificar áreas prioritárias para a oferta de serviços. Em 2008 realizou um Levantamento das Condições de Saúde Bucal. Pretende-se, neste estudo ecológico, analisar o perfil de saúde bucal em relação ao INS. As variáveis, estratificadas para as idades de 5, 12 e 15 anos, foram: porcentagem de indivíduos com dificuldade no acesso ao serviço odontológico; média do ceod e CPOD; prevalência da necessidade de extração e de livres de cárie. As informações foram analisadas para as 25 Supervisões Técnicas de Saúde (STS). Empregou-se o teste estatístico de covariância, o coeficiente de correlação de Pearson e o modelo de regressão linear. Observou-se uma correlação positiva entre maiores INS e a dificuldade de acesso aos serviços. Nas STS com maiores INS houve maior experiência de cárie, maior necessidade de exodontias e menor prevalência de livres de cárie. Reforça-se a necessidade de priorizar as áreas de privação social para melhorar a condição de saúde da população.

The Integrated European Project "GEHA - GEnetics of Healthy Aging": recruitment, health status assessment and survival of the Italian 90+ sibpairs

The present study is part of the EU Integrated Project “GEHA – Genetics of Healthy Aging” (Franceschi C et al., Ann N Y Acad Sci. 1100: 21-45, 2007), whose aim is to identify genes involved in healthy aging and longevity, which allow individuals to survive to advanced age in good cognitive and physical function and in the absence of major age-related diseases. Aims The major aims of this thesis were the following: 1. to outline the recruitment procedure of 90+ Italian siblings performed by the recruiting units of the University of Bologna (UNIBO) and Rome (ISS). The procedures related to the following items necessary to perform the study were described and commented: identification of the eligible area for recruitment, demographic aspects related to the need of getting census lists of 90+siblings, mail and phone contact with 90+ subjects and their families, bioethics aspects of the whole procedure, standardization of the recruitment methodology and set-up of a detailed flow chart to be followed by the European recruitment centres (obtainment of the informed consent form, anonimization of data by using a special code, how to perform the interview, how to collect the blood, how to enter data in the GEHA Phenotypic Data Base hosted at Odense). 2. to provide an overview of the phenotypic characteristics of 90+ Italian siblings recruited by the recruiting units of the University of Bologna (UNIBO) and Rome (ISS). The following items were addressed: socio-demographic characteristics, health status, cognitive assessment, physical conditions (handgrip strength test, chair-stand test, physical ability including ADL, vision and hearing ability, movement ability and doing light housework), life-style information (smoking and drinking habits) and subjective well-being (attitude towards life). Moreover, haematological parameters collected in the 90+ sibpairs as optional parameters by the Bologna and Rome recruiting units were used for a more comprehensive evaluation of the results obtained using the above mentioned phenotypic characteristics reported in the GEHA questionnaire. 3. to assess 90+ Italian siblings as far as their health/functional status is concerned on the basis of three classification methods proposed in previous studies on centenarians, which are based on: • actual functional capabilities (ADL, SMMSE, visual and hearing abilities) (Gondo et al., J Gerontol. 61A (3): 305-310, 2006); • actual functional capabilities and morbidity (ADL, ability to walk, SMMSE, presence of cancer, ictus, renal failure, anaemia, and liver diseases) (Franceschi et al., Aging Clin Exp Res, 12:77-84, 2000); • retrospectively collected data about past history of morbidity and age of disease onset (hypertension, heart disease, diabetes, stroke, cancer, osteopororis, neurological diseases, chronic obstructive pulmonary disease and ocular diseases) (Evert et al., J Gerontol A Biol Sci Med Sci. 58A (3): 232-237, 2003). Firstly these available models to define the health status of long-living subjects were applied to the sample and, since the classifications by Gondo and Franceschi are both based on the present functional status, they were compared in order to better recognize the healthy aging phenotype and to identify the best group of 90+ subjects out of the entire studied population. 4. to investigate the concordance of health and functional status among 90+ siblings in order to divide sibpairs in three categories: the best (both sibs are in good shape), the worst (both sibs are in bad shape) and an intermediate group (one sib is in good shape and the other is in bad shape). Moreover, the evaluation wanted to discover which variables are concordant among siblings; thus, concordant variables could be considered as familiar variables (determined by the environment or by genetics). 5. to perform a survival analysis by using mortality data at 1st January 2009 from the follow-up as the main outcome and selected functional and clinical parameters as explanatory variables. Methods A total of 765 90+ Italian subjects recruited by UNIBO (549 90+ siblings, belonging to 258 families) and ISS (216 90+ siblings, belonging to 106 families) recruiting units are included in the analysis. Each subject was interviewed according to a standardized questionnaire, comprising extensively utilized questions that have been validated in previous European studies on elderly subjects and covering demographic information, life style, living conditions, cognitive status (SMMSE), mood, health status and anthropometric measurements. Moreover, subjects were asked to perform some physical tests (Hand Grip Strength test and Chair Standing test) and a sample of about 24 mL of blood was collected and then processed according to a common protocol for the preparation and storage of DNA aliquots. Results From the analysis the main findings are the following: - a standardized protocol to assess cognitive status, physical performances and health status of European nonagenarian subjects was set up, in respect to ethical requirements, and it is available as a reference for other studies in this field; - GEHA families are enriched in long-living members and extreme survival, and represent an appropriate model for the identification of genes involved in healthy aging and longevity; - two simplified sets of criteria to classify 90+ sibling according to their health status were proposed, as operational tools for distinguishing healthy from non healthy subjects; - cognitive and functional parameters have a major role in categorizing 90+ siblings for the health status; - parameters such as education and good physical abilities (500 metres walking ability, going up and down the stairs ability, high scores at hand grip and chair stand tests) are associated with a good health status (defined as “cognitive unimpairment and absence of disability”); - male nonagenarians show a more homogeneous phenotype than females, and, though far fewer in number, tend to be healthier than females; - in males the good health status is not protective for survival, confirming the male-female health survival paradox; - survival after age 90 was dependent mainly on intact cognitive status and absence of functional disabilities; - haemoglobin and creatinine levels are both associated with longevity; - the most concordant items among 90+ siblings are related to the functional status, indicating that they contain a familiar component. It is still to be investigated at what level this familiar component is determined by genetics or by environment or by the interaction between genetics, environment and chance (and at what level). Conclusions In conclusion, we could state that this study, in accordance with the main objectives of the whole GEHA project, represents one of the first attempt to identify the biological and non biological determinants of successful/unsuccessful aging and longevity. Here, the analysis was performed on 90+ siblings recruited in Northern and Central Italy and it could be used as a reference for others studies in this field on Italian population. Moreover, it contributed to the definition of “successful” and “unsuccessful” aging and categorising a very large cohort of our most elderly subjects into “successful” and “unsuccessful” groups provided an unrivalled opportunity to detect some of the basic genetic/molecular mechanisms which underpin good health as opposed to chronic disability. Discoveries in the topic of the biological determinants of healthy aging represent a real possibility to identify new markers to be utilized for the identification of subgroups of old European citizens having a higher risk to develop age-related diseases and disabilities and to direct major preventive medicine strategies for the new epidemic of chronic disease in the 21st century.

Automated Analysis Methods for the Assessment of Bicycle Infrastructure and Demand

A first phase of the research activity has been related to the study of the state of art of the infrastructures for cycling, bicycle use and methods for evaluation. In this part, the candidate has studied the "bicycle system" in countries with high bicycle use and in particular in the Netherlands. Has been carried out an evaluation of the questionnaires of the survey conducted within the European project BICY on mobility in general in 13 cities of the participating countries. The questionnaire was designed, tested and implemented, and was later validated by a test in Bologna. The results were corrected with information on demographic situation and compared with official data. The cycling infrastructure analysis was conducted on the basis of information from the OpenStreetMap database. The activity consisted in programming algorithms in Python that allow to extract data from the database infrastructure for a region, to sort and filter cycling infrastructure calculating some attributes, such as the length of the arcs paths. The results obtained were compared with official data where available. The structure of the thesis is as follows: 1. Introduction: description of the state of cycling in several advanced countries, description of methods of analysis and their importance to implement appropriate policies for cycling. Supply and demand of bicycle infrastructures. 2. Survey on mobility: it gives details of the investigation developed and the method of evaluation. The results obtained are presented and compared with official data. 3. Analysis cycling infrastructure based on information from the database of OpenStreetMap: describes the methods and algorithms developed during the PhD. The results obtained by the algorithms are compared with official data. 4. Discussion: The above results are discussed and compared. In particular the cycle demand is compared with the length of cycle networks within a city. 5. Conclusions

Using human rights for sexual and reproductive health: improving legal and regulatory frameworks

This paper describes the development of a tool that uses human rights concepts and methods to improve relevant laws, regulations and policies related to sexual and reproductive health. This tool aims to improve awareness and understanding of States' human rights obligations. It includes a method for systematically examining the status of vulnerable groups, involving non-health sectors, fostering a genuine process of civil society participation and developing recommendations to address regulatory and policy barriers to sexual and reproductive health with a clear assignment of responsibility. Strong leadership from the ministry of health, with support from the World Health Organization or other international partners, and the serious engagement of all involved in this process can strengthen the links between human rights and sexual and reproductive health, and contribute to national achievement of the highest attainable standard of health.

The co-evolution of development needs and IOR forms: development by committee in Bosnia

This work highlights opportunities and obstacles to success in four task forces typically found at different times in states of conflict, transition, and development. They include: refugee return, media issues, privatization of state-owned enterprises, and efforts to promote business development. Based on over 180 in-depth interviews and observations of dozens of meetings during five lengthy field research trips to the Bosnian region between 1999 and 2005, this manuscript analyzes how these four task forces differed in terms of context, strategy, organization, and management in an attempt to understand the co-evolution of international development needs and the interorganizational forms that address them.