Cyanobacteria toxicity: potential public health impact in South Portugal populations

Cyanobacteria are prokaryotic, plantlike organisms present in lakes, recreational waters, and reservoirs, and often dominate phytoplankton communities in warm, nutrient-enriched hard waters. A stable water column rich in certain nutrients, especially nitrogen and phosphorus, is associated with favorable environmental conditions that support development of cyanobacterial population maxima or "blooms." Under specific conditions, cyanobacteria produce toxins that are responsible for acute poisoning and death of animals and humans. The main aim of this study was to correlate the presence of cyanobacteria blooms with potential toxicity to humans as a public health issue. In Portugal, seven reservoirs located in the southern region were selected and studied between 2000 and 2008. Reservoirs were characterized by physical and chemical aspects, and identification of phytoplankton communities. In the case of cyanobacterial blooms, toxins that affected the liver, nervous system, and skin were detected, namely, Microcystis aeruginosa, Aphanizomenon spp., and Oscillatoria. These findings suggest the presence of a potential risk for public health, and indicate the need to implement mitigation measures in all studied reservoirs. These measures may involve (1) water eutrophication control to avoid blooms, (2) appropriate treatment of water for human consumption, and (3) public warnings or information to those individuals that use these reservoirs for several recreational activities.

Social protection systems in vulnerable families: their importance for the public health

OBJECTIVE To analyze the effectiveness of the Chilean System of Childhood Welfare in transferring benefits to socially vulnerable families. METHODS A cross-sectional study with a sample of 132 families from the Metropolitan Region, Chile, stratified according to degree of social vulnerability, between September 2011 and January 2012. Semi-structured interviews were conducted with mothers of the studied families in public health facilities or their households. The variables studied were family structure, psychosocial risk in the family context and integrated benefits from the welfare system in families that fulfill the necessary requirements for transfer of benefits. Descriptive statistics to measure location and dispersion were calculated. A binary logistic regression, which accounts for the sample size of the study, was carried out. RESULTS The groups were homogenous regarding family size, the presence of biological father in the household, the number of relatives living in the same dwelling, income generation capacity and the rate of dependency and psychosocial risk (p ≥ 0.05). The transfer of benefits was low in all three groups of the sample (≤ 23.0%). The benefit with the best coverage in the system was the Single Family Subsidy, whose transfer was associated with the size of the family, the presence of relatives in the dwelling, the absence of the father in the household, a high rate of dependency and a high income generation capacity (p ≤ 0.10). CONCLUSIONS The effectiveness of benefit transfer was poor, especially in families that were extremely socially vulnerable. Further explanatory studies of benefit transfers to the vulnerable population, of differing intensity and duration, are required in order to reduce health disparities and inequalities.

Trends in public health policies addressing violence against women

OBJECTIVE To analyze the content of policies and action plans within the public healthcare system that addresses the issue of violence against women.METHODS A descriptive and comparative study was conducted on the health policies and plans in Catalonia and Costa Rica from 2005 to 2011. It uses a qualitative methodology with documentary analysis. It is classified by topics that describe and interpret the contents. We considered dimensions, such as principles, strategies, concepts concerning violence against women, health trends, and evaluations.RESULTS Thirteen public policy documents were analyzed. In both countries’ contexts, we have provided an overview of violence against women as a problem whose roots are in gender inequality. The strategies of gender policies that address violence against women are cultural exchange and institutional action within the public healthcare system. The actions of the healthcare sector are expanded into specific plans. The priorities and specificity of actions in healthcare plans were the distinguishing features between the two countries.CONCLUSIONS The common features of the healthcare plans in both the counties include violence against women, use of protocols, detection tasks, care and recovery for women, and professional self-care. Catalonia does not consider healthcare actions with aggressors. Costa Rica has a lower specificity in conceptualization and protocol patterns, as well as a lack of updates concerning health standards in Catalonia.

Healthcare-associated infections: challenges to public health in Brazil

This study presents a critical evaluation of the scientific literature related to this subject, aiming to assess the policies and administrative issues regarding the prevention and magnitude of healthcare-associated infections and discuss the challenges for their prevention in Brazil. The topics discussed included historical and administrative issues, challenges imposed by the characteristics of the healthcare system and the territorial dimension, laboratorial support limitations, costs, institutional culture, professional qualification, and patient engagement. It is urgent to hold a nationwide discussion among government representatives, institutions, and healthcare workers and users to overcome these challenges.

The patient safety journey in Portugal : challenges and opportunities from a public health perspective

ABSTRACT - Despite improvements in healthcare interventions, the incidence of adverse events and other patient safety problems constitutes a major contributor to the global burden of diseases and a concern for Public Health. In the last years there have been some successful individual and institutional efforts to approach patient safety issues in Portugal, unless such effort has been fragmented or focused on specific small areas. Long-term and global improvement has remained elusive, and most of all the improvement of patient safety in Portugal, must evaluate not only the efficacy of a change but also what was effective for implementing the change. Clearly, patient safety issues result from various combinations of individual, team, organization, system and patient factors. A systemic and integrated approach to promote patient safety must acknowledge and strive to understand the complexity of work systems and processes in health care, including the interactions between people, technology, and the environment. Safety errors cannot be productively attributed to a single human error. Our objective with this paper is to provide a brief overview of the status quo in patient safety in Portugal, highlighting key aspects that should be taken into account in the design of a strategy for improving patient safety. With these key aspects in mind, policy makers and implementers can move forward and make better decisions about which changes should be made and about the way the needed changes to improve patient safety should be implemented. The contribution of colleagues that are international leaders on healthcare quality and patient safety may also contribute to more innovative research methods needed to create the knowledge that promotes less costly successful changes.---- ---------------------- RESUMO – As questões relacionadas com a Segurança do Doente, e em particular, com a ocorrência de eventos adversos tem constituído, de há uns tempos a esta parte, uma crescente preocupação para as organizações de saúde, para os decisores políticos, para os profissionais de saúde e para os doentes/utentes e suas famílias, sendo por isso considerado um problema de Saúde Pública a que urge dar resposta. Em Portugal, nos últimos anos, têm sido desenvolvidos esforços baseados, maioritariamente, em iniciativas isoladas, para abordar os aspectos da Segurança do Doente. O facto de essas iniciativas não serem integradas numa estratégia explícita e de dimensão regional ou nacional, faz com que os resultados sejam parcelares e tenham visibilidade reduzida. Paralelamente, a melhoria da qualidade dos cuidados de saúde (a longo prazo) resultante dessas iniciativas tem sido esparsa e nem sempre a avaliação tem sido feita tendo em conta critérios de efectividade e de eficiência. A Segurança do Doente resulta da interacção de diversos factores relacionados, por um lado, com o doente e, por outro, com a prestação de cuidados que envolvem elementos de natureza individual (falhas activas) e organizacional/estrutural (falhas latentes). Devido à multifactorialidade que está na base de «problemas/falhas» na Segurança do Doente, qualquer abordagem a considerar deve ser sistémica e integrada. Simultaneamente, tais abordagens devem contemplar a compreensão da complexidade dos sistemas e dos processos de prestação de cuidados de saúde e as suas interdependências (envolvendo aspectos individuais, tecnológicos e ambientais). O presente trabalho tem por objectivo reflectir sobre o «estado da arte» da Segurança do Doente em Portugal, destacando os elementos-chave que se consideram decisivos para uma estratégia de acção nesse domínio. Com esses elementos os responsáveis pela governação da saúde poderão valorizar os aspectos que consideram decisivos para uma política de Segurança do Doente mais eficaz. A contribuição de quatro colegas internacionalmente reconhecidos como líderes na área da Qualidade em Saúde e da Segurança do Doente, constitui, por certo, uma oportunidade ímpar para a identificação e discussão de alguns dos principais desafios, ameaças e oportunidades que s

Human papillomavirus status and cervical abnormalities in women from public and private health care in Rio de Janeiro State, Brazil

This article reports the HPV status and cervical cytological abnormalities in patients attended at public and private gynecological services from Rio de Janeiro State. It also comments the performance of each HPV DNA tests used. A set of 454 women from private health clinics was tested by routine Capture Hybrid II HPV DNA assay. Among these, 58.4% presented HPV and nearly 90% of them were infected by high risk HPV types. However, this group presented few premalignant cervical lesions and no invasive cervical cancer was registered. We also studied 220 women from low income class attended at public health system. They were HPV tested by polymerase chain reaction using My09/11 primers followed by HPV typing with E6 specific primers. The overall HPV prevalence was 77.3%. They also showed a high percentage of high squamous intraepithelial lesion-HSIL (26.3%), and invasive cervical carcinoma (16.3%). HPV infection was found in 93.1% and 94.4% of them, respectively. The mean ages in both groups were 31.5 and 38 years, respectively. In series 1, HPV prevalence declined with age, data consistent with viral transient infection. In series 2, HPV prevalence did not decline, independent of age interval, supporting not only the idea of viral persistence into this group, but also regional epidemiological variations in the same geographic area. Significant cytological differences were seen between both groups. Normal and benign cases were the most prevalent cytological findings in series 1 while pre-malignant lesions were the most common diagnosis in the series 2. HPV prevalence in normal cases were statistically higher than those from series 1 (p < 0.001), indicating a higher exposure to HPV infection. Women from both samples were referred for previous abnormal cytology. However, socio-demographic evidence shows that women from series 1 have access to treatment more easily and faster than women from series 2 before the development of pre-malignant lesions. These data provides baseline support for the role of social inequalities linked to high risk HPV infection leading to cervical cancer. Broadly screening programs and the development of safe and effective vaccines against HPV would diminish the toll of this disease that affect mainly poor women.

Public Service Agreement 2010-2014 - Health Sector Action Plan 2012

This revised Action Plan is designed to support the delivery of the HSEâ?Ts 2012 National Service Plan by facilitating the fast-tracking of measures required to deliver essential health and personal social services across the country within the context of further reductions in funding and staff numbers. The implementation of the National Service Plan, approved by the Minister for Health on 13 January 2012, represents a major challenge to the health services and comes at a time of major reform of the public health system.   Click here to download PDF 161kb

Health Care Quality Indicators in the Irish Health System

  Public reporting of quality indicators promotes the principle of a transparent and accountable health care system that encourages a continuing focus on improving the quality of care it provides. This work brings us a step further in enhancing the quality and safety of our system. It is important that this report is not relied upon to draw conclusions on quality of care. That was not the purpose of the exercise. The data is mostly over five years old and was collected from the system before the improvements to collection and reporting of information that the hospitals were asked to put in place as part of the work to prepare this report. The Department of Health will produce a report of quality indicators based on data from 2011 to 2013 inclusive later in 2014 which will identify regions and hospitals. A governance process will shortly be established to oversee the selection and reporting of these indicators. This system will report at national and regional level and will be aligned with international systems so that international comparisons can be reported. The publication of this report is an important step in the development of this national reporting system. It shows that we can use a major IT system called HIPE which captures information on all hospital stays in all public hospitals to examine quality and safety of care. Health Care Quality Indicators in the Irish Health System

Joint Commissioning Plan of the Health and Social Care Board and the Public Health Agency: 2010-2011

Legislation enacted on 1 April 2009 created a new Commissioning system with the establishment of a region-wide Health and Social Care Board, including 5 Local Commissioning Groups (LCGs), and a Public Health Agency. In line with Departmental direction and guidance the objectives of the new commissioning arrangements were to: - Approach the future delivery of Health and Social Care from a region-wide perspective focused on outcomes. - Ensure local sensitivity through the creation of five Local Commissioning Groups reflective of their areas. - Give appropriate weight to the public health agenda to ensure that commissioning reflects the drive to reduce health inequalities in our society and works in partnership with others to improve health and wellbeing. In this regard the legislation signalled a new way forward which would first be expressed in a Commissioning Plan for 2010/11 and beyond. This plan outlines how the Health and Social Care Board and the Public Health Agency are approaching that task. It is our aim that this plan is straightforward and written in a manner which will encourage public engagement and understanding. We wish to show clearly how the commissioning task is to be approached and to signal the decisions necessary to ensure the maintenance of a health and social care system in Northern Ireland which responds to the population it serves.

Obesity - an acknowledged public health challenge

As we face a difficult economic climate, in which inequalities may worsen, the PHA faces many challenges in its efforts to improve the health of the population. One such challenge is the issue of obesity. Recently, in the Draft Programme for Government and, again today, in anticipation of the publication of the Consultation on the Review of Health and Social Care Services in Northern Ireland, the specific issue of obesity has been highlighted in the media.The PHA is committed to playing a lead role in tackling this major health issue and has been systematically examining the evidence of best practice and effectiveness to ensure that investment and working in partnership will bring clear benefits. A welcome consequence of any success would be a reduction in the impact of the physical, and emotional costs of obesity related ill-health to individuals - and the financial costs to an overstretched healthcare system.A multi-facetted approach to tackling obesity is required for Northern Ireland. This will mean working across government departments, looking at relevant legislation, taxation, food standards and labelling, as well as supporting a raft of programmes within education, workplace, and at the local community level."The prevalence of overweight and obesity has risen dramatically in recent years in Northern Ireland and is now the norm to be overweight, rather than the exception. The Northern Ireland Health and Social Wellbeing Survey (2010-11) indicated that 36% of adults are overweight and a further 23% are obese; this means that approximately 3 in 5 adults in Northern Ireland carry excess weight. A similar proportion of males and females were obese (23%) however males were more likely to be overweight (44%) than females (30%).Data from the Northern Ireland Health and Wellbeing Survey (2010-11) reported that 27% of children aged 2-15 years are obese or overweight. The findings presented here are based on the guidelines put forward by the International Obesity Task Force. Using this approach, 8% of children were assessed as obese, with similar results for boys (8%) and girls (9%). Obesity has serious implications for health and wellbeing and is associated with an increased risk of heart disease and stroke, type 2 diabetes, some cancers, respiratory problems and joint pain.Evidence indicates that being obese can reduce life expectancy by up to 9 years; and it can impact on emotional and psychological well-being and self-esteem, especially among young people.Obesity also impacts on wider society through economic costs, loss of productivity and increased demands on our health and social care system. It is estimated that obesity in Northern Ireland is resulting in 260,000 working days lost each year with a cost to the local economy of £500 million.The good news is that the intentional loss of significant weight (approx 10kg) in overweight and obese adults has been shown to confer significant health benefits, decreased morbidity and may also reduce obesity-related mortality.Key programmes and interventions are undertaken by the PHA in order to prevent and reduce overweight and obesity. The programmes/interventions are supported by significant ongoing work at local level. Examples include:the promotion of breastfeeding; local programmes to increase awareness of good nutrition and develop cooking skills, for example 'Cook It!'; promotion of more active lifestyles, for example, Walking for Health' and 'Teenage Kicks'; development of community allotment schemes; programmes for primary school children, for example Skip2bfit and Eat, Taste and Grow; and sports and other recreation, for example 'Active Belfast'. The PHA's multi media campaign 'It all adds up!' to encourage children to become more active and understand the importance of keeping fit, in a fun and exciting way, ran until October 2011. It encouraged parents and carers to go to the website www.getalifegetactive.com and download the PHA logbook It all adds up! to plan activities as a family. The logbook helped children and parents plan and keep track of their participation in physical activity at school, home and in the community. PHA is currently developing a public information campaign and other supportive work to increase public awareness of obesity as well as to provide advice and support for those who want to make real changes. The campaign development is well underway and is anticipated for launch in late Spring 2012. Like many common health problems, people living in disadvantaged circumstances suffer most and the PHA is committed to tackling this aspect of health inequality. The good news is that even a modest weight loss, of 1-1 Â_ stones, can help to reduce the risk of many of the health problems resulting from being overweight or obese. Information on losing weight through healthier eating and being more active can be found on the PHA websites - www.enjoyhealthyeating.info and www.getalifegetactive.com . These websites provide help and advice for anyone who wants to improve their eating habits and fitness levels, by making small, sustainable, healthy changes to their lifestyle. The PHA leaflet, Small changes, big benefits is also available to download from the PHA website, 'Publications' section.

A Study of a Staff Alcohol Policy in a Large Public Health Organisation, Looking at the Policy Content, the Policy Development and the Implementation Process, and the Policy Impact

There are different approaches to dealing with alcohol related problems in the workplace. A literature review indicates that two of the models that underpin programmes to deal with alcohol related problems in the workplace are the disease model and the health promotion model. The disease model considers alcoholism as an illness and uses curative techniques to restore the individual to sobriety. The health promotion model looks at the determinants of health and promotes changes in the environment and structures, which would support healthy behaviour in relation to alcohol. Employee Assistance Programmes (EAPs) may have elements of both theses models. Dealing with alcohol problems at work involves a captive audience and the workplace as a setting can be used to influence healthier lifestyles. A workplace alcohol policy is a mechanism through which alcohol related issues might be dealt with, and the necessary resources and commitment of managers and staff channelled to this end. The policy aims should be clear and unambiguous, and specific plans put in place for implementing all aspects of the policy. In the case of the alcohol policy in the organisation under study, the policy was underpinned by a health promotion ethos and the policy document reflects broad aims and objectives to support this. The steering group that oversaw the development of the policy had particular needs of their own which they brought to the development process. The common theme in their needs was how to identify and support employees with alcohol related problems within an equitable staff welfare system. The role of the supervisor was recognised as crucial and training was provided to introduce the skills needed for an early intervention and constructive confrontation with employees who had alcohol related problems. Opportunities provided by this policy initiative to deal with broader issues around alcohol and to consider the determinants of health in relation to alcohol were not fully utilised. The policy formalised the procedures for dealing with people who have alcohol related problems in an equitable and supportive manner. The wider aspect of the health promotion approach does not appear to have been a priority in the development and implementation of the policy.This resource was contributed by The National Documentation Centre on Drug Use.

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

Joint Commissioning Plan of the Health and Social Care Board and the Public Health Agency: 2010-2011

Legislation enacted on 1 April 2009 created a new Commissioning system with the establishment of a region-wide Health and Social Care Board, including 5 Local Commissioning Groups (LCGs), and a Public Health Agency. In line with Departmental direction and guidance the objectives of the new commissioning arrangementswere to:- Approach the future delivery of Health and Social Care from a region-wide perspective focused on outcomes.- Ensure local sensitivity through the creation of five Local Commissioning Groups reflective of their areas.