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.

Regional governance: strategies and disputes in health region management

OBJECTIVE To analyze the regional governance of the health systemin relation to management strategies and disputes.METHODOLOGICAL PROCEDURES A qualitative study with health managers from 19 municipalities in the health region of Bahia, Northeastern Brazil. Data were drawn from 17 semi-structured interviews of state, regional, and municipal health policymakers and managers; a focus group; observations of the regional interagency committee; and documents in 2012. The political-institutional and the organizational components were analyzed in the light of dialectical hermeneutics.RESULTS The regional interagency committee is the chief regional governance strategy/component and functions as a strategic tool for strengthening governance. It brings together a diversity of members responsible for decision making in the healthcare territories, who need to negotiate the allocation of funding and the distribution of facilities for common use in the region. The high turnover of health secretaries, their lack of autonomy from the local executive decisions, inadequate technical training to exercise their function, and the influence of party politics on decision making stand as obstacles to the regional interagency committee’s permeability to social demands. Funding is insufficient to enable the fulfillment of the officially integrated agreed-upon program or to boost public supply by the system, requiring that public managers procure services from the private market at values higher than the national health service price schedule (Brazilian Unified Health System Table). The study determined that “facilitators” under contract to health departments accelerated access to specialized (diagnostic, therapeutic and/or surgical) services in other municipalities by direct payment to physicians for procedure costs already covered by the Brazilian Unified Health System.CONCLUSIONS The characteristics identified a regionalized system with a conflictive pattern of governance and intermediate institutionalism. The regional interagency committee’s managerial routine needs to incorporate more democratic devices for connecting with educational institutions, devices that are more permeable to social demands relating to regional policy making.

On the use of the ZigBee protocol for wireless sensor networks

This project was developed within the ART-WiSe framework of the IPP-HURRAY group (http://www.hurray.isep.ipp.pt), at the Polytechnic Institute of Porto (http://www.ipp.pt). The ART-WiSe – Architecture for Real-Time communications in Wireless Sensor networks – framework (http://www.hurray.isep.ipp.pt/art-wise) aims at providing new communication architectures and mechanisms to improve the timing performance of Wireless Sensor Networks (WSNs). The architecture is based on a two-tiered protocol structure, relying on existing standard communication protocols, namely IEEE 802.15.4 (Physical and Data Link Layers) and ZigBee (Network and Application Layers) for Tier 1 and IEEE 802.11 for Tier 2, which serves as a high-speed backbone for Tier 1 without energy consumption restrictions. Within this trend, an application test-bed is being developed with the objectives of implementing, assessing and validating the ART-WiSe architecture. Particularly for the ZigBee protocol case; even though there is a strong commercial lobby from the ZigBee Alliance (http://www.zigbee.org), there is neither an open source available to the community for this moment nor publications on its adequateness for larger-scale WSN applications. This project aims at fulfilling these gaps by providing: a deep analysis of the ZigBee Specification, mainly addressing the Network Layer and particularly its routing mechanisms; an identification of the ambiguities and open issues existent in the ZigBee protocol standard; the proposal of solutions to the previously referred problems; an implementation of a subset of the ZigBee Network Layer, namely the association procedure and the tree routing on our technological platform (MICAz motes, TinyOS operating system and nesC programming language) and an experimental evaluation of that routing mechanism for WSNs.

Experimental Study And Evaluation Of Paper-Based Inkjet Electrodes For ECG Signal Acquisition

Applications involving biosignals, such as Electrocardiography (ECG), are becoming more pervasive with the extension towards non-intrusive scenarios helping targeting ambulatory healthcare monitoring, emotion assessment, among many others. In this study we introduce a new type of silver/silver chloride (Ag/AgCl) electrodes based on a paper substrate and produced using an inkjet printing technique. This type of electrodes can increase the potential applications of biosignal acquisition technologies for everyday life use, given that there are several advantages, such as cost reduction and easier recycling, resultant from the approach explored in our work. We performed a comparison study to assess the quality of this new electrode type, in which ECG data was collected with three types of Ag/AgCl electrodes: i) gelled; ii) dry iii) paper-based inkjet printed. We also compared the performance of each electrode when acquired using a professional-grade gold standard device, and a low cost platform. Experimental results showed that data acquired using our proposed inkjet printed electrode is highly correlated with data obtained through conventional electrodes. Moreover, the electrodes are robust to high-end and low-end data acquisition devices. Copyright © 2014 SCITEPRESS - Science and Technology Publications. All rights reserved.

Trends in the use of antidepressants among older adults: Bambuí Project

OBJECTIVE To analyze the trends and factors associated with the antidepressant use among older adults. METHODS This population-based study evaluated older adults in 1997 (n = 351, baseline) and the survivors at the 15th follow-up year (n = 462, in 2012) among the aging cohort of Bambuí. The prevalence of antidepressant use was estimated, and the most commonly used antidepressants each year were identified. Prevalence ratios with 95% confidence intervals were estimated using Poisson regression with robust variance to investigate differences in the prevalence of use between 1997 and 2012. RESULTS The overall consumption of antidepressants (PR = 2.87, 95%CI 1.94;4.25) and of selective serotonin reuptake inhibitors (PR = 7.50, 95%CI 3.74;15.02) was significantly higher in 2012. However, no significant difference was observed in the use of tricyclic antidepressants between the two cohorts (PR = 0.89, 95%CI 0.49;1.62). In the 2012 cohort, antidepressant use was associated with females, increased age, increased income (≥ 4 minimum wages), self-assessment of health as reasonable, and attending ≥ 5 medical consultations in the last 12 months. CONCLUSIONS The increased consumption of antidepressants in the period due to increased use of selective serotonin reuptake inhibitors was consistent with results observed in international studies of different population groups and contexts. The positive correlation observed between antidepressant use and family income may be a warning of possible inequalities in access to mental health services.

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.

Viability of the use of an A-SiC:H multiplayer device in a domestic VLC application

In this paper the viability of an integrated wavelength optical filter and photodetector for visible light communication (VLC) is discussed. The proposed application uses indoor warm light lamps lighting accomplished by ultra-bright light-emitting diodes (LEDs) pulsed at frequencies higher than the ones perceived by the human eye. The system was analyzed at two different wavelengths in the visible spectrum (430 nm and 626 nm) with variable optical intensities. The signals were transmitted into free space and measured using a multilayered photodetector based on a-SiC:H/a-Si:H. The detector works as an optical filter with controlled wavelength sensitivity through the use of optical bias. The output photocurrent was measured for different optical intensities of the transmitted optical signal and the extent of each signal was tested. The influence of environmental fluorescent lighting was also analysed in order to test the strength of the system. © 2014 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

Viability of the use of thin-film A-SiC:H photodiodes for protein identification

In this paper, we present a multilayer device based on a-Si:H/a-SiC:H that operates as photodetector and optical filter. The use of such device in protein detection applications is relevant in Fluorescence Resonance Energy Transfer (FRET) measurements. This method demands the detection of fluorescent signals located at specific wavelengths bands in the visible part of the electromagnetic spectrum. The device operates in the visible range with a selective sensitivity dependent on electrical and optical bias. Several nanosensors were tested with a commercial spectrophotometer to assess the performance of FRET signals using glucose solutions of different concentrations. The proposed device was used to demonstrate the possibility of FRET signals detection, using visible signals of similar wavelength and intensity. The device sensitivity was tuned to enhance the wavelength band of interest using steady state optical bias at 400 nm. Results show the ability of the device to detect signals in this range. © 2014 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

Access to continued-use medication among older adults, Brazil

OBJECTIVE To determine the prevalence and associated access factors for all continued-use prescription drugs and the ways in which they can be obtained.METHODS Data was obtained from the 2008 Household National Survey. The sample comprised 27,333 individuals above 60 years who reported that they used continued-use prescription drugs. A descriptive analysis and binary and multiple multinomial logistic regressions were performed.RESULTS 86.0% of the older adults had access to all the medication they needed, and among them, 50.7% purchased said medication. Those who obtained medication from the public health system were younger (60-64 years), did not have health insurance plans, and belonged to the lower income groups. It is remarkable that 14.0% of the subjects still had no access to any continued-use medication, and for those with more than four chronic diseases, this amount reached 22.0%. Those with a greater number of chronic diseases ran a higher risk of not having access to all the medication they needed.CONCLUSIONS There are some groups of older adults with an increased risk of not obtaining all the medication they need and of purchasing it. The results of this study are expected to contribute to guide programs and plans for access to medication in Brazil.

Performance management in primary healthcare services: evidence from a field study

Health services

On the use of particle swarm optimization to maximize bending stiffness of functionally graded structures

Functionally graded materials are a type of composite materials which are tailored to provide continuously varying properties, according to specific constituent's mixing distributions. These materials are known to provide superior thermal and mechanical performances when compared to the traditional laminated composites, because of this continuous properties variation characteristic, which enables among other advantages, smoother stresses distribution profiles. Therefore the growing trend on the use of these materials brings together the interest and the need for getting optimum configurations concerning to each specific application. In this work it is studied the use of particle swarm optimization technique for the maximization of a functionally graded sandwich beam bending stiffness. For this purpose, a set of case studies is analyzed, in order to enable to understand in a detailed way, how the different optimization parameters tuning can influence the whole process. It is also considered a re-initialization strategy, which is not a common approach in particle swarm optimization as far as it was possible to conclude from the published research works. As it will be shown, this strategy can provide good results and also present some advantages in some conditions. This work was developed and programmed on symbolic computation platform Maple 14. (C) 2013 Elsevier B.V. All rights reserved.

Institutional and matrix support and its relationship with primary healthcare

OBJECTIVE To analyze whether the level of institutional and matrix support is associated with better certification of primary healthcare teams.METHODS In this cross-sectional study, we evaluated two kinds of primary healthcare support – 14,489 teams received institutional support and 14,306 teams received matrix support. Logistic regression models were applied. In the institutional support model, the independent variable was “level of support” (as calculated by the sum of supporting activities for both modalities). In the matrix support model, in turn, the independent variables were the supporting activities. The multivariate analysis has considered variables with p < 0.20. The model was adjusted by the Hosmer-Lemeshow test.RESULTS The teams had institutional and matrix supporting activities (84.0% and 85.0%), respectively, with 55.0% of them performing between six and eight activities. For the institutional support, we have observed 1.96 and 3.77 chances for teams who had medium and high levels of support to have very good or good certification, respectively. For the matrix support, the chances of their having very good or good certification were 1.79 and 3.29, respectively. Regarding to the association between institutional support activities and the certification, the very good or good certification was positively associated with self-assessment (OR = 1.95), permanent education (OR = 1.43), shared evaluation (OR = 1.40), and supervision and evaluation of indicators (OR = 1.37). In regards to the matrix support, the very good or good certification was positively associated with permanent education (OR = 1.50), interventions in the territory (OR = 1.30), and discussion in the work processes (OR = 1.23).CONCLUSIONS In Brazil, supporting activities are being incorporated in primary healthcare, and there is an association between the level of support, both matrix and institutional, and the certification result.

Occupational conditions and the risk of the use of amphetamines by truck drivers

OBJECTIVE To test whether the occupational conditions of professional truck drivers are associated with amphetamine use after demographic characteristics and ones regarding mental health and drug use are controlled for.METHODS Cross-sectional study, with a non-probabilistic sample of 684 male truck drivers, which was collected in three highways in Sao Paulo between years 2012 and 2013. Demographic and occupational information was collected, as well as data on drug use and mental health (sleep quality, emotional stress, and psychiatric disorders). A logistic regression model was developed to identify factors associated with amphetamine use. Odds ratio (OR; 95%CI) was defined as the measure for association. The significance level was established as p < 0.05.RESULTS The studied sample was found to have an average age of 36.7 (SD = 7.8) years, as well as low education (8.6 [SD = 2.3] years); 29.0% of drivers reported having used amphetamines within the twelve months prior to their interviews. After demographic and occupational variables had been controlled for, the factors which indicated amphetamine use among truck drivers were the following: being younger than 38 years (OR = 3.69), having spent less than nine years at school (OR = 1.76), being autonomous (OR = 1.65), working night shifts or irregular schedules (OR = 2.05), working over 12 hours daily (OR = 2.14), and drinking alcohol (OR = 1.74).CONCLUSIONS Occupational aspects are closely related to amphetamine use among truck drivers, which reinforces the importance of closely following the application of law (Resting Act (“Lei do Descanso”); Law 12,619/2012) which regulates the workload and hours of those professionals. Our results show the need for increased strictness on the trade and prescription of amphetamines in Brazil.

Factors associated with dietary supplement use by people who exercise at gyms

OBJECTIVE To assess the factors associated with the use of dietary supplements by people who exercise at gyms.METHODS A cross-sectional study with a sample defined by convenience, considering the number of gyms registered in the Conselho Regional de Educação Física (Regional Council of Physical Education) of Sao Luis, MA, Northeastern Brazil, from July 2011 to July 2012. The final sample comprised 723 individuals who exercise at gyms. The dependent variable was supplement use, and the explanatory variables were length of time and motivation of the physical exercises, duration, goal and self-perception of training, weekly frequency of gym attendance, sex, age, educational attainment, self-perception of body weight, smoking and self-perception of diet. The association between variables was analysed by hierarchical Poisson regression based on a theoretical model.RESULTS Supplement use was reported by 64.7% of the participants. Most of the sample was male (52.6%). The most frequent age group was 20 to 39 years (74.4%). Most participants (46.1%) had been exercising for over a year. The following variables were associated with supplement use: self-perceiving body weight as below ideal (p < 0.001), smoking (p < 0.001), exercising for 7 to 12 months (p = 0.028) or more than one year (p < 0.001), spending more than two hours at the gym (p = 0.051), and perceiving training as moderate (p = 0.024) or intense (p = 0.001).CONCLUSIONS The use of supplements lacks proper professional guidance, being motivated by individuals unsatisfied with their low body weight and who perceive their workout as intense, which raises the need for monitoring this population.

Trends in alcohol and tobacco use among Brazilian students: 1989 to 2010

OBJECTIVE To analyze temporal trends of the prevalence of alcohol and tobacco use among Brazilian students. METHODS We analyzed data published between 1989 and 2010 from five epidemiological surveys on students from the 6th to the 12th grade of public schools from the ten largest state capitals of Brazil. The total sample consisted of 104,104 students and data were collected in classrooms. The same collection tool – a World Health Organization self-reporting questionnaire – and sampling and weighting procedures were used in the five surveys. The Chi-square test for trend was used to compare the prevalence from different years. RESULTS The prevalence of alcohol and tobacco use varied among the years and cities studied. Alcohol consumption decreased in the 10 state capitals (p < 0.001) throughout 21 years. Tobacco use also decreased significantly in eight cities (p < 0.001). The highest prevalence of alcohol use was found in the Southeast region in 1993 (72.8%, in Belo Horizonte) and the lowest one in Belem (30.6%) in 2010. The highest past-year prevalence of tobacco use was found in the South region in 1997 (28.0%, in Curitiba) and the lowest one in the Southeast in 2010 (7.8%, in Sao Paulo). CONCLUSIONS The decreasing trend in the prevalence of tobacco and alcohol use among students detected all over the Country can be related to the successful and comprehensive Brazilian antitobacco and antialcohol policies. Despite these results, the past-year prevalence of alcohol consumption in the past year remained high in all Brazilian regions.