Blaming the victim: Aspects of the Brazilian case

This report describes the consequences and some aspects of the origin and development of victim blaming in accident analysis, and some methods for investigating such events, with particular emphasis on the situation in Brazil. In Brazil, the spread of this practice seems to have been helped by several factors. (1) the idea that occupational accidents are simple phenomena with a limited number of causal factors linked to unsafe actions and/or conditions. In the past, the theory of accident proneness had less influence than in other countries. (2) Government regulations that stipulate the hiring of health and safety officers, production of educational material, and preventive campaigns that emphasize the role of the victim's faulty behavior in the origin of an accident. (3) Mandatory implementation of standardized models for accident investigation directed toward searching for a single cause. Usually one conclusion, expressed in terms of unsafe acts or conditions, is formulated so that whoever performs an unsafe act is responsible for the accident. (4) Lack of knowledge, as shown in Brazilian publications on occupational accidents and in the evolution of studies on the nature of accident phenomena and of strategies adopted for their prevention.

Brazilian health regions and scales: A geographical perspective

This paper offers a geographical perspective on the way in which health regions have been defined and established in São Paulo as part of overall Brazilian health policy. To accomplish this, I first situate the Brazilian case in the international debate over the regionalization of health services. Second, I examine health regionalization in the case of São Paulo and show how the process is dynamic and complex, involving geographical scales that go well beyond the administrative boundaries of Brazilian municipalities.

Gender differences in predictors of health status in patients with COPD

Objective: To evaluate the health status (HS) of COPD patients and to identify the main predictors of HS in these patients according to gender. Methods: The study included 90 COPD patients (60 males and 30 females; mean age = 64 +/- 9 years) with a wide range of airway obstruction disorders (mean FEV(1) = 56 +/- 19% of predicted). The men were individually matched to the women by % of predicted FEV(1) (ratio: 2:1). The patients were assessed regarding body composition; six-minute walk distance; perception of dyspnea using the Modified Medical Research Council Dyspnea Scale; Saint George's Respiratory Questionnaire (SGRQ); Charlson comorbidity index; and the multidimensional Body mass index, airway Obstruction, Dyspnea, and Exercise capacity (BODE) index. Multiple linear regression analysis was performed to identify the predictors of HS by gender. Results: Impairment of HS was greater among the women than among the men for SGRQ total score and for all SGRQ domains (total: 51 +/- 18% vs. 38 19%; p = 0.002; symptoms: 61 +/- 22% vs. 42 +/- 21%; p < 0.001; activity: 62 +/- 18% vs. 49 +/- 21%; p = 0.004; and impact: 41 +/- 19% vs. 27 +/- 18%; p = 0.001). The multiple linear regression showed that age and perception of dyspnea correlated with SGRQ total score for both genders (males, r(2) = 0.42; females, r(2) = 0.70; p < 0.05). Conclusions: Our results showed an association between gender and HS in COPD patients. Age and dyspnea are determinants of HS in both genders.

Fish Migration, Dams, and Loss of Ecosystem Services in the Mekong Basin

The past decade has seen increased international recognition of the importance of the services provided by natural ecosystems. It is unclear however whether such international awareness will lead to improved environmental management in many regions. We explore this issue by examining the specific case of fish migration and dams on the Mekong river. We determine that dams on the Mekong mainstem and major tributaries will have a major impact on the basin's fisheries and the people who depend upon them for food and income. We find no evidence that current moves towards dam construction will stop, and consider two scenarios for the future of the fisheries and other ecosystems of the basin. We conclude that major investment is required in innovative technology to reduce the loss of ecosystem services, and alternative livelihood strategies to cope with the losses that do occur.

Assessment of health-related quality of life in children with functional defecation disorders

Objective: To evaluate the health-related quality of life in children with functional defecation disorders. Methods: One hundred children seen consecutively were enrolled and subdivided into three subsets according to the Roma II classification criteria: functional constipation (n = 57), functional fecal retention (n = 29) and nonretentive functional soiling (n = 14). The generic instrument Child Health Questionnaire - Parent Form 50 (CHQ-PF50®), was used to measure quality of life and to assess the impact of these disorders from the point of view of parents. The instrument measures physical and psychosocial wellbeing in 15 health domains, each of which is graded on a scale from 0 to 100, with higher values indicating better health and greater wellbeing. Ten of these are then used to obtain two aggregated and summary scores: the physical and psychosocial scores. Results: No statistically significant differences were detected between subsets in terms of demographic or anthropometric characteristics. In 14 domains, children with defecation disorders scored lower than healthy children. When subsets were compared, statistically significant differences were detected between children with nonretentive functional soiling (lower scores) and those with functional constipation. Physical and psychosocial scores for the entire sample were lower than those for the group of healthy children used as controls. Conclusions: The CHQ-PF50® was considered adequate for demonstrating compromised quality of life in children with functional defecation disorders, as has been reported for other diseases, being a useful tool for making treatment decisions and for patient follow-up. Copyright © 2006 by Sociedade Brasileira de Pediatria.

Contribution of energy services to the Millennium Development Goals and to poverty alleviation in Latin America and the Caribbean: executive summary

Includes bibliography

Contribution of energy services to the millennium development goals and to poverty alleviation in Latin America and the Caribbean

Includes bibliography

Sumary of the presentation at the seminar on the regulation of public services: water and elctricity

Includes bibliography

The migration of health care workers in the Western Hemisphere: issues and impacts

Includes bibliography

Private participation in the provision of water services: alternative means for private participation in the provision of water services

Includes bibliography

Reform to health system financing in Chile

Includes bibliography

Production structure of the services sector in countries at different development levels

Includes bibliography