Public policy and the prevention of substance-use disorders

Drug prevention has traditionally focused on influencing individual attitudes and behaviours. In particular, efforts have been directed towards adolescents in the school setting. However, evaluations of school-based drug education have identified limited success. There is increasing recognition that drug abuse is one of a number of risk behaviours, including truancy, delinquency and mental health problems, which share common antecedents that begin in the early years of childhood. Furthermore, these behaviours are shaped by macroenvironmental influences including the economic, social, cultural, and physical environment. Drug prevention needs to adopt a broader perspective: with greater collaboration in related programmes such as crime prevention and suicide prevention; with greater attention to the macroenvironmental influences on problem behaviours; and with greater attention to healthy development in the first years of childhood. (C) 2002 Lippincott Williams Wilkins.

Fondaparinux verses enoxaparin for the prevention of venous thromboembelism

Venous thromboembolism is a frequent, life-threatening, postoperative complication of hip-fracture and total-knee-replacement surgery. Fondaparinux is a synthetic polysaccharide that selectively binds to antithrombin, the primary endogenous regulator of blood coagulation. Low molecular weight heparins, such as enoxaparin, are less specific inhibitors of coagulation. In patients undergoing hip-fracture surgery, fondaparinux is more effective than once-daily enoxaparin as prophylaxis for venous thromboembolism. Fondaparinux (25 mg/day s.c.) was also more effective than enoxaparin (30 mg s.c. b.i.d.) as prophylaxis for venous thromboembolism in elective knee surgery. These differences may be explained by the fact that there is less prophylaxis cover with enoxaparin, as it has a much shorter duration of action than fondaparinux. Thus, with the present dosing regimens, fondaparinux is probably preferable to enoxaparin for the prevention of venous thromboembolism.

Economic Analysis of Occupational Risk Prevention in the Construction Sector

The construction sector has one of the worst occupational safety and health records in Europe. The costs of this scenario are very high, namely costs for workers and their families, costs to organizations, resulting from the absence of workers due to illness, insurance premiums, costs resulting from reduced productivity, cost of replacement and training of workers, etc., and costs to society, which in turn increases the costs of health systems. This paper presents and discusses the development of a methodology for economic evaluation in the context of risk management, which will allow senior management to support decision making. The possible application of this methodology to the construction sector is discussed.

Economic analysis of occupational risk prevention: a case study in a textile company

Work accidents affect business and society as a whole. Fewer accidents mean fewer sick leaves, which results in lower costs and less disruption in the production process, with clear advantages for the employer. But workers and their households bear also a significant burden following a work accident, only partially compen-sated by insurance systems. Furthermore, the consequences of work accidents to the State and Society need also to be considered. When an organization performs an integrated risk analysis in evaluating its Occupational Health and Safety Management System, several steps are suggested to address the identified risk situations. Namely, to avoid risks, a series of preventive measures are identified. The organization should make a detailed analysis of the monetary impact (positive or negative) for the organization of each of the measures considered. Particularly, it is also important to consider the impact of each measure on society, involving an adequate eco-nomic cost-benefit analysis. In the present paper, a case study in a textile finishing company is presented. The study concentrates on the dyeing and printing sections. For each of the potential risks, several preventive measures have been identified and the corresponding costs and benefits have been estimated. Subsequently, the Benefit/Cost ratio (B/C) of these measures has been calculated, both in financial terms (from the organisa-tion���s perspective) and in economic terms (including the benefits for the worker and for the Society). Results show that, while the financial analysis in terms of the company does not justify the preventive measures, when the externalities are taken into account, the B/C ratio increases significantly and investments are fully justified.

Financial and economic analysis of prevention of needlesticks in the hospital sector

This paper discusses the financial and economic analysis of prevention of needlestick accidents related to Occupational Health and Safety projects and presents the application to a case study involving a Hospital.

Viol��ncia, escola e territ��rio: interven����o educativa em contextos urbanos complexos

Na presente comunica����o apresentamos parte dos resultados de um estudo de caso desenvolvido pelos autores no ��mbito do Observat��rio de Seguran��a Escolar (OSE). A investiga����o a que nos propusemos resulta do desenvolvimento e aprofundamento de estudos que a equipa do OSE tem vindo a realizar nos ��ltimos 6 anos (Sebasti��o, Campos, Alves e Merlini: 2010; Sebasti��o, Campos e Merlini: 2011) e justifica-se pela necessidade de an��lises contextualizadas da problem��tica de viol��ncia na escola, no sentido de contribuir para futuras estrat��gias e mecanismos de interven����o e preven����o sobre esta forma de viol��ncia. Tendo como ponto de partida os dados estat��sticos nacionais sobre os incidentes de viol��ncia nas escolas1, procur��mos compreender como os tra��os identificados a n��vel nacional se traduzem e s��o reconfigurados territorialmente. Em particular, saber porque �� que escolas situadas em territ��rios com condi����es sociais id��nticas apresentam n��veis de viol��ncia e abordagens de regula����o diferenciadas. Partindo de uma abordagem meso anal��tica do fen��meno de viol��ncia na escola, que engloba as perspetivas organizacional (Burns e Flam: 2000; Mouzelis: 2000; Torres e Palhares: 2010; Lima: 2001) e ecol��gica (Fuchs: 2008; Machado: 2008; Carvalho, 2010; Leal: 2010), o estudo privilegiou uma estrat��gia metodol��gica intensiva e desenvolveu-se em tr��s territ��rios do Concelho de Sintra. Nesta apresenta����o o foco anal��tico incide sobre as estrat��gias e mecanismos acionados pelas escolas nos processos de regula����o (preven����o e interven����o) das ocorr��ncias de viol��ncia na escola, considerando a diversidade de condi����es contextuais e organizacionais. Ou seja, analisamos o modo como as escolas respondem aos incidentes e procuram pacificar os seus quotidianos e as condi����es em que o fazem. Tendo em conta as possibilidades de a����o encontradas, identific��mos um conjunto de fatores significativos nos processos de regula����o da viol��ncia, entre os quais destacamos: as lideran��as e pr��ticas organizacionais; as orienta����es para a interven����o e a import��ncia da prioriza����o da viol��ncia e os instrumentos para intervir, como a constitui����o de gabinetes de media����o de conflitos. Face ��s condi����es para agir, verific��mos que as escolas demonstram ter margem para adequar, planear e implementar estrat��gias de resposta, adotando modalidades de resolu����o da conflitualidade/viol��ncia, diversificadas, independentemente desta ter origem, ou n��o, em condi����es externas �� escola.

Processos de regula����o da viol��ncia escolar: das pol��ticas ��s pr��ticas

Esta comunica����o tem como objetivo analisar como as pol��ticas respeitantes �� seguran��a escolar s��o reinterpretadas e reorientadas em resultado das estrat��gias e filosofias de interven����o das dire����es das escolas e outros agentes educativos. Tendo como premissa que o contexto social n��o determina linearmente a viol��ncia escolar, o estudo centrou-��se na an��lise das rela����es entre o contexto social local e organizacional das escolas, procurando identificar os factores relevantes para o processo de regula����o da viol��ncia. Foram selecionados tr��s clusters de escolas na ��rea Metropolitana de Lisboa, tendo em conta contrastes intra e inter clusters assim como a sua posi����o relativa face aos n��veis de viol��ncia registadas a n��vel nacional. Foi identificada uma diversidade significativa de respostas �� viol��ncia, concretizadas na mobiliza����o de diferentes recursos pelos respons��veis das escolas com o duplo objetivo de atingir as metas pol��ticas definidas e os seus pr��prios interesses estrat��gicos. Esta apropria����o e reorienta����o das pol��ticas realiza-��se atrav��s da estrutura����o de redes locais de poder, hierarquizando compet��ncias e responsabilidades, e no processo, redefinindo os objetivos do processo de preven����o e interven����o. A oculta����o das situa����es de viol��ncia, o recrutamento preferencial de estudantes de classe m��dia ou com sucesso educativo elevado, ou ainda as san����es desproporcionais para alunos agressores ou indisciplinados, foram algumas das estrat��gias identificadas. Isto mostra que os atores t��m diferentes possibilidades e capacidades de a����o num sistema complexo de regras sociais que, dentro de certos limites, lhes permite reinterpretar e reconstruir regras e, em ��ltima inst��ncia, contribuir para a altera����o do pr��prio sistema (Mouzelis, 2000;�� Burns e Flam, 2000;�� Lipsky, 1980).

Missed opportunities for congenital syphilis and HIV perinatal transmission prevention

OBJECTIVE: To estimate the prevalence of missed opportunities for congenital syphilis and HIV prevention in pregnant women who had access to prenatal care and to assess factors associated to non-testing of these infections. METHODS: Cross-sectional study comprising a randomly selected sample of 2,145 puerperal women who were admitted in maternity hospitals for delivery or curettage and had attended at least one prenatal care visit, in Brazil between 1999 and 2000. No syphilis and/or anti-HIV testing during pregnancy was a marker for missed prevention opportunity. Women who were not tested for either or both were compared to those who had at least one syphilis and one anti-HIV testing performed during pregnancy (reference category). The prevalence of missed prevention opportunity was estimated for each category with 95% confidence intervals. Factors independently associated with missed prevention opportunity were assessed through multinomial logistic regression. RESULTS: The prevalence of missed prevention opportunity for syphilis or anti-HIV was 41.2% and 56.0%, respectively. The multivariate analysis showed that race/skin color (non-white), schooling (<8 years), marital status (single), income (<3 monthly minimum wages), having sex during pregnancy, history of syphilis prior to the current pregnancy, number of prenatal care visits (<6), and last prenatal visit before the third trimester of gestation were associated with an increased risk of missed prevention opportunity. A negative association with missed prevention opportunity was found between marital status (single), prenatal care site (hospital) and first prenatal visit in the third trimester of gestation. CONCLUSIONS: High rates of non-tested women indicate failures in preventive and control actions for HIV infection and congenital syphilis. Pregnant women have been discontinuing prenatal care at an early stage and are failing to undergo prenatal screening for HIV and syphilis.

HIV rapid testing as a key strategy for prevention of mother-to-child transmission in Brazil

OBJECTIVE: To assess the feasibility of HIV rapid testing for pregnant women at maternity hospital admission and of subsequent interventions to reduce perinatal HIV transmission. METHODS: Study based on a convenience sample of women unaware of their HIV serostatus when they were admitted to delivery in public maternity hospitals in Rio de Janeiro and Porto Alegre, Brazil, between March 2000 and April 2002. Women were counseled and tested using the Determine HIV1/2 Rapid Test. HIV infection was confirmed using the Brazilian algorithm for HIV infection diagnosis. In utero transmission of HIV was determined using HIV-DNA-PCR. There were performed descriptive analyses of sociodemographic data, number of previous pregnancies and abortions, number of prenatal care visits, timing of HIV testing, HIV rapid test result, neonatal and mother-to-child transmission interventions, by city studied. RESULTS: HIV prevalence in women was 6.5% (N=1,439) in Porto Alegre and 1.3% (N=3.778) in Rio de Janeiro. In Porto Alegre most of women were tested during labor (88.7%), while in Rio de Janeiro most were tested in the postpartum (67.5%). One hundred and forty-four infants were born to 143 HIV-infected women. All newborns but one in each city received at least prophylaxis with oral zidovudine. It was possible to completely avoid newborn exposure to breast milk in 96.8% and 51.1% of the cases in Porto Alegre and Rio de Janeiro, respectively. Injectable intravenous zidovudine was administered during labor to 68.8% and 27.7% newborns in Porto Alegre and Rio de Janeiro, respectively. Among those from whom blood samples were collected within 48 hours of birth, in utero transmission of HIV was confirmed in 4 cases in Rio de Janeiro (4/47) and 6 cases in Porto Alegre (6/79). CONCLUSIONS: The strategy proved feasible in maternity hospitals in Rio de Janeiro and Porto Alegre. Efforts must be taken to maximize HIV testing during labor. There is a need of strong social support to provide this population access to health care services after hospital discharge.

Use of medicines recommended for secondary prevention of acute coronary syndrome

ABSTRACT OBJECTIVE : To analyze if the demographic and socioeconomic variables, as well as percutaneous coronary intervention are associated with the use of medicines for secondary prevention of acute coronary syndrome. METHODS : In this cohort study, we included 138 patients with acute coronary syndrome, aged 30 years or more and of both sexes. The data were collected at the time of hospital discharge, and after six and twelve months. The outcome of the study was the simultaneous use of medicines recommended for secondary prevention of acute coronary syndrome: platelet antiaggregant, beta-blockers, statins and angiotensin-converting-enzyme inhibitor or angiotensin receptor blocker. The independent variables were: sex, age, education in years of attending, monthly income in tertiles and percutaneous coronary intervention. We described the prevalence of use of each group of medicines with their 95% confidence intervals, as well as the simultaneous use of the four medicines, in all analyzed periods. In the crude analysis, we verified the outcome with the independent variables for each period through the Chi-square test. The adjusted analysis was carried out using Poisson Regression. RESULTS : More than a third of patients (36.2%; 95%CI 28.2;44.3) had the four medicines prescribed at the same time, at the moment of discharge. We did not observe any differences in the prevalence of use in comparison with the two follow-up periods. The most prescribed class of medicines during discharge was platelet antiaggregant (91.3%). In the crude analysis, the demographic and socioeconomic variables were not associated to the outcome in any of the three periods. CONCLUSIONS : The prevalence of simultaneous use of medicines at discharge and in the follow-ups pointed to the under-utilization of this therapy in clinical practice. Intervention strategies are needed to improve the quality of care given to patients that extend beyond the hospital discharge, a critical point of transition in care.