827 resultados para Health Policy
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Objective: To outline the major methodological issues appropriate to the use of the population impact number (PIN) and the disease impact number (DIN) in health policy decision making. Design: Review of literature and calculation of PIN and DIN statistics in different settings. Setting: Previously proposed extensions to the number needed to treat (NNT): the DIN and the PIN, which give a population perspective to this measure. Main results: The PIN and DIN allow us to compare the population impact of different interventions either within the same disease or in different diseases or conditions. The primary studies used for relative risk estimates should have outcomes, time periods and comparison groups that are congruent and relevant to the local setting. These need to be combined with local data on disease rates and population size. Depending on the particular problem, the target may be disease incidence or prevalence and the effects of interest may be either the incremental impact or the total impact of each intervention. For practical application, it will be important to use sensitivity analyses to determine plausible intervals for the impact numbers. Conclusions: Attention to various methodological issues will permit the DIN and PIN to be used to assist health policy makers assign a population perspective to measures of risk.
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Over the past decade or so, there has been increasing demand for greater clarity about the major causes of disease and injury, how these differentially affect populations, and how they are changing. In part, this demand has been motivated by resource constraints and a realisation that better health is possible with more informed allocation of resources. At the same time, there has been a change in the way population health and its determinants are quantified, with a much closer integration of the quantitative population sciences (such as epidemiology, demography and health economics) to strengthen and broaden the evidence base for healthcare policy.
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A discussion of health policy in developing countries is presented. It argues that developing countries must adopt a progressive approach to health policy which rejects the two-tiered system of public and private health care. However, it also points out that ideology is not sufficient to maintain support. A progressive health system must utilize administrative and social and behavioral sciences to achieve effectiveness and efficiency in health care delivery. It cannot ignore these goals any more than a private health care system can.
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A sample (n=124) of schizophrenic patients from a defined catchment area of the city os S.Paulo, Brazil, who had been consecutively admitted to hospital, was assessed for psychopathological status and social adjustment levels. Sociodemographic, socio-economic and occupational characteristics were recorded: almost 30% of the subjects had no occupation and received no social benefit, more than two-thirds had a monthly per capita income of US$ 100.00 or less. Sixty-five percent presented with Schneiderian firstrank symptoms. Nearly half the sample showed poor or very poor social adjustment in the month prior to admission. The most affected areas of social functioning were participation in the household activities, work and social withdrawal. The current mental health policy of promoting extra-mural care as an alternative to the previous hospital-based model will then mean the investment in a network of new community-based services, that give effective treatment and support to patients and their families. The need of further research into the current picture of mental disorders in the country is stressed.
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OBJECTIVE To analyze the dynamics of operation of the Bipartite Committees in health care in the Brazilian states.METHODS The research included visits to 24 states, direct observation, document analysis, and performance of semi-structured interviews with state and local leaders. The characterization of each committee was performed between 2007 and 2010, and four dimensions were considered: (i) level of institutionality, classified as advanced, intermediate, or incipient; (ii) agenda of intergovernmental negotiations, classified as diversified/restricted, adapted/not adapted to the reality of each state, and shared/unshared between the state and municipalities; (iii) political processes, considering the character and scope of intergovernmental relations; and (iv) capacity of operation, assessed as high, moderate, or low.RESULTS Ten committees had advanced level of institutionality. The agenda of the negotiations was diversified in all states, and most of them were adapted to the state reality. However, one-third of the committees showed power inequalities between the government levels. Cooperative and interactive intergovernmental relations predominated in 54.0% of the states. The level of institutionality, scope of negotiations, and political processes influenced Bipartite Committees’ ability to formulate policies and coordinate health care at the federal level. Bipartite Committees with a high capacity of operation predominated in the South and Southeast regions, while those with a low capacity of operations predominated in the North and Northeast.CONCLUSIONS The regional differences in operation among Bipartite Interagency Committees suggest the influence of historical-structural variables (socioeconomic development, geographic barriers, characteristics of the health care system) in their capacity of intergovernmental health care management. However, structural problems can be overcome in some states through institutional and political changes. The creation of federal investments, varied by regions and states, is critical in overcoming the structural inequalities that affect political institutions. The operation of Bipartite Committees is a step forward; however, strengthening their ability to coordinate health care is crucial in the regional organization of the health care system in the Brazilian states.
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Comunicao apresentada na 19th International Conference on Health Promoting Hospitals and Health Services, Turku, Finlndia de 1 a 3 de Junho de 2011.
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RESUMO: Em 2006, foi aprovada uma nova poltica governamental para a sade mental intitulada Uma Viso para a Mudana, a qual est neste momento no stimo ano de implementao. A poltica descreve um enquadramento para o desenvolvimento e promoo da sade mental positiva para toda a Comunidade e para a prestao de servios acessveis, baseados na comunidade, servios especializados para pessoas com doena mental. A implementao da poltica e o tornar a Vision for Change uma realidade tm sido problemticos, com crticas considerveis por parte dos intervenientes, relativas lenta e desconexa implementao. Este estudo fornece informao sobre as caractersticas dos servios de trs importantes tipos de instituies de sade mental comunitria a nvel nacional, nomeadamente Hospitais de Dia, Centros de Dia e residncias comunitrias operantes 24 horas. A pesquisa analisa objetivos e funes, perfis dos pacientes, atividades teraputicas, a eficcia das redes de comunicao e beneficia da perspectiva dos funcionrios sobre o que mudou no terreno ao longo dos ltimos sete anos. As questes identificadas a partir das caractersticas dos trs servios dizem respeito a todos. Os participantes indicaram que o ethos da recuperao parece ter alcanado um papel mais central no tratamento do paciente na comunidade mas reconheceram que o desafio de integrar os princpios de recuperao na prtica clnica se mantm presente. Parece ser reconhecida a importncia da planificao do cuidado individual nos servios comunitrios e os entrevistados indicaram que existe um empenho para garantir o envolvimento do usurio do servio. H diferenas entre os pontos de vista do pessoal e os pontos de vista dos representantes sobre uma srie de aspetos da prestao de servios. Este o primeiro estudo irlands deste gnero a examinar a prestao de servios das trs principais instituies comunitrias de sade mental num s estudo. Estes servios representam um enorme investimento em recursos, quer a nvel monetrio, quer humano. O estudo examinou os desafios e as questes fundamentais que lhe so aplicveis e que tm impacto nestes trs tipos de prestao de servios. Tambm forneceu informaes sobre os elementos de mudana positiva, os quais se comeam a focar lentamente na prestao do servio, assim como na importncia da centralidade do utilizador do servio e na promoo de um ethos da recuperao.----------ABSTRACT: In 2006, a new Government policy for mental health A Vision for Change was endorsed and is currently in the seventh year of implementation. The policy describes a comprehensive framework for building and fostering positive mental health across the entire community and for providing accessible, community based, specialist services for people with mental illness. The implementation of the policy and turning Vision for Change into reality has been problematic with considerable criticism from stakeholders concerning slow and disjointed implementation. This study provides information on three key community mental health service settings, namely Day Hospitals, Day Centres and 24 Hour Community Residences at a national level. The research looks at aims and functions, patient profiles, therapeutic activities, effectiveness of key communication networks and gains an insight from staff on what has changed on the ground over the past seven years. Issues identified from the three service settings pertain to all. Participants indicated that the recovery ethos appears to have moved to a more central role in patient care in the community but acknowledged that the challenge of integrating recovery principles in clinical practice remains present. The importance of individual care planning appears to be recognised in community services and respondents indicated that efforts are being made to ensure service user involvement. There were differences between staff views and advocate views on a number of aspects of service provision. This is the first Irish study of its kind to examine service provision across the three main community mental health settings in one study. These services represent a huge investment in resources both on a monetary and human level. This study has examined the challenges and key issues which are applicable and impacting on all three types of service provision. It has also provided information on the elements of positive change, which are slowly embedding themselves in service provision such as the importance of the centricity of the service user and the promotion of a recovery ethos.
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INTRODUCTION: Zoonotic kala-azar, a lethal disease caused by protozoa of the genus Leishmania is considered out of control in parts of the world, particularly in Brazil, where transmission has spread to cities throughout most of the territory and mortality presents an increasing trend. Although a highly debatable measure, the Brazilian government regularly culls seropositive dogs to control the disease. Since control is failing, critical analysis concerning the actions focused on the canine reservoir was conducted. METHODS: In a review of the literature, a historical perspective focusing mainly on comparisons between the successful Chinese and Soviet strategies and the Brazilian approach is presented. In addition, analyses of the principal studies regarding the role of dogs as risk factors to humans and of the main intervention studies regarding the efficacy of the dog killing strategy were undertaken. Brazilian political reaction to a recently published systematic review that concluded that the dog culling program lacked efficiency and its effect on public policy were also reviewed. RESULTS: No firm evidence of the risk conferred by the presence of dogs to humans was verified; on the contrary, a lack of scientific support for the policy of killing dogs was confirmed. A bias for distorting scientific data towards maintaining the policy of culling animals was observed. CONCLUSIONS: Since there is no evidence that dog culling diminishes visceral leishmaniasis transmission, it should be abandoned as a control measure. Ethical considerations have been raised regarding distorting scientific results and the killing of animals despite minimal or absent scientific evidence
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RESUMO: Santa Lcia pequena ilha de pas em desenvolvimento com recursos limitados e confrontada com uma srie de desafios socioeconmicos que exigem solues criativas e inovadoras. comprovado que a combinao de recursos entre setores para estabelecer os determinantes social, econmico e ambiental da sade so uma estratgia til para melhorar a sade da populao, principalmente a sua sade mental. Este estudo, o primeiro do seu tipo em Santa Lcia, procurou examinar at que ponto a disponibilidade de uma poltica nacional de sade mental levou a ao intersetorial para o fornecimento de servios e promoo da sade mental. Alm disso, o estudo examinou o nvel de colaborao intersetorial que existe entre as agncias que prestam cuidados diretos e servios de suporte para pessoas com doenas mentais e problemas srios de sade mental. O estudo tambm teve como objetivo identificar os fatores que promovem ou dificultam a colaborao intersectorial e gerar recomendaes que possam ser aplicadas para pases muito pequenos e com perfis socioeconmicos semelhantes. Os dados gerados a partir de trs (3) fontes foram sintetizados para formar uma viso ampla das questes. Uma avaliao da poltica de sade mental de 2007, uma avaliao que identifica at que ponto a ao intersetorial atualmente deixa a prestao de servios de sade mental e a administrao de entrevistas semiestruturadas nas mos de gestores do programa de diferentes agncias em todos os setores. O estudo concluiu que, apesar da disponibilidade de uma poltica de sade mental, que articula clara e explicitamente a colaborao intersetorial como rea prioritria para ao, quase no existe no sistema de fornecimento atual do servio. Os provedores de servios em todos os setores reconhecem que h os benefcios da colaborao intersectorial e com entraves significativos em relao colaborao intersetorial, que por sua vez, impede uma abordagem nacional para o planejamento e o fornecimento do servio. A colaborao intersetorial no ser possvel se os prprios setores dependerem da abordagem direta do setor da sade ou se a atmosfera geral for ofuscada pela estigmatizao das doenas mentais.------------------------------------------------------------------------ABSTRACT: Saint Lucia a small island developing country with limited resources, is faced with a number of socio-economic challenges which require creative and innovative solutions to address. Combining resources across sectors to address the social, economic and environmental determinants of health has proven to be a useful strategy for improving population health in particular mental health. This study, the first of its kind for Saint Lucia sought to examine the extent to which the availability of a national mental health policy led to intersectoral action for mental health promotion and service delivery. In addition the study examined the level of intersectoral collaboration which actually exist between agencies which provide direct care and support services to people with mental illnesses and significant mental health problems. The study also aimed to identify the factors which promote or hinder intersectoral collaboration and generate recommendations which can be applied to extremely small countries with similar socio-economic profiles. Data generated from three (3) sources was synthesized to form a broad picture of the issues. An evaluation of the mental health policy of 2007, an assessment of the extent to which intersectoral action currently exist in mental health service delivery and the administration of semi-structured interviews with program managers from different agencies across sectors to identify implementation issues. The study concluded that despite the availability of a mental health policy which clearly and explicitly articulates intersectoral collaboration as a priority area for action, very little exists in the current service delivery system. Services providers across sectors acknowledge the benefits of intersectoral collaboration and that there are significant barriers to intersectoral collaboration, which in turn hinders a national approach to service planning and delivery. Intersectoral collaboration is not possible if sectors themselves are dependent on a top-down health sector driven and dominated approach, or if the general atmosphere is clouded by stigmatization of mental health illnesses.
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The Department of Health (Republic of Ireland) is developing a public health policy, which aims to improve the health of the population and reduce health inequalities by addressing the causes of preventable illnesses. The aim is to develop a policy for a healthier population for all ages and all sectors in society. To succeed in developing and implementing a first-class public health policy, in which everyone is encouraged to play a part in protecting and improving the nation’s health, a consultation process was put in place to ensure wide engagement.
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The Institute of Public Health in Ireland aims to improve health in Ireland, North and South, by working to combat health inequalities and influence public policies in favour of health. The Institute’s work is based on the premise that improving health and reducing health inequalities will be best achieved through taking a broad determinants of health perspective. It applies a holistic model of health which emphasises a wide range of determinants on health including social, economic, environmental and biological factors. The Institute also recognises the importance of accessible, effective and efficient health and social services in determining health and the quality of life experienced by people. The Institute of Public Health welcomes the consultation process undertaken by the Department of Health and Children on a National Men’s Health Policy. In our response we focus on how inequality impacts on Irish men’s lives and how, as a consequence, ways to combat inequalities need to be at the heart of a health strategy for men
