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PubMed2006

Improvement of child survival in Mexico: the diagonal approach.

Public health interventions aimed at children in Mexico have placed the country among the seven countries on track to achieve the goal of child mortality reduction by 2015. We analysed census data, mortality registries, the nominal registry of children, national nutrition surveys, and explored temporal association and biological plausibility to explain the reduction of child, infant, and neonatal mortality rates. During the past 25 years, child mortality rates declined from 64 to 23 per 1000 livebirths. A dramatic decline in diarrhoea mortality rates was recorded. Polio, diphtheria, and measles were eliminated. Nutritional status of children improved significantly for wasting, stunting, and underweight. A selection of highly cost-effective interventions bridging clinics and homes, what we called the diagonal approach, were central to this progress. Although a causal link to the reduction of child mortality was not possible to establish, we saw evidence of temporal association and biological plausibility to the high level of coverage of public health interventions, as well as significant association to the investments in women education, social protection, water, and sanitation. Leadership and continuity of public health policies, along with investments on institutions and human resources strengthening, were also among the reasons for these achievements.

Adolescent↗

PubMedDate not supplied

[Human resources and the health system in Brazil].

This article discusses some questions related to human resources that act on Brazilian health system. At the beginning, it identifies the trends on health human resources in the last years. Then it shows on a brief discussion the health system reform, pointing out changes in the health model design through the implementation of the Family Health Program. This program tries to reorder the health care model, bringing the primary health care, in order to substitute the traditional model, designed to the cure of diseases and centered on hospitals. It also points out important changes on work conditions, such as: doctors' and dentists' no liberal work, low salaries, consultations paid by the HMO's, flexibilization of work, loss of work guarantees. Finally, it identifies serious problems in the Family Health Program, especially those related to the instability of work process and decreasing of social protection of workers who act on this program.

Brazil↗

PubMedDate not supplied

[Types of employment and health: analysis of the Second European Survey on Working Conditions].

OBJECTIVES: To investigate the relationships among types of employment and several health self-perceived outcomes in a sample of active workers from the 15 state members of the European Union. METHODS: Cross-sectional study with data drawn from the Second European Survey on Working Conditions (n = 15,146 individuals). The predictive variable was the types of employment aggregated in: permanent workers, sole traders, small employers (less than 10 employees) and temporary workers (full-and part-time). Unconditional logistic regression models were adjusted by age, gender and several indications of working conditions. Permanent workers was used as the baseline category. RESULTS: Employees with permanent (69,3%) and temporary (12,5%) contracts notified the highest level of a job absenteeism while temporary employees reported the highest level of job dissatisfaction. On the other hand, sole traders (12,2%) and small employees (6.1%) notified the most frequent level of overall fatigue, backache and muscular pains. Having permanent workers as baseline category, temporary employees was associated with high dissatisfaction (OR = 1.68), and and overall fatigue (OR = 1.16), but with lower frequency of stress (OR = 0.74) and job absenteeism (OR = 0.87). Small employers showed a low frequency of absenteeism (OR = 0.68), but a high stress (OR = 1.77) and overall fatigue (OR = 1.27). Finally, sole traders reported more frequently overall fatigue (OR = 1.40), and stress (OR = 1.33), but less job absenteeism (OR = 0.58). CONCLUSIONS: These findings suggest that types of employment may have an independent effect on several health self-perceive outcomes. Further research is necessary to overcome various shortcoming of this study, and to assess the role either job security or level of income and social protection.

Absenteeism↗

PubMed2003

Current scientific, ethical and social issues of biomonitoring in the European Union.

Occupational health regulations and practices in EU Member States have been directed, to a large extent, by the principle of social protection, aiming to protect both the health and the employment of every (candidate) worker. Medical and biomonitoring practices have played a major role in identifying health problems at work and also in establishing preventive measures. Lately, a new tendency is occurring that reduces health protection to compliance with a limited set of standards for workplaces and individuals. According to this approach, 'predictive' medical tests might be used for the selection of the fittest workers. At a time when the labor market is evolving towards less stable forms of work, such a 'standardization approach' may lead to an unequal occupational health policy: the better off being more protected, the more exposed being less protected and the more susceptible being excluded. Instead, biomonitoring tools should only be developed as part of medical surveillance and used for those who need it most.

Environmental Monitoring↗

PubMed1998

Motivation to volunteer by older adults: a test of competing measurement models.

Four measurement models of the structure of motivation to volunteer were evaluated in 2 samples of older (minimum age = 50 years), active volunteers. Motivation to volunteer was assessed with the Volunteer Functions Inventory. Whereas no support was found for either unidimensional or bipartite models, qualified support was observed for both 6-factor and 2nd-order factor models. The best fit of the data was obtained with the 6-factor model of motivation to volunteer (career, enhancement, protective, social, understanding, and values). Contrary to the prediction derived from the 2nd-order factor model, the 6 volunteer motives were differentially related to demographic variables and number of hours spent volunteering for the organization during the past year. Implications for assessing motivation to volunteer among older adults and recruiting older adults as volunteers are discussed.

Age Distribution↗

PubMed2001

Preterm birth research: from disillusion to the search for new mechanisms.

No intervention has been shown to decrease the rate of preterm birth. There was thus a need for a new research agenda. The new emphasis is on social and biological mechanisms, including the impact on stress of racism and poverty, and gene-environment interactions. New markers are also under study, and pertain mostly to infection and inflammation. The impact on preterm birth of broad contextual factors, such as universal social protection, will need to be explored further. The recent trends toward increased rates of preterm births deserve much attention. New policies and interventions to decrease medically indicated preterm births should be urgently developed and evaluated. The failure to prevent preterm deliveries has been so disappointing that there is a risk that high rates of preterm births will be seen as unavoidable. The research programme launched by March of Dimes is a timely effort to foster new enthusiasm, to test new ideas and to generate new hypotheses.

Female↗

PubMedDate not supplied

Trends in approaches to night and shiftwork and new international standards.

While relatively few countries have changed their working time legislation in recent years, new working time patterns show some changes in approaches to night and shiftwork. Prominent trends include (i) the spread of irregular hours of work to different sectors, including services, often as a result of decoupling business hours from individual working hours; (ii) greater flexibility, often in return for shorter hours, in covering operating hours by different individuals; (iii) the appearance of complex combinations of different categories of working time arrangements, such as a combination of full-time semi-continuous shifts and part-time weekend shifts; and (iv) the adoption of a complex process for changes in schemes, incorporating group study and joint planning. Importantly, these trends reflect fundamental changes in the concept of night work (and that of nightworkers). The issues related to these recent trends were apparent in the two-year debate that led to new international labour standards, the Night Work Convention (No. 171) and Recommendation (No. 178), 1990, both of which apply to both sexes and to nearly all occupations. Also adopted was the Protocol of 1990 to the Night Work (Women) Convention (No. 89) of 1948, under which national laws or regulations may now permit night work of women in industry under strictly defined conditions. The new Convention and Recommendation define 'nightworker' to include workers performing a substantial amount of night work. They prescribe a variety of actions to improve the quality of working life of such workers, including measures related to working hours, rest periods, safety and health, transfer to day work, maternity protection, social services, and consultations. Strategies should be adopted that take into account the local situation, that are participatory, and that take due account of the diverse aspects of working life associated with the new concept of night work.

Circadian Rhythm↗

PubMed2003

The impact of the 1997-98 East Asian economic crisis on health and health care in Indonesia.

This article identifies the effects of the 1997-98 East Asian economic crisis on health care use and health status in Indonesia. The article places the findings in the context of a framework showing the complex cause and effect relationships underlying the effects of economic downturns on health and health care. The results are based on primary analysis of Indonesian household survey data and review of a wide range of sources from the Indonesian government and international organizations. Comparisons are drawn with the effects of the crisis in Thailand. The devaluation of the Indonesian currency, the Rupiah, led to inflation and reduced real public expenditures on health. Households' expenditures on health also decreased, both in absolute terms and as a percentage of overall spending. Self-reported morbidity increased sharply from 1997 to 1998 in both rural and urban areas of Indonesia. The crisis led to a substantial reduction in health service utilization during the same time period, as the proportion of household survey respondents reporting an illness or injury that sought care from a modern health care provider declined by 25%. In contrast to Indonesia, health care utilization in Thailand actually increased during the crisis, corresponding to expansion in health insurance coverage. The results suggest that social protection programmes play a critical role in protecting populations against the adverse effects of economic downturns on health and health care.

Economics↗

PubMed2001

A global review of legislation on HIV/AIDS: the issue of HIV testing.

OBJECTIVE: Critical review of worldwide legislation on HIV/AIDS, with a focus on the issue of HIV testing, mainly in a military context. DESIGN: Analysis of health legislation on HIV/AIDS among 121 of the 191 member states of the World Health Organization (WHO), representing 85% of the world's population. METHODS: The WHO Directory of Legal Instruments Dealing with HIV Infection and AIDS has been the main source consulted. Relevant findings of two global surveys were used to examine HIV testing in the military. RESULTS: AIDS cases are reportable in 60% of the 121 countries, whereas HIV infections in no more than 26%. Notifications are kept confidential by law in 20% of countries. Only 17% have developed HIV-specific legislation against social discrimination, whereas 10% have passed legislation establishing financial reimbursement to those who have acquired HIV infection after injection of HIV-contaminated biologic material, support for occupational risk, and/or social protection for patients. Only 42% of the 121 countries report having legal instruments that require screening of donated blood. Legislative measures that address, generally in a prescriptive but sometimes also in a protective way, vulnerable groups, such as commercial sex workers, men who have sex with men, injecting drug users, and recipients of multiple transfusions of blood or blood-derivatives, are reported in 27% of countries. Other categories considered potentially vulnerable, for which specific legislation has been passed, include immigrants (17% of countries), prisoners (5%), and health personnel (14%). Further legislative measures for HIV prevention address testing pregnant women in the prenatal period (7% of countries), supporting condom promotion (11%), measures requiring quarantine, isolation, or coercive hospitalization of HIV-infected people or AIDS patients (9%), or imposing penal sanctions for HIV-infected people who deliberately expose others to the risk of transmission (10%). A National AIDS Committee responsible for addressing issues related to HIV/AIDS has been established by law in 39% of the 121 countries. Global surveys show that 27 countries carry out compulsory HIV screening on recruitment of military personnel. CONCLUSIONS: These data represent a useful tool to make governments aware of the problem of underreporting of legal instruments to the WHO and of the need to promote legislation in line with the idea that public health and human rights are complementary, not conflicting, goals.

Acquired Immunodeficiency Syndrome↗

PubMed2004

[Healthcare rights: an invitation for reflection].

This study focuses on changes and breaks in contemporary society relating to the right to healthcare as a universal value, in conformity with the guidelines provided by multilateral agencies and disseminated particularly since the 1990s. From the genesis of social rights and by tracing the interdependence between social and economic aspects of social citizenship in democratic capitalist countries, the study presents the two paradigms informing the approach to healthcare in the early 21st century: the full citizenship paradigm, according to which the right to healthcare is a universal value, and the paradigm of restricted social citizenship, according to which the right to healthcare is guided by the criterion of efficiency and economic rationalization. These propositions align with the health economy paradigm, which (i) defends focused resource allocation to attenuate poverty conditions, (ii) reduces the role of the state, (iii) recommends resource allocation to healthcare in association with social protection, and (iv) defines the market as the privileged regulator of healthcare actions.

Community Participation↗

PubMed2006

[Beyond dissemination: lessons from the interaction between researchers and decision-makers during a research project in Bogotá, Colombia].

This paper discusses the experiences and conceptual and theoretical lessons learned during interaction between researchers, policy-makers, program beneficiaries, and other actors in a research project on social protection, health, and forced displacement in Bogotá, Colombia. The article begins by presenting the methodological approach and a description of interaction between various actors. This experience provides the basis for a conceptual discussion on the factors and determinants of research use. The article also highlights the need for taking an epistemological view beyond the positivist and rationalist underpinnings of the dominant explanations concerning interaction between researchers and decision-makers.

Administrative Personnel↗

PubMed2006

Cross-sector learning among researchers and policy-makers: the search for new strategies to enable use of research results.

This paper assesses the preliminary results of a research funding strategy that alters the structure and process of research by requiring interaction between researchers and policy-makers. The five research teams focused on different aspects of expanding social protection in health in Latin America and the Caribbean. Preliminary results revealed negotiation of the research questions at the start of the process, influencing not only the project design, but the decision-makers' ways of thinking about the problem as well. As the projects advanced, turnover among government officials on four of the teams impaired the process. However, for the one team that escaped re-composition, the interaction has led to use of data in decision-making, as well as a clear recognition by both parties that different kinds of evidence were at play. The process highlighted the importance of stimulating systems of learning in which multiple kinds of knowledge interact. This interaction may be a more realistic expectation of such initiatives than the original goal of "transferring" research knowledge to policy and practice.

Administrative Personnel↗

PubMed2004

Cousin marriage and premarital carrier matching in a Bedouin community in Israel: attitudes, service development and educational intervention.

CONTEXT: Premarital carrier matching is a form of genetic counselling in which two individuals are told, if both are carriers, that they have a 25% risk at each pregnancy of having a child affected by the disease for which they were tested. If only one individual is a carrier this information is not disclosed. This scheme is offered to a consanguineous Bedouin community characterised by high prevalence of genetic diseases and a religious ban on abortion. OBJECTIVE: To elicit attitudes of community members concerning cousin marriage and genetic counselling. METHOD: Semi-structured interviews were conducted with Bedouin respondents (n = 49). RESULTS AND CONCLUSIONS: Interviews revealed that a majority of Bedouin respondents confirmed the traditional and social role of cousin marriage. The main reasons given in this context were clan solidarity, interpersonal compatibility, preservation of family property, parental authority and social protection for women. A majority of the respondents also associated cousin marriage with genetic diseases. Regarding genetic testing, the majority of respondents preferred the option of premarital carrier matching, which was supposed to reduce stigmatisation, especially of women. Prenatal genetic testing was rejected on religious grounds. The result of this community-based and culture-sensitive process was a focus on premarital carrier matching.

Adolescent↗

PubMed1997

The House of Falk: the paranoid style in American health politics.

The onset of the Cold War had a blighting effect on the campaign for a national health insurance program in the United States. In the highly charged atmosphere of the late 1940s, proponents of social insurance spent considerable time and energy denying that they were agents of foreign powers. In one widely promoted conspiratorial formulation, some on the right traced the origins of subversion not only to Moscow but also to Geneva, Switzerland, home of the International Labor Organization. In the fractiously partisan context of the period, conservative political leaders amplified concerns over disloyal bureaucrats' manipulating the levers of legislative politics as well as the design of health policy. One federal official in particular, I. S. Falk, became the object of outright demonization. The paranoid attacks took their toll on the drive to extend social protection. The reformers' difficulties suggest the limitations of heavy dependence on bureaucratic expertise in the pursuit of health security.

Health Policy↗

PubMed2003

Work security in a global economy.

Work security is a fundamental right of all working people. After World War II, the welfare state became an intrinsic part of the "Golden Age" of capitalism, in which universal prosperity seemed attainable. Workers' organizations frequently played a crucial role in policy decisions that promoted full employment, income stability, and equitable treatment of workers. Today's world order is quite different. Globalization in its present form is a major obstacle to work security. Globalization is not simply a market-driven phenomenon. It is a political and ideological movement that grants authority to capital over governments and labor. This transfer of authority hinders national efforts to promote work security and may impact the well-being of communities worldwide. In the absence of domestic autonomy, international labor standards are needed to protect social welfare. They should be geared toward curbing unemployment, poverty, and social exclusion in the global economy. The article looks at three initiatives to promote global work security.

Journal Article↗

PubMed2005

[Current view of sexual abuse in childhood and adolescence].

OBJECTIVE: To review single aspects, which involve sexual abuse in childhood and adolescence, giving subsidies for accurate diagnosis and management, emphasizing the short and long-term consequences. SOURCES OF DATA: National and international literature review of the MEDLINE and LILACS databases, using abuse and sexual violence as keywords (1988 to 2005), in addition to the authors theoretical and practical experiences. SUMMARY OF THE FINDINGS: Sexual abuse has a great impact on child and adolescent physical and mental health, affecting development and causing lifelong damage. Its early detection allows for adequate treatment and follow-up, with minimum consequences. Family involvement must be taken into consideration, and any kind of improper relationship should be evaluated and treated, so that it can be discouraged and eliminated; otherwise, intergenerational abuse will result and probably recur. The identification of domestic violence and of physical and psychological warning signs concerning sexual abuse is part of the general evaluation. CONCLUSIONS: Pediatricians should be able to identify the signs and symptoms sexually abused children and adolescents carry with them. They have to listen carefully to the patients, perform the necessary clinical examination and establish the proper treatment. They should also be able to deal with psychological aspects and have enough knowledge about the laws and about legal and social protection measures, which are always very useful in assisting victims of sexual violence.

Adolescent↗

PubMed2004

[Factors associated with the late management of HIV-infected patients: literature review].

In the United States, Australia and Europe, many HIV infected individuals are still diagnosed and/or treated late in the course of the disease. This literature review of studies published over a ten year period between 1993 and 2003 has identified the following principle factors associated with the late diagnosis of HIV: male gender, aged older than 45 years, heterosexual intercourse, the lack of previous screening. It also identified the factors linked to the delay in beginning anti-retroviral treatment as being male gender, the lack of awareness or denial of the possibility of HIV infection, intravenous drug use, lack of post-screening follow-up or counseling, lack of social protection, and the lack of regular medical visits and care. Early detection and suitable early treatment of the HIV virus are the main determining factors which will effectively contribute to the control and maintenance of the virus in as much as they are focused upon these particular at-risk populations.

Adult↗

PubMed1999

The reform of the rural cooperative medical system in the People's Republic of China: interim experience in 14 pilot counties.

During the 1960's and 1970's the Chinese government encouraged the 'rural cooperative medical systems' (RCMS), in order to ensure access to basic health care among the rural population. There was a break in the development of the RCMS in the early 1980's, as a consequence of market economic reforms. These reforms involved a shift from a communal to a household production system. As a result the collective way of financing rural health care was more or less abandoned. However, the government of the People's Republic of China was aware of the need to provide social protection against health care expenses. In March 1994 the government initiated a project to reestablish the RCMS. This project was implemented on a pilot basis in 14 counties of seven provinces. The reestablishment of the RCMS would be guided by the basic principles of health insurance. In October 1995, a first mid-term evaluation of the RCMS Project was held. One of the major research questions concerned the extent to which the RCMS had reduced the risk of paying health care bills that would otherwise be a burden on families. This article addresses this question and assesses the results obtained after two years of RCMS experimental work. A general finding is that the population structure by occupation and income varies, and that the RCMS has adapted itself to this variety. It is also confirmed that the burden of health care costs on families was reduced, more so in some counties than in others, but this reduction has been modest. The research results indicate that there is ample room for improvement. The outlook is hopeful, however. At the national level, there is now systematic thinking about RCMS. The current RCMS work is also having a considerable influence on other counties that are keen to reestablish the RCMS.

China↗