bluuebunny/crossref_metadata_2025 huggingface dataset:
Health Politics Meets Post-Modernism: Its Meaning and Implications for Community Health Organizing
Authors: Rosenau Pauline Vaillancourt
Published: January 2008

In this article, post-modern theory is described and applied to health politics with examples from community health organizing, social movements, and health promotion. Post-modernism questions conventional assumptions about concepts such as representation, participation, empowerment, community, identity, causality, accountability, responsibility, authority, and roles in community health promotion (those of expert, leader, and organizer). I compare post-modern social movements with their modern counterparts: the organizational forms, leadership styles, and substantive intellectual orientations of the two differ. I explain the social planning, community development, and social action models of community health organizing, comparing them with the priorities of post-modern social movements, and show the similarities and differences between them as to structural preferences, process, and strategies. Finally, and most importantly, I present the implicit lessons that post-modernism offers to health politics and outline the strengths and weaknesses of this approach to health politics.
Education and the Health Professions: Explaining Policy Choices among the States
Authors: Weissert Carol S. , Knott Jack H. , Stieber Blair E.
Published: January 2008

Recent calls for restructuring of the nation's health care system have highlighted the deficiencies in the current system of education for the health professions. Of particular concern are the dominance of specialization and hospital-based training and the tendency of new health care providers to settle in communities without substantial health needs. The states are the key actors in reforming health professions education, serving as a primary funding source for health professions schools, chief licensors and regulators of health professions, regulators of private health insurance, key providers of Medicaid, and architects of a variety of subsidy and regulatory programs providing incentives for health professionals to choose specialities and locations for practice. This article provides a taxonomy of state policies affecting health professions education reform and classifies the states according to the choices they have made. Findings show that few states take advantage of their policy options across the four policy types and that most tend to concentrate their efforts on a few policiesignoring potential means of encouraging more primary care providers in underserved areas. Results from regression models explaining state choice of policy adoption highlight the political nature of policy choice and the highly variable nature of state response in health professions education reform.
Hospitals and Antitrust: Defining Markets, Setting Standards
Authors: Zwanziger Jack , Melnick Glenn , Eyre Kathleen M.
Published: January 2008

The definition of geographic and product markets is a critical aspect of any antitrust analysis. This paper argues for a different approach to market definition in areas where insurance plans that contract selectively are a significant market presence. Such a proposed approach is described and some policy implications are drawn.
Market Competition and the Quality of Nursing Home Care
Authors: Zinn Jacqueline S.
Published: January 2008

This article identifies factors influencing the degree of competition in the nursing home market. Using data obtained from the 1987 Medicare and Medicaid Automated Certification Survey, the relationship between competition and structural and process measures of quality (registered nurse staffing and resident care management practices) is estimated by weighted two-stage least squares regression. Results suggest that the quality effects of indicators of competition vary and that market concentration may not diminish quality-based competition. Proposals for nursing home reimbursement reform are evaluated with respect to their incentives for enhancing quality, particularly in the Medicaid market segment.
The Impact of Intra-Drg Severity of Illness on Hospital Profitability: Implications for Payment Reform
Authors: Rosko Michael D. , Carpenter Caryl E.
Published: January 2008

We examined the relationship between variations in intra-DRG severity of illness classifications and hospital profitability. Unlike in previous studies, we created a direct hospital-level measure of severity, formed from MedisGroup severity scores. We estimated separate regression equations for total margin, operating margin, net revenue per admission, and expense per admission. We examined data for 201 Pennsylvania hospitals and found that hospital profits were inversely related to the severity of illness index. Expense per admission was positively related to severity; however the relationship between severity and net revenue per admission was not significant. The results suggest that hospitals with a more severe case mix may not recover the full costs of providing services. Thus payment reform should include adjustments for severity of illness.
Birth Choices, the Law, and Medicine: Balancing Individual Freedoms and Protection of the Public's Health
Authors: Hafner-Eaton Chris , Pearce Laurie K.
Published: January 2008

To many Americans, the idea of home birth, the use of a “direct-entry midwife,” or both seem archaic. Although much of the professional medical community disapproves of either, state laws regarding birth choices vary dramatically and are not necessarily based on empirical findings of childbirth outcomes. Public health practitioners, policymakers, and consumers view childbirth from the perspectives of safety, cost, freedom of choice, quality of the care experience, and legality, yet the professional, policy, and lay literatures have not offered an unemotional, balanced presentation of evidence. Reviewing the full spectrum of literature from the United States and abroad, we present a Constitutional medical-legal analysis of whether home birth with direct-entry midwives is in fact a safe alternative to physician-attended hospital births, and whether there is a legal basis for allowing alternative health policy choices in such an important yet personal family matter as childbirth. The literature shows that low- to moderate-risk home births attended by direct-entry midwives are at least as safe as hospital births attended by either physicians or midwives. The policy ramifications include important changes in state regulation of medical and alternative health personnel, the allowance of the home as a medically acceptable and legal birth setting, and reimbursement of this lower-cost option through private and public health insurers.
The Rise and Fall of Democratic Universalism: Health Care Reform in Italy, 1978–1994
Authors: Ferrera Maurizio
Published: January 2008

In 1978, a sweeping reform created the first national health service of continental Europe: Italy's Servizio Sanitario Nazionale. This new scheme was based on the principle of “full democratic universalism”: The state would provide free and equal benefits to every citizen and the organization of public health would be subject to popular control, essentially through political parties. However, the severe problems encountered in implementing the reform design and rapidly increasing health expenditures soon eroded any consensus on this principle. Thus the 1980s and early 1990s witnessed a gradual shift to “conditional and well managed universalism.” These latter principles stress the need to differentiate access to care according to some criterion to regulate demand and the need for efficient use of scarce resources through adequate valorization of managerial skills and the use of “market-type” incentives. An elaborated system of user copayments was introduced gradually, and in 1992 a “reform of the reform” profoundly changed the organizational framework of the Servizio Sanitario Nazionale. The new government elected in the spring of 1994 announced ambitious plans to partially dismantle public universal insurance. Although these plans may prove difficult, the potential to form an anti-universalistic coalition seems strong in the contemporary Italian health care arena.
States Facing Interests: Struggles Over Health Care Policy in Advanced, Industrial Democracies
Authors: Wilsford David
Published: January 2008

Given alarming fiscal imperatives, states and interests in all advanced industrial democracies have struggled over health care policy. I explore the interface between state autonomy in health care policy and the political mobilization of provider interests, especially physicians. Evidence from Germany, Japan, Canada, and Great Britain suggests that, longitudinally, policy makers everywhere have tried to increase state autonomy in health care, and this has generally triumphed over even effectively mobilized providers. The countries that have most successfully restrained the growth of health care expenditureswhile still providing ready access to relatively high-quality careare those where states have most actively restrained both demand- and supply-side system interests in policy making. In each country, states have increasingly articulated their own greater capacities in health care policy, pushed to do so by the imperatives, especially fiscal, embedded in the policy domain.
Miasma and “Social Factors” In Disease Causality: Lessons from the Nineteenth Century
Authors: Tesh Sylvia N.
Published: January 2008

Conventional public health wisdom holds that the end of the nineteenth century saw a dramatic change in beliefs about what causes disease, as early convictions about the importance of broad social factors gave way to a concentration on microorganisms. I argue, however, that in both the middle and late nineteenth century nearly everyone, professionals and laypeople alike, saw disease causality in terms of precise, invisible entities, and that prevention policies were as reductionist and narrow as the available technology would allow. My argument is based on a rereading of the primary documents that other scholars have seen as supporting the idea of two distinct public health periods, and on a new interpretation of the revisionist history that questions the idea. I suggest that health policy analysts today are too vague about the meaning of “social factors” and that disease prevention policies might be better if the term was clarified.
Defensive Medicine and Tort Reform: New Evidence in an Old Bottle
Authors: Bovbjerg Randall R. , Dubay Lisa C. , Kenney Genevieve M. , Norton Stephen A.
Published: January 2008

Quantitative analysis of medical liability’s influence on medical practice is a small but growing field. The three foregoing articles illustrate three of the possible analytic approaches: case study of technological diffusion, survey of physician responses to detailed clinical scenarios, and multivariate analysis of the relation of physicians’ scenario responses to objective liability experience. The articles also offer a good picture of the state of the art: Many difficulties hamper research in this area, and these articles, like others, offer considerable illumination but leave much uncovered. Defensive medicine surely exists, but its effects on health care spending and access are unclear. The most important lessons for public policy are that tort reform may be necessary but not sufficient to reduce the problems associated with defensive medicine, and that the major malpractice problem continues to be malpractice.
Community Health Clinics Under Managed Competition: Navigating Uncharted Waters
Authors: Schauffler Helen Halpin , Wolin Jessica
Published: January 2008

In this article, we consider how major changes in the health care system, both real and proposed, may affect the future of community health clinics (CHCs) in the United States and their ability to continue to provide comprehensive care to underserved populations. We discuss the constraints and opportunities that CHCs face in a health care system that is rapidly moving away from fee-for-service medical care toward a model of managed competition. We describe the role that the National Association of Community Health Centers has played in advocating for CHCs in Congress and the role state primary care associations are playing in spearheading the development of statewide CHC-sponsored health maintenance organizations. We also analyze CHC reactions to the changes in federal policies that were proposed in the major health care reform bills of the 103d Congress, as well as the prospects for CHCs under Medicaid managed care as it sweeps rapidly across the nation. As a case study, we examine California’s policies that mandate that Medicaid recipients enroll in either a private managed care plan or a newly created public plan, which compete against each other within each county. CHCs are vulnerable during the transition to managed care and managed competition, and they have neither the resources nor the ability to integrate or compete successfully with private health maintenance organizations without safeguards, new sources of funding, technical assistance, improved infrastructure, and vigorous monitoring and oversight from federal and state governments, as well as the continued education, training, and policy advocacy provided by the National Association of Community Health Centers and state primary care associations.
From Piety to Platitudes to Pork: The Changing Politics of Health Workforce Policy
Authors: Fox Daniel M.
Published: January 2008

Policy to subsidize the education of health professionals in the United States has become contentious and uncertain. This article examines the politics of workforce policy in the twentieth century, emphasizing the years since World War II. From early in the century until the 1970s, most decision makers viewed policy to subsidize the education of health professionals as self-evidently correct. As consensus eroded, proponents insisted to increasingly skeptical audiences that these subsidies created benefits for the public. Recently, decision makers outside health care institutions have come to regard workforce policy as serving particular rather than general interests. Thus health workforce policy, like other policies outside of health affairs, may be said, perhaps oversimply but not inaccurately, to have gone through three stages: from piety to platitudes to pork.
Surface Morphology and Proton Conduction Imaging of Nafion Membrane
Authors: Takimoto Naohiko , Ohira Akihiro , Takeoka Yuko , Rikukawa Masahiro
Published: January 2008

AC-mode atomic force microscopy (AFM) and electrochemical methods were used to identify the proton conducting regions of Nafion membrane. It was found that the surface of Nafion membrane was constructed of small hydrophobic granular domains and that protons passed through the hydrophilic regions formed in the interstices between those domains.
Synthesis of a Hetero-bimetallic Complex with an Inorganic Cyclic Framework Using a Bis(iminophosphorane)iron Complex as a Chelating Ligand
Authors: Kubo Kazuyuki , Akimoto Takashi , Mizuta Tsutomu , Miyoshi Katsuhiko
Published: January 2008

An iron–rhodium bimetallic complex bearing a six-membered metallacycle was synthesized from a lithium bis(iminophosphorane)iron complex, which served as an anionic chelating ligand carrying a bis(iminophosphorano)methanide-like inorganic framework. The metallacycle complex takes a peculiar boat shape, in which the two metal centers are in close proximity and the carbonyl ligand on the iron atom overhangs the rhodium atom, giving a considerably low-frequency IR absorption and assuming a slightly bent structure.
Quantifying and Mitigating the Splitting Bias and Other Value Tree-Induced Weighting Biases
Authors: Jacobi Sarah K. , Hobbs Benjamin F.
Published: January 2008

This paper develops a model for estimating and correcting attribute-weighting biases (such as the splitting bias) that result from the use of value trees when structuring value function weight elicitation. The model is based on the conjecture that attribute weights are influenced by tree structure and a subject's use of the “anchor-and-adjust” heuristic, meaning that the subject starts with an equal allocation of weight among attributes in each tree partition and then adjusts the weights to reflect his or her innate preferences. Adjustments tend to be insufficient, resulting in attribute weights that are closer in value to each other than if the anchor-and-adjust heuristic was not employed. Weights corresponding to environmental and economic attributes of electric system expansion alternatives are elicited from employees of an electric utility and used to illustrate the existence and correction of value tree-induced attribute-weighting biases. Two weight sets are elicited from each subject, one using a nonhierarchical assessment and the other using a hierarchical one. The model results support the hypothesis that a bias exists that is consistent with the anchor-and-adjust heuristic. An analysis of rankings of alternatives and value losses caused by using elicited versus model-estimated debiased weight sets is provided.
How Effective Are Decision Analyses? Assessing Decision Process and Group Alignment Effects
Authors: Schilling Martin S. , Oeser Nadine , Schaub Cornelius
Published: January 2008

In this paper, we analyze approaches to assess the effectiveness of decision analyses. We develop an effectiveness framework, categorized in metrics to assess the quality of the decision process (“process effectiveness”), the quality of the model results (“output effectiveness”), and the quality of the long-term consequences of the analysis (“outcome effectiveness”). With a focus on the first two dimensions, “process” and “output,” we introduce two new approaches to assess the effectiveness of decision analyses applied in organizations. First, a new process effectiveness approach serves to compare the effectiveness of decision analyses to existing decision processes. Second, we assess output effectiveness with a before/after preference measurement design, which aids to capture the alignment of group members quantitatively when using decision analysis. We used six case studies, implemented during an applied research project, to test the two measures.
Analysis of Direct Shipping Policies in an Inventory-Routing Problem with Discrete Shipping Times
Authors: Bertazzi Luca
Published: January 2008

We consider the problem in which several products have to be shipped from a supplier to a set of retailers over an infinite time horizon. Each product is made available at the supplier and absorbed by each retailer at given constant production and consumption rates. For each product, the unit inventory cost at the supplier is equal to the unit inventory cost at the retailers. Shipments can be performed in each discrete time instant by a fleet of vehicles of given transportation capacity, and routing is allowed. The aim is to determine shipping policies that minimize the sum of transportation cost and inventory cost both at the supplier and at the retailers. We study direct shipping policies, i.e., policies in which each retailer is served independently. We show the worst-case performance of the best single, best double, best triple, best frequency-based, and optimal direct shipping policies. In each of these policies each link is optimized independently. We prove that, in the worst case, the ratio between the cost of the optimal direct shipping policy and the optimal cost of the problem in which routing is allowed—i.e., the worst-case performance bound of this policy—is not greater than two whenever the unit volume on each link is not lower than 1/4 of the vehicle capacity. Moreover, if the unit volume is not lower than the capacity, the bound is about 1.21. These bounds are tight and obtained by applying frequency-based policies that make use of at most three different shipping frequencies and cannot be improved by allowing more frequencies or using time-based policies on each link. Computational results show that the best among the frequency-based direct shipping policies used to obtain the worst-case results gives an average percent increase error, with respect to a lower bound on the optimal cost of the problem in which routing is allowed, of 6.44% on a large set of randomly generated problem instances.
Technical Note—Exact Distribution of Visiting Rates
Authors: Nadarajah Saralees , Kotz Samuel
Published: January 2008

The exact distribution of visiting rates does not appear to be widely known in the marketing literature. Here, analytical expressions are derived for the exact distribution, and their performance is compared with some known approximation. Some computer programs are provided for practical use.
Relaxations of Weakly Coupled Stochastic Dynamic Programs
Authors: Adelman Daniel , Mersereau Adam J.
Published: January 2008

We consider a broad class of stochastic dynamic programming problems that are amenable to relaxation via decomposition. These problems comprise multiple subproblems that are independent of each other except for a collection of coupling constraints on the action space. We fit an additively separable value function approximation using two techniques, namely, Lagrangian relaxation and the linear programming (LP) approach to approximate dynamic programming. We prove various results comparing the relaxations to each other and to the optimal problem value. We also provide a column generation algorithm for solving the LP-based relaxation to any desired optimality tolerance, and we report on numerical experiments on bandit-like problems. Our results provide insight into the complexity versus quality trade-off when choosing which of these relaxations to implement.
Using Stochastic Approximation Methods to Compute Optimal Base-Stock Levels in Inventory Control Problems
Authors: Kunnumkal Sumit , Topaloglu Huseyin
Published: January 2008

In this paper, we consider numerous inventory control problems for which the base-stock policies are known to be optimal, and we propose stochastic approximation methods to compute the optimal base-stock levels. The existing stochastic approximation methods in the literature guarantee that their iterates converge, but not necessarily to the optimal base-stock levels. In contrast, we prove that the iterates of our methods converge to the optimal base-stock levels. Moreover, our methods continue to enjoy the well-known advantages of the existing stochastic approximation methods. In particular, they only require the ability to obtain samples of the demand random variables, rather than to compute expectations explicitly, and they are applicable even when the demand information is censored by the amount of available inventory.
Cross‐National Comparisons of the Association between Alcohol Consumption and Deliberate Self‐Harm in Adolescents
Authors: Rossow Ingeborg , Ystgaard Mette , Hawton Keith , Madge Nicola , Van Heeringen Kees , De Wilde Erik Jan , DeLeo Diego , Fekete Sandor , Morey Carolyn
Published: January 2008

How differences in drinking patterns may affect the impact of alcohol consumption on deliberate self‐harm among adolescents is explored in this international comparative study. Schools in Australia, Belgium, England, Hungary, Ireland, the Netherlands, and Norway (N= 30,532) were surveyed. In all countries the risk of deliberate self‐harm was significantly elevated among adolescents who reported some or numerous episodes of intoxication, controlling for confounding factors. The results support the assumption that intoxication is significantly related to the association between alcohol consumption and deliberate self‐harm in adolescents.
The Epidemiology of Suicide‐Related Outcomes in Mexico
Authors: Borges Guilherme , Nock Matthew K. , Medina‐Mora Maria Elena , Benjet Corina , Lara Carmen , Chiu Wai Tat , Kessler Ronald C.
Published: January 2008

Nationally representative data from the Mexican National Comorbidity Survey are presented on the lifetime prevalence and age‐of‐onset (AOO) distributions of suicide ideation, plan and attempt and on temporally prior demographic and DSM‐IV psychiatric risk factors. Lifetime ideation was reported by 8.1% of respondents, while 3.2% reported a lifetime plan and 2.7% a lifetime suicide attempt. Onset of all outcomes was highest in adolescence and early adulthood. The risk of transition from suicide ideation to plan and attempt was highest within the first year of onset of ideation. The presence of one or more temporally prior DSM‐IV/CIDI (Composite International Diagnostic Instrument) disorder was strongly related to each suicide‐related outcome. Suicidal outcomes are prevalent, have an early AOO, and are strongly related to temporally prior mental disorders in Mexico. Given the early AOO, intervention efforts need to focus more than currently on children and adolescents with mental disorders to be effective in prevention.
Interpersonal Reactions to Suicide Attempt: The Role of Respondent Causal Attributions
Authors: Paukert Amber L. , Pettit Jeremy W.
Published: January 2008

Interpersonal responses to a depressed person with or without a suicide attempt were examined. It was hypothesized that the depressed person who attempted suicide would receive higher negative attributions and interpersonal rejection, and that attributions would mediate the relationship between exposure to a depressed person and rejection. Contrary to hypotheses, respondents were more willing to interact with, held higher esteem for, and endorsed lower negative attributions for the depressed person who attempted suicide. Mediation hypotheses were supported. Findings suggest that a suicide attempt may promote less negative attributions toward depressed individuals, which in turn dampen negative interpersonal reactions.
Suicide by Jumping and Accessibility of Bridges: Results from a National Survey in Switzerland
Authors: Reisch Thomas , Schuster Ursula , Michel Konrad
Published: January 2008

Rates of suicide by jumping show large regional differences. Barriers on bridges may prevent suicides but also may lead to a substitution of jumping site or method. The aim of our study was to compare suicide data from regions with and without suicide bridges and to estimate the effects on method and site substitution if bridges were to be secured. In a national survey, suicide data for the years 1990 to 2003 were collected. Regions with high rates of bridge suicides were identified and compared with regions with low rates, and the analysis revealed that only about one third of the individuals would be expected to jump from buildings or other structures if no bridge was available. The results suggest no method substitution for women. For men, a trend of a substituting jumping by overdosing in regions without suicide bridges was found. We conclude that restricted access to suicide bridges will not automatically lead suicidal individuals to choose another jumping site or suicide method. The results support the notion that securing bridges may save lives.
Marital Status Integration, Suicide Disapproval, and Societal Integration as Explanations of Marital Status Differences in Female Age‐Specific Suicide Rates
Authors: Cutright Phillips , Stack Steven , Fernquist Robert
Published: January 2008

Sociological analyses of suicide have often neglected female suicide rates. Three competing explanations are tested to determine why the suicide rates of married women are, typically, lower than the suicide rates of women who are not married: (1) marital status integration, (2) societal integration, and (3) a nation's normative order about disapproval of suicide. Data refer to age and marital status‐specific female suicide rates from 12 developed countries. The results provide the strongest support for the marital status integration theory and consistent support for the social integration perspective. There is also mixed support for the cultural disapproval of suicide hypothesis.
Friends at Table
Authors: Portman Adrian
Published: January 2008

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I Feel, Therefore I am
Authors: Nathanson Paul
Published: January 2008

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Responses among Australians to the Death and Funeral of Princess Diana
Authors: Bellamy John , Black Alan , Hughes Philip
Published: January 2008

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Hinduism
Authors: Sweetman Will
Published: January 2008

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Believing and Belonging
Authors: Grainger Roger
Published: January 2008

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Adaptação transcultural da Escala de Independência em Atividades da Vida Diária (Escala de Katz)
Authors: Lino Valéria Teresa Saraiva , Pereira Silvia Regina Mendes , Camacho Luiz Antônio Bastos , Ribeiro Filho Sergio Telles , Buksman Salo
Published: January 2008

Desenvolvimento e análise do desempenho de uma adaptação transcultural para o português da Escala de Katz de independência em atividades da vida diária. Duas traduções e duas retrotraduções analisaram as equivalências conceitual, de itens e semântica para a escolha da versão final. A equivalência operacional foi avaliada em um estudo piloto, testando-se a confiabilidade e a consistência interna da versão adaptada por meio de reteste no mesmo dia em 156 pacientes ou após sete dias da primeira entrevista. A resolução de diferenças sutis em alguns itens levou à equivalência cultural. A versão final foi considerada fácil de se entender e de aplicar. A concordância corrigida para o acaso (kappa ponderado) foi de 0,91. O alfa de Chronbach variou de 0,80 a 0,92. A versão em português da Escala de Katz de independência em atividades da vida diária, completamente desenvolvida e testada, provou ser equivalente à original em inglês. Os itens apresentaram consistência interna e as taxa foram confiáveis.
Epidemiologia das pregas cutâneas triciptal e subescapular elevadas em adolescentes
Authors: Duquia Rodrigo Pereira , Dumith Samuel de Carvalho , Reichert Felipe Fossati , Madruga Samanta Winck , Duro Luciano Nunes , Menezes Ana Maria Baptista , Araújo Cora Luiza
Published: January 2008

O objetivo deste estudo foi descrever e comparar as pregas cutâneas triciptal (PCT) e subescapular (PCS) de acordo com características demográficas, sócio-econômicas, comportamentais e biológicas em adolescentes de Pelotas, Rio Grande do Sul, Brasil. Realizou-se um estudo transversal aninhado a uma coorte de nascimentos (N = 4.452; média de idade = 11 anos). Os desfechos foram apresentar prega cutânea maior ou igual ao percentil 90 da curva de referência do National Center for Health Statistics. A prevalência de PCT e PCS elevada foi, respectivamente, de 20,2% e 17,3% nos meninos e de 14,2% e 10,5% nas meninas. O fator mais fortemente associado com adiposidade nos meninos foi o nível econômico (p < 0,001) e entre as meninas foi o índice de massa corporal materno (p < 0,001). Baixo nível de atividade física (< 300 minutos/semana) esteve associado com PCS elevadas somente entre as meninas, enquanto que escolaridade se associou à PCT e PCS elevada somente entre os meninos. Dieta, cor da pele e comportamento sedentário não se associaram com nenhum dos desfechos. Concluiu-se que os principais preditores de adiposidade foram características maternas e sócio-econômicas. Recomendam-se investigações utilizando-se outras técnicas de composição corporal para confirmação dos achados deste estudo.
¿Qué muestran las Encuestas de Calidad de Vida sobre el sistema de salud en Colombia?
Authors: Zambrano Andrés , Ramírez Manuel , Yepes Francisco José , Guerra José Alberto , Rivera David
Published: January 2008

En este documento se esbozan los principales avances en cuanto a aseguramiento en salud y demanda de servicios médicos en Colombia, a partir de las Encuestas de Calidad de Vida de 1997 y 2003. Se encuentra un aumento en el aseguramiento en salud de la población, con un mayor incremento del régimen subsidiado; aún así, persiste una gran proporción que no cuenta con aseguramiento. También se encuentra que el tipo de afiliación afecta directamente la demanda de servicios. Se evidencia un aumento en la consulta por prevención para 2003 y una disminución en las consultas médicas cuando el individuo se siente enfermo, esta disminución se debe principalmente a la falta de dinero. El acceso a los medicamentos aumenta entre 1997 y 2003, lo que se refleja en la disminución del gasto privado en medicamentos.
Defeitos congênitos no Município do Rio de Janeiro, Brasil: uma avaliação através do SINASC (2000-2004)
Authors: Guerra Fernando Antônio Ramos , Llerena Jr Juan Clinton , Gama Silvana Granado Nogueira da , Cunha Cynthia Braga da , Theme Filha Mariza Miranda
Published: January 2008

Avaliou-se a ocorrência de defeitos congênitos em nascidos vivos no Município do Rio de Janeiro, Brasil, com base no Sistema de Informações sobre Nascidos Vivos (SINASC), no período de 1º de janeiro de 2000 a 31 de dezembro de 2004. Através de um estudo seccional e descritivo, estudaram-se as variáveis relativas aos defeitos congênitos (presença e aparelho ou sistema acometido), aos serviços de saúde, às mães, às gestações, aos recém-natos e aos partos. Constatou-se uma prevalência de defeitos congênitos de 83/10 mil nascidos vivos. Os sistemas orgânicos mais afetados foram o osteomuscular, nervoso central, genital, as fendas lábio-palatinas e as anomalias cromossômicas. A maioria dos casos nasceu nas maternidades municipais e na rede privada, e maior prevalência de defeitos congênitos ocorreu no Instituto Fernandes Figueira da Fundação Oswaldo Cruz. Os defeitos congênitos foram mais prevalentes entre os filhos de mulheres mais velhas e menos instruídas. O percentual de casos ignorados foi alto, chegando a 21% em algumas maternidades. Uma maior divulgação das informações do SINASC sobre defeitos congênitos deveria ser estimulada. Estudos de confiabilidade são recomendados para melhor aproveitamento das informações.
Acesso a e utilização de serviços odontológicos no Estado do Rio de Janeiro, Brasil, em 1998: um estudo exploratório a partir da Pesquisa Nacional por Amostra de Domicílios
Authors: Manhães Antonio Luís Dias , Costa Antonio José Leal
Published: January 2008

O objetivo deste estudo foi analisar o acesso a e a utilização de serviços odontológicos no Estado do Rio de Janeiro, Brasil, em 1998, a partir da Pesquisa Nacional por Amostra de Domicílios (PNAD 1998). A população de estudo foi composta por 7.756 indivíduos subdivididos em três estratos etários (15 a 19, 35 a 44 e 65 a 74 anos). A avaliação do acesso baseou-se na pergunta sobre a última vez que o entrevistado foi ao dentista. O fato de um indivíduo nunca ter ido ao dentista na vida foi considerado como indicativo de restrição de acesso, analisado segundo variáveis demográficas, sócio-econômicas e epidemiológicas. As proporções de indivíduos que nunca consultaram dentista foram 7,6%, 1,8% e 2,6% respectivamente, entre os jovens, adultos e idosos. Os resultados sugerem que indivíduos menos favorecidos em termos sócio-econômicos apresentavam maior limitação de acesso, ou seja, os menos escolarizados (jovens e adultos), com menor renda per capita (jovens e idosos) e com menor posse de eletrodomésticos (adultos). Entre os jovens e os adultos, a posse de plano de saúde mostrou-se inversamente associada à restrição de acesso.
Amamentação natural como fonte de prevenção em saúde
Authors: Antunes Leonardo dos Santos , Antunes Lívia Azeredo Alves , Corvino Marcos Paulo Fonseca , Maia Lucianne Cople
Published: January 2008

A importância da amamentação natural tem sido abordada sob âmbito multiprofissional. O cirurgião dentista como profissional da área de saúde está incluído neste contexto e deve ser capaz de orientar a gestante e as recém-mães visto a forte relação que existe entre amamentação natural e o desenvolvimento do sistema estomatognático. São inúmeros os benefícios gerados tanto para a mãe quanto para o bebê. Baseado nisso, o presente artigo propõe, por meio de uma revisão de literatura discutida, argumentar com informações atuais e esclarecedoras os benefícios da amamentação dando estímulo à conscientização da sua importância e à formulação de políticas e ações, através do SUS, que priorizem a prática da amamentação como meta.
Ações de educação em saúde para prevenção e controle da dengue: um estudo em Icaraí, Caucaia, Ceará
Authors: Sales Fátima Maria de Sousa
Published: January 2008

O estudo analisa as ações educativas para prevenção e controle da dengue, as estratégias utilizadas nas ações educativas e aponta os limites/dificuldades. Abordagem qualitativa, desenvolvida na Unidade Básica de Saúde e oito imóveis em Icaraí-CE. Os sujeitos foram dezessete pessoas, distribuídas entre três grupos: I (oito usuários da UBS); II (quatro Agentes de Controle de Endemias); III (cinco profissionais de Saúde). As técnicas de coleta de dados: a entrevista semi-estruturada; a observação participante, a análise de documental. O método de análise foi hermenêutica dialética. Pode-se afirmar que as práticas educativas em saúde são divergentes, a ação transformadora é ineficaz para impactar a doença. Apontaram-se como dificuldades as fragilidade e ações pontuais; conteúdo das mensagens educativas descontextualizadas; estratégias autoritárias e coercitivas, ausência de políticas públicas, limites entre a UBS e a população; ênfase às campanhas sanitárias; os profissionais não ouvem a população e vice-versa; ainda predomina o saber técnico sobre o usuário. Evidencia a necessidade de ações que fortaleçam a possibilidade dos sujeitos terem o poder e a responsabilidade pela própria história e pelo processo de construção de sua cidadania.
A eutanásia e os paradoxos da autonomia
Authors: Siqueira-Batista Rodrigo , Schramm Fermin Roland
Published: January 2008

O princípio de respeito à autonomia tem se mostrado muito útil para a argumentação bioética em favor da eutanásia. Sem embargo, a despeito de sua inquestionável eficácia teórica, inúmeras aporias podem ser levantadas, no momento em que se procede a uma análise rigorosa deste conceito, sendo possível colocá-lo em xeque. Com base nesta ponderação, o presente artigo busca investigar o princípio de autonomia, partindo de suas origens nas tradições grega e cristã e mapeando alguns desdobramentos na tradição ocidental, até sua formulação na modernidade, legado de Immanuel Kant. A seguir, são apresentados seus principais paradoxos, no âmbito da filosofia, biologia, psicanálise e política, expondo-se, assim, várias das dificuldades teóricas que precisam ser enfrentadas, a fim de tornar possível sua aplicabilidade no âmbito das decisões relativas ao fim da vida.
Construção de uma práxis educativa em informática na saúde para ensino de graduação
Authors: Cardoso Jefferson Paixão , Rosa Valéria Argolo , Lopes Claudia Ribeiro Santos , Vilela Alba Benemérita Alves , Santana Aurisan Souza de , Silva Sandro Tonini da
Published: January 2008

O artigo apresenta uma visão da prática educativa em informática para a educação de profissionais da área da saúde no âmbito do ensino de graduação. Partindo da experiência vivenciada na disciplina de Informática Aplicada à Saúde, ministrada na Universidade Estadual do Sudoeste da Bahia (UESB), campus de Jequié, aos cursos de Enfermagem e de Fisioterapia, é relatada uma experiência onde foi possível perceber a importância de realizar um ensino da informática que estabelecesse relações entre as Tecnologias da Informação e Comunicação com a práxis do profissional da saúde, contribuindo, com isso, para a melhoria do processo pedagógico e fazendo com que o discente pudesse "visualizar" como tais tecnologias podem ser utilizadas na qualificação e na produção de impacto da sua atuação profissional.
Morbidade hospitalar de indígenas Xavante, Mato Grosso, Brasil (2000-2002)
Authors: Lunardi Rosaline , Santos Ricardo Ventura , Coimbra Jr Carlos E.A.
Published: January 2008

OBJETIVO: Analisar as causas de hospitalização de indígenas Xavante, Estado de Mato Grosso, Brasil, no período 2000-2002. MÉTODOS: As causas de hospitalização foram pesquisadas nos prontuários de oito hospitais que atendem aos Xavante das reservas Areões, Pimentel Barbosa, Sangradouro e São Marcos. Os dados coletados incluíram: nome, idade, sexo, terra indígena, data de admissão, data de alta, diagnóstico no momento da internação. Os diagnósticos foram classificados segundo a CID-10. RESULTADOS: Foram analisados 1.698 prontuários. As idades variaram entre 0-93 anos. Mais da metade dos pacientes eram crianças < 5 anos (65,8%). As cinco principais causas de hospitalização foram: doenças do aparelho respiratório (41,5%); doenças infecciosas e parasitárias (17,4%); gravidez, parto e puerpério (12,7%); doenças endócrinas, nutricionais e metabólicas (9,7%); e lesões, envenenamentos e conseqüências de causas externas (3,7%). Se excluídas as causas relacionadas à gravidez, parto e puerpério, a distribuição passa a ser a seguinte: doenças do aparelho respiratório (47,7%); doenças infecciosas e parasitárias (19,9%); doenças endócrinas, nutricionais e metabólicas (11,2%); e lesões, envenenamentos e conseqüências de causas externas (4,3%). As crianças Xavante foram proporcionalmente mais hospitalizadas por doenças infecciosas e parasitárias, respiratórias e desnutrição que as não-indígenas de Mato Grosso. CONCLUSÕES: O perfil de morbidade hospitalar Xavante é coerente com a reconhecida precariedade do perfil sanitário e nutricional predominante nas aldeias. Destacam-se as seguintes conclusões: crianças < 5 anos constituem mais de 50% das hospitalizações; as principais causas de internação na população são devido a doenças respiratórias, nutricionais e infecciosas e parasitárias. Frisa-se a relevância dos achados para a discussão do modelo de assistência à saúde indígena no Brasil.
Internações por Diabetes Mellitus como diagnóstico principal na Rede Pública do Brasil, 1999-2001
Authors: Rosa Roger dos Santos , Schmidt Maria Inês , Duncan Bruce Bartholow , Souza Maria de Fátima Marinho de , Lima André Klafke de , Moura Lenildo de
Published: January 2008

OBJETIVO: Descrever no âmbito nacional e por faixa etária, sexo e região as 327.800 hospitalizações por diabetes mellitus (DM) da rede pública do Brasil, entre 1999-2001. MÉTODOS: Foram utilizados dados do Sistema de Informação Hospitalar do Sistema Único de Saúde (SIH/SUS) referentes ao DM (diagnóstico principal CID-10 E10-E14 combinado com procedimento realizado) e indicadores anuais de hospitalizações/10(4)hab. e óbitos hospitalares/10(6)hab. (ajustados pelo método direto por idade), letalidade, médias de permanência e gastos por internação e por 10(4)hab. em US$, e regressão logística múltipla para desfecho óbito. RESULTADOS: Houve mais hospitalizações anuais do sexo feminino (7,5/10(4)hab. [intervalo de confiança de 95%: 7,4-7,6] vs. masculino (5,2/10(4)hab. [5,2-5,3]), mais óbitos hospitalares anuais de mulheres (38,1/10(6)hab. [36,8-39,3] vs. 30,7 [29,5-32,0]), porém maior letalidade no sexo masculino (5,9 vs. 5,0%) em todas as regiões. Observou-se incremento das hospitalizações com a idade, mais acentuado para mulheres. Não houve diferença na permanência das internações com óbito (6,5 dias [6,3-6,6]) ou sem (6,4 [6,3-6,6]), apesar do gasto por internação superior (US$ 275,27 [268,37-282,16] vs. 143,45 [136,56-150,35]). O gasto anual/10(4)hab. equivaleu a US$ 969,09. A razão de chances de óbito hospitalar aumentou com a idade, foi maior para homens (1,21 [1,17-1,24]) e 2 vezes maior para habitantes das regiões Nordeste e Sudeste comparados aos da região Sul. Os gastos anuais/10(4)hab. foram 50-100% maiores nas regiões mais desenvolvidas. CONCLUSÕES: O volume e a desigualdade nos gastos enfatizam a necessidade de cobertura mais adequada da população, evitando as hospitalizações e suas complicações.
Perfil lipídico e estado nutricional de adolescentes
Authors: Carvalho Danielle Franklin de , Paiva Adriana de Azevedo , Melo Adriana Suely de Oliveira , Ramos Alessandra Teixeira , Medeiros Josimar dos Santos , Medeiros Carla Campos Muniz de , Cardoso Maria Aparecida Alves
Published: January 2008

OBJETIVOS: Avaliar a associação entre obesidade e dislipidemias em adolescentes do ensino público e privado de Campina Grande-PB, Brasil. MÉTODOS: Estudo transversal com 180 adolescentes de 14 a 17 anos matriculados no ensino público e privado de Campina Grande-PB. O estado nutricional foi classificado segundo os percentis do Índice de Massa Corporal para sexo e idade. Foi realizada coleta sangüínea para avaliação do perfil lipídico (colesterol total, frações HDL-colesterol, LDL-colesterol e triglicerídeos). Considerou-se dislipidemia a existência de alteração em pelo menos um dos exames. As análises estatísticas foram realizadas a partir do Epi Info 3.3 e Stata 7.0. RESULTADOS: A prevalência de sobrepeso foi de 14,4% enquanto que 83,9% dos estudantes eram eutróficos e 1,7% apresentavam baixo peso. Não foram encontradas diferenças estatisticamente significantes para o estado nutricional quando estratificado por sexo e tipo de escola. Todas as taxas bioquímicas investigadas mostraram algum nível de alteração. Chamou à atenção a prevalência de dislipidemia, observada em 66,7% dos estudantes, e a alteração do HDL-colesterol, verificada em 56,7% destes. Registrou-se associação estatisticamente significante (p<0,05) do Índice de Massa Corporal, categorizado em tercis, com o colesterol total e sua fração LDL, inclusive quando estratificados por sexo e tipo de escola. CONCLUSÕES: Considerando-se a faixa etária estudada, foram elevados os achados de sobrepeso e dislipidemia. Recomenda-se a adição de medidas preventivas, a fim de evitar que cada vez mais crianças e adolescentes venham a se tornar adultos portadores de obesidades e outras doenças crônicas.
Avaliação nutricional: descrição da concordância entre avaliadores
Authors: Beghetto Mariur Gomes , Luft Vivian Cristine , Mello Elza Daniel de , Polanczyk Carísi Anne
Published: January 2008

Este estudo objetivou avaliar a concordância interobservadores de medidas antropométricas e avaliação subjetiva do estado nutricional em adultos hospitalizados. Pacientes internados em um hospital geral universitário tiveram peso atual, peso usual, altura, circunferência do braço, prega cutânea tricipital, percentual de perda de peso, Índice de Massa Corporal, circunferência muscular do braço e Avaliação Nutricional Subjetiva Global obtidos por avaliadores independentes. A concordância foi avaliada pelo coeficiente kappa, teste t pareado e coeficiente de correlação intraclasse (ICC). Foram avaliados 102 pacientes, com idade de 53±15 anos. Foi obtida boa correlação entre observadores para todos os métodos antropométricos (ICC>0,86) e diferenças médias de pequena magnitude. As variáveis categorizadas mostraram concordância ótima para o Índice de Massa Corporal (kappa=0,98; IC95%: 0,95-1,0), fraca para a Avaliação Nutricional Subjetiva Global (kappa=0,46; IC95%: 0,31-0,60) e moderada para os percentis 5 e 10 da circunferência do braço (kappa=0,78; IC95%: 0,65-0,91), circunferência muscular do braço (kappa=0,73; IC95%: 0,54-0,92) e prega cutânea tricipital (kappa=0,65; IC95%: 0,48-0,82). Para muitos pacientes houve discrepâncias clinicamente relevantes no percentual de perda de peso, circunferência do braço, prega cutânea tricipital e circunferência muscular do braço. Embora estatisticamente a reprodutibilidade dos métodos antropométricos tenha sido boa, deve-se ser prudente ao empregá-los no contexto hospitalar, visto as diferenças encontradas, em especial na antropometria do braço e na Avaliação Nutricional Subjetiva Global.