A saúde persecutória : os limites da responsabilidade

Os autores, ao cunharem a expressão ´saúde persecutória´, discutem a “complexa tarefa de avaliar a real efetividade das propostas individualistas hegemônicas de promoção em saúde centradas em evidências científicas” e as conseqüências de uma concepção de promoção e prevenção em saúde que, coerente com o liberalismo, minimiza a dimensão pública da responsabilidade pela saúde dos indivíduos

‘A synergy model of health’ - an integration of salutogenesis and the health assets model

This article proposes to advance the connections between salutogenic theory and assets models for health improvement. There is a need to integrate their use in public health and health promotion so that their respective potentials can be fully developed. This requires their synergies to be made more explicit so that a more coherent approach can be taken to their utilization. A mechanism is therefore needed that helps to raise awareness of them and their value as a resource together. Bronfenbrenner’s bioecological theory provides one framework that can support better integration of salutogenesis with the applied nature of assets-based models. This paper proposes a new ‘synergy model for health’ that integrates key concepts associated with salutogenic theory—generalized and specific resistance resources (GRRs/SRRs) and generalized and specific resistance deficits and the sense of coherence (SOC). In doing so, it highlights those GRRs and SRRs which are assets that, either individually or collectively, help to develop a stronger SOC. Higher levels of SOC can then support the transformations of potential resources into available assets (that people can understand, manage and make sense of), capable of producing positive health development. The proposed ‘Synergy model of health’ aims to contribute to a deeper theoretical understanding of health and development through the integration of the key elements of both salutogenesis and assets models. This can facilitate a better contextualization of the ideas into public health policy and practice by making the salutogenic theory more action-oriented and the assets model more theoretical.This paper is supported by the Vice-Rectory for Research and Development, University of Concepción (VRID 217.089.007-1.0IN)

Clinical pathway intervention compliance and effectiveness when used in the treatment of patients with severe sepsis and septic shock at an Intensive Care Unit in Spain

The purpose of this quasi-experimental study was to assess levels of compliance with the intervention bundles contained in a clinical pathway used in the treatment of patients with severe sepsis and septic shock, and to analyze the pathway's impact on survival and duration of hospital stays. We used data on 125 patients in an Intensive Care Unit, divided into a control group (N=84) and an intervention group (N=41). Levels of compliance increased from 13.1% to 29.3% in 5 resuscitation bundle interventions and from 14.3% to 22% in 3 monitoring bundle interventions. In-hospital mortality at 28 days decreased by 11.2% and the duration of hospital stay was reduced by 5 days. Although compliance was low, the intervention enhanced adherence to the instructions given in the clinical pathway and we observed a decline in mortality at 28 days and shorter hospital stays.El objetivo de este estudio cuasiexperimental fue valorar el nivel de cumplimiento de las intervenciones de los paquetes de medidas de un protocolo clínico para pacientes con sepsis grave y shock séptico y analizar su impacto sobre la supervivencia y la duración de estancias hospitalarias. Se incluyeron los datos de 125 pacientes divididos en grupo control (N=84) e intervención (N=41) de una Unidad de Cuidados Intensivos. El nivel de cumplimiento aumentó de 13,1% a 29,3% en 5 intervenciones del paquete de reanimación y de 14,3% a 22% en 3 intervenciones del paquete de seguimiento. La mortalidad hospitalaria a los 28 días disminuyó un 11,2% y la duración de la estancia hospitalaria se redujo en 5 días. Aunque el cumplimiento fue bajo, la intervención aumentó la adhesión a las indicaciones del protocolo clínico y se observó un descenso de la mortalidad a los 28 días y menor duración de estancias hospitalarias.O objetivo deste estudo quase-experimental foi avaliar o grau de cumprimento das intervenções de um pacote de medidas, em um protocolo clínico proposto para pacientes com sepse grave e choque séptico, e analisar o seu impacto na sobrevivência e duração das permanências hospitalares. Foram incluídos 125 pacientes, alocados no grupo controle (n=84) e intervenção (n=41) de uma Unidade de Cuidados Intensivos, na Espanha. O nível de adesão aumentou em pelo menos 5 intervenções do pacote de reanimação (de 13,1 para 29,3%) e em pelo menos 3 intervenções do pacote de acompanhamento (de 14,3 para 22%). A mortalidade hospitalar aos 28 dias diminuiu em 11,2% e a duração da permanência hospitalar foi reduzida em 5 dias. Embora o cumprimento tenha sido baixo, a intervenção aumentou a adesão às indicações do protocolo clínico e foram observadas queda da mortalidade aos 28 dias e menor duração da permanência hospitalar

Looking twice at the gender equity index for public health impact.

Background: It has been shown that gender equity has a positive impact on the everyday activities of people (decision making, income allocation, application and observance of norms/rules) which affect their health. Gender equity is also a crucial determinant of health inequalities at national level; thus, monitoring is important for surveillance of women’s and men’s health as well as for future health policy initiatives. The Gender Equity Index (GEI) was designed to show inequity solely towards women. Given that the value under scrutiny is equity, in this paper a modified version of the GEI is proposed, the MGEI, which highlights the inequities affecting both sexes. Methods: Rather than calculating gender gaps by means of a quotient of proportions, gaps in the MGEI are expressed in absolute terms (differences in proportions). The Spearman’s rank coefficient, calculated from country rankings obtained according to both indexes, was used to evaluate the level of concordance between both classifications. To compare the degree of sensitivity and obtain the inequity by the two methods, the variation coefficient of the GEI and MGEI values was calculated. Results: Country rankings according to GEI and MGEI values showed a high correlation (rank coef. = 0.95). The MGEI presented greater dispersion (43.8%) than the GEI (19.27%). Inequity towards men was identified in the education gap (rank coef. = 0.36) when using the MGEI. According to this method, many countries shared the same absolute value for education but with opposite signs, for example Azerbaijan (−0.022) and Belgium (0.022), reflecting inequity towards women and men, respectively. This also occurred in the empowerment gap with the technical and professional job component (Brunei:-0.120 vs. Australia, Canada Iceland and the U.S.A.: 0.120). Conclusion: The MGEI identifies and highlights the different areas of inequities between gender groups. It thus overcomes the shortcomings of the GEI related to the aim for which this latter was created, namely measuring gender equity, and is therefore of great use to policy makers who wish to understand and monitor the results of specific equity policies and to determine the length of time for which these policies should be maintained in order to correct long-standing structural discrimination against women

Policy options for obesity in Europe: a comparison of public health specialists with other stakeholders

Objective: To explore policy options that public health specialists (PHS) consider appropriate for combating obesity in Europe, and compare their preferences with those of other stakeholders (non-PHS). Design: Structured interviews using multicriteria mapping, a computer-based, decision-support tool. Setting: Nine European countries. Subjects: A total of 189 stakeholders. Twenty-seven interviewees were PHS and non-PHS included food, sports and health sectors. Measurements: A four-step approach was taken, i.e. selecting options, defining criteria, scoring options quantitatively and weighting the criteria to provide overall rankings of options. Interviews were recorded and transcribed to yield qualitative data. Results: The PHS concur with other stakeholders interviewed, as all emphasised the importance of educational initiatives in combating obesity, followed by policies to improve community sports facilities, introduce mandatory food labelling and controlling food and drink advertising. Further analyses revealed several significant differences. The non-PHS from the private sector ranked institutional reforms favourably; the PHS from non-Mediterranean countries supported the option of medicines to prevent obesity; and those PHS from Mediterranean countries endorsed the use of activity monitoring devices such as pedometers. As far as appraisal criteria were concerned, PHS considered efficacy and the economic impact on the public sector to be the most important. Conclusion: There is clear consensus among PHS and other stakeholders concerning the need for a package of policy options, which suggests that European-wide implementation could be successful. However, it would be advisable to avoid more contentious policy options such as taxation until future changes in public opinion.New and Emerging Science and Technology (NEST) research programme (European Union)

Punching above their weight: A network to understand broader determinants of increasing life expectancy

Background: Life expectancy initially improves rapidly with economic development but then tails off. Yet, at any level of economic development, some countries do better, and some worse, than expected - they either punch above or below their weight. Why this is the case has been previously researched but no full explanation of the complexity of this phenomenon is available. New research network: In order to advance understanding, the newly formed Punching Above Their Weight Research Network has developed a model to frame future research. It provides for consideration of the following influences within a country: political and institutional context and history; economic and social policies; scope for democratic participation; extent of health promoting policies affecting socio-economic inequities; gender roles and power dynamics; the extent of civil society activity and disease burdens. Conclusion: Further research using this framework has considerable potential to advance effective policies to advance health and equity.Flinders University provided a capacity building grant to support the research reported in this paper

Punching above their weight: a network to understand broader determinants of increasing life expectancy

BACKGROUND: Life expectancy initially improves rapidly with economic development but then tails off. Yet, at any level of economic development, some countries do better, and some worse, than expected – they either punch above or below their weight. Why this is the case has been previously researched but no full explanation of the complexity of this phenomenon is available. NEW RESEARCH NETWORK: In order to advance understanding, the newly formed Punching Above Their Weight Research Network has developed a model to frame future research. It provides for consideration of the following INFLUENCES WITHIN A COUNTRY: political and institutional context and history; economic and social policies; scope for democratic participation; extent of health promoting policies affecting socio-economic inequities; gender roles and power dynamics; the extent of civil society activity and disease burdens. CONCLUSION: Further research using this framework has considerable potential to advance effective policies to advance health and equity

GACETA SANITARIA in 2017. Improving the quality of our journal

Empezamos este año 2018 con nuestra Nota editorial anual, en la cual pretendemos compartir con los/las lectores/as, personas autoras y la sociedad la actividad realizada por el equipo editorial de la revista a lo largo del año anterior. El documento también permite analizar los avances y las áreas de mejora en marcha de la revista. A continuación, presentaremos brevemente las actividades realizadas durante el año 2017, así como la información sobre el desempeño de la revista. Muchas de estas actividades se ven reflejadas también en el blog del comité editorial de Gaceta Sanitaria

GACETA SANITARIA in 2018. Strengthening the presence in Latin America and promoting the publication of essential issues for the National Health System

Una vez más, presentamos el informe de la actividad realizada por el equipo editorial a lo largo del año anterior y los datos de desempeño de la revista, con el fin de rendir cuentas a nuestros/as lectores/as, a las personas socias de SESPAS y a la sociedad. El documento permite analizar los avances y las áreas de mejora de la revista, así como los logros alcanzados más relevantes. Este año queremos destacar el fortalecimiento de la presencia en Latinoamérica y la promoción de la publicación de temas esenciales para el Sistema Nacional de Salud