Políticas de descentralização e desenvolvimento da educação em saúde

How the policy of action and professional standards have influenced the development and decentralization of health education is discussed. It is concluded that a review of policies both of developing as well as of developed countries could help to put some observations into a perspective that is closer to the Brazilian reality.Discute-se como a política de ação e os padrões profissionais têm influenciado o desenvolvimento e a descentralização da Educação em Saúde. Conclui-se que estudos sobre política de ação em países desenvolvidos e em desenvolvimento contribuem para observações a partir de uma perspectiva mais próxima à realidade brasileira

Building capacity for evidence-based public health: Reconciling the pulls of practice and the push of research

Timely implementation of principles of evidence-based public health (EBPH) is critical for bridging the gap between discovery of new knowledge and its application. Public health organizations need sufficient capacity (the availability of resources, structures, and workforce to plan, deliver, and evaluate the preventive dose of an evidence-based intervention) to move science to practice. We review principles of EBPH, the importance of capacity building to advance evidence-based approaches, promising approaches for capacity building, and future areas for research and practice. Although there is general agreement among practitioners and scientists on the importance of EBPH, there is less clarity on the definition of evidence, how to find it, and how, when, and where to use it. Capacity for EBPH is needed among both individuals and organizations. Capacity can be strengthened via training, use of tools, technical assistance, assessment and feedback, peer networking, and incentives. Modest investments in EBPH capacity building will foster more effective public health practice

Stroop Interference in a Delayed Match-To-Sample Task: Evidence for Semantic Competition

Discussions of the source of the Stroop interference effect continue to pervade the literature. Semantic competition posits that interference results from competing semantic activation of word and color dimensions of the stimulus prior to response selection. Response competition posits that interference results from competing responses for articulating the word dimension vs. the color dimension at the time of response selection. We embedded Stroop stimuli into a delayed match-to-sample (DMTS) task in an attempt to test semantic and response competition accounts of the interference effect. Participants viewed a sample color word in black or colored fonts that were ongruent or incongruent with respect to the color word itself. After a 5 s delay, participants were presented with two targets (i.e., a match and a foil) and were instructed to select the correct match. We probed each dimension independently during target presentations via color targets (i.e., two colors) or word targets (i.e., two words) and manipulated whether the semantic content of the foil was related to the semantic content of the irrelevant sample dimension (e.g., word sample “red” in blue font with the word “red” as the match and the word “blue” as the foil). We provide evidence for Stroop interference such that response times (RTs) increased for incongruent trials even in the presence of a response option with semantic content unrelated to the semantic content of the irrelevant sample dimension. Accuracy also deteriorated during the related foil trials. A follow-up experiment with a 10 s delay between sample and targets replicated the results. Results appear to provide converging evidence for Stroop interference in a DMTS task in a manner that is consistent with an explanation based upon semantic competition and inconsistent with an explanation based upon response competition

Practice-Based Evidence and the Need for More Diverse Methods and Sources in Epidemiology, Public Health and Health Promotion

Using practice-based evidence from the field to adapt evidence-based practices in guiding interventions in health promotion and public health has gained some traction in recent years. Although there are multiple sources of practice-based evidence, three—participatory research and Practice-Based Research Networks, systematic reviews and systems science—comprise the most promising potential candidates for collecting and analyzing organized evidence that demonstrates relevance, applicability or generalizability, and effectiveness. This paper argues for generating more diversity and complementarity in the methods and sources of evidence for epidemiology, public health and health promotion, if we are to improve population health and eliminate health disparities

Diffusion theory and knowledge dissemination, utilization and integration

Many accomplishments of public health have been distributed unevenly among populations. This article reviews the concepts of applying evidence-based practice in public health in the face of the varied cultures and circumstances of practice in these varied populations. Key components of EBPH include: making decisions based on the best available scientific evidence, using data and information systems systematically, applying program planning frameworks, engaging the community and practitioners in decision making, conducting sound evaluation, and disseminating what is learned. The usual application of these principles has overemphasized the scientific evidence as the starting point, whereas this review suggests engaging the community and practitioners as an equally important starting point to assess their needs, assets and circumstances, which can be facilitated with program planning frameworks and use of local assessment and surveillance data

Upending the Social Ecological Model to Guide Health Promotion Efforts Toward Policy and Environmental Change

Efforts to change policies and the environments in which people live, work, and play have gained increasing attention over the past several decades. Yet health promotion frameworks that illustrate the complex processes that produce health-enhancing structural changes are limited. Building on the experiences of health educators, community activists, and community-based researchers described in this supplement and elsewhere, as well as several political, social, and behavioral science theories, we propose a new framework to organize our thinking about producing policy, environmental, and other structural changes. We build on the social ecological model, a framework widely employed in public health research and practice, by turning it inside out, placing health-related and other social policies and environments at the center, and conceptualizing the ways in which individuals, their social networks, and organized groups produce a community context that fosters healthy policy and environmental development. We conclude by describing how health promotion practitioners and researchers can foster structural change by (1) conveying the health and social relevance of policy and environmental change initiatives, (2) building partnerships to support them, and (3) promoting more equitable distributions of the resources necessary for people to meet their daily needs, control their lives, and freely participate in the public sphere

Differences Between The Optical/Uv Spectra Of X-Ray Bright And X-Ray Faint QSOs

We contrast measurements of composite optical and ultraviolet (UV) spectra constructed from samples of QSOs defined by their soft X-ray brightness. X-ray bright (XB) composites show stronger emission lines in general, but particularly from the narrow line region. The difference in the [OIII]/Hbeta ratio is particularly striking, and even more so when blended FeII emission is properly subtracted. The correlation of this ratio with X-ray brightness were principal components of QSO spectral diversity found by Boroson & Green (1992). We find here that other, much weaker narrow optical forbidden lines ([OII] and NeV) are enhanced by factors of 2 to 3 in our XB composites, and that narrow line emission is also strongly enhanced in the XB UV composite. Broad permitted line fluxes are slightly larger for all XB spectra, but the narrow/broad line ratio stays similar or increases strongly with X-ray brightness for all strong permitted lines except Hbeta. Spectral differences between samples divided by their relative X-ray brightness (as measured by alpha_{ox}) exceed those seen between complementary samples divided by luminosity or radio loudness. We propose that the Baldwin effect may be a secondary correlation to the primary relationship between alpha_{ox} and emission line equivalent width. We conclude that either 1) equivalent width depends strongly on the SHAPE of the ionizing continuum, as crudely characterized here by alpha_{ox} or 2) both equivalent width and alpha_{ox} are related to some third parameter characterizing the QSO physics. One such possibility is intrinsic warm absorption; a soft X-ray absorber situated between the broad and narrow line regions can successfully account for many of the properties observed.Comment: 16 pages including 3 figures, AAS latex, plus 4 tables totaling 5 pages, to appear in ApJ Vol. 498, May 1, 199