DESENVOLVIMENTO DE CONSÓRCIOS REGIONAIS E REDES SOCIAIS PARA O URBANISMO SAUDÁVEL

Introdução: Envolver diferentes setores no planejamento urbano, considerar os interesses coletivos, bem como a participação social e a cooperação intersetorial tem sido premissa básica para a governança urbana,  especialmente quando envolve o desenvolvimento de espaços urbanos saudáveis. Objetivo: Descrever estudos de casos Brasileiro e Canadense que exemplificam através da capacidade coletiva e da intersetorialidade, a construção do planejamento urbano saudável. Metodologia: Descrição de dois estudos de casos. Consulta de documentos técnicos e oficiais que ressaltem a capacitação das redes sócio-técnicas e mecanismos de participação social para as políticas públicas. Identificação dos facilitadores que interfeririam na implementação do urbano saudável por meio do acompanhamento e observação dos projetos. Foram utilizados mapas de desejos da comunidade e o desenvolvimento de consórcio e rede, identificando-se os aspectos convergentes. Resultados: demonstraram a importância de facilitar as oportunidades de participação, conforme especificidades locais e na tomada de decisão dos gestores para o urbano saudável. Conclusão: consórcios e redes asseguram espaços inclusivos e promovem governança para o planejamento urbano saudável

Taking account of context in population health intervention research: guidance for producers, users and funders of research

Population health intervention research (PHIR) seeks to develop and evaluate policies, programmes and other types of interventions that may affect population health and health equity. Such interventions are strongly influenced by context – taken to refer to any feature of the circumstances in which an intervention is conceived, developed, implemented and evaluated. Understanding how interventions relate to context is critical to understanding how they work; why they sometimes fail; whether they can be successfully adapted, scaled up or translated from one context to another; why their impacts vary; and how far effects observed in one context can be generalised to others. Concerns that context has been neglected in research to develop and evaluate population health interventions have been expressed for at least 20 years. Over this period, an increasingly comprehensive body of guidance has been developed to help with the design, conduct, reporting and appraisal of PHIR. References to context have become more frequent in recent years, as interest has grown in complex and upstream interventions, systems thinking and realist approaches to evaluation, but there remains a lack of systematic guidance for producers, users and funders of PHIR on how context should be taken into account. This document draws together recent thinking and practical experience of addressing context within PHIR. It provides a broad, working definition of context and explains why and how context is important to PHIR. It identifies the dimensions of context that are likely to shape how interventions are conceptualised, the impacts that they have and how they can be implemented, translated and scaled up. It suggests how context should be taken into account throughout the PHIR process, from priority setting and intervention development to the design and conduct of evaluations and reporting, synthesis and knowledge exchange. It concludes by summarising the key messages for producers, users and funders of PHIR and suggesting priorities for future research. The document is meant to be used alongside existing guidance for the development, evaluation and reporting of population health interventions. We expect the guidance to evolve over time, as practice changes in the light of the guidance and experience accumulates on useful approaches. The work was funded by the Canadian Institutes of Health Research (www.cihr-irsc.gc.ca) – Institute of Population and Public Health (CIHR-IPPH) and the UK National Institute for Health Research (NIHR)

The Privileged Normalization of Marijuana Use – an Analysis of Canadian Newspaper Reporting, 1997–2007

The objective of this study was to systematically examine predominant themes within mainstream media reporting about marijuana use in Canada. To ascertain the themes present in major Canadian newspaper reports, a sample (N = 1999) of articles published between 1997 and 2007 was analyzed. Drawing from Manning’s theory of the symbolic framing of drug use within media, it is argued that a discourse of ‘privileged normalization’ informs portrayals of marijuana use and descriptions of the drug’s users. Privileged normalization implies that marijuana use can be acceptable for some people at particular times and places, while its use by those without power and status is routinely vilified and linked to deviant behavior. The privileged normalization of marijuana by the media has important health policy implications in light of continued debate regarding the merits of decriminalization or legalization and the need for public health and harm reduction approaches to illicit drug use

Correlates of Performance of Healthcare Workers in Emergency, Triage, Assessment and Treatment plus Admission Care (ETAT+) Course in Rwanda: Context Matters.

BACKGROUND:The Emergency, Triage, Assessment and Treatment plus Admission care (ETAT+) course, a comprehensive advanced pediatric life support course, was introduced in Rwanda in 2010 to facilitate the achievement of the fourth Millennium Development Goal. The impact of the course on improving healthcare workers (HCWs) knowledge and practical skills related to providing emergency care to severely ill newborns and children in Rwanda has not been studied. OBJECTIVE:To evaluate the impact of the ETAT+ course on HCWs knowledge and practical skills, and to identify factors associated with greater improvement in knowledge and skills. METHODS:We used a one group, pre-post test study using data collected during ETAT+ course implementation from 2010 to 2013. The paired t-test was used to assess the effect of ETAT+ course on knowledge improvement in participating HCWs. Mixed effects linear and logistic regression models were fitted to explore factors associated with HCWs performance in ETAT+ course knowledge and practical skills assessments, while accounting for clustering of HCWs in hospitals. RESULTS:374 HCWs were included in the analysis. On average, knowledge scores improved by 22.8/100 (95% confidence interval (CI) 20.5, 25.1). In adjusted models, bilingual (French & English) participants had a greater improvement in knowledge 7.3 (95% CI 4.3, 10.2) and higher odds of passing the practical skills assessment (adjusted odds ratio (aOR) = 2.60; 95% CI 1.25, 5.40) than those who were solely proficient in French. Participants who attended a course outside of their health facility had higher odds of passing the skills assessment (aOR = 2.11; 95% CI 1.01, 4.44) than those who attended one within their health facility. CONCLUSIONS:The current study shows a positive impact of ETAT+ course on improving participants' knowledge and skills related to managing emergency pediatric and neonatal care conditions. The findings regarding key factors influencing ETAT+ course outcomes demonstrate the importance of considering key contextual factors (e.g., language barriers) that might affect HCWs performance in this type of continuous medical education

Dispensation of antiretroviral therapy and methadone maintenance therapy at the same facility in a low‐barrier setting linked to optimal adherence to HIV treatment

Objectives: We sought to examine the association between dispensation of methadone maintenance therapy (MMT) and antiretroviral therapy (ART) at the same facility, across multiple low-barrier dispensing outlets, and achieving optimal adherence to ART among people who use illicit drugs (PWUD). Methods: We used data from the AIDS Care Cohort to Evaluate Exposure to Survival Services (ACCESS) study, a long-running study of a community-recruited cohort of HIV-positive PWUD, linked to comprehensive HIV clinical records in Vancouver, Canada, a setting of no-cost, universal access to HIV care. The longitudinal relationship between MMT-ART dispensation at the same facility and the odds of ≥ 95% ART adherence was analysed using multivariable generalized linear mixed-effects modelling. We conducted a further analysis using a marginal structural mode with inverse probability of treatment weights as a sensitivity analysis. Results: This study included data on 1690 interviews of 345 ART- and MMT-exposed participants carried out between June 2012 and December 2017. In the final multivariable model, MMT-ART dispensation, compared with nondispensation at the same facility, was associated with greater odds of achieving ≥ 95% adherence [adjusted odds ratio (AOR) 1.56; 95% confidence interval (CI) 1.26–1.96]. A marginal structural model estimated a 1.48 (95% CI 1.15–1.80) greater odds of ≥ 95% adherence among participants who reported MMT-ART dispensation at the same facility compared with those who did not. Conclusions: The odds of achieving optimal adherence to ART were 56% higher during periods in which MMT and ART medications were dispensed at the same facility, in a low-barrier setting. Our findings highlight the need to consider a simpler integrated approach with medication dispensation at the same facility in low-threshold settings. © 2019 British HIV Associatio

ETAT+ course content.

<p>ETAT+ course content.</p

Performance on Knowledge and Practical Skills Assessments.

<p>Performance on Knowledge and Practical Skills Assessments.</p

Rate of failure per each criterion assessed in the scenario on neonatal resuscitation.

<p>BVM, bag valve mask.</p

Rate of failure per each criterion assessed in the scenario on management of shock due to dehydration.

<p>CRT, capillary refill time; IO, intra-osseous; NP, neutral position; PP, peripheral pulse; TG, temperature gradient; LOC, level of consciousness; RD, respiratory distress.</p