86 results
Search Results
2. [Letter to the Editors on the paper by Melo et al.]
- Author
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Machado LZ and Marcon CEM
- Subjects
- Brazil, Humans, Pharmacovigilance, SARS-CoV-2, COVID-19, Drug-Related Side Effects and Adverse Reactions
- Published
- 2021
- Full Text
- View/download PDF
3. Debate on the paper by Diez Roux
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Paulo Saldiva, Nilmara de Oliveira Alves, and Mariana Veras
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Medicine ,Public aspects of medicine ,RA1-1270 - Published
- 2015
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- View/download PDF
4. Debate sobre o artigo de Gadelha.
- Author
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Escorel, Sarah
- Published
- 2015
- Full Text
- View/download PDF
5. Comment on the paper by Pitanguy
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Florencia Luna
- Subjects
Medicine ,Public aspects of medicine ,RA1-1270 - Published
- 2016
- Full Text
- View/download PDF
6. Carta às Editoras sobre o artigo de Melo et al.
- Author
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Zumblick Machado, Lia and Mendes Marcon, Chaiana Esmeraldino
- Published
- 2021
- Full Text
- View/download PDF
7. Comentários sobre o artigo de Almeida Filho.
- Author
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Dussault, Gilles, de Aguiar, Adriana Cavalcanti, Tuttman, Malvina Tania, and Filho, Naomar Almeida
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- 2014
- Full Text
- View/download PDF
8. Carta às Editoras sobre o artigo de Cardoso et al.
- Author
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Carla Soares, Beatriz, Belarminda Blasius, Katia Regina, Mendes Marcon, Chaiana Esmeraldino, and Francisco Marcelino, Liete
- Abstract
Purpose: The paper analyses two current topics in sport economics research and their relationship. Looking at the past 25 years and 21 countries as well as leagues in European football, it is worth looking for the answer to the question of whether there is causality between international competitiveness and competitive balance. In other words, whether an increase in the balance of the national league (namely in excitement) causes the development (better performance of the national team) of a given country's football or this causality is reversed. Methodology: By measuring the extent of competitive balance and identifying the measure of competitiveness, the Granger causality was tested to analyse the relationship of the UEFA country coefficient, the FIFA World Ranking and the Herfindahl ratio of competitive balance (HRCB). Findings: Based on the estimation and testing of vector autoregressions in panel data, it can be stated that the FIFA World Ranking Granger-causes HRCB. Better sports performance of a country's national team indicates that a given league will also be appreciated, meaning that better and better players will arrive in a better and better league, which will attract more exciting games, so a decrease can be observed in competitive balance. Research limitations: The study focused on only two indicators of competitiveness, so it is worth examining causality with more measures in the future. Value: From a management perspective, it is believed that the boards of leagues should consider the results presented in this study, such as that better presence of the national team will make the league more balanced, which will lead to a rise in demand. [ABSTRACT FROM AUTHOR]
- Published
- 2020
- Full Text
- View/download PDF
9. [Letter to the Editors on the paper by Cardoso et al.]
- Author
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Soares BC, Blasius KRB, Marcon CEM, and Marcelino LF
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- Brazil, Female, Humans, Pregnancy, Abortion, Induced
- Published
- 2020
- Full Text
- View/download PDF
10. Debate sobre o artigo de von Zuben & Donalísio.
- Author
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Sierra Romero, Gustavo Adolfo
- Published
- 2016
- Full Text
- View/download PDF
11. Debate on the paper by Diez Roux
- Author
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Carlos Dora
- Subjects
Medicine ,Public aspects of medicine ,RA1-1270 - Published
- 2015
- Full Text
- View/download PDF
12. Debate on the paper by Diez Roux
- Author
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Marilia Sá Carvalho
- Subjects
Medicine ,Public aspects of medicine ,RA1-1270 - Published
- 2015
- Full Text
- View/download PDF
13. Debate on the paper by Diez Roux
- Author
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Sandro Galea
- Subjects
Medicine ,Public aspects of medicine ,RA1-1270 - Published
- 2015
- Full Text
- View/download PDF
14. Debate on the paper by Diez Roux
- Author
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Anthony Capon and José Siri
- Subjects
Medicine ,Public aspects of medicine ,RA1-1270 - Published
- 2015
- Full Text
- View/download PDF
15. Comentário sobre o artigo de Freitas et al.
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do Carmo Leal, Maria, Freitas, Paulo Fontoura, Moreira, Bianca Carvalho, Manoel, Andre Luciano, and Albuquerque Botura, Ana Clara de
- Published
- 2015
- Full Text
- View/download PDF
16. Debate on the paper by Diez Roux
- Author
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Gérard Salem
- Subjects
Medicine ,Public aspects of medicine ,RA1-1270 - Published
- 2015
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- View/download PDF
17. Debate on the paper by Guimarães
- Author
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Carlos Medicis Morel
- Subjects
Medicine ,Public aspects of medicine ,RA1-1270 - Published
- 2014
- Full Text
- View/download PDF
18. Debate on the paper by Costa e Silva et al.
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Johns P
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- 2017
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19. Debate on the paper by Costa e Silva et al.
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Guimarães R
- Published
- 2017
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20. Debate sobre o artigo de von Zuben & Donalísio.
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da Luz, Zélia M. Profeta
- Published
- 2016
- Full Text
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21. [Notes on the paper by Paulo Gadelha].
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Costa AM
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- Humans, Congresses as Topic, National Health Programs trends, Public Policy
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- 2015
- Full Text
- View/download PDF
22. [Comment on the paper by Freitas et al].
- Author
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Leal Mdo C
- Subjects
- Female, Humans, Pregnancy, Cesarean Section economics, Cesarean Section statistics & numerical data
- Published
- 2015
- Full Text
- View/download PDF
23. [Comments on the paper by Almeida Filho].
- Author
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Dussault G
- Subjects
- Education, Medical history, Health Education history
- Published
- 2014
- Full Text
- View/download PDF
24. Comment on the papers by Carles Muntaner and Graça Druck.
- Author
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Carsalade Martins, Maria Inês
- Abstract
The article discusses aspects of the papers by Carles Muntaner and Graça Druck focusing on the process of flexibilization of labor relations from the 1980s and its impact on workers' health.
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- 2016
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25. Desafios à intersetorialidade no cuidado das crianças com deficiência na perspectiva de profissionais da educação.
- Author
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Nascimento da Silva, Lenir, de Souza Dias, Francine, de Freitas Lenzi, Márcia, and da Silva Costa, Izabelle
- Abstract
Copyright of Cadernos de Saude Publica is the property of Escola Nacional de Saude Publica Sergio Arouca and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
- Published
- 2022
- Full Text
- View/download PDF
26. "Cesárea? Não, Obrigada!": ativismo em uma comunidade online na busca pelo parto normal no Brasil.
- Author
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Macedo Hugues, Gabriela and Heilborn, Maria Luiza
- Abstract
Copyright of Cadernos de Saude Publica is the property of Escola Nacional de Saude Publica Sergio Arouca and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
- Published
- 2021
- Full Text
- View/download PDF
27. Meeting the complex challenge of health and social care provision for rapidly-ageing populations: introducing the concept of 'avoidable displacement from home'
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Peter Lloyd-Sherlock, Jenny Billings, Janaína de Souza Aredes, João Bastos Freire Neto, Ana Amélia Camarano, João Macedo Coelho Filho, Josélia Oliveira Araújo Firmo, Alexandre Kalache, James Macinko, Lucas Sempé, and Karla Cristina Giacomin
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Aged ,Intersectoral Collaboration ,Comprehensive Health Care ,Hospitalization ,Medicine ,Public aspects of medicine ,RA1-1270 - Abstract
Abstract: The increasing numbers of people at very old ages pose specific policy challenges for health and social care and highlight the need to rethink established models of service provision. The main objective of this paper is to introduce the concept of “avoidable displacement from home” (ADH). The study argues that ADH builds on and adds value to existing concepts, offering a holistic, person-centered framework for integrated health and social care provision for older people. It also demonstrates that this framework can be applied across different levels, ranging from macro policymaking to organizational and individual decision-making. The paper pays attention to the Brazilian context but argues that ADH is a universally applicable concept.
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- 2020
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28. Implementation of strategies and programs for breastfeeding, complementary feeding, and malnutrition of young children in Brazil: advances and challenges
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Sonia Isoyama Venancio and Gabriela Buccini
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Breastfeeding ,Complementary Feeding ,Malnutrition ,Nutrition Programs ,Unified Health System ,Medicine ,Public aspects of medicine ,RA1-1270 - Abstract
Abstract: Malnutrition in all its forms has risen on global agendas due to the recognition of its magnitude and consequences for a wide range of human, social, and economic outcomes. Implementing strategies and programs with the needed scale and quality is a major challenge. The Brazilian National Survey on Child Nutrition (ENANI-2019) pointed out several advances but numerous challenges. In this paper, we reflect on the implementation progress of breastfeeding, complementary feeding and young children malnutrition strategies and programs in Brazil and how existing challenges can be overcome through the lens of implementation science. First, we present a brief history of such programs. Second, we selected two breastfeeding initiatives to illustrate and reflect on common implementation challenges. In these case studies, we used the RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) framework to analyze the implementation and scaling up barriers and facilitators. We found common barriers related to unclear goals about the reach of programs, challenges in assessing effectiveness and fidelity/quality during the real-world implementation, discontinuation or lack of funding, and lack of monitoring and evaluation impacting the sustainability of programs. We also discuss the use of implementation science to achieve adequate nutrition by 2030 and present critical elements for successful scale implementation of nutrition programs based on global evidence. Despite the investment to implement different actions aimed at facing infant feeding and malnutrition, high-quality implementation research must become a priority to catalyze progress in Brazil.
- Published
- 2023
- Full Text
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29. Health in cities: is a systems approach needed?
- Author
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Ana V. Diez Roux
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Desigualdades en la Salud ,Determinantes Sociales de la Salud ,Ciudades ,Salud Urbana ,Medicine ,Public aspects of medicine ,RA1-1270 - Abstract
Abstract This paper reviews the potential utility of using the concepts and tools of systems to understand and act on health in cities. The basic elements of systems approaches and the links between cities as systems and population health as emerging from the functioning of a system are reviewed. The paper also discusses implications of systems thinking for urban health including the development of dynamic conceptual models, the use of new tools, the integration of data in new ways and the identification of data gaps, and the formulation of different kinds of questions and identification of new policies. The paper concludes with a review of caveats and challenges.
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- 2015
- Full Text
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30. The social construction of the PrEP1519 study: conditions of possibility for advances in HIV/AIDS prevention
- Author
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Sandra Garrido de Barros, Sandra Assis Brasil, and Thais Regis Aranha Rossi
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Pre-Exposure Prophylaxis ,Teenagers ,Acquired Immunodeficiency Syndrome ,Public Health Policies ,Medical Sociology ,Medicine ,Public aspects of medicine ,RA1-1270 - Abstract
This paper analyzed the genesis of the PrEP1519 study and feasibility conditions for its construction. A qualitative-approach study was conducted using the Bourdieusian sociology framework to reconstruct the dynamics of the social environment where PrEP1519 emerged during 2015-2018. A document analysis and ten in-depth interviews were carried out to analyze the trajectory of the project. Pre-exposure prophylaxis (PrEP) was introduced in Brazil as a public policy in 2017. The lack of scientific evidence available among the adolescent population led to the development of a demonstrative cohort study, associated with an intervention, aimed at combining the prevention and treatment of sexually transmitted infections at three sites in Brazil. PrEP1519 sought to generate evidence for global use and to help the Brazilian Ministry of Health apply PrEP among adolescents. The articulation of bureaucratic, scientific, and activist stakeholders enabled this study. The feasibility conditions for developing PrEP1519 included a favorable relationship of national organizations with international organizations, the favorable approach that public administrators had at the time towards new technologies and prevention strategies, the researchers’ previous experience in studies with the target population or with PrEP, articulation efforts with social movements, civil society organizations, and other public agencies, and the integration between scientific institutions, which allowed using international resources and developing a response to the problem. Completing this study at a moment when conservatism advances in Brazil demands that the scientific community and activists closely monitor and take stances on PrEP to ensure its availability for adolescents as a public policy.
- Published
- 2023
- Full Text
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31. Diferenciais de mortalidade entre indígenas e não indígenas no Brasil com base no Censo Demográfico de 2010.
- Author
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de Campos, Marden Barbosa, Mendes Borges, Gabriel, Lanza Queiroz, Bernardo, and Ventura Santos, Ricardo
- Abstract
Copyright of Cadernos de Saude Publica is the property of Escola Nacional de Saude Publica Sergio Arouca and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
- Published
- 2017
- Full Text
- View/download PDF
32. Understanding alcohol-related indicators from population surveys: answering the 'Five W’s of Epidemiology'
- Author
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Raquel Brandini De Boni
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Alcohol Drinking ,Binge Drinking ,Surveys and Questionnaires ,Epidemiological Monitoring ,Public Health Surveillance ,Medicine ,Public aspects of medicine ,RA1-1270 - Abstract
The harmful use of alcohol is a major risk factor for the global burden of disease, and public policies are the most effective strategies to prevent it. Population-based surveys are milestones for planning, implementing, and monitoring those policies. However, there are numerous ways to measure alcohol consumption which may result in different indicators. Researchers and stakeholders should find common ground in the understanding of these measures to avoid misinterpretation and confusion in the field. Answering to the “Five W’s Epidemiology”, when interpreting alcohol-related information, may improve the communication, as well as reproducibility and comparability of research findings. This paper aims to exemplify this approach by describing some indicators from the World Health Organization’s Global Information System on Alcohol and Health (GISAH) and the corresponding data available from the latest Brazilian household surveys. Notably, none of the Brazilian surveys reports on all the nine selected GISAH indicators, and only two provided the necessary methodological details to be fully reproducible. A stronger agenda is of the utmost importancefor advancing in the monitoring and prevention of alcohol-related harms in Brazil.
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- 2022
- Full Text
- View/download PDF
33. Construindo um "Brasil Sorridente"? Olhares sobre a implementação da Política Nacional de Saúde Bucal numa região de saúde do interior paulista.
- Author
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Aquilante, Aline Guerra and Aciole, Geovani Gurgel
- Abstract
Copyright of Cadernos de Saude Publica is the property of Escola Nacional de Saude Publica Sergio Arouca and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
- Published
- 2015
- Full Text
- View/download PDF
34. Saúde na Agenda de Desenvolvimento pós-2015 das Nações Unidas.
- Author
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Buss, Paulo Marchiori, de Paiva Magalhães, Danielly, Freitas Setti, Andréia Faraoni, Gallo, Edmundo, de Abreu Franco Netto, Francisco, Huet Machado, Jorge Mesquita, and Buss, Daniel Forsin
- Abstract
Copyright of Cadernos de Saude Publica is the property of Escola Nacional de Saude Publica Sergio Arouca and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
- Published
- 2014
- Full Text
- View/download PDF
35. Equivalência conceituai, de itens, semântica e operacional da versão brasileira do s-EMBU para aferição de práticas educativas parentais em adolescentes.
- Author
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Sampaio, Paula Florence, Moraes, Claudia Leite, and Reichenheim, Michael
- Abstract
Copyright of Cadernos de Saude Publica is the property of Escola Nacional de Saude Publica Sergio Arouca and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
- Published
- 2014
- Full Text
- View/download PDF
36. 'A little monster inside me that comes out now and again': endometriosis and pain in Austria
- Author
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Margret Jaeger, Manuela Gstoettner, and Ines Fleischanderl
- Subjects
Endometriosis ,Pain ,Qualitative Research ,Medicine ,Public aspects of medicine ,RA1-1270 - Abstract
Abstract: The topics of endometriosis and pain imply far-reaching problems for women’s health. Using a qualitative research approach, this paper addresses the subjective experience and effects of pain, the methods for dealing with these issues, and the needs of affected women in Austria. Data were collected by problem-focused interviews conducted with ten women suffering from endometriosis, which were later transcribed and subjected to qualitative content analysis. Findings are therefore described using content-related categories. Results show that negative thoughts and feelings like fear, despair, and anger are associated with endometriosis and pain. Moreover, predominantly negative impacts and changes are found in various areas of life, such as the well-being and psyche of those affected, their attitude towards life in general, partnerships, social life, leisure time and work-life balance. In dealing with endometriosis and pain, both Western biomedicine and complementary medicine treatments are used. Support from one’s inner circle of friends and exchange and interaction with others affected by the disease are seen to be invaluable. Attending physicians as well as patients themselves and their private, social, and working environment should encourage open communication about endometriosis and the related pain.
- Published
- 2022
- Full Text
- View/download PDF
37. The path of canine visceral leishmaniasis versus the path of Center for Zoonoses Control: contributions of spatial analysis to health
- Author
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Patricia Sayuri Silvestre Matsumoto, Edilson Ferreira Flores, José Seguinot Barbosa, Umberto Catarino Pessoto, José Eduardo Tolezano, Roberto Mitsuyoshi Hiramoto, Helena Hilomi Taniguchi, and Raul Borges Guimarães
- Subjects
Visceral Leishmaniasis ,Decision-Making ,Epidemiologic Surveillances ,Medicine ,Public aspects of medicine ,RA1-1270 - Abstract
Visceral leishmaniasis (VL) is a public health problem in Brazilian municipalities. As much as there is a planning of public policies regards VL in São Paulo State, new cases have been reported and spread. This paper aims to discuss how the Center for Zoonoses Control conducts its actions spatially in endemic city of Presidente Prudente, São Paulo State. Data are from the Municipal Health Department of Presidente Prudente, Adolfo Lutz Institute, and Brazilian Institute of Geography and Statistics. We spatially estimated the dog population per census tract and used geoprocessing tools to perform choropleth maps, spatial trends, and spatial autocorrelation. We found a spatial pattern of higher prevalence in the city’s outskirt and a positive statistically significant spatial autocorrelation (I = 0.2, p-value < 0.000) with clusters of high-high relationships in the Northwest part of the city. Moreover, we identified a different direction in the path of the conducted serosurveys versus the canine VL trend, which stresses the fragility of the Center for Zoonoses Control actions to control the disease. The Center for Zoonoses Control always seems to chase the disease. The spatial analysis may be useful for rethinking how the service works and helps in public policies.
- Published
- 2022
- Full Text
- View/download PDF
38. Pharmaceutical patent term extension and patent prosecution in Brazil (1997-2018)
- Author
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Eduardo Mercadante and Julia Paranhos
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Drug Patents ,Patent ,Patent Indicators ,Medicine ,Public aspects of medicine ,RA1-1270 - Abstract
In Brazil, if patent prosecution takes more than 10 years, this extra period is added to the regular 20-year term. This paper analyses all pharmaceutical patents granted by the Brazilian National Institute of Industrial Property (INPI) with term extension and later discusses some intellectual property and health policy implications. On average, pharmaceutical patent applications wait seven years after substantive examination is requested before being examined, which takes only three and a half years. Furthermore, the role of the Brazilian Health Regulatory Agency (Anvisa) in providing prior consent has a marginal effect in prolonging the prosecution. Therefore, the extension of pharmaceutical patents’ term is caused by the number of pending applications per examiner, which halts the prosecution for double the time it takes to examine the applications. Thus, proper solutions should focus on reducing the backlog per examiner at the INPI, which has caused the extension of 92% of the pharmaceutical patents in three and a half years, on average. We concluded that the Brazilian pharmaceutical patenting policy is biased towards the patentee. This imbalance will only be effectively corrected when the INPI is financially and administratively autonomous to reduce the ratio between the pharmaceutical patent application backlog and the number of examiners.
- Published
- 2022
- Full Text
- View/download PDF
39. A simple protocol for tuberculin skin test reading certification
- Author
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Lara de Lima Gloria, Mayara Lisboa Bastos, Bráulio dos Santos Júnior, and Anete Trajman
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Training Courses ,Observer Variation ,Tuberculin Test ,Medicine ,Public aspects of medicine ,RA1-1270 - Abstract
Although tuberculosis preventive therapy is one of the cornerstones for eliminating the disease, many barriers exist in the cascade of care for latent tuberculosis infection, including the need to certify healthcare professionals for reading tuberculin skin tests (TST). This paper proposes and evaluates a simple protocol for TST reading training. Primary care workers from different backgrounds received a 2-hour theoretical course, followed by a practical course on bleb reading. Blebs were obtained by injecting saline into sausages and then in volunteers. A certified trainer then evaluated the effectiveness of this protocol by analyzing the trainees’ ability to read TST induration in clinical routine, blinded to each other’s readings. Interobserver agreement was analyzed using the Bland-Altman test. The trainees’ reading accuracy was calculated using two cut-off points - 5 and 10mm - and the effect of the number of readings was analyzed using a linear mixed model. Eleven healthcare workers read 53 saline blebs and 88 TST indurations, with high agreement for TST reading (0.07mm average bias). Sensitivity was 100% (94.6; 100.0) at 5mm cut-off and 87.3% (75.5; 94.7) at 10mm cut-off. The regression model found no effect of the number of readings [coefficient: -0.007 (-0.055; 0.040)]. A simple training protocol for reading TST with saline blebs simulations in sausages and volunteers was sufficient to achieve accurate TST induration readings, with no effect observed for the number of readings. Training with saline blebs injected into voluntary individuals is safer and easier than the traditional method.
- Published
- 2021
- Full Text
- View/download PDF
40. Mortality from AIDS and tuberculosis-HIV coinfection in the Chilean AIDS Cohort of 2000-2017
- Author
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Carlos Sanhueza-Sanzana, Ligia Kerr, and Carl Kendall
- Subjects
HIV ,AIDS ,Tuberculosis ,Adult ,Mortality ,Medicine ,Public aspects of medicine ,RA1-1270 - Abstract
Abstract: This article aims to assess the sociodemographic and epidemiological factors associated with AIDS and tuberculosis-HIV coinfection mortality in the Chilean adult population between 2000 and 2017. This is a retrospective observational study, evaluating the incidence density of TB-HIV coinfection mortality in the population over 14 years of age. We used data from the Chilean AIDS Cohort database, 17,512 people enrolled in highly active antiretroviral therapy in the public health system in Chile. The Kaplan-Meier survival function and Cox regression were applied. Incidence density of 0.05 for 39,283 person-years for mortality with TB-HIV coinfection was recorded, with an increase in new cases in people living with AIDS among Aymara and Mapuche indigenous populations. Risk factors included CD4 < 500 cells/mm3 (HR = 3.2; 95%CI: 2.2-4.9), viral load at the start of treatment > 10,000 copies/uL (HR = 1.3; 95%CI: 1.2-1.6). Having high school or higher education (HR = 0.76; 95%CI: 0.6-0.9) is a protective factor for mortality for coinfection. Mortality was concentrated in TB-HIV coinfected people with increasing mortality among women and indigenous populations. The paper contributes to the growing recognition of the role of social determinants in disease outcomes, and the requirement to improve community-focused and community-based testing, sex education in schools, and structural interventions to reduce the adult mortality in Chilean population.
- Published
- 2021
- Full Text
- View/download PDF
41. RPS Brazilian Birth Cohorts Consortium (Ribeirão Preto, Pelotas and São Luís): history, objectives and methods
- Author
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Susana Cararo Confortin, Marizélia Rodrigues Costa Ribeiro, Aluísio J. D. Barros, Ana Maria Baptista Menezes, Bernardo L. Horta, Cesar Gomes Victora, Fernando C. Barros, Helen Gonçalves, Heloisa Bettiol, Iná Silva dos Santos, Marco Antonio Barbieri, Maria da Conceição Pereira Saraiva, Maria Teresa Seabra Soares de Britto e Alves, Mariângela Freitas da Silveira, Marlos Rodrigues Domingues, Natália Peixoto Lima, Paulo Ricardo Higassiaraguti Rocha, Ricardo Carvalho Cavalli, Rosângela Fernandes Lucena Batista, Viviane Cunha Cardoso, Vanda Maria Ferreira Simões, and Antônio Augusto Moura da Silva
- Subjects
Indicators of Morbidity and Mortality ,Noncommunicable Diseases ,Cohort Studies ,Risk Factors ,Medicine ,Public aspects of medicine ,RA1-1270 - Abstract
Abstract: This paper describes the history, objectives and methods used by the nine Brazilian cohorts of the RPS Brazilian Birth Cohorts Consortium (Ribeirão Preto, Pelotas and São Luís) Common thematic axes are identified and the objectives, baseline periods, follow-up stages and representativity of the population studied are presented. The Consortium includes three birth cohorts from Ribeirão Preto, São Paulo State (1978/1979, 1994 and 2010), four from Pelotas, Rio Grande do Sul State (1982, 1993, 2004 and 2015), and two from São Luís, Maranhão State (1997 and 2010). The cohorts cover three regions of Brazil, from three distinct states, with marked socioeconomic, cultural and infrastructure differences. The cohorts were started at birth, except for the most recent one in each municipality, where mothers were recruited during pregnancy. The instruments for data collection have been refined in order to approach different exposures during the early phases of life and their long-term influence on the health-disease process. The investigators of the nine cohorts carried out perinatal studies and later studied human capital, mental health, nutrition and precursor signs of noncommunicable diseases. A total of 17,636 liveborns were recruited in Ribeirão Preto, 19,669 in Pelotas, and 7,659 in São Luís. In the studies starting during pregnancy, 1,400 pregnant women were interviewed in Ribeirão Preto, 3,199 in Pelotas, and 1,447 in São Luís. Different strategies were employed to reduce losses to follow-up. This research network allows the analysis of the incidence of diseases and the establishment of possible causal relations that might explain the health outcomes of these populations in order to contribute to the development of governmental actions and health policies more consistent with reality.
- Published
- 2021
- Full Text
- View/download PDF
42. Testing COVID-19 in Brazil: fragmented efforts and challenges to expand diagnostic capacity at the Brazilian Unified National Health System
- Author
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Koichi Kameda, Mady Malheiros Barbeitas, Rosângela Caetano, Ilana Löwy, Ana Claudia Dias de Oliveira, Marilena Cordeiro Dias Villela Corrêa, and Maurice Cassier
- Subjects
COVID-19 ,Biotechnology ,Diagnostic Tests ,Universal Access to Health Care Services ,Medicine ,Public aspects of medicine ,RA1-1270 - Abstract
Abstract: Since the first recorded case of COVID-19 on February 26, 2020, Brazil has seen an exponential growth in the number of cases and deaths. The national testing approach has been insufficient to correctly use this tool in the support of containing the epidemic in the country. In this communication, we discuss efforts and challenges to scale-up COVID-19 testing at the Brazilian Unified National Health System (SUS). This communication presents the initial results of the research project created to investigate the political, industrial, technological, and regulatory aspects that may affect the diagnostic and testing capacity for COVID-19 in Brazil. The paper draws on the review of academic literature, media publication, and collection of public data on tests purchase and regulation. It enlists initiatives to enhance PCR testing, national production and development of technologies, as well as regulatory measures to fast-track new tests. Our analysis indicates some points of reflection. Firstly, the lack of a consistent national strategy to fight COVID-19 exarcebated supply problems of diagnostic components. If the country was eventually able to circumvent this situation, it still faces a more structural dependency on the importation of diagnostic components. Secondly, the discontinued funding and distribution of tests may have implied health policy fragmentation and the growing importance of local governments and non-state actors to fighting the epidemics within SUS. Finally, initiatives established since the second semester of 2020 have expanded the testing capacity at SUS. However, it has not been sufficient to control the progress of the epidemic in the country.
- Published
- 2021
- Full Text
- View/download PDF
43. Health care seeking due to COVID-19 related symptoms and health care cancellations among older Brazilian adults: the ELSI-COVID-19 initiative
- Author
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James Macinko, Natalia Oliveira Woolley, Brayan V. Seixas, Fabiola Bof de Andrade, and Maria Fernanda Lima-Costa
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Aging ,COVID-19 ,Access to Health Care ,Medicine ,Public aspects of medicine ,RA1-1270 - Abstract
The continent of the Americas has the greatest number of people infected and deaths associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in the world. Brazil occupies the 2nd position in numbers of infected cases and deaths, preceded only by the United States. Older adults and those with pre-existing chronic illnesses are more vulnerable to the consequences of the virus. The SARS-CoV-2 epidemic has serious consequences for health services. Therefore, an assessment of the pandemic’s effect on the older Brazilian population is urgently needed. The study examines the prevalence of COVID-19 related symptoms, care-seeking, and cancellation of surgery or other scheduled medical care among a nationally representative sample of Brazilians aged 50 and over derived from the Brazilian Longitudinal Study of Aging (ELSI-Brazil) and a telephone follow-up survey (the ELSI-COVID-19 initiative) between late May and early June 2020. About 10.4% of older adults reported any fever, dry cough or difficulty breathing in the 30 days prior to the interview, with the highest prevalence in the North region (50%). Among individuals with symptoms, only 33.6% sought care. Individuals living in the South or Southeast regions were significantly less likely to seek care for COVID-19 related symptoms. Nearly one in six participants had to cancel scheduled surgery or other medical care; this proportion was higher among women, those with more education, and people with multiple chronic conditions. This paper is among the first to investigate the effect of COVID-19 on health care use in Brazil among older adults. Results highlight the need to adapt health care delivery (such as through telemedicine) to ensure the continuity of care as well as the urgent need for wide dissemination of information to guide the population on disease prevention measures and how to obtain healthcare when needed.
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- 2020
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44. Quaternary prevention: a concept relevant to public health? A bibliometric and descriptive content analysis
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Miguel Andino Depallens, Jane Mary de Medeiros Guimarães, and Naomar Almeida Filho
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Quaternary Prevention ,Medical Overuse ,Bibliometrics ,Qualitative Research ,Medicine ,Public aspects of medicine ,RA1-1270 - Abstract
According to the World Organization of Family Doctors (WONCA), quaternary prevention (P4) is a recent concept that aims to prevent medical overuse. Thus, this study aimed to measure and map research output on P4 as outline research trends, evaluating its current international status through a bibliometric and descriptive content analysis. We reviewed scientific articles on P4 recorded in PubMed, LILACS, SciELO or CINAHL with the outcomes: publication year, first authors’ name and nationality, journals’ name, country and ranking, publication language, used methods and main reported subjects. The analysis included 65 articles published in 33 journals of 16 countries between 2003 and 2018 with a peak of publications in 2015. The first authors came from 17 different countries, 23% Brazilian, with Uruguay as the leading nation in scientific production per capita. Q1 or Q2 journals amassed 28% of published papers. Bibliographic research comprised 88% of articles and 38% of all focused on specific examples of medical overuse. P4 represents an ethical and valid approach to prevent iatrogenic events and achieve equal and fair access to health services. Conceptual, geographical, and linguistic elements, as well as WONCA conferences and type of healthcare systems in the authors’ country were fundamental factors that affected research output. The available studies are still of limited quality and quantity, with further investigations needed to assess the effective impact of P4 on public health.
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- 2020
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45. Evaluating the effectiveness of an educative workshop for pregnant women using pre and post intervention surveys
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Rodrigo Dias Nunes, Ana Gabriela Puel, Natália Gomes, and Jefferson Traebert
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Pregnant Women ,Health Education ,Pregnancy Complications ,Breast Feeding ,Medicine ,Public aspects of medicine ,RA1-1270 - Abstract
Abstract: This paper will report the findings of an education intervention performed by a workshop aimed to provide pregnant women with knowledge about pregnancy, delivery, breastfeeding and newborn care. A cross-sectional study, using a pre and post-intervention research design, was performed with 105 pregnant women from an obstetric service for a two-year period. Time points (pre and post) were compared using either Student t test and ANOVA. Significance was set at p ≤ 0.05. After the intervention all items increased their level from the three stations: antenatal care (20.4%), labor and delivery (36.8%) and postnatal and breastfeeding (32.1%). The total score of the surveys also increased 31.7% when comparing the pre and post applications (p < 0.001). It was evidenced the importance of strategies to improve knowledge about pregnancy and its surroundings to pregnant women. The workshop proposal presented increases in its knowledge and can most likely bring better results in short and long-term outcomes.
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- 2019
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46. Implementing the protocol of a pilot randomized controlled trial for the recovery-oriented intervention to people with psychoses in two Latin American cities
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Franco Mascayano, Ruben Alvarado, Howard F. Andrews, Maria Jose Jorquera, Giovanni Marcos Lovisi, Flavia Mitkiewicz de Souza, Charissa Pratt, Graciela Rojas, Maria E. Restrepo-Toro, Kim Fader, Prakash Gorroochurn, Sandro Galea, Catarina Magalhães Dahl, Jacqueline Cintra, Sarah Conover, Maria Soledad Burrone, Joy Noel Baumgartner, Robert Rosenheck, Sara Schilling, Keli Rodrigues Sarução, Peter Stastny, Eric Tapia, Maria Tavares Cavalcanti, Eliecer Valencia, Lawrence H. Yang, and Ezra Susser
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Community Mental Health Services ,Psychotic Disorders ,Randomized Controlled Trial ,Global Health ,Medicine ,Public aspects of medicine ,RA1-1270 - Abstract
Several Latin American countries have made remarkable strides towards offering community mental health care for people with psychoses. Nonetheless, mental health clinics generally have a very limited outreach in the community, tending to have weaker links to primary health care; rarely engaging patients in providing care; and usually not providing recovery-oriented services. This paper describes a pilot randomized controlled trial (RCT) of Critical Time Intervention-Task Shifting (CTI-TS) aimed at addressing such limitations. The pilot RCT was conducted in Santiago (Chile) and Rio de Janeiro (Brazil). We included 110 people with psychosis in the study, who were recruited at the time of entry into community mental health clinics. Trial participants were randomly divided into CTI-TS intervention and usual care. Those allocated to the intervention group received usual care and, in addition, CTI-TS services over a 9-month period. Primary outcomes include quality of life (WHO Quality of Life Scale - Brief Version) and unmet needs (Camberwell Assessment of Needs) at the 18-month follow-up. Primary outcomes at 18 months will be analyzed by Generalized Estimating Equations (GEE), with observations clustered within sites. We will use three-level multilevel models to examine time trends on the primary outcomes. Similar procedures will be used for analyzing secondary outcomes. Our hope is that this trial provides a foundation for planning a large-scale multi-site RCT to establish the efficacy of recovery-oriented interventions such as CTI-TS in Latin America.
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- 2019
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47. Perceptions and evaluations of front-line health workers regarding the Brazilian National Program for Improving Access and Quality to Primary Care (PMAQ): a mixed-method approach
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Fabiana da Cunha Saddi, Matthew J. Harris, Germano Araújo Coelho, Raquel Abrantes Pêgo, Fernanda Parreira, Wellida Pereira, Ana Karoline C. Santos, Heloany R. Almeida, and Douglas S. Costa
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Política Pública ,Política de Salud ,Reembolso de Incentivo ,Atención Primaria de Salud ,Medicine ,Public aspects of medicine ,RA1-1270 - Abstract
Abstract: Although it is well known that a successful implementation depends on the front-liners’ knowledge and participation, as well as on the organizational capacity of the institutions involved, we still know little about how front-line health workers have been involved in the implementation of the Brazilian National Program for Improving Access and Quality to Primary Care (PMAQ). This paper develops a contingent mixed-method approach to explore the perceptions of front-line health workers - managers, nurses, community health workers, and doctors - regarding the PMAQ (2nd round), and their evaluations concerning health unit organizational capacity. The research is guided by three relevant inter-related concepts from implementation theory: policy knowledge, participation, and organizational capacity. One hundred and twenty-seven health workers from 12 primary health care units in Goiânia, Goiás State, Brazil, answered semi-structured questionnaires, seeking to collect data on reasons for adherence, forms of participation, perceived impact (open-ended questions), and evaluation of organizational capacity (score between 0-10). Content analyses of qualitative data enabled us to categorize the variables “level of perceived impact of PMAQ” and “reasons for adhering to PMAQ”. The calculation and aggregation of the means for the scores given for organizational capacity enabled us to classify distinct levels of organizational capacity. We finally integrated both variables (Perceived-Impact and Organizational-Capacity) through cross-tabulation and the narrative. Results show that nurses are the main type of professional participating. The low organizational capacity and little policy knowledge affected workers participation in and their perceptions of the PMAQ.
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- 2018
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48. Diabetes research in Mexico: a map of 13 years of public funding
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Soledad Rojas-Rajs, José Miguel Natera, and Oswaldo Sinoé Medina Gómez
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Diabetes Mellitus ,Investigación ,Financiación de la Investigación ,Financiación Gubernamental ,Medicine ,Public aspects of medicine ,RA1-1270 - Abstract
Abstract: In Mexico, diabetes represents a serious public health problem and a high-cost disease for the health system. Health research is essential for generating new knowledge to combat such a serious issue, however, there is not enough information on how to generate and use it. This paper examines the public funding of 303 diabetes research projects, granted by the National Council of Science and Technology in Mexico between 2002 and 2014. The projects were systematized and classified according to their type of research, discipline or subject, and aim of knowledge. Considering these information, an econometric model that links the funding with the characteristics of the projects was prepared. The results show that the funding is focused on the basic and biomedical areas, particularly on genetic research, and also that diabetes research resources have increased over time, not steadily, but rather cyclically. In diabetes research projects there is a high level of concentration at several dimensions: research areas, topics, objects, institutions conducting research, and regions. The analysis of the resource allocation suggests that Mexico needs a stronger and oriented diabetes research agenda, including in its bases discussions about balance between basic and applied research, and about oriented research towards practical implementations. The importance of promoting health systems research to improve diabetes care is also discussed, as well as implementing mechanisms to assess the impact of diabetes research in short, medium and long term, as part of Mexico’s science and technology policy.
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- 2018
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49. Effects of smoking on tooth loss among individuals under periodontal maintenance therapy: a systematic review and meta-analysis
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Thais Ribeiral Vieira, Carolina Castro Martins, Renata Magalhães Cyrino, Andrea Mara Oliveira Azevedo, Luís Otávio Miranda Cota, and Fernando Oliveira Costa
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Tooth Loss ,Smoking ,Periodontitis ,Meta-analysis ,Medicine ,Public aspects of medicine ,RA1-1270 - Abstract
Abstract: Dental mortality has been reported by longitudinal studies on periodontal maintenance therapy (PMT), but the independent effect of smoking on tooth loss (TL), adjusted for important confounding variables, has been poorly evaluated. This systematic review aimed to assess and analyze the isolated effect of smoking TL among individuals undergoing PMT. Electronic, manual, grey literature, and recent articles (from April 2018) were searched, with no restriction regarding language; respective dates of publication were included. Epidemiological clinical studies reporting TL data among smokers undergoing PMT in comparison to nonsmoker control groups were selected. Methodological quality was assessed using the Newcastle-Ottawa Scale. Meta-analysis was performed, as well as I2 heterogeneity and sensitivity tests. Evidence quality was assessed using GRADE (Grading of Recommendations, Assessment, Development and Evaluation). Eleven papers were included in the systematic review: four case-control and seven cohort studies. Ten out of the 11 studies concluded that smoking was an important risk factor for the occurrence of TL. Meta-analysis of four of the cohort studies found that smokers had 3.24 times the chance of occurrence of TL than nonsmokers undergoing PMT (95%CI: 1.33-7.90). Overall, studies’ risk of bias was low. The quality of the scientific evidence moderately supports that smokers undergoing PMT have a greater chance of TL than nonsmokers.
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- 2018
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50. Lay perceptions of health and environmental inequalities and their associations to mental health
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Maria Luisa Lima and Rita Morais
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Desigualdades em la Salud ,Inequidad Social ,Ambiente ,Medicine ,Public aspects of medicine ,RA1-1270 - Abstract
Abstract Health inequalities are very well documented in epidemiological research: rich people live longer and have fewer diseases than poor people. Recently, a growing amount of evidence from environmental sciences confirms that poor people are also more exposed to pollution and other environmental threats. However, research in the social sciences has shown a broad lack of awareness about health inequalities. In this paper, based on data collected in Portugal, we will analyze the consciousness of both health and environmental injustices and test one hypothesis for this social blindness. The results show, even more clearly than before, that public opinion tends to see rich and poor people as being equally susceptible to health and environmental events. Furthermore, those who have this equal view of the world present lower levels of depression and anxiety. Following cognitive adaptation theory, this “belief in an equal world” can be interpreted as a protective positive illusion about social justice, particularly relevant in one of the most unequal countries in Europe.
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- 2015
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