Escola Nacional de Saude Publica

Rio de Janeiro, Brazil

Escola Nacional de Saude Publica

Rio de Janeiro, Brazil
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Grant
Agency: European Commission | Branch: H2020 | Program: RIA | Phase: PHC-06-2014 | Award Amount: 3.00M | Year: 2015

Cigarette smoking is a main risk factor for premature disease, disability and death in Europe, especially in disadvantaged groups. Prevention of youth smoking is crucial to any strategy aimed at reducing this disease burden in the future. Several potentially effective strategies and programs are available to address youth smoking. However, in practice their impact often appears to be limited, especially among socially disadvantaged youth. There is very little systematic evidence on HOW smoking prevention strategies and programs worked in practice, and WHY some programs seemed to influence youth smoking only in some settings or groups. Yet, such evidence is urgently needed to enable decision makers to use the resources available for smoking prevention in the most effective and equitable way. We will generate such evidence by addressing these HOW and WHY questions in a comparative approach. For Finland, Ireland, Germany, Netherlands, Belgium, Italy and Portugal, we aim to assess HOW strategies and programs to prevent smoking in national and local settings affected smoking behaviour of 16 year olds. Moreover, we aim to assess HOW and WHY this impact varied according to city, school, gender, and socioeconomic group. We will be among the first to apply the approach of realist evaluation to the evaluation of preventive programs, and to use this innovative approach to compare European countries. We will acquire primary data that are comparable across these countries, including a quantitative survey among 10,000\ students, and in-depth structured interviews with students and various stakeholders. We expect to make a major contribution to the reduction of disease burden and health inequalities among future elderly populations. We will apply a new method for learning from different countries, and for generating the fine-grained evidence that is needed to develop youth smoking prevention programs that are context-sensitive, cost-effective and equity-oriented.


Costa N.R.,Escola Nacional de Saude Publica
Ciencia e Saude Coletiva | Year: 2017

This paper presents the arguments in favor of government intervention in financing and regulation of health in Brazil. It describes the organizational arrangement of the Brazilian health system, for the purpose of reflection on the austerity agenda proposed for the country. Based on the literature in health economics, it discusses the hypothesis that the health sector in Brazil functions under the dominance of the private sector. The categories employed for analysis are those of the national health spending figures. An international comparison of indicators of health expenses shows that Brazilian public spending is a low proportion of total spending on Brazilian health. Expenditure on individuals’ health by out-of-pocket payments is high, and this works against equitability. The private health services sector plays a crucial role in provision, and financing. Contrary to the belief put forward by the austerity agenda, public expenditure cannot be constrained because the government has failed in adequate provision of services to the poor. This paper argues that, since the Constitution did not veto activity by the private sector segment of the market, those interests that have the greatest capacity to vocalize have been successful in imposing their preferences in the configuration of the sector. © 2017, Associacao Brasileira de Pos - Graduacao em Saude Coletiva. All rights reserved.


Fernandes F.M.B.,Escola Nacional de Saude Publica
Ciencia e Saude Coletiva | Year: 2017

This article is a review of the literature on the regionalization of healthcare, published in Brazilian journals indexed in the SciELO system. Objective: to review the output and the use of the data to support managers in making decisions on the healthcare system, and analyze academic output on the theme. Method: An online search of the SciELO database for articles using ‘regionalization’ and ‘health/healthcare’ as the keywords, and all indices as the ‘scope of the study’. We found a total of 102 references, and after analyzing the abstracts selected 70 articles that effectively discuss regionalization of health/healthcare in Brazil. We also found four articles in non-health related journals. Analysis: the institutional criteria (journal, theme area, date of publication, scope and number of authors), and the analytical criteria created by author - Type 1 - "Exploratory Studies" (26), "Evaluation Studies" (6), "Comparison Studies" (3); and "Reports of Experience" (5), Type 2 - "Theoretical-Analytical" papers (20) and "Historical-Conceptual Reviews" (4), and Type 3 - "Editorials (3) and "Book Reviews" (3). Findings: regionalization has become more important in journals published since 2010. Most of the articles fall in the Type 1 category. © 2017, Associacao Brasileira de Pos - Graduacao em Saude Coletiva. All rights reserved.


Bioethics of protection (BP) was proposed in the early 21st century in bioethics, built in Latin America following attempts by researchers to work on the possibilities of public health policies being morally legitimate, socially fair (equitable) and respectful of human rights, after noting the limits of traditional bioethical tools, essentially implemented in and restricted to interpersonal conflicts between moral agents and patients involved in the practice of biomedicine. Methodologically, BP tries to negotiate distinct problematic disciplinary realms that are, however, interlinked through interdisciplinary dialogue and common concern with the quality of life of the human population, considered in its natural, technological, social and cultural contexts: Public Health, concerned with the health and well-being of individuals and populations; Bioethics, concerned primarily with the moral legitimacy of practices that affect their quality of life; Biopolitics, concerned with the social effects of health policies. © 2017, Associacao Brasileira de Pos - Graduacao em Saude Coletiva. All rights reserved.


Submarine outfalls are proposed as an efficient alternative for the final destination of wastewater in densely populated coastal areas, due to the high dispersal capacity and the clearance of organic matter in the marine environment, and because they require small areas for implementation. This paper evaluates the probability of unsuitable bathing conditions in coastal areas nearby to the Ipanema, Barra da Tijuca and Icaraí outfalls based on a computational methodology gathering hydrodynamic, pollutant transport, and bacterial decay modelling. The results show a strong influence of solar radiation and all factors that mitigate its levels in the marine environment on coliform concentration. The aforementioned outfalls do not pollute the coastal areas, and unsuitable bathing conditions are restricted to nearby effluent launching points. The pollution observed at the beaches indicates that the contamination occurs due to the polluted estuarine systems, rivers and canals that flow to the coast. © 2017, Associacao Brasileira de Pos - Graduacao em Saude Coletiva. All rights reserved.


Within the context of the recently released United Nations Secretary-Generals Report of the High-Level Panel on Access to Medicines, the author reviews issues related to the context and discussions on access to medicines and the conflict between trade and health during the last decades. These issues have been relevant and outstanding in Global Health, especially questioning the current system of innovation, R&D and IP protection. Lessons learned from the HLP Report are highlighted and the need to further discuss and implement concrete actions, as the world has moved from the MDGs to the SDGs, demand strong actions derived from the United Nations and a strong interaction with other key stakeholders. Affordability and unaffordability of new technologies are discussed, making clear that we need to implement bold actions in order to ensure access to medicines as a human right. © 2017, Associacao Brasileira de Pos - Graduacao em Saude Coletiva. All Rights Reserved.


Grant
Agency: European Commission | Branch: FP7 | Program: CP-FP | Phase: HEALTH.2011.3.3-1 | Award Amount: 2.25M | Year: 2012

For any strategy aimed to reduce socioeconomic inequities in health in Europe it is vital to tackle the large and widening inequalities in smoking. However, there is only limited evidence on effectiveness of tobacco control policies in terms of reducing inequalities. Especially lacking are evaluations of the effects of policies that have actually been implemented in different European countries. In addition, no studies have assessed the role of strategic drivers such as social welfare or educational policies. The aim of the proposed project is to analyse various natural policy experiments within Europe with the aim to generate new empirical evidence on the effectiveness of possible strategies to reduce inequalities in smoking. The project has three parts. First, time trends in various European countries will be analyzed with the aim to assess whether changes in national tobacco control policies have influenced inequalities in smoking cessation among adults. Second, comparisons between European countries will be made with the aim to assess whether cross-national differences in specific tobacco control policies were associated with inequalities in smoking initiation among adolescents. These cross-national comparisons will also assess whether different types of educational systems are associated with inequalities in smoking initiation. Third, the project will review the published results of intervention studies, and integrate these with our results. The combined evidence base will be disseminated across Europe, especially among those who are involved in the development of tobacco control policies and health-in-all policies. This innovative project will develop comparative research into a new strategy for the evaluation of natural experiments, combining methods from different disciplines. Top researchers from different European countries will work together, and bring together four large international networks relevant to inequities in smoking.


Grant
Agency: European Commission | Branch: H2020 | Program: RIA | Phase: EURO-3-2014 | Award Amount: 2.50M | Year: 2015

The current crisis has indirectly contributed to questioning the efficiency of financial markets and democratic institutions at European and national levels. Recent data from the Eurobarometer (July 2013) shows a continuous decrease in the trust levels that citizens from the European Union have on national governments and parliaments, radically decreasing in more than 25 points in the last six years (European Commission, 2013). This situation is jeopardizing the European project while at the same time a lively public debate about the meaning of European identity is taking place across Europe. Several social scientists have argued that the social and economic inequalities in the new global order are contributing to civil social reactions, based on solidarity, aiming to achieve a better society for all (Touraine, 2007; Wright, 2010). This project aims to analyzing in depth the acts of solidarity which are being developed across Europe, the extent to which they respond to dialogic and inclusive processes, the related outcomes and the policy developments. The project starts from previous findings on successful actions which are combating the crisis by creating employment or improving access to health through acts of solidarity. These acts are thus contributing to construct more inclusive and prosperous societies, by influencing at the macro-level (social inequalities) and micro-level (psychological wellbeing). In this regard, the research will identify common elements among these acts in order to examine their transferability to different contexts. To cover this objective, effects of these actions in five social areas will be studied in depth: housing, education, employment, engagement and health. Simultaneously, special attention will be paid on social investment policies which are supporting these initiatives.


Grant
Agency: European Commission | Branch: FP7 | Program: CP-FP | Phase: HEALTH-2009-3.2-2 | Award Amount: 3.40M | Year: 2010

ECHO, European Collaboration for Healthcare Optimization, gathers the interests for Healthcare Performance Measurement of different Academic and Research Institutions from six European countries and an International Body for Healthcare Policy Analysis. Designed as a 48 months project, it has been conceived as a pilot study based on available administrative databases. It aims at describing the actual performance of six different Healthcare Systems at hospital, healthcare area, regional and country level. To tackle performance measurement in this project, two different methodological approaches will be used: [a] a population geographical-based, responding the question: Is the access to a diagnostic or surgical procedure dependant on the place where a person lives? And, [b] a provider-specific, answering the question: Is the risk for a patient to access high quality care -and have better health outcomes- different regarding the provider in which he or she is admitted? Utilization, equity in access and allocative efficiency will be analysed as performance measures in the former approach; and, healthcare outcomes and associated costs will be measures in the latter one. ECHO has been envisaged as a five work packages project. The first two work packages are devoted to prepare the core work package (WP#3) Performance Measurement and Report; so, the WP#1 is committed with the creation of the ECHO Data Warehouse and the second one is dedicated to the Methodological foundations of the project. Work packages #4 (web-based tools development) and #5 (dissemination) are carefully thought to ease the diffusion of our findings to decision-makers; in the former, a web-based analytical tool will allow advanced users to replicate methods and analysis; in the latter, local key agents like policy decision-makers and managers, will feed the findings making them transferable to their own decision-making process.


Fox J.,McMaster University | Carvalho M.S.,Escola Nacional de Saude Publica
Journal of Statistical Software | Year: 2012

The R Commander graphical user interface to R is extensible via plug-in packages, which integrate seamlessly with the R Commander's menu structure, data, and model handling. The paper describes the RcmdrPlugin.survival package, which makes many of the facilities of the survival package for R available through the R Commander, including Cox and parametric survival models. We explain the structure, capabilities, and limitations of this plug-in package and illustrate its use.

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