Evaluation of strategies by the Brazilian Ministry of Health to stimulate the municipal response to AIDS

The aim of this study was to evaluate strategies by the Brazilian Ministry of Health to expand the municipal response to AIDS. Cities "included" and "not included" in Federal strategies for "municipalization" of the response were compared according to the response profile and trends in the epidemic. Multinomial logistic regression was used, among other statistical procedures. Municipalities included from 1994 to 1998 showed higher chances of providing HIV diagnostic testing [OR = 15.0; 95%CI: 5.6-40.1], of having AIDS services [OR = 18.4; 95%CI: 8.4-40.5], and reducing cases involving heterosexual [OR = 3.1; 95%CI: 1.4-7.3], homosexual/bisexual [OR = 3.0; 95%CI: 1.4-6.2], and IDU transmission [OR = 6.6; 95%CI: 2.9-14.9] as compared to those "included in 2003" and "not included". There were no associations between the included Municipalities, greater coverage in prevention, the reduction in cases due to vertical transmission or blood transfusion, or mortality rates. Municipalities with a more structured response were associated with better results. The findings suggest that the municipalization policy contributed to improvement in the local response to AIDS.     

The Brazilian Ministry of Health policy model in the 1990s

This paper analyzes the policy model of the Brazilian Ministry of Health from 1990 to 2002. The methodology included interviews with key actors in the national health policy, document review, and analysis of the Federal budget and official databases. The Brazilian Ministry of Health underwent major changes under the influence of the health reform agenda and the liberal State reform agenda prevailing in the 1990s, shaped by two movements: institutional unification of national policy control and political/administrative decentralization. The Federal role was diminished in terms of direct services provision, and there were changes in financing and regulation. The model in the late 1990s featured strong Federal induction of States and municipalities and the adoption of market regulation strategies. There is no record of a long-term planning effort, which favors distortions in the Federal intervention model and hinders solutions to structural problems in the Brazilian health system.     

Analysis of rulings by the Brazilian Ministry of Health and reflections on national health policy management

Ministry of Health rulings and provisions are important policy regulation tools that aim to orient the enforcement of health-related laws passed by the Legislative Branch, under the terms of the 1988 Federal Constitution. Such provisions have played a major role in the health sector, due not only to the number of documents submitted since the late 1990s, but mainly because of this tool's persuasive power in defining health sector policy. The current article aims to foster reflection on both national health policy management in Brazil and the main obstacles to the implementation of health reform operational aspects. The article classified and analyzed Ministry of Health rulings issued from 1990 to 2002. The study highlights the Ministry's centralizing approach and the use of financial and political persuasion tools that subject State and Municipal governments to the system's rules without creating a negotiated and sustained health policy that the country's institutional realities ratify and support.     

Evaluation of the self-administered respiratory questionnaire recommended by the Japanese Labour Ministry based on the standardized interviewer-administered BMRC questionnaire

The self-administered respiratory questionnaire on persistent cough or sputum prepared and recommended by the Japanese Labour Ministry to detect pneumoconiosis was evaluated and compared with the Japanese version of the standardized interviewer-administered respiratory questionnaire developed by the British Medical Research Council (BMRC). The two questionnaires were given to 800 subjects on the same day. Because the wording of the questions was similar, the two questionnaires yielded very similar results. In terms of the overall prevalence of persistent cough or sputum, no important differences could be demonstrated between the results of the two questionnaires. The results of this study indicate that the self-administered questionnaire has good concordance with the BMRC questionnaire. When compared to the BMRC questionnaire, the specificity of the self-administered questionnaire was found to be more than 99%, but the sensitivity was inferior to the specificity, being less than 80%. When confined to subjects with persistent cough or sputum for two years or more, the sensitivity was up to 84%. These findings suggest the responses of the subjects to the self-administered questionnaire tend to be negative. A validity of the self-administered questionnaire needs to be further studied among dust workers including pneumoconiotics.     

The fight against AIDS among adolescent girls: the impact of the 2003 Carnival campaign by the Brazilian Ministry of Health

In 2003, the Brazilian Ministry of Health launched a nationwide campaign aimed at promoting condom use by adolescent girls. The "Carnival Campaign" was broadcast on television and radio from February 16 to March 3 and targeted adolescent girls (13-19 years), a group which had shown an increase in the number of cases of AIDS and other sexually transmitted diseases. The MoH hired Kelly Key, a Brazilian pop singer, to star the television and radio ads and deliver the campaign message. One of the objectives was to empower girls and encourage them not to be ashamed of purchasing condoms or of demanding that their partners use them. The article presents the results of a nationwide survey with 1,006 adolescent girls in 86 municipalities, sponsored by the MoH. The results show that campaign materials reached the main target public and were evaluated in a very positive light. Finally, the survey data show that the Carnival Campaign had important effects, stimulating discussions in the adolescent social environment and reinforcing positive attitudes towards condom use.     

Recent contribution of the World Health Organization to control childhood tuberculosis

The article comments the pioneer and recent publication of the World Health Organization called "Guidance for National Tuberculosis Programmes on the Management of Childhood Tuberculosis in Children", aiming at spreading interesting aspects on the practice of health professionals. A parallel between Latin America and the African continent is established, concerning the co-infection TB-HIV and childhood tuberculosis.     

An analysis of financial flows from the Brazilian Ministry of Health for research and development in 2003-2005 according to the National Agenda for Health Research Priorities

This study mapped the application of financing in research and development in health (R&D/H) by the Brazilian Ministry of Health in 2003-2005, according to the National Agenda for Health Research Priorities, created in 2004. The analysis was based on data from a study aimed primarily at measuring these investment flows during the same period. The calculations included only direct financing with actual outlays in research, including payroll expenditures. The studies were categorized according to the 24 sub-agendas of the national priority agenda by two independent researchers, and disagreements were resolved by consensus. Research and development expenditures in health totaled 409.7 million reais, concentrated mainly in the following sub-agendas: transmissible diseases, the health industry complex, clinical research, pharmaceutical care, and non-communicable diseases (79% of the total). All 24 sub-agendas received some financing during the period. The study established a baseline for subsequent evaluations of this financing instrument's inductive capacity and the relationship between R&D/H investments and the population's health needs.     

Variability of the diagnosis of stroke by clinical judgement and by a scoring method.

Existing criteria for the diagnosis of acute cerebrovascular disease (stroke) have not been satisfactory in epidemiological studies. Variability of the diagnosis of stroke, which had not been studied before, was investigated in a WHO collaborative study. Intra-observer and inter-observer variation of the diagnosis of stroke was studied by means of 45 case reports drawn at random from among those included in the study. Diagnosis of stroke and of the type of stroke was made by clinical judgement and by a scoring method. The clinical diagnosis of stroke was more consistent and more comparable than the diagnosis of the type of stroke. Inter-observer agreement in clinical diagnosis was improved by using the score method.     

流式细胞术积分系统在骨髓增生异常综合征诊断中的应用

目的:评估流式细胞术积分系统(flow cytometric scoring system,FCSS)在骨髓增生异常综合征(myelodysplasticsyndrome,MDS)诊断中的应用。方法:选取我院疑似MDS的患者32例,利用流式四色荧光标记技术分析其骨髓细胞的抗原表达情况。结果:21例确诊MDS的患者中,不同比例地出现髓系抗原表达紊乱的情况。FCSS≥2分时敏感性为80.95%,特异性为89.47%,是诊断MDS较为合适的一个指标。结论:FCSS分值对MDS的诊断具有重要意义。     

Adoption of revised dosage recommendations for childhood tuberculosis in countries with different childhood tuberculosis burdens

Background and objective:

In 2010, the World Health Organization (WHO) published revised dosage recommendations for the treatment of tuberculosis (TB) in children. The aim of the survey was to assess whether countries adopt these new dosage recommendations, as well as to identify challenges in the management and treatment of childhood TB. In addition, countries were asked to provide 2010 surveillance data on childhood TB.

Design:

A survey questionnaire was developed and broadly disseminated to National Tuberculosis Programmes or people with close links to them.

Results:

Among the 34 countries that responded to the survey, the proportion of total national TB caseload reported in children in 2010 ranged from 0.67% to 23.6%. The data on new cases reported to this survey varied from data provided to the WHO global TB database. Most countries had childhood TB guidelines in place, and half had adopted the new dosage recommendations. Countries reported a number of challenges related to the implementation of the new recommendations and general management of childhood TB.

Conclusions:

Despite the adoption of the new dosage recommendations, their implementation is complicated by the lack of appropriate fixed-dose combinations. In addition, accurate and consistent estimates of the global burden of childhood TB remained a major challenge. Technical assistance and support to countries is needed to improve childhood TB activities.     

Latent tuberculosis in nursing professionals of a Brazilian hospital

Tuberculosis (TB) is considered an occupational disease among health-care workers (HCWs). Direct contact with TB patients leads to an increased risk to become latently infected by Mycobacterium tuberculosis. The objective of this study is to estimate the prevalence of latent M. tuberculosis minfection among nursing professionals of a hospital in Rio Grande do Sul, Brazil, assessed by tuberculin skin test (TST). From November 2009 to May 2010, latent M. tuberculosis infection was assessed by TST in 55 nursing professionals. Epidemiological information was collected using a standardized questionnaire. A positive TST result (> or = 10 mm) was observed in 47.3% of the HCWs tested. There was no significant difference in TST positivity when duration of employment or professional category (technician or nurse) was evaluated. The results of this work reinforce the need for control measures to prevent latent M. tuberculosis infection among nursing professionals at the hospital where the study was conducted.     

Equity in the Brazilian Health Care System: a contribution for debate

In this article it is discussed some relevant issues in regard to inequalities in the consumption of health care services and the construction of more equitable health care system in Brazil. The concept of inequalities in health is distinguished from the concept of inequalities in the consumption of health care services. It is argued that the geographical dimension of health care service consumption differs from the social dimension. This implies that a better distribution of financial resources between geographical regions acts at the level of regional inequalities but might not have a positive impact on existing social inequalities. A more equitable system depends on a greater participation on the financing of the system of the richer people. It depends on the solidarity of the different social groups in society. The present situation of great scarcity of financial resources calls for a definition of priorities. Nonetheless, it is argued that the establishment of priorities in the availability of health care services is an ethical approach only if it is assumed to be a transient strategy directed to the construction of a system based in universal access for all those in need.     

The expanded enrollment form in the Brazilian Family Health Program as a management tool for diagnosis of living and health conditions

As a consequence of the introduction of the Family Health Program in the city of Sao Paulo, Brazil, a pilot experiment was conducted with an expanded enrollment form for gathering information on families at two school health services. The aim of the study was to analyze this enrollment form as a management tool capable of identifying differences and inequities in each area. The collected data provided the basis for generating six related indicators: time of residence in the area, family members per bedroom, per capita family income, number of children as a percentage of total family members, schooling, and health insurance coverage. A compound indicator was constructed, called the Mean Living Standard Score, in addition to another indicator -- Mean Score/ Basic Health Care Information System -- from the three indicators existing in form A of the Basic Health Care Information System. The results identified contiguous geographic areas with different living standards. The two scores showed similar discriminatory power. In conclusion, it is possible to differentiate and discriminate sub-areas, thereby highlighting the need to organize different health actions for each sub-area.