Taxa e custos médicos diretos de cesáreas em beneficiárias da saúde suplementar no estado de São Paulo, Brasil: 2015 a 2021 / Rate and direct medical costs of cesarean sections among supplementary health plan holders living in the state of São Paulo, Brazil: 2015-2021

Resumo O Brasil tem a segunda maior taxa de cesárea do mundo. Há diferença dessas taxas nos setores públicos e privados. Foram utilizados dados de internação de beneficiárias residentes no estado de São Paulo, internadas entre 2015 e 2021, com idades entre 10 e 49 anos, para verificar as taxas e custos das cesáreas no setor privado. Foi realizado estudo parcial de avaliação econômica em saúde na perspectiva da saúde suplementar considerando custos médicos diretos de internação. Foram analisadas 757.307 internações, com gasto total de R$ 7,701 bilhões. As taxas de cesáreas foram de 80% no período. São menores nas gestantes mais novas (69%) e maiores nas mais velhas (86%), e sempre superiores a 67%. Essa população tem taxas 71% maiores do que aquelas do SUS. Há maior proporção de internações com uso de unidade de terapia intensiva nas cesáreas. O custo mediano da cesárea é 15% maior do que o parto normal e são duas vezes maiores nas seguradoras do que nas cooperativas médicas. Há oportunidade de aplicação de políticas públicas de saúde amplamente utilizadas no Sistema Único de Saúde visando a redução das taxas, dos custos diretos da internação e dos planos de saúde.

Abstract Brazil has the second largest cesarean section rate in the world. Differences in rates exist between the public and private health sectors. This study used data on admissions of supplementary health plan holders aged between 10 and 49 years living in the state of São Paulo admitted between 2015 and 2021 to determine cesarean section rates and costs in the private health sector. We conducted a partial economic analysis in health from a supplementary health perspective focusing on the direct medical costs of admissions. A total of 757,307 admissions were analyzed with total costs amounting to R$7.701 billion. The cesarean section rate over the period was 80%. Rates were lowest in young women (69%) and highest in the oldest age group (86%), exceeding 67% across all groups. The rate was 71% higher than in public services. The proportion of admissions with use of the intensive care unit was higher among cesarian deliveries. The median cost of a cesarean was 15% higher than that of a normal delivery and twice as high in insurance companies than healthcare cooperatives. There is an opportunity to apply policies that are widely used in public services to the private sector with the aim of reducing cesarean rates in private services, direct costs of admission, and the cost of supplementary health plans.

Sustainability disclosure in the Ecuadorian banking sector: channels used, determining factors and type of information revealed

This study aimed to provide evidence on sustainability disclosure in the banking sector of Ecuador Using a descriptive-correlational approach, three key areas were examined: the most common reports for the disclosure of sustainability information, factors influencing banks' willingness to disclose, and the type of sustainability information being disclosed. Fisher's test and mean difference tests were employed to identify factors influencing banks' willingness to disclose sustainability information. Additionally, a content analysis was conducted to identify the main themes disclosed by banks regarding sustainability An index incorporating environmental, social, economic, and governance aspects was utilized for this analysis. The findings revealed low levels of disclosure, a higher prevalence of specialized reports, a positive association between willingness to disclose and organizational visibility, and a predominance of social dimension disclosure practices. These findings underscore the need to enhance disclosure standards and strengthen communication with stakeholders in Ecuador's banking sector. JEL CLASSIFICATION MI0, MI4; G2I

Este estudio buscó proporcionar evidencia sobre la divulgación de sostenibilidad en el sector bancario de Ecuador Mediante un enfoque descriptivo-correlacional se abordaron tres temáticas: los medios más utilizados para divulgar información de sostenibilidad, los factores que influyen en la disposición de los bancos a divulgar y el tipo de información sobre sostenibilidad que divulgan. Se utilizaron las pruebas de Fisher y de diferencia de medias para identificar los factores que influyen en la disposición de los bancos a divulgar información de sostenibilidad. De igual forma, se realizó un análisis de contenido para identificar los temas principales que divulgan los bancos sobre sostenibilidad. Para ello, se usó un índice que identificó aspectos ambientales, sociales, económicos y de gobernanza. Los resultados revelaron niveles bajos de divulgación, un mayor uso de informes especializados, una asociación positiva entre la disposición a divulgar y la visibilidad de la organización, y una predominancia de la divulgación de prácticas en la dimensión social. Estos hallazgos resaltan la necesidad de mejorar los estándares de divulgación y fortalecer la comunicación con los grupos de interés en el sector bancario de Ecuador. CLASIFICACIÓN JEL M10, M14; G21

Este estudo buscou fornecer evidências sobre a divulgação da sustentabilidade no setor bancário do Ecuador. Usando uma abordagem descritiva-correlacional, foram abordadas três questões: os meios mais comuns usados para divulgar informações sobre sustentabilidade, os fatores que influenciam a disposição dos bancos em divulgar e o tipo de informações sobre sustentabilidade que eles divulgam. O teste de Fisher e os testes de diferença de médias foram usados para identificar os fatores que influenciam a disposição dos bancos em divulgar informações sobre sustentabilidade. Da mesma forma, foi realizada uma análise de conteúdo para identificar os principais tópicos que os bancos divulgam sobre sustentabilidade. Isso foi feito por meio de um índice que identificou questões ambientais, sociais, econômicas e de governança. Os resultados revelaram baixos níveis de divulgação, um maior uso de relatórios especializados, uma associação positiva entre a disposição de divulgar e a visibilidade organizacional, e uma predominância de divulgação de práticas na dimensão social. Essas conclusões destacam a necessidade de melhorar os padrões de divulgação e fortalecer a comunicação com as partes interessadas no setor bancário do Ecuador. CLASSIFICAÇÃO JEL M10, M14; G21

Fatores associados ao estresse ocupacional entre cirurgiões-dentistas do setor privado no primeiro ano da pandemia de COVID-19 / Factors related to occupational stress among private sector dentists in the first year of the COVID-19 pandemic

Resumo O objetivo deste estudo transversal foi analisar os fatores associados ao estresse ocupacional entre cirurgiões-dentistas atuantes no setor privado no primeiro ano da pandemia de COVID-19 no Brasil. Incluiu 384 profissionais do estado do Paraná, cujos dados foram obtidos entre agosto e outubro de 2020 por meio de formulário online. Dois desfechos compuseram proxy de estresse ocupacional: (1) ansiedade e preocupação e (2) preparo e segurança para o trabalho durante a pandemia. As variáveis independentes foram agrupadas segundo modelo teórico explicativo em fatores individuais, organizacionais e extraorganizacionais. As associações foram testadas por regressão logística bi e multivariada. Apesar de preparados e seguros, os profissionais se sentiam ansiosos e preocupados para o atendimento clínico. Mulheres, mais jovens e que não receberam orientações sobre as medidas de segurança apresentaram maiores chances de relatar insegurança e despreparo. Profissionais mais jovens, que não participavam da tomada de decisões e que às vezes dispunham de auxiliar para o trabalho a quatro mãos, tiveram maiores chances de se sentirem ansiosos e preocupados. Além dos fatores individuais, fatores organizacionais do trabalho estão associados ao estresse ocupacional entre cirurgiões-dentistas no primeiro ano da pandemia.

Abstract This cross-sectional study examined factors associated with occupational stress among 384 dentists working in the private sector in the first year of the COVID-19 pandemic in Brazil. Data were collected from August to October 2020 through an online form. Two outcomes - (1) anxiety and worry and (2) preparation and safety for work during the pandemic - constituted a proxy for occupational stress. The independent variables were grouped according to the explanatory theoretical model into individual, organisational and extra-organisational factors. Associations were tested by bivariate and multivariate logistic regression. Although prepared and confident, dentists felt anxious and worried about providing clinical care. Women, younger respondents and those who received no guidance on safety measures were more likely to report insecurity and unpreparedness. Younger professionals, those who did not participate in decision-making and who only sometimes had an assistant for four-hand work, were more likely to feel anxious and worried. In addition to individual factors, work organisation factors were associated with occupational stress among dentists in the first year of the pandemic.

How can internal marketing practices help achieve organizational success? / ¿Cómo las prácticas de marketing interno pueden ayudar a lograr el éxito organizacional? / Como as práticas de marketing interno podem ajudar a alcançar o sucesso organizacional?

Abstract Internal marketing is a concept still little recognized and disseminated, with most of the research on this area of marketing focusing on the service sector and well-consolidated and industrialized markets. This article sheds light on the importance of internal marketing practices by identifying their impact on workers' proactive behavior and life satisfaction while observing the effects of affective commitment and job satisfaction. The study collected 428 valid questionnaires from Portuguese workers (218 in the private sector and 210 in the public sector) and applied structural equation modeling to test the hypotheses. The results showed how adopting an internal marketing perspective can contribute to successful organizational and human resource management. It was observed that internal marketing practices lead to affective commitment and job satisfaction in both the private and public sectors, although more pronounced in the private sector. Also, the findings pointed out that the workers' affective commitment leads to adopting proactive behavior and life satisfaction only in the public sector and that job satisfaction leads to proactive behavior and life satisfaction for workers of both the private and public sector. This study contributes to increasing understanding of internal marketing, its applicability, and its importance for workers and organizations. Additionally, comparing the private and public sectors helps understand and show how this practice matches the workers' expectations.

Resumen Este artículo tiene como objetivo arrojar luz sobre la importancia de las prácticas de marketing interno, identificando su impacto en el comportamiento proactivo y en la satisfacción con la vida de los trabajadores, a través de los efectos del compromiso afectivo y la satisfacción laboral. El marketing interno sigue siendo un concepto poco reconocido y difundido. Esta investigación compara estos efectos entre los trabajadores del sector público y privado para reforzar la importancia de dicho concepto. En total, se recogieron 428 cuestionarios válidos de trabajadores portugueses (218 del sector privado y 210 del sector público). Se utilizó el modelo de ecuaciones estructurales para testar las hipótesis de estudio. Esta investigación muestra cómo la adopción de una perspectiva de marketing interno puede contribuir a una gestión organizacional y gestión de personas exitosa. Los resultados mostraron que las prácticas de marketing interno generan compromiso afectivo y satisfacción laboral, tanto en el sector privado como en el público, aunque de forma más acentuada en el sector privado. También se constató que el compromiso afectivo conduce a la adopción de conductas proactivas y a la satisfacción con la vida de los trabajadores del sector público únicamente, y que la satisfacción laboral conduce a la adopción de esta conducta y a la satisfacción con la vida para ambos, sector público y privado. Este trabajo contribuye a una mejor comprensión del concepto de marketing interno y su aplicabilidad e importancia para los trabajadores y las organizaciones. Además, al comparar los sectores público y privado, ayuda a comprender y mostrar cómo esta práctica coincide con las expectativas de los trabajadores de estos dos sectores.

Resumo Este estudo pretende evidenciar a importância das práticas de marketing interno, identificando o seu impacto no comportamento proativo e na satisfação com a vida dos trabalhadores, através dos efeitos do compromisso afetivo e da satisfação no trabalho. O marketing interno continua a ser um conceito com pouco reconhecimento e divulgação, uma vez que a maioria das pesquisas relacionadas com esse campo de marketing é direcionada para o setor de serviços e concentra-se predominantemente em mercados bem estabelecidos e industrializados. Esta pesquisa compara esses efeitos entre trabalhadores do setor privado e público para reforçar a importância deste conceito, sendo que, no total, foram recolhidos 428 questionários válidos junto de trabalhadores portugueses (218 no setor privado e 210 no setor público). O modelo de equações estruturais foi utilizado para testar as hipóteses de investigação. Esta pesquisa mostra como a adoção do marketing interno pode contribuir para o sucesso da gestão organizacional e da gestão de pessoas. Os resultados mostraram que as práticas de marketing interno levam ao comprometimento afetivo e à satisfação no trabalho, tanto no setor privado como no público, embora mais pronunciadas no setor privado. Constatou-se também que o comprometimento afetivo leva à adoção de comportamentos proativos e leva à satisfação com a vida dos trabalhadores, mas apenas do setor público, e que a satisfação no trabalho leva à adoção desse comportamento e à satisfação com a vida para ambos, setor privado e público. Este trabalho contribui para uma melhor compreensão do conceito de marketing interno, da sua aplicabilidade e importância, quer para os trabalhadores, como para as organizações. Além disso, ao comparar os setores privado e público, ajuda a entender e mostrar como essa prática atende às expectativas dos trabalhadores desses dois setores.

Salud: Dignidad, Derechos y Ética

La salud y la atención de las personas enfermas implican no solo aspectos de diagnósticos y tratamientos médicos; por el contrario, encierran un conjunto de aspectos que están intrínsecamente vinculados (o deberían estarlo) aun cuando aparentemente no sean visibilizados con facilidad. La salud de las personas involucra las perspectivas de respeto a la dignidad de las personas, el ejercicio de sus derechos, y el desempeño ético de los protagonistas (los que atienden y los atendidos), que no deben ser dejadas de lado en el momento real que sucede cada atención de salud.

SUMMARY Health and care for sick people involve not only aspects of medical diagnosis and treatment; on the contrary, it contains a set of aspects that are intrinsically linked (or should be) even though they are apparently not easily visible. The health of the people involves the perspectives of respect for the dignity of the people, the exercise of their rights, and the ethical performance of the protagonists (those who attend and those attended), which should not be left aside in the real moment. that happens every health care.

A Study On Workplace Ostracism, Psychological Capital And Work Engagement Among Private Sector Employees In Mumbai

The current study focuses on the relationship between workplace ostracism, psychological capital and work engagement among private sector employees in Mumbai. The data was collected from a total of 180 private sector employees (i.e., 90 males, 90 females). The tools been administered are The Workplace Ostracism Scale by Ferris et al. (2008), Psychological Capital Questionnaire- PsyCap-12 by Luthans et al. (2007), and The Utretch Work Engagement Scale- UWES-9S by Schaufeli et al. (2002). Correlational research design using quantitative approach was used. The findings of the study indicate significant relationships between the variables, with perceived workplace ostracism accounting for a significant variational impact on psychological capital and work engagement.Years of work experience also show to have a significant difference on the perception of workplace ostracism. Surprisingly, no significant gender difference was observed.

Evolución de la cesárea en Colombia y su asociación con la naturaleza jurídica de la institución donde se atiende el parto / Evolution of cesarean sections in Colombia and its association with the legal standing of the institutions where deliveries take place

RESUMEN Objetivos: Describir la evolución de la frecuencia de la cesárea en Colombia a partir de 1998, tanto global como discriminada según la naturaleza jurídica de las instituciones prestadoras de salud (IPS) donde se atienden los partos, y calcular la magnitud de la asociación entre la naturaleza jurídica de la IPS y la realización de cesáreas entre 2015 y 2017. Materiales y métodos: Estudio de corte transversal que describe la frecuencia de partos por cesárea entre los años 1998 y 2020, y un componente analítico para estimar la asociación entre la naturaleza jurídica y la vía del parto entre los años 2015 y 2017, a partir de las bases de registros de nacimientos del Departamento Administrativo Nacional de Estadística (DANE) de Colombia. Se presentan las proporciones de cesárea por año y el incremento en la proporción de cesárea por tipo de institución; como estimador de esta asociación se utilizó la razón de prevalencia. Resultados: En 1998, la proporción de cesárea fue 25,7 %, incrementó hasta 46,4 % en 2015 y descendió a 44,6 % para 2020. A partir de 1998, la proporción de cesárea en las IPS públicas pasó de 26,2 a 42,9 % para el año 2014 y en las privadas de 45,0 a 57,7 % para el año 2013. La razón de prevalencia de la cesárea de las instituciones privadas con respecto a las públicas fue 1,57 (IC 95 %: 1,56-1,57). Conclusiones: Después de un periodo largo de incremento sostenido, se está presentando una disminución en la proporción de cesáreas en el país; las IPS públicas incrementaron estos procedimientos en mayor proporción durante la mayor parte del tiempo estudiado y en las IPS privadas se realizan con mayor frecuencia a todos los subgrupos de mujeres. Se deberá evaluar en el futuro, mediante metodologías más robustas, si el descenso en la frecuencia de cesárea es una tendencia real o secular.

ABSTRACT Objectives: To describe how the frequency of cesarean section has evolved in Colombia since 1998, both in overall terms as well as discriminated according to the legal standing of the healthcare providers (IPSs) where delivery takes place, and to estimate the size of the association between the legal standing of the institutions and the performance of cesarean sections between 2015 and 2017. Material and methods: A cross-sectional cohort study that describes the frequency of cesarean deliveries between 1998 and 2020, plus an analytical component to estimate the association between the legal nature and the route of delivery between 2015 and 2017, based on the birth records of the Colombian National Statistics Administrative Department (DANE). Proportions of cesarean sections and their increase by institution type are presented. The prevalence ratio was used as an estimator of this association. Results: In 1998, the proportion of cesarean deliveries was 25.7 %; it increased to 46.4 % by 2015 and then dropped to 44.6 % by 2020. After 1998, the proportion of cesarean sections in public hospitals increased from 26.2 % to 42.9 % by 2014, while in private providers it increased from 45.0 % to 57.7 % by 2013. The prevalence ratio of cesarean sections in private versus public institutions was 1.57 (95 % CI: 1.56-1.57). Conclusions: After a long period of sustained growth, there is now a reduction in the proportion of cesarean sections in the country. In public health care institutions, these procedures increased in greater proportion during most of the study period, while in private healthcare providers they are carried out at a higher frequency in all subgroups of women. It will be necessary to evaluate in the future, using more robust methodologies, whether the decrease in the frequency of cesarean section is a real or secular trend.

Oferta de leitos exclusivos para Covid-19 no estado do Espírito Santo / Offer of exclusive beds for COVID-19 in the state of Espírito Santo

RESUMO A pandemia trouxe vários desafios a toda estrutura social, requisitando a organização e desenvolvimento de políticas públicas para conduzir o quadro sanitário. Com relação à saúde, as ações inicialmente envolveram medidas não farmacológicas e preparação do sistema de saúde. No caso do Brasil, em março de 2020 foram deliberadas portarias específicas sobre a oferta de leitos UTI Covid-19. Em abril de 2020, o estado do Espírito Santo iniciou a estruturação dos hospitais referência para Covid-19 habilitando leitos em hospitais públicos de gestão direta e indireta, e em hospitais privados e filantrópicos. Assim sendo, o objetivo deste estudo é analisar a relação de compra e oferta de leitos exclusivos para Covid-19 pela rede SUS no estado do Espírito Santo. Os dados revelam uma rede com diferentes formatos jurídicos, com forte presença de setor filantrópico, seja por Organizações Sociais de Saúde (OSS) ou hospitais. Por fim, o estudo concluiu que a condução da rede hospitalar para leitos UTI Covid-19 ocorreu pela heterogeneidade de formatos jurídicos, com a participação da gestão pública direta substituída por diferentes tipos de gestão, condicionando o estado a reafirmar as contratualizações conforme lógica do mercado.

ABSTRACT The pandemic brought several challenges to the entire social structure, demanding the organization and development of public policies to guide the health situation. With regard to health, actions so far have involved non-pharmacological measures and preparation of the health system. In the case of Brazil, in March 2020, specific ordinances were deliberated on the offer of COVID-19 ICU beds. In April 2020, the state of Espírito Santo began structuring reference hospitals for COVID-19, enabling beds in public hospitals under direct and indirect management, and in private and philanthropic hospitals. Therefore, the objective of this study is to analyze the relationship of purchase and supply of exclusive beds for COVID-19 by the SUS network in the State of Espírito Santo. The data reveal a network with different legal formats, with a strong presence of the philanthropic sector, whether by Social Health Organizations (OSS) or hospitals. Finally, the study concluded that the conduction of the hospital network for COVID-19 ICU beds occurred due to the heterogeneity of legal formats, with the participation of direct public management replaced by different types of management, conditioning the state to reaffirm the contractualizations according to market logic.

Vulnerability to Mental Health Problems in Indian Population during Lockdown amidst COVID-19 Pandemic: An Alarm not to Snooze

Background: Lockdown measures are being implemented in several parts of the world to control the spread of novel coronavirus. This unprecedented crisis has significantly affected the lives of people in different ways. Aim: To understand the experiences and vulnerability to mental health problems during lockdown among the Indian population during COVID-19 pandemic. Materials and Methods: A cross-sectional study was conducted using an online survey form circulated through various social media platforms from April 12 to May 3, 2020 containing self-reported questionnaires to collect lockdown related experiences and scales to assess anxiety (GAD-7) and depression (PHQ-9). A convenience sampling method was used. Results: 442 valid responses were received from different states of India. Statistical analysis revealed that one-third of the respondents suffered from some form of anxiety and depression during a lockdown. Less than 10% of them had severe levels of symptoms. The majority were males aged 18-45 years and private sector employees. Delivering essential services was involved with significant anxiety and depression. Availability of food and daily essentials was the most common problem. Difficulty in availing medicines and financial crisis were significant predictors of anxiety and depression. Worsening of interpersonal relationships was associated with higher levels of anxiety and depression. Conclusions: The study concluded that experiences during the lockdown and associated psychological outcomes are important factors to consider and appropriate preventive measures to be taken in case of any future lockdowns.

IMPACTS OF COVID-19 ON THE INFORMAL SECTOR OF INDIA

The Indian economy is comprised of both the formal or organized sector and the informal or unorganized sector. Both these sectors were severely harmed during the Covid-19 pandemic. The government of India announced an abrupt and sudden lockdown without any prior steps of combating the drawbacks of such an abrupt action. This left the informal sector completely stranded amidst the pandemic. Taking this into consideration, the paper tries to discuss the impacts of the lockdown on the informal sector. While stressing on the adversaries faced by the labourers, the paper addresses the negative impacts of the lockdown on the female workers in the informal sector. Followed by this contextual discussion, the paper attempts to discuss the steps and schemes promulgated by the government for combating this crisis and its limitations. Finally, the paper concludes with an attempt on briefly analyzing the contingencies and suggesting ways forward to meet the exigencies.

Prevalencia y características clínicas de los síntomas depresivos y ansiosos de los trabajadores de una institución de salud en Medellín durante la pandemia por COVID-19

Introducción: Afrontar las circunstancias de la vida y el trabajo que la pandemia por COVID-19 ha impuesto al personal sanitario implica un reto extraordinario: cuidar y atender a otros, exponiéndose a sí mismos al contagio. A médicos, enfermeras, terapeutas y demás personal asistencial y no asistencial en clínicas y hospitales, se les pide estar preparados para trabajar en situaciones extraordinariamente complejas y estresantes, lo que los hace vulnerables a problemas mentales. Objetivo: Determinar la prevalencia y las características clínicas de los síntomas ansiosos y depresivos del personal que trabaja en una institución de salud en Medellín, Colombia. Métodos: Estudio observacional, descriptivo y transversal, a partir de una encuesta disenada al efecto, la cual incluyó 2 escalas para tamizar síntomas depresivos y ansiosos, además de variables sociodemográficas. Resultados: Se incluyó a 1.247 trabajadores de la institución de salud. El 14,6% reportó síntomas depresivos y el 18,5%, ansiosos clínicamente significativos. Se encontró una mayor proporción de síntomas depresivos y ansiosos moderados-graves en la modalidad de trabajo presencial. Conclusiones: Los síntomas ansiosos y depresivos son muy prevalentes entre los trabajadores de una institución de salud de Medellín durante la pandemia de COVID-19. Dado el papel vital del sector salud en tiempos de pandemia, el desarrollo de programas de salud mental que aborden los problemas de esta población debería considerarse una prioridad.

Introduction: The COVID-19 pandemic has represented an extraordinary challenge for health workers as they care for others while exposing themselves to contagion. Doctors, nurses, therapists and other non-care staff in clinics and hospitals are asked to be prepared to work in particularly complex and stressful situations, which makes them vulnerable to mental health problems. Objective: To determine the prevalence and clinical characteristics of anxiety and depression symptoms in staff working at a health institution in Medellin, Colombia. Methods: Observational, descriptive and cross-sectional study, based on a survey designed for the investigation, which included two scales to screen depression and anxiety symptoms, as well as sociodemographic variables. Results: A total of 1,247 workers from the health institution were included. Of these, 14.6% reported symptoms of depression and 18.5% of clinically significant anxiety. A higher proportion of moderate to severe depression and anxiety symptoms was found in those working face to face. Conclusions: Anxiety and depression symptoms are highly prevalent among staff at a health institution in Medellin, Colombia, during the COVID-19 pandemic. Given the vital role of the health sector in times of pandemic, the development of mental health programmes that address the problems of this population should be considered a priority.

BANKING SECTOR DEVELOPS RURAL WOMEN THROUGH MICRO FINANCE: AN ANALYSIS

The institutional credit agencies like commercial banks, Regional Rural Banks (RRBS) and Cooperative banks have been playing a pivotal role in the formation, strengthening and development of the Self-Help Groups (SHGs) through micro finance in India. In fact, the banking institutions have become more instrumental in developing micro-enterprises by the women members of Self-Help Groups through providing financial services. Self-Help Groups linkage programmes is suitable and an effective intervention in economic uplift met and financial inclusion for the bottom of the pyramid.1 A proven platform initially conceived for increasing the outreach of banking services among the poor has since graduated to a programme for promotion of livelihoods and poverty the banking sector in rural and urban areas.2 An attempt is made her to analyze the different, financial agencies such as CBs, RRBs and Cooperative banks in providing financial services to the poor and marginalized sections for the promotion and strengthening of self-help groups in India. Micro-finance is an economic development tool whose objective is to assist the poor to work their way out of poverty. In fact, micro-finance is powerful weapon to remove the poverty in our country. There is a greater involvement of banks in providing the loans to the women members of the Self-Help Groups in the country. The institutional credit agencies have played a crucial role in the development of the poor women members of the SHGs.The Regional Rural Banks have covered more than 45 per cent of the women by way of providing loans and advances whereas the Commercial Banks have given the highest amount of loans to the women members of the SHGs. The Cooperative Banks are in the third position in providing the microcredit to the women members of the SHGs. On the whole, the banking sector has played a dominant role in the provision of the bank loans to the poor women of the SHGs in India.

Awareness, willingness, and challenges of the informal sector toward state National Health Insurance Services in Benin City, Nigeria

Background: As access to vital health services expands and universal health coverage is attained, health insurance is projected to serve as a critical risk protection for families and small enterprises. Aim: To assess the informal sector’s awareness, willingness, and problems in enrolling in the state national health insurance program. Materials and Methods: This cross-sectional descriptive study was done in Benin City, Nigeria, in the unorganized sector. A self-structured questionnaire was created, distributed, and retrieved for this study, which was conducted among 155 artisans chosen through a stratified random sample procedure. To evaluate the data, Statistical Package for the Social Sciences, SPSS version 22 was used. Results: In total, 138 people (89.0%) are aware of the National Health Insurance Scheme (NHIS), while only 93 people (60.0%) know that Edo state has a state-owned Health Insurance Scheme (SHIS). Only 17 people, or 11.0%, are engaged in the NHIS/SHIS program, whereas 107 people, or 77.5%, have expressed interest. Lack of accessibility to authorized healthcare facilities near house 22 (71.0%) is a significant deterrent to enrollment in the program. Long lines at service points (3.88, 1.093), the time it takes to enroll new members in the program (3.78, 1.101), the time it takes for health maintenance organizations to issue authorization codes (3.62, 1.316), the accessibility of NHIS services outside of registration institutions (3.29, 1.289), and the standard of drugs provided by the SHIS (3.12, 1.358) are all factors that hinder utilization. Sex and place of residence each strongly correlated with readiness to sign up for the program (AOR = 4.234, P = 0.017, 95% CI: 1.293–13.873 and AOR = 5.224, P = 0.007, 95% CI: 1.557–17.530, respectively). Conclusion: The artisans have a low rate of health insurance coverage but are eager to sign up for the program. State policymakers should increase their reach and make enrollment required to attain a higher range.

Rehabilitación del sector anterior con disilicato de litio. Relato de un caso / Rehabilitation of the previous sector with lithium disilicate. Case report

Mediante este caso se describen los criterios de selección del color en restauraciones indirectas con disilicato de litio en el sector anterior. Mujer de 34 años, atendida en la Facultad de Odontología de la Universidad Nacional de Concepción (FOUNC), Paraguay, por una preocupación estética del sector anterior, en especial la diferencia de color de las piezas dentarias. La rehabilitación consistió en la confección de coronas de disilicato de litio de las piezas 11, 12, 13, 14, 21, 22, 24, 25 y laminado para carillas de la pieza 23. Fueron aplicadas técnicas de selección de color individualizadas, pruebas de color y cementación antes del cementado final para obtener resultados altamente estéticos. Gracias a los resultados fue posible observar la conjunción de factores como la correcta selección del color del sustrato dentario, el cemento resinoso, el material de restauración y la comunicación eficiente con el laboratorio, fundamental para el éxito del tratamiento.

This case describes the color selection criteria for indirect lithium disilicate restorations in the anterior sector. A 34-year-old woman treated at the Faculty of Dentistry of the National University of Concepción (FOUNC), Paraguay, due to an aesthetic concern in the anterior sector, especially the difference in color of the teeth. The rehabilitation consisted of making lithium disilicate crowns for teeth 11, 12, 13, 14, 21, 22, 24, 25 and laminate for veneers for tooth 23. Individualized color selection techniques, color and cementation prior to final cementation for highly esthetic results. Thanks to the results, it was possible to observe the conjunction of factors such as the correct selection of the color of the dental substrate, the resinous cement, the restorative material, and efficient communication with the laboratory, essential for the success of the treatment.

Emerging roles of telemedicine in dementia treatment and care / Papéis emergentes da telemedicina no tratamento e cuidado da demência

ABSTRACT. Dementia is a neurological disorder that affects memory, thinking, orientation, and other important functions of the brain; telemedicine is a part of the healthcare delivery system involving diagnosis and consultation over telecommunications devices such as mobile phones and computers. In this review, we assessed the impact, accessibility, and possible improvements in telemedicine in dementia treatment. Regarding the use of telemedicine in the treatment, we evaluated its impact on the management of the disease (i.e., diagnosis and follow-up). We also evaluated studies on the current improvements and accessibility of telemedicine in dementia treatment. The review findings showed that it is effective in diagnosing patients, monitoring their progress during treatment, and providing caregiver support. However, studies have revealed a lack of accessibility and improvement in telemedicine among the elderly, particularly in West African countries. Finally, lasting solutions were provided to address the problems in the review permanently.

RESUMO. A demência é um distúrbio neurológico que afeta a memória, o pensamento, a orientação e outras funções importantes do cérebro, enquanto a telemedicina faz parte do sistema de prestação de cuidados de saúde que envolve diagnóstico e consulta por meio de dispositivos de telecomunicações, como telefones celulares e computadores. Nesta revisão, avaliamos o impacto, a acessibilidade e as possíveis melhorias da telemedicina no tratamento da demência. Ao avaliar o impacto da telemedicina no tratamento da demência, avaliamos também seu impacto no manejo da demência (ou seja, diagnóstico e acompanhamento do tratamento da demência). Também avaliamos estudos sobre as melhorias atuais a acessibilidade da telemedicina no tratamento da demência. Os resultados da revisão mostraram que a telemedicina é eficaz para diagnosticar pacientes, monitorar seu progresso durante o tratamento e fornecer suporte ao cuidador. No entanto, estudos revelaram falta de acessibilidade e melhoria da telemedicina entre os idosos, principalmente nos países da África Ocidental. Finalmente, para resolver o problema, foram fornecidas soluções duradouras para resolver permanentemente os problemas na revisão.

"¿Qué opción les queda a las personas, más que nosotros?": Las funciones de los consultorios adyacentes a farmacias en la pandemia de covid-19 / "What choice do people have other than us?": The role of doctors' offices adjacent to private pharmacies in the Covid-19 pandemic

RESUMEN Con la llegada del coronavirus a México, los consultorios adyacentes a farmacias desempeñaron un rol preponderante en el diagnóstico, atención y prevención del covid-19. De acuerdo a las encuestas nacionales, entre el 11,7% y el 23% de las personas con síntomas de covid-19 se atendieron en uno. Por ello, este artículo busca identificar el papel de los consultorios adyacentes a farmacias (CAF) como sistema de salud privado que atendió a personas con síntomas de covid-19 en la ciudad de Oaxaca y describir y analizar los factores que influyeron en su utilización. Desde una metodología cualitativa, entre septiembre de 2020 y agosto de 2022 se entrevistó a 12 médicos y médicas y se aplicó un cuestionario a 59 personas usuarias de los consultorios adyacentes a farmacias del municipio de Oaxaca de Juárez. Asimismo se hizo una recopilación y análisis de fuentes secundarias. Entre los hallazgos, se describen sus funciones como frente de atención al covid-19 y a otras necesidades de salud que emergieron con la crisis sanitaria y se analizan los factores determinantes en las trayectorias de atención de personas usuarias de estos consultorios, como son el incremento en la percepción del riesgo y la desconfianza hacia los servicios públicos o hacia las estrategias implementadas por el gobierno federal.

ABSTRACT With the arrival of coronavirus in Mexico, doctors' offices adjacent to private pharmacies (DAPPs) played a major role in the diagnosis, care, and prevention of Covid-19, providing treatment for 11.7% to 23% of people with Covid-19 symptoms according to national surveys. Therefore, this article seeks to identify the role of DAPPs as a private health system providing care for patients with Covid-19 symptoms in the city of Oaxaca, and to describe and analyze the factors that influenced their utilization. Using a qualitative methodology, twelve physicians were interviewed and 59 users responded to a questionnaire at doctors' offices adjacent to pharmacies in the municipality of Oaxaca de Juárez between September 2020 and August 2022. Secondary data were also collected. Among the findings, the function of these offices at the front line of care for Covid-19 and other health needs that emerged with the public health crisis is described, and the determining factors in care trajectories of users that sought care there are analyzed, such as the increase in perception of risk and mistrust towards public services or strategies implemented by the federal government..

A quantitative study of regulatory policy texts in China′s healthcare sector from the perspective of policy instruments / 中华医院管理杂志

Objective:To analyze the evolution of China′s national-level healthcare sector regulatory policies between 2003 and 2021, and explore the characteristics and patterns of the use of policy instruments at different stages, for references in policy optimization.Methods:The policy documents related to the regulation of the healthcare sector released by the central government were searched from 2003 to 2021 from the policy document database of the State Council using the keywords " medical" " regulation" and " health" " regulation". Based on the analysis framework of " formulation subject-implementation subject-policy tools", such methods as content analysis, social network analysis, and policy tool analysis were used to analyze policy documents and conduct descriptive analysis of data.Results:A total of 236 policies were included in the study.From 2003 to 2008, according to the time progression, a total of 27 documents were issued, with the State Council as the main formulation subject (77.78%, 21/27), and the government as the main implementation subject (100.00%, 27/27). 191 policy tools were used, and the composition ratios of supply-based, demand-based, and environment-based policy instruments were 21.46% (41/191), 30.37% (58/191), and 48.17% (92/191). From 2009 to 2017, a total of 48 policies were issued, the formulation subject was mostly the State Council (93.75%, 45/48), and the implementation subject was still mostly the government (100.00%, 48/48), but the proportion of institutions (25.00%, 12/48), industry organizations (43.75%, 21/48) and the society (37.50%, 18/48) has increased. 500 policy tools were used, and the composition ratios of supply-based, demand-based, and environment-based policy instruments were 17.40% (87/500), 32.00% (160/500), and 50.60% (253/500), respectively.From 2018 to 2021, a total of 161 documents were issued, with the formulation subjects featuring multiple subjects (38.51%, 62/161), with a decrease in the percentage of the State Council′s issuance (22.36%, 36/161), and 157 (97.52%) policies were implemented by the government. 1 140 policy tools were used, and the composition ratios of supply-based, demand-based, and environment-based policy instruments being 18.42% (210/1 140), 34.74% (396/1 140), and 46.84% (534/1 140), respectively.Conclusions:From 2003 to 2021, there was an upward trend in the number of policies issued in the field of healthcare sector regulation in China, and the subjects of formulation and implementation were diversified. But the use of different types of policy instruments was uneven.

Governance for health: A critical, but poorly understood, health system component

@#The paper by Bernal-Sundiang et al.1 in this issue of Acta Medica Philippina provides one of the more extensive and in-depth empirical discussion of governance in the health sector. Utilizing data collected over a one-year period as part of the Philippine Primary Care Studies in urban, rural, and remote settings, the authors reported on challenges their team encountered in project implementation as it relates to leadership and governance. One strength of the paper is that it situates leadership and governance as a health system keystone that links to all the other components of infrastructure and supply chains, information system, health workforce, financing, and stakeholder engagement, and monitoring and evaluation. This harks back to the framework posited in the World Health Report 20002, highlighting the interaction between governance and the other system elements. Despite this critical role of governance, however, it has been characterized as being poorly understood, and often difficult to operationalize, not least because of poor capacities of different institutions and actors to bring to the fore the good governance agenda.3 For instance, it has been suggested that good governance, regardless of the sector, is “accountable, transparent, responsive, equitable and inclusive, effective and efficient, participatory, consensus-oriented and follows the rule of law.”4 This characterization assumes the existence of traditions and institutions that places the common good front and center, something which may not be present, if not willfully disregarded, in many jurisdictions. Another set of related buzzwords for governance is that it entails a “whole-of-government” and “whole-of-society” approaches, which means the mobilization of public agencies, on the one hand, and private sector and civil society organizations, on the other, towards the realization of shared goals.5 Aside from the need for conceptual and operational clarity on these two terms, the reality of token participation and siloed working environments remain barriers to achieving true multisectoral approaches in health and other areas. Relatedly, I wish to bring to the discussion one insight from our case study of tuberculosis program implementation.6 In this research, we identified facilitating and hindering factors to the successful implementation of the tuberculosis prevention and control program in cities and municipalities, and we posited that these factors were rooted in a common source of governance for health. We further extended the argument by stating that focusing on the local chief executive as the responsible entity for good governance is a myopic view of the issue as it only covers the levels that can be labelled as “broader governance environment” and “public policies.”7 The more fine-grained institutional or sectoral governance is within the ambit of the local health officer, while what we propose to refer to as “program-level” governance is the realm of the program coordinator. The scope and specificity of governance as exercised across these levels, and consequent access to precise information, differ, which highlights the shared responsibility of these three principal actors at the local level in so far as exercise of good governance is concerned. Good governance in health has been an aspirational goal for many decades, and was identified as an important constituent in our quest for better health and sustainable development. The recommendations outlined by Bernal-Sundiang et al.1 provide a starting point on how we can gradually improve the health sector to come closer to this ambition. However, embedding good governance in institutions and society at large will be critical in sustaining such gains moving forward.

Current status on independent school health department in the centers for disease control and prevention across China / 中国学校卫生

Objective@#To understand the current status of main professional work in independent school health departments of Chinese centers for disease control and prevention, so as to provide reference and suggestions for the further development of school health work in China.@*Methods@#Electronic questionnaire was used to collect the basic work of school health, the monitoring work, the intervention action of common diseases and the development of health intervention among students in independent school health departments of centers for disease control and prevention in China.@*Results@#Among the 357 institutions that have set up independent school health departments, the implementation rates of school mental health work, safety emergency and risk avoidance health intervention were low, which were 11.8% and 11.5%, respectively. Relying on the project "national monitoring and intervention of common diseases and health influencing factors of students", the overall implementation of health monitoring in schools nationwide was successful, but the overall implementation rate of students nutritional status monitoring and "healthy parents action" were low, accounting for 44.5% and 24.4%, respectively. At the same time, there were still as many as 27.2% institutions that had not carried out the intervention action for common diseases of students which advocated in the monitoring program. The failure rate of county level institutions was higher than that of provincial level and prefecture level institutions, and the failure rate of the central and western institutions was much higher than that of the eastern institutions; the difference was statistically significant( χ 2=30.1, 41.6, P <0.05).@*Conclusion@#We should increase support including policy preference, fund guarantee, technical guidance and so on for the school health work of disease control institutions at the grass roots level and in economically underdeveloped areas, so as to ensure the healthy growth of children and adolescents in all respects.

Is chemical exposure present in informal work associated with Sars-CoV-2 infection?

ABSTRACT OBJECTIVE To compare the incidence of covid-19 symptoms between informal home-based workers and a control group and to assess the association of these cases with blood elements concentrations and other relevant risk factors for Sars-Cov-2 infection. METHODS Welders chemically exposed to potentially toxic elements (PTEs) (n = 26) and control participants (n = 25) answered questionnaires on adherence to social distancing and signs and symptoms of the disease for five months during the covid-19 pandemic. After follow-up, covid-19 serology tests were performed on a subsample of 12 chemically exposed workers and 20 control participants. Before the pandemic, PTE concentrations in blood (As, Mn, Ni, Cd, Hg, Sb, Sn, Cu, Zn, and Pb) were measured by ICP-MS. RESULTS The chemically exposed group had higher lead and cadmium levels in blood (p < 0.01). The control group presented lower adherence to social distancing (p = 0.016). Although not significant, welders had a 74% greater chance of having at least one covid-19 symptom compared with control participants, but their adherence to social distancing decreased this chance by 20%. The use of taxis for transportation was a risk factor significantly associated with covid-19 symptoms. CONCLUSION The lower adherence to social distancing among the control group greatly influences the development of covid-19. The literature lacks data linking exposure to PTEs and Sars-Cov-2 infection and/or severity. In this study, despite chemical exposure, working from home may have protected welders against covid-19, considering that they maintained greater social distancing than control participants.