Introdução ao estudo das políticas públicas: uma visão interdisciplinar e contextualizada

Em relação a políticas públicas, a sociedade contemporânea se comporta de duas maneiras distintas: pode ser mais esclarecida e participante, solicitando melhores resultados da gestão pública na solução de seus problemas, ou assiste estarrecida aos fatos que envolvem os desvios em torno da gestão pública. Entender como se articulam as variáveis, explícitas ou implícitas, na formulação, na execução e na avaliação das políticas públicas, é uma necessidade urgente. Este livro propõe olhar os acontecimentos recentes, da perspectiva do conhecimento de políticas públicas.

Representação social de adultos sobre tabagismo e suas implicações para a saúde: estudo realizado em comunidade rural - MG / The social representation of smoking among adults and its implications for health: study conducted in a rural community in the state of Minas Gerais

Objetivo: Apreender a representação social de adultos de uma comunidade rural sobre o tabagismo e suas implicações para a saúde e, por conseguinte, fornecer subsídios para planejamento das ações dos serviçosde saúde. Materiais e Métodos: Foram realizadas entrevistas semi-estruturadas com 15 adultos (fumantes, exfumantes e não-fumantes), entre 30 a 59 anos, moradores de uma região rural em Santa Bárbara-MG e usuários do serviço de saúde municipal, para uma análise utilizando a abordagem qualitativa dos dados. Resultados:Foi possível classificar e separar os discursos em três grandes temas: Iniciação do Tabagismo; Influência naQualidade de Vida e Cessação do Hábito. Os entrevistados consideraram importante que os profissionais desaúde tenham maior ação no apoio à cessação do tabagismo. Há concordância de que é necessário não apenasmanter as propagandas antitabaco nos maços e ampliar o número de áreas restritivas ao cigarro, bem comoa intensificação destas medidas. Conclusão: Deve-se aumentar as ações direcionadas aos jovens e à família,pois ambos interferem fundamentalmente na iniciação ao fumo. A criação de grupos de convivência podeauxiliar na cessação do hábito de fumar. Diminuir as formas de pressão social aos grupos em situação devulnerabilidade social pode ajudar na diminuição do número de fumantes.

Habits and beliefs pertaining to tobacco among undergraduates of medical college in the state of Uttarakhand.

Background: Tobacco surveillance among medical students offers an opportunity to assess the preparedness for tobacco control among future healthcare professionals in India. The purpose of the present study was to evaluate the use of tobacco in the undergraduate medical students and to assess the factors influencing medical students to indulge in tobacco use. Objective: To assess the prevalence of tobacco use among undergraduate students and to assess the attitude and awareness towards participating in tobacco cessation. Material and methods: A cross-sectional questionnaire-based study to assess the prevalence of tobacco use among undergraduate students of Himalayan Institute of Medical Sciences, Dehradun (Uttarakhand State) was conducted from January 2010 to January 2011. A pre-designed structured questionnaire was used to study various correlates of the tobacco use. Data was collected and analysed. Global Health Professional Students Survey (GHPSS), questionnaire given by the Centers for Disease Control (CDC), Atlanta, USA, which is a standard pre-tested questionnaire for assessing prevalence of tobacco use among health care professionals around the world was used. Results: Overall, 386 of 400 eligible students (97%) participated in the survey. The mean age and standard deviation of the study group was 21.47 ± 3.70 years. The rates of smoking among male medical and female medical students were 38.6% and 6.5%, respectively (p < 0.001). A 6-times higher tobacco use was found among male medical students as compared to females. Out of the 386 participants, current tobacco use (last 30 days) was reported by 11.1% of students. About 21.7% of students had never used tobacco. More than 80% favoured a ban on tobacco sales to adolescents, tobacco advertising, and tobacco use in public places. Over 90% reported interest in further training in tobacco control. There was a familial aggregation of the use of tobacco. The factor initiating the use of tobacco was peer pressure in most of the cases. Conclusion: This study reflects an alarming situation and demands urgent measures to be adopted by health professionals, who happen to be health promoters and health role models for the society.

A Preliminary investigation of periodontal disease and diabetes in Trinidad / Una investigación de la enfermedad periodontal y la diabetes en Trinidad

OBJECTIVES: To describe periodontal disease status in diabetic patients in Trinidad. METHOD: A cross-sectional study was conducted. Patients attending a tertiary referral centre for diabetes at an out-patient clinic were invited to undergo oral examinations. The basic periodontal examination (BPE) was used to assess periodontal disease status. RESULTS: Seventy-two patients participated in the study. Mean age was 55.7 years, 54.2% were female, with 66.7% and 22.2% being of Indo-Trinidadian and Afro-Trinidadian ethnicity respectively. There were 61.1% who had not attended for dental treatment within the last year and 56.9% only attended when in pain; 15.3% had a history of cigarette smoking and 31.9% currently wore a denture. Plaque was detectable with the use of a probe in 40.3% of the 67% that underwent a BPE assessment; 38.8% were found to have advanced periodontal disease. CONCLUSION: The prevalence of periodontal disease in this sample of diabetic patients suggests that regular dental examinations, oral health education, and collaborative patient care between medical and dental practitioners should form part ofthe routine management ofdiabetic patients in Trinidad.

OBJETIVOS: Describir el estado de la enfermedad periodontal en los pacientes diabéticos en Trinidad. MÉTODO: Se llevó a cabo un estudio transversal. Un número de pacientes que asistían a un centro terciario de remisión terciario para la diabetes en una clínica ambulatoria, fue invitado a recibir exámenes orales. Se usó el examen periodontal básico (EPB) para evaluar el estado de la enfermedad periodontal. RESULTADOS: Setenta y dos pacientes participaron en el estudio. La edad promedio fue 55.7 años, 54.2% fueron hembras; 66.7% y 22.2% fueron de etnicidad indotrinitense y afrotrinitense respectivamente. Hubo un 61.1% que no habían asistido para recibir tratamiento dental en el último año, y 56.9% que sólo asistieron cuando tuvieron dolor; el 15.3% tenía una historia de hábito de fumar cigarrillos, y el 31.9% usaba una prótesis dental. La placa era detectable usando una sonda dental en el 40.3% del 67% que recibió la evaluación del EPB, en tanto que se halló que el 38.8% tenía la enfermedad periodontal en estado avanzado. CONCLUSIÓN: La prevalencia de la enfermedad periodontal en esta muestra de pacientes diabéticos indica que los exámenes dentales regulares, la educación para la salud oral, y el cuidado colaborativo entre pacientes y trabajadores de la salud dental, deben formar parte del manejo de los pacientes diabéticos en Trinidad.

Association Between MicroRNA196a2 rs11614913 Genotypes and the Risk of Non-Small Cell Lung Cancer in Korean Population / 예방의학회지

OBJECTIVES: The microRNA (miRNA) miR-196a2 may play an important role in lung cancer development and survival by altering binding activity of target mRNA. In this study, we evaluated their associations with the susceptibility of non-small cell lung cancers (NSCLC) by case-control study in a Korean population. METHODS: We performed genotyping analyses for miR-196a2 rs11614913 T/C at miRNA regions in a case-control study using blood samples of 406 NSCLC patient and 428 cancer-free control groups. RESULTS: The total C allele frequencies for miR-196a2 were 48.8% for the patients and 45.6% for the controls; and the genotype frequencies of TT, TC, and CC were 23.7%, 55.2%, and 21.1% for the patients and 31.1%, 46.35%, and 22.4% for the controls (p<0.05). Participants who possesses TC/CC genotypes showed high risk for NSCLC compared to those possessed TT genotypes (OR, 1.42; 95% CI, 1.03 to 1.96). The association was persisted in 60 and older age group, male, smokers, those without family history for cancer. However, no significant association of CC genotypes in recessive genetic model was observed. CONCLUSIONS: In conclusion, this case-control study provides evidence that miR-196a2 rs11614913 C/T polymorphisms are associated with a significantly increased risk of NSCLC in a dominant model, indicating that common genetic polymorphisms in miR-196a2 rs11614913 are associated with NSCLC. The association of miR196a2 rs11614913 polymorphisms and NSCLC risk require confirmation through additional larger studies.

Secondhand smoke exposure among nonsmoking adults in Seoul, Korea.

Despite having one of the highest smoking rates among men, information about secondhand smoke (SHS) exposure among Korean adults is lacking. This study describes SHS exposure among Korean men and women. The results were derived from a population-based, cross-sectional telephone survey conducted with 332 adult nonsmokers in Seoul. Sixty-eight percent of nonsmokers were exposed to SHS during a typical day. Exposure was most common in locations other than home and work, where 57% of respondents were exposed, compared to 26% at home and 25% at work. However, among those exposed, the greatest dose of exposure occurred at work (9 cigarettes/day), followed by at home (6 cigarettes/day). Men were more likely to be exposed to SHS at work than women. For men, lack of home smoking bans and strong belief in traditional Korean values were independently associated with SHS exposure in any location. For women, younger age, family members' smoking (non-spouse), and having fewer sources of anti-SHS messages were independently associated with SHS exposure anywhere. The results highlight the need for strong, comprehensive SHS control measures, such as a complete ban of smoking in all workplaces and public places, as well as public health campaigns to promote home smoking bans and non-smoking norms.

Longitudinal study of smoking progression in Chinese and Vietnamese American adolescents.

The use of tobacco remains a significant public health concern among Asian American (AA) adolescents. Understanding the factors that affect smoking progression among Chinese and Vietnamese adolescents in particular, may help in illuminating potential interventions that can be implemented to maximize scarce programming and resources. This study is a longitudinal cohort study with data collected in California via telephone over a two-year period. 1,270 Chinese and Vietnamese American adolescents were recruited via telephone listings from one southern and four northern California counties. Main outcomes were smoking susceptibility and change in smoking status. Examination of these adolescents indicated that in both groups: boys were more likely than girls to become susceptible to smoking, risk behaviors were associated with becoming smokers, having been susceptible at baseline was associated with susceptibility and smoking at follow-up, and the influence of friends was a predictor of susceptibility and smoking.

Helicobacter pylori infection in peptic ulcer disease: the importance of smoking and ethnicity.

This study was conducted to determine the prevalence of Helicobacter pylori (H. pylori) and its associated factors among patients with peptic ulcer disease in Taiping Hospital. Consecutive peptic ulcer disease patients who had undergone esophagogastro-duodenoscopy were included. The H. pylori status was assessed by the rapid urease test. We excluded those who had active bleeding, a perforated peptic ulcer, severe vomiting, a history of gastric surgery, peptic ulcer disease or renal or liver diseases, carcinoma of the stomach, and recent use of antibiotics or proton pump inhibitors. Socio-demography, H. pylori status, medication history and other relevant clinical data were collected from case notes. A total of 416 subjects were selected, 49.7% were positive and 50.3% were negative for H. pylori infection. There were significant associations between H. pylori and age, ethnicity, smoking status and NSAID usage. However, there were no significant relationships between H. pylori status and gender or type of peptic ulcer. Multiple logistic regression showed that other ethnicities than Malays and smokers had a higher risk of H. pylori. Our prevalence rate was low and the identified risk factors were consistent with previous studies. Ethnic differences may be related to genetic and sociocultural behaviors. Quitting smoking may benefit peptic ulcer patients with H. pylori infection.

Tabaquismo entre estudiantes de medicina

Objetivo: Estimar la prevalencia de tabaquismo entre estudiantes de medicina de nuestra universidad y determinar su actitud hacia las acciones contra el tabaquismo. Métodos: Se aplicó un cuestionario de 12 preguntas a todos los estudiantes de los semestres primero a décimo de la Facultad de Medicina de la Pontificia Universidad Javeriana de Bogotá. Resultados: 618 de 625 estudiantes (99 por ciento) contestaron la encuesta. El 19 por ciento del total fueron fumadores, 14 por ciento de las mujeres y el 22 por ciento de los hombres (p<0.01). La prevalencia fue diferente en cada semestre con una tendencia a aumentar en los semestres más altos: 10 por ciento en primer semestre y 32 por ciento en décimo semestre (p<0.01). Entre los fumadores, las mayores razones para no fumar fueron no interés (43 por ciento) y salud (25 por ciento). Los estudiantes estuvieron expuestos al tabaco en cafeterías (96 por ciento), oficinas (69 por ciento), salones de clases (41 por ciento), ascensores (27 por ciento) y pabellones de hospitalización (9 por ciento). Sobre la posibilidad de implementar áreas restringidas para fumar, 94 por ciento estuvieron de acuerdo (79 por ciento fumadores, 98 por ciento, no fumadores) y 67 por ciento (39 por ciento fumadores, 74 por ciento no fumadores) en prohibirlo. El 68 por ciento de los fumadores participarían en un programa de cesación del tabaquismo. Conclusiones: La prevalencia de tabaquismo en esta población de estudiantes de medicina es levemente inferior a la nacional del 21.4 por ciento. Hay una prevalencia mayor en los semestres superiores (p<0.01), lo que podría estar influenciado por la ausencia de programas contra el tabaquismo en nuestra universidad. Es necesaria la implementación de programas de educación y áreas sin tabaco la universidad y en el hospital.

Fumar o no fumar: ¿Cual es el problema? / To smoke or not smoke: what is the problem?

El trabajo es una selección selectiva de la investigación conductual y farmacológica realizada sobre el hábito de fumar. Se examinan la mayoría de las implicaciones teóricas oriundas de la investigación anterior y reciente relacionadas con la iniciación, mantenimiento y terapia del hábito de fumar, incluyendo algunos estudios sobre suspensión y abandono del hábito