Aspects that facilitate access to care for viral hepatitis: An evaluative research

ABSTRACT BACKGROUND: Viral hepatitis is a major public health concern worldwide. OBJECTIVES: This study aimed to analyze the factors that facilitate access to care for viral hepatitis. DESIGN AND SETTING: Using a sequential mixed method, this evaluation research was conducted in the state of Mato Grosso, Brazil. METHODS: Mapping of references and selection of regions were made based on the quantity and heterogeneity of services. The stakeholders, including the managers of the State Department of Health and professionals from reference services, were identified. Nine semi-structured interviews were conducted using content analysis and discussions guided by the dimensions of the analysis model of universal access to health services. RESULTS: In the political dimension, decentralizing services and adhering to the Intermunicipal Health Consortium are highly encouraged. In the economic-social dimension, a commitment exists to allocate public funds for the expansion of referral services and subsidies to support users in their travel for appointments, medications, and examinations. In the organizational dimension, the availability of inputs for testing, definition of user flow, ease of scheduling appointments, coordination by primary care in testing, collaboration following the guidelines and protocols, and engagement in extramural activities are guaranteed. In the technical dimension, professionals actively commit to the service and offer different opening hours, guarantee the presence of an infectious physician, expand training opportunities, and establish intersectoral partnerships. In the symbolic dimension, professionals actively listen to the experiences of users throughout their care trajectory and demonstrate empathy. CONCLUSIONS: The results are crucial for improving comprehensiveness, but necessitate managerial efforts to enhance regional governance.

Reflections on Moral Governance Path of Public Health Emergencies / 中国医学伦理学

Moral governance is an important social practice activity to improve social norms, cultivate citizens’ moral character, and cultivate citizens’ legal literacy. The changes of the social environment under public health emergencies have brought new changes and challenges to the work of moral governance. Under the background of normalization epidemic prevention and control, it is necessary to accurately understand and deeply grasp the risks of social and environmental changes caused by public health emergencies, fully combine the needs of public health emergency management, and be targeted in the content and requirements of moral governance. At the same time, it is significant to actively transform governance ideas, and improve the effectiveness of moral governance through multi-dimensional path innovation such as value and orientation, resources and methods, technology and carrier, strategies and means.

Supervision Strategy and Implementation Key Points of Scientific and Technological Ethical Governance in Health and Medical Field / 中国医学伦理学

The ethical governance of science and technology is a kind of practical ethics, which develops in the process of continuously solving the ethical problems and ethical conflicts arising from scientific and technological activities. Ethical governance has common requirements and professional standards. Health-related science and technology activities, including the application of life science and artificial intelligence in health and medical field, make the medical ethical governance face common and unique challenges. The supervision and ethical review should consider the speciality of life science and medical research, and bring the existing ethical review system into full play. However, the focus, emphasis and standards of ethical governance have changed with the application of some technologies (ex. the next-generation sequencing, gene editing, and artificial intelligence). Actions should be taken to strengthen the ethical governance and promote ethics in advance with science and technological implementation in health and medical field. Here in this article, the classified, hierarchical supervision and ethical review strategies are discussed; then some potential effective organization and mechanisms for regional ethics committees are introduced. Promoting the medical education and continuing education of ethical governance of science and technology is also recommended.

Science and Technology Ethics Governance, How to Put Ethics First? / 中国医学伦理学

Science and technology ethics governance, how to put ethics first? The purpose of "technological innovation, ethics first" is to build an ethical soft landing mechanism for scientific and technological innovation. Researchers of science and technology ethics should start from the practice of international and domestic science and technology ethics governance, and explore the realistic way of science and technology ethics governance on the basis of understanding and thinking about the innovative culture, value orientation and operation mechanism. First of all, it should be noted that seeking technical, management and institutional solutions in the current ethical governance of science and technology may not be perfect and thorough, but operable management measures can be explored and continuously improved under the framework of mainstream scientific and technological innovation. Secondly, the co-governance of science and technology ethics needs to further explore the corresponding group co-governance epistemology facing pluralistic co-governance. Finally, the ethical governance of science and technology should pay attention to the principle of proportionality, and avoid both lax and being too strict.

Discrimination of the Governance Principles of Science and Technology Ethics and Dissemination of Ideas / 中国医学伦理学

Ethical governance is inherent in responsible research and innovation. The Opinions on Strengthening Ethical Governance of Science and Technology puts forward five ethical principles: promoting human well-being, respecting the right to life, adhering to fairness and justice, reasonably controlling risks and maintaining openness and transparency. This paper interpreted the ideas, key points and difficulties of these five ethical principles. Three suggestions were put forward to strengthen the ethics education of science and technology: first, optimize the curriculum of science and technology ethics for related majors in colleges and universities, and help young students understand ethical principles and establish the correct ethics view of science and technology; second, colleges and universities should carry out education and training for teachers, researchers, managers and members of ethics committees, and actively explore scientific research ethics training and effect evaluation; third, the professional courses offered by college teachers should be organically integrated with the ideological and political content of the courses to play a warning role.

The Ethical Principles of Science and Technology Need Concrete Research to Guide / 中国医学伦理学

On March 20, 2022, the General Office of the CPC Central Committee and the General Office of the State Council issued The Opinions on Strengthening Ethical Governance of Science and Technology, which put forward five ethical principles of science and technology: promoting human well-being, respecting the right to life, adhering to fairness and justice, reasonably controlling risks and maintaining openness and transparency. Ethical principles require to be studied and interpreted concretely by ethical scholars, that is, first, they need to be refined in order to be truly guided; second, the principle of balance is needed to truly guide; third, it is necessary to study ethical theory in order to truly guide; fourth, it is significant to explore Chinese civilization in order to truly guide. In this way, the ethical principles of science and technology can be practically applied and guide the concrete practice of science and technology.

Ethical Governance of Human Health Related Research / 中国医学伦理学

The frequent several ethical events in recent years suggested carry out the construction of ethical governance system involving human health-related research under the background of national governance. The subjects of ethical governance include the government, medical institutions, universities, scientific research institutes, enterprise, ethics committees, researchers, the public, etc., the multiple subjects are interrelated and interact with each other to restrict and standardize ethics through different governance tools. However, there are some problems in China’s ethical governance, such as the relative lag in the construction of ethical governance concept and system, insufficient multi-party participation, the difficulty in sole legislation to solve risk and ethical problems, the specification cannot be met, inadequate supervision, insufficient accountability for violations, researchers lack ethical awareness, ethical education lags behind and insufficient information disclosure to the public. It should be taken such as countermeasures as paying attention to the theoretical research of ethical governance system, strengthening the construction of ethical governance system, pluralistic co governance, agile governance, strengthening legislation, improving norms, implementing supervision, strengthening the construction of ethics committee, talent training, training researchers, ethical education, popular science public, academic self-discipline, information disclosure and public participation, so as to build a scientific and technological ethics governance system in line with China’s national conditions and in line with international standards, and contribute China’s wisdom for world ethical governance.

Mapping projects for expanding rapid HIV testing in key populations, Brazil, 2004-2021 / Projetos de mapeamento para a expansão da testagem rápida para HIV em populações-chave, Brasil, 2004-2021 / Proyectos para mapear la expansión de las pruebas rápidas del VIH en poblaciones clave, Brasil, 2004-2021

Abstract: The HIV/AIDS epidemic remains a persistent and real issue, especially in key populations such as men who have sex with men (MSM), travestis and transgender persons. Projects for expanding rapid HIV testing are strategic initiatives aimed at the earliest possible identification of individuals' serological status and thus early treatment, screening of sex partners, and upscaling of preventive actions to interrupt the transmission chain. This study thus maps, describes, and systematizes the projects for expanding rapid HIV testing implemented from 2004 to 2021 in Brazil, highlighting the on-going contribution of civil society organizations and discussing the interoperability and cooperation resulting from public governance processes. We selected 67 documents for analysis, including 30 scientific publications retrieved from electronic databases and 37 documents produced by government institutions and nongovernmental organizations (NGOs). Find Out (Fique Sabendo), I Want to Get Tested (Quero Fazer), The Time is Now (A Hora É Agora), Live Better Knowing (Viva Melhor Sabendo), and Live Better Knowing Young (Viva Melhor Sabendo Jovem) were the projects mapped. Results show that the projects have used strategies adapted to the key population, such as mobile testing units, peer education, and innovative community engagement approaches. Such actions were enabled by effective cooperation and interoperability between participating stakeholders, especially NGOs.

Resumo: A epidemia de HIV/aids está longe de terminar. Ainda é muito real, especialmente em populações-chave, como homens que fazem sexo com homens (HSH), travestis e pessoas transgênero. Projetos de ampliação da testagem rápida anti-HIV são iniciativas estratégicas que visam à identificação mais precoce possível do status sorológico dos indivíduos e, consequentemente, ao tratamento precoce, à triagem de parceiros sexuais e à ampliação das ações preventivas para interrupção da cadeia de transmissão. Assim, este estudo se propõe a mapear, descrever e sistematizar os projetos de expansão da testagem rápida para HIV realizados de 2004 a 2021 no Brasil, destacando a contribuição em curso das organizações da sociedade civil e discutindo a interoperabilidade e a cooperação resultantes dos processos de governança pública. Foram selecionados 67 documentos para análise, incluindo 30 publicações científicas recuperadas de bases de dados eletrônicas e 37 documentos produzidos por instituições governamentais e organizações não governamentais (ONGs). Os projetos mapeados foram: Fique Sabendo, Quero Fazer, A Hora É Agora, Viva Melhor Sabendo e Viva Melhor Sabendo Jovem. Os resultados mostram que os projetos utilizaram estratégias adaptadas à população-chave, como unidades móveis de testagem, educação entre pares e abordagens inovadoras de engajamento comunitário. Tais ações foram possíveis graças à cooperação e interoperabilidade efetivas entre as partes interessadas participantes, especialmente as ONGs.

Resumen: La epidemia de VIH/SIDS está lejos de terminar. Sigue siendo muy real, sobre todo en poblaciones clave, como hombres que tienen sexo con hombres (HSH), travestís y personas transgénero. Proyectos para ampliar las pruebas rápidas anti-VIH son iniciativas estratégicas que tienen el objetivo de identificar el estado serológico de las personas lo antes posible y, consiguientemente, hacer el tratamiento precoz, el triaje de las parejas sexuales y ampliar las acciones preventivas para interrumpir la cadena de transmisión. Así, este estudio tiene el objetivo de mapear, describir y sistematizar los proyectos de expansión de las pruebas rápidas del VIH realizados entre 2004 y 2021 en Brasil, resaltando la contribución en curso de los organismos de la sociedad civil y discutiendo la interoperabilidad y la cooperación que resultan de los procesos de gobernanza pública. Se seleccionaron 67 documentos para el análisis, entre ellos 30 publicaciones científicas recuperadas de bases de datos electrónicas y 37 documentos producidos por instituciones gubernamentales y organizaciones no gubernamentales (ONGs). Los proyectos mapeados fueron: Para que Sepas (Fique Sabendo), Quiero Hacer (Quero Fazer), La Hora Es Ahora (A Hora É Agora), Viva Mejor Sabiendo (Viva Melhor Sabendo) y Viva Mejor Sabiendo Joven (Viva Melhor Sabendo Jovem). Los resultados demuestran que los proyectos utilizaron estrategias adaptadas a la población clave, como las unidades móviles de prueba, educación entre pares y enfoques innovadores de participación comunitaria. Estas acciones fueron posibles gracias a la cooperación e interoperabilidad efectivas entre las partes interesadas participantes, sobre todo las ONGs.

Biodiversidade e saúde: priorizando ações para inclusão produtiva, desenvolvimento territorial e conservação ambiental / Biodiversity and health: prioritizing actions for productive inclusion, territorial development, and environmental conservation

Resumo O Projeto ArticulaFito realizou um amplo diagnóstico da base produtiva de espécies vegetais com valor medicinal, cosmético e alimentar, mapeando 26 cadeias de valor (CdV) de povos e comunidades tradicionais e de agricultores familiares (PCTAFs). O objetivo é definir critérios para priorização de ações de fortalecimento das CdV mapeadas, tendo como referência os desafios e oportunidades identificados. As metodologias de análise envoltória de dados e diagrama de Pareto foram aplicadas em dados quantitativos extraídos de cada mapa de CdV. Dessa forma, o conjunto de CdV foi dividido em quatro grupos de níveis de desempenho. Para cada grupo foi traçado um diagrama de ação que ordenou as ocorrências e suas origens, permitindo relacionar e indicar, em ordem de prioridade, as instituições e os atores a serem considerados no processo de fortalecimento. O grupo com o melhor desempenho apresentou dez espécies, sendo 70% no segmento cosmético, no bioma Amazônia e na região norte, 80% nativas sob regime de extrativismo e 20% exóticas sob regime de cultivo. O diagrama de ação gerado priorizou as ações e os investimentos, otimizando os recursos públicos aplicados para a inclusão produtiva dos PCTAFs por meio do uso sustentável da sociobiodiversidade.

Abstract The ArticulaFito Project conducted a broad analysis of the production base of plants with medicinal, cosmetic, and food value, mapping 26 value chains (CdV) of traditional peoples and communities and family farmers (PCTAFs). The objective is to define criteria to prioritize actions in order to strengthen the mapped CdV, maintaining the identified challenges and opportunities as a reference. Data Envelopment Analysis and Pareto Diagram methodologies were applied to quantitative data extracted from each CdV map. In this way, the CdV set was divided into four groups of performance levels. For each group, an action diagram was drawn, which, ordered the occurrences and their origins, enabling the reporting and indication, in order of priority, of the institutions and actors to be considered in the strengthening process. The group with the best performance had ten species, 70% in the cosmetic segment, in the Amazon biome, and in the northern region, with 80% native under an extractive regime and 20% exotic under a cultivation regime. The Action Diagram generated prioritized actions and investments, optimizing public resources in the productive inclusion of PCTAFs for the sustainable use of (socio) biodiversity.

Panorama dos esportes ginásticos olímpicos nos municípios paranaenses / Panorama of olympic gymnastics in municipalities of paraná state

RESUMO Este artigo objetivou analisar o panorama dos esportes ginásticos olímpicos nos municípios paranaenses. Metodologicamente, seguiu-se os critérios da análise descritiva com coleta de dados realizada em três etapas distintas: 1) coleta de registros sobre a oferta das modalidades gímnicas no instrumento de pesquisa GEEM, do Instituto de Pesquisa Inteligência Esportiva; 2) consulta a documentos e notícias nos portais oficiais da Secretaria de Esporte do Paraná e Federação Paranaense de Ginástica; e 3) cruzamento dos dados levantados. Conclui-se que há ênfase na oferta de Ginástica Artística Feminina e Ginástica Rítmica, sem fomento à Ginástica de Trampolim - especialmente nos Jogos oficiais do Estado -, sendo que 16% dos municípios paranaenses incentivam ao menos uma das práticas gímnicas competitivas, seja na Formação Esportiva, Excelência Esportiva ou Esporte para a Vida Toda.

ABSTRACT This article aimed to analyze the panorama of Olympic gymnastics in municipalities of Paraná. Methodologically, the study followed the criteria of descriptive analysis with data collection conducted in three distinct stages: 1) gathering records on the provision of gymnastic modalities using the GEEM research tool from the Instituto de Pesquisa Inteligência Esportiva; 2) consulting documents and news on the official portals of the Sports Department of Paraná and the Paraná Gymnastics Federation; and 3) cross-referencing the collected data. It is concluded that there is an emphasis on the provision of Women's Artistic Gymnastics and Rhythmic Gymnastics, with little support for Trampoline Gymnastics - especially in official state games - as only 16% of municipalities in Paraná encourage at least one of the competitive gymnastic practices, whether in Sports Training, Sports Excellence, or Lifelong Sports.

Gerenciando paradoxos da estratégia aberta no setor público / Gestión de las paradojas de la estrategia abierta en el sector público / Managing open strategy paradoxes in the public sector

Resumo A chamada "estratégia aberta" preconiza a inclusão de colaboradores de diferentes níveis, bem como de agentes externos e parceiros, no processo de construção da estratégia. Esse movimento de abertura e inclusão também tem avançado no setor público por meio da governança colaborativa, como consequência das mudanças do entendimento do papel do Estado numa forma de gestão que promove a interação entre os atores públicos e privados. O argumento central deste ensaio é que há paradoxos inerentes à estratégia aberta no setor público que precisam ser gerenciados para evitar ou minimizar tensões prejudiciais entre os envolvidos. O artigo adota uma abordagem reflexiva e indutiva, baseada nas perspectivas teóricas tanto da estratégia aberta quanto da governança colaborativa. Como resultado, contribui para o campo de estudos em gestão pública e apresenta proposições teóricas e práticas que indicam caminhos para gerenciamento da estratégia aberta.

Resumen La denominada estrategia abierta aboga por la inclusión de empleados de diferentes niveles, y de agentes y socios externos, en el proceso de construcción de la estrategia. Este movimiento hacia la apertura y la inclusión también ha avanzado en el sector público a través de la gobernanza colaborativa, como consecuencia de cambios en la comprensión del papel del Estado en una forma de gestión que promueve la interacción entre actores públicos y privados. El argumento central de este ensayo es que existen paradojas inherentes al uso de la estrategia abierta en el sector público que deben gestionarse para evitar o minimizar tensiones dañinas entre los involucrados. El ensayo adopta un enfoque reflexivo e inductivo, basado en las perspectivas teóricas tanto de la estrategia abierta como de la gobernanza colaborativa. Como resultado, contribuye al campo de los estudios en gestión pública y presenta propuestas teóricas y prácticas que indican caminos para la gestión de estrategias abiertas.

Abstract The open strategy approach advocates the inclusion of external agents, partners, and employees working at different levels in the strategy construction process. This movement toward openness and inclusion has also advanced in the public sector through collaborative governance. This development is due to changes in understanding the state's role as a promoter of interaction between public and private actors. The central argument of this essay is that there are paradoxes inherent in the use of open strategy in the public sector that need to be managed in order to avoid or minimize damaging tensions between those involved. The essay adopts a reflexive and inductive approach based on the theoretical perspectives of both open strategy and collaborative governance. As a result, it contributes to the field of public management studies and presents theoretical and practical propositions that indicate ways of managing open strategy.

Fortalecimiento del liderazgo para la gestión educativa en las Américas: una estrategia de investigación-acción / Strengthening leadership for educational management in the Americas: an action research strategy / Fortalecimento da liderança para a gestão educacional na Região das Américas: uma estratégia de pesquisa-ação

RESUMEN La formación de recursos humanos en salud es una preocupación recurrente. El Campus Virtual de Salud Pública (CVSP) es la plataforma educativa de la Organización Panamericana de Salud (OPS) que busca mejorar la accesibilidad a la educación en salud pública, con énfasis en la formación en liderazgo educativo orientado a planificar, implementar y evaluar políticas y acciones educativas. El objetivo de este trabajo es presentar los resultados de una consulta a personas expertas sobre el curso virtual "Liderazgo para la Gestión Educativa en Organizaciones de Salud", como parte de una estrategia de fortalecimiento de las capacidades de liderazgo para la gestión educativa en las Américas propuesta por el CVPS/OPS. Se realizó un estudio cualitativo de investigación-acción, con una metodología Delphi de dos iteraciones de consultas, una virtual y una presencial, a expertos en gestión educativa en organizaciones de salud. Los resultados muestran la relevancia que adquieren ocho dimensiones de análisis: el perfil de los destinatarios, las competencias, el enfoque y los contenidos, las actividades, la evaluación del y para el aprendizaje, la adaptabilidad, la implementación y el seguimiento durante y poscurso. La participación de actores de diferentes ámbitos geopolíticos en el diseño e implementación de una propuesta educativa regional promueve la transformación del contexto de aplicación y mejora su potencial adopción. Se destaca el lugar estratégico del curso como catalizador en la conformación y la consolidación de una red integrada de organizaciones para fortalecer el liderazgo educativo en las Américas, y la conveniencia de la estrategia metodológica empleada para mejorar la calidad de la formación de recursos humanos en salud.

ABSTRACT The training of human resources for health (HRH) is a recurring concern. The Virtual Campus for Public Health (VCPH) - the educational platform of the Pan American Health Organization (PAHO) - seeks to improve access to public health education, emphasizing leadership training for teams that plan, implement, and evaluate policies and educational initiatives. The objective of this work is to present the results of a consultation with experts on the virtual course "Leadership for Educational Management in Health Organizations", as part of a PAHO/VCPH strategy to strengthen leadership capacities for educational management in the Americas. A qualitative action-research study was carried out using the Delphi method with two iterations of consultations (one virtual and one in person) with experts in educational management in health organizations. The results show the importance of eight dimensions of analysis: recipient profiles, competencies, approach and contents, activities, evaluation of and for learning, adaptability, implementation, and monitoring during and after the course. The participation of actors from different geopolitical spheres in the design and implementation of a regional educational initiative fosters adaptations in the context of its implementation and improves the likelihood it will be adopted. This course can play a strategic role as a catalyst in the formation and consolidation of an integrated network of organizations that strengthen educational leadership in the Americas. This study also highlights the value of the methodological strategy used to improve the quality of HRH training.

RESUMO A formação de recursos humanos em saúde é uma preocupação recorrente. O Campus Virtual de Saúde Pública (CVSP) é a plataforma educacional da Organização Pan-Americana da Saúde (OPAS), que busca melhorar a acessibilidade à educação em saúde pública, com ênfase na formação de lideranças educacionais voltadas para o planejamento, a implementação e a avaliação de políticas e ações educacionais. O objetivo deste documento é apresentar os resultados de uma consulta com especialistas sobre o curso virtual "Liderazgo para la Gestión Educativa en Organizaciones de Salud" [Liderança para a Gestão Educacional em Organizações de Saúde], como parte de uma estratégia para fortalecer as capacidades de liderança para gestão educacional na Região das Américas proposta pelo CVPS/OPAS. Foi realizado um estudo qualitativo de pesquisa-ação utilizando o método Delphi com duas rodadas de consultas, uma virtual e outra presencial, a especialistas em gestão educacional em organizações de saúde. Os resultados mostram a relevância de oito dimensões de análise: perfil do público-alvo; competências; abordagem e conteúdo; atividades; avaliação de e para as aprendizagens; adaptabilidade; implementação; e acompanhamento durante e após o curso. A participação de atores de diferentes esferas geopolíticas no delineamento e na implementação de uma proposta educacional regional promove a transformação do contexto de aplicação e aumenta seu potencial de adoção. Destaca-se o posicionamento estratégico do curso como catalisador na criação e consolidação de uma rede integrada de organizações para fortalecer a liderança educacional na Região das Américas e a adequação da estratégia metodológica empregada para melhorar a qualidade da formação de recursos humanos em saúde.

Estilos de liderazgo en profesionales sanitarios peruanos

Fundamento: el liderazgo representa un rasgo importante que debe poseer toda persona encargada de dirigir un grupo. Los cambios organizacionales generados en las oficinas farmacéuticas deben ser asumidos mediante un estilo de liderazgo que permita alcanzar los objetivos y metas planteadas, con el fin de asegurar y optimizar la atención sanitaria. Objetivo: determinar los estilos de liderazgo en profesionales Químico-Farmacéuticos que laboran en establecimientos públicos y privados de la ciudad de Trujillo (Perú). Métodos: estudio descriptivo de corte transversal que incluyó 94 profesionales colegiados que se desempeñan como directores técnicos. En la recolección de datos se empleó como técnica la encuesta y como instrumento al cuestionario Multifactor Leadership Questionnaire , que constó de 36 preguntas en escala de Likert, distribuidas en tres dimensiones: liderazgo transformacional, transaccional y correctivo/pasivo/evitador. Resultados: el 82, 9 % de los profesionales laboran como directores técnicos en el sector privado; el 57, 4 % son del género femenino y más del 60 % presentan un nivel alto de liderazgo. Unidos ambos sectores, los estilos de liderazgo transformacional y transaccional de nivel alto estuvieron presente en un 28,7 % y 61, 7 %, respectivamente; el liderazgo correctivo/pasivo/evitador de nivel medio estuvo presente en 72, 3 % de los profesionales. Asimismo, el liderazgo transformacional de nivel alto estuvo presente en 62, 5 % de los que trabajan en el sector público y en 56, 4 % de los del sector privado; el estilo de liderazgo correctivo/pasivo/evitador en un nivel medio estuvo presente en más del 60 % de los profesionales de ambos sectores. Conclusiones: el estilo de liderazgo más predominante fue el transaccional.

Foundation: leadership represents an important trait that must be presented by every person in charge of directing a group of people. The organizational changes generated in pharmaceutical offices must be assumed through a leadership style that allows achieving the objectives and goals set, in order to ensure and optimize health care. Objective: to determine the Chemist-Pharmaceutical professionals' leadership styles who work in public and private establishments in the city of Trujillo (Peru). Methods: a descriptive cross-sectional study that included 94 collegiate professionals who work as technical directors. In data collection, the survey was used as a technique and the Multifactor Leadership Questionnaire (MLQ) as an instrument, which consisted of 36 questions on a Likert scale, distributed in three dimensions: transformational, transactional, and corrective/avoidant leadership. Results: 82.9 % of the professionals work as technical directors in the private sector; 57.4 % are female and more than 60 % have a high level of leadership. Together both sectors, the high-level transformational and transactional leadership styles were present in 28.7 % and 61.7 %, respectively; mid-level corrective/passive/avoidant leadership was present in 72.3 % of the professionals. Likewise, high-level transformational leadership was present in 62.5 % of those who work in the public sector and in 56.4 % of those in the private sector; the corrective/passive/avoidant leadership style at a medium level was present in more than 60 % of the professionals in both sectors. Conclusions: the most predominant leadership style was transactional.

Índice de Dependência Regional e Macrorregional: uma contribuição ao processo de regionalização do SUS / Regional and Macro-regional Dependency Index: A contribution to the SUS regionalization process

RESUMO O estudo aborda a interdependência das regiões e macrorregiões de saúde no Brasil nas internações de média e alta complexidade, no ano de 2019. Foi realizada a análise dos fluxos estabelecidos, utilizando o Índice de Dependência Regional e Macrorregional, a partir de dados secundários do Sistema Único de Saúde (SUS) obtidos no Sistema de Informação Hospitalar. Os resultados demonstram que grande parte das regiões e macrorregiões de saúde absorvem em seus territórios as internações de média complexidade, com variações entre as especialidades. Nas internações de alta complexidade, a maioria das regiões de saúde apresenta grande dependência, sendo que a assistência está concentrada em 15% delas. Entre as macrorregiões de saúde, o cenário é significativamente heterogêneo, com dependência expressiva nas regiões Norte, Nordeste e Centro-Oeste, e alta resolutividade na região Sul. Em todas as análises, o porte populacional das regiões e macrorregiões de saúde apresenta relação inversa à dependência regional e macrorregional. O aprimoramento da regionalização pressupõe a organização de uma rede de atenção à saúde que considere as desigualdades e as diversidades territoriais, a interdependência e a autonomia entre os territórios e os atores implicados, e a coordenação entre as unidades federativas, de modo a garantir cuidado integral e equânime.

ABSTRACT The study addresses the interdependency between health regions and macro-regions in Brazil in 2019, concerning both medium and high complexity hospitalizations. The analysis of the flows established was carried out using the Regional and Macro-regional Dependency Index, based on secondary data provided by the Hospital Information System of the Unified Health System (SUS). The results show that a significant number of health regions and macro-regions absorb medium-complexity hospitalizations in their territories, varying according to specialties. In high-complexity hospitalizations, most health regions are highly dependent, assistance concentrated in 15% of these. Among health macro-regions, the scenario is significantly heterogeneous: highly dependent on the North, Northeast and Midwest Regions, and highly resolutive in the South Region. Analyses show that the population size of health regions and macro-regions is inversely related to the regional and macro-regional dependency. The improvement of regionalization requires an organized health care network, one that takes into account territorial inequalities and diversities, interdependency and autonomy among the territories and actors involved, and inter-federative coordination, so as to provide care that is both comprehensive and equitable.

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.

ASSESSING PUBLIC SERVICE QUALITY & SERVICE SATISFACTION:WITH REFERENCE TO GOVERNANCE IN KARNATAKA, INDIA

Being a democratic country India has brought in various acts and reforms to uphold citizen centricity. Right to service act has been one of such initiatives. As on 2023, the state of Karnataka has been able to provide highest number of services under this act. This study explores and investigates citizen's perspective of service quality & service satisfaction attained by availing the public services. A questionnaire survey was formulated and study found that the ve factors 'Reliability' 'Assurance', 'Empathy', 'Valence', and 'Waiting Time' are determinants of the quality of citizen/government services. The outcome indicate that overall service quality has signicantly positive impact on service satisfaction. This research is of greater value to scholars who are interested in the area of governance, administration, and service delivery.

Applying the SES Framework to coral reef restoration projects on the Pacific coast of Costa Rica

Introduction: Global and local stressors have led to rapid declines in coral reef health. The high rates of coral degradation have motivated restoration initiatives worldwide. Evaluation of these initiatives has provided valuable information regarding coral restoration techniques and limitations faced by projects. However, most of the literature is focused on evaluating metrics related to fragment survival rate and growth, leaving a gap in understanding how social aspects such as governance structure affect project outcomes. Objective: The present research applies the Social-Ecological Systems Framework to identify social and ecological factors contributing to the success of three coral reef restoration projects in Costa Rica. Methods: Data was gathered from 50 semi-structured interviews with project members, volunteers, tour operators, fishers, and related community and government organizations that were analyzed using the categories determined by the Social-Ecological Systems Framework. Results: Despite each case's specific ecological and governance characteristics, research results show that three main steps have contributed to project success. First, the importance of locals having a positive perception of coral reef and project benefits; second, the use of network structure to obtain adequate financial and human resources and third, the importance of compliance with a regulatory framework to create enabling environments for reef restoration. Conclusions: Results show no universal solutions for coral reef restoration projects. Project managers must understand the ecological and social context of the restoration site to boost the benefits that reef restoration projects can provide, such as an increase in local stewardship, income generation, and the creation of more resilient communities.

Introducción: Los factores de estrés globales y locales han llevado a una rápida disminución de la salud de los arrecifes de coral. Las altas tasas de degradación de los corales han motivado iniciativas de restauración en todo el mundo. La evaluación de estas iniciativas ha proporcionado información valiosa sobre las técnicas de restauración de coral y las limitaciones que enfrentan los proyectos. Sin embargo, la mayor parte de la literatura se centra en la evaluación de métricas relacionadas con la tasa de supervivencia y el crecimiento de fragmentos, lo que deja un vacío en la comprensión de cómo los aspectos sociales y estructura de gobernanza, afectan los resultados del proyecto. Objetivo: La presente investigación aplica el Marco Conceptual de Sistemas Socio-Ecológicos para identificar los factores sociales y ecológicos que contribuyen al éxito de tres proyectos de restauración de arrecifes de coral en Costa Rica. Métodos: Los datos se recopilaron a partir de 50 entrevistas semiestructuradas con miembros del proyecto, voluntarios, operadores turísticos, pescadores y organizaciones comunitarias y gubernamentales relacionadas que se analizaron utilizando las categorías determinadas por el Marco Conceptual de Sistemas Socio- Ecológicos. Results: A pesar de las características ecológicas y de gobernanza específicas de cada caso, los resultados de la investigación muestran que tres pasos principales han contribuido al éxito del proyecto. Primero, la importancia de que los locales tengan una percepción positiva de los arrecifes de coral y los beneficios del proyecto; segundo, el uso de la estructura de la red para obtener recursos financieros y humanos adecuados y tercero, la importancia del cumplimiento de un marco regulatorio para crear entornos propicios para la restauración de arrecifes. Conclusiones: A pesar de las características ecológicas y de gobernanza específicas de cada caso, los resultados de la investigación muestran que tres puntos principales han contribuido al éxito del proyecto. Primero, la importancia de que los locales tengan una percepción positiva de los arrecifes de coral y los beneficios del proyecto; segundo, el uso de la estructura de la red para obtener recursos financieros y humanos y tercero, la importancia del cumplimiento de un marco regulatorio para crear entornos propicios para la restauración de arrecifes.

Participatory construction of the food security agenda in Brazil: Interests and priorities from re-democratization to institutional dismantling

This study analyzed the trajectory of interests and priorities related to food security expressed in the reports of the five National Food and Nutritional Security Conferences (Conferências Nacionais de Segurança Alimentar e Nutricional - CNSAN) held in Brazil between 1994 and 2015. The documentary research was systematized through content analysis with a quantitative and qualitative focus. Food security dimensions were identified in the 1,181 action proposals assessed through an analysis model consisting of 3 cross-sectional categories, 8 thematic categories, and 10 subcategories. The temporal content analysis revealed: continuous reduction in demands for "universal access to adequate food", especially in the subcategory "employment and income"; constant predominance of the category "structuring sustainable food production and supply systems" with a progressive increase in the subcategory "incentive to agroecology-based production"; and increased demands for "prioritization of traditional peoples and communities". The timeline suggests different contributions of the Conferences to the evolution of the debate on food security in Brazil. However, the insertion of social actors in the process of formulating the Brazilian National Food and Nutritional Security Policy did not guarantee the incorporation of the problems into the public agenda, which should be re-established and deepened in the decision-making processes. The findings attest to the importance of social participation for the theoretical and political qualification of food security in Brazil.

Este estudio analizó la trayectoria de los intereses y prioridades relacionados con la seguridad alimentaria expresados en los informes de las cinco Conferencias Nacionales de Seguridad Alimentaria y Nutricional (Conferências Nacionais de Segurança Alimentar e Nutricional - CNSAN) realizadas en Brasil entre 1994 y 2015. La investigación fue sistematizada a través del análisis de contenido con un enfoque cuantitativo y cualitativo. Las dimensiones de la seguridad alimentaria se identificaron en las 1.181 propuestas de acción evaluadas a través de un modelo de análisis que consta de 3 categorías transversales, 8 categorías temáticas y 10 subcategorías. El análisis de contenido temporal reveló: continua reducción de las demandas de "acceso universal a una alimentación adecuada", especialmente en la subcategoría "empleo e ingresos"; predominio de la categoría "estructuración de sistemas sostenibles de producción y abastecimiento de alimentos" con un aumento progresivo de la subcategoría "incentivo a la producción basada en la agroecología"; y mayores demandas de "priorización de los pueblos y comunidades tradicionales". La línea de tiempo sugiere diferentes contribuciones de las Conferencias a la evolución del debate sobre la seguridad alimentaria en Brasil. Sin embargo, la inserción de los actores sociales en el proceso de formulación de la Política Nacional de Seguridad Alimentaria y Nutricional de Brasil no garantizó la incorporación de los problemas en la agenda pública, que debe ser reconquistada y profundizada en los procesos de toma de decisiones. Los hallazgos atestiguan la importancia de la participación social para la calificación teórica y política de la seguridad alimentaria en Brasil.

Governança da Saúde Pública: conflitos e desafios para uma gestão compartilhada na fronteira Brasil-Bolívia / Public Health Governance: conflicts and challenges of shared management on the Brazil-Bolivia border

Resumo Este estudo de caso tem por objetivo apresentar a importância da gestão compartilhada da saúde pública para as zonas de fronteira. Especificamente, apresentaremos como ocorreu o enfrentamento inicial da covid-19 na fronteira Brasil-Bolívia, para demonstrar as fragilidades territoriais, tanto em relação à covid-19, quanto ao enfrentamento de outras doenças infectocontagiosas. De ordem metodológica, este artigo propõe uma nova leitura teórico-analítica para os estudos da governança da saúde pública, com base na sociologia dos problemas públicos, de base pragmatista. Através de uma investigação qualitativa (teórico-reflexiva), realizada mediante levantamento bibliográfico, documental e uma consulta junto a 14 especialistas, foram identificadas as controvérsias e os conflitos que definem o problema e a ação para tentar resolvê-lo. A covid-19 reacende a importância da gestão compartilhada binacional, tanto para combate da pandemia, quanto para o controle de outras endemias locais urgentes, como a dengue e o H1N1, na fronteira.

Abstract This case study aims to present the importance of shared public health management for border areas. Specifically, we will present how the initial confrontation of covid-19 took place on the Brazil-Bolivia border, to demonstrate the territorial weaknesses, both regarding covid-19 and in the face of other infectious diseases. Of methodological order, this article proposes a new theoretical-analytical reading for the study of public health governance, based on the pragmatist sociology of public problems. By an investigation (qualitative and theoretical-reflective), carried out with a bibliographic and documental survey and a consultation with 14 specialists, the controversies and the conflicts that define the problem and the action to try to solve it were identified. covid-19 rekindles the importance of shared binational management, both to fight the pandemic and to control other urgent local endemics, such as dengue and H1N1 on the border.

Governança federal na construção da política de enfrentamento à COVID-19 na atenção primária à saúde brasileira / Federal governance in building the policy to combat the COVID-19 pandemic in Brazilian primary health care

Resumo Este artigo objetiva descrever e analisar o processo de pactuação federal da política de enfrentamento à pandemia de COVID-19 no âmbito da atenção primária à saúde (APS). Trata-se de um estudo de análise de políticas para o qual se realizou pesquisa documental exploratória buscando identificar os registros dos debates e publicações oficiais do Ministério da Saúde acerca das políticas/orientações relacionadas à gestão e ao trabalho na APS ao longo da pandemia. À luz do referencial de governança em políticas públicas, procedeu-se à análise de conteúdo dos achados. O debate sobre o tema foi identificado em 23 reuniões/encontros oficiais, em sua maioria no âmbito da gestão, sendo menores os espaços científicos e de participação popular. No que se refere ao conteúdo das 34 publicações ministeriais, apenas 15 haviam sido discutidas previamente com outras representações institucionais. Não apenas pela pouca propensão aos debates, mas pelas contradições e ausências percebidas ao se concatenar o conteúdo das discussões e das publicações oficiais, percebeu-se evidente descoordenação central, rompimento do pacto federativo e hierarquização do modelo histórico de governança em redes no Sistema Único de Saúde, induzidos pela agenda autoritária e negacionista da Presidência da República.

Abstract This article aims to describe and analyze the process of federal agreement of the policy to combat the COVID-19 pandemic within the scope of primary health care (PHC). This is a policy analysis study for which exploratory documentary research was conducted seeking to identify the records of debates and official publications of the Ministry of Health on policies/guidelines related to management and work in PHC throughout the pandemic. In the light of the governance framework in public policies, content analysis of the findings was carried out. The debate on the topic was identified in 23 official meetings, mostly in the management sphere, with fewer scientific and popular participation spaces. With respect to the contents of the 34 ministerial publications, only 15 had been previously discussed with other institutional representations. Not only due the lack of propensity for debates, but also because of the contradictions and absences perceived when integrating the content of discussions and official publications, there was a clear lack of central coordination, as well as the rupture of the federative pact and hierarchization of the historical model of governance in networks in the Unified Health System, induced by the authoritarian and denialist agenda of the Presidency of the Republic.