RESUMO
Tobacco use is the leading cause of preventable death, and is estimated to kill more than 5 million persons each year worldwide. Tobacco use and exposure to second-hand smoke pose a major public health problem in the Philippines. Effective tobacco control policies are enshrined in the World Health Organization (WHO) Framework Convention on Tobacco Control (FCTC), a legally binding international treaty that was ratified by the Philippines in 2005. Since 2007, Bloomberg Philanthropies has supported the accelerated reduction of tobacco use in many countries, including the Philippines. Progress in the Philippines is discussed with particular emphasis on the period since ratification of the WHO FCTC, and with particular focus on the grants programme funded by the Bloomberg Initiative. Despite considerable progress, significant challenges are identified that must be addressed in future if the social, health and economic burden from the tobacco epidemic is to be alleviated.
L'emploi de tabac est la principale cause évitable de décès et on estime qu'il tue chaque année plus de 5 millions de personnes au niveau mondial. L'utilisation de tabac et l'exposition à la fumée secondaire posent un problème majeur de santé publique aux Philippines. Les politiques efficientes de lutte contre le tabagisme sont garanties dans la Convention Cadre de Lutte contre la Tabagisme (FCTC) de l'Organisation Mondiale de la Santé (OMS), un traité international d'application légale obligatoire qui a été ratifié par les Philippines en 2005. Depuis 2007, Bloomberg Philanthropies a soutenu l'accélération de la réduction de l'utilisation de tabac dans beaucoup de pays, notamment les Philippines. On discute les progrès observés aux Philippines en insistant particulièrement sur la période faisant suite à la ratification de la FCTC de l'OMS et en se focalisant particulièrement sur le programme de dons financé par l'Initiative Bloomberg. En dépit de progrès significatifs, on identifie des défis majeurs auxquels il faut répondre à l'avenir, si l'on veut alléger le fardeau social économique et sanitaire provenant de l'épidémie de tabagisme.
El consumo de tabaco representa la principal causa prevenible de mortalidad y se calcula que provoca la muerte de más de 5 millones de personas cada año en todo el mundo. El tabaquismo y la exposición pasiva al humo del tabaco plantean un problema mayor de salud pública en las Filipinas. El Convenio Marco para el Control del Tabaco (FCTC) de la Organización Mundial de la Salud (OMS) consagra las políticas eficaces de control del tabaquismo; este tratado internacional jurídicamente vinculante fue ratificado por las Filipinas en el 2005. Desde el 2007, la iniciativa Bloomberg Philanthropies ha apoyado una disminución acelerada del tabaquismo en muchos países, incluidas las Filipinas. En el presente artículo se examinan los progresos alcanzados en este país, con especial interés en el período posterior a la ratificación del FCTC de la OMS y se hace hincapié en el programa de subsidios financiado por la Iniciativa Bloomberg. Pese a los considerables progresos alcanzados, se destacan retos importantes que exigen una respuesta en el futuro, si se busca aliviar la carga social, sanitaria y económica que representa la epidemia de tabaquismo.
RESUMO
OBJECTIVE: To investigate GPs' perceptions of consultation outcomes and to investigate the associations between these and outcomes perceived by the patients. DESIGN: 25 GPs and 10 patients for each GP filled in a questionnaire about the outcome of the same consultation. The questions in the questionnaires were formulated from concepts found in preceding qualitative studies. Their answers were analysed and compared. SETTING: GPs and patients from 16 group practices in Norrbotten, Sweden. RESULTS: The GPs had the apprehension that their consultations would lead to cure/symptom relief in half of their consultations. They believed that their patients were satisfied up to 90% and that up to 75% had been reassured, understood more or could cope better. The GPs were satisfied themselves with up to 95% of the consultations, they enhanced their relationship to their patient up to 70%. Their affirmative concordance with their patients was high regarding satisfaction, intermediate regarding patient reassurance and patient understanding and lowest regarding cure/symptom relief. CONCLUSION: The GPs' were lacking in their ability to assess the patients' increased understanding and the concordance between their own and the patients' expectation of cure/symptom relief was low.
