RESUMO
BACKGROUND: The Mexico City Policy, first announced by US President Ronald Reagan and since lifted and reinstated by presidents along partisan lines, prohibits US foreign assistance to any organisation that performs or provides counselling on abortion. Many organisations affected by this policy are also providers of modern contraception. If the policy reduces these organisations' ability to supply modern contraceptives, it could have the unintended consequence of increasing abortion rates. METHODS: We empirically examined patterns of modern contraception use, pregnancies, and abortion among women in 26 countries in sub-Saharan Africa in response to the reinstatement and subsequent repeal of the Mexico City Policy across three presidential administrations (William Clinton, George W Bush, and Barack Obama). We combine individual-level data on pregnancies and abortions from 743â691 women, country-year data on modern contraception use, and annual data on development assistance for family planning and reproductive health in a difference-in-difference framework to examine relative changes in use of modern contraception, pregnancy, and abortion in response to the policy. FINDINGS: We found that when the Mexico City Policy was in effect (2001-08), abortion rates rose among women in countries highly exposed to the policy by 4·8 abortions per 10â000 woman-years (95% CI 1·5 to 8·1, p=0·0041) relative to women in low-exposure countries and relative to periods when the policy was rescinded in 1995-2000 and 2009-14, a rise of approximately 40%. We found a symmetric reduction in use of modern contraception by 3·15 percentage points (relative decrease of 13·5%; 95% CI -4·9 to -1·4; p=0·0006) and increase in pregnancies by 3·2 percentage points (relative increase of 12%; 95% CI 1·6 to 4·8; p<0·0001) while the policy was enacted. INTERPRETATION: Our findings suggest that curbing US assistance to family planning organisations, especially those that consider abortion as a method of family planning, increases abortion prevalence in sub-Saharan African countries most affected by the policy. FUNDING: The William and Flora Hewlett Foundation, the Doris Duke Charitable Foundation, the David and Lucile Packard Foundation, and the Stanford Earth Dean's Fellowship.
Assuntos
Aborto Induzido , Aconselhamento , Dissidências e Disputas , Cooperação Internacional/legislação & jurisprudência , Formulação de Políticas , Aborto Induzido/tendências , África Subsaariana , Dissidências e Disputas/legislação & jurisprudência , Feminino , Humanos , Gravidez , Inquéritos e Questionários , Estados UnidosRESUMO
BACKGROUND: In Brazil, health is fundamental human right guaranteed by the Constitution of 1988, which created the Brazilian Universal Health System (Sistema Único de Saúde - SUS). The SUS provides medications for outpatient care via policy of pharmaceutical assistance (PA) programmes. Despite the advances in PA policies which include the improvement in access to medications, there has been a significant increase in lawsuits related to health products and services. This study aimed to characterize the medication processes filed between 2010 and 2014 against the Secretary of State for Health of São Paulo (State Health Department of São Paulo - SES/SP), in Brazil, following PA policies. METHODS: This descriptive study used secondary data on medication lawsuits filed against the SES/SP between 2010 and 2014. The data source was the S-Codes computerized system. RESULTS: In the period evaluated, the number of lawsuits filed concerning health-related products increased approximately 63%; requests for medications were predominant. Approximately 30% of the medications involved in court proceedings were supplied via PA programmes. With regard to medications supplied via specialized component, 81.3% were prescribed in disagreement with the protocols published by the Ministry of Health. Insulin glargine was the most requested medication (6.3%), followed by insulin aspart (3.3%). Because there is no scientific evidence that either of these medicines is superior for the treatment of diabetes, neither of them has been incorporated into the SUS by the National Commission for Technology Incorporation. The judicial data showed that most of the lawsuits involved normal proceedings (i.e., individual demands), were filed by private lawyers, and named the State of São Paulo as the sole defendant, demonstrating the individual nature of these claims. The data indicate inequality in the distribution between the number of cases and lawyers and the number of lawsuits and prescribers, evidencing the concentration of lawyers and physicians in filing lawsuits. CONCLUSION: The judicialization of health in the State of São Paulo with the characteristics presented herein is a threat to the SUS.
Assuntos
Acessibilidade aos Serviços de Saúde/legislação & jurisprudência , Legislação de Medicamentos , Medicamentos sob Prescrição/provisão & distribuição , Assistência Ambulatorial , Brasil , Dissidências e Disputas/legislação & jurisprudência , Programas Governamentais/legislação & jurisprudência , Programas Governamentais/estatística & dados numéricos , Política de Saúde/legislação & jurisprudência , Serviços de Saúde/legislação & jurisprudência , Serviços de Saúde/estatística & dados numéricos , Direitos Humanos , Humanos , Advogados/legislação & jurisprudência , Advogados/estatística & dados numéricos , Assistência Médica/legislação & jurisprudência , Assistência Médica/estatística & dados numéricos , Médicos/legislação & jurisprudência , Médicos/estatística & dados numéricos , Saúde Pública/legislação & jurisprudência , Fatores SocioeconômicosRESUMO
Una marcada tendencia en América Latina ha sido la de construir conocimiento sobre la premisa del desarrollo histórico con una dirección más o menos precisa, emancipatoriay valórica. Pero el siglo XX nos legó una historia caprichosa, incierta, fuertemente indeterminada, sin garantía. En este sentido, más que una comprensión pesimista, lahistoria del siglo XX exige encarnar desafíos sustantivos. Enfrentamos enormes exigencias en lo que se refiere a desarrollar nuestra capacidad de pensar como latinoamericanos; yesto, atañe a la formación de sujetos capaces de ver y pensar realidades inéditas y viables, para lo cual es imprescindible replantear las formas de construir conocimiento; entendiendoque éste debería ser de naturaleza histórica más que teórica de cara a ampliar los límites de lo posible, en perspectiva de futuro.
A marked trend in Latin America has been the one of constructing knowledge on the premise of the historical development with a more or less precise, emancipatory, and valueddirection. But the twentieth century gave us a capricious, uncertain, highly indeterminate, and unsecured history. In this sense, rather than a pessimistic understanding, the historyof the twentieth century requires embodying substantive challenges. We face enormous demands in regards to developing our ability to think as Latin Americans; and this relatesto the formation of subjects able to see and to think new and viable realities, which is essential to rethink the ways to construct knowledge; understanding that this should be historical in nature rather than theoretical in the face to expand limits as possible, in perspective for the future.
Assuntos
Conflito Psicológico , Dissidências e Disputas , Dissidências e Disputas/economia , Dissidências e Disputas/história , Dissidências e Disputas/legislação & jurisprudênciaRESUMO
El tema que aborda este trabajo es la construcción de subjetividades a través de una razón dialógica en la elaboración de políticas públicas por parte del Estado de Chile, en el ámbito de la interculturalidad y la expresión que ello tiene en la enseñanza de la historia,específicamente en la educación básica en las zonas de alta concentración de estudiantes de origen étnico aymara. Metodológicamente se aplica un análisis estructural con la finalidadde dar cuenta de las percepciones de los actores principales de una escuela, con el fin de indagar en la inconsistencia que se pueden estar generando con el Convenio 169 de la OIT.
The topic which deals with this paper is the construction of subjectivities through a dialogic reason in the elaboration of public policies by Chile, in the field of interculturality and theexpression that it has in the teaching of history, specifically on basic education in the areas of high concentration of students from Aymará ethnic groups. Methodologically a structuralanalysis is applied in order to give an account of the perceptions of the main actors in a school, and thus investigate the inconsistency that can be generated with the InternationalLabor Organization (ILO) Convention N°169.
Assuntos
Conflito Psicológico , Dissidências e Disputas , Dissidências e Disputas/economia , Dissidências e Disputas/história , Dissidências e Disputas/legislação & jurisprudênciaRESUMO
OBJECTIVE: The aim of this study was to review the use of orthodontic records (OTR's) by Brazilian orthodontists and propose a behavioral approach from a legal point of view, drawing on their interpersonal relationship with their patients. METHODS: A statistical cross-analysis was performed to compare five groups. A sixth group was created comprising the intersection of the responses provided by the five aforementioned groups. RESULTS: The results demonstrate that 42.2% of orthodontists require initial and final records and keep orthodontic records throughout their professional career; 13.9% duplicate the initial records and consider patients as the lawful owners of these documents; 19.5% make use of a medical history questionnaire, to be duly signed by all patients; 5.4% acknowledge that the decision to undergo treatment is ultimately the patient's, and, therefore, the alternative response "not perform the treatment" should be included in the questionnaire; 24% recognize the importance of the Consumer Protection Code (CPC), regard the provision of orthodontic services as an obligation of means; and explain to the patient the risks involved in orthodontic treatment. Among the 1,469 orthodontists researched, 0% simultaneously took into account all aspects of this study. CONCLUSIONS: It was concluded that Brazilian orthodontists adopt a mistaken legal, professional and behavioral attitude, neglecting to build patient's orthodontic record with due care and in accordance with the law, which makes them vulnerable to patient disputes, contentious or otherwise.
Assuntos
Registros Odontológicos/legislação & jurisprudência , Odontólogos/legislação & jurisprudência , Ortodontia/legislação & jurisprudência , Atitude do Pessoal de Saúde , Brasil , Estudos Transversais , Relações Dentista-Paciente , Odontólogos/psicologia , Dissidências e Disputas/legislação & jurisprudência , Humanos , Consentimento Livre e Esclarecido/legislação & jurisprudência , Responsabilidade Legal , Anamnese , Propriedade/legislação & jurisprudência , Participação do Paciente/legislação & jurisprudência , Recusa do Paciente ao Tratamento/legislação & jurisprudênciaRESUMO
OBJECTIVE: The aim of this study was to review the use of orthodontic records (OTR's) by Brazilian orthodontists and propose a behavioral approach from a legal point of view, drawing on their interpersonal relationship with their patients. METHODS: A statistical cross-analysis was performed to compare five groups. A sixth group was created comprising the intersection of the responses provided by the five aforementioned groups. RESULTS: The results demonstrate that 42.2% of orthodontists require initial and final records and keep orthodontic records throughout their professional career; 13.9% duplicate the initial records and consider patients as the lawful owners of these documents; 19.5% make use of a medical history questionnaire, to be duly signed by all patients; 5.4% acknowledge that the decision to undergo treatment is ultimately the patient's, and, therefore, an alternative response "not perform the treatment" should be included in the questionnaire; 24% recognize the importance of the Consumer Protection Code (CPC), regard the provision of orthodontic services as an obligation of means; and explain to the patient the risks involved in orthodontic practice. Among the 1,469 orthodontists researched, 0% simultaneously took into account all aspects of this study. CONCLUSION: It was concluded that Brazilian orthodontists adopt a mistaken legal, professional and behavioral attitude, neglecting to build patient's orthodontic record with due care and in accordance with the law, which makes them vulnerable to patient disputes, contentious or otherwise.
OBJETIVO: a proposta desse trabalho foi analisar a prática do prontuário ortodôntico e as atitudes comportamentais sob o ponto de vista jurídico entre os ortodontistas do Brasil, mediante seu relacionamento interpessoal com seus pacientes. MÉTODOS: um questionário composto por 35 perguntas foi enviado para 5.355 ortodontistas. Após a devolução de 27% das correspondências, foi realizado um cruzamento informatizado estatístico em cinco grupos. Um sexto grupo criado foi a intersecção de todas as respostas dos cinco grupos anteriores. RESULTADOS: constatou-se que 42,2% dos ortodontistas solicitam as documentações iniciais ou finais, e guardam o prontuário ortodôntico por toda a carreira profissional; 13,9% duplicam a documentação inicial e consideram que o prontuário ortodôntico pertence ao paciente; 19,5% aplicam questionário de anamnese para todos os pacientes, que é assinado ao final; 5,4% consideram que a decisão pela opção terapêutica é do paciente, incluem a opção "não realizar o tratamento" e afirmam que o contrato é fundamental para o início do tratamento; 24,0% reconhecem a importância do Código de Defesa do Consumidor na profissão, consideram obrigação de meio (obrigação de diligência) os serviços ortodônticos prestados e esclarecem sobre os riscos envolvidos na prática da especialidade; 0% dos ortodontistas realizam simultaneamente todas essas considerações. CONCLUSÃO: o ortodontista brasileiro mantém uma atitude comportamental equivocada, mediante seus pacientes, pois, sob o ponto de vista jurídico-profissional, negligencia a elaboração cautelosa do prontuário dentro dos fundamentos legais conforme o estágio atual da especialidade. Sob o aspecto legal de seu exercício profissional, o ortodontista brasileiro está vulnerável diante questionamentos de seus pacientes, sejam eles litigiosos ou não, justos ou injustos.
Assuntos
Humanos , Registros Odontológicos/legislação & jurisprudência , Odontólogos/legislação & jurisprudência , Ortodontia/legislação & jurisprudência , Atitude do Pessoal de Saúde , Brasil , Estudos Transversais , Relações Dentista-Paciente , Odontólogos/psicologia , Dissidências e Disputas/legislação & jurisprudência , Consentimento Livre e Esclarecido/legislação & jurisprudência , Responsabilidade Legal , Anamnese , Propriedade/legislação & jurisprudência , Participação do Paciente/legislação & jurisprudência , Recusa do Paciente ao Tratamento/legislação & jurisprudênciaRESUMO
The achievements of modern medicine are manifold and impressive. However, there is a broad recognition of the fact that continuing medical treatment is not always beneficial to the patient, nor is it always what the patient wants. This has led to a debate about the way physicians may or may not be involved in the end of life of patients. Could there be a justification for the active ending of a patient's life? This debate has a global character. In this article we will explore this debate for developing countries; we will focus on physician-assisted death (PAD) in Latin American countries. At stake is the moral relevance of differences, not the moral justification of PAD per se. We argue that arguments for PAD apply equally in affluent and in developing countries. Some of the counterarguments, however, would seem to hold more in developing countries than in affluent countries. Yet, under certain conditions, a policy tolerating PAD would be as acceptable in developing countries as in developed countries.