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      A integração de saúde entre fronteiras internacionais: uma revisão integrativa Translated title: Integración de salud atravesando fronteras internacionales: una revisión integrativa Translated title: Health integration across international borders: an integrative review

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          Abstract

          Resumo Objetivo: Evidenciar os tipos e a finalidade dos acordos de integração de atenção à saúde que ocorrem em regiões de fronteiras internacionais. Métodos: Revisão integrativa de literatura, na qual foram selecionados estudos publicados entre 2006 a 2015, indexados nas bases eletrônicas CINAHL, Clinics Collection, LILACS, MEDLINE, PubMed, Scopus e SocINDEX. Foram incluídos 13 estudos. Resultados: Demonstram que os acordos de integração em regiões de fronteiras entre países são dos tipos formais e informais, formalizadas por governos federais ou legislações internacionais. Como finalidade destes acordos, prevalecem os de monitoramento, detecção e controle de doenças em regiões fronteiriças. Conclusão: Os acordos estudados objetivam a cooperação para o enfrentamento de dificuldades regionais. As ações de integração tendem a minimizar as assimetrias de saúde das populações fronteiriças.

          Translated abstract

          Resumen Objetivo: Evidenciar los tipos y finalidad de los acuerdos de integración de atención de salud existentes en zonas de frontera internacionales. Método: Revisión integrativa de literatura, en la que fueron seleccionados estudios publicados de 2006 a 2015, indexados en las bases CINAHL. Clinics Collection, LILACS, MEDLINE, PubMed, Scopus y SocINDEX. Fueron incluidos 13 estudios. Resultados: Demostraron que los acuerdos de integración en zonas de fronteras entre países responden a los tipos formales e informales, respaldados por gobiernos federales o por la legislación internacional. Como fin de estos acuerdos, prevalecen los de monitoreo, detección y control de enfermedades en regiones fronterizas. Conclusión: Los acuerdos estudiados apuntan a la cooperación para enfrentar las dificultades regionales. Las acciones de integración tienden a minimizar las asimetrías sanitarias de las poblaciones fronterizas.

          Translated abstract

          Abstract Objective: Evidence the types and goal of the healthcare integration agreements in international border regions. Methods: Integrative literature review, in which studies published between 2006 and 2015 were selected that were indexed in the electronic databases CINAHL, Clinics Collection, LILACS, MEDLINE, PubMed, Scopus and SocINDEX. Thirteen studies were included. Results: The results demonstrate that formal and informal integration agreements exist in border regions, formalized by federal governments or international laws. The prevalent goals of these agreements are monitoring, disease detection and control in border regions. Conclusion: The agreements studied aim for cooperation to cope with regional difficulties. The integration actions tend to minimize the health asymmetries of border populations.

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          Joint malaria surveys lead towards improved cross-border cooperation between Savannakhet province, Laos and Quang Tri province, Vietnam

          Background In Savannakhet province, Laos and Quang Tri province, Vietnam, malaria is still an important health problem and most cases are found in the mountainous, forested border areas where ethnic minority groups live. The objectives of this study were to obtain a better joint understanding of the malaria situation along the border and, on the basis of that, improve malaria control methods through better cooperation between the two countries. Methods Fourteen villages in Savannakhet and 22 villages in Quang Tri were randomly selected within 5 km from the border where a blood survey for microscopic diagnosis (n = 1256 and n = 1803, respectively), household interviews (n = 400, both sides) and vector surveys were conducted between August and October 2010. Satellite images were used to examine the forest density around the study villages. Results Malaria prevalence was significantly higher in Laos (5.2%) than in Vietnam (1.8%) and many other differences were found over the short distance across the border. Bed net coverage was high (> 90%) in both Laos and Vietnam but, while in Laos more than 60% of the nets were long-lasting insecticide-treated, Vietnam used indoor residual spraying in this area and the nets were untreated. Anopheles mosquitoes were more abundant in Laos than in Vietnam, especially many Anopheles dirus were captured in indoor light traps while none were collected in Vietnam. The forest cover was higher around the Lao than the Vietnamese villages. After this study routine exchange of malaria surveillance data was institutionalized and for the first time indoor residual spraying was applied in some Lao villages. Conclusions The abundance of indoor-collected An. dirus on the Laos side raises doubts about the effectiveness of a sole reliance on long-lasting insecticide-treated nets in this area. Next to strengthening the early detection, correct diagnosis and prompt, adequate treatment of malaria infections, it is recommended to test focal indoor residual spraying and the promotion of insect repellent use in the early evening as additional vector interventions. Conducting joint malaria surveys by staff of two countries proved to be effective in stimulating better collaboration and improve cross-border malaria control.
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            Análise comparativa dos sistemas de saúde da tríplice fronteira: Brasil/Colômbia/Peru

            Os objetivos deste artigo são: descrever o processo de reforma sanitária ocorrido em países da América Latina e suas repercussões nos sistemas de saúde do Brasil, da Colômbia e do Peru; analisar a conformação dos sistemas nacionais de saúde desses três países fronteiriços; e avaliar os limites e possibilidades de uma integração dos sistemas locais de saúde no contexto da tríplice fronteira amazônica. A partir de documentos e bases de dados oficiais, faz-se uma análise do desenvolvimento dos sistemas de saúde e da organização da rede de serviços nesse segmento de fronteira localizado em plena região amazônica. Na comparação entre os três países, constata-se que o modelo adotado pelo Brasil tem as características de um sistema nacional de saúde de finalidade pública, enquanto na Colômbia e no Peru vigoram sistemas de asseguramento, com adoção de planos obrigatórios de assistência, segmentação dos usuários e contingenciamento da cobertura. Os três países convergem quanto à mescla de público e privado na provisão de serviços, mas diferem no nível de acesso e no tipo de regulação por parte do Estado. Conclui-se que as especificidades dos sistemas de saúde dos três países fronteiriços tornam complexo o desafio da construção de um sistema único de saúde na fronteira que possa garantir a universalidade do acesso, a equidade no atendimento e a integralidade da assistência. Apesar das discrepâncias identificadas, porém, constata-se que a preponderância do setor público na rede de atenção básica permite vislumbrar a possibilidade de integração dos sistemas locais de saúde no que concerne à oferta organizada de ações programáticas de saúde do primeiro e segundo níveis de assistência.
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              Twentieth anniversary of the European Union health mandate: taking stock of perceived achievements, failures and missed opportunities – a qualitative study

              Background The European Union (EU) health mandate was initially defined in the Maastricht Treaty in 1992. The twentieth anniversary of the Treaty offers a unique opportunity to take stock of EU health actions by giving an overview of influential public health related EU-level policy outputs and a summary of policy outputs or actions perceived as an achievement, a failure or a missed opportunity. Methods Semi-structured expert interviews (N = 20) were conducted focusing on EU-level actions that were relevant for health. Respondents were asked to name EU policies or actions that they perceived as an achievement, a failure or a missed opportunity. A directed content analysis approach was used to identify expert perceptions on achievements, failures and missed opportunities in the interviews. Additionally, a nominal group technique was applied to identify influential and public health relevant EU-level policy outputs. Results The ranking of influential policy outputs resulted in top positions of adjudications and legislations, agencies, European Commission (EC) programmes and strategies, official networks, cooperative structures and exchange efforts, the work on health determinants and uptake of scientific knowledge. The assessment of EU health policies as being an achievement, a failure or a missed opportunity was often characterized by diverging respondent views. Recurring topics that emerged were the Directorate General for Health and Consumers (DG SANCO), EU agencies, life style factors, internal market provisions as well as the EU Directive on patients’ rights in cross-border healthcare. Among these recurring topics, expert perceptions on the establishment of DG SANCO, EU public health agencies, and successes in tobacco control were dominated by aspects of achievements. The implementation status of the Health in All Policy approach was perceived as a missed opportunity. Conclusions When comparing the emerging themes from the interviews conducted with the responsibilities defined in the EU health mandate, one can identify that these responsibilities were only partly fulfilled or acknowledged by the respondents. In general, the EU is a recognized public health player in Europe which over the past two decades, has begun to develop competencies in supporting, coordinating and supplementing member state health actions. However, the assurance of health protection in other European policies seems to require further development.
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                Author and article information

                Contributors
                Role: ND
                Role: ND
                Role: ND
                Journal
                ape
                Acta Paulista de Enfermagem
                Acta paul. enferm.
                Escola Paulista de Enfermagem, Universidade Federal de São Paulo (São Paulo, SP, Brazil )
                0103-2100
                1982-0194
                February 2018
                : 31
                : 1
                : 102-107
                Affiliations
                [2] Florianópolis Santa Catarina orgnameUniversidade Federal de Santa Catarina Brazil
                [1] Manaus Amazonas orgnameUniversidade do Estado do Amazonas Brazil
                Article
                S0103-21002018000100102
                10.1590/1982-0194201800015
                3d1aa633-0ac0-4ac4-9653-d21ae5126667

                This work is licensed under a Creative Commons Attribution 4.0 International License.

                History
                : 13 December 2017
                : 22 February 2018
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 26, Pages: 6
                Product

                SciELO Brazil


                Cooperação internacional,Emigração e imigração,Gestão em saúde,Border areas,Border health,International cooperation,Emigration and immigration,Health management,Áreas fronterizas,Salud fronteriza,Cooperación internacional,Emigración e inmigración,Gestión en salud,Áreas de fronteira,Saúde na fronteira

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