In connection with the change of tariffication net ofpayment for medical personnel, i.e. paramedical and junior medical staff, the minimum income has been increased. data received from questionnaires of paramedical and junior medical staff have revealed the fact that with time working enthusiasm decreases and tendency to material welfare increases. While young specialists are intended to find out more prestigious and well-paid place of work. the main task of managers is to provide optimal labour conditions and motivational background for high-quality and effective work of medical stafff.
The position of the Coordinators’ Forum published in this issue calls attention to the potential harmful effects that the new Qualis Periodicals criteria proposed by CAPES could have on the publishing of scientific journals in Brazil, especially inPublicHealth. With one fell swoop, as compared to the previous evaluation (2004-2006), several important national journals in the Qualis system were demoted on the basis of arbitrary criteria. The argu- ments are laid out quite clearly in the document, but it is important to reiterate that these new criteria, applied indiscriminately and without considering the specificities of the re- search areas, can do more to reverse important strides and triumphs achieved in recent decades than to strengthen new horizons.
Contrary to the declining populations that are often seen in natural habitats, populations of E. coli can increase in such substrates under sterile condi- tions, that is, without predatory, antagonistic or competing organisms. This indicates that the natural microbiota in such cases has an overriding effect on survival (Jiang et al., 2002; Unc et al., 2006; Semenov et al., 2007). The diversity of the indigen- ous microbial communities has been brought up as an important factor that regulates the population dynamics of invading E. coli (van Elsas et al., 2007). According to this view, ecosystems with a higher level of biodiversity (Trevors, 1998) are more resistant to perturbances than those with a lower diversity (Tilman, 1997). Consequently, the former habitats would be less susceptible to invasion by E. coli than the latter (Girvan et al., 2005; Semenov et al., 2008). It is an old paradigm that most ecosystems are microbiostatic, that is, they have filled ecological niches and are difficult to invade. Although the exact influence of autochthonous microbial diversity and community structure on E. coli survival is still unclear, these two aspectsof the microbiota are considered to be important. Indeed, the survival in soil of an introduced E. coli O157:H7 derivative was inversely proportional to the diversity of the microbial community present, established through differential fumigation and regrowth (van Elsas et al., 2007). The progressively changed microbial diversities and community compositions coincided with an enhancement of the survival rate of the invading pathogen. However, the impact of the indigenous microflora on E. coli might have been exacerbated, as the nutritional conditions are remote from those in the natural reservoir of the organism. To explain the effect, we hypothesized that lowering of the complexity of the soil microbiota probably resulted in a reduction of functional redundancy, which enhances the chances for the introduced organism to occupy a niche in the system and persist as a member of the community. However, we did not examine to what extent different functional groups in the indigenous micro- flora affected survival of the invading E. coli. Some
The African cobras (Naja spp.), puff adders (Bitis arietans) (Figure 1) and mambas (Dendroaspis spp.) are frequently involved in attacks on humans while Atractaspis spp. and small vipers are only occasionally involved [1,8-11]. Snakebite affects farmers, nomads and rural dwellers of all ages. The main clinical features of E. ocellatus envenoming are systemic hemorrhage, incoagulable blood, shock, local swelling, bleeding and occasionally necrosis [1,8,12]. All body systems may be affected; cardiac and hemodynamic abnormalities may result while the strongest predictor of mortality is central-nervous-system involvement with intracranial hemorrhage [13-15]. Neurotoxicity has been reported following Egyptian cobra (Naja haje) bites in certain parts of the country. Occasionally, snakebite may lead to important complications such as amputation, blindness resulting from spitting cobra (Naja nigricollis) venom, opthalmia, fetal loss, and wound infection, tetanus and scarring with potential for malignant transformation, and psychological consequences e.g., excessive anxiety, stress, hysteria and worry [16-19].
In Brazil the challenge of meeting the needs of those living in deprived areas has generated dis- cussions on replacing the existing approach to epidemiological surveillance with an integrated publichealth surveillance system. This new approach would supplant the traditional focus on high-risk individuals with a method for identifying high-risk populations and the areas where these persons live. Given the magnitude of the problem that tuberculosis (TB) poses for Brazil, we chose that disease as an example of how such a new, integrated publichealth surveillance system could be constructed. We integrated data from several sources with geographic infor- mation to create an indicator of tuberculosis risk for Olinda, a city in the Brazilian state of Pernambuco. In order to stratify the urban space in Olinda and to check for an association be- tween the resulting TB risk gradient and the mean incidence of the disease between 1991 and 1996, we applied two different methods: 1) a “social deprivation index” and 2) principal com- ponent analysis followed by cluster analysis. Our results showed an association between so- cial deprivation and the occurrence of TB. The results also highlighted priority groups and areas requiring intervention. We recommend follow-up that would include treating acid-fast bacilli smear-positive pulmonary TB cases, tracing of these persons’ contacts, and monitoring of multidrug-resistant cases, all in coordination with local health services.
Abstract Taking into account the four underpin- ning areas ofHealth Surveillance (environmental, epidemiological, health and worker’s health), the performance of professionals in this area requires a broad and complex set of information from many fields of knowledge, including that which is not classified as health. Considering the need to prepare professionals to work inHealth Surveil- lance in the Unified HealthSystem (SUS), inte- grating the four fields of knowledge, the PublicHealth School of Rio Grande do Sul (ESP/RS) and the surveillance areas of the municipality of Porto Alegre and Rio Grande do Sul State have estab- lished a new emphasis in the traditional residency of ESP/RS. This work uses the experience report descriptive method. It shows the activities of res- idents in the formation course of the first year, fourth class of this in-service education experience and takes stock of results of residency freshmen. Key words Health education, Integrated health residency, Health Surveillance, Education-service integration
tributions referenced in the introduction, our analysis does not look at adoption as the result of the interaction of the health care sector with other sectors of the economy, but as the strict consequence of the reimbursement systemin place. The results obtained are to be used to interpret empirical evidence that addresses speed of diffusion ofnew technologies and payment systems. Some caveats are worth pointing out. First, we take a relationship between the provider and the third-party payer to take place without influence from other forces. In particular, there is no role for competition between hospitals in our model. Second, investment in the new technology is perfectly lumpy. It is done once and it cannot be adjusted fur- ther within the same time frame of uncertain demand. Third, we acknowledge the limitation of the analysis associated to not considering how the paymentsystem will affect the number and type ofnew technologies available rather than simply whether existing technologies are adopted. Finally, we also acknowledge the dif- ficulties both for patients and providers to assess the level of patient benefits. In the same vein, there may be substantial heterogeneity across patients with respect to the net health benefits. Both features will blur the distinction between the effect and/or desirability of one paymentsystem versus another.
A final consideration: as mentioned earlier, when presenting the possibility to choose the sex of offspring for non-therapeutic reasons, biomedical technologies, new or not so new, should not become a new element of discrimination, a new source of injustice, at society’s or global level. This means that applications must be in the service of those who need it (and not just available to whoever can pay by private means). Consequently, to incorporate and develop research and application of these new biomedical technologies within the publichealthsystem is not only a political decision, but an ethical requirement of first order, because it concerns the contribution to the improvement or maintenance of the quality of life of people, their welfare, and ultimately, their happiness.
Performance assessment system. Based on NPAISCHSI issued by the MOH in June 2011, the performance assessment indicators system and scoring criteria for the CHSCs were drafted according to the local health practice and the recent reform policies, with the assistance of the national professionals. The quality and equity of the system was further improved by pre-trialing the localized protocol involving three CHSCs in different regions, and well af- firmed by the health administrative departments and assessment institutes. Thus, the revised index of performance assessment systemof CHSCs in Pudong new area was comprised of five dimensions, which were institutional management, publichealth service, basic medical service, CTM service, and comprehensive satisfaction. Two-thirds of the indicators in the index system conformed to the national standards, while the rest agreed with the district standards, which accounted for 1200 points in total. Moreover, the scores were approximately the same between the pilot and formal appraisal on the three centers (margin of error < 0.17) in the first year of 2011, which reflected the validity and reliability of the measurement.
We contribute to the theoretical literature by setting up a model of uncertain demand, where the technological shift is driven by the increased benefit for pa- tients, financial variables, and the reimbursement system to providers. We seek to assess the impact of the paymentsystem to providers on the rate of technology adoption. We propose two payment schemes, a reimbursement according to the cost of treating patients, and a DRG paymentsystem where the new technology may or may not be reimbursed differently from the old technology. We find that under a cost reimbursement system, large enough patient benefits are necessary for adoption to occur. However, when the DRG contemplates a higher reimbursement for new technology, adoption occurs even in the absence of patients’ benefits. In this case, the new technology must be reimbursed sufficiently higher than the old one. Finally, to compare the levels of technological adoption the payment regimes, we take as reference an investment level yielding to the provider the same marginal return of investment innew capacity across regimes. Cost reimbursement leads to higher adoption of the new technology if the rate of reimbursement is high relative to the margin ofnew vs. old DRG. Having larger patient benefits favors more adop- tion under the cost reimbursement paymentsystem, provided that adoption occurs initially under both payment systems.
tutions, interests, thinking and practices intrinsic to an inter-disciplinary field like publichealth. This challenge, perhaps the greatest faced, has, however, driven and ensured the richness and diversity of the Saúde e Sociedade journal’s scientific output, as can be seen in the 29 articles of this issue. They discuss the role of the State inpublichealth policy; public spending; social management and participation in the Unified HealthSystem (SUS); computerizing and using health indicators; urgency and emergency care networks; health care and access to health care services; shared diagnosis in primary care; qualifying primary health care; competencies in promoting health; bio-ethical aspectsin the Family Health Strategy; community health workers’ quali- ty of life; risky behavior; children’s mental health; Center of Psychosocial Attention Center (CAPS) referrals; experience of carers for those with mental illness; imagery in Social Psychology; technological organization of work in oral healthin the SUS; and ethics and the labor market in oral health. There are also studies on contemporary environmental health issues, such as selective waste collection by waste pickers; advertising of insecticides for domestic use and publichealth implications; and an ethnographic study of soil-transmitted helminthes. Topics and issues that are extremely relevant to publichealth are thus identified by the authors and approached from different theoretical and methodological pers- pectives, in different national and international contexts, always highlighting the bringing together of human and social sciences.
carried out in Campinas (SP), they found the paymentof the MMG test by the publicsystemof 28.8% and by health plan/private paymentof 71.2%. This finding may reflect the regional characteristics of each research and SUS organi- zation in each region. In Uberaba, one can con- sider the result found as a probable consequence of actions to promote the MMG test by the SUS, such as the “Pink October” campaign, which has a significant mobilization ofpublichealth ser- vices to encourage breast cancer screening in the city. Besides, the city’s territory is home to several universities, one of which is public, which facil- itates people’s access to screening tests through the partnership of these universities with other municipal publichealth services.
Since the 1950s, researchers in the area ofhealth systems and services have acknowledged the importance of perceiving the area as a topic worthy of investigation. The history of the development ofhealth surveys of the population has close ties with the emergence of the thematic area of Research into Health Services. This area is geared to the study of the various components of the organization ofhealth systems and healthcare processes, with a view to contribute positively to the impact of the latter on the healthof the population. It therefore involves the health needs of population groups, the characteristics of supply and demand, financing systems and payment mechanisms to service providers, public and private relations and their impact on equity inhealth. It also encompasses the managerial and clinical aspects evaluated in terms of effectiveness, safety and efficiency of healthcare, and also ensures the rights of patients and their participation in the process of healthcare and the humanization of care. In a book published to commem- orate the fiftieth anniversary of the International Epidemiological Association (IEA), Kerr White recounts the long struggle of researchers to demonstrate the importance of Research into Health Services. In 1961, Kerr White published the classic article “The ecology of medical care” in The New England Journal of Medicine. His leadership in the first comparative survey on the use ofhealth services, conducted in seven countries between 1964 and 1976, in collaboration with the WHO, should also be stressed. It is worth highlighting the major importance of this study for research into health services in South America, espe- cially in Argentina, where its deployment has enabled the training of professionals in various specialized areas in the design, implementation and analysis of data from household health surveys. As reported in Mario Hamilton’s recently published posthumous book, this study would have had a greater impact if his premature demise in 1973 had not occurred before he had completed analysis of the data.
EC 86 EC 95 PIB 0,0% a.a. EC 95 PIB 1,0% a.a. EC 95 PIB 2,0% a.a. EC 95 PIB RGPS (média 3,0% a.a.) Hipóteses: 1) PIB: foram projetados quatro cenários para as taxas de crescimento real de PIB: três deles com taxa de crescimento real do PIB de 1,0% para 2017 Hypotheses: 1) GDP: four real GDP growth scenarios were considered: three based on a real GDP growth rate of 1.0% for 2017 (Focus / Bacen of 11/18/2016) and 0.0 % , 1.0 % and 2.0 % per year between 2018 and 2036 and a fourth scenario, where GDP and inflation estimates were based on projections for the General Social Security Regime (RGPS, acronym in Portuguese) annexed to the 2016 Project of Budgetary Guidelines Law (PLDO, acronym in Portuguese), which presents an average annual rate of 3.0 %; 2) Consumer Price Index: the first three scenarios based on 4.93 % in 2017 (Focus / Bacen of 18/11) and 4.5 % between 2018 and 2036; the fourth scenario based on projections for the RGPS annexed to the 2016 PLDO (2017: 6.0%; 2018: 5.4%; 2019: 5.0%; 2020 to 2036: 3.5%); 3) CNR/GDP hypothesis – publichealth at 11.45% of GDP (forecast 2017); 4) CNR 2017 = R $ 758.3 billion, according to 2017 PLOA; 5) Nominal GDP of 2016 estimated at R$ 6,220.5 billion, and RCL for 2016 estimated at R$ 729.8 billion, according to the SOF / MPOG Primary Revenue and Expenses Evaluation Report - 5th Bimester, 2016; 6) Base for minimum application in actions and publichealth services according to CA 95 of 15.0% of the CNR of 2017.
bites as one of the most neglected problems in the Amazon region. This review demonstrates the magnitude of this type of envenoming in a background of lack of information, calling for a more aggressive approach by the authorities and affected communities to implement an appropriate surveillance system and promote the reduction of risk in the affected populations as well as ensuring access to timely treatment. Despite the low mortality registered, the sequelae of severe poisoning are important and timely treatment would reduce both harmful sequelae and mortality (11) .
The Basic Psychological Needs in Exercise Scale (BPNES) validated initially by Vlachopoulos and Michailidou 11 contains 12 items with Likert scale from one to five points, related to basic psychological needs of human beings: autonomy (questions 3, 6, 9 and 12), competence (questions 2, 4, 7 and 10) and relationship (questions 1, 5, 8 and 11). The questionnaire has as objective to verify the basic psychological need that prevails in the behavior of students. The need for autonomy reflects a sense of will and self-assertion on the behavior of individuals; the need for competence refers to the need to properly interact with the environment and experience opportunities to express or develop the skills of a person; the need for relationship refers to situations where individuals feel they have a connection with significant others and experience a sense of belonging.
icine, veterinary medicine, nutrition, odontolo- gy, psychology, social service and occupational therapy). However, the uptake of places was only 50%, with major variations between courses. Medicine had the highest number of places, and 100% uptake; nursing and physical education offered more than 100,000 places, with low up- take. This scenario is important for the SUS, and also for PSCH, which accepts professionals from these areas. In the last five years, opening of many faculties of medicine has been authorized, as a re- sponse to a diagnosis by the federal government that there were not enough doctors to serve the population, which also led to the Mais Médicos (‘More Doctors’) Program 14,15 .
Development of information technologies and communication in a public sector have to pay more attention to the complexity in its implementation rather than focusing on best practice and strategies which are universal to prescribe how successfully applied Electronic Government program. As a result of advanced civilization for conducting residents of the state of being high-profile figures in the service in the era of democracy. Due to existence of interaction in the form of consultations will find a pattern, approaches such as what is appropriate to the needs of the community in exercising the functions of participation to the state. Based on the results of research on public services in the context of democratic consultation. Look about how the process of consultation with citizens. At the end result appears that the consultants who holds the project activities which implement electronic government that coupled with the community members who said that if the process of consultation having no democratic value. Certainly, it is negative in the development of democracy in the region licensing office, where community involvement not be used as reference to build an understanding together in achieving common interests in accordance with the concept ofnewpublic service. Criticism of the statement above , delivered by George (2002) that the failure of the process of the interaction between citizens with the government is located on the level of bureaucracy that is not acceptable to open direct communication. Given only communication with the use of symbols and an intermediary. Statement above supported by Robbins (2005) that stiff of a bureaucracy that has become part the past, of communications for interaction are the dominant choice for in the success of a form of service. All stiffness will perish along
Abstract This article deals with a public policy in education, Post Graduation in Collective Health, to identify forms of dialogue of this policy, with the publichealth policy, the SUS, starting in 1990. The main product of PGSC policy is the train- ing of masters and doctors, essential for teaching and research in the field. Bibliographic review and analysis of CAPES documents and databas- es based the analysis. Education policy was con- sistent over time and core to social development, alongside health policy, without presenting formal points of intercession, and its impacts occur main- ly through the formation of good and committed professionals, teachers and researchers. In PGSC, professional masters programs are more relevant, for a more direct link of postgraduate programs with the SUS, and the initiatives of the Ministry ofHealth to finance priorities in research for the HealthSystem. Even ininitiatives that explicit- ly seek to approximate the knowledge produced by PG with praxis in the SUS, the mechanisms involved in translating or impacting scientific knowledge into concrete practice are complex and must be context specific andthematic.
OBJECTIVES: To describe the indications for and visual outcomes of intrastromal corneal ring segment implantation. METHODS: A large retrospective case-series chart-review study was conducted using Sorocaba Ophthalmological Hospital medical records. This study included 1222 eyes (1196 patients) that were surgically treated between November 2009 and December 2012. The following preoperative data were collected: age, gender, type of medical care and funding source, surgical technique, best-corrected visual acuity, manifest sphere and cylinder refractive error, maximum and minimum central keratometry, and pachymetry measurements of the cornea at the thinnest point and at the ring channel. The postoperative best-corrected visual acuity and patient satisfaction were also determined. The cases were classified into six groups: four keratoconus groups (severe, advanced, moderate and mild), a pellucid marginal degeneration group and a post-graft irregular astigmatism group. This study was approved by the Brazilian Registry of Clinical Trials (UTN number 1111-1182-6181, TRIAL RBR-6S72RF). RESULTS: The age (mean±standard deviation) of the patients was 31.0±10.0 years. The most prevalent pathol- ogy was keratoconus (1147 eyes, 93.8%). A correlation was found between ectasia severity and medical assis- tance (po0.001), and the most serious cases was treated by the Brazilian publichealthsystem. No complications were found in a total of 1155 surgeries, and after surgery, 959 patients were satisfied. Among the 164 dis- satisfied patients, the majority failed to show improved best-corrected visual acuity.