Processos de democracia direta: sim ou não? Os argumentos clássicos à luz da teoria e da prática

Regularmente surgem controvérsias sobre os processos de democracia direta, dos quais os mecanismos mais frequentes são a iniciativa popular, o plebiscito e o referendo. Por um lado, há autores que defendem a posição de que essas instituições tornam o jogo político mais lento, caro, confuso e ilegítimo; outros defendem a posição contrária e argumentam que processos de democracia direta são fundamentais para os cidadãos e a qualidade da democracia. O presente estudo analisa esse tema em torno de sete questões, baseadas em considerações teóricas e pesquisas empíricas: 1. A questão entre o minimalismo e o maximalismo democrático; 2. A concorrência entre maioria e minoria; 3. A concorrência entre as instituições representativas e os processos de democracia direta; 4. A questão da competência dos cidadãos; 5. A questão dos efeitos colaterais dos processos de democracia direta; 6. A questão do tamanho do eleitorado; 7. A questão dos custos dos processos de democracia direta. As sete questões são analisadas a partir de uma revisão bibliográfica que considera tanto fontes nacionais como internacionais. O estudo mostra que os processos de democracia direta podem ser um complemento para as instituições representativas em um sistema democrático. O bom desempenho dos plebiscitos, referendos e iniciativas populares depende tanto da regulamentação destes como também do desempenho das outras instituições políticas e da situação socioeconômica de um país. O estudo permite ampliar e aprofundar o debate sobre processos de democracia direta no Brasil

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries