26 research outputs found
How the 'plates' of a health system can shift, change and adjust during economic recessions: A qualitative interview study of public and private health providers in Brazil's Sao Paulo and Maranhao states
Background:
Economic recessions carry an impact on population health and access to care; less is known on how health systems adapt to the conditions brought by a downturn. This particularly matters now that the COVID-19 epidemic is putting health systems under stress. Brazil is one of the world’s most affected countries, and its health system was already experiencing the aftermath of the 2015 recession.
Methods:
Between 2018 and 2019 we conducted 46 semi-structured interviews with health practitioners, managers and policy-makers to explore the impact of the 2015 recession on public and private providers in prosperous (São Paulo) and impoverished (Maranhão) states in Brazil. Thematic analysis was employed to identify drivers and consequences of system adaptation and coping strategies. Nvivo software was used to aid data collection and analysis. We followed the Standards for Reporting Qualitative Research to provide an account of the findings.
Results:
We found the concept of ‘health sector crisis’ to be politically charged among healthcare providers in São Paulo and Maranhão. Contrary to expectations, the public sector was reported to have found ways to compensate for diminishing federal funding, having outsourced services and adopted flexible–if insecure–working arrangements. Following a drop in employment and health plans, private health insurance companies have streamlined their offer, at times at the expenses of coverage. Low-cost walk-in clinics were hit hard by the recession, but were also credited for having moved to cater for higher-income customers in Maranhão.
Conclusions:
The ‘plates’ of a health system may shift and adjust in unexpected ways in response to recessions, and some of these changes might outlast the crisis. As low-income countries enter post-COVID economic recessions, it will be important to monitor the adjustments taking place in health systems, to ensure that past gains in access to care and job security are not eroded
Identification of key areas for Aedes aegypti control through geoprocessing in Nova Iguaçu, Rio de Janeiro State, Brazil
Vigilância sanitária: estratégias para sua descentralização em Mato Grosso, 1996-2005
Baixo peso e dependência funcional em idosos institucionalizados de Uberlândia (MG), Brasil
Sand flies (Diptera, Psychodidae, Phlebotominae), vectors of Leishmania protozoa, at an Atlantic Forest Conservation Unit in the municipality of NÃsia Floresta, Rio Grande do Norte state, Brazil
Vibration control of a flexible rotor suspended by shape memory alloy wires
The present contribution is devoted to the study of the influence of shape memory alloys on the dynamic behavior of flexible rotors. In this sense, a suspension composed by pseudoelastic shape memory alloy wires that are connected to a rotor-bearing test rig was designed. To evaluate the performance of the system, both numerical and experimental investigations are carried out. The suspension stiffness can vary, especially in the pseudoelastic region, so that this variation takes place per a hysteretic cycle denoting energy dissipation whenever the loading magnitude is sufficient to induce a phase transformation. The constitutive model used to describe the shape memory alloy behavior is a modified version of the Brinson model for the one-dimensional case. To provide all thermomechanical properties of shape memory alloy wire, a complete characterization process was performed. Due to numerical reasons, the size of the model of the rotating system was reduced. Finally, numerical and experimental results demonstrate the success of shape memory alloy applied to the suspension of rotating machines as an interesting alternative for vibration control
Correlation of c-erbB-2 oncogene and p53 tumor suppressor gene with malignant transformation of hydatidiform mole
Considering the roles of c-erB-2 and p53 oncoproteins in tumor progression, we aimed to evaluate their expression in hydatidiform moles, and the possible predictive value of this immunoexpression in postmolar follow-up.Group I comprised 35 patients with progression to gestational trophoblastic tumor, and group II included 32 patients with progression to spontaneous remission. Immunohistochemical tests were performed by streptavidin-peroxidase method. c-erbB-2 immunoexpression was evaluated according to quantitative and semiquantitative criteria; p53 according to percentage of cells with stained nuclei. Data were analyzed by Student t-test, Mann-Whitney test, ROC curve and logistic regression analysis.c-erbB-2 and p-53 expressions were significantly increased in group I. Quantitative and semiquantitative analysis of c-erb-2 showed that its expression may be associated with mole hydatidiform progression to gestational trophoblastic tumor. Taking into account cells with complete membranous delineation we proposed a cut-off value of 10.8%. Similarly, considering the percentage of cells presenting nuclei marked by p53 we suggested a cut-off value of 40.1% for the prediction of malignant transformation of mole hydatidiform.c-erbB-2 and p53 immunoexpression in hydatidiform mole are usually increased with malignant transformation. in addition to beta-fraction of human chorionic gonadotropin, they could possibly help the establishment of a therapeutic protocol.Universidade Federal de São Paulo, Paulista Med Sch, Dept Obstet, São Paulo, BrazilUniversidade Federal de São Paulo, Paulista Med Sch, Dept Pathol, São Paulo, BrazilUniversidade Federal de São Paulo, Paulista Med Sch, Dept Obstet, São Paulo, BrazilUniversidade Federal de São Paulo, Paulista Med Sch, Dept Pathol, São Paulo, BrazilWeb of Scienc