Os desafios para a saúde

O TRABALHO DÁ ênfase à natureza econômica da saúde num momento em que o setor terciário da economia é o que mais cresce e a área da saúde é de todas a mais dinâmica. Aborda a crise da saúde pública considerando seus problemas, métodos e serviços. Adota o conceito de comunidade epistêmica para a análise da situação atual. Identifica duas correntes, com paradigmas conceituais distintos - o da Saúde Pública e o da Economia da Saúde. As principais agências de formulação desses paradigmas são, respectivamente, a Organização Mundial da Saúde e o Banco Mundial. No plano nacional, lembra que a Constituição de 1988 previu um Sistema Único de Saúde (SUS) universal, com integralidade das ações, descentralizado e participativo, com controle social. O SUS vem sendo implementado através de Normas Operacionais e dos mecanismo de compensação representados pelas Comissões Intergestores. Questão ainda não totalmente resolvida é a do financiamento do SUS.THIS PAPER emphasizes the economic nature of health care at a time when the tertiary sector is the one fastest growing in economy and health care is the most dynamic. It touches upon the public health crisis considering health problems, methods and services. The epistemic community concept is used to analyse the current situation. Two trends are identified, exhibiting distinct conceptual paradigms: one in Public Health, the other in Health Economics. The main agencies for the formulation of those paradigms are, respectively, the World Health Organization and the World Bank. On the national level, the 1988 Constitution provided a universal Unified Health System (SUS - Sistema Unificado de Saúde), complete in its activities, decentralized and fully engaged, under social control. The SUS has been established according to the Operational Rules and the compensation mechanisms represented by its Intermanaging Committees. An issue not yet fully settled is the SUS finacing

“Água mole em pedra dura, tanto bate até que fura”: o caminho das águas na catalisação social no Brasil Colonial

Guarulhos has many natural paths through hills, mountains, and a network of watersheds that allowed the Europeans to move around, enslave humans, and exploit local mineral resources. Besides the natural routes, Guarulhos (São Paulo, Brazil) gold mining archaeological remains (dated back to 1590 according to historical data) also show the great effort made by humans, especially indigenous people, for the construction of reservoirs and canals used for gold mining. Today’s region of Guarulhos is important for understanding the earliest forms of contact during the Portuguese colonization. The region sheds light on the interaction between Portuguese and indigenous groups, as well as the Portuguese strategies for territorial expansion. The purpose of this article is to point out how the mining process has been shaping the behavior of Guarulhos’s different segments of society since the beginning of this economic cycle to the present day.Entre serras, montanhas e uma rede de bacias hidrográficas, Guarulhos possui caminhos naturais que permitiram a movimentação da colonização europeia para a exploração humana e de seus recursos minerais. Ademais das rotas naturais, remanescentes arqueológicos da mineração de Guarulhos, SP, datados de acordo com dados históricos a partir de 1590, indicam um grande empenho por meio de trabalho humano, sobretudo indígena, na construção de reservatórios e canais como objetivo de se explorar o ouro. A região onde se encontra atualmente o município de Guarulhos é um importante ponto para se compreender as primeiras formas de contato durante a colonização portuguesa e sua interação com grupos indígenas e suas estratégias para expansão territorial. O objetivo deste artigo é apontar como o empreendimento de mineração vem implicando no comportamento de diversos segmentos da sociedade guarulhense, desde o início deste ciclo econômico até os dias atuais

Unraveling genetic sensitivity of beef cattle to environmental variation under tropical conditions

International audienceAbstractBackgroundSelection of cattle that are less sensitive to environmental variation in unfavorable environments and more adapted to harsh conditions is of primary importance for tropical beef cattle production systems. Understanding the genetic background of sensitivity to environmental variation is necessary for developing strategies and tools to increase efficiency and sustainability of beef production. We evaluated the degree of sensitivity of beef cattle performance to environmental variation, at the animal and molecular marker levels (412 K single nucleotide polymorphisms), by fitting and comparing the results of different reaction norm models (RNM), using a comprehensive dataset of Nellore cattle raised under diverse environmental conditions.ResultsHeteroscedastic RNM (with different residual variances for environmental level) provided better fit than homoscedastic RNM. In addition, spline and quadratic RNM outperformed linear RNM, which suggests the existence of a nonlinear genetic component affecting the performance of Nellore cattle. This nonlinearity indicates that within-animal sensitivity depends on the environmental gradient (EG) level and that animals may present different patterns of sensitivity according to the range of environmental variations. The spline RNM showed that sensitivity to environmental variation from harsh to average EG is lowly correlated with sensitivity from average to good EG, at both the animal and molecular marker levels. Although the genomic regions that affect sensitivity in harsher environments were not the same as those associated with less challenging environments, the candidate genes within those regions participate in common biological processes such as those related to inflammatory and immune response. Some plausible candidate genes were identified.ConclusionsSensitivity of tropical beef cattle to environmental variation is not continuous along the environmental gradient, which implies that animals that are less sensitive to harsher conditions are not necessarily less responsive to variations in better environmental conditions, and vice versa. The same pattern was observed at the molecular marker level, i.e. genomic regions and, consequently, candidate genes associated with sensitivity to harsh conditions were not the same as those associated with sensitivity to less challenging conditions

Impact of remnant vital tissue after locoregional treatment and liver transplant in hepatocellular cancer patients. A multicentre cohort study

The role of pathological findings after locoregional treatments as predictors of hepatocellular cancer recurrence after liver transplantation has been poorly addressed. The aim of the study was to identify the role of remnant vital tissue (RVT) of the target lesion in predicting hepatocellular cancer recurrence. Two hundred and seventy-six patients firstly undergoing locoregional treatment and then transplanted between January 2010 and December 2015 in four European Transplant Centres (i.e. Rome Tor Vergata, Birmingham, Brussels and Ancona) were enrolled in the study to investigate the role of pathological response at upfront locoregional treatment. At multivariable Cox regression analysis, RVT ≥2 cm was a strong independent risk factor for post-LT recurrence (HR = 5.6; P < 0.0001). Five-year disease-free survival rates were 60.8%, 80.9% and 95.0% in patients presenting a RVT ≥2 cm vs. 0.1-1.9 vs. no RVT, respectively. When only Milan Criteria-IN patients were analysed, similar results were reported, with 5-year disease-free survival rates of 58.1%, 79.0% and 94.0% in patients presenting a RVT ≥2 cm vs. 0.1-1.9 vs. no RVT, respectively. RVT is an important determinant of tumour recurrence after liver transplantation performed for hepatocellular cancer. Its discriminative power looks to be evident also in a Milan-IN setting, suggesting to more liberally use locoregional treatments also in these patients

Políticas científicas e tecnológicas e saúde

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