MODELO DE GESTÃO DE CARTA DE SERVIÇOS DA CIDADE DE MADRI: UMA OPÇÃO PARA OS ESTADOS E MUNICÍPIOS BRASILEIROS OPERACIONALIZAREM A LEI Nº 13.460/2017

A partir da publicação da Lei Nº 13.460/2017, a utilização da Carta de Serviços passou a ser um dos principais mecanismos de participação, proteção e de defesa dos direitos dos usuários de serviços públicos no Brasil. No entanto, a descontinuação da metodologia para sua correta implantação pelo Poder Executivo Federal, deixou estados e municípios sem orientações claras sobre como elaborar e gerir de forma efetiva as Cartas de Serviços. Dentro desse contexto pouco promissor, identificou-se uma janela de oportunidade de contribuir para a Administração Pública brasileira trazendo à luz o modelo de gestão de Cartas de Serviços fomentado pela cidade de Madri na Espanha como uma opção a ser seguida pelos estados e municípios brasileiros. Para isso, optou-se por apresentar essa alternativa por meio de uma pesquisa comparativa entre o modelo fomentado pela cidade de Madri e o modelo descontinuado fomentado pelo Programa GESPÚBLICA com o objetivo de evidenciar as diferenças e similaridades do processo de implantação das Cartas de Serviços empregado por cada um dos modelos, bem como aferir os resultados alcançados por cada um deles. Os resultados da pesquisa demonstraram como duas iniciativas com o mesmo objetivo podem produzir resultados bem diferentes. Enquanto o modelo da cidade de Madri conseguiu produzir resultados tangíveis frutos de uma estratégia de implantação centralizada apoiada por um regramento legal claro e objetivo, o modelo brasileiro encontrou grandes barreiras para produzir efeitos práticos que tiveram como causas raízes uma estratégia de implantação descentralizada apoiada por um regramento legal impreciso e confuso

Improving Surgical Care in Low- and Middle-Income Countries: A Pivotal Role for the World Health Organization

In response to increasing evidence that surgical conditions are an important global public health problem, and data suggesting that essential surgical services can be delivered in a cost-effective manner in low- and middle-income countries, the World Health Organization (WHO) has expanded its interest in surgical care. In 2004, WHO established a Clinical Procedures Unit within the Department of Essential Health Technologies. This unit has developed the Emergency and Essential Surgical Project (EESC), which includes a basic surgical training program based on the “Integrated Management of Emergency and Essential Surgical Care” Toolkit and the textbook “Surgery at the District Hospital.” To promote the importance of emergency and essential surgical care, a Global Initiative for Emergency and Essential Care was launched in 2005. In what maybe the most important development, surgical care is included in WHO’s new comprehensive primary health care plan. Given these rapid developments, surgical care at WHO may be approaching a critical “tipping point.” Lobbying for a World Health Assembly resolution on emergency and essential surgical care, and developing “structured collaborations” between WHO and various stakeholders are potential ways to ensure that the global surgery agenda continues to move forward

Abandono afetivo inverso: o dever de cuidado e a responsabilização civil da prole

O presente trabalho, inicialmente, irá passar pela evolução histórica do Direito de Família no âmbito das relações familiares e, paralelamente a isto, trará o papel dos idosos no núcleo familiar. Após será feita uma análise dos princípios norteadores afetos ao idoso, tais como o princípio da dignidade da pessoa humana, a solidariedade familiar e a proteção integral do idoso, bem como adentrar no conceito de idoso à luz do Direito, fazendo-se necessário compreender quais os direitos que lhes são assegurados pelo ordenamento jurídico pátrio. Em seguida, se reservará um capítulo com intuito de compreender institutos do afeto, do abandono afetivo, como fica caracterizado o abandono afetivo inverso e quais as consequências do abandono ao idoso. Por fim, se analisará o abandono afetivo sob a égide da responsabilidade civil para, analogamente, aplicar a reparação civil nos casos de abandono afetivo inverso. Não obstante, se indagará uma situação hipotética se é possível que o pai que abandonou o filho na infância possa pleitear indenização quando abandonado por este filho na velhice

Desenvolvimento e avaliação de uma atividade baseada na solução de problemas em grupo para o ensino integrado de Fisiologia Humana

Atividades que integrem os sistemas fisiológicos utilizando situações-problema são promissoras para resolverem uma questão comum ao ensino de fisiologia humana que é o estudo dos órgãos e sistemas de forma isolada. A aprendizagem baseada em problemas normalmente envolve a discussão entre grupos de estudantes que podem ser estruturados de diferentes formas, dentre elas podemos destacar as estratégias colaborativa e cooperativa. A aprendizagem cooperativa é caracterizada por uma divisão de tarefas entre os membros do grupo. Na aprendizagem colaborativa os membros do grupo trabalham em conjunto, porém sem divisão de tarefas definidas a priori. No presente trabalho iremos descrever e avaliar uma atividade baseada na solução de problemas que integra diferentes sistemas fisiológicos, intitulada “Qual é o Diagnóstico?”. A atividade foi aplicada utilizando estratégias cooperativa e colaborativa a fim de avaliar se a divisão de tarefas favorece a solução de um problema e caracterizar a percepção dos alunos acerca dessas duas estratégias. A proporção de soluções corretas para cada estratégia foi obtida a partir das respostas dadas por escrito ao final da atividade. Já a percepção dos alunos acerca das estratégias foi obtida por meio da análise do “Questionário de Avaliação”. Os resultados mostraram que nas duas estratégias a atividade foi bem aceita pelos alunos que a consideraram de dificuldade mediana e que conseguiram em sua maioria resolver o problema em questão. Porém, a estratégia cooperativa favoreceu a solução do problema, apesar de problemas na dinâmica de grupo terem sido mais apontados do que na estratégia colaborativa

How does comorbidity affect cost of health care in patients with irritable bowel syndrome? A cohort study in general practice

<p>Abstract</p> <p>Background</p> <p>Irritable bowel syndrome (IBS) is associated with other disorders (comorbidity), reduced quality of life and increased use of health resources. We aimed to explore the impact of comorbidity on cost of health care in patients with IBS in general practice.</p> <p>Methods</p> <p>In this cohort study 208 consecutive patients with IBS (Rome II) were recruited. Sociodemographic data, IBS symptoms, and comorbidity (somatic symptoms, organic diseases and psychiatric disorders) were assessed at baseline. Based on a follow up interview after 6-9 months and use of medical records, IBS and non-IBS related health resource use were measured as consultations, hospitalisations, use of medications and alternative health care products and sick leave days. Costs were calculated by national tariffs and reported in Norwegian Kroner (NOK, 1 EURO equals 8 NOK). Multivariate analyses were performed to identify predictors of costs.</p> <p>Results</p> <p>A total of 164 patients (mean age 52 years, 69% female, median duration of IBS 17 years) were available at follow up, 143 patients (88%) had consulted their GP of whom 31 (19%) had consulted for IBS. Mean number of sick- leave days for IBS and comorbidity were 1.7 and 16.3 respectively (p < 0.01), costs related to IBS and comorbidity were 954 NOK and 14854 NOK respectively (p < 0.001). Age, organic diseases and somatic symptoms, but not IBS severity, were significant predictors for total costs.</p> <p>Conclusion</p> <p>Costs for health resource use among patients with IBS in general practice were largely explained by comorbidity, which generated ten times the costs for IBS.</p

Sri Lankan tsunami refugees: a cross sectional study of the relationships between housing conditions and self-reported health

BACKGROUND: On the 26th December 2004 the Asian tsunami devastated the Sri Lankan coastline. More than two years later, over 14,500 families were still living in transitional shelters. This study compares the health of the internally displaced people (IDP), living in transitional camps with those in permanent housing projects provided by government and non-government organisations in Sri Lanka. METHODS: This study was conducted in seven transitional camps and five permanent housing projects in the south west of Sri Lanka. Using an interviewer-led questionnaire, data on the IDPs' self-reported health and housing conditions were collected from 154 participants from transitional camps and 147 participants from permanent housing projects. Simple tabulation with non-parametric tests and logistic regression were used to identify and analyse relationships between housing conditions and the reported prevalence of specific symptoms. RESULTS: Analysis showed that living conditions were significantly worse in transitional camps than in permanent housing projects for all factors investigated, except 'having a leaking roof'. Transitional camp participants scored significantly lower on self-perceived overall health scores than those living in housing projects. After controlling for gender, age and marital status, living in a transitional camp compared to a housing project was found to be a significant risk factor for the following symptoms; coughs OR: 3.53 (CI: 2.11-5.89), stomach ache 4.82 (2.19-10.82), headache 5.20 (3.09-8.76), general aches and pains 6.44 (3.67-11.33) and feeling generally unwell 2.28 (2.51-7.29). Within transitional camp data, the only condition shown to be a significant risk factor for any symptom was household population density, which increased the risk of stomach aches 1.40 (1.09-1.79) and headaches 1.33 (1.01-1.77). CONCLUSION: Internally displaced people living in transitional camps are a vulnerable population and specific interventions need to be targeted at this population to address the health inequalities that they report to be experiencing. Further studies need to be conducted to establish which aspects of their housing environment predispose them to poorer health

Improving the Quantitative Basis of the Surgical Burden in Low-Income Countries

Theo Vos discusses how surgery is beginning to be considered an essential component of primary health care in low-income countries, and how we need to improve our understanding of the burden of surgical conditions in these settings

Interactions and potential implications of Plasmodium falciparum-hookworm coinfection in different age groups in south-central Côte d'Ivoire

BACKGROUND: Given the widespread distribution of Plasmodium and helminth infections, and similarities of ecological requirements for disease transmission, coinfection is a common phenomenon in sub-Saharan Africa and elsewhere in the tropics. Interactions of Plasmodium falciparum and soil-transmitted helminths, including immunological responses and clinical outcomes of the host, need further scientific inquiry. Understanding the complex interactions between these parasitic infections is of public health relevance considering that control measures targeting malaria and helminthiases are going to scale.METHODOLOGY: A cross-sectional survey was carried out in April 2010 in infants, young school-aged children, and young non-pregnant women in south-central Côte d'Ivoire. Stool, urine, and blood samples were collected and subjected to standardized, quality-controlled methods. Soil-transmitted helminth infections were identified and quantified in stool. Finger-prick blood samples were used to determine Plasmodium spp. infection, parasitemia, and hemoglobin concentrations. Iron, vitamin A, riboflavin, and inflammation status were measured in venous blood samples.PRINCIPAL FINDINGS: Multivariate regression analysis revealed specific association between infection and demographic, socioeconomic, host inflammatory and nutritional factors. Non-pregnant women infected with P. falciparum had significantly lower odds of hookworm infection, whilst a significant positive association was found between both parasitic infections in 6- to 8-year-old children. Coinfected children had lower odds of anemia and iron deficiency than their counterparts infected with P. falciparum alone.CONCLUSIONS/SIGNIFICANCE: Our findings suggest that interaction between P. falciparum and light-intensity hookworm infections vary with age and, in school-aged children, may benefit the host through preventing iron deficiency anemia. This observation warrants additional investigation to elucidate the mechanisms and consequences of coinfections, as this information could have important implications when implementing integrated control measures against malaria and helminthiases

Holocene deglaciation and glacier readvances on the Fildes Peninsula and King George Island (Isla 25 de Mayo), South Shetland Islands, NW Antarctic Peninsula

To provide insights into glacier-climate dynamics of the South Shetland Islands (SSI), NW Antarctic Peninsula, we present a new deglaciation and readvance model for the Bellingshausen Ice Cap (BIC) on Fildes Peninsula and for King George Island/Isla 25 de Mayo (KGI) ~62°S. Deglaciation on KGI began after c. 15 ka cal BP and had progressed to within present-day limits on the Fildes Peninsula, its largest ice-free peninsula, by c. 6.6–5.3 ka cal BP. Probability density phase analysis of chronological data constraining Holocene glacier advances on KGI revealed up to eight 95% probability ‘gaps’ during which readvances could have occurred. These are grouped into four stages – Stage 1: a readvance and marine transgression, well-constrained by field data, between c. 7.4–6.6 ka cal BP; Stage 2: four probability ‘gaps’, less well-constrained by field data, between c. 5.3–2.2 ka cal BP; Stage 3: a well-constrained but restricted ‘readvance’ between c. 1.7–1.5 ka; Stage 4: two further minor ‘readvances’, one less well-constrained by field data between c. 1.3–0.7 ka cal BP (68% probability), and a ‘final’ well-constrained ‘readvance’ after 1950 CE) is associated with recent warming/more positive SAM-like conditions