O apoio matricial como tecnologia para integração da vigilância em saúde com a atenção básica no âmbito municipal

Dissertação (mestrado)—Universidade de Brasília, Faculdade de Ciências da Saúde, Programa de Pós-Graduação em Ciências da Saúde, 2013.Este estudo realizado em um município de uma região metropolitana da região Sudeste, visa analisar apoio matricial como instrumento de integração entre as ações de vigilância em saúde e atenção básica no âmbito municipal. Trata-se de uma pesquisa centrada no âmbito da gestão municipal e suas atribuições no sentido de organizar e qualificar a atenção à saúde no município. Partimos de algumas inquietações importantes para a gestão do SUS: O gestor municipal dispõe de informação e tecnologia suficiente para organizar o sistema municipal de saúde de forma que integre os saberes e as práticas de vigilância em saúde ao conjunto das ações da atenção básica? Caso ele disponha, essas tecnologias são aplicadas no planejamento integrado e na adequação do processo de trabalho das equipes de atenção básica para a qualificação do cuidado com a necessária integralidade em rede em seus respectivos territórios de abrangência? O estudo exploratório foi realizado em município que fez a opção pela implantação da tecnologia de apoio matricial, no espaço de tempo equivalente de uma gestão. Esta condição criou as condições para esta pesquisa, pois foi possível vincular o período de governo como critério de escolha para elucidar o processo de construção deste tipo de tecnologia de integração e integralidade, desde sua formulação, institucionalização, suas dificuldades e desafios, ganhos de qualidade e perspectivas. Ao final, demonstrou ser acertada a opção pelo apoio matricial, sendo percebida como um ganho tanto na gestão como na gestão do cuidado, planejamento integrado, organização do sistema e sua funcionalidade a partir do usuário em seu território. Como recomendação, a necessidade de, em municípios de menor porte, se fazer o dimensionamento do território de abrangência da rede e suas linhas de cuidado, que, ao ultrapassar seus limites geopolíticos, dependam de uma gestão interfederativa para sua construção e operação. Neste caso o apoio matricial deve ser pactuado regionalmente e a participação do estado torna-se evidente nos casos em que os serviços regionais que compõem as linhas de cuidado necessárias para a garantia da integralidade do cuidado estejam sob sua gestão. Recomendamos ainda, às instâncias gestoras do SUS, a revisão das atribuições dos Núcleos de Apoio à Saúde da Família. _______________________________________________________________________________________ ABSTRACTThis study carried out in a city of a metropolitan southeastern region aims at analyzing matrix support as a tool for the integration of health surveillance actions and primary care at the municipal level. This is a research centered within the municipal management and its assignments to organize and qualify health care in the city. At first, there were some important concerns for the management of the SUS: Does the city manager has enough information and technology to organize the municipal health system in a way that integrates knowledge and health surveillance practices to all the actions of primary care? In case he has, are these technologies applied in the integrated planning and the adjustment of the work process of primary care teams to qualify health care with the necessary network comprehensiveness in their respective covered territories? The exploratory study was conducted in the municipality that chose the implementation of the matrix support technology within the time equivalent to one time management. This created the conditions for this research because it made possible to link the period of government as a choice criteria to elucidate the process of construction of this type of technology of integration and comprehensiveness, since its formulation, institutionalization, its difficulties and challenges, quality improvements and perspectives. At the end, it was proved that matrix support was the right option, perceived as a gain in both the management and care management, integrated planning, the system organization and its functionality for users in their territory. As a recommendation, in smaller cities, it is necessary the scaling of the territory covered by the network and its lines of care, when overcoming their geopolitical boundaries, rely on interfederative management for its construction and operation. In this case the matrix support should be agreed regionally and the state participation becomes evident in cases where regional services to guarantee comprehensive care are under their management. We also recommend to management levels of the SUS, the review of assignments of Family Health Support Centers

Análise da crise do Subprime e os derivativos de crédito nos Estados Unidos da América

O artigo objetiva analisar como os instrumentos e estruturas financeiras permitiram que o setor mais sólido e representativo dos Estados Unidos da América gerasse uma crise sem precedentes. As origens da crise imobiliária de 2008 remontam a criação e difusão dos títulos hipotecários (mortgage backed securities) na mesa do Salomon Brothers nos anos 70, passam pela incorporação de empréstimos de alto risco (subprime) ao longo dos últimos 30 anos a fim de rentabilizar os títulos e chegam até o reempacotamento de hipotecas não pagas por meio dos títulos lastreados em dívidas, popularmente conhecidos como CDOs (Collateralized Debt Obligation). Ao passo que o mundo noticiava e comentava as perdas envolvendo a crise, que em 2008 já haviam superado o valor de US$1 trilhão, foi possível constatar que um grupo de investidores atento aos indicadores acabou apostando contra o sistema e saiu ganhando. Fundos como a Scion Capital e a FrontPoint Partners acompanharam, por anos, a derrocada na qualidade do que estava sendo comercializado nos bancos e revendido incontáveis vezes. A queda na qualidade dos empréstimos hipotecários era evidente e um derivativo de crédito, em particular, o credit default swap, foi usado como seguro contra calote de instituições e títulos que não faziam parte da carteira de ativos dos investidores. Os contratos de swaps garantiram tempo e proteção aos investidores, que, ao longo da crise, aguardaram seus milhões de retorno, enquanto enxergavam a derrocada de gigantes como Lehman Brothers e Merrill Lynch, assim como, a derrocada de milhares de pessoas, sem emprego e sem moradia.The article aims to analyze how the financial instruments and structures allowed the most solid and representative sector of the United States of America to generate an unprecedented crisis. The origins of the 2008 housing crisis go back to the creation and diffusion of mortgage backed securities at the Salomon Brothers table in the 1970s, through the incorporation of subprime loans over the last 30 years in order to monetize bonds and even repackaging unpaid mortgages through debt-backed securities, popularly known as CDOs (Collateralized Debt Obligation). While the world was reporting and commenting on the losses involving the crisis, which in 2008 had already surpassed the value of US$ 1 trillion, it was possible to see that a group of investors, looking at the indicators, ended up betting against the system and won. Funds such as Scion Capital and Front Point Partners have been tracking for years the quality of what was being marketed at banks and resold countless times. The decline in the quality of mortgage loans was evident and a credit derivative, in particular the credit default swap, was used as insurance against defaulting institutions and securities that were not part of the portfolio of investor assets. The swap contracts ensured time and protection for investors who, over the course of the crisis, waited for their millions of return as they saw the collapse of giants like Lehman Brothers and Merrill Lynch, as well as the collapse of thousands of people without jobs and without housing.El artículo tiene como objetivo analizar cómo los instrumentos y estructuras financieras permitieron que el sector más sólido y representativo de los Estados Unidos de América generara una crisis sin precedentes. Los orígenes de la crisis inmobiliaria de 2008 se remonta à la creación y difusión de los títulos hipotecarios en la mesa de Salomon Brothers en los años 70, pasando por la incorporación de préstamos de alto riesgo (subprime) a lo largo de los últimos 30 años a fin de rentabilizar los títulos y llegan hasta el reempaquete de hipotecas no pagadas por medio de los títulos respaldados en deudas, popularmente conocidos como CDOs (Collateralized Debt Obligation). Al paso que el mundo noticiaba y comentaba las pérdidas involucrando la crisis, que en 2008, ya habían superado el valor de US $ 1 billón, fue posible constatar que un grupo de inversores, atento a los indicadores, acabó apostando contra el sistema y salió ganando. Fondos como Scion Capital y FrontPoint Partners acompañaron, por años, el derrocamiento en la calidad de lo que estaba siendo comercializado en los bancos y revendido incontables veces. La caída en la calidad de los préstamos hipotecarios era evidente y un derivado de crédito, en particular, el credit default swap, fue utilizado como seguro contra el incumplimiento de instituciones y títulos que no formaban parte de la cartera de activos de los inversores. Los contratos de swaps garantizaron tiempo y protección a los inversores que, a lo largo de la crisis, aguardaron sus millones de retorno, mientras veían el derrocamiento de gigantes como Lehman Brothers y Merrill Lynch, así como el derrocamiento de miles de personas, sin empleo y sin vivienda.L'article vise à analyser comment les instruments financiers et les structures financières ont permis au secteur le plus solide et le plus représentatif des États-Unis d'Amérique de générer une crise sans précédent. Les origines de la crise du logement de 2008 remontent à la création et à la diffusion de titres adossés à des créances hypothécaires à la table des Salomon Brothers dans les années 1970, à travers l'incorporation de prêts subprime au cours des 30 dernières années afin de monétiser obligations et même reconditionner les hypothèques impayées à travers des titres adossés à des créances, communément appelées CDO (Collateralized Debt Obligation). Tandis que le monde faisait rapport et commentait les pertes liées à la crise, qui avait déjà dépassé la valeur de 1 000 milliards de dollars en 2008, il était possible de voir qu'un groupe d'investisseurs, en regardant les indicateurs, finissait par parier contre le système et gagnait. Des fonds tels que Scion Capital et FrontPoint Partners suivent depuis des années la qualité de ce qui était commercialisé dans les banques et revendu d'innombrables fois. La baisse de la qualité des prêts hypothécaires était évidente et un dérivé de crédit, en particulier le swap sur défaillance de crédit, a été utilisé comme assurance contre les institutions défaillantes et les titres qui ne faisaient pas partie du portefeuille d'actifs des investisseurs. Les contrats de swap ont assuré temps et protection aux investisseurs qui, au cours de la crise, ont attendu leurs millions de retours en voyant l'effondrement de géants comme Lehman Brothers et Merrill Lynch, ainsi que l'effondrement de milliers de personnes sans emploi et sans logement

Composição de carboidratos do abacaxi (cv. pérola) e resposta glicêmica em humanos

Brazil is the third largest producer of pineapple (Ananas comosus) and the market for fresh pineapple is sustained by the Hawaii and Perola cultivars. In this work the Perola cultivar was divided into three main parts, shell, core and pulp, for characterization. Moisture in the pulp was higher (between 10 and 15%) than in the shell and core. The amount of protein was higher in the core (35%) than in the pulp and shell. Perola contained relatively low concentrations of total ascorbic acid in the edible parts, although higher levels of ascorbic acid in the shell. Citric acid corresponded to almost 60% of the total organic acids. The total soluble sugars [~7-12% (FW)] were predominantly sucrose, fructose and glucose. The core had almost twice as much total sugar (12%) than the pulp (6.8%). The amount of insoluble dietary fiber was around 1%, and the soluble fiber was less than 0.1%. The pulp showed the highest concentration of polyphenols (0.49%) and antioxidant activity (33 µmol.g-1) out of the parts. The consumption of the pineapple pulp or core produced a high glycemic index (~93%), but considering the glycemic load, this fruit can be considered as low dietary.O Brasil é o terceiro maior produtor de abacaxi(Ananas comosus) e as principais cultivares encontradas no mercado são Havaí e Pérola. Neste trabalho, frutas da cultivar Pérola foram divididas em casca, cerne e polpa e analisadas. A umidade da polpa foi superior (entre 10 e 15%) à encontrada na casca e no cerne. A concentração de proteína foi maior no cerne (35%) que na polpa e na casca. Essa cultivar contém baixas concentrações de ácido ascórbico nas partes comestíveis, no entanto a casca apresentou maiores níveis. O ácido cítrico correspondeu a aproximadamente 60% do total de ácidos orgânicos. Entre os açúcares solúveis [~7-12% (BU)], a sacarose, frutose e glicose foram predominantes. O cerne continha quase o dobro dos açúcares totais (12%) em relação à polpa (6,8%). A concentração de fibra alimentar insolúvel foi em torno de 1%, enquanto a de fibra solúvel foi menor que 0,1%. A polpa apresentou maior concentração de polifenóis (0,49%) e maior atividade antioxidante (33 µmol.g-1) que as demais partes. O consumo da polpa e do cerne produziu alto índice glicêmico (~93%), mas considerando a quantidade usual consumida, o abacaxi apresenta baixa carga glicêmica

Clinical and echocardiographic predictors of left ventricular remodeling following anterior acute myocardial infarction

OBJECTIVES: Coronary artery disease is the primary cause of death and is responsible for a high number of hospitalizations worldwide. Ventricular remodeling is associated with worse prognosis following ST-segment elevation myocardial infarction (STEMI) and is a risk factor for ventricular dysfunction and heart failure. This study aimed to identify the predictors of ventricular remodeling following STEMI. Additionally, we evaluated the clinical, laboratory, and echocardiographic characteristics of patients with anterior wall STEMI who underwent primary percutaneous intervention in the acute phase and at 6 months after the infarction. METHODS: This prospective, observational, and longitudinal study included 50 patients with anterior wall STEMI who were admitted to the coronary care unit (CCU) of a tertiary hospital in Brazil between July 2017 and August 2018. During the CCU stay, patients were evaluated daily and underwent echocardiogram within the first three days following STEMI. After six months, the patients underwent clinical evaluation and echocardiogram according to the local protocol. RESULTS: Differences were noted between those who developed ventricular remodeling and those who did not in the mean±standard deviation levels of creatine phosphokinase MB isoenzyme (CKMB) peak (no remodeling group: 323.7±228.2 U/L; remodeling group: 522.4±201.6 U/L; p=0.008) and the median and interquartile range of E/E’ ratio (no remodeling group: 9.20 [8.50–11.25] and remodeling group: 12.60 [10.74–14.40]; p=0.004). This difference was also observed in multivariate logistic regression. CONCLUSIONS: Diastolic dysfunction and CKMB peak in the acute phase of STEMI can be predictors of ventricular remodeling following STEMI

Interaction between perceived maternal care, anxiety symptoms, and the neurobehavioral response to palatable foods in adolescents

Studies in rodents have shown that early life trauma leads to anxiety, increased stress responses to threatening situations, and modifies food intake in a new environment. However, these associations are still to be tested in humans. This study aimed to verify complex interactions among anxiety diagnosis, maternal care, and baseline cortisol on food intake in a new environment in humans. A community sample of 32 adolescents and young adults was evaluated for: psychiatric diagnosis using standardized interviews, maternal care using the Parental Bonding Inventory (PBI), caloric consumption in a new environment (meal choice at a snack bar), and salivary cortisol. They also performed a brain fMRI task including the visualization of palatable foods vs. neutral items. The study found a three-way interaction between anxiety diagnosis, maternal care, and baseline cortisol levels on the total calories consumed (snacks) in a new environment. This interaction means that for those with high maternal care, there were no significant associations between cortisol levels and food intake in a new environment. However, for those with low maternal care and who have an anxiety disorder (affected), cortisol was associated with higher food intake; whereas for those with low maternal care and who did not have an anxiety disorder (resilient), cortisol was negatively associated with lower food intake. In addition, higher anxiety symptoms were associated with decreased activation in the superior and middle frontal gyrus when visualizing palatable vs. neutral items in those reporting high maternal care. These results in humans mimic experimental research findings and demonstrate that a combination of anxiety diagnosis and maternal care moderate the relationship between the HPA axis functioning, anxiety, and feeding behavior in adolescents and young adults

Pervasive gaps in Amazonian ecological research

Biodiversity loss is one of the main challenges of our time,1,2 and attempts to address it require a clear un derstanding of how ecological communities respond to environmental change across time and space.3,4 While the increasing availability of global databases on ecological communities has advanced our knowledge of biodiversity sensitivity to environmental changes,5–7 vast areas of the tropics remain understudied.8–11 In the American tropics, Amazonia stands out as the world’s most diverse rainforest and the primary source of Neotropical biodiversity,12 but it remains among the least known forests in America and is often underrepre sented in biodiversity databases.13–15 To worsen this situation, human-induced modifications16,17 may elim inate pieces of the Amazon’s biodiversity puzzle before we can use them to understand how ecological com munities are responding. To increase generalization and applicability of biodiversity knowledge,18,19 it is thus crucial to reduce biases in ecological research, particularly in regions projected to face the most pronounced environmental changes. We integrate ecological community metadata of 7,694 sampling sites for multiple or ganism groups in a machine learning model framework to map the research probability across the Brazilian Amazonia, while identifying the region’s vulnerability to environmental change. 15%–18% of the most ne glected areas in ecological research are expected to experience severe climate or land use changes by 2050. This means that unless we take immediate action, we will not be able to establish their current status, much less monitor how it is changing and what is being lostinfo:eu-repo/semantics/publishedVersio

Photography-based taxonomy is inadequate, unnecessary, and potentially harmful for biological sciences

The question whether taxonomic descriptions naming new animal species without type specimen(s) deposited in collections should be accepted for publication by scientific journals and allowed by the Code has already been discussed in Zootaxa (Dubois & Nemésio 2007; Donegan 2008, 2009; Nemésio 2009a–b; Dubois 2009; Gentile & Snell 2009; Minelli 2009; Cianferoni & Bartolozzi 2016; Amorim et al. 2016). This question was again raised in a letter supported by 35 signatories published in the journal Nature (Pape et al. 2016) on 15 September 2016. On 25 September 2016, the following rebuttal (strictly limited to 300 words as per the editorial rules of Nature) was submitted to Nature, which on 18 October 2016 refused to publish it. As we think this problem is a very important one for zoological taxonomy, this text is published here exactly as submitted to Nature, followed by the list of the 493 taxonomists and collection-based researchers who signed it in the short time span from 20 September to 6 October 2016

Differential cross section measurements for the production of a W boson in association with jets in proton–proton collisions at √s = 7 TeV

Measurements are reported of differential cross sections for the production of a W boson, which decays into a muon and a neutrino, in association with jets, as a function of several variables, including the transverse momenta (pT) and pseudorapidities of the four leading jets, the scalar sum of jet transverse momenta (HT), and the difference in azimuthal angle between the directions of each jet and the muon. The data sample of pp collisions at a centre-of-mass energy of 7 TeV was collected with the CMS detector at the LHC and corresponds to an integrated luminosity of 5.0 fb[superscript −1]. The measured cross sections are compared to predictions from Monte Carlo generators, MadGraph + pythia and sherpa, and to next-to-leading-order calculations from BlackHat + sherpa. The differential cross sections are found to be in agreement with the predictions, apart from the pT distributions of the leading jets at high pT values, the distributions of the HT at high-HT and low jet multiplicity, and the distribution of the difference in azimuthal angle between the leading jet and the muon at low values.United States. Dept. of EnergyNational Science Foundation (U.S.)Alfred P. Sloan Foundatio