O avanço da noção privatista na política pública de saúde : uma análise da proposta dos planos de saúde acessíveis e a Emenda Constitucional 95/2016

O presente trabalho faz uma reflexão acerca dos rumos da proteção social no Brasil, observando de que forma a política de saúde foi ganhando contornos privatistas ao longo do tempo. A pesquisa objetiva identificar as repercussões do projeto de planos de saúde acessíveis, iniciado no governo Temer, em 2016, no desfinanciamento e desmonte do SUS. Parte-se do pressuposto que, com a criação dos planos de saúde acessíveis, somada à reforma EC 95/2016 implementada pelo governo Temer, o SUS tornou-se mais vulnerável à iniciativa privada e aos interesses do mercado, trazendo como possíveis consequências, a precarização de seu financiamento e da prestação dos seus serviços. Do ponto de vista metodológico, foi realizada uma pesquisa exploratória com análise documental e bibliográfica em que foram levantados dados do orçamento da saúde no Painel do Orçamento Federal do Ministério da Economia e do portal da Agência Nacional de Saúde Suplementar (ANS) para identificar as receitas dos planos de saúde privados. Através desse estudo foi possível observar que, apesar dos avanços significativos no acesso à saúde pela população de baixa renda durante os anos 2000, no contexto atual, verifica-se um processo de desfinanciamanto do SUS iniciada após a Emenda Constitucional nº 95, de 2016. Observou-se igualmente, uma relação inversa entra o orçamento do SUS e as receitas dos planos de saúde privados. Enquanto aquelas foram reduzidas, estas apresentaram crescimento.The present paper reflects on the paths of social protection in Brazil, observing how health policy has been privatized over time. The research aims to identify the impact of the accessible health plan project, started by the Temer government in 2016, on the unfinancing and deconstruction of the SUS. It is assumed that, with the creation of accessible health plans, added to the EC 95/2016 reform implemented by the Temer government, the SUS became more vulnerable to become private and to market interests, bringing consequences like, the precariousness of its financing and services. From a methodological point of view, an exploratory research was carried out with documental and bibliographic analysis in which data on the health budget were collected from the Federal Budget Panel of the Ministry of Economy and from the National Agency for Supplementary Health portal (ANS) to identify the earnings of private health plans. Through this study, it was possible to observe that, besides the significant advances accessing health by the low-income population during the 2000s, in the current context, there is a process of unfinancing the SUS that started after Constitutional Amendment No. 95, of 2016. It was also observed an inverse relationship between the SUS budget and the earnings of private health plans. While those were reducing, these were growing

Bibliotheken privater Krankenhausketten in Deutschland : ein kritischer Situationsbericht

Die deutsche Krankenhauslandschaft ist derzeit in einem umfassenden Wandel begriffen. In Zeiten knapper werdender Ressourcen, einer ausgeprägten Trägerpluralität und einer umstrittenen Krankenhausfinanzierung überrollt eine Privatisierungswelle nicht nur einzelne Leistungserbringer sondern den gesamten Markt. Der Krankenhausbereich nimmt zusehends an Wettbewerb und am Gewinn orientierte Züge an, der Patient mutiert zum Kunden und es lässt sich eine starke Bildung und vor allem Ausbreitung von Krankenhausketten beobachten. Im Kontext dieser Veränderungen wird die aktuelle Situation von Krankenhausbibliotheken dargestellt. Eine Skizzierung des deutschen Krankenhauswesens sowie eine Marktsichtung aktuell expandierender Krankenhausketten geht der Darstellung voraus, um die die Krankenhausbibliotheken umgebenden Strukturen zu beleuchten. Anschließend wird die derzeitige Situation speziell der Krankenhausbibliotheken deutscher privater Krankenhausketten mittels einer Befragung analysiert. Die Ergebnisse lassen eine weitere Zuspitzung der ohnehin konfliktträchtigen Situation erahnen. Ein Vergleich zwischen den Darstellungen und Aussagen der Krankenhausketten in Geschäftsberichten, Unternehmensbroschüren und Homepages mit den Umfrageergebnissen macht deutlich, wie sehr Theorie und Praxis in Ansehen, Aufgaben und Stellenwert der betroffenen Krankenhausbibliotheken differenzieren. Vor diesem Hintergrund sind die abschließenden Überlegungen zur generellen Rolle von Krankenhausbibliotheken innerhalb der privaten Krankenhausketten in Deutschland sowie des Krankenhausbibliothekswesens allgemein heute und in Zukunft zu sehen

Periimplantäre Mukositis - Lebensqualität, Atemgasanalysen und klinische Parameter

Die Versorgung mit dentalen Implantaten nach Zahnverlust hat heute einen festen Stellenwert bei der Wiederherstellung von Ästhetik und Funktion. Implantate zeigen hohe Überlebensraten. Zu einem Verlust kann es trotzdem beispielsweise durch die Entwicklung einer periimplantären Infektion kommen. Ziel der vorliegenden Studie war es zu untersuchen, ob die orale Lebensqualität durch das Auftreten einer Mukositis beeinträchtigt wird. Außerdem sollte die Untersuchung von Atemgasproben zeigen, ob ein verändertes Atemgasspektrum zwischen Patienten mit einer periimplantären Infektion verglichen mit Patienten mit gesunden oralen Verhältnissen vorliegt. Zudem sollte untersucht werden, ob Patienten mit einer Mukositis im Verlauf eine Periimplantitis entwickeln und ob additive Maßnahmen diesen Prozess beeinflussen können. Ein Patientenkollektiv von 27 Patienten aus der Implantatsprechstunde der Klinik für Mund-Kiefer-und Gesichtschirurgie des Universitätsklinikums Schleswig-Holstein, Campus Kiel wurde im Studienzeitraum von 24 Wochen an vier Untersuchungsterminen kontrolliert. Die Einteilung erfolgte randomisiert. Die Patienten mit Mukositis (n=14) erhielten je nach Gruppe nach einer konservativen Therapie, Motivation und Instruktion das Implantatpflegemittel durimplant (lege artis Pharma GmbH + Co KG, n=5), Chlorhexamed®-Gel 1 % (CHX-Gel, GlaxoSmithKline Consumer Healthcare GmbH & Co. KG, n=5) oder keine weiteren additiven Maßnahmen (n=4). Die Kontrollgruppe mit gesunden oralen Verhältnissen bestand aus 13 Probanden. Die Lebensqualität wurde anhand von Befragungen durch den „Oral Health Impact Profile“ überprüft und den Patienten wurden zu Beginn und am Ende der Studie Atemgasproben entnommen, die auf experimenteller Basis durch einen hochsensiblen Gaschromatographen/Massenspektrometer (GC/MS) an der Technischen Universität in Hamburg-Harburg (TUHH), Institut für Messtechnik, analysiert und, im Hinblick auf Unterschiede im Atemgasspektrum von Patienten mit gesunden oralen Verhältnissen und Patienten mit periimplantären Entzündungen verglichen wurden. An allen vier Terminen wurden die klinischen Parameter Bluten auf Sondieren (BOP), Sondierungswerte, die Beweglichkeit mit Hilfe des Periotests (Periotest ®M, Medizintechnik Guldene K, Germany) und der Klopfschall bei allen Patienten erhoben. Das Vorliegen einer Mukositis verursachte nach der Evaluation mit dem OHIP keine signifikante Einschränkung der oralen Lebensqualität. In den Atemgasanalysen konnten 57 typische Stoffe aus der Atemluft bei allen Probanden analysiert werden, von denen 27 bei Patienten mit einer periimplantären Infektion signifikant erhöht waren. Nach medikamentöser Therapie zeigte sich in den Analysen eine Reduktion der Intensität dieser atemtypischen Stoffe. Während bekannt ist, dass Hunde Karzinome erkennen können, ist dies die erste klinische Studie, die mittels hochsensitivem Analyseverfahren nachweisen konnte, dass intraorale Entzündungen zu Veränderungen der Atemluft führen. In Zukunft könnte dieses Verfahren beim frühzeitigen Aufspüren oraler Entzündungen eingesetzt werden bzw. weitere Hinweise zu den Entstehungsmechanismen der Periimplantitis beitragen. Der Zusatz von durimplant zur konservativen Therapie bei periimplantärer Mukositis konnte unter den herrschenden Studienbedingungen den BOP ebenso wie CHX-Gel deutlich reduzieren. Der Verlauf der Sondierungswerte zeigte keine signifikanten Unterschiede. Es entwickelte sich keine Periimplantitis aus der bestehenden Mukositis

JUSTIÇA SOCIAL: UMA POSSIBILIDADE ÉTICA NO PROCESSO DE INCLUSÃO NO ENSINO SUPERIOR

Este artigo tem o objetivo de problematizar a discussão acerca da chegada dos alunos com deficiência no ensino superior, já que com este novo público se acredita que novas formas de exclusão foram criadas. Assim, justifica-se a necessidade de pensar o binômio inclusão/exclusão. Para tanto, tem-se que a Instituição de Ensino Superior é marcada pela diversidade e,  durante anos, um de seus principais objetivos era selecionar aqueles considerados melhores, decidindo quem teria condições de prosseguir nos estudos e quem não possuía capacidade intelectual. A legislação garante o acesso a todos, mas em relação à acessibilidade ainda se precisa avançar,  consideravelmente, pois ainda há currículos escontextualizados, alto índice de evasão, principalmente entre as camadas mais  pobres. A parcela de deficientes que chega ao Ensino Superior é muito pequena, mesmo considerando as cotas existentes, e isto demonstra que ao longo de suas vidas escolares há uma interrupção, por abandono, evasão, reprovação ou pela própria condição financeira, mesmo com as políticas assistenciais. A educação é um direito humano e social, e como tal precisa ser garantida a todos, sem distinção de cor, sexo, gênero ou  indição social

Measuring the Overall Complexity of Graphical and Textual IEC 61131-3 Control Software

Software implements a significant proportion of functionality in factory automation. Thus, efficient development and the reuse of software parts, so-called units, enhance competitiveness. Thereby, complex control software units are more difficult to understand, leading to increased development, testing and maintenance costs. However, measuring complexity is challenging due to many different, subjective views on the topic. This paper compares different complexity definitions from literature and considers with a qualitative questionnaire study the complexity perception of domain experts, who confirm the importance of objective measures to compare complexity. The paper proposes a set of metrics that measure various classes of software complexity to identify the most complex software units as a prerequisite for refactoring. The metrics include complexity caused by size, data structure, control flow, information flow and lexical structure. Unlike most literature approaches, the metrics are compliant with graphical and textual languages from the IEC 61131-3 standard. Further, a concept for interpreting the metric results is presented. A comprehensive evaluation with industrial software from two German plant manufacturers validates the metrics' suitability to measure complexity.Comment: 8 pages, https://ieeexplore.ieee.org/abstract/document/9444196

Incorporation of EPA and DHA into plasma phospholipids in response to different omega-3 fatty acid formulations - a comparative bioavailability study of fish oil vs. krill oil

<p>Abstract</p> <p>Background</p> <p>Bioavailability of omega-3 fatty acids (FA) depends on their chemical form. Superior bioavailability has been suggested for phospholipid (PL) bound omega-3 FA in krill oil, but identical doses of different chemical forms have not been compared.</p> <p>Methods</p> <p>In a double-blinded crossover trial, we compared the uptake of three EPA+DHA formulations derived from fish oil (re-esterified triacylglycerides [rTAG], ethyl-esters [EE]) and krill oil (mainly PL). Changes of the FA compositions in plasma PL were used as a proxy for bioavailability. Twelve healthy young men (mean age 31 y) were randomized to 1680 mg EPA+DHA given either as rTAG, EE or krill oil. FA levels in plasma PL were analyzed pre-dose and 2, 4, 6, 8, 24, 48, and 72 h after capsule ingestion. Additionally, the proportion of free EPA and DHA in the applied supplements was analyzed.</p> <p>Results</p> <p>The highest incorporation of EPA+DHA into plasma PL was provoked by krill oil (mean AUC_{0-72 h}: 80.03 ± 34.71%*h), followed by fish oil rTAG (mean AUC_{0-72 h}: 59.78 ± 36.75%*h) and EE (mean AUC_{0-72 h}: 47.53 ± 38.42%*h). Due to high standard deviation values, there were no significant differences for DHA and the sum of EPA+DHA levels between the three treatments. However, a trend (<it>p = </it>0.057) was observed for the differences in EPA bioavailability. Statistical pair-wise group comparison's revealed a trend (<it>p </it>= 0.086) between rTAG and krill oil. FA analysis of the supplements showed that the krill oil sample contained 22% of the total EPA amount as free EPA and 21% of the total DHA amount as free DHA, while the two fish oil samples did not contain any free FA.</p> <p>Conclusion</p> <p>Further studies with a larger sample size carried out over a longer period are needed to substantiate our findings and to determine differences in EPA+DHA bioavailability between three common chemical forms of LC n-3 FA (rTAG, EE and krill oil). The unexpected high content of free EPA and DHA in krill oil, which might have a significant influence on the availability of EPA+DHA from krill oil, should be investigated in more depth and taken into consideration in future trials.</p

Impact of perinatal asphyxia on parental mental health and bonding with the infant: a questionnaire survey of Swiss parents

Objective To compare current mental health symptoms and infant bonding in parents whose infants survived perinatal asphyxia in the last 2 years with control parents and to investigate which sociodemographic, obstetric and neonatal variables correlated with parental mental health and infant bonding in the asphyxia group. Design Cross-sectional questionnaire survey of parents whose children were registered in the Swiss national Asphyxia and Cooling register and of control parents (Post-traumatic Diagnostic Scale, Hospital Anxiety and Depression Scale, Mother-to-Infant Bonding Scale). Results The response rate for the asphyxia group was 46.5%. Compared with controls, mothers and fathers in the asphyxia group had a higher frequency of post-traumatic stress disorder (PTSD) symptoms (p&lt;0.001). More mothers (n=28, 56%) had a symptom diagnosis of either full or partial PTSD than controls (n=54, 39%) (p=0.032). Similarly, more fathers (n=31, 51%) had a symptom diagnosis of either partial or full PTSD than controls (n=19, 33%) (p=0.034). Mothers reported poorer bonding with the infant (p=0.043) than controls. Having a trauma in the past was linked to more psychological distress in mothers (r=0.31 (95% CI 0.04 to 0.54)) and fathers (r=0.35 (95% CI 0.05 to 0.59)). For mothers, previous pregnancy was linked to poorer bonding (r=0.41 (95% CI 0.13 to 0.63)). In fathers, therapeutic hypothermia of the infant was related to less frequent PTSD symptoms (r=−0.37 (95% CI −0.61 to −0.06)) and past psychological difficulties (r=0.37 (95% CI 0.07 to 0.60)) to more psychological distress. A lower Apgar score was linked to poorer bonding (r=−0.38 (95% CI −0.64 to −0.05)). Conclusions Parents of infants hospitalised for perinatal asphyxia are more at risk of developing PTSD than control parents

Herbicide resistance technologies in soybean cultivars

The objective of this work was to carry out a technical analysis of the biotechnologies that confer resistance to herbicides in soybeans. Two experiments were carried out (I and II) in the agricultural years 2016/17 and 2017/18, using a randomized block design with six &nbsp;and four &nbsp;replicates. In experiment I, two forms of management in weed control were evaluated for each technology studied (Roundup Ready® and Liberty Link®) and for conventional soybeans, as well as grain yield. In experiment II, the efficiency of using different herbicides to control voluntary soybeans (with and without technology) was evaluated. The pre-emergent herbicides in both managements proposed for the cultivars controlled the weeds from the emergence of the soybean crop to the application of the post-emergent herbicides in both crops. Likewise, all post-emergent herbicides showed weed control above 90% at 14 and 28 days after application. In the evaluation of the chemical control of Garra IPRO voluntary soybean, the herbicide 2,4-D stood out among the others for being more efficient in both agricultural years (above 90%). The herbicides glyphosate, 2,4-D and metsulfuron-methyl are the most effective in controlling voluntary soybean cultivars BRS 284 and CZ16B39LL