EPIDEMIOLOGIA DA HANSENÍASE E A DESCENTRALIZAÇÃO DAS AÇÕES DE CONTROLE NO BRASIL

Objetivo: Analisar a situação epidemiológica da hanseníase no Brasil e sua associação com a descentralização das ações de controle. Método: Estudo ecológico misto com dados secundários do Sistema de Informação de Agravos de Notificação dos municípios brasileiros. Foi utilizado o modelo de regressão binomial negativo, período 2001-2015. Resultados: A análise das variações geográficas e temporais mostrou comportamentos heterogêneos dos indicadores epidemiológicos de hanseníase, sendo que o aumento significativo destes foi associado à proporção de casos de hanseníase diagnosticados na Atenção Primária à Saúde; já a proporção da cobertura populacional estimada por Estratégia Saúde da Família foi associada somente à redução significativa do indicador taxa de detecção de hanseníase entre os menores de quinze anos de idade. Conclusão: Apesar da expansão da Estratégia Saúde da Família ser importante, a condição identificada como fundamental para o controle da doença é o aumento da oferta de ações pelos profissionais de saúde

A instrumentalidade nas ações de vigilância sanitária em Minas Gerais

This article is part of a doctoral thesis that uses both Symbolic Interactionism as a theoretical framework, and Grounded Theory as a method, to understand the interpretations and meanings attributed to the instruments used in local actions of health surveillance; also to comprehend how these instruments interfere with risk identification and decision-making processes of interventions. The professional uses a set of empirical techniques and instrumental references that allow him to interpret possibilities for actions and situational conditions. Using health legislation, knowledge, and experience, the professional identifies and assesses the risk. These instruments structure knowledge and actions, rationally composing an objectified process using technical knowledge and critical interpretations; this nonetheless involves subjective decisions based on experience and interpretations. The intervention is the representation of the existence of risk and of protective measures. It is set in a specific context, constituting a system aiming to modify a problematic situation. It is not enough to identify the risk, but to define how and what means can be mobilized to control it. Intervening constitutes therefore a scientific and political challenge for the professional.Trata-se de um recorte de tese de doutorado que utilizou o Interacionismo Simbólico como referencial teórico e a Teoria Fundamentada dos Dados como método, para compreender as interpretações e os sentidos atribuídos aos instrumentos utilizados nas ações locais de vigilância sanitária e como eles interferem na identificação do risco e nas escolhas das intervenções. O profissional utiliza um conjunto de referências técnicas, empíricas e instrumentais que lhe permite interpretar as possibilidades de ações e as condições situacionais. Utilizando a legislação sanitária, o conhecimento e a experiência, o profissional identifica e avalia o risco. Estes instrumentos estruturam os saberes e as ações, compondo um processo objetivado racionalmente que utiliza o conhecimento técnico e interpretações críticas, mas que envolve decisões subjetivas baseadas na experiência e nas interpretações. A intervenção é a representação da existência do risco e da ação protetora. É definida em um contexto específico, constituindo um sistema com  objetivo de modificar uma situação problemática. Não basta identificar o risco, mas definir como e quais meios podem ser mobilizados para controlá-lo. Intervir constitui-se, portanto, em um desafio científico e político para o profissional

Significando o risco sanitário: modos de atuação sobre o risco na vigilância sanitária

This qualitative study that utilizes Symbolic Interactionism as a theoretical background and Grounded Theory as a method, sought to understand the modes of action about risk. It summarizes the meanings of risk to the professionals of Health Surveillance (HS), and analyses the modes of action to control it. The summary is the systematization of the in-terpretations and meanings of risk. The analysis shows the existence of two modes of ac-tion, allowing to undertake the application of the meaning of risk in the scope of domain of an specific knowledge. Between the risk identification and the intervention there are processes that mixture the rationality, subjectivity, authority, control, experience, the formal knowledge acquired. The act of the HS professional consists of knowledge, acquired experience, socio-cultural contexts, and interactions that define and redefine the modes of action. The actions are based on the meanings of the risk that moves in the planes of objectivity and subjectivity and, the legislation is an important instrument of decision and persuasion. Although there is an offset to the use of the knowledge and ex-perience, it is the legal framework that prints what should or should not be controlled.Este estudo qualitativo, que utiliza o Interacionismo Simbólico como referencial teórico e a Teoria Fundamentada nos Dados como método, buscou compreender os modos de atuação sobre o risco. Sintetiza os significados do risco para os profissionais da Vigilância Sanitária (VISA) e analisa os modos de atuação para o seu controle. A síntese é a sistematização das interpretações e significados do risco. A análise apresenta a existência de dois modos de atuação, permitindo empreender a aplicação do significado de risco no âmbito do domínio de um saber específico. Entre a identificação do risco e a intervenção existem processos que mesclam a racionalidade à subjetividade, a autoridade ao controle, a experiência ao conhecimento formal adquirido. O agir do profissional da VISA é constituído por conhecimentos, pela experiência adquirida, pelos contextos socioculturais e pelas interações que definem e redefinem os modos de atuar. As ações são baseadas nos significados do risco que se deslocam no plano da objetividade e da subjetividade, e a legislação é um importante instrumento de decisão e de persuasão. Embora ocorra um deslocamento para o uso do conhecimento e da experiência, é o arcabouço legal que imprime o que deve ou não ser controlado

Mortalidade perinatal e desigualdades socioespaciais

OBJECTIVE: to analyze the social inequalities in the distribution of perinatal mortality in Belo Horizonte. MATERIAL AND METHODS: the perinatal deaths of residents in Belo Horizonte in the period 2003 to 2007 were studied on the basis of the Information Systems on Mortality and Newborns. The space analysis and the Health Vulnerability Index were used to identify existing inequalities in the sanitary districts regarding coverage and risk, determined by the Odds Ratio and a value pOBJETIVO: analizar las desigualdades sociales en la distribución de la mortalidad perinatal en Belo Horizonte. MATERIAL Y MÉTODOS: fueron estudiadas las muertes perinatales de residentes en Belo Horizonte, en el período de 2003 a 2007, con base en los Sistemas de Información sobre Mortalidad y Nacidos Vivos. El análisis espacial y el Índice de Vulnerabilidad de la Salud fueron utilizados para identificar desigualdades existentes en los Distritos Sanitarios, en las áreas de influencias y de riesgo, determinadas por el Odds Ratio y el valor pOBJETIVO: analisar as desigualdades sociais constatadas na distribuição da mortalidade perinatal em Belo Horizonte. MATERIAIS E MÉTODOS: estudaram-se os óbitos perinatais de residentes em Belo Horizonte, no período de 2003 a 2007, com base nos sistemas de informação sobre mortalidade e nascidos vivos e utilizaram-se a análise espacial e o índice de vulnerabilidade à saúde para identificar desigualdades existentes nos distritos sanitários, nas áreas de abrangências e de risco, determinadas pelo odds ratio e valor

Tendência temporal de internações por sífilis congênita entre 2008 e 2018, em Minas Gerais

Objetivou-se analisar a tendência temporal de internações por sífilis congênita entre 2008 e 2018 em Minas Gerais. Método: estudo ecológico de série temporal. Para a análise de tendência, realizou-se modelo de Prais-Winsten. Calculou-se a Variação Percentual Anual para apresentar a intensidade da tendência. Resultados: foi observada tendência ascendente de internações por sífilis congênita em 12 macrorregiões de Minas Gerais. As maiores Variações Percentuais Anuais foram observadas nas regiões: Leste do Sul, Oeste e Leste. A macrorregião Leste do Sul apresentou a maior variação do estado (84,34%; IC₉₅% 50,30; 126,09) e a Triângulo Norte apresentou menor variação percentual anual (19,62; IC₉₅% 6,48; 34,38). Conclusão: a tendência de aumento de internações por sífilis congênita, observada em 12 das 13 macrorregiões de saúde, caracteriza uma tendência ascendente no estado e reforça a necessidade de formulação ou revisão de ações que priorizem a prevenção desse agravo

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London

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

Optimasi Portofolio Resiko Menggunakan Model Markowitz MVO Dikaitkan dengan Keterbatasan Manusia dalam Memprediksi Masa Depan dalam Perspektif Al-Qur`an

Risk portfolio on modern finance has become increasingly technical, requiring the use of sophisticated mathematical tools in both research and practice. Since companies cannot insure themselves completely against risk, as human incompetence in predicting the future precisely that written in Al-Quran surah Luqman verse 34, they have to manage it to yield an optimal portfolio. The objective here is to minimize the variance among all portfolios, or alternatively, to maximize expected return among all portfolios that has at least a certain expected return. Furthermore, this study focuses on optimizing risk portfolio so called Markowitz MVO (Mean-Variance Optimization). Some theoretical frameworks for analysis are arithmetic mean, geometric mean, variance, covariance, linear programming, and quadratic programming. Moreover, finding a minimum variance portfolio produces a convex quadratic programming, that is minimizing the objective function ðð¥with constraintsð ð 𥠥 ðandð´ð¥ = ð. The outcome of this research is the solution of optimal risk portofolio in some investments that could be finished smoothly using MATLAB R2007b software together with its graphic analysis

Juxtaposing BTE and ATE – on the role of the European insurance industry in funding civil litigation

One of the ways in which legal services are financed, and indeed shaped, is through private insurance arrangement. Two contrasting types of legal expenses insurance contracts (LEI) seem to dominate in Europe: before the event (BTE) and after the event (ATE) legal expenses insurance. Notwithstanding institutional differences between different legal systems, BTE and ATE insurance arrangements may be instrumental if government policy is geared towards strengthening a market-oriented system of financing access to justice for individuals and business. At the same time, emphasizing the role of a private industry as a keeper of the gates to justice raises issues of accountability and transparency, not readily reconcilable with demands of competition. Moreover, multiple actors (clients, lawyers, courts, insurers) are involved, causing behavioural dynamics which are not easily predicted or influenced. Against this background, this paper looks into BTE and ATE arrangements by analysing the particularities of BTE and ATE arrangements currently available in some European jurisdictions and by painting a picture of their respective markets and legal contexts. This allows for some reflection on the performance of BTE and ATE providers as both financiers and keepers. Two issues emerge from the analysis that are worthy of some further reflection. Firstly, there is the problematic long-term sustainability of some ATE products. Secondly, the challenges faced by policymakers that would like to nudge consumers into voluntarily taking out BTE LEI

Search for stop and higgsino production using diphoton Higgs boson decays

Results are presented of a search for a "natural" supersymmetry scenario with gauge mediated symmetry breaking. It is assumed that only the supersymmetric partners of the top-quark (stop) and the Higgs boson (higgsino) are accessible. Events are examined in which there are two photons forming a Higgs boson candidate, and at least two b-quark jets. In 19.7 inverse femtobarns of proton-proton collision data at sqrt(s) = 8 TeV, recorded in the CMS experiment, no evidence of a signal is found and lower limits at the 95% confidence level are set, excluding the stop mass below 360 to 410 GeV, depending on the higgsino mass