Os serviços públicos urbanos e a regulação: novo enfoque em políticas públicas

In the last decades Brazil has been through some deep changes, which affected both economic and political structures, the latter including the responsibilities of the public sector. The discussion of new models should not restricted to the mere management of urban public services, but must also include the need to come up with new ways of managing urban policies in general. Other participants in this process should also be given responsibilities and new technical solutions should be found, particularly involving existing institutions. Within this new scenario, areas dealing with infrastructure should be subject to criteria of efficiency and productivity, brought by new regulations that deal with key issues, such as (1) the management of public service rendering; (2) the safeguarding of the public interest; and (3) the role public services play in promoting urban development. s serviços públicos urbanos e a regulação: novo enfoque em políticas públicas o Jacqueline Low-Beer Orientadora: Profa. Dra. Sueli Ramos SchifferNas últimas décadas, o Brasil vem assistindo a profundas mudanças, tanto no que se refere à gestão econômica como no perfil da atuação do Estado e as responsabilidades do setor público. A discussão de novos modelos não se limita às formas de gestão dos serviços públicos urbanos, mas inclui a necessidade de “inventar” novas maneiras de gerir o urbano de modo geral, estendendo as responsabilidades a outros atores e recorrendo a novas soluções técnicas, sobretudo institucionais. Neste novo quadro, a criação de condições propícias a um ambiente de eficiência e produtividade nos setores de infra-estrutura repousa sobre o estabelecimento de um novo marco regulatório que trate de questões essenciais como: (1) a gestão da prestação dos serviços; (2) a defesa do interesse público; e (3) o papel indutor da regulação dos serviços públicos no desenvolvimento urbano

O ESTADO E AS POLÍTICAS PÚBLICAS: UMA REVISÃO HISTÓRICA (1950 a 1997)

During the last decades, Brazil has been through some great changes referring to economic and political structures, enclosing the role of the State and it’s responsibilities upon the public sector. This article presents a brief review of the economic and infrastructural policies and de main directives referring to urban development. Completing this panel, is the inclusion of the social policies and the recent environmental and sanitation policies that occurred from the 80’s on, when the establishing of development policies encompassed new issues like: sanitation, health and environment.O Brasil vem assistindo a profundas mudanças tanto na gestão econômica como na atuação do Estado e responsabilidades do setor público. O artigo apresenta uma revisão das políticas econômica, de infraestrutura e das diretrizes de desenvolvimento urbano bem como um rápido painel da inserção das políticas sociais. Completando a revisão, são apresentadas as políticas ambientais e a vertente sanitarista que, a partir dos anos 80 contribuíram para operar uma mudança substantiva nas políticas públicas observada na virada do milênio

Scaling Up Towards International Targets for AIDS, Tuberculosis, and Malaria: Contribution of Global Fund-Supported Programs in 2011–2015

OBJECTIVE: The paper projects the contribution to 2011-2015 international targets of three major pandemics by programs in 140 countries funded by the Global Fund to Fight AIDS, Tuberculosis and Malaria, the largest external financier of tuberculosis and malaria programs and a major external funder of HIV programs in low and middle income countries. DESIGN: Estimates, using past trends, for the period 2011-2015 of the number of persons receiving antiretroviral (ARV) treatment, tuberculosis case detection using the internationally approved DOTS strategy, and insecticide-treated nets (ITNs) to be delivered by programs in low and middle income countries supported by the Global Fund compared to international targets established by UNAIDS, Stop TB Partnership, Roll Back Malaria Partnership and the World Health Organisation. RESULTS: Global Fund-supported programs are projected to provide ARV treatment to 5.5-5.8 million people, providing 30%-31% of the 2015 international target. Investments in tuberculosis and malaria control will enable reaching in 2015 60%-63% of the international target for tuberculosis case detection and 30%-35% of the ITN distribution target in sub-Saharan Africa. CONCLUSION: Global Fund investments will substantially contribute to the achievement by 2015 of international targets for HIV, TB and malaria. However, additional large scale international and domestic financing is needed if these targets are to be reached by 2015

Taking the Pressure Off the Patient - Understanding Digital Rectal Examinations on a Real Subject.

Better understanding of palpation techniques during unsighted physical examinations has mostly been limited to qualitative and quantitative studies of performance of experts whilst conducting examinations on plastic benchtop models. However, little is known about their performance when conducting such examinations on real subjects. OBJECTIVE: The aim of this paper is to better understand palpation techniques of experts whilst conducting a Digital Rectal Examination on a real subject. METHODS: We recruited four consultants from relevant specialties and asked them to conduct two DREs on a Rectal Teaching Assistant whilst wearing small position and pressure sensors on their examining finger. We segmented the relevant anatomy from an MRI taken of the pelvic region, registered 3D models and analysed retrospectively performance in relation to executed tasks, supination/pronation, palpation convex hull and pressure applied. RESULTS: Primary care consultants examined the anatomy more holistically compared to secondary care experts, the maximum pressure applied across experiments is 3.3N, overall the pressure applied on the prostate is higher than that applied to rectal walls, and the urologist participant not only applied the highest pressure but also did so with the highest most prominent frequency (15.4 and 25.3 Hz). CONCLUSIONS: The results of our research allow for better understanding of experts' technical performance from relevant specialities when conducting a DRE, and suggest the range of pressure applied whilst palpating anatomy. SIGNIFICANCE: This research will be valuable in improving the design of haptics-based learning tools, as well as in encouraging reflection on palpation styles across different specialities to develop metrics of performance

Requirements for global elimination of hepatitis B: a modelling study

Background Despite the existence of effective prevention and treatment interventions, hepatitis B virus (HBV) infection continues to cause nearly 1 million deaths each year. WHO aspires to global control and elimination of HBV infection. We aimed to evaluate the potential impact of public health interventions against HBV, propose targets for reducing incidence and mortality, and identify the key developments required to achieve them. Methods We developed a simulation model of the global HBV epidemic, incorporating data on the natural history of HBV, prevalence, mortality, vaccine coverage, treatment dynamics, and demographics. We estimate the impact of current interventions and scaling up of existing interventions for prevention of infection and introducing wide-scale population screening and treatment interventions on the worldwide epidemic. Findings Vaccination of infants and neonates is already driving a large decrease in new infections; vaccination has already prevented 210 million new chronic infections by 2015 and will have averted 1·1 million deaths by 2030. However, without scale-up of existing interventions, our model showed that there will be a cumulative 63 million new cases of chronic infection and 17 million HBV-related deaths between 2015 and 2030 because of ongoing transmission in some regions and poor access to treatment for people already infected. A target of a 90% reduction in new chronic infections and 65% reduction in mortality could be achieved by scaling up the coverage of infant vaccination (to 90% of infants), birth-dose vaccination (to 80% of neonates), use of peripartum antivirals (to 80% of hepatitis B e antigen-positive mothers), and population-wide testing and treatment (to 80% of eligible people). These interventions would avert 7·3 million deaths between 2015 and 2030, including 1·5 million cases of cancer deaths. An elimination threshold for incidence of new chronic infections would be reached by 2090 worldwide. The annual cost would peak at US$7·5 billion worldwide ($3·4 billion in low-income and lower-middle-income countries), but decrease rapidly and this would be accelerated if a cure is developed. Interpretation Scale-up of vaccination coverage, innovations in scalable options for prevention of mother-to-child transmission, and ambitious population-wide testing and treatment are needed to eliminate HBV as a major public health threat. Achievement of these targets could make a major contribution to one of the Sustainable Development Goals of combating hepatitis