A nova gestão pública, as reformas no sector da saúde e os profissionais de enfermagem com funções de gestão em Portugal

Doutoramento em Ciências SociaisNas últimas décadas têm surgido profundas reestruturações nos diversos sectores públicos dos países desenvolvidos. Estas reestruturações, que assumem um carácter muito semelhante, decorrem, em grande parte, das alterações nas concepções tradicionalmente dominantes acerca do papel do Estado, das formas de organização e gestão que caracterizam as suas instituições e, ainda, dos profissionais e do seu trabalho. As políticas e as medidas concretas propostas neste âmbito direccionam-se, em termos gerais, no sentido do aumento da competição, da preferência por mecanismos de mercado, do primado da orientação do serviço para o consumidor e ainda da apologia do espírito empreendedor. Tais tendências são facilmente constatáveis em diversos sectores, com especial destaque para a saúde, configurando a presença de um movimento conhecido na literatura como a Nova Gestão Pública (NGP) ou managerialismo. Também em Portugal, as alterações verificadas nas políticas públicas de saúde, nos últimos anos, podem ser enquadradas dentro deste movimento. As propostas de mudança ao nível da organização e gestão das instituições públicas, em particular das instituições hospitalares, assumem como um dos seus principais objectivos mudar as tradicionais formas de regulação e autonomia dos profissionais que aí exercem a sua actividade. O que se pretende indagar com este trabalho de investigação é a forma como estas mudanças produzem impactos ao nível da profissionalização e das práticas de enfermagem no campo da gestão dos cuidados. Para tal, foram eleitos, como objecto de análise, os enfermeiros que exercem funções de gestão nas instituições hospitalares portuguesas. O trabalho empírico baseouse em estratégias qualitativas de recolha de informação, tendo sido realizadas oitenta e três entrevistas semi-estruturadas a enfermeiros com funções de gestão vinculados a cinco hospitais pertencentes ao sector público tradicional e a cinco hospitais empresarializados. O tratamento da informação recolhida foi efectuado com base na análise de conteúdo de tipo temático-categorial cujos resultados permitem extrair as seguintes principais conclusões: 1. A introdução da Nova Gestão Pública promoveu o surgimento de formas híbridas na organização e gestão dos hospitais que configuram um afastamento, mais ou menos pronunciado, da burocracia profissional que, tradicionalmente, caracterizava as organizações públicas; 2. Estas alterações parecem traduzir-se numa diminuição do poder e autonomia dos enfermeiros com funções de gestão, decorrente essencialmente das alterações na organização do trabalho; 3. Não se verificam, no entanto, processos de desprofissionalização ou proletarização destes profissionais. 4. A forma como a ideologia managerialista permeou os valores e ideologias profissionais não permite a sua categorização como ideologia dominante nos enfermeiros entrevistados. 5. Foi possível detectar um conjunto de estratégias, definidas por estes actores, ao nível microorganizacional, tendentes a assegurar a manutenção do poder e estatuto da profissão.Over the last years some structural reforms occurred in the public sectors in developed countries. These reforms, which have present some common features, emerged from changes in the prevailing ideas about the role of the state in society, the way public institutions are organized and managed and also about the professionals and their work. Different states proposed the same kind of politics generally aiming to increase competition, favour market mechanisms, introduce costumer philosophy and also improve the entrepreneurial spirit. These politics were particularly visible in the health sector and configure a tendency known in the literature as New Public Management (NPM) or Managerialism. In Portugal, the political restructure in health conform also with this movement. Changes at the organizational level, especially in the organization and management of hospitals, assume as main objective to alter the traditional way professionals are regulated and their autonomy. This work aims to examine if changes in the organization and management of hospitals have some kind of influence in the professionalization process of nurses with managerial functions in Portugal. To accomplish this objective the empirical work was based in qualitative analysis. Eighty-three interviews were made with nurses who had managerial duties in five hospitals from the traditional public sector and other five from the corporate sector. From data analysis we can withdraw the following conclusions: 1. The NPM intromission in hospitals promotes the emergence of hybrid models management and organisation, which are found to be gradually moving away from the traditionally bureaucratic public model to the private model of organisation. 2. These organisational changes result in loss of professional autonomy and power of nurses with managerial duties due to changes in the organisation of work. 3. It is not possible, though, to talk about a proletarianization or deprofessionalization process. 4. The way managerial ideology has penetrated professional values and ideologies does not allow its categorization as dominant among interviewees. 5. It is possible to identify different kinds of strategies developed by the actors at the micro organisational level in order to assure the maintenance of their power and prestige inside hospitals.PRODEP II

FORMAÇÃO DE PROFESSORES DE ENSINO SUPERIOR PARA A GESTÃO: PERSPECTIVAS E CONSEQUÊNCIAS

O trabalho buscou analisar como professores de uma universidade federal brasileira percebem o papel que as políticas públicas e organizacionais têm na formação dos academic-managers. Argumenta-se que diante dos papeis-chave que os professores-gestores desempenham nas instituições de ensino superior, entende-se que há necessidade de políticas públicas (PP) e políticas organizacionais (PO) voltadas a formação desses atores. A investigação, baseada num estudo de caso, adotou uma perspectiva qualitativa e os dados foram coletados a partir de entrevistas semiestruturadas realizadas com professores-gestores do nível estratégico da Universidade Federal do Vale do São Francisco (Univasf). Em resposta ao objetivo geral desta pesquisa, os dados mostraram que os professores nesta universidade percebem uma lacuna de PPs e POs que os prepare para desempenhar o papel de gestor e apontam a temporalidade do papel de gestor, a priorização dos papéis de professor e de pesquisador sobre o de gestor, como possíveis entraves ao desenvolvimento de tais políticas.

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

Post-intervention Status in Patients With Refractory Myasthenia Gravis Treated With Eculizumab During REGAIN and Its Open-Label Extension

OBJECTIVE: To evaluate whether eculizumab helps patients with anti-acetylcholine receptor-positive (AChR+) refractory generalized myasthenia gravis (gMG) achieve the Myasthenia Gravis Foundation of America (MGFA) post-intervention status of minimal manifestations (MM), we assessed patients' status throughout REGAIN (Safety and Efficacy of Eculizumab in AChR+ Refractory Generalized Myasthenia Gravis) and its open-label extension. METHODS: Patients who completed the REGAIN randomized controlled trial and continued into the open-label extension were included in this tertiary endpoint analysis. Patients were assessed for the MGFA post-intervention status of improved, unchanged, worse, MM, and pharmacologic remission at defined time points during REGAIN and through week 130 of the open-label study. RESULTS: A total of 117 patients completed REGAIN and continued into the open-label study (eculizumab/eculizumab: 56; placebo/eculizumab: 61). At week 26 of REGAIN, more eculizumab-treated patients than placebo-treated patients achieved a status of improved (60.7% vs 41.7%) or MM (25.0% vs 13.3%; common OR: 2.3; 95% CI: 1.1-4.5). After 130 weeks of eculizumab treatment, 88.0% of patients achieved improved status and 57.3% of patients achieved MM status. The safety profile of eculizumab was consistent with its known profile and no new safety signals were detected. CONCLUSION: Eculizumab led to rapid and sustained achievement of MM in patients with AChR+ refractory gMG. These findings support the use of eculizumab in this previously difficult-to-treat patient population. CLINICALTRIALSGOV IDENTIFIER: REGAIN, NCT01997229; REGAIN open-label extension, NCT02301624. CLASSIFICATION OF EVIDENCE: This study provides Class II evidence that, after 26 weeks of eculizumab treatment, 25.0% of adults with AChR+ refractory gMG achieved MM, compared with 13.3% who received placebo

Minimal Symptom Expression' in Patients With Acetylcholine Receptor Antibody-Positive Refractory Generalized Myasthenia Gravis Treated With Eculizumab

The efficacy and tolerability of eculizumab were assessed in REGAIN, a 26-week, phase 3, randomized, double-blind, placebo-controlled study in anti-acetylcholine receptor antibody-positive (AChR+) refractory generalized myasthenia gravis (gMG), and its open-label extension

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 understanding 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,5,6,7 vast areas of the tropics remain understudied.8,9,10,11 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 underrepresented in biodiversity databases.13,14,15 To worsen this situation, human-induced modifications16,17 may eliminate pieces of the Amazon's biodiversity puzzle before we can use them to understand how ecological communities 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 organism 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 neglected 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 lost

A Portuguese tale on knowledge-based society: narrowing bonds between higher education and the innovation system

Within the knowledge society framework, higher education has become a driving factor for democratizing and rising equality in societies and consequently stimulating economic development (Panitsidou et al., Procedia Soc & Behav Sci, 46: 548–553, 2012). In Portugal, as elsewhere, higher education institutions (HEI) were expected to play a key role within the changing dynamics in the orientation of knowledge production and dissemination. Research and the national scientific system are closely connected to the higher education system, with knowledge production being mostly concentrated in universities, especially in public ones. In this context, HEIs are considered as a privileged locus of change framed by the knowledge society providing the new epistemological, ontological, and methodological logics as well as legitimacy for a new “political economy” of knowledge. However, this chapter has a double purpose. On the one hand, it intends to present an overview of the Portuguese higher education system and its relation to the research and innovation system. On the other hand, the paper seeks to analyze the contemporary conceptions of the “knowledge-based society” in the Portuguese state policies and HEI narratives, as well as the expected role assigned to academics in the new knowledge production, dissemination, and transfer systems.This work was financially supported by the project POCI-01-0145-FEDER- 029427- funded by FEDER, through COMPETE2020 - Programa Operacional Competitividade e Internacionalização (POCI), and by national funds (OE), through FCT/MCTES.publishe

FORMAÇÃO DE PROFESSORES DE ENSINO SUPERIOR PARA A GESTÃO: PERSPECTIVAS E CONSEQUÊNCIAS

O trabalho buscou analisar como professores de uma universidade federal brasileira percebem o papel que as políticas públicas e organizacionais têm na formação dos academic-managers. Argumenta-se que diante dos papeis-chave que os professores-gestores desempenham nas instituições de ensino superior, entende-se que há necessidade de políticas públicas (PP) e políticas organizacionais (PO) voltadas a formação desses atores. A investigação, baseada num estudo de caso, adotou uma perspectiva qualitativa e os dados foram coletados a partir de entrevistas semiestruturadas realizadas com professores-gestores do nível estratégico da Universidade Federal do Vale do São Francisco (Univasf). Em resposta ao objetivo geral desta pesquisa, os dados mostraram que os professores nesta universidade percebem uma lacuna de PPs e POs que os prepare para desempenhar o papel de gestor e apontam a temporalidade do papel de gestor, a priorização dos papéis de professor e de pesquisador sobre o de gestor, como possíveis entraves ao desenvolvimento de tais políticas