Falsas democracias, verdadeiras ditaduras?

O artigo é fruto de pesquisa realizada pelo autor sobre o tema da participação popular em sociedades democráticas e, tendo em vista os recentes acontecimentos de protesto nas principais cidades brasileiras, apresenta a contribuição de estudiosos do tema. Como o estudo da temática da democratização no Brasil apresenta-se, de algum modo, datada, com mais intensidade no período de luta pela redemocratização do país, na década de 80 e seguintes, o autor vale-se, em grande parte da produção de pesquisadores da época citada, além de outros estudiosos com produção atual ou que continuaram suas pesquisas atingindo o momento presente

Significados da maternidade: um olhar antropológico sobre a experiência do pós-parto

This study aimed to understand the meanings attributed to motherhood, by women of the middle class of the city of São Paulo, in light of postpartum experience. To this end, interviews in depth with nine women of the described profile, the analysis of thirteen postpartum narratives available on the internet and the ethnography of two online discussion communities were conducted. The postpartum period was defined as a period of transition in which a woman goes to become a mother, and its variable duration is determined by each woman. In light of the postpartum period, the high degree of exchange of information and sharing of experiences among mothers on the internet, labor experience, the practice of breastfeeding, the feeling of loneliness and physical fatigue were shown as outstanding elements of the contemporary experience of motherhood. The meanings attributed to motherhood also pass through the social patterns associated with being a mother.O presente trabalho buscou compreender os sentidos atribuídos à maternidade, por mulheres das camadas médias da cidade de São Paulo, a partir da experiência do pós-parto. Para tal, foram realizadas entrevistas em profundidade com nove mulheres do perfil acima indicado, a análise de treze relatos de pós-parto disponíveis na internet e a etnografia de duas comunidades de discussão online. O pós-parto foi definido, a partir da etnografia empreendida, como um período de transição pelo qual a mulher passa ao se tornar mãe, sendo sua duração variável e determinada por cada mulher. À luz do puerpério, o alto grau de troca de informações e compartilhamento de experiências entre mães na internet, a vivência do parto, a prática da amamentação, a sensação de solidão e o cansaço físico se mostraram como elementos marcantes da experiência contemporânea da maternidade. Os significados atribuídos à maternidade também passam pelos padrões sociais associados ao ser mãe.Dados abertos - Sucupira - Teses e dissertações (2013 a 2016

O Orçamento Público E A Geração De Valor Econômico: Um Estudo De Caso No Departamento De Oftalmologia E Ciências Visuais Da Escola Paulista De Medicina Unifesp

The financial activity carried out by the State is directly responsible for economic, social and cultural maintenance of Brazil. In order to materialize this activity, the legislation established a set of laws and regulations governing the so-called budget cycle, public administration part ordering revenues and expenses through the Federal Constitution of 1988, common and complementary laws as the Multiyear Plan - PPA, Budget Guidelines Law - LDO , Annual Budget Law - LOA and Fiscal Responsibility Law - LRF. It is the duty of the State to raise taxes, manage resources and provide benefits to society. With the constant changes in the behavior of Brazilian citizens who are at the same time funders of public affairs and beneficiaries of public services, society, in order to satisfy their desires, expects from the State an efficient and effective management which adds benefits. It is increasingly present the citizens´ desire for answers, transparency, and result in the correct application of their contributions. Therefore, this research seeks to identify the used public funds to maintain and fund the Department of Ophthalmology and Visual Sciences at the Paulista Medical School (EPM) of the Federal University of São Paulo (UNIFESP), and apply the model Economic Income Statement (DRE) described by Applied Accounting Manual to the Public Sector (2011) - MCASP, and the Slomski Model (1996). The research also seeks to determine which economic value the services provided to society yield when it replaces the private service for the public service. We analyzed revenues, expenses and the number of visits and consultations in the clinics of Cataract, Refractive and outpatient CERESO in the year 2015. The implementation of the economic result of measurement model showed surplus, and justifies the importance of ophthalmic health services offered to users and patients of the Department of Ophthalmology and Visual Sciences of the hospital complex EPM / UNIFESP / Hospital São Paulo / SPDM.A atividade financeira exercida pelo Estado é responsável direta pela manutenção econômica, social e cultural que o Brasil encontra-se, e para materializar esta atividade a legislação institui um conjunto de leis e normas que regulamenta o chamado ciclo orçamentário, peça da administração pública que ordena receitas e despesas por meio da Constituição Federal de 1988, Leis Ordinárias e Complementares como o PPA Plano Plurianual, a LDO Lei de Diretrizes Orçamentárias, a LOA Lei Orçamentária Anual e LRF Lei de Responsabilidade Fiscal. É dever do Estado, arrecadar impostos, administrar os recursos e prover benefícios para a sociedade. Com as constantes mudanças no comportamento do cidadão brasileiro que é ao mesmo tempo financiador da coisa pública e beneficiário dos serviços públicos oferecidos, a sociedade, para satisfazer os seus anseios, espera do Estado uma gestão eficaz, eficiente e que agregue benefícios. É cada vez mais presente o desejo do cidadão por respostas, por transparência, e por resultado na correta aplicação de suas contribuições. Neste sentido, esta pesquisa busca identificar a verba pública empregada na manutenção e custeio do Departamento de Oftalmologia e Ciências Visuais da Escola Paulista de Medicina EPM, da Universidade Federal de São Paulo UNIFESP, e aplicar o modelo de DRE Demonstrativo de Resultado Econômico descrito pelo MCASP Manual de Contabilidade Aplicada ao Setor Público (2011), e pelo modelo Slomski (1996). A pesquisa busca apurar qual o valor econômico que os serviços prestados à sociedade rendem quando esta deixa de usar o serviço privado em função do Serviço Público. Foram analisadas as receitas, as despesas e o número de atendimentos e consultas nos ambulatórios de Catarata, Refração e Cereso no ano de 2015. A aplicação do modelo de mensuração de resultado econômico evidenciou superávit, e justifica a importância dos serviços de saúde oftálmica oferecido aos usuários e pacientes do Departamento de Oftalmologia e Ciências Visuais do complexo hospitalar EPM/UNIFESP/Hospital São Paulo/SPDM.Dados abertos - Sucupira - Teses e dissertações (2017

Food insecurity and associated factors among households in Maputo City

Food insecurity (FI) is a global concern and is one of the main causes of malnutrition in low- and middle-income countries. In Mozambique, the burden of FI and how various factors contribute to FI is not well known. This study aimed to investigate the prevalence of FI and its associated factors in southern Mozambique. Data from 1842 household heads in Maputo City were analyzed in a cross-sectional design. Food insecurity was measured using a modified version of the US Department of Agriculture Household Food Security scale, and its association with socio-demographic factors was assessed through multiple regressions. Altogether, 79% of the households were food insecure; of these, 16.6% had mild FI, 28.1% moderate and 34.4% severe FI. The study revealed that low-income households, those with less educated heads, and those engaged in informal work were significantly more prone to FI. Likewise, dietary diversity and the number of meals were also significant predictors of FI. These findings suggest the need for decent work and job creation, which calls for joint efforts from government, the private sector, and international institutions. Furthermore, these key drivers should be considered in the development of public health policies and programs designed to alleviate household FI and malnutrition in Mozambique

The economic burden of tuberculosis and latent tuberculosis in people living with HIV in Brazil: a cost study from the patient perspective.

OBJECTIVE: The objective of this study was to evaluate the direct and indirect costs of tuberculosis (TB) (active and latent TB [LTB]) and HIV co-infection from the patient perspective. STUDY DESIGN: Costing study conducted alongside a pragmatic clinical trial. METHODS: The study was conducted in Brazil in a referral service for HIV/AIDS. We applied a standardised questionnaire to collect data about out-of-pocket expenses and indirect cost. The questionnaire was applied at every patient's appointment in the referral service after TB or LTB diagnosis. We followed all patients' pathways during the prediagnosis period and treatment period. For patients on sickness benefit due to TB/HIV, income loss was calculated as the difference between an employee's wages forgone and the sickness benefit received. The monetary value of the time loss was calculated based on the Brazilian minimum wage/2015. RESULTS: Among 239 people living with HIV recruited in the first year of the trial, 31 patients were included into the costing study, 26 patients who were diagnosed and treated for TB/HIV and five patients who were diagnosed and treated for LTB/HIV. TB/HIV patients incurred higher total costs than LTB/HIV (US$1,429 vs US$ 166). The main cost component for TB/HIV was indirect costs, especially income loss (US$ 749). CONCLUSIONS: Public health policies may address ways to prevent high patients' costs through the introduction of more accurate algorithms for TB diagnosis to prevent delays in the diagnosis and treatment

Smoking increases the risk of relapse after successful tuberculosis treatment

Background Recent tobacco smoking has been identified as a risk factor for developing tuberculosis, and two studies which have investigated its association with relapse of tuberculosis after completion of treatment had conflicting results (and did not control for confounding). The objective of this study was to investigate risk factors for tuberculosis relapse, with emphasis on smoking

Associacao entre tabagismo e o uso de crack com a descontinuidade da terapia antirretroviral combinada em Recife, Pernambuco, Brasil

Apesar da eficácia da terapêutica antirretroviral combinada para o tratamento de pessoas vivendo com HIV/Aids, a não adesão aos medicamentos tem se tornado uma das maiores ameaças à efetividade dessa terapêutica. O objetivo desse estudo foi estimar a prevalência de uso irregular autorreferido da terapia antirretroviral e os fatores associados com essa irregularidade em pessoas vivendo com HIV. Foi realizado um estudo seccional de pessoas vivendo com HIV/Aids atendidas em dois centros de referência no Recife, Nordeste do Brasil, entre junho 2007 e outubro de 2009. Foram analisados os fatores socioeconômicos, de apoio social e de hábitos do indivíduo, ajustados através de análise de regressão logística multivariada. A prevalência de pessoas vivendo com HIV/Aids que relataram o uso irregular da terapia antirretroviral combinada (TARC) foi de 25,7%. No modelo multivariado final, o uso irregular da TARC esteve associado às seguintes variáveis: ter menos de 40 anos (OR = 1,66, IC95%: 1,29-2,13), fumantes (OR = 1,76, IC95%: 1,31-2,37) ou ex-fumantes (OR = 1,43, IC95%: 1,05-1,95) e ser usuário de crack (OR = 2,79, IC95%: 1,24-6,32). Medidas especiais devem ser direcionadas para cada um dos seguintes grupos: adultos com menos de 40 anos, fumantes, ex-fumantes e usuários de crack. Ações voltadas para a cessação do tabagismo e do crack devem ser incorporadas ao programa de controle dos infectados pelo HIV, visando promover a maior adesão aos antirretrovirais e, consequentemente, aumentar a expectativa e a qualidade de vida.Despite the effectiveness of combination antiretroviral therapy in the treatment of people living with HIV/AIDS (PLWHA), nonadherence to medication has become a major threat to its effectiveness. This study aimed to estimate the prevalence of self-reported irregular use of antiretroviral therapy and the factors associated with such an irregularity in PLWHA. A cross-sectional study of PLWHA who attended two referral centers in the city of Recife, in Northeastern Brazil, between June 2007 and October 2009 was carried out. The study analyzed socioeconomic factors, social service support and personal habits associated with nonadherence to antiretroviral therapy, adjusted by multivariable logistic regression analysis. The prevalence of PLWHA who reported irregular use of combination antiretroviral therapy (cART) was 25.7%. In the final multivariate model, the irregular use of cART was associated with the following variables: being aged less than 40 years (OR = 1.66, 95%-CI: 1.29-2.13), current smokers (OR = 1.76, 95%-CI: 1.31-2.37) or former smokers (OR = 1.43, 95%-CI: 1.05-1.95), and crack cocaine users (OR = 2.79, 95%-CI: 1.24-6.32). Special measures should be directed towards each of the following groups: individuals aged less than 40 years, smokers, former smokers and crack cocaine users. Measures for giving up smoking and crack cocaine should be incorporated into HIV-control programs in order to promote greater adherence to antiretroviral drugs and thus improve the quality of life and prolong life expectancy

Association between Schistosomiasis mansoni and hepatitis C: systematic review

OBJETIVO: Realizar revisão sistemática sobre a prevalência da confecção do vírus da hepatite C e Schistosoma mansoni e os fatores de risco associados a indivíduos com esquistossomose. MÉTODOS: Revisão realizada nas bases de dados Medline, Lilacs, SciELO, Biblioteca Cochrane e Ibecs. Os critérios de seleção e a obtenção dos dados foram baseados em métodos de revisão sistemática. Foram encontradas 45 referências relevantes, das quais nove foram excluídas na primeira triagem, 14 na leitura dos resumos e nove na leitura completa. Treze artigos foram selecionados para análise. RESULTADOS: A prevalência da associação entre vírus da hepatite C e Schistosoma mansoni variou de 1% na Etiópia a 50% no Egito. Alguns estudos apresentam metodologias pouco definidas, mesmo em áreas caracterizadas pela associação entre vírus da hepatite C e S. mansoni , como Brasil e Egito, o que não permitiu conclusões consistentes. As taxas de infecção pelo VHC em populações esquistossomáticas foram heterogêneas e os fatores de risco para adquirir o vírus foram variáveis. CONCLUSÕES: Apesar das limitações, esta análise pode ajudar a identificar regiões com maiores taxas dessa associação. Outros estudos serão necessários para o desenvolvimento de políticas públicas de prevenção e controle dessas doenças.OBJETIVO: Realizar revisión sistemática sobre la prevalencia de la co-infección del virus de la hepatitis C y Schistosoma mansoni y los factores de riesgo asociados a individuos con esquistosomosis. MÉTODOS: Revisión realizada en las bases de datos MEDLINE, LILACS, SciELO, Biblioteca Cochrane e IBECS. Los criterios de selección y la obtención de los datos fueron basados en métodos de revisión sistemática. RESULTADOS: Fueron encontradas 45 referencias relevantes, de las cuales, nueve fueron excluidas en la primera selección, 14 en la lectura de los resúmenes y nueve en la lectura completa. Trece artículos fueron seleccionados para análisis. La prevalencia de la asociación entre virus de la hepatitis C y Schistosoma mansoni varió de 1% en Etiopia, a 50% en Egipto. Algunos estudios presentan metodologías poco definidas, inclusive en áreas caracterizadas por la asociación entre el virus de la hepatitis C y S. mansoni, como Brasil y Egipto, lo que no permitió conclusiones consistentes. Los cocientes de infección por el VHC en poblaciones esquistosómicas fueron heterogéneos y los factores de riesgo para adquirir el virus fueron variables. CONCLUSIONES: A pesar de las limitaciones, este análisis pudo ayudar a identificar regiones con mayores cocientes de esa asociación. Otros estudios serán necesarios para el desarrollo de políticas públicas de prevención y control de estas enfermedades.OBJECTIVE: To perform a systematic review of the prevalence of the HCV/ S. mansoni co-infection and associated factors in Schistosoma mansoni -infected populations. METHODS: The bibliographic search was carried out using the Medline, Lilacs, SciELO, Cochrane Library and Ibecs databases. The criteria for the studies' selection and the extraction data were based on systematic review methods. Forty five studies were found, with nine being excluded in a first screening. Thirteen articles were used for data extraction. RESULTS: The HCV infection rates in schistosomiasis populations range from 1% in Ethiopia to 50% in Egypt. Several studies had poorly defined methodologies, even in areas characterized by an association between hepatitis C and schistosomiasis, such as Brazil and Egypt, which meant conclusions were inconsistent. HCV infection rates in schistosomotic populations were heterogeneous and risk factors for acquiring the virus varied widely. CONCLUSIONS: Despite the limitations, this review may help to identify regions with higher rates of hepatitis C and schistosomiasis association. However, more studies are necessary for the development of public health policies on prevention and control of both diseases

Economic burden of HIV and TB/HIV coinfection in a middle-income country: a costing analysis alongside a pragmatic clinical trial in Brazil.

OBJECTIVE: The objective of this study was to measure the costs of people living with HIV (PLHIV) as well as active tuberculosis (TB/HIV), latent tuberculosis infection (LTBI/HIV) or without TB (HIV/AIDS). METHODS: We analysed the costs through the entire pathway of care during the prediagnosis and treatment periods from the Brazilian public health system perspective. We applied a combination of bottom-up and top-down approaches to capture and estimate direct medical and non-medical costs. We measured the mean cost per patient per type of care (inpatient, outpatient and emergency care) and disease category (HIV/AIDS, HIV/AIDS death, TB/HIV, TB/HIV death and LTBI/HIV). RESULTS: Between March 2014 and March 2016 we recruited 239 PLHIV. During the follow-up 26 patients were diagnosed and treated for TB and 5 received chemoprophylaxis for LTBI. During the prediagnosis and treatment period, the mean total costs for HIV or AIDS and AIDS death categories were US$1558 and US$2828, respectively. The mean total costs for TB/HIV and TB/HIV death categories were US$5289.0 and US$8281, respectively. The mean total cost for the LTBI/HIV category was US$882. CONCLUSIONS: Patients with TB/HIV impose a higher economic burden on the health system than HIV/AIDS and LTBI/HIV. Patients with LTBI/HIV were the lowest cost group among all disease categories, indicating that preventive TB treatment can avoid the further costs treating active TB. TRIAL REGISTRATION NUMBER: RBR-22t943, Results

Effectiveness of screening for tuberculosis in HIV : a pragmatic clinical trial

OBJECTIVE: To verify the effectiveness of screening for tuberculosis (TB) on all-cause mortality and tuberculosis cases in newly diagnosed HIV-infected patients through a clinical algorithm based on recommendations of the World Health Organization. METHODS: From March 2014 to April 2016, a pragmatic randomized clinical trial was conducted with newly diagnosed and TB-free HIV-infected adults undergoing antiretroviral therapy for up to one month at a major tertiary hospital for HIV in the state of Pernambuco, Brazil. Participants were randomized into intervention and control groups using an automatically-generated random list, and followed-up for at least 6 months. The intervention group was screened for TB at hospital admission and at every follow-up visit through a series of questions addressing TB-related symptoms (cough, fever, night sweating, and weight loss). Patients presenting with any of these symptoms were referred to a pulmonologist and underwent sputum smear microscopy, sputum culture, and rapid molecular testing (GeneXpert). When at least one test result came back positive, TB treatment was initiated. In turn, if patients tested negative but presented with severe clinal symptoms, TB preventive treatment was initiated. Screening for TB was not performed systematically in the control group. The primary outcome assessed in this study was death from all causes, and secondary outcomes included sensitivity and specificity of this screening test, as well as its detection time. RESULTS: This study evaluated 581 patients, 377 in the intervention group (64.9%) and 204 in the control group (35.1%). In total, 36 patients died during the follow-up period. Of these, 26 (6.9%) were from the intervention group, reaching a cumulative mortality coefficient of 69 per 1,000 inhabitants, and 10 (4.9%) from the control group (p = 0.341), with a cumulative mortality coefficient of 49 per 1,000 inhabitants (p = 0.341)