Management models and Brazil's National Health System (SUS)

O recente documento do Ministério do Planejamento sobre Fundações Públicas (2005) e a crise da área hospitalar colocaram novamente na agenda do SUS a questão dos modelos de gestão pública. O objetivo deste artigo é situar no contexto das reformas de estado pensadas na década de 90 para o Brasil, as propostas de mudança dos modelos de gestão da administração pública, com foco no processo de implementação do SUS. Essa abordagem trata em primeiro lugar da personalidade jurídica das organizações de saúde na esfera estatal, conceituando o público a partir de seus objetivos; em segundo, discute o contexto as reformas de estado e as mudanças propostas para a administração pública. Os autores entendem que critérios e parâmetros para avaliação institucional devem contemplar quatro aspectos: subordinação à política de saúde; legalidade; eficiência gerencial e capacidade de controle. A partir do quadro de referencia geral elaborou-se uma análise comparativa em relação à proposta das fundações públicas de direito privado. Na análise comparativa das características desse tipo de entidade proposta para gestão hospitalar, observam-se semelhanças com a proposta de Organizações Sociais. Fundação Estatal e Contrato de Gestão podem ser vistos como modelos que possibilitam modernizar o Estado, além de re-introduzirem o tema da reforma hospitalar na agenda governamental brasileiraThe recent document on Public Foundations issued by the Ministry of Planning (2005) and the crisis in the hospital area bring the issue of public management models back to the agenda of Brazil's National Health System (SUS). This paper brings up changes in civil service management models within the context of the State restructuring processes of the 1990s in Brazil, particularly in the National Health System (SUS). The approach examines, initially, the legal status of healthcare entities at the State level, establishing their publics by their objectives; second, it discusses the context of State reforms and the changes proposed. The authors feel that the criteria and parameters used for institutional assessments must encompass four aspects: subordination to healthcare policy; status under the law; managerial efficiency and control capacity. Based on an overview of the various options, a more detailed comparative analysis is carried out of the proposal for public foundations established under private law. The comparative analysis of public foundations proposed for hospital management also examines other entities sharing common characteristics, such as Social Organizations. Moreover, the State Foundation and Management Contract may be viewed models paving the way to the modernization of the State, reintroducing the issue of hospital reform to Government agend

A historical overview of regional health planning and primary care services in the state of São Paulo

Com notável vigor, nos últimos anos, o debate da saúde pública brasileira tem sedimentado a ideia de que a organização regional da atenção primária à saúde é um passo inicial obrigatório para a consecução dos princípios da universalidade, equidade e integralidade do Sistema Único de Saúde (SUS). Ideário que contrapõe em definitivo o peso histórico mobilizado pela descentralização como essência do processo de organização dos serviços nos estados, mas explicita a insuficiência do modelo burocrático de gestão e dos papéis clássicos das instâncias governamentais, com reflexo particular na aptidão gerencial das Secretarias de Estado da Saúde. Sendo assim, este artigo busca contribuir com uma visão histórica geral da trajetória, as concepções, as mudanças gerenciais e o papel da instância estadual na conformação da organização regional e dos serviços básicos de saúde no estado de São Paulo. Sob o referencial da história do discurso e balizado pela introdução do modelo dos centros de saúde distritais nos anos 1920 como origem mais remota do discurso contemporâneo da atenção básica, o texto se estrutura sobre a identificação de quatro fases dinâmicas, marcadas por reformas que alteram de modo incisivo a questão regional e dos serviços básicos no estado.In recent years, public health debate in Brazil has settled the idea that regional planning of primary health care is an obligatory initial step towards the achievement of the principles of universality, equity and integrality of the Sistema Único de Saúde (SUS - National Health System). That view opposes the historical weight of decentralization as the essence of service organization in the States, but also marks the failure of the bureaucratic model of administration and of the classic roles of governmental levels, with particular consequences to the capability of the State Health Departments. Thus, this paper seeks to contribute with an overview of the ideas, management changes and the role of the State level in the conformation of the regional and primary care services organization in the state of São Paulo. Within the framework of discourse history, the text is structured on the identification of four dynamic periods, marked by health reforms that alter the regional issue and the question of primary care services organization in the State of São Paulo. The model of district health centers, introduced in the 1920s, is seen as the most remote origin of the contemporary discourse of primary health care

Navigating job satisfaction in family firms during crisis

Occupational health is one of the aspects significantly affected during crisis periods. It is essential to learn about the factors that improve organizational capacity in coping with such shocks. This study investigates how the working environment of a family business influences job satisfaction during crises. Conducting a survey with 516 employees at the peak of the pandemic, the research utilizes structural equation analysis, revealing that family business environments can mitigate burnout, enhance affective commitment, and consequently, boost job satisfaction. The study highlights the need to manage burnout and utilize resources, such as employee commitment, for family firms to sustain job satisfaction amidst disruptions. It deepens the comprehension of family businesses’ crisis response, emphasizing the significance of human resource commitment and management. The investigation illuminates the dynamic interplay between the work environment, employee well-being, and organizational resilience, providing valuable insights for both theoretical understanding and practical application

Um olhar histórico sobre a questão regional e os serviços básicos de saúde no Estado de São Paulo

Com notável vigor, nos últimos anos, o debate da saúde pública brasileira tem sedimentado a ideia de que a organização regional da atenção primária à saúde é um passo inicial obrigatório para a consecução dos princípios da universalidade, equidade e integralidade do Sistema Único de Saúde (SUS). Ideário que contrapõe em definitivo o peso histórico mobilizado pela descentralização como essência do processo de organização dos serviços nos estados, mas explicita a insuficiência do modelo burocrático de gestão e dos papéis clássicos das instâncias governamentais, com reflexo particular na aptidão gerencial das Secretarias de Estado da Saúde. Sendo assim, este artigo busca contribuir com uma visão histórica geral da trajetória, as concepções, as mudanças gerenciais e o papel da instância estadual na conformação da organização regional e dos serviços básicos de saúde no estado de São Paulo. Sob o referencial da história do discurso e balizado pela introdução do modelo dos centros de saúde distritais nos anos 1920 como origem mais remota do discurso contemporâneo da atenção básica, o texto se estrutura sobre a identificação de quatro fases dinâmicas, marcadas por reformas que alteram de modo incisivo a questão regional e dos serviços básicos no estado.In recent years, public health debate in Brazil has settled the idea that regional planning of primary health care is an obligatory initial step towards the achievement of the principles of universality, equity and integrality of the Sistema Único de Saúde (SUS - National Health System). That view opposes the historical weight of decentralization as the essence of service organization in the States, but also marks the failure of the bureaucratic model of administration and of the classic roles of governmental levels, with particular consequences to the capability of the State Health Departments. Thus, this paper seeks to contribute with an overview of the ideas, management changes and the role of the State level in the conformation of the regional and primary care services organization in the state of São Paulo. Within the framework of discourse history, the text is structured on the identification of four dynamic periods, marked by health reforms that alter the regional issue and the question of primary care services organization in the State of São Paulo. The model of district health centers, introduced in the 1920s, is seen as the most remote origin of the contemporary discourse of primary health care

Consumption of food supplements: is there a risk of muscle dysmorphia? [version 1; peer review: awaiting peer review]

Background. Bigorexia is an eating disorder and obsessive-compulsive disorder where the subject has an incorrect perception of their body image with exercise addiction. This study aims to determine whether there is a relationship between body mass index (BMI), food supplement consumption, dietary adherence, gender and risk of muscle dysmorphia in the individual and to provide information to build recommendation systems to monitor the health and mental state of the population. Methods. A cross-sectional descriptive observational study was conducted in Barranquilla (Colombia) between February – May 2020. A face-to-face survey of 200 individuals of both sexes was used in which users evaluated different variables that helped to identify their risk of muscle dysmorphia. Results. Of the 200 participants, 105 men: N=48, 45.7% vs. women: N=57, 54.3%) consume nutritional supplements. There is no relationship in the total population with the risk of muscle dysmorphia with the consumption of nutritional supplements nor with the feeling of guilt for non-adherence to the diet, nor with age, gender, or BMI (p<0.05). In contrast, gender, age and BMI are related to nutritional supplement consumption, and gender is related to feelings of guilt for non-adherence to the diet. In the population that consumes nutritional supplements the risk of muscle dysmorphia is increased and the frequency varies by risk group: low risk: N=16, 15.2%; medium risk: N=46, 43.8%; high risk: N=28, 26.7%; and very high risk: N=15, 14.3%. The consumption of food supplements is higher in the female gender (57, 54.3% vs. 48, 45.7%), and moderate the feeling of guilt for not completing the diet, BMI and the risk of muscle dysmorphia. Conclusions. Women consume more food supplements, but gender does not determine the risk of muscle dysmorphia. Food supplement consumption influences the feeling of guilt for not completing the diet, BMI and the risk of muscle dysmorphia

Exotic leptoquarks from superstring derived models

The H1 and ZEUS collaborations have recently reported a significant excess of events at high $Q^2$ in positron-proton collisions. While there exists insufficient data to conclusively determine the origin of this excess, one possibility is that it is due to a new leptoquark at mass scale around 200 GeV. We examine the type of leptoquark states that exist in superstring derived standard-like models, and show that, while these models may contain the standard leptoquark states which exist in Grand Unified Theories, they also generically contain new and exotic leptoquark states with fractional lepton number, $\pm1/2$. In contrast to the traditional GUT-type leptoquark states, the couplings of the exotic leptoquarks to the Standard Model states are generated after the breaking of $U(1)_{B-L}$. This important feature of the exotic leptoquark states may result in local discrete symmetries which forbid some of the undesired leptoquark couplings. We examine these couplings in several models and study the phenomenological implications. The flavor symmetries of the superstring models are found to naturally suppress leptoquark flavor changing processes.Comment: 28 pages. Standard Latex. Final version to appear in Nuclear Physics B. Minor changes. References adde

Proton Decay, Neutrino Oscillations And Other Consequences From Supersymmetric SU(6) With Pseudo-Goldstone Higgs

We suggest a new mechanism for naturally suppressing dimension five baryon number violating in supersymmetric SU(5+N) (N=0, 1,...) GUTs. The mechanism is realized through suppression of qqT type couplings, and is implemented by introducing new `matter' multiplets belonging to symmetric representations of SU(5+N). Together with the suppression of nucleon decay, these multiplets also enable one to avoid the unwanted asymptotic mass relations $m_s=m_{\mu}$, $\frac{m_d}{m_s}=\frac{m_e}{m_{\mu}}$. As an example, we consider a SU(6) model with pseudo-Goldstone Higgs. By supplementing the model with an anomalous ${\cal U}(1)$ flavor symmetry, we also obtain a simple `all-order' solution of the gauge hierarchy problem and natural explanation of charged fermion mass hierarchies and values of the CKM matrix elements. The proton life time $\tau_p\sim 10^{2}\tau_p^{SU(5)}$~yr. is compatible with experiments, with the dominant decay being $p\to K\nu_{\mu, \tau}$. Thanks to the SU(6) symmetry, successful unification of the gauge couplings can be retained, and the value of the strong coupling $\alpha_s(M_Z)$ can be reduced to $\simeq 0.12$. Finally, we show how to accommodate the solar and atmospheric neutrino data through the bi-maximal neutrino mixing scenario, with maximal vacuum $\nu_e-\nu_{\mu, \tau}$ and large angle $\nu_{\mu}-\nu_{\tau}$ oscillations.Comment: 20 pp. LATEX. Version with minor corrections accepted for Nucl. Phys.

Mortalidad en un hospital pediátrico de referencia regional de Colombia: Hospital Infantil Napoleón Franco Pareja de Cartagena – Colombia, 2000 – 2010

Objetivo: Estimar la mortalidad intrahospitalaria como insumo para la planificación de la atención sanitaria en pediatría. Método: Se realizó un estudio descriptivo de la mortalidad intrahospitalaria del Hospital Infantil Napoleón Franco Pareja a partir del análisis de los registros de mortalidad de 969 niños fallecidos entre 2000 y 2010. Los casos fueron resumidos a partir de sus variables sociodemográficas y epidemiológicas. Resultados: La tasa de mortalidad hospitalaria media del periodo fue 8.5 muertes por mil egresos (Min= 2,6 y Max = 17,3). De los 969 fallecimientos, 54,5 % fueron hombres. Dos de cada tres muertes fue en menores de un año y menos del 1 % en mayores de 15 años. Entre 2000 y 2004 la principal causa de muerte en ambos géneros fue la enfermedad diarreica (25 %), seguida por la neumonía (17,2 %) y la sepsis (12,3 %), y el 71.3 % de las causas estuvo asociado a infecciones. Entre 2005 y 2010 ocurrió el 26,2 % de las muertes totales, y sus principales causas se asocian a enfermedades crónicas. La tasa de mortalidad intrahospitalaria se redujo 6,7 veces, y en términos absolutos en 2010 se produjeron 10 veces menos muertes que en el 2000. Conclusiones: El Hospital Infantil Napoleón Franco Pareja ha impactado esencialmente la mortalidad infantil de Cartagena (pasó de aportar el 23 % en el 2000 al 7 % en 2010)

Anomalous U(1), Gauge-Mediated Supersymmetry Breaking and Higgs as Pseudo-Goldstone Bosons

We study the breaking of supersymmetry in models with anomalous U(1). These models are simple to construct and contain natural candidates for being the messengers of gauge-mediated supersymmetry breaking. When some of the ordinary matter fields transform under the anomalous U(1), we find a hybrid scenario in which the U(1) and the gauge interactions mediate the breaking of supersymmetry. This leads to a hierarchy of soft masses between the charged and neutral fields and provides a solution to the $\mu$-problem. Among these models, we present a scenario in which the Higgs arises as a pseudo-Goldstone boson. This scenario naturally allows for values of the $\mu$-term and the scalar soft masses larger than the weak scale.Comment: 17 pages, Latex, 1 figure include

Alternatives to Seesaw

The seesaw mechanism is attractive not only because it "explains'' small neutrino mass, but also because of its packaging with the SUSY-GUT, leptogenesis, Dark Matter, and electroweak symmetry breaking. However, this package has the flavor, CP, and gravitino problems. I discuss two alternatives to the seesaw mechanism. In one of them, the anomaly-mediated supersymmetry breaking solves these problems, while predicts naturally light Dirac neutrinos. In the other, the light Majorana neutrinos arise from supersymmetry breaking with right-handed neutrinos below TeV, and the Dark Matter and collider phenomenology are significantly different.Comment: Talk at Fujihara Seminar On Neutrino Mass And Seesaw Mechanism (SEESAW 1979-2004), 23-25 Feb 2004, KEK. 14 pages, uses espcrc2.st