A dívida pública no Distrito Federal

Trabalho de conclusão de curso (graduação)—Universidade de Brasília, Faculdade de Economia, Administração e Contabilidade, Departamento de Ciências Contábeis e Atuariais, Bacharelado em Ciências Contábeis, 2015.Não apenas em âmbito nacional, 2015 tem sido um ano de crises, greves, manifestações, demissões. Muito é falado sobre superávits primários, ajustes fiscais, desemprego, recessão, mas pouco é falado sobre a verdadeira vilã do desenvolvimento brasileiro: a dívida pública. O processo de endividamento brasileiro é nebuloso, e o do Distrito Federal inclui-se nessa categoria. Uma dívida gigante que continua a promover desembolsos anuais com juros, encargos e amortizações questionáveis que ainda não passaram por uma auditoria adequada. Mesmo com uma lei – Lei nº 9.496/97 –criada com a intenção de aliviar, teoricamente, a dívida dos estados, resultando em um refinanciamento, no caso do DF, desconsiderando-se o “subsídio” inicial, de R$647.983.876,23 (647 milhões, 983 mil, 876 reais e 23 centavos), hoje ainda consta como parte integrante da dívida contratual interna do Distrito Federal, porém com um montante bem maior, mesmo os juros pagos no período 1999-2014 já terem somado R$ 2.275.655.001,65, além de amortizações no valor de R$ 2.014.649.237,62, para o mesmo intervalo de tempo. Isso mostra a urgência de auditoria em uma dívida em que o montante da dívida e os pagamentos são diretamente proporcionais. O que antes era para ser um instrumento de financiamento do Estado, agora exige um financiamento para si, em que cada parcela é representada pela crescente falta de prioridade a obras públicas, projetos sociais e ao desenvolvimento da nação supostamente autônoma e soberana

Challenges and lessons from a primary care intervention in a Brazilian municipality

OBJECTIVE: To address the implementation of the Lab for Innovation in Chronic Conditions in Santo Antonio do Monte, indicating the main challenges and lessons of a new chronic condition model. METHODS: This is an observational study based on two sources of data: 1) two cross-sectional household surveys, 2013 (2012 as reference year) and 2015 (2014 as reference year), representative for the entire population and four target groups (pregnant women; children under two years old; individuals with hypertension and diabetes); medical records of individuals who self-reported having hypertension or diabetes in the household survey of 2013. A descriptive statistics analysis was performed. RESULTS: The main findings showed that the public health system is the main provider of health services, mainly primary care, in Santo Antonio do Monte. Besides, the implementation of Lab for Innovation in Chronic Conditions showed the importance of building a Primary Health Care network in small municipalities. CONCLUSIONS: Community health agents and health managers played a fundamental role in the Primary Health Care network. The case study of Santo Antonio do Monte poses some challenges and lessons that clarify future interventions on building a Primary Health Care network that is essential to provide an adequate and longitudinal care to chronic conditions

Global Prevalence of Bronchopulmonary Dysplasia in Very Low Birth Weight Neonates: A Systematic Review and Meta-Analysis

Importance: Large-scale estimates of bronchopulmonary dysplasia (BPD) are warranted for adequate prevention and treatment. However, systematic approaches to ascertain global rates of BPD are lacking. Objective: To conduct a systematic review and meta-analysis to assess the prevalence of BPD in very low birth weight (≤1,500 grams) or very low gestational age (\u3c32 \u3eweeks) neonates. Data sources: A search of MEDLINE from January 1990 until September 2019 using search terms related to BPD and prevalence was performed. Study selection: Randomized controlled trials and observational studies evaluating rates of BPD in very low birth weight or very low gestational age were eligible. Included studies defined BPD as positive pressure ventilation or oxygen requirement at 28 days (BPD28) or at 36 weeks postmenstrual age (BPD36). Data extraction and synthesis: Two reviewers independently conducted all stages of the review. Random-effects meta-analysis was used to calculate the pooled prevalence. Subgroup analyses included gestational age group, birth weight group, setting, study period, continent, and gross domestic product. Meta-regression was performed to identify the impact of significant variables on study effect. Main outcomes and measures: Prevalence of BPD defined as BPD28, BPD36, AnyBPD (BPD 28 or BPD 36), and by subgroups. Results: A total of 82 articles and 696,881 patients were included in this review. The pooled prevalence was 23% (95% CI, 17%-30%) for BPD28 (n=29 studies, 101,848 neonates), 21% (95% CI, 17%-24%) for BPD36 (n=56 studies, 584,448 neonates), and 19% (95% CI, 16%-22%) for any BPD (n=70 studies, 607,653 neonates). In subgroup meta-analyses, birth weight was the strongest driver of the pooled prevalence of BPD. Conclusions and relevance: This study provides a global estimation of BPD prevalence in very low birth weight/low gestation neonates

Intranasal Delivery of Human Umbilical Cord Stromal Cell Conditioned Media Improves Alveolar Growth and Vascular Remodeling In Experimental Bronchopulmonary Dysplasia

Introduction: Bronchopulmonary dysplasia (BPD) is a lung disease with high morbidity and mortality in premature neonates exposed to mechanical ventilation and oxygen support. Preclinical studies demonstrate mesenchymal stromal cell (MSC) conditioned media (CdM) improves histologic changes in BPD via the release of paracrine factors. Current modes of administration include intratracheal or intraperitoneal routes with CdM cultured in ambient air. Objectives: The objective of this study was twofold: (i) assess the efficacy of intranasal delivery of CdM, and (ii) determine whether hypoxic preconditioning stimulates the therapeutic potential of CdM. Methods: Newborn rat pups were randomly assigned to four groups: (1) room air treated with αMEM vehicle (RA+Veh), (2) four days of hyperoxia (BPD+Veh), (3) BPD treated with CdM from normoxic MSCs (BPD+CdM), and (4) BPD treated with CdM from hypoxic preconditioned (1% O2) MSCs (BPD+hypoCdM). Twenty μL of human mesenchymal stromal cell CdM or hypoxic CdM (hypoCdM) was administered intranasally to rat pups on days 4, 10, and 20. Mean linear intercept, medial wall thickness, and vascular density were used to assess alveolarization, pulmonary remodeling, and vascular growth, respectively. Gene expression of cytokines and growth factors in animal lungs and CdM were measured. Results and Discussion: Intranasal CdM, but not hypoxic CdM, improved lung alveolarization. Both CdM and hypoCdM improved pulmonary vascular remodeling; however, only hypoCdM restored vascular density. CdM upregulated the expression of genes involved in wound healing and inflammation. Conclusion: Intranasal delivery of CdM/hypoCdM restored lung development in a BPD rat model. Mechanisms by which umbilical cord-derived stem cell CdM provides pulmonary benefit points toward wound repair and immunomodulation. Future directions include: (i) optimizing the timing, volume, frequency, and concentration of the CdM and (ii) improving the preconditioning approach for MSCs to enhance the therapeutic efficacy. Acknowledgements: Data were generated in the Flow Cytometry Shared Resource Facility, which is supported by UTHSCSA, NIH-NCI P30 CA054174-20 (Cancer Therapy and Research Center at UTHSCSA) and UL1 TR001129 (Clinical and Translational Science Award). Our gratitude extends to the Pathology Core at UTHSCSA

Equidade na utilização dos serviços de saúde no Brasil: um estudo comparativo entre as regiões brasileiras no período 1998-2008

Brazil presents severe socioeconomic inequalities among regions and individuals. Several studies analyze the determinants of these inequalities and its effects on social welfare indicators, such as health. This paper measures the socioeconomic inequalities in healthcare utilization in Brazil and in Brazilian regions over the period 1998-2008, using the Brazilian household survey, Pesquisa Nacional por Amostra de Domicílios (PNAD). Health concentration curves and indexes – CC and CI – were estimated. This methodology takes into account differences throughout the income distribution. The results show a consistent improvement during the period. These improvements were largest among individuals without health insurance, suggesting an improvement at Brazilian Health System (SUS) services. The estimation of CC and IC suggests a small magnitude of inequality in outpatient and hospital services. The dental service is the only one, among the healthcare utilization variables, with relevant magnitude of inequality favoring of the richest groups. The analysis of healthcare access suggests the presence of constrained demand more concentrated among the poorest groups, especially for the population without health insurance. This study moves forward in the health equity literature since it analyzes equity at SUS in the last ten years considering differences among socioeconomic groups and Brazilian regions.Healthcare inequalities. Brazilian Health System. Brazilian regions.

Desigualdade socioeconômica no acesso aos serviços de saúde no Brasil: um estudo comparativo entre as regiões brasileiras em 1998 e 2008

This paper measures inequalities in healthcare access in Brazil and each region in 1998 and 2008. The analysis controls for predisposing, enabling and need factors. The results show an increase of utilization rates and reduction of inequalities in primary care, especially among uninsured individuals, which suggest an improvement in the public health sector. The exception is the utilization of dentistry visits that still presents high social inequality and higher utilization rates among insured individuals. Regarding the variable "difficulty of access" results showed pro-rich inequality. After controlling for health insurance coverage, this inequality decreases in a great amount.Este artigo mensura a desigualdade socioeconômica no acesso aos serviços de saúde no Brasil e regiões, em 1998 e 2008. A análise controla por fatores predisponentes, capacitantes e de necessidade. Os resultados mostram um aumento das taxas de utilização e redução das desigualdades no cuidado primário, especialmente entre indivíduos sem plano sugerindo melhora nos serviços públicos. A exceção é a utilização de serviços odontológicos, que ainda apresenta desigualdade elevada e maior utilização entre indivíduos com plano. Para o indicador de problema de acesso, observa-se ainda desigualdade favorável aos ricos. Ao controlar para plano de saúde, essa desigualdade se reduz consideravelmente

Estresse e a necessidade da valorização profissional na implantação dos processos de humanização do SUS (Humanizasus)

Introdução: O Ministério da Saúde vem desde 2004 implantando medidas para melhoria da qualidade e atendimento humanizado ao usuário do SUS, o HumanizaSUS. Várias diretrizes foram instituídas dentre elas a valorização profissional, no entanto, nenhuma medida prática foi tomada em prol do valor do profissional de saúde, que é um dos mais propensos a estresse. Objetivo: Mostrar associação entre as síndromes de estresse relacionadas com o trabalho em profissionais da área de saúde e seu impacto no processo de humanização, proposto pelo Ministério da Saúde. Métodos: Foi realizada pesquisa bibliográfica dentre diversas bases de dados disponíveis como Biblioteca Virtual em Saúde, PubMed e Scielo visando a obtenção de dados. Citações sobre presença de estresse e síndrome de burnout e necessidade de valorização profissional foram encontradas nas fontes estudadas. Resultados: Embora existam referências sobre o tema, permanece lacuna sobre associação da atividade profissional e implantação do HumanizaSUS, do contrário, foram encontradas medidas que aumentam a exposição do profissional foram provisionadas, tratando a valorização profissional de forma secundária, aumentando o grau de estresse e aumentando o número de profissionais com síndrome de burnout, com atraso e problemas para implementação das medidas requisitadas pelo Ministério da Saúde. Conclusão: A valorização do profissional de saúde é fundamental para a implementação do HumanizaSUS, a não observação desta necessidade acarreta em atrasos e má condução no objetivo de humanização do Sistema Único de Saúde

Wiskott-Aldrich syndrome protein deficiency in innate immune cells leads to mucosal immune dysregulation and colitis in mice

BACKGROUND & AIMS: Immunodeficiency and autoimmune sequelae, including colitis, develop in patients and mice deficient in Wiskott-Aldrich Syndrome protein (WASP), a hematopoietic-specific intracellular signaling molecule that regulates the actin cytoskeleton. Development of colitis in WASP-deficient mice requires lymphocytes; transfer of T cells is sufficient to induce colitis in immunodeficient mice. We investigated the interactions between innate and adaptive immune cells in mucosal regulation during development of T-cell-mediated colitis in mice with WASP-deficient cells of the innate immune system. METHODS: Naïve and/or regulatory CD4(+) T cells were transferred from 129 SvEv mice into RAG-2 deficient (RAG-2 KO) mice or mice lacking WASP and RAG-2 (WRDKO). Animals were observed for the development of colitis; effector and regulatory functions of innate immune and T cells were analyzed with in vivo and in vitro assays. RESULTS: Transfer of unfractionated CD4(+) T cells induced severe colitis in WRDKO, but not RAG-2 KO, mice. Naïve wild-type T cells had higher levels of effector activity and regulatory T cells had reduced suppressive function when transferred into WRDKO mice compared to RAG-2 KO mice. Regulatory T-cell proliferation, generation, and maintenance of FoxP3 expression were reduced in WRDKO recipients, and associated with reduced numbers of CD103(+) tolerogenic dendritic cells and levels of interleukin (IL)-10. Administration of IL-10 prevented induction of colitis following transfer of T cells into WRDKO mice. CONCLUSIONS: Defective interactions between WASP-deficient innate immune cells and normal T cells disrupt mucosal regulation, potentially by altering the functions of tolerogenic dendritic cells, production of IL-10, and homeostasis of regulatory T cells

A multi-level system quality improvement intervention to reduce racial disparities in hypertension care and control: study protocol.

PMC3680084Abstract BACKGROUND: Racial disparities in blood pressure control have been well documented in the United States. Research suggests that many factors contribute to this disparity, including barriers to care at patient, clinician, healthcare system, and community levels. To date, few interventions aimed at reducing hypertension disparities have addressed factors at all of these levels. This paper describes the design of Project ReD CHiP (Reducing Disparities and Controlling Hypertension in Primary Care), a multi-level system quality improvement project. By intervening on multiple levels, this project aims to reduce disparities in blood pressure control and improve guideline concordant hypertension care. METHODS: Using a pragmatic trial design, we are implementing three complementary multi-level interventions designed to improve blood pressure measurement, provide patient care management services and offer expanded provider education resources in six primary care clinics in Baltimore, Maryland. We are staggering the introduction of the interventions and will use Statistical Process Control (SPC) charting to determine if there are changes in outcomes at each clinic after implementation of each intervention. The main hypothesis is that each intervention will have an additive effect on improvements in guideline concordant care and reductions in hypertension disparities, but the combination of all three interventions will result in the greatest impact, followed by blood pressure measurement with care management support, blood pressure measurement with provider education, and blood pressure measurement only. This study also examines how organizational functioning and cultural competence affect the success of the interventions. DISCUSSION: As a quality improvement project, Project ReD CHiP employs a novel study design that specifically targets multi-level factors known to contribute to hypertension disparities. To facilitate its implementation and improve its sustainability, we have incorporated stakeholder input and tailored components of the interventions to meet the specific needs of the involved clinics and communities. Results from this study will provide knowledge about how integrated multi-level interventions can improve hypertension care and reduce disparities. TRIAL REGISTRATION: ClinicalTrials.gov NCT01566864.JH Libraries Open Access Fun