Avaliação na saúde pública : um olhar sobre o desempenho dos municípios brasileiros na subfunção atenção básica à saúde

Dissertação (mestrado)—Universidade de Brasília, Faculdade de Economia, Administração e Contabilidade e Gestão de Políticas Públicas, Programa de Pós-Graduação em Ciências Contábeis, 2018.A avaliação como componente da gestão em saúde tem hoje um reconhecimento que se traduz na existência de múltiplas iniciativas voltadas para a consolidação e aprimoramento do Sistema Único de Saúde (SUS) no Brasil. Com o objetivo de avaliar a eficiência na Atenção Primária em Saúde (APS) nos municípios brasileiros, além de averiguar possíveis disparidades regionais, de fatores socioeconômicos e de características do sistema de saúde, foi utilizada a metodologia proposta por Varela et al (2012). Utilizou-se, portanto, análise envoltória de dados e regressão multivariada, para analisar os municípios brasileiros, entes responsáveis pela subfunção atenção básica à saúde. A população composta inicialmente era de 5.560, sendo excluídos os municípios com informações ausentes ou inconsistentes para as bases de dados utilizadas, quais sejam: o Sistema de Informações Ambulatoriais - SIA, o Sistema de Informações da Atenção Básica - SIAB e o Sistema de Informações sobre Orçamentos Públicos em Saúde – SIOPS. Os resultados validam a metodologia utilizada e confirmam que as variáveis densidade populacional e número de habitantes idosos determinam a eficiência no gasto municipal com APS no Brasil.The evaluation as a component of health management has now been recognized that there are multiple initiatives aimed at consolidating and improving the Unified Health System (SUS) in Brazil. The methodology proposed by Varela et al (2012) was used to assess the efficiency of Primary Health Care in Brazilian municipalities, as well as to investigate possible regional disparities and socioeconomic factors and characteristics of the health system. Data and multivariate regression analysis were used to analyze the Brazilian municipalities, which are responsible for the basic health subfunction. The population initially comprised 5560, excluding municipalities with missing or inconsistent information for the databases used, namely: the Outpatient Information System - SIA, the Basic Attention Information System - SIAB and the Information System on Public Budgets in Health - SIOPS. The results validate the methodology used and confirm that the variables population density and number of elderly inhabitants determine the efficiency in municipal spending with basic care in Brazil

NORMAS DE CONTABILIDADE PÚBLICA NO BRASIL: UM OLHAR PARA OS BALANÇOS DA UNIÃO

Este artigo tem como objetivo identificar e analisar o nível de adoção das normas internacionais de contabilidade aplicadas ao setor público, NBC – 16, nos balanços da União, no triênio de 2010 a 2012. Para atingir tal objetivo foi realizada uma pesquisa exploratória, utilizando a técnica da análise de conteúdo nas demonstrações contábeis e financeiras e nas notas explicativas da União. O tratamento de dados foi realizado de três formas: estudo e análise das NBC- T 16, análise das demonstrações contábeis e financeiras e das notas explicativas, comparação entre NBC – T 16 e as demonstrações da União. Verificou-se que está havendo empenho por parte da União para que ocorra a adoção integral das normas de contabilidade. Constatou-se também que a forma de adoção está acontecendo de forma gradativa ao longo dos anos. De acordo com a legislação brasileira, o prazo final para adoção das normas internacionais de contabilidade aplicadas ao setor público, expira-se em 2014. Nesse sentido, esta pesquisa aponta que a tarefa dos contadores ligados ao setor público não está fácil, pois várias etapas ainda precisam ser cumpridas

Convergência das Normas Brasileiras Aplicadas ao Setor Público: Um estudo exploratório no município de Uberlândia - MG

Este artigo tem por objetivo identificar e analisar o nível de informação que os servidores públicos possuem sobre a convergência Normas Brasileiras Aplicadas ao Setor Público, no município de Uberlândia. Para atingir este objetivo foi realizada uma pesquisa exploratória sendo realizada por meio de uma pesquisa de campo, com aplicação de questionário na escala likert, em órgãos públicos: federal, estadual e municipal. O tratamento de dados foi realizado de três formas: análise do Ranking Médio (RM), para as questões específicas; estatística descritiva para as questões que tratam do perfil dos respondentes e a técnica multivariada HOMALS. Conclui-se que não está havendo empenho pelos órgãos públicos do município de Uberlândia para a capacitação dos servidores para a efetiva implantação das normas internacionais

Trophic position of dolphins tracks recent changes in the pelagic ecosystem of the Macaronesian region (NE Atlantic)

14 pages, 6 figures, 1 table.-- Open accessDolphins play a key role in marine food webs as predators of mid-trophic-level consumers. Because of their mobility and relatively long life span, they can be used as indicators oflarge-scale changes in the ecosystem. In this study, we calculated the trophic position (TP) of 5 dolphin species from the Canary, Madeira and Azores Islands using bulk and compound-specific stable isotope ratios from muscle tissue to assess trophic adaptations to recent changes in the availability of feeding resources. Dolphin TP values were then compared with those of 7 other species of cetaceans from this region. Analysis of stable nitrogen isotopes in amino acids of the common dolphin indicated non-significant effects of changes in the basal resources of the food web and thus supported the use of bulk samples for TP estimations. Dolphins occupied an intermediate TP (mean: 3.91 to 4.20) between fin (3.25) and sperm whales (4.95). Species-specific TP were equivalent among islands. However, TP increased for the common dolphin and decreased for the bottlenose dolphin (the latter also becoming more oceanic) between 2000 and 2018 in the Canary Islands. These results suggest different impacts of recent changes in the oceanography and in the pelagic food web of the Macaronesian region on the trophic ecology of dolphin speciesThis study was supported in part by the projects QLOCKS (PID2020-115620RB-I00), funded by MCIN/AEI/10.13039/501100011033 (Spain), MISTIC SEAS 2 (‘Applyinga subregional coherent and coordinated approach to the monitoring and assessment of marine biodiversity in Macaronesia for the second cycle of the MSFD’), funded by the Directorate General Environment of the European Commission (Grant Agreement No. 11.0661/2017/750679/SUB/ENV.C2), MISTIC SEAS 3 (‘Developing a coordinated approach for assessing Descriptor 4 via its linkages with D1 and other relevant descriptors in the Macaronesian subregion’), funded by the Directorate General Environment of the European Commission (Grant Agreement No. 110661/2018/794676/SUB/ENV.C2), RACAM (Rede de Arrojamentos de Cetáceos do Arquipélago da Madeira), implemented by the Madeira Whale Museum and funded by the Machico Municipality and projects MARCET (MAC/1.1b/149) and MARCET II (MAC/2.6c/392), both co-financed by EU Programme INTERREG MAC 2014−2020, and through the Commission (28-5307) for ‘Technical scientific advice for the protection of the marine environment: assessment and monitoring of marine strategies, monitoring of marine protected areas of state competence (2018−2021)’ of the Spanish Ministry of Economy and Competitiveness Demographic Challenge (MITECO). Data collection in the Azores was supported by FCT and FRCT through TRACE-PTDC/MAR/74071/2006, MAPCET-M2.1.2/F/012/2011, IF/00943/2013/CP1199/CT0001 (FEDER, COMPETE, QREN, POPH, ESF, Portuguese Ministry for Science and Education, Azores 2020 Operational Programme). M.A.S. was funded by SUMMEREU-H2020 GA 817806. M.A.S. and R.P. were funded by OP AZORES 2020, through the EU Fund 01-0145-FEDER-000140. Okeanos is funded by FCT (UIDB/05634/2020) and by the Regional Government of the Azores (M1.1.A/REEQ.CIENTÍFICO UI&D/2021/010). J.G. was supported by the Spanish National Programme Juan de la Cierva-Formación (MCIN/AEI/10.13039/501100011033 FJC2019-040016-I). This work acknowledges the ‘Severo Ochoa Centre of Excellence’ accreditation (CEX2019-000928-S) to the Institute of Marine Science (ICM-CSIC)Peer reviewe

Fine scale population genomics of the bottlenose dolphin off Western Iberia (northeast Atlantic)

34th European Cetacean Society Conference, O Grove, 16-20 April 2023Bottlenose dolphin (Tursiops truncatus) populations sampled across various geographic regions show fine-scale patterns of genetic structure, likely associated with local habitat preferences. Several population genetic studies have focused on populations from the northeast Atlantic Ocean (NEA), very few including the Portuguese coast. This study investigated the population structure and demographic history of the bottlenose dolphin in this region using double digest restriction site associated DNA sequencing (ddRAD-seq). Samples were collected from the Iberian Peninsula including SW Spain, the Portuguese coast (including Sado estuary), NW Spain and from two Portuguese Macaronesian archipelagos, Madeira and Azores (N=110 samples). We genotyped thousands of single nucleotide polymorphisms markers to study the fine-scale population structure, inbreeding levels and demographic history. Bayesian clustering and Principal Component Analyses showed three major genetic clusters: Pelagic (incl. Madeira and Azores; North Galicia, Portugal coast), Southern/Mediterranean (incl. Gibraltar/Cadiz, previously identified as of Mediterranean origin, and Portugal coast), and Resident (Sado and south Galicia). These clusters differ from each other in terms of genetic diversity and inbreeding levels. While the Pelagic and Southern/Med clusters shows high genetic diversity and a wide geographic distribution, the Resident populations show the opposite. The Resident cluster can be subdivided in Galicia and Sado populations, the latter revealing concerning levels of inbreeding. Preliminary demographic analyses suggest that the Resident populations diverged from the others prior to the Southern/Med-Pelagic divergence, although further analyses are needed. Our results suggest that i) the Resident populations of the Iberian Peninsula should be considered as different management units; ii) bottlenose dolphins sampled along the Portuguese coast are highly genetically diverse, including individuals from the three different clusters; and iii) the Sado population faces a critical situation. Within the framework of the recently proposed SACs for bottlenose dolphins in Portugal, these results highlight the importance of discussions on conservation and management policiesN

Burnout among surgeons before and during the SARS-CoV-2 pandemic: an international survey

Background: SARS-CoV-2 pandemic has had many significant impacts within the surgical realm, and surgeons have been obligated to reconsider almost every aspect of daily clinical practice. Methods: This is a cross-sectional study reported in compliance with the CHERRIES guidelines and conducted through an online platform from June 14th to July 15th, 2020. The primary outcome was the burden of burnout during the pandemic indicated by the validated Shirom-Melamed Burnout Measure. Results: Nine hundred fifty-four surgeons completed the survey. The median length of practice was 10 years; 78.2% included were male with a median age of 37 years old, 39.5% were consultants, 68.9% were general surgeons, and 55.7% were affiliated with an academic institution. Overall, there was a significant increase in the mean burnout score during the pandemic; longer years of practice and older age were significantly associated with less burnout. There were significant reductions in the median number of outpatient visits, operated cases, on-call hours, emergency visits, and research work, so, 48.2% of respondents felt that the training resources were insufficient. The majority (81.3%) of respondents reported that their hospitals were included in the management of COVID-19, 66.5% felt their roles had been minimized; 41% were asked to assist in non-surgical medical practices, and 37.6% of respondents were included in COVID-19 management. Conclusions: There was a significant burnout among trainees. Almost all aspects of clinical and research activities were affected with a significant reduction in the volume of research, outpatient clinic visits, surgical procedures, on-call hours, and emergency cases hindering the training. Trial registration: The study was registered on clicaltrials.gov "NCT04433286" on 16/06/2020

Elective cancer surgery in COVID-19-free surgical pathways during the SARS-CoV-2 pandemic: An international, multicenter, comparative cohort study

PURPOSE As cancer surgery restarts after the first COVID-19 wave, health care providers urgently require data to determine where elective surgery is best performed. This study aimed to determine whether COVID-19–free surgical pathways were associated with lower postoperative pulmonary complication rates compared with hospitals with no defined pathway. PATIENTS AND METHODS This international, multicenter cohort study included patients who underwent elective surgery for 10 solid cancer types without preoperative suspicion of SARS-CoV-2. Participating hospitals included patients from local emergence of SARS-CoV-2 until April 19, 2020. At the time of surgery, hospitals were defined as having a COVID-19–free surgical pathway (complete segregation of the operating theater, critical care, and inpatient ward areas) or no defined pathway (incomplete or no segregation, areas shared with patients with COVID-19). The primary outcome was 30-day postoperative pulmonary complications (pneumonia, acute respiratory distress syndrome, unexpected ventilation). RESULTS Of 9,171 patients from 447 hospitals in 55 countries, 2,481 were operated on in COVID-19–free surgical pathways. Patients who underwent surgery within COVID-19–free surgical pathways were younger with fewer comorbidities than those in hospitals with no defined pathway but with similar proportions of major surgery. After adjustment, pulmonary complication rates were lower with COVID-19–free surgical pathways (2.2% v 4.9%; adjusted odds ratio [aOR], 0.62; 95% CI, 0.44 to 0.86). This was consistent in sensitivity analyses for low-risk patients (American Society of Anesthesiologists grade 1/2), propensity score–matched models, and patients with negative SARS-CoV-2 preoperative tests. The postoperative SARS-CoV-2 infection rate was also lower in COVID-19–free surgical pathways (2.1% v 3.6%; aOR, 0.53; 95% CI, 0.36 to 0.76). CONCLUSION Within available resources, dedicated COVID-19–free surgical pathways should be established to provide safe elective cancer surgery during current and before future SARS-CoV-2 outbreaks

Elective Cancer Surgery in COVID-19-Free Surgical Pathways During the SARS-CoV-2 Pandemic: An International, Multicenter, Comparative Cohort Study.

PURPOSE: As cancer surgery restarts after the first COVID-19 wave, health care providers urgently require data to determine where elective surgery is best performed. This study aimed to determine whether COVID-19-free surgical pathways were associated with lower postoperative pulmonary complication rates compared with hospitals with no defined pathway. PATIENTS AND METHODS: This international, multicenter cohort study included patients who underwent elective surgery for 10 solid cancer types without preoperative suspicion of SARS-CoV-2. Participating hospitals included patients from local emergence of SARS-CoV-2 until April 19, 2020. At the time of surgery, hospitals were defined as having a COVID-19-free surgical pathway (complete segregation of the operating theater, critical care, and inpatient ward areas) or no defined pathway (incomplete or no segregation, areas shared with patients with COVID-19). The primary outcome was 30-day postoperative pulmonary complications (pneumonia, acute respiratory distress syndrome, unexpected ventilation). RESULTS: Of 9,171 patients from 447 hospitals in 55 countries, 2,481 were operated on in COVID-19-free surgical pathways. Patients who underwent surgery within COVID-19-free surgical pathways were younger with fewer comorbidities than those in hospitals with no defined pathway but with similar proportions of major surgery. After adjustment, pulmonary complication rates were lower with COVID-19-free surgical pathways (2.2% v 4.9%; adjusted odds ratio [aOR], 0.62; 95% CI, 0.44 to 0.86). This was consistent in sensitivity analyses for low-risk patients (American Society of Anesthesiologists grade 1/2), propensity score-matched models, and patients with negative SARS-CoV-2 preoperative tests. The postoperative SARS-CoV-2 infection rate was also lower in COVID-19-free surgical pathways (2.1% v 3.6%; aOR, 0.53; 95% CI, 0.36 to 0.76). CONCLUSION: Within available resources, dedicated COVID-19-free surgical pathways should be established to provide safe elective cancer surgery during current and before future SARS-CoV-2 outbreaks

MAMÍFEROS. Livro Vermelho dos Vertebrados de Portugal.

Atribui o estatutao de ameaça da UICN para Portugal, a todas as espécies de mamíferos ocorrentes no nosso país

Stable C and N isotope data for cetacea collected in the Macaronesian region between 1996 and 2018

This dataset provides the values of stable carbon and nitrogen stable isotopes in bulk muscle samples of 11 species of cetacea from the Macaronesian regions (Canary, Madeira, and Azores Islands) collected between 1996 and 2018. The values of nitrogen stable isotopes in amino acids of muscle samples of the common dolphin (Delphinus delphis) were also provided. The samples were collected from stranded animals by trained personnel. Cetacean samples were obtained from necropsies of stranded cetaceans following a standard protocol defined by the European Cetacean Society (after Kuiken and García Hartmann 1991). Additional data included body length, age (adult, juvenile) and sex for each animal, along with carbon, nitrogen, and lipid content of muscle samples. Isotope data for bulk samples included values for samples with and without lipids. Exact latitude and longitude coordinates for each sample are not available, geographical position of the center of a circle including each island is given instead. Samples were freeze dried or dried (60°C, 48h) before analysis. Stable isotopes in bulk muscle samples were analysed in an isotope-ratio mass spectrometer coupled to an elemental analyser. Aliquots of each sample were analysed whole or after lipid extraction with trichloromethane:methanol (Bligh and Dyer, 1959). Stable nitrogen isotopes in amino acids were analysed after hydrolisis and derivatization of samples in an isotope-ratio mass spectrometer coupled to a gas chromatograph. Details on the analytical procedures can be found in Bode et al. (2021)