Descentralização no setor da saúde: um estudo sobre a adesão à gestão plena do sistema municipal

Este estudo tem como objetivo avaliar os efeitos da adesão à Gestão Plena do Sistema Municipal. Este processo começou com a instituição da Norma Operacional Básica do SUS de 1996 (NOB/SUS 01/96) e foi descontinuado em 2006 sem explicações oficiais. Os indicadores estudados foram a taxa de mortalidade, total e separada em faixas de idade, e a despesa per capita. As equações foram estimadas utilizando-se o método de difference-in-differences, através de um painel de efeitos fixos, utilizando dados anuais dos municípios brasileiros para o período de 2000 à 2006. Os resultados indicam que os aderentes na primeira metade de vigência da política (1998-2002) obtiveram uma redução de mortalidade gradual, já a partir do primeiro ano de adesão. Contudo, ao incluir os municípios que aderiram na metade final do período de vigência, não foram encontrados resultados estatisticamente relevantes, o que pode indicar uma mudança no rigor dos requisitos cobrados para aderência. Sobre as despesas, com exceção do primeiro ano após a adesão, há indícios de melhora da eficiência.

A regulação da previdência complementar fechada sob a perspectiva da economia comportamental: e a adesão automática como proposta para a mitigação de vieses cognitivos

A presente dissertação investiga a utilização de medidas como a adesão automática pela regulação da previdência complementar fechada a partir da flexibilização do conceito de racionalidade, tendo como base a Análise Econômica e Comportamental do Direito. Inicia-se o trabalho pela evolução histórica da regulação da previdência no Brasil, avaliando os impactos sistêmicos das alterações ocorridas no primeiro pilar previdenciário (regimes básicos). Em virtude dessas alterações e do crescimento da relevância do segundo pilar de previdência social (Previdência Complementar Fechada) para a manutenção do bem-estar, analisa-se a possibilidade de ocorrência de vieses cognitivos que implicam desvios de racionalidade dos indivíduos nas decisões relativas à previdência complementar. Esses vieses cognitivos podem fazer com que indivíduos escolham alternativas que não maximizam seu bem-estar, por razões como inércia, procrastinação e superotimismo, ao contrário do que aponta o pressuposto de racionalidade da Economia Neoclássica. Os resultados analisados conduzem à necessidade de adoção de medidas regulatórias capazes de mitigar esses desvios de racionalidade, na forma de adoção de arquitetura de escolhas que induzam à maximização do bem-estar individual, sem limitar a liberdade individual dos envolvidos. Essas medidas, entretanto, especialmente a adesão automática aos planos de benefícios, destinam-se à mitigação de vieses cognitivos, sendo criticável sua adoção em planos de previdência onde observa-se predominância de outras razões para baixos níveis de adesão, como desconfiança em relação à gestão do plano. Ademais, faz-se necessário respeitar certos critérios para sua implementação, a fim de garantir que esse instrumento somente seja utilizado quando se observar vieses cognitivos que prejudiquem significativamente o bem-estar, bem como que a opção à qual os indivíduos estão sendo induzidos é vantajosa, ao menos na grande maioria das vezes. Ao final, verifica-se a juridicidade dessas medidas, à luz da proporcionalidade, norma que permite identificar os limites para a intensidade regulatória.

Qual a evolução do tecido empresarial da RAM a nível sectorial no período pós-adesão à CE (1988-2008)?

O presente estudo tem como principal objectivo analisar o desempenho global e por sector de actividade do tecido empresarial da RAM no período 1988-2008 através da análise de dados financeiros. A relevância do estudo baseia-se na reflexão da resposta dada pelo tecido empresarial regional aos desafios que foram surgindo ao longo do período referido, e na análise do espírito empresarial e das linhas estratégicas de actuação que pautaram o tecido empresarial a nível das diferentes actividades na RAM. Para a realização deste estudo quantitativo utilizamos uma amostra de conveniência que contêm dados contabilísticos anuais de 545 empresas do tecido empresarial regional, que participaram na iniciativa anual das 100 Maiores Empresas da RAM ao longo dos 21 anos em estudo e que constituem, eventualmente, a única base de dados de cariz semipúblico da região. Os dados foram obtidos através de recolha exaustiva nas instituições responsáveis pelo tratamento da informação disponibilizada pelas empresas concorrentes (Previsão, ECAM), consolidada por pesquisa em jornais (DN, JM), revistas e dados recolhidos no arquivo regional. Estas fontes constituem-se como um precioso instrumento de recolha de dados financeiros de difícil acesso. No tratamento dos dados foram utilizados métodos de estatística descritiva, taxas de crescimento e números índices de base fixa e aplicado teste de correlação de «Pearson». Obteve-se como principais resultados a evolução anual positiva do indicador Volume de Negócios (7,95%) e Activo Líquido (12,23%), Capital Próprio (11,04%), Cash-Flow (12,40%) e Produtividade (2,51%). Os resultados obtidos permitem concluir que houve crescimento empresarial na RAM no período em estudo. As actividades industriais, comerciais e de serviços cresceram a ritmos diferenciados ao longo do período de análise, com predominância para o crescimento do sector terciário, alicerçada nas actividades comerciais e de serviços, que evidenciaram crescimento superiores à actividade industrial.

Estudo das características físico-químicas e biológicas pela adesão de osteoblastos em superfícies de titânio modificadas pela nitretação em plasma

SILVA, J. S. P. Estudo das características físico-químicas e biológicas pela adesão de osteoblastos em superfícies de titânio modificadas pela nitretação em plasma. 2008. 119 f. Tese (Doutorado) - Faculdade de Medicina, Universidade de São Paulo. São Paulo, 2008.

Estudo da adesão de pinos endodônticos modificados superficialmente por plasma de oxigênio

The work presents the effect of plasma treatment when applied in fibers or carbon/glass posts in the adhesion fiber/resin and posts/cement. This has for objective the modification of the surface of the fibers, as well as the wettability of the posts, seeking the improvement of the adhesion and of the connection fiber/resin in the processing of polymeric composites reinforced with the same ones. 120 posts (Reforpost) were used and 30 meters of fibers of carbon and of glass (Fibrex), of the company Angelus. The samples were divided in three groups of 40 specimens: GROUP I - 20 posts of glass fiber and 20 of carbon without treatment to it shapes, GROUP II -20 posts of glass fiber and 20 of carbon treated to it shapes in the surface and GROUP III - 20 posts of glass fiber and 20 of carbon make with fibers in natura after plasma treatment. The plasma treatment was accomplished with oxygen and with temperature in the camera fixed at 200°C, for one hour of exhibition. The posts and the fibers were characterized before and after the treatment. The wettability was measure by pendent drop method, and interface fiber/resin and posts/cement were observed by optical and electronic microscopy. It was observed that both wettability and texture were increased with plasma treatment

Efeito das variáveis laboratoriais protéticas na adesão da porcelana com ligas de níquel-cromo

The metalceramic crowns are usually used in dentistry because they provide a resistant structure due to its metallic base and its aesthetics from the porcelain that recovers this structure. To manufacture these crowns, a series of stages should be accomplished in the prosthetic laboratories, and many variables can influence its success. Changes in these variables cause alterations in the metallic alloy and in the porcelain, so, as consequence, in the adhesion between them. The composition of the metal alloy can be modified by recasting alloys, a common practice in some prosthetic laboratories. The aim of this paper is to make a systematic study investigating metalceramic crowns as well as analyzing the effect of recasting Ni-Cr alloys. Another variable which can influence the mechanism of metalceramic union is the temperature used in firing porcelain procedure. Each porcelain has to be fired in a fixed temperature which is determined by the manufacturer and its change can cause serious damages. This research simulate situations that may occur on laboratory procedures and observe their consequences in the quality of the metalceramic union. A scanning eletron microscopy and an optic microscopy were accomplish to analyse the metal-ceramic interface. No differences have been found when remelting alloys were used. The microhardness were similar in Ni-Cr alloys casted once, twice and three times. A wettability test was accomplished using a software developed at the Laboratório de Processamento de Materiais por Plasma, on the Universidade Federal do Rio Grande do Norte. No differences were found in the contact angle between the solid surface (metallic substratum) and the tangencial plane to the liquid surface (opaque). To analyse if the temperature of porcelain firing procedure could influence the contact area between metal and porcelain, a variation in its final temperature was achieve from 980° to 955°C. Once more, no differences have been found

Adesão, proliferação e genotoxicidade celular de celulose bacteriana modificada por plasma

Bacterial cellulose (BC) has a wide range of potential applications, namely as temporary substitute skin in the treatment of skin wounds, such as burns, ulcers and grafts. Surface properties determine the functional response of cells, an important factor for the successful development of biomaterials. This work evaluates the influence of bacterial cellulose surface treatment by plasma (BCP) on the cellular behavior and its genotoxicity potential. The modified surface was produced by plasma discharge in N2 and O2 atmosphere, and the roughness produced by ion bombardment characterized by scanning electron microscopy (SEM) and atomic force microscopy (AFM). Cell adhesion, viability and proliferation on BCP were analysed using crystal violet staining and the 3-[4,5-dimethylthiazol-2-yl]-2,5-diphenyl-tetrazolium (MTT) method. Genotoxicity was evaluated using the comet and cytokinesis block micronucleus assay. The results show that the plasma treatment changed surface roughness, producing an ideal cell attachment, evidenced by more elongated cell morphology and improved proliferation. The excellent biocompatibility of BCP was confirmed by genotoxicity tests, which showed no significant DNA damage. The BCP has therefore great potential as a new artificial implant

Resiliência e adesão ao tratamento em pacientes com lúpus eritematoso sistêmico

Universidade Federal do Rio Grande do Norte

Análise da adesão ao tratamento e da qualidade de vida de pessoas com úlcera venosa

The therapeutic adherence is still a big problem among people with venous ulcers (VU) because the treatment is long, expensive and demand changes in lifestyle. In this context, this study aims to examine treatment adherence and quality of life (QOL) of people with VU assisted at primary health care. This is an analytical, cross-sectional study with a quantitative approach to treatment and data analysis. The study had the scenario 13 Family Health Units and 02 Units Mixed of Natal. The target population consisted of 44 persons with UV indicated by the teams of the Family Health Strategy between February and April 2014. Three instruments were used: an instrument to characterize the sociodemographic, health and care aspects, the Multidimensional Scale of Adherence Therapy composed of the dimensions: healthy lifestyle, compressive therapy and neurovascular monitoring and the Charing Cross Venous Ulcer Questionnaire (CCVUQ) that evaluates QOL in persons with VU composed by the domains: Total Score, Social Interaction, Domestic Activities, Aesthetics and Emotional State. The study was approved by the Ethics Committee in Research of the Federal University of Rio Grande do Norte, CAAE: 07556312.0.0000.5537. The data concerning the sociodemographic characteristics showed that there was a predominance of females (65.9%), age range as of 60 years (59.1%) and income of up to 1 minimum wage (81.8%). With the characterization of health, it was evident that most people reported chronic diseases (63.6%), sleep more than 6 hours (81.8%), present pain (81.8%), denying alcoholism (86 4%) and smoking (77.3%) and showed a number greater than or equal to 1 (77.3%) recurrences. Concerning the therapeutic adherence was found that in the dimension compressive therapy there poor adherence. No associations between the domains of adherence and sociodemographic and health variables were found. Was observed, however, better adherence among individuals without pain and with higher schooling. When analyzed the averages of the dimensions of therapeutic adherence with the care characteristics there was statistical significance between: adherence to compression therapy and guidance for use of compressive therapy (p = 0.002) and guidance for regular exercise (p = 0.026). Considering the mean of total score of CCVUQ (mean 51.47, SD 18.33) it is observed that the overall QOL of respondents has approximate value of the median of the scale (50). The mean of the domain Social Interaction (mean 44.23, SD 21.38) and Domestic Activities (mean 45.70, SD 23.21) were those who reported better QOL. There were weak correlations but significant between adherence to healthy lifestyle and Domains Total Score (p = 0.012), social interaction (p-value = 0.048), Aesthetics (p-value = 0.025) and Emotional State (0.017) of CCVUQ. From the data analysis it is concluded that among people with UV, there poor adherence to compressive therapy. Furthermore, we found no statistically significant association between treatment adherence and sociodemographic and health characteristics. It is added that there was a correlation between the healthy lifestyle dimension and domains CCVUQ

Comportamento de adesão da madeira de um híbrido clonal de Eucalyptus urophylla x Eucalyptus grandis proveniente de três condições de manejo

This study aimed to evaluate the adhesion ability of eucalyptus lumber from three tillage systems, using adhesives: resorcinol formaldehyde and two adhesives in water emulsion based on vinyl poly-acetate. The management systems were characterized by three strata, the stratum one (E1) characterized by wood from coppice and 70 months of age, the stratum two (E2) characterized by wood and retirement age of 166 months and stratum three (E3), also characterized by retirement at 70 months of age. The wood was derived from a random mixture of the first two sawn logs, each three feet from the base, which comprised three treatments on the adhesive used. We evaluated the shear strength by compression tests and the percentage of wood failure in the glue line. Based on the results obtained, it can be said that the adhesion had satisfactory performance with all the resins used, and the average values of shear strength of the glue line were shown to be equivalent to the shear strength of solid wood only for the samples which adhered with 'Wonderbond' adhesive and also provide higher values for wood failure (97.64%). The highest density present in the wood of the second stratum (E2) influenced only sticking with the resorcinol formaldehyde resin. For polyvinyl acetate (Cascorez 2590), shear values decreased in the third management condition (E3).

Variáveis relacionadas ao processo de adesão a um programa de prevenção de quedas em idosos cadastrados na Estratégia de Saúde da Família

Introduction: Falls among older adults is a public health problem, therefore it is necessary preventive actions, however the adherence is the major problem faced by practitioners and researchers working on falls prevention programs. Objective: To evaluate the variables related to the adherence to falls prevention programs among the elderly enrolled in a Basic Health Unit (BHU). Methods: Was performed an observational cross-sectional analytical study. All elderly registered in a BHU and able to ambulate independently were invited to participate in a falls prevent program. The Elderly who Adhered to the Program (EAP) were evaluated at BHU; and the Elderly Not Adhered to the Program (ENAP) were identified and assessed at home. The assessment for both groups was performed using an evaluation form containing personal data, measures and clinical scales to assess cognitive status, balance, mobility, fear of falling, handgrip strength. Data were analyzed with SPSS 20.0. In addition to this assessment, the ENAP underwent a semi structured interview, in which we used the qualitative approach based on the figure of the Collective Subject Discourse. Results: The study included 222 elderly, 111 EAP and 111ENAP, most aged between 70 and 79 years (48.2%), female (68.5%), married (52.3%) and illiterate (47.7%). Consolidated as protective factors for adherence, worst rates of physical activity (p = 0.001), balance (p = 0.010) and cognition (p = 0.007). The interview of ENAP identified two themes: "Local implementation of programs for the prevention of falls" and "Relationship between BHU and the elderly health care," and found that the elderly who did not adhere were unable to displace and did not mention that primary care programs are related to health care in elderly. Conclusions: Elderly who do not adhere to the program differ from elderly who adhere as worst indices of cognition, balance and physical activity which implies greater risk of falling; and they were unable to participate in falls prevention program and by to be caregiver and showed displacement difficult