O dif��cil acesso a servi��os de m��dia complexidade do SUS

O acesso aos servi��os de m��dia complexidade tem sido apontado, por gestores e pesquisadores, como um dos entraves para a efetiva����o da integralidade do SUS. Este artigo teve o objetivo de avaliar mecanismos utilizados pela gest��o do SUS, no munic��pio de S��o Paulo, para garantir acesso �� assistência de m��dia complexidade, durante o per��odo de 2005 a 2008. Optou-se pela estrat��gia de estudo de caso, utilizando as seguintes fontes de evid��ncia: entrevistas com gestores; grupo focal com usu��rios e observa����o participante. Utilizouas t��cnica de an��lise tem��tica, a partir do referencial te��rico da integralidade da assistência, na dimens��o da organiza����o de servi��os. Buscou-se descrever os caminhos percorridos pelos usu��rios para acessar os servi��os da m��dia complexidade, a partir da vis��o dos gestores e dos pr��prios usu��rios. A m��dia complexidade foi identificada, pelos gestores, como o "gargalo" do SUS e um dos principais obst��culos para a constru����o da integralidade. Para enfrentar essa situa����o, o gestor municipal investiu na informatiza����o dos servi��os, como medida isolada e, ainda, sem considerar a necessidade dos usu��rios. Sendo assim, essa incorpora����o tecnol��gica teve pouco impacto na melhoria do acesso, o que se confirmou no relato dos usu��rios. Discute-se que para o enfrentamento de um problema t��o complexo s��o necess��rias a����es articuladas, tanto no ��mbito da pol��tica de sa��de, quanto da organiza����o dos servi��os, bem como a (re)organiza����o do processo de trabalho em todos os n��veis do sistema de sa��de

Diferenciais de c��rie dent��ria entre os ��ndios Xavante de Mato Grosso, Brasil

O objetivo do estudo foi avaliar n��veis de experi��ncia de c��rie entre subgrupos Xavante que vivem em diferentes Terras Ind��genas (T.I.) no Estado de Mato Grosso, Brasil, a fim de investigar a presen��a de desigualdades no interior de uma mesma etnia ind��gena. Os dados foram coletados atrav��s de um censo de sa��de bucal realizados em 2004. Das sete T.I. Xavante existentes, foram investigadas quatro (Pimentel Barbosa, Sangradouro, Are��es e Marechal Rondon), nas quais foram selecionadas a maior aldeia de cada. Foram adotados os crit��rios preconizados pela Organiza����o Mundial da Sa��de, e utilizado o ��ndice CPOS. Para mensurar as diferen��as entre as T.I. foi estimada a raz��o de preval��ncia (RP) por meio de an��lise de regress��o de Poisson, efetuada na faixa et��ria entre 6 e 34 anos para cada sexo, incluindo a idade como covari��vel. Nesta faixa et��ria, as perdas variaram entre 26 a 30 por cento. Pimentel Barbosa foi considerada como refer��ncia para compara����es por apresentar menor preval��ncia de c��rie em todas as faixas et��rias analisadas. A maior disparidade foi notada entre as T.I. Pimentel Barbosa e Sangradouro, tanto em homens (RP 2,68- IC95 por cento 2,41 a 2,97) como em mulheres (RP 2,03- IC95 por cento 1,85 a 2,23). A RP do componente obturado em Are��es e Marechal Rondon (diferen��a relativa a Pimentel Barbosa) �� muito pequena em rela����o �� carga de doen��a total nestas T.I., indicando menor presen��a de servi��o odontol��gico restaurador. Conclui-se que a transi����o em sa��de bucal n��o �� homog��nea entre os Xavante e que as diferen��as podem estar associadas a particularidades do processo hist��rico de intera����o com a sociedade n��o-ind��gena (Continua) (Continua����o) Determinantes locais e regionais, incluindo fatores demogr��ficos, caracter��sticas econ��micas e s��cio-culturais espec��ficas, acesso e utiliza����o de servi��os de sa��de, podem ter determinado as desigualdades de ataque de c��rie observadas entre os Xavante

Sa��de bucal e cuidado odontol��gico: representa����es sociais de m��es usu��rias de um servi��o p��blico de sa��de

Objetivo: identificar as representa����es sociais de m��es de crian��as da faixa et��ria de zero a cinco anos de idade do N��cleo de Sa��de da Fam��lia IV, em Ribeir��o Preto-SP, procurando saber o que pensam sobre sa��de bucal e tratamento odontol��gico. M��todo: trata-se de pesquisa qualitativa, sendo utilizada a entrevista semi-estruturada para a coleta dos dados e a an��lise de conte��do. Resultados: constatou-se grande dificuldade das m��es em se expressar a respeito do que ��, para elas, sa��de. Para essas m��es a sa��de bucal est�� relacionada com normas de higiene e diet��ticas e tamb��m com a ida ao dentista, restringindo-se na preocupa����o com a est��tica e pouco com a fun����o. J�� em rela����o ao tratamento odontol��gico, a grande maioria demonstrou apresentar medo, causado pela sua experi��ncia anterior com o tratamento. A assistência particular est�� associada �� pontualidade e ao atendimento da maneira desejada enquanto o tratamento oferecido pelo setor p��blico �� demora e �� falta de equipamentos e materiais. A humaniza����o no atendimento e compet��ncia do profissional emergiram como dois aspectos importantes, e podem estar determinando a decis��o de ir ou n��o ao dentista. Conclus��es: A express��o sa��de bucal foi associada �� assistência odontol��gica. O atendimento pelo setor privado foi referido como o que mais se aproxima do tipo ideal de assistência odontol��gica

Aten����o b��sica de sa��de e a assistência em Hansen��ase em servi��os de sa��de de um munic��pio do Estado de S��o Paulo

Este �� um estudo descritivo desenvolvido em um munic��pio do Estado de S��o Paulo. Objetivo: identificar e caracterizar as a����es do Programa de Controle da Hansen��ase nos servi��os de sa��de municipais. Metodologia: entrevistas gravadas com gestor municipal de sa��de e profissionais da assistência �� hansen��ase. Resultados: a pol��tica p��blica municipal em sa��de prioriza o desenvolvimento da aten����o b��sica com ��nfase na sa��de p��blica. As a����es s��o realizadas por profissionais capacitados e experientes em hansen��ase. Ve rificou-se a n��o realiza����o da busca ativa dos casos, necess��ria para o real conhecimento da situa����o epidemiol��gica, e das a����es de educa����o em sa��de, importante para a redu����o do estigma e aproxima����o do sujeito �� nova situa����o de vida e enfrentamento de limita����es

A quest��o social na Fran��a contempor��nea: uma experi��ncia de pesquisa

A Fran��a passou por conflitos urbanos em seus bairros populares. Incidentes com a pol��cia marcados pela morte de um morador, geralmente jovem ou adolescente, s��o seguidos por manifesta����es violentas: quebra-quebras, inc��ndios de carros e/ou estabelecimentos p��blicos e privados, enfrentamentos com a pol��cia. Nos conflitos da "banlieue" francesa podem ser percebidos elementos comuns a eventos ingleses e/ou americanos de outras d��cadas.OBJETIVO: consiste em identificar a percep����o e as representa����es de moradores sobre suas condi����es de vida e sa��de na Fran��a.M��TODO: pesquisa qualitativa realizada em Les Aubiers, bairro popular de Bordeaux, nos anos de 2002 e 2005. A popula����o de moradores desse bairro e �� composta principalmente por imigrantes ou fanceses de origem estrangeira, provenientes de diferentes locais: ��frica do Norte, ��frica Sub-Sahariana, Turquia, Portugal , Ilha de Reuni��o. Os indicadores sociais e econ��micos apresentam n��veis significativamente mais baixos do que os de outros bairros de Bordeaux, acompanhando as tend��ncias encontradas nas outras "banlieues". Entre esses indicadores, a taxa de desemprego, principalmente entre jovens, �� alarmante (40 por cento).RESULTADOS E DISCUSS��O: as pol��ticas sociais deveriam ser mais voltadas para os indiv��duos do que para o territ��rio, pois este s�� poder�� ser transformado pelos primeiros e n��o o contr��rio. Um bairro e uma popula����o estigmatizados, est��o contemplados por uma ampla pol��tica social. Ainda que pass��vel de cr��tica, n��o se pode ignorar a exist��ncia de esfor��os sistematicos de integra����o, nem a exist��ncia de pol��ticas sociais. Se elas s��o inadequadas, trata-se de ampliar o espa��o de discus��o para sua reforma. Trata-se de saber qual a disposi����o das sociedades contempor��neas, como um todo, para lutar contra as inequidades e segrega����es

Mobility and social network effects on extremist opinions

Understanding the emergence of extreme opinions and in what kind of environment they might become less extreme is a central theme in our modern globalized society. A model combining continuous opinions and observed discrete actions (CODA) capable of addressing the important issue of measuring how extreme opinions might be has been recently proposed. In this paper I show extreme opinions to arise in a ubiquitous manner in the CODA model for a multitude of social network structures. Depending on network details reducing extremism seems to be possible. However, a large number of agents with extreme opinions is always observed. A significant decrease in the number of extremists can be observed by allowing agents to change their positions in the network.

A produ����o social do conhecimento na sociedade da informa����o

This work is an approach to some problems and challenges to a contemporary social construction of knowledge from some paradoxes generated around the concepts of knowledge, information, culture and information society. The article proposes to think over problems about a common sense concept which is that the technologies would automatically release the man from repetitive work and would allow the access to information and knowledge. In this sense, it points out to the importance of cultural mediation and information activities in the field of Information Science.

Ovariole structure and oogenesis in queens and workers of the stingless bee Melipona quadrifasciata (Hymenoptera: Apidae, Meliponini) kept under different social conditions

The high variability in the reproductive biology of stingless bees makes them very amenable for comparative studies with other eusocial bee taxa. We investigated the structural organization of the ovaries of Melipona quadrifasciata queens and workers kept under different social conditions by analyzing their general histology, mitotic activity, and microfilament organization. The overall dynamics of ovarian activity were similar in the two castes, and at emergence their ovarioles contained a previtellogenic follicle. Stingless bees and honey bees differ in the structural organization in the lower germarium, but they have in common synchronized mitotic activity and putative germ line stem cells in the terminal filament. Unlike honey bees, stingless bee workers lay trophic eggs in addition to reproductive eggs. The overall similarities in oogenesis between the two taxa suggest that the decision to form trophic eggs should only occur in the late stages of oogenesis.

Social Networks Shape the Transmission Dynamics of Hepatitis C Virus

Hepatitis C virus (HCV) infects 170 million people worldwide, and is a major public health problem in Brazil, where over 1% of the population may be infected and where multiple viral genotypes co-circulate. Chronically infected individuals are both the source of transmission to others and are at risk for HCV-related diseases, such as liver cancer and cirrhosis. Before the adoption of anti-HCV control measures in blood banks, this virus was mainly transmitted via blood transfusion. Today, needle sharing among injecting drug users is the most common form of HCV transmission. Of particular importance is that HCV prevalence is growing in non-risk groups. Since there is no vaccine against HCV, it is important to determine the factors that control viral transmission in order to develop more efficient control measures. However, despite the health costs associated with HCV, the factors that determine the spread of virus at the epidemiological scale are often poorly understood. Here, we sequenced partial NS5b gene sequences sampled from blood samples collected from 591 patients in Sao Paulo state, Brazil. We show that different viral genotypes entered Sao Paulo at different times, grew at different rates, and are associated with different age groups and risk behaviors. In particular, subtype 1b is older and grew more slowly than subtypes 1a and 3a, and is associated with multiple age classes. In contrast, subtypes 1a and 3b are associated with younger people infected more recently, possibly with higher rates of sexual transmission. The transmission dynamics of HCV in Sao Paulo therefore vary by subtype and are determined by a combination of age, risk exposure and underlying social network. We conclude that social factors may play a key role in determining the rate and pattern of HCV spread, and should influence future intervention policies.

Social interaction as a heuristic for combinatorial optimization problems

We investigate the performance of a variant of Axelrod's model for dissemination of culture-the Adaptive Culture Heuristic (ACH)-on solving an NP-Complete optimization problem, namely, the classification of binary input patterns of size F by a Boolean Binary Perceptron. In this heuristic, N agents, characterized by binary strings of length F which represent possible solutions to the optimization problem, are fixed at the sites of a square lattice and interact with their nearest neighbors only. The interactions are such that the agents' strings (or cultures) become more similar to the low-cost strings of their neighbors resulting in the dissemination of these strings across the lattice. Eventually the dynamics freezes into a homogeneous absorbing configuration in which all agents exhibit identical solutions to the optimization problem. We find through extensive simulations that the probability of finding the optimal solution is a function of the reduced variable F/N(1/4) so that the number of agents must increase with the fourth power of the problem size, N proportional to F(4), to guarantee a fixed probability of success. In this case, we find that the relaxation time to reach an absorbing configuration scales with F(6) which can be interpreted as the overall computational cost of the ACH to find an optimal set of weights for a Boolean binary perceptron, given a fixed probability of success.

Estrutura populacional do camar��o-branco Litopenaeus schmitti nas regi��es estuarina e marinha da baixada santista, S��o Paulo, Brasil

The white-shrimp Litopenaeus schmitti distributes in West Atlantic Ocean, occurring along all Brazilian cost. Population structure in the Baixada Santista region was identified from samples obtained from artisanal and industrial fishery between June of 2005 and May of 2006. A total of 2.912 specimens were collected, being 2.138 females (1.008 in the estuary and 1.130 in the marine region) and 774 males ( 334 in the estuary and 440 in the marine region). Environmental parameters were annotated together the sampling, allowing to identify that water temperature influences directly the catches. Catches variations, length composition of samples by sex and gonadal maturation of females allowed to identify that: (i) estuary is used as a nursery area by individuals with small lengths, most young; (ii) marine region is used by larger individuals ( adults) and the spawning period extend from June to February, mainly between November and January. It was verified that estuarine fishery ( artisanal) focuses immature and in development individuals, with small lengths and, the marine fishery ( industrial) focuses adults during the whole year and, only in the summer, youngling from spawn. The length of first gonadal maturation of females was estimated in 15,8mm. These results and diagnoses must be considered in the management of L. schmitti fishery in Baixada Santista region.

Lignin phenols used to infer organic matter sources to Sepetiba Bay - RJ, Brasil

Lignin phenols were measured in the sediments of Sepitiba Bay, Rio de Janeiro, Brazil and in bedload sediments and suspended sediments of the four major fluvial inputs to the bay: Sao Francisco and Guandu Channels and the Guarda and Cacao Rivers. Fluvial suspended lignin yields (Sigma 8 3.5-14.6 mgC 10 g dw(-1)) vary little between the wet and dry seasons and are poorly correlated with fluvial chlorophyll concentrations (0.8-50.2 mu gC L(-1)). Despite current land use practices that favor grassland agriculture or industrial uses, fluvial lignin compositions are dominated by a degraded leaf-sourced material. The exception is the Guarda River, which has a slight influence from grasses. The Lignin Phenol Vegetation Index, coupled with acid/aldehyde and 3.5 Db/V ratios, indicate that degraded leaf-derived phenols are also the primary preserved lignin component in the bay. The presence of fringe Typha sp. and Spartina sp. grass beds surrounding portions of the Bay are not reflected in the lignin signature. Instead, lignin entering the bay appears to reflect the erosion of soils containing a degraded signature from the former Atlantic rain forest that once dominated the watershed, instead of containing a significant signature derived from current agricultural uses. A three-component mixing model using the LPVI, atomic N:C ratios, and stable carbon isotopes (which range between -26.8 and -21.8 parts per thousand) supports the hypothesis that fluvial inputs to the bay are dominated by planktonic matter (78% of the input), with lignin dominated by leaf (14% of the input) over grass (6%). Sediments are composed of a roughly 50-50 mixture of autochthonous material and terrigenous material, with lignin being primarily sourced from leaf. (C) 2010 Elsevier Ltd. All rights reserved.

The development of social tourism in Brazil

This article reflects on the origins and development of social tourism in Brazil, with particular reference to the socio-economic conditions in the country. It discusses the theoretical conceptualisation of social tourism and its implementations in the non-European context. The case study presented here is based on a secondary bibliographical research of existing definitions and an in-depth analysis of the political conditions that have framed its development. More particularly, this article will discuss public initiatives since the Labour Party gained power in Brazil in 2003. Apart from public sector involvement in social tourism, this article also examines the role of the third sector in provision. The example of Social Service of Commerce will be presented. This article will conclude by evaluating the phenomenon of social tourism in Brazil, highlighting where progress has been made and which are the key challenges that need to be overcome.