(Im)possibilidades de implementar uma direção única no SUS em município de grande porte: o caso de São Paulo, Brasil

A construção da direção única na saúde constitui-se um desafio para a gestão local do SUS, particularmente para municípios de grande porte. Este artigo analisou o processo de implementação do SUS no município de São Paulo, visando identificar estratégias para viabilizar uma direção única, no período de 2001 a 2008. Com base em um estudo de caso, foram utilizados dados obtidos de informantes privilegiados da gestão e de documentos de gestão. O conceito de integração sanitária foi utilizado como categoria analítica. Foram analisados movimentos e estratégias dos atores institucionais envolvidos diretamente na gestão do SUS, os gestores municipal e estadual. Observaram-se avanços institucionais como a municipalização das unidades básicas de saúde estaduais e a habilitação do município na gestão plena do sistema municipal. Apesar dessa condição de gestão e da identidade político-partidária entre os governos municipal e estadual desde 2005, constatou-se a coexistência de dois subsistemas públicos de saúde pouco integrados. Um municipal, que concentrava os serviços de atenção básica; outro estadual, que concentrava parte considerável dos serviços de média e alta complexidades. Instrumentos de gestão adotados, como o sistema de regulação, mostraram-se frágeis para superar a falta de integração entre os referidos subsistemas. Como implementar a direção única no SUS implica uma (re)divisão de recursos e poder, discute-se que não bastam normas nem instrumentos de gestão para viabilizá-la. É um desafio estratégico para o SUS implementar processo de negociação, envolvendo os atores institucionais e políticos, visando a pactuação de um projeto político na saúde.

Brazilian foreign policy: Old and new paths as regards institutional aspects, multilateralism and foreign policy towards the South

This paper emphasizes the important changes in Brazilian foreign policy after Luiz Inacio Lula da Silva took tip the power in 2002. The paper defends the idea that it is not possible to argue that there were deep changes in comparison to Cardoso's administration. However, evidence shows that new things are happening as regards the design of a more active and clear foreign action line which led to institutional changes and to more incisive multilateral paths. This results both from the political profile of the direct operators of foreign policy and the aims of lite presidential diplomacy, The hypothesis dealt with on this paper consists on the fact that Lula's administration has not fully broken with the old administration practices, however the aims of global and regional integration are being plotted more clearly and with a higher degree of activism. This becomes clear in three aspects of the Brazilian foreign policy: the institutional framework, the practice of multilateralism and the foreign policy towards the South, the three topics analyzed in this paper.

Evaluating the Taxonomic Identity in Four Species of the Lobose Testate Amoebae Genus Arcella Ehrenberg, 1832

The taxonomic identity in microbial eukaryotes remains an impediment to discussing ecology, biogeography and phylogeny, mainly due to a lack of standards in organism descriptions and few comparative works. The lobose testate amoebae (Arcellinida) present an ideal study system, as progress is severely hindered due to taxonomic confusion. In the present survey, we have examined the morphology, biometry and ecology of 2400 individuals in the genus Arcella Ehrenberg, 1832, collected from the Tiete River in Sao Paulo, Brazil. We then contrasted these new data with 26 previously described species, varieties and forms, looking for consistencies and trying to establish distinct entities. Using a combination of morphology and multivariate statistics we were able to determine 4 distinct taxa (Arcella hemisphaerica, Arcella discoides, Arcella gibbosa and Arcella brasiliensis), each of them encompassing a number of other non-distinct nominal taxa. We describe in detail each of the 4 taxa with notes on ecology and biogeography, and list the indistinguishable names in an effort to make identification and taxonomy in the testate amoebae a more objective and precise exercise by clarifying the taxonomic identity.

Strongyloides venezuelensis: The antigenic identity of eight strains for the immunodiagnosis of human strongyloidiasis

The antigens of eight strains of Strongyloides venezuelensis were identified by means of the indirect immunofluorescence antibody (IFAT), enzyme-linked immunosorbent assay (ELISA) and immunoblot (IB) tests. Infective larvae (L3) from these strains were obtained from Rattus norvegicus feces cultures. For IFAT, sections of U were used while the ELISA and IB, tests were conducted with alkaline extract. Ninety serum samples were tested: 30 from patients with S. stercoralis, 30 from patients with other parasitic diseases, and 30 from healthy subjects (free of parasites). Average sensitivity and specificity among all eight strains, both for IFAT and ELISA, were, respectively, 93% and 100%. In the IB, anti-S. stercoralis IgG recognized a single antigenic fraction with 45 kDa. Serum samples from patients with S. stercoralis revealed antigens from different strains of S. venezuelensis, indicating antigenic identity for possible use in the synthesis of recombinant antigen that could be useful in immunodiagnosis and vaccine against this parasite. (C) 2008 Elsevier Inc. All rights reserved.

The identity of Paratrizygia conformis Tonnoir (Diptera, Mycetophilidae), with comments on its systematic position

Paratrizygia conformis, the type-species of the genus Paratrizygia, from Tasmania, is redescribed from the holotype. The wing venation and male terminalia are illustrated in detail. The question of the monophyly of the genus-which has four additional species in Chile and southern Argentina, and four species in the Atlantic Forest, in Brazil-is addressed. Comments are made on the relationships of the genus in the Azana-group of Sciophilinae. The hypothesis of monophyly of Paratrizygia is retained, as indicated by the presence of modified, elongated spines on a distal fold of tergite 9.

INSTITUTIONAL DEVELOPMENT THROUGH POLICY-MAKING A Case Study of the Brazilian Central Bank

A number of contemporary studies rightly emphasize the notion that policy outcomes result from institutional determinants. But as a growing literature on institutional development notes, these institutions are themselves impermanent. Sometimes, in crisis moments, institutions are replaced wholesale. More frequently, institutions evolve gradually over time. Using the Brazilian Central Bank as a case study, this article illustrates that the policy-making process itself can be a central driver of gradual institutional development, with institutions evolving through the accumulation of policy choices made over many years and under different policymakers in response to contemporaneous events and unforeseeable economic and political challenges.

Schizophrenia Modifying the Expression of Gender Identity Disorder

According to the Brazilian Federal Medical Association, transsexualism is recognized as a gender identity disorder if a long-term diagnostic therapeutic process has demonstrated that the transposition of gender roles is irreversible, and if only hormonal and surgical procedures are appropriate to relieve the stress associated with the gender identity. Although such treatment will only be initiated with caution and after a long phase of intense diagnostic screening, the differentiation between pure identity disorders and transsexual feelings secondary to an ongoing psychopathologic process, such as schizophrenia, can be arduous for many health professionals. To report a case of a female patient with schizophrenia and transsexualism and the risks of a potential diagnostic confusion. A 19-year-old black woman, with an 8-year history of undifferentiated schizophrenia and intense gender dysphoria, was referred for sex reassignment surgery evaluation in the Ambulatory for the Treatment of Sexual Disorders of the ABC Medical School. After a more adequate antipsychotic treatment, her masculine behavior has persisted, but her desire to change her own genital organs has decreased. A better acceptance of the multiplicity of possible genders should neither contribute to inadequate interpretations of the signs and symptoms of our patients nor facilitate dangerous clinical or surgical recommendations. Baltieri DA, and De Andrade AG. Schizophrenia Modifying the expression of gender identity disorder. J Sex Med **;**:**-**.

Comparison of Brazilian spiritist mediumship and dissociative identity disorder

We studied the similarities and differences between Brazilian Spiritistic mediums and North American dissociative identity disorder (DID) patients. Twenty-four mediums selected among different Spiritistic organizations in Sao Paulo, Brazil, were interviewed using the Dissociative Disorder Interview Schedule, and their responses were compared with those of DID patients described in the literature. The results from Spiritistic mediums were similar to published data on DID patients only with respect to female prevalence and high frequency of Schneiderian first-rank symptoms. As compared with individuals with DID, the mediums differed in having better social adjustment, lower prevalence of mental disorders, lower use of mental health services, no use of antipsychotics, and lower prevalence of histories of physical or sexual childhood abuse, sleepwalking, secondary features of DID, and symptoms of borderline personality. Thus, mediumship differed from DID in having better mental health and social adjustment, and a different clinical profile.

Salvage Radical Prostatectomy for Radiation-recurrent Prostate Cancer: A Multi-institutional Collaboration

Background: Oncologic outcomes in men with radiation-recurrent prostate cancer (PCa) treated with salvage radical prostatectomy (SRP) are poorly defined. Objective: To identify predictors of biochemical recurrence (BCR), metastasis, and death following SRP to help select patients who may benefit from SRP. Design, setting, and participants: This is a retrospective, international, multi-institutional cohort analysis. There was amedian follow-up of 4.4 yr following SRP performed on 404 men with radiation-recurrent PCa from 1985 to 2009 in tertiary centers. Intervention: Open SRP. Measurements: BCR after SRP was defined as a serum prostate-specific antigen (PSA) >= 0.1 or >= 0.2 ng/ml (depending on the institution). Secondary end points included progression to metastasis and cancerspecific death. Results and limitations: Median age at SRP was 65 yr of age, and median pre-SRP PSA was 4.5 ng/ml. Following SRP, 195 patients experienced BCR, 64 developed metastases, and 40 died from PCa. At 10 yr after SRP, BCR-free survival, metastasis-free survival, and cancer-specific survival (CSS) probabilities were 37% (95% confidence interval [CI], 31-43), 77% (95% CI, 71-82), and 83% (95% CI, 76-88), respectively. On preoperative multivariable analysis, pre-SRP PSA and Gleason score at postradiation prostate biopsy predicted BCR (p = 0.022; global p < 0.001) and metastasis (p = 0.022; global p < 0.001). On postoperative multivariable analysis, pre-SRP PSA and pathologic Gleason score at SRP predicted BCR (p = 0.014; global p < 0.001) and metastasis (p < 0.001; global p < 0.001). Lymph node involvement (LNI) also predicted metastasis (p = 0.017). The main limitations of this study are its retrospective design and the follow-up period. Conclusions: In a select group of patients who underwent SRP for radiation-recurrent PCa, freedom from clinical metastasis was observed in > 75% of patients 10 yr after surgery. Patients with lower pre-SRP PSA levels and lower postradiation prostate biopsy Gleason score have the highest probability of cure from SRP. (C) 2011 European Association of Urology. Published by Elsevier B. V. All rights reserved.

An old taxonomic dilemma: the identity of the western south Atlantic lebranche mullet (Teleostei: Perciformes: Mugilidae)

The identification of the lebranche mullet in the western south Atlantic has long been problematical. In most recent works either Mugil liza Valenciennes and M. platanus Gunther, 1880 or M. liza and M. cephalus Linnaeus, 1758 were recognized from the region and more rarely the occurrence of only one species has been proposed but without sufficient morphological, biochemical or molecular data to allow the designation of the taxonomically appropriate name. Analysis of meristic and morphometric data taken from samples collected from Venezuela to Argentina, clearly indicates that there is only one species of lebranche mullet in the Caribbean Sea region and the Atlantic coast of South America and that Mugil liza is the appropriate name. The comparison of the combined data from all the samples of M. liza with the data taken from one sample of M. cephalus that originated in the Mediterranean, the possible locality from which type specimens were collected (Eschmeyer and Fricke, 2009), revealed significant differences indicating that they are different species. It is also suggested that individuals from the western north Atlantic identified as M. cephalus might represent a population of M. liza in this region.

On the generic identity of Odontophrynus moratoi Jim & Caramaschi, 1980 (Anura, Cycloramphidae)

The generic identity of Odontophrynus moratoi is controversial since the original description due to the presence of intermediate morphological features between the genera Odontophrynus and Proceratophrys. Herein we performed molecular analyses of three genes (16S, cyt b and Rag-1) and recovered O. moratoi deeply imbedded inside a clade containing only Proceratophrys species, appearing as the sister group of Proceratophrys concavitympanum. Therefore, this study formally transfers the species O. moratoi to the genus Proceratophrys [Proceratophrys moratoi (Jim & Caramaschi 1980) comb. nov].

ON THE IDENTITY OF CYCLORAMPHUS JORDANENSIS HEYER, 1983 (ANURA: CYCLORAMPHIDAE)

Cycloramphus jordanensis was described based on a single preserved specimen from Campos do Jordao (22 degrees 44` S ,45 degrees 35` W), State of Sao Paulo, Brazil. While examining the holotype; we noticed the presence of toe and tarsal fringes. Because these characters are absent in Cycloramphus, we suspected that the species was mistakenly placed in the genus. X-ray images of the holotype revealed T-shaped terminal phalanges and fang-like teeth. Together with the presence of toe and tarsal fringes, these characters squarely place the specimen in the genus Megaelasia. Considering the striking niche differences between Cycloramphus and Megaclosia, we expect the new combination will facilitate location of new individuals of this rare frog.

Taxonomic Identity in Microbial Eukaryotes: A Practical Approach Using the Testate Amoeba Centropyxis to Resolve Conflicts Between Old and New Taxonomic Descriptions

The present work focuses on 12 taxa of the genus Centropyxis Stein, 1857 to explore the conflict between traditional and contemporary taxonomic practices. We examined the morphology, biometry, and ecology of 2,120 Centropyxis individuals collected from Tiete River, Sao Paulo, Brazil; with these new data we studied the consistency of previously described species, varieties, and forms. We encountered transitional forms of test morphology that undermine specific and varietal distinctions for three species and nine varieties. Biometrical analyses made comparing the organisms at the species level suggest a lack of separation between Centropyxis aculeata and Centropyxis discoides, and a possible distinction for Centropyxis ecornis based on spine characteristics. However, incongruence between recent and previous surveys makes taking any taxonomic-nomenclatural actions inadvisable, as they would only add to the confusion. We suggest an explicit and objective taxonomic practice in order to enhance our taxonomic and species concepts for microbial eukaryotes. This will allow more precise inferences of taxon identity for studies in other areas.

Effects of competition on sexual and clonal reproduction of a tunicate: the importance of competitor identity

Individual fitness and the structure of marine communities are strongly affected by spatial competition. Among the most common space holders are the colonial ascidians, which have the ability to monopolize large areas of hard substrate, overgrowing most other competitors. The effects of competition on colony growth and on gonad production of the ascidian Didemnum perlucidum were studied in southeastern Brazil by experimentally removing surrounding competitors. Colonies of D, perlucidum competing for space exhibited a growth rate 9 times less than that of colonies that were competitor free. Among the colonies subject to competition, growth rates were unrelated to the percentage of colony border that was free of competitors. However, the identity of the competitor was important in the outcome of border contacts. At the beginning of the experiment, most border encounters of D. perlucidum were with solitary organisms, which in most cases were overgrown. These were progressively replaced by colonial ascidians and bryozoans, resulting mostly in stand-off interactions. Besides reducing asexual growth, spatial competition also affected female gonad production. Colonies free of competitors had a significantly higher proportion of zooids with ovaries. Thus, our findings show that spatial competition reduces both ascidian colony size and gonad production.

The identity of Mygale brunnipes CL Koch 1842 (Araneae, Theraphosidae), with a redescription of the species and the description of a new genus

We describe Kochiana new genus to accommodate a small Brazilian theraphosine species described originally as Mygale brunnipes by Koch (1842), resulting in Kochiana brunnipes new combination. Recently, specimens were rediscovered in northeastern Brazilian Atlantic rainforest. A preliminary cladistic analysis using equal weights parsimony and implied weights, was carried out to examine its phylogenetic placement. Kochiana new genus was monophyletic in all trees regardless of weighting scheme or concavity used. There is preliminary evidence for Kochiana new genus monophyly and weak evidence for its placement as sister group of Plesiopelma. Kochiana new genus can be characterized by the presence of a hornshaped spermatheca in females and males with a palpal bulb having prolateral accessory keels and a well developed medial crest on the embolus apex.