(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.

The historiographic Hispano-Americanism: Spain and America in the perspective of Ricardo Levene and Rafael Altamira

This article analyzes how Latin American history was interpreted by two eminent historians, the Argentine Ricardo Levene and the Spaniard Rafael Altamira. It discusses how their paths crossed in the advocacy of Hispano-Americanism as a political project and interpretive horizon of Iberian and American history.

Methods and Participant Characteristics of a Randomized Intervention to Promote Physical Activity and Healthy Eating Among Brazilian High School Students: The Saude na Boa Project

Background: A cross-cultural, randomized study was proposed to observe the effects of a school-based intervention designed to promote physical activity and healthy eating among high school students in 2 cities from different regions in Brazil: Recife and Florianopolis. The objective of this article is to describe the methodology and subjects enrolled in the project. Methods: Ten schools from each region were matched and randomized into intervention and control conditions. A questionnaire and anthropometry were used to collect data in the first and last month of the 2006 school year. The sample (n = 2155 at baseline; 55.7% females; 49.1% in the experimental group) included students 15 to 24 years, attending nighttime classes. The intervention focused on simple environmental/organizational changes, diet and physical activity education, and personnel training. Results: The central aspects of the intervention have been implemented in all 10 intervention schools. Problems during the intervention included teachers' strikes in both sites and lack of involvement of the canteen owners in schools. Conclusions: The Saude no Boa study provides evidence that public high schools in Brazil represent an important environment for health promotion. Its design and simple measurements increase the chances of it being sustained and disseminated to similar schools in Brazil.

Effectiveness of a School-Based Intervention on Physical Activity for High School Students in Brazil: The Saude na Boa Project

Background: We evaluated the effectiveness of a school-based intervention on the promotion of physical activity among high school students in Brazil: the Saude no Boa project. Methods: A school-based, randomized trial was carried out in 2 Brazilian cities: Recife (northeast) and Florianopolis (south). Ten schools in each city were matched by size and location, and randomized into intervention or control groups. The intervention included environmental/organizational changes, physical activity education, and personnel training and engagement. Students age 15 to 24 years were evaluated at baseline and 9 months later (end of school year). Results: Although similar at baseline, after the intervention, the control group reported significantly fewer d/wk accumulating 60 minutes+ moderate-to-vigorous physical activity (MVPA) in comparison with the intervention group (2.6 versus 3.3, P < .001). The prevalence of inactivity (0 days per week) rose in the control and decreased in the intervention group. The odds ratio for engaging at least once per week in physical activity associated with the intervention was 1.83 (95% CI = 1.24-2.71) in the unadjusted analysis and 1.88 (95% CI = 1.27-2.79) after controlling for gender. Conclusion: The Saude no Boa intervention was effective at reducing the prevalence of physical inactivity. The possibility of expanding the intervention to other locations should be considered.

Spatial patterns of malaria in a land reform colonization project, Juruena municipality, Mato Grosso, Brazil

Background: In Brazil, 99% of malaria cases are concentrated in the Amazon, and malaria's spatial distribution is commonly associated with socio-environmental conditions on a fine landscape scale. In this study, the spatial patterns of malaria and its determinants in a rural settlement of the Brazilian agricultural reform programme called ""Vale do Amanhecer"" in the northern Mato Grosso state were analysed. Methods: In a fine-scaled, exploratory ecological study, geocoded notification forms corresponding to malaria cases from 2005 were compared with spectral indices, such as the Normalized Difference Vegetation Index (NDVI) and the third component of the Tasseled Cap Transformation (TC_3) and thematic layers, derived from the visual interpretation of multispectral TM-Landsat 5 imagery and the application of GIS distance operators. Results: Of a total of 336 malaria cases, 102 (30.36%) were caused by Plasmodium falciparum and 174 (51.79%) by Plasmodium vivax. Of all the cases, 37.6% (133 cases) were from residents of a unique road. In total, 276 cases were reported for the southern part of the settlement, where the population density is higher, with notification rates higher than 10 cases per household. The local landscape mostly consists of open areas (38.79 km(2)). Training forest occupied 27.34 km(2) and midsize vegetation 7.01 km(2). Most domiciles with more than five notified malaria cases were located near areas with high NDVI values. Most domiciles (41.78%) and malaria cases (44.94%) were concentrated in areas with intermediate values of the TC_3, a spectral index representing surface and vegetation humidity. Conclusions: Environmental factors and their alteration are associated with the occurrence and spatial distribution of malaria cases in rural settlements.

Confederações indígenas em luta por participação política, comercial e territorial: Argentina, 1852 - 1859

Entre 1852 e 1859, a atual Argentina se encontrava politicamente dividida entre Buenos Aires e a Confederação, que congregava as demais Províncias. Nesse período, diferentes grupos étnicos dos pampas, dos Andes e da Patagônia se organizaram em confederações indígenas com o objetivo de enfrentar os avanços territoriais, defender suas autonomias e a participação em lucrativas redes de comércio. Nesta luta por autonomia política, territorial e comercial, negociaram com os grupos criollos em luta pelo poder, avaliaram seus projetos e aderiram a aquele que os reconheceu enquanto interlocutores políticos e aliados militares. Participantes ativos da política argentina, conseguiram reconquistar territórios e oferecer intensas resistências aos criollos.

Organized Crime and Terrorism: From the Cells Towards Political Communication, A Case Study

During the first half of 2006 the city of Sao Paulo suffered three series of violent attacks against the security forces, civilians, and the government. The violent campaign also included a massive rebellion in prisons and culminated in the kidnapping of a journalist and the broadcast of a manifesto from the criminal organization PCC threatening the police and the government. Right after, the main device used to contain organized crime in the prisons was declared unconstitutional. This episode represents a prototypical example of the use of media-focused terrorism by organized crime for projection into the political communication arena.

Political Systems and the Perspective on Nursing Education during the Spanish Transition (from the Franco Regime to Democracy). A Contribution based on Nursing History

The aim of this study is to describe the changes in nursing education during the process prior to and after the establishment of democracy in Spain. It begins with the hypothesis that differences in social and political organization influenced the way the system of nursing education evolved, keeping it in line with neopositivistic schemes and exclusively technical approaches up until the advent of democracy. The evolution of a specific profile for nursing within the educational system has been shaped by the relationship between the systems of social and political organization in Spain. To examine the insertion of subjects such as the anthropology of healthcare into education programs for Spanish nursing, one must consider the cultural, intercultural and transcultural factors that are key to understanding the changes in nursing education that allowed for the adoption of a holistic approach in the curricula. Until the arrival of democracy in 1977, Spanish nursing education was solely technical in nature and the role of nurses was limited to the tasks and procedures defined by the bureaucratic thinking characteristic of the rational-technological paradigm. Consequently, during the long period prior to democracy, nursing in Spain was under the influence of neopositivistic and technical thinking, which had its effect on educational curricula. The addition of humanities and anthropology to the curricula, which facilitated a holistic approach, occurred once nursing became a field of study at the university level in 1977, a period that coincided with the beginnings of democracy in Spain.

Tiering strategic environmental assessment and project environmental impact assessment in highway planning in Sao Paulo, Brazil

Constructing highways in dense urban areas is always a challenge. In Sao Paulo Metropolitan Region, heavy truck traffic contributes to clog streets and expressways alike. As part of the traffic neither originates nor head to the region, a peripheral highway has been proposed to reduce traffic problems. This project called Rodoanel, is an expressway approximately 175 km long. The fact that the projected south and north sections would cross catchments that supply most of the metropolis water demand was strongly disputed and made the environmental permitting process particularly difficult. The agency in charge commissioned a strategic environmental assessment (SEA) of a revamped project, and called it the Rodoanel Programme. However, the SEA report failed to satisfactorily take account of significant strategic issues. Among these, the highway potential effect of inducing urban sprawl over water protection zones is the most critical issue, as it emerged later as a hurdle to project licensing. Conclusion is that, particularly where no agreed-upon framework for SEA exists, when vertical tiering with downstream project EIA is sought, then a careful scoping of strategic issues is more than necessary. If an agreement on `what is strategic` is not reached and not recognized by influential stakeholders, then the unsettled conflicts will be transferred to project EIA. In such a context, SEA will have added another loop to the usually long road to project approval. (c) 2008 Elsevier Inc. All rights reserved.

Destiny and will, religion and politics: Jesus Society and Enlightenment in the posthumous Malabar Rites controversy

The first presentation of Antoine-Marin Le Mierre`s tragedy Malabar Widow, or the Empire of Customs, took place in 1770. It was based on the famous controversy over the Malabar (south west India) Rites. The object of the controversy was the Jesuit project in India, which started in the beginning of XVII century and was stopped by the Pope Benedict XIV, with the Apostolic Constitution Omnium Sollicitudinum. The papal condemnation of the rites closed a long process which shows the progressive loss of power of the Jesuit Company in the Age of Enlightenment, which will be definitive in 1773, with the suppression of the Company. In Le Mierre`s tragedy, we find the judgment of Malabar rites according to the rationalist ideas of the Enlightenment, with some typical topoi of the philosophes`s cultural perspective. At the same time, the enlightened disputation reproduces the Jesuit internal debate about India itself. Starting from a religious universal perspective of the different strategies of Christianization in India, or in the entire East, the missionary controversy had been about the religious or political interpretation of local signs. Briefly, this polemic would turn into the controversy on the rites. The criticism to the Jesuitical strategy of mission, in XVII and XVIII centuries, would start from here. The enormous number of documents on this issue became a powerful instrument in the battle against the Jesuits, in the XVIII century. On the base of the missionary disputation, the Enlightenment constructs the proposal of a new political and humanistic universal perspective. According to this, eventuality, the religion becomes just a privileged instrument to realize this operation.

Political Parties and Governors as Determinants of Legislative Behavior in Brazil`s Chamber of Deputies, 1988-2006

This article examines the relative importance of regional and national forces in shaping the behavior of Brazilian legislators at the national level. A widely held view is that national legislators respond to state pressures in making decisions, rather than pressures from the national government. Governors not only can influence national debates but also can determine outcomes by exerting control over their states` legislative delegations. This article examines a dataset of all roll-call votes in the Chamber of Deputies between 1989 and 2006 to isolate and evaluate the impact of local pressures on legislative voting. Spanning the terms of five presidents and five different congresses, the data show that the local influence is weaker than the national on the voting decisions of individual legislators and the voting cohesion of state delegations. Alternative institutional resources allow the central government to counteract the centrifugal pressures of federalism and other institutional influences.

Sweeping democracy: considerations on the political relations between Janio Quadros and the National Congress

This article examines the relation between President Janio Quadros and the National Congress during the early 1960`s. Based on the analysis of the discourse of these figures, it proposes that Quadros maneuvered to diminish the legitimacy of the Congress in the public opinion, thus disrespecting its constitutional competencies. Consequently, it shows that not only did the Congress structure political mechanisms in an attempt to recover its credibility with society, but also that this dispute and its results had important effects on President Joao Goulart`s administration and even on the 1964 military coup.

RACE, RESOURCES, AND POLITICAL PARTICIPATION IN A BRAZILIAN CITY

Does race influence political behavior in Brazil? Using data from Belo Horizonte, Brazil, we explore whether an individual`s propensity to take part in a political association is affected by race, independent of socioeconomic position and of the availability of resources derived from this position. We found that white individuals participate more in political associations than do black individuals; however, after taking into account the differences in all types of resources, we found no difference in participation by racial groups. Nevertheless, by interacting race, skills, and income, it turns out that different racial groups use the same resources differently. A white individual`s propensity to participate politically is significantly more affected by income than a similar black individual`s propensity. Therefore, we argue that race mediates the effect of resources on political participation, which means that either different groups may use different resources or different groups can differ in how intensively they use resources.

Letters that construct limits: intellectual and political projects in the letters of Capistrano de Abreu to Barao do Rio Branco (1886-1903)

The intention of this paper is to analyze the letters from Capistrano de Abreu to Barao do Rio Branco in the years between 1886 and 1903. The focus will be given to the divergences around the notion of territorial formation, a basic concept for these authors who were thinking about the construction of a historical narrative at the end of the 19(th) and beginning of the 20(th) century. Later, the question is the construction of the craft of the historian in the letters of Capistrano de Abreu and his distinction and proximity to the ideas of the Barao do Rio Branco.