Novas perspectivas na gestão do sistema de saúde da Espanha

Ao longo dos últimos vinte e cinco anos, a organização do sistema de saúde na Espanha vem adotando diversas medidas que reorientaram seu gerenciamento, melhoraram sua eficiência e aprimoraram seu sistema de financiamento, resultado de profundas reformas e da introdução de novos instrumentos de gestão. Este artigo é resultado de uma análise documental que objetivou descrever a trajetória de conformação do sistema de saúde espanhol e sua organização na contemporaneidade. Apresenta alguns determinantes históricos que tornaram possíveis as reformas no setor sanitário, como a descentralização para o nível das Comunidades Autônomas, a incorporação de mecanismos de coordenação e a integração e o financiamento dos novos e distintos formatos organizativos coexistentes no país. Além disso, identifica desafios que emergem no cenário atual do Sistema Nacional de Saúde, como o fenômeno da imigração, o avançado processo de transição demográfica, a crescente demanda por melhorias na qualidade da atenção e de incorporação tecnológica. Todos esses fatores influem na sustentabilidade do sistema, o que motivou a criação de mais um espaço para estabelecimentos de consensos sobre o papel fundamental do sistema sanitário para o Estado de Bem-Estar espanhol.

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.

Pyrolysis-Gas Chromatography/Mass Spectrometry of Soil Organic Matter Extracted from a Brazilian Mangrove and Spanish Salt Marshes

The soil organic matter (SOM) extracted under different vegetation types from a Brazilian mangrove (Pai Matos Island, Sao Paulo State) and from three Spanish salt marshes (Betanzos Ria and Corrubedo Natural Parks, Galicia, and the Albufera Natural Park, Valencia) was investigated by pyrolysis-gas chromatography/mass spectrometry (Py-GC/MS). The chemical variation was larger in SOM from the Spanish marshes than in the SOM of the Brazilian mangroves, possibly because the marshes included sites with both tidal and nontidal variation, whereas the mangrove forest underwent just tidal variation. Thus, plant-derived organic matter was better preserved under permanently anoxic environments. Moreover, given the low number of studied profiles and sedimentary-vegetation sequences in both areas, depth trends remain unclear. The chemical data also allow distinction between the contributions of woody and nonwoody vegetation inputs. Soil organic matter decomposition was found to cause: (i) a decrease in lignin contents and a relative increase in aliphatics; (ii) an increase in short-chain aliphatics at the expense of longer ones; (iii) a loss of odd-over-even dominance in alkanes and alkenes; and (iv) an increase in microbial products, including proteins, sterols, short-chain fatty acids, and alkanes. Pyrolysis-gas chromatography/mass spectrometry is a useful tool to study the behavior and composition of SOM in wetland environments such as mangroves and salt marshes. Additional profiles need to be studied for each vegetation type, however, to improve the interpretability of the chemical data.