Gasto com a internação de idosos em unidades de terapia intensiva

Introduction: Population aging in Brazil underscores the need to discuss the proper management of the budget allocated in health field, especially in the sectors of high complexity, where coexist costly procedures, limited resources and the need for cost containment. In the other hand, demand is growing in a way directly proportional to the increase in the number of elderly in country. Objective: In this way, this research had as main objective to analyze the costs resulting from the admission of elderly in intensive care units (ICU) and its associated factors. Methods: This is a cross-sectional study with a quantitative approach and featured as a descriptive and exploratory research. Data were collected from medical records of elderly hospitalized in ICU from a brazilian city called Natal-RN, between november first, 2013 and january, 31 of 2014. The variables collected relate to the socio demographic profile, morbidity framework and characterization of hospitalization. The dependent variable was categorized by quartile 75 in high and low expense of hospitalization and submitted to chi-square test with the independent variables of the survey. Associations with p value <0.20 in the bivariate analysis were submitted to the technique of multiple logistic regression. We opted for the construction of three regression models from the above algorithm: general regression model, composed by all 493 hospitalizations in the study, other made with 181 individuals admitted in health public system (SUS) and a third one related to 312 cases from private service in health area. Results: In the general regression model, the variables respiratory diseases, hospitalizations in the private system, disoriented patient and previous stroke were associated with greater probability of high spending in the ICU. In the other hand, in SUS kind of hospitalizations, this probability was associated with disoriented patient, 80 years old or more, sepsis and admission for clinical reason. In the cases from the private network health, the high expenditure was associated with respiratory disease, mechanical ventilation, hospitalization for clinical reason and disoriented patients. Conclusion: The increased expenditure on hospitalization of elderly in intensive care depends on the clinical conditions of individuals. This highlights the importance of avoiding hospitalizations due to diseases sensitive to primary care by health preventive actions and providing comprehensive care to the elderly. In addition, obtaining different explanatory models, according to kind hospital funding, demonstrates the importance of the organization in health services related to composition of costs of hospitalization among the elderly. Another question founded was the need that to improve the funding, we must use rationally the available resources by avoiding unnecessary hospitalizations of elderly people in the extremes of severity. On this kind of precarious funding, ICU hospitalization of elderly non-critical or in a terminal state can compromise the quality of services provided to those who really need intensive care.

Emoções, documentos e subjetivação na construção de transexualidades em João Pessoa/PB

This research aims to understand how the affective components involved in transgender relations with documents constitute specific ways in which these people recognize themselves and build their bodies and their paths, their life projects and their relationship with others. We understand that the documents, if the personal identification or those produced by social movements, legal actors and health and the State, are experienced by trans people beyond administrative functions that are initially thought, but also involve a series of emotional experiences mark their subjective processes, in how these people produce themselves and design in the world their sociality networks. We elected as research field two institutions located in the city of João Pessoa (Paraíba State), noting the intense institutional movement, political, social in favor of the rights of transexuals that have occurred in that city in recent years. Thus, the Rights Reference Centre for LGBT and Fight Against Homophobia (Espaço LGBT) and Health Clinic of Transvestites and Transexuals (Ambulatório de Saúde de Travestis e Transexuais) were the spaces where we find our interlocutors and analyze their experiences with the documents noting two key aspects: the search for first name change in the civil registry and the relationship of trans people with documents produced by the health policies and services such as protocols, records, receipts and psychiatric reports. We realized that although there is disagreement about the perception that our interlocutors have on the documentation that regulates health services, all reported experiencing embarrassment in social situations when you have those who make use of a document that is not consistent with the performance and “social face” taken. In addition to the reports of embarrassment, we saw that the discussion of social distress and trauma has grounded the platforms of social movements, public policy, legal processes and become “narratives of pains” that present strong potential micro-political on demand for rights to “trans people”.

A responsabilidade civil extracontratual do estado na prestação de serviços públicos de saúde

This study aims to examine the Brazilian legal model for the non-contractual liability of the state in providing public health services, from the perspective of threedimensional theory of law. Up based on bibliographical and documentary research, with emphasis on legislation, doctrine and Brazilian jurisprudence, the following conclusions were reached. The right to health is typified in the Constitution as a social fundamental right, and understands the pretension to obtain from the State, the supply of goods or the provision of services that reduce the risk of disease and other health problems; or promote, protect and recover the physical and mental well-being. Once violated the fundamental right to health, provides the managed, among other fundamental guarantees, the non-contractual liability of the state. The provision of public services by the state can be made directly through the Direct or Indirect Public Administration, or by recourse to private entities. In any case, the provision of public health services is entirely subordinate to the principles of administrative law and should be fully funded by tax revenues. As the provision of public health services is part of the administrative activity of the State, there is no way to exclude the application of the guarantee of non-contractual liability of the state in the face of the damage suffered by administered as users of these services. Therefore, it applies the theory of administrative risk, even in the event of harmful and illegal state failure.

Relações de cooperação em consórcios públicos de regiões metropolitanas: análises do CONDIAM/PB e consórcio grande Recife

With the disorganized decentralization occurred in Brazil after the 1988 Constitution, municipalities have risen to the level of federal entities. This phenomenon became known as "municipalism" also brought some negative effects such as low capacity financial, economic and political of these entities. In the face of this reality , the municipalities sought in models of collaborative features to address public policy issues ultrarregionais, one of these models are the Public Consortia. Characterized as the organization of all federal entities that aim to solve public policy implementation alone that they could not, or spend great resources for such. This reality of the municipalities have an aggravating factor when looking at the situation in Metropolitan Regions (MRs). This is because the RMs has a historical process of formation that does not encourage cooperation, since that were created top-down during the military regime. Furthermore, the metropolitan municipalities have significant power asymmetries, localist vision, rigidity earmarked revenues, different scenarios conurbation, difficulty standardization of concepts and others that contribute to the vision of low cooperation of these metropolitan areas. Thus, the problem of this work is in the presence of collaborative arrangements, such as the Public Consortia in metropolitan areas, which are seen as areas of low cooperation. To elucidate this research was used for analysis the cases of CONDIAM/PB and Consórcio Grande Recife/PE, because they are apparently antagonistic, but with some points of similarity. The cases has as foundation the Theory of Common Resources, which provides the possibility of collective action through the initiative of individuals. This theory has as its methodology for analyzing the picture IAD Framework, which proposes its analysis based on three axes: external variables, the arena of action and results. The nature of the method of this research was classified as exploratory and descriptive. For the stage of date analysis, was used the method of document analysis and content, Further than of separation of the cases according to theur especificities. At the end of the study, noted that the CONDIAM/PB was a strategy of municipal government of Joao Pessoa to attract funds from the Federal Government for the purpose of to build a landfill, and over the years the ideology of cooperation was left aside, the prevailing view localist municipalities. In the case of Consórcio Grande Recife/PE, members act with some degree of cooperation, especially the collaborative aspect of the region, however, still prevails with greater strength the power of the state of Pernambuco in the decisions and paths of the consortium. Thus, was conclude that the Public Consortia analyzed are an experience of collaborative arrangement, from the initiative of members, as the theory of common resources says, but has not actually signed as a practice of collective action to overcome the dilemmas faced by metropolitan areas

Filhos da independência: etnografando os estudantes Bissau-guineenses do PEC-G em Fortaleza-CE e Natal-RN

Notre travail propose de comprendre l`immigration africaine contemporaine du Brésil à travers l'univers des étudiants guinéens participant au Programme Étudiants « Convênio de Graduação » (PEC-G) dans les villes de Fortaleza dans l'Etat Ceará et Natal dans l'Etat de Rio Grande do Norte, en étudiant leurs stratégies de convivialité et d'adaptation. Les étudiants étrangers sélectionnés dans ce programme font leur licence gratuitement dans les Instituts d'Enseignement Supérieur (IES). Pour accéder à ce programme ils doivent répondre à certains critères : montrer qu'ils sont en mesure de payer leurs frais au Brésil, avoir le bac ou un diplôme équivalent et maîtriser la langue portugaise lorsqu'ils sont originaires d'un pays n'appartenant pas à la Communauté de Pays de Langue Portugaise (CPLP). Les étudiants qui participent à des programmes de développement socio-économique contractés entre le Brésil et leurs pays d'origine sont prioritaires. Ces accords les contraignent à rentrer dans leurs pays d'origine et de travailler dans le domaine dans lequel ils ont été diplômés une fois les études terminées. Les étudiants, qui arrivent au Brésil porteurs de leurs identités ethniques guinéennes, entrent en contact avec la société brésilienne et acquièrent ainsi une « identité hybride ». C'est dans ce contexte que ce travail analyse le quotidien des étudiants africaines au Brésil avec un regard porté sur les étudiants de Guinée-Bissau à Fortaleza et à Natal comprendre l'expérience des étudiants qui vivent en terre étrangère. Ainsi, le lieu (Brésil) prend toute sa valeur par rapport au distant (Guinée) autrefois lié par l'histoire coloniale et aujourd'hui lié par des relations internationales ou diplomatiques. Finalement, la construction d'une « nouvelle » identité ethnique, d'une culture guinéenne au Brésil s'opère dans une célébration mobile c'est-à-dire successivement formée et transformée en relation avec les formes à travers lesquelles l'individu est représenté ou interpelé dans les systèmes culturels dans lesquels il est impliqué.

Controle aplicado a poços com método de elevação e bombeio centrífugo submerso

The Electrical Submersible Pumping is an artificial lift method for oil wells employed in onshore and offshore areas. The economic revenue of the petroleum production in a well depends on the oil flow and the availability of lifting equipment. The fewer the failures, the lower the revenue shortfall and costs to repair it. The frequency with which failures occur depends on the operating conditions to which the pumps are submitted. In high-productivity offshore wells monitoring is done by operators with engineering support 24h/day, which is not economically viable for the land areas. In this context, the automation of onshore wells has clear economic advantages. This work proposes a system capable of automatically control the operation of electrical submersible pumps, installed in oil wells, by an adjustment at the electric motor rotation based on signals provided by sensors installed on the surface and subsurface, keeping the pump operating within the recommended range, closest to the well s potential. Techniques are developed to estimate unmeasured variables, enabling the automation of wells that do not have all the required sensors. The automatic adjustment, according to an algorithm that runs on a programmable logic controller maintains the flow and submergence within acceptable parameters avoiding undesirable operating conditions, as the gas interference and high engine temperature, without need to resort to stopping the engine, which would reduce the its useful life. The control strategy described, based on modeling of physical phenomena and operational experience reported in literature, is materialized in terms of a fuzzy controller based on rules, and all generated information can be accompanied by a supervisory system