International drivers of Brazilian agricultural cooperation in Africa in the post-2008 economic crisis

This text focuses on the major drivers of Brazilian agricultural cooperation in Africa as conceived and pursued from 2004 to 2014, with emphasis on the impacts of political and economic international changes that took place in that period, and particularly the impacts of the 2008 economic crisis, in framing Brazil's foreign policy and development assistance initiatives. It addresses current international forces and developments at the systemic level, but also analyses recent economic domestic developments, in particular those directly related to Brazilian agriculture and those related to the policy framework of its evolving internationalization. Special attention is paid to the dual dimensions of Brazilian agricultural policy and to its projection in agricultural cooperation as pursed in Africa.

Towards modular regionalism: the proliferation of Latin American cooperation

This article addresses three questions: why there was a surge in regional cooperation projects in Latin America in the last decade; how to characterize the current multi-faceted scenario; and how to make this complexity work. After a review of six theoretical perspectives, an original conceptual approach is proposed: "modular regionalism." This credibly answers the three questions and offers policy recommendations.

O Mercosul e a integração regional dos mercados acionários argentino e brasileiro

Este estudo analisa o comportamento recente dos mercados acionários argentino e brasileiro. Nosso objetivo é avaliar o nível de integração entre esses mercados nos períodos anterior (1982-1990) e posterior (1991-1995) à criação do Mercosul. Os resultados mostram clara distinção entre os dois períodos analisados. No período anterior ao Mercosul, os mercados latinos encontravam-se segmentados, não mantendo qualquer relação com os fatores globais que utilizamos. Para o período posterior ao Mercosul, encontramos evidência de que os mercados argentino e brasileiro estão mais integrados entre si, mesmo depois de se controlar para a integração com os mercados americano e chileno.

Competitiveness of tourist destinations: the study of 65 key destinations for the development of regional tourism

Tourism has reached world importance in the economy. The competition in tourism has intensified between destinations, whether the destinations are cities, regions or countries. In this sense, the evaluation of the tourism competitiveness of these destinations may be helpful in planning and prioritizing actions that will benefit the industry. This article discusses the concept of competitiveness by the multidimensional view of performance, efficiency and unit analysis. Using the theoretical framework lifted, this article shows the 'Study on the competitiveness of the 65 destinations inducers of regional tourism development' prepared by the Tourism Ministry, the Brazilian Support Service to Micro and Small Enterprises (Sebrae) and Getulio Vargas Foundation (FGV), its assumptions that guided this study as well its methodological aspects. Based on this methodology, it was carried out a diagnosis of these 65 destinations selected by the Brazilian Ministry of Tourism to be inducers of tourism in their respective regions. The result of competitiveness reached by these 65 inductors destinations is presented in this article, providing a map of the level of competitiveness of tourism in Brazil.

Consórcio Intermunicipal da Fronteira (CIF): descrevendo as principais ações voltadas ao desenvolvimento regional a partir da perspectiva do poder público municipal

Este artigo propõe-se descrever as principais ações voltadas ao desenvolvimento regional promovidas pelo Consórcio Intermunicipal da Fronteira (CIF), constituído pelos municípios de Barracão e Bom Jesus do Sul (PR) e Dionísio Cerqueira (SC), localizados no Brasil, e Bernardo de Irigoyen de Misiones, localizado na Argentina, da perspectiva do poder público municipal, representado pelos prefeitos destas cidades e pelo coordenador executivo do CIF. Assim, trata-se de uma pesquisa que utiliza a abordagem qualitativa, realizada por meio de entrevista individual em profundidade aplicada aos quatro prefeitos municipais que compõem o CIF e o coordenador executivo deste. Tais entrevistas se propuseram a examinar, sob a ótica desses agentes, a formação do CIF, bem como as ações planejadas e as ações em implementação desde sua constituição. Neste sentido, os principais resultados apontaram os meios que os municípios encontraram para buscar recursos que viabilizassem a melhoria da infraestrutura, garantindo o progresso e o desenvolvimento social, econômico e cultural da região. Apresentou ainda os resultados positivos da implantação do CIF em âmbito regional e as dificuldades e limitações enfrentadas neste processo.

Studies on mosquitoes (Diptera: Culicidae) and anthropic environment: 9- Synanthropy and epidemiological vector role of Aedes scapularis in South-Eastern Brazil

Behaviour comparisons of Aedes scapularis and Ae. serratus are presented. Results were obtained by sampling Aedes adult mosquitoes at several places in the rural anthropic environment in the Ribeira Valley region of S. Paulo State, Brazil. Aedes dominance was shared by those two species, but Ae. scapularis Sshowed a clear tendency to frequent the modified environment, while Ae. serratus was to be found in the more preserved ones, here represented by the vestigial patchy forests. Regarding the open cultivated land and the dwelling environments, Ae. scapularis preponderates. Considering the regional developmental phases, this mosquito showed a remarkable increase in the modified environment differently from Ae. serratus that underwent a considerable decrease in migrating from the forest to the anthropic environment. As a consequence of these results it is reasonable to conclude that Ae. scapularis may be considered as an epidemiologically efficient vector and that it quite probably played this role in the Rocio encephalitis and other arbovirus epidemics.

The epidemiologic paradox of low birth weight in Brazil

OBJECTIVE: To examine whether the low birth weight (LBW) paradox exists in Brazil. METHODS: LBW and cesarean section rates between 1995 and 2007 were estimated based on data from SINASC (Brazilian Live Births Database). Infant mortality rates (IMRs) were obtained using an indirect method that correct for underreporting. Schooling information was obtained from census data. Trends in LBW rate were assessed using joinpoint regression models. The correlations between LBW rate and other indicators were graphically assessed by lowess regression and tested using Spearman's rank correlation. RESULTS: In Brazil, LBW rate trends were non-linear and non-significant: the rate dropped from 7.9% in 1995 to 7.7% in 2000, then increased to 8.2% in 2003 and remained nearly steady thereafter at 8.2% in 2007. However, trends varied among Brazilian regions: there were significant increases in the North from 1999 to 2003 (2.7% per year), and in the South (1.0% per year) and Central-West regions (0.6% per year) from 1995 to 2007. For the entire period studied, higher LBW and lower IMRs were seen in more developed compared to less developed regions. In Brazilian States, in 2005, the higher the IMR rate, the lower the LBW rate (p=0.009); the lower the low schooling rate, the lower the LBW rate (p=0.007); the higher the number of neonatal intensive care beds per 1,000 live births, the higher the LBW rate (p=0.036). CONCLUSIONS: The low birth weight paradox was seen in Brazil. LBW rate is increasing in some Brazilian regions. Regional differences in LBW rate seem to be more associated to availability of perinatal care services than underlying social conditions.

Temporal trends and spatial distribution of unsafe abortion in Brazil, 1996-2012

OBJECTIVE To analyze temporal trends and distribution patterns of unsafe abortion in Brazil. METHODS Ecological study based on records of hospital admissions of women due to abortion in Brazil between 1996 and 2012, obtained from the Hospital Information System of the Ministry of Health. We estimated the number of unsafe abortions stratified by place of residence, using indirect estimate techniques. The following indicators were calculated: ratio of unsafe abortions/100 live births and rate of unsafe abortion/1,000 women of childbearing age. We analyzed temporal trends through polynomial regression and spatial distribution using municipalities as the unit of analysis. RESULTS In the study period, a total of 4,007,327 hospital admissions due to abortions were recorded in Brazil. We estimated a total of 16,905,911 unsafe abortions in the country, with an annual mean of 994,465 abortions (mean unsafe abortion rate: 17.0 abortions/1,000 women of childbearing age; ratio of unsafe abortions: 33.2/100 live births). Unsafe abortion presented a declining trend at national level (R2: 94.0%, p < 0.001), with unequal patterns between regions. There was a significant reduction of unsafe abortion in the Northeast (R2: 93.0%, p < 0.001), Southeast (R2: 92.0%, p < 0.001) and Central-West regions (R2: 64.0%, p < 0.001), whereas the North (R2: 39.0%, p = 0.030) presented an increase, and the South (R2: 22.0%, p = 0.340) remained stable. Spatial analysis identified the presence of clusters of municipalities with high values for unsafe abortion, located mainly in states of the North, Northeast and Southeast Regions. CONCLUSIONS Unsafe abortion remains a public health problem in Brazil, with marked regional differences, mainly concentrated in the socioeconomically disadvantaged regions of the country. Qualification of attention to women’s health, especially to reproductive aspects and attention to pre- and post-abortion processes, are necessary and urgent strategies to be implemented in the country.

Regional governance: strategies and disputes in health region management

OBJECTIVE To analyze the regional governance of the health systemin relation to management strategies and disputes.METHODOLOGICAL PROCEDURES A qualitative study with health managers from 19 municipalities in the health region of Bahia, Northeastern Brazil. Data were drawn from 17 semi-structured interviews of state, regional, and municipal health policymakers and managers; a focus group; observations of the regional interagency committee; and documents in 2012. The political-institutional and the organizational components were analyzed in the light of dialectical hermeneutics.RESULTS The regional interagency committee is the chief regional governance strategy/component and functions as a strategic tool for strengthening governance. It brings together a diversity of members responsible for decision making in the healthcare territories, who need to negotiate the allocation of funding and the distribution of facilities for common use in the region. The high turnover of health secretaries, their lack of autonomy from the local executive decisions, inadequate technical training to exercise their function, and the influence of party politics on decision making stand as obstacles to the regional interagency committee’s permeability to social demands. Funding is insufficient to enable the fulfillment of the officially integrated agreed-upon program or to boost public supply by the system, requiring that public managers procure services from the private market at values higher than the national health service price schedule (Brazilian Unified Health System Table). The study determined that “facilitators” under contract to health departments accelerated access to specialized (diagnostic, therapeutic and/or surgical) services in other municipalities by direct payment to physicians for procedure costs already covered by the Brazilian Unified Health System.CONCLUSIONS The characteristics identified a regionalized system with a conflictive pattern of governance and intermediate institutionalism. The regional interagency committee’s managerial routine needs to incorporate more democratic devices for connecting with educational institutions, devices that are more permeable to social demands relating to regional policy making.

Federalism and health policy: the intergovernmental committees in Brazil

OBJECTIVE To analyze the dynamics of operation of the Bipartite Committees in health care in the Brazilian states.METHODS The research included visits to 24 states, direct observation, document analysis, and performance of semi-structured interviews with state and local leaders. The characterization of each committee was performed between 2007 and 2010, and four dimensions were considered: (i) level of institutionality, classified as advanced, intermediate, or incipient; (ii) agenda of intergovernmental negotiations, classified as diversified/restricted, adapted/not adapted to the reality of each state, and shared/unshared between the state and municipalities; (iii) political processes, considering the character and scope of intergovernmental relations; and (iv) capacity of operation, assessed as high, moderate, or low.RESULTS Ten committees had advanced level of institutionality. The agenda of the negotiations was diversified in all states, and most of them were adapted to the state reality. However, one-third of the committees showed power inequalities between the government levels. Cooperative and interactive intergovernmental relations predominated in 54.0% of the states. The level of institutionality, scope of negotiations, and political processes influenced Bipartite Committees’ ability to formulate policies and coordinate health care at the federal level. Bipartite Committees with a high capacity of operation predominated in the South and Southeast regions, while those with a low capacity of operations predominated in the North and Northeast.CONCLUSIONS The regional differences in operation among Bipartite Interagency Committees suggest the influence of historical-structural variables (socioeconomic development, geographic barriers, characteristics of the health care system) in their capacity of intergovernmental health care management. However, structural problems can be overcome in some states through institutional and political changes. The creation of federal investments, varied by regions and states, is critical in overcoming the structural inequalities that affect political institutions. The operation of Bipartite Committees is a step forward; however, strengthening their ability to coordinate health care is crucial in the regional organization of the health care system in the Brazilian states.

Prevalence of syphilis in pregnancy and prenatal syphilis testing in Brazil: Birth in Brazil study

OBJECTIVE Determine the coverage rate of syphilis testing during prenatal care and the prevalence of syphilis in pregnant women in Brazil. METHODS This is a national hospital-based cohort study conducted in Brazil with 23,894 postpartum women between 2011 and 2012. Data were obtained using interviews with postpartum women, hospital records, and prenatal care cards. All postpartum women with a reactive serological test result recorded in the prenatal care card or syphilis diagnosis during hospitalization for childbirth were considered cases of syphilis in pregnancy. The Chi-square test was used for determining the disease prevalence and testing coverage rate by region of residence, self-reported skin color, maternal age, and type of prenatal and child delivery care units. RESULTS Prenatal care covered 98.7% postpartum women. Syphilis testing coverage rate was 89.1% (one test) and 41.2% (two tests), and syphilis prevalence in pregnancy was 1.02% (95%CI 0.84;1.25). A lower prenatal coverage rate was observed among women in the North region, indigenous women, those with less education, and those who received prenatal care in public health care units. A lower testing coverage rate was observed among residents in the North, Northeast, and Midwest regions, among younger and non-white skin-color women, among those with lower education, and those who received prenatal care in public health care units. An increased prevalence of syphilis was observed among women with < 8 years of education (1.74%), who self-reported as black (1.8%) or mixed (1.2%), those who did not receive prenatal care (2.5%), and those attending public (1.37%) or mixed (0.93%) health care units. CONCLUSIONS The estimated prevalence of syphilis in pregnancy was similar to that reported in the last sentinel surveillance study conducted in 2006. There was an improvement in prenatal care and testing coverage rate, and the goals suggested by the World Health Organization were achieved in two regions. Regional and social inequalities in access to health care units, coupled with other gaps in health assistance, have led to the persistence of congenital syphilis as a major public health problem in Brazil.

Hospitalizations for ambulatory care-sensitive conditions, Minas Gerais, Southeastern Brazil, 2000 and 2010

OBJECTIVE To analyze hospitalization rates and the proportion of deaths due to ambulatory care-sensitive hospitalizations and to characterize them according to coverage by the Family Health Strategy, a primary health care guidance program. METHODS An ecological study comprising 853 municipalities in the state of Minas Gerais, under the purview of 28 regional health care units, was conducted. We used data from the Hospital Information System of the Brazilian Unified Health System. Ambulatory care-sensitive hospitalizations in 2000 and 2010 were compared. Population data were obtained from the demographic censuses. RESULTS The number of ambulatory care-sensitive hospitalizations declined from 20.75/1,000 inhabitants [standard deviation (SD) = 10.42) in 2000 to 14.92/thousand inhabitants (SD = 10.04) in 2010 Heart failure was the most frequent cause in both years. Hospitalizations rates for hypertension, asthma, and diabetes mellitus, decreased, whereas those for angina pectoris, prenatal and birth disorders, kidney and urinary tract infections, and other acute infections increased. Hospitalization durations and the proportion of deaths due to ambulatory care-sensitive hospitalizations increased significantly. CONCLUSIONS Mean hospitalization rates for sensitive conditions were significantly lower in 2010 than in 2000, but no correlation was found with regard to the expansion of the population coverage of the Family Health Strategy. Hospitalization rates and proportion of deaths were different between the various health care regions in the years evaluated, indicating a need to prioritize the primary health care with high efficiency and quality.

Hospitalization flow in the public and private systems in the state of Sao Paulo, Brazil

OBJECTIVE To describe the migration flows of demand for public and private hospital care among the health regions of the state of Sao Paulo, Brazil. METHODS Study based on a database of hospitalizations in the public and private systems of the state of Sao Paulo, Southeastern Brazil, in 2006. We analyzed data from 17 health regions of the state, considering people hospitalized in their own health region and those who migrated outwards (emigration) or came from other regions (immigration). The index of migration effectiveness of patients from both systems was estimated. The coverage (hospitalization coefficient) was analyzed in relation to the number of inpatient beds per population and the indexes of migration effectiveness. RESULTS The index of migration effectiveness applied to the hospital care demand flow allowed characterizing health regions with flow balance, with high emigration of public and private patients, and with high attraction of public and private patients. CONCLUSIONS There are differences in hospital care access and opportunities among health regions in the state of Sao Paulo, Brazil.

Angiostrongylus costaricensis: first record of its occurrence in the State of Espirito Santo, Brazil, and a review of its geographic distribution

Abdominal angiostrongyliasis is a parasitic disease caused by Angiostrongylus costaricensis, a metastrongylid nematode with wide geographic distribution, occurring from the United States to Argentina. In Brazil, the disease has been reported from the States of Rio Grande do Sul, Santa Catarina, Paraná, São Paulo, Federal District of Brasilia and Minas Gerais. We report here a case of abdominal angiostrongyliasis in a 9-year-old girl, from Itatiba, State of Espirito Santo, Brazil, submitted to exploratory laparotomy for acute abdomen. Extensive inflammatory lesions of terminal ileum and cecum, with perforations of the first, were present, and ileocecal resection was performed. The pathological picture was characterized by transmural inflammatory granulomatous reaction, extensive eosinophilic infiltration, eosinophilic vasculitis and the presence of worms within a mesenteric artery branch, with histological features of metastrongylid nematodes. This case report contributes to a better knowledge of the geographic distribution of this parasite in Brazil, suggesting that abdominal angiostrongyliasis may represent a disease of medical importance, more than a rarity of academic interest.

Hepatocellular carcinoma in Brazil: report of a national survey (Florianópolis, SC, 1995)

In order to investigate epidemiological aspects of hepatocellular carcinoma (HCC) in Brazil, basic informations about cases diagnosed from January 1992 to December 1994 were requested to several medical centers of different Brazilian States. A simple questionnaire included age, sex, alcohol abuse (over 80g/day), associated liver cirrhosis, persistent HBV infection (HBsAg), HCV infection (anti-HCV) and serum levels of alpha fetoprotein. 287 cases, over 16 years old, from 19 medical centers of 8 States (Pará, Bahia, Minas Gerais, Espirito Santo, Rio de Janeiro, São Paulo, Paraná and Rio Grande do Sul) were analysed. The results showed: (a) Mean age was 56.3 ± 14.4 for men and 54.7 ± 16.8 yr for women and the male/female ratio was 3.4:1. (b) 69.6% were caucasians, 21.8% mullatoes, 4.8% orientals and 3.7% blacks. (c) HBsAg (+) in 77/236 cases (41.6%) without differences between males and females. (d) Anti-HCV (+) in 52/193 cases (26.9%). (e) 7/180 cases were positive both for HBsAg and anti-HCV (3.8%). (f) There was chronic alcoholism in 88/235 cases (37%). (g) HCC was found in cirrhotic livers in 71.2% of 202 cases in which the presence or absence of cirrhosis was reported. (h) Alpha-fetoprotein above 20 ng/ml was found in 124/172 cases (72%) and above 500 ng/ml only in 40 cases (23.2%). These results showed that the HCC in Brazil has an intermediate epidemiological pattern as compared to those from areas of low and high incidence of the tumor. In spite of the high frequency of the association of HCC with the HBV and/or HCV infections, 42% of 180 cases were negative both for HBsAg and anti-HCV, indicating the possible role of other etiological factors. The comparison of data from different States showed some regional differences: higher frequency of associated HBsAg in Pará, Bahia, Minas Gerais and Espírito Santo, higher frequency of associated HCV infection in Rio de Janeiro, São Paulo and States of the Southern region and low frequency of associated liver cirrhosis in Salvador and Rio de Janeiro (55.5 and 50% respectively). Further investigation will be necessary to study the presence of other possible etiological factors as aflatoxins, suggested by the favourable climatic conditions for food contamination by fungi in the majority Brazilian regions