Governança judicial: proposta de modelo teórico-metodológico

Governança judicial é um conceito multifacetado, pouco explorado na literatura, e são raros os estudos desse tema com dados empíricos que analisem as variáveis que o influenciam. Este artigo tem como objetivo propor um modelo teórico-metodológico de governança judicial, cuja aplicação futura permita a coleta de dados para descrever e avaliar a validade da relação entre os construtos e variáveis que o compõem em cada contexto. Premissas da teoria da agência e da teoria de custos de transação, dirigidas originalmente para empresas, foram transpostas para elaboração do modelo. Os procedimentos de coleta de dados incluíram análise documental e realização de 10 entrevistas. O modelo proposto inclui a sistematização de sete construtos teóricos - accountability; acessibilidade; independência; recursos e estrutura; práticas de governança; ambiente institucional; desempenho - e variáveis componentes desses construtos.

Análise técnica para a tomada de decisão do fornecimento de medicamentos pela via judicial

OBJETIVO: Analisar a solicitação judicial de medicamentos previstos nos componentes da assistência farmacêutica no Sistema Único de Saúde. MÉTODOS: Foram analisados 81 processos judiciais para fornecimento de medicamentos no Estado de São Paulo, entre 2005 e 2009. As informações dos processos foram obtidas do Tribunal de Justiça do Estado de São Paulo. Portarias que regulamentam a assistência farmacêutica foram consultadas para identificar a solicitação judicial de medicamentos incorporados pelo Sistema Único de Saúde. Para análise do nível de evidência dos medicamentos nas indicações clínicas referidas, foi consultada a base de dados Thomson Micromedex®. RESULTADOS: O número de medicamentos solicitados em cada processo variou entre um e sete itens, nos quais foram identificados 77 fármacos diferentes. Dos medicamentos solicitados, 14,3% deveriam estar disponíveis na atenção básica do Sistema Único de Saúde, 19,5% no componente de medicamentos de dispensação excepcional e 66,2% não pertenciam a nenhuma lista oficial. Medicamentos do componente de dispensação excepcional apresentaram melhor evidência clínica quando indicados no tratamento de doenças cobertas pelos Protocolos Clínicos e Diretrizes Terapêuticas do Ministério da Saúde. CONCLUSÕES: A via judicial tem sido utilizada para garantir o acesso a medicamentos cujo fornecimento está previsto no Sistema Único de Saúde e para solicitar aqueles não incorporados por ele. A avaliação do nível de evidência reforça a necessidade de análise técnica para a tomada de decisão do fornecimento de medicamentos pela via judicial.

Paragonimosis in the Cajabamba and Condebamba districts, Cajamarca, Peru

Stool samples from 409 pre-school and school students, living in six villages of the Cajabamba and Condebamba districts, Cajamarca, Perú, were examined using wet preparations and Lumbreras' method, looking for Paragonimus eggs. Fecal and sputum samples from two children (0.5%) of 6 and 8 year-old showed eggs of Paragonimus. One hundred and twenty freshwater crabs, Hypolobocera chilensis eigenmanni, were collected from the Condebamba valley and 21 (17.5%) of them were infected with P. mexicanus (syn. P. peruvianus) metacercariae. Our results show the persistence of Paragonimus in human beings and in the main source of infection, the crabs.

Enteroparasites and commensals among children in four peripheral districts of Uberlândia, State of Minas Gerais

The aim of this study was to determine the occurrence of intestinal parasites and commensals among children in four peripheral districts located in the northern, southern, eastern and western sectors of Uberlândia, Minas Gerais, using the Baermann methods as modified by Moraes and Lutz. Out of 160 individuals studied, 93 (58.1% CI: 50.4-65.7) were infected, distributed among the sectors as follows: northern (72.5%), southern (47.5%), eastern (57.5%) and western (55%). The positive findings according to age groups were: 0-5 years (26.9%), 5-10 years (21.2%) and 10-15 years (10%). Male children presented 2.7 times higher risk of infection than females did (OR: 2.7; CI: 1052-7001). The parasites and commensals identified were: Giardia lamblia (27.5%), Entamoeba coli (20.6%), Ascaris lumbricoides (14.4%), Enterobius vermicularis (8.8%), Hymenolepis nana (7.5%), Hymenolepis diminuta (5%), hookworms (3.1%), Trichuris trichiura (2.5%), Endolimax nana (2.5%), Entamoeba hartmanni (2.5%), Strongyloides stercoralis (1.3%), Iodamoeba butschlii (1.3%) and Capillaria hepatica (0.6%). The infection rate in these children was high and showed the need to implement prophylactic education programs in the community.

Distribution of sibling species of Anopheles culicifacies s.l. and Anopheles fluviatilis s.l. and their vectorial capacity in eight different malaria endemic districts of Orissa, India

The study was undertaken in eight endemic districts of Orissa, India, to find the members of the species complexes of Anopheles culicifacies and Anopheles fluviatilis and their distribution patterns. The study area included six forested districts (Keonjhar, Angul, Dhenkanal, Ganjam, Nayagarh and Khurda) and two non-forested coastal districts (Puri and Jagatsingpur) studied over a period of two years (June 2007-May 2009). An. culicifacies A, B, C and D and An. fluviatilis S and T sibling species were reported. The prevalence of An. culicifacies A ranged from 4.2-8.41%, B from 54.96-76.92%, C from 23.08-33.62% and D from 1.85-5.94% (D was reported for the first time in Orissa, except for occurrences in the Khurda and Nayagarh districts). The anthropophilic indices (AI) were 3.2-4.8%, 0.5-1.7%, 0.7-1.37% and 0.91-1.35% for A, B, C and D, respectively, whereas the sporozoite rates (SR) were 0.49-0.54%, 0%, 0.28-0.37% and 0.41-0.46% for A, B, C and D, respectively. An. fluviatilis showed a similarly varied distribution pattern in which S was predominant (84.3% overall); its AI and SR values ranged from 60.7-90.4% and 1.2-2.32%, respectively. The study observed that the co-existence of potential vector sibling species of An. culicifacies (A, C and D) and An. fluviatilis S (> 50%) was responsible for the high endemicity of malaria in forested districts such as Dhenkanal, Keonjhar, Angul, Ganjam, Nayagarh and Khurda (> 5% slide positivity rate). Thus, the epidemiological scenario for malaria is dependent on the distribution of the vector sibling species and their vectorial capacity.

Occurrences of anti-Toxoplasma gondii and anti-Neospora caninum antibodies in sheep from four districts of Tocantins state, Brazilian Legal Amazon Region

Toxoplasmosis and neosporosis have been recognized as economically important diseases with considerable impact on the livestock industry. Little is known concerning the occurrence of Toxoplasma gondii and Neospora caninum in sheep from Tocantins state, Brazil. Here, we investigated antibodies against these parasites and associated factors in 182 sheep from Araguaína, Santa Terezinha do Tocantins, Arguianópolis and Palmeiras do Tocantins districts, Tocantins. Sheep sera were assayed for T. gondii and N. caninum IgG antibodies by indirect fluorescence antibody test (IFAT), using cut-off point at a dilution of 1:40 and 1:25 respectively. The prevalence of seropositive animal for T. gondii was 13.74% and 13.74% for N. caninum. None of the characteristics studied including reproductive problems, presence of cats, presence of dogs and veterinary care (p>0.05) was associated with occurrence of T. gondii or N. caninum infection. Only breed was identified as associated factor for the occurrence of toxoplasmosis in sheep (p<0.05). The present study is the first report on serum occurrence of T. gondii and N. caninum in sheep from the state of Tocantins, Brazil.