Qualidade no Serviço Nacional de Saúde : evolução recente e perspectivas futuras

RESUMO - A qualidade é um pilar fundamental de qualquer sector de actividade. No sector da saúde, a qualidade deixou de ser um factor opcional e tornou-se uma prioridade, uma exigência e um requisito de enorme importância na gestão das organizações de saúde, representando a sua responsabilidade, ética e respeito pelos cidadãos que a elas recorrem. O crescente interesse pelas questões da qualidade segue, ao longo das últimas décadas, uma tendência mundial nos sistemas de saúde, sendo um dos temas mais presentes no debate político e nas estratégias de saúde um pouco por todo o mundo. Porém, as abordagens à qualidade são díspares, reflectindo a sua dinâmica e o pouco consenso nesta área, o que justifica a necessidade de reflectir sobre o tema e de estudar as estratégias actualmente implementadas. Objectivos Este trabalho pretendeu apresentar uma perspectiva integrada e completa da qualidade em saúde em Portugal, contribuindo para o seu entendimento global e reflexão. Teve como finalidade estudar a sua evolução, nomeadamente a nível das políticas, das práticas e dos seus resultados, e conhecer a situação actual da qualidade nas organizações públicas de saúde nacionais, podendo assim contribuir para novas medidas nesta área. Metodologia Foram realizadas entrevistas semi-estruturadas a oito peritos portugueses na área da qualidade em saúde, seleccionados diante critérios de diversidade profissional, formação de base, tipo de instituição e localização geográfica onde exercem a sua actividade. Para as entrevistas foi elaborado um guião com perguntas sobre vários temas relacionados com a área da qualidade em saúde. As entrevistas foram gravadas e a informação foi transcrita e organizada em categorias através de uma análise de conteúdo. Para o segundo objectivo do estudo, foi construído e proposto um questionário, como projecto para investigações futuras. Resultados e Conclusões Os resultados mostraram que a qualidade é um tema muito valorizado e presente nos quadros da administração de saúde portuguesa. A sua evolução sofreu diversas mudanças, com fases de grande progresso e outras de grande indefinição. No entanto, ficou evidente que a grande divergência de opiniões justifica a necessidade de uma maior discussão e consenso a nível nacional e internacional nesta área. O futuro da qualidade em saúde em Portugal irá depender da capacidade do Departamento da Qualidade na Saúde e das organizações gerirem esta complexa área.

Uma contribuição à gestão do risco de crédito baseado no modelo Raroc - retorno ajustado ao risco de capital

A implantação do Plano Real em 1994 provocou mudanças na estrutura de receitas dos bancos brasileiros. Em épocas de altas taxas de inflação, o resultado dos bancos era composto substancialmente por rendas oriundas do financiamento da dívida interna do país e em menor parcela de outras receitas como dos empréstimos ao setor privado. Com a estabilização da economia e a globalização dos mercados financeiros mundiais, refletida na entrada de bancos estrangeiros no mercado brasileiro, as taxas de juros tenderam a diminuir, ocasionando uma mudança no foco de atuação dos Bancos que estão se concentrando na intermediação financeira. Neste projeto é apresentada a formação básica do resultado de um banco obtido com a intermediação financeira e explana-se sobre os riscos da atividade bancária. É focado o risco de crédito, abrangendo a descrição das principais metodologias de análise. Estuda-se a Resolução CMN/BACEN nO 2682 que mudou a contabilização das rendas de renegociação de dívidas e estabeleceu parâmetros mínimos para a classificação das operações de crédito alterando os critérios de constituição da provisão para créditos de liquidação duvidosa. É explicado como pode ser utilizado um modelo RARO C - Risk Adjusted Return on Capital - desenvolvido originalmente pelo Bankers Trust - para gerenciamento da Carteira de crédito de um Banco de Varejo típico. Para ilustração e considerando que no mercado brasileiro os dados estatísticos sobre operações de crédito são escassos, além de existirem dificuldades na obtenção de dados de uma Carteira de crédito real relacionadas ao sigilo bancário e estratégias de investimento, o modelo RAROC será aplicado em uma Carteira de crédito fictícia de um Banco de Varejo, especialmente criada para esse fim. O estudo não abrange os recursos necessários para a implementação do modelo, nem customização para outros tipos de Bancos, restringindo-se à análise da utilização da metodologia. Por fim, apresentamos nossas conclusões a respeito da gestão do risco do crédito baseada na utilização de um modelo RAROC.

Educação do campo e alternância :reflexões sobre uma experiência na Transamazônica/Pará

The study theme is the Rural Familiar House Program (RFHP), through the Rural Familiar House of Uruará-PA city (URFH), from 2000 to 2005. It is considered as base the education offered to the field young people, in the modality of basic education by alternation methodology between the Familiar and School Times in the two first from 5th to 8th grade classrooms. From the argument about the understanding importance and need of knowledge transmission and construction to be established in the inter-section between general references of the social reality and the subjective ones. It constitutes an educative work that both values domain of knowing and the creative capacity of each pupil. Considering that the greatest aim of the education is the human being emancipation, this thematic for the development of the documentary and field research was defined with the delimitated thematic for the educative practice-proposal in alternation, choosing the Program of the RFHs as the reference to carry out an analysis which considered fruitful in the articulation between education and educative work. This study had the objective to contribute for the debate concerning the alternation and to understand presuposals and educative practice of the RFHs what its importance for the young people and its relation with the field educational policy. For this, it was used, mainly, from analytical references of authors, such as Williams, Gramsci, Adorno, Freire, Shiva, Soares, Molina, Tonet, et. all, all were also important for the construction of this work. The studied documentary sources, as well as the verbal ones the actors also interviewed had allowed, in irreplaceable way and significantly, a critical analysis on the pedagogical proposals and the articulation among school, familiar work and education, which was carried out in the formation of URFH, the sessions of alternation between Time School and Time Family. The results are scored with the chapter construction, as they had presented themselves in several sources and the reading which was made. A reading that signals for the affirmation which is possible to overtake the emphasis on technicality, mediated in the practice-theory-practice relation, still present in the alternation, and, thus, to be able to make an educative work that intends to contribute for the young people education with capacity of being, thinking and to act actually as subjects of their history

A física no contexto da biologia molecular

Nas últimas décadas tem havido uma crescente abordagem física no estudo de moléculas e sistemas macromoleculares de interesse biológico. Essa abordagem inclui tanto aspectos experimentais quanto teóricos. de fato, há um vasto campo a ser explorado pela física nessa área. Discutimos neste texto as características gerais e formação básica do profissional interessado em ter como objeto o estudo de sistemas biomoleculares, tanto em nível de graduação como na pós-graduação. Nessa linha de pensamento, assuntos como a formação básica e os fundamentos biológicos e físicos são discutidos.

Desenvolvimento estético: entre as expectativas do professor e as possibilidades dos alunos

Pós-graduação em Artes - IA

Fabrication of nanoparticles by short-distance sputter deposition

During the past decades, tremendous research interests have been attracted to investigate nanoparticles due to their promising catalytic, magnetic, and optical properties. In this thesis, two novel methods of nanoparticle fabrication were introduced and the basic formation mechanisms were studied. Metal nanoparticles and polyurethane nanoparticles were separately fabricated by a short-distance sputter deposition technique and a reactive ion etching process. First, a sputter deposition method with a very short target-substrate distance is found to be able to generate metal nanoparticles on the glass substrate inside a RIE chamber. The distribution and morphology of nanoparticles are affected by the distance, the ion concentration and the process time. Densely-distributed nanoparticles of various compositions are deposited on the substrate surface when the target-substrate distance is smaller than 130mm. It is much less than the atoms’ mean free path, which is the threshold in previous research for nanoparticles’ formation. Island structures are formed when the distance is increased to 510mm, indicating the tendency to form continuous thin film. The trend is different from previously-reported sputtering method for nanoparticle fabrication, where longer distance between the target and the substrate facilitates the formation of nanoparticle. A mechanism based on the seeding effect of the substrate is proposed to interpret the experimental results. Secondly, in polyurethane nanoparticles’ fabrication, a mechanism is put forward based on the microphase separation phenomenon in block copolymer thin film. The synthesized polymers have formed dispersed and continuous phases because of the different properties between segments. With harder mechanical property, the dispersed phase is remained after RIE process while the continuous phase is etched away, leading to the formation of nanoparticles on the substrate. The nanoparticles distribution is found to be affected by the heating effect, the process time and the plasma power. Superhydrophilic property is found on samples with these two types of nanoparticles. The relationship between the nanostructure and the hydrophilicity is studied for further potential applications.

Dynamical study of ZnO nanocrystal and Zn-HDS layered basic zinc acetate formation from sol-gel route

We have pointed out that zinc based particles obtained from ethanolic solution of a zinc acetate derivative (zinc oxy-acetate, Zn4O(Ac)(6)) are a mixture of nanometer sized ZnO, zinc oxy-acetate, and zinc hydroxide double salt (Zn-HDS). The knowledge of the mechanisms involved in the formation of ZnO and Zn-HDS phases, and the evolution of Zn species in reaction medium was monitored in situ during 14 h by simultaneous measurements of UV-vis absorption and extended X-ray absorption fine structures (EXAFS) spectra. This spectroscopic monitoring was initialized just after the addition of an ethanolic lithium hydroxide solution ([LiOH]/[Zn] = 0. 1) to the reaction medium kept under controlled temperature (40 degrees C). This study points out the first direct evidence of the reaction between ZnO nanoparticles and unreacted zinc oxy-acetate to form a Zn-HDS phase. The dissolution of ZnO and the reprecipitation of Zn-HDS are induced by the gradual release of water mainly produced by ethanol esterification well evidenced by gas chromatography coupled to mass spectroscopy and FT-IR measurements.

The physical education teacher's competences and professional formation

This study has as objective identifies the necessary competences to the physical education teachers of the basic education, in the teachers` of the public network of teaching of the Sao Paulo state perspective, licentiates and exits of the Physical Education School and Sport of the Sao Paulo University starting from 1995. It is a qualitative research, of nature no experimental, consisting of two studies (diagnostic and deepening). As instruments, questionnaire and semi-structured interview were used. It happened what the teachers judge importantly mobilize determined knowledges placed in a hierarchy or associated during the teaching practice, such as: knowledges pedagogic-educational, technical knowledges and cultural luggage, inserted in the current context and considering the cultural, social, political, economical and education transformations occurred along the history. There was shown up in this study the relevance of the formation continued for the teachers of Physical Education, who found her essential and basic added to the initial formation.

Macrocycle formation through carbon acid-formaldehyde condensation reactions of bis(propane-1,2-diamine)- and bis (2-methylpropane-1,2-diamine)-copper(II) ions

The reaction of the bis(1,2-diamine) copper(II) complexes of racemic propane-1,2-diamine (pn) and 2-methylpropane-1,2-diamine (dmen) with formaldehyde and nitroethane in methanol under basic conditions yields minor macrocyclic condensation products in addition to the major acyclic products. Where C-pendant methyl groups on the pair of coordinated diamines are in cis dispositions, the first -NH-CH2-C(CH3)(NO2)-CH2-NH- ring formation occurs at amine pairs distant from these C-methyl substituents, and further reaction to yield a macrocycle is not observed. However, where the C-methyl substituents are in trans dispositions, the chemistry proceeds to yield the macrocycle. Commencing with pn, trans-(6,13-diammonio-2,6,9,13-tetramethyl-1,4,7,10-tetraazacyclotetradecane)copper(II) perchlorate formed and crystallized in the space group P2(1)/n, with a 9.782(2), b 9.2794(6), c 17.017(4) Angstrom, beta 103.24(1)degrees. The copper ion is found in a square-planar environment, with the two methyl groups of the pn residues and the pairs of introduced pendant groups all in trans arrangements.

Trans-resveratrol inhibits early blood vessel formation (Vasculogenesis) without impairment of embryonic growth

Resveratrol is a stilbene compound found in grapes and other sources. In this study we examined the effects of trans-resveratrol (4.38-438 mu M/implant) in the vasculogenesis of yolk-sac membranes and its capacity to improve chick embryo growth. High concentrations of the stilbene (43.8-438 mu M) significantly inhibited early vessel formation, decreasing the percentage vitelline vessels of 3.5-day embryos by 50% compared to the control. In addition, basic fibroblast growth factor-stimulated vasculogenesis (140% of vessels as compared to control) was partially reversed by t-resveratrol (35% of inhibition) and treatments with cyclooxygenase inhibitors (acetylsalicylic acid and indomethacin) as well a protein-kinase C (PKC) activator (phorbol-12,13-dibutyrate) decreased the vessel number to 60%, 50%, and 44%, respectively. Treatments with t-resveratrol (4.38-43.8 mu M/implant) significantly increased the body length of embryos incubated in vitro uncoupled from any impairment in the body shape or detectable embryotoxic effect. We suggest that the antivasculogenic activity and the enhancement in embryonic growth promoted by non acute treatments with t-resveratrol were, at least in part, due to PKC inhibition. We suggest that t-resveratrol can be usable not only as a reliable functional nutriment, but also is useful for the development of prophylactic and/or therapeutic agents for treatment of angiogenic-degenerative diseases.

Influence of synthesis parameters on the formation of mesoporous SAPOs

The synthesis and characterization of high-quality mesoporous silicoaluminophosphates (SAPOs) with a hexagonally arranged pore structure and a good thermal stability are described. The influence of some important synthesis parameters including temperature, time, and Si content in the synthesis gel was examined. The local environments of Al, P, and Si were investigated using MAS NMR spectroscopy. The acidity of the mesoporous SAPOs was studied and compared with those of aluminosilicate MCM-41 and SAPO-5. Results show that both the synthesis temperature and time have a significant impact on the formation of mesoporous SAPOs, whereas the presence of Si in the synthesis gel has a direct influence on the structure type and the quality of the resulting mesoporous SAPO materials. High-quality mesoporous SAPOs can be synthesized from the synthesis gels with Si/Al ratio smaller than 0.5 in the presence of cationic surfactants in a weakly basic aqueous solution. The mesoporous SAPO materials show interesting acidity properties, possessing both strong and mild sites. (C) 2002 Elsevier Science Inc. All rights reserved.

Endothelial nitric oxide synthase gene transfer restores endothelium-dependent relaxations and attenuates lesion formation in carotid arteries in apolipoprotein E-deficient mice.

Nitric oxide (NO) and monocyte chemoattractant protein-1 (MCP-1) exert partly opposing effects in vascular biology. NO plays pleiotropic vasoprotective roles including vasodilation and inhibition of platelet aggregation, smooth muscle cell proliferation, and endothelial monocyte adhesion, the last effect being mediated by MCP-1 downregulation. Early stages of arteriosclerosis are associated with reduced NO bioactivity and enhanced MCP-1 expression. We have evaluated adenovirus-mediated gene transfer of human endothelial NO synthase (eNOS) and of a N-terminal deletion (8ND) mutant of the MCP-1 gene that acts as a MCP-1 inhibitor in arteriosclerosis-prone, apolipoprotein E-deficient (ApoE(-/-)) mice. Endothelium-dependent relaxations were impaired in carotid arteries instilled with a noncoding adenoviral vector but were restored by eNOS gene transfer (p < 0.01). A perivascular collar was placed around the common carotid artery to accelerate lesion formation. eNOS gene transfer reduced lesion surface areas, intima/media ratios, and macrophage contents in the media at 5-week follow-up (p < 0.05). In contrast, 8ND-MCP-1 gene transfer did not prevent lesion formation. In conclusion, eNOS gene transfer restores endothelium-dependent vasodilation and inhibits lesion formation in ApoE(-/-) mouse carotids. Further studies are needed to assess whether vasoprotection is maintained at later disease stages and to evaluate the long-term efficacy of eNOS gene therapy for primary arteriosclerosis.

A novel role for proline- and acid-rich basic region leucine zipper (PAR bZIP) proteins in the transcriptional regulation of a BH3-only proapoptotic gene.

Proline- and acid-rich (PAR) basic region leucine zipper (bZIP) proteins thyrotroph embryonic factor (TEF), D-site-binding protein (DBP), and hepatic leukemia factor have been involved in neurotransmitter homeostasis and amino acid metabolism. Here we demonstrate a novel role for these proteins in the transcriptional control of a BH3-only gene. PAR bZIP proteins are able to transactivate the promoter of bcl-gS. This promoter is particularly responsive to TEF activation and is silenced by NFIL3, a repressor that shares the consensus binding site with PAR bZIP proteins. Consistently, transfection of TEF induces the expression of endogenous bcl-gS in cancer cells, and this induction is independent of p53. A naturally occurring variant of DBP (tDBP), lacking the transactivation domain, has been identified and shown to impede the formation of active TEF dimers in a competitive manner and to reduce the TEF-dependent induction of bcl-gS. Of note, treatment of cancer cells with etoposide induces TEF activation and promotes the expression of bcl-gS. Furthermore, blockade of bcl-gS or TEF expression by a small interfering RNA strategy or transfection with tDBP significantly reduces the etoposide-mediated apoptotic cell death. These findings represent the first described role for PAR bZIP proteins in the regulation of a gene involved in the execution of apoptosis.

The naturally occurring food mycotoxin fumonisin B1 impairs myelin formation in aggregating brain cell culture.

The effects of subchronical applications of the mycotoxin Fumonisin B1 (FB1) were analyzed in vitro, using aggregating cell cultures of fetal rat telencephalon as a model. As cells in the aggregates developed from an immature state to a highly differentiated state, with synapse and compact myelin formation, it was possible to study the effects of FB1 at different developmental stages. The results showed that FB1 did not cause cell loss and it had no effects on neurons. However it decreased strongly the total content of myelin basic protein, the main constituent of the myelin sheath, during the myelination period (DIV 18-28). The loss of myelin was not accompanied by a loss of oligodendrocytes, the myelinating cells. However FB1 had effects on the maturation of oligodendrocytes, as revealed by a decrease in the expression of galactocerebroside, and on the compaction of myelin, as shown by a reduction of the expression of the mnyelin/oligodendrocyte glycoprotein MOG. The content of the cytoskeletal component glial fibrillary acidic protein (GFAP) was decreased in differentiated astrocytes, exclusively, while neurons were not affected by 40 microM of FB1 applied continuously for 10 days. In summary, FB1 selectively affected glial cells. In particular, FB1 delayed oligodendrocyte development and impaired myelin formation and deposition.