As ouvidorias de sa��de p��blica no Estado do Par��: uma rela����o dial��gica entre governo, medicina e sociedade?

Esta Disserta����o tematiza sobre as ouvidorias de sa��de p��blica como um espa��o de participa����o cidad�� na gest��o administrativa, indagando se acontece uma rela����o dial��gica entre governo, medicina e sociedade, na perspectiva de aproxima����o da gest��o e servi��os prestados pela sa��de p��blica, de acordo com a Pol��tica de Humaniza����o do SUS. A hip��tese norteadora do estudo �� a de que com a participa����o popular, atrav��s das ouvidorias, s��o produzidas transforma����es nas pr��ticas desempenhadas pelos diferentes atores na configura����o das pr��ticas no cuidado em sa��de, em aproxima����o com os princ��pios e estrat��gias de Humaniza����o do Sistema ��nico de Sa��de, com capacidade de tensionar os pap��is constitu��dos no contexto biom��dico que se constituiu como predominante, a partir dos fins do s��culo XVII. Objetiva identificar as contribui����es efetivas da atua����o das ouvidorias de sa��de p��blica, na constru����o e execu����o de novas pr��ticas da sa��de, de acordo com a PNH. Foi desenvolvida em quatro cap��tulos, que tratam da participa����o social e da hist��ria das ouvidorias de sa��de p��blica, no Brasil, do SUS e da Pol��tica de Humaniza����o na Sa��de,da pesquisa propriamente dita e as considera����es finais. A investiga����o, com desenho qualitativo e explorat��rio, visa a conhecer, descrever e compreender a realidade da pol��tica de humaniza����o nas institui����es de sa��de p��blica no estado do Par��, por interm��dio das demandas das ouvidorias em um processo de amplia����o de mecanismos democr��ticos de controle social das pol��ticas p��blicas de sa��de. Entre os resultados alcan��ados nesta pesquisa, cita-se que as Ouvidorias de Sa��de P��blica t��m o claro compromisso de se tornarem institui����es de excel��ncia e cumprirem o seu papel na promo����o do di��logo entre o estado, a medicina e a sociedade. Quanto a esse processo colaborar na constru����o de novas pr��ticas em sa��de, n��o se identificam grandes efetividades, por��m, serve como valor simb��lico de representatividade de acessibilidade de comunica����o e di��logo sem burocracia entre sociedade e gest��o p��blica �� significativa. Observa-se a necessidade da gest��o da sa��de p��blica, no sentido de se organizar em suas v��rias inst��ncias.

A import��ncia da integra����o universidade e servi��os de sa��de

Brazilian Curricular Directrix demand changes on teaching dental surgeon, proposing new scenes of learning and study other than the classroom. So, pedagogic projects should search for integral and adequate education by relating teaching, research and extension/assistance. This paper discusses the importance of university extension activities on teaching Odontology students and relates the experience of Ara��atuba Dental School of S��o Paulo State University. This school develops some university extension activities since the 60s by Dental Service Beyond School (SEMO, in portuguese). Among the activities included by SEMO there are several projects, such as: ���Program of Dental Attention for Pregnant Women���, ���Program of Dental Attention to Juvenile Foundation at Ara��atuba���, ���Always Smiling ��� Health Promotion for Institutionalized Elderlies���, ���Santa Clara de Assis Nursery School Program of Dental Attention���, and "Promotion of oral health in Ara��atuba public kindergarten schools���. These programs give the student knowledge of structure dimensions of public health services; chance to participate on attendance for the population, comprehension of oral health politics, and the role of dental surgeon in social context, where these students will work in the future. The positive impact obtained with these services is perceived by students return. Most of them feel satisfied about the experience lived there.

A sa��de e seu direito sob o olhar do usu��rio

Coordena����o de Aperfei��oamento de Pessoal de N��vel Superior (CAPES)

Schistosomiasis control in a primary health care system

The successful implementation of a Primary Health Care System (PHC) in any country depends primarily on the ability to adapt its concepts and principles to the country's culture and development stage. Thus, the PHC system should reflect a balanced interaction between available resources, such as health manpower capabilities, and the nature and magnitude of the health problems. In addition, PHC should be viewed as the inlet to a multi-level pyramidal health system which caters to both community and individual needs in a balanced way. The adage that Ministries of Health should "work with and for the people" in health development, is especially true in the area of PHC, and hence, the health policy should aim to integrate health services in community development and involve people in its planning, implementation and evaluation.

Department of Health Annual Report 2011

Annual Report 2011 Undoubtedly, 2011 was a year of significant change in the health services. The general election brought a new Government and a new direction and policies in healthcare with a commitment to introduce Universal Health Insurance. The health system is being reformed so as to guarantee equal access to healthcare for all, achieved through a single-tier system enabling access based on need and not on ability to pay. Click here to download PDF 353kb ����

The Path to Universal Healthcare: White Paper on Universal Health Insurance

���� The Government is committed to ending the unfair, unequal and inefficient two-tier health system and to introducing a single-tier system, supported by universal health insurance The Government will achieve a single-tier system via a multi-payer model of universal health insurance (UHI), in line with the Programme for Government (PfG), involving competing private health insurers and a State-owned VHI. UHI will be gradually rolled out over several years, with full implementation by 2019 at the latest. Click here to download the White Paper (PDF, 1.5mb) Read the UHI Explained document (PDF, 200kb). See the stakeholder briefing (PDF, 400kb)

Diversity and regional inequalities: Assessing the outcomes of the Spanish 'System of Health Care Services'

The consolidation of a universal health system coupled with a process of regionaldevolution characterise the institutional reforms of the National Health System(NHS) in Spain in the last two decades. However, scarce empirical evidence hasbeen reported on the effects of both changes in health inputs, outputs andoutcomes, both at the country and at the regional level. This paper examinesthe empirical evidence on regional diversity, efficiency and inequality ofthese changes in the Spanish NHS using cross-correlation, panel data andexpenditure decomposition analysis. Results suggest that besides significantheterogeneity, once we take into account region-specific needs there is evidenceof efficiency improvements whilst inequalities in inputs and outcomes, althoughmore visible , do not appear to have increased in the last decade. Therefore,the devolution process in the Spanish Health System offers an interesting casefor the experimentation of health reforms related to regional diversity butcompatible with the nature of a public NHS, with no sizeable regionalinequalitiest.

Phase voltage control and filtering in a converter-fed single-phase customer-end system of the LVDC distribution network

In recent years, the network vulnerability to natural hazards has been noticed. Moreover, operating on the limits of the network transmission capabilities have resulted in major outages during the past decade. One of the reasons for operating on these limits is that the network has become outdated. Therefore, new technical solutions are studied that could provide more reliable and more energy efficient power distributionand also a better profitability for the network owner. It is the development and price of power electronics that have made the DC distribution an attractive alternative again. In this doctoral thesis, one type of a low-voltage DC distribution system is investigated. Morespecifically, it is studied which current technological solutions, used at the customer-end, could provide better power quality for the customer when compared with the current system. To study the effect of a DC network on the customer-end power quality, a bipolar DC network model is derived. The model can also be used to identify the supply parameters when the V/kW ratio is approximately known. Although the model provides knowledge of the average behavior, it is shown that the instantaneous DC voltage ripple should be limited. The guidelines to choose an appropriate capacitance value for the capacitor located at the input DC terminals of the customer-end are given. Also the structure of the customer-end is considered. A comparison between the most common solutions is made based on their cost, energy efficiency, and reliability. In the comparison, special attention is paid to the passive filtering solutions since the filter is considered a crucial element when the lifetime expenses are determined. It is found out that the filter topology most commonly used today, namely the LC filter, does not provide economical advantage over the hybrid filter structure. Finally, some of the typical control system solutions are introduced and their shortcomings are presented. As a solution to the customer-end voltage regulation problem, an observer-based control scheme is proposed. It is shown how different control system structures affect the performance. The performance meeting the requirements is achieved by using only one output measurement, when operating in a rigid network. Similar performance can be achieved in a weak grid by DC voltage measurement. An additional improvement can be achieved when an adaptive gain scheduling-based control is introduced. As a conclusion, the final power quality is determined by a sum of various factors, and the thesis provides the guidelines for designing the system that improves the power quality experienced by the customer.

On the health and wellbeing of single working women without children : an analysis of scientific and lay discourse

Cette th��se examine la fa��on dont on interpr��te la sant�� et le bien-��tre des travailleuses c��libataires et sans enfant au sein de deux types de r��cits : ceux provenant d�����tudes publi��es dans des p��riodiques (r��cits scientifiques) et ceux provenant d���entrevues qualitatives avec des membres de ce groupe (r��cits profanes). Sur le plan d��mographique, leur nombre est significatif; elles repr��sentent 28% des employ��es canadiennes. Par contre, leur sant��/bien-��tre est peu visible dans les ��crits de recherche. Dans les sciences sociales, plusieurs ��tudes portent sur l���exp��rience parfois ��prouvante d�����tre un adulte c��libataire vivant dans une culture orient��e sur le couple et la famille. Elles mettent l���accent sur le stigma associ�� �� ce statut. Certains sugg��rent m��me que les pratiques de recherche peuvent contribuer �� la perp��tuation de repr��sentations n��gatives �� l�����gard des c��libataires. En ayant un profil qui pourrait ��tre symbolique d���une d��viation vis-��-vis des attentes normatives entourant la vie de couple ou de famille, les travailleuses c��libataires et sans enfant semblent un point de rep��re utile pour ��valuer cette derni��re possibilit��. S���attarder autant aux r��cits scientifiques que profanes permettrait d���explorer les tensions et convergences entre eux. Suivant cet objectif, un ��chantillon de 32 articles scientifiques et de 22 retranscriptions d���entrevues ont ��t�� analys��s selon une approche d���analyse de discours guid��e par les concepts de r��pertoire interpr��tatif (une fa��on coh��rente d���aborder un sujet donn��) et de position du sujet (une identit�� mise en ��vidence par une fa��on de parler ou d�����crire). Trois articles ont ��merg�� de cette recherche. Suite �� une analyse des th��mes communs utilis��s dans l���interpr��tation de la sant��/du bien-��tre du groupe en question, un r��pertoire interpr��tatif surnomm�� la famille comme r��f��rence a ��t�� identifi��. Ce r��pertoire expliquerait notamment la tendance observ��e d���expliquer leur sant��/bien-��tre en r��f��rant aux ��tats et aux charact��ristiques d�����tre parent ou partenaire. Cette pratique peut avoir l���effet de voiler leur vie priv��e ou de la construire comme ��tant relativement appauvrie. L���article 2 examine comment les membres de ce groupe construisent leur propre bien-��tre. Il identifie la notion d�����quilibre entre plusieurs sph��res de vie et une identit�� de femme dynamique comme ��l��ments centraux aux r��cits sur leur bien-��tre. Ces derniers vont �� l���encontre de la perception des c��libataires ou des personnes sans enfant comme ayant des vies moins ��panouies ou enrichies et qui ne sont pas touch��es par des questions de conciliation travail-vie personnelle. Le troisi��me article rassemble les deux types de r��cits autour des sujets de l���emploi et du statut de c��libataire en lien avec le bien-��tre. Il met en ��vidence de nombreuses similarit��s et divergences, et th��orise la fonction de ces diverses constructions. En conclusion, j���avance qu���une perspective plus critique face au statut de couple ou familial et de ses aspects normatifs pourrait offrir �� la recherche en sant�� publique un point de r��flexivit�� �� d��velopper davantage.

Validation of an instrument for assessing the medicolegal death investigation system: A public health approach

Background. This study validated the content of an instrument designed to assess the performance of the medicolegal death investigation system. The instrument was modified from Version 2.0 of the Local Public Health System Performance Assessment Instrument (CDC) and is based on the 10 Essential Public Health Services. ^ Aims. The aims were to employ a cognitive testing process to interview a randomized sample of medicolegal death investigation office leaders, qualitatively describe the results, and revise the instrument accordingly. ^ Methods. A cognitive testing process was used to validate the survey instrument's content in terms of the how well participants could respond to and interpret the questions. Twelve randomly selected medicolegal death investigation chiefs (or equivalent) that represented the seven types of medicolegal death investigation systems and six different state mandates were interviewed by telephone. The respondents also were representative of the educational diversity within medicolegal death investigation leadership. Based on respondent comments, themes were identified that permitted improvement of the instrument toward collecting valid and reliable information when ultimately used in a field survey format. ^ Results. Responses were coded and classified, which permitted the identification of themes related to Comprehension/Interpretation, Retrieval, Estimate/Judgment, and Response. The majority of respondent comments related to Comprehension/Interpretation of the questions. Respondents identified 67 questions and 6 section explanations that merited rephrasing, adding, or deleting examples or words. In addition, five questions were added based on respondent comments. ^ Conclusion. The content of the instrument was validated by cognitive testing method design. The respondents agreed that the instrument would be a useful and relevant tool for assessing system performance. ^

Delivery of a stringent dimerizer-regulated gene expression system in a single retroviral vector

Small molecule-regulated transcription has broad utility and would benefit from an easily delivered self-contained regulatory cassette capable of robust, tightly controlled target gene expression. We describe the delivery of a modified dimerizer-regulated gene expression system to cells on a single retrovirus. A transcription factor cassette responsive to the natural product dimerizer rapamycin was optimized for retroviral delivery by fusing a highly potent chimeric activation domain to the rapamycin-binding domain of FKBP-rapamycin-associated protein (FRAP). This improvement led to an increase in both the potency and maximal levels of gene expression induced by rapamycin, or nonimmunosuppressive rapamycin analogs. The modified transcription factor cassette was incorporated along with a target gene into a single rapamycin-responsive retrovirus. Cell pools stably transduced with the single virus system displayed negligible basal expression and gave induction ratios of at least three orders of magnitude in the presence of rapamycin or a nonimmunosuppressive rapamycin analog. Levels of induced gene expression were comparable to those obtained with the constitutive retroviral long terminal repeat and the single virus system performed well in four different mammalian cell lines. Regulation with the dimerizer-responsive retrovirus was tight enough to allow the generation of cell lines displaying inducible expression of the highly toxic diphtheria toxin A chain gene. The ability to deliver the tightly inducible rapamycin system in a single retrovirus should facilitate its use in the study of gene function in a broad range of cell types.

Single-Server Queueing System with Markov-Modulated Arrivals and Service Times

Key words: Markov-modulated queues, waiting time, heavy traffic.

The Affordable Care Act and the Transformation of US Health Care

The neoliberal period was accompanied by a momentous transformation within the US health care system.�� As the result of a number of political and historical dynamics, the healthcare law signed by President Barack Obama in 2010 ���the Affordable Care Act (ACA)��� drew less on universal models from abroad than it did on earlier conservative healthcare reform proposals. This was in part the result of the influence of powerful corporate healthcare interests. While the ACA expands healthcare coverage, it does so incompletely and unevenly, with persistent uninsurance and disparities in access based on insurance status. Additionally, the law accommodates an overall shift towards a consumerist model of care characterized by high cost sharing at time of use. Finally, the law encourages the further consolidation of the healthcare sector, for instance into units named ���Accountable Care Organizations��� that closely resemble the health maintenance organizations favored by managed care advocates. The overall effect has been to maintain a fragmented system that is neither equitable nor efficient. A single payer universal system would, in contrast, help transform healthcare into a social right.

[principles Of Universality, Comprehensiveness And Equity In A Hearing Health Care Service].

This article analyzed whether the practices of hearing health care were consistent with the principles of universality, comprehensiveness and equity from the standpoint of professionals. It involved qualitative research conducted at a Medium Complexity Hearing Health Care Center. A social worker, three speech therapists, a physician and a psychologist constituted the study subjects. Interviews were conducted as well as observation registered in a field diary. The thematic analysis technique was used in the analysis of the material. The analysis of interviews resulted in the construction of the following themes: Universality and access to hearing health, Comprehensive Hearing Health Care and Hearing Health and Equity. The study identified issues that interfere with the quality of service and run counter to the principles of Brazilian Unified Health System. The conclusion reached was that a relatively simple investment in training and professional qualification can bring about significant changes in order to promote a more universal, comprehensive and equitable health service.

[strategies For Integration Of Health Care Practices And Sanitary Surveillance In The Context Of The Implementation Of Rede Cegonha - A Brazilian Mother And Infant Health Care Network].

Mother and infant mortality has been the scope of analysis throughout the history of public health in Brazil and various strategies to tackle the issue have been proposed to date. The Ministry of Health has been working on this and the Rede Cegonha strategy is the most recent policy in this context. Given the principle of comprehensive health care and the structure of the Unified Health System in care networks, it is necessary to ensure the integration of health care practices, among which are the sanitary surveillance actions (SSA). Considering that the integration of health care practices and SSA can contribute to reduce mother and infant mortality rates, this article is a result of qualitative research that analyzed the integration of these actions in four cities in the State of S��o Paulo/Brazil: Campinas, Indaiatuba, Jaguari��na and Santa B��rbara D'Oeste. The research was conducted through interviews with SSA and maternal health managers, and the data were evaluated using thematic analysis. The results converge with other studies, identifying the isolation of health care practices and SSA. The insertion of SSA in collectively-managed areas appears to be a potential strategy for health planning and implementation of actions in the context under scrutiny.