Usuários de um centro de atenção psicossocial e sua vivência com a doença mental

Tendo em vista as mudanças na atenção psiquiátrica, este estudo teve por objetivo conhecer a opinião da população atendida em um CAPS sobre o tratamento, a convivência com a doença mental e suas implicações psicossociais, relacionando estes indicadores com seu perfil sociodemográfico e clínico. Realizou-se um estudo exploratório descritivo, onde 65 portadores de transtornos mentais em tratamento no CAPS de Pindamonhangaba-SP e 53 familiares responderam a um questionário semi-estruturado. Os resultados mostraram que portadores de transtornos mentais e familiares reconhecem o quanto a doença mudou suas vidas, mas as opiniões divergem quanto ao grau de dificuldade na realização das atividades diárias. Apesar dos anos de tratamento desta atenção individualizada extra hospitalar, os usuários conhecem pouco sobre sua doença. Observou-se que 62% têm doenças severas, porém, ambos os grupos manifestam uma capacidade especial para enfrentar as adversidades. O estudo contribui com informações importantes para a prática da enfermagem em saúde mental.

Inspection Intensity and Market Structure, October 2005

An investigation of financing an inspection policy while allowing the enforcement of a market regulation is described. A simple model shows that the intensity of controls depends on the market structure. Under a given number of firms, the per-firm probability of controls is lower than one, since firms’ incentive to comply with regulation holds under positive profits. In this case, a lump-sum tax is used for limiting distortions coming from financing with a fixed fee. Under free entry, the per-firm probability of controls is equal to one, and only a fixed fee that prevents excess entry is used to finance inspection.

O Centro de Atenção Psicossocial no cotidiano dos seus usuários

O estudo teve por objetivo compreender o cotidiano de usuários de um Centro de Atenção Psicossocial (CAPS). Trata-se de um estudo qualitativo, tendo como referencial teórico-metodológico a sociologia fenomenológica de Alfred Schutz. O campo do estudo foi um CAPS localizado em Porto Alegre e os sujeitos entrevistados constituíram-se em 13 usuários. A coleta de dados ocorreu entre abril e junho de 2008, por meio de entrevista com uma questão norteadora. Na análise compreensiva dos depoimentos, emergiram cinco categorias concretas e este artigo relata sobre a categoria denominada: Os usuários consideram o CAPS como uma dimensão do seu cotidiano. Com essa pesquisa pôde-se compreender as concepções que os usuários têm acerca do seu cotidiano, demonstrando que estão (re)adquirindo o convívio social em diversos espaços da sociedade. Considera-se que os CAPS estão promovendo, além do atendimento, a reabilitação psicossocial dos seus usuários.

Os desafios da integralidade em um Centro de Atenção Psicossocial e a produção de projetos terapêuticos

Este estudo tem por objeto a produção dos projetos terapêuticos realizados pela equipe de um Centro de Atenção Psicossocial - CAPS III. Considera o processo de criação e expansão do Sistema Único de Saúde - SUS e da Reforma Psiquiátrica do país. Nesse contexto, os trabalhadores têm o desafio de produzir um cuidado a partir de um projeto terapêutico individual que considere as necessidades das pessoas e seu contexto de vida real. O objetivo do estudo foi analisar e descrever as potencialidades e dificuldades da equipe na construção dos projetos terapêuticos tendo como base o método cartográfico e a técnica do grupo focal, do qual participaram trabalhadores de um CAPS III do município de Diadema - SP. Na análise realizada a partir dos dados provenientes das discussões nos grupos focais, identificamos, sobretudo, a cisão entre a equipe noturna e a diurna e a falta de espaços sistemáticos de conversa para elaboração e discussão dos projetos terapêuticos.

Descrição de oferta e consumo dos psicofármacos em Centros de Atenção Psicossocial na Região Sul brasileira

A descrição do consumo e da oferta de psicofármacos nos Centros de Atenção Psicossocial (CAPS) é relevante para a efetividade da assistência dos serviços de saúde mental. Objetivou-se descrever o consumo e a oferta destes em CAPS dos tipos I e II na Região Sul do Brasil. Trata-se de um estudo de delineamento transversal, no qual foram pesquisados, em maio e junho de 2006, aspectos estruturais desse serviço, através dos prontuários de 1.162 usuários e de questionários respondidos por 30 coordenadores dos CAPS em que esses usuários encontram-se em acompanhamento. Identificaram-se usuários predominantemente do sexo feminino, adultos de meia-idade, de baixa condição econômica, majoritariamente com o diagnóstico de depressão maior e o consumo de antidepressivos. Constatou-se também que pode haver carência de distribuição e fornecimento de psicofármacos na rede do SUS, o que prejudica a terapia medicamentosa desse serviço especializado de saúde mental, diante das condições socioeconômicas dos usuários.

Produção científica sobre os Centros de Atenção Psicossocial

Este estudo objetivou apresentar uma visão panorâmica da produção científica sobre os Centros de Atenção Psicossocial (CAPS). Trata-se de revisão bibliográfica a partir das bases de dados LILACS, MEDLINE e SciELO. Foram selecionadas 68 referências. Dessas, a maioria era de artigos de periódicos (88,24%) e de trabalhos relacionados à conclusão de cursos de pós-graduação (10,29%); 75% das referências foram incluídas a partir do ano de 2003. Dentre os objetivos mais frequentes, destacam-se: a análise e avaliação da nova proposta assistencial em saúde mental, representada pela Reforma Psiquiátrica e pelo CAPS, e a análise dos profissionais de saúde mental e suas expectativas quanto aos serviços. Espera-se que a presente revisão contribua para refletir caminhos e implicações que (re)configurem novos trabalhos científicos e práticas no cotidiano dos serviços.

¿Es posible reducir el gasto sanitario a través del subsidio a los seguros sanitarios privados? La doble cobertura sanitaria en Catalunya. Estimación de patrones de utilización de servicios sanitarios y simulación de costes asociados a la asistencia sanit

The objective of this study consists in quantifying in money terms the potential reduction in usage of public health care outlets associated to the tenure of double (public plus private) insurance. In order to address the problem, a probabilistic model for visits to physicians is specified and estimated using data from the Catalonian Health Survey. Also, a model for the marginal cost of a visit to a physician is estimated using data from a representative sample of fee-for-service payments from a major insurer. Combining the estimates from the two models it is possible to quantify in money terms the cost/savings of alternative policies which bear an impact on the adoption of double insurance by the population. The results suggest that the private sector absorbs an important volume of demand which would be re-directed to the public sector if consumers cease to hold double insurance.

Human Capital, the Structure of Production, and Growth

Recent decisions by the Spanish national competition authority (TDC) mandate payment systems to include only two costs when setting their domestic multilateral interchange fees (MIF): a fixed processing cost and a variable cost for the risk of fraud. This artificial lowering of MIFs will not lower consumer prices, because of uncompetitive retailing; but it will however lead to higher cardholders fees and, likely, new prices for point of sale terminals, delaying the development of the immature Spanish card market. Also, to the extent that increased cardholders fees do not offset the fall in MIFs revenue, the task of issuing new cards will be underpaid relatively to the task of acquiring new merchants, causing an imbalance between the two sides of the networks. Moreover, the pricing scheme arising from the decisions will cause unbundling and underprovision of those services whose costs are excluded. Indeed, the payment guarantee and the free funding period will tend to be removed from the package of services currently provided, to be either provided by third parties, by issuers for a separate fee, or not provided at all, especially to smaller and medium-sized merchants. Transaction services will also suffer the consequences that the TDC precludes pricing them in variable terms.

Caution on the storage of waters and aqueous solutions in plastic containers for hydrogen and oxygen stable isotope analysis

RATIONALE The choice of containers for storage of aqueous samples between their collection, transport and water hydrogen (2H) and oxygen (18O) stable isotope analysis is a topic of concern for a wide range of fields in environmental, geological, biomedical, food, and forensic sciences. The transport and separation of water molecules during water vapor or liquid uptake by sorption or solution and the diffusive transport of water molecules through organic polymer material by permeation or pervaporation may entail an isotopic fractionation. An experiment was conducted to evaluate the extent of such fractionation. METHODS Sixteen bottle-like containers of eleven different organic polymers, including low and high density polyethylene (LDPE and HDPE), polypropylene (PP), polycarbonate (PC), polyethylene terephthalate (PET), and perfluoroalkoxy-Teflon (PFA), of different wall thickness and size were completely filled with the same mineral water and stored for 659?days under the same conditions of temperature and humidity. Particular care was exercised to keep the bottles tightly closed and prevent loss of water vapor through the seals. RESULTS Changes of up to +5 parts per thousand for d2H values and +2.0 parts per thousand for d18O values were measured for water after more than 1?year of storage within a plastic container, with the magnitude of change depending mainly on the type of organic polymer, wall thickness, and container size. The most important variations were measured for the PET and PC bottles. Waters stored in glass bottles with Polyseal (TM) cone-lined PP screw caps and thick-walled HDPE or PFA containers with linerless screw caps having an integrally molded inner sealing ring preserved their original d2H and d18O values. The carbon, hydrogen, and oxygen stable isotope compositions of the organic polymeric materials were also determined. CONCLUSIONS The results of this study clearly show that for precise and accurate measurements of the water stable isotope composition in aqueous solutions, rigorous sampling and storage procedures are needed both for laboratory standards and for unknown samples. Copyright (c) 2012 John Wiley & Sons, Ltd.

Investigation of County Treasurers' Tax-Sale Registration Fees, June 2007

On January 2, 2007, the Ombudsman received a complaint regarding the fee that county treasurers charge registrants at annual tax sales. The complainant said generally that many of the state’s counties, especially larger ones, appeared to be charging higher fees than was thought to be allowed by law. Investigation The investigation was conducted by Assistant Ombudsman Bert Dalmer. For purposes of this report, all investigative actions are ascribed to the Ombudsman. In early 2007, the Ombudsman surveyed tax-sale registration fees in 10 of the state’s 99 counties. Interviews of 10 county treasurers and/or some of their deputies were conducted. In addition, the Ombudsman researched the Iowa Code and relevant case law. The Ombudsman also consulted with the Iowa State Auditor and the president of the Iowa State County Treasurers Association.

¿Es posible reducir el gasto sanitario a través del subsidio a los seguros sanitarios privados? La doble cobertura sanitaria en Catalunya. Estimación de patrones de utilización de servicios sanitarios y simulación de costes asociados a la asistencia

The objective of this study consists in quantifying in money terms thepotential reduction in usage of public health care outlets associatedto the tenure of double (public plus private) insurance. In order to address the problem, a probabilistic model for visits to physicians is specified and estimated using data from the Catalonian Health Survey. Also, a model for the marginal cost of a visit to a physician is estimated using data from a representative sample of fee-for-service payments from a major insurer. Combining the estimates from the two models it is possible to quantify in money terms the cost/savings of alternative policies which bear an impact on the adoption of double insurance by the population. The results suggest that the private sector absorbs an important volumeof demand which would be re-directed to the public sector if consumerscease to hold double insurance.

Transfers, social safety nets and economic growth

The role of social safety nets in the form of redistributional transfersand wage subsidies is analyzed using a simple model of criminal behavior. Itis argued that public welfare programs act as a crime--preventing ordisruption--preventing devices because they tend to increase the opportunitycost of engaging in crime or disruptive activities. It is shown that, in thepresence of a leisure choice, wage subsidies may be better than pure transfers. Using a simple growth model, it is shown that it is not optimal for the governmentto try to fully eliminate crime. The optimal size of the public welfare programis found and it is argued that public welfare should be financed with income(not lump--sum) taxes, despite the fact that income taxes are distortionary.The intuition for this result is that income taxes act as a user fee oncongested public goods and transfers can be thought of as {\it productive}public goods {\it subject to congestion}. Finally, using a cross-section of 75 countries, the partial correlation betweentransfers and growth is shown to be significantly positive.

Price regulation of plastic money: A critical assessment of Spanish rules

Recent decisions by the Spanish national competition authority (TDC) mandate paymentsystems to include only two costs when setting their domestic multilateral interchange fees(MIF): a fixed processing cost and a variable cost for the risk of fraud. This artificiallowering of MIFs will not lower consumer prices, because of uncompetitive retailing; but itwill however lead to higher cardholders fees and, likely, new prices for point of saleterminals, delaying the development of the immature Spanish card market. Also, to the extent that increased cardholders fees do not offset the fall in MIFs revenue, the task of issuing new cards will be underpaid relatively to the task of acquiring new merchants, causing an imbalance between the two sides of the networks. Moreover, the pricing scheme arising from the decisions will cause unbundling and underprovision of those services whose costs are excluded. Indeed, the payment guarantee and the free funding period will tend to be removed from the package of services currently provided, to be either provided by third parties, by issuers for a separate fee, or not provided at all, especially to smaller and medium-sized merchants. Transaction services will also suffer the consequences that the TDC precludes pricing them in variable terms.

The provision on non-audit services by auditors: Let the market evolve and decide

The provision of non-audit services by auditors to their auditclients reduces total costs, increases technical competence and motivates more intense competition. Furthermore, theseservices do not necessarily damage auditor independence nor the quality of non-audit services. This assessment leads to recommending that legislative policy should aim at facilitating the development and use of the safeguardsprovided by the free action of market forces. Regulation should thus aim to enable the parties-audit firms, self-regulatory bodies and audit clients-to discover through competitive market interaction both the most efficient mix of services and the corresponding quality safeguards, adjusting for the costs and benefits of each possibility. Particular emphasis is placed on the role played by fee income diversification and the enhancement, through disclosurerules, of market incentives to diversify.

Electronic Payments for Driver's Licensing Transactions,December 31, 2008

House File 2196 required the Department of Transportation (DOT) to study the acceptance of electronic payments at its customer service sites and sites operated by county treasurers. Specifically the legislation requires the following: “The department of transportation shall review the current methods the department employs for the collection of fees and other revenues at sites operated by county treasurers under chapter 321M and at customer service sites operated by the department. In conducting its review, the department, in cooperation with the treasurer of state, shall consider providing an electronic payment option for all of its customers. The department shall report its findings and recommendations by December 31, 2008, to the senate and house standing committees on transportation regarding the advantages and disadvantages of implementing one or more electronic payment systems.” This review focused on estimating the costs of providing an electronic payment option for customers of the DOT driver’s license stations and those of the 81 county treasurers. Customers at these sites engage in three primary financial transactions for which acceptance of electronic payments was studied: paying for a driver’s license (DL), paying for a non-operator identification card (ID), and paying certain civil penalties. Both consumer credit cards and PIN-based debit cards were reviewed as electronic payment options. It was assumed that most transactions would be made using a consumer credit card. Credit card companies charge a fee for each transaction for which they are used. The amount of these fees varies among credit card companies. The estimates for credit card fees used in this study were based on the State Treasurer of Iowa’s current credit card contract, which is due to expire in September 2009. Since credit card companies adjust their fees each year, estimates were based on the 2008 fee schedule. There is also a fee for the use of PIN-based debit cards. The estimates for PIN-based debit card transactions were based on information provided by Wells Fargo Merchant Services for current fees charged by debit card networks. Credit and debit card transactions would be processed through vendor-provided hardware and software. The costs would be determined through the competitive bidding process since several vendors provide this function; therefore, these costs are not reflected in this document.