Análise dos custos assistenciais de uma operadora de plano de saúde no Brasil

The relevance of rising healthcare costs is a main topic in complementary health companies in Brazil. In 2011, these expenses consumed more than 80% of the monthly health insurance in Brazil. Considering the administrative costs, it is observed that the companies operating in this market work, on average, at the threshold between profit and loss. This paper presents results after an investigation of the welfare costs of a health plan company in Brazil. It was based on the KDD process and explorative Data Mining. A diversity of results is presented, such as data summarization, providing compact descriptions of the data, revealing common features and intrinsic observations. Among the key findings was observed that a small portion of the population is responsible for the most demanding of resources devoted to health care

Avaliação do impacto do plano de expansão da rede federal na qualidade dos institutos federais de educação segundo indicadores de desempenho

The Expansion Plan of the Federal Network of Vocational Education foresees the construction of 860 new units of instruction until 2020, representing a strong growth against the 140 existing units prior to its disclosure by Federal Government of Brazil, in 2005. The Federal Institutes of Education, Science and Technology have been performing the expansion while experiencing the shortcomings and challenges of units still in development, created in previous phases of the Plan. The quality of the services of these institutions has been evaluated by the control bodies, which require the submission of performance indicators in annual management reports of institutions under their jurisdiction. In this context of expansion process, particularly, is desirable to identify possible changes in quality standards. Thus, this research was motivated by the following problem: there was difference in the performance of the Federal Institutes of Education, Science and Technology after the inauguration of the first units of phase II of the Expansion Plan of the Federal Network of Vocational Education? This is an exploratory-descriptive, ex-post-facto, quantitative approach research, which aims to contribute to the knowledge of the impact of the expansion of the Federal Network. The data were collected from 12 indicators presented in management reports of 38 Federal Institutes through years 2007 to 2011 to evaluate the performances using descriptive statistical techniques. The indicators were analyzed in both consolidated and open manners by the following perspectives: country region, growth of instruction units and institutions origin. Was also performed a multivariate analysis of clusters in order to identify excellence groups of Institutes. The results showed differences in the expansion plan s development among Brazilian regions, both in terms of infrastructure and academic indicators, with better results in the Midwest and South, and that there are differentiated profiles of institutes as its origin, where the best quality indicators occur in those originated by integration of different educational institutions. Still, were identified two excellence groups, with emphasis on academic management, human resources and expansion

Efeito da inclinação do plano de terra para antenas de microfita multicamadas com elementos parasitas fractais

This work presents the analysis of an antenna of fractal microstrip of Koch with dielectric multilayers and inclinations in the ground plane, whose values of the angles are zero degree (without inclinations), three, seven and twelve degrees. This antenna consists of three dielectric layers arranged vertically on each other, using feeding microstrip line in patch 1, of the first layer, which will feed the remaining patches of the upper layers by electromagnetic coupling. The objective of this work is to analyze the effects caused by increase of the angle of inclination of the ground plane in some antenna parameters such as return loss, resonant frequency, bandwidth and radiation pattern. The presented results demonstrate that with the increase of the inclination angle it is possible to get antennas with characteristics multiband, with bigger bandwidth, and improving the impedance matching for each case analyzed, especially the larger angle

Estratégias para elaboração de um plano de segurança da água para abastecimento humano do município do Natal/RN

This research study deals with the production and distribution of drinking water with quality and safety in order to meet the needs of the Man. Points out the limitations of the methodology for assessing water quality in use today. Approaches the recommendations of the World Health Organization (WHO) for adoption, by the companies responsible for producing and distributing water, of assessment methodologies and risk management (HACCP), in order to ensure the quality and safety of water drinking. Suggests strategies for implementing the plan for water safety plan. Uses the process of water production, composed by Maxaranguape river basin, the water treatment plant and distribution system, which is part of the Plan for Expansion of the Supply System of Natal, as case study. The results, it was possible to devise strategies for implementation of the Water Safety Plan (WSP), which comprises the following steps: a) a preliminary stage. b) assessment system. c) process monitoring. d) management plan and e) validation and verification of the PSA. At each stage are included actions for its implementation. The implementation of the PSA shows a new type of water production, in which the fountain as a whole (watershed and point of capture), the Water Treatment Plant (WTP) and distribution, shall compose the production process, over which to build quality and safety of the final product (drinking water)

O ensino médio no contexto do Plano Nacional de Educação: o que ainda precisa ser feito

A intenção desse artigo é analisar alguns objetivos e metas propostos para o ensino médio, pelo antigo Plano Nacional de Educação (pne Lei n. 10.172/01), no sentido de avaliar quais deles foram totalmente alcançados, quais foram parcialmente alcançados e quais não foram atingidos, visto que um novo pne está sendo proposto. Por outro lado, nosso objetivo também é avaliar em que medida o alcance ou não das metas propostas no início da década passada influencia na percepção e nas expectativas dos alunos do ensino médio em relação ao seu ingresso, num futuro próximo, no ensino superior. Serão abordadas questões referentes ao atendimento e à oferta de ensino médio e suas questões pedagógicas específicas.

Sobre o financiamento no Plano de Desenvolvimento da Educação

Este artigo apresenta uma análise inicial do financiamento das ações do Plano de Desenvolvimento da Educação - PDE -, lançado em abril de 2007 pelo governo federal, focalizando algumas expectativas, impasses e impactos. Muitas das inquietações e dúvidas aqui expostas foram manifestadas no Seminário Itinerante O Plano de Desenvolvimento da Educação - PDE - em Debate nas Universidades Públicas Paulistas, em que especialistas de diferentes instituições tiveram a oportunidade de debater com os formuladores e responsáveis pela implementação do plano. Optou-se por organizar análise em três partes. Na primeira parte, discutem-se alguns pressupostos do financiamento da educação nacional, mostrando que o país pode e deve aplicar mais recursos para alcançar um desenvolvimento educacional e social adequado. Na segunda, analisam-se documentos do MEC que explicitam as concepções que fundamentam o PDE no que se refere ao financiamento das 40 ações propostas. Na terceira, os autores se posicionam quanto à forma de financiamento adotada e quanto aos recursos previstos ou alocados para a execução das ações. Para finalizar, uma série de questões sobre o plano são levantadas em perspectiva propositiva.

Plano Nacional de Saúde e o lugar social em disputa

O presente artigo apresenta uma análise do Plano Nacional de Saúde publicado em 2004. Este documento expressa um importante período de transição na gestão do SUS, uma vez que foi predecessor do Pacto pela Saúde. A partir de um estudo descritivo com base em procedimentos quantitativos e qualitativos, o objetivo foi compreender as ideias centrais do documento, identificando as conexões existentes entre seus princípios, objetivos e prioridades. O principal resultado do estudo foi a identificação da integralidade das ações, da capacitação dos recursos humanos e mudança do marco regulatório com base numa visão intersetorial como núcleo central do documento. Essas ideias, por sua vez, circulam pelo discurso das diretrizes do plano, fortalecendo os laços do eixo central do texto na reorganização da atenção ambulatorial e na qualificação profissional. Por fim, quando comparadas metas e ações previstas nas diretrizes, observa-se uma tensão entre o que foram denominados vetores da verticalidade e da horizontalidade, deixando em aberto o rumo do lugar social em disputa.

O Planejamento estratégico sem plano: ícones urbanos e dinâmica imobiliária em Natal

The model of strategic city planning is applied to Latin American and Brazilian cities since the 1990s. Notwithstanding, in many cities, the production of space has not followed the international model stricto sensu, but a variation of the model, here called, strategic city planning without a plan or peripheral (or yet incomplete) urban entrepreneurialism . This seeks to build city attributes in order to qualify cities for the competitive international and/or regional markets. This includes the production of iconic buildings and structures, here called urban icons. They rapidly become symbols in the contemporary city landscape, facilitating the promotions of the city for tourism and business. This also helps produce charismatic leaderships. However, what it does best is to promote real estate development. This dissertation seeks to understand the role of iconic buildings in the promotion of real estate business in Natal, especially how it helps to fuel prices in the market. The research is done by use of interviews with civil servants and private entrepreneurs related to real estate business

Análise de células t regulatórias foxp3+no líquen plano oral

T regulatory cells have the function of controlling immune responses and maintaining self-tolerance. The FoxP3 has been considered the most specific marker for Treg cells. The aiming of this paper was to evaluate the immunoexpression of FoxP3 in the inflammatory infiltrate from oral lichen planus (OLP) and to compare it with the infiltrate in fibrous inflammatory hyperplasia (FIH) and then, between reticular and erosive forms of OLP. The samples were composed by 32 cases of OLP (17 reticular and 15 erosive) beyond 10 cases of FIH that were submitted to immunohistochemistry staining for FoxP3. Localization of the staining was classified in underepithelial and intraepithelial and the amount of FoxP3+ cells was evaluated through cells counting in 10 consecutive fields, at 400x power magnification. The values were expressed in mean ± standart deviation, and submitted to statistical tests with 5% of significance level. It was observed a statistical significant difference in the amount of FoxP3+ Treg cells between the two combined forms of OLP (1,6 ± 2,2) and the FIH (0,5 ±0,4) (P<0,05). This maybe could be explained by immunological mechanism of OLP, which involves a permanent antigenic induction likely with consequent perpetuation of lesion, eliciting the proliferation and constant recruitment of Treg cells. Otherwise, FIH presents a different etiopathogenesis, in which there is also generation of a variable inflammatory infiltrate, however qualitatively distinct from that seen in OLP. The erosive form of OLP exhibited a greater number (1,7 ± 2,4) of FoxP3+ Treg cells than reticular form (1,5 ± 2,1). These alterations could have relation with the great disease activity verified in erosive OLP, or also, with abnormalities in the regulatory function of Treg cells that could cause the increase observed. Considering the capacity already well established in the literature, both about Treg cells in modulating immune responses, as in the oral mucosa in showing great potential for regeneration, it is suggested that the possibility of development and implantation of immunotherapeutic strategies that regulate the frequency and function of these cells, may help in future treatment of immune-mediated inflammatory diseases such as OLP

Estudo clínico e níveis de ansiedade em uma série de casos de líquen plano oral

Oral Lichen Planus (OLP) is a relatively common, cronic inflammatory disease. Its etiopathogenesis is no completely understood and several factors have proposed in attempt to explain the appearance, variety of clinical manifestations and periods of exacerbation and remission of the symptons of the lesions. The objective of the present study was to assess the presence of local factors, systemic diseases and levels of anxiety in patients with OLP, investigating their association with the clinical characteristics of the lesions. The sample consisted of 37 patients with histopathologically confirmed OLP that were submitted to a clinical exam to evaluate the presence of smoking habits, consumption of alcoholic beverages, diabetes mellitus, hypertension and hepatitis C virus (HCV) infection. The existence of skin lesions, as well as the time course, clinical form, symptomatology, number and location of the oral lesions were also registered. The trait anxiety was measured by Spielberger s Stai-Trait Anxiety Inventory (STAI), and to associate the variables we used the chi-square or Fisher s exact test. It was observed that females were the most affected (75%) and the mean age of the patients was 53,3 years. Most cases were non-smoker (97,3%) and none was drinker. Diabetes mellitus and hypertension were present in 10,8% e 16,2% of the sample, respectively and only one patient was HCV-seropositive (2,7%). Moderate levels of anxiety were seen in most cases (78,4%) and 21,6% had elevated levels. The oral lesions persisted in 95% of the cases for a period of 6 months to 13 years. The erosive form was the most prevalent (57,1%) and symptons were reported by 45,7% of the patients. Multiple lesions were frequent (60%), affecting mainly the buccal mucosa, followed by gums e tongue. There was no significant association of the presence of diabetes mellitus, hypertension and levels of anxiety with the clinical form or symptomatology of the oral lesions (p>0,005), despite a trend in patients with hypertension to have erosive lesions. It was concluded that, in the sample studied, moderate levels of anxiety were commonly observed, and the HCV infection apparently is not related to the onset of the OLP. In this study, the presence of diabetes mellitus, hypertension and levels of anxiety seem not to be associated with the clinical characteristics of the lesions of OLP

Análise da resposta th17 em líquen plano oral

Th17 cells have been strongly associated with the pathogenesis of several autoimmune and inflammatory diseases. IL-17 and IL-23 are important cytokines associated with this lineage. The aim of this study was to analyze, through immunohistochemical methods, the immunoexpression of IL-17 and IL-23 in the inflammatory infiltrate of oral lichen planus (OLP) lesion compared to that of inflammatory fibrous hyperplasia (IFH) and between clinical forms reticular and erosive of OLP. The sample included 41 cases of OLP, of which 23 were reticular and 18 erosive and 10 cases of IFH. The results were subjected to nonparametric statistical tests with a 5% significance level. In OLP lesions histomorphological analysis, the most common findings were: hyperparakeratinization, specimens with atrophic epithelium in erosive clinical form (p = 0.011), epithelial projections in most of reticular type of lesions, in addition Civatte bodies were identified in most samples of both clinical forms. For immunohistochemistry analysis, five fields with strong immunoreactivity for IL-17 and IL-23 were photomicrographed at 400x magnification, images were transferred to a computer where with ImageJ software®, lymphocytes that exhibited cytoplasmic immunostaining for these cytokines were counted. A mean was established after for each case. There was no statistically significant difference in the number of imunopositive lymphocytes for IL-17 and IL-23 among the group of OLP and IFH group, however a larger amount of lymphocytes imunopositive for IL-17 was found in the LPO group (p = 0.079) and significantly higher amounts of those lymphocytes were found in the erosive OLP when compared to the group of reticular OLP and IFH (p = 0.019). Furthermore, a marker epithelial immunopositivity for IL-17 was observed in OLP group. Although the results of this study do not permit the forceful assertion about the participation of Th17 lineage in OLP lesions, the findings of immunopositive lymphocytes counting for IL-17 and IL-23, which are potent proinflammatory cytokines, together with the the marked epithelial immunopositivity found for IL-17 in this study, suggest a possible role of this lineage in the pathogenesis of this disorder

Avaliação da angiogênese em lesões de líquen plano oral e pênfigo vulgar

Oral lichen planus and pemphigus vulgaris are chronic diseases mucous membrane immune of unknown aetiology that can be observed affecting to the oral mucous. A relevant as regards neoplasies the role angiogenesis in the inflammatory chronic disease pathogenesis as it provides a substancial interest can be considered as being an activity diseases marker; besides being through specialised research of this angiogenic process to improve of understanding pathogenic mechanism. This research proposes to assess angiogenic active through of antibody immunohistochemistry expression antiCD34 antibody in 26 OLP of reticular cases, 14 OLP erosives cases, 18 of PV cases and 15 specimens of normal oral mucosa. The result was submitted non-parametric tests of 5% significance level. It is not statistically significant correlacion was seen regarding between average vessels. However, only be effectively observed the median of OLP cases was larger than pemphigus vulgaris in fact proved average larger than oral normal mucosa (p=0,280). Regarding the microvascular count of CD34 concerning clinic form oral lichen planus (reticular and erosion) increased emphasis is more cross-border average for the form erosion clinic. Despite of the statistic tests could not be more effective (p=0,720). Even though, the results of the research is not sufficient to enable to consider of angiogenic process in the pathogenesis and lesions progression of oral lichen planus and pemphigus vulgaris, we suggest this process is present in both forms lesion, however, more studies must be made in the near future in order to prepare a well-founded proposal

Um estudo algorítmico para otimização do plano de tratamento da radioterapia conformal

This work performs an algorithmic study of optimization of a conformal radiotherapy plan treatment. Initially we show: an overview about cancer, radiotherapy and the physics of interaction of ionizing radiation with matery. A proposal for optimization of a plan of treatment in radiotherapy is developed in a systematic way. We show the paradigm of multicriteria problem, the concept of Pareto optimum and Pareto dominance. A generic optimization model for radioterapic treatment is proposed. We construct the input of the model, estimate the dose given by the radiation using the dose matrix, and show the objective function for the model. The complexity of optimization models in radiotherapy treatment is typically NP which justifyis the use of heuristic methods. We propose three distinct methods: MOGA, MOSA e MOTS. The project of these three metaheuristic procedures is shown. For each procedures follows: a brief motivation, the algorithm itself and the method for tuning its parameters. The three method are applied to a concrete case and we confront their performances. Finally it is analyzed for each method: the quality of the Pareto sets, some solutions and the respective Pareto curves

Comparação entre os exames radiográficos convencional e digitalizado em relação ao plano de tratamento de superfícies oclusais

O objetivo deste estudo foi comparar as decisões de tratamento restaurador de superfícies oclusais, sem cavitação, quando realizadas através dos aspectos clínicos e radiográficos, convencional e digitalizado. Foram examinados, 33 sítios das superfícies oclusais de 30 molares permanentes extraídos, com e sem pigmentação. O plano de tratamento para cada região foi realizado por 5 cirurgiões-dentistas, professores universitários, utilizando dois tipos de exames: exame visual de fotografias e radiografia interproximal convencional (IV + RXC); e exame visual de fotografias e radiografia digitalizada (IV + DIGORA). O padrão de validação para os planos de tratamento foi realizado através do aspecto histológico. A sensibilidade em determinar a não-necessidade de tratamento restaurador foi, em média, tanto para a IV + RXC quanto para a IV + DIGORA, de 0,23. A especificidade foi, em média, de 0,83 e 0,86, para a IV + RXC e IV + DIGORA, respectivamente. Quando comparou-se os planos de tratamento intra-examinadores, não foi encontrada diferença estatisticamente significante à nível de 5%. Baseado nestes dados, pode-se concluir que os métodos radiográficos, convencional e digitalizado, não demonstraram diferenças na efetividade da determinação do plano de tratamento de superfícies oclusais sem cavitação.

Avaliação da alteração do plano oclusal em cirurgias ortognáticas combinadas com utilização de fixação interna rígida em pacientes com padrão facial de Classe II

OBJETIVO: avaliar a estabilidade de cirurgias bimaxilares com fixação interna rígida, na qual promoveu-se uma rotação anti-horária da mandíbula e conseqüente redução do ângulo do plano oclusal. METODOLOGIA: foram estudados 15 pacientes com padrão facial de Classe II e deficiência mandibular. Os movimentos cirúrgicos foram avaliados por meio de medidas lineares e angulares realizadas no programa CefX, obtidas de telerradiografias cefalométricas em norma lateral em três diferentes tempos: (T0) pré-operatório, (T1) pós-operatório imediato e (T2) pós-operatório de no mínimo 6 meses. RESULTADOS E CONCLUSÕES: os resultados demonstraram que a cirurgia bimaxilar promove mudanças faciais significativas e, principalmente, que a rotação anti-horária da mandíbula com redução do ângulo do plano oclusal mostrou-se estatisticamente estável, sendo uma opção confiável em cirurgias de pacientes com padrão facial de Classe II com deficiência mandibular.