O desafio da descentralização do Sistema Único de Saúde em município de grande porte: o caso de São Paulo, Brasil

A descentralização do Sistema Único de Saúde (SUS) ainda enfrenta importantes desafios, em particular a busca de alternativas para grandes municípios. Por se caracterizar como um processo eminentemente político, variáveis político-institucionais, dentre as quais se destaca a capacidade de gestão do nível local, são determinantes para a conformação da descentralização em cada contexto. Utilizando o referencial do triângulo de governo para avaliar a capacidade de gestão, realizou-se um estudo de caso, com o objetivo de analisar o processo de descentralização do SUS no Município de São Paulo, Brasil, a maior metrópole brasileira. Pela análise de entrevistas com gestores selecionados e documentos da gestão, identificou-se um movimento de centralização da saúde na gestão municipal 2005-2008, acompanhado do desconcerto das estruturas locorregionais da Secretaria Municipal de Saúde, o que resultou no esvaziamento técnico e político dessas instâncias. Apesar dos limites da descentralização, destaca-se sua potência enquanto estratégia operacional para alcançar os objetivos do SUS. Aponta-se a necessidade de retomar o processo de descentralização da saúde no Município de São Paulo que, além de avançar para instâncias locorregionais, esteja articulado à descentralização da gestão pública municipal.

Política de saúde e gestão no processo de (re)construção do SUS em município de grande porte: um estudo de caso de São Paulo, Brasil

O processo de (re)construção do SUS no Município de São Paulo, Brasil, foi analisado, no período de 2001- 2008, por meio de estudo de caso, utilizando-se distintas fontes: documentos; entrevistas com informantes-chave e observação participante. Os conceitos de política de saúde e de gestão em saúde foram utilizados na qualidade de categorias analíticas. Foram selecionadas e analisadas apenas políticas priorizadas pela gestão iniciada em 2001 e que tiveram sustentação até 2008. Discutem-se desafios para a (re)construção do SUS no município relacionados com o contexto político-institucional e com mudanças de estrutura implementadas. As reorganizações da Secretaria Municipal de Saúde de São Paulo propiciaram a constituição e manutenção de dois subsistemas municipais, um hospitalar e outro ambulatorial. Negociações entre os governos municipal, estadual e federal não avançaram para que o município assumisse a gestão de fato de todo sistema de saúde, constatando-se a coexistência de três subsistemas públicos de saúde paralelos: dois municipais e um estadual. A sustentação política do Programa Saúde da Família foi associada ao fato de que esse programa não se constituiu como marca da primeira gestão municipal e, ainda, de ser política prioritária e estimulada pelo governo federal.

Social interaction as a heuristic for combinatorial optimization problems

We investigate the performance of a variant of Axelrod's model for dissemination of culture-the Adaptive Culture Heuristic (ACH)-on solving an NP-Complete optimization problem, namely, the classification of binary input patterns of size F by a Boolean Binary Perceptron. In this heuristic, N agents, characterized by binary strings of length F which represent possible solutions to the optimization problem, are fixed at the sites of a square lattice and interact with their nearest neighbors only. The interactions are such that the agents' strings (or cultures) become more similar to the low-cost strings of their neighbors resulting in the dissemination of these strings across the lattice. Eventually the dynamics freezes into a homogeneous absorbing configuration in which all agents exhibit identical solutions to the optimization problem. We find through extensive simulations that the probability of finding the optimal solution is a function of the reduced variable F/N(1/4) so that the number of agents must increase with the fourth power of the problem size, N proportional to F(4), to guarantee a fixed probability of success. In this case, we find that the relaxation time to reach an absorbing configuration scales with F(6) which can be interpreted as the overall computational cost of the ACH to find an optimal set of weights for a Boolean binary perceptron, given a fixed probability of success.

Lignin phenols used to infer organic matter sources to Sepetiba Bay - RJ, Brasil

Lignin phenols were measured in the sediments of Sepitiba Bay, Rio de Janeiro, Brazil and in bedload sediments and suspended sediments of the four major fluvial inputs to the bay: Sao Francisco and Guandu Channels and the Guarda and Cacao Rivers. Fluvial suspended lignin yields (Sigma 8 3.5-14.6 mgC 10 g dw(-1)) vary little between the wet and dry seasons and are poorly correlated with fluvial chlorophyll concentrations (0.8-50.2 mu gC L(-1)). Despite current land use practices that favor grassland agriculture or industrial uses, fluvial lignin compositions are dominated by a degraded leaf-sourced material. The exception is the Guarda River, which has a slight influence from grasses. The Lignin Phenol Vegetation Index, coupled with acid/aldehyde and 3.5 Db/V ratios, indicate that degraded leaf-derived phenols are also the primary preserved lignin component in the bay. The presence of fringe Typha sp. and Spartina sp. grass beds surrounding portions of the Bay are not reflected in the lignin signature. Instead, lignin entering the bay appears to reflect the erosion of soils containing a degraded signature from the former Atlantic rain forest that once dominated the watershed, instead of containing a significant signature derived from current agricultural uses. A three-component mixing model using the LPVI, atomic N:C ratios, and stable carbon isotopes (which range between -26.8 and -21.8 parts per thousand) supports the hypothesis that fluvial inputs to the bay are dominated by planktonic matter (78% of the input), with lignin dominated by leaf (14% of the input) over grass (6%). Sediments are composed of a roughly 50-50 mixture of autochthonous material and terrigenous material, with lignin being primarily sourced from leaf. (C) 2010 Elsevier Ltd. All rights reserved.

Bait and Habitat Preferences, and Temporal Variability of Social Wasps (Hymenoptera: Vespidae) Attracted to Vertebrate Carrion

In addition to feeding on carrion tissues and fluids, social wasps can also prey on immature and adult carrion flies, thereby reducing their populations and retarding the decomposition process of carcasses. In this study, we report on the occurrence and behavior of social wasps attracted to vertebrate carrion. The collections were made monthly from September 2006 to October 2007 in three environments (rural, urban, and forest) in six municipalities of southeast Brazil, using baited bottle traps. We collected Agelaia pallipes (Olivier, 1791) (n = 143), Agelaia vicina (Saussure, 1854) (n = 106), Agelaia multipicta (Haliday, 1836) (n = 18), and Polybia paulista Ihering, 1896 (n = 3). The wasps were observed feeding directly on the baits and preying on adult insects collected in the traps. Bait and habitat associations, temporal variability of social wasps, and possible forensic implications of their actions are discussed.

Neural basis of anxiolytic effects of cannabidiol (CBD) in generalized social anxiety disorder: a preliminary report

Animal and human studies indicate that cannabidiol (CBD), a major constituent of cannabis, has anxiolytic properties. However, no study to date has investigated the effects of this compound on human pathological anxiety and its underlying brain mechanisms. The aim of the present study was to investigate this in patients with generalized social anxiety disorder (SAD) using functional neuroimaging. Regional cerebral blood flow (rCBF) at rest was measured twice using (99m)Tc-ECD SPECT in 10 treatment-naive patients with SAD. In the first session, subjects were given an oral dose of CBD (400 mg) or placebo, in a double-blind procedure. In the second session, the same procedure was performed using the drug that had not been administered in the previous session. Within-subject between-condition rCBF comparisons were performed using statistical parametric mapping. Relative to placebo, CBD was associated with significantly decreased subjective anxiety (p < 0.001), reduced ECD uptake in the left parahippocampal gyrus, hippocampus, and inferior temporal gyrus (p < 0.001, uncorrected), and increased ECD uptake in the right posterior cingulate gyrus (p < 0.001, uncorrected). These results suggest that CBD reduces anxiety in SAD and that this is related to its effects on activity in limbic and paralimbic brain areas.

Anticoagulant and fibrinogenolytic properties of the venom of Polybia occidentalis social wasp

Previous studies have shown that venoms of social wasps and bees exhibit strong anticoagulant activity. The present study describes the anticoagulant and fibrinogen-degrading pharmacological properties of the venom of Polybia occidentalis social wasp. The results demonstrated that this venom presented anticoagulant effect, inhibiting the coagulation at different steps of the clotting pathway (intrinsic, extrinsic and common pathway). The venom inhibited platelet aggregation and degraded plasma fibrinogen, possibly containing metal-dependent metalloproteases that specifically cleave the B beta-chain of fibrinogen. In conclusion, fibrinogenolytic and anticoagulant properties of this wasp venom find a potential application in drug development for the treatment of thrombotic disorders. For that, further studies should be carried out in order to identify and isolate the active compounds responsible for these effects. Blood Coagul Fibrinolysis 21: 653-659 (c) 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins.

Evaluation of the psychometric properties of the Social Phobia Inventory in university students

Objective: The aim of the study was to study the psychometric properties of the Social Phobia Inventory (SPIN) in its version for the context of Brazilian adults. Methods: A sample of Brazilian university students from the general population (n = 2314) and a sample of university students identified as cases (n = 88) and noncases (n = 90) of social phobia were assessed, using as a parameter the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. The different instruments were applied individually in the presence of a rater. Results: The SPIN showed adequate internal consistency (.63-.90) and concurrent validity with different instruments of auto- and hetero-evaluation of social phobia. Discriminative validity showed 0.84 to 0.86 sensitivity and 0.84 to 0.87 specificity for cutoff notes between 19 and 21. Factorial analysis showed the presence of a variable number of factors as a function of the different samples. Conclusions: The version of the SPIN studied is quite adequate for use in the context of Brazilian university students, favoring the screening of social phobia. However, further studies using more diverse samples are needed. (C) 2010 Elsevier Inc. All rights reserved.

Further Study of the Psychometric Qualities of a Brief Screening Tool for Social Phobia (MINI-SPIN) Applied to Clinical and Nonclinical Samples

PURPOSE. The purpose of this study was to further assess the psychometric qualities of the Mini-Social Phobia Inventory (MS) to screen for social anxiety disorder (SAD). DESIGN AND METHODS. The MS and other self- and clinician-rated scales for anxiety and social anxiety were applied in 2,314 university students and in samples of SAD patients (n = 88) and nonpatients (n = 90). FINDINGS. The MS revealed adequate discriminative validity, internal consistency (alpha = 0.49-0.73), convergent validity with the Social Phobia Inventory, Brief Social Phobia Scale, and Self-Statements During Public Speaking Scale and convergent and divergent validity with the Beck Anxiety Inventory. PRACTICE IMPLICATIONS. The MS has shown to be a fast and efficient screening instrument for SAD in different cultures and contexts.

Study of the psychometric qualities of the Brief Social Phobia Scale (BSPS) in Brazilian university students

Purpose: To perform a psychometric analysis of the Brazilian version of the Brief Social Phobia Scale (BSPS). Materials and methods: Hundred and seventy-eight university students of both genders aged on average 21.2 years and identified as Social Anxiety Disorder (SAD) cases and non-cases was studied, with the structured clinical interview for DSM-IV being used as a parameter. The different instruments were applied in an individual manner in the presence of a rater and of an observer. Results: The BSPS showed adequate internal consistency (0.48-0.88) and concurrent and divergent validity with the Beck Anxiety Inventory (BAI) (0.21-0.62), Social Phobia Inventory (0.24-0.82) and Self Statements During Public Speaking Scale (SSPS) (0.23-0.31). Discriminative validity revealed a sensitivity of 0.88-0.90 and a specificity of 0.81(0.83 for cut-off notes of 18/19. Factorial analysis demonstrated the presence of six factors that jointly explained 71.79% of data variance. Construct validity indicated some limits of the scale regarding the diagnosis of SAD. Inter-rater reliability was strong (0.86-1.00, p < 0.001). Conclusions: The BSPS is adequate for use with university students, although further studies in different cultures, samples and contexts are still necessary. (C) 2009 Elsevier Masson SAS. All rights reserved.

Boletim eletr??nico de bibliografias especializadas: qualifica????o e valoriza????o dos servidores p??blicos

O dia do servidor p??blico ?? comemorado em 28 de outubro desde 1937, quando da cria????o do Conselho Federal do Servi??o P??blico Civil. Desde ent??o, muito se conquistou em rela????o ao reconhecimento desse profissional. Hoje, os servidores t??m consci??ncia da import??ncia de sua atua????o para o desenvolvimento econ??mico e social do pa??s. O incentivo aos servidores p??blicos, por meio de a????es voltadas ?? forma????o e ?? capacita????o permanentes, ?? fundamental para motiv??-los a prestar servi??os de excel??ncia aos cidad??os. Com base na pol??tica vigente e em homenagem ao dia do servidor, a Biblioteca Graciliano Ramos traz como tema de seu 9?? Boletim Eletr??nico de Bibliografias Especializadas uma sele????o de publica????es, pertencentes ao seu acervo, que abordam a quest??o da qualifica????o e da valoriza????o dos servidores p??blicos

Boletim eletr??nico de bibliografias especializadas: pol??tica de transfer??ncia condicionada de renda

As pol??ticas de Transfer??ncia Condicionada de Renda (TCR) s??o consideradas a mais nova gera????o de pol??ticas sociais. O fato tem chamado a aten????o de profissionais do setor p??blico e de acad??micos de diferentes ??reas. Nos ??ltimos anos, diversas experi??ncias, sobretudo na Am??rica Latina, t??m-se destacado pelo impacto positivo sobre os indicadores sociais da popula????o, entre elas: o Programa Bolsa Fam??lia, no Brasil; o Programa de Desarrollo Humano Oportunidades, no M??xico; e o Sistema Chile Solid??rio, no Chile. O Programa Bolsa Fam??lia, criado em 2003, constitui a maior pol??tica p??blica de TCR da Am??rica Latina, tanto em or??amento quanto em cobertura. Atualmente, atende cerca de 13.800.000 fam??lias, em todos os munic??pios do Pa??s. O Programa tem servido de modelo para a difus??o desse tipo de pol??tica no mundo. O tema envolve v??rias dimens??es da ??rea social, por se tratar de uma pol??tica essencialmente intersetorial. O Bolsa Fam??lia vem se destacando nos debates da administra????o p??blica, devido ?? sua forte capacidade de melhoria das condi????es das fam??lias benefici??rias. Diante disso, a 5a edi????o do Boletim Eletr??nico de Bibliografias Especializadas apresenta uma reuni??o de publica????es do acervo da Biblioteca Graciliano Ramos que abordam os seguintes temas: transfer??ncia condicionada de renda, programas sociais, desigualdade social, combate da pobreza e pol??ticas p??blicas. O objetivo ?? divulgar obras que auxiliem servidores p??blicos na reflex??o e compreens??o desses assuntos

Programa de apoio ao desenvolvimento de novas empresas de base tecnol??gica agropecu??ria e ?? transfer??ncia de tecnologia (Proeta)

Em dezembro de 2001, o Proeta foi criado pela Empresa Brasileira de Pesquisa Agropecu??ria (Embrapa) com apoio financeiro do Fundo Multilateral de Investimentos do Banco Interamericano de Desenvolvimento (Fumin/BID), por meio de um acordo de coopera????o t??cnica n??o-reembols??vel. O programa tem o objetivo de contribuir para a transfer??ncia de tecnologias e conhecimentos gerados pela Embrapa para empreendimentos de base tecnol??gica, mediante a utiliza????o do processo de incuba????o de empresas. Para concretizar a iniciativa, foram estabelecidas experi??ncias-piloto em cinco unidades de pesquisa da Embrapa, estrategicamente situadas nas regi??es Nordeste, Centro-Oeste e Sudeste. Entre os resultados e avan??os obtidos merecem destaque 21 tecnologias disponibilizadas, 14 conv??nios firmados com incubadoras, 16 propostas de neg??cios apresentadas, 14 empresas pr??-selecionadas e incubadas, e uma empresa graduada. A consolida????o das alian??as e parcerias no processo de incuba????o resultou em um sistema de inova????o que auxilia o desenvolvimento sustent??vel da cadeia produtiva do agroneg??cio, gerando benef??cios para a sociedade em geral

Sistema de controle de remanejamento e reserva t??cnica: siscort

O Sistema de Controle de Remanejamento e Reserva T??cnica (SISCORT) ?? uma tecnologia social in??dita na gest??o p??blica. ?? um inovador instrumento de gest??o no desenvolvimento de pol??ticas p??blicas voltadas para a melhoria da qualidade da educa????o. O SISCORT, por meio de suas consultas e cadastros dispon??veis, ?? ferramenta eficaz na concretiza????o das a????es propostas. Ele facilita, registra e controla o remanejamento dos livros adquiridos e distribu??dos em todas as escolas p??blicas de ensino fundamental, no ??mbito do maior programa do g??nero no mundo, o Programa Nacional do Livro Did??tico (PNLD). Acessando o SISCORT, no s??tio eletr??nico do FNDE, ?? poss??vel saber a quantidade de livros enviados para cada escola, por t??tulo, por s??rie e por componente curricular, permitindo que as escolas, ap??s informar o seu alunado real, saibam, automaticamente, se e onde h?? excesso ou escassez de livros, proporcionando mais transpar??ncia e maior controle social dos recursos p??blicos

A????es premiadas no 13?? Concurso Inova????o na Gest??o P??blica Federal 2008

Nesta publica????o, referente ao 13?? Concurso Inova????o na Gest??o P??blica Federal, o leitor encontrar?? iniciativas inovadoras nas seguintes ??reas: Arranjos institucionais para coordena????o e/ou implementa????o de pol??ticas p??blicas; atendimento ao cidad??o; melhoria dos processos de trabalho; planejamento, gest??o e desempenho institucional