Planos de saúde e envelhecimento populacional: um modelo viável?

O presente trabalho versa sobre a relação presente e futura dos planos de saúde com os idosos. Tem como pressupostos iniciais a existência de uma janela demográfica de oportunidades que será encerrada, conforme estimativa do IBGE, em 2020 e o fato de o modelo de atenção à saúde por planos de saúde se encontrar em expansão. Diante da realidade de envelhecimento populacional, pergunta-se: Os planos de saúde são um modelo viável para a garantia da atenção à saúde dos idosos? As respostas a essa questão foram construídas adotando-se como método de trabalho a análise de doutrina, jurisprudência, legislação e, quando necessário, fontes não tradicionais do Direito como os dados de órgãos de pesquisa demográficos e econômicos, a imprensa e as associações setoriais. Inicialmente tratou-se do funcionamento do setor de planos de saúde, desde a sua origem, indicando-se que historicamente sempre manteve uma relação simbiótica com o Estado, em especial com os recursos públicos. Para tanto, foram explorados temas como o ressarcimento ao SUS, o uso da estrutura dos hospitais públicos pelos planos de saúde e a existência de subsídios, abatimentos e outras formas de financiamento público das atividades deste setor. No capítulo seguinte se detalhou a questão do envelhecimento populacional, apresentando-se a legislação pertinente, os dados que revelam a composição presente e estimada da população brasileira, os principais problemas de saúde que afetam os idosos e os impactos da mudança de perfil demográfico para a política de saúde. No capítulo 3 evidenciou-se a já problemática relação dos planos de saúde com os idosos, permeada por discriminações na contratação, cobrança de mensalidades proibitivas e reajustes expulsivos, presença de cláusulas abusivas em contratos antigos, judicialização dos reajustes por mudança de faixa etária e conflitos decorrentes da prevalência da contratação na forma coletiva. Por fim, no derradeiro capítulo concluiu-se que o modelo de planos de saúde não é viável para a garantia da atenção à saúde do idoso, sendo urgente que haja uma discussão sobre qual modelo de saúde o país deseja sob pena de que as conquistas decorrentes da afirmação da saúde como direito fundamental se percam. Há características inerentes ao setor que o aparta dos idosos e, portanto, da nova realidade demográfica do país, como a prática da seleção de risco, a cobrança de mensalidades com preços insustentáveis para os idosos, o foco no modelo curativo de atenção à saúde e o afastamento da prevenção. Por outro lado, o cenário se agrava por conta das recorrentes falhas na regulação e na regulamentação, e pelo tratamento cindido, na prática, da política de saúde como se não fosse una e não devesse funcionar em harmonia, independentemente da fonte de financiamento. Há, portanto, um alto risco de que a situação dos idosos nos planos de saúde se torne insustentável, dando margem a medidas imediatistas ampliadoras dos subsídios públicos aos planos de saúde. A contrarreforma sanitária, entendida como o retrocesso das ações e dos serviços de saúde ao modelo anterior à Constituição Federal, é um perigo a ser considerado e combatido.

The normative ontology of the law - Peter Cane's responsibility in law and morality

Implications of Peter Cane's analysis of responsibility in 'Responsibility in Law and Morality' - Cane's preconceptualisation of the 'symbiotic' relationship between law and morality - a principal criticism is that Cane does not develop his seven methodological principles into a more ambitious argument.

On bridging the gap: The relevance of theory to the practice of conflict resolution

It is often claimed that policy makers and scholars inhabit different worlds and have little for each other. We challenge this perception and claim that there is a strong symbiotic relationship between the two. This relationship is particularly strong in the field of conflict where policy makers may be in desperate need of guidelines, advice and analysis on how to transform complex conflict situations into more peaceful ones. We suggest that policy makers may think in terms of macro and micro-level theories and ideas if they wish to embrace better strategies of conflict resolution.

Regulation - the movie:a semiotic study of the periodic review of UK regulated industry

This paper explores the regulatory process of UK privatised utilities as manifest in the periodic review of prices. Two separate review processes are identified, operating concurrently - a covert dialogue between the regulator and the regulated and an overt dialogue taking place in the public arena. Using a semiotic analysis of the review the authors argue that the overt event is the real review. Furthermore they argue that the unfolding of each review is so similar that it can be likened to a film script which is constantly re-enacted. The purpose of the review as a legitimating vehicle for the regulator and regulated, who exist in a symbiotic relationship, is explored in terms of the semiotics involved and the myth creation role of legitimation in order to explain the significance of the regulatory process.

Social impact assessment:A case study of a sewerage project in Barbados

The purpose of this paper is to investigate the reasons of social impacts of projects in developing countries despite of thorough impact assessment in appraisal phase of projects. A case study approach on a sewerage project in Barbados was undertaken using primary and secondary information. The study reveals that although the impact assessment report suggested appropriate mitigation measures, but they were not implemented by the contractors. The study suggests fostering an interconnected and symbiotic relationship between appraisal and implementation phases of a project in order to manage project environment. Additionally, a more vigilant and proactive supervisory role should be instituted and strengthened over time and adapted within the dictates of environmental needs. Copyright © 2005 Inderscience Enterprises Ltd.

Social impact assessment of a sewerage project in Barbados

This report investigates why a nationally important and internationally funded infrastructural project within the Caribbean island of Barbados — The South Coast Sewerage Project — spurned a substantial level of negative socio-economic externalities. Primary and secondary research evaluated the presence or effectiveness of social impact assessment as a mitigation tool. The mitigation measures suggested within the appraisal report appear to have been considered by the Project Execution Unit (PEU) of Government of Barbados. The primary obstacle seems to have been the implementation of the mitigation process by the contractor. This highlights the need to foster an interconnected and symbiotic relationship between appraisal and implementation, if an initiative is to be conducted efficiently and effectively. Additionally, the South Coast Sewerage Project exemplifies the importance of establishing and sustaining a monitoring/control mechanism as an integral part of project construction.

‘Wir stehen fest zusammen/Zu Kaiser und zu Reich!’: Nationalism Among Germans in Britain, 1871–1918

German unification in 1871 triggered a wave of enthusiasm for the fatherland amongst German migrants worldwide. Britain was no exception. National confidence and coherence received a boost through the new symbols of ‘Kaiser’ and ‘Reich’. From the 1880s onwards, more and more militaristic and chauvinistic undertones could be heard. Local branches of German patriotic and militaristic pressure groups were founded in Britain. Support for Germany’s ‘new course’ of colonialist expansion and its ambitious naval programme was, however, not confined to right–wing groups but permeated ethnic life in general. Religion and nationalism stood in a symbiotic relationship; some German academics lecturing at British universities displayed chauvinistic attitudes; social clubs were increasingly dominated by an atmosphere of ‘Reich’–nationalism. After the outbreak of war, public expressions of pro–German attitudes did not disappear and were one of numerous factors contributing to Germanophobia within the host society.

Professionalism and Ethics in Hospitality

In their discussion - Professionalism and Ethics in Hospitality - by James R. Keiser, Associate Professor and John Swinton, Instructor, Hotel, Restaurant and Institutional Management, The Pennsylvania State University, Keiser and Swinton initially offer: “Referring to “the hospitality profession” necessitates thinking of the ethics of that profession and how ethics can be taught. The authors discuss what it means for the hospitality industry to be a profession.” The authors will have you know, a cursory nod to the term or description, profession and/or professional, is awarded to the hospitality industry at large; at least in an academic sense. Keiser and Swinton also want you to know that ethics, and professionalism are distinctly unique concepts, however, they are related. Their intangible nature does make them difficult, at best, to define, but ethics in contemporary hospitality has, to some degree, been charted and quantified. “We have left the caveat emptor era, and the common law, the Uniform Commercial Code, and a variety of local ordinances now dictate that the goods and services hospitality offers carry an implied warranty of merchantability,” the authors inform you. About the symbiotic relationship between ethics and professionalism, the authors say this: The less precise a code of ethics goes, the general rule, the fewer claims the group has to professional status.” The statement above may be considered a cornerstone principle. “However, the mere existence of an ethical code (or of professional status, for that matter) does not ensure ethical behavior in any group,” caution Keiser and Swinton. “Codes of ethics do not really define professionalism except as they adopt a group's special, arcane, exclusionary jargon. Worse, they can define the minimum, agreed-upon standards of conduct and thereby encourage ethical corner-cutting,” they further qualify the thought. And, in bridging academia, Keiser and Swinton say, “Equipped now with a sense of the ironies and ambiguities inherent in labeling any work "professional," we can turn to the problem of instilling in students a sense of what is professionally ethical. Students appear to welcome this kind of instruction, and while we would like to think their interest comes welling up from altruism and intellectual curiosity rather than drifting down as Watergate and malpractice fallout, our job is to teach, not to weigh the motives that bring us our students, and to provide a climate conducive to ethical behavior, not supply a separate answer for every contingency.” Keiser and Swinton illustrate their treatise on ethics via the hypothetical tale [stylized case study] of Cosmo Cuisiner, who manages the Phoenix, a large suburban restaurant. Cosmo is “…a typical restaurant manager faced with a series of stylized, over-simplified, but illustrative decisions, each with its own ethical skew for the students to analyze.” A shortened version of that case study is presented. Figure 1 outlines the State Restaurant Association Code of Ethics.

Travel Marketing: Industry Relationships and Benefits

In the discussion - Travel Marketing: Industry Relationships and Benefits - by Andrew Vladimir, Visiting Assistant Professor, School of Hospitality Management at Florida International University, the author initially states: “A symbiotic relationship exists among the various segments of the travel and tourism industry. The author has solicited the thinking of 37experts and leaders in the field in a book dealing with these relationships and how they can be developed to benefit the industry. This article provides some salient points from those contributors.” This article could be considered a primer on networking for the hospitality industry. It has everything to do with marketing and the relationships between varied systems in the field of travel and tourism. Vladimir points to instances of success and failure in marketing for the industry at large. And there are points of view from thirty-seven contributing sources here. “Miami Beach remains a fitting example of a leisure product that has been unable to get its act together,” Vladimir shares a view. “There are some first class hotels, a few good restaurants, alluring beaches, and a splendid convention center, but there is no synergism between them, no real affinity, and so while visitors admire the Fontainebleau Hilton and enjoy the food at Joe's Stone Crabs, the reputation of Miami Beach as a resort remains sullied,” the author makes a point. In describing cohesiveness between exclusive systems, Vladimir says, “If each system can get a better understanding of the inner workings of neighboring related systems, each will ultimately be more successful in achieving its goals.” The article is suggesting that exclusive systems aren’t really exclusive at all; or at least they shouldn’t be. In a word – competition – drives the market, and in order for a property to stay afloat, aggressive marketing integrated with all attendant resources is crucial. “Tisch [Preston Robert Tisch, currently – at the time of this writing - the Postmaster General of the United States and formerly president of Lowe’s Hotels and the New York Visitors and Convention Bureau], in talking about the need for aggressive marketing says: “Never...ever...take anything for granted. Never...not for a moment...think that any product or any place will survive strictly on its own merits.” Vladimir not only sources several knowledgeable representatives in the field of hospitality and tourism, but he also links elements as disparate as real estate, car rental, cruise and airlines, travel agencies and traveler profiles to illustrate his points on marketing integration. In closing, Vladimir quotes the Honorable Donna Tuttle, Undersecretary of Commerce for Travel and Tourism, “Uniting the components of this industry in an effective marketing coalition that can compete on an equal footing with often publicly-owned foreign tourism conglomerates and multi-national consortia must be a high priority as the United States struggles to maintain and expand its share of a rapidly changing global market.”

Produção do espaço e reestruturação produtiva do setor de laticínio no Rio Grande do Norte

Since the 1970s, Brazil has gone through several changes in its economic and productive structures, which have symbiotic relationship with the organization and dynamics of the Brazilian territory. This set of economic, social and technical-scientific transformations developed in the amid the productive capital restructuring, a process that occurs on a global scale, but that effective with particularities in different places. Adopting this presuposition the present research had as main objective analyze the productive restructuring of the dairy sector in Rio Grande do Norte, highlighting its relationship with production process / organization of space and its impact on the social relations of production. The adopted methodology to elaborate of this study was based on the achievement a bibliographic review with regard to proceedings of production of space and productive restructuring, document research about the dynamics of the dairy sector in Rio Grande do Norte, as well as on regulatory instructions governing the dairy production in Brazil, we achieve parallel secondary data collection, with official organs such as IBGE, EMATER and SINDLEITE. Another important methodological resource was the realization of the field research, which enabled us to empirically understand the distinct realities lived by agents acting on milk production system in Rio Grande do Norte. The analyzes performed nevertheless evidence that the restructuring process in the dairy sector is fomented, greatly by state,that finance, encourages and normatizes the production of milk in the country. In the specific case of Rio Grande do Norte, this process is boosted by the creation of "Programa do Leite," which by constituting of an institutional market, contributes to the strengthening and expansion of industries, the detriment of the artisanal processing sector. Nevertheless family farmers continue to act in the activity, be only producing and trading fresh milk, supplying milk to processing units, mediating the production of their peers or by the craft benefiting milk in traditional cheese factories presents in the entire state of Rio Grande do Norte. The results reveal that it is a complex web of social relations of production that are established at the heart of laticinista activity in the Rio Grande Norte, these are summarily marked by relations of competition and complementarity between industrial and artisanal processing of milk

A molecular analysis of the interactions of escherichia coli and macrophages

Escherichia coli (E.coli) is a diverse bacterial species that primarily forms a beneficial symbiotic relationship with the host in the human lower gastrointestinal track (GIT), however it can also be pathogenic in this environment. Furthermore, some strains can diverge from the GIT and occupy niches such as the urinary tract. In all these environments, E. coli interacts with the immune system and macrophages represent the front line of the innate immune system. In this study we characterise the immune response by macrophages to E. coli infection. It was shown that E. coli broadly provoke a similar cytokine response during macrophages infection and furthermore are degraded primarily by the phagocytosis pathway. Recently a new group of E. coli called Adherent Invasive Escherichia coli (AIEC) has been described. AIEC are present in the guts of Crohn’s disease (CD) patients at a higher frequency than in healthy patients. AIEC can replicate in macrophages but the mechanism for this is not fully understood. The processing of AIEC by macrophages was investigated and it was shown that AIEC only replicated in permissive macrophages. Furthermore, even in a permissive macrophages AIEC are trafficked through macrophages in a similar manner to commensal E. coli. This supports the hypothesis that AIEC are highly similar to commensal E. coli and only cause pathogenicity when present in the permissive environment of the gut of CD patients. Replication in macrophages requires functioning metabolic pathways and it was identified that glycolysis is important for AIEC survival in macrophages. AIEC mutants without a fully functioning glycolysis pathway induced less IL-1β cytokine release from macrophages than wild type strain suggesting that metabolism plays a role in inflammasome activation. Furthermore, AIEC mutants that could not produce the glycolytic end product acetate induced significantly reduced IL-1β release during infection. This suggest that the acetate molecule or a phenotypic effect of its production may be a driver of IL-1β release from AIEC infected macrophages. The interaction of uropathogenic E. coli (UPEC) with macrophages was also investigated. UPEC induced very high levels of cytotoxicity in human macrophages which was shown to be dependent on the production of the pore forming toxin α-hemolysin. However, UPEC did not induced high levels of cytotoxicity in murine macrophages suggesting there are species specific sensitivity to α-hemolysin that should be considered when studying UPEC pathogenicity in murine models.

Panoramic Sea Happening (After Kantor): Video Installation

Panoramic Sea Happening (After Kantor) is a 7 minute durational film that reimagines part of Tadeusz Kantor's original sea happenings from 1967 in a landscape in which the sea has retreated. The conductor of Kantor’s original performance is replaced with a sound object cast adrift on a beach in Dungeness (UK). The object plays back the sound of the sea into the landscape, which was performed live and then filmed from three distinct angles. The first angle mimics the position of the conductor in Kantor’s original happening, facing outwards into the horizon of the beach and recalls the image in Kantor’s work of a human figure undertaking the absurd task of orchestrating the sound of a gigantic expanse of water. The second angle exposes the machine itself and the large cone that amplifies the sound, reinforcing the isolation of the object. The third angle reveals a decommissioned nuclear power station and sound objects used as a warning system for the power plant. Dungeness is a location where the sea has been retreating from the land, leaving traces of human activity through the disused boat winches, abandoned cabins and the decommissioned nuclear buildings. It is a place in which the footprint of the anthropocene is keenly felt. The sound object is intended to act as an anthropomorphic figure, ghosting the original conductor and offering the sound of the sea back into the landscape through a wide mouthpiece, echoing Kantor’s own load hailer in the original sequence of sea happenings. It speculates on Kantor's theory of the bio-object, which proposed a symbiotic relationship between the human and the nonhuman object in performance, as a possible instrument to access a form of geologic imagination. In this configuration, the human itself is absent, but is evoked through the objects left behind. The sound object, helpless in a red dingy, might be thought of as a co-conspirator with the viewer, enabling a looking back to the past in a landscape of an inevitable future. The work was originally commissioned by the University of Kent in collaboration with the Polish Cultural Institute for the Symposium Kantorbury Kantorbury in Canterbury (UK) to mark the 100 years since Tadeusz Kantor’s birth (15 - 19 September 2015). It should be projected and requires stereo speakers.

TROMBONE MUSIC OF SCANDINAVIA: A STUDY OF TROMBONE SOLO AND CHAMBER WORKS FROM SWEDEN, NORWAY, AND DENMARK

This dissertation project aims to establish Scandinavian trombone solo and chamber works as a major contribution to the trombone repertoire. From the late 19th century to modern day, Scandinavian composers have produced a steady output of trombone works of substantial musical quality. Deep-rooted in the traditions of strong military wind bands, Scandinavia has also produced an unusual number of trombone virtuosos, ranging from those holding positions in leading orchestras, and internationally renowned pedagogues, to trombonists enjoying careers as soloists. In this study I propose that it is the symbiotic relationship between strong performers and traditionally nationalist composers that created the fertile environment for the large number of popular trombone solo and chamber repertoire not seen in any other region besides the Paris Conservatory and its infamous test pieces. I also interpret the selected repertoire through the prism of nationalism and influence of folk music, and convey that the allure of the mystic Nordic folk influences enhances the appeal of the Scandinavian trombone repertoire to world-wide audiences and performers. The dissertation project was realized over three solo recitals, each showcasing the music of Sweden, Norway, and Denmark respectively. For each program, I looked to choose a standard work from the trombone solo repertoire, a work written for or by a native virtuoso, and a lesser-known work that warrants the attention of other performers for its musical qualities. The recital of Swedish music presented Mandrake in the Corner by Christian Lindberg, Subadobe by Frederik Högberg, A Christian Song by Jan Sandström, and Concertino for trombone and strings by Lars-Erik Larsson. The recital of Norwegian music presented Concerto for Trombone op. 76 by Egil Hovland, Ordner Seg by Øystein Baadsvik, Elegi by Magne Amdahl, and Concerto in F major by Ole Olsen. The recital of Danish music presented Rapsodia Borealis by Søren Hyldgaard, Madrigal by Bo Gunge, Romance for trombone and piano by Axel Jørgensen, Concerto for trombone by Launy Grøndahl, and Three Swedish Tunes by Mogens Andresen. Through the performance of works from these three countries, the dissertation establishes Scandinavia as a rich source of solo trombone repertoire perpetuated by nationalist composers and virtuosos, as well as providing a brief survey of Scandinavian trombone works of various instrumentation and difficulty levels to be enjoyed by student, professional, and amateur performers and their audience.

Survey of Amphiprion clarki & Amphiprion sebae populations in Persian Gulf by molecular genetics

Anemone fishes are a group of 28 species of coral reef fishes belonging to the family Pomacentridae, subfamily Amphiprioninae and all have an obligate symbiotic relationship with sea anemones. Two species of these small ornamental fishes have been identified in the Persian Gulf including Amphiprion clarkii and A. sebae. The phylogenetic relationship between Amphiprion species of the Persian Gulf was studied by collecting 15 samples from three Iranian islands, Larak, Farur and Kish. DNA was extracted from each sample and a part of mtDNA was amplified. Two pairs of primers were designed to amplify a final target of 400 by nested-PCR. Each amplicon was sequenced, aligned and genetic diversity among samples was investigated by phylogenetic analysis. Results show that there is no significant genetic variation among A. clarkii individuals; however, A. sebae individuals from Larak were different from other fishes of the same species. Most probably this is due to the ability of A. clarkii to be symbiotant with all 10 species of host sea anemones which enables it to spread its own population in the 3 islands. However, A. sebae is observed to be symbiotant only with one host in the sea, therefore, has one option that reduces its distribution.

Vai morrer o meu menino - Paralisado, doente, isolado, exclusivo, desejado e amado: Estudo de um processo de comunicação num universo simbiótico

Dissertação de Mestrado apresentada ao Instituto Superior de Psicologia Aplicada para obtenção de grau de Mestre na especialidade de Psicologia Clínica.