Situação financeira e satisfação do consumidor das operadoras de saúde suplementar no Brasil

Este artigo elabora um diagnóstico sobre a situação financeira das operadoras de saúde suplementar no Brasil de acordo com a modalidade de gestão (seguro saúde, medicina de grupo, cooperativa médica, filantrópica e autogestão). Como indicador principal de saúde financeira, utiliza-se uma versão adaptada do zscore de Altman. Paralelamente, o estudo examina empiricamente os determinantes de satisfação do consumidor do sub-sistema suplementar de saúde, focando a análise no impacto da situação financeira da operadora e nas modalidades de gestão existentes sobre o nível de reclamações registradas junto à Agência Nacional de Saúde Suplementar. Para tanto, utiliza-se uma amostra de 270 operadoras de saúde suplementar para o período 2003-2005, e são utilizadas regressões de dados em painel, com variáveis de controle de mercado, operacionais e de gestão. Os resultados indicam que (1) as operadoras de saúde se beneficiam de economias de escala, (2) as empresas que operam no modelo de autogestão têm melhor situação financeira que as demais, e (3) as despesas com marketing não impactam a satisfação dos consumidores dos planos de saúde no Brasil. Finalmente, encontra-se também evidência fraca de que boa situação financeira implica melhor satisfação do consumidor.

Fiscal policy in Brazil: from counter-cyclical response to crisis

The main goal of this article is to identify the dynamic effects of fiscal policy on output in Brazil from 1997 to 2014, and, more specifically, to estimate those effects when the output falls below its potential level. To do so, we estimate VAR (vector autoregressive) models to generate impulse-response functions and causality/endogeneity tests. Our most remarkable results indicate the following channel of economic policy in Brazil: to foster output, government spending increases causing increases in both tax rates and revenue and the short-term interest rate. A fiscal stimulus via spending seems efficient for economic performance as well as monetary policy; however, the latter operates pro-cyclically in the way we defined here, while the former is predominantly countercyclical. As the monetary shock had a negative effect on GDP growth and GDP growth responded positively to the fiscal shock, it seems that the economic policy has given poise to growth with one hand and taken it with the other one. The monetary policy is only reacting to the fiscal stimuli. We were not able to find any statistically significant response of the output to tax changes, but vice versa seems work in the Brazilian case.

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

Radon surveys in Brazil using CR-39

In this work results of two radon daughters survey in Brazil are presented and discussed. Some methodological problems concerning the first survey are pointed out which were corrected for the second survey in order to make a realistic long-term measurement of radon decay products in the air. The technique employed in both surveys was the alpha-spectroscopy using CR-39. The reliability of this technique as well as the results of the second survey are discussed, which indicate a poor correlation between radon and its decay products in the air at the researched dwellings. (c) 2005 Elsevier Ltd. All rights reserved.

Polycyclic aromatic hydrocarbons (PAHs) in raw cane sugar (rapadura) in Brazil

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Burkitt's lymphoma in Brazil: Strong association with Epstein-Barr virus

The incidence of Burkitt's lymphoma (BL) in Brazil is intermediate between the endemic form of equatorial Africa and the sporadic form in the United States, To characterize these lymphomas, we evaluated the clinical, morphologic, and immunohistochemical features of 24 Brazilian cases of BL, We also analyzed the cases for the presence of Epstein-Barr virus (EBV)-RNA using a highly sensitive and specific method of in situ hybridization, Most cases presented with involvement of intraabdominal organs, similar to the sporadic form of BL, EBV-RNA was detected in 17 of 24 cases (71%) in all or virtually all the tumor cells, This prevalence of EBV-positivity in our cases is intermediate between the endemic form of BL in equatorial Africa (100%) and the sporadic form in the United States (30%), These findings suggest that EBV plays an important role in the pathogenesis of BL in Brazil, This intermediate incidence of EBV infection may explain in part the differences of incidence of BL in different geographic regions.

Nitric oxide and anglotensin II receptors mediate the pressor effect of angiotensin II: A study in conscious and zoletil-anesthetized rats

The circumventricular structures of the central nervous system and nitric oxide are involved in arterial blood pressure control, and general anesthesia may stimulate the central renin-angiotensin system. We therefore investigated the central role of angiotensin 11 and nitric oxide on the regulation of systemic arterial blood pressure in conscious and anesthetized rats. METHODS: Rats with stainless steel cannulae implanted into their lateral ventricle were studied. We injected the AT(1) and AT(2) angiotensin 11 receptor antagonists, losartan and PD123319, L-NAME, 7-nitroindazole (nitric oxide synthetase inhibitors), and FK409 (nitric oxide donor agent) into the lateral ventricles. Mean arterial blood pressure (MAP) was recorded in conscious and zoletil-anesthetized rats. RESULTS: Mean +/- (SEM) baseline MAP was 117.5 +/- 2 mm Hg. Angiotensin II injected into the brain lateral ventricle increased MAP from 136.5 +/- 2 min Hg to 138.5 +/- 4 mm Hg (Delta 16 +/- 3 mm Hg to Delta 21 +/- 3 mm Hg) for all experimental groups versus control from 116 +/- 2 mm Hg to 120 +/- 3 mm Hg (Delta 3 +/- 1 mm Hg to A5 +/- 2 mm Hg) (P < 0.05). L-NAME or 7-nitroindazole enhanced the angiotensin II pressor effect (P < 0.05). Prior injection of losartan and PD123319 decreased the angiotensin 11 pressor effect and the enhancement effect of L-NAME and 7-nitroindazole (P < 0.05). Zoletil anesthesia did not interfere with the effects of angiotensin 11, AT,, AT2 antagonists, or nitric oxide synthetase inhibitors. CONCLUSIONS: Endogenous nitric oxide functions tonically as a central inhibitory modulator of the angiotensinergic system. AT, and AT2 receptors influence the angiotensin 11 central control of arterial blood pressure. Zoletil anesthesia did not interfere with these effects. (Anesth Analg 2007;105:1293-7)

A comunidade terapêutica para recuperação da dependência do álcool e outras drogas no Brasil: mão ou contramão da reforma psiquiátrica?

Na segunda metade do século passado iniciava-se um movimento revolucionário no cenário mundial da saúde mental: a Reforma Psiquiátrica. No mesmo momento nascia a proposta das Comunidades Terapêuticas, que mais tarde se tornaria um modelo consagrado de atendimento para a dependência do álcool e outras drogas. Por outro lado, com o alarmante crescimento deste problema no Brasil, assim como pela ausência de políticas públicas que dessem conta do problema, houve uma indiscriminada proliferação de locais de internação para dependentes químicos que, mesmo se autodenominando como Comunidades Terapêuticas, em nada se assemelham ao modelo inicial proposto. Estes locais apresentam práticas desumanas e iatrogênicas, muito semelhantes às criticadas pelo movimento da Reforma Psiquiátrica, o que tem provocado o descrédito para com o modelo das Comunidades Terapêuticas. Este artigo tem como objetivo demonstrar, através de pesquisa bibliográfica, como as bases conceituais e metodológicas da Reforma Psiquiátrica se assemelham profundamente as do movimento das Comunidades Terapêuticas, tendo surgido na mesma época e pelo mesmo motivo, e como a falta de regulamentação dos locais de internação para dependentes químicos no Brasil tem contribuído com o atual descrédito deste modelo.

Genetic Parameters for Productive and Reproductive Traits for Milk Buffalo in Brazil

Knowing the genetic parameters of productive and reproductive traits in milking buffaloes is essential for planning and implementing of a program genetic selection. In Brazil, this information is still scarce. The objective of this study was to verify the existence of genetic variability in milk yield of buffaloes and their constituents, and reproductive traits for the possibility of application of the selection. A total of 9,318 lactations records from 3,061 cows were used to estimate heritabilities for milk yield (MY), fat percentage (%F), protein percentage (%P), length of lactation (LL), age of first calving (AFC) and calving interval (CI) and the genetic correlations among traits MY, %F and %P. The (co) variance components were estimated using multiple-trait analysis by Bayesian inference method, applying an animal model, through Gibbs sampling. The model included the fixed effects of contemporary groups (herd-year and calving season), number of milking (2 levels), and age of cow at calving as (co) variable (quadratic and linear effect). The additive genetic, permanent environmental, and residual effects were included as random effects in the model. Estimated heritability values for MY, % F, % P, LL, AFC and CI were 0.24, 0.34, 0.40, 0.09, 0.16 and 0.05, respectively. The genetic correlation estimates among MY and % F, MY and % P and % F and % P were -0.29, -0.18 and 0.25, respectively. The production of milk and its constituents showed enough genetic variation to respond to a selection program. Negative estimates of genetic correlations between milk production and its components suggest that selection entails a reduction in the other.

Making the case for grid-connected photovoltaics in Brazil

In the developed world, grid-connected photovoltaics (PVs) are the fastest-growing segment of the energy market. From 1999 to 2009, this industry had a 42% compound annual growth-rate. From 2009 to 2013, it is expected to grow to 45%, and in 2013 the achievement of grid parity - when the cost of solar electricity becomes competitive with conventional retail (including taxes and charges) grid-supplied electricity - is expected in many places worldwide. Grid-connected PV is usually perceived as an energy technology for developed countries, whereas isolated, stand-alone PV is considered as more suited for applications in developing nations, where so many individuals still lack access to electricity. This rationale is based on the still high costs of PV when compared with conventional electricity. We make the case for grid-connected PV generation in Brazil, showing that with the declining costs of PV and the rising prices of conventional electricity, urban populations in Brazil will also enjoy grid parity in the present decade. We argue that governments in developing nations should act promptly and establish the mandates and necessary conditions for their energy industry to accumulate experience in grid-connected PV, and make the most of this benign technology in the near future. (C) 2010 Elsevier Ltd. All rights reserved.

Nitric Oxide Mediates the Hormonal Control of Crassulacean Acid Metabolism Expression in Young Pineapple Plants

Genotypic, developmental, and environmental factors converge to determine the degree of Crassulacean acid metabolism (CAM) expression. To characterize the signaling events controlling CAM expression in young pineapple (Ananas comosus) plants, this photosynthetic pathway was modulated through manipulations in water availability. Rapid, intense, and completely reversible up-regulation in CAM expression was triggered by water deficit, as indicated by the rise in nocturnal malate accumulation and in the expression and activity of important CAM enzymes. During both up-and down-regulation of CAM, the degree of CAM expression was positively and negatively correlated with the endogenous levels of abscisic acid (ABA) and cytokinins, respectively. When exogenously applied, ABA stimulated and cytokinins repressed the expression of CAM. However, inhibition of water deficit-induced ABA accumulation did not block the up-regulation of CAM, suggesting that a parallel, non-ABA-dependent signaling route was also operating. Moreover, strong evidence revealed that nitric oxide (NO) may fulfill an important role during CAM signaling. Up-regulation of CAM was clearly observed in NO-treated plants, and a conspicuous temporal and spatial correlation was also evident between NO production and CAM expression. Removal of NO from the tissues either by adding NO scavenger or by inhibiting NO production significantly impaired ABA-induced up-regulation of CAM, indicating that NO likely acts as a key downstream component in the ABA-dependent signaling pathway. Finally, tungstate or glutamine inhibition of the NO-generating enzyme nitrate reductase completely blocked NO production during ABA-induced up-regulation of CAM, characterizing this enzyme as responsible for NO synthesis during CAM signaling in pineapple plants.

Transcriptional regulation of the {\it neu\/} oncogene and its negative regulation by the c-{\it myc\/} oncogene

The first part of my research involved the characterization of the neu gene promoter. I subcloned a 2.2-kb sequence located upstream to the extreme 5$\sp\prime$ end of the neu gene, in front of the bacterial reporter gene, chloramphenicol acetyltransferase (CAT). Transfection of this construct into different cell lines and subsequent CAT assays demonstrated that this 2.2-kb fragment was functional as a promoter. A series of deletion constructs was engineered to study the contribution of different fragments to transcription. Subcloning of individual fragments was followed by a cotransfection competition experiment, which demonstrated the involvement of protein factors interacting with the promoter. A gel retardation assay was also performed to show the physical binding of protein factors to the promoter. The combined results suggested that both positively and negatively acting protein factors are involved in interacting with different regions of the promoter, contributing to the overall transcription activity. My findings provide an insight into the regulation of neu gene expression, which in turn provides the tools to understand the molecular mechanisms of overexpression of the neu gene in some breast cancer and ovarian cancer cell lines.^ In the second part of my research, I discovered that another oncogene, c-myc, was able to reverse the transformed morphology that was induced by the neu oncogene. Utilizing the promoter constructs that I made, I was able to show that the c-myc oncogene has a negative regulatory effect on the expression of the neu oncogene. Further studies suggested that c-myc is able to lower the effective concentration of a positive factor(s) that interact with a 139-bp fragment of the neu gene promoter. These findings may provide a direct evidence of the long suspected role of the c-myc gene in transcriptional regulation. The neu gene may very well be the first identified mammalian target gene that is regulated by the c-myc oncogene. Since c-myc is known to be stimulated by various mitogenic signals and the neu gene is likely to be a growth factor receptor, it is possible that c-myc, when stimulated by the signal transduction pathway of the neu gene, would function as a negative feedback regulator on the neu gene receptor. (Abstract shortened with permission of author.) ^

Complex regulation of human inducible nitric oxide synthase gene transcription by Stat 1 and NF-κB

The human inducible nitric oxide synthase (hiNOS) gene is expressed in several disease states and is also important in the normal immune response. Previously, we described a cytokine-responsive enhancer between −5.2 and −6.1 kb in the 5′-flanking hiNOS promoter DNA, which contains multiple nuclear factor κβ (NF-κB) elements. Here, we describe the role of the IFN-Jak kinase-Stat (signal transducer and activator of transcription) 1 pathway for regulation of hiNOS gene transcription. In A549 human lung epithelial cells, a combination of cytokines tumor necrosis factor-α, interleukin-1β, and IFN-γ (TNF-α, IL-1β, and IFN-γ) function synergistically for induction of hiNOS transcription. Pharmacological inhibitors of Jak2 kinase inhibit cytokine-induced Stat 1 DNA-binding and hiNOS gene expression. Expression of a dominant-negative mutant Stat 1 inhibits cytokine-induced hiNOS reporter expression. Site-directed mutagenesis of a cis-acting DNA element at −5.8 kb in the hiNOS promoter identifies a bifunctional NF-κB/Stat 1 motif. In contrast, gel shift assays indicate that only Stat 1 binds to the DNA element at −5.2 kb in the hiNOS promoter. Interestingly, Stat 1 is repressive to basal and stimulated iNOS mRNA expression in 2fTGH human fibroblasts, which are refractory to iNOS induction. Overexpression of NF-κB activates hiNOS promoter–reporter expression in Stat 1 mutant fibroblasts, but not in the wild type, suggesting that Stat 1 inhibits NF-κB function in these cells. These results indicate that both Stat 1 and NF-κB are important in the regulation of hiNOS transcription by cytokines in a complex and cell type-specific manner.

Monthly bulletin - Bureau of Child Hygiene and Bureau of Public Health Nursing.

WI docs no.: HE 1 CH.4:1924-1926

Monthly bulletin - Bureau of Child Welfare and Bureau of Public Health Nursing.

WI docs no.: HE 1 CH.4:1926-1927