Política publica de saúde: análise da agenda do Estado do Rio de Janeiro

Esta tese analisa a política de saúde no estado do Rio de Janeiro, focando nas modificações estruturais produzidas pela adoção da contrarreforma de natureza neoliberal. O marco temporal da análise é partir de 2006, com a eleição de Sérgio Cabral governador do estado. Num contexto histórico mais amplo, buscamos compreender os processos que conduziram as escolhas políticas desde a hegemonia da política neoliberal no Brasil na década de 1990, até a situação atual. Da análise das prioridades do governo estadual centradas na adoção de novos modelos de gestão e seus resultados, conclui-se, do ponto de vista financeiro e social, que a proposta de contrarreforma na saúde continua direcionando a política para ampliar a participação privada no setor público, que permite a transferência de recursos públicos para ente privados. Entretanto a eficiência da gestão privada se mostrou falaciosa, os quesitos de qualidade, eficiência e economicidade na assistência à saúde, usados para justificar ideologicamente a contrarreforma, não foram alcançados. Ao contrário a gestão privada ampliou os gastos operacionais em saúde e não foi capaz de manter constante a oferta de serviços.

A efetivação judicial do direito fundamental à saúde e o orçamento público

O presente trabalho tem por objetivo estudar as principais questões relacionadas à efetivação pelo Poder Judiciário do direito social a saúde. Serão analisados na primeira parte do trabalho os direitos sociais fundamentais e o mínimo existencial, no qual se inclui o direito à saúde, abordando-se a importância dada pela Constituição Federal a tal direito e sua regulamentação infraconstitucional, com destaque para a organização do Estado e as fontes de recursos. Após se demonstrar a importância do direito à saúde como direito social fundamental, será estudada na segunda parte do trabalho a escassez de recursos para o atendimento de todas as necessidades da população, abordando-se o conceito de reserva do possível e a relevância das leis orçamentárias para o alcance as prioridades sociais. Por fim, será demonstrada a legitimidade e necessidade de ingerência do Poder Judiciário na concretização do direito à saúde, destacando-se as posições doutrinárias e decisões judiciais que buscam alcançar o equilíbrio entre o atendimento de tal direito fundamental, o reconhecimento da limitação de recursos e a valorização do orçamento público.

Cheshire Meres 1994 November surveys

This is the Cheshire Meres 1994 November surveys report produced by the National Rivers Authority in 1995. The report focuses on some of Cheshire meres, which were showing evidence of increasing eutrophication, commonly due to anthropogenic inputs. Concern for the deterioration of the water quality of still waters has been translated by incorporating these priorities into the NRA North West Regional Environmental Strategy for Stillwaters. The meres were also being investigated as possible polluted waters under the EC Nitrate Directive. The ultimate aim is to formulate lakes management options in order to help preserve North West still waters and minimise future restoration programmes. For such pro-active work to be carried out, sufficient background data must be available. It should then be possible to fully assess the current status of these lakes, identify seasonal trends and detect significant point/diffuse pollution inputs. These surveys were the first of a series, and it was intended to repeat similar surveys in Summer and Autumn 1995, and include a further 20 meres.

The Rivers Avon & Erme SAP Final Plan

This is the Rivers Avon & Erme Salmon Action Plan Final document produced by the Environment Agency in 2004. The Rivers Avon and Erme Salmon Action Plan (SAP) has been produced after consideration of feedback from public consultation. The final plan provides a list of the agreed issues and actions for the next five years to maintain and improve the salmon stocks and fisheries of both rivers. Efforts have been made to identify possible sources of funding, partners and timescales. It indicates how the plan will be managed, including the process for reviewing stock status, issues, actions and progress. Low marine survival is currently a major factor limiting the numbers of salmon returning to spawn in both the Avon and the Erme. Actions to improve the accessibility of spawning areas and to maximise the productivity of spawning and nursery habitats are seen as priorities, which should help to offset the low marine survival. The quality of the information available to assess salmon stocks is recognised as a limiting factor in the management of salmon fisheries. The SAP aims also to promote long term collaboration between the Agency and other interested parties in managing the salmon stocks and fisheries of the Avon and the Erme.

The River Axe SAP Final Plan

This is the River Axe Salmon Action Plan Final document produced by the Environment Agency in 2004. The River Axe Salmon Action Plan (SAP) has been produced after consideration of feedback from public consultation. The final plan provides a list of the agreed issues and actions for the next five years to maintain and improve the salmon stock of the River Axe. Efforts have been made to identify possible sources of funding, partners and timescales. It indicates how the plan will be managed, including the process for reviewing stock status, issues, actions and progress. Low marine survival is currently a major factor limiting salmon stocks throughout the United Kingdom. However, on the River Axe the freshwater environment is still the main factor limiting the recovery of the salmon stock. Most of the adults returning to the Axe at present are probably derived from hatchery reared smolts, although there has been some natural reproduction in recent years. Juvenile populations in the Yarty indicate that this is a tributary where salmon have started to re-establish a self-sustaining population. Actions to improve the quality of the freshwater environment, both in terms of water quality and sedimentation, are seen as the top priorities, and are required to allow the Axe to support a self-sustaining salmon population.

The River Dart SAP Final Plan

This is the River Dart Salmon Action Plan Final document produced by the Environment Agency in 2003. This final Salmon Action Plan (SAP) for the River Dart catchment has been produced after consideration of feedback from external consultation. It provides a list of the agreed issues and actions for the next five years to maintain and improve the River Dart salmon stock. The low marine survival (likely to be below 10%) is possibly to be the main cause for the River Dart salmon stock non-compliance with its conservation limit. Actions protecting smolts and maximising spawning activity of returning adults are seen as priorities to contribute to mitigate the low marine survival. Also the lack of information on salmon stock and its habitat is recognised as one main factor limiting the better management of salmon fisheries. Efforts will be focused on gaining more knowledge and improving modelling techniques. The actions presented in this document are perceived as those required to address the important issues and factors limiting the salmon stock. This SAP aims also to promote long term collaboration between the Agency and other interested parties in managing the River Dart salmon stock and fisheries.

The River Exe SAP Final Plan

This is the River Exe Salmon Action Plan Final document produced by the Environment Agency in 2003. This final Salmon Action Plan (SAP) for the River Exe catchment has been produced after consideration of feedback from external consultation. The actions presented within this Salmon Action Plan clarify the important issues and factors currently limiting the salmon stock on the river. An attempt has been made to cost these actions, identify possible sources of funding and to provide a timescale for action. This SAP aims also to promote long term collaboration between the Agency and other interested parties in managing the River Exe salmon stock and fisheries. The River Exe salmon population is currently judged to be passing its Conservation Limit. However, its apparent declining trend in egg deposition in the recent years and the high uncertainty in its stock assessment suggest the following actions as priorities: actions promoting good land management, maximising salmon natural spawning activity and protecting smolts throughout the Exe catchment. Also, the lack of information on salmon stocks and its habitat quality and availability is recognised as the main factor limiting the better management of salmon fisheries. The actions presented in this document are perceived as those required to address the important issues and factors limiting the salmon stock.

The River Teign SAP Final Plan

This is the River Teign Salmon Action Plan Final document produced by the Environment Agency in 2003. This final Salmon Action Plan (SAP) for the River Teign catchment has been produced after consideration of feedback from external consultation. This final plan provides a list of the agreed issues and actions for the next five years to maintain and improve the River Teign salmon stock. An attempt has been made to cost these actions, identify possible sources of funding, partners and the timescale under which they will be dealt with. It indicates how the plan will be managed, i.e., implemented and reviewed, and, summarises progress of on-going actions. The low marine survival (likely to be below 10%) is possibly the main cause for the River Teign salmon stock non-compliance with its conservation limit. Actions protecting smolts and maximising spawning activity of returning adults are seen as priorities to contribute to offset the low marine survival. This SAP aims also to promote long term collaboration between the Agency and other interested parties in managing the River Teign salmon stock and fisheries.

Perfil dos HPA prioritários na exaustão de veículo a diesel, no combustível diesel utilizado durante os ensaios de emissão veicular e no óleo lubrificante do motor

As concentrações na exaustão e os fatores de emissão dos hidrocarbonetos policíclicos aromáticos (HPA) prioritários de um veículo a diesel e as suas respectivas concentrações no diesel usado durante os ensaios de emissão veicular foram determinados com a finalidade de estimar a contribuição dos HPA provenientes do combustível nas emissões. Os produtos da combustão foram coletados diretamente nas emissões brutas do escapamento, utilizando um sistema de amostragem a volume constante sem diluição dos gases da exaustão. Os HPA associados ao MP foram amostrados de forma estratificada, utilizando um impactador em cascata MOUDI e filtros de fibra de vidro como substratos, e os HPA em fase gasosa foram amostrados usando cartuchos de amberlite XAD-2. A concentração dos HPA no óleo lubrificante do motor também foi monitorada ao longo do tempo até a sua troca após 12.000 km de uso. Após a extração e tratamento das amostras, a identificação e quantificação dos HPA foram realizadas, utilizando cromatografia de fase gasosa acoplada à espectrometria de massas (CG-EM) com injetor de grande volume de vaporização com a temperatura programável (PTV-LVI). Cinco variáveis do PTV-LVI foram otimizadas, utilizando planejamento de experimentos, o que permitiu obter limites de detecção menores do que 2,0 g L-1. Somente 7 dos 16 HPA prioritários foram identificados na exaustão: NAP, ACY, ACE, FLU, FEN, FLT e PYR. Os ensaios de emissão veicular foram realizados com o veículo em modo estacionário, sem aplicação de carga e com baixa velocidade de rotação do motor (1500 rpm), utilizando um diesel com menor teor de enxofre (10 mg kg-1) e com 5% v/v de biodiesel. Esses fatores possivelmente contribuíram para reduzir as emissões dos outros 9 HPA a valores abaixo dos limites de detecção do método desenvolvido. Aproximadamente 80% da massa dos HPA totais associados ao MP estavam presentes em partículas com tamanho entre 1,0 m e 56 nm, e aproximadamente 4,5% estavam presentes em partículas menores do que 56 nm. Partículas menores que 2,5 m são facilmente inaladas e depositadas no trato respiratório e na região alveolar, justificando a preocupação com relação às emissões de HPA associados a partículas provenientes da exaustão veicular de motores a diesel. Somente 5 dos 7 HPA identificados na exaustão foram detectados no diesel: NAP, ACY, FLU, FEN e PYR. A razão entre os fatores de emissão (g L-1diesel) dos HPA na exaustão e suas respectivas concentrações do diesel (g L-1) variaram de 0,01 0,02 a 0,05 0,029, dependendo do HPA. Esses valores indicam que pelo menos 95 a 99% dos HPA identificados no diesel foram destruídos e/ou transformados em outros compostos durante a combustão, e/ou foram retidos no reservatório do óleo lubrificante. Por outro lado, os HPA que tiveram maiores concentrações no diesel também apresentaram maiores fatores de emissão, o que sugere que os HPA provenientes do diesel possuem uma contribuição significativa para as emissões dos HPA totais. O perfil dos HPA prioritários no óleo lubrificante mostrou-se semelhante ao perfil dos HPA no diesel e nas emissões totais, onde o NAP, FEN e PYR foram os HPA majoritários

Mapping the shallow-water coral ecosystems of the Freely Associated States: an implementation plan

This Freely Associated States Shallow-water Coral Ecosystem Mapping Implementation Plan (FAS MIP) presents a framework for the development of shallow-water (~0–40 m; 0–22 fm) benthic habitat and possibly bathymetric maps of critical areas of the Freely Associated States (FAS). The FAS is made up of three self-governing groups of islands and atolls—the Republic of Palau (Palau), the Federated States of Micronesia (FSM), and the Republic of the Marshall Islands (RMI)—that are affiliated with the United States through Compacts of Free Association. This MIP was developed with extensive input from colleges, national and state regulatory and management agencies, federal agencies, non-governmental organizations, and individuals involved in or supporting the conservation and management of the FAS’s coral ecosystems. A list of organizations and individuals that provided input to the development of this MIP is provided in Appendix 1. This MIP has been developed to complement the Coral Reef Mapping Implementation Plan (2nd Draft) released in 1999 by the U.S. Coral Reef Task Force’s Mapping and Information Synthesis Working Group. That plan focused on mapping United States and FAS shallow-water (then defined as <30 m) coral reefs by 2009, based on available funding and geographic priorities, using primarily visual interpretation of aerial photography and satellite imagery. This MIP focuses on mapping the shallow-water (now defined as 0–40 m, rather than 0–30 m) coral ecosystems of the FAS using a suite of technologies and map development procedures. Both this FAS MIP and the 1999 Coral Reef Mapping Implementation Plan (2nd Draft) support to goals of the National Action Plan to Conserve Coral Reefs (U.S. Coral Reef Task Force, 2000). This FAS MIP presents a framework for mapping the coral ecosystems of the FAS and should be considered an evolving document. As priorities change, funding opportunities arise, new data are collected, and new technologies become available, the information presented herein will change.

Harmful algal blooms in coastal waters: options for prevention, control and mitigation

This report is the product of a panel of experts in the science of blooms of unicellular marine algae which can cause mass mortalities in a variety of marine organisms and cause illness and even death in humans who consume contaminated seafood. These phenomena are collectively termed harmful algal blooms or HABs for short. As a counterpart to recent assessments of the priorities for scientific research to understand the causes and behavior of HABs, this assessment addressed the management options for reducing their incidence and extent (prevention), actions that can quell or contain blooms (control), and steps to reduce the losses of resources or economic values and minimize human health risks (mitigation). This assessment is limited to an appraisal of scientific understanding, but also reflects consideration of information and perspectives provided by regional experts, agency managers and user constituencies during three regional meetings. The panel convened these meetings during the latter half of 1996 to solicit information and opinions from scientific experts, agency managers and user constituencies in Texas, Washington, and Florida. The panel's assessment limited its attention to those HABs that result in neurotoxic shellfish poisoning, paralytic shellfish poisoning, brown tides, amnesic shellfish poisoning, and aquaculture fish kills. This covers most, but certainly not all, HAB problems in the U.S.

Atmospheric nutrient input to coastal areas: reducing the uncertainties

A significant fraction of the total nitrogen entering coastal and estuarine ecosystems along the eastern U.S. coast arises from atmospheric deposition; however, the exact role of atmospherically derived nitrogen in the decline of the health of coastal, estuarine, and inland waters is still uncertain. From the perspective of coastal ecosystem eutrophication, nitrogen compounds from the air, along with nitrogen from sewage, industrial effluent, and fertilizers, become a source of nutrients to the receiving ecosystem. Eutrophication, however, is only one of the detrimental impacts of the emission of nitrogen containing compounds to the atmosphere. Other adverse effects include the production of tropospheric ozone, acid deposition, and decreased visibility (photochemical smog). Assessments of the coastal eutrophication problem indicate that the atmospheric deposition loading is most important in the region extending from Albemarle/Parnlico Sounds to the Gulf of Maine; however, these assessments are based on model outputs supported by a meager amount of actual data. The data shortage is severe. The National Research Council specifically mentions the atmospheric role in its recent publication for the Committee on Environmental and Natural Resources, Priorities for Coastal Ecosystem Science (1994). It states that, "Problems associated with changes in the quantity and quality of inputs to coastal environments from runoff and atmospheric deposition are particularly important [to coastal ecosystem integrity]. These include nutrient loading from agriculture and fossil fuel combustion, habitat losses from eutrophication, widespread contamination by toxic materials, changes in riverborne sediment, and alteration of coastal hydrodynamics. "

Mapping reef fish and the seascape: using acoustics and spatial modeling to guide coastal management

Reef fish distributions are patchy in time and space with some coral reef habitats supporting higher densities (i.e., aggregations) of fish than others. Identifying and quantifying fish aggregations (particularly during spawning events) are often top priorities for coastal managers. However, the rapid mapping of these aggregations using conventional survey methods (e.g., non-technical SCUBA diving and remotely operated cameras) are limited by depth, visibility and time. Acoustic sensors (i.e., splitbeam and multibeam echosounders) are not constrained by these same limitations, and were used to concurrently map and quantify the location, density and size of reef fish along with seafloor structure in two, separate locations in the U.S. Virgin Islands. Reef fish aggregations were documented along the shelf edge, an ecologically important ecotone in the region. Fish were grouped into three classes according to body size, and relationships with the benthic seascape were modeled in one area using Boosted Regression Trees. These models were validated in a second area to test their predictive performance in locations where fish have not been mapped. Models predicting the density of large fish (≥29 cm) performed well (i.e., AUC = 0.77). Water depth and standard deviation of depth were the most influential predictors at two spatial scales (100 and 300 m). Models of small (≤11 cm) and medium (12–28 cm) fish performed poorly (i.e., AUC = 0.49 to 0.68) due to the high prevalence (45–79%) of smaller fish in both locations, and the unequal prevalence of smaller fish in the training and validation areas. Integrating acoustic sensors with spatial modeling offers a new and reliable approach to rapidly identify fish aggregations and to predict the density large fish in un-surveyed locations. This integrative approach will help coastal managers to prioritize sites, and focus their limited resources on areas that may be of higher conservation value.

Integration of fisheries acoustics surveys and bathymetric mapping to characterize midwater-seafloor habitats of US Virgin Islands and Puerto Rico (2008-2010)

NOAA’s Coral Reef Conservation program (CRCP) develops coral reef management priorities by bringing together various partners to better understand threats to coral reef ecosystems with the goal of conserving, protecting and restoring these resources. Place-based and ecosystem-based management approaches employed by CRCP require that spatially explicit information about benthic habitats and fish utilization are available to characterize coral reef ecosystems and set conservation priorities. To accomplish this, seafloor habitat mapping of coral reefs around the U.S. Virgin Islands (USVI) and Puerto Rico has been ongoing since 2004. In 2008, fishery acoustics surveys were added to NOAA survey missions in the USVI and Puerto Rico to assess fish distribution and abundance in relation to benthic habitats in high priority conservation areas. NOAA’s National Centers for Coastal Ocean Science (NCCOS) have developed fisheries acoustics survey capabilities onboard the NOAA ship Nancy Foster to complement the CRCP seafloor habitat mapping effort spearheaded by the Center for Coastal Monitoring and Assessment Biogeography Branch (CCMA-BB). The integration of these activities has evolved on the Nancy Foster over the three years summarized in this report. A strategy for improved operations and products has emerged over that time. Not only has the concurrent operation of multibeam and fisheries acoustics surveys been beneficial in terms of optimizing ship time and resources, this joint effort has advanced an integrated approach to characterizing bottom and mid-water habitats and the fishes associated with them. CCMA conducts multibeam surveys to systematically map and characterize coral reef ecosystems, resulting in products such as high resolution bathymetric maps, backscatter information, and benthic habitat classification maps. These products focus on benthic features and live bottom habitats associated with them. NCCOS Centers (the Center for Coastal Fisheries and Habitat Research and the Center for Coastal Environmental Health and Biomolecular Research) characterize coral reef ecosystems by using fisheries acoustics methods to capture biological information through the entire water column. Spatially-explicit information on marine resources derived from fisheries acoustics surveys, such as maps of fish density, supports marine spatial planning strategies and decision making by providing a biological metric for evaluating coral reef ecosystems and assessing impacts from pollution, fishing pressure, and climate change. Data from fisheries acoustics surveys address management needs by providing a measure of biomass in management areas, detecting spatial and temporal responses in distribution relative to natural and anthropogenic impacts, and identifying hotspots that support high fish abundance or fish aggregations. Fisheries acoustics surveys conducted alongside multibeam mapping efforts inherently couple water column data with information on benthic habitats and provide information on the heterogeneity of both benthic habitats and biota in the water column. Building on this information serves to inform resource managers regarding how fishes are organized around habitat structure and the scale at which these relationships are important. Where resource managers require place-based assessments regarding the location of critical habitats along with high abundances of fish, concurrent multibeam and fisheries acoustics surveys serve as an important tool for characterizing and prioritizing coral reef ecosystems. This report summarizes the evolution of fisheries acoustics surveys onboard the NOAA ship Nancy Foster from 2008 to 2010, in conjunction with multibeam data collection, aimed at characterizing benthic and mid-water habitats in high priority conservation areas around the USVI and Puerto Rico. It also serves as a resource for the continued development of consistent data products derived from acoustic surveys. By focusing on the activities of 2010, this report highlights the progress made to date and illustrates the potential application of fisheries data derived from acoustic surveys to the management of coral reef ecosystems.

Assessment of existing information on Atlantic coastal fish habitats: development of a web-based spatial bibliography, query tools, and data summaries

The primary objective of this project, “the Assessment of Existing Information on Atlantic Coastal Fish Habitat”, is to inform conservation planning for the Atlantic Coastal Fish Habitat Partnership (ACFHP). ACFHP is recognized as a Partnership by the National Fish Habitat Action Plan (NFHAP), whose overall mission is to protect, restore, and enhance the nation’s fish and aquatic communities through partnerships that foster fish habitat conservation. This project is a cooperative effort of NOAA/NOS Center for Coastal Monitoring and Assessment (CCMA) Biogeography Branch and ACFHP. The Assessment includes three components; 1. a representative bibliographic and assessment database, 2. a Geographical Information System (GIS) spatial framework, and 3. a summary document with description of methods, analyses of habitat assessment information, and recommendations for further work. The spatial bibliography was created by linking the bibliographic table developed in Microsoft Excel and exported to SQL Server, with the spatial framework developed in ArcGIS and exported to GoogleMaps. The bibliography is a comprehensive, searchable database of over 500 selected documents and data sources on Atlantic coastal fish species and habitats. Key information captured for each entry includes basic bibliographic data, spatial footprint (e.g. waterbody or watershed), species and habitats covered, and electronic availability. Information on habitat condition indicators, threats, and conservation recommendations are extracted from each entry and recorded in a separate linked table. The spatial framework is a functional digital map based on polygon layers of watersheds, estuarine and marine waterbodies derived from NOAA’s Coastal Assessment Framework, MMS/NOAA’s Multipurpose Marine Cadastre, and other sources, providing spatial reference for all of the documents cited in the bibliography. Together, the bibliography and assessment tables and their spatial framework provide a powerful tool to query and assess available information through a publicly available web interface. They were designed to support the development of priorities for ACFHP’s conservation efforts within a geographic area extending from Maine to Florida, and from coastal watersheds seaward to the edge of the continental shelf. The Atlantic Coastal Fish Habitat Partnership has made initial use of the Assessment of Existing Information. Though it has not yet applied the AEI in a systematic or structured manner, it expects to find further uses as the draft conservation strategic plan is refined, and as regional action plans are developed. It also provides a means to move beyond an “assessment of existing information” towards an “assessment of fish habitat”, and is being applied towards the National Fish Habitat Action Plan (NFHAP) 2010 Assessment. Beyond the scope of the current project, there may be application to broader initiatives such as Integrated Ecosystem Assessments (IEAs), Ecosystem Based Management (EBM), and Marine Spatial Planning (MSP).