Some aspects of implementing Regulatory Impact Analysis in Brazil

In an increasingly complex society, regulatory polices emerge as an important tool in public management. Nevertheless, regulation per se is no longer enough, and the agenda for a regulatory reform is increasing. Following this context, Brazil has implemented Regulatory Impact Analysis (RIA) in its regulatory agencies. Thus, Brazilian specificities have to be considered and, in this regard, a systematic approach provides a significant contribution. This article aims to address some critical reflections about which policy-makers should ask themselves before joining the implementation of a RIA system in the Brazilian context. Through a long-term perspective, the implementation of RIA must be seen as part of a permanent change in the administrative culture, understanding that RIA should be used as a further resource in the decision-making process, rather than a final solution.

Ecological aspects of American cutaneous leishmaniasis: 4. Observations on the endophilic behavior of the sandfly and the vectorial role of Psychodopygus intermedius in the Ribeira Valley region of the S.Paulo State, Brazil

The invasive tendency of Psychodopygus intermedius in the home environment, observed initially by Forattini et al. (1976), has now been confirmed by the demonstration of its high endophilic ability and by the use of human residences for shelter. Populations such as Lutzomyia migonei and Pintomyia fischeri were also present in that environment, though their low densities registered during this investigation could be an indication of their poor ability to overcome the barriers raised by the artificial environment. An objective epidemiological analysis based on the variables here given showed that human infection takes place in the extraforest environment, and the principal vectorial function falls, without doubt, on P. intermedius.

The social adjustment of patients with schizophrenia: implications to the mental health policy in Brazil

A sample (n=124) of schizophrenic patients from a defined catchment area of the city os S.Paulo, Brazil, who had been consecutively admitted to hospital, was assessed for psychopathological status and social adjustment levels. Sociodemographic, socio-economic and occupational characteristics were recorded: almost 30% of the subjects had no occupation and received no social benefit, more than two-thirds had a monthly per capita income of US$ 100.00 or less. Sixty-five percent presented with Schneiderian firstrank symptoms. Nearly half the sample showed poor or very poor social adjustment in the month prior to admission. The most affected areas of social functioning were participation in the household activities, work and social withdrawal. The current mental health policy of promoting extra-mural care as an alternative to the previous hospital-based model will then mean the investment in a network of new community-based services, that give effective treatment and support to patients and their families. The need of further research into the current picture of mental disorders in the country is stressed.

Aspectos psicossociais associados à percepção da dor pós-operatória em indivíduos submetidos a cirurgia coronária

Objectivo: Identificar os factores psicossociais que influenciam a percepção da dor pós-operatória em doentes submetidos a cirurgia de revascularização do miocárdio (CRM). Material e Métodos: Estudo exploratório correlacional de 91 doentes (71 homens e 20 mulheres) submetidos a CRM (pontagem aortocoronária) por esternotomia). A idade média era de 63,8 ± 9,6 anos (entre 39 e 84). Foram utilizados os seguintes instrumentos: Escala Analógica Visual às 24, 48 e 96 horas do pós-operatório; Questionário de Caracterização Demográfica; Mental Health Inventory de 5 itens; Percepção de Saúde Geral (SF-36); Escala de Expectativas de Dor; Escala de Percepção de Apoio; Escala de Expectativas de Auto-eficácia; Satisfação com o tratamento, médicos e enfermeiros (American Pain Society Questionnaire) aplicados às 96 horas após a cirurgia. Resultados: Os doentes que apresentaram expectativas elevadas de dor, percepcionaram maior apoio, apresentaram níveis elevados de auto-eficácia para lidar com a dor ou, se pertenciam ao sexo masculino, sentiram menos dor. De igual modo, os doentes que apresentaram melhor saúde mental, percepcionaram a sua saúde como boa e os doentes que expressaram maior satisfação com o tratamento sentiram menos dor. A dor não foi influenciada pela idade, grau de escolaridade ou pela satisfação com a conduta de médicos e enfermeiros. Conclusão: Após as primeiras 48 horas do pós-operatório, a experiência de dor é influenciada por factores psicossociais, em oarticular pela expectativa de dor, expectativa de auto-eficácia, apoio percebido, percepção da saúde geral, percepção de saúde mental e satisfação com o tratamento para a dor. Perante os resultados, evidencia-se a necessidade de conjugar conhecimentos no sentido de dar respostas mais alargadas e de carácter multidisciplinar no tratamento da dor pós-operatória em CRM devendo, a par de outros aspectos, focar-se na gestão das expectativas dos doentes. ABSTRACT - Objective: To identify the psychological factors that influence post-surgery pain perception in patients undergoing coronary artery bypass graft surgery (CABG). Methods: This was an exploratory correlational study of 91 patients (71 men and 20 women) who underwent CABG (aortocoronary anastomosis) by sternotomy. Mean age was 63.8 ± 9.6 years (between 39 and 84). The following instruments were used: visual analogical scales at 24, 48 and 96 hours of post-surgery; demographic characteristics survey; pain expectations scale; perceived support scale; self-efficacy scale, Mental Inventory (5 items); health perception scale; and satisfaction with treatment, doctors and nurses (American Pain Society questionnaire) at 96 hours after surgery. Results: Patients who had presented high expectations of pain, perceived more support, presented high levels of self-efficacy to deal with pain or were male, felt less pain. Furthermore, patients who presented better mental health, perceived their general health as being good, or expressed greater satisfaction with treatment, felt less pain. Pain was not influenced by age, level of education or satisfaction with doctors and nurses. Conclusion: After the first 48 hours following surgery, the pain experience is influenced by psychosocial factors, in particular by expectation of pain and of self-efficacy, perceived support, perception of general and mental health, and satisfaction with pain treatment. The results confirm the need to bring together different kinds of knowledge for a broad, multidisciplinary approach to postoperative CABG pain treatment, focusing, along with other aspects, on management of patients’ expectations.

The development of a scale to measure concepts of schizophrenia: experience among Brazilian psychiatrists

INTRODUCTION: Among psychiatric disorders schizophrenia is often said to be the condition with the most disputed definition.The Bleulerian and Schneiderian approaches have given rise to diagnostic formulations that have varied with time and place. Controversies over the concept of schizophrenia were examined within European/North American settings in the early 1970s but little has since been reported on the views of psychiatrists in developing countries. In Brazil both concepts are referred to in the literature. A scale was developed to measure adherence to Bleulerian and Schneiderian concepts among psychiatrists working in S. Paulo. METHODOLOGY: A self-reported questionnaire comprising seventeen visual analogue-scale statements related to Bleulerian and Schneiderian definitions of Shizophrenia, plus sociodemographic and training characteristics, was distributed to a non-randomised sample of 150 psychiatrists. The two sub-scales were assessed by psychometric methods for internal consistency, sub-scale structure and test-retest reliability. Items selected according to internal consistency were examined by a two-factor model exploratory factor analysis. Intraclass correlation coefficients described the stability of the scale. RESULTS: Replies were received from 117 psychiatrists (mean age 36 (SD 7.9)), 74% of whom were made and 26% female. The Schneiderian scale showed better overall internal consistency than the Bleulerian scale. Intra-class correlation coefficients for test-retest comparisons were between 0.5 and 0.7 for Schneiderian items and 0.2 and 0.7 for Bleulerian items. There was no negative association between Bleulerian and Schneiderian scale scores, suggesting that respondents may hold both concepts. Place of training was significantly associated with the respondent's opinion; disagreement with a Bleulerian standpoint predominated for those trained at the University of S. Paulo. CONCLUSIONS: The less satisfactory reliability for the Bleulerian sub-scale limits confidence in the whole scale but on the other hand this questionnaire contributes to the understanding of the controversy over Bleulerian and Schneiderian models for conceptualisation of schizophrenia, the former requiring more inference and therefore being prone to unreliability.

Epidemiological aspects of centipede (Scolopendromorphae: Chilopoda) bites registered in Greater S. Paulo, SP, Brazil

INTRODUCTION: The lack of basic knowledge on venomous arthropods and the benignity of the clinical manifestations contribute to the centipede bite victims' not being taken to a treatment reference center, leading to underestimation of the number of cases and minimizing the possibility of a broader epidemiological view. An inventory of the centipede bite occurrences in Greater S. Paulo, Brazil, and the therapeutic methods employed, by the main Brazilian medical center for the notification of poisoning by venomous animals, is presented. METHOD: All patient cards of the period 1980-1989 have been checked as to place, month and time of occurrence; sex, age, affected part of the body, signs and symptoms have been observed, as well as the therapeutic methods employed. The centipedes that caused the accidents were identified at the Arthropods Laboratory. RESULTS: It was registered 216 accidents, with a 69% predominance of the Greater S. Paulo and in only 63% of the cases (136) was the agent brought in by the victim for identification. The genera most frequently represented were Cryptops (58%), Otostigmus (33%) and Scolopendra (4%). Of the 136 cases, 87% showed erythema, edema, hemorrhage, burns, cephalalgia, and intense pain. There was a predominance of accidents in the warm rainy season, in the morning and for females between 21 and 60 years of age. Hands and feet were the parts of the body most affected. The benign evolution of the clinical picture (54%) made therapeutical treatment unnecessary. Only the victims of Scolopendra and Otostigmus (46%) were medicated with anesthetics (51%), analgesics (25%), antihistamines and cortisone (24%). CONCLUSION: The reproductive period of the centipedes, associated with their sinanthropic habits, contributes to the greater incidence of accidents in urban areas in the warm rainy season. Only patients bitten by Scolopendra and Otostigmus require therapeutical treatment.

Sociological and philosophical aspects of human interaction with technology: advancing concepts

It is not possible to imagine our lives today without technology. From the moment we get up in the morning until the time that we go to bed at night, technology is present in almost every moment, even if we are not aware of it. Some of the most basic activities we need to perform regularly could not be carried out without technology. Sociological and Philosophical Aspects of Human Interaction with Technology: Advancing Concepts presents a careful blend of conceptual, theoretical and applied research in regards to the relationship between technology and humans. This book explores the importance of these interactions, aspects related with trust, communication, data protection, usability concerning organizational change, and e-learning. The advancement of these theories and practices will benefit from this publication as it provides a voice for the users.

Entomological aspects of Chagas' disease transmission in the domestic habitat, Argentina

OBJECTIVE: To study the risk of Trypanosoma cruzi domestic transmission using an entomological index and to explore its relationship with household's characteristics and cultural aspects. METHODS: There were studied 158 households in an endemic area in Argentina. Each household was classified according to an entomological risk indicator (number of risky bites/human). A questionnaire was administered to evaluate risk factors among householders. RESULTS: Infested households showed a wide range of risk values (0 to 5 risky bites/human) with skewed distribution, a high frequency of lower values and few very high risk households. Of all collected Triatoma infestans, 44% had had human blood meals whereas 27% had had dogs or chickens blood meals. Having dogs and birds sharing room with humans increased the risk values. Tidy clean households had contributed significantly to lower risk values as a result of low vector density. The infested households showed a 24.3% correlation between time after insecticide application and the number of vectors. But there was no correlation between the time after insecticide application and T. infestans' infectivity. The statistical analysis showed a high correlation between current values of the entomological risk indicator and Trypanosoma cruzi seroprevalence in children. CONCLUSIONS: The risk of T. cruzi domestic transmission assessed using an entomological index show a correlation with children seroprevalence for Chagas' disease and householders' habits.

Self-optimization aspects for dynamic scheduling

Scheduling is a critical function that is present throughout many industries and applications. A great need exists for developing scheduling approaches that can be applied to a number of different scheduling problems with significant impact on performance of business organizations. A challenge is emerging in the design of scheduling support systems for manufacturing environments where dynamic adaptation and optimization become increasingly important. At this scenario, self-optimizing arise as the ability of the agent to monitor its state and performance and proactively tune itself to respond to environmental stimuli.

Prevalência e impacte da incontinência urinária e stresse. Antes e durante a gravidez

Introdução: A Incontinência Urinária (IU) feminina é um importante problema de saúde pública, quer pela sua elevada prevalência, quer pelo elevado impacte físico, psíquico e social na vida da mulher. O objectivo deste estudo foi determinar a prevalência, o impacte da Incontinência Urinária de Stresse (IUS) antes e durante a gravidez em parturientes do distrito de Viana do Castelo e determinar a percentagem de mulheres que procura apoio de um profissional de saúde para o seu problema. Método: Realizou-se um estudo transversal considerando uma amostra representativa do distrito, constituída por 336 mulheres, cujo parto ocorreu no Hospital de Santa Luzia, no período compreendido entre 15 de Janeiro a 29 de Março de 2002. Todas as mulheres foram submetidas a um questionário no pós-parto hospitalar. Resultados: A prevalência da IUS, definida como Alguma vez teve perda de urina durante a realização de um esforço? foi de 5,4% (IC 95%: 3,0-7,8) antes da gravidez e 51,5% (IC 95%: 46,1-56,9) durante a gravidez actual. Os factores associados à ocorrência da IUS antes da gravidez foram a multiparidade (OR=9,96), a presença de diabetes (OR=4,61) e obesidade (OR=4,76), e à IUS durante a gravidez foram a multiparidade (OR=1,66), a diabetes (OR=2,62) e a obstipação (OR=1,73). A grande maioria (88,9%) das mulheres com IUS sente-se incomodada por se sentir húmida, 48,5% sente-se nervosa ou ansiosa e 57,3% tem medo que os outros se apercebam do odor. Durante a gravidez, apenas menos de metade das mulheres que tiveram perdas de urina procurou apoio de um profissional de saúde, apesar de a maioria ter interesse em tratar o problema. Conclusões: A IUS afecta um grande número de mulheres deste distrito antes e durante a gravidez. A IUS tem reflexos em várias dimensões da saúde, sendo o bem-estar físico e emocional os mais afectados, mas apenas uma pequena percentagem de mulheres revela o seu problema de IUS a um profissional de saúde. Perante esta evidência tornase importante que os profissionais de saúde conheçam esta realidade e se preocupem em dar resposta a estes problemas de saúde.

ABS4GD: a multi-agent system that simulates group decision processes considering emotional and argumentative aspects

Emotion although being an important factor in our every day life it is many times forgotten in the development of systems to be used by persons. In this work we present an architecture for a ubiquitous group decision support system able to support persons in group decision processes. The system considers the emotional factors of the intervenient participants, as well as the argumentation between them. Particular attention will be taken to one of components of this system: the multi-agent simulator, modeling the human participants, considering emotional characteristics, and allowing the exchanges of hypothetic arguments among the participants.

LAID - a smart decision room with ambient intelligence for group decision making and argumentation support considering emotional aspects

Decision Making is one of the most important activities of the human being. Nowadays decisions imply to consider many different points of view, so decisions are commonly taken by formal or informal groups of persons. Groups exchange ideas or engage in a process of argumentation and counter-argumentation, negotiate, cooperate, collaborate or even discuss techniques and/or methodologies for problem solving. Group Decision Making is a social activity in which the discussion and results consider a combination of rational and emotional aspects. In this paper we will present a Smart Decision Room, LAID (Laboratory of Ambient Intelligence for Decision Making). In LAID environment it is provided the support to meeting room participants in the argumentation and decision making processes, combining rational and emotional aspects.

Cost of schizophrenia: direct costs and use of resources in the State of São Paulo

OBJECTIVE: To estimate the direct costs of schizophrenia for the public sector. METHODS: A study was carried out in the state of São Paulo, Brazil, during 1998. Data from the medical literature and governmental research bodies were gathered for estimating the total number of schizophrenia patients covered by the Brazilian Unified Health System. A decision tree was built based on an estimated distribution of patients under different types of psychiatric care. Medical charts from public hospitals and outpatient services were used to estimate the resources used over a one-year period. Direct costs were calculated by attributing monetary values for each resource used. RESULTS: Of all patients, 81.5% were covered by the public sector and distributed as follows: 6.0% in psychiatric hospital admissions, 23.0% in outpatient care, and 71.0% without regular treatment. The total direct cost of schizophrenia was US$191,781,327 (2.2% of the total health care expenditure in the state). Of this total, 11.0% was spent on outpatient care and 79.2% went for inpatient care. CONCLUSIONS: Most schizophrenia patients in the state of São Paulo receive no regular treatment. The study findings point out to the importance of investing in research aimed at improving the resource allocation for the treatment of mental disorders in Brazil.

Riscos psicossociais no trabalho: estresse e estratégias de coping em enfermeiros em oncologia

Objetivo: identificar fontes de estresse e estratégias de coping em enfermeiros que exercem funções em três Serviços de Oncologia de Cirurgia Cabeça e Pescoço, de três hospitais centrais de Portugal. Método: estudo transversal, de carácter descritivo e exploratório, cuja amostra foi constituída pelos 96 enfermeiros dos três serviços. Na recolha de dados, foram utilizados: Questionário Sociodemográfico, Questionário de Saúde Geral-12, Inventário de Estressores Ocupacionais e Brief COPE. Resultados: verificaram-se níveis razoáveis de saúde geral. Os estressores mais referidos foram: sobrecarga de trabalho, baixa remuneração salarial, espaço físico onde se desenvolve a profissão, situações emocionalmente perturbadoras e falta de reconhecimento da profissão. As estratégias de coping mais utilizadas foram: planeamento, coping ativo, aceitação e autodistração. Conclusão: os estressores identificados relacionam-se principalmente a aspetos organizacionais e condições de trabalho, e as estratégias de coping escolhidas estão direcionadas para a resolução de problemas e melhoria do bemestar dos enfermeiros. Percentagem expressiva de enfermeiros apresentou níveis elevados de pressão e emoções deprimidas. Os resultados apresentados corroboram estudos anteriores que alertam para a importância do desenvolvimento de estratégias de prevenção dos níveis de estresse.

A pessoa idosa em situação de fim de vida no domicílio : estudo de caso

Dissertação de Mestrado em Gerontologia Social