As representações sociais da judicialização da saúde para profissionais de saúde

A judicialização da saúde é uma expressão cada vez mais presente nos cenários de assistência à saúde no Brasil materializada, principalmente, pelos mandados judiciais para a realização de procedimentos diagnósticos e terapêuticos, consultas, internações e dispensação de insumos médico-cirúrgicos. Como objetivo geral o estudo visa analisar o processo de judicialização da saúde no Brasil, no âmbito do SUS, a partir dos profissionais de saúde envolvidos nesse processo. Foram definidos como objetivos específicos descrever a estrutura e os conteúdos das representações sociais da judicialização da saúde no âmbito do SUS para gestores, reguladores e profissionais de saúde envolvidos no processo de atendimento às demandas geradas pela prática da ação judicial; comparar as Representações Sociais sobre a judicialização da saúde destes grupos sociais; discutir os conteúdos dessas representações no processo de judicialização da saúde compreendendo o campo social no qual esta questão se insere, as relações de poder que as perpassam e as construções simbólicas que as especificam. Trata-se de um estudo qualitativo, desenvolvido à luz da Teoria das Representações Sociais, realizado com 152 profissionais, em um hospital universitário e na central de regulação de procedimentos e leitos na cidade do Rio de Janeiro. Aplicou-se a Técnica de Evocação Livre através do termo indutor judicialização da saúde, sendo essas analisadas com a técnica de quadro de quatro casas e 40 entrevistas semiestruturadas analisadas através da análise de conteúdo temático-categorial instrumentalizada pelo software NVivo. Na análise estrutural foram evocadas 761 palavras, com média das ordens médias de evocação de três, com frequência máxima de 17 e mínima de 10, já a análise processual resultou em seis categorias, com 2257 unidades de registro, distribuídas em 85 temas. Identificou-se que os profissionais de saúde apresentam um posicionamento negativo diante da realidade imposta pela judicialização, entretanto reconhecem esse recurso como necessário mediante a crise da saúde pública brasileira. Os profissionais de saúde trabalham sob a pressão do poder judiciário, com a ameaça de prisão levando a um cotidiano estressante de suas práticas profissionais decorrente de uma ação ineficaz do Estado na execução da política de saúde. Conclui-se que a representação social encontra-se em fase final de consolidação. Considerando a representação social como determinante de práticas, concluímos também que as representações que emergiram deste estudo podem contribuir para a mudança das práticas dos profissionais de saúde que operacionalizam esse sistema. Espera-se desta forma, que ocorra a promoção de melhorias no resultado final da assistência direta aos usuários que buscam as instituições públicas de saúde para serem atendidos em suas necessidades de saúde, caracterizando-se dessa forma um desafio maior que caminha no sentido de fazer avançar a democracia e a cidadania.

Ecology and growth of juvenile California spiny lobster, Panulirus interruptus (Randall)

ABSTRACT TRANSCRIBED FROM ENGLE'S PH.D. ORAL DEFENSE PAMPHLET: The natural history of juvenile California spiny lobster, Panulirus interruptus (Randall), was investigated, with primary emphasis placed on ascertaining juvenile habitats, determining juvenile growth rates and component growth processes, and evaluating ecological and behavioral phenomena associated with juvenile survival and growth. Habitat surveys of island and mainland localities throughout southern and lower California revealed that small, greenish juveniles typically inhabit crevices or temporary burrows in 0-4m deep, wave-swept rocky habitats covered by dense beds of surf grass, Phyllospadix torreyi S. Watson. Phyllospadix beds were more abundant on gradually sloping rocky mainland beaches than on steeply sloping island shores. Phyllospadix abundance was positively correlated with P. interruptus abundance; however, at Santa Catalina Island, the Phyllospadix habitat was not extensive enough to be the sole lobster nursery. In laboratory tests, puerulus larvae and early juveniles chose Phyllospadix over rubble rocks or broad-bladed kelp, but did not consistently prefer Phyllospadix over reticulate algae. Ecology, growth, and behavior of juvenile P. interruptus inhabiting a discrete Phyllospadix habitat at Bird Rock, Santa Catalina Island, were investigated from October 1974 through December 1976 by means of frequent scuba surveys. Pueruli settled from June to November. Peak recruitment occurred from July to September, when seasonal temperatures were maximal. Settled larvae were approximately one year old. Juvenile growth was determined by size-frequency, single molt increment, mark-recapture, and laboratory culture studies. Carapace length vs. wet weight relationships fit standard power curve equations. Bird Rock juveniles grew from 7 to 32mm CL in 10-11 molts and from 32 to 56mm CL in 5-6 molts during their first and second benthic years, respectively. Growth rates were similar for males and females. Juveniles regenerating more than two limbs grew less per molt than intact lobsters. Long-term growth of laboratory-reared juveniles was 20% less than that of field lobsters. Growth component multiple regression analyses demonstrated that molt increment was directly proportional to premolt size and temperature for age 1+ lobsters. Molt frequency was inversely proportional to size and directly proportional to temperature. Temperature affected age 2+ lobsters similarly, but molt increment was independent of size, and molt frequency declined at a different rate. Juvenile growth rates more than doubled during warm water months compared to cold water months, primarily because of increased molt frequency. Based on results from this study and from previous investigations, it is estimated that P. interruptus males and females become sexually mature by ages 4 and 5 years, respectively, and that legai size is reached by 7 or 8 years of age. Juvenile P. interruptus activity patterns and foraging behavior were similar to those of adults, except that juvenile home ranges were proportionally smaller, and small juveniles were apparently not attracted to distant food. Small mollusks, abundant in Phyllospadix habitats, were the major food items. Size-dependent predation by fish and octopus apparently caused the considerable juvenile mortality observed at Bird Rock. Juveniles approaching 2 years of age gathered in mixed size-class aggregations by day and foraged beyond the grass beds at night. In autumn, these juveniles migrated to deeper habitats, coincident with new puerulus settlement in the Phyllospadix beds. Based on strong inferences from the results, it is proposed that size-dependent predation is the most important factor determining the !ife history strategy of juvenile P. interruptus. Life history tactics promoting rapid growth apparently function dually in reducing the period of high vulnerability to predation and decreasing the time required to reach sexual maturity. The Phyllospadix habitat is an excellent lobster nursery because it provides shelter from predators and possesses abundant food resources for sustaining optimum juvenile growth rates in shallow, warm water.

The food habits of four kelp-bed rockfishes (Scorpaenidae, Sebastes) off Santa Barbara, California

The diets of four common rockfishes from the kelp beds near Santa Barbara, California, were determined by gut contents analysis, and related to feeding strategies. The guts of one hundred specimens of each species were examined, and the importance of prey evaluated by their frequency of occurrence, numbers, and volumes. The volumes of stomach contents were standardized for the size of specimen. Estimates of overlap in diet between the species were made. Sebastes atrovirens fed primarily on small animals from the kelp canopy, and may have employed a browsing rather than pursuing strategy of feeding. It showed low overlap in diet with the three bottom-dwelling species, S. carnatus, S. chrysomelas, and S. vexillaris, all of which preferred larger types of prey and seemed more like pursuers. The closely related S. carnatus and S. chrysomelas were quite similar in diet, eating primarily medium sized demersal invertebrates, especially crabs and shrimp. S. vexillaris ate fewer crabs and shrimp but more large-sized fish and octopus than the latter two species. Its more active life style indicates that it may react to prey at greater distances and have a larger home range than these species, as has been predicted for pursuers feeding on larger (and rarer) prey.

O desempenho da Maternidade da Santa Casa de Angra dos Reis face aos critérios de qualidade do Programa Nacional de Avaliação dos Serviços de Saúde - PNASS.

A Santa Casa de Angra dos Reis é uma Instituição Filantrópica inaugurada em 06 de janeiro de 1839. A Unidade passa por Intervenção Municipal, recomendada pelo Ministério Público, no intuito de garantir o restabelecimento adequado de seus serviços, a eficiência desejável e para resgatar a credibilidade e sustentabilidade do Hospital. Da motivação pelos projetos da nova gestão emergiu a necessidade de conhecer a situação do desempenho desta unidade hospitalar, em especial a Maternidade, ponto de partida do projeto. Este estudo é relevante para a institucionalização da avaliação da qualidade nesta Unidade Hospitalar, bem como condição primária para construção de planos de trabalho. O Programa Nacional de Avaliação dos Serviços de Saúde PNASS é uma proposta do Ministério da Saúde, e é visto como uma ferramenta de gestão para monitoramento e avaliação. O programa pode apontar diversas oportunidades de melhorias e auxiliar a tomada de decisão tornando-se adequado seu emprego no levantamento das informações necessárias para o conhecimento do cenário da Maternidade, como base para um futuro plano de ação. Este estudo tem por objetivo aplicar o programa de avaliação normativa proposto pelo PNASS na Maternidade da Santa Casa, a fim de identificar seu desempenho, como primeiro passo para a construção do plano estratégico de ação em busca do aprimoramento da qualidade em saúde neste setor. Como metodologia, é uma pesquisa quantitativa onde foram utilizados padrões de conformidade, questionários fechados direcionados aos usuários e trabalhadores da Maternidade, e análise de indicadores. Resultados: foram entrevistadas 35 mulheres e 47 profissionais de saúde, num total de 85% da amostra desejada; ficou evidente a necessidade de intervenção e implementação de mudanças na área de Gerenciamento de Risco; e melhorias quanto às condições de trabalho relacionadas à infraestrutura e equipamentos. Os indicadores de internação apontam a necessidade de revisão do número de leitos disponíveis; a taxa de parto cesáreo, 59%, é extremamente alta e muito acima do preconizados pela Organização Mundial de Saúde. Este estudo mostrou um resultado positivo quanto à satisfação das parturientes com o serviço prestado, embora existam áreas carentes de melhorias. Melhorias também são necessárias para o dimensionamento efetivo do quadro de profissionais para atendimento à demanda. A interrupção do lançamento de relatórios sobre atuais avaliações feitas pelo PNASS e a pouca divulgação do mesmo são questões levantadas por este estudo. Considera-se que a aplicação do PNASS na Maternidade da Santa Casa de Angra dos Reis proporcionou embasamento para a elaboração de uma oportuna matriz de intervenção.

An ecological characterization of Salt River Bay National Historical Park and Ecological Preserve, U.S. Virgin Islands

Salt River Bay National Historical Park and Ecological Preserve (hereafter, SARI or the park) was created in 1992 to preserve, protect, and interpret nationally significant natural, historical, and cultural resources (United States Congress 1992). The diverse ecosystem within it includes a large mangrove forest, a submarine canyon, coral reefs, seagrass beds, coastal forests, and many other natural and developed landscape elements. These ecosystem components are, in turn, utilized by a great diversity of flora and fauna. A comprehensive spatial inventory of these ecosystems is required for successful management. To meet this need, the National Oceanic and Atmospheric Administration (NOAA) Biogeography Program, in consultation with the National Park Service (NPS) and the Government of the Virgin Islands Department of Planning and Natural Resources (VIDPNR), conducted an ecological characterization. The characterization consists of three complementary components: a text report, digital habitat maps, and a collection of historical aerial photographs. This ecological characterization provides managers with a suite of tools that, when coupled with the excellent pre-existing body of work on SARI resources, enables improved research and monitoring activities within the park (see Appendix F for a list of data products).

Literature review for a resource characterization of Cape Romain National Wildlife Refuge

Through research aimed at understanding the coastal environment, surveys designed to help manage the resource, and national programs to monitor environmental condition, we see a picture of a dynamic ecosystem that is Cape Romain National Wildlife Refuge (CRNWR). Currently, there are efforts underway to protect threatened species; monitor fish populations; and quantify the biological, physical, and chemical characteristics of this environment. The potential impacts to this system are just now being understood as ecological responses to human modification are observed and explained. As a starting point, this document compiles existing information about Cape Romain NWR in five topic areas and addresses the potential impacts to the Refuge. This review is intended to serve as a stepping stone to developing a research agenda in support of management of the Refuge. There are various sources of information on which to build a framework for monitoring conditions and detecting change to this environment. For instance, information on basic ecological function in estuarine environments has evolved over several decades. Long-term surveys of Southeast fisheries exist, as well as shellfish and sediment contaminants data from estuaries. Environmental monitoring and biological surveys at the Refuge continue. Recently, studies that examine the impacts to similar coastal habitats have been undertaken. This document puts past studies and ongoing work in context for Refuge managers and researchers. This report recommends that the next phase of this resource characterization focus on: • compiling relevant tabular and spatial data, as identified here, into a Geographic Information System (GIS) framework • assessing the abundance and diversity of fisheries utilizing CRNWR • delineating additional data layers, such as intertidal habitats and subtidal clam beds, from low-level aerial photography, hard copy maps, and other sources • continued inventories of plant and animal species dependent on the Refuge • monitoring physical and chemical environmental parameters using the methodology employed at National Estuarine Research Reserve System (NERRS) and other coastal sites, where appropriate • further definition of the potential risks to the Refuge and preparing responses to likely impacts.

Guidelines for the conservation and restoration of seagrasses in the United States and adjacent waters

Seagrass ecosystems are protected under the federal "no-net-loss" policy for wetlands and form one of the most productive plant communities on the planet, performing important ecological functions. Seagrass beds have been recognized as a valuable resource critical to the health and function of coastal waters. Greater awareness and public education, however, is essential for conservation of this resource. Tremendous losses of this habitat have occurred as a result of development within the coastal zone. Disturbances usually kill seagrasses rapidly, and recovery is often comparatively slow. Mitigation to compensate for destruction of existing habitat usually follows when the agent of loss and responsible party are known. Compensation assumes that ecosystems can be made to order and, in essence, trades existing functional habitat for the promise of replacement habitat. While ~lant ingse agrass is not technically complex, there is no easy way to meet the goal of maintaining or increasing seagrass acreage. Rather, the entire process of planning, planting and monitoring requires attention to detail and does not lend itself to oversimplification.

Assessment of natural resource conditions in and adjacent to Dry Tortugas National Park

This project characterized and assessed the condition of coastal water resources in the Dry Tortugas National Park (DRTO) located in the Florida Keys. The goal of the assessment was to: (1) identify the state of knowledge of natural resources that exist within the DRTO, (2) summarize the state of knowledge about natural and anthropogenic stressors and threats that affected these resources, and (3) describe strategies being implemented by DRTO managers to meet their resource management goals. The park, located in the Straits of Florida 113 km (70 miles) west of Key West, is relatively small (269 square kilometers) with seven small islands and extensive shallow water coral reefs. Significant natural resources within DRTO include coastal and oceanic waters, coral reefs, reef fisheries, seagrass beds, and sea turtle and bird nesting habitats. This report focuses on marine natural resources identified by DRTO resource managers and researchers as being vitally important to the Tortugas region and the wider South Florida ecosystem. Selected marine resources included physical resources (geology, oceanography, and water quality) and biological resources (coral reef and hardbottom benthic assemblages, seagrass and algal communities, reef fishes and macro invertebrates, and wildlife [sea turtles and sea-birds]). In the past few decades, some of these resources have deteriorated because of natural and anthropogenic factors that are local and global in scale. To meet mandated goals (Chapter 1), resource managers need information on: (1) the types and condition of natural and cultural resources that occur within the park and (2) the stressors and threats that can affect those resources. This report synthesizes and summarizes information on: (1) the status of marine natural resources occurring at DRTO; and (2) types of stressors and threats currently affecting those resources at the DRTO. Based on published information, the assessment suggests that marine resources at DRTO and its surrounding region are affected by several stressors, many of which act synergistically. Of the nine resource components assessed, one resource category – water quality – received an ecological condition ranking of "Good"; two components – the nonliving portion of coral reef and hardbottom and reef fishes – received a rating of "Caution"; and two components – the biotic components of coral reef and hardbottom substrates and sea turtles – received a rating of "Significant concern" (Table E-1). Seagrass and algal communities and seabirds were unrated for ecological condition because the available information was inadequate. The stressor category of tropical storms was the dominant and most prevalent stressor in the Tortugas region; it affected all of the resource components assessed in this report. Commercial and recreational fishing were also dominant stressors and affected 78% of the resource components assessed. The most stressed resource was the biotic component of coral reef and hardbottom resources, which was affected by 76% of the stressors. Water quality was the least affected; it was negatively affected by 12% of stressors. The systematic assessment of marine natural resources and stressors in the Tortugas region pointed to several gaps in the information. For example, of the nine marine resource components reviewed in this report, the living component of coral reefs and hardbottom resources had the best rated information with 25% of stressor categories rated "Good" for information richness. In contrast, the there was a paucity of information for seagrass and algal communities and sea birds resource components.

Prioritizing seagrass restoration sites: study examines predictors of seagrass bed recovery

Ecologic researchers are modeling the impact of vessel grounding to seagrass beds using GIS in the Florida Keys National Marine Sanctuary. The surface creation tools in the ArcGIS 3D Analyst extension help assess both the damage and recovery of these seagrass beds.

The coupling of St. John, US Virgin Islands Marine Protected Areas based on reef fish habitat affinities and movements across management boundaries [Poster]

NOAA's Biogeograpy Branch, the National Park Service (NPS), US Geological Survey, and the University of the Virgin Islands (UVI) are using acoustice telemetry to quantify spatial patterns and habitat affinities of reef fishes in the US Virgin Islands (USVI). The objective of the study is to define the movements of reef fishes among habitats within and between the Virgin Islands Coral Reef Nationla Monument (VICRNM), adjacent to Virgin Islands National Park (VIIS), and USVI Territorial waters. In order to better understand species habitat utilization patterns and movement of fishes among management regimes and areas open to fishing around St. John, we deployed an array of hydroacoutstic receivers and acoustically tagged reef fishes. A total of 150 fishes, representing 18 species and 10 families were acoustically tagged along the south shore of St. John from July 2006 to June 2008. Thirty six receivers with a detection range of approximately 300m each were deployed in shallow nearshore bays and across the shelf to depths of approximately 30m. Receivers were located within reefs and adjacent to reefs in seagrass, algal beds, or sand habitats. Example results include the movement of lane snappers and blue striped grunts that demonstrated diel movement from reef habitats during daytime hours to offshore seagrass beds at night. Fish associated with reefs that did not have adjacent seagrass beds made more extensive movements than those fishes associated with reefs that had adjacent seagrass habitats. The array comprised of both nearshore and cross shelf location of receives provides information on fine to broad scale fish movement patterns across habitats and among management units to examine the strength of ecological connectivity between management areas and habitats. For more information go to: http://ccma.nos.noaa.gov/ecosystems/ coralreef/acoustic_tracking.html

Nocturnal migration patterns of two Caribbean reef fishes, Haemulon sciurus and Lutjanus apodus [Poster]

In the Caribbean, many coral reef associated fishes have been observed making diel migrations, yet little is known about the detailed movement pathways and space use patterns of individual fish. Often these migrations occur along temporally or spatially consistent corridors that connect preferred resting and foraging habitats. Recent analysis of gut contents from Haemulids and Lutjanids, has provided evidence that these species forage in seagrass beds and other habitats near their coral reef refuges. Few studies have provided direct and spatially explicit evidence of nocturnal migrations and detailed day and night space use patterns for individual fish. This study integrated manual acoustic telemetry to track two common reef species, the bluestriped grunt (Haemulon sciurus) and schoolmaster snapper (Lutjanus apodus) throughout their daily home range. Space use patterns of these species were then examined using Geographical Information System (GIS) tools to link movement behavior to seascape structure derived in a benthic habitat map. This study represents a novel integration of spatial technologies to enhance our understanding of the movement ecology of adult H. sciurus and L. apodus.

Acoustic tracking of reef fishes to elucidate habitat utilization patterns and residence times inside and outside marine protected areas around the island of St. John, USVI

This technical memorandum describes a developing project under the direction of NOAA’s Biogeography Branch in consultation with the National Park Service and US Geological Survey to understand and quantify spatial patterns and habitat affinities of reef fishes in the US Virgin Islands. The purpose of this report is to describe and disseminate the initial results from the project and to share information on the location of acoustic receivers and species electronic tag ID codes. The Virgin Islands Coral Reef National Monument (VICRNM), adjacent to Virgin Islands National Park (VIIS), was established by Executive Order in 2000, but resources within the monument are poorly documented and the degree of connectivity to VIIS is unknown. Whereas, VICRNM was established with full protection from resource exploitation, VIIS has incurred resource harvest by fishers since 1956 as allowed in its enabling legislation. Large changes in local reef communities have occurred over the past several decades, in part due to overexploitation. In order to better understand the habitat utilization patterns and movement of fishes among management regimes and areas open to fishing around St, John, an array of hydroacoustic receivers was deployed while a variety of reef fish species were acoustically tagged. In July 2006, nine receivers with a detection range of ca. 350 m were deployed in Lameshur Bay on the south shore of St. John, within VIIS. Receivers were located adjacent to reefs and in seagrass beds, inshore and offshore of these reefs. It was found that lane snappers and bluestriped grunts showed diel movement from reef habitats during daytime hours to offshore seagrass bed at night. Timing of migrations was highly predictable and coincided with changes in sunrise and sunset over the course of the year. Fish associated with reefs that did not have adjacent seagrass beds made more extensive movements than those fishes associated with reefs that had adjacent seagrass habitats. In April 2007, 21 additional receivers were deployed along much of the south shore of St. John (ca. 20 km of shoreline). This current array will address broader-scale movement among management units and examine the potential benefits of the VICRNM to provide adult “spillover” into VIIS and adjacent harvested areas. The results from this work will aid in defining fine to moderate spatial scales of reef fish habitat affinities and in designing and evaluating marine protected areas.

Historical nitrogen and phosphorus loadings to the northern Gulf of Mexico

Primary productivity in many coastal systems is nitrogen (N) limited; although, phytoplankton productivity may be limited by phosphorus (P) seasonally or in portions of an estuary. Increases in loading of limiting nutrients to coastal ecosystems may lead to eutrophication (Nixon 1996). Anthropogenically enhanced eutrophication includes symptoms such as loss of seagrass beds, changes in algal community composition, increased algal (phytoplankton) blooms (Richardson et al. 2001), hypoxic or anoxic events, and fish kills (Bricker et al. 2003).

Does the California market squid (Loligo opalescens) spawn naturally during the day or at night? A note on the successful use of ROVs to obtain basic fisheries biology data

The California market squid (Loligo opalescens Berry), also known as the opalescent inshore squid (FAO), plays a central role in the nearshore ecological communities of the west coast of the United States (Morejohn et al., 1978; Hixon, 1983) and it is also a prime focus of California fisheries, ranking first in dollar value and tons landed in recent years (Vojkovich, 1998). The life span of this species is only 7−10 months after hatching, as ascertained by aging statoliths (Butler et al., 1999; Jackson, 1994; Jackson and Domier, 2003) and mariculture trials (Yang, et al., 1986). Thus, annual recruitment is required to sustain the population. The spawning season ranges from April to November and spawning peaks from May to June. In some years there can be a smaller second peak in November. In Monterey Bay, the squids are fished directly on the egg beds, and the consequences of this practice for conservation and fisheries management are unknown but of some concern (Hanlon, 1998). Beginning in April 2000, we began a study of the in situ spawning behavior of L. opalescens in the southern Monterey Bay fishing area.

A study on the trend of sports fishery of Mafia Island (Tanzania) along the East African coast from 1961-1972

Mafia waters in the western Indian Ocean on the east coast of Africa is a natural attractive area for fishing. It has extensive coral beds which harbour good fish life and attracts sport fishery in the area. About 12 commercially important fishes listed are caught by sports fishermen. The data indicates that this area can become an attractive centre for sports fishery almost throughout the year with peak season from November to February. Long-term planning of the fishery is necessary. The conservation measures should be evolved and gan fishing, dynamiting or any other kind of distructive fishing should be prohibited. This area has natural potential to become a sports fishing centre in the future and a great attraction for tourists and anglers.