O papel da análise custo-efetividade no processo decisório em saúde: o caso do sub-programa de controle da hanseníase

A introdução da Análise Custo-Efetividade na área da Saúde decorre desta preocupação de aperfeiçoamento dos métodos gerenciais em geral, e de escolha de alternativas de ação que levem ao melhor resultado em relação ao custo. Derivada das técnicas econômicas de análise de investimentos em uso no setor empresarial, a ACE pode ser de grande utilidade na montagem de programas e planos de saúde, na escolha entre diversos programas alternativos, e na sua avaliação. Consiste basicamente em confrontar os custos (esperados ou realizados a) de um programa, com seus resultados ou impactos (esperados ou realizados). A aplicação da Análise Custo-Efetividade é ainda recente, e restringe-se aos Estados Unidos e a alguns países europeus. No Brasil, embora comece a ser divulgada, ainda não foi utilizada em programas reais. Seus princípios e sua metodologia são relativamente simples, mas sua utilização em casos concretos esbarra em algumas dificuldades. Assim, a aplicação da análise a um dos programas desenvolvidos na Secretaria da Saúde poderá, além de divulgar a ACE na instituição, estabelecer claramente seu potencial e suas limitações no contexto da saúde pública brasileira. Um dos programas mais problemáticos da Secretaria é o Sub-programa de Controle da Hanseníase. Em vigência há vários anos, seus resultados estão aquém do esperado, em que pesem as características de uma doença endêmica e complexa e as falhas do próprio sub-programa. O interesse em se avaliar um programa cujos resultados são reconhecidamente insatisfatórios, e nosso conhecimento e experiência pessoal na área da hanseníase, justificam a escolha deste Sub-programa para a aplicação da Análise Custo-Efetividade.

Efeito do dispositivo intra-uterino de cobre (TCU 380A) na vascularização sub-endometrial e nos índices de resistência e pulsatilidade das artérias uterinas

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Análise da sobre-reação e sub-reação nos ativos de primeira e segunda lina do mercado acionário brasileiro

The Behavioral Finance develop as it is perceived anomalies in these markets efficient. This fields of study can be grouped into three major groups: heuristic bias, tying the shape and inefficient markets. The present study focuses on issues concerning the heuristics of representativeness and anchoring. This study aimed to identify the then under-reaction and over-reaction, as well as the existence of symmetry in the active first and second line of the Brazilian stock market. For this, it will be use the Fuzzy Logic and the indicators that classify groups studied from the Discriminant Analysis. The highest present, indicator in the period studied, was the Liabilities / Equity, demonstrating the importance of the moment to discriminate the assets to be considered "winners" and "losers." Note that in the MLCX biases over-reaction is concentrated in the period of financial crisis, and in the remaining periods of statistically significant biases, are obtained by sub-reactions. The latter would be in times of moderate levels of uncertainty. In the Small Caps the behavioral responses in 2005 and 2007 occur in reverse to those observed in the Mid-Large Cap. Now in times of crisis would have a marked conservatism while near the end of trading on the Bovespa speaker, accompanied by an increase of negotiations, there is an overreaction by investors. The other heuristics in SMLL occurred at the end of the period studied, this being a under-reaction and the other a over-reaction and the second occurring in a period of financial-economic more positive than the first. As regards the under / over-reactivity in both types, there is detected a predominance of either, which probably be different in the context in MLCX without crisis. For the period in which such phenomena occur in a statistically significant to note that, in most cases, such phenomena occur during the periods for MLCX while in SMLL not only biases are less present as there is no concentration of these at any time . Given the above, it is believed that while detecting the presence of bias behavior at certain times, these do not tend to appear to a specific type or heuristics and while there were some indications of a seasonal pattern in Mid- Large Caps, the same behavior does not seem to be repeated in Small Caps. The tests would then suggest that momentary failures in the Efficient Market Hypothesis when tested in semistrong form as stated by Behavioral Finance. This result confirms the theory by stating that not only rationality, but also human irrationality, is limited because it would act rationally in many circumstances

Chronic exposure to sub-lethal concentration of a glyphosate-based herbicide alters hormone profiles and affects reproduction of female Jundia (Rhamdia quelen)

This work was carried out to verify the effect of a glyphosate-based herbicide on Jundia hormones (cortisol, 17 beta-estradiol and testosterone), oocyte and swim-up fry production. Earthen ponds containing Jundia females were contaminated with glyphosate (3.6 mg/L); blood samples were collected from eight females from each treatment immediately before, or at 1, 10, 20 30 and 40 days following contamination. A typical post-stress rise in cortisol levels was observed at the 20th and 40th days following exposure to glyphosate. At the 40th day, 17 beta-estradiol was decreased in the exposed females. A similar number of oocytes were stripped out from females from both groups, however, a lower number of viable swim-up fry were obtained from the herbicide exposed females, which also had a higher liver-somatic index (LSI). The results indicate that the presence of glyphosate in water was deleterious to Rhamdia quelen reproduction, altering steroid profiles and egg viability. (c) 2006 Elsevier B.V. All rights reserved.

Avaliação dos parâmetros genéticos em progênies de meio-irmãos de uma sub-população de milho composto Flint para resistência à lagarta-da-espiga Helicoverpa zea (Bod.)

Foram estudadas 100 progênies de meio-irmãos de uma sub-população de milho (Zea mays L.) Composto Flint com o objetivo de avaliar a resistência de genótipos à lagarta-da-espiga Helicoverpa zea (Bod.). Foram obtidos os valores de danos médios da lagarta-da-espiga de 1,14 cm de comprimento na espiga determinado pela escala de Widstrom e coeficiente de variação experimental (CVE) de 23,4%. Dos parâmetros genéticos avaliados, a estimativa de herdabilidade (h²) foi de 6%, variância genética (VG) de 0,0015 cm² e variância fenotípica (VF) de 0,025 cm² para danos de H. zea. No entanto, o comprimento da ponta da bráctea e compactação da bráctea alcançaram resultados de herdabilidade de 75% e 72% respectivamente. Essa sub-população de milho apresenta variabilidade genética suficiente para utilização em programas de melhoramento, sendo que a resistência à lagarta-da-espiga pode ser obtida através da melhoria dos caracteres morfológicos diretamente relacionados à praga, como a compactação e comprimento da bráctea.

Intravitreal injection versus sub-Tenon's infusion of triamcinolone acetonide for refractory diabetic macular edema: A randomized clinical trial

PURPOSE. To compare the effectiveness of posterior sub-Tenon's infusion (STi) and intravitreal injection (IVI) of triamcinolone acetonide (TA) for treatment of refractory diffuse diabetic macular edema.METHODS. Thirty-six phakic diabetic patients with refractory diffuse diabetic macular edema were prospectively enrolled. Patients randomly received either 40 mg STi or 4 mg IVI of TA. Comprehensive ophthalmic evaluation was performed at baseline and 1, 2, 4, 8 +/- 1, 12 +/- 2 and 24 +/- 2 weeks after treatment. Macular morphologic changes detected by optical coherence tomography and visual acuity, intraocular pressure, and lens status were evaluated.RESULTS. Twenty-eight patients (28 eyes) completed the 24-week study. Central macular thickness was significantly reduced in the IVI group when compared with the STi group at 2, 4, 8, 12, and 24 weeks after treatment (P < 0.01). Mean visual acuities (in logarithm of the minimum angle of resolution [logMAR]) at week-4, -8, and -12 follow-up examinations were significantly higher in the IVI group (0.74, 0.75, and 0.82, respectively) when compared with the STi group (0.88, 0.88, and 0.90, respectively; P < 0.01). A significant change from baseline in mean intraocular pressure (mm Hg) was seen at weeks 4 (+/- 3.21) and 8 (+/- 3.35) in STi the group (P < 0.01), and at week 8 (+/- 2.78) in the IVI group (P < 0.05). No patient had cataract progression during the study.CONCLUSIONS. Although the number of patients and length of follow-up in this preliminary study were limited, the changes in central macular thickness and visual acuity observed after treatment suggest that IVI TA may be more effective than STi for the management of refractory diffuse diabetic macular edema. Further studies are needed to confirm these preliminary findings.

Natural infection of gastrointestinal nematodes in long-nosed armadillos Dasypus novemcinctus Linnaeus, 1758 from Pantanal wetlands, Aquidauana sub-region, Mato Grosso do Sul State, with the description of Hadrostrongylus speciosum n. gen. et n. sp (Molineidae : Anoplostrongylinae)

This study evaluated the gastrointestinal helminth fauna of long-nosed armadillos, Dasypus novemcinctus, from the Pantanal wetlands, Aquidauana sub-region, Aquidauana County, Mato Grosso do Sul State, Brazil. Thirteen species of nematodes, comprising seven genera and four families, were recovered from their gastrointestinal tracts. The following descriptors of infection were determined: prevalence, variation of intensity, average intensity and abundance. Hadrostrongylus speciosum n. gen. et n. sp. is first described here. (c) 2006 Published by Elsevier B.V.

Germination of Albizia hassleri seeds at different temperatures, under laboratory conditions

The objective of this study was to analyze the germination of seeds of Albizia hassleri under different temperatures. A completely random design arranged as a split plot for temperatures regimes, with 11 seed lots and four replications of 15 seeds was used. The plot was represented by the various lots and the sub plots for different temperatures. The means were compared by Scott-Knott test at 5% probability. The temperatures used were: a) constant: 20, 25 and 30 degrees C, and b) alternating: 20-30 and 25-35 degrees C. For all 11 seed lots the mean germination was 90%, speed germination index (IVG) was 5.059, fresh matter of seedlings (MMF) was 0.0628 g and dry matter (MMS) 0.0499 g. The variation coefficient (CV) between plots ranged from 8.48% for germination to 51.71% for dry matter of seedlings and sub plot of 6.77% to 60.45% for germination and MMS. These high values of CV, tested for MMS and MMF, indicate low repeatability of results within each treatment. In general, the IVG obtained at temperatures of 20 and 25 degrees C was lower than those in temperatures of 30, 20-30 and 25-35 degrees C. The best temperature for IVG was the alternating 25-35 degrees C and constant 30 degrees C. The germination test can be conducted at 30, 20-30 and 25-35 degrees C for 19 days.

Modelagem de dados de falhas de equipamentos de sub-superfície em poços de petróleo da Bacia Potiguar

This master´s thesis presents a reliability study conducted among onshore oil fields in the Potiguar Basin (RN/CE) of Petrobras company, Brazil. The main study objective was to build a regression model to predict the risk of failures that impede production wells to function properly using the information of explanatory variables related to wells such as the elevation method, the amount of water produced in the well (BSW), the ratio gas-oil (RGO), the depth of the production bomb, the operational unit of the oil field, among others. The study was based on a retrospective sample of 603 oil columns from all that were functioning between 2000 and 2006. Statistical hypothesis tests under a Weibull regression model fitted to the failure data allowed the selection of some significant predictors in the set considered to explain the first failure time in the wells

SurRFE -Sub-rede de filtragens específicas

The increasing of the number of attacks in the computer networks has been treated with the increment of the resources that are applied directly in the active routers equip-ments of these networks. In this context, the firewalls had been consolidated as essential elements in the input and output control process of packets in a network. With the advent of intrusion detectors systems (IDS), efforts have been done in the direction to incorporate packets filtering based in standards of traditional firewalls. This integration incorporates the IDS functions (as filtering based on signatures, until then a passive element) with the already existing functions in firewall. In opposite of the efficiency due this incorporation in the blockage of signature known attacks, the filtering in the application level provokes a natural retard in the analyzed packets, and it can reduce the machine performance to filter the others packets because of machine resources demand by this level of filtering. This work presents models of treatment for this problem based in the packets re-routing for analysis by a sub-network with specific filterings. The suggestion of implementa- tion of this model aims reducing the performance problem and opening a space for the consolidation of scenes where others not conventional filtering solutions (spam blockage, P2P traffic control/blockage, etc.) can be inserted in the filtering sub-network, without inplying in overload of the main firewall in a corporative network

A Single Intraoperative Sub-Tenon's Capsule Injection of Triamcinolone and Ciprofloxacin in a Controlled-Release System for Cataract Surgery

PURPOSE. To compare intraoperative injection of triamcinolone and ciprofloxacin in a controlled-release system (DuoCat) with prednisolone and ciprofloxacin eye drops after cataract surgery.METHODS. In this randomized, double-masked, controlled trial, a total of 135 patients undergoing cataract surgery were randomly allocated to two groups: 67 patients treated after surgery with prednisolone 1% and ciprofloxacin 3% eye drops four times daily (week 1), three times daily (week 2), twice daily (week 3), and once daily (week 4) and 0.3% ciprofloxacin drops four times daily (weeks 1 and 2), and 68 patients treated at the end of surgery with a sub-Tenon's injection of 25 mg triamcinolone and 2 mg ciprofloxacin in biodegradable microspheres. The patients were examined on postoperative days 1, 3, 7, 14, and 28. The main outcome measures were postoperative anterior chamber cell and flare, intraocular pressure (IOP), lack of anti-inflammatory response, and presence of infection.RESULTS. No significant differences were observed between the groups in anterior chamber cell (P > 0.14) and flare (P > 0.02) at any postoperative visits. The mean (99% confidence interval) differences in IOP between the prednisolone and triamcinolone groups on days 1, 3, 7, 14, and 28 were -0.4 mm Hg (-2.1 to 1.3), 0.0 mm Hg (-1.4 to 1.3), 0.0 mm Hg (-1.1 to 1.1), -0.2 mm Hg (-1.1 to 0.8), and -0.1 mm Hg (-1.1 to 0.9), respectively. No patient had a postoperative infection.CONCLUSIONS. One injection of DuoCat had a therapeutic response and ocular tolerance that were equivalent to conventional eye drops in controlling inflammation after cataract surgery. (Clinical-Trials. gov number, NCT00431028.) (Invest Ophthalmol Vis Sci. 2009; 50: 3041-3047) DOI: 10.1167/iovs.08-2920

Biased Atmospheric, Sub-Atmospheric, and Low-Pressure Air Plasmas for Material Surface Improvements

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Sub-Optimal Orbital Maneuvers for Artificial Satellites

The determination of a specific orbit and the procedure to calculate orbital maneuvers of artificial satellites are problems of extreme importance in the study of orbital mechanics. Therefore, the transferring problem of a spaceship from one orbit to another, and the attention due to this subject has in increased during the last years. Many applications can be found in several space activities, for example, to put a satellite in a geostationary orbit, to change the position of a spaceship, to maintain a specific satellite's orbit, in the design of an interplanetary mission, and others. The Brazilian Satellite SCD-1 (Data Collecting Satellite) will be used as example in this paper. It is the first satellite developed entirely in Brazil, and it remains in operation to this date. SCD-1 was designed, developed, built, and tested by Brazilian scientists, engineers, and technicians working at INPE (National Institute for Space Research, and in Brazilian Industries. During the lifetime, it might be necessary do some complementary maneuvers, being this one either an orbital transferring, or just to make periodical corrections. The purpose of transferring problem is to change the position, velocity and the satellite's mass to a new pre determined state. This transfer can be totally linked (in the case of "Rendezvous") or partially free (free time, free final velocity, etc). In the global case, the direction, the orientation and the magnitude of the thrust to be applied must be chosen, respecting the equipment's limit. In order to make this transferring, either sub-optimal or optimal maneuvers may be used. In the present study, only the sub-optimal will be shown. Hence, this method will simplify the direction of thrust application, to allow a fast calculation that may be used in real time, with a very fast processing. The thrust application direction to be applied will be assumed small and constant, and the purpose of this paper is to find the time interval that the thrust is applied. This paper is basically divided into three parts: during the first one the sub-optimal maneuver is explained and detailed, the second presents the Satellite SCD-1, and finally the last part shows the results using the sub-optimal maneuver applied to the Brazilian Satellite.