Regionalization and access to healthcare in Brazilian states: historical and political-institutional conditioning factors

This article examines the healthcare regionalization process in the Brazilian states in the period from 2007 to 2010, seeking to identify the conditions that favor or impede this process. Referential analysis of public policies and especially of historical institutionalism was used. Three dimensions sum up the conditioning factors of regionalization: context (historical-structural, political-institutional and conjunctural), directionality (ideology, object, actors, strategies and instruments) and regionalization features (institutionality and governance). The empirical research relied mainly on the analysis of official documents and interviews with key actors in 24 states. Distinct patterns of influence in the states were observed, with regionalization being marked by important gains in institutionality and governance in the period. Nevertheless, inherent difficulties of the contexts prejudice greater advances. There is a pressing need to broaden the territorial focus in government planning and to integrate sectorial policies for medium and long-term regional development in order to empower regionalization and to overcome obstacles to the access to healthcare services in Brazil.

Da autonomia da boca: práticas curriculares e identidade profissional na emergência do ensino brasileiro da odontologia

Analisa como ocorreu a separação entre o ensino da medicina e o da odontologia no Brasil. Privilegia a institucionalização das políticas de ensino da odontologia no país como vertente produtora de identidade profissional. Políticas de ensino e práticas profissionais são interrelacionadas para mostrar como suas relações e sentidos mudam historicamente. Propõe que a autonomia do ensino da odontologia emergiu da necessidade de conformação do sistema de regulação das práticas de cura no Brasil e seu processo de instituição desenvolveu-se sob inspiração das políticas positivistas acerca do ensino livre. Práticas curriculares foram produzindo a subjetividade do cirurgião-dentista moderno e também da clínica por ele desempenhada.

Gestão do empréstimo unificado nas bibliotecas da Universidade de São Paulo

Apresenta a implantação do empréstimo unificado nas Bibliotecas do Sistema Integrado de Bibliotecas da Universidade de São Paulo (SIBiUSP), coordenado pelo Grupo de Gestão do Empréstimo Unificado. Introduz o cenário inicial das bibliotecas da Universidade, destacando a autonomia para definir políticas locais. Descreve as iniciativas isoladas que culminaram com unificação da política do empréstimo utilizada por todas as bibliotecas. Estabelece comparação entre os procedimentos adotados antes e depois da implantação e conclui relatando os benefícios obtidos pelos 138 mil usuários das bibliotecas USP e na padronização de procedimentos e rotinas adotadas pelas bibliotecas em seus 1,7 milhões de empréstimos domiciliares.

Tradition, Change and Variation : Past and Present Trends in Public Old-age Care

The general aim of this dissertation is to describe and analyse how public old-age care in Sweden has developed and changed during the last century. The study applies a provider perspective on how care has been planned and professionally carried out. A broader social policy perspective, studying old-age care at central/national as well as local/municipal level, is also developed. A special focus is directed at the large local variation in care and services for the elderly. The empirical base is comprised of official documents and other public sources, survey data from interviews with elderly recipients of public old-age care, and official statistics on publicly financed and controlled old-age care and services. Study I addresses the development of old-age care in Sweden during the twentieth century by studying an important occupation in this field – the supervisors and their professional roles, tasks and working conditions. Throughout, the roles of supervisors have followed the prevailing official policy on the proper way to provide care for elderly people in Sweden; from poor relief at the beginning of the 1900s, via a generous level of services in the 1960s and 1970s, to today’s restricted and economy-controlled mode of operation. Study II describes and compares two main forms of public old-age care in Sweden today, home help services and institutional care. The care-load found in home-based care was comparable to and sometimes even larger than in service-homes and other institutions, indicating that large care needs among elderly people in Sweden today can be met in their homes as well as in institutional settings. Studies III and IV analyse the local variation in public old-age care in Sweden. During the last decades there has been an overall decline in home help services. The coverage of home help for elderly people shows large differences between municipalities throughout this period, and the relative variation has increased. The local disparity seems to depend more on historical factors, e.g., previous coverage rates, than on the present municipal situation in levels of need or local economy and politics. In an introductory part the four papers are linked together by an outline of the demographic situation and the social policy model for old-age care in Sweden. Trends that have been apparent over time, e.g. professionalisation and market orientation, are traced and discussed. Conflicts between prevailing ideologies are analysed, in regards to for instance home-based and institution-based care, social and medical culture, and local and central levels of decision-making. ’Welfare municipality’, ‘path dependency’, and ‘decentralisation’ are suggested as a conceptual framework for describing the large and increasing local variations in old-age care. Finally, implications of the four studies with regard to old-age care policy and further research are discussed.

Simulatore di interfaccia uomo-macchina per i controllo di UAV

Recent statistics have demonstrated that two of the most important causes of failures of the UAVs (Uninhabited Aerial Vehicle) missions are related to the low level of decisional autonomy of vehicles and to the man machine interface. Therefore, a relevant issue is to design a display/controls architecture which allows the efficient interaction between the operator and the remote vehicle and to develop a level of automation which allows the vehicle the decision about change in mission. The research presented in this paper focuses on a modular man-machine interface simulator for the UAV control, which simulates UAV missions, developed to experiment solution to this problem. The main components of the simulator are an advanced interface and a block defined automation, which comprehend an algorithm that implements the level of automation of the system. The simulator has been designed and developed following a user-centred design approach in order to take into account the operator’s needs in the communication with the vehicle. The level of automation has been developed following the supervisory control theory which says that the human became a supervisor who sends high level commands, such as part of mission, target, constraints, in then-rule, while the vehicle receives, comprehends and translates such commands into detailed action such as routes or action on the control system. In order to allow the vehicle to calculate and recalculate the safe and efficient route, in term of distance, time and fuel a 3D planning algorithm has been developed. It is based on considering UASs representative of real world systems as objects moving in a virtual environment (terrain, obstacles, and no fly zones) which replicates the airspace. Original obstacle avoidance strategies have been conceived in order to generate mission planes which are consistent with flight rules and with the vehicle performance constraints. The interface is based on a touch screen, used to send high level commands to the vehicle, and a 3D Virtual Display which provides a stereoscopic and augmented visualization of the complex scenario in which the vehicle operates. Furthermore, it is provided with an audio feedback message generator. Simulation tests have been conducted with pilot trainers to evaluate the reliability of the algorithm and the effectiveness and efficiency of the interface in supporting the operator in the supervision of an UAV mission. Results have revealed that the planning algorithm calculate very efficient routes in few seconds, an adequate level of workload is required to command the vehicle and that the 3D based interface provides the operator with a good sense of presence and enhances his awareness of the mission scenario and of the vehicle under his control.

Pasta secca e identità nazionale. Note di storia dell'alimentazione

In the wide range of data that the nutrition subject offers to the historical observation, this investigation focuses on one of the functions that food serves in the social context: that is, to signify cultural identity. In this context, we will analyse the ways in which industrially produced pasta has come to its status as one of the symbolic forms of twentieth-century Italian food, contributing to a sense of social identity that forms part of the process of nation-building developed during the XX century. The nature of the relationship between pasta and Italian food is analysed for a period of almost a century (1886-1984) through a variety of different sources: government enquiries, cookery books, gastronomic guides and menus of official dinners. The assemblage of such documents in one study allows investigation of certain themes throughout a wide range of gastronomical cultures active within the national borders. In this way, links are made between the production, adoption, reception and dissemination of the ingredients and Italian Unification.This method has made it possible to restore one possible form of historical knowledge of twentieth-century gastronomy and of the experiences by which it was influenced.

Giustizia sanitaria e diseguaglianze globali in salute: il caso dell'aiuto allo sviluppo in sanità

Life expectancy at birth is the average number of years that a group of people born in the same year should live. The estimate for those born in 2010 is 80.2 years for Italy. On the other side of the chart are a number of countries in sub Saharan Africa. Haiti is in last place: children born in this country in 2010 have a life expectancy by an average of even 30 years, fifty in less than peers born in Italy. From a bioethical point of view, the first question that arises is: Is it right? Is it right that there is such inequality in health? The answer is simple: it is not right. But if we ask ourselves what are the best solution to remedy this situation, the answers become more than one. The differences in life expectancy depends on many factors, including no doubt the effectiveness of health systems. The scope of this work is precisely that of justice in health care and how the different general concepts related to it can be applied in health care settings with very limited financial and human resources. The first chapter describes the main inequalities in global health. The second discusses the main theories of justice. In the next chapter we reason on official development assistance and health cooperation. In the fourth we analyze the contribution of theories of justice through such issues as equity in health, the right of access to health services and right to health. In the fifth chapter the aim is to reason about global justice, the role of health in this context and how the official development assistance in health can contribute.

La Ragione violenta di Ramiro Ledesma Ramos. Fascismo e pensiero conservatore in Spagna

Aunque esta tesis puede leerse desde diferentes perspectivas, tiene una voluntad fundamental: explicar, desde la metodología propia de la historia conceptual, la racionalidad específica del llamado fascismo español. Centra su interés en la figura de Ramiro Ledesma Ramos (1905-1936), fundador del primer movimiento fascista español. Ledesma ideó un proyecto de modernización de España que sólo podía pasar por la organización de un Estado total. Trató de crear un movimiento de masas de corte fascista con capacidad para fundar un Estado total capaz de ser una alternativa viable al liberalismo republicano y al socialismo. El fascismo español emergerá como una experiencia temporal propia de la modernidad. Buscará revitalizar y acelerar un proceso, el moderno, que a la luz de los jóvenes exaltados de principios de siglo se percibía como agotado y decadente. El planteamiento de Ledesma brotaba de la necesidad de combatir aquellas presuntas fuerzas degenerativas (liberalismo, comunismo, conservadurismo, etc.) de la historia contemporánea española para erigir una nueva modernidad basada en el renacimiento de la nación. Al mismo tiempo, se pretende poner en relieve la eficacia de la acción histórica planteada por el pensamiento reaccionario español. Bajo sus coordenadas, la nación jamás desarrollaría los rasgos sublimados de la política moderna europea. Jamás abandonó los pretendidos órdenes del derecho natural del clasicismo católico que, en última instancia, limitaban la potencia absoluta de cualquier soberano político. Esta particularidad histórica, arrastrada desde la primera modernidad, impedirá con obstinación cualquier oleada revolucionaria que supusiera la autonomización de la esfera política y por tanto, la instauración de un poder totalitario. De hecho, cuando se instauré la dictadura del Franco, a lo más que se llegaría, sería a un Estado mínimo, que bajo los presupuestos del tradicionalismo, dejaba a su suerte las dinámicas económicas.

Riccardo Lombardi nel socialismo italiano (1947-1964)

Il primo capitolo della tesi verte sull’ultimo anno di vita del Partito d’Azione, sulle modalità di partecipazione di Lombardi allo scontro elettorale del 1948 nelle liste del Fronte democratico popolare, e sul breve periodo di direzione ‘centrista’ del Psi a cavallo tra il 1948 e il 1949, quando Lombardi, appena entratovi, fu magna pars nel gruppo dirigente del partito. Il secondo capitolo abbraccia il periodo in cui Lombardi agì all’interno del Psi ‘morandiano’, o frontista: si è cercato di dare ragione sia dell’inserimento di Lombardi nelle logiche del frontismo socialista, sia della peculiarità di quell’inserimento negli ambiti privilegiati della politica economica e della politica estera. Oggetto del terzo capitolo è il ruolo giocato da Lombardi nella definizione delle linee guida dell’autonomismo socialista, un ruolo fattosi via via più pregnante a partire dal 1956, che ebbe la sua massima consacrazione col XXXIV Congresso del Psi, celebrato a Milano nel 1961: centrale in questo periodo la riflessione lombardiana sulle «riforme di struttura», un argomento che ci si è sforzati di inquadrare storicamente, sfuggendo dai luoghi comuni storiografici di cui spesso – con lodevoli eccezioni – è caduto vittima. Tali «riforme di struttura» Lombardi avrebbe voluto alla base dei governi di centro-sinistra. La tesi si chiude con un ultimo capitolo dedicato ad illustrare l’apporto di Lombardi al quarto Governo Fanfani e al primo Governo Moro, il ruolo da lui giocato nella loro nascita e il suo progressivo allontanamento da quell’esperimento che era stato, in gran parte, sua creatura.

La inclusión de declaraciones de derechos y principios en los Estatutos de Italia y España

La ricerca riguarda l’inclusione di dichiarazioni di diritti e principi introdotte negli Statuti di autonomia delle Regioni italiane e delle Comunità Autonome spagnole riformati negli ultimi anni. La tesi consta, oltre che nell’introduzione dei concetti preliminari, di due parti per ognuno dei Paesi nelle quali si esaminano i sistemi regionali e concretamente queste carte di diritti e principi. La terza parte raccoglie un’analisi comparativa di ambedue gli Stati. Il problema dell’efficacia di questi diritti e principi rappresenta la chiave fondamentale. In questo senso, la Giurisprudenza costituzionale risulta essere basilare per lo studio delle differenti risposte alle novità dei diversi elenchi di diritti e principi a livello regionale. Mentre la Corte Costituzionale italiana ha negato la loro efficacia giuridica, anche come norme programmatiche assimilabili a quelle costituzionali, il Tribunale Costituzionale spagnolo ha qualificato un nuovo tipo di diritto, i c. d. diritti statutari, che non sono diritti pubblici soggettivi ma mandati ai poteri pubblici autonomici, specialmente al legislatore autonomico. Lo studio si completa con la problematica dell’uguaglianza e la garanzia dei diritti e i principi in questi Stati composti.

I limiti all'autonomia procedurale degli Stati membri dell'UE in materia risarcitoria

This work analyses the limits that the principle of State liability for damages suffered by individuals because of breach of EU law poses to the procedural autonomy of the Member States of the EU. The introductory part of this work is dedicated to the general character of the limitations EU law poses to the State’s competence in procedural matters. The first part of the research, instead, focuses on the specific limits that european law poses on the rules of procedure related to the legal regime of the right to compensation and its operating conditions; in particular, this first part explores respectively the “substantive” and “procedural” limits that EU law poses to the State’s autonomy to regulate actions for damages for breaches of EU law. The substantial limits concern the conditions of eligibility of liability and the constitutive conditions of the right to compensation; the procedural limits to the action for damages refer to the concrete organization and characteristics of the judicial action. The second part of the research is devoted to rules of procedure governing the relations between judicial remedies explicitly aimed at protecting the right to reparation and other remedies that may be relevant, both europeans and nationals. The first chapter of the second part of this work focuses on the rules governing the relations between the action for damages brought up at the national level and the remedies provided by european Treaties; finally, I explore the relations between the action for damages brought up at the national level and other remedies present in the same national juridical order. I reconstruct all the limits to the procedural autonomy of Member States concerning the right to compensation; consequently, I verify that those limits represent part of the system of internal procedures, able to guarantee the respect of european law.

Ghana@50 – celebrating the nation: an eyewitness account from Accra /// Arbeitspapiere / Institut für Ethnologie und Afrikastudien ; 83

This article offers an account of the 50th Ghanaian independence-day celebrations during March 2007. The multi-perspective approach examines how celebrations were experienced in the Ghanaian capital Accra by the political elite and the grass roots at a variety of official and unofficial events that took place on 5 and 6 March 2007. During the festivities the authors accompanied Ghanaian friends from different political factions and thus provide close-hand accounts of political controversies over issues regarding how the nation ought to organise and celebrate its Independence Day, controversies which provide important insights into Ghanaian political culture. From this it is clear that the celebrations not only serve as expressions of national pride but also moments of critical reflection on the nation, national values and socio-political unity. These reflections, manifest as disputes about national and ethnic symbols, centre on the conditions and limits of political, social, ethnic and regional inclusiveness. At the same time, underlying such disputes are commonalities resting not on substantive symbols, cultural traits or other objectifiable characteristics, but on a Ghanaian consensus to agree on the issues at stake and on the rules of debate. Controversy thus functions not to divide but rather to strengthen national consciousness and deepen a sense of commonality that Ghanaians generally express as their commitment to ‘unity in diversity’.

La traduzione letteraria in Unione Sovietica (1930-1955)

In Unione Sovietica il partito mette in atto un sistema di istituzioni per controllare il mondo culturale e la produzione scritta: il Glavlit, il massimo istituto censorio, l’Unione degli scrittori, un’editoria centralizzata e statalizzata e un unico metodo creativo possibile, il realismo socialista. Il settore della traduzione letteraria e della ricezione della letteratura straniera vengono ugualmente posti sotto controllo. All’interno dell’Unione degli scrittori operano la Sezione dei Traduttori, a cui spetta la formazione dei nuovi traduttori sovietici, e la Commissione Straniera, che stabilisce quali autori e quali libri occidentali debbano essere tradotti. Il Reparto straniero del Glavlit controlla il materiale a stampa proveniente dall’estero, la sua distribuzione e le modalità di consultazione e si occupa di effettuare una censura sia sul testo in lingua straniera che su quello tradotto in lingua russa. Parallelamente, il codice estetico e normativo del realismo socialista comincia a influenzare lo sviluppo della teoria della traduzione. La traduttologia si allinea alla critica letteraria ufficiale e promuove un approccio libero al testo che permetta l’introduzione di modifiche testuali arbitrarie da parte del traduttore o del redattore.

Naturaleza jurídica del contrato de mediación

Desde los plantemientos que entienden la mediación como una mera relación de hecho, se avanzará hasta la consideración de la misma como contrato. Para ello, se separarán las categorías o institutos que no se consideren adecuados a la naturaleza de la mediación, profundizando en sus estructuras más básicas, hasta llegar a la consideración contractual de la misma. Desde el contrato, se tratarán los elementos de sinalagmaticidad, principalidad, onerosidad o consensualidad, entre otras circunstancias, esenciales o naturales, antes de abordar la que quizá sea la circunstancia que merezca un tratamiento más especial: el riesgo aleatorio de la mediación. Además, al tratarse de contratos infrarregulados, la dimensión económica y efectiva de los mismos no sólo permite la reflexión, sino que impulsa la crítica y, si bien no puede ofrecer por sí misma respuestas, sí puede ayudar a descartar opciones menos adecuadas en cada caso. De todo lo anterior se concluirá una única categoría contractual, clara y precisa, enfrentada también a un análisis económico de cada uno de sus elementos, así como una confrontación con las propuestas, sobre los mismos supuestos, del Derecho contractual europeo. Así, se tratará de evaluar, en cada paso, que las conclusiones parciales sobre las que se asienten ulteriores estadios de la investigación no sólo resulten sistemáticas, sino también idóneas para alcanzar la finalidad de contrato y, a su través, la de las partes. El contrato resultante se encontrará categorizado, pero no por ello regulado. De ahí la necesidad, última, de ubicarlo en una categoría contractual más amplia que pueda informar dichos caracteres con una regulación suficiente, desde la que establecer una normatividad real.

Autonomia finanziaria degli enti territoriali al tempo della crisi, tra unione europea e garanzia dei diritti

La tesi si propone di ricostruire la struttura attuale dell'autonomia finanziaria degli enti locali italiani, e in particolare le regioni italiane, alla luce delle riforme legislative e costituzionali approvate dal Parlamento italiano negli ultimi anni (come ad esempio il bilancio riforma costituzionale equilibrata del 2012). Lo studio si concentra sulla situazione italiana alla luce dei vincoli europei introdotti nel corso degli anni, da quelli contenuti nel Trattato di Maastricht a quelli derivati dalla crisi economica e finanziaria. L'obiettivo è quello di verificare se le scelte del legislatore italiano possano dirsi coerenti con il processo di unione politica europea e quali conseguenze abbiano avuto sulla garanzia dei diritti. In particolare, lo studio si concentra sulla garanzia dei diritti sociali nel contesto politico ed economico attuale, a livello europeo e nazionale, con particolare attenzione al diritto alla salute.