FATORES DETERMINANTES DA MORTALIDADE DE MICRO E PEQUENAS FARMÁCIAS DA BAIXADA SANTISTA: sob o olhar do farmacista

Esse trabalho estudou o segmento farmacêutico de micro e pequenas farmácias da região da Baixada Santista, em relação aos fatores determinantes da mortalidade no segmento, sob o olhar dos proprietários e gestores das farmácias, visto que nos últimos anos o segmento vêm sofrendo um encolhimento, além da migração das farmácias de micro e pequeno porte para as zonas mais periféricas das cidades da região da Baixada Santista. A metodologia utilizada para a pesquisa foi qualitativa, através de uma pesquisa exploratória e bibliográfica, tendo como instrumento de coleta de dados entrevistas, com roteiro semi-estruturado, aplicado a gestores e proprietários de sete farmácias na região da Baixada Santista. Cinco delas em atividade e duas fechadas, nos municípios de Santos, São Vicente, Guarujá e Praia grande. A análise dos dados foi feita com base em categorias analíticas criadas a partir da literatura que embasa esse estudo, chegando a dois blocos de análise: um relacionado diretamente aos fatores mercadológicos das farmácias, e outro relacionado a fatores administrativos e de custo. A análise dos dados comprovou existir fatores determinantes para a mortalidade das micro e pequenas farmácias da região, separados em dois blocos. No bloco mercadológico, estão relacionados os fatores determinantes que afetam diretamente a parte comercial das micro e pequenas farmácias, como o crescimento das grandes redes de farmácias, programa Farmácia Popular e falta de poder de compra por parte das farmácias. No bloco administrativo e de custos, estão relacionados a deficiência na gestão empresarial, custos operacionais, tributação e problemas pessoais. Através dessa pesquisa se conclui que esses fatores determinantes têm enfraquecido o segmento de micro e pequenas farmácias, ocasionando a mortalidade de diversas farmácias, não poupando nem mesmo as tradicionais da região da Baixada Santista.

SÍNDROME DE BURNOUT ENTRE OS PASTORES ADVENTISTAS DA CIDADE DE SÃO PAULO: CAUSAS POTENCIAIS E MEDIDAS PREVENTIVAS

A prevalência de stress e burnout tem-se tornado um problema comum nas profissões assistenciais. Os ministros religiosos não são uma exceção. Evidências disponíveis derivadas de reflexões pessoais e pesquisas científicas demonstram que o trabalho pastoral hoje é uma ocupação com elevados índices de burnout; entretanto, pouca atenção tem sido dada a este assunto. O presente estudo tem como objetivo contribuir para o desenvolvimento de pré-condições e recursos individuais de forma a prevenir e controlar os efeitos da síndrome entre os pastores adventistas da cidade de São Paulo. Inicialmente o trabalho apresentará uma análise do burnout, a partir de referências selecionadas, incluindo informações gerais sobre os sintomas, antecedentes, instrumentos de medida; intervenções e métodos preventivos. Os ministros religiosos geralmente são tratados como outros profissionais de ajuda nas pesquisas de burnout, com pouca consideração para com a dimensão espiritual, o que é prioritário ou mesmo vital para o clero. Para este estudo, em particular, o burnout pastoral será considerado como um fator resultante de um relacionamento deficiente com Deus. Somam-se a isso as condições ambientais do trabalho e as características pessoais. Finalmente, o estudo pretende sugerir estratégias para ajudar na redução e na prevenção última da síndrome entre os pastores em foco.(AU)

IDOLATRIA E CONQUISTA: Estudo do conceito de Idolatria na obra de Juan Ginés de Sepúlveda Democrates Alter Tratado de las Justas Causas de la Guerra contra los Indios e sua controvérsia travada com Frei Bartolomé de Las Casas .

Pouco mais de meio século depois da descoberta do Novo Mundo, em plena Conquista espanhola, ocorreria em Valladolid, nos anos de 1550 e 1551, um evento sem precedentes: um debate público protagonizado por duas notáveis personagens, a saber: o Frei dominicano Bartolomé de Las Casas e Juan Ginés de Sepúlveda. Este debate ficou conhecido na História como a Controvérsia de Valladolid, e teve, como principal objetivo, discutir o modo como deveriam ser tratados os índios do Novo Mundo, quais eram os seus direitos e as suas atribuições. Esta tese discute o contexto em que se deu essa controvérsia, suas personagens e, é claro, ela própria, em seus argumentos, modo de exposição e estrutura constitutiva.(AU)

INTERDISCIPLINARIDADE: AS CAUSAS DAS DIFICULDADES DE IMPLEMENTAÇÃO DO NOVO ENSINO MÉDIO BRASILEIRO E DO TRABALHO DOCENTE

O objetivo principal desta dissertação foi o de pesquisar as causas; I) das dificuldades de implementação do Novo Ensino Médio (que estabelece no currículo nacional a interdisciplinaridade como um princípio); II) das dificuldades dos professores para com o trabalho interdisciplinar; III) da resistência dos mesmos em relação a ele. O método utilizado foi o da pesquisa bibliográfica, observando-se as posições de dois grupos de pensadores quanto ao problema discutido neste trabalho. No primeiro grupo (Foucault; Nietzsche; Hockeimer da Escola de Frankfurt e Veiga-Neto) foram indicadas para a implementação dificuldades epistemológicas, enquanto, no segundo (Marx e Santos Filho), foram apresentadas políticas, econômicas e sociológicas dificuldades a serem superadas para que se atinja o objetivo almejado no projeto educacional.(AU)

Una sociedad legalista: Abogados, procuradores de causas y la creación de una cultura legal colonial en Lima y Potosí, 1540–1670

This study deals with the formation, reproduction, and the role in litigation of two branches of the legal profession, lawyers and procurators. They were the experts in charge of civil, criminal, and ecclesiastical litigation during the Old Regime. While the lawyers provided erudite legal advice, procurators oriented and drove the procedure as legal representatives of their clients. The European legal revolutions of the twelfth and thirteenth centuries forged a new legal culture in which the lawsuit was reputed to be the best way to settle disputes. Likewise, that legal culture conferred an important place to specialists as legal facilitators of the contending parties. When Castilians exported their legal system to the New World, they spread a complex and bureaucratic framework, contributing to the reproduction of a class of experts in urban spaces. Lima and Potosi, two urban centers created in the sixteenth century, quickly became significant ‘legal cities’. This dissertation explores how the legal markets of these cities operated, the careers of their specialists, their professional options, social images regarding them, and litigation costs. This study examines the careers of 267 facilitators and demonstrates that they constituted a class of distinctive legal professionals. Legal culture embodies the representation and use of law. The closeness of specialists with litigants, in particular of procurators familiarized the parties with litigation and its complex processes. These specialists forged dominant legal discourses and manipulated juridical order. Litigants were not passive agents of their specialists. Caciques and members of the Hispanicized communities appropriated the law in a visible way as the growing litigiousness illustrates. Colonial law (of a pluralistic basis) was an arena of assertion and discussion of rights by different social actors, encomenderos, leading citizens, widows, native chieftains, artisans, and commoners. This study concludes that this struggle and manipulation served to legitimate the role of those legal experts and gave birth to a complex legalistic society in the Andes under Spanish Habsburg rule.

Prevalência e fatores associados à morbidade materna: inquérito populacional em Natal/RN

INTRODUCTION: Severe maternal morbidity , also known as maternal near miss , has been used as an alternative to the study of maternal mortality , since being more frequent shares the same determinants and enables the implementati on of epidem iological surveillance of cases . Since then, hospital audits ha ve been carried out to determine the rates of maternal near miss, its mai n causes and associated factors . More recently, population surveys based on self - reported morbidity have als o been presented as vi able in identifying these cases . OBJECTIVE: The aim of this study was to determine the prevalence and associated factors of maternal near miss and complications during pregnancy and puerperal period in Natal/RN. METHODS: A cross - secti onal population - based study was conducted in Natal /RN , Brazil, which has as its target population women aged 15 to 49 years who were pregnant in the last five years. It was carried out a probabilistic sam pling design based on a multi - stage complex sample , in which 60 census tracts were selected from three strata (north , south - east and west). Afterwards, domiciles were visited in order to obtain a sample of the 908 eligible women in whom a questionnaire was applied. The descriptive analyzes and bivariate ass ociations were performed using the Chi - square test and the estimate of the prevalence ratio (PR ) with 95% confidence interval (CI) and considering the weights and design effects . The Poisson regression analysis , also with 5% significance and 95% CI, was us ed for analyzes of associated factors. RESULTS: 848 women were identified and interviewed after visits in 8.227 households corresponding to a response rate of 93 . 4 %. The prevalence of maternal near miss was 41 . 1 /1 000NV, being the Intensive Care Unity stay i ng (19 . 1 /1 000 LB ) and eclampsia (13 . 5/1000LB) the most important marker s . The prevalence of complications in the puerperal peri od was 21 . 2 %, and hemorrhage (10 . 7%) and urinary tract infection (10 . 7%) the most frequently reported clinical conditions and rema in ing in the hospital for over a week after delivery the mo st frequent intervention (5.4%) . Regarding associated factors , the bivariate analysis showed an association between the increased number of complications in women of black/brown race ( PR= 1 . 23; CI95 % : 1 . 04 - 1 . 46) and lower socioeconomic status ( PR= 1 . 33; CI95%: 1 . 12 - 1 . 58) in women who had pre natal care in public service ( PR= 1 . 42; CI95%: 1 . 16 to 1 . 72 ) and that were not advised during prenatal about where they should do the d elivery (PR= 1 . 24; CI95%: 1 . 05 - 1 . 46), made the del ivery in the public service (PR= 1 . 63; CI95%: 1 . 30 - 2 . 03), had to search for more than one hospital for delivery (PR=1 . 22; CI95%: 1 . 03 - 1 . 45) and had no companion during childbirth ( PR =1 . 19; CI95%: 1 . 01 - 1 . 41) or at all times of childbirth c are - before, during and after childbirth - ( PR= 1 . 25, CI95%: 1 . 05 - 1 . 48) . Moreover, the number of days postpartum hospitalization was higher in women who had more complications (P R= 1 . 59 ; CI95%: 1 . 36 - 1 . 86). In the final regression model for both birth place (P R= 1 . 21 ; CI 95% : 1 . 02 to 1 . 44 ) and socioeconomic status (PR = 1.54 ; CI95%: 1 . 25 - 1 . 90 ) the association remained. CONCLUSION : Conducting population surveys using the pragmatic definition of near miss is feasible and may add importa nt information about this ev ent . It was possible to find the expression of health inequalities related to maternal health in the analysis of both socioeconomic conditions and on the utilization of health services.

A morte pode ser conhecida: percurso em torno da compreensão da mortalidade na filosofia de Epicuro

This paper intends to investigate the route required for the formation of adequate knowledge of death based on analysis of the philosophy of Epicurus. The central hypothesis is to demonstrate that the understanding of death can only be achieved through a continuous process of research into the nature of things, guided reflection within a system of thought, with radical impact on the conceptions of the universe, man, soul and world. The human mortality can only become clear to the man himself through philosophy. Epicurus developed his thinking so that when investigating the nature, man could understand the principles of the constitution of all things. This raises issues about the consequences of knowledge generation and corruption in human life, the most disturbing of them is death. The vain opinions are considered the causes of evils, the proper knowledge of death is one way of purging the disturbances that the souls of men, thereby promoting the wisdom philosophy combines knowledge to health. Strictly speaking advocate, confirmed the relevance of the connections mentioned above, the problem of knowledge of the nature of death is one of the privileged ways to demonstrate the coherence and unity of the philosophy of Epicurus

Diferenciais de mortalidade adulta por nível de escolaridade no Brasil e regiões

The study of mortality by various differentials has been an important tool to guide public health policies, due to better describing the events of deaths in a population. This research aims to seek disparities in mortality according to educational level, sex and adulthood in large Brazilian regions and consequently for Brazil as a whole. A vast literature has shown that people with more education tend to have lower risk of death. Studies on inequalities in mortality by level of education in Brazil are still very specific and has still known very little about Brazil about mortality according to educational level, due to lack of information about the well-filled school in the records of deaths arising from the Mortality Information System (MIS) of the Ministry of Health. This data source has shown improvement in the coverage of sub reports in the last decade, however, it has still perceived negligence in completing the question regarding schooling of death (about 30% of registered deaths in 2010 to Brazil, Given this scenario, this work contributes to the national literature on the behavior of adult mortality differentials having as proposed, using data from the new variable mortality of the 2010 Census (CD 2010), assuming the characteristics of education of the head the household for deaths occurring in the same. It is therefore considered that the probability of mortality is homogeneous within the household. Events of deaths were corrected only for the records come from households where the head possessed levels of schooling and Instruction Elementary Education No Incomplete and Primary Education and Secondary Education Complete Incomplete through the Generations Extinct Adjusted method. With deaths already corrected, probabilities of death were calculated between 15 and 60 years life, as well as tables by sex and level of education to all regions of Brazil. No que se refere às probabilidades de morte por idade, nas idades entre 15 e 60 anos as maiores probabilidades seguem um gradiente, maior probabilidade para os menos escolarizados. Results corroborate the literature, the more educated the population is, the greater the life expectancy. In all Brazilian regions, life expectancy of the female population is greater than that of men at all levels of schooling. With respect to probabilities of death by age between the ages of 15 and 60 years the most likely follow a gradient, most likely to the least educated. At older ages (from 70 years), this behavior has presented another pattern, the lowest level of education has the lowest odds in the regions, North, Northeast, South and Midwest, except in the Southeast region

Análise comparativa da tendência na mortalidade infantil em áreas cobertas e não cobertas pela estratégia saúde da família no município de Garanhuns entre 2003 e 2012

A mortalidade infantil é tida como um indicador sensível para descrever as condições de vida e de saúde de uma população, sendo, portanto, interpretada como a estimativa do risco de um nascido vivo morrer antes de completar o primeiro ano de vida. Esse indicador é considerado elevado quando atinge patamares superiores a 50/1.000 nascidos vivos, médios quando se encontra entre 20 e 49/1.000 e mais baixos quando está até 20/1.000. No Brasil, a Mortalidade Infantil tem evidenciado variações ao longo dos anos, e nas duas últimas décadas esse indicador tem sofrido um acentuado decréscimo, provavelmente devido à melhoria no acesso aos serviços de saúde, ao saneamento básico, redução da taxa de fecundidade, melhoria das condições de vida e implementação de tecnologias na atenção à saúde. O objetivo principal do estudo foi avaliar a tendência na mortalidade infantil no município de Garanhuns no período de 2003 a 2012, segundo áreas cobertas e não cobertas pela estratégia saúde da família. Foi realizado um estudo de série temporal, e para isso foram coletados os dados referentes aos nascidos vivos e óbitos de menores de 01 (um) ano através do Sistema de Informações de Atenção Básica – SIAB, nas áreas cobertas e não cobertas pela estratégia, a fim de estabelecer relação de possível causalidade entre a intervenção e o indicador. Os resultados foram apresentados em gráficos, com a curva da Mortalidade Infantil no município de Garanhuns entre os anos de 2003 e 2012 segmentado através das áreas cobertas e não cobertas pela estratégia saúde da família ao longo do mesmo período. Após a análise dos resultados, observou-se uma tendência de queda no coeficiente de mortalidade infantil tanto nas áreas cobertas pela estratégia saúde da família quanto nas áreas cobertas pelo PACS, e que não foi possível estabelecer isoladamente uma maior redução da mortalidade infantil em áreas cobertas pela estratégia. No entanto, os resultados das ações desenvolvidas pela estratégia saúde da família são consistentes e plausíveis de causar impacto no declínio da mortalidade infantil, sobretudo as ações voltadas para a saúde da mulher e da criança

Tendências e projeções da mortalidade pelos cânceres específicos ao gênero no Brasil

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - CAPES

LCD-OpenPACS: sistema integrado de telerradiologia com auxílio ao diagnóstico de nódulos pulmonares em exames de tomografia computadorizada

Lung cancer is one of the most common types of cancer and has the highest mortality rate. Patient survival is highly correlated with early detection. Computed Tomography technology services the early detection of lung cancer tremendously by offering aminimally invasive medical diagnostic tool. However, the large amount of data per examination makes the interpretation difficult. This leads to omission of nodules by human radiologist. This thesis presents a development of a computer-aided diagnosis system (CADe) tool for the detection of lung nodules in Computed Tomography study. The system, called LCD-OpenPACS (Lung Cancer Detection - OpenPACS) should be integrated into the OpenPACS system and have all the requirements for use in the workflow of health facilities belonging to the SUS (Brazilian health system). The LCD-OpenPACS made use of image processing techniques (Region Growing and Watershed), feature extraction (Histogram of Gradient Oriented), dimensionality reduction (Principal Component Analysis) and classifier (Support Vector Machine). System was tested on 220 cases, totaling 296 pulmonary nodules, with sensitivity of 94.4% and 7.04 false positives per case. The total time for processing was approximately 10 minutes per case. The system has detected pulmonary nodules (solitary, juxtavascular, ground-glass opacity and juxtapleural) between 3 mm and 30 mm.

Causas e consequências da onivoria de peixes em ecossistemas aquáticos

Omnivory is a predominant feeding strategy among tropical fishes, but knowledge about its causes and consequences of this pattern is scarce. In this study we hypothesized that tropical fish feed lower in food web as a way to compensate a higher energetic demand, which increases with increasing water temperature and body size. Information about 8172 freshwater and marine fish species from whole world, from tropical and temperate ecosystems, showed that the trophic position of non-carnivore fish decreases with increasing body size in tropical but not in temperate ecosystems. This result indicates that the higher energetic demand of large-bodied tropical fish should exert a selective force in favor of omnivory. As a consequence, trophic dynamics in tropical freshwater ecosystems should have different patterns comparing to temperate ones, with major implications for water management and restoration of eutrophic aquatic ecosystems. Another hypothesis of this work was that effects of tropical omnivorous planktivorous fish on planktonic communities depend of primary producers stoichiometric composition, which depends of light availability relative to nutrients ratios. A mesocosm experiment, manipulating light availability and planktivorous fish presence, confirmed our hypothesis indicating that resource stoichiometric composition (consequently nutritional quality), determine trophic structure of pelagic food webs in tropical lakes. Finally another mesocosm experiment indicated that the removal of omnivorous benthivorous fish should be more efficient than removal of omnivorous planktivorus fish, as a way to improve water quality in tropical lakes and reservoirs. This last experiment showed that omnivorous planktivorous fish increase phytoplankton biomass due to trophic cascade interactions, without increasing nutrient concentrations in the water column. On the other hand, omnivorous benthivorous fish, feeding on detritus and other benthonic food sources and excreting nutrients in the water column, are responsible for translocate nutrient from sediments to the water column, increasing phosphorus pool and phytoplankton biomass. Thereby, internal phosphorus supply should be reduced and water quality of eutrophicated lakes could be improved by removing omnivorous benthivorous fish.

Causas e consequências da onivoria de peixes em ecossistemas aquáticos

Omnivory is a predominant feeding strategy among tropical fishes, but knowledge about its causes and consequences of this pattern is scarce. In this study we hypothesized that tropical fish feed lower in food web as a way to compensate a higher energetic demand, which increases with increasing water temperature and body size. Information about 8172 freshwater and marine fish species from whole world, from tropical and temperate ecosystems, showed that the trophic position of non-carnivore fish decreases with increasing body size in tropical but not in temperate ecosystems. This result indicates that the higher energetic demand of large-bodied tropical fish should exert a selective force in favor of omnivory. As a consequence, trophic dynamics in tropical freshwater ecosystems should have different patterns comparing to temperate ones, with major implications for water management and restoration of eutrophic aquatic ecosystems. Another hypothesis of this work was that effects of tropical omnivorous planktivorous fish on planktonic communities depend of primary producers stoichiometric composition, which depends of light availability relative to nutrients ratios. A mesocosm experiment, manipulating light availability and planktivorous fish presence, confirmed our hypothesis indicating that resource stoichiometric composition (consequently nutritional quality), determine trophic structure of pelagic food webs in tropical lakes. Finally another mesocosm experiment indicated that the removal of omnivorous benthivorous fish should be more efficient than removal of omnivorous planktivorus fish, as a way to improve water quality in tropical lakes and reservoirs. This last experiment showed that omnivorous planktivorous fish increase phytoplankton biomass due to trophic cascade interactions, without increasing nutrient concentrations in the water column. On the other hand, omnivorous benthivorous fish, feeding on detritus and other benthonic food sources and excreting nutrients in the water column, are responsible for translocate nutrient from sediments to the water column, increasing phosphorus pool and phytoplankton biomass. Thereby, internal phosphorus supply should be reduced and water quality of eutrophicated lakes could be improved by removing omnivorous benthivorous fish.

Análisis virológico y epidemiológico del síndrome de despoblamiento de las colmenas en España: estudio de causas y consecuencias

La abeja de la miel Apis mellifera es la principal especie polinizadora empleada por el hombre para aumentar la productividad de los cultivos, y además desempeña una importante función en el mantenimiento de la biodiversidad en todo el mundo. En las últimas décadas, se ha apreciado un incremento de la mortalidad de las colonias de abejas en numerosas regiones, lo que ha llevado a generar una gran alarma debido a sus potenciales repercusiones económicas y medioambientales. Este fenómeno, caracterizado por no tener una causa conocida, se ha clasificado principalemente en “Síndrome de Despoblamiento de las Colmenas” (SDC), cuando presenta una sintomatología concreta de despoblamiento de abejas adultas, o simplemente “mortalidad invernal”, cuando las colmenas no superan el invierno por causas no identificadas. Estas pérdidas se han observado también en España, el país con mayor censo de colmenas de la Unión Europea e importante productor de miel. Esta situación ha generado la necesidad de estudiar las causas de tales pérdidas. Actualmente se considera que no existe una causa única que explique esta mortalidad sino que, por el contrario, se trata de un fenómeno en el que la interacción de varios factores afecta a las colonias. Entre estos factores considerados ‘de riesgo’ destacan la mala nutrición y la escasez de recursos, la climatología adversa y el cambio climático, la exposición a pesticidas neonicotinoides empleados en los cultivos donde pecorean las abejas, la presencia de depredadores naturales y especies invasoras y la acción de los patógenos presentes en las colmenas. Entre los patógenos que pueden afectar a la abejas, destacan los virus porque a pesar de conocerse su amplia distribución y prevalencia en las colmenas y haber sido asociados con eventos de mortalidad de colonias de abejas, aún son muchos los interrogantes sobre su patogenia, cómo se ven afectados por otros factores y cómo son capaces de alterar el equilibrio con el hospedador produciendo estados patológicos...