A prescrição de medicamentos por enfermeiros na atenção primária à saúde no Brasil: caracterização, normatização, formação e lições aprendidas.

O papel do enfermeiro como prescritor vem se ampliando em muitos países nos últimos anos, em diferentes situações e amplitudes de ação, se configurando como prática avançada na enfermagem. No Brasil, a prescrição de medicamentos por enfermeiros está prevista na Lei do Exercício Profissional desde 1986, e permite a esse profissional, a prescrição de medicamentos estabelecidos em programas de saúde pública. Esse estudo tem como objetivo geral analisar as determinações e perspectivas da prescrição de medicamentos por enfermeiros nos protocolos da Estratégia Saúde da Família. Os objetivos específicos são: apreender a atual situação internacional da prescrição de medicamentos por enfermeiros em comparação a essa prática no Brasil identificando semelhanças e diferenças; identificar os contornos legais e normativos da prescrição de medicamentos por enfermeiros no Brasil apontando sua história, tendências e desafios; caracterizar o modelo de prescrição de medicamentos por enfermeiros nos protocolos de Atenção Primária à Saúde no Brasil; investigar possíveis lacunas entre formação, capacitação, autoavaliação e prática da prescrição de medicamentos na Atenção Primária à Saúde na perspectiva do enfermeiro. Trata-se de Estudo de Caso Exemplar com abordagem qualitativa através de Revisão Bibliográfica, Análise Documental e Grupo Focal com enfermeiros. A análise dos dados deu-se por meio da Análise de Conteúdo e Análise Qualitativa de Conteúdo. Os resultados revelam que a categoria da enfermagem contribuiu para a legalização da prescrição, porém não para a sua legitimação; na Atenção Primária à Saúde, essa atribuição está consolidada por meio de protocolos e legislação, embora sem estratégia clara de acompanhamento pelo Ministério da Saúde; observa-se resistência em algumas normatizações dentro do setor saúde. Quanto aos protocolos, observou-se não há exigência de pré-requisitos na maioria deles; há possibilidade de diagnóstico pelo enfermeiro na gravidez, nutrição infantil e doenças sexualmente transmissíveis; observou-se variados graus de autonomia; amplo grupo de medicamentos prescritos por enfermeiros. Dos 37 participantes do Grupo Focal, 97,3% eram do sexo feminino; 54% formados há menos de 10 anos, 27% entre 10 e 20 anos, 16,2% há mais de 20 anos; 83,8% com especialização em Saúde Pública. Todos os enfermeiros relataram insuficiência da disciplina de farmacologia para instrumentalizar a prática prescritiva. Destacou-se a necessidade de pós-graduação; a importância da experiência clínica; falta de discussões e capacitação. Apenas alguns se autoavaliaram como competentes para prescrever, outros revelam medo de reação adversa a medicamentos. Conclui-se que há tendência da prescrição de medicamento por enfermeiros permanecer apenas na legalidade e o principal desafio é alcançar a legitimidade. Confirma-se uma prática prescritiva sem requisitos, diversidade de orientações induzindo a multiplicidade de ações que pode afetar a qualidade da prescrição. Há lacunas entre formação, capacitações e exigências cotidianas da prescrição de medicamentos por enfermeiros na Atenção Primária à Saúde. No Brasil se faz premente pesquisa para avaliar o impacto, a qualidade e a segurança da prescrição de medicamentos por enfermeiros. A experiência internacional sugere também que essa prescrição deve ser apoiada pelo coletivo de enfermeiros, com robusto plano de capacitação nacional, além de governança e apoio local.

Cidades saudáveis e qualidade de vida em Uberlândia (MG): aportes metodológicos para um processo em construção

The current study includes theoretical and methodological reflections on the quality of life in the city of Uberlândia, Minas Gerais. It started from the thought that the quality of life is multifactorial and is permanently under construction and the main objective of analyzing it as one of the componets of Healthy Cities's moviment. The theoretical research focused on the concepts of healthy cities, quality of life, health, sustainability, well-being, happiness, indexes and indicators. From the use of multiple search strategies, documentary and on field of quantitative and qualitative character, this research of exploratory descriptive nature can offers a contribution to the studies on the quality of life in cities. It is proposed that the studies startes to work with some concept, like some notions os life quality adequated for some paticular reality, whose notions can approach concepts already established as health. This step is important on the exploratory researches. The studies may include aspects of objective analysis, subjective or both. The objective dimension, which is most common approach, are traditionally considered variables and indicators related to: the urban infrastructure (health, education, leisure, security, mobility), dwelling (quantitative and qualitative dwlling deficit), the urban structure (density and mix uses), socioeconomic characteristics (age, income, education), urban infrastructure (sanitation, communication), governance (social mobilization and participation). To focus on the subjective dimension, most recent and unusual, it is proposed to consider the (dis)satisfaction, the personal assessment in relation to the objective aspects. In conclusion, being intrinsically related to the health, the quality of life also has a number of determinants, and the ideal of the reach of quality of life depends on the action of all citizens based on the recognition of networks and territories, in a interescalar perspective and intersectoral. Therefore, emphasis in given on the potential of tools, such as the observatories, to monitor and intervent in reality, aiming in a building process of healthy cities.

Internacionalização de empresas e o fechamento do capital : um estudo sobre a deslistagem no mercado brasileiro

This work contributes to the finance literature proposing to analyze the relationship between the degree of internationalization of Brazilian companies and the likelihood of delisting. Therefore, even though the internationalization as a differential, in the formulation of hypotheses and analysis of the relationship between the variables dealt with concepts and theories within the Corporate Governance, which is already established in theory when it comes to delisting. First, with a view to the theory of internalization, which gives competitive advantages to the company due the adoption internationalization strategy and in parallel to the positive effects that this strategy generates on firms performance, it was formulated an hypothesis that the degree of internationalization would be adversely related to the probability of delisting, mainly due to such benefits generated to the organization. In turn, as an alternative hypothesis of the research, it proposed a positive relationship between these variables, based on agency theory, according to which internationalization would contribute to delisting by increasing geographical separation between shareholders and managers and, consequently, agency conflicts and the difficulty of monitoring. For the achievement of objectives, as well as being included economic and financial variables and GC, it was proposed the analysis of periods of crisis, as the events of recent past of the Brazilian economy. Starting from a base model initially developed by Pour and Lasfer (2013), which later, the proxies of internationalization and crisis have been added also contemplating adjustments to the Brazilian context. The data collected include the period from 2006 to 2014 and information on active and inactive companies at Bovespa. As results, it was found negative significance between the degree of internationalization and the delisting decision, confirming the first hypothesis of the research and stating that the benefits generated by internationalization in the company generate it spreads and results that reduce the probability of delisting. By analyzing the results of control variables was still possible to observe that, even internationalization reducing the likelihood of delisting, by particular aspects of corporate governance in Brazil, such as the high ownership concentration, the benefits it generates contribute to delisting. Regarding the analysis in crisis, the consequences of the crisis of the US subprime in general market were more relevant that the occurrence of itself, unlike the Brazilian internal crisis of 2014, which was statistically significant for the analyzed event. For future researches it is suggested the expansion of database and individual treatment of the reasons adopted by a company when delisting decision.

Commodification of health care systems: The Catalan case

Commodification of the public healthcare system has been a growing process in recent decades, especially in universal healthcare systems and in high-income countries like Spain.  There are substantial differences in the healthcare systems of each autonomous region of Spain, among which Catalonia is characterized by having a mixed healthcare system with complex partnerships and interactions between the public and private healthcare sectors.  Using a narrative review approach, this article addresses various aspects of the Catalan healthcare system, characterizing the privatization and commodification of health processes in Catalonia from a historical perspective with particular attention to recent legislative changes and austerity measures.  The article approximates, the eventual effects that commodification and austerity measures will have on the health of the population and on the structure, accessibility, effectiveness, equity and quality of healthcare services.

Articulação terriotiral e sustentabilidade: estudo sobre o gerenciamento de resíduos de serviços de saúde no ABC Paulista

Tese apresentada ao Programa de Pós-Graduação em Administração da Universidade Municipal de São Caetano do Sul para a obtenção do título de Doutor em Administração

Proposta de avaliação estratégica de clusters turísticos: o caso de Paranapiacaba - SP

O artigo tem como objetivo utilizar a contribuição do conceito de cluster para avaliação estratégica e apresentar uma proposta de análise das oportunidades do setor turístico, considerando todos os agentes envolvidos na criação, comercialização e divulgação dos serviços/produtos turísticos, que possibilitem atender as necessidades exigidas pela demanda e o desenvolvimento sustentável da população receptora. Utilizando como foco o distrito de Paranapiacaba, na cidade de Santo André/SP, foi feita uma pesquisa descritiva, em que inicialmente foram utilizados dados secundários e, em seguida, foi realizada a coleta de dados primários por meio de entrevistas programadas e observação direta em campo dos agentes envolvidos. Os resultados obtidos indicam a necessidade da consolidação de uma entidade supra-empresarial que exerça a governança e que seja capaz de agregar os interesses dos diversos setores, além de garantir a implantação de uma série de ações que venham contribuir para a criação de vantagens competitivas.

Avaliação do Processo Sucessório em Empresas de Gestão Familiar

As mudanças e o aumento da concorrência em todos os segmentos econômicos têm exigido das empresas um grau de profissionalização cada vez maior. As empresas familiares, além desse desafio frente ao mercado, ainda se deparam com dificuldades intrínsecas às suas características, como a dificuldade em separar o que é família, empresa e patrimônio. Portanto, é necessário se preparar para continuar no mercado e desenvolver um plano de sucessão para as próximas gerações. O objetivo geral deste trabalho é propor um instrumento de avaliação do processo sucessório em empresas familiares. Dentre os objetivos específicos, encontram-se identificar itens de maturidade no processo sucessório, oferecer diretrizes estratégicas para promover a sucessão em empresas familiares e avaliar a aplicabilidade do instrumento de pesquisa. Para a empresa estar preparada para a sucessão, ela não pode tratar somente o assunto isoladamente. Portanto, os temas estratégia, planejamento estratégico, distinção entre família, propriedade e gestão, governança corporativa e maturidade, também são aprofundados ao longo da revisão de literatura. Por meio de um estudo de caso com abordagem exploratória, o trabalho foi desenvolvido tendo-se como base modelos disponíveis na literatura para avaliação de maturidade. Antes da aplicação, o instrumento foi submetido à avaliação por cinco especialistas em empresas familiares. Como resultado, foi possível propor uma avaliação para o processo sucessório, identificando itens de maturidade e oferecendo diretrizes estratégicas para promover a sucessão em empresas familiares. Conclui-se que a avaliação do processo sucessório pode contribuir para a empresa identificar seus pontos fortes, minimizando dificuldades e superando obstáculos para sua sobrevivência no mercado ao longo das gerações. / The advance of competition in all of the economy markets has being demanding companies to have professional businesses, in an increasing way. The family business, beyond this challenge, still faces particular difficulties, such as the difference among family, business and ownership. So, it is a necessity for them being ready for their continuity in the market and developing a succession plan for the next generations. The main objective of this work is to propose an evaluation instrument for succession process. Specific objectives are to identify maturity items in the succession process, offer strategic directions to promote succession in family businesses and evaluate the usage of the research instrument. To get ready for succession, the company can not work just this subject. Therefore, it includes topics like: strategy, strategic planning, difference among family, business and ownership, corporate governance, and maturity are reviewed along the literature. Using a case study research method with an exploratory approach, it was developed based on maturity models available in the literature for maturity evaluation. Prior to the application, the research instrument was applied to five specialists in family businesses. As a result, it was possible to propose an evaluation model for succession, identifying maturity items and offering strategic perspectives to promote the succession process in family businesses. As conclusion, the succession evaluation could contribute for the company identifies its strengths, minimizing difficulties and overcoming obstacles for survival throughout generations.

A estrutura de poder tradicional no stricto sensu: o caso do mestrado profissional em Administração Pública em Rede Nacional - PROFIAP

This study approaches bureaucratic organizational structures with the aim to understand the adherence procedure to virtual technologies in the stricto sensu educational administrative process. Thus, the author navigates through the formation of these organizations in Brazil with the intent to demonstrate the bureaucratic organizational culture and the consequent form of domination of those who detain power. In this epistemological construction, the author explores the culture s bureaucratic environment and the organizational power. In the analyses, it was observed the technological phenomenon in the ODL s administrative environment, which can explain the adherence procedure to structures and technological instruments for stricto sensu courses that, hypothetically, dilutes the traditional inherited organizational axiom. Therefore, it was utilized as object of study the Professional Master s degree in National Scale Public Administration PROFIAP, hence analyzing the documental content and the legislation related to institutionalization as well as the positioning of professors/coordinators and of the director of CAPES/MEC. Considering this axioms, it was concluded that the bureaucratic structures can admit ODL in the stricto sensu s environment. However, this can only be done as long as the adherence does not imply in a dilution of the traditional forms of power and institutional bureaucratic inherited dominance, as well as the alleged hegemony of the governmental structure in the educational administration adopted in person by the stricto sensu courses in Brazil

Relações interorganizacionais e eficiência coletiva: um estudo de caso no arranjo produtivo local de confecções do Agreste de Pernambuco

This work is a study in the Local Productive Arrangement of confections from Agreste of Pernambuco, as a relevant sector in economic and social aspect. This research has as central aim to understand how the inter-organizational relations influence the collective efficiency of arrangement. The theoretical framework employed highlights the approaches that deal with the benefits of business agglomeration for the develop­ment of firms and regions. It has discussed the approach of small and medium enter­ prises and industrial districts (SCHMITZ, 1997), which introduce the concept of col­ lective efficiency, explaining that only those externalities explained by Marshall (1996) are not sufficient to explain the competitive advantage of enterprises, expand­ing the idea that organizations achieve competitive advantage not acting alone. To examine the influences of relations in the collective efficiency, it has been taken as analytical perspective theory of social networks (GRANOVETTER, 1973, 1985; BURT, 1992; UZZI, 1997) because it has believe that this approach provides subsi­ dies for a structural analysis of social relationships in face the behavior of human ac­tion. By examining the organizations in a social network, you should understand the reason of this establishment of the relationship, their benefits, and as the information flow takes place and density of links between the actors (Powell; SMITH-DOERR, 1994). As for the methods, this study is characterized as a case study, in according to the purposed objectives, in addition to qualitative method. Also, due to recovering of the historical milestones of the arrangement, it is used a sectional approach with longitudinal perspective (VIEIRA, 2004). The primary and secondary data were used in order to understand the evolutionary process of the sector and their inter-actors re­ lationships in the arrangement for the promotion of development, for both, was used the contend and documentary analysis technique, respectively (DELLAGNELO ; SIL­VA, 2005). The approach of social networks has permitted understand that social re­lationships may extend the collective efficiency of the arrangement, and therefore need to develop policies that encourage the legalization of informal companies in ar­rangement, by showing up themselves representative. Thus, the relations estab­ lished in LPA of confections from Agreste of Pernambuco need for more effective mechanisms to broaden the collective efficiency. Therefore, this way as take place has directly benefited only a group of companies that are linked in some way the sup­portive institutions. So we can conclude that the inter-actor relations have limited the collective efficiency of LPA, being stimulated by the institutions in support only to groups of entrepreneurs, even those that produce external relations for all clustered companies

Relações interorganizacionais e confiança no setor da carcinicultura: um estudo de caso na camanor produtos marinhos

This study investigated how the types of confidence based on competence and good will act in the formation and maintenance of cooperation relationships between the Camanor and its partners (Aquatec, Purina, Caçuá, Uvifrios and Malta / Cleyton). It used organizational approaches on networks based primarily on studies of Powell (1987, 1990), Das and Teng (2000, 2001), Child (2001) and Contractor and Lorange (2004) which have described the advantages that cooperative relationships can provide, as well as their limits as alternative governance structures. Confidence has been considered an important factor affecting the actions and development of organizations involved in networks or in strategic alliances (ZAHEER; HARRIS, 2006) and is the most appropriate control mechanism in these situations (SYDOW, 1998). Confidence is seen from two different approaches: the economic and the sociological (ZAHEER; HARRIS, 2006). To facilitate the understanding of confidence some typologies have been created, as proposed by Barney and Hansen (1994), Lane (1998), Das and Teng (2000), Child (2001) and Wever, Martens and Vandenbempt (2005). This study made use of the case study as proposition of Yin (2005). Semi-structured interviews were held with pre-determined routes, in a single stage performed in early 2008. The research subjects were owners and / or responsible for Camanor and its business partners (Aquatec, Purina, Caçuá, Uvifrios and Malta / Cleyton). Also secondary data were collected in several sites related to the industry and enterprises studied, in addition to data collected by previous studies conducted by CARCINEREDES (2006). The primary data were analyzed using the analysing technique of the content proposed by Bardin (1994). Regarding the secondary data, they were qualitatively analyzed according to documentary analysis technique (BARDIN, 1994). Thus, through the data collected, could be concluded that although there is confidence based on good faith in relationships(UZZI, 1998; OF; TENG, 2001), their presence does not determine the formation and / or maintenance of a partnership, serves only in order to facilitate the relationship, making them more flexible. The confidence based on competence (DAS; TENG, 2001) influenced the formation and maintenance of relations studied. Because whether or not to form a relationship with another organization it is used the perception of the partner acts, namely the reputation (image) as decision basis. And it is through the verification of the performance of the partner activities that will determine the continuation of the partnership

Relação entre ciclo de vida do produto turístico e estratégias de cooperação na faixa litorânea urbana do município de Natal

Tourism in the Northeast of Brazil was introduced as an alternative economic development for the Region by federal promoting policies that focused primarily in structuring the local geographic area. With the completion of these structuring actions, mass tourism expanding the area, as well as spread actions based on cooperation and formalization of governance institutions. This study aimed to examine the relationship between the life cycle of the tourism product 'Coastal Cities of Natal and the cooperation strategies in a historical perspective. Thus was submitted to the life cycle of the tourism product 'Coastal Cities of Natal ; the major projects of tourism development were mapped, the existing cooperation strategies were characterized, and investigated the influence of the cooperation actions for the current stage of product. The specific theoretical support to tourism was built on the perspective of the Theory of Population Ecology, System of Tourism and Touristic Product Life Cycle. Regarding to cooperation the theoretical foundation addressed issues of strategy, New Forms and Collective Efficiency. The survey consisted of a causal descriptive study, using a case study. We used the qualitative and quantitative methodological approaches, and data collected by consulting of secondary data and semistructured interviews with twelve staff working in tourism in Natal. Results showed that the life cycle graph of product 'Coastal Cities of Natal is moving from one stage of growth to a stage of maturity, with a primary upward trend and with crises that are up over the graph. They have been mapped six of tourism development projects of relevance to the product: The Politics of Mega Projects, PRODETUR/NE, Municipalization National Program of Tourism, Regionalization Program, Urbanization Project Beach do Meio and Actions for the Promotion of Destiny. They have been identified sixty-four participating players in process of tourism development, which twenty were considered relevant to the respondents. The main strategies identified for cooperation were the consortium, collective strategy and clusters. Results indicated that co-operation strategies were adopted so that the benefits were obtained at the collective level, dedicated to the strengthening of Natal Destiny and its products. The main reasons were the need of cooperative marketing, international market entry and actions inducing the state. Finally, it was concluded that strategies for cooperation related to product life cycle 'Coastal Cities of Natal' as that work in the consolidation of projects for development of tourism, when the efficiency of collective action is achieved

Aspectos do gerenciamento de riscos de tecnologia da informação nas empresas: um estudo de caso múltiplos

The information technology - IT- benefits have been more perceived during the last decades. Both IT and business managers are dealing with subjects like governance, IT-Business alignment, information security and others on their top priorities. Talking about governance, specifically, managers are facing it with a technical approach, that gives emphasis on protection against invasions, antivirus systems, access controls and others technical issues. The IT risk management, commonly, is faced under this approach, that means, has its importance reduced and delegated to IT Departments. On the last two decades, a new IT risk management perspective raised, bringing an holistic view of IT risk to the organization. According to this new perspective, the strategies formulation process should take into account the IT risks. With the growing of IT dependence on most of organizations, the necessity of a better comprehension about the subject becomes more clear. This work shows a study in three public organizations of the Pernambuco State that investigates how those organizations manage their IT risks. Structured interviews were made with IT managers, and later, analyzed and compared with conceptual categories found in the literature. The results shows that the IT risks culture and IT governance are weakly understood and implemented on those organizations, where there are not such an IT risk methodology formally defined, neither executed. In addition, most of practices suggested in the literature were found, even without an alignment with an IT risks management process