Health in Brazil 6 Health conditions and health-policy innovations in Brazil: the way forward

Brazil is a large complex country that is undergoing rapid economic, social, and environmental change In this Series of six articles, we have reported important improvements in health status and life expectancy, which can be ascribed largely to progress in social determinants of health and to implementation of a comprehensive national health system with strong social participation. Many challenges remain, however. Socioeconomic and regional disparities are still unacceptably large, reflecting the fact that much progress is still needed to improve basic living conditions for a large proportion of the population. New health problems arise as a result of urbanisation and social and environmental change, and some old health issues remain unabated. Administration of a complex, decentralised public-health system, in which a large share of services is contracted out to the private sector, together with many private insurance providers, inevitably causes conflict and contradiction. The challenge is ultimately political, and we conclude with a call for action that requires continuous engagement by Brazilian society as a whole in securing the right to health for all Brazilian people.

Health in Brazil 2 Maternal and child health in Brazil: progress and challenges

In the past three decades, Brazil has undergone rapid changes in major social determinants of health and in the organisation of health services. In this report, we examine how these changes have affected indicators of maternal health, child health, and child nutrition. We use data from vital statistics, population censuses, demographic and health surveys, and published reports. In the past three decades, infant mortality rates have reduced substantially, decreasing by 5.5% a year in the 1980s and 1990s, and by 4.4% a year since 2000 to reach 20 deaths per 1000 livebirths in 2008. Neonatal deaths account for 68% of infant deaths. Stunting prevalence among children younger than 5 years decreased from 37% in 1974-75 to 7% in 2006-07. Regional differences in stunting and child mortality also decreased. Access to most maternal-health and child-health interventions increased sharply to almost universal coverage, and regional and socioeconomic inequalities in access to such interventions were notably reduced. The median duration of breastfeeding increased from 2.5 months in the 1970s to 14 months by 2006-07. Official statistics show stable maternal mortality ratios during the past 10 years, but modelled data indicate a yearly decrease of 4%, a trend which might not have been noticeable in official reports because of improvements in death registration and the increased number of investigations into deaths of women of reproductive age. The reasons behind Brazil`s progress include: socioeconomic and demographic changes (economic growth, reduction in income disparities between the poorest and wealthiest populations, urbanisation, improved education of women, and decreased fertility rates), interventions outside the health sector (a conditional cash transfer programme and improvements in water and sanitation), vertical health programmes in the 1980s (promotion of breastfeeding, oral rehydration, and immunisations), creation of a tax-funded national health service in 1988 (coverage of which expanded to reach the poorest areas of the country through the Family Health Program in the mid-1990s); and implementation of many national and state-wide programmes to improve child health and child nutrition and, to a lesser extent, to promote women`s health. Nevertheless, substantial challenges remain, including overmedicalisation of childbirth (nearly 50% of babies are delivered by caesarean section), maternal deaths caused by illegal abortions, and a high frequency of preterm deliveries.

Comparative molecular field analysis of a series of inhibitors of HIV-1 protease

Several protease inhibitors have reached the world market in the last fifteen years, dramatically improving the quality of life and life expectancy of millions of HIV-infected patients. In spite of the tremendous research efforts in this area, resistant HIV-1 variants are constantly decreasing the ability of the drugs to efficiently inhibit the enzyme. As a consequence, inhibitors with novel frameworks are necessary to circumvent resistance to chemotherapy. In the present work, we have created 3D QSAR models for a series of 82 HIV-1 protease inhibitors employing the comparative molecular field analysis (CoMFA) method. Significant correlation coefficients were obtained (q(2) = 0.82 and r(2) = 0.97), indicating the internal consistency of the best model, which was then used to evaluate an external test set containing 17 compounds. The predicted values were in good agreement with the experimental results, showing the robustness of the model and its substantial predictive power for untested compounds. The final QSAR model and the information gathered from the CoMFA contour maps should be useful for the design of novel anti-HIV agents with improved potency.

Columnar joints in the Patino Formation sandstones, Eastern Paraguay: a dynamic interaction between dyke intrusion, quartz dissolution and cooling-induced fractures

The Patino Formation sandstones, which crop out in Aregua neighborhood in Eastern Paraguay and show columnar joints near the contact zone with a nephelinite dyke, have as their main characteristics the high proportion of syntaxial quartz overgrowth and a porosity originated from different processes, initially by dissolution and later by partial filling and fracturing. Features like the presence of floating grains in the syntaxial cement, the transitional interpenetrative contact between the silica-rich cement and grains as well as the intense fracture porosity are strong indications that the cement has been formed by dissolution and reprecipitation of quartz from the framework under the effect of thermal expansion followed by rapid contraction. The increase of the silica-rich cement towards the dyke in association with the orthogonal disposition of the columns relative to dyke walls are indicative that the igneous body may represent the main heat source for the interstitial aqueous solutions previously existing in the sediments. At macroscopic scale, the increasing of internal tensions in the sandstones is responsible for the nucleation of polygons, leading to the individualization of prisms, which are interconnected by a system of joints, formed firstly on isotherm surfaces of low temperature and later on successive adjacent planes towards the dyke heat source.

Boundary and internal conditions for adjoint fluid-flow problems

The ever-increasing robustness and reliability of flow-simulation methods have consolidated CFD as a major tool in virtually all branches of fluid mechanics. Traditionally, those methods have played a crucial role in the analysis of flow physics. In more recent years, though, the subject has broadened considerably, with the development of optimization and inverse design applications. Since then, the search for efficient ways to evaluate flow-sensitivity gradients has received the attention of numerous researchers. In this scenario, the adjoint method has emerged as, quite possibly, the most powerful tool for the job, which heightens the need for a clear understanding of its conceptual basis. Yet, some of its underlying aspects are still subject to debate in the literature, despite all the research that has been carried out on the method. Such is the case with the adjoint boundary and internal conditions, in particular. The present work aims to shed more light on that topic, with emphasis on the need for an internal shock condition. By following the path of previous authors, the quasi-1D Euler problem is used as a vehicle to explore those concepts. The results clearly indicate that the behavior of the adjoint solution through a shock wave ultimately depends upon the nature of the objective functional.

Analysis of Structure and Tendencies of Qualified Immigrant Workforce on the Swedish Labor Market

The purpose of this paper is to make quantitative and qualitative analysis of foreign citizens who may participate on the Swedish labor market (in text refers to as ‘immigrants’). This research covers the period 1973-2005 and gives prediction figures of immigrant population, age and gender structure, and education attainment in 2010. To cope with data regarding immigrants from different countries, the population was divided into six groups. The main chapter is divided into two parts. The first part specifies division of immigrants into groups by country of origin according to geographical, ethnical, economical and historical criteria. Brief characteristics and geographic position, dynamic and structure description were given for each group; historical review explain rapid changes in immigrant population. Statistical models for description and estimation future population were given. The second part specifies education and qualification level of the immigrants according to international and Swedish standards. Models for estimating age and gender structure, level of education and professional orientation of immigrants in different groups are given. Inferences were made regarding ethnic, gender and education structure of immigrants; the distribution of immigrants among Swedish counties is given. Discussion part presents the results of the research, gives perspectives for the future brief evaluation of the role of immigrants on the Swedish labor market.

Ambiente interno : a participação e o envolvimento das pessoas na busca do diferencial competitivo

Day after day, even small companies and multinationals brands need to compete in a worldwide market. All kind of global strategies have to involve production and regional market knowledge. Still being essential for company have a complete view of it market and it right position to gain competitive advantage. In a global market, get possible for the companies be in touch with last generation technologies and equipment's and all kind of research. Companies like that should develop products focused in customer's desire, even those extremely strict. Specifically in our country, as hard as we could think, the companies have access to credit lines, to the fiscal incentives offered by the states that alliance with the market potential are making possible the appearance of a lot companies and the growth of the companies already existent. However, these resources alone don't produce results to the company if it doesn't possess an internal organization able to assimilate the new market situation. The companies have to be able to apply the maximum resources offered by new technologies and understand how a communications facility means solution for many internal problems. In short terms, technology, financial resources, research and knowledge are available, however, the human resources might be prepared and developed in order to become the whole knowledge in profits. According 'JURAN' and his Total Quality Control philosophy the human resources playing fundamental role in the process, and in my opinion a company is something like a ship where all must be prepared to hold the rudder. I will develop a basic job looking for productivity and company's development through the people's involvement, focused in process of motivation, creativity and staff valorization. I believe that there no good production process without those requirements. Based on real case of a automotive parts and foundry company, located in Bento Gonçalves - RS, this work will look for to organize it mainly in its Industrial Division, adopting in participate administration where, through a information system and personnel involvement we will seek all favorable conditions to politics and strategies in get the growth of company.

A formação do campo da saúde suplementar no Brasil

The aim of the present study is to analyze the evolution of the historical and institutional elements that generate the current design of the private health market in Brazil. Its main theoretical basis is the Theory of the Symbolic Power, by Pierre Bourdieu, complemented, in the non-conflictive aspects of these two visions, by the Anthony Giddens¿ institutional vision on the field genesis motivational factors. The research¿ data were collected through documents and semi structured interviews during 2002 e 2003 period, involving the qualitative analyze due to understand the field¿s phenomena under an actors¿ perspective. The research identifies the several players that integrate the market, their evident strategic goals, and those that are not so, besides of the powers¿ resources used to reach them, by DiMaggio and Powell¿ vision. Thus, it tries to show, through a historic linear description, and emphasis in the determinant facts, the evolution of the market¿s constitution. The study demonstrates that the field had formed from several Estate¿ actions, basically after the past seventy¿ decade, as result of a alternative Government¿ strategy towards a Brazilian population¿s dissemination plan of health¿ services that enforced the institutionalization of isomorphic structures, with a strong internal interaction and a hierarchy between kinds of values, that had emphasized the health¿ symbol as a citizenship¿s value. In the end, the study estimates that the crescent longevity¿ Brazilian¿s population and the consequent work¿s dismiss may cause a private health¿ elitism conforming a future problem in this sensible segment of the social politics of the Brazilian government.

Gestão da inovação para a sustentabilidade ambiental: estudos de caso do desenvolvimento e difusão de produtos de consumo industrializados com materiais de fontes renováveis

O objetivo desta tese é identificar como ocorre a gestão da inovação de produto ambientalmente sustentável. Pelo método de estudo de caso e sob a perspectiva de três vertentes da teoria organizacional (estrutura do setor de negócios, visão baseada em recursos e visão relacional) foi realizada uma análise abrangente de como os condicionantes externos do ambiente competitivo, os condicionantes internos empresariais e os relacionamentos organizacionais impactaram no projeto de desenvolvimento e difusão de duas inovações de produto com atributos favoráveis à sustentabilidade ambiental: uma esponja de banho com fibras amazônicas e PET reciclado e um lava-louças líquido para o pronto-uso de fontes renováveis. Os dois casos apresentam marcantes diferenças em relação ao porte das empresas, às estruturas, competências e culturas organizacionais, à maturidade das respectivas plataformas tecnológicas de fontes renováveis e às abordagens utilizadas na gestão dos projetos de desenvolvimento de novo produto. Além disso, os dois casos são distintos na competitividade dos atributos de produto ambientais e funcionais em relação ao preço ante os produtos concorrentes. Apesar destas diferenças, construtos da visão relacional foram utilizados para identificar similaridades entre os dois estudos de caso na gestão da inovação. Redes informais internas realizaram uma inovação organizacional ao criarem um departamento de sustentabilidade, o qual realizou diagnósticos e recomendações para minimizar os riscos sócio-ambientais e regulatórios decorrentes do suprimento da fibra amazônica para a esponja de banho. E um relacionamento colaborativo complementou a inovação de produto e realizou inovações de marketing que proporcionaram o melhor desempenho na difusão do lava-louças pronto-uso de fontes renováveis no varejo. Portanto, apesar das diferenças nos condicionantes internos e externos, a gestão da inovação nos dois casos se utilizou de relacionamentos colaborativos a fim de gerar inovações empresariais que solucionaram as restrições ao processo de inovação de produto ambientalmente sustentável.

Distribution strategies for the base of the pyramid: an exploratory study in Brazil

Access has been one of the main difficulties companies have faced in emerging markets (PRAHALAD, 2005). The capillarity of the market, the existence of small, not professionalized and sometimes informal retailers, the lack of infrastructure and high transportation costs are some of the distribution challenges companies face in poorer regions. The literature concerning the Base of the Pyramid (BoP) is still recent and only after the seminal article by Prahalad and Hart (2002), it evolved into many different management perspectives. However, there is a lack of researches concerning distribution strategies to the BoP. Therefore, the main objective of this research is to identify, in the perception of executives working in the market, the conditions associated to a satisfactory distribution for the BoP market in Brazil and to build a substantive theory that helps to shed light to the understanding of the distribution phenomenon adopted by consumer goods companies to reach the BoP market in Brazil. In order to accomplish the objectives of this thesis, a grounded theory methodology (Glaser; Strauss, 1967; Corbin; Strauss, 2008) was used. This approach helped to identify the channel strategies used by local and global companies in the market. Many techniques for data collection were applied. The most important one was in-depth interviews with 26 executives from 24 different consumer goods companies in Brazil. Among the companies there were small, medium and large enterprises; which were also grouped as manufacturers, distributors and retailers. Furthermore, secondary data were examined to identify business strategies to reach BoP and map global distribution initiatives. A database from a consumer panel was also used to analyze what and where BoP consumers purchase non-durable goods. It was verified that small and traditional retailing is a very strong format in BoP markets and in the Northern/Northeastern regions. Cash & Carry is a format that is growing a lot. On the other hand, hypermarkets are not very used by low income population. The results suggest that three major categories are associated to a satisfactory distribution: (a) willingness, which means the effort, knowledge and enthusiasm a firm has to operate at BoP markets; (b) well-done execution, which is related to designing correctly the marketing channel and operating efficiently in an environment full of obstacles, such as lack of infrastructure, capillarity, lack of safety, regional differences and informality, and (c) relationship, which was perceived to be friendlier and essential at BoP markets, since it is very difficult for manufacturers to reach the entire market alone. It is more likely to have a satisfactory distribution when manufacturers establish strong relationships in the marketing channel. Besides, small retailers have a perception of isolation and expect a higher level of relationship. These major categories explain also the competitive advantage that local companies have in relation to MNCs and large companies. Despite of the limitations of an exploratory study, it is expected that this thesis will contribute to the BoP knowledge as well as to the identification of the peculiarities of distribution in BoP markets.

Produção de acetato de etila em biorrefinaria: uma análise de viabilidade

O estudo aqui apresentado tem como objetivo mostrar que a competitividade da indústria química brasileira pode ser revista por meio do desenvolvimento da área química a partir dos recursos naturais renováveis e de alto desempenho de produtividade, aqui representado pela cana-de-açúcar. A base deste estudo analisa a competitividade econômica da produção do acetato de etila, utilizando o etanol como única matéria-prima, sendo o Brasil um grande exportador e, ao mesmo tempo, detentor de um mercado interno forte quando comparado a outros países desenvolvidos. O acetato de etila exportado representou 52% da capacidade nominal instalada no Brasil no ano de 2008. No Brasil existem três ofertantes, mas apenas um produtor é exportador. Todos usam a esterificação como tecnologia de produção, via reação do ácido acético e etanol, sendo o ácido acético largamente importado. O estudo tem como premissa que a competitividade do acetato de etila no Brasil seja dada pelo etanol, que aqui é produzido pela fermentação do caldo de cana-de-açúcar. Já a tecnologia de esterificação é conhecida e de domínio público mundial, e o ácido acético é uma commodity petroquímica com preço referenciado globalmente. Argumenta-se neste trabalho que a competitividade do acetato de etila decorre da linkage com a produção de etanol de cana-de-açúcar, o que coloca o Brasil como grande potencial exportador desse produto. Utilizando a tecnologia de desidrogenação do etanol, pode-se obter acetato de etila utilizando-se apenas o etanol como matéria-prima, reduzindo-se assim a necessidade de importação de ácido acético, que representaria redução anual do déficit da balança comercial petroquímica brasileira em aproximadamente meio bilhão de dólares e, ademais, permitindo que o acetato de etila produzido no Brasil seja ainda mais competitivo. A partir deste estudo é possível avaliar, por analogia, a competitividade de outros produtos químicos produzidos a partir da matriz cana-de-açúcar, tais como eteno, lubrificantes, plásticos etc. Tal caminho permite criar um novo marco para a indústria química brasileira, com consequente redução da dependência de petróleo e gás natural.

Essays on regulatory risk issues

Most studies around that try to verify the existence of regulatory risk look mainly at developed countries. Looking at regulatory risk in emerging market regulated sectors is no less important to improving and increasing investment in those markets. This thesis comprises three papers comprising regulatory risk issues. In the first Paper I check whether CAPM betas capture information on regulatory risk by using a two-step procedure. In the first step I run Kalman Filter estimates and then use these estimated betas as inputs in a Random-Effect panel data model. I find evidence of regulatory risk in electricity, telecommunications and all regulated sectors in Brazil. I find further evidence that regulatory changes in the country either do not reduce or even increase the betas of the regulated sectors, going in the opposite direction to the buffering hypothesis as proposed by Peltzman (1976). In the second Paper I check whether CAPM alphas say something about regulatory risk. I investigate a methodology similar to those used by some regulatory agencies around the world like the Brazilian Electricity Regulatory Agency (ANEEL) that incorporates a specific component of regulatory risk in setting tariffs for regulated sectors. I find using SUR estimates negative and significant alphas for all regulated sectors especially the electricity and telecommunications sectors. This runs in the face of theory that predicts alphas that are not statistically different from zero. I suspect that the significant alphas are related to misspecifications in the traditional CAPM that fail to capture true regulatory risk factors. On of the reasons is that CAPM does not consider factors that are proven to have significant effects on asset pricing, such as Fama and French size (ME) and price-to-book value (ME/BE). In the third Paper, I use two additional factors as controls in the estimation of alphas, and the results are similar. Nevertheless, I find evidence that the negative alphas may be the result of the regulated sectors premiums associated with the three Fama and French factors, particularly the market risk premium. When taken together, ME and ME/BE regulated sectors diminish the statistical significance of market factors premiums, especially for the electricity sector. This show how important is the inclusion of these factors, which unfortunately is scarce in emerging markets like Brazil.

O planejamento estratégico do capital humano como fator de desenvolvimento sustentável das organizações na agroenergia: estudo de caso

O objetivo desta tese é analisar, orientar e indicar algumas formas de mensuração de resultados das ações ou programas na área de Gestão de Pessoas ao longo dos anos, bem como de novas tendências no setor de agroenergia. O trabalho procura também propor práticas de planejamento estratégico e, indicadores para as organizações com foco no desenvolvimento e nas mudanças previstas nas organizações, no mercado de trabalho, nos modelos de gestão e de negócios do segmento de produção de cana-de-açúcar para os próximos anos. No estudo são analisados as transformações organizacionais, novos desafios competitivos do presente e do futuro, e a forma como a área de Recursos Humanos nas diversas organizações do setor, tem acompanhado tal processo, verificando o impacto dessas ações em um contexto de mudanças nos processos da cadeia agrícola (mecanização do plantio, colheita,.dentre outros), da cadeia industrial (biorefinarias, etanol de segunda geração, gaseificação...dentre outros), e no desenvolvimento organizacional e humano como parte integrante de um programa de sustentabilidade das organizações. São abordados metodologias, sistemas e ferramentas de planejamento estratégico, e mensuração propostas por certos autores que visam a demonstrar o impacto das estratégias e as ações na Gestão de Pessoas em direção ao cumprimento das metas e objetivos das organizações, em um cenário de forte crescimento interno e global do mercado de bioenergia. Nesse cenário, expõe-se e discute-se como as empresas do setor sucroalcooleiro utilizam, na prática, essas metodologias e os indicadores de performance da área frente às necessidades, e indicam-se as melhores práticas e ferramentas que visam a facilitar os processos decisórios, o uso de métricas de Recursos Humanos para previsão e acompanhamento do Capital Humano, e a otimização dos recursos e dos investimentos frente aos novos desafios do setor. Embora já se notem várias iniciativas visando a tornar a Gestão de Pessoas um fator estratégico para as organizações da agroenergia, a pesquisa identificou que a área de Recursos Humanos está evoluindo nessa direção e pode contribuir de forma efetiva para a melhor performance e sustentabilidade dos negócios. Palavras chaves: Cana-de Açúcar, Estratégia Organizacional, Capital Humano

O mercado sobe a favela: um estudo sobre o Santa Marta pós-UPP

O presente estudo de caso teve por objetivo identificar como a implantação da Unidade de Polícia Pacificadora na favela Santa Marta, na Zona Sul do Rio de Janeiro, alterou a interação do mercado com esta comunidade e como isso afetou as relações sociais na favela a partir da percepção dos moradores. O intuito era perceber como o mercado interno, seja ele formal ou informal, tem respondido à nova conjuntura e como atores do mercado externo, como Firjan, Light, entre outros, vêm atuando no local. Ademais, buscou-se analisar como essa nova dinâmica do mercado, viabilizada pela maior presença do estado no Santa Marta, influenciou a sociabilidade local. Para tal, por meio de pesquisa de campo, foram realizadas observações participantes e entrevistas semi-abertas com representantes de empresas que atuam na comunidade, empreendedores locais, moradores e lideranças. Concluiu-se que a expansão do mercado interno e da atuação do mercado externo na comunidade, permite que alguns benefícios cheguem; contudo, essa nova conjuntura tem gerado inseguranças nos moradores que sentem que tiveram espaços de lazer restringidos com o aumento do turismo e eventos festivos para o público externo, receiam não ter condições de arcar com o aumento do custo de vida e conseqüente empobrecimento e temem que venham a sofrer um processo de remoção branca causada pela pressão do mercado. Assim, alguns terão condições de aproveitar e até se desenvolver com as oportunidades que têm surgido com a expansão do mercado, enquanto outros, provavelmente, não terão capacidade e sofrerão uma nova exclusão.

O processo evolutivo de uma subsidiária brasileira : estudo de caso de uma companhia de tecnologia de petróleo e gás

O objetivo dessa dissertação é analisar o processo evolutivo da subsidiária brasileira do setor de tecnologia de petróleo e gás, ao compreender quais são as suas características e de que forma que elas se modificaram ao longo do tempo. Para atender ao objetivo deste trabalho, foi realizada uma revisão da literatura sobre o tema na área de negócios internacionais, para entender quais são os fatores que influenciam os papéis desempenhados pelas subsidiárias em relação as matrizes e os mercados onde elas atuam. A partir do referencial teórico, foram selecionadas algumas tipologias tomadas como critério de análise e investigação do modo pelo qual ocorre a gestão da subsidiária. A pesquisa foi realizada por meio de um estudo de caso, com a participação de gestores da companhia que detivessem tempo de experiência suficiente para analisar o processo evolutivo da companhia desde o momento em que a FMC Technologies se instalou oficialmente no Brasil. Por fim, é feita uma análise dos resultados encontrados na pesquisa, e são confrontados com o referencial teórico apresentado. Por meio da análise, conclui-se que a subsidiária brasileira possui autonomia perante a matriz no que concerne ao seu processo decisório estratégico, fato este que está ligado a aspectos como o contexto interno da companhia, iniciativas tomadas pela própria subsidiária, e também por questões regulatórias no Brasil.