Diabetes mellitus : magnitude das hospitalizações na rede pública do Brasil, 1999-2001

Contexto: O diabetes mellitus (DM) é uma causa importante de morbimortalidade nas sociedades ocidentais devido à carga de sofrimento, incapacidade, perda de produtividade e morte prematura que provoca. No Brasil, seu impacto econômico é desconhecido. Objetivos: Dimensionar a participação do DM nas hospitalizações da rede pública brasileira (1999-2001), colaborando na avaliação dos custos diretos. Especificamente, analisar as hospitalizações (327.800) e os óbitos hospitalares (17.760) por DM como diagnóstico principal (CID-10 E10-E14 e procedimento realizado) e estimar as hospitalizações atribuíveis ao DM, incluindo as anteriores e aquelas por complicações crônicas (CC) e condições médicas gerais (CMG). Métodos: A partir de dados do Sistema de Informação Hospitalar do Sistema Único de Saúde (SIH/SUS) (37 milhões de hospitalizações), foram calculados indicadores por região de residência do paciente e sexo (ajustados por idade pelo método direto, com intervalos de confiança de 95%), faixas etárias, médias de permanência e de gastos por internação e populacional em US$. Realizou-se regressão logística múltipla para o desfecho óbito. As prevalências de DM foram combinadas aos riscos relativos de hospitalização por CC e CMG (metodologia do risco atribuível) e somadas às internações por DM como diagnóstico principal. Utilizou-se análise de sensibilidade para diferentes prevalências e riscos relativos. Resultados: Os coeficientes de hospitalizações e de óbitos hospitalares e a letalidade por DM como diagnóstico principal atingiram respectivamente 6,4/104hab., 34,9/106hab. e 5,4%. As mulheres apresentaram os coeficientes mais elevados, porém os homens predominaram na letalidade em todas as regiões. O gasto médio (US$ 150,59) diferiu significativamente entre as internações com e sem óbito, mas a média de permanência (6,4 dias) foi semelhante. O gasto populacional equivaleu a US$ 969,09/104hab. As razões de chances de óbito foram maiores para homens, pacientes ≥75 anos, e habitantes das regiões Nordeste e Sudeste. As hospitalizações atribuíveis ao DM foram estimadas em 836,3 mil/ano (49,3/104hab.), atingindo US$ 243,9 milhões/ano (US$ 14,4 mil/104hab.). DM como diagnóstico principal (13,1%), CC (41,5%) e CMG (45,4%) responderam por 6,7%, 51,4% e 41,9% respectivamente dos gastos. O valor médio das internações atribuíveis (US$ 292) situou-se 36% acima das não-atribuíveis. As doenças vasculares periféricas apresentaram a maior diferença no valor médio entre hospitalizações atribuíveis e não-atribuíveis (24%), porém as cardiovasculares destacaram-se em quantidade (27%) e envolveram os maiores gastos (37%). Os homens internaram menos (48%) que as mulheres, porém com gasto total maior (53%). As internações de pacientes entre 45-64 anos constituíram o maior grupo (45%) e gastos (48%) enquanto os pacientes com ≥75, os maiores coeficientes de hospitalização (350/104hab.) e de despesa (US$ 93,4 mil/104hab.). As regiões mais desenvolvidas gastaram o dobro (/104hab.) em relação às demais. Considerações Finais e Recomendações: As configurações no consumo de serviços hospitalares foram semelhantes às de países mais desenvolvidos, com importantes desigualdades regionais e de sexo. O gasto governamental exclusivamente com hospitalizações atribuíveis ao DM foi expressivo (2,2% do orçamento do Ministério da Saúde). A ampliação de atividades preventivas poderia diminuir a incidência do DM, reduzir a necessidade de internações, minimizar as complicações e minorar a severidade de outras condições médicas mais gerais.

Mundos pequenos, produção acadêmica e grafos de colaboração: um estudo de caso dos Enanpads

Utilizando a base de dados dos trabalhos publicados nos Enanpads realizados em 2002-04, este artigo focaliza a área de administração da informação para realizar um estudo exploratório sobre a formação de padrões nas estruturas de disseminação do conhecimento acadêmico no Brasil, apoiado nos conceitos oriundos da análise das redes sociais e conjugados com a base proveniente da teoria dos grafos e em recursos computacionais. Procurou-se mapear os fluxos de informações que possibilitam as trocas de conhecimento através das ligações existentes no meio acadêmico. Os resultados indicam a necessidade de ampliar e estreitar os laços entre os autores, notadamente os que possuem algum grau de centralidade local, no intuito de obter o fortalecimento das instituições de ensino, de forma a quebrar as resistências à produção conjunta entre elas, em detrimento do padrão de reprodução endógena detectado.

Melhoria da comunicação e do relacionamento entre o governo e os cidadãos com aplicativos móveis : o caso do m-government do estado de São Paulo

Esta dissertação tem como objetivo explorar como o governo do Estado de São Paulo pode utilizar a tecnologia para aproximar o Estado dos cidadãos por meio de aplicativos móveis. A intensificação do uso dos dispositivos móveis pela população brasileira e a recente ampliação do uso de m-government como esforço na busca da melhoria da prestação de serviços ao cidadão pelo Estado de São Paulo nas duas últimas décadas configuram o cenário em que foi estabelecido o Termo de Referência da Subsecretaria de Tecnologia e Serviços ao Cidadão, da Secretaria de Governo do Estado de São Paulo. Neste trabalho, houve a integração de métodos de pesquisa de diferentes naturezas: revisão da literatura, entrevistas semi-estruturadas com atores influentes na formulação das políticas públicas, avaliação da política de aplicativos móveis do Governo do Estado de São Paulo e dos próprios aplicativos, benchmarking de experiências internacionais e diagnóstico analítico da situação atual. Foram identificados como pontos fortes a importância da existência de uma subsecretaria próxima ao Governador, a criação de um aplicativo central que facilita o conhecimento dos aplicativos do governo existentes e a existência de uma empresa pública de processamento de dados com competência para desenvolver serviços e aplicativos. Como desafios foram identificados a estratégia de comunicação e divulgação dos aplicativos, ausência de legislação sobre m-government e a falta de uma política pública e planejamento estratégico consistente para orientar melhorias e alcance de resultados com rapidez e eficiência. Recomenda-se, principalmente: 1) que a Subsecretaria de Tecnologia e Serviços ao Cidadão atue como órgão central para além de emitir as diretrizes de e-goverment, também emanar as de m-government, 2) que o foco governamental seja na orientação do serviço ao cidadão e não primordialmente ao desenvolvimento de aplicativos e 3) a formulação e implementação de uma política clara para a difusão de m-government que seja passível de ser entendida e replicada por todos os atores governamentais e permeie todos os órgãos da administração direta e indireta, não se restringindo às áreas de TI. A abordagem de m-government ainda é incipiente no Brasil, necessitando de novos estudos acadêmicos complementares para consolidação de massa crítica sobre o tema. Este assunto receberá atenção e investimentos governamentais nos próximos anos. Conclui-se que o Estado de São Paulo está em uma boa direção, mas para avançar com efetividade os gestores estaduais devem se apropriar das melhores práticas da experiência internacional em m-government, havendo um longo caminho para melhorar o relacionamento entre o Estado e os cidadãos com o uso de aplicativos móveis, com a abordagem de um governo único para um cidadão único.

Do tratamento das reclamações à gestão da insatisfação: o comportamento de empresas hoteleiras mediante a insatisfação de seus clientes

Consumer dissatisfaction, when properly handled, is a significant information source for the manager. Studies in this area allow broadening the understanding of certain customer attitudes and behaviors, such as loyalty, repurchase intention or satisfaction and trust increase. Above and beyond supporting consumer feedback, dissatisfaction can provide significant opportunities for organizational learning. Starting from dissatisfied customer information, companies can detect service flaws and develop new products. This work presents the results of an investigation on the behavior of businesses belonging to the hotel sector in Natal, RN, through the dissatisfaction of their customers. We have sought to map the main problems presented by customers to hotels, in the perception of managers and employees, as well as to understand both the process of dissatisfactionrelated data collection, analysis, and processing, and the utilization of such information by businesses. Beyond this, we have compared the habits of organizations to the company reaction approaches described in the literature: Complaint Handling, Complaint Management, and Dissatisfaction Management. The used methodology has been based on case study. Data was collected via indepth interviews with managers and employees in six hotels, two independent ones and four belonging to national and international hotel networks. We have also made use of documents provided by the organizations, such as guest complaint registers and reports from satisfaction surveys on which content analysis was subsequently performed. The results of the investigation point to a high level of awareness in the companies concerning the importance of consumer dissatisfaction. Even though the maximum grade in the procedure scale is not achieved, it has been observed that answer to dissatisfaction is given in planned and systematic form, geared towards consumer satisfaction and improvement of products and processes. Hotel businesses still have to look into other possibilities for mapping consumer dissatisfaction, which implies, among other aspects, articulation with a range of public and private organizations in such a way as to guarantee sustainability of touristic activities in the long term

Vertical distribution of benthic invertebrate larvae during an upwelling event along a transect off the tropical Brazilian continental margin

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

Desenvolvimento como acesso às políticas públicas: a reforma do estado e a concretização dos direitos prestacionais

The state s evolution, after its liberal and the social stages, arrives at the post-social state, also regarded as regulatory state, which, in order to accomplish the state s aims, employs indirect interventions in the economy. The new model of administration adapts principles and concepts form the private sector such as the quest for efficience and tangible results, also striving for the decentralization of state s power to improve effectiveness before the new paradigm of handling of affairs of public interest. Present state derives its legitimacy from the efficiency principle, the legitimacy of the public administration cannot be limited to an analysis of legality, but the fulfillment of the ends envisaged by the public authority on its policies. These public policies have the objective of satisfying fundamental rights of the citizens. The access to public policies set by states as a way of enjoyment of the aforementioned rights constitute a legal and demandable path of development. The creation of public policies and the access to them must abide to the efficiency principle. This access must be taken unther the principles of legal and material equality, inasmuch as the liberty and real liberty. The access must also be observed as a matter of limited resources to grant, in reality, the access and enjoyment of these rights. The demandable nature of the access to public policies binds the public authority into broadening the range of these policies to every one who needs them. Thus, in this spectrum, the role of the Regulatory State, as the legal instruments for access of public policies as a legal path to development, is analyzed in the present work

Uma prática educativa ambiental na construção de agenda 21 local.

This proposal is to search, investigate practical experience in environmental education for the construction of Local Agenda 21, in the municipality of Maxaranguape-RN, attended that brought together various subject and collective social actors of civil society organizations, among them, the Center for Education and Advice Herbert de Souza - CEAHS (NGOs who serves on the council since 1999), associations of farmers and farmers in areas of settlements, teachers / as, groups of women and young people, entrepreneurs, public power, the German partner entities IBAMA. INCRA, BNB in the project of Agenda 21. They are members and participants, constituents of the Permanent Forum of Agenda 21, the main actor privileged in the search. As an object of study to identify the limits and scope of this practice, with regard to aspects of awareness / participation and awaken to an awareness of critical social subjects in the collective social and environmental perspective. The study seeks to investigate if this experience has allowed the individual and collective social subjects, understand and act in their daily life, as the changes in attitudes postures, and expand their interests to participate in various public spaces this intention, is considered the educational activities made with the principles of environmental education in the construction of Agenda 21 that have contributed in raising awareness / participation of social actors of the Permanent Forum of Agenda 21. While reference methodology, the research focuses on theoretical design Freireana with relevance on the dimensions of dialogue, critical thinking and the human dimension comprising the act as educational practice of freedom, the prospect of human emancipation and social transformation of reality, and bring other thinkers as, Carvalho (2004), Trigueiro (2003), Days (2004), among others. The investigation of this practice points to the subject of education, which ECOCIENCIA to install the Agenda 21 and its effect on demand under municipal, German, providing a change of attitudes and postures and certainly, generating a new look and act in the world, broadening their interests and desires of inserting themselves, to participate in public spheres, particularly in establishing relations with dialogical criticality with the authorities and face the demands socio-environmental locations.

Simulação do escoamento multifásico no interior de bombas de cavidades progressivas metálicas

The progressing cavity pumping (PCP) is one of the most applied oil lift methods nowadays in oil extraction due to its ability to pump heavy and high gas fraction flows. The computational modeling of PCPs appears as a tool to help experiments with the pump and therefore, obtain precisely the pump operational variables, contributing to pump s project and field operation otimization in the respectively situation. A computational model for multiphase flow inside a metallic stator PCP which consider the relative motion between rotor and stator was developed in the present work. In such model, the gas-liquid bubbly flow pattern was considered, which is a very common situation in practice. The Eulerian-Eulerian approach, considering the homogeneous and inhomogeneous models, was employed and gas was treated taking into account an ideal gas state. The effects of the different gas volume fractions in pump volumetric eficiency, pressure distribution, power, slippage flow rate and volumetric flow rate were analyzed. The results shown that the developed model is capable of reproducing pump dynamic behaviour under the multiphase flow conditions early performed in experimental works

Synthesis and structural characterization of Eu(III)-doped Zn7Sb2O12

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

Photoluminescence of SrTiO3: Influence of Particle Size and Morphology

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

O Modelo de Ising inomogêneo: uma interrupção contínua entre as redes quadrada e triangular.

The ferromagnetic and antiferromagnetic Ising model on a two dimensional inhomogeneous lattice characterized by two exchange constants (J1 and J2) is investigated. The lattice allows, in a continuous manner, the interpolation between the uniforme square (J2 = 0) and triangular (J2 = J1) lattices. By performing Monte Carlo simulation using the sequential Metropolis algorithm, we calculate the magnetization and the magnetic susceptibility on lattices of differents sizes. Applying the finite size scaling method through a data colappse, we obtained the critical temperatures as well as the critical exponents of the model for several values of the parameter α = J2 J1 in the [0, 1] range. The ferromagnetic case shows a linear increasing behavior of the critical temperature Tc for increasing values of α. Inwhich concerns the antiferromagnetic system, we observe a linear (decreasing) behavior of Tc, only for small values of α; in the range [0.6, 1], where frustrations effects are more pronunciated, the critical temperature Tc decays more quickly, possibly in a non-linear way, to the limiting value Tc = 0, cor-responding to the homogeneous fully frustrated antiferromagnetic triangular case.

Teoria cinética não extensiva: efeitos físicos em gases e plasmas

The standard kinetic theory for a nonrelativistic diluted gas is generalized in the spirit of the nonextensive statistic distribution introduced by Tsallis. The new formalism depends on an arbitrary q parameter measuring the degree of nonextensivity. In the limit q = 1, the extensive Maxwell-Boltzmann theory is recovered. Starting from a purely kinetic deduction of the velocity q-distribution function, the Boltzmann H-teorem is generalized for including the possibility of nonextensive out of equilibrium effects. Based on this investigation, it is proved that Tsallis' distribution is the necessary and sufficient condition defining a thermodynamic equilibrium state in the nonextensive context. This result follows naturally from the generalized transport equation and also from the extended H-theorem. Two physical applications of the nonextensive effects have been considered. Closed analytic expressions were obtained for the Doppler broadening of spectral lines from an excited gas, as well as, for the dispersion relations describing the eletrostatic oscillations in a diluted electronic plasma. In the later case, a comparison with the experimental results strongly suggests a Tsallis distribution with the q parameter smaller than unity. A complementary study is related to the thermodynamic behavior of a relativistic imperfect simple fluid. Using nonequilibrium thermodynamics, we show how the basic primary variables, namely: the energy momentum tensor, the particle and entropy fluxes depend on the several dissipative processes present in the fluid. The temperature variation law for this moving imperfect fluid is also obtained, and the Eckart and Landau-Lifshitz formulations are recovered as particular cases

Efeitos das inomogeneidades da matéria em Cosmologias Aceleradas

The recent observational advances of Astronomy and a more consistent theoretical framework turned Cosmology in one of the most exciting frontiers of contemporary science. In this thesis, homogeneous and inhomogeneous Universe models containing dark matter and different kinds of dark energy are confronted with recent observational data. Initially, we analyze constraints from the existence of old high redshift objects, Supernovas type Ia and the gas mass fraction of galaxy clusters for 2 distinct classes of homogeneous and isotropic models: decaying vacuum and X(z)CDM cosmologies. By considering the quasar APM 08279+5255 at z = 3.91 with age between 2-3 Gyr, we obtain 0,2 < OM < 0,4 while for the j3 parameter which quantifies the contribution of A( t) is restricted to the intervalO, 07 < j3 < 0,32 thereby implying that the minimal age of the Universe amounts to 13.4 Gyr. A lower limit to the quasar formation redshift (zJ > 5,11) was also obtained. Our analyzes including flat, closed and hyperbolic models show that there is no an age crisis for this kind of decaying A( t) scenario. Tests from SN e Ia and gas mass fraction data were realized for flat X(z)CDM models. For an equation of state, úJ(z) = úJo + úJIZ, the best fit is úJo = -1,25, úJl = 1,3 and OM = 0,26, whereas for models with úJ(z) = úJo+úJlz/(l+z), we obtainúJo = -1,4, úJl = 2,57 and OM = 0,26. In another line of development, we have discussed the influence of the observed inhomogeneities by considering the Zeldovich-Kantowski-DyerRoeder (ZKDR) angular diameter distance. By applying the statistical X2 method to a sample of angular diameter for compact radio sources, the best fit to the cosmological parameters for XCDM models are OM = O, 26,úJ = -1,03 and a = 0,9, where úJ and a are the equation of state and the smoothness parameters, respectively. Such results are compatible with a phantom energy component (úJ < -1). The possible bidimensional spaces associated to the plane (a , OM) were restricted by using data from SNe Ia and gas mass fraction of galaxy clusters. For Supernovas the parameters are restricted to the interval 0,32 < OM < 0,5(20") and 0,32 < a < 1,0(20"), while to the gas mass fraction we find 0,18 < OM < 0,32(20") with alI alIowed values of a. For a joint analysis involving Supernovas and gas mass fraction data we obtained 0,18 < OM < 0,38(20"). In general grounds, the present study suggests that the influence of the cosmological inhomogeneities in the matter distribution need to be considered with more detail in the analyses of the observational tests. Further, the analytical treatment based on the ZKDR distance may give non-negligible corrections to the so-calIed background tests of FRW type cosmologies

Influence of Tungsten Dopant on Sintering and Curie Temperatures of Ba(Zr0.10Ti0.90)O-3 Ceramics

Ba(Zr0.10Ti0.90)O3 (BZT10) and W+ 6 substituted BZT ceramics (BZT10:W) were prepared by mixed oxide method. The effect of W+ 6 addition in the BZT was evaluated by X-ray diffraction (XRD), dilatometer analysis, microstructural and dielectrical properties. When tungsten is introduced in the BZT lattice, a decrease in the grain size and shift on Curie temperature to lower value besides broadening of dielectric permittivity is evident. This is due repulsion between tungsten and their nearest neighbors leading to a structure which is tetragonal distorted. The sintering temperature is reduced when tungsten is introduced in the BZT lattice.

Quantitative microscopy characterization of hydrous niobium phosphate into bleached cellulose

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