O papel da análise custo-efetividade no processo decisório em saúde: o caso do sub-programa de controle da hanseníase

A introdução da Análise Custo-Efetividade na área da Saúde decorre desta preocupação de aperfeiçoamento dos métodos gerenciais em geral, e de escolha de alternativas de ação que levem ao melhor resultado em relação ao custo. Derivada das técnicas econômicas de análise de investimentos em uso no setor empresarial, a ACE pode ser de grande utilidade na montagem de programas e planos de saúde, na escolha entre diversos programas alternativos, e na sua avaliação. Consiste basicamente em confrontar os custos (esperados ou realizados a) de um programa, com seus resultados ou impactos (esperados ou realizados). A aplicação da Análise Custo-Efetividade é ainda recente, e restringe-se aos Estados Unidos e a alguns países europeus. No Brasil, embora comece a ser divulgada, ainda não foi utilizada em programas reais. Seus princípios e sua metodologia são relativamente simples, mas sua utilização em casos concretos esbarra em algumas dificuldades. Assim, a aplicação da análise a um dos programas desenvolvidos na Secretaria da Saúde poderá, além de divulgar a ACE na instituição, estabelecer claramente seu potencial e suas limitações no contexto da saúde pública brasileira. Um dos programas mais problemáticos da Secretaria é o Sub-programa de Controle da Hanseníase. Em vigência há vários anos, seus resultados estão aquém do esperado, em que pesem as características de uma doença endêmica e complexa e as falhas do próprio sub-programa. O interesse em se avaliar um programa cujos resultados são reconhecidamente insatisfatórios, e nosso conhecimento e experiência pessoal na área da hanseníase, justificam a escolha deste Sub-programa para a aplicação da Análise Custo-Efetividade.

Eficiência do controle do Programa Bolsa Família na perspectiva da gestão por resultados

Os programas sociais do governo se inserem em um novo contexto teórico e político, com a mudança do foco assistencialista para uma visão mais científica e com o devido comprometimento político, inclusive realçado no Planejamento Plurianual Avança Brasil 2000/2003, que prevê ações integradas e um orçamento próprio para os programas sociais. Ao mesmo tempo, vive-se no Brasil a mudança de uma administração pública burocrática para uma administração por resultados, que tem como uma das principais dificuldades a implementação da gestão propriamente dita e do controle, considerando-se os aspectos culturais até então vigentes. Nessa conjuntura, avaliar um programa social requer contextualizá-lo na perspectiva da administração por resultados, considerando-o em relação aos próprios princípios e aos daquela. O objetivo deste trabalho é avaliar a eficiência do controle do Programa Bolsa Família, na perspectiva de cumprimento de sua proposta e da gestão por resultados. O estudo de caso foi feito por meio de uma pesquisa documental, e os resultados demonstraram falhas no referido controle.

Como são julgados os juízes? Uma análise do controle disciplinar do Conselho Nacional de Justiça (2005-2013)

Uma das principais modificações introduzidas pela Reforma do Judiciário (Emenda Constitucional 45/2004) foi a criação do Conselho Nacional de Justiça (CNJ). Dentre suas competências constitucionais, a do controle dos deveres funcionais dos magistrados por meio dos Processos Administrativos Sancionadores foi bastante questionada, chegando a ser objeto de controle concentrado de constitucionalidade pelo Supremo Tribunal Federal (STF). A composição do Conselho foi também alvo de reiteradas críticas, pois considerável parte dos conselheiros (6 dos 15, representando 40% do total) é composta por membros não oriundos da magistratura – vindos do Ministério Público, da Advocacia, além dos Juristas indicados pelo Congresso Nacional -, os conselheiros não-juízes. O Poder Judiciário, historicamente hermético e corporativista, passava a ser controlado por um órgão novo, um Conselho de Justiça que não contava apenas com conselheiros juízes entre seus membros. O presente trabalho estudou o CNJ a partir desses dois pontos mais controversos, com enfoque no controle disciplinar exercido pelo órgão sobre a magistratura nacional. Conselhos de Justiça, em especial em sua feição disciplinar, devem lidar com e existente tensão entre controle (ou accountability) e independência judicial. Observamos a atuação do Conselho Nacional de Justiça em vista dessa constante tensão ao longo de sua historia: por meio de uma análise que percorreu um período que vai da instalação do CNJ, em 2005, até o final do ano de 2013. Identificamos, com isso, as estratégias de legitimação institucional utilizadas para o exercício da competência disciplinar, analisamos as normas jurídicas surgidas nesse período, bem como descrevemos qual o perfil dos atores que ocuparam as cadeiras do colegiado enquanto conselheiros. Como resultado dessa observação, importante destacar que o Conselho Nacional de Justiça jogou luz sobre um Poder historicamente fechado, mas que ainda apresenta problemas de transparência. A dificuldade de localizar dados sobre matérias mais sensíveis (processos administrativos sancionadores) e as ausências de envio de informações quando solicitadas foram marcantes na pesquisa. Sobre o comportamento do órgão, mobilizamos a variável do profissionalismo (com especial enfoque na origem de carreira) para interpretar esse processo. Esperávamos um Conselho com duas características: corporativista e pouco harmônico. As análises empíricas quantitativas, que compuseram um retrato de todos os Processos Administrativos Sancionadores julgados até o final de 2013 pelo CNJ, mostraram um cenário inverso: um colegiado não corporativista e coeso. Mesmo em vista dessas características globais, identificamos que existem importantes diferenças no comportamento decisório e, quando elas estão presentes, o elemento da carreira é influente.

Avaliação de impacto do Programa de Modernização Tributária e da Gestão dos Setores Sociais Básicos (PMAT) na arrecadação de ISSQN e IPTU dos municípios, no período de 1999 a 2011

O objetivo deste trabalho é avaliar o impacto do Programa de Modernização da Administração Tributária e da Gestão dos Setores Sociais Básicos (PMAT), gerido pelo Banco Nacional de Desenvolvimento Econômico e Social (BNDES), na arrecadação tributária dos Municípios, no período de 1999 a 2011. Para tanto, utilizamos um modelo econométrico de dados em painel com estimador de efeitos fixos. As variáveis dependentes são os logs da arrecadação de ISSQN e IPTU, as variáveis explicativas são os desembolsos do BNDES e o PIB municipal desagregado. Realizamos regressões com dummies de tratamento e com o log dos desembolsos. Além realizar regressões com toda a amostra disponível, delimitamos a amostra do grupo de controle em dois subgrupos para tentar eliminar efeitos de tendências entre entidades. A primeira delimitação foi utilizar a amostra que realizou consultas ao banco de fomento e não obteve sucesso. A segunda delimitação foi a de municípios que possuem proximidade geográfica daqueles comtemplados pelo financiamento. Os resultados encontrados demonstram não haver significância estatística entre desembolsos realizados pelo BNDES e a trajetória da arrecadação dos tributos em análise na maior parte dos modelos utilizados. Apenas nas regressões com dados da amostra que realizou consulta ao BNDES, obteve-se significância estatística, ao nível de 5% para o tributo IPTU, no efeito acumulado ao longo do tempo.

O Insituto do Amicus Curiae no controle de consitucionalide brasileiro: uma abordagem à luz da efetividade do princípio do acesso à justiça

It presents a study about the control of constitutionality, its requirements and beddings. It brings, at first, notions about the concept of constitution, in its most varied aspects, as well as the systems of Control of Constitutionality. It emphasizes, considering the actual Brazilian situation, which passes through constitutional reforms and, therefore, assenting the appearance of an enormous amount of ordinary laws, the legal instability that has formed itself within the national panoram. Because of this situation, the institute of the Control of Constitutionality gains inmportancy as a way of protection of our Great Letter, against possible violations which can unfortunately happen. More ahead in the difuse control of constitutionality argues the new trend of generalization, especially after the recent reform that introduced the general repercussion as new requirement of admissibilidade of the appeal to the Brazilian Supreme Court. In the final chapter brings an analysis on the institute of amicus curiae, arguing its historical origins and its evolution, in the comparative jurisprudence, and the Brazilian right. From then is gone deep the paper of amicus curiae in the constitutionality control and, after quarrel on the difficulties of the Brazilian population to materialize its right before the judiciary, as this new institute could contribute in basic way for the materialization of the constitutional rule of access to justice

Repercussão geral e súmula vinculante: os efeitos no controle difuso

Brazil since its first republican constitution has adopted systems of laws control. The review activity was given to three state powers or functions state, Executive, Legislative and Judiciary. However, it appears that in the country along the constitutional history, has stood considerably the jurisdictional control of the most important control. Initially, back in 1891, Brazil adopted the jurisdictional control of diffuse from U.S, whose role in monitoring of standards is delivered to all organs of the judiciary, which may face a case, put on trial, ascertain whether or not the possibility of applying a law, removing its impact in case of unconstitutionality. In 1969, entered in the second legal model of judicial review, the concentrated control of constitutionality, whose inspiration comes from the positivist theory of Hans Kelsen, and was adopted by the Austrian Constitution of 1920. According to the abstract control the supervision of law is given to a Court or Constitutional Court, responsible for the analysis of the legal constitutionality independent of its application to a specific case. In Brazil the role of concentrated control was handed over exclusively to the Supreme Court, which serves as the Constitutional Court, which accumulates that function with other constitutionally provided jurisdiction. Throughout this period, from 1891 until today, Brazil has maintained a dual system of judicial control of legal constitutionality, where they coexist and harmonize the diffuse control exercised by any organ of the Judiciary, and concentrated control of competence the Supreme Court. However, one must recognize that with the advent of the Federal Constitution of 1988, the concentrated control has emerged on the national stage due to two important factors: the expansion of the legal capacity to sue and the inclusion of other ways control, besides the already known Direct Claim of Unconstitutionality. This concentrated control and projection of the Supreme Court s attempt to become a true constitutional court, led to a relative weakening of diffuse control even when performed by the Brazilian Constitutional Court. In order to become a true constitutional court, all decisions handed down by the Supreme in the exercise of constitutional jurisdiction should have the same weight and the same measure, or at least bring improvement to similar effects, once is the responsible for the final word when it comes to constitutional interpretation. Thus, the writs of certiorari and stare decisis were responsible for profound changes in the diffuse control, allowing the Supreme Court can strengthen its decisions even in the diffuse control. These two institutions have substantially changed the legal status of diffuse control, allowing an extension of the effects of decisions handed down by the Supreme Court, so that you can no longer be said that the effects of this control to restrict the disputing parties in the process

A implementação do programa Gestão nota 10 no sistema municipal de educação em Mossoró/RN (2005 a 2009)

This research work is focused to show the changes in educational administration from the agreements between the Mossoró / RN and the Ayrton Senna Institute IAS, for education provision. Nowadays, the partnership policy is a constitutive element of the reform of the Brazilian State, which dropped its action on social policies and to strengthen its regulatory role, encouraging private participation in planning, preparation and implementation of public policies, new printing setting the political-social. In this context, the 10 Note Management Programme, developed by the IAS, is part of the neoliberal logic of modernization of public school systems, focusing on results and developing strategies for control and regulation of schools work and its efficiency, effectiveness and greater productivity. The 10 Note focuses on two dimensions: the management of learning and teaching in networking, in a managerial perspective to overcome the culture of failure (expressed as age-grade, dropout and repetition rates in) and implantation of culture of success (as measured in the improvement of the indices). To understanding the process, we have delimited as the object of study, the process of implementing them mentioned program in the city, which its objective is to analyze implications for the school community from the perspective of democratic management, adopting the dimensions of autonomy and participation in institutional processes as a criterion of analysis. From a methodological point of view, the survey was conducted from a literature review and documentary about educational policy developed in the country since the 1990´s, seeking to understand, in a dialectical perspective, the political dimensions of teaching, training and performance of the subjects involved in the school work. Besides the empirical observation, it was also used semi-structured interviews with a methodological tool for gathering information and opinions about the partnership and the implementation of the 10 Note Management Program in the county. The interviewee participants were ex-former education managers, coordinators, school managers, secretaries and teachers. Regarding the dimensions inside the analysis (autonomy and participation), the research led to the conclusion: that GEED, under the guidance of IAS promoted regulation of school autonomy, set up the selection process for exercising the office of school administration and system awards to schools, pupils and teachers, subject to results, there is mismatch between the managerial logic and the democratic management principles, that the ideological discourse of modernization of municipal management coexists with traditional practices, centralizing patronage, which ignores the democratic participation in the school decisions processes, the goals of the partnership were partially achieved, since that the city has improved over the approval and dropouts, although the approval of the Education Municipal Plan of the rules institutional (administrative, financial and educational) and the creation of the Councils observed that the school community participation is still limited, not being characterized as a coordinated intervention, capable of promoting the transformation and improvement its quality in the county. In the same way, the orientation of networking is a limit to the autonomy of schools, given the external definition of goals and strategies to be adopted, along with pressure exerted through the accountability of each school community for their achievements

Desenpenho aeróbio e controle autonômico cardíaco em idosas praticantes de tai chi chuan e sedentárias

Conselho Nacional de Desenvolvimento Científico e Tecnológico

Desempenho dos serviços de atenção primária do município de Natal/RN para o diagnóstico e controle da tuberculose

Tuberculosis (TB) is one of the most important health problems being faced worldwide. In Brazil, the responsibility for the actions of to diagnosis and control of this disease was transferred to the municipalities within the Primary Health Care (PHC), aiming at improvement in epidemiological indicators, requiring reorientation of the practice of family health teams and requiring methodologies to analyze the extent to which components of the PHC are being achieved. Thus, this study aims to analyze the performance of primary care services in the city of Natal-RN for the diagnosis and control of TB, from the perspective of health professionals (doctors and nurses). The study is descriptive, cross-sectional and quantitative. Data collection was conducted from March to July 2011 and involved 121 health professionals working in 52 health units (family health unit, basic health unit and mixed units). The instrument is structured based on the Primary Care Assessment Tool (PCAT), validated and adapted to assess attention to TB in Brazil, and includes questions regarding the Structure and Process components of health services. For quantitative analysis, it was constructed indicators, whose response patterns are followed according to the Likert scale between one and five, which meant the degree of preference relation (or agreement) of the claims. Values between 1 and 3 were considered unsatisfactory for the indicator, between 3 and less than 4, regular, and between 4 and 5, satisfactory. With regard to inputs and equipment, the units had satisfactory condition for form (  = 4.26), consultation (  = 4.02) and basic basket (  = 4.24); regular condition to pot (  = 3.56) and unsatisfactory conditions for transportation tickets (  = 1.50) and sputum smear microscopy (  = 2.42) and X-rays (  = 1.07). In relation to actions, there was satisfactory development for those focused on the individual patient. Actions aimed at the collective level, as the search for respiratory symptoms (RS), monitoring of contacts and guidelines for the community ranged from regular to unsatisfactory (  = 3.16 -  = 1.34). With regard to training, 94,2% received training to identify RS. As regards the time for diagnosis, the median time elapsed between the identification of RS and the beginning of treatment it was 22 days. In relation to the difficulties faced by professionals in the diagnosis of TB, 56,2% reported that they are related only to health services, especially for the failure in the rearguard laboratory and in the specialized services reference, the lack of human and material resources and low performing an active search. The professionals perceive the performance of diagnosis and control of TB, permeated with limitations and barriers to organizational and operational character of various sizes, emerging the need for effective coordination of various sectors and key stakeholders of TB care, to adoption of a new intersectoral strategies that aim to increase the responsiveness of the PHC, providing the best performance in service delivery to the user, family and community, and ensuring effective action and resolving the needs of this population group.

Segurança Alimentar e Controle de Qualidade: um estudo da implantação do Programa Alimentos Seguros em supermercados de bairro

This study aimed to analyze the percentage of compliance, related to the requirements of Practice, achieved by 23 supermarkets in neighborhood after the deployment of Food Insurance Program. For its development research methodology adopted was the application start and end of a check-list (tool-specific SBP) in 23 supermarkets, target of this study. After the deployment of PAS was made a comparative study where it was possible to see that these companies need to improve conditions related to food safety, because according to the study, none of the 23 supermarkets evaluated met the criteria recommended by the SBP to 100% of compliance for the items critical of the check-list. Only 04 of the 23 supermarkets were in the range of 80 to 90% of the overall percentage of compliance, representing only 17.3% of the sample. Most of the sample submitted in a regular situation, according to the methodology of Cardoso (2001). Of the 23 supermarkets studied, 03 supermarkets were classified as poor (13.04%), 13 as scheduled (56.52%) as good and 07 (30.43%). You can see improvements in a small part of the sample, but the decline in the percentage of compliance of 02 companies after working for the implementation of the program, showing lack of responsibility and commitment of companies which should have as its top priority to food safety that market

Controle de estoques de sal: uma inovação da quantificação e no gerenciamento dos recursos naturais da indústria mineral

The strengthening of the domestic industry in Brazil required the modernization, mechanization and expansion of salt production. Thereafter the production of sea salt started to be made in a process of continuous flow, where the product is constantly stored in yards, with daily movements in and out of salt. Thus far, the major bottleneck found in this production process is the control of production, because due to the large amount produced and variety of losses existing in the various stages of production there are not a regulated and safe way to control inventories with accuracy and speed demanded. In a typical case with a salt marsh company of Rio Grande do Norte state, salt produced is stored in two open courtyards and inventory control of salt made by carrying input / output relationship of salt in each storage yard. This work developed a conceptual model of inventory control, based on topography, adopting surveys into one of the courtyards of the company. There were 25 biweekly survey measurements over a year book to generate digital models representing the stock. For each measurement, results were compared with the values of inventory accounting provided by the salt marsh in order to identify existing losses and mark out the sales department on the actual stock available at each measurement date. Inventories calculated by the model indicated losses of 6,349 tonnes for the period of one year book and 3,279 tonnes for the period between harvests, when compared to the accounting control

Controle vetorial de velocidade de uma máquina de indução sem mancais trifásica com bobinado dividido utilizando estimação neural de fluxo

This work describes the study and the implementation of the vector speed control for a three-phase Bearingless induction machine with divided winding of 4 poles and 1,1 kW using the neural rotor flux estimation. The vector speed control operates together with the radial positioning controllers and with the winding currents controllers of the stator phases. For the radial positioning, the forces controlled by the internal machine magnetic fields are used. For the radial forces optimization , a special rotor winding with independent circuits which allows a low rotational torque influence was used. The neural flux estimation applied to the vector speed controls has the objective of compensating the parameter dependences of the conventional estimators in relation to the parameter machine s variations due to the temperature increases or due to the rotor magnetic saturation. The implemented control system allows a direct comparison between the respective responses of the speed and radial positioning controllers to the machine oriented by the neural rotor flux estimator in relation to the conventional flux estimator. All the system control is executed by a program developed in the ANSI C language. The DSP resources used by the system are: the Analog/Digital channels converters, the PWM outputs and the parallel and RS-232 serial interfaces, which are responsible, respectively, by the DSP programming and the data capture through the supervisory system

Controle preditivo bilinear aplicado a um motor de indução

The present work is based on the applied bilinear predictive control applied to an induction motor. As in particular case of the technique based on predictive control in nonlinem systems, these have desperted great interest, a time that present the advantage of being simpler than the non linear in general and most representative one than the linear one. One of the methods, adopted here, uses the linear model "quasi linear for step of time" based in Generalized Predictive Control. The modeling of the induction motor is made by the Vectorial control with orientation given for the indirect rotor. The system is formed by an induction motor of 3 cv with rotor in squirregate, set in motion for a group of benches of tests developed for this work, presented resulted for a variation of +5% in the value of set-point and for a variation of +10% and -10% in the value of the applied nominal load to the motor. The results prove a good efficiency of the predictive bilinear controllers, then compared with the linear cases

Controlador preditivo generalizado multi-modelo aplicado ao controle de pressão arterial

Postsurgical complication of hypertension may occur in cardiac patients. To decrease the chances of complication it is necessary to reduce elevated blood pressure as soon as possible. Continuous infusion of vasodilator drugs, such as sodium nitroprusside (Nipride), would quickly lower the blood pressure in most patients. However, each patient has a different sensitivity to infusion of Nipride. The parameters and the time delays of the system are initially unknown. Moreover, the parameters of the transfer function associated with a particular patient are time varying. the objective of the study is to develop a procedure for blood pressure control i the presence of uncertainty of parameters and considerable time delays. So, a methodology was developed multi-model, and for each such model a Preditive Controller can be a priori designed. An adaptive mechanism is then needed for deciding which controller should be dominant for a given plant

Estratégia de controle robusto para filtro ativo paralelo sem detecção de harmônicos de correntes

Conventional control strategies used in shunt active power filters (SAPF) employs real-time instantaneous harmonic detection schemes which is usually implements with digital filters. This increase the number of current sensors on the filter structure which results in high costs. Furthermore, these detection schemes introduce time delays which can deteriorate the harmonic compensation performance. Differently from the conventional control schemes, this paper proposes a non-standard control strategy which indirectly regulates the phase currents of the power mains. The reference currents of system are generated by the dc-link voltage controller and is based on the active power balance of SAPF system. The reference currents are aligned to the phase angle of the power mains voltage vector which is obtained by using a dq phase locked loop (PLL) system. The current control strategy is implemented by an adaptive pole placement control strategy integrated to a variable structure control scheme (VS¡APPC). In the VS¡APPC, the internal model principle (IMP) of reference currents is used for achieving the zero steady state tracking error of the power system currents. This forces the phase current of the system mains to be sinusoidal with low harmonics content. Moreover, the current controllers are implemented on the stationary reference frame to avoid transformations to the mains voltage vector reference coordinates. This proposed current control strategy enhance the performance of SAPF with fast transient response and robustness to parametric uncertainties. Experimental results are showing for determining the effectiveness of SAPF proposed control system