Determinantes de uso de serviços de saúde: análise multinível da região metropolitana de São Paulo

OBJETIVO: Analisar os determinantes individuais e contextuais do uso de serviços de saúde na Região Metropolitana de São Paulo. MÉTODOS: Foram utilizados os dados do estudo São Paulo Megacity, a versão brasileira da pesquisa multicêntrica World Mental Health Survey. Foram analisados 3.588 indivíduos adultos residentes em 69 áreas da Região Metropolitana de São Paulo, SP (38 municípios adjacentes e 31 subprefeituras do município de São Paulo), selecionados por meio de amostragem multiestratificada da população não institucionalizada. Foram ajustados modelos multinível logísticos Bayesianos para identificar os determinantes individuais e contextuais do uso de serviços de saúde nos últimos 12 meses e a presença de médico de referência para cuidados de rotina. RESULTADOS: As características contextuais do local de residência (desigualdade de renda, violência e renda mediana) não apresentaram associação significativa (p > 0,05) com o uso de serviços ou com a presença de médico de referência para cuidados de rotina. A única exceção foi a associação negativa entre residir em uma área com alta desigualdade de renda e a presença de médico de referência (OR 0,77; IC95% 0,60;0,99) após controle das características individuais. O estudo apontou uma forte e consistente associação entre algumas características individuais (principalmente escolaridade e presença de plano de saúde) com o uso de serviços de saúde e ter médico de referência. A presença de doenças crônicas e mentais associou-se fortemente com o uso de serviços no último ano (independentemente de características individuais), mas não com a presença de médico de referência. CONCLUSÕES: Características individuais como maior escolaridade e ter plano de saúde foram determinantes importantes do uso de serviços de saúde na Região Metropolitana de São Paulo. A melhor compreensão desses determinantes é necessária para o desenvolvimento de políticas públicas que permitam o uso equitativo dos serviços de saúde.

Os estilos de liderança nas organizações não governamentais da região metropolitana de Belém

This study aimed to analyze the leadership style adopted by managers of nongovernmental organizations in the metropolitan region of Belem on the theory of Hersey and Blanchard. This theory is called situational leadership ranks E1, E2, E3, E4 and the styles of leadership and maturity in parallel classes M1, M2, M3 and M4. This study examined the relationship of leadership styles with the maturity of work, identified the relationship of leadership styles as related to psychological maturity and job maturity and psychological maturity. The main objectives were to analyze and relate leadership styles with the maturity of the leaders and understand the phenomenon of leadership from the self-perception of those who lead the organizations studied. To achieve the objectives we used a questionnaire already validated the theory of situational leadership and applied in 320 non-governmental organizations in the metropolitan region of Belem The methodology was quantitative, descriptive and exploratory. The analysis was by descriptive statistics and inferential statistics for univariate and bivariate form, applying the chi-square, the V Crammer and Spearman correlation. The data analysis shows safety, attested to the frequencies, and average margin of error and after application of the tests it was found that a relationship between the leadership style of work with the maturity and psychological maturity. The managers of nongovernmental organizations practicing various styles of leadership and focus on the quadrant of high maturity. It was diagnosed when the manager uses only one style of leadership was the predominance of E3 "share or support", which represents 24% of the sample. As uses two styles of leadership is the predominance of E3 and E2, which represents 76%. So the managers of nongovernmental organizations in the metropolitan region of Belem, practicing a style of leadership support, sharing ideas for decision making using a democratic style

Comportamento do consumidor: um estudo do mercado imobiliário em condomínios verticais fechados na região metropolitana de Natal

The research in question looked for to establish the relation between the motivation (of the proprietor of apartment) to change itself of another one apartment, in closed vertical condominium (residential mobility) in the period of the recognition of the necessity, and the satisfaction with the apartment after consume. The universe or the population chosen for the development of the study was of proprietors of apartment in vertical condominiums located in the region metropolitan of Natal. The analysis of data was made using the techniques of linear regression and logistic regression between variables. The linear regression found relations between the motivations for housing change and the satisfaction in after consume with some attributes of the apartment. The logistic regression showed that relations between the motivations for change and the general satisfaction to the apartment exist as a whole, in the period after consumes. With regard to the motivation to change itself of a apartment for another one, some reasons shown more motivation them the others. The research found different degrees of satisfaction with certain characteristics of the apartment and degrees of no satisfaction with others. Finally the results of the research had contributed for the reply of the problem that guided the present study, therefore had obtained in such a way to find how much logistic not linear relations between the two periods purchase (recognition of the necessity and evaluation after consume) and had elucidated the process that goes since the choice the product until the satisfaction of the necessities

O Litoral e a metrópole dinâmica imobiliária, turismo e expansão urbana na região metropolitana de Natal-RN

The metropolitan regions of Northeast Brazil are being gradually included in a scenario of international investments, which are motivated by the restructuring of both touristic and real-estate sectors. The new capital, real-estate developers and space configurations that result from this process indicate the need for the creation and implementation of public tools which should, at least, allow the mitigation of the urban impacts and environmental losses resulting from this situation. The effects on landscape and on the socio-spatial configuration result from the intensification caused by the dynamism of the "real estate-tourism" sector. There is a regional integration as an expression of the urban expansion of the metropolitan area of Natal. This study investigates the uniqueness of the restructuring and territorial integration of coastal areas and the strategies of the circuit of capital accumulation formed by linking the real estate to tourism. It is intended to increase the understanding about the strategies of tourism, real estate and public policy agents involved in this territorial reconfiguration and in the fund-raising needed for the investments, to understand the existing social and environmental effects and their future trends and also to understand the forms of spatial production as results from the practices of approaching the land transformation and the tourism valorization of the landscape, in a synchronous manner, first in the Northeast region and, as a focal study, in the Metropolitan Area of Natal. Likewise, it is intended to apprehend the current processes of metropolization of the eastern coast of Rio Grande do Norte, in addition to indicate its physical-territorial transformation and the types of projects/developments promoted by the market in the recent period. Based upon analysis undertaken for the Metropolitan Region of Natal RN, this piece of work presents some considerations on possible legal instruments that can be adjusted to the municipalities which are experiencing the impact of this peculiar and recent phenomenon in the region, caused by the arrival of the real estate-touristic capital. It is also intended to point out basic proposals to the forms of public intervention, in a speculative way, starting from a Metropolitan Planning project within a medium and long term

Entre serras e sertões A(s) (trans)formaç(ões) de centralidade(s) da Região Metropolitana do Cariri/CE

This study reviews the spatial configuration from the road network of an urban compound formed by the cities of Crato, Juazeiro do Norte and Barbalha (the Crajubar - core of the Cariri metropolitan region, in the State of Ceará, Brazil), in order to establish nexus (or relations) between different levels of accessibility and the formation/ transformation and specialization of centralities in local and metropolitan scales. Stemming from the Social Logic of Space theoretical and operational apparatus, the study explores modeling possibilities (with axial lines, segments and lines of continuity) which is then confronted to empirical observations concerning movement flows and land use, within a Geographic Information System database. At different scales of analysis, the results suggest evidences of continuity were found in the permanence of intra-urban centres and sub-centres within each town, whereas evidences of change pointed out to the formation of a new centrality of metropolitan magnitude in the neighbourhood referred to as the Triângulo, in the municipality of Juazeiro, where high levels of topological accessibility coincides with the appearance of new business buildings as well as with the emergence of urban equipment of a scale more adequate to meet a regional demand

Avaliação da ecotoxicidade de percolados em áreas de disposição de resíduos na região metropolitana de Natal/RN

Leachates are effluent produced by decomposition of solid waste, they have complex composition and can be highly toxic. Therefore such percolated liquid should be collected and treated properly to avoid environmental contamination of soil and of water bodies. The objective of this study was to evaluate the toxicity through ecotoxicological tests with Ceriodaphnia dubia (Cladocera - Crustacea) of percolated liquids generated in two different systems of municipal solid waste (MSW) disposal in the city of Natal/ RN: A Sanitary Landfill in the Metropolitan Region of Natal/ RN, and in a dump off area. Furthermore, it was evaluated the possible contamination of the underground water of the dump off area. Two monthly samples were taken at four points between the months of May/2009 and January/2010. The Point "A" corresponds to the end of the pond leachate treatment in ASRMN; The Point "B" corresponds to a containment pond at the dump. The Point "C" is an area near one of the cells of the dump off area where the leachate outcrops; The Point "D" stands for an underground water well at the area. The last point, called "E" was sampled only once and corresponds to the slurry produced by temporary accumulation of solid waste in the open area of the dump. The ecotoxicological tests, acute and chronic, followed the ABNT 13373/2005 rules, with some modifications. The samples were characterized by measuring the pH number, the dissolved oxygen (DO), the salinity, BOD5, COD, Cd, Cu, Pb, Cr, Fe, Mg, Ni, and Zn. At Point A, the average number of EC50-48h ranged between 1.0% and 2.77% (v/v), showing a high toxicity of the leachate to C.dubia in all months. To this point, positive correlations were found between the EC50- 48 with precipitation. Negative correlations were found between the EC50- 48h with salinity. At point B there was no response of the acute exposure of organisms to the test samples. At point C the EC50-48h ranged from 17.68% to 35.36% in just two months of the five ones analyzed, not correlated meaning. Point D, the EC50-48h level ranged between 12.31% and 71.27%, showed a negative correlation with, only, precipitation. Although it was observed toxicity of underground water in the Landfill Area, there was no evidence of water contamination by leachate, however, due to the toxic character of this water, additional tests should be conducted to confirm the quality of water that is used for human supply. At point E there was no acute toxicity. These results support the dangers of inappropriate disposal of MSW to water bodies due to the high toxicity of the leachate produced highlighting the necessity of places of safe confinement and a treatment system more effective to it

Flebotomíneos (Diptera: Psychodidae) em um sistema agroflorestal da Região Metropolitana de Natal, Rio Grande do Norte, Brasil

Sandflies stand out as important vectors of leishmaniasis. The females need to ingest blood meals, enabling them to transmit protozoa of the genus Leishmania, which may give rise to visceral leishmaniasis (VL) or American tegumentary leishmaniasis (ATL), in addition to transmitting other parasites. Leishmaniasis are important infirmities, distributed worldwide, whose infection results from the interaction of reservoir animals, the vector insect, parasitic protozoa and the healthy host. In the state of Rio Grande do Norte (RN), Brazil, these insects are important transmitters of VL, which usually presents in the most serious form. It occurs mainly in metropolitan areas, with the dog as its main reservoir and Lutzomyia longipalpis as the vector. ATL is most present in the highland areas of the state. In addition to hematophagia, engaged in by the females, both sexes need to ingest carbohydrates, which are essential to the sand flies energy requirements and may interfere in the development of Leishmania. The aim of this study was to determine the occurrence and abundance of sand flies in different environments on the farm belonging to the Empresa de Pesquisas Agropecuárias do RN (Institute of Agricultural Research of RN), in the municipality of Parnamirim, in order to relate this occurrence with climatological and biological references and eating habits. Three consecutive monthly collections were carried out with CDC traps in a fragment of the Atlantic Forest, in a residence, on a goat breeding farm and on cashew, dwarf and giant coconut, mango, banana, eucalyptus, acacia and bean plantations. A total of 1241 sandflies from eight species (Lutzomyia evandroi, Lutzomyia longipalpis, Lutzomyia shannoni, Lutzomyia sordellii Lutzomyia walkeri, Lutzomyia wellcomei, Lutzomyia whitmani, and Lutzomyia intermedia) were collected, most in the forest environment. L. longipalpis, the main VL transmitter, was confirmed as a species adapted to anthropic environments, whereas others such as L. wellcomei, the vector of ATL, occurred predominantly in forests. Carbohydrate characterization of the sand flies and plants of the region demonstrated that a number of exotic plants such as hay and eucalyptus may play some role in the adaptation of these species to modified environments. Breeding in laboratory showed a mean biological cycle of 53.5 days from egg to adulthood for L. shannoni and the possibility of diapause behavior in L. wellcomei. This study serves as a source of information that may contribute to the epidemiological vigilance of tegumentary and visceral leishmaniasis in the state, given that it analyzes the bioecology of transmitting species, as well as their potential to adapt to new environments