bluuebunny/crossref_metadata_2025 huggingface dataset:
Copolymer of chitosan with acrylamide: electron beam stimulated synthesis, structure and properties
Authors: Antonov Ilia M. , Mikhailenko Mikhail A. , Shakhtshneider Tatyana P. , Eltsov Ilia V. , Kuznetsova Svetlana A. , Zelikman Maxim V. , Bryazgin Alexander A.
Published: September 2023

The aim of this research was to obtain the grafted copolymer of chitosan with acrylamide using the electron beam irradiation. Radiation dose was varied from 6 to 160 kGy. The highest yield of the product was observed at radiation dose of 12–40 kGy. Further increase in the dose caused a decrease in the product yield as well as its solubility in water. Using gel permeation chromatography, it was confirmed that unreacted chitosan remained in the product. NMR study of the water-soluble part of the product obtained under the doses of 6, 12, and 20 kGy showed that the length of the side chains of grafted acrylamide was about 2 elementary units. Investigation of chitosan solutions by means of dynamic light scattering revealed the presence of chitosan agglomerates in the solution. The possibility of obtaining dense films was demonstrated. Mechanical treatment of the copolymer in the ball mill caused an increase in the solubility of the samples obtained even at radiation doses of 80 and 160 kGy. It was determined by means of chromatographic methods that there were no products with low molecular weight in the ball-milled product, and unreacted chitosan did not undergo mechanocracking during the mechanical treatment.
The Impact of Tax Structure on Economic Growth: New Empirical Evidence from Central and Eastern Europe
Authors:   South-West University “Neofit Rilski”, Blagoevgrad, Bulgaria, Stoilova Desislava G.
Published: September 2023

This study aims to provide new evidence of the impact of total tax revenue and tax structure on economic growth in a sample of eleven European Union (EU) member states located in Central and Eastern Europe (CEE), namely Bulgaria, Croatia, Czech Republic, Estonia, Hungary, Latvia, Lithuania, Poland, Romania, Slovakia, and Slovenia. The methods used are description, comparison, synthesis, regression and correlation analysis of annual panel data for the period 2000-2021. The ordinary least squares (OLS) method is used to estimate the parameters of the regression models. The causal relationship between the variables is confirmed by the Granger causality test. The main results indicate that there is a significant negative effect of total government spending on economic growth rate, while the total tax revenue has a positive impact. These findings suggest low efficiency of public spending. The structure of tax systems does not seem to hinder economic growth, as both direct and indirect tax revenues show a positive growth-supporting effect. Only social security contributions are estimated to have a detrimental impact on economic growth. Value added tax and both income taxes (personal and corporate) are found to be growth-conductive, while property taxes and excise duties seem to have no significant impact on the growth rate. Based on the research findings it is obvious that government expenditure is not an effective tool for positive fiscal impact on the economy, so policymakers can support economic growth by decreasing the share of public spending in GDP or by increasing its efficiency. It is recommended to maintain the current ratio between direct and indirect tax revenue, while carefully considering changes to social security systems to promote sustainable and inclusive growth.
Determinants of Ethical Decision-Making: A Study on the Role of the Professionalism of Members of the Indonesian Association of Tax Consultants
Authors:   Universitas Riau, Riau, Indonesia, Ratnawati Vince , Anggraini Riska ,   Universitas Riau, Riau, Indonesia, Fitrios Ruhul ,   Universitas Riau, Riau, Indonesia
Published: September 2023

This study aims to examine and analyze the direct influence among Machiavellian Traits, Perceptions of Ethics and Social Responsibility, and Risk Preference on Tax Consultant Ethical Decision Making. The novelty of this research is to use of the professionalism of tax consultants as members of the profession as a moderating variable. It is expected that the professionalism of the tax consultant can limit the occurrence of unethical decision making by tax consultant. The respondents were all tax consultants registered with the Indonesian Tax Consultants Association for the Pekanbaru region. Data analysis techniques in this study using Structural Equation Modeling– Partial Least Square (SEM-PLS) Smart-PLS Software version 4.0. This study found that Machiavellian traits, ethical perceptions and social responsibility, and risk preferences have an influence on the ethical decision-making of tax consultants. This study also found that professionalism moderates the effect of Machiavellian Traits, Perceptions of Ethics and Social Responsibility, and Risk Preference on Ethical Decision Making. This study offers theoretical and practical implications for strengthening attitudes that always prioritize ethics in every decision-making. Ethical decision making can be done by reducing Machiavellian traits, considering ethics and social responsibility, and always considering the risks that will be faced because of the decisions to be taken. The value of the study provides an academic contribution regarding the effect of Machiavellian traits, ethical perception, and social responsibility, and also risk preference, and the moderating role of professionalism in reducing unethical decision making.
The Impact of Perceptions of Corruption and Trust in Government on Indonesian Micro, Small and Medium Enterprises Compliance with Tax Laws
Authors:   Universitas Muhammadiyah Yogyakarta, Bantul, Indonesia, Tahar Afrizal , Yunianto Andan ,   Universitas Muhammadiyah Yogyakarta, Bantul, Indonesia, Sofyani Hafiez ,   Universitas Muhammadiyah Yogyakarta, Bantul, Indonesia, Simorangkir Panubut ,   Perbanas Institute, Jakarta, Indonesia, Remalya Velisa Devina ,   Universitas Muhammadiyah Yogyakarta, Bantul, Indonesia, Az-Zahro Siti Fatimah ,   Universitas Muhammadiyah Yogyakarta, Bantul, Indonesia
Published: September 2023

Indonesia is a country with a relatively large level of MSMEs development. The Micro, Small, and Medium Enterprises (MSMEs) sector itself has a crucial role and is the main pillar of a country’s progress. Ironically, this rapid development is not followed by the compliance of MSMEs taxpayer. Based on the survey results by the Directorate General of Taxes of the Indonesian Ministry of Finance in 2019, the contribution of MSMEs final income tax was only IDR 7.5 trillion or only around 1.1% of the total income tax revenue in the same year 711.2 trillion. Thus, it is important to explore the main factors causing (non)compliance of MSMEs in paying their taxes. This research examined the effect of perceptions of corruption and trust in the government on MSMEs’ taxpayer compliance with perceived justice as a moderating variable. This study used a questionnaire survey design with hypothesis testing. The samples included MSMEs actors who had been operating for more than one year and MSMEs actors who already had a taxpayer identification number. The results uncovered that the perceptions of corruption negatively affected MSMEs’ taxpayer compliance, while trust in the government positively affected MSMEs’ taxpayer compliance. The perceived justice could not moderate the effect of perceptions of corruption on MSMEs’ taxpayer compliance. However, the perceived justice strengthened the influence of trust in the government on MSMEs’ taxpayer compliance. This study’s results are additional discussion toward theory and literature related to taxpayer compliance. Specifically, this study proposes a tax compliance model by testing perceived justice as a moderation variable.
Vaccination coverage in children under one year of age and associated socioeconomic factors: maps of spatial heterogeneity
Authors: Pereira Matheus Adriano Divino , Arroyo Luis Henrique , Gallardo Maria Del Pilar Serrano , Arcêncio Ricardo Alexandre , Gusmão Josianne Dias , Amaral Gabriela Gonçalves , Oliveira Valéria Conceição de , Guimarães Eliete Albano de Azevedo
Published: September 2023

ABSTRACT Objective: to analyze vaccination coverage spatial distribution in children under one year old and the socioeconomic factors associated with meeting the recommended goals in Minas Gerais. Methods: an ecological study, carried out in 853 municipalities in the state. Pentavalent, poliomyelitis, meningococcal conjugate, yellow fever, rotavirus, and 10-valent pneumococcal conjugate vaccination coverage were analyzed. Scan statistics and multiple logistic regression were performed to identify spatial clusters and factors associated with meeting coverage goals. Results: spatial analysis revealed clusters with risk of low coverage for all vaccines. Number of families with per capita income of up to 1/2 wage, Minas Gerais Social Responsibility Index and percentage of the poor or extremely poor population were associated with meeting the established goals. Conclusions: the results are useful for designing interventions regarding the structuring of vaccination services and the implementation of actions to increase vaccination coverage in clusters with less propensity to vaccinate.
Transferências intergovernamentais são capturadas pelos servidores municipais? Os determinantes da diferença salarial entre o setor público e o setor privado
Authors: Sousa Kleber Morais de , Monte Paulo Aguiar do
Published: September 2023

Resumo Esta pesquisa tem por objetivo investigar o efeito das transferências intergovernamentais na diferença salarial entre os servidores municipais e os funcionários do setor privado. A amostra foi formada por 5.449 municípios durante o período de 2000 a 2016, agrupados em 5.344 áreas mínimas comparáveis. Os procedimentos metodológicos quantitativos foram desenvolvidos em duas etapas. Na primeira, mediu-se a diferença salarial mediana entre os servidores municipais e os funcionários do setor privado por meio da regressão quantílica incondicional. Na segunda, a análise dos determinantes da diferença salarial foi realizada por meio de regressão múltipla com dados em painel, efeitos fixos e estimações adicionais com erros robustos a cluster, correlação temporal e correlação espacial. Os resultados indicaram que o aumento de 1% das transferências intergovernamentais per capita resulta em aumento de 0,067% na diferença salarial nos municípios brasileiros entre os servidores municipais e os funcionários do setor privado. Além disso, a elevação de 1% no Produto Interno Bruto (PIB) per capita resulta numa redução de 0,036% da diferença salarial. Por último, a pesquisa observou que o tamanho populacional aumenta enquanto a competição eleitoral reduz a diferença salarial nos municípios brasileiros.
Um processo de design para definir desafios públicos envolvendo os ODS
Authors: Medeiros Hugo , Santos George Augusto Valença , Guedes Bruno Nunes , Santiago Katarina , Brito Kellyton
Published: September 2023

Resumo Como podemos definir os desafios locais de inovação que são centrados no usuário, mas também abordam objetivos estratégicos, como os Objetivos de Desenvolvimento Sustentável (ODS)? Propomos um processo de design que apresenta uma contribuição relevante para as práticas no campo das políticas de inovação orientadas para a missão (em inglês, Mission-oriented Innovation Policies - MIPs), uma vez que vai dos grandes desafios societais (em inglês, Grand Societal Challenges - GSCs) aos desafios locais de inovação, que são mais relevantes para as necessidades locais e capacidades de solução. O principal objetivo do processo de desenho é passar de um GSC, como o “acesso à saúde” e uma de suas missões, como “reduzir as Doenças Crônicas Não Transmissíveis (DCNT)”, para um desafio de inovação mais capaz de resolver, passando pela sua missão, diferentes problemas e aspectos. Os métodos de amostragem bola de neve nos permitem encontrar e mobilizar assuntos elegíveis e técnicas de design thinking para processar o mapeamento de problemas, eleição e agrupamento; e criar declarações de desafio. Foi possível traduzir o GSC para a realidade local, reduzindo a contestação e a complexidade, e produzindo um mapa agrupado de problemas com priorização e três declarações de problemas (desafios) com formulação aberta e critérios de solução para promover os resultados desejados pelos usuários.
A design process to define public challenges addressing SDGs
Authors: Medeiros Hugo , Santos George Augusto Valença , Guedes Bruno Nunes , Santiago Katarina , Brito Kellyton
Published: September 2023

Abstract How might we define local innovation challenges that are user-centered but also address strategic goals, such as the Sustainable Development Goals (SDGs)? We propose a design process that introduces a relevant contribution to the practices of the Mission-oriented Innovation Policies (MIPs) field as it goes from Grand Societal Challenges (GSCs) to local innovation challenges, which are more relevant to local needs and capabilities of solution. The main goal of the design process is to go from a GSC, such as “access to health” and one of its missions, like “reducing chronic Non-Communicable Diseases (NCD),” to a more able-to-solve innovation challenge, passing by its mission, and different problems and aspects. Snowball sampling methods allow us to find and mobilize electable subjects and design thinking techniques to process problem mapping, election, and clustering, as well as create challenge statements. It was possible to translate GSC to the local reality while reducing contestation and complexity and producing a problem-grouped map with prioritization and three problem statements (challenges) with open phrasing and solution criteria to foster the users’ desired outcomes.
Association between total available nutritional quality and food expenditure in Peruvian households, 2019-2020
Authors: Bonilla-Aguilar Karen , Bernabe-Ortiz Antonio
Published: September 2023

Abstract: Evidence points to a direct relationship between nutritional quality and food expenditure. However, food expenditure is highly susceptible to changes, and nutritional quality of household food presents limited evidence. The aim of this study was to assess the relationship between nutritional quality available and total food expenditure in Peruvian households, and whether there were differences by area (urban and rural) and between years of the COVID-19 pandemic. For this, we used Peru’s National Household Survey (ENAHO) from 2019 and 2020. We assessed total food expenditure in US dollars per day, whereas household nutritional quality available was assessed based on dietary diversity and compliance with the household calorie requirements, percentage of food expenditure, and potential confounders. We used the Student’s t-test, analysis of variance (ANOVA), linear regression, and the Wald test to assess the interaction effect. Households with adequate total/partial nutritional quality available by area were found to spend, on average, USD 2.00 more in urban than in rural areas and, by year, they presented 7.1% more percentage of food expenditure in 2020 than in 2019. Despite associations existing between nutritional quality available and total food expenditure by year and study area, the effect modification was only present by study area. In multivariable model, households with adequate total/partial nutritional quality available consistently presented a lower total food expenditure by year, with a lower total food expenditure in urban areas. An inverse relationship was found between nutritional quality available and total food expenditure, in contrast to the direct relationship of studies assessing dietary cost and nutritional quality. Our results reflect the nutritional deficit in the food purchases of Peruvian households.
Physical and social neighborhood disorder in Latin American cities: a scoping review
Authors: Magalhães Amanda Silva , Andrade Amanda Cristina de Souza , Moreira Bruno de Souza , Lopes Adalberto Aparecido dos Santos , Caiaffa Waleska Teixeira
Published: September 2023

Abstract: Neighborhood disorder is an important aspect that may influence the health of residents in urban areas. The aims of this study were to map and systematize methods for measuring physical and social neighborhood disorder in studies conducted in Latin American cities. By means of a scoping review, articles published from 2000 in English, Spanish, and Portuguese with the following descriptors were mapped: neighborhood, physical disorder, and social disorder. Searches were conducted in MEDLINE (PubMed), LILACS (Virtual Health Library), Scopus, Web of Science, and Cochrane Library. Information on authorship, year, study type, locality, data source, target population, outcome, dominion, indicator, method, geographic unit, and unit of analysis was extracted. Variables from the disorder-related studies were extracted and grouped by similarity of content and themes. A total of 22 articles were identified, all published between 2012 and 2022, the majority in Brazil (n = 16). The perception of the individual was the most used method. The most frequent theme addressed in the physical disorder dominion was public streets (n = 20) and security (n = 15), in the social disorder dominion. A lack of consensus in the literature regarding variables used to measure physical and social neighborhood disorder in Latin American cities was detected. In addition to the need for standardization of the theme, studies to verify the sustainability of proposed measurement methods relevant to dynamically classify and compare urban neighborhoods and health impacts based on levels of exposure to physical and social disorder, are recommended.
Detection of intimate partner aggression through dark personality and moral disengagement
Authors: Ferreiros Laura , Clemente Miguel
Published: September 2023

Abstract: Health professionals are often the first to detect abuse. Intimate partner aggression can be approached by studying the personality of the aggressor. From this perspective, dark personality and the use of moral disengagement mechanisms are two key variables. In this study, information was collected from 348 individuals, mostly women, and a questionnaire was applied to determine what their sexual behavior was like with their partner. The Short Dark Tetrad (SD4) test was used to identify dark personality and the Propensity to Moral Disengagement to identify moral disengagement. Data were collected via Google forms and multivariate decision tree analysis (CHAID growth method) was performed. Results show that men score higher on the variables of dark personality variables and use of moral disengagement mechanisms than on the three variables that, along with sex, increase the presence of dark personality and moral disengagement mechanisms: infidelity, pornography consumption, and maintaining homosexual relationships. Infidelity and pornography consumption are characteristics present in all dimensions of dark personality. Moreover, these three variables are defining characteristics of relationships with high sadism scores. Nursing staff are possibly able to detect the presence of these variables in aggressors and thus initiate a process of victim protection. Therefore, this study proposes that nursing staff should be trained to perform this detection.
Environmental neurodevelopment toxicity from the perspective of Bronfenbrenner’s bioecological model: a case study of toxic metals
Authors: Bah Homègnon Antonin Ferréol , Santos Nathália Ribeiro dos , Costa Daisy Oliveira , Carvalho Chrissie Ferreira de , Martinez Victor Otero , Gomes-Júnior Erival Amorim , Antônio Menezes-Filho José
Published: September 2023

A growing body of literature reports the need for an integrated approach to study the effects of the physical environment on the neurodevelopment of children. Assessment of the true neurotoxicity of pollutants cannot be performed separately from the ecological and multidimensional contexts in which they act. In this study, from the perspective of the Bronfenbrenner’s bioecological model, a conceptual model was developed that encompasses the social and biological characteristics of children from the gestational period to childhood, considering exposure to toxic metals. First, we present the toxicity of the main metals and some concept notions that we used in our framework, such as social and structural determinants of health, allostatic load, embodiment, and epigenetic concepts. Then, the main aspects of the Bronfenbrenner’s bioecological model, which allow integration of the gene-social relationship in addition to the physical environment, where these metals act, are explained. Finally, we present and discuss the conceptual framework showing how, in real life, biological and social factors may together influence the neurodevelopment of children. Although this model is based on a group of contaminants, it opens new horizons on how environmental sciences, such as neurotoxicology and environmental epidemiology, can articulate with the theoretical models from human sciences to provide a broader approach to study the effects on human neurodevelopment.
Padrões de desempenho da atenção primária à saúde diante da COVID-19 no Brasil: características e contrastes
Authors: Schenkman Simone , Bousquat Aylene Emilia Moraes , Facchini Luiz Augusto , Gil Célia Regina Rodrigues , Giovanella Lígia
Published: September 2023

O enfrentamento adequado de pandemias requer forte articulação entre atenção primária à saúde (APS) e vigilância em saúde, atenção garantida às demandas agudas e crônicas e vinculação com a dimensão comunitária no âmbito das unidades básicas de saúde (UBS). O objetivo deste artigo é contrastar dois padrões extremos de desempenho da APS no enfrentamento da COVID-19 no Brasil, cotejando-os com os perfis dos respectivos municípios e características da organização dos serviços. A partir dos resultados de inquérito nacional transversal com amostra representativa das UBS, foi criado um índice sintético de desempenho da APS em relação à COVID-19, denominado CPI, composto pelos eixos de vigilância e apoio social (dimensão coletiva) e de atendimento ao paciente com COVID-19 e continuidade do cuidado (dimensão individual). Das 907 UBS pesquisadas, foram selecionadas 120, sendo a metade com os maiores índices encontrados (padrão completo) e a outra com os menores (padrão restrito). Os municípios das UBS com padrão completo são preponderantemente rurais, com baixo Índice de Desenvolvimento Humano Municipal (IDHM), alta cobertura da Estratégia Saúde da Família (ESF) e destacam-se na dimensão coletiva, enquanto as UBS nesse mesmo padrão situadas em municípios urbanos apresentam alto IDHM, baixa cobertura de ESF, com ênfase na dimensão individual. No padrão restrito, destaca-se a reduzida atuação de agentes comunitários de saúde no território. Na Região Nordeste, predominam UBS com padrão completo, enquanto na Sudeste preponderam UBS com padrão restrito. O estudo apresenta questões que remetem ao papel e à organização da APS na rede de cuidados em situações que requerem pronta resposta aos agravos de saúde e indica maior capacidade potencial da ESF em tais situações.
Condições de saúde autorrelatadas por solicitantes de refúgio no Rio de Janeiro, Brasil, de 2010 a 2017
Authors: Proença Raquel , Cavalcante João Roberto , Trajman Anete , Faerstein Eduardo
Published: September 2023

No Brasil, entre 2011 e 2022, 348.067 pessoas solicitaram o reconhecimento da condição de refugiado no país. Os motivos que resultaram na migração, os riscos durante o trajeto e a transição cultural ao chegar podem estar associados a diferentes problemas de saúde. O objetivo deste estudo foi analisar as condições de saúde autorrelatadas por solicitantes de refúgio no Município do Rio de Janeiro no período de 2010 a 2017. Trata-se de um estudo transversal de dados secundários. Foram coletadas informações preenchidas nos formulários de solicitação de refúgio do Comitê Nacional para os Refugiados (Conare) de 2010 a 2017 e da entrevista social da Cáritas Arquidiocesana do Rio de Janeiro (Cáritas/RJ). Calcularam-se as taxas de prevalência de condições de saúde e respectivos intervalos de 95% de confiança (IC95%) e a razão de chances (RC) e IC95% em um modelo de regressão logística simples segundo variáveis sociodemográficas e de migração. O estudo incluiu 1.509 indivíduos. Na chegada ao Brasil, 620 (41%) relataram ter uma ou mais condições de saúde. As chances de apresentar problemas de saúde foram maiores em pessoas oriundas do Congo (RC = 18,7) e República Democrática do Congo (RC = 9,5), nos indocumentados (RC = 4,4), nas mulheres (RC = 2,1), em pessoas com Ensino Fundamental (RC = 1,9), com idade ≥ 45 anos (RC = 1,8) e entre os que vivem/viveram maritalmente (RC = 1,8 e 2,5, respectivamente). Entre as pessoas que relataram alguma condição de saúde, mais da metade informaram sentir dores (52%). É possível que as dores físicas tenham relação com estresse pós-traumático e outros sofrimentos em saúde mental, que podem se manifestar por meio de sintomas de dores somáticas.
Análise espacial da morbimortalidade materna em usuárias do Sistema Único de Saúde no Município do Rio de Janeiro, Brasil, 2014-2016
Authors: Correa Heloisa Ferreira dos Santos , Domingues Rosa Maria Soares Madeira , Pina Maria de Fátima
Published: September 2023

O objetivo deste estudo é analisar a morbimortalidade materna de mulheres atendidas em hospitais do Sistema Único de Saúde (SUS) no Município do Rio de Janeiro, Brasil, no período de 2014 a 2016. Foi realizado estudo ecológico, por meio da coleta de dados do Sistema de Informações sobre Nascidos Vivos (SINASC), Sistema de Informação sobre Mortalidade (SIM) e Sistema de Informações Hospitalares (SIH/SUS). Para analisar a razão de mortalidade materna (RMM), foram utilizados dados do SIM. Para investigar a morbidade materna, adotaram-se critérios da Organização Mundial da Saúde para estimar as razões de near miss materno e de condições potencialmente ameaçadoras à vida. Dados do SINASC foram usados para número de nascidos vivos e caracterização demográfica, social e de acesso a serviço de pré-natal. Para avaliar a associação espacial entre os indicadores RMM, razões de near miss materno e condições potencialmente ameaçadoras à vida e os indicadores demográficos, sociais, obstétricos e de acesso obtidos no SINASC, foi calculado o índice de Moran bivariado com nível de 0,05 de significância, por meio do programa GeoDa. No período analisado, a RMM no Município do Rio de Janeiro foi de 94,16/100 mil nascidos vivos, a razão de near miss materno de 28,21/1.000 nascidos vivos e a razão de condições potencialmente ameaçadoras à vida de 34,31/1.000 nascidos vivos. Casos de condições potencialmente ameaçadoras à vida foram utilizados pela primeira vez neste estudo e apresentaram diagnósticos de internação e procedimentos realizados mais condizentes com o perfil de mortalidade materna no Município do Rio de Janeiro. Houve associação significativa entre RMM e percentual de nascidos vivos no SUS, razão de condições potencialmente ameaçadoras à vida e percentual de nascidos vivos no SUS e razão de condições potencialmente ameaçadoras à vida e ser solteira.
CICLOPEDALEIROS: PROCESSOS EDUCATIVOS DECORRENTES DA ESTRUTURAÇÃO DE UM EMPREENDIMENTO DE ECONOMIA SOLIDÁRIA
Authors: MECCA ANDRÉIA CORDEIRO , GONÇALVES JUNIOR LUIZ
Published: September 2023

RESUMO A implantação e a consolidação do modelo econômico neoliberal tiveram como consequências a precarização acentuada do trabalho no Brasil e o aumento das desigualdades. O grande número de pessoas vivendo em situação de vulnerabilidade socioeconômica e a busca pela superação desse quadro faz emergir alternativas à geração de renda. Essas alternativas promoveram práticas exploratórias como a uberização do trabalho, mas também contribuíram para impulsionar outras economias. O Empreendimento de Economia Solidária CicloPedaleiros busca, através da realização de cicloentregas, viabilizar geração de renda para adultos que estão à margem do mercado de trabalho, sujeitos ao desemprego e à informalidade. O presente artigo teve como objetivo identificar e compreender os processos educativos decorrentes da prática social da cicloentrega a partir das ações do citado empreendimento. Como metodologia utilizamos pesquisa participante, sistematização das observações por meio de diários de campo e análise pautada na fenomenologia. Da análise emergiram três categorias temáticas: A) “Eu fui lá na frente falar, falei, sou dos CicloPedaleiros, empreendimento de economia solidária”; B) “É bão usar o capacete, viu, numa hora dessa salva”; e C) “Precarização é a palavra do ano”.
ACUTE CHOLECYSTITIS IN HIGH-RISK PATIENTS. SURGICAL, RADIOLOGICAL, OR ENDOSCOPIC TREATMENT? BRAZILIAN COLLEGE OF DIGESTIVE SURGERY POSITION PAPER
Authors: COELHO Júlio Cezar Uili , COSTA Marco Aurélio Raeder da , ENNE Marcelo , TORRES Orlando Jorge Martins , ANDRAUS Wellington , CAMPOS Antonio Carlos Ligocki
Published: September 2023

ABSTRACT Acute cholecystitis (AC) is an acute inflammatory process of the gallbladder that may be associated with potentially severe complications, such as empyema, gangrene, perforation of the gallbladder, and sepsis. The gold standard treatment for AC is laparoscopic cholecystectomy. However, for a small group of AC patients, the risk of laparoscopic cholecystectomy can be very high, mainly in the elderly with associated severe diseases. In these critically ill patients, percutaneous cholecystostomy or endoscopic ultrasound gallbladder drainage may be a temporary therapeutic option, a bridge to cholecystectomy. The objective of this Brazilian College of Digestive Surgery Position Paper is to present new advances in AC treatment in high-risk surgical patients to help surgeons, endoscopists, and physicians select the best treatment for their patients. The effectiveness, safety, advantages, disadvantages, and outcomes of each procedure are discussed. The main conclusions are: a) AC patients with elevated surgical risk must be preferably treated in tertiary hospitals where surgical, radiological, and endoscopic expertise and resources are available; b) The optimal treatment modality for high-surgical-risk patients should be individualized based on clinical conditions and available expertise; c) Laparoscopic cholecystectomy remains an excellent option of treatment, mainly in hospitals in which percutaneous or endoscopic gallbladder drainage is not available; d) Percutaneous cholecystostomy and endoscopic gallbladder drainage should be performed only in well-equipped hospitals with experienced interventional radiologist and/or endoscopist; e) Cholecystostomy catheter should be removed after resolution of AC. However, in patients who have no clinical condition to undergo cholecystectomy, the catheter may be maintained for a prolonged period or even definitively; f) If the cholecystostomy catheter is maintained for a long period of time several complications may occur, such as bleeding, bile leakage, obstruction, pain at the insertion site, accidental removal of the catheter, and recurrent AC; g) The ideal waiting time between cholecystostomy and cholecystectomy has not yet been established and ranges from immediately after clinical improvement to months. h) Long waiting periods between cholecystostomy and cholecystectomy may be associated with new episodes of acute cholecystitis, multiple hospital readmissions, and increased costs. Finally, when selecting the best treatment option other aspects should also be considered, such as costs, procedures available at the medical center, and the patient’s desire. The patient and his family should be fully informed about all treatment options, so they can help making the final decision.
OLIGOMETASTASIS IN GASTRIC CANCER TREATMENT: IS THERE A PLACE FOR THE SURGEON?
Authors: ASSUMPÇÃO Paulo Pimentel de , SILVA Jéssica Manoelli Costa da , CALCAGNO Danielle Queiroz , BARRA Williams Fernandes , ISHAK Geraldo , KASSAB Paulo
Published: September 2023

ABSTRACT Metastatic gastric cancer traditionally hinders surgical treatment options, confining them to palliative procedures. The presence of metastases in these tumors is classified as M1, irrespective of their characteristics, quantity, or location. However, oligometastatic disease emerged as an intermediate state between localized and widely disseminated cancer. It exhibits diverse patterns based on metastatic disease extent, type, and location. Adequately addressing this distinctive metastatic state necessitates tailored strategies that surpass the realm of palliative care. Differentprimary tumor types present discernible scenarios of oligometastatic disease, including preferred sites of occurrence and chronological progression. Due to the novelty of this theme and the heterogeneity of the disease, uncertainties still exist, and the ability to provide confident guidelines is challenging. Currently, there are no effective predictors to determine the response and provide clear indications for surgical interventions and systemic treatments in oligometastatic disease. Treatment decisions are commonly based on apparent disease control by systemic therapies, with a short observation period and imaging assessments. Nonetheless, the inherent risk of misinterpretation remains a constant concern. The emergence of novel technologies and therapeutic modalities, such as immunotherapy, cellular therapy, and adoptive therapies, holds the potential to reshape the landscape of surgical treatment for the oligometastatic disease in gastric cancer, expanding the surgeon’s role in this multidisciplinary approach. Prospective tools for patient selection in oligometastatic gastric cancer are being explored. Using non-invasive, cost-effective, widely available imaging techniques that provide real-time information may revolutionize medical practice, ensuring precision medicine accessibility, even in resource-constrained small healthcare facilities. Incorporating molecular classifications, liquid biopsies, and radiomic analysis in a complementary protocol will augment patient selection precision for surgical intervention in oligometastasis. Hopefully, these advancements will render surgeries unnecessary in many cases by providing highly effective alternative treatments.
AN EXPERIENCE ON LIVING DONOR LIVER TRANSPLANTATION FOR COLORECTAL LIVER METASTASIS IN SOUTH AMERICA: A NEW ERA IN TRANSPLANT ONCOLOGY
Authors: Fernandes Eduardo de Souza Martins , Souza Gabrielle Oliveira de , Braga Eduardo Pinho , Furtado Rodrigo Lopes Leite , Corrêa Raphael Rodrigues , Queiroz Camila Tobias , Mello Felipe Pedreira Tavares de , Girão Camila Liberato , Line Pal-Dag , Torres Orlando Jorge Martins
Published: September 2023

ABSTRACT BACKGROUND: Complete surgical resection is the treatment of choice for patients with liver metastases, but in some patients, it is not possible to obtain a complete R0 resection. Moreover, the recurrence rate is up to 75% after three years. After the experience of the Oslo group with cadaveric liver transplant, some centers are starting their experience with liver transplant for colorectal liver metastasis. AIMS: To present our initial experience with living donor liver transplant for colorectal liver metastasis. METHODS: From 2019 to 2022, four liver transplants were performed in patients with colorectal liver metastases according to the Oslo criteria. RESULTS: Four patients underwent living donor liver transplants, male/female ratio was 3:1, mean age 52.5 (42–68 years). All patients were included in Oslo criteria for liver transplant. Two patients had already been submitted to liver resection. The decision for liver transplant occurred after discussion with a multidisciplinary team. Three patients recurred after the procedure and the patient number 3 died after chemotherapy. CONCLUSIONS: Living donor liver transplant is a viable treatment option for colorectal liver metastasis in Brazil, due to a shortage of donors.
Estudo comparativo entre empresa farmacêutica global e instituição pública de produção e inovação em saúde
Authors: Rocha Kelly Cristina Rodrigues da , Gadelha Carlos Augusto Grabois
Published: September 2023

RESUMO O cenário tecnológico no campo da saúde é um fato alarmante, mormente no contexto provocado pela Covid-19. Nessa conjuntura, a Fundação Oswaldo Cruz, por meio da Unidade de Bio-Manguinhos, e o Butantan foram protagonistas para o acesso universal, dialogando com estratégicas internacionais. No adensamento da discussão estratégica para Instituições Públicas de Produção e Inovação em Saúde (Ippis), o uso de diretrizes da Avaliação de Tecnologias em Saúde destaca-se como via de mudança paradigmática para a introdução de tecnologias no Sistema Único de Saúde (SUS) alinhada à visão de inovação de futuro em saúde consonante às demandas nacionais. Este artigo, desenvolvido metodologicamente mediante pesquisas descritiva qualitativa, bibliográfica, documental e trabalho de campo, buscou traçar simetrias e assimetrias baseado nas experiências coletadas em empresa farmacêutica global e instituição de referência nacional pública do campo de incorporação tecnológica em saúde. Como resultados, são explicitados pontos-chave para o fortalecimento técnico e político do Complexo Econômico-Industrial da Saúde, por meio da revisão organizacional das Ippis quanto a aspectos de inovação e de gestão, culminado na promoção de melhorias na Política de ciência, tecnologia e inovação em resposta ao desafio da sustentabilidade, efetividade e acesso no SUS.
Comparative study between global pharmaceutical company and public institution of production and innovation in health
Authors: Rocha Kelly Cristina Rodrigues da , Gadelha Carlos Augusto Grabois
Published: September 2023

ABSTRACT The technological scenario in the field of health is an alarming fact, especially in the context caused by COVID-19. In this context, the Oswaldo Cruz Foundation, through the Bio-Manguinhos Unit, and the Butantan Institute were protagonists for universal access, dialoguing with international strategies. In the strategic discussion for Public Institutions of Production and Innovation in Health (IPPIS), the use of guidelines of the Technological Assessment in Health stands out as a way of paradigmatic change for the introduction of technologies in the Unified Health System (SUS) in line with the vision of future innovation in health in accordance with national demands. This article, methodologically developed through qualitative descriptive research, bibliographical, documentary and field work, sought to trace symmetries and asymmetries based on the experiences collected in a global pharmaceutical company and a public national reference institution in the field of technological incorporation in health. As a result, key points are explained for the technical and political strengthening of the Health Economic-Industrial Complex, through the organizational review of the IPPIS regarding innovation and management aspects, culminating in the promotion of improvements in the science, technology and innovation policy in response to the challenge of sustainability, effectiveness and access in the SUS.
Residências em saúde: análise de uma política estadual de formação de profissionais para o SUS
Authors: Santos Juliana Siqueira , Santos Neto Pedro Miguel dos
Published: September 2023

RESUMO As residências em saúde constituem-se importante estratégia de Estado na regulação da formação de profissionais para o Sistema Único de Saúde (SUS) no âmbito da política de gestão do trabalho e educação na saúde. Foi realizada uma investigação que objetivou analisar como a política de residência em área profissional da saúde tem sido implementada no estado de Pernambuco, Brasil, no período de 2010 a 2021, nos aspectos gestão, características dos programas de residência e recursos investidos. O trabalho é uma pesquisa social, do tipo estudo de caso e abordagem de métodos mistos, com pesquisa documental e dados governamentais, que utilizou como referencial teórico-analítico a Abordagem do Ciclo de Políticas. Foi desenvolvida análise de conteúdo temática com base no que foi coletado, na teoria e na perspectiva dos pesquisadores, identificando as categorias: atores da política e governança; expansão da formação e financiamento; áreas temáticas prioritárias; formação nas residências multiprofissionais em saúde. Foram identificadas experiências de gestão com participação dos diversos atores locais, investimento incremental em bolsas de residência e ampliação das residências multiprofissionais em saúde. Persiste o desafio de implementar uma política de formação em saúde, que, pautada pelo ensino em serviço, atue como força motriz para fazer avançar o SUS.
Funding for research on dengue in Brazil, 2004-2020
Authors: Melo Gabriela Bardelini Tavares , Angulo-Tuesta Antonia , Silva Everton Nunes da , Obara Marcos Takashi
Published: September 2023

ABSTRACT Dengue represents an important public health problem in Brazil, due to the constant epidemics caused by the disease in the country. This study aimed to analyze the funding of research on dengue by the Department of Science and Technology of the Ministry of Health of Brazil and partners between 2004 to 2020. Was analyzed the trend of the funding by generalized linear regression using Prais-Winster and its distribution between Brazilian regions and Federated Units, research contracting modalities, benefited institutions, and studied themes. Between 2004 and 2020, 232 research studies were funded (R$ 164.03 million), carried out mostly in institutions in the Southeast Region (77.55%), addressing especially the vector control theme (37.93%). The funding trend was stationary in the years studied. The state calls were the main form of contracting modality for the research (65.95%). There was a statistically significant difference in the distribution of the loan amount between the contracting modalities, and in the number of researches funded and loan amount among Brazilian regions. These findings demonstrate the importance of monitoring the research funding on dengue in Brazil and of implementing strategies to evaluate the research funded, to support and improve the policy to combat the disease and its vector.
Efficiency in public health: the trajectory of a concept from engineering
Authors: Borges Janiele Cristine Peres , Bordin Ronaldo
Published: September 2023

ABSTRACT This article aims to describe the development trajectory of the concept of efficiency in public administration, more specifically in the area of public health. To achieve this objective, a theoretical essay was carried out, in which a theoretical-analytical argument was developed to guide empirical research in relation to the issue of efficiency in health management. This argument is based on three assumptions: over a century of development of the concept of efficiency in public administration, this concept is still heavily loaded with assumptions from engineering; these assumptions, in turn, are directly connected with principles of neoclassical economics, which underlie neoliberal perspectives applied to public management; and in the health area, the concept of efficiency based only on market economy assumptions is insufficient, needing to be articulated with the concepts of efficacy and effectiveness.
Cirurgia bariátrica: complexidades e caminhos para a atenção da obesidade no SUS
Authors: Andrade Rebecca Soares de , Cesse Eduarda Ângela Pessoa , Figueiró Ana Cláudia
Published: September 2023

RESUMO Este ensaio objetivou analisar como o Sistema Único de Saúde (SUS) tem lidado com o aumento da obesidade com indicação para cirurgia bariátrica no Brasil e apontar caminhos para a atenção à saúde integral dessa população. Fez-se um resgate do momento político-histórico de transformação epistemológica da obesidade e suas repercussões para indivíduos, sociedade, sistema de saúde e outros setores; expuseram-se alguns ataques sofridos pelo SUS, em especial os mais recentes, que afetam o já dificultoso acesso à cirurgia bariátrica; e refletiu-se sobre estratégias que buscam garantia da atenção à essa população e a sustentabilidade do sistema de saúde. Destacam-se os documentos produzidos pelo próprio Ministério da Saúde para a orientação do cuidado da obesidade, haja vista sua consonância com as evidências científicas mais atuais e sua utilização por outros países na construção de suas políticas. Ademais, reforça-se a importância do compartilhamento de responsabilidades entre todos os atores envolvidos; a regulamentação da publicidade voltada ao público que possui obesidade; o mandatório aumento de financiamento do SUS; e a utilização da avaliação em saúde de políticas, serviços e ações, para que se façam os ajustes necessários em tempo oportuno, garantindo uma melhor gestão do cuidado em saúde.
Elaboração de um protocolo de classificação de risco para pacientes oncológicos em Cuidados Paliativos Domiciliares
Authors: Souza Flavia Navi de , Silva Vanessa Gomes da , Silva Alexandre Sousa da
Published: September 2023

RESUMO Os serviços de Cuidados Paliativos Domiciliares especializados no tratamento de pacientes oncológicos têm como objetivo identificar e controlar sintomas físicos, psicossociais e espirituais em domicílio. Alguns desafios encontrados são a complexidade de sintomas, a sobrevida reduzida dos pacientes com câncer avançado e limitações do sistema de saúde. Para estratificar a prioridade de atendimento dos pacientes com câncer avançado em Cuidados Paliativos Domiciliares, foi elaborado um protocolo de classificação de risco. Este artigo é um relato de experiência sobre o processo de elaboração de um protocolo de classificação de risco para pacientes com câncer avançado atendidos em um serviço de Cuidados Paliativos Domiciliares no Rio de Janeiro. A etapa inicial envolveu reuniões da equipe da Assistência Domiciliar de um hospital oncológico e buscas estruturadas na literatura. Depois, foram listadas as situações clínicas de manejo mais complexo no domicílio, chamadas de sinais e sintomas de alerta: dor, falta de ar, náuseas/ vômitos, sangramento e confusão mental aguda. Elaborou-se um protocolo de avaliação e classificação de risco com cinco categorias/cores, para determinar a prioridade de atendimento dos pacientes. O sistema de triagem desenvolvido possui fácil aplicabilidade e requer um treinamento breve do profissional de saúde para que possa ser utilizado durante os atendimentos domiciliares.
Development of a risk classification protocol for cancer patients in Home-based Palliative Care
Authors: Souza Flavia Navi de , Silva Vanessa Gomes da , Silva Alexandre Sousa da
Published: September 2023

ABSTRACT Home-based Palliative Care services specialized in the treatment of cancer patients aim to identify and control physical, psychosocial, and spiritual symptoms at home. Some challenges encountered are the complexity of symptoms, reduced survival of patients with advanced cancer, and limitations of the health care system. To stratify the priority of care for patients with advanced cancer in home Palliative Care, a risk classification protocol was developed. This article is an experience report on the process of creating a risk classification protocol for patients with advanced cancer treated at a home Palliative Care service in Rio de Janeiro. The initial stage involved meetings of the home care team at an oncology hospital and structured searches in the literature. Afterwards, the clinical situations of more complex management at home were listed and named as warning signs and symptoms: pain, shortness of breath, nausea/ vomiting, bleeding, and acute mental confusion. An assessment and triage protocol was developed with five categories/colors to determine the priority of patient care. The developed triage system has easy applicability and requires a brief training of the health professional so that it can be used during home visits.