bluuebunny/crossref_metadata_2025 huggingface dataset:
Has Economic Analysis Improved Regulatory Decisions?
Authors: Hahn Robert W , Tetlock Paul C
Published: February 2008

In response to the increasing impact of regulation, several governments have introduced economic analysis as a way of trying to improve regulatory policy. This paper provides a comprehensive assessment of government-supported economic analysis of regulation. We find that there is growing interest in the use of economic tools, such as benefit–cost analysis; however, the quality of analysis in the U.S. and European Union frequently fails to meet widely accepted guidelines. Furthermore, the relationship between analysis and policy decisions is tenuous. To address this situation, we recommend pursuing an agenda in which economics plays a more central role in regulatory decision making. In addition, we suggest that prediction markets could help improve regulatory policy and improve measurement of the impact of regulation.
Is the Food and Drug Administration Safe and Effective?
Authors: Philipson Tomas J , Sun Eric
Published: February 2008

In the United States, the Food and Drug Administration (FDA) provides public oversight of the safety and efficacy of drugs; medical devices; biologics like vaccines and blood products; cosmetics; radiation-emitting electronic products; veterinary products; and all foods, except meat and poultry (which are regulated by the Department of Agriculture). According to the FDA, the products it regulates account for more than one-fifth of U.S. consumer spending. In the area of medical products, the FDA is responsible for determining whether marketed products are both safe and effective before and after they have been marketed. In this paper, we will explore whether the policies of the agency itself are safe and effective. We stress two issues, one static and one dynamic. The static issue concerns the potential duplication inefficiency when product safety is protected not only by the FDA but also by the private sector through product liability law. Put another way, what is the rationale for using product liability and the FDA to regulate drug safety? While intuitively it may seem that two systems must be better than one in ensuring drug safety, each system comes with costs. We then turn to the dynamic issue, the speed–safety trade off, and consider the extent to which higher safety is achieved at a cost of later market entry of effective and even life-saving products. We assess the Prescription Drug User Fee Acts (PDUFAs), which increased the speed of the agency's regulatory process starting in 1992, although according to some, at the cost of reducing drug safety. We conclude by suggesting a research agenda for future work on the Food and Drug Administration.
pH-dependent structural changes of helix 69 from Escherichia coli 23S ribosomal RNA
Authors: Abeysirigunawardena Sanjaya C. , Chow Christine S.
Published: February 2008

Helix 69 in 23S rRNA is a region in the ribosome that participates in a considerable number of RNA–RNA and RNA–protein interactions. Conformational flexibility is essential for such a region to interact and accommodate protein factors at different stages of protein biosynthesis. In this study, pH-dependent structural and stability changes were observed for helix 69 through a variety of spectroscopic techniques, such as circular dichroism spectroscopy, UV melting, and nuclear magnetic resonance spectroscopy. In Escherichia coli 23S rRNA, helix 69 contains pseudouridine residues at positions 1911, 1915, and 1917. The presence of these pseudouridines was found to be essential for the pH-induced conformational changes. Some of the pH-dependent changes appear to be localized to the loop region of helix 69, emphasizing the importance of the highly conserved nature of residues in this region.
Assessing the fraction of short-distance tandem splice sites under purifying selection
Authors: Hiller Michael , Szafranski Karol , Sinha Rileen , Huse Klaus , Nikolajewa Swetlana , Rosenstiel Philip , Schreiber Stefan , Backofen Rolf , Platzer Matthias
Published: February 2008

Many alternative splice events result in subtle mRNA changes, and most of them occur at short-distance tandem donor and acceptor sites. The splicing mechanism of such tandem sites likely involves the stochastic selection of either splice site. While tandem splice events are frequent, it is unknown how many are functionally important. Here, we use phylogenetic conservation to address this question, focusing on tandems with a distance of 3–9 nucleotides. We show that previous contradicting results on whether alternative or constitutive tandem motifs are more conserved between species can be explained by a statistical paradox (Simpson's paradox). Applying methods that take biases into account, we found higher conservation of alternative tandems in mouse, dog, and even chicken, zebrafish, andFugugenomes. We estimated a lower bound for the number of alternative sites that are under purifying (negative) selection. While the absolute number of conserved tandem motifs decreases with the evolutionary distance, the fraction under selection increases. Interestingly, a number of frameshifting tandems are under selection, suggesting a role in regulating mRNA and protein levels via nonsense-mediated decay (NMD). An analysis of the intronic flanks shows that purifying selection also acts on the intronic sequence. We propose that stochastic splice site selection can be an advantageous mechanism that allows constant splice variant ratios in situations where a deviation in this ratio is deleterious.
Service-Level Agreements in Call Centers: Perils and Prescriptions
Authors: Milner Joseph M. , Olsen Tava Lennon
Published: February 2008

Acall center with both contract and noncontract customers was giving priority to the contract customers only in off-peak hours, precisely when having priority was least important. In this paper, we investigate whether this is rational behavior on the part of the call center and what the implications are for customers. In particular, we show that under contracts on the percentile of delay, which are commonly used in the call center industry, this is rational behavior, at least under the approximating asymptotic regime considered in this paper. We then suggest other contracts that do not result in this type of undesirable behavior from a contract customer's perspective. We compare the performance of the different contracts in terms of mean, variance, and outer percentiles of delay for both customer types using both numerical and asymptotic heavy-traffic analyses. We argue that including terms reflecting the second moment of delay in a contract would be beneficial to contract customers and, in a sense, fairer.
Call Center Outsourcing: Coordinating Staffing Level and Service Quality
Authors: Ren Z. Justin , Zhou Yong-Pin
Published: February 2008

In this paper, we study the contracting issues in an outsourcing supply chain consisting of a user company and a call center that does outsourcing work for the user company. We model the call center as a G/G/s queue with customer abandonment. Each call has a revenue potential, and we model the call center's service quality by the percentage of calls resolved (revenue realized). The call center makes two strategic decisions: how many agents to have and how much effort to exert to achieve service quality.

We are interested in the contracts the user company can use to induce the call center to both staff and exert effort at levels that are optimal for the outsourcing supply chain (i.e., chain coordination). Two commonly used contracts are analyzed first: piecemeal and pay-per-call-resolved contracts. We show that although they can coordinate the staffing level, the resulting service quality is below system optimum. Then, depending on the observability and contractibility of the call center's effort, we propose two contracts that can coordinate both staffing and effort. These contracts suggest that managers pay close attention to service quality and its contractibility in seeking call center outsourcing.
Staffing of Time-Varying Queues to Achieve Time-Stable Performance
Authors: Feldman Zohar , Mandelbaum Avishai , Massey William A. , Whitt Ward
Published: February 2008

This paper develops methods to determine appropriate staffing levels in call centers and other many-server queueing systems with time-varying arrival rates. The goal is to achieve targeted time-stable performance, even in the presence of significant time variation in the arrival rates. The main contribution is a flexible simulation-based iterative-staffing algorithm (ISA) for the Mt/G/st + G model—with nonhomogeneous Poisson arrival process (the Mt) and customer abandonment (the + G). For Markovian Mt/M/st + M special cases, the ISA is shown to converge. For that Mt/M/st + M model, simulation experiments show that the ISA yields time-stable delay probabilities across a wide range of target delay probabilities. With ISA, other performance measures—such as agent utilizations, abandonment probabilities, and average waiting times—are stable as well. The ISA staffing and performance agree closely with the modified-offered-load approximation, which was previously shown to be an effective staffing algorithm without customer abandonment. Although the ISA algorithm so far has only been extensively tested for Mt/M/st + M models, it can be applied much more generally—to Mt/G/st + G models and beyond.
Call Center Outsourcing Contract Analysis and Choice
Authors: Akşin O. Zeynep , de Véricourt Francis , Karaesmen Fikri
Published: February 2008

This paper considers a call center outsourcing contract analysis and choice problem faced by a contractor and a service provider. The service provider receives an uncertain call volume over multiple periods and is considering outsourcing all or part of these calls to a contractor. Each call brings in a fixed revenue to the service provider. Answering calls requires having service capacity; thus implicit in the outsourcing decision is a capacity decision. Insufficient capacity implies that calls cannot be answered, which in turn means there will be a revenue loss. Faced with a choice between a volume-based and a capacity-based contract offered by a contractor that has pricing power, the service provider determines optimal capacity levels. The optimal price and capacity of the contractor together with the optimal capacity of the service provider determine optimal profits of each party under the two contracts being considered. This paper characterizes optimal capacity levels and partially characterizes optimal pricing decisions under each contract. The impact of demand variability and the economic parameters on contract choice are explored through numerical examples. It is shown that no contract type is universally preferred and that operating environments as well as cost-revenue structures have an important effect.
Service-Level Differentiation in Call Centers with Fully Flexible Servers
Authors: Gurvich Itay , Armony Mor , Mandelbaum Avishai
Published: February 2008

We study large-scale service systems with multiple customer classes and many statistically identical servers. The following question is addressed: How many servers are required (staffing) and how does one match them with customers (control) to minimize staffing cost, subject to class-level quality-of-service constraints? We tackle this question by characterizing scheduling and staffing schemes that are asymptotically optimal in the limit, as system load grows to infinity. The asymptotic regimes considered are consistent with the efficiency-driven (ED), quality-driven (QD), and quality-and-efficiency-driven (QED) regimes, first introduced in the context of a single-class service system.

Our main findings are as follows: (a) Decoupling of staffing and control, namely, (i) staffing disregards the multiclass nature of the system and is analogous to the staffing of a single-class system with the same aggregate demand and a single global quality-of-service constraint, and (ii) class-level service differentiation is obtained by using a simple idle-server-based threshold-priority (ITP) control (with state-independent thresholds); and (b) robustness of the staffing and control rules: our proposed single-class staffing (SCS) rule and ITP control are approximately optimal under various problem formulations and model assumptions. Particularly, although our solution is shown to be asymptotically optimal for large systems, we numerically demonstrate that it performs well also for relatively small systems.
Culture and Coworker Relations: Interpersonal Patterns in American, Chinese, German, and Spanish Divisions of a Global Retail Bank
Authors: Morris Michael W. , Podolny Joel , Sullivan Bilian Ni
Published: February 2008

This paper examines coworker networks in the American, Chinese, German, and Spanish divisions of a global retail bank. Because the bank has standardized structure and policies across countries, it is possible to examine how norms rooted in national culture impact on various features of informal ties. We propose that cultures vary in the models on which coworker interaction norms are based, with market, family, law, and friendship relations serving as alternative templates. In elucidating these templates, we generate hypotheses about how each culture's norms influence the content and structure of employees' interactions with coworkers. Results from an egocentric network survey largely support the hypotheses. We discuss implications for organizational behavior research on culture as well as practical implications for multinational firms.
Genetics of the Musculoskeletal System: A Pleiotropic Approach
Authors: Karasik David , Kiel Douglas P
Published: February 2008

The risk of osteoporotic fracture can be viewed as a function of loading conditions and the ability of the bone to withstand the load. Skeletal loads are dominated by muscle action. Recently, it has become clear that bone and muscle share genetic determinants. Involution of the musculoskeletal system manifests as bone loss (osteoporosis) and muscle wasting (sarcopenia). Therefore, the consideration of pleiotropy is an important aspect in the study of the genetics of osteoporosis and sarcopenia. This Perspective will provide the evidence for a shared genetic influence on bone and muscle. We will start with an overview of accumulating evidence that physical exercise produces effects on the adult skeleton, seeking to unravel some of the contradictory findings published thus far. We will provide indications that there are pleiotropic relationships between bone structure/mass and muscle mass/function. Finally, we will offer some insights and practical recommendations as to the value of studying shared genetic factors and will explore possible directions for future research. We consider several related questions that together comprise the general paradigm of bone responses to mechanical loading and the relationship between muscle strength and bone parameters, including the genetic factors that modulate these responses. We believe that further progress in understanding the common genetic etiology of osteoporosis and sarcopenia will provide valuable insight into important biological underpinnings for both conditions and may translate into new approaches to reduce the burdens of both conditions through improved diagnosis, prevention, and early targeted treatment.
Detection of Emergency Vehicles: Driver Responses to Advance Warning in a Driving Simulator
Authors: Lenné Michael G. , Triggs Thomas J. , Mulvihill Christine M. , Regan Michael A. , Corben Bruce F.
Published: February 2008

Objective: This research evaluated the effects of an advance warning device (AWD) on the safety of driver interactions with emergency vehicles (EVs). The AWD was intended to provide drivers with advance warning of an approaching on-call EV via visual and auditory warnings when the EV was within a 300- to 400-m radius. Background: Research suggests that drivers can experience difficulty accurately detecting the distance and direction of approaching on-call EV. In-vehicle technology has not previously been explored as a means of overcoming the limitations of existing EV lights and sirens and improving driver detection of EV. Method: An experimental study using an advanced driving simulator examined the effects of the AWD on driving performance in a range of circumstances in which real-world EV crashes and near-misses commonly occur. Each event contained a combination of scenario type (adjacent lane, turning across, car following) and warning condition (control, standard, advance). Results: Data from 22 participants were collected, including measures of speed, braking, and visual scanning. For adjacent-lane and turning-across events, the AWD was associated primarily with reductions in mean speed. The AWD resulted in an earlier lane change to clear a path for the EV in the car-following event. Conclusion: The reduction in speed observed was a positive finding, given the relationship between impact speed and injury severity. Response priming emerged as the mechanism underpinning these effects. Application: Response priming may result in safety benefits in other settings when an advisory warning is presented before the threat can be perceived.
Children's Posture and Muscle Activity at Different Computer Display Heights and During Paper Information Technology Use
Authors: Straker Leon , Burgess-Limerick Robin , Pollock Clare , Coleman Jemma , Skoss Rachel , Maslen Barbara
Published: February 2008

Objective: The 3-D posture and muscle activity in the neck and upper limb were assessed in children using high-, mid-, and book-level displays, which correspond to working conditions frequently observed when children interact with computers or books and paper. Background: The 3-D posture and muscle activity of children reading and inputting data with computers and paper had not been previously assessed. Methods: Twenty-four children aged 10 to 12 years and of normal height performed an interactive task involving reading from a book and writing on paper or reading from a computer display and inputting data using a mouse and keyboard. Results: Head and neck flexion increased as the visual target was lowered. The high display resulted in mainly upper cervical relative extension, and the book display resulted in both upper and lower cervical flexion. The book condition resulted in greater cervical erector spinae and upper trapezius activity than did the mid and high conditions. Conclusion: The data suggest that a mid-level display may be more appropriate for children than a high display (e.g., when the display is placed on top of the central processing unit). The mid display also results in a more upright and symmetrical posture and lower mean muscle activity than does working with books and paper flat on the desk. Application: This study provides short-term laboratory study evidence for the formulation of guidelines for workstation design and adjustment for children. Use of computers by children is increasing, yet ergonomic guidelines lag behind those for adults.
Inward Torque and High-Friction Handles Can Reduce Required Muscle Efforts for Torque Generation
Authors: Seo Na Jin , Armstrong Thomas J. , Chaffin Don B. , Ashton-Miller James A.
Published: February 2008

Objective: The effects of handle friction and torque direction on muscle activity and torque are empirically investigated using cylindrical handles. Background: A torque biomechanical model that considers contact force, friction, and torque direction was evaluated using different friction handles. Methods: Twelve adults exerted hand torque in opposite directions about the long axis of a cylinder covered with aluminum or rubber while grip force, torque, and finger flexor electromyography (EMG) were recorded. In addition, participants performed grip exertions without torque, in which they matched the EMG level obtained during previous maximum torque exertions, to allow us to determine how grip force was affected by the absence of torque. Results: (a) Maximum torque was 52% greater for the high-friction rubber handle than for the low-friction aluminum handle. (b) Total normal force increased 33% with inward torque (torque applied in the direction fingertips point) and decreased 14% with outward torque (torque in the direction the thumb points), compared with that with no torque. Consequently, maximum inward torque was 45% greater than maximum outward torque. (c) The effect of torque direction was greater for the high-friction rubber handle than for the low-friction aluminum handle. Conclusion: The results support the proposed model, which predicts a large effect of torque direction when high-friction handles are gripped. Application: Designing tasks with high friction and inward rotations can increase the torque capability of workers of a given strength, or reduce required muscle activities for given torque exertions, thus reducing the risk of fatigue and musculoskeletal disorders.
Tactile Displays: Guidance for Their Design and Application
Authors: Jones Lynette A. , Sarter Nadine B.
Published: February 2008

Objective: This article provides an overview of tactile displays. Its goal is to assist human factors practitioners in deciding when and how to employ the sense of touch for the purpose of information representation. The article also identifies important research needs in this area. Background: First attempts to utilize the sense of touch as a medium for communication date back to the late 1950s. For the next 35 years progress in this area was relatively slow, but recent years have seen a surge in the interest and development of tactile displays and the integration of tactile signals in multimodal interfaces. A thorough understanding of the properties of this sensory channel and its interaction with other modalities is needed to ensure the effective and robust use of tactile displays. Methods: First, an overview of vibrotactile perception is provided. Next, the design of tactile displays is discussed with respect to available technologies. The potential benefit of including tactile cues in multimodal interfaces is discussed. Finally, research needs in the area of tactile information presentation are highlighted. Results: This review provides human factors researchers and interface designers with the requisite knowledge for creating effective tactile interfaces. It describes both potential benefits and limitations of this approach to information presentation. Conclusion: The sense of touch represents a promising means of supporting communication and coordination in human-human and human-machine systems. Application: Tactile interfaces can support numerous functions, including spatial orientation and guidance, attention management, and sensory substitution, in a wide range of domains.
The Effect of Stimulus Modality on Signal Detection: Implications for Assessing the Safety of In-Vehicle Technology
Authors: Merat Natasha , Jamson A. Hamish
Published: February 2008

Objective: This study examined the effect of two in-vehicle information systems (IVIS) on signal detection in the visual, auditory, and tactile modalities; established whether the detrimental effects of an IVIS on driving could be quantified by these detection tasks; and examined the effect of stimulus modality on signal detection. Background: The peripheral detection task has been used widely for assessing the effects of an IVIS on driving. However, performance on this task relies on drivers' ability to see a series of LEDs, which can be problematic in field tests (e.g., on sunny days). Method: Participants responded to one of three detection tasks during a simulated driving experiment. The effect of IVIS interaction on these detection tasks was also measured. Reduced performance in the detection tasks was assumed to indicate a decline in drivers' ability to handle sudden events in the driving task. Results: Response time to all detection tasks increased by around 200 ms when drivers performed the IVIS tasks, as compared with baseline driving. Analyses of variance and comparison of effect sizes showed the effects of these two IVISs to be the same across the three detection tasks. Conclusion: These detection tasks are useful for quantifying the safety of an IVIS during driving. The absence of a difference in signal detection by modality suggests that performance on these tasks relies on general attentional resources and is not modality specific. Application: The signal detection tasks employed here should be further investigated for their suitability in assessing the safety of in-vehicle systems.
Articulating the Differences Between Safety and Resilience: The Decision-Making Process of Professional Sea-Fishing Skippers
Authors: Morel Gaël , Amalberti René , Chauvin Christine
Published: February 2008

Objective: As the world's most dangerous profession, sea fishing enables discussion of the concept of resilience and its articulation to the notion of safety in complex systems. Background: In the small, emerging community working on this concept, the prevailing idea to improve safety is that resilience must be reinjected into the know-how of complex systems. Method: Thirty-four male skippers, divided into two groups, took part in an interactive simulation of a fishing campaign. They had to make decisions in situations of trade-off between safety and production goals. Results: From the time they left the harbor, the fishermen never gave up on fishing, even in extreme conditions, and regardless of whether or not the catch was good. Not being suicidal, however, they used multiple expert strategies to reduce risk without giving up on their fishing activity. Conclusion: Systems run by craftspeople are very resilient because they rely on a high level of adaptability, based on the actors' expertise, linked to an exposure to frequent and considerable risk. Each actor is responsible for his or her own safety. The final discussion bears on the question of knowing whether or not it is possible to design a safe system while preserving its craftsmanship and therefore its native resilience. Application: The results of these studies suggest potential adverse effects of classic safety interventions in complex sociotechnical systems either in terms of professional reluctance to accept new recommendations or through the emergence of new sources of risk.
Neonatal mortality: description and effect of hospital of birth after risk adjustment
Authors: Barros Aluísio J D , Matijasevich Alicia , Santos Iná S , Albernaz Elaine P , Victora Cesar G
Published: February 2008

OBJECTIVE: To assess the effect of hospital of birth on neonatal mortality. METHODS: A birth cohort study was carried out in Pelotas, Southern Brazil, in 2004. All hospital births were assessed by daily visits to all maternity hospitals and 4558 deliveries were included in the study. Mothers were interviewed regarding potential risk factors. Deaths were monitored through regular visits to hospitals, cemeteries and register offices. Two independent pediatricians established the underlying cause of death based on information obtained from medical records and home visits to parents. Logistic regression was used to estimate the effect of hospital of birth, controlling for confounders related to maternal and newborn characteristics, according to a conceptual model. RESULTS: Neonatal mortality rate was 12.7‰ and it was highly influenced by birthweight, gestational age, and socioeconomic variables. Immaturity was responsible for 65% of neonatal deaths, followed by congenital anomalies, infections and intrapartum asphyxia. Adjusting for maternal characteristics, a three-fold increase in neonatal mortality was seen between similar complexity hospitals. The effect of hospital remained, though lower, after controlling for newborn characteristics. CONCLUSIONS: Neonatal mortality was high, mainly related to immaturity, and varied significantly across maternity hospitals. Further investigations comparing delivery care practices across hospitals are needed to better understand NMR variation and to develop strategies for neonatal mortality reduction.
Modelos assistenciais em saúde bucal no Brasil
Authors: Nickel Daniela Alba , Lima Fábio Garcia , Silva Beatriz Bidigaray da
Published: February 2008

Foi realizada uma revisão da literatura sobre os modelos assistenciais em saúde bucal no Brasil, desenvolvidos a partir do Sistema Incremental. Os modelos destacados nas publicações científicas utilizadas como referência foram, além do Sistema Incremental, o Programa de Inversão da Atenção, a Atenção Precoce em Odontologia e o Programa Saúde da Família. Foram descritas as origens e as bases da programação, caracterizando-se os fatos positivos e negativos de cada modelo. Ao fim, foi constatada uma falha comum que dificulta o acesso universal e integral à atenção odontológica: a exclusão de clientelas.
Diretrizes clínicas e outras práticas voltadas para a melhoria da qualidade assistencial em operadoras de planos de saúde sob a perspectiva dos seus dirigentes, no Brasil
Authors: Portela Margareth Crisóstomo , Lima Sheyla Maria Lemos , Ferreira Vanja Maria Bessa , Escosteguy Claudia Caminha , Brito Cláudia , Vasconcellos Maurício Teixeira Leite de
Published: February 2008

Este estudo objetivou caracterizar a implementação de diretrizes clínicas e outros instrumentos e práticas de melhoria da qualidade nas operadoras de planos de saúde no Brasil. O estudo foi transversal e descritivo, de abrangência nacional, considerando 1.573 operadoras de planos de saúde, que constavam do cadastro da Agência Nacional de Saúde Suplementar. A amostra foi do tipo complexo, estratificada por macrorregião, segmento de mercado e número de beneficiários. Foram entrevistadas 90 operadoras que aceitaram participar. Para a obtenção das estimativas sobre o universo de operadoras de planos de saúde, levou-se em conta um fator de expansão da amostra atribuído por estrato. Apenas 32,3% das operadoras de planos de saúde conduziam o uso de diretrizes clínicas, havendo variação regional e entre segmentos de mercado. A prática de gestão da clínica ainda é muito incipiente. Desafios colocam-se para a incorporação da gestão da clínica como dimensão da gestão nas organizações de saúde, entre as quais, as operadoras de planos de saúde. Iniciativas voltadas para a melhoria da qualidade assistencial precisam ser integradas e conduzidas no nível organizacional.
Avaliação da cobertura do Serviço Odontológico da Polícia Militar da Bahia em Salvador, Bahia, Brasil
Authors: Ribeiro-Sobrinho Clóvis , Souza Luís Eugênio Portela Fernandes de , Chaves Sônia Cristina Lima
Published: February 2008

Este estudo visou avaliar a cobertura do Serviço Odontológico da Polícia Militar da Bahia (SOPMBA) na cidade de Salvador, Bahia, Brasil, entre 2002 e 2004, e estimar as taxas de sua cobertura potencial e real. Foi realizado um estudo de caso único, descritivo. Foram calculadas as taxas de cobertura potencial levando-se em conta a carga horária dos cirurgiões-dentistas do serviço e cobertura real, com base na produção ambulatorial odontológica. Encontrou-se uma adequada cobertura potencial de recursos humanos (1 cirurgião-dentista/1.618 habitantes) e a taxa de cobertura real foi considerada abaixo do padrão proposto pelo Ministério da Saúde (0,39 procedimento/habitante/ano). A baixa cobertura real encontrada pode estar relacionada à baixa produtividade do serviço, cujas razões devem ser mais bem investigadas em estudos posteriores como problemas estruturais e a falta de um sistema de gestão do desempenho da qualidade da prática profissional com metas a serem cumpridas.
Perspectivas de eliminação da hanseníase como problema de saúde pública no Estado do Paraná, Brasil
Authors: Silva Sobrinho Reinaldo Antonio da , Mathias Thaís Aidar de Freitas
Published: February 2008

A hanseníase, moléstia infecto-contagiosa endêmica, constitui ainda problema de saúde pública na maioria dos estados brasileiros, embora, nos últimos anos, venha apresentando queda importante em seu coeficiente de prevalência. Este estudo tem por objetivo analisar a perspectiva de eliminação da hanseníase no Estado do Paraná por meio dos coeficientes de detecção e de prevalência, nos anos de 2000 a 2005, além do sexo, idade, forma clínica, classificação operacional e número de lesões de pele. A fonte de informações foi o banco de dados do Sistema de Informação de Agravos de Notificação (SINAN) e o programa Tabnet. Os coeficientes de detecção e de prevalência da hanseníase no Paraná permaneceram sem alteração no período de estudo. Verificou-se, no Paraná, segundo as Regionais de Saúde, que o coeficiente de detecção da hanseníase foi, em sua maioria, alto ou muito alto. Quanto à prevalência, oito Regionais de Saúde alcançaram a meta de eliminação. Conclui-se que o Estado do Paraná está próximo de alcançar a meta de eliminação da hanseníase. Recomenda-se o fortalecimento das ações para que a eliminação da doença como um problema de saúde pública seja uma realidade.
The Charlson comorbidity index (CCI) for adjustment of hip fracture mortality in the elderly: analysis of the importance of recording secondary diagnoses
Authors: Souza Rômulo Cristovão de , Pinheiro Rejane Sobrino , Coeli Cláudia Medina , Camargo Jr. Kenneth Rochel de
Published: February 2008

This study evaluates the role of the number of secondary diagnoses for calculating the Charlson comorbidity index (CCI) in risk adjustment of the 90-day mortality rate after hip fracture surgical repair. Comorbidities were selected by reviewing the medical records of 390 patients 50 years of age or older in a teaching hospital in Rio de Janeiro from 1995 to 2000. Logistic regression models were fitted including the variables age, sex, and CCI. The CCI was calculated based on: (1) all patients' comorbidities; (2) only the comorbidity with the highest weight; and (3) a single randomly selected comorbidity. There was a gradient in the prediction of the CCI mortality rate when all comorbidities were used (OR = 6.53; 95%CI: 2.27-18.77, for scores ³ 3). The predictive capacity of the CCI was observed even when it was calculated using only one comorbidity: with the highest weight (OR = 2.83; 95%CI: 1.11-7.22); and randomly selected (OR = 2.90; 95%CI: 1.07-7.81). Using all comorbidities for CCI calculation is important. Severity indices based on a single comorbidity can be useful for risk adjustment procedures.
Determinantes nas intoxicações medicamentosas agudas na zona urbana de um município do Sul do Brasil
Authors: Margonato Fabiana Burdini , Thomson Zuleika , Paoliello Mônica Maria Bastos
Published: February 2008

As intoxicações medicamentosas no Brasil resultam entre diversos fatores os relacionados a uma frágil política de medicamentos em nosso país. Assim, o objetivo deste estudo foi analisar variáveis sócio-econômicas, tipos de indicação, formas de aquisição e armazenamento de medicamentos das pessoas acometidas por intoxicações medicamentosas agudas não-intencionais. Os dados foram coletados durante visitas domiciliares aos pacientes com registro de intoxicação medicamentosa aguda não-intencional pelo Centro de Controle de Intoxicações de Maringá, Paraná, em 2004. Foram estudadas variáveis relacionadas ao intoxicado, à intoxicação, ao medicamento e armazenamento doméstico de medicamentos. Dentre as 97 intoxicações registradas no período, foram entrevistadas 72 famílias, sendo a maioria de menores de 10 anos (73,6%), sexo masculino (54,2%), estratos econômicos C e D (63,9%). Muitos entrevistados referiram não ter recebido informações sobre o medicamento (76,5%). Houve associação significativa entre pessoas dos estratos econômicos C e D e armazenamento inadequado de medicamentos (p < 0,05). Entrevistados dos estratos econômicos A e B apresentaram medicamentos vencidos com maior freqüência (p < 0,05). Concluiu-se que condições inadequadas de aquisição e armazenamento domiciliar de medicamentos podem ter favorecido a ocorrência das intoxicações.
Utilização de método sorológico como ferramenta diagnóstica para implementação da vigilância e controle da esquistossomose no Município de Holambra, São Paulo, Brasil
Authors: Gargioni Cybele , Silva Rita Maria da , Thomé Célia Maria , Quadros Celma Maria da Silva , Kanamura Hermínia Yohko
Published: February 2008

O presente estudo teve como objetivo avaliar a incorporação da reação de imunofluorescência indireta para pesquisa de anticorpos IgM (RIF-IgM) como método diagnóstico no programa de controle da esquistossomose do Município de Holambra, Estado de São Paulo, Brasil. O município foi selecionado para este estudo considerando-se a notificação dos primeiros casos de esquistossomose a partir de 1993 e a necessidade do município de implementar o programa com técnicas diagnósticas mais sensíveis, tendo em vista ser caracteristicamente área de baixa endemicidade. Duzentos e dois indivíduos foram submetidos à RIF-IgM, dos quais 48 apresentaram-se positivos, sendo 28 destes submetidos à técnica de Kato-Katz, examinando-se três amostras de fezes. Ovos de Schistosoma mansoni foram encontrados em 14, com carga parasitária variando de 2,7 a 224,0 ovos por grama de fezes. Os resultados indicam a potencialidade da RIF-IgM como método de triagem, para posterior confirmação exaustiva por método parasitológico, em áreas de baixa endemicidade.
Avaliação da aplicação do protocolo de triagem pré-natal para toxoplasmose em Belo Horizonte, Minas Gerais, Brasil: estudo transversal em puérperas de duas maternidades
Authors: Carellos Ericka Viana Machado , Andrade Gláucia Manzan Queiroz de , Aguiar Regina Amélia Lopes Pessoa de
Published: February 2008

Foi realizado estudo transversal, em duas maternidades públicas de Belo Horizonte, Minas Gerais, Brasil, com entrevista de 420 puérperas, de agosto de 2004 a maio de 2005, para avaliar a aplicação do protocolo de triagem pré-natal para toxoplasmose implantado, e as orientações oferecidas às gestantes suscetíveis. A cobertura do pré-natal foi de 98%, e da primeira triagem sorológica de 97%. O início do pré-natal e a realização da primeira sorologia ocorreram em média com 16 semanas. Foram identificadas 163 gestantes suscetíveis à toxoplasmose: 44% não repetiram a sorologia, e 42% alegaram não ter recebido orientações para prevenção da toxoplasmose. O início precoce do pré-natal e um maior número de consultas foram associados à repetição da sorologia e ao recebimento de orientações. As informações oferecidas foram: evitar contato com gatos (95%), não ingerir ou manipular carne crua (70%) e lavar cuidadosamente as hortaliças (53%). Concluiu-se que a adesão inadequada ao protocolo de triagem pré-natal de toxoplasmose encontrada no estudo pode gerar gastos financeiros sem melhoria na qualidade do cuidado perinatal.
Avaliação do sistema de pontuação para o diagnóstico da tuberculose na infância preconizado pelo Ministério da Saúde, Brasil
Authors: Maciel Ethel Leonor Noia , Dietze Reynaldo , Silva Rita Elizabeth Checon de Freitas , Hadad David Jamil , Struchiner Claudio Jose
Published: February 2008

A tuberculose é conhecida como uma das mais importantes causas de mortalidade no mundo. O diagnóstico da tuberculose na infância tem entre suas muitas dificuldades o achado bacteriológico do Mycobacterium tuberculosis. Este foi um estudo de caso-controle aninhado em uma coorte prospectiva com crianças que coletaram lavado gástrico em nível ambulatorial e hospitalar, com o objetivo de identificar se o sistema de pontuação para o diagnóstico de tuberculose em crianças negativas à baciloscopia, proposto pelo Ministério da Saúde, poderia ser utilizado como instrumento inicial de identificação do diagnóstico da tuberculose na infância. Um total de 108 crianças foi submetido ao lavado gástrico, sendo que 53 tiveram diagnóstico de tuberculose e 55 com diagnóstico descartado. O sistema de pontuação proposto pelo Ministério da Saúde para o diagnóstico de tuberculose em crianças com baciloscopia negativa apresentou uma boa sensibilidade em ambos os grupos estudados, sendo o melhor ponto de corte o critério 1 (possível diagnóstico de tuberculose) com sensibilidade de 92% podendo, então, ser usado como um auxiliar na investigação diagnóstica de crianças que se submeterão ao lavado gástrico. Nossa recomendação é que o sistema de pontuação do Ministério da Saúde seja utilizado nos serviços de saúde para auxiliar o médico a decidir sobre continuar ou não a investigação da tuberculose infantil, e não somente em crianças que já foram submetidas ao procedimento e tiveram suas amostras com resultado negativo.
Mortalidade infantil por causas evitáveis no Brasil: um estudo ecológico no período 2000-2002
Authors: Boing Antonio Fernando , Boing Alexandra Crispim
Published: February 2008

O objetivo desse estudo foi testar as associações entre a mortalidade infantil por causas evitáveis no Brasil com indicadores sócio-econômicos e de serviços e investimentos em saúde. Trata-se de um estudo ecológico, cujas unidades de análise foram os 296 municípios brasileiros com população superior a 80 mil habitantes. Realizaram-se os testes de Kruskall-Wallis e ANOVA para identificar diferenças significativas entre os quartis de mortalidade infantil segundo as variáveis independentes, e foram calculados os coeficientes de correlação de Pearson e de Spearman para testar as associações entre todas as variáveis. Os municípios que compuseram os quartis com maior mortalidade infantil por causas evitáveis apresentaram também menor Índice de Desenvolvimento Humano Municipal, Produto Interno Bruto per capita, pessoas que vivem em domicílios com banheiro e água encanada, despesa total com saúde por habitante e médicos por mil habitantes; e maior coeficiente de Gini. A compreensão do papel protagonista das condições sócio-econômicas e de investimentos em saúde sobre a mortalidade infantil por causas evitáveis deve permear as ações que visem à minimização da magnitude e da desigualdade desses óbitos.
Anthropological contributions for thinking and acting in the health area and its ethical dilemas
Authors: Minayo Maria Cecília de Souza
Published: February 2008

This paper attempts to analyze the way in which the issue of ethics in social research is dealt by institutional commissions based in biomedicine criteria. This discussion is particularly important for Social Sciences in Health, as our projects must necessarily be presented to Committees for assessment. In actual fact, Resolution Nº 196/1996 issued by the National Health Council establishes this mandatory requirement for all social areas. However, there is a question among researchers working with social issues, arguing that the health sector is moving outside its field when attempting to regulate actions in other fields of investigation. Grounded on philosophical anthropology, this paper is divided into three parts: (1) elements of anthropological foundations of ethics; (2) contributions of Anthropology to thinking about ethics and human rights in health; (3) internal and external questioning about anthropological practice. I conclude that if the ethical issue that involves human beings cannot be reduced to the procedures established by Ethics Committees, discussions in greater depth are required among social scientists on the construction of a practice based on and guided by respect for the intersubjectivity of all the players engaged in a research project.
Research and the (free and) informed consent
Authors: Concone Maria Helena Villas Bôas , Cerveny Ceneide Maria De Oliveira
Published: February 2008

The aim of this article was to reflect about the Free and Informed Consent (IC) in qualitative researches in the health field. Coming from the experience of being part of a CER (Committee for Ethic in Research) in the health area the authoresses place in debate some important questions, exploring them and conducting suggestions. One of these questions and topic of analysis is the meaning of IC, as for the participant as for the researcher.
Ethical aspects considered by researchers who use qualitative approaches in health
Authors: Nunes Everardo Duarte
Published: February 2008

The paper first analyzes the ethical question of qualitative researches from the philosophical viewpoint, and the bioethical question as an interdisciplinary gap that enlarges from the seventies. Afterwards, the question on qualitative research considered as technique and art is raised and understood in a philosophical way of thinking science as a theoretical body, which is epistemically organized in the face of the social reality investigation, and as a movement instituted to defend and discuss the properties of these methodologies. Anthropology is used as an example, and some parts of the codes of professional ethics of anthropology, sociology and psychology are presented. Finally, particularities of the social science fields are discussed, as well as the need to develop a code of ethics for qualitative research. In addition, ethical ways to work in social researches are suggested.
O modelo bioético principialista para a análise da moralidade da pesquisa científica envolvendo seres humanos ainda é satisfatório?
Authors: Schramm Fermin Roland , Palácios Marisa , Rego Sergio
Published: February 2008

O artigo discute a aplicação do principialismo à pesquisa envolvendo seres humanos a partir da pergunta se o modelo é ainda pertinente na situação de pluralização paradigmática nas ciências e de multiplicação dos modelos de avaliação ética, vigentes nas sociedades complexas contemporâneas. Destaca o fato do desenvolvimento da moderna medicina científica ter-se dado fortemente calcado na experimentação em humanos e que, até meados do século XX, bastava a princípio a boa intenção do pesquisador para que uma pesquisa fosse justificada moralmente, mas que, com a dupla transição paradigmática em Ciência e em Ética, delineou-se uma pluralização e complexificação tanto do campo do saber-fazer científico como do campo da ética aplicada à pesquisa científica, a qual se encontrará na inconfortável situação de ter que lidar, no plano normativo, com uma contestação permanente dos paradigmas científicos e éticos. No campo da ética, outros princípios passam também a orientar as decisões, como o princípio de proteção, aplicável às situações de carência em que se encontram, sobretudo, as populações do Terceiro Mundo. O artigo defende a pertinência do principialismo devido a sua postura filosófica geral e método, mas destaca suas insuficiências quando aplicado à saúde pública e à pesquisa nos países dependentes.
Re-imagining the "subject: "conceptual and ethical considerations on the participant in qualitative research
Authors: van den Hoonaard Will C.
Published: February 2008

The conventional biomedical concept of the "human subject" is out of step with World Health Organization's (WHO) holistic definition of health. The "human subject" in international and national research-ethics policies is a highly individualistic, autonomous person, in contrast to WHO's holistic definition of the healthy person. Qualitative research, this paper suggests, offers a way out of this conundrum. We need to reconceptualize the human "subject" in line with WHO's holistic definition of health. The paper offers concepts of "research participants" derived from qualitative research as an essential way to reconceptualize the human "subject." Moreover, field work, or ethnographic research, as undertaken by qualitative researchers presents a useful way of gaining a fuller understanding of issues of health in a given population.
Os níveis de ética de Henri Atlan e o desafio do "quarto nível"
Authors: Aleksandrowicz Ana Maria Coutinho
Published: February 2008

Este artigo apresenta as idéias sobre a ética do biofísico e filósofo spinozista francês contemporâneo Henri Atlan, a partir de sua posição epistemológica singular, em constante trânsito entre a filosofia naturalista (em aliança com as ciências cognitivas) e a recusa aos fundamentos naturais da ética. Sublinha a defesa atlaniana da casuística em relação aos dilemas bioéticos e relaciona-a com sua proposta de diferentes níveis da ética. O texto introduz uma reflexão acerca de uma passagem possível entre os terceiro e quarto níveis de ética, assinalando seu impacto positivo na qualidade de vida de indivíduos e grupos sociais.