Títulos de impacto social como política pública: panorama internacional e contribuições para a implementação no Brasil / Títulos de impacto social como política pública: panorama internacional y contribuciones para la implementación en Brasil / Social impact bonds as public policy: international panorama and contributions to implementation in Brazil

Resumo Apesar de lançado em 2011, o título de impacto social (SIB, na sigla em inglês social impact bonds) é um instrumento ainda em desenvolvimento e que encontra inúmeros desafios. Este artigo tem como objetivo apresentar características dos SIBs e desafios relativos à sua implementação como mecanismo para financiamento de projetos públicos com propósito social. Após revisão bibliográfica e documental, foram identificadas e apresentadas as principais críticas ao modelo. Três casos internacionais de SIBs que já encerraram seus ciclos de maturidade foram selecionados para a análise de aspectos éticos e metodológicos, de métricas, de resultados e de atores. Implicações para projetos no Brasil foram consideradas com base nas análises dos casos internacionais.

Resumen A pesar de haber sido lanzado en 2011, el contrato de impacto social (SIB, acrónimo del término inglés social impact bond) es un instrumento inmaduro que enfrenta numerosos desafíos. Este artículo tiene como objetivo presentar las características de los SIB y los desafíos relativos a su implementación como mecanismos para financiar proyectos públicos con propósito social. Después de la revisión bibliográfica y documental, se identificaron y presentaron las principales críticas al modelo. Se seleccionaron tres casos internacionales de SIB que ya completaron sus ciclos de madurez para el análisis de aspectos éticos, metodológicos, de métricas de resultados y de actores. Las implicaciones para proyectos en Brasil se consideraron a partir del análisis de estos casos internacionales.

Abstract Despite being launched in 2011, the social impact bond (SIB) is an instrument under development that faces numerous challenges. This article presents the characteristics of SIBs and challenges related to their implementation as mechanisms to finance public projects with a social purpose. After a bibliographical and documentary review, three international cases of SIBs that have completed their maturity cycles, relevant for critical analysis of possible projects in Brazil, were selected. Ethical, methodological, metrics, results, and actor networks are analyzed in the three SIBs. Implications for projects in Brazil were considered from the analysis of these international cases.

Consensus document on chronic coronary syndrome assessment and risk stratification in Portugal: A position paper statement from the [Portuguese Society of Cardiology's] Working Groups on Nuclear Cardiology, Magnetic Resonance and Cardiac Computed Tomography, Echocardiography, and Exercise Physiology and Cardiac Rehabilitation. / Documento de Consenso sobre Estratificação de Risco Cardiovascular e estudo da doença coronária em Portugal: a posição dos Grupos de Estudo de Cardiologia Nuclear, Ressonância Magnética e Tomografia Computorizada Cardíaca, de Ecocardiografia e de Fisiopatologia do Esforço e Reabilitação Cardíaca.

Despite constant medical evolution, the reimbursement policy of Portuguese National Health Service (NHS) for the study and risk stratification of coronary heart disease has remained unchanged for several decades. Lack of adjustment to contemporary clinical practice has long been evident. However, the recent publication of the European Guidelines for diagnosis and treatment of chronic coronary syndromes further highlighted this gap and the urgent need for a change. Prompted by these Guidelines, the Working Group on Nuclear Cardiology, Cardiac Magnetic Resonance and Cardiac CT, the Working Group on Echocardiography and the Working Group on Stress Pathophysiology and Cardiac Rehabilitation of the Portuguese Society of Cardiology, began a process of joint reflection on the current limitations and how these recommendations could be applied in Portugal. To this end, the authors suggest that the new imaging methods (stress echocardiogram, cardiac computed tomography and cardiac magnetic resonance), should be added to exercise treadmill stress test and myocardial perfusion scintigraphy in the available exam portfolio within the Portuguese NHS. This change would allow full adoption of European guidelines and a better use of tests, according to clinical context, availability and local specificities. The adoption of clinical guidance standards, based on these assumptions, would translate into a qualitative improvement in the management of these patients and would promote an effective use of the available resources, with potential health and financial gains.

Running economy in recreational male and female runners with similar levels of cardiovascular fitness.

This study explored differences in running economy between well-conditioned young male and female (tested within the early follicular phase of their menstrual cycle) participants, matched for age and percent difference between predicted and actual maximum oxygen uptake (V̇o2max). Twenty-five recreational runners (13 men and 12 women), aged 19-27 yr, performed graded treadmill exercise to assess V̇o2max. Participants also performed three bouts of submaximal continuous treadmill running at 8, 10, and 12 km/h. Sex comparisons revealed lower maximal aerobic speed (MAS) and V̇o2max in women relative to men (P < 0.05). However, the percent difference from predicted V̇o2max was similar between men and women (men: 149.6 ± 18.7%, women: 150.8 ± 16.4%; P > 0.05). Absolute running economy (mL·kg-0.75·km-1) improved in transition between treadmill speeds, and this occurred similarly in both sexes. Despite this, women showed overall lower oxygen cost of running than men during treadmill locomotion at predetermined absolute and relative intensities (P < 0.05). Finally, in a small subset of participants (n = 6, 3 male and 3 female participants) with similar MAS (16 km/h), men still exhibited higher V̇o2max and gross oxygen cost of running than women (difference of ~6%, statistics not computed). The present results indicate that, in men and women with similar percent of predicted V̇o2max, running economy follows a sexually dimorphic pattern throughout a broad spectrum of treadmill speeds. Ultimately, from a motor performance perspective, our data strongly suggest that lower V̇o2max values in female recreational runners are partially compensated by lower gross oxygen cost of locomotion during submaximal running.NEW & NOTEWORTHY Our data demonstrate that, compared with that seen in men with similar percent difference from predicted maximum oxygen uptake (V̇o2max), scaled gross oxygen cost of running (in absolute and relative terms) is lower in women throughout a broad spectrum of treadmill speeds. Importantly, these findings were obtained after controlling for the effects of the menstrual cycle on running economy, and this is novel.

Contrato de gestão: O impacto da contratualização no Centro de Referência da Saúde da Mulher de Ribeirão Preto - MATER / Contract management: the impact of contracts in the Reference Centerfor Women’s Health Ribeirão Preto - Mater

Introdução: Contrato de gestão é um instrumento firmado entre o Poder Público e as Organizações Sociais de Saúde (OSS), pelo qual se transfere a gestão de serviços e equipamentos do primeiro para a execução das atividades pelo segundo. Objetivo: analisar os indicadores de desempenho do contrato entre a Secretaria Estadual de Saúde de São Paulo e a FAEPA (OSS), na administração do Centro de Referência da Saúde da Mulher de Ribeirão Preto – MATER. Metodologia: Por meio de um estudo exploratório na modalidade estudo de caso, realizou-se entrevistas com os gestores da MATER e análise de dados referentes ao número de saídas hospitalares, atendimento e cirurgias ambulatoriais, além de indicadores qualitativos dos serviços de atenção ao usuário. Resultados: Entre os contratos de gestão de 2009 e 2013 houve aumento nos valores pactuados. Entretanto, ao ajustar as metas entre Março à Dezembro de 2009 e Janeiro a Fevereiro de 2013, houve redução das saídas hospitalares, cirurgias ambulatoriais e exames radiológicos; com aumento no atendimento ambulatorial, de urgências e de exames endoscópicos. Esses resultados estão atrelados ao repasse de verbas. Conclusão: nossos dados sugerem a necessidade de uma busca ativa da real demanda da população atendida, para que haja planejamento estratégico na oferta de serviços aos usuários do Sistema Único de Saúde...

Introduction: The interaction between the Brazilian Government and Social Health Organization (SHO) has been used as an instrument to transfer services and facilities from the first to implement the activities by the second. Objective: To analyze the indicators of one contract between the Department of Health of São Paulo State and FAEPA, a SHO, in administering the Reference Center for Women’s Health at Ribeirão Preto - MATER. Methods: Using an exploratory case control study, interviews were performed with the managers of MATER. Analysis of data were performed on the number of hospital outputs, outpatient careand surgeries and qualitative indicators of care services to the user. Results: Among the management contracts of 2009 and 2013, there was an increase in money values. However, when setting goals between March to December of 2009 and January and February of 2013, there was a reduction of hospital outputs, outpatient surgeries, and imaging exams and an increased outpatient care, emergency care, and endoscopy. These results are linked to the transfer of funds from governament to SHO. Conclusion: Our data suggest a strategic planning in order to offer to the Unified Health System users their real needs...

Quantitative assessment of peptide-lipid interactions. Ubiquitous fluorescence methodologies.

Peptide-membrane interactions have been gaining increased relevance, mainly in biomedical investigation, as the potential of the natural, nature-based and synthetic peptides as new drugs or drug candidates also expands. These peptides must face the cell membrane when they interfere with or participate in intracellular processes. Additionally, several peptide drugs and drug leads actions occur at the membrane level (e.g., antimicrobial peptides, cell-penetrating peptides and enveloped viruses membrane fusion inhibitors). Here we explore fluorescence spectroscopy methods that can be used to monitor such interactions. Two main approaches are considered, centered either on the peptide or on the membrane. On the first, we consider mainly the methodologies based on the intrinsic fluorescence of the aminoacid residues tryptophan and tyrosine. Regarding membrane-centric approaches, we review methods based on lipophilic probes sensitive to membrane potentials. The use of fluorescence constitutes a simple and sensitive method to measure these events. Unraveling the molecular mechanisms that govern these interactions can unlock the key to understand specific biological processes involving natural peptides or to optimize the action of a peptide drug.