Atenção primária e informação em saúde: desempenho e financiamento no município de Natal/rn / Primary Care and Health Information: Performace and finance in the municipality Natal/RN / Atención Primaria e Información en Salud: Desempenõ y financiamiento en elmunicipio de Natal/RN

Introdução: O país adotou, com a criação do Programa Previne Brasil, uma nova forma de financiamento da Atenção Primária à Saúde, com a portaria ministerial 2.979/2019, a qual estabeleceu critérios para alocação de recursos, com foco para o desempenho e produtividade da Atenção Primária. Talmodelo vem sendo alvo de críticas pelo campo acadêmico da Saúde Coletiva e por gestões municipais, que em diferentes situações demonstram perdas financeiras, sobretudo, devido ao componente de capitação ponderada. Objetivo: Sistematizar o desempenho da Atenção Primária à Saúde do município de Natal, Rio Grande do Norte, com base em indicadores de desempenho do Sistema de Informação em Saúde para a Atenção Básica, e o financiamento da Atenção Primária, com base no Sistema de Informações sobre Orçamentos Públicos em Saúde, entre os anos 2019 a 2022. Metodologia: Trata-se de uma pesquisa descritiva-exploratória, com utilização de dados secundários e sistematização dos sete indicadores de desempenho da Atenção Primária e análise das despesas com saúdedo município de Natal. Resultados:Dos sete indicadores analisados, o município de Natal alcançou a meta em dois indicadores, referente à proporção de gestantes com pelo menos seis consultas pré-natal realizadas (46% em 2022) e com realização de exames para sífilis e HIV (67% em 2022). O município destinou à Atenção Primária, em 2022, apenas 6,33% de todas suas despesas com saúde. Destaca-se, também, que a cobertura da Atenção Primária no município é de 60%, havendo ainda um vazio assistencial para grande parte da população natalense. Conclusões:A análise de indicadores de saúde, torna-se importante ferramenta para a ação avaliativa do Sistema Único de Saúde, bem como dá suporte para a tomada de decisão por parte de gestores e equipes de saúde, além de produzir conhecimento crítico para a qualificação da Atenção Primária à Saúde (AU).

Introduction:The country adopted, with the creation of the Previne Brasil Program, a new form of financing Primary Health Care, with ministerial decree 2.979/2019, which established criteria for resource allocation, focusing on the performance and productivity of Primary Care. This model has been criticized by the academic field of Public Health and by municipal administrations, which in different situations demonstrate financial losses, mainly due to the weighted capitation component. Objective:Systematize the performance of Primary Health Care in the city of Natal, Rio Grande do Norte, based on performance indicators from the Health Information System for Primary Care, and the financing of Primary Care, based on the Information System of Public Health Budgets, between the years 2019 and 2022. Methodology:This is descriptive-exploratory research, using secondary data and systematization of the seven Primary Care performance indicators and analysis of health expenses in the city of Natal. Results: Of the seven indicators analyzed, the municipality of Natal reached the target in two indicators, referring to the proportion of pregnant women with at least six prenatal consultations carried out (46% in 2022) and with tests for syphilis and HIV (67% in 2022). In 2022, the municipality allocated only 6.33% of all its health expenses to PrimaryCare. It is also noteworthy that Primary Care coverage in the municipality is 60%, with there still being a care gap for a large part of the population of Natal. Conclusions:The analysis of health indicators becomes an important tool for the evaluative action of the Unified Health System, as well as providing support for decision-making by managers and health teams, in addition to producing critical knowledge for the qualification of Primary Health Care (AU).

Introducción: El país adoptó, con la creación del Previne Brasil, una nueva forma de financiamiento de la Atención Primaria de Salud, con el decreto ministerial 2.979/2019, que estableció criterios para la asignación de recursos, con foco en el desempeño y productividad de la Atención Primaria. Este modelo ha sido criticado por el ámbito académico de la Salud Pública y por las administraciones municipales, que en diferentes situaciones demuestran pérdidas financieras, principalmente por el componente de capitación ponderada. Objetivo: Sistematizar el desempeño de la Atención Primaria de Salud en la ciudad de Natal, Rio Grande do Norte, con base en indicadores de desempeño del Sistema de Información en Salud para la Atención Primaria, y el su financiamiento, con base en el Sistema de Información Presupuestaria Pública en Salud, entre los años 2019 y 2022. Metodología: Se trata de una investigación descriptiva-exploratoria, utilizando datos secundarios y sistematización de siete indicadores de desempeño de la Atención Básica y análisis del gasto en salud. Resultados: De los siete indicadores analizados, el municipio de Natal alcanzó la meta en dos indicadores, referidos a la proporción de gestantes con al menos seis consultas prenatales realizadas (46% en 2022) y con pruebas de sífilis y HIV (67% en 2022). En 2022, el municipio destinó sólo el 6,33% de todos sus gastos sanitarios a la Atención Primaria. También se destaca que la cobertura de Atención Primaria en el municipio es del 60%, existiendo aún brecha de atención para gran parte de la población. Conclusiones: El análisis de indicadores de salud se convierte en herramienta importante para la acción de evaluación del Sistema Único de Salud, además de brindar apoyo para la toma de decisiones de gestores y equipos de salud, además de producir conocimiento crítico para la calificación de la Atención Primaria de Salud (AU).

Growing or reproducing? Assessing the existence of a trade-off in the globose cactus Gymnocalycium monvillei.

Resource allocation in plants is a fundamental aspect of life history theory. In Cactaceae, the specific trade-off between sexual reproduction and vegetative growth has still not been studied. The aim of this work was to assess if there is a trade-off between growth and reproduction, and to analyse whether both growth and allocation to reproduction depend on size of the individual. In this study, we used Gymnocalycium monvillei, a globose cactus endemic to the mountains of central Argentina, as a model species. Specifically, we analysed the relationship of growth (percentage increase in diameter) and size of individuals (diameter) to seed production, seed mass, germination, and mean germination time. To relativize the effect of size on seed production, two variables were calculated: the ratio of seed production to plant size (RSPS), and the ratio of total seed mass to plant size (RSMS). We found that both seed production and total seed mass were significantly related to cactus size. However, growth was not related to seed mass or to seed production, even when they were relativized. Germination and mean germination time were not related to plant size or growth. In the studied species, a slow-growing globose cactus, we did not find a trade-off between growth and reproduction.

Developing a Nomogram for Prioritizing Hysteroscopy in Endometrial Cancer Diagnosis: A Case-Control Study.

(1) Background: The pandemic led to significant healthcare disruptions, resulting in postponed surgeries and extended waiting times for non-urgent treatments, including hysteroscopies essential for diagnosing endometrial cancer. This study aims to formulate a risk stratification model to enhance the prioritization of hysteroscopy procedures in Brazil; (2) Methods: A case-control study was conducted at Vila Santa Catarina Hospital in São Paulo, analyzing the medical records of 2103 women who underwent hysteroscopy between March 2019 and March 2022. We used bivariate analysis and multivariate linear regression to identify risk factors associated with endometrial cancer and formulate a nomogram; (3) Results: The findings revealed a 5.5% incidence of pre-invasive and invasive endometrial disease in the study population, with an average waiting time of 120 days for hysteroscopy procedures. The main risk factors identified were hypertension, diabetes, postmenopausal bleeding, and obesity; (4) Conclusions: This research highlights the urgent need for efficient prioritization of hysteroscopy procedures in the wake of the pandemic. The developed nomogram is an innovative tool for identifying patients at higher risk of endometrial cancer, thus facilitating timely diagnosis and treatment and improving overall patient outcomes in a strained healthcare system.

Efeitos das emendas parlamentares no financiamento municipal da atenção primária à saúde do Sistema Único de Saúde / Effects of parliamentary amendments on municipal financing of primary health care in the Brazilian Unified National Health System / Efectos de las enmiendas parlamentarias sobre el financiamiento municipal de la atención primaria de salud del Sistema Único de Salud brasileño

O objetivo deste artigo é analisar os efeitos da ampliação do repasse federal de emendas parlamentares no financiamento municipal da atenção primária à saúde (APS) do Sistema Único de Saúde (SUS), no período de 2015 a 2020. Foi realizado estudo longitudinal com dados secundários de transferências por emendas parlamentares do Ministério da Saúde e de despesas com recursos próprios dos municípios, aplicadas em ações e serviços públicos de saúde e na APS. O efeito do repasse de emendas parlamentares no financiamento municipal foi verificado de forma estratificada por porte populacional dos municípios, por meio de modelos de equações de estimativas generalizadas. O repasse de emendas parlamentares para a APS apresentou grande discrepância de valores per capita entre os municípios de diferentes portes populacionais. Observou-se inexistência de correlação com a despesa municipal em ações e serviços públicos de saúde nos municípios com mais de 10 mil habitantes e associação inversa com a despesa em APS (p < 0,050) em todos os grupos. Conclui-se que o aumento do repasse de emendas parlamentares pelo Ministério da Saúde favoreceu a redução da alocação de receitas municipais com APS, que podem ter sido direcionados para outras finalidades de gasto no SUS. Tais mudanças parecem refletir prioridades estabelecidas para a despesa orçamentária dos municípios, que repercutem sobre as condições locais para a garantia da estabilidade do financiamento da APS no Brasil.

This study aims to analyze the effects of the expansion of the federal transfer of parliamentary amendments for municipal financing of primary health care (PHC) in the Brazilian Unified National Health System (SUS), from 2015 to 2020. A longitudinal study was conducted using secondary data on transfers of parliamentary amendments from the Brazilian Ministry of Health and expenditure of municipalities' own resources on public health actions and services and PHC. The effect of the transfer of parliamentary amendments on municipal financing was verified in a stratified way by population size of the municipalities, using generalized estimating equation models. The transfer of parliamentary amendments for PHC showed a large discrepancy in per capita values among municipalities of different population sizes. No correlation with municipal spending on public health actions and services was observed in municipalities with more than 10,000 inhabitants, and the association with spending on PHC (p < 0.050) was inverse in all municipalities. Therefore, the increase in the transfer of parliamentary amendments by the Brazilian Ministry of Health favored a reduction in the allocation of municipal revenues to PHC, which may have been directed to other spending purposes in the SUS. These changes seem to represent priorities established for municipal budget expenditure, which have repercussions on local conditions for guaranteeing stable funding for PHC in Brazil.

El artículo tiene como objetivo analizar los efectos de la ampliación de la transferencia de recursos federal de enmiendas parlamentarias sobre el financiamiento municipal de la atención primaria de salud (APS) en el Sistema Único de Salud brasileño (SUS), en el período del 2015 al 2020. Se realizó un estudio longitudinal con datos secundarios de transferencias de recursos por enmiendas parlamentarias del Ministerio de Salud y de gastos con recursos propios de los municipios, aplicados a acciones y servicios públicos de salud y a la APS. El efecto de la transferencia de recursos de enmiendas parlamentarias sobre el financiamiento municipal se verificó de forma estratificada por tamaño de población de los municipios, utilizando modelos de ecuaciones de estimaciones generalizadas. La transferencia de recursos de enmiendas parlamentarias para la APS mostró una gran discrepancia en los valores per cápita entre municipios de diferente tamaño poblacional. No hubo correlación con el gasto municipal en acciones y servicios públicos de salud en aquellos con más de 10.000 habitantes y asociación inversa con el gasto en APS (p < 0,050) en todos los grupos de municipios. Se concluye que el aumento en la transferencia de recursos de enmiendas parlamentarias por parte del Ministerio de Salud favoreció la reducción de la asignación de ingresos municipales a la APS, que pueden haber sido dirigidos a otros fines de gasto en el SUS. Tales cambios parecen reflejar prioridades establecidas para el gasto presupuestario municipal, que repercuten en las condiciones locales para garantizar la estabilidad del financiamiento de la APS en Brasil.

Is it possible to estimate the number of patients with COVID-19 admitted to intensive care units and general wards using clinical and telemedicine data?

ABSTRACT Objective: To develop and validate predictive models to estimate the number of COVID-19 patients hospitalized in the intensive care units and general wards of a private not-for-profit hospital in São Paulo, Brazil. Methods: Two main models were developed. The first model calculated hospital occupation as the difference between predicted COVID-19 patient admissions, transfers between departments, and discharges, estimating admissions based on their weekly moving averages, segmented by general wards and intensive care units. Patient discharge predictions were based on a length of stay predictive model, assessing the clinical characteristics of patients hospitalized with COVID-19, including age group and usage of mechanical ventilation devices. The second model estimated hospital occupation based on the correlation with the number of telemedicine visits by patients diagnosed with COVID-19, utilizing correlational analysis to define the lag that maximized the correlation between the studied series. Both models were monitored for 365 days, from May 20th, 2021, to May 20th, 2022. Results: The first model predicted the number of hospitalized patients by department within an interval of up to 14 days. The second model estimated the total number of hospitalized patients for the following 8 days, considering calls attended by Hospital Israelita Albert Einstein's telemedicine department. Considering the average daily predicted values for the intensive care unit and general ward across a forecast horizon of 8 days, as limited by the second model, the first and second models obtained R² values of 0.900 and 0.996, respectively and mean absolute errors of 8.885 and 2.524 beds, respectively. The performances of both models were monitored using the mean error, mean absolute error, and root mean squared error as a function of the forecast horizon in days. Conclusion: The model based on telemedicine use was the most accurate in the current analysis and was used to estimate COVID-19 hospital occupancy 8 days in advance, validating predictions of this nature in similar clinical contexts. The results encourage the expansion of this method to other pathologies, aiming to guarantee the standards of hospital care and conscious consumption of resources.

Where do we invest money to implement active learning on caries detection? An economic evaluation

Abstract This trial-based economic evaluation aimed to estimate the incremental cost of implementing an active learning strategy (theoretical-practical workshop) to substitute the didactic lecture as the sole method for students training in caries detection. We also provided a budget impact analysis and explored the composition of costs related to the activity. Data from the coordinating centre of a multicentre randomized and controlled study (IuSTC01) was analyzed as the first part of our main economic analysis plan. The perspective of the educational provider (the institution implementing the activity) was considered, and an immediate time horizon was adopted. All used resources were valued in Brazilian Real by adopting a microcosting strategy. Costs for each strategy were estimated and converted into international dollars. The incremental Cost per student and the total cost of implementing the complete teaching strategy for 80 students were calculated. Monte Carlo simulations were used to estimate the uncertainties. The incremental Cost estimated for the workshop implementation would be $7.93 per student (interquartile range (IQR): $7.8-8.1), and the total cost of the teaching activity would be $684 (IQR:672-696). The laboratory training comprised more than 50% of the total amount spent, and a higher percentage of this value was related to human resources costs (72%). Saving 40% of the costs could be expected for the next rounds of activities in the institution, assuming no need for additional preparation of didactic materials and tutor training. A modest incremental cost per student and an acceptable organizational budget impact should be expected for the institution when including active learning training in caries detection for undergraduate students, mainly related to the human resources involved.

Influence of phylogenetic diversity of plant communities on tri-trophic interactions.

Phylogenetic diversity of plant communities can influence the interaction between plants, herbivores, and their natural enemies. Plant communities with phylogenetically distant species tend to present a wide variety of functional traits and ecological niches, which in turn can influence competitive interactions among plants as well as food and habitat quality for herbivores and their natural enemies. To assess some different mechanisms by which phylogenetic diversity of plant communities can influence herbivores and their natural enemies, we established 12 experimental plots of tropical trees with two treatments: high and low phylogenetic diversity. We measured plant growth and anti-herbivore defenses, herbivore foliar damage, and predator activity in seven species that were present in both treatments. We found significant differences in the expression of plant traits as a function of species identity and their life history, but also depending on the phylogenetic context in which they grew. Pioneer species had higher growth and produced more phenolics in plots with high phylogenetic diversity versus plants in plots with low phylogenetic diversity. Accordingly, herbivore damage in these species was greater in plots with low phylogenetic diversity. Finally, predator activity on caterpillar clay models placed on plants was greater within the low phylogenetic diversity treatment, but only for non-myrmecophytic species. These results suggest that plant phylogenetic diversity can influence the expression of growth and defensive traits and further modify the interaction between plants, herbivores, and their natural enemies. However, such effects depend on plant life history and the presence of mutualistic interaction with ants.

Collateral damage: has the COVID-19 pandemic more strongly impacted medical research than other scientific areas?

The principle of resource allocation states that diversion of resources to attend a function may compromise others. The COVID-19 pandemic required a rapid response with a justifiable relocation of equipment, funds and human resources. Based on the ecological principle of allocation, we tested whether the relocation of resources to support COVID-19 research was more detrimental to medical research than to research in other scientific areas. We compared the yearly number of published articles from 2015 to 2021 using disease-related keywords and non-medical scientific keywords. Contrary to the expectation, we found an abrupt reduction in the publication rates in all research areas from 2019 to 2020 or 2021, compared to the pre-pandemic period (2015-2019). The allocation effect on medical research may be overshadowed by stronger effects of the pandemic, or it may become evident in the coming years. The drastic reduction in published papers could have negative consequences for scientific advancements, including understanding and curing diseases other than COVID-19 that strongly affect humanity.

A Comprehensive Survey on Resource Allocation Strategies in Fog/Cloud Environments.

The growing number of connected objects has allowed the development of new applications in different areas. In addition, the technologies that support these applications, such as cloud and fog computing, face challenges in providing the necessary resources to process information for different applications due to the highly dynamic nature of these networks and the many heterogeneous devices involved. This article reviews the existing literature on one of these challenges: resource allocation in the fog-cloud continuum, including approaches that consider different strategies and network characteristics. We also discuss the factors influencing resource allocation decisions, such as energy consumption, latency, monetary cost, or network usage. Finally, we identify the open research challenges and highlight potential future directions. This survey article aims to serve as a valuable reference for researchers and practitioners interested in the field of edge computing and resource allocation.

An analysis of student numbers per class and educational performance in the Brazilian context.

The relationship between class size and school performance has always been ambiguous and the current literature has found no direct connection between them, especially in the Brazilian context. Therefore, this study aimed to verify whether the number of students per class influences school performance. We used Microdata from the Prova Brazil of 2017. Using the propensity score matching statistical model, with the nearest neighbor matching estimator, we grouped the classes into clusters by similarity. The metric used to group the clusters was the Euclidean distance. We attempted to verify adherence to the normal distribution of data using the Kolmogorov Smirnov test and tested the null hypothesis of the medians using the Wilcoxon test. All the statistical analysis were performed using SPSS Statistic version 20. The results showed that the number of students per class has little influence on performance and, when the influence exists, larger classes perform better.

Pollen production per flower increases with floral display size across animal-pollinated flowering plants.

PREMISE: The number of open flowers on a plant (i.e., floral display size) can influence plant fitness by increasing pollinator attraction. However, diminishing marginal fitness returns with increasing floral display are expected as pollinators tend to visit more flowers per plant consecutively. An extended flower visitation sequence increases the fraction of ovules disabled by self-pollination (ovule discounting) and reduces the fraction of a plant's own pollen that is exported to sire seeds in other plants (pollen discounting). Hermaphroditic species with a genetic system that prevents self-fertilization (self-incompatibility) would avoid ovule discounting and its fitness cost, whereas species without such a genetically based barrier would not. Contrarily, pollen discounting would be an unavoidable consequence of a large floral display irrespective of selfing barriers. Nevertheless, the increasing fitness costs of ovule and pollen discounting could be offset by respectively increasing ovule and pollen production per flower. METHODS: We compiled data on floral display size and pollen and ovule production per flower for 1241 animal-pollinated, hermaphroditic angiosperm species, including data on the compatibility system for 779 species. We used phylogenetic general linear mixed models to assess the relations of pollen and ovule production to floral display size. RESULTS: Our findings provide evidence of increasing pollen production, but not of ovule production, with increasing display size irrespective of compatibility system and even after accounting for potentially confounding effects like flower size and growth form. CONCLUSIONS: Our comparative study supports the pollen-discount expectation of an adaptive link between per-flower pollen production and floral display across animal-pollinated angiosperms.

Hospitalized COVID-19 patients with diabetes have an increased risk for pneumonia, intensive care unit requirement, intubation, and death: A cross-sectional cohort study in Mexico in 2020.

Background: Diabetes mellitus is a chronic health condition that has been linked with an increased risk of severe illness and mortality from COVID-19. In Mexico, the impact of diabetes on COVID-19 outcomes in hospitalized patients has not been fully quantified. Understanding the increased risk posed by diabetes in this patient population can help healthcare providers better allocate resources and improve patient outcomes. Objective: The objective of this study was to quantify the extent outcomes (pneumonia, intensive care unit [ICU] stay, intubation, and death) are worsened in diabetic patients with COVID-19. Methods: Between April 14, 2020 and December 20, 2020 (last accessed), data from the open-source COVID-19 database maintained by the Mexican Federal Government were examined. Utilizing hospitalized COVID-19 patients with complete outcome data, a retrospective cohort study (N = 402,388) was carried out. In relation to COVID-19, both univariate and multivariate logistic regression were used to investigate the effect of diabetes on specific outcomes. Results: The analysis included 402,388 adults (age >18) with confirmed hospitalized COVID-19 cases with mean age 46.16 (standard deviation = 15.55), 214,161 (53%) male. The outcomes delineated included pneumonia (N = 88,064; 22%), ICU requirement (N = 23,670; 6%), intubation (N = 23,670; 6%), and death (N = 55,356; 14%). After controlling for confounding variables diabetes continued to be an independent risk factor for both pneumonia (odds ratio [OR]: 1.8, confidence interval [CI]: 1.76-1.84, p < 0.01), ICU requirement (OR: 1.09, CI: 1.04-1.14, p < 0.01), intubation (OR: 1.07, CI: 1.04-1.11, p < 0.01), and death (OR: 1.88, CI: 1.84-1.93, p < 0.01) in COVID-19 patients. Conclusions: According to the study, all outcomes (pneumonia, ICU requirement, intubation, and death) were greater among hospitalized individuals with diabetes and COVID-19. Additional study is required to acquire a better understanding of how diabetes affects COVID-19 outcomes and to develop practical mitigation techniques for the risk of severe sickness and complications in this particular patient population.

Maximizing Resource Efficiency in Wireless Networks through Virtualization and Opportunistic Channel Allocation.

Wireless cellular networks have become increasingly important in providing data access to cellular users via a grid of cells. Many applications are considered to read data from smart meters for potable water, gas, or electricity. This paper proposes a novel algorithm to assign paired channels for intelligent metering through wireless connectivity, which is particularly relevant due to the commercial advantages that a virtual operator currently provides. The algorithm considers the behavior of secondary spectrum channels assigned to smart metering in a cellular network. It explores spectrum reuse in a virtual mobile operator to optimize dynamic channel assignment. The proposed algorithm exploits the white holes in the cognitive radio spectrum and considers the coexistence of different uplink channels, resulting in improved efficiency and reliability for smart metering. The work also defines the average user transmission throughput and total smart meter cell throughput as metrics to measure performance, providing insights into the effects of the chosen values on the overall performance of the proposed algorithm.

Provisão de recursos de saúde nas regiões intermediárias do Brasil, 2018 / Provision of health resources in the intermediate regions of Brazil, 2018

Resumo Introdução: A pandemia de COVID-19 exigiu a ampliação da capacidade dos serviços de saúde nos estados e municípios do Brasil. Este estudo analisou a distribuição geográfica da provisão de recursos de saúde no país no período que antecede essa crise sanitária. Objetivo: Descrever a provisão de recursos de saúde segundo o índice de desenvolvimento humano (IDH) das 133 regiões geográficas intermediárias do Brasil, em 2018. Método: Dados sobre cobertura populacional da Estratégia Saúde da Família, número de consultas ambulatoriais e hospitalizações, investimento público em saúde, leitos hospitalares, leitos mantidos pelo SUS, leitos de UTI e leitos de UTI mantidos pelo SUS foram obtidos junto ao Ministério da Saúde e IBGE. A associação das variáveis com o IDH das regiões intermediárias foi avaliada pela correlação de Pearson. Resultados: A provisão de recursos de saúde foi mais elevada nas regiões intermediárias do Sul e Sudeste, enquanto as regiões do Centro-Oeste tiveram valores intermediários. O IDH correlacionou positivamente com os recursos em saúde. O inverso ocorreu para a cobertura da Estratégia Saúde da Família, que foi maior nas regiões Norte e Nordeste. Conclusões: Monitorar geograficamente a provisão de recursos de saúde pode instruir estratégias para reduzir desigualdades no país. Em 2018, as regiões intermediárias estavam desigualmente preparadas para atender às necessidades em saúde de suas populações e refletiam a lei do cuidado inverso. Foi este o cenário de partida para a resposta à pandemia por COVID-19 em 2020.

Abstract Introduction: The COVID-19 pandemic required expanding the health services capacity in Brazilian states and municipalities. This study analyzed the geographic distribution of the health resources provision in the country in the period before the pandemic. Objective: This study aimed to describe the availability of health resources in the 133 intermediate geographic regions of Brazil in 2018 according to the human development index (HDI). Method: Data on population coverage of the family health strategy, number of outpatient consults and hospitalizations, public investment in health, total number of hospital beds, beds maintained by SUS, intensive care unit (ICU) beds, and ICU beds maintained by SUS were obtained from the Ministry of Health and IBGE. the association of variables with the HDI of the intermediate regions was assessed using Pearson's correlation. Results: The indices of health resources had higher average values for the South and Southeast regions, whereas the Central West ranked intermediate values. The HDI correlated positively with health resources. The coverage by family health strategy had an inverse distribution and was higher in the North and Northeast regions. Conclusions: Monitoring the health system at the intermediate region level can be a useful strategy to promote access and reduce health inequalities in Brazil. In 2018, the intermediate regions were unevenly prepared to meet their populations' health needs and reflected the inverse care law. This scenario was the starting point for the response to the COVID-19 pandemic in 2020.

Judicialization and right to health in Brazil: a trajectory of matches and mismatches / Judicialização e direito à saúde no Brasil: uma trajetória de encontros e desencontros

ABSTRACT This study discusses the impacts of judicialization on the guarantee of the right to health in Brazil and the need to reassess the role of the Judicial system in its protection. We used evidence from the technical-scientific literature and information on the budgetary-financial execution and the acquisition of medicines from the Brazilian Ministry of Health to substantiate the arguments. In 2019, lawsuits consumed 25.2% of the resources of the Specialized Component of Pharmaceutical Care, 21% for 10 medicines. Although the Judicial promotes this right when the State fails to ensure access to medicines incorporated into the Brazilian Unified Health System (SUS), this system compromises access to medicines of the population with the determinations of acquisition of non-incorporated products. The Judicial needs to guide its control over compliance with constitutional and legal precepts in public policies, especially in fiscal policy, given its impact on the financing of the SUS.

RESUMO Neste texto, discutem-se os impactos da judicialização na garantia do direito à saúde no Brasil e a necessidade de reavaliação do papel do Judiciário na sua proteção. Evidências da literatura técnico-científica e informações sobre a execução orçamentário-financeira e a aquisição de medicamentos do Ministério da Saúde foram utilizadas para fundamentar os argumentos. Mostra-se que, em 2019, as ações judiciais consumiram 25,2% dos recursos do Componente Especializado da Assistência Farmacêutica, sendo 21% para 10 medicamentos. Argumenta-se que, embora o Judiciário promova esse direito quando o Estado falha em assegurar o acesso a medicamentos incorporados ao Sistema Único de Saúde (SUS), ele compromete o acesso a medicamentos da população com as determinações de aquisição de produtos não incorporados. Defende-se a necessidade de o Judiciário pautar seu controle sobre a observância dos preceitos constitucionais e legais nas políticas públicas, especialmente na política fiscal, dado seu impacto sobre o financiamento do SUS.

Eficiencia del sistema de salud chileno: análisis comparativo entre los servicios de salud / Efficiency of the Chilean health system: comparative analysis between health services

BACKGROUND: The assessment of health systems efficiency determines how they use their supplies to produce results of health value. Aim: To determine the efficiency of the health services in Chile, managing their budget to improve the health of the population in 2016. MATERIAL AND METHODS: Data envelopment analysis (DEA) was used. The relationship or efficiency with external factors was determined ussing a multivariate analysis. As an input, the operating expense accrued per member of the public health system (National Health Fund, FONASA) was obtained. The years of life potentially lost were used as output. RESULTS: The health services of Chile had an efficiency of 68.8% for constant return and 81.3% for variable return. Sixteen percent of their inefficiency was related to the size of the health service. The most efficient health service was the Metropolitano Sur-Oriente and the least efficient was the Araucanía Norte. Urban health services had more uniform and higher efficiency than their rural counterparts. The external factors that were associated with a greater efficiency were having lower proportion of rural population, a lower proportion of beneficiaries of the National Health Fund (FONASA), fewer hospital discharges, fewer hospital beds, less poverty calculated by income, and a higher access to drinking water. Conclusions: Numerous factors influence the efficiency of the Chilean health system and delving into them would allow a better use of public resources for the benefit of the population.

QoS-Aware Resource Allocation with Pilot-Aided Channel Estimation for Heterogeneous Wireless Networks.

The deployment of heterogeneous networks (HetNets) is a way to increase the network capacity and release part of the traffic generated by users inside a cell to small-scale wireless networks for service. In this context, the main problem is managing the interference due to the coexistence of small cells and macro cells. In this paper, a QoS-aware Resource Allocation (RA) algorithm jointly working with admission control (AC) over a two-tier HetNet scenario is investigated in the presence of both the pilot-symbols for channel estimation and the channel estimation error. The RA algorithm allows two users, the macro cell user (CU) and small cell user (SU), to simultaneously share the same resource block. Moreover, system performance and fairness are improved by including adaptive power allocation to users over resource blocks. In the framework of RA with proportional rate constraints, a novel algorithm is designed by including the effects of pilot-aided channel estimation. The algorithm is able to distribute the same proportional rate to all CUs and SUs, even in the presence of channel estimation error. Relevant numerical results for the downlink of a two-tier HetNet with pilot-aided channel estimation show that the rate dispersion is driven to zero while the sum-rate is maximized, and the average user rate penalty with respect to a perfect-CSI scenario may rise to 20%.

Deep Reinforcement Learning for Resource Management on Network Slicing: A Survey.

Network Slicing and Deep Reinforcement Learning (DRL) are vital enablers for achieving 5G and 6G networks. A 5G/6G network can comprise various network slices from unique or multiple tenants. Network providers need to perform intelligent and efficient resource management to offer slices that meet the quality of service and quality of experience requirements of 5G/6G use cases. Resource management is far from being a straightforward task. This task demands complex and dynamic mechanisms to control admission and allocate, schedule, and orchestrate resources. Intelligent and effective resource management needs to predict the services' demand coming from tenants (each tenant with multiple network slice requests) and achieve autonomous behavior of slices. This paper identifies the relevant phases for resource management in network slicing and analyzes approaches using reinforcement learning (RL) and DRL algorithms for realizing each phase autonomously. We analyze the approaches according to the optimization objective, the network focus (core, radio access, edge, and end-to-end network), the space of states, the space of actions, the algorithms, the structure of deep neural networks, the exploration-exploitation method, and the use cases (or vertical applications). We also provide research directions related to RL/DRL-based network slice resource management.

Uso de beca estatal de alimentación para estudiantes universitarios según factores sociológicos / Influence of sociological factors on the use of a state scholarship to feed Chilean university students / Influência de fatores sociológicos no uso de uma bolsa estadual para alimentar estudantes universitários chilenos

Resumen (analítico) Conocer la influencia de factores sociodemográficos en el uso de la beca de alimentación Junaeb Baes, que otorga el Gobierno chileno a estudiantes universitarios con menores ingresos, es necesario para aumentar el beneficio social de este programa estatal. Se consideraron las variables género, modo de residencia, carrera y curso, etnia y posición socioeconómica. Se aplicó una encuesta a 114 estudiantes universitarios chilenos. Los resultados muestran que la posición socioeconómica y el modo de residencia son los factores sociodemográficos más influyentes en el uso de la beca Baes. La variable género no arrojó diferencias estadísticamente significativas. Se concluye que es posible aumentar el porcentaje de gasto en alimentos saludables si se consideran factores sociológicos en el estudio y diseño de políticas de uso de la beca Baes.

Abstract (analytical) Knowing the influence of sociodemographic factors in the use of the Junaeb Baes food benefit granted by the Chilean Government to low-income university students is necessary to increase the social benefit of this state program. The variables gender, mode of residence, major and year, ethnicity and socioeconomic position were considered. A survey was applied to 114 Chilean university students. The results show that socioeconomic position and mode of residence are the most influential socio-demographic factors in the use of the Baes benefit. The gender variable did not show statistically significant differences. It is concluded that it is possible to increase the percentage of spending on healthy foods if sociological factors are considered in the study and design of policies for the use of the Baes grant.

Resumo (analítico) Conhecer a influência de fatores sociodemográficos na utilização da bolsa de alimentação Junaeb Baes concedida pelo Governo do Chile a universitários de menor renda é necessário para aumentar o benefício social deste programa estadual. Foram consideradas as variáveis sexo, modo de residência, carreira e curso, etnia e posição socioeconômica. Uma pesquisa foi aplicada a 114 estudantes universitários chilenos. Os resultados mostram que a posição socioeconômica e o modo de residência são os fatores sociodemográficos mais influentes no uso da bolsa Baes. A variável sexo não apresentou diferenças estatisticamente significantes. Conclui-se que é possível aumentar o percentual de gastos com alimentos saudáveis se fatores sociológicos forem considerados no estudo e desenho de políticas para o uso da bolsa Baes.

Evidence-Informed Update of Argentina's Health Benefit Package: Application of a Rapid Review Methodology.

OBJECTIVES: Argentina has a fragmented healthcare system with social security covering almost two thirds of the population. Its benefit package-called compulsory medical program (PMO; by its Spanish acronym Programa Médico Obligatorio)-has not been formally and widely updated since 2005. However, laws, clinical practice guidelines (CPGs), and a high-cost technology reimbursement fund complement it. Our objective was to comprehensively review such a PMO and propose an update considering the corresponding complementary sources. METHODS: We followed four steps: (i) identification of health technologies from the current PMO and complementary sources, (ii) prioritization, (iii) assessment through rapid health technology assessment (HTA), and (iv) appraisal and recommendations. We evaluated three value domains: quality of evidence, net benefit, and economics, which were summarized in a five-category recommendation traffic-light scale ranging from a strong recommendation in favor of inclusion to a strong recommendation for exclusion. RESULTS: Eight hundred fifty technologies were identified; 164 of those, considered as high priority, were assessed through rapid HTAs. Those technologies mentioned in laws and CPGs were mostly outpatient essential medicines, whereas those from the reimbursement system were mostly high-cost drugs; of these 101 technologies, 50 percent were recommended to be kept in the PMO. The other 63 (identified by the Superintendence of Health Services, technology producers, and patients) were mostly medical procedures and high-cost drugs; only 25 percent of those resulted in a favorable recommendation. CONCLUSIONS: A methodology based on four clearly identified steps was used to carry out a comprehensive review of an outdated and fragmented benefit package. The use of rapid HTAs and a traffic-light recommendation framework facilitated the deliberative evidence-based update.