ABSTRACT The objective of this article is to analyze legal crossroads regarding the interpretation of the prescription established in literal d of article 83 of Decree-Law 2811 of 1974which prohibits the allocation of vacant lands within water circuits. For 50 years, the prohibition of appropriation of vacant lands has been in force in the ordinance when they are located within the strips of land known as water rings; however, in rural lands, due to the lack of a monitoring and protection policy. of water resources, this figure has had little effectiveness. Due to the updating of water resource management policies and the promotion of comprehensive rural reform, the regulation and application of the standard has gained notoriety: the environmental authorities and the land authority have expanded their intervention strategies to limit these areas. However, it is necessary to review the foundations of the prohibition of allocating vacant land in such of areas and overcome the interpretations made by some authorities that hinder the effective recognition of rights to peasants who have historically inhabited the banks of rivers and lakes and whose Participation in territorial management and adaptation to climate change can be a key piece in environmental and social reconciliation processes.

RESUMO O objetivo deste artigo é analisar a encruzilhada jurídica sobre a interpretação da prescrição estabelecida no artigo 83, "d", do Decreto-Lei 2.811 de 1974, que proíbe a adjudicação de terras não cultivadas próximas das margens de rios. Há 50 anos, a proibição de apropriação de terras não cultivadas vigora no ordenamento jurídico quando localizadas dentro das faixas de terra conhecidas como "beiras/margens/ entorno hídrico", porém, em terras rurais, devido à falta de uma política de monitoramento e proteção dos recursos hídricos, essa figura tem tido pouca eficácia. Em virtude da atualização das políticas de gestão de recursos hídricos e da promoção da reforma rural integral, a regulamentação e a aplicação da referida norma ganharam notoriedade: as autoridades ambientais e a autoridade fundiária ampliaram sua estratégia de intervenção para delimitar essas faixas. No entanto, é necessário revisar a base da proibição da adjudicação de terras devolutas nesse tipo de zonas e superar as interpretações feitas por algumas autoridades que impedem o reconhecimento efetivo dos direitos dos camponeses que historicamente habitaram as margens de rios e lagos e cuja participação na gestão territorial e na adaptação às mudanças climáticas pode ser um elemento-chave nos processos de reconciliação ambiental e social.

RESUMEN El objetivo de este articulo es analizar las encrucijadas jurídicas respecto de la interpretación de la prescripción establecida en el literal d del articulo 83 del Decreto Ley 2811 de 1974, que establece la prohibición de adjudicación de tierras baldías al interior de las rondas hídricas. Desde hace 50 años en el ordenamiento se encuentra vigente la prohibición de apropiación de terrenos baldíos cuando estuvieren localizados dentro de las fajas de terreno conocidas como rondas hídricas, sin embargo, en las tierras rurales por la falta de una política de monitoreo y protección del recurso hídrico, esta figura ha tenido poca efectividad. Debido a la actualización de las políticas de gestión del recurso hídrico y el impulso de la reforma rural integral, ha adquirido notoriedad la reglamentación y aplicación de la referida norma: las autoridades ambientales y la autoridad de tierras han ampliado su estrategia de intervención para acotar dichas fajas. Sin embargo, resulta necesario revisar los fundamentos de la prohibición de adjudicación de baldíos en esta clase de zonas y superar las interpretaciones que han realizado algunas autoridades que obstaculizan el reconocimiento efectivo de derechos a campesinos que históricamente han habitado las riberas de ríos y lagos, y cuya participación en la gestión del territorial y adaptación al cambio climático puede ser una pieza clave en los procesos de reconciliación ambiental y social.

INTRODUCTION: The aim of this scoping review was to explore whether clear guidelines for the practice of occupational therapists in psychiatric day hospitals exist, both locally and globally. METHODOLOGY: Searches were conducted in January 2024; 38 articles were screened and 22 were identified for data extraction. Articles were imported onto Covidence software. Data charting was done, and data were exported into a Microsoft Excel sheet, where content analysis was performed based on the review's objectives. Synthesis of the results was done through discussion and reported according to the PRISMA for Scoping Reviews guidelines. RESULTS: Thirty-eight articles were included but only 22 were relevant. Group therapy, individualised therapy, vocational and community workshops were identified as common modes of intervention in psychiatric day hospitals. Occupation-based activities are integral to intervention. However, there was no explicit definition regarding the role of occupational therapy and practice guidelines for psychiatric day hospitals. CONCLUSION: The general scope of occupational therapy remains the same for overnight hospitals, day hospitals and community-based centres. It is mainly occupation-centred, function-orientated, and patient-centred. However, there remains ambiguity on specific practice principles and guidelines that clearly define the role of occupational therapists in day hospitals. There is a need for occupational therapy practice guidelines specific for psychiatric day hospitals. IMPLICATIONS FOR PRACTICE • The study provides valuable insights into the current knowledge and availability regarding the role and scope of practice for occupational therapy in the rapidly expanding psychiatric day hospital setting, emphasising areas for further development. • Tangible evidence was identified on therapeutic principles, practice approaches, program content, and guidance for resource allocation in psychiatric day hospitals, which can be translated into practical guidelines. • Ultimately, the results inform occupational therapy service delivery, solidify the profession's role in psychiatric care, and contribute towards National Health Insurance (NHI) policy development.

Abstract: This research aims to analyze the configuration, distribution, and equity of nursing human resources in Sichuan Province, China, providing a reference for the future development of nursing care in the region. A descriptive analysis was conducted to describe the configuration of nursing human resources in 2010, 2015, and 2020. The Lorenz curve, Gini coefficient, health resource density index, and distribution density maps were used as resources and methodology to evaluate the changes and equity in the configuration of nursing human resources. The result of this research determined that the nurse-to-population ratio was 1.17, 2.09, and 3.42 in 2010, 2015, and 2020, and nursing staff accounted for 24%, 49%, and 35% of technical health personnel. The nurse-to-physician ratio was 1:0.72, 1:1.05, and 1:1.22 in the three years. The Gini coefficients of nursing resource allocation for permanent population and area were 0.24, 0.20, and 0.12 and 0.74, 0.72, and 0.72, respectively. The nursing resource density index was 0.50, 0.91, and 1.42, respectively. In conclusion, the study shows that the equity of nursing resources based on population increased, while the equity based on region still showed disparity, with a sustained increase in nursing human resource density from 2010 to 2020. However, it is necessary to continue increasing the number of nurses and improving the geographical accessibility of nursing care.

Resumen: Esta investigación tiene como objetivo analizar la configuración, distribución y equidad de los recursos humanos de enfermería en la provincia de Sichuan, China, proporcionando una referencia para el desarrollo futuro de la atención de enfermería en la región. Se realizó un análisis descriptivo para detallar la configuración de los recursos humanos de enfermería durante 2010, 2015 y 2020. Para evaluar los cambios y la equidad en la configuración de los recursos humanos de enfermería se utilizó como recurso metodológico la curva de Lorenz, el coeficiente de Gini, el índice de densidad de recursos de salud y los mapas de densidad de distribución. El resultado de esta investigación determinó que la relación enfermera-población fue de 1,17, 2,09 y 3,42 en 2010, 2015 y 2020, y el personal de enfermería representó el 24%, 49% y 35% del personal técnico de salud. La relación enfermera-médico fue de 1:0,72, 1:1,05 y 1:1,22 en los tres años. Los coeficientes de Gini de asignación de recursos de enfermería para población permanente y área fueron 0,24, 0,20 y 0,12 y 0,74, 0,72 y 0,72, respectivamente. El índice de densidad de recursos de enfermería fue 0,50, 0,91 y 1,42, respectivamente. En conclusión, el estudio muestra que la equidad de los recursos de enfermería en función de la población aumentó, mientras que la equidad en función de la región mostró disparidad, con un aumento sostenido en la densidad de recursos humanos de enfermería desde 2010 a 2020. Sin embargo, es necesario seguir aumentando el número de enfermeras y mejorando la accesibilidad geográfica de la atención de enfermería.

Resumo: Objetivos: Analisar a configuração, distribuição e equidade de recursos humanos de enfermagem na Província de Sichuan, China, fornecendo uma referência para o futuro desenvolvimento de cuidados de enfermagem na região. Materiais e Métodos: Foi realizada uma análise descritiva da situação atual de configuração de recursos humanos de enfermagem na Província de Sichuan em 2010, 2015 e 2020. Curva Lorenz, coeficiente Gini, índice de densidade de recursos de saúde e mapas de densidade da distribuição foram utilizados para avaliar as mudanças e equidade na configuração de recursos humanos de enfermagem. Resultados: A proporção enfermeiro-população foi 1,17, 2,09 e 3,42 em 2010, 2015 e 2020, respectivamente, com a equipe de enfermagem representando 24%, 49% e 35% do pessoal técnico de cuidados à saúde. A proporção enfermeiromédico foi 1:0,72, 1:1,05 e 1:1,22 nos três anos, respectivamente. Os coeficientes de alocação de recursos de enfermagem para a população permanente e área foram 0,24, 0,20 e 0,12 e 0,74, 0,72 e 0,72, respectivamente. O índice de densidade de recursos de enfermagem foi 0,50, 0,91 e 1,42, respectivamente. Conclusão: O estudo mostra que a equidade de recursos de enfermagem com base na população aumentou enquanto a equidade com base na região ainda apresentava disparidade, com um contínuo aumento na densidade de recursos humanos de enfermagem ao longo dos anos de 2010 a 2020. Todavia, há necessidade de continuar aumentando o número de enfermeiros e melhorar a acessibilidade a cuidados de enfermagem.

SIGNIFICANCE: A census provides a snapshot of a population at a point in time. In addition to describing the basic demographic and socio-economic characteristics of a population, census data provide denominators for estimating rates; inform resource allocation and policy, development and infrastructural investment; and are used to define sampling frames for other national inquiries. Although the 2022 South African census attempted to correct for a national undercount of over 30%, it was not entirely successful. We identify a number of concerns with the estimates released, which suggest that the data may not be fit for purpose.

BACKGROUND. Traumatic brain injury (TBI) can result in significant morbidity and mortality if not diagnosed in a timely manner. Brain computed tomography (CT) is the diagnostic gold standard but is of limited availability in most South African public hospitals, resulting in transfer of TBI patients to tertiary hospitals. OBJECTIVE. To describe the referral patterns and outcomes of patients with TBI referred to Groote Schuur Hospital Trauma Centre. METHODS. This was a retrospective audit of all patients admitted to the Trauma Centre who had a brain CT scan for suspected TBI between 1 February 2022 and 31 March 2022. Demographic data (age, sex), mechanism of injury and Glasgow Coma Score were recorded. Referral pathways were determined, and final disposition of patients was recorded. RESULTS. A total of 522 patients had a brain CT for TBI. Of these, 314 (60.1%) were referred from other hospitals. CT scan was abnormal in 178 (34.1%) patients. Three hundred and two (58.6%) were discharged home within 24 hours. The mean time between referral and CT scan was 13 hours. CONCLUSION. More than half of patients referred for a CT scan were discharged from the Trauma Centre within 24 hours of admission, which indicates. additional costs and inefficiencies in the health system. These data are useful to guide resource planning and allocation for district hospitals, since less expensive point-of-care modalities now exist to diagnose TBI, and which are useful in indicating the prognosis of patients.

ABSTRACT Introduction. In Peru, public budget laws define the level and initial distribution of the health budget. Objective. To analyze the evolution of the level and initial distribution of the health budget in Peru in the period 2019-2024. Methods. Descriptive study. The budget of the Health function was analyzed by budget categories, budget programs, levels of government and departments, from 2019 to 2024, according to data from the Ministry of Economy and Finance. Results. Between 2019 and 2024, the budget for the Health function increased by 35%; while its share in the budget of the General Government increased from 10.8% to 12.2%, respectively. Also, the participation of budgetary programs in the budget decreased; while participation of Regional Governments increased. Between 2019 and 2024, budget programs related to mental health, cancer and emergency and emergency medical care saw a progressive and significant increase in their budget; in contrast, budget programs related to non-communicable diseases, metaxians and zoonoses and tuberculosis-HIV/AIDS had a lower budget than in 2019. Also, 50% of the budget of the Health function was concentrated in 2 or 3 departments, mainly in Lima. Conclusions. There was a general increase in the health budget, although its evolution was irregular. This increase favored actions not linked to results, as well as regional governments. Some budget programs actually lost resources. Few departments concentrated much of the budget.

RESUMEN Introducción. En el Perú, las leyes de presupuesto público definen el nivel y la distribución inicial del presupuesto para la salud. Objetivo. Analizar la evolución del nivel y distribución inicial del presupuesto para la salud en el Perú en el periodo 2019-2024. Métodos. Estudio descriptivo. Se analizó el presupuesto de la función Salud, por categorías presupuestarias, programas presupuestales, niveles de gobierno y departamentos del periodo 2019-2024, según datos del Ministerio de Economía y Finanzas. Resultados. Entre 2019 y 2024, el presupuesto para la función Salud aumentó en 35%; mientras que su participación en el presupuesto del gobierno general aumentó de 10,8% a 12,2%, respectivamente. Asimismo, disminuyó la participación de programas presupuestales y aumentó la participación de gobiernos regionales. Entre 2019 y 2024, los programas presupuestales relacionados a salud mental, cáncer y atención de emergencias y urgencias médicas tuvieron un aumento progresivo e importante en su presupuesto; en contraste, los programas presupuestales relacionados a enfermedades no transmisibles, metaxénicas y zoonosis y tuberculosis-VIH/SIDA tuvieron un presupuesto menor al del 2019. Asimismo, el 50% del presupuesto de la función Salud se concentró en 2 o 3 departamentos, principalmente en Lima. Conclusiones. Hubo un aumento general del presupuesto para salud, aunque su evolución fue irregular. Dicho aumento favoreció a las acciones no vinculadas a resultados, así como a los gobiernos regionales. Algunos programas presupuestales tuvieron una pérdida efectiva de recursos. Pocos departamentos concentraron gran parte del presupuesto.

ABSTRACT Introduction. The lack of research in Health Administration and Management (AyGS) training, along with the need to improve residency programs, motivated this study. Objective. We described the availability of offered positions and curriculum plans for AyGS residency programs in Peru. Methods. Descriptive observational study. We reviewed the number of positions offered and awarded between 2013 and 2022 on the National Medical Residency Council (CONAREME) website. Additionally, we analyzed curriculum plans updated to 2022, identifying minimum achievements per academic year and comparing them with CONAREME standards. Results. Between 2013 and 2022, nine universities offered the AyGS residency program, with six located in Lima. The allocation of open vacancies showed a higher trend, reaching 100% in four of the ten years analyzed, while the highest allocation percentage for captive positions was 78%. Regarding the curriculum plans, six of the eight available in 2022 provided information on minimum achievements and described the courses that residents must take. Conclusion. There were no changes in the total number of positions offered for the AyGS program. Three universities in Lima concentrate more than 50% of the program offerings. The curriculum plans show similarities across the universities offering the program.

RESUMEN Introducción. La escasez de investigación en la formación en Administración y Gestión en Salud (AyGS), junto con la necesidad de fortalecer los programas de residencia, fundamentó este estudio. Objetivo. Describir la oferta de vacantes y los planes curriculares del residentado en AyGS en Perú. Métodos. Estudio observacional, descriptivo y retrospectivo. Se revisó el número de plazas ofertadas y adjudicadas entre 2013 y 2022 en la web del Consejo Nacional de Residentado Médico (CONAREME). Además, se analizaron los planes curriculares actualizados al 2022, identificando los logros mínimos por año académico y comparándolos con los estándares aprobados por CONAREME. Resultados. Entre 2013 y 2022, se identificaron nueve universidades que ofrecieron el programa de residentado en AyGS, seis de ellas ubicadas en Lima. La adjudicación de plazas libres mostró una tendencia mayor, alcanzando el 100% en cuatro de los diez años analizados, mientras que el porcentaje máximo de adjudicación para plazas cautivas fue de 78%. En cuanto a los planes curriculares, seis de los ocho disponibles en 2022 incluían información sobre logros mínimos, y describieron los cursos que deben llevar los residentes. Conclusión. No se observaron cambios en el número total de vacantes ofertadas para el programa en AyGS. Tres universidades en Lima concentran más del 50% de la oferta del programa. Los planes curriculares muestran similitudes entre las universidades que lo ofrecen.

Digital information and data are crucial drivers of progress in various industries, including mining, where data-driven decision making optimizes resource extraction, enhances safety, and ensures sustainability. The adoption of digital technologies like artificial intelligence (AI) and the Internet of Things has amplified the importance of digital information. However, the integrity and security of this information are paramount, leading to the exploration of blockchain technology as a potential solution for secure digital value exchange in mining. This research examines blockchain's capabilities, drawing insights from its applications in sectors like banking, government, healthcare, and entertainment, and evaluates their relevance to mining's core value chain processes. The study identifies blockchain's distributed ledger technology, cryptographic security, and decentralization as unique advantages that can revolutionize mining by enhancing transaction speed, reducing costs, and improving supply chain transparency and compliance with sustainability standards. Blockchain's transparent and auditable records can enhance business transparency, fostering trust among stakeholders, including investors and regulatory bodies. The technology's consensus mechanisms and smart contracts further promote trust in collaborative ventures. This research provides a foundational understanding for decision-makers in the mining industry to evaluate blockchain's feasibility and potential return on investment, guiding strategic planning and resource allocation for blockchain applications. By leveraging blockchain, mining companies can optimize operations, improve sustainability practices, and establish a robust foundation for future growth, positioning blockchain as a transformative technology in the sector.

The structure of climate finance flows from donors (multilateral sources) to recipients (sub-Saharan African countries) was studied. This is the first study to provide a comprehensive network structure of the climate finance flows into Africa, based on the global public climate finance governance system. Network theory and decision tree techniques were employed. The results obtained generally fit the multilateral funding units (MFUs) into two categories: central funding units (CFUs), which simultaneously attend to the climate-related projects of many African countries, and the boundary funding units (BFUs), which cater to only a few countries at once. An isolated region with no BFUs was identified. African countries within this group could be more exposed to climate financial risk as they rely on only the CFUs. In general, with the exception of mitigation REDD (reducing emissions from deforestation and forest degradation) climate finance, a disproportionate distribution of climate themes, with particular reference to adaptation finance, was observed across sub-Saharan Africa. This has real implications for equitable resource allocation of climate funds. The need for African-bred region-wide MFUs is recommended. SIGNIFICANCE: Insights from this analysis expose the presence of contagion effects within the sub-Saharan African climate finance network structure and, consequently, the flow of climate finance-related risks. This knowledge is critical for future planning as it can provide African governments and interested stakeholders with informed evidence upon which they can make reliable and justifiable decisions, such as shaping of sectoral strategies and improving of climate finance flow coordination.

ABSTRACT: This paper provides pioneering estimates of the impact of loan-to-value (LTV) ratios, also known as leverage, on Bolivia’s GDP. The empirical evidence reveals the pro-cyclicality between the economic and financial cycles, which affects the intertemporal resource allocation processes between the financial and real sectors. The findings from the RBC model demonstrate that shocks in the loan-to-value (LTV) ratios trigger a rise in housing prices and greater consumption by entrepreneurs, leading to an increase in investment, employment, and output. Additionally, the study confirms that LTV ratios can be a double-edged instrument, as excessive use can potentially destabilize the economy.

RESUMEN: El objetivo de la presente investigación es evidenciar los efectos del loan- to-value (LTV, apalancamiento) en el PIB de Bolivia. Los hechos estilizados muestran una relación procíclica entre el ciclo económico y financiero, aspecto que influye en los procesos intertemporales de asignación de recursos del sector financiero hacia el sector real. Los resultados del modelo RBC revelan que choques positivos (impulso-respuesta) en el LTV generan precios más elevados de los activos, un ciclo financiero positivo, reflejado en un incremento del nivel de créditos y depósitos; lo que se traduce en mayores niveles de inversión, empleo y producto. Asimismo, se corrobora que el LTV es un instrumento de doble filo y el uso excesivo puede desestabilizar la economía.

This article deals with the nature of social cost-benefit analysis (SCBA) and economic impact analysis (ECIA) of road projects and describes the coherence of and distinctions between the two types of analysis. In the final part of the article, the reasons are given for not including in an SCBA the economic impacts of a road as determined through an ECIA, regardless of how positive they may be. The SCBA of a road project is a systematic procedure to determine the economic viability of the road project by considering the costs and benefits that accrue when the road is constructed and during the service period of the project. The cost component in the SCBA of a road project is the once-off investment or capital cost of taking the road into service or improving it. The benefit component in the SCBA of a road is the difference between recurring costs associated with an improved road and without the road improvement. Recurring costs of a road include (a) road user costs, (b) external costs arising from road use and (c) maintenance costs to protect and preserve the usefulness of the road. The beneficiaries in an SCBA are the road users. The following road user groups can be distinguished: (i) Normal traffic (consisting of existing, normal-growth and non-induced development traffic; (ii) diverted traffic; and (iii) induced traffic (consisting of generated, induced development, and transferred traffic.) To assess the efficiency of resource allocation, an SCBA is based on the consideration of social cost. From the perspective of allocative efficiency, as determined by an SCBA, a road project is regarded as economically viable when the current value of the reduction in recurring costs associated with the road during its service life exceeds the current value of the once-off investment cost of taking the road into service. Road provision and use have economic impacts. Unlike an SCBA, which focuses on the efficiency with which a road project increases accessibility for and the mobility of road users, a regional economic impact analysis (ECIA) focuses on the effectiveness of a project to affect the performance of the economy of a region by enhancing time and place utilities creation by non-road-users. Consequently, an analysis of the effect construction, operation and use of a road will have on regional economic performance should focus on their expected income multiplier and accelerator effects on the number and size of activities in the economy of a region. The following non-road-user groups can be distinguished: (a) The public, (b) landowners, occupants and land users, (c) roadside enterprises, (d) utility enterprises and (e) goods consignors and consignees (in their capacity as non-road-users). An ECIA is based on a consideration of market prices. In an ECIA the following objectives serve as criteria for judging the impact of a road project on the performance of the economy: • Economic growth (including economic development) • Full employment • Price stability • Balance of payments stability • Equitable distribution of income These impacts, regardless of how positive they may be, are not included in an SCBA for the following reasons: • A comprehensive economic assessment consists of two components that are performed in tandem, namely an SCBA and an ECIA. An SCBA relies on allocative efficiency as assessment criterion, while an ECIA relies on output effectiveness as assessment criterion. The inclusion of effectiveness criteria among efficiency criteria in an SCBA will result in a misrepresentation of project viability. • Double counting of benefits will occur when road user cost savings and economic impacts are combined. • Not all the economic benefits obtained through coordinated investment in various sectors, one of which may be a road, can be ascribed to the investment in the road alone. The reason for conducting an ECIA of a road project is to determine to what measure the analysed road is expected to affect the performance of the economy of the region concerned. Although the results of an ECIA do not form part of the outcome of an SCBA, an ECIA can be used as an instrument in the pursuit of the economic policy objectives of a government.

Die hoofdoel van die sosialekoste-voordeel-ontleding (SKVO) van 'n pad is om die inligting oor die koste en voordele te verskaf wat nodig is om die lewensvatbaarheid, al dan nie, van die voorsiening en gebruik van die pad te beraam. Die kostekomponent in die SKVO is die eenmalige investeringskoste om die pad tot stand te bring, en die voordeelkomponent is die daling van die herhalende koste wat uit die gebruik en instandhouding van die pad sal spruit. Die hoofdoel van die ekonomiese-impakontleding (EKIO) van 'n pad behels dat die verwagte gevolge van die voorsiening en gebruik van die pad op die ekonomiese vertoning van 'n bepaalde streek geïdentifiseer en bereken word. Dié ontleding berus hoofsaaklik op die volgende: (a) die beraming van die verwagte eenmalige streeksinkome-vermenigvuldigereffek wat uit die investeringsbesteding aan die pad sal spruit, en (b) die beraming van die herhalende streeksinkome-versnellereffek wat uit die gebruik en instandhouding van die pad sal spruit. Die ekonomiese uitwerking van 'n padprojek word nie by 'n SKVO ingereken nie. Die rede hiervoor is drievoudig: Eerstens berus 'n SKVO op toewysingsdoelmatigheid as beoordelingsnorm, en 'n EKIO op doeltreffendheid as beoordelingsnorm. Die kombinering van doeltreffendheidsnorme en doelmatigheidsnorme sal tot 'n wanvertolking van 'n projek se ekonomiese lewensvatbaarheid lei. Tweedens sal voordele dubbeld getel word indien padgebruikerskostebesparings en ekonomiese impakte saamgevoeg word. Derdens kan ekonomiese voordele wat verkry word deur gekoördineerde investering in verskeie sektore, waarvan een 'n pad is, nie alles aan investering in die pad toegeskryf word nie.

Resumen Antecedentes: El cáncer de mama es la principal causa mundial de muerte por neoplasias. Por lo tanto, los centros médicos deben estar preparados para evaluar la gestión óptima de sus recursos, buscando el mejor resultado clínico. Objetivo: Presentar un modelo aplicado para la cuantificación y toma de decisiones informadas por parte de un servicio de cáncer de mama en México. Método: La información primaria necesaria para calibrar el modelo de esta metodología fue proporcionada por el Servicio de Tumores de Mama del Instituto Nacional de Cancerología de la Ciudad de México y el Hospital Centenario Miguel Hidalgo de la ciudad de Aguascalientes. El análisis de datos se realizó para cada una de las instituciones de salud debido a que el algoritmo de tratamiento, el número de pacientes y la distribución de pacientes por estadio con cáncer de mama difieren entre ambas instituciones. Resultados: La metodología permitió evaluar el costo del manejo actual del cáncer de mama en cada institución, así como el impacto clínico y económico que genera la inclusión de nuevos fármacos innovadores al algoritmo de tratamiento actual. Conclusión: La metodología propuesta permite optimizar la asignación de recursos, así como estimar escenarios potenciales para la inclusión de nuevas tecnologías en salud.

Abstract Background: Breast cancer is worldwide the leading cause of death from neoplasia. Therefore, health-care centers must be prepared for assessing the most optimal management of resources while seeking the best clinical outcome. Objective: To present a currently applied model for quantification and informed decision-making by a breast cancer service in Mexico. Method: The primary information necessary to calibrate this methodology's model was provided by the Breast Tumors Service of the National Cancer Institute of Mexico City and the Centennial Hospital Miguel Hidalgo in the city of Aguascalientes. The data analysis was carried out for each one of the health institutions because the treatment algorithm, the number of patients, and the distribution of patients by stage with breast cancer differ between both institutions. Results: The methodology allowed the assessment of the cost of the current management of breast cancer in each institution, as well as the clinical and economic impact generated by the inclusion of new innovative drugs to the current treatment algorithm. Conclusion: The proposed methodology allows the allocation of resources to be optimized, as well as estimating potential scenarios for the inclusion of new health technologies.

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.

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.

Abstract The present article analyzes the transfers from parliamentary amendments by the Ministry of Health to municipalities to finance public health actions and services from 2015 to 2021. A descriptive and exploratory study was carried out with secondary data, including all Brazilian cities. Resources from amendments showed an increase, particularly from 2018 onwards, indicating the expansion of their relevance for financing SUS. From 2016 to 2021, over 80% was allocated to municipalities, representing 9.5% of all federal transfers, with 91.2% for operational expenses. Transfers from amendments differ from regular transfers due to greater instability and per capita variation among the amounts collected by municipalities and due to the fact that they allocate most resources to the Northeast and primary care to the detriment of the Southeast and medium and high complexity care. These transfers represent a differentiated modality of resource allocation in SUS that produces new distortions and asymmetries, with implications for intergovernmental relations, as well as between the executive and legislative powers, increasing the risk of the discontinuity of actions and services and imposing challenges for the municipal management.

Resumo O artigo tem como objetivo analisar as transferências por emendas parlamentares do Ministério da Saúde aos municípios para o financiamento de ações e serviços públicos de saúde, de 2015 a 2021. Foi realizado estudo descritivo e exploratório com dados secundários, abrangendo a totalidade de municípios brasileiros. Os recursos provenientes de emendas apresentaram aumento, em especial a partir de 2018, indicando a expansão de sua relevância para o financiamento do SUS. No período de 2016 a 2021, mais de 80% foram alocados aos municípios, representando 9,5% dos repasses federais, com 91,2% de natureza de custeio. As transferências por emendas diferem dos repasses regulares por possuir maior instabilidade e variação per capita entre os montantes captados pelos municípios, e por destinar a maior parte dos recursos ao Nordeste e à atenção primária, em detrimento do Sudeste e da média e alta complexidade. Configura-se uma modalidade diferenciada de alocação de recursos no SUS que produz novas distorções e assimetrias, com implicações para as relações intergovernamentais e entre os poderes executivo e legislativo, ampliando o risco de descontinuidade de ações e serviços e impondo desafios para as gestões municipais.

ABSTRACT Objective: Tuberculosis (TB) is the second most deadly infectious disease globally, posing a significant burden in Brazil and its Amazonian region. This study focused on the “riverine municipalities” and hypothesizes the presence of TB clusters in the area. We also aimed to train a machine learning model to differentiate municipalities classified as hot spots vs. non-hot spots using disease surveillance variables as predictors. Methods: Data regarding the incidence of TB from 2019 to 2022 in the riverine town was collected from the Brazilian Health Ministry Informatics Department. Moran’s I was used to assess global spatial autocorrelation, while the Getis-Ord GI* method was employed to detect high and low-incidence clusters. A Random Forest machine-learning model was trained using surveillance variables related to TB cases to predict hot spots among non-hot spot municipalities. Results: Our analysis revealed distinct geographical clusters with high and low TB incidence following a west-to-east distribution pattern. The Random Forest Classification model utilizes six surveillance variables to predict hot vs. non-hot spots. The machine learning model achieved an Area Under the Receiver Operator Curve (AUC-ROC) of 0.81. Conclusion: Municipalities with higher percentages of recurrent cases, deaths due to TB, antibiotic regimen changes, percentage of new cases, and cases with smoking history were the best predictors of hot spots. This prediction method can be leveraged to identify the municipalities at the highest risk of being hot spots for the disease, aiding policymakers with an evidenced-based tool to direct resource allocation for disease control in the riverine municipalities.

RESUMO Objetivo: A tuberculose (TB) é a segunda doença infecciosa que mais mata no mundo, representando um problema de saúde pública no Brasil, especialmente na região amazônica. Este estudo analisa a TB nos municípios ribeirinhos” com o objetivo de identificar aglomerados de alta incidência, também conhecidos como “hot spots”. Posteriormente, utilizando aprendizagem de máquina, visamos prever estes aglomerados por meio de variáveis de vigilância epidemiológica. Assim buscamos auxiliar o ente público no combate à TB nesta região. Métodos: Dados da incidência de TB nos “municípios ribeirinhos” foram coletados entre os anos de 2019 e 2022 do Departamento de Informática do Ministério da Saúde. O índice de Moran foi utilizado para a determinação de autocorrelação espacial global, enquanto o método Getis-Ord GI* foi empregado para a autocorrelação espacial local. Variáveis referentes ao diagnóstico, tratamento e características socioeconômicas associadas aos casos foram utilizadas para a predição de aglomerados de alta incidência por meio de um modelo Random Forest. Resultados: Foram identificados aglomerados com alta incidência de TB a oeste e baixa incidência a leste. O total de seis variáveis de vigilância epidemiológica foi identificado como relevante para a predição. Nosso modelo Random Forest alcança uma área sob a curva da característica operacional do receptor (AUC-ROC) de 0,81. Conclusão: Municípios com altas porcentagens de casos recorrentes, mortes por TB, mudança do esquema de tratamento, casos novos e casos com história de tabagismo estão associados a aglomerados de alta incidência. Esperamos que este método de identificação de possíveis aglomerados de TB seja útil para o ente público no combate à doença na região.