ABSTRACT The standard for diagnosing invasive pneumococcal disease (IPD) is to isolate pneumococcus in culture. However, the etiological agent cannot be identified in some patients, especially those who received empirical antibiotic therapy. This study aimed to detect pneumococcus in normally sterile fluids by qPCR in patients with suspected IPD hospitalized in Lima. qPCR had a detection limit of 1.2 x 101 genome copies/uL. Of the 71 clinical samples (51 were pleural fluid [PF] and 20 were cerebrospinal fluid [CSF]), 29.4% (28/71) were positive for pneumococcus by culture and 71.8% (51/71) were positive by qPCR, including 78.4% (40/51) in PF and 55.0% (11/20) in CSF. Of the positive samples, 13/51 were serotype 19A. The detection of pneumococcus was almost double by qPCR compared to the conventional microbiological method. Therefore, molecular methods such as qPCR should be implemented to improve the identification and timely treatment of IPD in Peru and in the region.

RESUMEN El estándar para diagnosticar enfermedad neumocócica invasiva (ENI) es aislar neumococo en cultivo. Sin embargo, en algunos pacientes, sobre todo los que recibieron terapia antibiótica empírica, no se logra identificar el agente etiológico. El objetivo de este estudio fue detectar neumococo en líquidos normalmente estériles mediante qPCR en pacientes con sospecha de ENI hospitalizados en Lima. La qPCR tuvo un límite de detección de 1,2 x 101 copias del genoma/uL. De las 71 muestras clínicas (51 de líquido pleural [LP] y 20 de líquido cefalorraquídeo [LCR]), el 29,4% (28/71) fueron positivas para neumococo por cultivo y 71,8% (51/71) fueron positivas por qPCR, incluyendo 78,4% (40/51) en LP y 55,0% (11/20) en LCR. De las muestras positivas, 13/51 fueron del serotipo 19A. La detección de neumococo fue casi el doble por qPCR en comparación con el método microbiológico convencional. Por lo tanto, se debe implementar métodos moleculares como esta qPCR para mejorar la identificación y tratamiento oportuno de ENI en Perú y en la región.

ABSTRACT The clinical and microbiological characteristics of pneumococcal pneumonia in children hospitalized in Lima were analyzed, before and after the introduction of pneumococcal conjugate vaccines (PCV). We reviewed cases that occurred between 2006-2019, in the pre-PCV7 (2006-2008), post-PCV7 (2009-2011) and post-PCV13 (2016-2019) periods. Of 128 patients with positive cultures (92 blood and 36 pleural fluid), most were infants in the pre-PCV7 (77.1%) and post-PCV7 (43.3%) studies, while in the post-PCV13 study they were mostly preschoolers (62%). We found an increase in complicated pneumonia cases from 14.6% to 72% and an increase in serotype 19A (6.3% to 68%). The most frequent sequence type was ST320 (31 isolates). Resistance to penicillin and ceftriaxone was low (6% and 2%, respectively), although higher in empyema (21.4% and 14.3%, respectively). Resistance to azithromycin increased from 27% to 92%. Penicillin remains the antibiotic of choice for the treatment of uncomplicated pneumococcal pneumonia in Lima.

RESUMEN Se analizaron las características clínicas y microbiológicas de neumonía neumocócica en niños hospitalizados en Lima, antes y después de la introducción de las vacunas neumocócicas conjugadas (PCV). Se revisaron casos entre 2006-2019, en los periodos pre-PCV7 (2006-2008), post-PCV7 (2009-2011) y post-PCV13 (2016-2019). De 128 pacientes con cultivos positivos (92 de sangre y 36 de líquido pleural), la mayoría fueron lactantes en los estudios pre-PCV7 (77,1%) y post-PCV7 (43,3%), mientras que en el estudio post-PCV13 fueron mayoritariamente preescolares (62%). Se observó un aumento de neumonías complicadas de 14,6% a 72% y un incremento del serotipo 19A (6,3% a 68%). El secuenciotipo más frecuente fue ST320 (31 aislamientos). La resistencia a penicilina y ceftriaxona fue baja (6% y 2%, respectivamente), aunque mayor en empiema (21,4% y 14,3%, respectivamente). La resistencia a azitromicina se incrementó de 27% a 92%. La penicilina sigue siendo el antibiótico de elección para el tratamiento de neumonía neumocócica no complicada en Lima.

ABSTRACT The objective of this research is to point out studies that describe variables that are associated with the impact of contingency measures resulting from the pandemic on the mental health of university students. A systematic review was carried out, following the PRISMA-P guidelines and PECO approach, and the review protocol was registered in INPLASTY. The search was conducted in five databases from December 2019 to December 2022. A selection process was carried out by title, abstract and full text, according to the inclusion and exclusion criteria. Initially, 27,458 articles were identified, and after eliminating duplicates, applying the inclusion criteria and critical analysis, 11 original articles were selected for qualitative analysis. The sample size was 47,552 participants, the majority of whom were women (68.07%) with an average age of 21.07 years. It was concluded that contingency measures (social isolation, quarantine, distancing) as a measure to prevent the spread of the pandemic had a negative impact on the psychological well-being of university students. Adequate support and research into which interventions can mitigate these risks are essential. We suggest the implementation of psychological interventions, which should be promoted proactively, to minimise negative impacts.

Abstract Introduction: Pediatric extreme hydrocephalus (PEH) is a complex condition with uncertain prognostic outcomes. Objectives: In this study, we analyze the long-term change in cerebral parenchymal thickness of pediatric patients with extreme hydrocephalus after shunting. Methods: A retrospective observational study was conducted on patients with PEH treated at the General Hospital of Mexico from 2009 to 2016. Cerebral parenchymal thickness was measured in computed tomography studies before surgical intervention, at 5 months, and 4 years post-surgery. The average change in thickness in millimeters was analyzed, and its normalized value was assessed using the Wilcoxon test and the R2 of a linear function. Results: Twelve patients, including 5 females and 7 males, were studied. Nine cases were congenital, while the remaining 3 cases were 6 months, 7, and 10-years-old. At 5.2 months PostOp., patients showed an average increase of 160% in cerebral parenchymal thickness, which increased to 270% at 4.3 years. However, 4 cases (33.3%) had an increase of < 10% from the original thickness. One patient at 4.3 years exhibited a 594% increase compared to the baseline. In the congenital cases, pre-operative thickness had a good correlation (R2 = 0.70) with post-operative thickness, but pre-operative age of patients did not correlate with post-operative thickness (R2 = 0.03). Conclusions: In this study, 3 out of 12 cases of PEH showed a long-term increase of > 200% compared to preoperative thickness. Even in cases of extreme hydrocephalus, significant long-term improvement can occur. Rapid treatment of these cases is crucial to increase the likelihood of improvement.

Abstract This article addresses the world of healthcare work, especially in the Brazilian Unified Healthcare System (SUS) in the context of the COVID-19 pandemic in Brazil. This study used data from the following surveys: “Working conditions of health professionals in the context of COVID-19 in Brazil” and “The Invisible health workers: working conditions and mental health in the context of COVID-19 in Brazil”. Data analysis proves that the pandemic highlighted existing structural problems within SUS, involving the issue of healthcare workforce (HWF) management, which can be interpreted as another reflection of the socioeconomic inequalities that already exist in the country. This article highlights: the reduced provision of permanent education, the regulation of hybrid care, precariousness, a lack of protection in the work environment, as well as fragile biosecurity leading to tragic rates of illness and death of health workers. Our study concludes by showing the importance of formulating public policies in the scope of education and work management in SUS that ensure the discussion on hybrid care as a new way of acting without losing quality, together with the need to review issues related to permanent education, protection, valuation, and reduction of inequalities pointed out among the professional contingents analyzed in this article.

Resumo O artigo versa sobre o mundo do trabalho da saúde, especialmente no SUS no contexto da pandemia no Brasil. O artigo utilizou dados das pesquisas “Condições de trabalho dos profissionais de saúde no contexto da COVID-19 no Brasil” e “Os trabalhadores invisíveis da saúde: condições de trabalho e saúde mental no contexto da COVID-19 no Brasil”. A análise dos dados comprova que a pandemia evidenciou problemas estruturais existentes no âmbito do Sistema Único de Saúde, envolvendo a gestão da FTS o que pode ser interpretado como mais um dos reflexos das desigualdades socioeconômicas já existentes no país. Destacam-se: a reduzida oferta de educação permanente, a regulação do cuidado híbrido, precarização, desproteção no ambiente de trabalho, frágil biossegurança levando a trágicas taxas de adoecimento e mortes de trabalhadores da saúde. Conclui mostrando a importância de formulação de políticas públicas no âmbito da gestão da educação e do trabalho no SUS que assegurem a discussão sobre cuidado híbrido como nova forma de atuar sem perder qualidade, a necessidade de se rever questões referentes a: educação permanente, proteção, valorização e redução das desigualdades apontadas entre os contingentes profissionais analisados nesse artigo.

Resumo O artigo versa sobre o mundo do trabalho da saúde, especialmente no SUS no contexto da pandemia no Brasil. O artigo utilizou dados das pesquisas “Condições de trabalho dos profissionais de saúde no contexto da COVID-19 no Brasil” e “Os trabalhadores invisíveis da saúde: condições de trabalho e saúde mental no contexto da COVID-19 no Brasil”. A análise dos dados comprova que a pandemia evidenciou problemas estruturais existentes no âmbito do Sistema Único de Saúde, envolvendo a gestão da FTS o que pode ser interpretado como mais um dos reflexos das desigualdades socioeconômicas já existentes no país. Destacam-se: a reduzida oferta de educação permanente, a regulação do cuidado híbrido, precarização, desproteção no ambiente de trabalho, frágil biossegurança levando a trágicas taxas de adoecimento e mortes de trabalhadores da saúde. Conclui mostrando a importância de formulação de políticas públicas no âmbito da gestão da educação e do trabalho no SUS que assegurem a discussão sobre cuidado híbrido como nova forma de atuar sem perder qualidade, a necessidade de se rever questões referentes a: educação permanente, proteção, valorização e redução das desigualdades apontadas entre os contingentes profissionais analisados nesse artigo.

Abstract This article addresses the world of healthcare work, especially in the Brazilian Unified Healthcare System (SUS) in the context of the COVID-19 pandemic in Brazil. This study used data from the following surveys: “Working conditions of health professionals in the context of COVID-19 in Brazil” and “The Invisible health workers: working conditions and mental health in the context of COVID-19 in Brazil”. Data analysis proves that the pandemic highlighted existing structural problems within SUS, involving the issue of healthcare workforce (HWF) management, which can be interpreted as another reflection of the socioeconomic inequalities that already exist in the country. This article highlights: the reduced provision of permanent education, the regulation of hybrid care, precariousness, a lack of protection in the work environment, as well as fragile biosecurity leading to tragic rates of illness and death of health workers. Our study concludes by showing the importance of formulating public policies in the scope of education and work management in SUS that ensure the discussion on hybrid care as a new way of acting without losing quality, together with the need to review issues related to permanent education, protection, valuation, and reduction of inequalities pointed out among the professional contingents analyzed in this article.

Abstract This in vitro study compared the antimicrobial efficacy of 2.5% sodium hypochlorite (NaOCl) and 8 µg/mL ozonated water agitated by passive ultrasonic irrigation (PUI) or PUI combined with EndoActivator (EA) against mature multispecies biofilm. One hundred and five oval-shaped mandibular premolars were instrumented, sterilized, and inoculated with Enterococcus faecalis, Candida albicans, and Staphylococcus aureus, divided into: control group - saline; O3 group - ozonated water; O3 PUI group - ozonated water with PUI agitation; O3 PUI+EA group - ozonated water with PUI+EA agitation; NaOCl group - NaOCl; NaOCl PUI group - NaOCl with PUI agitation; and NaOCl PUI+EA group - NaOCl with PUI+EA agitation. Microbiological samples were collected before (S1) and after (S2) the disinfection procedures and the data were statistically analyzed using the Kruskal-Wallis test. In the culture method, there was significant disinfection in the O3 PUI+EA, NaOCl, NaOCl PUI, and NaOCl PUI+EA groups (p˂0.05). The combination of NaOCl with PUI+EA reduced microbial counts to zero (p˂0.05). In the qPCR method, there was a significant reduction in the total count of viable microorganisms in the O3 PUI, O3 PUI+EA, NaOCl, NaOCl PUI, and NaOCl PUI+EA groups (p˂0.05). It can be concluded that 2.5% NaOCl with and without agitation, as well as 8 µg/mL ozonated water with its action enhanced by the agitation techniques, were effective in root canal disinfection, and their antimicrobial efficacy is related to the microorganisms present in the biofilm.

Resumo Este estudo in vitro comparou a desinfecção do hipoclorito de sódio 2,5% (NaOCl) e da água ozonizada 8 µg/mL agitados pela irrigação ultrassônica passiva (PUI) e por associação da PUI com EndoActivator (EA) na redução de biofilme misto maduro. Cento e cinco pré-molares inferiores ovalados foram instrumentados, esterilizados e inoculados com Enterococcus faecalis, Candida albicans e Staphylococcus aureus, divididos em: Grupo controle: soro; Grupo O3: água ozonizada; Grupo O3 PUI: água ozonizada agitada por PUI; Grupo O3 PUI + EA: água ozonizada agitada por PUI e EA: Grupo NaOCl: hipoclorito de sódio; Grupo NaOCl PUI: hipoclorito de sódio agitado por PUI; Grupo NaOCl PUI + EA: hipoclorito de sódio agitado por PUI e EA. Amostras microbiológicas foram coletadas antes (S1) e após (S2) os procedimentos de desinfecção e os dados foram analisados estatisticamente pelo teste de Kruskal-Wallis. No método de cultura, houve desinfecção significativa nos grupos O3 PUI + EA, NaOCl, NaOCl PUI e NaOCl PUI + EA (p˂0.05), sendo que no grupo NaOCl PUI + EA não houve crescimento de microrganismo (p˂0.05). No método de qPCR, nas contagens dos microrganismos antes e após os protocolos de desinfecção, houve redução microbiana nos grupos O3 PUI, O3 PUI + EA, NaOCl, NaOCl PUI, NaOCl PUI + EA (p˂0.05). Concluiu-se que o NaOCl 2,5% com e sem agitação foi eficiente, assim como a água ozonizada 8 µg/mL potencializada pelos métodos de agitação na desinfecção e que a mesma está relacionada com os microrganismos presentes no biofilme.

Abstract This document aims to analyze the Social Infrastructure Fund for Entities, a tool used by the Mexican Government to reduce extreme poverty and social backwardness, through the construction of basic social infrastructure. Subsequently, based on socioeconomic indicators collected between 2010 and 2020, the problem was analyzed based on the Logical Framework Approach, the only one accepted for the design of public policies in Mexico, proposing adjustments to the fund, as well as the competences of each of the levels of government involved, must apply in order to improve the impact on the indicators. The periodicity of the distribution of the resources, the publication of the legal framework in a clear and timely manner, professionalization and innovation, as well as accountability, are desirable in the management of the fund.

Resumen El presente documento tiene como finalidad analizar el Fondo de Infraestructura Social Estatal, herramienta utilizada por el Estado mexicano para reducir la pobreza extrema y el rezago social, mediante la construcción de infraestructura social básica. Posteriormente, con base en indicadores socioeconómicos recolectados entre los años 2010 y 2020, se analizó la problemática a partir de la Metodología del Marco Lógico, única aceptada para el diseño de políticas públicas en México, proponiéndose diversas adecuaciones al fondo, así como de las competencias de cada uno de los niveles de gobierno involucrados, debe realizar para mejorar el impacto sobre los indicadores que se atienden. La periodicidad de la distribución de recursos, la publicación del marco normativo de forma clara y oportuna, la profesionalización e innovación, así como la rendición de cuentas, resultan deseables en la gestión del fondo.

ABSTRACT After ozone therapy for bleaching, it is important to evalúate enamel surface properties, to ensure that bleaching provides adequate conditions for sound dental substrate. Aim: The aim of this in vitro study was to evaluate the effects of a bleaching treatment with 10% carbamide peroxide (CP), with or without ozone (O), on the microhardness, roughness and micromorphology of the enamel surface. Materials and Method: Bovine enamel blocks were planed and distributed among the following three bleaching treatment groups (n=10): CP - 1 hour per day/14 days (Opalescence PF 10%/ Ultradent); O - 1 hour per day every 3 days/3 sessions (Medplus VPhilozon, 60 mcg/mL and oxygen flow rate of 1 L/min); and OCP - CP with O, 1 hour per day every 3 days/3 sessions. Enamel surface microhardness (Knoop), roughness (Ra), and micromorphology by scanning electron microscopy (5,000x magnificaron) were determined before and after the treatments. Results: ANOVA and Tukey-Kramer’s test showed that enamel microhardness remained unchanged by treatment with O and OCP (p=0.0087), but decreased by treatment with CP. Treatment with O promoted higher enamel microhardness than the other groups (p=0.0169). Generalized linear mixed models for repeated measures over time indicated treatment with CP increased enamel roughness more than OCP or O (p=0.0003). CP produced slight irregularities in enamel micromorphology after the whitening treatment. O, with or without CP, maintained the mechanical and physical properties of microhardness and enamel surface micromorphology, and either maintained or reduced surface roughness, compared to the conventional tray-delivered CP bleaching treatment. Conclusions: Treatment with 10% carbamide peroxide in trays promoted greater changes in enamel surface properties than treatments with ozone and with 10% ozonized carbamide peroxide in the office.

RESUMO É importante avaliar as propriedades da superficie do esmalte após a aplicagao da ozonioterapia para clareamento, para garantir que o efeito clareadorproporcione condigoes adequadaspara um substrato dentário higido. Objetivo: O objetivo deste estudo in vitro foi avaliar os efeitos de um tratamento clareador com peróxido de carbamida (PC) a 10%, associado ou nao ao ozonio (O), na microdureza, rugosidade e micromorfologia da superficie do esmalte. Materials e Método: Blocos de esmalte bovino foram aplainados e distribuidos entre tres grupos de tratamento clareador (n=10): PC - 1 hora por dia/14 dias (Opalescence PF 10%/ Ultradent); O - 1 hora por dia a cada 3 dias/3 sessoes (Medplus VPhilozon, 60 mcg/mL e fluxo de oxigenio de 1 L/min); e PCO - CP com O, 1 hora por dia a cada 3 dias/3 sessoes. A microdureza (Knoop), a rugosidade (Ra) e a micromorfologia da superficie do esmalte avaliada por microscopia eletronica de varredura (aumento de 5.000x) foram analisadas antes e após os tratamentos. Resultados: ANOVA e teste de Tukey-Kramer mostraram que O e PCO mantiveram os valores de microdureza do esmalte ao final do tratamento (p=0,0087), enquanto PC promoveu diminuigao da microdureza. O promoveu maiores valores de microdureza do esmalte do que os outros grupos ao final do tratamento (p=0,0169). Modelos lineares generalizados mistos para medidas repetidas no tempo indicaram um aumento na rugosidade da superficie para PC, levando a maior rugosidade do esmalte ao final do tratamento, em comparagao com PCO ou O (p=0,0003). PC apresentou pequenas irregularidades na micromorfologia do esmalte após o tratamento clareador. O, com ou sem PC, manteve as propriedades mecánicas e fisicas de microdureza e micromorfologia da superficie do esmalte, e manteve ou reduziu a rugosidade da superficie, em comparagao com o tratamento clareador a base de PC aplicado em moldeira convencional. Conclusoes: O tratamento com peróxido de carbamida a 10% para uso em moldeiras promoveu maiores alteragoes nas propriedades de superficie do esmalte do que aquelas observadas nos tratamentos com ozonio e com peróxido de carbamida ozonizado a 10% para uso em consultório.

Resumen La presente investigación analiza la eficiencia de 24 departamentos colombianos en el uso de sus recursos para cumplir con los objetivos de los programas educativos del país, durante el período 2007-2018. La valoración de la eficiencia se llevó a cabo mediante el Análisis de la Envolvente de Datos, diseñando tres modelos orientados al output y estructurados con rendimientos variables a escala. Los resultados de los modelos muestran que únicamente los departamentos de Bogotá D.C., Antioquia y Quindío emplearon de manera eficiente su personal docente y sedes educativas para incrementar el alfabetismo, la matriculación, y la equidad urbano-rural; por ello, es recomendable el establecimiento de políticas públicas orientadas a fortalecer el sector educativo, y con estas contribuir al bienestar de la sociedad.

Abstract This research analyzes the efficiency of 24 departments of Colombia in the use of their resources to achieve the objective of the national educational programs, during the 2007-2018 period. The efficiency assessment was carried out through the Data Envelope Analysis (DEA), designing three models oriented to output and structured with variable returns to scale. The results of the three shows that only the departments of Bogota D.C., Antioquia, and Quindio efficiently used their teaching staff and educational facilities to increase literacy, enrollment, and urban-rural equity. Therefore, it is advisable to develop public policies aimed at strengthening the education sector, and thus contribute to the well-being of society.

Resumen El presente documento tiene por objetivo analizar la eficiencia de las entidades federativas mexicanas en la utilización del Fondo de Infraestructura Social para las Entidades y el Capítulo 1000 del gasto corriente para la provisión de infraestructura básica, en el período 2014-2018. En virtud de que el uso adecuado de estos insumos económicos puede coadyuvar a la reducción de la pobreza y el rezago social a nivel nacional. La determinación de la eficiencia se llevó a cabo mediante el Análisis Envolvente de Datos. Los resultados revelaron que sólo Baja California Sur, Colima y Tlaxcala fueron eficientes. Por lo que es necesario la implementación de mecanismos que logren la eficiencia en el manejo de los recursos para generar las condiciones físicas esenciales suficientes que contribuyan a la disminución de las carencias sociales y la desigualdad.

Abstract The objective of this document is to analyze the efficiency of the Mexican states in the use of the Social Infrastructure Fund for Entities and the Chapter 1000 of current expenditure for the provision of basic infrastructure, in the period 2014-2018. Given that the proper use of these economic inputs can contribute to the reduction of poverty and social backwardness at the national level. The determination of the efficiency was carried out by the Data Envelope Analysis. The results revealed that only Baja California Sur, Tlaxcala, and Colima were efficient. Therefore, it is necessary to implement mechanisms that make the management of economic resources more efficient to generate sufficient essential physical conditions that contribute to reduce the social deprivation and inequality.

Resumo A atenção especializada do sistema público de saúde brasileiro é crítica e subfinanciada. Poucos estudos avaliaram o planejamento da atenção secundária em um nível estratégico, portanto ainda há questões em aberto a serem examinadas. Este estudo objetiva determinar a localização de centros médicos e a quantidade de equipamentos com base em um processo de otimização em duas etapas para atender a população. Balanceamos decisões conflitantes de propensão dos médicos em trabalharem em metrópoles e de pacientes em mudarem o mínimo de seus municípios para fornecer a localização dos centros médicos, e equipamentos a esses locais e as horas adicionais de especialistas para atender aos padrões oficiais de demanda. Para a demanda restante, a segunda etapa do modelo de otimização sugere a aquisição de equipamento para os centros médicos eleitos, para atender às necessidades. A localização proposta das unidades de atendimento secundário abrange 834 municípios, correspondendo a 97,77% do estado, com um deslocamento médio de pacientes de 58,73 km (IC95%: 56,18 km - 61,28 km). Em geral, 39 das 77 regiões de saúde devem contratar horas adicionais de especialidades médicas. Pediatria e ginecologia representam a maior lacuna.

Abstract The specialized care level of the public Brazilian national health system is critical and chronically underfunded. Few studies have evaluated public secondary care planning on a strategic level, so there are open issues yet to examine. This study aims at locating medical centers and sizing equipment based on a two-step optimization process to meet the population’s needs. The models consider physicians’ propensity for working on a metropolis and the patients’ choice on moving the least from their municipalities, therefore, conflicting decisions. The models provide the location of medical centers, the assignment of equipment to such locations, and the additional hours of specialists required to meet official standards of demand. Available equipment with idle capacity should partly satisfy the requirement for exams within the current infrastructure. For the remaining uncovered demand, the second step of the optimization model suggests the acquisition of additional equipment for the elected medical centers to meet established needs. The proposed location of secondary care facilities covers 834 municipalities, corresponding to 97.77% of the estate, with an average patient displacement of 58.73 km (CI95%: 56.18 km - 61.28 km). In general, 39 out of 77 health regions should hire additional hours of medical specialties. Pediatrics and gynecology represent the major gap.

Resumo A atenção especializada do sistema público de saúde brasileiro é crítica e subfinanciada. Poucos estudos avaliaram o planejamento da atenção secundária em um nível estratégico, portanto ainda há questões em aberto a serem examinadas. Este estudo objetiva determinar a localização de centros médicos e a quantidade de equipamentos com base em um processo de otimização em duas etapas para atender a população. Balanceamos decisões conflitantes de propensão dos médicos em trabalharem em metrópoles e de pacientes em mudarem o mínimo de seus municípios para fornecer a localização dos centros médicos, e equipamentos a esses locais e as horas adicionais de especialistas para atender aos padrões oficiais de demanda. Para a demanda restante, a segunda etapa do modelo de otimização sugere a aquisição de equipamento para os centros médicos eleitos, para atender às necessidades. A localização proposta das unidades de atendimento secundário abrange 834 municípios, correspondendo a 97,77% do estado, com um deslocamento médio de pacientes de 58,73 km (IC95%: 56,18 km - 61,28 km). Em geral, 39 das 77 regiões de saúde devem contratar horas adicionais de especialidades médicas. Pediatria e ginecologia representam a maior lacuna.

Abstract The specialized care level of the public Brazilian national health system is critical and chronically underfunded. Few studies have evaluated public secondary care planning on a strategic level, so there are open issues yet to examine. This study aims at locating medical centers and sizing equipment based on a two-step optimization process to meet the population’s needs. The models consider physicians’ propensity for working on a metropolis and the patients’ choice on moving the least from their municipalities, therefore, conflicting decisions. The models provide the location of medical centers, the assignment of equipment to such locations, and the additional hours of specialists required to meet official standards of demand. Available equipment with idle capacity should partly satisfy the requirement for exams within the current infrastructure. For the remaining uncovered demand, the second step of the optimization model suggests the acquisition of additional equipment for the elected medical centers to meet established needs. The proposed location of secondary care facilities covers 834 municipalities, corresponding to 97.77% of the estate, with an average patient displacement of 58.73 km (CI95%: 56.18 km - 61.28 km). In general, 39 out of 77 health regions should hire additional hours of medical specialties. Pediatrics and gynecology represent the major gap.

Resumen Esta investigación tiene como objetivo analizar los determinantes de la inversión extranjera directa (IED) en 14 economías del APEC durante el periodo 1990-2019. Para tal fin, y partiendo de la segmentación de las economías en grupos homogéneos de análisis se elaboraron dos modelos econométricos de datos panel. Los resultados del estudio denotan que el flujo de IED en las economías del grupo 1 (Australia, Canadá, China, Estados Unidos, Hong Kong, Japón y Rusia) estuvo determinado por las remuneraciones al trabajo, las exportaciones de alta tecnología y el nivel de gasto de las naciones. Mientras que en el caso del grupo 2 (Chile, Corea del Sur, Indonesia, Malasia, México, Singapur y Tailandia) fueron el gasto público en educación y el valor agregado por trabajador en la industria los factores que la determinaron.

Abstract This research aims to analyze the determinants of Foreign Direct Investment (FDI) in 14 APEC economies during the period 1990-2019. For this purpose and starting from the segmentation of the economies into homogeneous groups of analysis, two econometric panel data models were developed. The results show that the flow of FDI in Group 1 (Australia, Canada, China, the United States, Hong Kong, Japan, and Russia) was determined by wages, high technology exports, and the level of spending of nations. While in the case of Group 2 (Chile, South Korea, Indonesia, Malaysia, Mexico, Singapore, and Thailand) it was public spending on education and value-added per worker in industry that determined it.

ABSTRACT BACKGROUND: The fragility of healthcare systems worldwide had not been exposed by any pandemic until now. The lack of integrated methods for bed capacity planning compromises the effectiveness of public and private hospitals’ services. OBJECTIVES: To estimate the impact of the COVID-19 pandemic on the provision of intensive care unit and clinical beds for Brazilian states, using an integrated model. DESIGN AND SETTING: Experimental study applying healthcare informatics to data on COVID-19 cases from the official electronic platform of the Brazilian Ministry of Health. METHODS: A predictive model based on the historical records of Brazilian states was developed to estimate the need for hospital beds during the COVID-19 pandemic. RESULTS: The proposed model projected in advance that there was a lack of 22,771 hospital beds for Brazilian states, of which 38.95% were ICU beds, and 61.05% were clinical beds. CONCLUSIONS: The proposed approach provides valuable information to help hospital managers anticipate actions for improving healthcare system capacity.