Efficiency of the primary health care policy in Brazilian municipalities: an application of the Pearl's Structural Causal Model / A eficiência da política de atenção básica de saúde nos municípios brasileiros: uma aplicação do Modelo Causal Estrutural de Pearl

ABSTRACT Background In recent years, public health policies and their effects on improving health outcomes have been gaining prominence in the economic literature and on the agenda of international organizations. Objective This study aims to evaluate the causal effect of the "Pacto pela Saúde" (Pact for Health) program on health policy performance in terms of a Health Vulnerability Index (HVI) of Brazilian municipalities from 2006 to 2013. The "Pacto pela Saúde" program is the current operational standard of the Brazilian Unified Health System (SUS). One of the main guidelines of this program was to improve health policy governance. Method The effect resulting from efficiency gains of the participation of municipalities in the health policy on the HVI was estimated by the Pearl's Structural Causal Model. Results The results indicate a positive and significant impact of efficiency management on the reduction of health vulnerability in the municipalities. The Pearl's Causal Model and the back-door criterion of causal identification were employed to calculate the effects of the "Pacto pela Saúde" program on the HVI. Conclusion The use of Pearl's method in this study contributed to a more comprehensive analysis of the effects of the "Pacto pela Saúde" program on health outcomes and, therefore, its use in future research on the analysis of public policies is recommended.

RESUMO Introdução A condução da política de saúde pública e seus efeitos sobre a melhoria dos resultados de saúde vêm ganhando destaque nos últimos anos na literatura econômica e na agenda dos organismos internacionais. Objetivo Avaliar o efeito causal do Pacto pela Saúde sobre o desempenho da política de saúde, em termos de um indicador de vulnerabilidade de saúde (IVS), dos municípios brasileiros no período de 2006 a 2013. O Pacto pela Saúde é a norma operacional vigente pelo Sistema Único de Saúde (SUS) do Brasil e teve como uma de suas principais diretrizes o aprimoramento da governança da política de saúde. Método A estimação do efeito causal decorrente dos ganhos de eficiência da participação do município na política sobre o IVS se deu por meio do Modelo Causal Estrutural (MCE) de Pearl. Resultados Houve a estimação de um impacto positivo e significante da eficiência da gestão sobre a queda da vulnerabilidade de saúde dos municípios e a adequação do MCE e do critério back-door de Pearl de identificação causal com o cálculo do efeito do Pacto pela Saúde sobre o IVS. Conclusão A utilização do método de Pearl contribuiu para uma análise mais adequada do efeito do Pacto pela Saúde sobre os IVS, e, portanto, recomenda-se sua utilização em estudos futuros de análise de políticas públicas.

Separate Neural Networks for Gains and Losses in Intertemporal Choice / 神经科学通报·英文版

An important and unresolved question is how human brain regions process information and interact with each other in intertemporal choice related to gains and losses. Using psychophysiological interaction and dynamic causal modeling analyses, we investigated the functional interactions between regions involved in the decision-making process while participants performed temporal discounting tasks in both the gains and losses domains. We found two distinct intrinsic valuation systems underlying temporal discounting in the gains and losses domains: gains were specifically evaluated in the medial regions, including the medial prefrontal and orbitofrontal cortices, and losses were evaluated in the lateral dorsolateral prefrontal cortex. In addition, immediate reward or punishment was found to modulate the functional interactions between the dorsolateral prefrontal cortex and distinct regions in both the gains and losses domains: in the gains domain, the mesolimbic regions; in the losses domain, the medial prefrontal cortex, anterior cingulate cortex, and insula. These findings suggest that intertemporal choice of gains and losses might involve distinct valuation systems, and more importantly, separate neural interactions may implement the intertemporal choices of gains and losses. These findings may provide a new biological perspective for understanding the neural mechanisms underlying intertemporal choice of gains and losses.

The primary explore of the damage of the executive control network in major depressive disorder:a dynamic causal model on magnetoencephalography / 中华行为医学与脑科学杂志

Objective To investigate the interconnection of the executive control network in major depressive disorder when they recognized the sad facial stimuli,and to discuss the aberrant mechanism of emotion processing.Methods Twenty major depressive patients and 20 well-matched healthy volunteers participated in the experiment.The brain actions of all subjects were recorded by the magnetoencephalography (MEG) when they were required to distinguish the emotion face.Based on prior knowledge,the interested brain area consisted of the primary visual cortex (V1),the orbitofrontal cortex(OFC),the dorsolateral prefrontal cortex (DLPFC),the anterior cingulated cortex (ACC).Then constructing three competing models to select an optimal model by the method of dynamic causal model(DCM),finally the differences of the effective connections of the optimal model between the depressed patients and healthy controls were analyzed.Results According to the results of Bayesian model selection (BMS),model 1 had the most exceedance probability of 0.80 with the features that there were bidirectional modulatory connections between the OFC,ACC and DLPFC.Given the best model,the parameters of effective connectivity of the optimal model were extracted,and then two-sample t-test over the model 1 was adopted.The modulatory effective connectivity from the OFC to the DLPFC in both hemisphere(t=-2.73,P=0.0096;t=-3.01,P=0.0046) and the OFC to the ACC (t=-2.93,P=0.0057) in the left hemisphere were significantly reduced in MDD.Conclusion There exists abnormal function of executive control network in depressed patients,the decreased effective connections between the OFC and the DLPFC,as well as the OFC and the ACC,may have correlation with the negative

Modelo empírico entre busca de sensação e as variações do delinquir em brasileiros / Empirical model between sensation seeking and the variations of the delinquency in the Brazilian

Apesar de existir muitas variáveis que expliquem o delinquir em jovens, os traços de personalidade ainda tem sido, na Psicologia, um construto muito promissor para compreender esse problema, contribuindo como mais uma resposta na intervenção desse fenômeno. Neste trabalho pretende-se desenvolver, a partir da modelagem de equação estrutural, a explicação da variação do delinquir (composto pelo uso potencial de drogas, condutas desviantes e comportamento agressivo) a partir do construto personalístico da busca de sensação. 284 jovens, de 14 a 20 anos, responderam o questionário do uso potencial de drogas, condutas desviantes, comportamento agressivo e busca de sensação. A partir do programa AMOS GRAFICS 7.0, os principais resultados indicaram que o construto busca de sensação se associou à variação do delinquir, na qual se observou uma associação entre uso potencial de drogas, condutas desviantes e comportamento agressivo.

Although there are many variables that explain delinquency of young people, the personality characteristics still have been in Psychology a very promising issue to understand this problem, contributing for an intervention in this problem. In this study we intended to develop, from the modeling of a structural equation, the explanation of the variation of deliquency (related to the potential use of drugs, deviant and aggressive behaviors), based on a personal issue – sensation seeking. 284 youngs, of 14 to 20 years, answered a questionnaire about the potential use of drugs, deviant behaviors, aggressive behavior and sensation seeking. With the software AMOS GRAFICS7.0, the main results indicated that the question of sensation seeking was associated to the variation of delinquency, in which was observed an association among the potential use of drugs, deviant and aggressive behaviors and aggressive.

The most optimal effective connections of prefrontal-amygdala during major depressive patients recognizing happy face / 中华行为医学与脑科学杂志

Objective To investigate whether there is exists optimal effective connections of prefrontal-amygdala in patients with major depressive disorder when they recognize dynamic positive face expressions with the technology of magnetoencephalograph (MEG),and discuss the possible aberrant mechanism of emotion processing.Methods Twenty major depressive patients and 20 well-matched healthy volunteer controls participated in the experiment.The regions of interested brain area included the primary visual cortex (V1),the precuneus (PQ),the dorsolateral prefrontal cortex (DLPFC),the anterior cingulate cortex (ACC),the amygdala (AMYG).After constructing three putative models,dynamic causal model was used to select an optimal model,then extracted all the effective connection parameters and conducted t-test under the overall optimal model between-group comparison.Results The bayesian model selection (BMS) indicated that model with top-down modulate connections between DLPFC-ACC,DLPFC-AMYG and ACC-AMYG was the most superior model,whose exceedance probability was 0.41.In the fight hemisphere of patient group,the endogenous connectivity from AMYG to ACC significantly decreased compared to healthy controls (t=-2.21,P=0.033),while the endogenous connectivity from ACC to DLPFC was enhanced significandy (t=2.50,P=0.017),which was the same with the endogenous connectivity from AMYG to DLPFC (t=2.10,P=0.040).Conclusion The effective connections of prefrontal-amygdala in major depressive disorder are exactly impaired,which may indicate that major depressive disorder have a bias toward negative.While depressed patients don' t show abnormality in the modulate connectivity under happy stimulus.

Teste empírico de um modelo teórico sobre o estilo da orientação cultural e condutas desviantes em jovens de diferentes contextos socioescolares / Empirical testing of a theoretical model about the style of cultural orientation and deviant conduct of young people in different social and school contexts

Estudos já realizados defenderam que a orientação cultural social se relaciona positivamente com a conduta desviante. Por outro lado, a orientação individual tem relação positiva com tais condutas. Neste estudo, pretende-se testar um modelo teórico entre estilo de orientação cultural e conduta desviante de jovens em diferentes contextos socioescolares, proposta sugerida, mas ainda não efetivada. Duas amostras de jovens entre 14 a 21 anos, do sexo masculino e do sexo feminino, responderam as escalas dos atributos de individualismo e coletivismo e das condutas desviantes. No programa AMOS GRAFICS 18.0, comprovou-se que, independente do contexto sócio-escolar, as orientações individualistas explicaram, positivamente, as condutas desviantes; e as orientações coletivistas explicaram negativamente tais condutas.

Existing studies have argued that the socio-cultural orientation is positively related to deviant behavior, on the other hand, individual orientation has a positive relation with such conducts. This study aims to test a theoretical model about the style of cultural orientation of deviant behavior in young people in different social and school environments. Such proposal was suggested, but not yet fulfilled. Two groups of youths, ranging between 14 and 21 years old, both male and female, were sampled and answered the scale of the attributes of individualism and collectivism and deviant conduct. In the AMOS GRAFICS 18.0 computer program it was shown that, regardless of social and school context, the individualistic orientations explained the deviant behaviors in a positive way; and collectivist orientations explained the same behaviors negatively.

Estilo da orientação cultural e condutas desviantes: testagem de um modelo teórico / Style of cultural orientation and deviant conduct: testing of a theoretical model

O problema dos comportamentos desviantes entre jovens tem sido motivo de reflexão por especialistas das diversas áreas das ciências humanas e sociais. Das muitas explicações sobre esse fenômeno, a que se refere às mudanças culturais que vêm ocorrendo no mundo, apreendendo uma dinâmica individualista ao invés da valorização do coletivo, tem merecido destaque. Sendo assim, as consideradas síndromes culturais, referidas aos compartilhamento de atitudes, crenças, normas, papéis sociais e definições do eu, que orientam as pessoas a determinado tipo de comportamento, seriam mais uma variável que contribuiria para o quebra-cabeça das condutas juvenis, especificamente as que permeiam a delinquência. 540 jovens entre 14 e 21 anos responderam aos atributos de individualismo e coletivismo e condutas antissociais e delitivas. A partir do programa AMOS GRAFICS 7.0, os principais resultados indicaram que as orientações individualistas explicam, positivamente, as condutas desviantes; enquanto as orientações coletivistas explicam negativamente tais condutas.

The problem of deviant behaviors among young people has been discussed by experts in various areas of human and social science. Of the many explanations for this phenomenon, the one which focus on the cultural changes taking place in the world, adopting an individualistic approach instead of a collective one, deserves more attention. According to this view, the so called cultural syndromes, which relate to the sharing of attitudes, beliefs, norms, social roles and definitions of the self, which motivate people to certain type of behavior, would be a variable that contribute to the puzzle of young conducts, specifically those that lead to crime. A survey with 540 young people, between 14 and 21 years old, was applied with questions on the attributes of individualism, collectivism, and antissocial, criminal conducts. Based on the program AMOS GRAFICS 7.0, the main findings suggest that individualistic orientations may explain, positively, deviant conducts; while collective orientations might be negatively accounted for those conducts.