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Introducción. La deuda económica durante la residencia en cirugía general puede afectar el desempeño profesional, las decisiones de vida y el bienestar psicológico. La información disponible en Colombia es limitada. El objetivo de este estudio fue cuantificar la deuda económica del residente de cirugía general, identificar los factores asociados y evaluar su efecto en el bienestar psicológico. Métodos. Estudio de corte transversal analítico. Se invitó a 380 residentes a diligenciar una encuesta sobre los aspectos relacionados con su deuda económica y se utilizó el WHO-index para evaluar su bienestar psicológico. Resultados. Un total de 259 residentes participaron en el estudio (67,6 %). El 56 % posee una deuda económica promedio de COP $88.000.000 ((US$21.826)). Un alto nivel de endeudamiento se relacionó con el año de residencia, el tipo de institución (privada) y la solicitud de préstamos. Se identificó algún trastorno mental en 14,7 % y un bajo nivel de bienestar psicológico en 56,4 % de los participantes. No se identificó ninguna asociación entre una elevada deuda económica y el bajo bienestar psicológico. Conclusiones. La deuda económica tiene un efecto sobre los residentes. El endeudamiento de los residentes de cirugía en Colombia es altamente prevalente, y no se correlaciona con un pobre bienestar psicológico. La autodeterminación favorece el bienestar psicológico en el posgrado en cirugía general. Existe la necesidad de educación financiera en los residentes. Se requieren nuevos estudios que evalúen las causas del pobre bienestar psicológico.
Introduction. Financial debt during surgery residency can affect professional performance, life decisions, and psychological well-being. The information available in Colombia is limited. The objective of this study is to quantify the financial debt of the general surgery resident, identify the associated factors and evaluate their effect on psychological well-being. Methods. A cross-sectional study was carried out. A total of 380 residents were invited to complete a survey on aspects related to their financial debt, and the WHO-index to evaluate their psychological well-being. Results. A total of 259 residents participated in the study (67.6%). 56% have an average economic debt of $88,000,000 COP (US$21,826). High debt was related to level of residence, type of institution (private), and loan application. Some mental disorder was identified in 14.7% and a low level of psychological well-being in 56.4% of the participants. No association was identified between high financial debt and low psychological well-being. Conclusions. Economic debt has an effect on residents. Financial debt among surgical residents in Colombia is highly prevalent; however, it does not correlate with poor psychological well-being. Self-determination favors psychological well-being in the postgraduate course in general surgery. Likewise, the need for financial education in residents is imminent. New studies are required that thoroughly evaluate the causes of poor well-being.
Subject(s)
Humans , General Surgery , Economics , Psychological Well-Being , Training Support , Education, Medical, GraduateABSTRACT
Resumen: El fenómeno de la deuda de oxígeno (dO2) descrito hace varias décadas en el contexto del ejercicio físico se ha incorporado progresivamente al terreno de la medicina. En particular se ha utilizado durante los cambios hemodinámicos producidos por la cirugía y la anestesia en los pacientes de alto riesgo. La dO2 se definió como el aumento en la cantidad de oxígeno consumida por el organismo inmediatamente después de realizar un ejercicio físico hasta que el consumo se normaliza nuevamente. En el perioperatorio se llega a producir cuando se presenta un desbalance entre la oferta (DO2) y la demanda de oxígeno (VO2) que lleva a hipoxia tisular. El grado de la dO2 tisular se ha relacionado directamente con la falla de órganos múltiples y morbimortalidad perioperatoria. A pesar de los avances en la medicina, aún no es posible prevenir o disminuir la dO2 con la administración de líquidos o con el uso de agentes vasoactivos. Por lo que un retardo o manejo inadecuado de la hemodinámica perioperatoria producirá hipoperfusión e hipoxia tisular afectando los resultados de la cirugía. El conocimiento y la valoración de la dO2 es esencial durante la anestesia del paciente de alto riesgo. Para lograr este objetivo se requiere del uso de índices adecuados que permitan detectar y cuantificar la hipoperfusión tisular y el desbalance entre la DO2 y la VO2. En esta revisión se presentan los conceptos fundamentales de la dO2, su mecanismo, detección y cuantificación; además de las intervenciones para evitarla o disminuirla y las recomendaciones para los anestesiólogos con el fin de asegurar mejores resultados en los pacientes quirúrgicos de alto riesgo.
Abstract: The phenomenon of oxygen debt (dO2) described several decades ago in the context of physical exercise has been incorporated into medicine, particularly during the hemodynamic changes produced by surgery and anesthesia in high-risk patients. dO2 is defined as the increase in the amount of oxygen consumed by the body immediately after physical exercise until O2 consumption returns to normal. In the perioperative period, an imbalance between oxygen supply (DO2) and demand (VO2) could generate dO2. The degree of tissue dO2 has been directly related to multiple organ failure and perioperative morbimortality. Despite advances in medicine, it is not yet possible to prevent or lower the dO2 with fluid administration or vasoactive agents. Delay or inadequate management of hemodynamics could produce tissue hypoperfusion and hypoxia, affecting surgery outcomes. Knowledge and assessing dO2 during perioperative are essential during anesthesia for high-risk patients. Adequate indices are required to detect and quantify tissue hypoperfusion and the imbalance between DO2 and VO2 during anesthesia. This review presents the mechanism, detection, and quantification of dO2. In addition to interventions to avoid or reduce dO2 and recommendations for anesthesiologists to ensure better results in high-risk surgical patients.
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Non-pharmaceutical interventions (NPIs) implemented during the severe acute respiratory syndrome coronavirus 2(SARS-CoV-2) epidemic have been proven to be effective in blocking the spread of the epidemic.While reducing SARS-CoV-2 transmission, NPIs also reduce children exposure to other pathogens, leading to a decline in the incidence of many viral and bacterial infections.The reduction in contact with viruses and bacteria and the delay or interruption of routine immunization during SARS-CoV-2 epidemic have resulted in insufficient immune stimulation of pathogens on the population, leading to an increase in susceptible populations and a decline in herd immunity, forming the immune debt during SARS-CoV-2 epidemic.After reducing or lifting NPIs, the incidence of some viral or bacterial infectious diseases was significantly higher than pre-epidemic.In this review, the definition, source, impact and strategies of immune debt during epidemic period were expounded, inorder to improve clinicians′ attention and understanding of immune debt and optimize the prevention of children′s infectious diseases.
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Resumo: Este artigo objetiva retomar as contribuições de Rui Mauro Marini para o pensamento crítico latino-americano. Apresentamos três temas candentes contemporâneos da realidade brasileira como expressões do capitalismo dependente: 1. O padrão de especialização produtiva e a reprimarização da economia brasileira; 2. A transferência de valor por meio das dívidas públicas;3. O aprofundamento da superexploração.
Abstract: This article aims to review Rui Mauro Marini's contributions to Latin American critical thought. We present three burning contemporary themes in the Brazilian reality as expressions of dependent capitalism: 1. The pattern of productive specialization and the reprimarization of the Brazilian economy; 2. The transfer of value through public debts;3. The deepening of superexploitation
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RESUMO. A intenção deste ensaio é circunscrever na tradição social brasileira recente a problemática do populismo de extrema direita, em uma retomada e repetição do que se passou nos tempos nefastos da ditadura militar. Para isso, vamos destacar a dívida estabelecida pela sociedade brasileira para com os mortos, na medida em que os crimes realizados pela ditadura não foram julgados. Além disso, tal dívida remete a outras dívidas existentes na sociedade brasileira, referentes à tradição escravocrata, assim como as relações patriarcais no registro do gênero.
RESUME: L'intention de cet essai est de circonscrire dans la récente tradition sociale brésilienne la problématique du populisme d'extrême droite, dans une reprise et une répétition de ce qui s'est passé dans les temps néfastes de la dictature militaire. Pour cela, nous soulignerons la dette établie par la société brésilienne envers les morts, dans la mesure où les crimes perpétrés par la dictature n'ont pas été jugés. En outre, cette dette fait référence à d'autres dettes existant dans la société brésilienne, se référant à la tradition esclavagiste, ainsi qu'aux relations patriarcales dans le registre des sexes.
ABSTRACT. This essay intends to circumscribe in the recent Brazilian social tradition the problem of far right-wing populism, in a resumption and repetition of what happened in the nefarious times of the military dictatorship. For this, we analyzed the debt established by Brazilian society towards the dead, insofar as the crimes committed by the dictatorship were not judged. In addition, this debt refers to other existing debts in Brazilian society, referring to the slavery tradition, as well as gender related patriarchal relations.
Subject(s)
Politics , Psychoanalysis , UnconsciousnessABSTRACT
Resumen La deuda pública en Colombia entre el periodo de 1990 a 2020 se ha convertido en un eje estructurante de la economía política del país y bajo su manutención se ha generado un sin número de Leyes, Decretos y Normas que han determina do en gran parte las dinámicas de inversión y gasto social. Así mismo, se han su bordinado los derechos de la población colombiana a la estabilidad macroeco- nómica establecida bajo la teoría neoclásica. Si bien la deuda pública tiene una gran relevancia en la configuración del Estado en Colombia, los análisis sobre la problemática de la deuda pública y el servicio de esta es vago y no estructura la crisis fiscal del Estado con la del endeudamiento público, por lo cual en este artí culo se pretende evidenciar la configuración de la deuda pública en los últimos 30 años y su relación con la crisis fiscal del Estado.
Abstract The public debt in Colombia between 1990 and 2020 has become a structuring axis of the country's political economy and under its maintenance has generated a number of laws, decrees, and norms, which have largely determined the dyna mics of investment and social spending. Likewise, the rights of the Colombian population have been subordinated to the macroeconomic stability established under neoclassical theory. Although the public debt has a great relevance in the configuration of the State in Colombia, the analysis of the problem of public debt and its service is vague, and it does not structure the fiscal crisis of the Sta te with that of public indebtedness. Thus, this article aims to show the configu ration of the public debt in the last 30 years and its relationship with the fiscal crisis of the State.
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Background: Sleep is an essential component of human life because it provides for relaxation and recovery from the stresses of everyday living. Reduced sleep quantity or quality leads to sleep deprivation which may offer indirect dangers by affecting cognitive and physical performance and raising the chance of motor vehicle and occupational accidents. Insomnia chronic sleep debt snoring sleep apnea circadian rhythm disturbances (including shift work syndrome) RLS parasomnias and uncommon diseases such as narcolepsy are the most common sleep disorders found in sleep clinics according to experts. Obstructive Sleep apnea is a common disorder in which your breathing stops and starts periodically while you sleep. To determine the design and validation of an Integrated Yoga Module (IYM) for OSA patients. The ?rst phase - IYM for OSA - was created based on a survey of classic books and Materials and Procedures: recently available research studies. The designed IYM was validated by 20 subject matter (yoga) experts in the second phase. Lawshe's formula was used to calculate the content-validity ratio (CVR). Yoga practices were created for the OSA Results: Integrated Yoga Module. The ?nal Integrated Yoga Module featured yoga practises with CVR ?0.5 that were assessed by 20 yoga experts and agreed in faculty group discussion. The yoga practices were designed and validated for IYM for Conclusion: OSA. By applying Lawshe's content validity criteria 20 yoga professionals veri?ed the IYM design.
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This article assesses the impact of the HIV and COVID-19 pandemics and debt dynamics on health, HIV and pandemic preparedness and response-related financing in developing countries. Using a novel dataset, we did a cross-national systematic analysis of all data sources available for government expenditures on health, HIV, COVID-19 and debt servicing in selected developing countries. We found an inadequate multilateral response with the ensuing gaps allowing both pandemics to thrive. The G20 Debt Service Suspension Initiative and the Common Framework only covered countries with a third of the global population of people living with HIV. Rising and unsustainable debt levels are limiting the capacity of governments to protect the health of their populations. Government spending is already falling in response to high debt payments. Specifically, debt servicing is crowding out lifesaving investments. In 2020, for every USD 5 available, USD 4 was spent on debt servicing. Only USD 1 was invested in health. This is a binding constraint on countries' efforts to control COVID-19. Even with a gargantuan effort to increase health expenditure, the outlook for health financing remains negative. Fiscal consolidation, with a heavy emphasis on expenditure cuts, is expected to take place across 139 countries in the coming years. These findings suggest that fiscal policymakers should be concerned about the crowding-out and constraining effects of public debt. To this end, pragmatic recommendations are made to treat and cancel debt as a critical policy lever to accelerate the end of the HIV and COVID-19 pandemics in developing countries as a key condition to addressing the growing inequalities and to ensure debt can be a benefit, not a burden.
Subject(s)
HIV , COVID-19 , Health Services Accessibility , Developing Countries , Fiscal Policy , Analysis of the Budgetary Impact of Therapeutic AdvancesABSTRACT
Abstract Deaths in traffic represent a global and multicausal problem. We verified, through a linear regression model, that cognitive abilities (CA) and population indebtedness (PI) predict, together, 56% of the variation of death rates in the traffic (DT) of the twenty-seven states of Brazil. CA's are related to a greater control of the attention and, possibly, to a greater compliance with norms for preventing traffic accidents, has a greater impact than PI on DT, since PI associates to only one deficit of people's attention resources. The decrease of PI and the improvement of CA can decrease DT.
Resumo Os óbitos no trânsito representam um problema global e multicausal. Verificamos, por meio de um modelo de regressão linear, que as habilidades cognitivas (HC) e o endividamento populacional (ENDP), predizem, juntos, 56% da variação das taxas de óbitos no trânsito (TOT) das 27 unidades federativas (UF) do Brasil. As HC, por estarem relacionadas a um maior controle da atenção e, possivelmente, a um maior cumprimento de normas de prevenção contra acidentes de trânsito, possuem um impacto maior que o ENDP sobre as TOT, já que o ENDP associa somente a um deficit dos recursos de atenção das pessoas. A diminuição do ENDP e a melhoria das HC podem reduzir as TOT.
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El soporte nutricional que se brinda a los pacientes críticos, constituye para la mayoría la única vía de acceso a través de la cual es posible cubrir sus requerimientos nutricionales diarios. Sin embargo, se ha identificado que la presencia de deuda calórica impide cubrir dichos requerimientos. Este estudio determinó la deuda calórica y su potencial efecto clínico a través de una cohorte prospectiva que incluyó 191 pacientes que recibieron soporte nutricional en unidades de cuidado intensivo (UCI). Se evaluó la magnitud de la deuda calórica, los principales factores que la favorecen y se exploraron diferencias en desenlaces clínicos relacionados con mortalidad, complicaciones infecciosas y tiempo de estancia en UCI. Los resultados evidenciaron que la deuda calórica estuvo presente en el 73,8%(IC 95% = 67%-80%) de los pacientes evaluados; la principal causa estuvo relacionada con la interrupción de la nutrición enteral y no se encontró asociación entre el porcentaje de adecuación calórico y los desenlaces evaluados. Esta evaluación permitió establecer que la mayoría de los pacientes, a pesar de recibir soporte nutricional, se encuentran expuestos a deuda calórica siendo necesario generar estrategias de atención que permitan disminuir la exposición de esta población a dicha condición.
The nutritional support offered to critically ill patients is, for most of them, the only means to fulfill their daily nutritional requirements. However, it has been documented that nutritional support is not enough to cover such needs, due to the presence of caloric debt. We seek to determine the caloric debt and its potential to clinical affect critically ill patients that receive nutritional support in the Intensive Care Unit (ICU). We conducted a prospective cohort study with 191 patients. We assessed the magnitude of caloric debt and its related factors. We also explored variations in clinical outcomes related to mortality, infectious complications and ICU stay length. Caloric debt was found in 73.8% (95% CI = 67-80%) of patients who received less than 80% of their daily caloric requirements. Main causes were related to enteral nutrition interruption. We found no association between caloric debt and the evaluated outcomes. This evaluation made it possible to establish that the majority of patients, despite receiving nutritional support, were exposed to caloric debt, and it is necessary to generate care strategies to reduce the patients' exposure to this condition.
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Enteral Nutrition , Parenteral Nutrition , Caloric Restriction/adverse effects , Intensive Care Units , Prospective Studies , Risk Factors , Follow-Up Studies , Critical Illness , Nutritional Support , Eating , HospitalizationABSTRACT
Resumen Este artículo presenta los resultados de una investigación sobre los procesos de reversión de memorias del conflicto armado colombiano publicados en la prensa escrita. Se adopta la noción de memoria revertida como dispositivo narrativo mediante el que se relatan acontecimientos del pasado a partir de la cobertura de eventos actuales con valor noticioso en los medios de comunicación. Se empleó el método de Análisis del Discurso sobre notas de prensa referidas a los procesos de reparación a víctimas del conflicto, adelantados en el marco de las disposiciones de la Ley de Víctimas y Restitución de Tierras (2011) en Colombia. Dicha narrativa opera a través de diferentes portadores de memoria, entendidos como personas en las categorías de víctimas y victimarios; la reparación como fenómeno a través del que se paga una deuda histórica, por medio del reconocimiento y búsqueda de la verdad; y lugares donde se conmemoran los eventos, representados en museos. El análisis revela una narrativa en la que se concibe la memoria institucional del conflicto como rectificación del olvido ante el sufrimiento de las víctimas. Este desplazamiento discursivo configura un marco de posibilidad para el desarrollo de formas diferentes de relacionamiento entre las víctimas, el Estado y la sociedad en general, legitimando así el accionar del Estado como ente aglutinador y factor de cohesión nacional.
Abstract This paper aims to make a discourse analysis of the processes that reverse memories of the Colombian conflict in national newspapers. The research adopts a theoretical approach that describes reversed memory as a narratological device which tells past events while covers the present in news media. Methodology of discourse analysis on news pieces refered to the processes of reparation of victims was employed. These processes are being carried out in accordance with legal provisions stablished by Law of Victims and Land Restitution (2011). The analysis shows a narrative construction in which institutional memory of the conflict is conceived as a rectification on forgetting the victims' suffering. Such a narrative operates through memory carriers, which are understood as people under the name of victims and victimizers; reparation as a phenomenon through discursive forms such as payment of historical debt, acknowledgment of the victim and seeking of truth; and places represented as museums. This narrative process shapes an escenario in which development of new sorts of relations between victims, the State and society, legitimizing the State as a factor of national cohesion.
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Resumen El presente artículo propone un análisis de los dispositivos biopolíticos que se encuentran detrás de la figura del crédito o la deuda en el campo de la educación superior, a partir de una lectura histórica de la deuda y la relación acreedor-deudor en su interior, planteada esta como una relación de poder. Desde la comprensión de la deuda como un dispositivo de control biopolítico constitutivo del aparato neoliberal, esta se traslada al campo de la educación a través de la figura de crédito educativo, que está disponible a toda la población y facilita el acceso a la educación superior, y alimenta así un ideal de inversión a largo plazo con la promesa infinita de la conquista de un sujeto "empresario de sí mismo", que se encuentra en una procura permanente de recursos que le permitan mantener la inversión en sí mismo como aparato productivo. Así, este análisis consigue plantear el ideal del sujeto aparentemente independiente, que se sumerge en la deuda como mecanismo de acceso a los recursos que le acercan a la meta de ser "su propio jefe", como la esencia de uno de los engranajes principales en los modos de sujeción de la conducta, propios del neoliberalismo, y su mecanismo de la deuda, aplicados al campo de la educación. Sobre esta base tiene lugar una "pedagogía de la deuda" en la cual emergen como elementos indispensables en la fabricación de dicho sujeto la universidad y la educación superior.
Abstract This article proposes an analysis of the biopolitical devices that are behind the figure of credit or debt in the higher education field, based on a historical reading of the debt and the creditor-debtor relationship, explained as a relationship of power. From the understanding of the debt as a biopolitical constitutive device of control of the neoliberal apparatus, it is transferred to the field of education through the figure of educational credit, which is available to the entire population and facilitates access to higher education. And thus feeds an idea of long-term investment with the infinite promise of the conquest of a subject "entrepreneur of himself," who finds himself in a permanent pursuit of resources that allow him to maintain the investment in himself as a productive apparatus. Therefore, this analysis manages to pose the idea of the apparently independent subject, who immerses himself in the debt as a mechanism of access to resources that bring him closer to the goal of being "his own boss", as the essence of one of the main gears in modes of subjection of behavior, typical of neoliberalism, and its mechanism of debt, applied to the field of education. On this basis, there is a "debt pedagogy" in which the university and higher education emerge as indispensable elements in the manufacture of said subject.
Resumo O presente artigo propõe uma análise dos dispositivos biopolíticos que estão por trás da figura do crédito ou a dívida no campo do ensino superior, desde em uma leitura histórica da dívida e do relacionamento credor-devedor dentro dela, levantada ela como uma relação de poder. Desde a compreensão da dívida como um dispositivo de controle biopolítico constitutivo do aparelho neoliberal, esta é transferida para o campo da educação através da figura do crédito educacional, que está disponível para toda a população e facilita o acesso ao ensino superior, e assim alimenta um ideal de investimento em longo prazo com a infinita promessa da conquista de um sujeito "empresário de si mesmo", que se encontra em uma busca permanente de recursos que lhe permitam manter o investimento em si mesmo como um aparelho produtivo. Assim, esta análise consegue levantar o ideal do sujeito aparentemente independente, que se submerge na dívida como um mecanismo de acesso aos recursos que o aproximam ao objetivo de ser "seu próprio chefe", como a essência de uma das engrenagens principais nos modos de sujeição do comportamento, próprio do neoliberalismo, e seu mecanismo da dívida, aplicados ao campo da educação. Nesta base, tem lugar uma "pedagogia da dívida" na qual emergem como elementos indispensáveis na fabricação do referido sujeito à universidade e o ensino superior.
Subject(s)
Humans , Bioethics , Politics , Economics , JurisprudenceABSTRACT
INTRODUCTION@#Medical school fees are rising globally. Student debt and financial background may affect residency choices, but few studies have been conducted in Asia. This study aimed to explore the relationship between financial background, student debt and postgraduate residency choices among medical students in Singapore.@*METHODS@#An anonymised survey of all medical students in Singapore was conducted and had a response rate of 67.9%.@*RESULTS@#40.5% of our study population would graduate with debt. Medical students with monthly per capita household income < SGD 1,000 were more likely to graduate with debt (unadjusted odds ratio [OR] 2.0, 95% confidence interval [CI] 1.6-2.7; p < 0.001) and feel burdened by the cost of medical education (unadjusted OR 2.8, 95% CI 2.0-3.9; p < 0.001). Students with monthly per capita household income < SGD 1,000 (unadjusted OR 1.818, 95% CI 1.338-2.470, p < 0.001; adjusted OR 1.692, 95% CI 1.202-2.381, p = 0.003) and those with debt (unadjusted OR 1.623, 95% CI 1.261-2.090, p < 0.001; adjusted OR 1.393, 95% CI 1.048-1.851, p = 0.022) were more likely to rank at least one economic factor as 'very significant' in influencing their postgraduate training choices.@*CONCLUSION@#It is concerning that despite financial aid schemes, the cost of medical education remains a burden to students from lower-income households in Singapore. Student debt and financial background may distort postgraduate career choices, creating an undue push towards high-paying specialties.
Subject(s)
Humans , Career Choice , Choice Behavior , Education, Medical , Economics , Internship and Residency , Economics , Odds Ratio , Schools, Medical , Economics , Singapore , Social Class , Students, Medical , Surveys and Questionnaires , Training SupportABSTRACT
Resumo Este artigo faz uso da técnica de análise envoltória de dados em painel, para uma amostra balanceada com dados anuais de 2004 a 2013, visando modelar o processo de geração de bem-estar social por parte das unidades da federação. Uma primeira inovação está no uso de fontes de insumos associados às receitas tradicionais, como transferências e tributos, e de fontes alternativas de financiamento, via crédito nacional e via paradiplomacia. Como resultado desse processo, o Estado proporciona produtos e serviços associados a variáveis de natureza socioeconômica, de saúde, de violência, de demografia, de estudo e de infraestrutura básica. Apenas sete unidades foram plenamente eficientes na década em questão: Bahia, Ceará, Maranhão, Minas Gerais, Pará, Paraná e São Paulo. A incorporação das fontes de crédito com insumos aumenta a eficiência dos estados, alterando o ranking nacional. O nível de eficiência de alguns estados pode vir a ser comprometido pelo endividamento excessivo. Em termos de política pública, sugere-se o uso da eficiência como métrica de meritocracia na reforma tributária.
Resumen Este artículo utiliza envolvente de datos panel de la técnica de análisis de una muestra equilibrada de los datos anuales de 2004 a 2013, con el objetivo de modelar el proceso de generación de bienestar social por las unidades de la federación. La primera innovación es el uso de fuentes de entradas asociadas con recetas tradicionales, como las transferencias y los impuestos, así como fuentes alternativas de financiación a través de crédito nacional y por medio de la paradiplomacia. Como resultado de este proceso, el Estado proporciona bienes y servicios asociados a variables de carácter socioeconómico, la salud, la violencia, la demografía, el estudio y la infraestructura básica. Sólo siete unidades eran totalmente eficiente en la década en cuestión, Bahia, Ceará, Maranhão, Minas Gerais, Pará, Paraná y São Paulo. La incorporación de fuentes de crédito con entradas influye significativamente en la eficiencia y en el ranking nacional. El nivel de la eficiencia de algunos estados podría verse comprometido por la deuda excesiva. En términos de políticas públicas, se sugiere el uso de la eficiencia como métrica meritocracia en la reforma fiscal.
Abstract We use panel data envelopment analysis on a sample that aims to model the process of social welfare generation by federation units. The first innovation is the use of input sources associated with traditional revenues, such as transfers and taxes, as well as alternative sources of funding via national credit and paradiplomacy. As a result of this process, the State provides goods and services associated with socioeconomic variables such as, health, violence, demographics, study, and basic infrastructure. Only seven units, Bahia, Ceará, Maranhão, Minas Gerais, Pará, Paraná, and São Paulo, were entirely efficient in the decade studied (2004 to 2013). The incorporation of credit sources as inputs significantly influences efficiency gains and changes to national ranking. The level of efficiency of some states might be compromised by excessive debt. In terms of public policy, the use of efficiency as a meritocracy metric in tax reform is suggested.
Subject(s)
Humans , Male , Female , Public Policy , Social Welfare , Capital Financing , Efficiency, Organizational , Efficiency , DiplomacyABSTRACT
Durante los últimos treinta años, los recursos primarios han aumentado su presencia en el comercio internacional; en parte, esto se debe al cambio estructural en el modelo productivo que se adoptó en América Latina durante la década de los noventa. Asimismo, el incremento en los flujos de inversión extranjera directa (IED), dirigida hacia proyectos de explotación ambiental han tenido un impacto negativo en relación con el endeudamiento de la región. Es decir, al mismo tiempo que la IED aumentó para las actividades extractivas, también creció la deuda externa de la región. El objetivo de este trabajo es señalar que la deuda externa actual y la primarización del comercio latinoamericano coinciden con lo que ha sucedido históricamente en la región, respecto a sus relaciones comerciales con el mundo. Esta interacción ha generado un empobrecimiento constante para las naciones de América Latina debido a que priorizan la explotación y el comercio de sus recursos naturales por encima de otras actividades productivas. El método que se utilizó para esta investigación fue mediante un contraste entre las estadísticas sobre deuda económica, IED y exportaciones regionales, obteniendo como resultado una relación entre el incremento de los niveles de la IED en actividades de explotación ambiental y el aumento en los niveles de deuda externa. Por lo que se concluye que la priorización en este tipo de actividades ha fortalecido la dependencia estructural de América Latina con las naciones desarrolladas y ha derivado en un proceso de endeudamiento económico con los países desarrollados. Aunque estos últimos generan una deuda ecológica con los países subdesarrollados.
Primary resources have increased their presence in international trade during the last thirty years, partly due to a structural change in the production model adopted in Latin America in the nineties. Similarly, the increase on Foreign Direct Investment (FDI) addressed to environmental exploitation projects has had a negative impact in relation to the region's indebtedness. That is, while FDI increased for extractive activities, the external debt for the region also increased. The aim of this research is to point out that the current external debt and the Latin American trade primarization coincide with what historically has happened in the region regarding its trade relations with the world. This interaction has generated a steady impoverishment of Latin American nations because they prioritize the exploitation and trade of their natural resources over other productive activities. The method used for this research was a contrast between statistics of economic debt, FDI and regional exports, having as a result a relationship between the increase in the FDI levels in environmental exploitation activities and the increase in levels of external debt. It is concluded that the prioritization of this type of activities has strengthened the structural dependence of Latin America from developed nations and has resulted in a process of economic indebtedness with developed countries. Although, the latter generate an ecological debt with the underdeveloped countries.
Subject(s)
Exportation of ProductsABSTRACT
This paper analyzes the main performance problems of public hospitals in China,s health service field,including the deep institutional mechanism contradictions and the inefficient use of resources relying on debt to expand.Based on the policy paper of public hospital reform,this paper puts forward the path of public hospitals,par-ticipation in supply-side structural reform of medical services with objectives including:to resolve the historical debts of public hospitals,to control the financial and fiscal risks;to strictly control the cost of public hospitals, to cutrail the unreasonable increase of expenses in public hospitals and provide affordable services;to innovate the management system and operation mechanism,to make compensation and supervision in place, and improve the governance sys-tem of public hospitals;to strengthen the links between public hospitals and primary,social capital so as to integrate the medical industry chain,and expand the supply of high-quality medical resources.
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A proposta do presente artigo é analisar em que medida o fundamentalismo do superávit primário afeta a concretização dos direitos fundamentais sociais. A hipótese que serve de norte à presente análise é a de que o Estado brasileiro está estruturado para propiciar lucro ao capital financeiro e não para garantir a concretização dos direitos fundamentais sociais previstos na Constituição Federal de 1988. Para tanto, sob uma perspectiva de prioridade econômica e fiscal, buscamos mensurar o impacto das despesas com o serviço e o refinanciamento da dívida pública no Orçamento Geral da União, confrontando-as com os gastos em saúde, educação e assistência social. A conclusão possível é a de que, independentemente da concepção ideológica do governo, o Estado brasileiro se encontra capturado pelo capital financeiro, prejudicando seriamente a concretização dos direitos fundamentais sociais. O objetivo é incitar o debate sobre a dívida pública brasileira a partir de um enfoque interdisciplinar, demonstrando a partir de elementos econômicos e fiscais o descumprimento do compromisso social estatuído na Constituição Federal.
The purpose of this article is to analyze to what extent fundamentalism primary surplus affects the achievement of fundamental social rights. The hypothesis that serves north to this analysis is that the Brazilian State is structured to provide income to finance capital and not to ensure the achievement of fundamental social rights under the Federal Constitution of 1988. Thus, from the perspective of economic priority and tax, we seek to measure the impact of the costs of the service and the public debt refinancing in the Federal Budget, confronting them with spending on health, education and social assistance. The possible conclusion is that regardless of the ideological conception of government, the Brazilian State is captured by financial capital, seriously jeopardizing the achievement of fundamental social rights. The aim is to encourage the debate on the Brazilian public debt from an interdisciplinary approach, demonstrating from economic and fiscal elements the failure of social commitment requirements established in the Federal Constitution.
Subject(s)
Humans , Public PolicyABSTRACT
Resumo O artigo tem como objetivo abordar o endividamento dos trabalhadores no Brasil e a proposta da "educação financeira". Os números do endividamento são impactantes se comparados com as estatísticas do fim do século passado. O Relatório de Estabilidade Financeira (REF), publicação semestral do Banco Central do Brasil (Bacen), apresentou em 2014 o índice de endividamento das famílias em 45,5%, referente a dezembro de 2013. A "educação financeira" surge como ideologia estratégica do capital financeiro, com o objetivo de manipular o consumo e controlar os riscos de inadimplência.
Abstract The article aims at approaching the Brazilian workers´ debt and the proposal for "financial education". The numbers related to the debt are impacting if they are compared with the statistics from the last century. In 2014 the Financial Stability Report (Relatório de Estabilidade Financeira - REF), a biannual publication of Banco Central do Brasil (Bacen), presented a families´ debt rate of 45.5% in December, 2013. The "financial education" rises as a strategic ideology of the financial capitalism in order to manipulate consumption and to control the risks of default.
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El endeudamiento tiene un gran impacto en la calidad de vida, por ello es necesaria la comprensión de las variables que subyacen a este comportamiento. Al respecto, el locus de control ha sido señalado como una variable psicológica relevante que podría estar relacionada con las actitudes hacia la deuda y, por ende, con el uso del crédito en los jóvenes. El objetivo de este estudio fue determinar si existe relación entre el locus de control del consumidor y las actitudes hacia el endeudamiento en una muestra de 472 estudiantes universitarios chilenos de carreras de pedagogía de dos universidades del sur de Chile. Para recoger los datos, se adaptó y transculturizó la Escala de Locus de Control del Consumidor al contexto chileno. Para evaluar las actitudes hacia el endeudamiento se utilizó la Escala de Actitudes hacia el Endeudamiento. Los análisis de la escala de locus de control del consumidor indicaron la necesidad de abandonar la unidimensionalidad de la escala; así, emergió una nueva solución de tres factores. El análisis de diferencias de sexo revela que los hombres presentan actitudes más favorables hacia el endeudamiento. En concordancia con la hipótesis general del estudio, actitudes de mayor tolerancia hacia el endeudamiento se relacionan con un locus externo en materia de consumo. Los resultados aportan evidencia que sustenta la relación teórica entre las atribuciones de control y las actitudes hacia la deuda, y constituyen un insumo relevante para el diseño de estrategias de educación financiera en los jóvenes, al enfatizar la importancia de considerar la influencia de variables psicológicas y no solamente contenidos financieros si se esperan cambios significativos del comportamiento.
Indebtedness has great impact on quality of life, and this is why it is necessary to understand the variables that underlie this behaviour. In this regard, the locus of control has been identified as an important psychological variable that could be related to attitudes towards debt and therefore, with the behaviour of the credit use in young people. This paper sought to determine whether there is a relationship between consumer locus of control and attitudes toward debt in Chilean college students of pedagogy undergraduate programs. The sample included 472 pedagogy students from 2 universities in southern Chile. The Consumer Locus of Control Scale was validated and adapted to the Chilean context in order to carry out data collection. Attitudes towards debt were evaluated by means of the Attitudes Towards Indebtedness Scale to assess attitudes towards indebtedness. The Consumer Locus of Control Scale analysis indicated the need to abandon the one-dimensionality of the scale, thereby giving rise to a new 3-factor solution. Analysis of gender differences reveals that men have more favourable attitudes toward indebtedness. Finally, and in accordance with the general hypothesis of the study, more tolerant attitudes toward indebtedness are associated with an external locus in terms of consumption. The results provide evidence that supports the theoretical relationship between the attributes of control and attitudes towards debt, and constitute a relevant input for the design of financial education strategies in young people, emphasis also placed in considering the influence of psychological variables, and not just the financial content, if significant changes are expected in the behaviour.
ABSTRACT
Objective To analyze the assets and liabilities of secondary public hospitals of Wuhan city in Hubei province ,in order to provide references to control the debt scale of such hospitals .Methods Twenty‐one public secondary public hospitals of Wuhan city were analyzed using official statistics on their asset and liabilities from 2012-2014 .Results Such a timeframe witnessed a year‐on‐year growth of both total assets and liabilities of these hospitals ,yet the growth rate of total assets(35.15% ) falls behind that of total liabilities (53.62% )significantly ;significantly slower growth rate of non‐current assets since 2013 ;higher current liabilities than long‐term liabilities on yearly basis ;year‐on‐year grow th of liquidity rate and quick ratio in general ;significant rise of debt‐to‐assets ratio .Conclusions The overall debt scale of such hospitals keeps growing ,a trend deserving actions and correction .