Cobrança pelo uso da água para o saneamento: mecanismos para incentivo a eficiência e atendimento ao uso mínimo / Freshwater use charging for sanitation: mechanisms to encourage efficiency and meet the basic needs

RESUMO A cobrança pelo uso da água como instrumento econômico de gestão deve orientar os usuários quanto ao valor do recurso hídrico e incentivar o combate ao uso perdulário. Metodologias recentes inserem mecanismos relacionados às boas práticas no uso da água, mensurado no saneamento por meio do indicador de perdas percentuais na distribuição. Contudo, desprezam-se as perdas ocorridas nas etapas anteriores, bem como a essencialidade do serviço para a sociedade. Usando variáveis que abarcam todo o sistema de abastecimento desde a captação, este trabalho propôs uma metodologia de cobrança que amplia e penaliza as perdas reais, ao mesmo tempo em que permite descontos decorrentes da retirada para atendimento às necessidades mais fundamentais da população. Revela-se como resultado uma equação simples e transparente, com homogeneidade nas parcelas precificadas, que pode ter a punição e os privilégios ajustados às especificidades da bacia em que seja aplicada.

Abstract Freshwater use charging as an economic instrument must guide users as to the value of water resources and encourage the struggle against wasteful use. Recent methodologies include mechanisms related to good practices in the use of water resources, measured in sanitation sector by the indicator of percentage losses in distribution. However, leakages that occurred in the previous stages are ignored, as well as the essentiality of the service for society. Using variables that cover the entire supply system since withdrawn point, this paper proposes a freshwater charging methodology that conceptually expand and penalizes real losses, while imputing discounts resulting from the water use to supply a minimum volume to meet basic needs of the population. The result is a simple and transparent equation, with homogeneity in the variables charged, which might have the punishment and privileges adjusted to the specificities of the watershed in which it is applied.

Relación de anemia y talla baja con el diagnóstico de infección por Helicobacter pylori en niños de 6 a 14 años, de enero del 2014 a diciembre del 2016 en el Hospital del Niño Dr. José Renán Esquivel / Relationship of anemia and short stature with the diagnosis of Helicobacter pylori infection in children from 6 to 14 years old, from January 2014 to December 2016 at the Hospital del Niño Dr. José Renán Esquivel

Introducción: La infección por Helicobacter pylori es la enfermedad bacteriana crónica más extendida del mundo y afecta a más de la mitad de la población mundial, con una distribución vinculada con el grado de desarrollo económico de cada país. En la edad pediátrica no existe un cuadro clínico específico de esta infección, puede tener resultados clínicos diversos que incluye no sólo síntomas digestivos sino manifestaciones extradigestivas como anemia por deficiencia de hierro y retraso del crecimiento. La relación entre la infección por Helicobacter pylori, la anemia por déficit de hierro y talla baja ha sido confirmada en múltiples estudios, pero el tema sigue siendo controvertido. Debido a la escasez de estudios sobre esta asociación, particularmente en niños panameños, y el impacto de sus complicaciones a corto y largo plazo en una población tan vulnerable, es de extraordinaria importancia llevar a cabo estudios para mejorar nuestra comprensión de este tema. Material y Métodos: Se realizó un estudio analítico de casos y controles no pareados, retrospectivo. Se incluyeron 158 pacientes (79 casos y 79 controles) del Hospital del Niño Dr. José Renán Esquivel de Panamá, entre enero de 2014 a diciembre de 2016. Se hizo revisión de los expedientes clínicos con autorización del Comité de Bioética del hospital. Los datos demográficos generales y las variables de estudio seleccionadas se obtuvieron de los pacientes sometidos a endoscopia digestiva alta con biopsia gástrica que cumplían los criterios de inclusión. La existencia de una asociación estadística se evaluó con la prueba exacta de Fisher y el odds ratio.Resultados: La edad promedio de ambos grupos fue de 9.75 + 2.75 sin diferencia estadística entre las edades en los grupos. La infección fue más frecuente en el sexo femenino (63%). El dolor abdominal fue la principal indicación para realizar endoscopia. La frecuencia de anemia en los pacientes infectados fue de 31%, mayor a la reportada en países latinoamericanos, pero no se encontró asociación entre anemia e infección por Helicobacter pylori (p= 0.36) al igual que no se encontró asociación con talla baja (p= 0.74). El nivel socioeconómico fue más bajo en los pacientes enfermos (p= 0.01). El test de ureasa presentó especificidad de 100% en nuestro estudio. Conclusiones: No encontramos asociación entre anemia y talla baja con la infección por Helicobacter pylori, pero la frecuencia de anemia es elevada respecto a otros países de Latinoamérica; y el nivel socioeconómico es un factor influyente en el desarrollo de esta infección. Son necesarios estudios longitudinales que puedan evaluar a los pacientes en la evolución de la enfermedad y determinar las alteraciones en los parámetros hematológicos y velocidad de crecimiento.

Introduction: Helicobacter pylori infection is the most widespread chronic bacterial disease in the world and affects more than half of the world population, with a distribution linked to the degree of economic development of each country. In the pediatric age there is no specific clinical picture of this infection. In children, it can have diverse clinical outcomes that include not only digestive symptoms but extra-digestive manifestations such as iron deficiency anemia and growth retardation. The relationship between Helicobacter pylori infection, iron deficiency anemia and short stature has been confirmed in multiple studies, but the issue remains controversial. Due to the scarcity of studies on this association, particularly in Panamanian children, and the impact of its short and long term complications on such a vulnerable population, it is of extraordinary importance to carry out studies to improve our understanding of this topic. Material and Methods: It is a retrospective, analytical, unmatched case and control study involving a total of 158 patients (79 cases and 79 controls) from the Hospital del Niño Dr. José Renán Esquivel, Panamá, between January 2014 to December 2016. Patient records were examined with autorization from the hospital's bioethics committee. General demographic data and the selected study variables were obtained from patients who underwent upper digestive tract endoscopy with gastric biopsy that met the inclusion criteria. The existence of a statistical association was evaluated with Fisher's exact test and odds ratio. Results: The average age of both groups was 9.75 + 2.75 with no statistical difference between the ages in the groups. Infection was more frequent in females (63%). Abdominal pain was the main indication for endoscopy. The frequency of anemia in the infected patients was 31%, higher than that reported in Latin American countries, but no association was found between anemia and Helicobacter pylori infection (p= 0.36), as there was no association with growth retardatin (p= 0.74). The socioeconomic level was lower in the sick patients (p= 0.01). The urease test showed 100% specificity. Conclusions: We did not find an association between anemia and short stature with Helicobacter pylori infection, but the frequency of anemia is high compared to other Latin American countries, and the socioeconomic level is an influential factor in the development of this infection. Longitudinal studies are needed that can evaluate patients in the evolution of the disease and determine the alterations in the hematological parameters and growth rate.

Relationship between transformational leadership and creative work involvement among clinical medical workers / 中华医院管理杂志

Objective To examine the impact of transformational hospital leadership on clinical medical workers'creative work involvement.Methods From February to July 2016,826 clinical medical workers,including 359 doctors and 467 nurses, were randomly selected to complete a transformational leadership scale, a basic needs satisfaction scale and a creative work involvement scale.The data were analyzed using correlation analysis and structural equation model.Results Transformational leadership positively affected autonomy need satisfaction(β=0.40,P<0.001),competence need satisfaction(β=0.33, P<0.001),relatedness need satisfaction(β=0.81,P<0.001)and creative work involvement(β=0.64, P<0.001)respectively.All three needs satisfaction partially mediated the relationship between transformational leadership and creative work involvement.Conclusions Hospital personnel department should launch leaderships training programs to promote transformational leadership,which in turn will meet high level of psychological needs of medical workers,thus encouraging their creative work involvement.

Kano Analysis of Patients’ Satisfaction at Community Pharmacy—Applying Good Old Practice to Current Problems of Society— / 社会薬学

Consumer satisfaction is an important parameter for assessing the quality of pharmacy. Whereas expectation for pharmacists has been increasing recently, misconception still exists. The Kano analysis is a customer-oriented quality measurement and quality improvement technique. Using this analysis, the aim of the study is to assess the patients’ satisfaction regarding the services provided by pharmacists based on basic needs, performance needs, and excitement needs. Community pharmacists will need to distinguish them to enhance patients’ satisfaction.

Conflicto armado, variables socio-económicas y formación ciudadana: un análisis de impacto / Armed conflict, socio-economic variables and citizenship formation: an impact analysis / Conflito armado, variáveis socioeconômicas e formação cidadã: uma análise de impacto

En este artículo buscamos exponer los efectos que tienen las condiciones socioeconómicas y el conflicto armado sobre los aprendizajes ciudadanos. Para ello, adoptamos un enfoque cuantitativo que nos permitió analizar cómo las condiciones económicas, sociales y de conflicto armado determinan el desarrollo de Competencias Ciudadanas. Lo anterior nos llevó a establecer que las variables socio-económicas tienen un impacto mayor en el desarrollo de acciones, actitudes y emociones favorables, mientras que las condiciones de conflicto armado están más asociadas a la construcción de ambientes democráticos.

In this article the authors highlight the effects of socio-economic conditions and the armed conflict on citizens’ learning. To do this the researchers adopted a quantitative approach that facilitated an analysis of how economic and social conditions and armed conflict determine the development of citizenship competencies. This led to the identification that socio-economic variables have a greater impact on the development of actions, attitudes and favorable emotions while the conditions of the armed conflict are more associated with the construction of democratic environments.

Neste artigo buscou-se demonstrar os efeitos das condições socioeconômicas e do conflito armado sobre a aprendizagem cidadã. Para isso, foi adotada uma abordagem quantitativa que permitiu analisar como as condições econômicas, sociais e de conflito armado determinam o desenvolvimento de Competências de Cidadania. Com esses dados, percebeu-se que as variáveis socioeconômicas têm um impacto maior no desenvolvimento de ações, atitudes e emoções favoráveis, enquanto as condições de conflito armado estão mais associadas à construção de ambientes democráticos.

Relación entre las necesidades de cuidado y funcionamiento familiar en mujeres afectadas por violencia en un asentamiento humano del distrito de Puente Piedra / The relationship between care needs and family functioning of women affected by violence

Objetivo: determinar la relación entre las necesidades de cuidado y el funcionamiento familiar de las mujeres afectadaspor violencia intrafamiliar. Material y métodos: investigación de tipo correlacional y de corte transversal, que serealizó con 74 mujeres afectadas por violencia intrafamiliar según criterios de selección. Se utilizó un cuestionario queindagó sobre necesidades de cuidado empleando la valoración según 6 de las 14 necesidades de Virginia Henderson yel funcionamiento familiar según APGAR. Resultados: el 37,9% tenía entre 35 a 44 años; el 73% eran convivientes; el67,6% eran ama de casa; el 29,7% con secundaria incompleta. El 100% de mujeres presenta necesidades de cuidado deseguridad y la necesidad de comunicarse. Con un funcionamiento familiar del 51,4% con disfunción familiar severa.El coeficiente de correlación Rho de Spearman (R=-0.240) muestra una correlación estadísticamente significativa(p=0.039), la cual resultó negativa, lo que significa que niveles bajos de necesidades de cuidado se correspondencon niveles altos de funcionamiento familiar y viceversa. Conclusiones: Existe una relación significativa entre lasnecesidades de cuidado y el funcionamiento familiar donde las características sociodemográficas las hace vulnerables,con necesidades de seguridad y comunicación expresando emociones y temores, con disfunción familiar severa.

Objective: To determine the relationship between care needs and family functioning of women affected by domesticviolence. Material and methods: The study correlational and cross-sectional was conducted with 74 women affectedby domestic violence as selection criteria. It was a questionnaire that inquired about using care needs assessmentas 6 of the 14 Virginia Henderson needs and family functioning as APGAR. Results: 37.9% were between 35-44years; 73% were cohabiting; 67.6% were housewives; 29.7% of elementary education. 100% of women develop careneeds security and the need to communicate. With a familiar operation of 51.4% with severe family dysfunction. Thecorrelation coefficient Spearman Rho (R = 0.240) showed a statistically significant correlation (p=0.039), which wasnegative, which means that low levels of care needs correspond to high levels of family functioning and vice versa.Conclusions: There is a significant relationship between care needs and family functioning where the sociodemographiccharacteristics makes them vulnerable to security and communication needs of expressing emotions and fears, withsevere family dysfunction.

Role of ethnic women in biodiversity conservation.

Human population is very much dependent on the natural resources for the fulfilment of the basic needs of their lives. It is the ethical duty of every human being to protect it. Biodiversity conservation and management of the use of natural resources are the ways, by which major environmental issues can be solved up to certain limits. In recent times many efforts have been made to conserve the biodiversity. But the understanding of indigenous people in the biodiversity conservation cannot be ignored, especially the role of women. Women have always been accountable for the food and nutritional needs of their families as they play an essential role in the household. They are also being involved in almost all aspects of farming, from seed selection and plantation to harvesting, weeding, winnowing and grain storage. As they remain in direct contact with nature, they possess detailed knowledge about the species and ecosystem. It is near to impossible to manage and conserve the biodiversity without involvement of women power. And for this it is very essential to make them aware and educate on the ethics, management and sustainability of natural resources. This article focuses on women’s basic understanding and their role in biodiversity conservation.

Revision of the basic needs satisfaction in general scale( Chinese vision) / 中华行为医学与脑科学杂志

ObjectiveTo revise and test the reliability and validity of the Chinese vision of the Basic Needs Satisfaction in General Scale (BNSG-S).MethodsTotally 6366 youth workers from 5 organizations were recruited with stratified sampling method.Participants were asked to complete the Chinese vision of BNSG-S.Item analysis was conducted to identify valid items and revise the scale.Then the construct validity of the revised scale was tested through exploratory and confirmatory factor analysis ( EFA & CFA).The criterion validity was tested with the Index of Well-being Scale.Finally the reliability of the scale was examined.ResultsThe revised scale consists of 15 items with 4 factors- satisfied state of autonomy need,blocked state of autonomy need,satisfied state of relatedness need,blocked state of relatedness need.The four factors explained 63.95％ of the total variance.Besides,the CFA results demonstrated a satisfactory construct validity of the scale ( RMSEA =0.056,NFI =0.97,NNFI =0.96,CFI =0.97).The correlation coefficients between the scale and the Index of Well-being Scale was 0.50 (P＜0.01 ) and each factor was significantly correlated to the Index of Well-being Scale.The Cronbach's α coefficients of the Chinese vision of BNSG-S was 0.76,and those of its 4 factors were 0.80,0.67,0.83and 0.80 respectively.ConclusionThe Chinese vision of BNSG-S with 4 factors has good reliability and validity,demonstrating it a valid tool to measure Chinese basic needs satisfaction.

Evaluación del tratamiento de pacientes con enfermedad de Graves Basedow y su relación con indicadores de necesidades básicas insatisfechas / Medical treatment evaluation in patients with Graves Basedow disease in relation to indicators of unsatisfied basic needs

El objetivo del presente trabajo fue, evaluar el cumplimiento del tratamiento médico de pacientes con diagnóstico de enfermedad de Graves Basedow y la evolución de la misma (remisión o recidiva) en relación a indicadores de necesidades básicas insatisfechas (NBI). Se practicó la revisión retrospectiva de 156 pacientes con diagnóstico de enfermedad de Graves Basedow, los cuales tuvieron un seguimiento entre 3 y 36 años (: 9.6 años), evaluándose en cada caso los diferentes tratamientos de inicio instituidos (metimazol-MMI-, yodo radiactivo o cirugía). De los pacientes que iniciaron y continuaron el tratamiento médico con metimazol (n=140), se revisó el cumplimiento y la eficacia del mismo, relacionándolo con los indicadores de privación (NBI). De los 156 pacientes estudiados, (137 mujeres Y 19 hombres), con una edad : 42.3 años, el tratamiento de inicio fue: con metimazol en 144, con radio yodo en 6 y con cirugía en 6 pacientes. De los 144 casos que comenzaron el tratamiento con MMI, 140 lo continuaron; de los cuales el 42,86% (n=60), presentaron indicadores de necesidades básicas insatisfechas mientras que el 57.14% (n=80) no presentaron indicadores de NBI. De los 140 pacientes que continuaron el tratamiento médico, el 24,28% (n=34), presentaron remisión de la enfermedad. El 90% de los casos que presentaron algún indicador/es de NBI no cumplieron con el tratamiento vs. el 17.5% de los pacientes NO NBI. La enfermedad remitió con tratamiento con metimazol en el 3.3% de los casos con NBI y en el 40% de los casos NO NBI. Teniendo en cuenta los resultados obtenidos, creemos que podría ser de utilidad, evaluar en los casos de pacientes con enfermedad de Graves Basedow la presencia de indicadores de privación, antes de instituir el tratamiento antitiroideo apropiado.

The objective of the present paper was to evaluate the compliance of medical treatment in patients with Graves Basedow disease diagnosis and the disease evolution (remission or relapse) in relation to indicators of unsatisfied basic needs. A retrospective review of 156 patients with Graves Basedow diagnosis was performed. They were followed up between 3 and 36 years (: 9.6 years), in each case, evaluating the different initial treatments implemented (methimazole-MMI, radioactive iodine or surgery). In those patients who started and followed medical treatment with methimazole (n= 140), compliance and efficacy were reviewed in relation to deprivation indicators. Out of the 156 patients studied (137 women and 19 men), with a mean age of : 42.3 years old, the initial treatment was: 144 patients with methimazole, 6 patients with radioiodine and 6 patients submitted to surgery. Out of the 144 cases who started treatment with MMI, 140 continued with it, of which 42.86% (n=60) showed unsatisfied basic needs indicators whereas 57.14% (n= 80) did not present indicators of unsatisfied basic needs. Out of the 140 patients who continued the medical treatment, 24.28 (n= 34) showed disease remission. Concerning the cases that showed some indicators of unsatisfied basic needs, 90% did not comply with the treatment versus 17.5% which did not present unsatisfied basic needs. The disease showed remission with methimazole treatment in 3.3% of the cases with unsatisfied basic needs and in 40% of the cases which did not present unsatisfied basic needs. Taking into account the results obtained, we believe that in the cases of patients with Graves Basedow disease, it might be useful to evaluate the presence of deprivation indicators before implementing the appropriate antithyroid treatment.

La pobreza en México. I. Metodologías y evolución / The poverty in Mexico. I. Methodologies and evolution

Este artículo contiene la primera de dos partes de un trabajo sobre la evolución y magnitud de la pobreza en México. Aquí se presentan las metodologías utilizadas en ambas partes, así como la evolución de la pobreza. Se explica someramente la metodología de Línea de Pobreza (LP), en su variante de Canasta Normativa de Satisfactores Esenciales, utilizada para calcular los datos de esta evolución. Se destacan dos problemas en la definición de los requerimientos normativos: el de sus bases de sustentación y el de identificación de la vía de satisfacción de cada uno de los rubros (consumo privado o transferencias públicas). La identificación de seis fuentes de bienestar de los hogares sirve para criticar los métodos parciales de medición de la pobreza, el de LP y el de Necesidades Básicas Insatisfechas, que se integran en el Método de medición integrada de la Pobreza, que se utiliza para medir la magnitud de la pobreza en 1989, cuyos resultados se presentan en la segunda parte de este trabajo. Los resultados analizados en la última sección muestran que el descenso de la pobreza en el país, desde el 77.5 por ciento en 1963 hasta el 48.5 por ciento en 1981, se interrumpe y cambia de signo a partir de 1982, hasta llegar a 66 por ciento en 1992

This article is the first of two parts of a research report on the evolution and magnitude of poverty in Mexico. Herein are presented the methodologies used in both parts and the evolution of poverty. The Poverty Line methodology (PL), in its Standard Basket of Essential Satisfiers version, is succinctly explained. Two problems on the definition of normative requirements are emphasized: the foundations of such requirements and the access route by which needs are to be met (private consumption or public transfers). Identification of six household welfare sources allows for criticism of PL and Unsatisfied Basic Needs methodologies which the Integrated Poverty Measurement Method (IPMM) brings together. IPMM is used to estimate the magnitude of poverty in 1989. The results are presented in the second part of this report. Results analyzed in the last section of this article show that while poverty in Mexico decreased steadily from 77.5% in 1963 to 48.5% in 1981, it increased since 1982, reaching 66% in 1992.

La pobreza en México. II. Magnitud / The poverty in Mexico. II. Magnitude

Esta es la segunda parte de un trabajo sobre la evolución y magnitud de la pobreza en México. La aplicación del Método de Medición Integrada de la Pobreza, explicado en la primera parte, muestra una incidencia (H) de la pobreza del 70.6 por ciento y de la pobreza extrema del 44.7 por ciento en 1989. H es mayor por el método parcial de Necesidades Básicas Insatisfechas (NBI) que por el de Línea de Pobreza y tiempo de trabajo (LPT). La intensidad (I) de la pobreza, o proporción de la brecha respecto de las normas es para el conjunto de pobres de 0.44 y de 0.58 para los pobres extremos. Tanto H como I son sustancialmente más altos en el medio rural que en el urbano. La pobreza por NBI es más intensa que la de LPT. Al desagregar el índice de NBI en sus componentes, las carencias más intensas se encuentran en atención a la salud y la seguridad social. Los cálculos del grado de pobreza (HI), el producto de la incidencia (H) con la intensidad (I), que es una guía adecuada para la asignación óptima de recursos de lucha contra la pobreza, muestra que a pesar de que hay un mayor número de personas pobres en el medio urbano, el número de pobres equivalentes sigue siendo mayor en el medio rural

This is the second part of a research report on the evolution and magnitude of poverty in Mexico. Application of the Integrated Poverty Measurement Method, explained in the first part of this report, shows a poverty headcount ratio (H) of 70.6% and an extreme poverty H of 44.7%. H turns out higher by the UBN (Unsatisfied Basic Needs) method than by the PLT (Poverty Line plus working time) approach. The poverty gap or poverty intensity (I), is for all poor 0.44 but reaches 0.58 for the extremely poor. Both H and I are substantially higher in the rural than in the urban areas. UBN poverty gap is bigger than the PLT gap. When UBN is disaggregated into its components, deprivation turns out the highest in health care and social security. Degree of poverty calculations (HI), the product of H and I, which constitute a good basis for antipoverty expenditures allocation, show that despite the fact that a larger number of poor persons live in the urban areas, the number of equivalent poor people is higher in the rural areas.