Energy harnessing and storage from surface switching with a ferroelectric electrolyte.

In the quest for innovative energy solutions suitable for mobile, stationary and digital applications, ferroelectric topological insulators (FETIs)1 emerge as promising candidates. These materials combine topologically protected states with spontaneous and switchable polarization. This study reveals emergent phenomena in FETI-electrolytes through experiments and simulations, specifically in the A3-2xBaxClO family (where A = Li, Na or K, and x = 0 or 0.005). Here, it is shown that surface oscillations of the potential (V), temperature, and mass may synchronize with the bulk's oscillations, and be harnessed and stored in the form of electrical energy either in a sole FETI or in a battery-type cell presenting a panoply of applications from wireless batteries to transistors, memories, sensors, and selective catalysts.

Distinctive Electric Properties of Group 14 Oxides: SiO2, SiO, and SnO2.

The oxides of group 14 have been widely used in numerous applications in glass, ceramics, optics, pharmaceuticals, and food industries and semiconductors, photovoltaics, thermoelectrics, sensors, and energy storage, namely, batteries. Herein, we simulate and experimentally determine by scanning kelvin probe (SKP) the work functions of three oxides, SiO2, SiO, and SnO2, which were found to be very similar. Electrical properties such as electronic band structure, electron localization function, and carrier mobility were also simulated for the three crystalline oxides, amorphous SiO, and surfaces. The most exciting results were obtained for SiO and seem to show Poole-Frankel emissions or trap-assisted tunneling and propagation of surface plasmon polariton (SPP) with nucleation of solitons on the surface of the Aluminum. These phenomena and proposed models may also describe other oxide-metal heterojunctions and plasmonic and metamaterials devices. The SiO2 was demonstrated to be a stable insulator interacting less with the metals composing the cell than SnO2 and much less than SiO, configuring a typical Cu/SiO2/Al cell potential well. Its surface charge carrier mobility is small, as expected for an insulator. The highest charge carrier mobility at the lowest conduction band energy is the SnO2's and the most symmetrical the SiO's with a similar number of electron holes at the conduction and valence bands, respectively. The SnO2 shows it may perform as an n-type semiconductor.

Glass Fiber Reinforced Epoxy-Amine Thermosets and Solvate IL: Towards New Composite Polymer Electrolytes for Lithium Battery Applications.

To effectively use (Li) lithium metal anodes, it is becoming increasingly necessary to create membranes with high lithium conductivity, electrochemical and thermal stabilities, as well as adequate mechanical properties. Composite gel polymer electrolytes (CGPE) have emerged as a promising strategy, offering improved ionic conductivity and structural performance compared to polymer electrolytes. In this study, a simple and scalable approach was developed to fabricate a crosslinked polyethylene oxide (PEO)-based membrane, comprising two different glass fiber reinforcements, in terms of morphology and thickness. The incorporation of a solvated ionic liquid into the developed membrane enhances the ionic conductivity and reduces flammability in the resulting CGPE. Galvanostatic cycling experiments demonstrate favorable performance of the composite membrane in symmetric Li cells. Furthermore, the CGPE demonstrated electrochemical stability, enabling the cell to cycle continuously for more than 700 h at a temperature of 40 °C without short circuits. When applied in a half-cell configuration with lithium iron phosphate (LFP) cathodes, the composite membrane enabled cycling at different current densities, achieving a discharge capacity of 144 mAh·g-1. Overall, the findings obtained in this work highlight the potential of crosslinked PEO-based composite membranes for high-performance Li metal anodes, with enhanced near room temperature conductivity, electrochemical stability, and cycling capability.

Cork: Enabler of sustainable and efficient coaxial structural batteries.

Structural batteries aim to advance to 'massless' energy storage units. Here we report an electrode-less coaxial battery with a cork-internal shell, CFRP(+)/cork/Cu/Na2.99Ba0.005ClO/Al(-), where CFRP is carbon fiber reinforced polymer. The cell may, alternatively, solely have a cork external shell cork/Cu(+)/Na2.99Ba0.005ClO/Al(-). Cork is a cellular material with a negative CO2 footprint, light, elastic, impermeable to gases or liquids, and an excellent thermal insulator. Cork was used tandemly with a CFRP shell, working as the positive current collector to enhance the structural batteries' properties while allowing a giant electrostatic performance in conjunction with the Na+ solid-state ferroelectric injected between the Al negative collector and the cork. Cork was shown a polar dielectric. This 'minimalist' cell may perform without copper making the cells even more sustainable. Neither cells contain traditional electrodes, only one or two current collectors. The cells perform from 0 to >50 °C. The maximum capacity of the cork/Cu(+)/Na2.99Ba0.005ClO/Al(-) cells is ∼110 mAh.cm-2 (outer shell) with  ≈ 90 µA cm-2,  ≈ 0.90 V, Vmax ≈ 1.1-1.3 V, Imax ≈ 108 µA cm-2, and a constant resistance discharging life (>40 days). The novel family of cells presented may also harvest waste heat and thermal energy at a constant temperature as their potential and current increase with temperature. Conversely, rising potentials boost the cells' temperature, as expected from pyroelectrics, as shown herein.

Designing Versatile Polymers for Lithium-Ion Battery Applications: A Review.

Solid-state electrolytes are a promising family of materials for the next generation of high-energy rechargeable lithium batteries. Polymer electrolytes (PEs) have been widely investigated due to their main advantages, which include easy processability, high safety, good mechanical flexibility, and low weight. This review presents recent scientific advances in the design of versatile polymer-based electrolytes and composite electrolytes, underlining the current limitations and remaining challenges while highlighting their technical accomplishments. The recent advances in PEs as a promising application in structural batteries are also emphasized.

An All-Solid-State Coaxial Structural Battery Using Sodium-Based Electrolyte.

The transition to a sustainable society is paramount and requires the electrification of vehicles, the grid, industry, data banks, wearables, and IoT. Here, we show an all-solid-state structural battery where a Na+-based ferroelectric glass electrolyte is combined with metallic electrodes/current collectors (no traditional cathode present at fabrication) and thin-ply carbon-fiber laminates to obtain a coaxial multifunctional beam. This new concept aims to optimize the volume of any hollow beam-like structure by integrating an electrochemical system capable of both harvesting thermal and storing electrical energy while improving its mechanical performance. The coaxial cell is a coaxial cable where the dielectric is ferroelectric. The electrochemical results demonstrated the capability of performing three-minute charges to one-day discharges (70 cycles) and long-lasting discharges (>40 days at 1 mA) showing an energy density of 56.2 Wh·L-1 and specific energy of 38.0 Wh·kg-1, including the whole volume and weight of the structural cell. This is the highest specific energy among safe structural cells, while no Na+-based structural cells were found in the literature. The mechanical tests, instead, highlighted the coaxial cell capabilities to withstand severe inelastic deformation without compromising its functionalities, while increasing the flexural strength of the hosting structure. Moreover, the absence of alkali metals and liquid electrolytes together with its enhanced thermal properties makes this coaxial structural battery a valid and safe alternative as an energy reservoir for all the applications where traditional lithium-ion batteries are not suitable.

The Latest Trends in Electric Vehicles Batteries.

Global energy demand is rapidly increasing due to population and economic growth, especially in large emerging countries, which will account for 90% of energy demand growth to 2035. Electric vehicles (EVs) play a paramount role in the electrification revolution towards the reduction of the carbon footprint. Here, we review all the major trends in Li-ion batteries technologies used in EVs. We conclude that only five types of cathodes are used and that most of the EV companies use Nickel Manganese Cobalt oxide (NMC). Most of the Li-ion batteries anodes are graphite-based. Positive and negative electrodes are reviewed in detail as well as future trends such as the effort to reduce the Cobalt content. The electrolyte is a liquid/gel flammable solvent usually containing a LiFeP6 salt. The electrolyte makes the battery and battery pack unsafe, which drives the research and development to replace the flammable liquid by a solid electrolyte.

Coherence in the Ferroelectric A3ClO (A = Li, Na) Family of Electrolytes.

Coherence is a major caveat in quantum computing. While phonons and electrons are weakly coupled in a glass, topological insulators strongly depend on the electron-phonon coupling. Knowledge of the electron-phonon interaction at conducting surfaces is relevant from a fundamental point of view as well as for various applications, such as two-dimensional and quasi-1D superconductivity in nanotechnology. Similarly, the electron-phonon interaction plays a relevant role in other transport properties e.g., thermoelectricity, low-dimensional systems as layered Bi and Sb chalcogenides, and quasi-crystalline materials. Glass-electrolyte ferroelectric energy storage cells exhibit self-charge and self-cycling related to topological superconductivity and electron-phonon coupling; phonon coherence is therefore important. By recurring to ab initio molecular dynamics, it was demonstrated the tendency of the Li3ClO, Li2.92Ba0.04ClO, Na3ClO, and Na2.92Ba0.04ClO ferroelectric-electrolytes to keep phonon oscillation coherence for a short lapse of time in ps. Double-well energy potentials were obtained while the electrolyte systems were thermostatted in a heat bath at a constant temperature. The latter occurrences indicate ferroelectric type behavior but do not justify the coherent self-oscillations observed in all types of cells containing these families of electrolytes and, therefore, an emergent type phenomenon where the full cell works as a feedback system allowing oscillations coherence must be realized. A comparison with amorphous SiO2 was performed and the specific heats for the various species were calculated.

A Assistência Farmacêutica no município de Juiz de Fora em Minas Gerais: uma visão a partir dos Planos Municipais de Saúde / The Pharmaceutical Assistance in the municipality of Juiz de Fora in Minas Gerais: a look from the municipal health insurance plans

O presente estudo teve como objetivo discutir a Assistência Farmacêutica (AF) no município de Juiz de Fora, inserida nos Planos Municipais de Saúde (PMS), no período de 1988 a 2017. A pesquisa parte de revisão bibliográfica e avança pelo campo da investigação documental. Para contextualização do cenário foi utilizado o resgate histórico da AF no Brasil e no estado de Minas Gerais em recorte a partir dos anos 1980 tendo por base documentos, leis e portarias. A fonte principal da pesquisa inclui a busca, a leitura e a categorização dos Planos Municipais de Saúde de Juiz de Fora/MG, nos seguintes períodos: 1988; 1997; 2002/2005; 2006/2009; 2010/2013; e 2014/2017. Para a avaliação da assistência farmacêutica apoiou-se nos indicadores da Organização Pan-Americana da Saúde, de 2005: acesso, qualidade e uso racional de medicamentos. O estudo demonstrou que os indicadores acesso aos medicamentos e uso racional dos medicamentos foram, de certo modo, contemplados nesses planos. Todavia, o indicador qualidade dos medicamentos ainda se encontra incipiente. Foi possível concluir que a AF avançou no período com a introdução da Assistência Farmacêutica no organograma da Secretaria Municipal de Saúde, criação do Departamento de Assistência Farmacêutica (DAF), implantação da Comissão de Farmácia e Terapêutica (CFT), presença do farmacêutico como gestor da AF, aumento do número desses profissionais no quadro funcional do município e criação de uma equipe para acompanhar os processos de aquisição de medicamentos. No entanto, ainda são identificadas fragilidades em relação ao sistema de informação sobre os medicamentos e gestão da AF, ao acesso racional aos medicamentos, falta e desperdício de medicamentos, à não implantação do NASF, bem como à discussão e materialização das farmácias distritais, a exemplo de outros municípios mineiros, polos das macrorregiões de saúde.

The present study had as an objective to discuss the Pharmaceutical Assistance (PA) in the city of Juiz de Fora, inserted in the Municipal Health Plans (MHP), in the period from 1988 to 2017. The research sets off from the bibliographic review and advances through the field of the documental investigation. For the scenery contextualization, the historical rescue of the PA in Brazil and in the state of Minas Gerais was used, from the 1980s having, as base documents, laws and directives. The main source of the research includes the researching, reading and categorizing of the Municipal Health Plans of Juiz de Fora/MG, in the following periods: 1988; 1997; 2002/2005; 2006/2009; 2010/2013 and 2014/2017. For the evaluation, the pharmaceutical assistance based itself in the Pan-American Health Organization, from 2005: access, quality and the rational use of medication. The study shows that the indicators access to medication and rational use of medication were, in a certain way, contemplated in these plans. Even so, the quality indicator of the medication remains incipient. It was possible to conclude that the PA advanced in this period with the introduction of the Pharmaceutical Assistance in the Municipal Secretariat's organizational chart, the creation of the Pharmaceutical Assistance Department (PAD), implementation of the Therapeutic Pharmacy Commission (TPC), presence of the pharmaceutical professional as manager of the PA, increase in the number of these professionals in the city's health service and creation of a team to follow the medicament acquisition procedures. Although, there can still be identified frailties in relation to the information concerning the medication and management of the PA; the rational access to medication, lack and waste of medication; non implantation of the FHSN, as well as, the discussions about and implantation of the districtal pharmacies, following the example of other cities in the state, poles of the health macroregions.

Structural Batteries: A Review.

Structural power composites stand out as a possible solution to the demands of the modern transportation system of more efficient and eco-friendly vehicles. Recent studies demonstrated the possibility to realize these components endowing high-performance composites with electrochemical properties. The aim of this paper is to present a systematic review of the recent developments on this more and more sensitive topic. Two main technologies will be covered here: (1) the integration of commercially available lithium-ion batteries in composite structures, and (2) the fabrication of carbon fiber-based multifunctional materials. The latter will be deeply analyzed, describing how the fibers and the polymeric matrices can be synergistically combined with ionic salts and cathodic materials to manufacture monolithic structural batteries. The main challenges faced by these emerging research fields are also addressed. Among them, the maximum allowable curing cycle for the embedded configuration and the realization that highly conductive structural electrolytes for the monolithic solution are noteworthy. This work also shows an overview of the multiphysics material models developed for these studies and provides a clue for a possible alternative configuration based on solid-state electrolytes.

Lithium-ion electrolytic substrates for sub-1V high-performance transition metal dichalcogenide transistors and amplifiers.

Electrostatic gating of two-dimensional (2D) materials with ionic liquids (ILs), leading to the accumulation of high surface charge carrier densities, has been often exploited in 2D devices. However, the intrinsic liquid nature of ILs, their sensitivity to humidity, and the stress induced in frozen liquids inhibit ILs from constituting an ideal platform for electrostatic gating. Here we report a lithium-ion solid electrolyte substrate, demonstrating its application in high-performance back-gated n-type MoS2 and p-type WSe2 transistors with sub-threshold values approaching the ideal limit of 60 mV/dec and complementary inverter amplifier gain of 34, the highest among comparable amplifiers. Remarkably, these outstanding values were obtained under 1 V power supply. Microscopic studies of the transistor channel using microwave impedance microscopy reveal a homogeneous channel formation, indicative of a smooth interface between the TMD and underlying electrolytic substrate. These results establish lithium-ion substrates as a promising alternative to ILs for advanced thin-film devices.

Dataset on a primary lithium battery cell with a ferroelectric Li-glass electrolyte and MnO2 cathode.

Here we show the electrochemical data for a Ferroelectric Electrolyte Battery (FEB) Li/ferroelectric Li-glass electrolyte (Li2·99Ba0·005ClO) in cellulose/γ-MnO2 pouch-cell with (2.5 × 2.5 cm2) discharged with a green LED load. The Li2·99Ba0·005ClO electrolyte was synthesized and ground in ethanol. A cellulose matrix was dipped into the Li-glass/ethanol slurry. The γ-MnO2 based cathode was doctor bladed onto a carbon-coated aluminum foil current collector. The cell was assembled in an Ar-filled glove-box and it was not sealed and, therefore, it remained inside the glove-box while discharging with a green LED at approximately 24 °C for 334 days (>11 months) corresponding to 764 mAhg-1 of the active cathode and to 224 mAhg-1 of the electrolyte. The maximum capacity of γ-MnO2 is 209 mAhg-1 and of the MnO2 in the commercial cell is 308 mAhg-1, corresponding to LiMnO2; therefore, the capacity of the FEB is 370% the capacity of the γ-MnO2 and 250% the capacity of the MnO2 in the commercial cell. Moreover, the experimental capacity of the electrolyte minus the maximum capacity of the γ-MnO2 is 163 mAhg-1 of the electrolyte. The potential difference between anode and cathode in a diode is non-linear and dependent on the input current and, therefore, the plateaus in the potential vs time curves do not correspond to thermodynamic equilibria of the electrochemical cell energy source. Nevertheless, the maximum output current as well as the FEB cell's discharge profile may be determined with an LED and compared with traditional battery cells' profiles. The present data might be used by the electrochemical (in particular, battery), electrostatic and ferroelectric materials researchers and industrials for comparative analysis. Furthermore, it can be reused to calculate the maximum energy stored electrostatically in these devices.

Dataset on a ferroelectric based electrostatic and electrochemical Li-cell with a traditional cathode.

Here we show the electrochemical raw data for a Li/ferroelectric Li-glass electrolyte/plasticizer/Li-rich, F doped LNMO coin cell where the plasticizer is succinonitrile-SN. The nominal composition of the active oxide-host cathode particles is Li1.36Ni0.49Mn1.15O3.28F0.36 (LNMO) that disproportionated into 78 wt% spinel phase LiNi1/2Mn3/2O3.8F0.2 and 22 wt% Li-rich, F-doped layered phase containing Li2MnO3 planes separated by Li+ and Ni2+ ions. The Li2.99Ba0.005OCl electrolyte was synthesized and ground in ethanol. A cellulose matrix was dipped into the glass/ethanol slurry. This cell has been cycling for two years and six months. The electrochemical performance was firstly published in graphs after cycling the cell for about one year and three months [1]. The Li//LNMO CR2032 coin cell was assembled in an argon-filled glove box and electrochemically tested in a battery testing analyzer (LAND) at room temperature and at constant specific current densities and potentials between 2.5 and 4.8 V. Moreover, the cell's cycling current is 23 mA g-1 (active cathode). The data might be used by the electrochemical (in particular, battery), electrostatic and ferroelectric researchers and industrials for comparative analysis. Furthermore, it can be reused by anyone interested in solid-state devices that wants to calculate the maximum energy stored electrostatically in these devices.

Nontraditional, Safe, High Voltage Rechargeable Cells of Long Cycle Life.

A room-temperature all-solid-state rechargeable battery cell containing a tandem electrolyte consisting of a Li+-glass electrolyte in contact with a lithium anode and a plasticizer in contact with a conventional, low cost oxide host cathode was charged to 5 V versus lithium with a charge/discharge cycle life of over 23,000 cycles at a rate of 153 mA·g-1 of active material. A larger positive electrode cell with 329 cycles had a capacity of 585 mAh·g-1 at a cutoff of 2.5 V and a current of 23 mA·g-1 of the active material; the capacity rose with cycle number over the 329 cycles tested during 13 consecutive months. Another cell had a discharge voltage from 4.5 to 3.7 V over 316 cycles at a rate of 46 mA·g-1 of active material. Both the Li+-glass electrolyte and the plasticizer contain electric dipoles that respond to the internal electric fields generated during charge by a redistribution of mobile cations in the glass and by extraction of Li+ from the active cathode host particles. The electric dipoles remain oriented during discharge to retain an internal electric field after a discharge. The plasticizer accommodates to the volume changes in the active cathode particles during charge/discharge cycling and retains during charge the Li+ extracted from the cathode particles at the plasticizer/cathode-particle interface; return of these Li+ to the active cathode particles during discharge only involves a displacement back across the plasticizer/cathode interface and transport within the cathode particle. A slow motion at room temperature of the electric dipoles in the Li+-glass electrolyte increases with time the electric field across the EDLC of the anode/Li+-glass interface to where Li+ from the glass electrolyte is plated on the anode without being replenished from the cathode, which charges the Li+-glass electrolyte negative and consequently the glass side of the Li+-glass/plasticizer EDLC. Stripping back the Li+ to the Li+-glass during discharge is enhanced by the negative charge in the Li+-glass. Since the Li+-glass is not reduced on contact with metallic lithium, no passivating interface layer contributes to a capacity fade; instead, the discharge capacity increases with cycle number as a result of dipole polarization in the Li+-glass electrolyte leading to a capacity increase of the Li+-glass/plasticizer EDLC. The storage of electric power by both faradaic electrochemical extraction/insertion of Li+ in the cathode and electrostatic stored energy in the EDLCs provides a safe and fast charge and discharge with a long cycle life and a greater capacity than can be provided by the cathode host extraction/insertion reaction. The cell can be charged to a high voltage versus a lithium anode because of the added charge of the EDLCs.

Transformações recentes da indústria farmacêutica: um exame da experiência mundial e brasileira no século XXI / Recent changes in the pharmaceutical industry: a survey of worldwide and Brazilian experience in the 21st century

O artigo discute as características e tendências da indústria farmacêutica mundial e brasileira no século XXI, suas transformações e tendências setoriais, e seus atores. Foram utilizadas a pesquisa qualitativa e a técnica de análise documental, que permitiram verificar que, no início do século XX, a indústria farmacêutica mundial apresentava estrutura homogênea e oferta reduzida de seus produtos. Após a Segunda Guerra Mundial, houve fortalecimento da produção de medicamentos baseados na síntese química e diversificação da oferta e demanda por medicamentos. O mercado farmacêutico passou da competição mais ampla para uma de caráter oligopólico. Nos anos 1990, o portfólio dessas indústrias ampliou-se para áreas de saúde animal, produtos de higiene/cuidado pessoal e de nutrição/dietética. Na década de 2000, a indústria farmacêutica mundial intensificou esse processo, e devido à expiração das patentes dos medicamentos, se concentrou no segmento dos genéricos, adquirindo empresas nos mercados emergentes. O setor farmacêutico brasileiro seguiu os moldes da indústria farmacêutica mundial e passou a investir na produção de medicamentos genéricos, fitoterápicos e no avanço dos biotecnológicos, com o apoio financeiro público do BNDES. Esse contexto continua a exigir avanços na inovação em saúde, e reclama da regulação sanitária o enfrentamento dos desafios advindos dessa grande transformação. Cabe destacar os desafios relativos aos custos dos medicamentos e de seus fortes impactos sobre os sistemas de saúde, em especial aqueles de caráter mais inclusivo...

This article discusses the characteristics and trends of the global and Brazilian pharmaceutical industry in the 21st century, its transformations and industry trends, and its actors. Qualitative research and the technique of document analysis allowed us to check that in early 20th century, the global pharmaceutical industry was characterized by homogeneous structure and reduced supply of products. After the Second World War, there was strengthening of the production of medicines based on chemical synthesis and diversification of supply and demand for drugs. The pharmaceutical market has shifted from broader competition for one of oligopolistic character. In the 1990s, these industries' portfolio expanded to areas of animal health, hygiene / personal care and nutrition / dietetics. In the 2000s, the global pharmaceutical industry intensified this process, and due to the expiration of patents on medicines, focused on the generic segment, acquiring companies in emerging markets. The Brazilian pharmaceutical industry followed the lines of the global pharmaceutical industry and started to invest in the production of generic medicines, herbal and advancement of biotechnology, with public financial support of the BNDES. This context continues to demand advances in health innovation, and demands of the health regulation to face the challenges arising from this great transformation. It is worth mentioning the challenges relating to costs of drugs and their strong impact on health systems, particularly those of more inclusive character...

Políticas de saúde no Brasil: uma visão baseada nas normas reguladoras editadas no período de 1990 a 2010 / Health politicies in Brazil: a vision based on regulatory rules published from 1990 to 2010

Com a Constituição Federal (CF) de 1988 foi criado o Sistema Único de Saúde (SUS), regulamentado pelas Leis nº 8.080/90 e nº 8.142/90. Posteriormente foi sendo construído através de normas operacionais e, mais recentemente pelo Pacto da Saúde. Neste contexto o presente estudo teve por objetivo analisar a trajetória das políticas públicas de saúde no Brasil, buscando identificar avanços que se refere à equidade e acesso universal. Para tal utiliza como instrumentos de pesquisa as legislações e os documentos oficiais e administrativos do Ministério da Saúde editados nas décadas de 1990 e 2000. Verificou-se através dos documentos e textos acadêmicos analisados que, na prática, a regulamentação do SUS ocorreu através de normas reguladoras, criadas para operar as transformações previstas na Constituição e na Lei Orgânica da Saúde. Identifica a inserção da Estratégia de Saúde da Família como política prioritária para a atenção primária e os incentivos para a mudança do modelo de atenção. Destaca a fragmentação das ações e o enfraquecimento gradativo dos estados, ator desconsiderado no processo de descentralização em curso à época. Identifica os avanços na regionalização com a edição da Norma Operacional da Assistência à Saúde, NOAS SUS 01/ 2001/2002. A década de 2000 assiste a edição da Portaria GM/MS nº 399/2006, que divulga o Pacto pela Saúde e seus desdobramentos atuais. Concluiu-se que o SUS vem sendo implementado de forma lenta e apesar dos avanços identificados mudanças no processo de financiamento e gestão são necessárias para torná-lo efetivamente, como um direito de cidadania.

A assistência farmacêutica no Brasil contemporâneo: a produção pública de medicamento permite ampliar o acesso da população ao uso racional de medicamentos? / Pharmaceutical care in contemporary Brazil: public drug production allows greater access of population to the rational use of drugs?

O presente estudo avalia a produção pública de medicamentos no Brasil, abordando as personalidades de avanços no acesso aos medicamentos essenciais. Fundamentou-se na análise bibliográfica e documental. Esta última análise focou os documentos oficiais, originários dos diversos agentes institucionais vinculados à política de medicamentos do país. A Política Nacional de Medicamentos concentrou-se na provisão da assistência farmacêutica e, em especial, no acesso racional aos medicamentos essenciais. A pesquisa, de caráter histórico, destacou analiticamente o desenvolvimento dessa política desde 2003 até o presente. Nesse contexto, privilegiam-se as características universais do atual sistema de saúde no Brasil e o compromisso do Estado nacional em garantir o acesso a esse direito fundamental. Foram também objeto de destaque nesta pesquisa as alternativas de oferta de medicamentos por intermédio da indústria farmacêutica internacional a nacional. O núcleo deste estudo é a análise da produção dos medicamentos pelos laboratórios oficiais, bem como das dificuldades que esses laboratórios enfrentam em função da descontinuidade histórica de políticas voltadas para o fortalecimento de suas atividades. Assim, permite-se afirmar que a produção dos medicamentos essenciais poderia contribuir de forma decisiva para a inclusão da população historicamente excluída das políticas de saúde a partir de estratégias para o seu fortalecimento continuado, definidas pelo Estado brasileiro.

A regulação em saúde no Brasil: um breve exame das décadas de 1999 a 2008 / Health regulation in Brazil: a brief survey of the decade from 1999 to 2008

Este artigo discute a experiência brasileira de regulação em saúde no período de 1999 a 2008. Buscou-se compreender as interfaces do processo de regulação em saúde no Brasil, sobretudo com o setor farmacêutico, identificando, historicamente, os atores e contextos referentes a esse processo. A pesquisa baseou-se na revisão bibliográfica e no levantamento das resoluções da diretoria colegiada da Agência Nacional de Vigilância Sanitária. Esse levantamento permitiu identificar a concentração dessas resoluções nas subáreas: medicamentos, recursos humanos e alimentos. No tocante à subárea medicamentos, a concentração se deu em três descritores: registro de medicamentos, boas práticas e substâncias sujeitas a controle especial. Além de fazer uma síntese histórica da evolução da vigilância sanitária brasileira, o artigo focalizou os aspectos regulatórios da Agência Nacional de Vigilância Sanitária e sua relação com a indústria farmacêutica. Portanto, o texto pautou-se pela pretensão de dar resposta à seguinte questão: será que a experiência de regulação da Agência Nacional de Vigilância Sanitária está apta a enfrentar o cenário adverso gerado pela nova crise mundial, especialmente no que se refere ao setor farmacêutico? A principal conclusão do trabalho é de que, apesar dos muitos desafios a serem superados pela Agência Nacional de Vigilância Sanitária no Brasil contemporâneo, a experiência de regulação avançou bastante nesta década. Uma conclusão adicional é que esses avanços constituíram, para o setor farmacêutico, uma proteção face ao quadro adverso gerado pela crise mundial.

This paper discusses the Brazilian experience of health regulation from 1999 to 2008. It aims to understand the interfaces of the regulatory process in health in Brazil, particularly the pharmaceutical industry, seeking to identify, historically, the actors and contexts relating to the proceedings. The research was based on literature review and survey of the resolutions of the Board of the National Health Surveillance Agency. This survey identified the concentration of these resolutions in the following areas: drugs, human resources and food. Regarding drugs, emphasis was placed in three key words: drug registration, practices and substances subject to special control. In addition to a brief history of the evolution of Brazilian health surveillance, this paper focused on the regulatory aspects of the National Health Surveillance Agency and its relationship with the pharmaceutical industry. Therefore, the text was guided by the desire to answer the following question: is the experience of regulation of the National Health Surveillance Agency able to cope with the adverse scenario created by the world crisis, especially with regard to the pharmaceutical industry? The main conclusion of this study is that despite the many challenges to be overcome by the National Sanitary Surveillance Agency in Brazil today, the experience of regulation has made good progress in this decade. A further finding is that these developments were, for the pharmaceutical industry, a protection against the adverse situation created by the global crisis.

Avaliação da hipercalcemia assintomática em pacientes ambulatoriais / Assessment of asymptomatic hypercalcemia in outpatients

Introdução: Dosagens indiscriminadas de cálcio sérico podem levar à detecção de pacientes assintomáticos, com hipercalcemia, em que o hiperparatireoidismo primário é a causa mais comum. Objetivo: Discutir aforma de avaliação da hipercalcemia detectada em população atendida em regime ambulatorial, avaliando a sua freqüência, com ênfase na pesquisa de hiperparatireoidismo primário. Material e métodos: Foi realizado estudo prospectivo envolvendo 1.049 indivíduos, de 40 a 60 anos, com dosagens séricas de cálcio e albumina, e calculado o valor de cálcio corrigido. Na presença de elevação do cálcio corrigido,foram dosados cálcio iônico, fósforo, paratormônio (PTH) e calciúria. Resultados: A idade foi 49,7 ± 13,7anos e 188 (17,9%) indivíduos apresentaram valores elevados de cálcio corrigido. Desses, 90 pacientescompareceram à segunda avaliação e 19 (2%) mantiveram quadro de hipercalcemia. Os níveis de cálcio iônico (média: 1,2 ± 0,01 mmol/l) foram normais em todos os indivíduos. A calciúria foi 185,8 ± 111,8 mg/24 horas. Os níveis de PTH (média: 46 ± 11,8 pg/ml) foram elevados em três casos, com cintilografia de paratireóides normal. Discussão: A queda na freqüência de hipercalcemia com base novalor do cálcio corrigido e, sobretudo, após dosagem de cálcio ionizável sugere que a dosagem de cálcio livre seja preferida como triagem. Na população estudada não foi diagnosticado hiperparatireoidismo, sugerindo distribuição variável da doença em diferentes populações. Conclusão: Deve ser questionada a dosagem rotineira de cálcio sérico em indivíduos sem quadro clínico que indique a necessidade darealização desse exame. Quando realizada, a dosagem de cálcio iônico deverá ser preferida.

Introduction: Indiscriminate serum calcium measurement may lead to the identification of asymptomatic patientswith hypercalcaemia, which is caused mostly by primary hyperparathyroidism. Objective: To discuss the frequencyof hypercalcaemia and the type of assessment of this condition in an outpatient population, with emphasis on the investigation of primary hyperparathyroidism. Material and methods: In a prospective study 1,049 subjects (age range: 40 to 60 years old) underwent serum calcium and albumin determination and the corrected calcium values were calculated. When there was a rise in the corrected calcium level, ionized calcium, phosphate, parathyroid hormone (PTH) and urinary calcium were measured. Results: The average age was 49.7 ± 13.7 years old, and 188 subjects (17.9%) had elevated corrected calcium levels. Among these, 90 patients underwent the second investigation and 19 (2%) remained hypercalcemic. Ionized calcium levels (average: 1.2 ± 0.01 mmol/L) werenormal in all subjects. Urinary calcium was 185.8 ± 111.8 mg/24 hours. PTH levels (average: 46 ± 11.8 pg/mL)were elevated in three subjects whose parathyroid scintigraphies were normal. Discussion: The fall in the frequencyof hypercalcaemia based on corrected serum calcium levels and mostly after determination of serum ionized calciumsuggests that determinations of serum free calcium are a better screening test. No subject was diagnosed with hyperparathyroidism, what suggests an uneven distribution of the disease in different populations. Conclusion:Routine serum calcium determinations in asymptomatic patients must be questioned. When serum calcium determination is thought necessary, ionized calcium levels should be favored.