Consensos sobre o papel do gestor estadual na regionalização da assistência à saúde no Sistema Único de Saúde (SUS) Consensus regarding the role of the State manager in the regionalization of health care in Brazilian National Health System (SUS)

OBJETIVOS: identificar os consensos acerca do papel do gestor estadual na regionalização da assistência à saúde no SUS. MÉTODOS: foram elaborados um modelo teórico-lógico e uma matriz de avaliação acerca das atribuições do gestor estadual na condução da regionalização. Essa matriz foi submetida à apreciação de especialistas que julgaram a importância dos indicadores de análise definidos, estabelecendo-se o consenso ou o dissenso a partir de pontos de corte previamente definidos, utilizando-se como técnica a Conferência de Consenso. RESULTADOS: a matriz de avaliação resultante do consenso apresenta três níveis de análise (governo, gestão e assistência), que estão desmembrados em seis dimensões compostas de 14 critérios e 82 indicadores de avaliação que exploram as responsabilidades do gestor estadual do SUS frente à regionalização da saúde. Do total de indicadores, apenas quatro não apresentaram consenso, o que indica que a matriz se mostra um instrumento eficiente para avaliação da regionalização da assistência no SUS, abordando as diferentes dimensões dessa intervenção em saúde. CONCLUSÕES: apesar de provisório, o consenso ora estabelecido pode constituir um referencial de elevada utilidade para a realização de pesquisas, podendo servir de base para a realização de investigações avaliativas sobre a implantação dos processos de regionalização, de forma a permitir maior comparabilidade entre os estudos.<br>OBJECTIVES: to identify points of agreement regarding the role of the State manager in the regionalization of health care in Brazilian National Health System (SUS). METHODS: a theoretical framework and evaluation grid were drawn up to evaluate the role of the State manager in regionalization. These were ratified by specialists, who confirmed the importance of the indicators chosen to establish the existence of consensus or the lack of it, on the basis of previously established cut-off points, using the Consensus Conference technique. RESULTS: the evaluation grid resulting from the consensus achieved involves three levels of analysis (government, management and care), which are broken down into six categories comprising 14 criteria and 82 indicators exploring the responsibility of the State manager of the SUS vis-à-vis the regionalization of health care. There was not a consensus regarding only four of these indicators, suggesting that the grid adopted is an efficient instrument for the evaluation of the regionalization of health care in SUS care and covers the various levels of this healt care intervention. CONCLUSIONS: the consensus now established, however provisional, may be taken as an extremely useful point of reference for further research and could serve as the basis for future evaluations of the implementation of regionalization, in such a way as to allow for comparative studies to be carried out

Developments in life cycle assessment applied to evaluate the environmental performance of construction and demolition wastes

This paper provides a review of the literature that applies the life cycle assessment (LCA) methodology to the assessment of the environmental performance of the life cycle of construction and demolition waste (CDW) management systems. This article is focused on generating a general mapping of the literature and on identifying the best practices in compliance with LCA framework and proposing directions for future LCA studies in this field. The temporal evolution of the research in this field and the aim of the studies have grown in parallel with the legal framework related to waste and energy efficiency of buildings. Most studies have been published in Europe, followed by USA. Asia and Australia, being at an incipient application stage to the rest of the world. Topics related to "LCA of buildings, including their EoL" and "LCA of general CDW management strategies" are the most frequently analysed, followed by "LCA of EoL of construction elements" and "LCA of natural material vs recycled material". Regarding the strategies, recycling off-site and incineration, both combined with landfill for the rejected fractions, are the most commonly applied. Re-use or recycling on-site is the strategy least applied. The key aspect when LCA is applied to evaluate CDW management systems is the need to normalise which processes to include in the system boundary and the functional unit, the use of inventory data adapted to the context of the case study and the definition of a common set of appropriate impact assessment categories. Also, it is important to obtain results disaggregated by unit processes. This will allow the comparison between case studies