Worldwide the assistance on renal replacement therapy (RRT) is carried out mainly by private for-profit services and in a market with increase in mergers and acquisitions. The aim of this study was to conduct an integrative systematic review on privatization and oligopolies in the RRT sector in the context of contemporary capitalism. The inclusion criteria were scientific articles without language restrictions and that addressed the themes of oligopoly or privatization of RRT market. Studies published before 1990 were excluded. The exploratory search for publications was carried out on February 13, 2024 on the Virtual Health Library Regional Portal (VHL). Using the step-by-step of PRISMA flowchart, 34 articles were retrieved, of which 31 addressed the RRT sector in the United States and 26 compared for-profit dialysis units or those belonging to large organizations with non-profit or public ones. The main effects of privatization and oligopolies, evaluated by the studies, were: mortality, hospitalization, use of peritoneal dialysis and registration for kidney transplantation. When considering these outcomes, 19 (73%) articles showed worse results in private units or those belonging to large organizations, six (23%) studies were in favor of privatization or oligopolies and one study was neutral (4%). In summary, most of the articles included in this systematic review showed deleterious effects of oligopolization and privatization of the RRT sector on the patients served. Possible explanations for this result could be the presence of conflicts of interest in the RRT sector and the lack of incentive to implement the chronic kidney disease care line. The predominance of articles from a single nation may suggest that few countries have transparent mechanisms to monitor the quality of care and outcomes of patients on chronic dialysis.

In recent decades, the global and aggressive crises-transformed capitalist system has subjected society to fiscal austerity and strained the assurance of its right to health, as an imposition to increase health systems efficiency and effectiveness. Health equity, on the other hand, provides protection against the harmful effects of austerity on population health The aim of this article is to analyse the effect of the global financial crisis on how health equity is considered against effectiveness in international comparisons of health systems efficiency in the scientific literature. Integrative review, based on PubMed and VHL databases searches, 2008-18, and cross-case analysis. The balance between equity and effectiveness must be sought from health financing to results, in an efficient way, as a means to strengthening health systems. The choice between alterity or austerity must be made explicitly and transparently, with resilience of societal values and the principles of universality, integrality and equity.
Nas últimas décadas, o sistema capitalista, transformado por meio de crises mais agressivas e globais, tem submetido a sociedade à austeridade fiscal e tensionado a garantia dos direitos à saúde, como imposição para ampliar a eficiência e efetividade dos sistemas de saúde. A equidade em saúde, por outro lado, opera como fator protetor em relação aos efeitos nocivos da austeridade sobre a saúde da população. O objetivo deste artigo é analisar o efeito da crise financeira global quanto à valorização da equidade em saúde frente à efetividade nas comparações internacionais de eficiência dos sistemas de saúde na literatura científica. Realizada revisão integrativa, com busca nas bases de dados PubMed e BVS, de 2008-18, com análise cross-case. O equilíbrio entre equidade e efetividade deve ser buscado desde o financiamento até os resultados em saúde, de modo eficiente, como forma de fortalecimento dos sistemas de saúde. A escolha entre alteridade ou austeridade deve ser feita de forma explícita e transparente, com resiliência dos valores societais e princípios de universalidade, integralidade e equidade.

An unprecedented mortality crisis befell the former socialist countries between 1989 and 1995, representing one of the greatest demographic shocks of the period after the Second World War. While it is likely that country-level variation in the post-socialist mortality crisis in Eastern Europe can be explained by a constellation of political and socio-economic factors, no comprehensive review of the existing scholarly attempts at explaining these factors exists. We review 39 cross-national multi-variable peer reviewed studies of social determinants of mortality in post-socialist Europe in order to assess the social factors behind the post-socialist mortality crisis, determine the gaps in the existing literature and to make suggestions for future research. We propose a novel methodology to determine the relative importance of variables based on the ratio of significant to insignificant findings for each variable. The literature identifies inequality, welfare payments, religious composition, democracy, economic performance and unemployment as the leading factors that have a significant influence on mortality outcomes. Existing cross-country studies fail to establish a definitive connection between mortality and diets, drinking patterns, liberalisation, trust, health expenditure and war. We also point out that the level of analysis is not a neutral methodological choice but might influence the results themselves.

Most ecological economists believe that the transition to a steady-state economy is necessary to ensure ecological sustainability and to maximize a nation\'s economic welfare. While some observers agree with the necessity of the steady-state economy, they are nonetheless critical of the suggestion made by ecological economists-in particular, Herman Daly-that a steady-state economy is compatible with a capitalist system. First, they believe that steady-state capitalism is based on the untenable assumption that growth is an optional rather than in-built element of capitalism. Second, they argue that capitalist notions of efficient resource allocation are too restrictive to facilitate the transition to an \"ecological\" or steady-state economy. I believe these observers are outright wrong with their first criticism and, because they misunderstand Daly\'s vision of a steady-state economy, are misplaced with their second criticism. The nature of a capitalist system depends upon the institutional framework that supports and shapes it. Hence, a capitalist system can exist in a wide variety of forms. Unfortunately, many observers fail to recognize that the current \"growth imperative\" is the result of capitalist systems everywhere being institutionally designed to grow. They need not be designed this way to survive and thrive. Indeed, because continued growth is both existentially undesirable and ecologically unsustainable, redesigning capitalist systems through the introduction of Daly-like institutions would prove to be capitalism\'s savior. What\'s more, it would constitute humankind\'s best hope of achieving sustainable development.

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The mass media exert powerful influences on the way people perceive, think about, and ultimately act in their world. Despite agreement on this fact, communication scholars are divided into 2 opposing camps. The functionalists view the mass media as instruments for providing the framework for the education and enlightenment of the masses socially, economically, and politically. In contrast, the conflict and critical theorists see the mass media as instruments for rational domination and manipulation of the masses through ideological control. Because the mass media are part of the social system and their operators belong to the ruling elite class, they invariably support the ideology of the power structure through justifying the sociopolitical status quo. It is axiomatic that the mass media are capable of diverting people\'s attention and consciousness away from sociopolitical issues by filling their leisure time with escapist forms of entertainment. The political structure is fully aware of the potential of the mass media to effect cognitive changes among individuals and to structure their thinking. As long as social, political, and economic status determine who is important and who is not, the media will continue to be instruments of control. However, this control function can be weakened when media infrastructure and administration are decentralized and closer to the masses. Then, solutions to the problems of the masses are the priority targets of media contents. The democratic-participant media theory calls for the right of access to the mass media for citizens and the rights of the masses to be served by the media according to their own self-determined needs.

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