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Resumo O objetivo deste artigo é refletir sobre as expectativas malogradas da política urbana brasileira, muito identificada com a regulação do uso do solo urbano. Parte-se da premissa de que a política urbana é a dimensão da política social que dá efetividade ao planejamento urbano. Assim, ela deve ser avaliada num contexto em que passou a interagir com um conjunto de direitos sociais incluídos na Constituição de 1988. Tais reflexões estavam subjacentes à pesquisa realizada por meio de entrevistas com urbanistas que atuaram na política urbana no Município do Rio de Janeiro nas décadas de 1980, 1990 e 2000. As principais transformações na política urbana e os desafios enfrentados na gestão desta política foram utilizados como referência para refletir sobre os rumos da política urbana brasileira. Abstract The aim of this article is to reflect on the ill-fated expectations of Brazilian urban policy, much identified with the regulation of urban land use. The present work is based on the premise that urban policy is the dimension of social policy that provides effectiveness to urban planning. Thus, it is fitting that it should be evaluated within a context in which it began to interact with a set of social rights included in the 1988 Constitution. These were the underlying reflections resulting from research, which was conducted through interviews with urban planners who had worked with urban policy in the Municipality of Rio de Janeiro during the 1980s, 1990s and into the 2000s. The main transformations in urban policy and the challenges faced in managing this policy were used as a reference to reflect on the directions taken by Brazilian urban policy.

Background We hypothesized that treatment delays might be an effect modifier regarding risks and benefits of intravenous thrombolysis (IVT) before mechanical thrombectomy (MT). Methods We used the dataset of the SWIFT-DIRECT trial, which randomized 408 patients to IVT+MT or MT alone. Potential interactions between assignment to IVT+MT and expected time from onset-to-needle (OTN) as well as expected time from door-to-needle (DTN) were included in regression models. The primary outcome was functional independence (modified Rankin Scale (mRS) 0-2) at 3 months. Secondary outcomes included mRS shift, mortality, recanalization rates, and (symptomatic) intracranial hemorrhage at 24 hours. Results We included 408 patients (IVT+MT 207, MT 201, median age 72 years (IQR 64-81), 209 (51.2%) female). The expected median OTN and DTN were 142 min and 54 min in the IVT+MT group and 129 min and 51 min in the MT alone group. Overall there was no significant interaction between OTN and bridging IVT assignment regarding either the functional (adjusted OR (aOR) 0.76, 95% CI 0.45 to 1.30) and safety outcomes or the recanalization rates. Analysis of in-hospital delays showed no significant interaction between DTN and bridging IVT assignment regarding the dichotomized functional outcome (aOR 0.48, 95% CI 0.14 to 1.62), but the shift and mortality analyses suggested a greater benefit of IVT when in-hospital delays were short. Conclusions We found no evidence that the effect of bridging IVT on functional independence is modified by overall or in-hospital treatment delays. Considering its low power, this subgroup analysis could have missed a clinically important effect, and exploratory analysis of secondary clinical outcomes indicated a potentially favorable effect of IVT with shorter in-hospital delays. Heterogeneity of the IVT effect size before MT should be further analyzed in individual patient meta-analysis of comparable trials.

BackgroundThe clinical description of the neurological manifestations in COVID-19 patients is still underway. This study aims to provide an overview of the spectrum, characteristics and outcomes of neurological manifestations associated with SARS-CoV-2 infection.MethodsWe conducted a nationwide, multicentric, retrospective study during the French COVID-19 epidemic in March-April 2020. All COVID-19 patients withde novoneurological manifestations were eligible.ResultsWe included 222 COVID-19 patients with neurological manifestations from 46 centers throughout the country. Median age was 65 years (IQR 53-72), and 136 patients (61.3%) were male. COVID-19 was severe or critical in almost half of the patients (102, 45.2%). The most common neurological diseases were COVID-19 associated encephalopathy (67/222, 30.2%), acute ischemic cerebrovascular syndrome (57/222, 25.7%), encephalitis (21/222, 9.5%), and Guillain-Barré Syndrome (15/222, 6.8%). Neurological manifestations appeared after first COVID-19 symptoms with a median (IQR) delay of 6 (3-8) days in COVID-19 associated encephalopathy, 7 (5-10) days in encephalitis, 12 (7-18) days in acute ischemic cerebrovascular syndrome and 18 (15-28) days in Guillain-Barré Syndrome. Brain imaging was performed in 192 patients (86.5%), including 157 MRI (70.7%). Brain MRI of encephalitis patients showed heterogeneous acute non vascular lesion in 14/21 patients (66.7%) with associated small ischemic lesion or microhemorrhages in 4 patients. Among patients with acute ischemic cerebrovascular syndrome, 13/57 (22.8%) had multi territory ischemic strokes, with large vessel thrombosis in 16/57 (28.1%). Cerebrospinal fluid was analyzed in 97 patients (43.7%), with pleocytosis in 18 patients (18.6%). A SARS-CoV-2 PCR was performed in 75 patients and was positive only in 2 encephalitis patients. Among patients with encephalitis, ten out of 21 (47.6%) fully recovered, 3 of whom received corticosteroids (CS). Less common neurological manifestations included isolated seizure (8/222, 3.6%), critical illness neuropathy (8/222, 3.6%), transient alteration of consciousness (5/222, 2.3%), intracranial hemorrhage (5/222, 2.3%), acute benign lymphocytic meningitis (3/222, 1.4%), cranial neuropathy (3/222, 1.4%), single acute demyelinating lesion (2/222, 0.9%), Tapia syndrome (2/222, 0.9%), cerebral venous thrombosis (1/222, 0.5%), sudden paraparesis (1/222, 0.5%), generalized myoclonus and cerebellar ataxia (1/222, 0.5%), bilateral fibular palsy (1/222, 0.5%) and isolated neurological symptoms (headache, anosmia, dizziness, sensitive or auditive symptoms, hiccups, 15/222, 6.8%). The median (IQR) follow-up of the 222 patients was 24 (17-34) days with a high short-term mortality rate (28/222, 12.6%).ConclusionNeurological manifestations associated with COVID-19 mainly included CAE, AICS, encephalitis and GBS. Clinical spectrum and outcomes were broad and heterogeneous, suggesting different underlying pathogenic processes.

Since the twentieth century, the institutionalization of metropolitan regions in Brazil has been in progress. Sometimes under the concept of an authoritarian centralism of military governments, sometimes under the concept of strengthening of local governments designated by the 1988 Constitution. This is a complex process, and the formation of the main metropolitan regions of the Southeastern Region is still away of its ending. Even the Metropolis Statute, born in 2015, wasn’t able to resolve all conflicts related to the construction of urban policy in urban agglomerations. In Rio de Janeiro in particular, the construction of the metropolitan region involving the former federal capital demonstrates how the issue still challenges state and municipal governments. In this article, a brief historical retrospective of the construction of the metropolitan region of Rio de Janeiro was carried out, as well as the analysis of the legal impasses arising from its construction and a debate about the recent trajectory of the reformulation of the Metropolitan Region of Rio de Janeiro.

doi: 10.12957/geouerj.2017.32055 O artigo discute os aspectos estruturais de uma crise nas relações interfederativas no país e que foram agravados por aspectos conjunturais da crise econômica em 2014. Foram utilizados os dados de finanças municipais disponibilizados pela Secretaria do Tesouro Nacional (FINBRA) para situar a dimensão estrutural desta crise, tomando por referencia a situação dos municípios. A dimensão conjuntural foi analisada com base nos dados financeiros dos municípios fluminenses, ainda que reconhecendo a maior gravidade da crise no Estado do Rio de Janeiro dentre as demais unidades da federação. doi: 10.12957/geouerj.2017.32055The article discusses structural aspects of a crisis in the interfederative relations in Brazil which were aggravated by conjunctural aspects of the economic crisis in 2014. The municipal finance data provided by the National Treasury Secretariat (FINBRA) were used to locate the structural dimension of this crisis, taking into account municipalities situation. The cyclical dimension was analyzed based on Rio de Janeiro State municipalities financial data, although recognizing the crisis severity in the mentioned State among the other federation units.

O surgimento de novos arranjos territoriais como é o caso das regiões metropolitanas enseja o enfrentamento de determinados desafios que se colocam à consecução de uma gestão urbana sustentável e articulada. O advento do Estatuto da Metrópole, Lei nº 13.089/2015, tem sido identificado como um relevante avanço normativo a fim de induzir melhor a governança dos territórios não reconhecidos como entes federados. Nesta senda, o artigo se propõe a analisar os desdobramentos da entrada em vigor do Estatuto da Metrópole para a governança dos territórios metropolitanos. O presente trabalho é fruto do grupo de pesquisa institucional "Governança Territorial Urbana e Relações Interfederativas" realizado pelo Programa de Pós Graduação em Direito da UERJ no âmbito da linha de pesquisa Direito da Cidade. Os procedimentos de coleta e análise de dados se referem as capitais estaduais que são núcleos de regiões metropolitanas e demonstram entre outros fatores, a disseminação entre os especialistas sobre o tema governança territorial, e propõe um balanço acerca do avanço em direção às regras estabelecidas pelo Estatuto da Metrópole, com enfoque para a elaboração do Plano de Desenvolvimento Urbano Integrado e a agencia metropolitana de gestão territorial.

A pesar de la centralidad de la vivienda en las políticas urbanas, Brasil habría tenido solo una política de vivienda a partir de 1964. Sin embargo, el uso de recursos públicos para este asunto solo comenzó a ocurrir en 2009 a través del programa Minha Casa Minha Vida (MCMVP). Se centró en la construcción subsidiada de nuevas viviendas utilizando recursos públicos o mediante normas financieras menos costosas. En ese momento, la estrategia del gobierno federal implicaba una convergencia de las demandas sociales con la alternativa de enfrentar la crisis de 2008 mediante la adopción de medidas anticíclicas, con la construcción civil desempeñando un papel destacado en esta dinámica. Para comprender el tamaño de MCMVP, para octubre de 2018, ya se habían invertido alrededor de $ 115 mil millones de dólares en el programa, siendo Río de Janeiro el sexto estado que recibió la mayor cantidad de recursos. En el curso de su implementación, el discurso utilizado fue que la provisión de vivienda social estaría justificada como una alternativa viable que supuestamente dialogaría con las diversas dimensiones asociadas con el derecho a la vivienda. Sin embargo, a pesar de las promesas del gobierno federal, MCMVP contribuyó al crecimiento horizontal de las ciudades, por regla general, hacia las periferias de los centros urbanos y las áreas más pobres, una dinámica que se ha observado ampliamente en el país desde el comienzo del proceso de urbanización. Considerando este escenario, el presente trabajo tiene como objetivo analizar la implementación del programa, prestando especial atención al Estado de Río de Janeiro y su capital, en base a los datos solicitados al gobierno federal a fines de 2018. Dichos datos incluyen el número de unidades de vivienda contratadas, así como los montos involucrados, y considere tanto la variable de tiempo (por año), como la económica (por rango de ingresos atendidos por los proyectos) y territorial (para estados, ciudades, capitales estatales y área de planificación de la capital de Río de Janeiro). En el modelo analítico desarrollado, además de los montos totales invertidos en el país, solo se analizaron los datos que se refieren a los 10 estados más representativos (en número de unidades contratadas y recursos gastados). Con respecto a los municipios brasileños, solo se seleccionaron las capitales de los estados y aquellos con más de 100 mil habitantes, donde hay una mayor demanda de vivienda. Estos, a su vez, fueron categorizados considerando si pertenecían o no a un área metropolitana en particular. Finalmente, el análisis de la capital del estado de Río de Janeiro se realizó con base en las áreas de planificación definidas por el ejecutivo municipal. La observación del MCMVP a partir de este conjunto de datos tiene dos objetivos principales. Primero, para explicar los límites de la dimensión social de la política de vivienda pública en función de sus resultados verificados, especialmente en lo que respecta a la promoción del derecho a la ciudad. En segundo lugar, para ilustrar en qué medida el programa ha ayudado a intensificar el crecimiento horizontal de la capital hacia sus regiones periféricas y pobres. Con respecto al primero, el estudio indicó que, en el caso de Río de Janeiro, el MCMVP se usó principalmente en respuesta a los retiros realizados bajo el discurso de la preparación de la ciudad para megaeventos deportivos (por ejemplo, Juegos Olímpicos y Copa Mundial de la FIFA), limitando su incidencia bajo demanda preexistente de vivienda social. En el segundo, la ubicación de las viviendas sociales en el oeste y norte de la capital reitera las afirmaciones de que el programa habría estimulado el crecimiento de las periferias pobres de la capital. Sin embargo, fue posible observar algunos esfuerzos del ejecutivo municipal para limitar la incidencia de MCMVP, autorizando nuevos proyectos de vivienda solo en regiones con alguna infraestructura urbana. Los resultados reafirman la fuerza del emprendimiento frente a una narrativa del urbanismo social, es decir, una trampa de planificación urbana que aún no ha sido posible eliminar en Brasil. Tot i la centralitat de l'habitatge en les polítiques urbanes, el Brasil hauria tingut només una política d'habitatge a partir de 1964. No obstant això, l'ús de recursos públics per a aquest assumpte només va començar a ocórrer el 2009 a través de el programa Minha Casa Minha vida (MCMVP). Es va centrar en la construcció subsidiada de nous habitatges utilitzant recursos públics o mitjançant normes financeres menys costoses. En aquest moment, l'estratègia de govern federal implicava una convergència de les demandes socials amb l'alternativa d'enfrontar la crisi de 2008 mitjançant l'adopció de mesures anticícliques, amb la construcció civil exercint un paper destacat en aquesta dinàmica. Per comprendre la mida de MCMVP, per a octubre de 2018, ja s'havien invertit al voltant de 115 $ mil milions de dòlars en el programa, sent Rio de Janeiro el sisè estat que va rebre la major quantitat de recursos. En el curs de la seva implementació, el discurs utilitzat va ser que la provisió d'habitatge social estaria justificada com una alternativa viable que suposadament dialogaria amb les diverses dimensions associades amb el dret a l'habitatge. No obstant això, tot i les promeses de govern federal, MCMVP va contribuir a el creixement horitzontal de les ciutats, per regla general, cap a les perifèries dels centres urbans i les àrees més pobres, una dinàmica que s'ha observat àmpliament al país des del començament del procés d'urbanització. Considerant aquest escenari, el present treball té com a objectiu analitzar la implementació de el programa, prestant especial atenció a l'Estat de Rio de Janeiro i la seva capital, en base a les dades sol·licitades a govern federal a fins de 2018. Aquestes dades inclouen el nombre d'unitats d'habitatge contractades, així com les sumes involucrats, i consideri tant la variable de temps (per any), com l'econòmica (per rang d'ingressos atesos pels projectes) i territorial (per a estats, ciutats, capitals estatals i àrea de planificació de la capital de Rio de Janeiro). En el model analític desenvolupat, a més de les sumes totals invertits al país, només es van analitzar les dades que es refereixen als 10 estats més representatius (en nombre d'unitats contractades i recursos gastats). Pel que fa als municipis brasilers, només es van seleccionar les capitals dels estats i aquells amb més de 100 mil habitants, on hi ha una major demanda d'habitatge. Aquests, al seu torn, van ser categoritzats considerant si pertanyien o no a una àrea metropolitana en particular. Finalment, l'anàlisi de la capital de l'estat de Rio de Janeiro es va realitzar amb base en les àrees de planificació definides per l'executiu municipal. L'observació de l'MCMVP a partir d'aquest conjunt de dades té dos objectius principals. Primer, per explicar els límits de la dimensió social de la política d'habitatge públic en funció dels seus resultats verificats, especialment pel que fa a la promoció de el dret a la ciutat. En segon lloc, per il·lustrar en quina mesura el programa ha ajudat a intensificar el creixement horitzontal de la capital cap a les seves regions perifèriques i pobres. Pel que fa a el primer, l'estudi va indicar que, en el cas de Rio de Janeiro, el MCMVP es va usar principalment en resposta als recessos realitzats sota el discurs de la preparació de la ciutat per megaesdeveniments esportius (per exemple, Jocs Olímpics i Copa del Món de la FIFA), limitant la seva incidència sota demanda preexistent d'habitatge social. En el segon, la ubicació dels habitatges socials a l'oest i nord de la capital reitera les afirmacions que el programa hauria estimulat el creixement de les perifèries pobres de la capital. No obstant això, va ser possible observar alguns esforços de l'executiu municipal per limitar la incidència de MCMVP, autoritzant nous projectes d'habitatge només en regions amb alguna infraestructura urbana. Els resultats reafirmen la força de l'emprenedoria enfront d'una narrativa de l'urbanisme social, és a dir, un parany de planificació urbana que encara no ha estat possible eliminar al Brasil. Despite the centrality of housing in urban policies, Brazil would have had only a housing policy as of 1964. Nevertheless, public resources use for this matter only started occurring in 2009 through the Minha Casa Minha Vida program (MCMVP). Its focus was the subsidized construction of new housing using public resources or via less expensive financing rules. At that moment, the federal government's strategy implied a convergence of the social demands with the alternative of facing the 2008 crisis by adopting countercyclical measures, with civil construction playing a prominent role in this dynamic. In order to understand the size of MCMVP, by October 2018, about $115 billion dollars had already been invested in the program, with Rio de Janeiro being the sixth State that received the most resources. In the course of its implementation, the discourse used was that the social housing provision would be justified as a viable alternative that supposedly would dialogue with the various dimensions associated with the right to housing. However, despite the promises of the federal government, MCMVP contributed to the cities’ horizontal growth, as a rule, towards urban centers’ peripheries and poorer areas, a dynamic that has been widely observed in the country since the beginning of the urbanization process intensification. Considering this scenario, the present work aims to analyze the program’s implementation, giving special attention to the State of Rio de Janeiro and its capital, based on data requested to federal government at the end of 2018. Such data include the number of housing units contracted, as well as the amounts involved, and consider both the time variable (per year), as the economic (by income range served by the projects) and territorial (for states, cities, state capitals and planning area of the capital of Rio de Janeiro). In the analytical model developed, in addition to the total amounts invested in the country, only data referring to the 10 most representative states (in number of contracted units and resources spent) were analyzed. With regard to Brazilian municipalities, only the states’ capitals and those above 100 thousand inhabitants were selected - where there is greater demand for housing. These, in turn, were categorized considering whether or not they belonged to a particular metropolitan area. Finally, the analysis of the State capital of Rio de Janeiro was made based on the planning areas defined by the municipal executive. The observation of the MCMVP from this data set has two main objectives. First, to explicit the limits of the social dimension of public housing policy based on its verified results, especially in regard to the promotion of the right to the city. Secondly, to illustrate to what extent the program has helped to intensify the horizontal growth of the capital towards its peripheral and poor regions. Regarding the first, the study indicated that, in the case of Rio de Janeiro, MCMVP was mainly used in response to the removals made under the discourse of the city's preparation for sports mega events (e.g., Olympics and FIFA World Cup), limiting its incidence under pre-existing demand for social housing. On the second, the location of social housing in the west and north of the capital reiterates the assertions that the program would have stimulated the growth of the capital's poor peripheries. However, it was possible to observe some efforts of the municipal executive to limit the incidence of MCMVP, authorizing new housing projects only in regions with some urban infrastructure. The results reaffirm the strength of entrepreneurship against a narrative of social urbanism, i.e. a trap of urban planning which has not yet been possible to pull away in Brazil.

Neste artigo explora-se a difícil regulação do processo de urbanização brasileiro ao longo do século XX e os desafios que emergem no século XXI. Inicia-se com uma descrição do processo de urbanização no Brasil, visando associar a transformação de uma sociedade rural em outra de base urbano-industrial. Em seguida, destaca-se o avanço na legislação urbanística introduzida no período pós-constitucional, marcado por um aumento dos direitos sociais no país. E, apesar deste avanço, persistiu a urbanização periférica, característica do processo de urbanização brasileiro, o que permite situar o fracasso do avanço normativo das políticas urbanas em ter efetividade em prol de uma urbanização social e inclusiva da população pobre. This article deals with the difficult regulation of the Brazilian urbanization process throughout the twentieth century and the challenges that emerge in the 21st century. It begins with a description of the urbanization process in Brazil, aiming to associate the transformation of a rural society into an urban-industrial base. Then we pointed out the advance in urban legislation introduced in the post-constitutional period, marked by an increase in social rights in the country. And despite this advance, the peripheral urbanization, characteristic of the Brazilian urbanization process, persisted, which allows us to recognize the failure of the normative advance of urban policies to be effective in favor of a social and inclusive urbanization of the poor population.