Including civil society organizations in the policy process is a distinctive trait of democratic governance. But, while being highly valuable from a democratic point of view, not all civil society organizations are represented in the policy process. This dissertation draws attention to the role of the government in shaping the representation of civil society organizations in the Swedish government consultation referred to as the ‘remiss procedure’. The overall aim is to increase empirical and theoretical understanding of civil society organizations’ access to the national Swedish policy process. Drawing on various empirical data sources, it analyzes how access has changed during the second half of the 20th century, the factors influencing access, and the significance of the access provided by the government. The results are based on four empirical studies, and show that the government has encouraged an increasing number and more diverse types of civil society organizations to be represented in the remiss procedure. In addition, organizations with plenty of resources, such as labor and business organizations, are not overrepresented. However, access is slightly skewed in favor of civil society organizations with an insider position within other access points at national government level, which is consistent with a privileged pluralistic pattern of interest representation. In addition, civil society organizations seem to be invited into an arena for political influence of less relevance. Theoretically, the dissertation moves beyond the neo-corporatist perspective that dominated Swedish research during the second half of the 20th century by drawing attention to five different theoretical lenses: pluralism, neo-corporatism, political opportunity structures, policy network theory, and resource exchange theory. It concludes that a variety of theories are needed for access to be understood.

El presente proyecto trata sobre un aplicativo móvil llamado “Dr. App” para promocionar los servicios médicos de distintos doctores con distintas especializaciones, ya que actualmente atravesamos una pandemia donde a los usuarios o pacientes nos es difícil poder acceder, en un primer descarte, a un centro médico. Así mismo, este aplicativo contará con una asistente virtual quien organizará sus citas programadas con sus centros de atención; es decir, el paciente podrá acceder a la información sobre las distintas instituciones donde esté doctor atiende. El paciente tendrá distintas opciones de médicos y lugares donde se pueda atender, gracias a la geolocalización, podrá ver una lista de distintos centros médicos y también podrá elegir al doctor mediante un sistema de calificaciones. Todos los doctores que harán el triaje para destinarlo con una especialidad son médicos recién colegiados; por otro lado, en la plataforma podrán verificar sus documentos y códigos de estos ante cualquier consulta. El aplicativo móvil tendrá una sección donde los pacientes podrán ver la trayectoria de los doctores especializados, es decir, donde han trabajado, especializaciones y otros. / This project deals with a mobile application called “Dr. App” to promote the medical services of doctors with different specializations, since we are currently going through a pandemic where users or patients find it difficult to access a medical center in the first instance. Likewise, this application will have a virtual assistant who will organize your scheduled appointments with your care centers; that is, the patient will be able to access information about the different institutions where the doctor attends. The patient will have different options of doctors and places where he can attend, thanks to geolocation, he will be able to see a list of different medical centers and he will also be able to choose the doctor through a rating system. All the doctors who will do the triage to assign it to a specialty are recently registered doctors; on the other hand, on the platform they will be able to verify their documents and their codes before any query. The mobile application will have a section where patients can see the trajectory of specialized doctors, that is, where they have worked, specializations and others. / Trabajo de investigación

El mundo y el Perú viene pasando un momento crítico contra la pandemia Covid-19, ocasionando muchos cambios en el día a día de las personas debido al cambio de trabajo presencial hacia el trabajo remoto, así como también, el hecho que la economía se vio afectada en muchas familias por una la baja del salario o simplemente porque la empresa donde laboraban suspendió sus actividades. Este comportamiento incrementó un problema en la salud mental de jóvenes y adultos en el Perú. Para determinar si era factible seguir con el modelo de negocio se realizó una entrevista de profundidad a 20 personas de los distritos de San Isidro, Santiago de Surco, Miraflores, Chorrillos, Barranco, La Molina entre las edades de 25 a 55 años de los niveles socioeconómicos A, B y C. Es por ello que, se crea Centro de Bienestar Psicológico AyudArte, la cual cuenta con psicólogos especialistas en la materia para dar un servicio las 24 horas del día los 7 días de la semana, a través de consultas presencial, virtual y a domicilio. El Centro de Bienestar Psicológico AyudArte, tiene un plan de expansión de mercado a todo el Perú y a nivel Latinoamérica. / The world and Peru has been going through a critical moment against the Covid-19 pandemic, causing many changes in people's daily lives due to the change from face-to-face work to remote work, as well as the fact that the economy was seen affected in many families by a drop in wages or simply because the company where they worked suspended its activities. This behavior increased a problem in the mental health of youth and adults in Peru. To determine if it was feasible to continue with the business model, an in-depth interview was conducted with 20 people from the districts of San Isidro, Santiago de Surco, Miraflores, Chorrillos, Barranco, La Molina between the ages of 25 to 55 years of the levels socioeconomic A, B and C. AyudArte Psychological Wellbeing Center was created, which has psychologists specializing in the matter to provide a service 24 hours a day, 7 days a week, through face-to-face, virtual and home consultations. AyudArte Psychological Wellbeing Center has a market expansion plan to all of Peru and Latin America / Trabajo de investigación

En el presente documento se presentará la idea de negocio Neuro Help, ofreciendo un servicio online personalizado de consultas psicológicas en la especialidad de Neuropsicología. Mediante métodos de investigación, tales como entrevistas, focus groups y encuestas; se plantearon hipótesis para corroborar la viabilidad del proyecto. Igualmente, se buscará analizar el entorno interno como fortalezas y debilidades; y el entorno externo, que son factores los cuales no tenemos control alguno. Asimismo, la identificación del mercado objetivo es importante y por ello también se hizo un estudio de este para comprender a donde se dirigirán los esfuerzos de ventas, teniendo en cuenta sus necesidades y los problemas que le aquejan. Por ello, teniendo conocimiento de la situación actual del país y la viabilidad que tendría el proyecto, mediante un análisis financiero, se confirmará la escalabilidad en el mercado y el cumplimiento de los objetivos tanto a corto, mediano y largo plazo; asegurando un crecimiento e impacto sostenible con el transcurrir de los años. / This document will present the business idea of Neuro Help, an online service of psychology consultations in the specialist of neurology. Through different Market research methods such as interviews, focus groups and surveys; it was proposed different hypotheses in order to corroborate the viability of the business. Also, we will seek to analyze the internal environment such as strengths and weaknesses; and the external environment, uncontrollable factors that can affect the business development. In addition, seeking to understand the market that will surround us, we will investigate in which segment will be the target to which the sales efforts will be directed, knowing the different problems that they have throughout social networks. Therefore, knowing what it is really going on with the country and the entire world, and the viability of the business; we will confirm the scalability in the market and accomplishing with different strategies in short, medium and long term, ensuring a sustainable growing over the years. / Trabajo de investigación

No description available.

INTRODUÇÃO: Este estudo tem por objetivo avaliar, em pacientes portadores de dispepsia funcional, um tipo de atendimento médico que tem a sustentação de uma base epistemológica mais ampla (encontro terapêutico) comparada com o atendimento médico tradicional embasado no modelo biomédico (consulta médica). Inicia-se com um debate onde são descritas as teorias e definições acerca do tema \"pluralismo epistemológico\". O autor acredita que este é o alicerce capaz de fornecer a necessária sustentação para o exercício crítico da atividade profissional que se quer mais humanizada e humanista e para uma pesquisa em saúde que consiga integrar os múltiplos saberes. Em seguida, descreve os passos que transformam \"consultas\" em \"encontros terapêuticos\". De acordo com o autor essa transformação possibilita o resgate das características de arte da medicina. Arte no sentido de artesanal (de \"feita sob medida\") ao contrário da biomedicina que é técnica (no sentido de sistematizar, generalizar). MÉTODOS: Trata-se de um ensaio clínico randomizado e controlado por placebo, registrado no ClinicalTrials.gov. Realizado de novembro de 2007 a fevereiro de 2012. Foram recrutados 131 pacientes com dispepsia funcional a partir de 753 voluntários pertencentes ao Ambulatório de Gastroenterologia da Faculdade de Medicina do ABC. Esses pacientes foram divididos em dois grupos A e B, onde o grupo A (n = 63) foi tratado com consultas médicas tradicionais e o grupo B (n = 68) com encontros terapêuticos. Esses dois grupos foram divididos em 4 subgrupos A1, A2, B1 e B2, onde os subgrupos A1 (n = 31) e B1(n = 34) receberam o medicamento omeprazol, A2 (n = 32) e B2 (n = 34) receberam placebo. A todos os pacientes, foi aplicado o Questionário de Sintomas de Dispepsia Funcional (QSDF) no início do estudo. Aos que terminaram o tratamento, o QSDF foi aplicado no final (seis meses após o inicio). A variável desfecho foi definida como sendo a redução de 50% e mais no escore obtido entre a primeira e a segunda aplicação do QSDF. RESULTADOS: 1) Não houve diferenças entre os grupos e subgrupos com respeito ao número de pacientes, quanto à distribuição por sexo, idade e frequência de uso de medicação de resgate. 2) Dos 131 pacientes do estudo 74 (56,5%) completaram o tratamento e 57 (43,5%) abandonaram antes do término. Não há diferença significativa entre os grupos A (n = 30) e B (n = 44) quanto à proporção de pacientes que terminaram seu tratamento (p = 0,076). 3) Nos subgrupos B1 e B2, 79,5% e 80% dos pacientes, respectivamente, alcançaram a redução de 50% e mais no escore do QSDF, contra apenas 22,2% e 41,7% dos pacientes dos subgrupos A1 e A2. A diferença entre os subgrupos é significante (p < 0,001). CONCLUSÕES: Neste estudo o atendimento médico \"encontro terapêutico\" foi (2,65 vezes) mais eficaz do que a \"consulta médica tradicional\". A excelência técnica é fundamental para a boa prática da medicina, mas ela é mais eficaz quando associada à arte / INTRODUCTION: This study aims to evaluate, in patients with functional dyspepsia, a type of medical care that has the support of a larger epistemological basis (therapeutic encounter) compared with standard medical care grounded in the biomedical model (medical consultation). It begins with a discussion where theories and definitions on the topic \"epistemological pluralism\" are described. The author believes that this is the foundation capable of providing the necessary support for the critical exercise of professional activity in a more humane and humanistic basis, and for a health research capable of the integration of multiple areas of knowledge. Then he describes the steps that transform \"consultation\" in \"therapeutic encounters.\" According to the author, this transformation enables the rescue of the characteristics of the art of medicine. Art in the sense of artisanal (the \"tailor made\") instead of biomedicine that is technical (in the sense of systematic, generalized). METHODS: This was a randomized, placebo-controlled clinical trial, registered in ClinicalTrials.gov., held from November 2007 to February 2012. 131 patients with functional dyspepsia were recruited from 753 volunteers belonging to the Gastroenterology outpatient clinic of Faculdade de Medicina do ABC. These patients were divided into two groups A and B, where group A (n = 63) was treated with traditional medical consultations and group B (n = 68) with therapeutic encounters. These two groups were divided into 4 subgroups A1, A2, B1 and B2, where the subgroups A1 (n = 31) and B1 (n = 34) received omeprazole, A2 (n = 32) and B2 (n = 34) received placebo. All patients answered the Questionnaire Symptoms of Functional Dyspepsia (QSFD) at study entry. Those patients who completed treatment answered the QSFD again in the end (six months after the onset). The outcome variable was defined as a reduction of 50% and more on the score obtained between the first and second application of QSFD. RESULTS: 1) There were no differences between the groups and subgroups with respect to the number of patients, according to the distribution by gender, age and frequency of use of rescue medication. 2) Among the 131 patients in the study 74 (56.5%) completed treatment and 57 (43.5%) dropped out before completion. There is no significant difference between groups A (n = 30) and B (n = 44) as the proportion of patients who completed their treatment (p = 0.076). 3) In subgroups B1 and B2, 79.5% and 80% of patients, respectively, achieved a reduction of 50% and more in the score QSFD, against only 22.2% and 41.7% of patients in subgroups A1 and A2. The difference between the groups is significant (p <0.001). CONCLUSIONS: In this study the \"therapeutic encounter\" was (2.65 times) more effective than \"traditional medical consultation\". Technical excellence is fundamental to good medical practice, but it is more effective when combined with art

This research project addresses the following: how topical talk operates in the organisation and management of MSE interactions; and how topical talk operates in the co-ordination of specific service requests and service provisions. It draws on a corpus of audio-recorded and transcribed interactions between general practitioners and persons seeking general medical services in suburban clinics in Brisbane, Australia. The corpus comprised a total of 67 medical service events (henceforth MSEs), audio-taped with the full informed consent of the participants. Many contemporary medical sociological accounts of the operation of topical talk in MSEs, typified by the work of Mishler (1981, 1984) and Waitzkin (1991), remain anchored to the 'professional dominance' thesis (Freidson 1970a; 1970b), arguing for the fundamental conflict between two perspectives - lay and professional. Topical talk has been formulated as one expression of this conflict in 'doctor-centred' communicative 'styles' (Byrne and Long 1976; Silverman 1987). Within such accounts, familiar interactional patterns in MSEs, including the content and structure of topics, have been theorised as instruments of power and control whereby the dominance of specialised medical knowledge and expertise are established and maintained. Mishler's (1984) characterisation of the conflict between a biomedically oriented 'voice of medicine' used by professional physicians (henceforth GPs) and a 'voice of the lifeworld' used by persons seeking medical services (henceforth Ps) is an expression of the 'professional dominance' thesis. The voices are characterised as attesting to a fundamental, theoretically problematic, asymmetry of power relations between GPs and Ps, thereby reinforcing the ideological status of professionals in general and the medical profession in particular. Further, recommendations regarding correctives to 'professional dominance' centre on advice GPs to attend to the primacy of Ps' talk on their experiences of illnesses rather than apparently 'ignoring' or transforming these topics into biomedical accounts of disease. This research project critiques this formulation of topical talk and the traditional theoretical and empirical bases on which it has drawn. This critique arises from the application of ethnomethodological approaches to the study of MSEs. Such approaches, as outlined in Chapters 2 and 3, are characterised by a number of conceptual and analytic premises: First, particular social structural features of social activities and the institutional contexts within which activities occur should not be assumed to be the primary criteria for judging the import and adequacy of situated action. Second, the parties to situated social events mutually constitute those events in the real world. Third, issues of agency are collaborative situated accomplishments such that the management of everyday social activities is accomplished by the people involved who show one another the rationalities of their actions as they assemble the familiar scenic features of those same institutional events (Garfinkel 1967; Sacks 1992a, 1992b). These assumptions have been applied in ethnomethodological analyses of social action, including the analysis of professional service encounters that have critiqued the 'professional dominance' thesis (Eglin and Wideman 1986; Sharrock 1979). The novelty of this study is the analysis of the operation of topic organisation as a phenomenon of order. This study also draws on recommendations within Ethnomethodology (Hester & Eglin 1997b; Watson 1997) that sequential and categorial organisations are mutually informative in the analysis of the rationality of situated social action. One of the particular contributions of this thesis is that it not only jointly applies both conversation analysis and membership categorisation analysis but also extends this recommendation to the inclusion of topic analysis as was originally provided for by Sacks (1992a , 1992b) and Garfinkel and Sacks (1970). Within this study a model of analysis has been constructed that has enabled the analytical consideration of four dimensions of social organisation: local sequential, extended sequential, topical and categorial organisations. The theoretical and empirical concepts of ethnomethodogical analysis have thus been developed and extended within this project. The central findings of this study are that in institutional service events, the 'service topic' is both significant and consequential, and that persons constitute themselves as bona fide incumbents of the categories GP or P by attending to their actions as topically organised. The local adequacy of any particular interactional move (such as questioning-answering, greetings, the design of a topic proposal, etc) is shown to be referenced to the service topic. This study found no evidence of potential or actual "struggles" between the 'voice of the life-world and the voice of medicine'. Rather, this study finds routine recognition on the part of both Ps and GPs of the centrality of the service topic and, thereby, the service task, and no evidence of orientation to distinctive biographical contributions staged in competition with biomedically relevant service topics. It is found that Ps' biographical references were made in the context of an assembled service topic such that particular service tasks, however conventional, were constituted as both relevant and reasonable as medical goods and service for the specific service recipient and provider. At the most general level, it is concluded that the service topic operates as a phenomenon of order in MSEs where order, as defined by Garfinkel and Weider (1992: 202), refers to all of the rationalities evident in the generic features of institutional events and settings, that is, the situated logic and intelligibility as well as the procedures whereby they are constituted as recognisable social events. The thesis concludes with a discussion of the implications of the findings for the theorisation, policy-making, medical education, and practices of GPs and Ps within MSEs. Overall, the significance of this work for researchers into medical interactions is that the relevance of the service topic and its pervasive organisational consequences need to be considered analytically. A major outcome of this thesis is the establishment of a new order of interest within the study of institutional interactions. The project demonstrates the pervasive consequences of service topics and thus provides a step forward in the study of institutional service interactions and ways of theorising their rationality, a step that extends beyond social structural pre-theorisations of power and domination and also beyond interactional accounts of the primary relevance of turn taking structures.

INTRODUÇÃO: Este estudo tem por objetivo avaliar, em pacientes portadores de dispepsia funcional, um tipo de atendimento médico que tem a sustentação de uma base epistemológica mais ampla (encontro terapêutico) comparada com o atendimento médico tradicional embasado no modelo biomédico (consulta médica). Inicia-se com um debate onde são descritas as teorias e definições acerca do tema \"pluralismo epistemológico\". O autor acredita que este é o alicerce capaz de fornecer a necessária sustentação para o exercício crítico da atividade profissional que se quer mais humanizada e humanista e para uma pesquisa em saúde que consiga integrar os múltiplos saberes. Em seguida, descreve os passos que transformam \"consultas\" em \"encontros terapêuticos\". De acordo com o autor essa transformação possibilita o resgate das características de arte da medicina. Arte no sentido de artesanal (de \"feita sob medida\") ao contrário da biomedicina que é técnica (no sentido de sistematizar, generalizar). MÉTODOS: Trata-se de um ensaio clínico randomizado e controlado por placebo, registrado no ClinicalTrials.gov. Realizado de novembro de 2007 a fevereiro de 2012. Foram recrutados 131 pacientes com dispepsia funcional a partir de 753 voluntários pertencentes ao Ambulatório de Gastroenterologia da Faculdade de Medicina do ABC. Esses pacientes foram divididos em dois grupos A e B, onde o grupo A (n = 63) foi tratado com consultas médicas tradicionais e o grupo B (n = 68) com encontros terapêuticos. Esses dois grupos foram divididos em 4 subgrupos A1, A2, B1 e B2, onde os subgrupos A1 (n = 31) e B1(n = 34) receberam o medicamento omeprazol, A2 (n = 32) e B2 (n = 34) receberam placebo. A todos os pacientes, foi aplicado o Questionário de Sintomas de Dispepsia Funcional (QSDF) no início do estudo. Aos que terminaram o tratamento, o QSDF foi aplicado no final (seis meses após o inicio). A variável desfecho foi definida como sendo a redução de 50% e mais no escore obtido entre a primeira e a segunda aplicação do QSDF. RESULTADOS: 1) Não houve diferenças entre os grupos e subgrupos com respeito ao número de pacientes, quanto à distribuição por sexo, idade e frequência de uso de medicação de resgate. 2) Dos 131 pacientes do estudo 74 (56,5%) completaram o tratamento e 57 (43,5%) abandonaram antes do término. Não há diferença significativa entre os grupos A (n = 30) e B (n = 44) quanto à proporção de pacientes que terminaram seu tratamento (p = 0,076). 3) Nos subgrupos B1 e B2, 79,5% e 80% dos pacientes, respectivamente, alcançaram a redução de 50% e mais no escore do QSDF, contra apenas 22,2% e 41,7% dos pacientes dos subgrupos A1 e A2. A diferença entre os subgrupos é significante (p < 0,001). CONCLUSÕES: Neste estudo o atendimento médico \"encontro terapêutico\" foi (2,65 vezes) mais eficaz do que a \"consulta médica tradicional\". A excelência técnica é fundamental para a boa prática da medicina, mas ela é mais eficaz quando associada à arte / INTRODUCTION: This study aims to evaluate, in patients with functional dyspepsia, a type of medical care that has the support of a larger epistemological basis (therapeutic encounter) compared with standard medical care grounded in the biomedical model (medical consultation). It begins with a discussion where theories and definitions on the topic \"epistemological pluralism\" are described. The author believes that this is the foundation capable of providing the necessary support for the critical exercise of professional activity in a more humane and humanistic basis, and for a health research capable of the integration of multiple areas of knowledge. Then he describes the steps that transform \"consultation\" in \"therapeutic encounters.\" According to the author, this transformation enables the rescue of the characteristics of the art of medicine. Art in the sense of artisanal (the \"tailor made\") instead of biomedicine that is technical (in the sense of systematic, generalized). METHODS: This was a randomized, placebo-controlled clinical trial, registered in ClinicalTrials.gov., held from November 2007 to February 2012. 131 patients with functional dyspepsia were recruited from 753 volunteers belonging to the Gastroenterology outpatient clinic of Faculdade de Medicina do ABC. These patients were divided into two groups A and B, where group A (n = 63) was treated with traditional medical consultations and group B (n = 68) with therapeutic encounters. These two groups were divided into 4 subgroups A1, A2, B1 and B2, where the subgroups A1 (n = 31) and B1 (n = 34) received omeprazole, A2 (n = 32) and B2 (n = 34) received placebo. All patients answered the Questionnaire Symptoms of Functional Dyspepsia (QSFD) at study entry. Those patients who completed treatment answered the QSFD again in the end (six months after the onset). The outcome variable was defined as a reduction of 50% and more on the score obtained between the first and second application of QSFD. RESULTS: 1) There were no differences between the groups and subgroups with respect to the number of patients, according to the distribution by gender, age and frequency of use of rescue medication. 2) Among the 131 patients in the study 74 (56.5%) completed treatment and 57 (43.5%) dropped out before completion. There is no significant difference between groups A (n = 30) and B (n = 44) as the proportion of patients who completed their treatment (p = 0.076). 3) In subgroups B1 and B2, 79.5% and 80% of patients, respectively, achieved a reduction of 50% and more in the score QSFD, against only 22.2% and 41.7% of patients in subgroups A1 and A2. The difference between the groups is significant (p <0.001). CONCLUSIONS: In this study the \"therapeutic encounter\" was (2.65 times) more effective than \"traditional medical consultation\". Technical excellence is fundamental to good medical practice, but it is more effective when combined with art

The main aim of the theoretical part is to define the term 'beginning teacher' and to describe the forms of support which a fresh graduate can use when he starts his teaching practice. Furthermore, I focus on communication and cooperation of a teacher and a parent and I offer reasons for their realization. In the end of the theoretical part, I describe parent - teacher conference and consultations teacher - parent - pupil in Step by step. The aim of the empiric part was to assess the interviews with the beginning primary school teachers in ZŠ Angel and some parents. The structured interview was focused on to what extent the beginning teachers felt prepared for the parent - teacher conference, what support which was given to them was the most appreciated, what a teacher needs to deal with in connection with the parent - teacher conference and consultations teacher - parent - pupil. Then I try to find out what challenges are the beginning teachers facing in connection with leading the parent - teacher conference and consultations teacher - parent - pupil, what has worked after realization of the parent - teacher conference and consultations teacher - parent - pupil and what the teachers see as the main advantages and disadvantages of the consultations teacher - parent - pupil in comparison with the...

[pt] Esta investigação aborda propostas de criação de novas unidades federativas no Brasil. Apresenta reflexões sobre o federalismo brasileiro, com destaque para a histórica centralização de recursos na União, em detrimento dos interesses de estados e municípios. Discute os mecanismos políticos, institucionais, econômicos e logísticos que estimulam discursos pró-divisão da unidade federativa do Maranhão. Destaca a presença do poder público estadual em diferentes regiões do estado do Maranhão. Evidencia o processo de descentralização administrativa vigente do Governo do Maranhão, com foco na efetividade da prestação de serviços públicos ofertados pelo executivo estadual maranhense. Analisa diferentes opiniões sobre a criação de novas unidades federativas no Brasil. Para tanto, obtiveram-se depoimentos de políticos de diferentes regiões do país, de acadêmicos com trabalhos vinculados ao tema desta pesquisa e de moradores de várias regiões do Maranhão. Adota diferentes procedimentos metodológicos: revisão de literatura, pesquisa documental, comparação de dados secundários e entrevistas semiestruturadas por pautas. Advoga que as atuais propostas de criação de novas unidades federativas em tramitação no Congresso Nacional não reúnem condições de se tornarem efetivas. Para tanto, são elencadas 12 razões que sustentam esta tese. / [en] This investigation addresses proposals for the creation of new federative units in Brazil. It presents reflections on Brazilian federalism, emphasizing the historical centralization of resources in the Union, to the detriment of the interests of states and municipalities. It discusses the political, institutional, economic and logistical mechanisms that stimulate pro-division discourses in the federative unit of Maranhão. It highlights the presence of the state government in different regions of the State of Maranhão. It highlights the current administrative decentralization process of the Government of Maranhão, focusing on the effectiveness of the provision of public services offered by the state executive of Maranhão. It analyzes different opinions about the creation of new federative units in Brazil. To this end, testimonies were obtained from politicians from different regions of the country, academics with works related to this research s theme and residents of various regions of Maranhão. It adopts different methodological procedures: literature review, documentary research, comparison of secondary data and semi-structured interviews based on guidelines. It advocates that the current proposals for the creation of new federative units being discussed in the National Congress do not meet the conditions to become effective. To this end, 12 reasons are listed that support this thesis.