Local Knowedge and Citizenship: the communitarian health agents

Discussions about the new meaning of citizenship, valuing differences and respecting knowledge diversity bring the question of how public policies can be locally rooted to ensure access to diversity. This is evident when we deal with health policies, where the interaction between implementers and beneficiaries is essential to understand the results of the policy. The Family Health Program (FHP) has tried to change the relationship between state and society, bringing health professionals with the daily experienced by the users where there is (re) production of the components that lead to insecurity, poor health and disease. To analyse this kind of policy we must take into account the interaction processes and the practices of the actors involved in the FHP implementation. This article aims to analyze the role of Health Communitarian Agents (HCA) as FHP implementers. Through ethnographic research followed the practices of ACS in different cities, we seek to understand how they deal with their different knowledge, enable and disable referrals and adapt action to enact the program. We want to understand how they use mediations and interactions in their practices and built policies locally rooted, constructing alternative ways to implement these policies.

Nutrients removed by Kappaphycus alvarezii (Rhodophyta, Solieriaceae) in integrated cultivation with fishes in re-circulating water

The potential of the red alga Kappaphycus alvarezii to remove nutrients was tested to treat effluents of Trachinotus carolinus fish cultivation, and the production of carrageenan in this condition was analyzed. Experiments were conducted in four tanks of 8000 L with approximately 1200 fishes of 30 g each integrated with three tanks of 100 L with 700 g of K. alvarezii, as initial biomass per tank. Seawater was re-circulated between tanks with seaweed and with fish. As a control, three tanks with seawater circulating in an open system were utilized. Seawater samples were collected daily for 10 days and concentrations of nitrate, nitrite, ammonium and phosphate were determined in the inflow and outflow water of the tanks. Significant differences between both collecting points were considered as nutrient removal by the seaweed. Growth rates and carrageenan yields were also analyzed in seaweed cultivated in seawater and in effluents. Growth rates of seaweed cultivated in tanks were lower than those obtained in open sea and in laboratory cultivation. Effluents had concentrations of nitrate and nitrite ca. 100 times higher than in the control. Maximum values of nutrient removal on effluents were: nitrate= 18.2%; nitrite =50.8%; ammonium =70.5% and phosphate =26.8%. All plants survived throughout the experimental period, but some developed ""ice-ice"", a disease associated with physiological stress. After the experimental period, some plants selected and cultivated in open sea presented higher growth rates in 40 days, indicating nutrient storage. No significant differences between carrageenan yields of K alvarezii cultivated in seawater and in the effluents were observed. Our results show that K. alvarezii can be utilized as a biofilter for fish cultivation effluents, reducing the eutrophication process and can also be processed for carrageenan production, which provides an additional benefit to the fisheries. (C) 2008 Elsevier B.V. All rights reserved.

Cross-cultural adaptation and assessment of the reliability and validity of the Core Outcome Measures Index (COMI) for the Brazilian-Portuguese language

The use of patient-orientated questionnaires is of utmost importance in assessing the outcome of spine surgery. Standardisation, using a common set of outcome measures, is essential to aid comparisons across studies/in registries. The Core Outcome Measures Index (COMI) is a short, multidimensional outcome instrument validated for patients with spinal disorders. This study aimed to produce a Brazilian-Portuguese version of the COMI. A cross-cultural adaptation of the COMI into Brazilian-Portuguese was carried out using established guidelines. 104 outpatients with chronic LBP (> 3 months) were recruited from a Public Health Spine Medical Care Centre. They completed a questionnaire booklet containing the newly translated COMI, and other validated symptom-specific questionnaires: Oswestry Disability Index (ODI) and Roland Morris disability scale (RM), and a pain visual analogue scale. All patients completed a second questionnaire within 7-10 days to assess reproducibility. The COMI summary score displayed minimal floor and ceiling effects. On re-test, the responses for each individual domain of the COMI were within 1 category in 98% patients for the domain 'function', 96% for 'symptom-specific well-being', 97% for 'general quality of life', 99% for 'social disability' and 100% for 'work disability'. The intraclass correlation coefficients (ICC2,1) for COMI pain and COMI summary scores were 0.91-0.96, which compared favourably with the corresponding values for the RM (ICC, 0.99) and ODI (ICC, 0.98). The standard error of measurement for the COMI was 0.6, giving a "minimum detectable change" (MDC95%) of approximately 1.7 points i.e., the minimum change to be considered "real change" beyond measurement error. The COMI scores correlated as hypothesised (Rho, 0.4-0.8) with the other symptom-specific questionnaires. The reproducibility of the Brazilian-Portuguese version of the COMI was comparable to that of other language versions. The COMI scores correlated in the expected manner with existing but longer symptom-specific questionnaires suggesting good convergent validity for the COMI. The Brazilian-Portuguese COMI represents a valuable tool for Brazilian study-centres in future multicentre clinical studies and surgical registries.

Coupled Boltzmann calculation of mixed axion/neutralino cold dark matter production in the early universe

We calculate the relic abundance of mixed axion/neutralino cold dark matter which arises in R-parity conserving supersymmetric (SUSY) models wherein the strong CP problem is solved by the Peccei-Quinn (PQ) mechanism with a concommitant axion/saxion/axino supermultiplet. By numerically solving the coupled Boltzmann equations, we include the combined effects of 1. thermal axino production with cascade decays to a neutralino LSP, 2. thermal saxion production and production via coherent oscillations along with cascade decays and entropy injection, 3. thermal neutralino production and re-annihilation after both axino and saxion decays, 4. gravitino production and decay and 5. axion production both thermally and via oscillations. For SUSY models with too high a standard neutralino thermal abundance, we find the combined effect of SUSY PQ particles is not enough to lower the neutralino abundance down to its measured value, while at the same time respecting bounds on late-decaying neutral particles from BBN. However, models with a standard neutralino underabundance can now be allowed with either neutralino or axion domination of dark matter, and furthermore, these models can allow the PQ breaking scale f(a) to be pushed up into the 10(14) - 10(15) GeV range, which is where it is typically expected to be in string theory models.

Necessidades de saúde, políticas públicas e gênero: a perspectiva das práticas profissionais

Examina-se a relação entre políticas públicas e práticas dos profissionais, relativamente às necessidades de saúde. Em abordagem teórico-conceitual, as práticas são definidas como desempenhos permeados por determinantes técnico-cien­tíficos e sócio-históricos para a produção social de um trabalho, analisando-se suas possibilidades de mudanças culturais, éticas e políticas, para um agir crítico das desigualdades de gênero. Tomando-se a atenção integral à saúde dos homens, examina-se a relevância da distinção entre necessidades masculinas e femininas, enquanto realidades parciais não necessariamente convergentes na (re)produção daquelas desigualdades. Igualmente se examinam as práticas profissionais, como realidade parcial e distinta das políticas, estabelecendo relações não imediatas. Desenvolve-se que são obstáculos simbólicos e práticos para mudanças: a normalização biomédica redutora das necessidades, a cultura do trabalho autônomo e da abordagem individualizante das necessidades, a cultura tradicional de gênero conservando práticas desiguais para homens e mulheres e a ausência de inscrição dos direitos como parte do agir profissio­nal. Isto exige propostas específicas às práticas de saúde e às necessidades masculinas para maior convergência com as reformas das políticas.

TUNGSTEN ISOTOPIC COMPOSITIONS IN STARDUST SiC GRAINS FROM THE MURCHISON METEORITE: CONSTRAINTS ON THE s-PROCESS IN THE Hf-Ta-W-Re-Os REGION

We report the first tungsten isotopic measurements in stardust silicon carbide (SiC) grains recovered from the Murchison carbonaceous chondrite. The isotopes (182,183,184,186)Wand (179,180)Hf were measured on both an aggregate (KJB fraction) and single stardust SiC grains (LS+ LU fraction) believed to have condensed in the outflows of low-mass carbon-rich asymptotic giant branch (AGB) stars with close-to-solar metallicity. The SiC aggregate shows small deviations from terrestrial (= solar) composition in the (182)W/(184)Wand (183)W/(184)Wratios, with deficits in (182)W and (183)W with respect to (184)W. The (186)W/(184)W ratio, however, shows no apparent deviation from the solar value. Tungsten isotopic measurements in single mainstream stardust SiC grains revealed lower than solar (182)W/(184)W, (183)W/(184)W, and (186)W/(184)W ratios. We have compared the SiC data with theoretical predictions of the evolution of W isotopic ratios in the envelopes of AGB stars. These ratios are affected by the slow neutron-capture process and match the SiC data regarding their (182)W/(184)W, (183)W/(184)W, and (179)Hf/(180)Hf isotopic compositions, although a small adjustment in the s-process production of (183)W is needed in order to have a better agreement between the SiC data and model predictions. The models cannot explain the (186)W/(184)W ratios observed in the SiC grains, even when the current (185)W neutron-capture cross section is increased by a factor of two. Further study is required to better assess how model uncertainties (e. g., the formation of the (13)C neutron source, the mass-loss law, the modeling of the third dredge-up, and the efficiency of the (22)Ne neutron source) may affect current s-process predictions.