A incorporação da avaliação da atenção básica no nível estadual do Sistema Único de Saúde através de processos participativos de ensino-aprendizagem-trabalho

OBJETIVOS: desenvolver uma metodologia de intervenção e aplicá-la às equipes das Secretarias Estaduais de Saúde (SES) objetivando incorporar a prática de monitoramento e avaliação da atenção básica através de processo de capacitação e realização de atividade real de planejamento e programação em saúde. MÉTODOS: foi desenvolvido um processo de ensino-aprendizagem-trabalho que incorporou ao processo de capacitação uma atividade de planejamento em saúde. A qualidade dos dois processos é assegurada através do estabelecimento de princípios e critérios para a organização da capacitação, para a elaboração da proposta metodológica de monitoramento e avaliação e para a condução didático-pedagógica do curso. RESULTADOS: a metodologia foi aplicada nos Estados de Mato Grosso do Sul (MS), Tocantins (TO) e Amazonas (AM), respeitando as particularidades locais em termos de organização da SES e da qualificação e capacidade dos técnicos responsáveis pela atenção básica. Foram produzidas propostas metodológicas estruturalmente semelhantes, mas diferentes nas suas prioridades e propostas de desenvolvimento. Dois anos após o término da intervenção, efeitos desse trabalho ainda estão sendo identificados. CONCLUSÕES: os resultados obtidos em MS, TO e AM revelam a capacidade que a abordagem baseada na tríade ensino-aprendizagem-trabalho possui para a institucionalização de novas práticas de trabalho nos serviços de saúde.

Desafios para um novo pacto sanitário: biotecnologia e risco

Este artigo discute a incorporação e o uso da biotecnologia na Saúde Pública, no contexto da sociedade de risco. Tendo por referência autores da teoria social contemporânea, analisam-se as implicações das práticas biotecnológicas. O artigo está dividido em três partes. Na primeira, são apresentados alguns exemplos de manipulação biológica desenvolvidos no âmbito da saúde e as consequências da utilização dessas técnicas na dinâmica ecológica das populações envolvidas. A partir desses exemplos, discute-se o que vem a ser esses seres biologicamente modificados, híbridos, e como ocorre sua incorporação nas práticas sociais, especialmente as de Saúde Pública. A segunda parte apresenta o referencial teórico utilizado para análise, que situa a sociedade contemporânea na etapa reflexiva da modernização e que tem na sociedade de risco uma de suas configurações. A última parte do artigo problematiza os usos da biotecnologia em saúde, mais especificamente em Saúde Pública, abordando os aspectos de risco dessa aplicação, propondo o necessário debate sobre um outro pacto sanitário.

Infant feeding practices, childhood growth and obesity in adult life

A saúde infantil é amplamente afetada pelo estado nutricional. Há um interesse crescente acerca da possibilidade do estado nutricional apresentado pela criança e das práticas alimentares na primeira infância estarem relacionados à obesidade em indivíduos adultos, aumentando os riscos para complicações metabólicas. Sabe-se que estudos prospectivos possibilitam a investigação e a avaliação apropriadas de determinantes do desenvolvimento infantil. Consequentemente, o presente artigo objetivou revisar as principais evidências disponíveis a partir de estudos longitudinais sobre associações entre práticas alimentares na primeira infância, padrões de crescimento infantil e estado nutricional verificados durante a vida adulta

Análise da produção acadêmica em vigilância sanitária de alimentos, 1993-2007

O objetivo do estudo foi analisar os temas relacionados à área de vigilância sanitária de alimentos abordados em pesquisas científicas de cursos de pós-graduação, com potencial de aplicação no serviço. O total de 337 teses e dissertações apresentadas à Universidade de São Paulo entre os anos de 1993 e 2007 foi analisado. Os resultados mostraram que as pesquisas desenvolvidas nas universidades têm potencial para aplicação em vigilância sanitária, sobretudo no sentido de orientar os profissionais da área em práticas atualizadas

Efetividade de programa de agentes comunitários na promoção da saúde bucal

OBJETIVO:Avaliar mudanças em conhecimentos, atitudes e acesso/utilização de serviços odontológicos decorrentes de um programa de promoção da saúde bucal com agentes comunitários de saúde. MÉTODOS:Um projeto de capacitação combinando ensino-aprendizagem, apoio e supervisão, foi desenvolvido entre os meses de julho de 2003 a agosto de 2004. As mudanças foram avaliadas por meio de entrevistas estruturadas em que participaram 36 agentes comunitários de saúde e uma amostra de 91 mulheres e mães, representativa de donas de casa com 25 a 39 anos de idade, alfabetizadas e residentes em domicílios de três a seis cômodos no município de Rio Grande da Serra (SP). Foram colhidos dados sobre conhecimentos de saúde-doença bucal, práticas e capacidades auto-referidas em relação ao auto-exame, higiene bucal, número de residentes e de escovas dentais individuais e coletivas em cada domicílio e acesso e uso de serviços odontológicos. Por meio do teste t de Student pareado, foram comparadas as médias dos valores obtidos antes e depois do programa para cada um dos grupos estudados. As respostas foram analisadas adotando-se um nível de significância de 5%. RESULTADOS: Foram observadas diferenças estatisticamente significativas para questões relativas ao conhecimento de saúde bucal entre os agentes e entre as mulheres antes e depois da capacitação (p<0,05). Desequilíbrio entre o número de escovas e de indivíduos em cada família diminuiu. A freqüência da escovação e do uso do fio dental se elevou depois da atuação dos agentes. Os valores de auto-avaliação da higiene bucal aumentaram. Modificação nas práticas e capacidades auto-referidas mostrou significativa elevação da auto-confiança. O acesso ao serviço foi mais fácil (p<0,000) e seu uso mais regular (p<0,000) entre mulheres. CONCLUSÕES: Houve mudanças positivas na percepção em relação a aspectos de saúde bucal, na auto-confiança e no acesso e uso de serviços odontológicos. Tais mudanças po

Práticas corporais: atividade física e políticas públicas de promoção da saúde

A promoção da saúde, entendida como estratégia de produção social de saúde, deve articular e permear políticas públicas que influenciem o futuro da qualidade de vida urbana. Esse grande desafio envolve arranjos intersetoriais na gestão pública, empoderamento da população, desenvolvimento de competências e habilidades, capacitação, acesso à informação, estímulo à cidadania ativa, entre outros, para que a população reconheça seus problemas e suas causas, a fim de que ela possa advogar por políticas públicas saudáveis. Para esse propósito, é necessário que o governo operacionalize uma forma de gestão pública que considere a melhoria nas condições de vida, de trabalho e de cultura, estabelecendo uma relação harmoniosa com o meio ambiente, com o corpo que envolva a participação social na cogestão e na democracia. Nesse contexto, a inserção de um programa de práticas corporais/atividade física direcionada à população deve estar fundamentada em uma concepção da Promoção da Saúde apoiada em processos educativos que vão além da transmissão de conhecimentos. Ela deve estar focada no enfrentamento das dificuldades, no fortalecimento da identidade e na incorporação de soluções criativas e saberes saudáveis. Este artigo tem o objetivo de refletir sobre políticas de promoção da saúde relacionadas às Práticas Corporais/Atividade Física, além de apresentar um breve relato sobre o trabalho desenvolvido nessa área no município de São Paulo

Environmental management system and human resource practices: is there a link between them in four Brazilian companies?

The aim of this article is to analyze the theoretical model proposed by [Jabbour CJC, Santos FCA. Relationships between human resource dimensions and environmental management in companies: proposal of a model. Journal of Cleaner Production 2008;16(1):5 1-8.] based on the data collected in four Brazilian companies. This model investigates how the phases of the environmental management system can be linked to human resource practices in order to attain continuous improvement of a company`s environmental performance. Our aim is to contribute to a field, which has little empirical evidence. Although the interaction between the phases of the environmental management system and human resource practices is recommended by the specialized literature [Daily BE Huang S. Achieving sustainability through attention to human resource factors in environmental management. International Journal of Operations and Production Management 2001:21(12):1539-52.], the results indicate that most of the theoretical assumptions could not be confirmed in these Brazilian companies. (C) 2008 Elsevier Ltd. All rights reserved.

Evaluating an Agile Method for Planning and Controlling Innovative Projects

This article presents an extensive investigation carried out in two technology-based companies of the So Carlos technological pole in Brazil. Based on this multiple case study and literature review, a method, entitled hereafter IVPM2, applying agile project management (APM) principles was developed. After the method implementation, a qualitative evaluation was carried out by a document analysis and questionnaire application. This article shows that the application of this method at the companies under investigation evidenced the benefits of using simple, iterative, visual, and agile techniques to plan and control innovative product projects combined with traditional project management best practices, such as standardization.

A reference business process for ecological niche modelling

Ecological niche modelling combines species occurrence points with environmental raster layers in order to obtain models for describing the probabilistic distribution of species. The process to generate an ecological niche model is complex. It requires dealing with a large amount of data, use of different software packages for data conversion, for model generation and for different types of processing and analyses, among other functionalities. A software platform that integrates all requirements under a single and seamless interface would be very helpful for users. Furthermore, since biodiversity modelling is constantly evolving, new requirements are constantly being added in terms of functions, algorithms and data formats. This evolution must be accompanied by any software intended to be used in this area. In this scenario, a Service-Oriented Architecture (SOA) is an appropriate choice for designing such systems. According to SOA best practices and methodologies, the design of a reference business process must be performed prior to the architecture definition. The purpose is to understand the complexities of the process (business process in this context refers to the ecological niche modelling problem) and to design an architecture able to offer a comprehensive solution, called a reference architecture, that can be further detailed when implementing specific systems. This paper presents a reference business process for ecological niche modelling, as part of a major work focused on the definition of a reference architecture based on SOA concepts that will be used to evolve the openModeller software package for species modelling. The basic steps that are performed while developing a model are described, highlighting important aspects, based on the knowledge of modelling experts. In order to illustrate the steps defined for the process, an experiment was developed, modelling the distribution of Ouratea spectabilis (Mart.) Engl. (Ochnaceae) using openModeller. As a consequence of the knowledge gained with this work, many desirable improvements on the modelling software packages have been identified and are presented. Also, a discussion on the potential for large-scale experimentation in ecological niche modelling is provided, highlighting opportunities for research. The results obtained are very important for those involved in the development of modelling tools and systems, for requirement analysis and to provide insight on new features and trends for this category of systems. They can also be very helpful for beginners in modelling research, who can use the process and the experiment example as a guide to this complex activity. (c) 2008 Elsevier B.V. All rights reserved.

A eficácia das medidas de recuperação ambiental implantadas em minas de calcário para cimento

The effectiveness of environmental reclamation measures implemented in limestone mines is reviewed. An assessment procedure developed by Neri and Sanchez (2008) was used. This tool comprises else! of statements of good practice grouped in three categories (essential, important and accessory practices) which are assessed through (i) carrying outfield technical inspections guided by a series of protocols especially designed for this put pose; (ii) classifying inspection evidences according to previously defined categories (totally applied or satisfactorily adapted, partially applied, not applied or not applicable); and (iii) calculating conformity indexes.. The results showed that: planning activities featured the lowest performance (low conformity indexes), operational practices reached the most satisfactory results and management practices medium conformity indexes. A general conclusion is that in these mines, current practices are partially effective in establishing favorable conditions for long-term success of rehabilitation. Improvements in planning practices could significantly enhance performance and reduce risks.

A procedure to evaluate environmental rehabilitation in limestone quarries

A procedure to evaluate mine rehabilitation practices during the operational phase was developed and validated. It is based on a comparison of actually observed or documented practices with internationally recommended best practices (BP). A set of 150 BP statements was derived from international guides in order to establish the benchmark. The statements are arranged in six rehabilitation programs under three categories: (1) planning (2) operational and (3) management, corresponding to the adoption of the plan-do-check-act management systems model to mine rehabilitation. The procedure consists of (i) performing technical inspections guided by a series of field forms containing BP statements; (ii) classifying evidences in five categories; and (iii) calculating conformity indexes and levels. For testing and calibration purposes, the procedure was applied to nine limestone quarries and conformity indexes were calculated for the rehabilitation programs in each quarry. Most quarries featured poor planning practices, operational practices reached high conformity levels in 50% of the cases and management practices scored moderate conformity. Despite all quarries being ISO 14001 certified, their management systems pay low attention to issues pertaining to land rehabilitation and biodiversity. The best results were achieved by a quarry whose expansion was recently submitted to the environmental impact assessment process, suggesting that public scrutiny may play a positive role in enhancing rehabilitation practices. Conformity indexes and levels can be used to chart the evolution of rehabilitation practices at regular intervals, to establish corporate goals and for communication with stakeholders. (C) 2010 Elsevier Ltd. All rights reserved.

Variability on red blood cell transfusion practices among Brazilian neonatal intensive care units

BACKGROUND: Guidelines for red blood cell (RBC) transfusions exist; however, transfusion practices vary among centers. This study aimed to analyze transfusion practices and the impact of patients and institutional characteristics on the indications of RBC transfusions in preterm infants. STUDY DESIGN AND METHODS: RBC transfusion practices were investigated in a multicenter prospective cohort of preterm infants with a birth weight of less than 1500 g born at eight public university neonatal intensive care units of the Brazilian Network on Neonatal Research. Variables associated with any RBC transfusions were analyzed by logistic regression analysis. RESULTS: Of 952 very-low-birth-weight infants, 532 (55.9%) received at least one RBC transfusion. The percentages of transfused neonates were 48.9, 54.5, 56.0, 61.2, 56.3, 47.8, 75.4, and 44.7%, respectively, for Centers 1 through 8. The number of transfusions during the first 28 days of life was higher in Center 4 and 7 than in other centers. After 28 days, the number of transfusions decreased, except for Center 7. Multivariate logistic regression analysis showed higher likelihood of transfusion in infants with late onset sepsis (odds ratio [OR], 2.8; 95% confidence interval [CI], 1.8-4.4), intraventricular hemorrhage (OR, 9.4; 95% CI, 3.3-26.8), intubation at birth (OR, 1.7; 95% CI, 1.0-2.8), need for umbilical catheter (OR, 2.4; 95% CI, 1.3-4.4), days on mechanical ventilation (OR, 1.1; 95% CI, 1.0-1.2), oxygen therapy (OR, 1.1; 95% CI, 1.0-1.1), parenteral nutrition (OR, 1.1; 95% CI, 1.0-1.1), and birth center (p < 0.001). CONCLUSIONS: The need of RBC transfusions in very-low-birth-weight preterm infants was associated with clinical conditions and birth center. The distribution of the number of transfusions during hospital stay may be used as a measure of neonatal care quality.

Modeling soil organic carbon dynamics in Oxisols of Ibiruba (Brazil) with the Century Model

introduction of conservation practices in degraded agricultural land will generally recuperate soil quality, especially by increasing soil organic matter. This aspect of soil organic C (SOC) dynamics under distinct cropping and management systems can be conveniently analyzed with ecosystem models such as the Century Model. In this study, Century was used to simulate SOC stocks in farm fields of the Ibiruba region of north central Rio Grande do Sul state in Southern Brazil. The region, where soils are predominantly Oxisols, was originally covered with subtropical woodlands and grasslands. SOC dynamics was simulated with a general scenario developed with historical data on soil management and cropping systems beginning with the onset of agriculture in 1900. From 1993 to 2050, two contrasting scenarios based on no-tillage soil management were established: the status quo scenario, with crops and agricultural inputs as currently practiced in the region and the high biomass scenario with increased frequency of corn in the cropping system, resulting in about 80% higher biomass addition to soils. Century simulations were in close agreement with SOC stocks measured in 2005 in the Oxisols with finer texture surface horizon originally under woodlands. However, simulations in the Oxisols with loamy surface horizon under woodlands and in the grassland soils were not as accurate. SOC stock decreased from 44% to 50% in fields originally under woodland and from 20% to 27% in fields under grasslands with the introduction of intensive annual grain crops with intensive tillage and harrowing operations. The adoption of conservation practices in the 1980s led to a stabilization of SOC stocks followed by a partial recovery of native stocks. Simulations to 2050 indicate that maintaining status quo would allow SOC stocks to recover from 81% to 86% of the native stocks under woodland and from 80% to 91 % of the native stocks under grasslands. Adoption of a high biomass scenario would result in stocks from 75% to 95% of the original stocks under woodlands and from 89% to 102% in the grasslands by 2050. These simulations outcomes underline the importance of cropping system yielding higher biomass to further increase SOC content in these Oxisols. This application of the Century Model could reproduce general trends of SOC loss and recovery in the Oxisols of the Ibiruba region. Additional calibration and validation should be conducted before extensive usage of Century as a support tool for soil carbon sequestration projects in this and other regions can be recommended. (C) 2009 Elsevier B.V. All rights reserved.

Biomass sustainability, availability and productivity

Research conducted on biomass for Ulcos (""Ultra-Low CO(2) Steelmaking"" European Integrated Project) has progressively focused on charcoal supply from tropical eucalyptus plantations. The sustainability of such plantations is being investigated from the viewpoint of their carbon, water and nutrient budgets: they must all be neutral or positive. Field research is producing results at the tree or stand level in several sites of Congo and Brazil, while a spatial model is developed to identify the conditions of biomass neutrality at the scale of the forest ecosystem. The productivity of biomass has been analyzed through the description of practices along the various supply-schemes that competitively feed the steel industry in Brazil and identification of bottlenecks for further expansion.

Exposure to contaminated water: perceptions and practices in a neighborhood in the city of Manaus, Brazil

Objective. To investigate the modes of water supply and the perception concerning the problems caused by this water among residents of a neighborhood without public supply of water, settled in an area previously used as a garbage dump in the city of Manaus, Brazil. Methods. One hundred and sixty-two semi-structured household interviews were conducted. In addition, a focal group with teachers from a local public school and a meeting with residents were held. The instruments employed focused on the perception and modes of water use and on the process of exposure to chemical contaminants through water. Results. Untreated well water was used by most families. This water was considered to be ""good"" by 64.8% of the individuals interviewed. Most residents (88.3%) declared knowledge about the garbage dump. Of these, 77.6% stated that the garbage dump caused health and environmental problems. However, qualitative analysis of the responses revealed that the residents were not aware of contamination by chemical elements or of the consequences of such contamination. The activities carried out with teachers revealed that they were partially aware of the problem, but did not design interventions to address the issue. In a meeting with neighborhood residents, the presence of social activism concerning the problem was identified, but it did not extend beyond the neighborhood or reach governmental spheres. Conclusions. The study identified a situation of critical exposure that tends to be maintained as a result of misperceptions and lack of social mobilization. The dissemination of research results to teachers and residents was useful to empower subjects.