A construção do direito à saúde no Brasil

O direito à saúde recebeu - pela primeira vez - tratamento constitucional no brasil em 1988, fruto de grande participação popular. Neste estudo, se busca compreender a extensão dessa afirmação e verificar sua implementação normativa e jurisprudencial. A partir do estudo da evolução dos conceitos de saúde e de direito, concluiu-se que o direito à saúde deve implicar a constante participação popular para que possa ser delimitado. Verificou-se, também, que o arcabouço normativo vem sendo construído em conformidade com as exigências constitucionais. Quanto à construção jurisprudencial, se percebeu que ela vem acontecendo de forma errática e que os tribunais superiores raramente enfrentam a discussão da política de saúde desenhada na Constituição da República Federativa do Brasil de 1988. Concluiu-se que a afirmação constitucional tem demonstrado vigor, haja vista o grande desenvolvimento normativo conforme `compreensão contemporânea; e que o controle judicial da realização da política sanitária é ainda incipiente

Vigilância em saúde no Brasil: os desafios dos riscos sanitários do século XXI e a necessidade de criação de um sistema nacional de vigilância em saúde

The technological development experienced in the contemporary world are transforming society and relations between State and people. The mobility of human being has reached levels never before imagined and a person can move from one side of the world to the other side in less than 24 hours. This mobility also includes goods and services, giving the keynote of the globalized world of the XXI Century. In this context, the risks of diseases and others health problems are intensely amplified. Nowadays, an epidemic that begins in China can arrive in Brazil the following day. Brazil recognizes health as a universal right and also consider it a State's obligation. Therefore, the State of Brazil is obligated to organize itself to eliminate or control health risks. Today, the organization of the Brazilian State regarding the surveillance of risks of diseases and other health problems is fragmented and includes sanitary surveillance (focused on goods, products and services), epidemiological surveillance (diseases and investigations of other risks) and environmental surveillance in health (the environment in general, including the workplace). This fragmentation causes problems for the management and consolidation of strategic information for health protection. Brazil has the need to think about an other model of organization that put together all "kinds" of surveillances within a single coordinated system, called the National System of Health Surveillance, which would be able to coordinate the various specialties of health surveillance that exists in the country in order to provide a effective system of information and health surveillance, able to face emergency situations of public health

Transforming Youth Identities: Interactions Across ""Races/Colors/Ethnicities,"" Gender, Class, and Sexualities in Johannesburg, South Africa

In South Africa, and especially in Johannesburg, apartheid's ""racial"" paradigms are being transformed. Fifteen years after the end of apartheid and the elimination of all forms of inequity based on notion of ""race,"" including the abolition of the Immorality Act of 1949 that prohibited mixed marriages, the discourses of youth challenge preestablished boundaries. Today, the South African Constitution gives people the right to proclaim their sexual orientation and to shape their own identities. Through ethnographic observations carried out in Johannesburg and in-depth interviews with young people, this paper explores transforming notions of identity based on ""race/color/ethnicity,"" gender, class, and sexuality. The dynamics and challenges faced by young people with regards to mixed interactions in post-apartheid Johannesburg are analyzed and the paper looks at how "" race,"" gender, and sexuality interact in the various spaces in Johannesburg and how they affect young people's lives, particularly their perceptions of risk, violence, and HIV/AIDS vulnerability.

An insight into the sialotranscriptome of the brown dog tick, Rhipicephalus sanguineus

Background: Rhipicephalus sanguineus, known as the brown dog tick, is a common ectoparasite of domestic dogs and can be found worldwide. R. sanguineus is recognized as the primary vector of the etiological agent of canine monocytic ehrlichiosis and canine babesiosis. Here we present the first description of a R. sanguineus salivary gland transcriptome by the production and analysis of 2,034 expressed sequence tags (EST) from two cDNA libraries, one consctructed using mRNA from dissected salivary glands from female ticks fed for 3-5 days (early to mid library, RsSGL1) and the another from ticks fed for 5 days (mid library, RsSGL2), identifying 1,024 clusters of related sequences. Results: Based on sequence similarities to nine different databases, we identified transcripts of genes that were further categorized according to function. The category of putative housekeeping genes contained similar to 56% of the sequences and had on average 2.49 ESTs per cluster, the secreted protein category contained 26.6% of the ESTs and had 2.47 EST's/clusters, while 15.3% of the ESTs, mostly singletons, were not classifiable, and were annotated as ""unknown function"". The secreted category included genes that coded for lipocalins, proteases inhibitors, disintegrins, metalloproteases, immunomodulatory and antiinflammatory proteins, as Evasins and Da-p36, as well as basic-tail and 18.3 kDa proteins, cement proteins, mucins, defensins and antimicrobial peptides. Comparison of the abundance of ESTs from similar contigs of the two salivary gland cDNA libraries allowed the identification of differentially expressed genes, such as genes coding for Evasins and a thrombin inhibitor, which were over expressed in the RsSGL1 (early to mid library) versus RsSGL2 (mid library), indicating their role in inhibition of inflammation at the tick feeding site from the very beginning of the blood meal. Conversely, sequences related to cement (64P), which function has been correlated with tick attachment, was largely expressed in the mid library. Conclusions: Our survey provided an insight into the R. sanguineus sialotranscriptome, which can assist the discovery of new targets for anti-tick vaccines, as well as help to identify pharmacologically active proteins.

Democracy on the Edge: Limits and Possibilities in the Implementation of an Urban Reform Agenda in Brazil

The 1990s in Brazil were a time of institutional advances in the areas of housing and urban rights following the signing of the new constitution in 1988 that incorporated the principles of the social function of cities and property, recognition of the right to ownership of informal urban squatters and the direct participation of citizens in urban policy decision processes. These propositions are the pillars of the urban reform agenda which, since the creation of the Ministry of Cities by the Lula government, has come under the federal executive branch. This article evaluates the limitations and opportunities involved in implementing this agenda on the basis of two policies proposed by the ministry - the National Cities Council and the campaign for Participatory Master Plans - focusing the analysis on government organization in the area of urban development in its relationship with the political system and the characteristics of Brazilian democracy. Resume Au Bresil, les annees 1990 ont ete marquees par des progres institutionnels en matiere de logement et de droits urbains, dans le sillage de la Constitution de 1988 qui integre les principes d`une fonction sociale de la ville et de la propriete urbaine, ainsi que la reconnaissance du droit a la propriete pour les squatters urbains et la participation directe des citoyens aux processus d`elaboration des politiques urbaines. Ce sont egalement les piliers du programme de reforme urbaine qui releve de l`executif federal depuis la creation d`un ministere des Villes par le gouvernement Lula. Pour evaluer les limites et potentiels lies a la mise en place de ce programme, cet article s`appuie sur deux politiques publiques proposees par le ministere, le Conseil national des villes et la campagne en faveur des Plans directeurs participatifs, en analysant plus particulierement l`organisation gouvernementale en matiere d`urbanisme par rapport au systeme politique et aux caracteristiques de la democratie bresilienne.

Trypanosoma cruzi: evaluation of (-)-cubebin derivatives activity in the messenger RNAs processing

No fully effective treatment has been developed since the discovery of Chagas` disease. Since drug-resistant Trypanosoma cruzi strains are occurring and the current therapy is effective in the acute phase but with various adverse side effects, more studies are needed to characterize the susceptibility of T. cruzi to new drugs. Pre-mRNA maturation in trypanosomatids occurs through a process called trans-splicing, which is unusual RNA processing reaction, and it implies the processing of polycistronic transcription units into individual mRNAs; a short transcript spliced leader (SL RNA) is trans-spliced to the acceptor pre-mRNA, giving origin to the mature mRNA. Cubebin derivatives seem to provide treatments with less collateral effects than benznidazole and showed similar or better trypanocidal activities than benznidazole. Therefore, the cubebin derivatives ((-)-6,6`-dinitrohinokinin (DNH) and (-)-hinokinin (HQ)) interference in the mRNA processing was evaluated using T. cruzi permeable cells (Y and BOL (Bolivia) strains) following by RNase protection reaction. These substances seem to intervene in any step of the RNA transcription, promoting alterations in the RNA synthesis, even though the RNA processing mechanism still occurs. Furthermore, HQ presented better activity against the parasites than DNH, meaning that BOL strain seems to be more resistant than Y.

Periurethral Suspension Stitch During Robot-Assisted Laparoscopic Radical Prostatectomy: Description of the Technique and Continence Outcomes

Background: Several studies have shown that robot-assisted laparoscopic radical prostatectomy (RALP) is feasible, with favorable complication rates and short hospital times. However, the early recovery of urinary continence remains a challenge to be overcome. Objective: We describe our technique of periurethral retropubic suspension stitch during RALP and report its impact on early recovery of urinary continence. Design, setting, and participants: We analyze prospectively 331 consecutive patients who underwent RALP, 94 without the placement of suspension stitch (group 1) and 237 with the application of the suspension stitch (group 2). Surgical procedure: The only difference between the groups was the placement of the puboperiurethral stitch after the ligation of the dorsal venous complex (DVC). The periurethral retropubic stitch was placed using a 12-in monofilament polyglytone suture on a CTI needle. The stitch was passed from right to left between the urethra and DVC, and then through the periostium on the pubic bone. The stitch was passed again through the DVC, and then through the pubic bone in a figure eight, and then tied. Measurements: Continence rates were assessed with a self-administered validated questionnaire (Expanded Prostate Cancer Index Composite [EPIC] at 1, 3, 6, and 12 mo after the procedure. Continence was defined as the use of no absorbent pads or no leakage of urine. Results and limitations: In group 1, the continence rate at 1, 3, 6, and 12 mo postoperatively was 33%, 83%, 94.7%, and 95.7%, respectively; in group 2, the continence rate was 40%, 92.8%, 97.9%, and 97.9%, respectively. The suspension technique resulted in significantly greater continence rates at 3 mo after RALP (p = 0.013). The median/mean interval to recovery of continence was also statistically significantly shorter in the suspension group (median: 6 wk; mean: 7.338 wk: 95% confidence interval [CI]: 6.387-8.288) compared to the non-suspension group (median: 7 wk; mean: 9.585 wk: 95% CI: 7.558-11.612; log rank test, p = 0.02). Conclusions: The suspension stitch during RALP resulted in a statistically significantly shorter interval to recovery of continence and higher continence rates at 3 mo after the procedure. (C) 2009 European Association of Urology. Published by Elsevier B.V. All rights reserved.

Influence of visual feedback on pelvic floor muscle strength

Objective: The objective of this study is to evaluate the visual feedback influence on pelvic floor muscle contraction. Study design: Seventeen nulliparous, urinary-continent women participated in this study. Pelvic floor muscle strength with and without the use of visual feedback was measured with a dynamometric speculum in two directions (anteroposterior and left-right). To compare the mean strength values with and without the use of visual feedback, the t test was applied. Results: There was no significant difference between the pelvic floor muscle anteroposterior strength values with and without the use of visual feedback (p = 0.30), and no significant difference for the left-right strength (p = 0.37). Conclusion: There was no difference between the pelvic floor muscle strength values with and without the use of visual feedback. (C) 2010 Elsevier Ireland Ltd. All rights reserved.

Communication between organ donor families and recipients: A definitely controversial subject

In transplant centers, few topics are more controversial than communication between organ donor families (ODF) and recipients (RE). The Organ Procurement Organizations and transplant centers have felt obliged to protect the confidentiality and interests of ODF and RE. However, some authors have reported favorable effects of contact between ODF and RE. This study sought to investigate the current situation of the communication between ODF and RE from the viewpoint of transplanted patients (n = 50) and waiting transplant patients (n 50) at a Brazilian University Hospital, ODF (n = 10), physicians from transplant centers (n 50), as well as the opinion of the general population of a Brazilian city (n = 100). This work was developed as a survey whose questions related to the issue of communication between ODF and RE. The results showed that the majority of transplanted patients (82%) and patients awaiting transplant (60%) wanted to meet ODF to express their gratitude for receiving the organ. Likewise, ODF (67%) wanted to have a meeting with recipients, which allowed them to confirm the benefit of their donation. The general population was also favorable (66%) to ODF and RE communication. In contrast, the physicians (74%) were opposed to the ODF and RE contact. They affirmed that direct contact could lead to serious emotional conflicts or attempts of material involvement. One believes that decisions concerning the contact between ODF and RE would have to be determined by the involved parties. The transplant team could analyze the requests case by case, but ODF and RE must have the right to make the final decision.

Perinatal outcome of fetal atrioventricular block - One-hundred-sixteen cases from a single institution

Background-Fetal atrioventricular (AV) block is an uncommon lesion with significant mortality. Because of the rarity of this disorder, the natural course, extensive evaluation of untreated fetuses, and late follow-up remain unclear. Methods and Results-Of the 116 consecutive cases of fetal AV block studied from 1988 to 2006, only 1 was terminated, and 75% were live births. Fifty-nine cases of AV block were associated with major structural heart disease, mainly left atrial isomerism (n = 40), with only 26% of neonatal survivors. Of the 57 fetuses with normal cardiac anatomy, 41 (72%) were positive for maternal antinuclear antibodies, and 32 of these seropositive mothers did not receive any treatment. This untreated group had live-birth and 1-year infant survival rates of 93% and 90%, respectively. Five fetuses from seronegative mothers showed regression to sinus rhythm during pregnancy. The presence of major structural heart disease, hydrops, an atrial rate <= 120 bpm, and a ventricular rate <= 55 bpm were identified as risk factors for mortality. Logistic regression analysis of the whole group showed that the presence of structural heart disease was the only independent predictor of death (P < 0.001). Conclusions-This long-term study confirms that fetal AV block has a poor outcome when associated with structural heart disease and that spontaneous regression of AV block is possible in seronegative forms. The survival rate of >90% of our untreated patients with isolated forms of AV block raises concerns about any decision to intervene with immunosuppressive agents.

Blood gases and cardiovascular shunt in the South American lungfish (Lepidosiren paradoxa) during normoxia and hyperoxia

The South American lungfish (Lepidosiren paradoxa) has an arterial P(O2), (Pa(O2)) as high as 70-100 mm Hg, corresponding to Hb-O(2) saturations from 90% to 95%, which indicates a moderate cardiovascular right to left (R-L) shunt. In hyperoxia (50% O(2)), we studied animals in: (1) aerated water combined with aerial hyperoxia, which increased Pa(O2) from 78 +/- 2 to 114 +/- 3 mm Hg and (2) and aquatic hyperoxia (50% O(2)) combined room air, which gradually increased Pa(O2) from 75 +/- 4 mm Hg to as much as 146 +/- 10 mm Hg. Further, the hyperoxia (50%) depressed pulmonary ventilation from 58 +/- 13 to 5.5 +/- 3.0 mLBTPS kg h(-1), and Pa(CO2) increased from 20 +/- 2 to 31 +/- 4 mm Hg, while pHa became reduced from 7.56 +/- 0.03 to 7.31 +/- 0.09. At the same time, venous P(O2) (Pv(O2)) rose from 40.0 +/- 2.3 to 46.4 +/- 1.2 mm Hg and, concomitantly, Pvco, increased from 23.2 +/- 1.1 to 32.2 +/- 0.5 mm Hg. R-L shunts were estimated to about 19%, which is moderate when compared to most amphibians. (C) 2010 Elsevier B.V. All rights reserved.

Health in Brazil 6 Health conditions and health-policy innovations in Brazil: the way forward

Brazil is a large complex country that is undergoing rapid economic, social, and environmental change In this Series of six articles, we have reported important improvements in health status and life expectancy, which can be ascribed largely to progress in social determinants of health and to implementation of a comprehensive national health system with strong social participation. Many challenges remain, however. Socioeconomic and regional disparities are still unacceptably large, reflecting the fact that much progress is still needed to improve basic living conditions for a large proportion of the population. New health problems arise as a result of urbanisation and social and environmental change, and some old health issues remain unabated. Administration of a complex, decentralised public-health system, in which a large share of services is contracted out to the private sector, together with many private insurance providers, inevitably causes conflict and contradiction. The challenge is ultimately political, and we conclude with a call for action that requires continuous engagement by Brazilian society as a whole in securing the right to health for all Brazilian people.

Operations research/management science tools for integrating people with disabilities into employment. A study on Valencia`s Sheltered Work Centres for Disabled

People with disabilities have a right to a full life in every sense and one of those fundamental rights is the possibility to work. In this paper, the importance of social employment integration of disabled people is highlighted as one of the stakeholders to be satisfied by companies in the new framework that corporate social responsibility is constructing. The objective of the paper is to revise the benefits of some well-known operations research/management science tools that, if applied correctly, have a double positive impact on work accessibility and improved productivity. The responses collected from managers of Valencia`s ShelteredWork Centres for Disabled by means of a structured questionnaire are used to analyse the level of implementation of these tools and their impact depending on the type of centre, the kind of disability and other structural variables.

Is the unfolding of the group discussion off-pattern? Improving coordination support in educational forums using mobile devices

A forum is a valuable tool to foster reflection in an in-depth discussion; however, it forces the course mediator to continually pay close attention in order to coordinate learners` activities. Moreover, monitoring a forum is time consuming given that it is impossible to know in advance when new messages are going to be posted. Additionally, a forum may be inactive for a long period and suddenly receive a burst of messages forcing forum mediators to frequently log on in order to know how the discussion is unfolding to intervene whenever it is necessary. Mediators also need to deal with a large amount of messages to identify off-pattern situations. This work presents a piece of action research that investigates how to improve coordination support in a forum using mobile devices for mitigating mediator`s difficulties in following the status of a forum. Based on summarized information extracted from message meta-data, mediators consult visual information summaries on PDAs and receive textual notifications in their mobile phone. This investigation revealed that mediators used the mobile-based coordination support to keep informed on what is taking place within the forum without the need to log on their desktop computer. (C) 2009 Elsevier Ltd. All rights reserved.