Controle social e gestão participativa em saúde pública em unidades de saúde do município de Campo Grande, MS, 1994-2002

A participação social no Brasil evoluiu de movimento operário e de sindicatos, culminando na institucionalização através de Conselhos. Na área da saúde, foi legalizada pela Lei 8142/90. O objetivo deste estudo é conhecer a prática do controle social exercida em Conselhos de Unidades e sua influência nas políticas de saúde do município de Campo Grande, MS. Foram feitos cinco estudos de caso, tendo como fonte principal as atas de reuniões e como referencial de análise um documento do Ilpes/Claps (1975). Os Conselhos organizam-se em plenário, com coordenador, secretário, composição hoje paritária, representatividade reduzida e periodicidade mensal. O processo decisório contempla principalmente elementos técnico-administrativos e técnico-operacionais. No período 1998-2002, o controle social fortaleceu-se por encaminhamentos mais concretos, mas a capacidade de deliberação precisa ser fortalecida por uma capacitação que inclua elementos técnicos, políticos e administrativos, representatividade, fortalecimento da cidadania, divulgação intensa das atividades dos Conselhos, inclusive na mídia, maior mobilização social e articulação entre os vários Conselhos e instâncias municipais que fazem interface com o setor de saúde.

Gene expression analysis of Paracoccidioides brasiliensis transition from conidium to yeast cell

Paracoccidioides brasiliensis infectious process relies on the initial expression of virulence faactors that are assumed to be controlled by molecular mechanisms through which the conidia and/or mycelial fragments convert to yeast cells. In order to analyze the profile of the thermally-induced dimorphic gene expression, 48 h C-L transition cultures which had been incubated at 36 degrees C were studied. By this time approximately 50% of the conidial population had already reverted to yeast form cells. At this transition time, an EST-Orestes library was constructed and characterized. As a result, 79 sequences were obtained, of which 39 (49.4%) had not been described previously in other libraries of this fungus and which could represent novel exclusive C-Y transition genes. Two of these sequences are, among others, cholestanol delta-isomerase, and electron transfer flavoprotein-ubiquinoneoxidoreductase (ETF-QO). The other 40 (50.6%) sequences were shared with Mycelia (M), Yeast (Y) or Mycelia to yest transition (M-Y) libraries. An important component of this group of sequences is a putative response regulator receiver SKN7, a protein of high importance in stress adaptation and a regulator of virulence in some bacteria and fungi. This is the first report identifying genes expressed during the C-Y transition process, the initial step required to understand the natural history of P brasiliensis conidia induced infection.

Air Pollution and Mortality in Latin America The Role of Education

Background: People with less education in Europe, Asia, and the United States are at higher risk of mortality associated with daily and longer-term air pollution exposure. We examined whether educational level modified associations between mortality and ambient particulate pollution (PM(10)) in Latin America, using several timescales. Methods: The study population included people who died during 1998-2002 in Mexico City, Mexico; Santiago, Chile; and Sao Paulo, Brazil. We fit city-specific robust Poisson regressions to daily deaths for nonexternal-cause mortality, and then stratified by age, sex, and educational attainment among adults older than age 21 years (none, some primary, some secondary, and high school degree or more). Predictor variables included a natural spline for temporal trend, linear PM(10) and apparent temperature at matching lags, and day-of-week indicators. We evaluated PM(10) for lags 0 and I day, and fit an unconstrained distributed lag model for cumulative 6-day effects. Results: The effects of a 10-mu g/m(3) increment in lag 1 PM(10) on all nonextemal-cause adult mortality were for Mexico City 0.39% (95% confidence interval = 0.131/-0.65%); Sao Paulo 1.04% (0.71%-1.38%); and for Santiago 0.61% (0.40%-0.83%. We found cumulative 6-day effects for adult mortality in Santiago (0.86% [0.48%-1.23%]) and Sao Paulo (1.38% [0.85%-1.91%]), but no consistent gradients by educational status. Conclusions: PM(10) had important short- and intermediate-term effects on mortality in these Latin American cities, but associations did not differ consistently by educational level.

Precipitation diurnal cycle and summer climatology assessment over South America: An evaluation of Regional Climate Model version 3 simulations

Regional Climate Model version 3 (RegCM3) simulations of 17 summers (1988-2004) over part of South America south of 5 degrees S were evaluated to identify model systematic errors. Model results were compared to different rainfall data sets (Climate Research Unit (CRU), Climate Prediction Center (CPC), Global Precipitation Climatology Project (GPCP), and National Centers for Environmental Prediction (NCEP) reanalysis), including the five summers mean (1998-2002) precipitation diurnal cycle observed by the Tropical Rainfall Measuring Mission (TRMM)-Precipitation Radar (PR). In spite of regional differences, the RegCM3 simulates the main observed aspects of summer climatology associated with the precipitation (northwest-southeast band of South Atlantic Convergence Zone (SACZ)) and air temperature (warmer air in the central part of the continent and colder in eastern Brazil and the Andes Mountains). At a regional scale, the main RegCM3 failures are the underestimation of the precipitation in the northern branch of the SACZ and some unrealistic intense precipitation around the Andes Mountains. However, the RegCM3 seasonal precipitation is closer to the fine-scale analyses (CPC, CRU, and TRMM-PR) than is the NCEP reanalysis, which presents an incorrect north-south orientation of SACZ and an overestimation of its intensity. The precipitation diurnal cycle observed by TRMM-PR shows pronounced contrasts between Tropics and Extratropics and land and ocean, where most of these features are simulated by RegCM3. The major similarities between the simulation and observation, especially the diurnal cycle phase, are found over the continental tropical and subtropical SACZ regions, which present afternoon maximum (1500-1800 UTC) and morning minimum (0900-1200 UTC). More specifically, over the core of SACZ, the phase and amplitude of the simulated precipitation diurnal cycle are very close to the TRMM-PR observations. Although there are amplitude differences, the RegCM3 simulates the observed nighttime rainfall in the eastern Andes Mountains, over the Atlantic Ocean, and also over northern Argentina. The main simulation deficiencies are found in the Atlantic Ocean and near the Andes Mountains. Over the Atlantic Ocean the convective scheme is not triggered; thus the rainfall arises from the grid-scale scheme and therefore differs from the TRMM-PR. Near the Andes, intense (nighttime and daytime) simulated precipitation could be a response of an incorrect circulation and topographic uplift. Finally, it is important to note that unlike most reported bias of global models, RegCM3 does not trigger the moist convection just after sunrise over the southern part of the Amazon.