The effect of Sao Paulo`s smoke-free legislation on carbon monoxide concentration in hospitality venues and their workers

Background Studies have shown that there is no safe level of secondhand smoke (SHS) exposure and there is a close link between SHS and the risk of coronary heart disease and stroke. Carbon monoxide (CO) is one of the most important components present in SHS. Objective To evaluate the impact of the smoking ban law in the city of Sao Paulo, Brazil, on the CO concentration in restaurants, bars, night clubs and similar venues and in their workers. Methods In the present study we measured CO concentration in 585 hospitality venues. CO concentration was measured in different environments (indoor, semi-open and open areas) from visited venues, as well as, in the exhaled air from approximately 627 workers of such venues. Measurements were performed twice, before and 12 weeks after the law implementation. In addition, the quality of the air in the city during the same period of our study was verified. Results The CO concentration pre-ban and pot-ban in hospitality venues was indoor area 4.57 (3.70) ppm vs 1.35 (1.66) ppm (p<0.0001); semi-open 3.79 (2.49) ppm vs 1.16 (1.14) ppm (p<0.0001); open area 3.31 (2.2) ppm vs 1.31 (1.39) ppm (p<0.0001); smoking employees 15.78 (9.76) ppm vs 11.50 (7.53) ppm (p<0.0001) and non-smoking employees 6.88 (5.32) ppm vs 3.50 (2.21) ppm (p<0.0001). The average CO concentration measured in the city was lower than 1 ppm during both pre-ban and post-ban periods. Conclusion Sao Paulos smoking-free legislation reduced significantly the CO concentration in hospitality venues and in their workers, whether they smoke or not.

Brazilian Agriculture and Environmental Legislation: Status and Future Challenges

Brazilian agriculture covers about one-third of the land area and is expected to expand further We assessed the compliance of present Brazilian agriculture with environmental legislation and identified challenges for agricultural development connected to this legislation We found (i) minor illegal land use in protected areas under public administration, (ii) a large deficit in legal reserves and protected riparian zones on private farmland, and large areas of unprotected natural vegetation in regions experiencing agriculture expansion Achieving full compliance with the environmental laws as they presently stand would require drastic changes in agricultural land use, where large agricultural areas are taken out of production and converted back to natural vegetation The outcome of a full compliance with environmental legislation might not be satisfactory due to leakage, where pristine unprotected areas become converted to compensate for lost production as current agricultural areas are reconverted to protected natural vegetation. Realizing the desired protection of biodiversity and natural vegetation, while expanding agriculture to meet food and biofuel demand, may require a new approach to environmental protection New legal and regulatory instruments and the establishment of alternative development models should be considered

Generic drugs in Brazil: historical overview and legislation

The Brazilian generic drugs policy was implemented in 1999 with the aim of stimulating competition in the market, improve the quality of drugs and improve the access of the population to drug treatment. The process of implementing this policy allowed the introduction and discussion of concepts that had never before been used in the context of drug registration in Brazil: bioavailability, bioequivalence, pharmaceutical equivalence, generic drugs, biopharmaceutical classification system, biowaiver. The present article provides definitions for these concepts in the context of Brazilian legislation as well as a historical and chronological description of the implementation of the generic drugs policy in Brazil, including a list of current generic drug legislation. This article contributes to the understanding of the Brazilian generic drugs policy and facilitates the search for information concerning the legal requirements for registration of drugs in Brazil.

Oral Health in Brazil - Part I: public oral health policies

This paper reviews the historical development of public health policies in Brazil and the insertion of oral health in this context. Since 1988, Brazil established a Unified National Health System ("Sistema Único de Saúde" - SUS), which was conceived to assure access to health actions and services, including oral health. However, a history of lack of access to health services and the health problems faced by the Brazilian population make the process of building and consolidating the SUS extremely challenging. Since 2004, the Oral Health National Policy has proposed a reorientation of the health care model, supported by an adaptation of the working system of Oral Health teams so that they include actions of health promotion, protection and recovery. Human resources should be prepared to act in this system. The qualifying process must take in consideration knowledge evolution, changes in the work process and changes in demographical and epidemiological aspects, according to a perspective of maintaining a balance between technique and social relevance.

Economic impact of treatment for surgical site infections in cases of total knee arthroplasty in a tertiary public hospital in Brazil

The aim of this study was to estimate the additional cost of treatment of a group of nosocomial infections in a tertiary public hospital. A retrospective observational cohort study was conducted by means of analyzing the medical records of 34 patients with infection after total knee arthroplasty, diagnosed in 2006 and 2007, who met the criteria for nosocomial infection according to the Centers for Disease Control and Prevention. To estimate the direct costs of treatment for these patients, the following data were gathered: length of hospital stay, laboratory tests, imaging examinations, and surgical procedures performed. Their costs were estimated from the minimum values according to the Brazilian Medical Association. The estimated cost of the antibiotics used was also obtained. The total length of stay in the ward was 976 days, at a cost of US$ 18,994.63, and, in the intensive care unit, it was 34 days at a cost of US$ 5,031.37. Forty-two debridement procedures were performed, at a cost of US$ 5,798.06, and 1965 tests (laboratory and imaging) were also performed, at a cost of US$ 15,359.25. US$ 20,845.01 was spent on antibiotics and US$ 1,735.16 on vacuum assisted closure therapy, microsurgical flaps, implant removal, spacer use, and surgical revision. The total additional cost of these cases of hospital infection in 2006 and 2007 was of US$ 91,843.75. Based on that, we demonstrate that the high cost of treatment for hospital infections emphasizes the importance of taking measures to prevent and control hospital infection.

Marcos regulatórios estaduais em saneamento básico no Brasil

Este artigo analisa os marcos regulatórios estaduais para o setor de saneamento básico. A pesquisa documental identificou a presença de leis estaduais em apenas cinco estados (São Paulo, Minas Gerais, Rio Grande do Sul, Rio Grande do Norte e Goiás). Os marcos legais estaduais são descritos quanto a um conjunto de atributos ou funções selecionadas: universalização, instrumentos financeiros, regulação e controle social. A principal conclusão é que o desenvolvimento dessas políticas, assim como sua regulamentação, encontra-se em estágio incipiente e poderá receber impulso com aprovação de nova lei federal de dezembro de 2006.

Acessibilidade dos sítios web dos governos estaduais brasileiros: uma análise quantitativa entre 1996 e 2007

A utilização da web para a disponibilização de informações e serviços de órgãos governamentais para os cidadãos tem se tornado cada vez mais expressiva. Assim, a garantia de que esses conteúdos e serviços possam ser acessíveis a qualquer cidadão é imprescindível, independentemente de necessidades especiais ou de quaisquer outras barreiras. No Brasil, o Decreto-Lei nº5.296/2004 determinou que todos os órgãos governamentais deveriam adaptar seus sítios na web de acordo com critérios de acessibilidade até dezembro de 2005. Com o objetivo de verificar a evolução da acessibilidade ao longo dos anos e como foi o impacto dessa legislação, este artigo analisa a acessibilidade dos sítios dos governos estaduais brasileiros por meio de amostras coletadas entre 1996 e 2007. Foram efetuadas análises por meio de métricas, obtidas por avaliações com ferramentas automáticas. Os resultados indicam que a legislação teve pouco impacto para a melhoria real da acessibilidade dos sítios no período indicado, com uma melhora somente em 2007. Verifica-se que se faz necessário adotar políticas públicas mais efetivas para que as pessoas com necessidades especiais tenham os seus direitos para acesso a informações e aos serviços públicos na web assegurados mais amplamente.

Jogo patológico e suas conseqüências para a saúde pública

O artigo teve por objetivo caracterizar o jogo patológico, apresentando as principais conseqüências desse transtorno. Foi realizado levantamento bibliográfico sobre o tema, na literatura nacional e internacional. Foram selecionadas as publicações cujos principais achados enfatizavam prevalência, custos sociais e econômicos associados, legalização de jogos de azar e conseqüente impacto na saúde pública. Alto índice de suicídio, comorbidade com outros transtornos psiquiátricos, problemas familiares e no trabalho, e prática de atos ilícitos foram conseqüências relatadas. A prevalência desse transtorno é maior em países que legalizaram jogos de azar e no Brasil, há evidências do crescimento do número de jogadores patológicos. O desenvolvimento de pesquisas nacionais é imprescindível para a definição de políticas públicas adequadas à realidade brasileira.

Qualidade da água para consumo humano e concentração de fluoreto

O artigo visa analisar a concentração de fluoreto na água para consumo humano, considerando o balanço entre benefícios e riscos à saúde, e produzir subsídios para atualização da legislação brasileira. Estudos de revisão sistemática, documentos oficiais e dados meteorológicos foram examinados. As temperaturas nas capitais brasileiras indicam que o fluoreto deveria variar de 0,6 a 0,9 mg/L para prevenir cárie dentária. Concentração de fluoreto natural de 1,5 mg/L é tolerável para consumo no Brasil se não houver tecnologia de custo-benefício aceitável para ajuste/remoção do seu excesso. A ingestão diária de água com fluoreto em concentração > 0,9 mg/L representa risco à dentição em menores de oito anos de idade e os consumidores deveriam ser expressamente informados desse risco. Considerando a expansão do programa nacional de fluoretação da água para regiões de clima tipicamente tropical, deve-se revisar a Portaria 635/75, relacionada ao fluoreto adicionado às águas de abastecimento público.

O óbito e sua investigação: reflexões sobre alguns aspectos relevantes

O artigo aborda questões relativas ao óbito e sua investigação como elementos importantes para a Epidemiologia e a Saúde Pública. Ressalta aspectos ligados à melhoria da sua qualidade e da vigilância, bem como da pesquisa científica/epidemiológica nessa área, vistos sob a óptica da legislação e das normas éticas existentes no Brasil. Discute o problema relativo, a saber, "a quem pertence a informação em saúde e quais os limites de sua utilização", tratando, inclusive, da possibilidade do uso de bancos de dados identificados. Conclui sugerindo meios hábeis, como "Termo de Responsabilidade e Confidencialidade" por parte do pesquisador, para que a pesquisa científica/epidemiológica possa ter continuidade no país, com agilidade e oportunidade.

Recommendations for folate intake in women: implications for public health strategies

Folate deficiency has been associated with anemia and other adverse outcomes in pregnancy such as neural tube defects. The current recommendations for prevention of such outcomes are difficult to achieve through diet only, and folic acid supplementation and food fortification are feasible public health strategies. However, it is necessary to determine the usual diet and supplement use among women of reproductive age, including an accurate assessment of other dietary micronutrients. In addition to the beneficial effects observed in randomized clinical trials, health risks to the population have also been widely evaluated and discussed in the scientific community: for a minority to benefit from fortification programs, many are exposed to high folic acid intake levels.

Quality of water sources used as drinking water in a Brazilian peri-urban area

The objective of this paper was to assess bacteriological quality of drinking water in a peri-urban area located in the Metropolitan Region of São Paulo, Brazil. A total of 89 water samples were collected from community plastic tanks and 177 water samples from wells were collected bimonthly, from September 2007 to November 2008, for evaluating bacteriological parameters including: Escherichia coli, Enterococcus and heterotrophic plate count (HPC). Clostridium perfringens was investigated in a subsample (40 samples from community plastic tank and 40 from wells). E. coli was present in 5 (5.6%) samples from community plastic tanks (2.0 - 5.1x10(4) MPN/100mL) and in 70 (39.5%) well samples (2.0 - 8.6x10(4) MPN/100mL). Thus, these samples were not in accordance with the Brazilian Regulation. Enterococcus was detected in 20 (22.5%) samples of the community plastic tanks (1 to 79 NC/100mL) and in 142 (80.2%) well samples (1 to >200 NC/100mL). C. perfringens was detected in 5 (12.5%) community plastic tanks samples and in 35 (87.5%) wells samples (2.2 to >16 MPN/100mL). HPC were above 500 CFU/mL in 5 (5.6%) waters from community plastic tanks. In wells samples, the HPC ranged from <1 to 1.6x10(4) CFU/mL. The residual chlorine did not attend the standard established in the drinking water legislation (0.2 mg/L), except in 20 (22.5%) samples. These results confirm the vulnerability of the water supply systems in this peri-urban area what is clearly a public health concern.

O programa de incentivo à instalação de cozinhas comunitárias: avaliação de uma política pública brasileira

O trabalho tem como objetivo descrever e avaliar as Cozinhas Comunitárias (CC) apoiadas pelo Ministério do Desenvolvimento Social (MDS) em funcionamento no Brasil em 2006. Trata-se de estudo transversal que investigou as CC, com projetos contemplados nos editais do MDS realizados entre os anos de 2003 a 2005. Inicialmente foram identificadas as CC em funcionamento e estas CC foram visitadas para a coleta de dados relativos ao atendimento prestado, avaliação da estrutura física e das refeições oferecidas. A estrutura física foi avaliada por meio de um check-list, baseado nas exigências da legislação sanitária, e a oferta de refeições foi caracterizada pelos alimentos e preparações oferecidas pelas CC para determinar o valor nutricional das refeições. A maioria das cozinhas financiadas (60%) estava em fase de implementação no momento da entrevista, entre as cozinhas em funcionamento, a maioria estava localizada nos Estados de Santa Catarina e Paraná. Observou-se também que cerca de 20% das cozinhas não ofereciam refeições regularmente. Ao realizar a avaliação nutricional das refeições, foi observada uma grande heterogeneidade na oferta de alimentos. Ao avaliar as condições higiênico-sanitárias, quase a totalidade das CC foram classificadas como deficientes ou regulares, indicando inadequação na produção de refeições. O Programa das Cozinhas Comunitárias pode exercer importante papel nas políticas de segurança alimentar e nutricional do país, no entanto, devem ser realizados esforços no sentido de garantir a implantação em comunidades situadas nos Estados menos desenvolvidos, com fixação de números mínimos para atendimento, de parâmetros nutricionais e garantia de fornecimento seguro de alimentos

Trends in morbid obesity and in bariatric surgeries covered by the Brazilian public health system

Background Obesity is an increasingly serious public health problem on a global level. Morbid obesity, defined as a body mass index greater than 40 kg/m2, is associated with increased mortality and a high burden of obesity-related morbidities. Methods To study the prevalence of morbid obesity in Brazil, three national anthropometric surveys were reanalyzed. Data about bariatric surgeries were obtained from the Ministry of Health Hospital Information System, which is available online. Results A 255% rise in the prevalence of morbid obesity was observed, starting at 0.18% in 1975-1976 and growing to 0.33% in 1989 and 0.64% in 2002-2003. There was a higher rate in the South in the first two surveys, but the prevalence in the Southeast rose steadily, reaching 0.77% in 2002-2003 and overtaking the South. Since 1999, the Brazilian Unified Health System has covered surgical treatment for morbid obesity. From 2000 to 2006, there was a sixfold increase in the number of surgeries, which topped the 2,500 mark in 2006. The geographic distribution of these surgeries is heavily concentrated in the Southeast, the most developed region of Brazil, where there is also the highest prevalence of morbid obesity. This was followed by the Southern region. Conclusions The figures for the rise in morbid obesity in Brazil are startling, especially the increase among men. This is a situation that calls for further study, alongside measures to encourage the adoption of healthy lifestyles. Preventive measures aimed at slowing down or reversing the obesity epidemic are urgently required