Urban upgrading interventions and engaging residents in fuzzy management: Case studies from Novos Alagados, Salvador, Brazil

International theory and practice have promoted state-assisted upgrading of `informal` urban areas worldwide since the late 1970s, with various forms of monitoring and assessment of impact. Two independent studies of how residents perceive and evaluate such interventions have recently been undertaken for neighbouring parts of the upgraded area of Novos Alagados on the Itapagipe peninsula in the northwestern part of Salvador, Brazil`s third largest city. These studies start from different premises and have been implemented in very different ways, but both have the objective of permitting the `voice` of the residents to be heard concerning the upgrading process. Comparing them helps highlight the essential `fuzzy` nature of values concerning urban interventions of this nature and leaves us with thought-provoking questions concerning the role of local society in relation to the state in urban development, and the potential this has for on-going forms of urban management in cities which are emerging globally. Crown Copyright (C) 2009 Published by Elsevier Ltd. All rights reserved.

Fatores de risco e proteção para doenças crônicas não transmissíveis entre beneficiários da saúde suplementar: resultados do inquérito telefônico Vigitel, Brasil, 2008

O objetivo deste artigo é descrever a distribuição dos principais fatores de risco (FR) e proteção para doenças crônicas não transmissíveis (DCNT) entre os beneficiários de planos de saúde. Foi utilizada amostra aleatória de adultos com 18 ou mais anos de idade nas capitais brasileiras, analisando-se frequências de FR em 28.640 indivíduos em 2008. Homens mostraram alta prevalência dos seguintes fatores de risco: tabaco, sobrepeso, baixo consumo de frutas e legumes, maior consumo de carnes gordurosas e álcool, enquanto mulheres mostraram maior prevalência de pressão arterial, diabetes, dislipidemia e osteoporose. Homens praticam mais atividade física e mulheres consomem mais frutas e vegetais. Homens com maior escolaridade apresentam maior frequência de sobrepeso, consumo de carnes com gorduras e dislipidemia. Entre mulheres, tabaco, sobrepeso, obesidade e doenças autorreferidas decrescem com aumento da escolaridade, enquanto o consumo de frutas e legumes, atividade física, mamografia e exame de papanicolau aumentam com a escolaridade. CONCLUSÃO: a população usuária de planos de saúde constitui cerca de 26% da população brasileira, e o estudo atual visa acumular evidências para atuação em ações de promoção da saúde para esse público.

Effectiveness of a School-Based Intervention on Physical Activity for High School Students in Brazil: The Saude na Boa Project

Background: We evaluated the effectiveness of a school-based intervention on the promotion of physical activity among high school students in Brazil: the Saude no Boa project. Methods: A school-based, randomized trial was carried out in 2 Brazilian cities: Recife (northeast) and Florianopolis (south). Ten schools in each city were matched by size and location, and randomized into intervention or control groups. The intervention included environmental/organizational changes, physical activity education, and personnel training and engagement. Students age 15 to 24 years were evaluated at baseline and 9 months later (end of school year). Results: Although similar at baseline, after the intervention, the control group reported significantly fewer d/wk accumulating 60 minutes+ moderate-to-vigorous physical activity (MVPA) in comparison with the intervention group (2.6 versus 3.3, P < .001). The prevalence of inactivity (0 days per week) rose in the control and decreased in the intervention group. The odds ratio for engaging at least once per week in physical activity associated with the intervention was 1.83 (95% CI = 1.24-2.71) in the unadjusted analysis and 1.88 (95% CI = 1.27-2.79) after controlling for gender. Conclusion: The Saude no Boa intervention was effective at reducing the prevalence of physical inactivity. The possibility of expanding the intervention to other locations should be considered.

Emerging Threats and Opportunities for Large-Scale Ecological Restoration in the Atlantic Forest of Brazil

Over the past 150 years, Brazil has played a pioneering role in developing environmental policies and pursuing forest conservation and ecological restoration of degraded ecosystems. In particular, the Brazilian Forest Act, first drafted in 1934, has been fundamental in reducing deforestation and engaging private land owners in forest restoration initiatives. At the time of writing (December 2010), however, a proposal for major revision of the Brazilian Forest Act is under intense debate in the National Assembly, and we are deeply concerned about the outcome. On the basis of the analysis of detailed vegetation and hydrographic maps, we estimate that the proposed changes may reduce the total amount of potential areas for restoration in the Atlantic Forest by approximately 6 million hectares. As a radically different policy model, we present the Atlantic Forest Restoration Pact (AFRP), which is a group of more than 160 members that represents one of the most important and ambitious ecological restoration programs in the world. The AFRP aims to restore 15 million hectares of degraded lands in the Brazilian Atlantic Forest biome by 2050 and increase the current forest cover of the biome from 17% to at least 30%. We argue that not only should Brazilian lawmakers refrain from revising the existing Forest Law, but also greatly step up investments in the science, business, and practice of ecological restoration throughout the country, including the Atlantic Forest. The AFRP provides a template that could be adapted to other forest biomes in Brazil and to other megadiversity countries around the world.

Ethical Conflicts over the Management of Transsexual Adolescents-Report of Two Cases

Introduction. The diagnosis and the treatment of transsexualism, particularly during adolescence, generate considerable discussion among specialists. Many health and legal professionals have not yet reached a strong consensus on medical treatment for juvenile transsexuals. Hormonal therapy cannot only represent a medical procedure to adjust the somatic sex to the psychological gender, but can also be a reasonable means of preventing some juvenile transsexuals from engaging in undesirable and risky behavior. Aim. To report the cases of two transsexual adolescents who resorted to prostitution to afford hormonal medications when treatment was denied because of age criteria. Results. Hormonal medications were not recommended by the endocrinology staff because specific laws regulating this medical procedure for juvenile transsexuals in Brazil are lacking. In response, these adolescents chose to use illegally obtained sex hormones to treat themselves. Conclusions. We propose ""harm reduction"" as a means of coping with this dilemma in some cases. Baltieri DA, Cortez FCP, and de Andrade AG. Ethical conflicts over the management of transsexual adolescents-report of two cases. J Sex Med 2009;6:3214-3220.

The Immunomodulatory Action of Sialostatin L on Dendritic Cells Reveals Its Potential to Interfere with Autoimmunity

Sialostatin L (SialoL) is a secreted cysteine protease inhibitor identified in the salivary glands of the Lyme disease vector Ixodes scapularis. In this study, we reveal the mechanisms of SialoL immunomodulatory actions on the vertebrate host. LPS-induced maturation of dendritic cells from C57BL/6 mice was significantly reduced in the presence of SialoL. Although OVA degradation was not affected by the presence of SialoL in dendritic cell cultures, cathepsin S activity was partially inhibited, leading to an accumulation of a 10-kDa invariant chain intermediate in these cells. As a consequence, in vitro Ag-specific CD4(+) T cell proliferation was inhibited in a time-dependent manner by SialoL, and further studies engaging cathepsin S(-/-) or cathepsin L(-/-) dendritic cells confirmed that the immunomodulatory actions of SialoL are mediated by inhibition of cathepsin S. Moreover, mice treated with SialoL displayed decreased early T cell expansion and recall response upon antigenic stimulation. Finally, SialoL administration during the immunization phase of experimental autoimmune encephalomyelitis in mice significantly prevented disease symptoms, which was associated with impaired IFN-gamma and IL-17 production and specific T cell proliferation. These results illuminate the dual mechanism by which a human disease vector protein modulates vertebrate host immunity and reveals its potential in prevention of an autoimmune disease. The Journal of Immunology, 2009, 182: 7422-7429.