Waves of Change Within Civil Society in Latin America: Mexico City and Sao Paulo

For the past half a century, Latin American scholars have been pointing toward the emergence of new social actors as agents of social and political democratization. The first wave of actors was characterized by the emergence of novel agents-mainly, new popular movements-of social transformation. At first, the second wave, epitomized by nongovernmental organizations (NGOs), was celebrated as the upsurge of a new civil society, but later on, it was the target of harsh criticism. The literature often portrays this development in Latin American civil society as a displacement trend of actors of the first wave by the second wave-""NGOization""-""and even denounces new civil society as rootless, depoliticized, and functional to retrenchment. Thus, supposedly, NGOization encumbers social change. The authors argue that NGOization diagnosis is a flawed depiction of change within civil society. Rather than NGOization related to the depoliticization and neoliberalization of civil society, in Mexico City and Sao Paulo, there has been modernization of organizational ecologies, changes in the functional status of civil society, and interestingly, specialization aimed at shaping public agenda. The authors argue that such specialization, instead of encumbering social change, brings about different repertoires of strategies and skills purposively developed for influencing policy and politics. Their argument relies on comparative systematic evidence. Through network analysis, they examine the organizational ecology of civil society in Mexico City and Sao Paulo.

Aspectos epidemiológicos da fluorose dentária no Brasil: pesquisas no período 1993-2006

A epidemiologia da fluorose dentária resulta de inquéritos realizados recentemente, em decorrência da melhor compreensão de aspectos metabólicos dos fluoretos no organismo humano e de preocupações no âmbito da saúde coletiva. Objetiva-se apresentar os estudos realizados sobre a fluorose entre 1993 e 2006. O período 1993-2004 demarca o intervalo entre a 2ªe a 3ª Conferência Nacional de Saúde Bucal. Em 2005-2006, a busca de dados primários apresentados em reuniões científicas confirmou os achados existentes na literatura, mostrando que a agenda científica brasileira não foi substancialmente influenciada pelas discussões travadas durante a 3ª Conferência. A maioria dos estudos concentra-se em áreas urbanas e a predominância no Brasil dos graus "muito leve" e "leve" de fluorose mostra não haver comprometimentos de ordem funcional. A baixa percepção da fluorose pela população, aliada à sua baixa prevalência, evoca o necessário debate sobre as questões de saúde coletiva no país. Visto que a produção científica nacional constitui uma importante fonte de conhecimentos para subsidiar a elaboração de políticas públicas para o setor da saúde, os sucessivos e pontuais estudos analisados mostram que, no que diz respeito à fluorose, o diagnóstico epidemiológico reafirma a necessidade, a importância e a segurança da fluoretação das águas de abastecimento público como medida de saúde coletiva.

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.

Reuniões de pais na educação infantil: modos de gestão

O artigo discute a relação entre escolas e famílias no contexto da educação infantil por meio da análise de reuniões de pais. Fundamenta-se em um estudo de caso qualitativo sobre 11 reuniões, realizadas em duas escolas municipais de educação infantil paulistanas. Foram analisados os diferentes modos de gestão pelo professor, segundo três aspectos: forma (pauta), conteúdo (temas), dinâmica (relações entre professor e pais). Os resultados indicaram modos de gestão que dificultam a participação dos pais e descaracterizam os objetivos das reuniões: forma desorganizada e rígida; conteúdo burocrático e comportamental; dinâmica fragmentada e centralizada. Ao mesmo tempo, identificaram-se indicadores que favorecem a construção de uma relação mais cooperativa durante as reuniões, correspondentes aos modos de gestão: forma compartilhada, conteúdo educacional e dinâmica coletiva. Os autores destacam a necessidade de registro e de avaliação coletiva das reuniões de pais, visando à articulação com o projeto pedagógico, o currículo e a dimensão didática

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.

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

Modelos de gestão e o SUS

O recente documento do Ministério do Planejamento sobre Fundações Públicas (2005) e a crise da área hospitalar colocaram novamente na agenda do SUS a questão dos modelos de gestão pública. O objetivo deste artigo é situar no contexto das reformas de estado pensadas na década de 90 para o Brasil, as propostas de mudança dos modelos de gestão da administração pública, com foco no processo de implementação do SUS. Essa abordagem trata em primeiro lugar da personalidade jurídica das organizações de saúde na esfera estatal, conceituando o público a partir de seus objetivos; em segundo, discute o contexto as reformas de estado e as mudanças propostas para a administração pública. Os autores entendem que critérios e parâmetros para avaliação institucional devem contemplar quatro aspectos: subordinação à política de saúde; legalidade; eficiência gerencial e capacidade de controle. A partir do quadro de referencia geral elaborou-se uma análise comparativa em relação à proposta das fundações públicas de direito privado. Na análise comparativa das características desse tipo de entidade proposta para gestão hospitalar, observam-se semelhanças com a proposta de Organizações Sociais. Fundação Estatal e Contrato de Gestão podem ser vistos como modelos que possibilitam modernizar o Estado, além de re-introduzirem o tema da reforma hospitalar na agenda governamental brasileira

Saúde bucal no sistema único de saúde: 20 anos de lutas por uma política pública

Desde a criação do Sistema Único de Saúde (SUS) em 1988, a inserção da saúde bucal é marcada por conflitos e contradições, expressando os diferentes projetos em disputa na sociedade brasileira. No período pré-SUS predominavam programas odontológicos centralizados e verticais, tendo escolares e trabalhadores inscritos na previdência social como população-alvo. Com a criação do SUS, esse enfoque tornou-se incompatível com um sistema unificado e descentralizado de caráter universalista. Abriu-se, então, a possibilidade de conformação de uma agenda para gestão da saúde bucal enquanto política pública. Neste artigo são abordados alguns dos aspectos mais relevantes que marcaram os 20 anos de construção dessa política no plano nacional

Extended-spectrum beta-lactamases among Enterobacteriaceae isolated in a public hospital in Brazil

Extended-spectrum beta-lactamases (ESBL) in enterobacteria are recognized worldwide as a great hospital problem. In this study, 127 ESBL-producing Enterobacteriaceae isolated in one year from inpatients and Outpatients at a public teaching hospital at Sao Paulo, Brazil, were Submitted to analysis by PCR with specific primers for bla(SHV), bla(TEM) and bla(CTX-M) genes. From the 127 isolates, 96 (75.6%) Klebsiella pneumoniae, 12 (9.3%) Escherichia coli, 8 (6.2%) Morganella morganii, 3 (2.3%) Proteus mirabilis, 2 (1.6%) Klebsiella oxytoca, 2 (1.6%) Providencia rettgeri, 2 (1.6%) Providencia stuartti, 1 (0.8%) Enterobacter aerogenes and 1 (0.8%) Enterobacter cloacae were identified as ESBL producers. Bla(SHV), bla(TEM), and bla(CTX-M) were detected in 63%, 17.3% and 33.9% strains, respectively. Pulsed field get eletrophoresis genotyping of K. pneumoniae revealed four main molecular patterns and 29 unrelated profiles. PCR results showed a high variety of ESBL groups among strains, in nine different species. The results Suggest the spread of resistance genes among genetically different strains of ESBL-producing K. pneumoniae in some hospital wards, and also that some strongly related strains were identified in different hospital wards, Suggesting clonal spread in the institutional environment

Revised criteria for the assessment and interpretation of occlusal deviations in the deciduous dentition: a public health perspective

Dados secundários de uma amostra aleatória de pré-escolares brasileiros foram analisados com o objetivo de avaliar a prevalência de desvios oclusais na dentição decídua, que podem adversamente afetar a dentição permanente, com base em critérios revisados. Overjet e overbite apresentaram pontos de corte descritos na literatura para a remoção dos casos de má oclusão leve. Overjet > 3mm e overbite > 3mm afetaram 16% e 7% das crianças, respectivamente. No plano sagital foram consideradas apenas as taxas de desvios bilaterais: relação molar em degrau distal (9,7%) e mesial (6,0%); relação dos caninos Classe 2 (11,0%) e Classe 3 (2,9%). Para os demais desvios não foram relatados na literatura critérios de severidade. Valores brutos de mordida aberta anterior (27,9%); mordida cruzada posterior (11,3%); apinhamento dentário maxilar (7,0%) e mandibular (11,3%) foram registrados. A avaliação da má oclusão na dentição decídua deve considerar a severidade dos desvios para a identificação de casos e não-casos de relevância em saúde pública. Enfatiza-se a necessidade de maior consenso e melhora na interpretação de dados epidemiológicos sobre a má oclusão nesse estágio de desenvolvimento

The burden of physical activity on type 2 diabetes public healthcare expenditures among adults: a retrospective study

Background: Determinants of public healthcare expenditures in type 2 diabetics are not well investigated in developing nations and, therefore, it is not clear if higher physical activity decreases healthcare costs. The purpose of this study was to analyze the relationship between physical activity and the expenditures in public healthcare on type 2 diabetes mellitus treatment. Methods: Cross-sectional study carried out in Brazil. A total of 121 type 2 diabetics attended to in two Basic Healthcare Units were evaluated. Public healthcare expenditures in the last year were estimated using a specific standard table. Also evaluated were: socio-demographic variables; chronological age; exogenous insulin use; smoking habits; fasting glucose test; diabetic neuropathy and anthropometric measures. Habitual physical activity was assessed by questionnaire. Results: Age (r = 0.20; p = 0.023), body mass index (r = 0.33; p = 0.001) and waist-to-hip ratio (r = 0.20; p = 0.025) were positively related to expenditures on medication for the treatment of diseases other than diabetes. Insulin use was associated with increased expenditures. Higher physical activity was associated with lower expenditure, provided medication for treatment of diseases other than diabetes (OR = 0.19; p = 0.007) and medical consultations (OR = 0.26; p = 0.029). Conclusions: Type 2 diabetics with higher enrollment in physical activity presented consistently lower healthcare expenditures for the public healthcare system.

Democracy on the edge: limits and possibilities for the implementation of an urban reform agenda in Brazil

In Brazil the 1990s constituted years of institutional achievements in the fields of housing and urban rights, given the incorporation of the principles of the social function of cities and property, the recognition of tenure rights for slum dwellers and the direct participation of citizens in the decision making process of urban policies, within the 1988 Constitution. These proposals have become the pillars of the Urban Reform agenda which has penetrated the federal government apparatus since the creation of the Ministry of Cities under Lula's administration. The article evaluates the limits and possibilities for the implementation of this agenda through the analysis of two policies proposed by the Ministry: the National Council of Cities and the campaign for Participatory Master Plans. The approach is based on the organization of the Brazilian State in terms of urban development, the relationship with the political system and the characteristics of Brazilian democracy.

Prevalence of Human T-Cell Lymphotropic Virus (HTLV-1/2) in Individuals from Public Health Centers in Mozambique

The prevalence of human T-cell lymphotropic viruses types 1 and 2 (HTLV-1/2) in Mozambique is not known. The present study examined blood samples from 208, 226, and 318 individuals from Northern, Central, and Southern Mozambique, respectively, of all socioeconomic and demographic strata attending public health centers in Mozambique for HTLV-1/2-specific antibodies. Serum samples were assessed for HIV- and HTLV-1/2-specific antibodies by using enzyme immunoassays, and infections with HTLV-1 and -2 were confirmed by using Western blot. An overall HTLV-1/2 prevalence of 2.3% (2.9% in female and 1.1% in male subjects) was observed, and the prevalence of infection increased with age. Regional variation in the prevalence of HIV and HTLV-1/2 was observed; 32.2%, 65.5%, and 44% of individuals tested HIV positive in Northern, Central, and Southern Mozambique, respectively, and 2.4%, 3.9%, and 0.9% tested HTLV-1/2 positive in the same regions. HTLV-1 infection was confirmed in these individuals. No association between HTLV-1 infection and socio-demographic variables or HIV status was detected, although the low number of HTLV-1-positive cases did not allow robust statistical analyses. The results obtained suggest different risk factors and epidemiologic correlates of HIV and HTLV-1 transmission in Mozambique. Furthermore, our results suggested that North and Central Mozambique should be considered endemic regions for HTLV-1 infection. As no cases of HTLV-2 were detected, HTLV-2 appears to have not been introduced into Mozambique.