Iniqüidade em saúde: uma extensão das desigualdades sociais no sistema público de saúde do Brasil (2003-2006)

This issue analises the unevenness in the brazilian system of public health care as an extension of socials inequities. It is a theoretical study based in a historical method, using empirical camp from academic, corporation and institution researchs, along the period 2002-2006. Equality and effectiveness in health systems are analitical basic cathegories grap in the root of the doctrine, principles and organization of the Unique Health System, in which sectorial actions are inserted. Discuss the estructural prodution and determined those inequalities through some social determiners of health system: income, land, food securitiy, nutritional situation, basic sanitation, epidemiological inequities and public management policy. Carry out a thematic review over health social production, it formlation and the goals of social policies, as well as the insertion of the equality principle in the assistance system, in the frame of the running public health regulations. It uses reflections that enlighted the correlation between the process of political-institutional actions and equity on health assistance. Analized the pertinency of sectorial reorganizational strategies on basic attendance, confronting the hipothesis that those strategies reinforce social inequities in health system, because it organize diferential assistance levels over not equal baselines. The results show up that social inequalities, even remaining, have had a small decrease; that the selectiviness of actual public policies and the duplication of the health system, increases the differences within and between the social classes and configures the assistance as inequal. The basic care system has great shortages that also appeares in middle and complex assistance levels. As conclusion, it remarks that the health assintance system, even with it integrality has limits; structural problems on material conditions of living and health system could not be reversed only with institutional legal arragements; by the contrary, in border conditions, these strategies produce policies that reinforce inequities, neglecting the equity principle of the system in which frame, they work. One patina of this tim

Efeito do ácido lático sobre as características microbiológicas, físico-químicas e sensoriais na carne do sol

The dried beef is a food traditionally eaten by Northeastern and has an extensive trade in the city of Natal-RN. It is usually produced in an empirical manner, without any standardization in production. Characterized as partially dehydrated meat product, so that the activity of water present is not sufficient to prevent microbial growth, degradation or the production of microbial toxins. The guarantee that the market dried beef is to provide a quality product hygienic, microbiological, physicochemical and sensory stable and adequate for the safety and consumer satisfaction, which has been increasingly attracted to food with natural preservatives. Thus, the meat industries are replacing the current seasonings and natural preservatives for similar, with it without affecting the shelf life of products. Lactic acid has been used to meet these requirements. In this sense, this study aimed to evaluate the effect of lactic acid on the physico-chemical, microbiological and sensory, besides knowing the consumer profile of dried meat of the City of Natal / RN. The results demonstrated that the use of lactic acid in concentrations of 1% and 2% during the processing of dried meat, had statistically significant effect (p < 0.05) on the physico-chemical (pH and water activity) and consequently reduced the microbial count does not alter the taste of the new product developed. Regarding the results on the consumer profile, it was found that the majority of respondents (71.75%) did not observe the presence of the stamp of the Federal Inspection Service (SIF) to buy this meat food that 81.55% of consumers check the hygiene conditions of the site and handlers, however, a large proportion of respondents not concerned with the guarantee of origin of typical regional products featuring a hazard to food safety for consumers of the city of Natal-RN

A agricultura familiar do Seridó potiguar: vulnerabilidade, percepção e adaptação às mudanças climáticas

At the semiarid regions of developing countries the rural population has always been vulnerable to the climatic variations e its consequences. The effects of the semiarid climate, together with other biophysics, social and political-economic factors, impair the agricultural production, generating a situation of food insecurity and poverty in the rural areas. With the occurrence of climate change, natural resources of the semiarid regions can became scarcer, what would directly affect the agricultural production and those who depend on it. Therefore, the present study sought to study one of the most susceptible areas to the effects of the semiarid climate and desertification of Rio Grande do Norte, the potiguar s Serido. The study aimed to analyze the socioeconomic and environmental factors that put farmers in a position of vulnerability to the effects of climate; assess their perceptions about climate variations that have already occurred and their knowledge about climate change and global warming, also to identify which adaptation strategies to climate they have adopted at the rural establishment. The survey was conducted in 29 communities of four counties of the potiguar s Serido Caico, Parelhas, Lagoa Nova and Acari. Semi-structured interviews were conducted with local leaders and 241 questionnaires were applied with the family farmers. It was found that in addition to environmental factors such as the scarcity of water resources and climatic conditions, other factors such as the environmental degradation, the small size of the properties, the lack of technical assistance and financial resources and also the low education levels reduce the resilience capacity of family farming to the effects of the Semiarid climate. With the occurrence of climate change, the challenges for family farming at Serido will intensify. If farmers cannot adapt, the impacts may preclude this category of agricultural production causing serious harm to food security and further increasing the vulnerability situation of these populations. Although the farmers perceived changes in climate, the lack resources and information appears as the main reasons preventing the adoption of adaptation strategies. The lack of knowledge about climate change and global warming and the impacts that these phenomena may cause are also limiting factors for adaptation. It is therefore essential to identify the factors that influence the adoption of adaptation strategies, and seek alternatives to living with the semiarid that can strengthen the resilience of family farming and social reproduction that allow agricultural segment, even in a climate change scenario

Avaliação da efetividade do Programa de Alimentação do Trabalhador

This study analyzed the Worker’s Healthy Eating Program in Rio Grande do Norte state (RN) to assess its possible impact on the nutritional status of the workers benefitted. To that end, we conducted a cross-sectional observational prospective study based on a multistage stratified random sample comparing 26 small and medium-sized companies from the Manufacturing Sector (textiles, food and beverages, and nonmetallic minerals) of RN, divided into two equal groups (WFP and Non WFP). Interviews were conducted at each company by trained interviewers from Tuesday to Saturday between September and December 2014. Data were collected on the company (characterization and information regarding the program’s desired results) and workers (personal and professional information, anthropometrics, health, lifestyle and food consumed the previous day). Population estimates were calculated for RN on the characteristics of workers and the study variables. The main variable was BMI. The secondary variables were waist circumference (WC), nutritional diagnosis, calorie intake, blood pressure, metabolic variables and lifestyle indicators. The statistical method used was hierarchical mixed effects linear regression for interval variables and hierarchical mixed effects logistic regression for binary variables. The variables measured in ordinal scales were analyzed by ordinal logistic regression adjusted for correlated variables, adopting robust standard errors. The results for interval variables are presented as point estimates and their 95% confidence intervals; and as odds-ratios and their 95% confidence intervals for binary variables. The Fisher’s exact and Student’s t-tests were used for simple comparisons between proportions and means, respectively. Differences were considered statistically significant at p<0.05. A total of 1069 workers were interviewed, of which 541 were from the WFP group and 528 from the Non WFP group. Subjects were predominantly males and average age was 34.5 years. Significant intergroup differences were observed for schooling level, income above 1 MW (minimum wage) and specific training for their position at the company. The results indicated a significant difference between the BMI of workers benefitted, which was on average 0.989 kg/m2 higher than the BMI of workers from the Non WFP group (p=0.002); and between the WC, with the waist circumference of WFP group workers an average of 1.528 cm larger (p<0.05). Higher prevalence of overweight and obesity (p<0.001) and cardiovascular risk (p=0.038) were recorded in the WFP group. Tests on the possible effect of the WFP on health (blood pressure and metabolic indicators) and lifestyle indicators (smoking, alcohol consumption and exercise) were not significant. With respect to worker’s diets, differences were significant for consumption of saturated fat (lunch and daily intake), salt (lunch, other meals and daily intake) and proteins (other meals and daily intake), with higher consumption of these nutrients in the WFP group. The study showed a possible positive impact of the WFP on nutritional status (BMI and WC) among the workers benefitted. No possible effects of the program were observed for the lifestyle indicators studied. Workers benefitted consumed less salt, saturated fat and protein. The relevance of the WFP is recognized for this portion of society and it is understood that, if the program can reach and impact those involved, the development of educational initiatives aimed at nutritional and food safety may also exert a positive influence.

A democracia participativa na jurisdição constitucional brasileira: o amicus curiae enquanto mediador democrático no controle concentrado de constitucionalidade no Supremo Tribunal Federal

This master thesis aims to research the tension established between the judicial review and democratic theory which was always present in the constitutional doctrine of separation of powers. In this regard, the expansion of the Brazilian constitutional jurisdiction checked after the occurrence of the Federal Constitution of 1988 and the inertia of the Legislature in disciplinary relevant legal aspects of Brazilian society contributed to a hyperactivity of the Supreme Court. However, in a complex society of context, as is the Brazilian society, there are contained demands and political controversies that hardly would be well represented or resolved through the action of the Court of ministers at the expense of other government bodies. Among the supremacy of Parliament and the legitimacy deficit of these magistrates, is the constitutional text and the social fabric that makes this legal status of the political. Participatory democracy established by the guidelines of the Federal Constitution requires this perspective when the Supreme Court acting in place of concentrated constitutionality control. In a plural society, there is no reason to get rid of state decision moments popular participation. Lack the Supreme Court, this time, the democratizing perception that the institute brings to the interior of the Court, as state determination of space in which to come together and meet the aspirations of society and state claims. The dissertation investigates thus the possibility of amicus curiae Institute serve as a mediator of the democratic debate, to assist the Supreme Court in the preparation of the decision is, historically, that which is of greater legitimacy, from the perspective of a theory participatory democracy. Analyzes, likewise, the unfolding of abstract judicial review in the context of Brazilian law. Proposes, incidentally, a rereading of the separation of powers, with the call for the Judiciary be careful not to become the protagonist of national political decisions. It maintains, finally, that procedural opening the interpreters of the constitution, through the amicus curiae Institute, shows up as able to decrease the legitimacy deficit in the performance of the Brazilian Supreme Court.

Atitudes e conhecimento dos consumidores sobre os alimentos irradiados: um inquérito conduzido em Natal, Brasil

The aim of this study is to assess the attitudes and knowledge of consumers about irradiated foods. The study sample corresponded to 65.52% women and the mean age was 41.82 (SD: 14.33) years. Only 66.9% of respondents consumers consult the list of ingredients on the label of packaged foods, and 13.4% of them said they had detected the phrase “FOOD TREATED BY IRRADIATION PROCESS.” Furthermore, 86.6% considered that irradiation becomes unsafe food and thus 94.9% of those not consume these foods, as well as 29.6% of those who felt otherwise. Women had a score of attitude towards irradiated foods less favorable than men. The television was considered the most efficient means of communication to report on irradiated foods. We conclude that consumers of the city of Natal lack information about food irradiation and acceptance of these products depends on how the policies are directed to food security and health education, including through the use of sources of mass information dissemination. The information on the labels of irradiated foods is controversial, although sufficient instruments for detection of irradiated foods by these consumers.

Desenvolvimento de métodos para quantificação de benzilpenicilina em medicamentos veterinários e seus resíduos em leite bovino e caprino por UFLC-DAD

The Benzylpenicillin (PENG) have been as the active ingredient in veterinary medicinal products, to increase productivity, due to its therapeutic properties. However, one of unfortunate quality and used indiscriminately, resulting in residues in foods exposed to human consumption, especially in milk that is essential to the diet of children and the ageing. Thus, it is indispensable to develop new methods able to detect this waste food, at levels that are toxic to human health, in order to contribute to the food security of consumers and collaborate with regulatory agencies in an efficient inspection. In this work, were developed methods for the quality control of veterinary drugs based on Benzylpenicillin (PENG) that are used in livestock production. Additionally, were validated methodologies for identifying and quantifying the antibiotic residues in milk bovine and caprine. For this, the analytical control was performed two steps. At first, the groups of samples of medicinal products I, II, III, IV and V, individually, were characterized by medium infrared spectroscopy (4000 – 600 cm-1). Besides, 37 samples, distributed in these groups, were analyzed by spectroscopy in the ultraviolet and near infrared region (UV VIS NIR) and Ultra Fast Liquid Chromatograph coupled to linear arrangement photodiodes (UFLC-DAD). The results of the characterization indicated similarities, between PENG and reference standard samples, primarily in regions of 1818 to 1724 cm-1 of ν C=O that shows primary amides features of PENG. The method by UFLC-DAD presented R on 0.9991. LOD of 7.384 × 10-4 μg mL-1. LOQ of 2.049 × 10-3 μg mL-1. The analysis shows that 62.16% the samples presented purity ≥ 81.21%. The method by spectroscopy in the UV VIS NIR presented medium error ≤ 8 – 12% between the reference and experimental criteria, indicating is a secure choice for rapid determination of PENG. In the second stage, was acquiring a method for the extraction and isolation of PENG by the addition of buffer McIlvaine, used for precipitation of proteins total, at pH 4.0. The results showed excellent recovery values PENG, being close to 92.05% of samples of bovine milk (method 1). While samples of milk goats (method 2) the recovery of PENG were 95.83%. The methods for UFLC-DAD have been validated in accordance with the maximum residue limit (LMR) of 4 μg Kg-1 standardized by CAC/GL16. Validation of the method 1 indicated R by 0.9975. LOD of 7.246 × 10-4 μg mL-1. LOQ de 2.196 × 10-3 μg mL-1. The application of the method 1 showed that 12% the samples presented concentration of residues of PENG > LMR. The method 2 indicated R by 0.9995. LOD 8.251 × 10-4 μg mL-1. LOQ de 2.5270 × 10-3 μg mL-1. The application of the method showed that 15% of the samples were above the tolerable. The comparative analysis between the methods pointed better validation for LCP samples, because the reduction of the matrix effect, on this account the tcalculs < ttable, caused by the increase of recovery of the PENG. In this mode, all the operations developed to deliver simplicity, speed, selectivity, reduced analysis time and reagent use and toxic solvents, particularly if compared to the established methodologies.

Desenvolvimento de métodos para quantificação de benzilpenicilina em medicamentos veterinários e seus resíduos em leite bovino e caprino por UFLC-DAD

The Benzylpenicillin (PENG) have been as the active ingredient in veterinary medicinal products, to increase productivity, due to its therapeutic properties. However, one of unfortunate quality and used indiscriminately, resulting in residues in foods exposed to human consumption, especially in milk that is essential to the diet of children and the ageing. Thus, it is indispensable to develop new methods able to detect this waste food, at levels that are toxic to human health, in order to contribute to the food security of consumers and collaborate with regulatory agencies in an efficient inspection. In this work, were developed methods for the quality control of veterinary drugs based on Benzylpenicillin (PENG) that are used in livestock production. Additionally, were validated methodologies for identifying and quantifying the antibiotic residues in milk bovine and caprine. For this, the analytical control was performed two steps. At first, the groups of samples of medicinal products I, II, III, IV and V, individually, were characterized by medium infrared spectroscopy (4000 – 600 cm-1). Besides, 37 samples, distributed in these groups, were analyzed by spectroscopy in the ultraviolet and near infrared region (UV VIS NIR) and Ultra Fast Liquid Chromatograph coupled to linear arrangement photodiodes (UFLC-DAD). The results of the characterization indicated similarities, between PENG and reference standard samples, primarily in regions of 1818 to 1724 cm-1 of ν C=O that shows primary amides features of PENG. The method by UFLC-DAD presented R on 0.9991. LOD of 7.384 × 10-4 μg mL-1. LOQ of 2.049 × 10-3 μg mL-1. The analysis shows that 62.16% the samples presented purity ≥ 81.21%. The method by spectroscopy in the UV VIS NIR presented medium error ≤ 8 – 12% between the reference and experimental criteria, indicating is a secure choice for rapid determination of PENG. In the second stage, was acquiring a method for the extraction and isolation of PENG by the addition of buffer McIlvaine, used for precipitation of proteins total, at pH 4.0. The results showed excellent recovery values PENG, being close to 92.05% of samples of bovine milk (method 1). While samples of milk goats (method 2) the recovery of PENG were 95.83%. The methods for UFLC-DAD have been validated in accordance with the maximum residue limit (LMR) of 4 μg Kg-1 standardized by CAC/GL16. Validation of the method 1 indicated R by 0.9975. LOD of 7.246 × 10-4 μg mL-1. LOQ de 2.196 × 10-3 μg mL-1. The application of the method 1 showed that 12% the samples presented concentration of residues of PENG > LMR. The method 2 indicated R by 0.9995. LOD 8.251 × 10-4 μg mL-1. LOQ de 2.5270 × 10-3 μg mL-1. The application of the method showed that 15% of the samples were above the tolerable. The comparative analysis between the methods pointed better validation for LCP samples, because the reduction of the matrix effect, on this account the tcalculs < ttable, caused by the increase of recovery of the PENG. In this mode, all the operations developed to deliver simplicity, speed, selectivity, reduced analysis time and reagent use and toxic solvents, particularly if compared to the established methodologies.

Desenvolvimento e validação de testes de fluxo lateral para a detecção de cultivares geneticamente modificados e de aflatoxinas em produtos agrícolas

The expansion of cultivated areas with genetically modified crops (GM) is a worldwide phenomenon, stimulating regulatory authorities to implement strict procedures to monitor and verify the presence of GM varieties in agricultural crops. With the constant growing of plant cultivating areas all over the world, consumption of aflatoxin-contaminated food also increased. Aflatoxins correspond to a class of highly toxic contaminants found in agricultural products that can have harmful effects on human and animal health. Therefore, the safety and quality evaluation of agricultural products are important issues for consumers. Lateral flow tests (strip tests) is a promising method for the detection both proteins expressed in GM crops and aflatoxins-contaminated food samples. The advantages of this technique include its simplicity, rapidity and cost-effective when compared to the conventional methods. In this study, two novel and sensitive strip tests assay were developed for the identification of: (i) Cry1Ac and Cry8Ka5 proteins expressed in GM cotton crops and; (ii) aflatoxins from agricultural products. The first strip test was developed using a sandwhich format, while the second one was developed using a competitive format. Gold colloidal nanoparticles were used as detector reagent when coated with monoclonal antibodies. An anti-species specific antibody was sprayed at the nitrocellulose membrane to be used as a control line. To validate the first strip test, GM (Bollgard I® e Planta 50- EMBRAPA) and non-GM cotton leaf (Cooker 312) were used. The results showed that the strip containing antibodies for the identification of Cry1Ac and Cry8Ka5 proteins was capable of correctly distinguishing between GM samples (positive result) and non-GM samples (negative result), in a high sensitivity manner. To validate the second strip test, artificially contaminated soybean with Aspergillus flavus (aflatoxin-producing fungus) was employed. Food samples, such as milk and soybean, were also evaluated for the presence of aflatoxins. The strip test was capable to distinguish between samples with and without aflatoxins samples, at a sensitivity concentration of 0,5 μg/Kg. Therefore, these results suggest that the strip tests developed in this study can be a potential tool as a rapid and cost-effective method for detection of insect resistant GM crops expressing Cry1Ac and Cry8Ka5 and aflatoxins from food samples.

Desenvolvimento e validação de testes de fluxo lateral para a detecção de cultivares geneticamente modificados e de aflatoxinas em produtos agrícolas

The expansion of cultivated areas with genetically modified crops (GM) is a worldwide phenomenon, stimulating regulatory authorities to implement strict procedures to monitor and verify the presence of GM varieties in agricultural crops. With the constant growing of plant cultivating areas all over the world, consumption of aflatoxin-contaminated food also increased. Aflatoxins correspond to a class of highly toxic contaminants found in agricultural products that can have harmful effects on human and animal health. Therefore, the safety and quality evaluation of agricultural products are important issues for consumers. Lateral flow tests (strip tests) is a promising method for the detection both proteins expressed in GM crops and aflatoxins-contaminated food samples. The advantages of this technique include its simplicity, rapidity and cost-effective when compared to the conventional methods. In this study, two novel and sensitive strip tests assay were developed for the identification of: (i) Cry1Ac and Cry8Ka5 proteins expressed in GM cotton crops and; (ii) aflatoxins from agricultural products. The first strip test was developed using a sandwhich format, while the second one was developed using a competitive format. Gold colloidal nanoparticles were used as detector reagent when coated with monoclonal antibodies. An anti-species specific antibody was sprayed at the nitrocellulose membrane to be used as a control line. To validate the first strip test, GM (Bollgard I® e Planta 50- EMBRAPA) and non-GM cotton leaf (Cooker 312) were used. The results showed that the strip containing antibodies for the identification of Cry1Ac and Cry8Ka5 proteins was capable of correctly distinguishing between GM samples (positive result) and non-GM samples (negative result), in a high sensitivity manner. To validate the second strip test, artificially contaminated soybean with Aspergillus flavus (aflatoxin-producing fungus) was employed. Food samples, such as milk and soybean, were also evaluated for the presence of aflatoxins. The strip test was capable to distinguish between samples with and without aflatoxins samples, at a sensitivity concentration of 0,5 μg/Kg. Therefore, these results suggest that the strip tests developed in this study can be a potential tool as a rapid and cost-effective method for detection of insect resistant GM crops expressing Cry1Ac and Cry8Ka5 and aflatoxins from food samples.

Ética da alimentação: porque devemos, segundo Kant, escolher uma alimentação adequada e saudável

This thesis proposes the adoption of a practical and philosophic approach to the discussion about what should be a healthy food, in view of the actual problems concerning this subject (from famine to obesity), which affect food and nutritional security and constitute target of many official policies. In order to handle this task, this work resorts to ethic, pedagogical and anthropological concepts inherent to Immanuel Kant’s philosophy, as valuable contributions to the practice of the professional nutritionist committed to the support and accomplishment of the human right to adequate nutrition (DHAA). Under this assumption, it intends to surpass the prevailing idea inside the social programs and policies favoring the utilitarian argument. It considers rather that a healthy food is also a duty of virtue, according to the Kantian duties to one-self. The liberation of transgenic seeds in Brazil comes up as an example of the violation of the right to food security and affects it negatively, resulting from the conflict between politics and moral faced by the Brazilian government. This paper concludes that DHAA realization requires not only a committed state, but also committed citizens and suggests that Kant’s philosophy should offer important contributions to supporting the practice of the professional nutritionist, awarding him the necessary information about this matter.

Ética da alimentação: porque devemos, segundo Kant, escolher uma alimentação adequada e saudável

This thesis proposes the adoption of a practical and philosophic approach to the discussion about what should be a healthy food, in view of the actual problems concerning this subject (from famine to obesity), which affect food and nutritional security and constitute target of many official policies. In order to handle this task, this work resorts to ethic, pedagogical and anthropological concepts inherent to Immanuel Kant’s philosophy, as valuable contributions to the practice of the professional nutritionist committed to the support and accomplishment of the human right to adequate nutrition (DHAA). Under this assumption, it intends to surpass the prevailing idea inside the social programs and policies favoring the utilitarian argument. It considers rather that a healthy food is also a duty of virtue, according to the Kantian duties to one-self. The liberation of transgenic seeds in Brazil comes up as an example of the violation of the right to food security and affects it negatively, resulting from the conflict between politics and moral faced by the Brazilian government. This paper concludes that DHAA realization requires not only a committed state, but also committed citizens and suggests that Kant’s philosophy should offer important contributions to supporting the practice of the professional nutritionist, awarding him the necessary information about this matter.