As (re)configurações das demandas ao serviço social no âmbito dos serviços públicos de saúde

Este artigo estuda as demandas impostas ao fazer profissional dos assistentes sociais na esfera pública dos serviços de saúde, a partir da redefinição do papel do Estado nos anos 1990. Inicialmente, discorre sobre o caráter reducionista do Estado à luz da política neoliberal implementada pelo governo brasileiro. Depois, lança um olhar sobre as políticas de saúde nos anos 1980 para explicitar as repercussões nos serviços públicos de saúde nos anos 1990. Por último, delineia as configurações e reconfigurações das demandas dirigidas ao serviço social no âmbito dos serviços públicos de saúde e aponta para a necessidade de uma leitura atenta das determinações sociais, históricas, econômicas, políticas e culturais nas expressões da questão social na saúde e, especialmente, das limitações da intervenção profissional nos processos relacionados ao binômio saúdedoença, uma vez que estão atrelados aos processos societários em nível macro.

RE-EVALUATION OF SCHISTOSOMIASIS MANSONI IN MINAS GERAIS, BRAZIL. III. "NOROESTE DE MINAS" MESOREGION

This study was conducted to assess the presence of schistosomiasis mansoni in the "Noroeste de Minas" mesoregion, an area considered non-endemic. A malacologic survey and parasitologic stool examinations were undertaken in 13 municipalities of the mesoregion. A sample of 3,283 primary school students was submitted to fecal examination by the Kato-Katz method. A total of 3,627 planorbids was collected and examined. The molluscs were identified as Biomphalaria straminea in seven municipalities (Unaí, Bonfinópolis de Minas, Paracatu, João Pinheiro, Vazante, Lagamar and Lagoa Grande) and as Biomphalaria peregrina in one (Presidente Olegário). All planorbids were negative for Schistosoma mansoni. Four students were diagnosed with schistosomiasis in the municipalities of Buritis, Formoso, Paracatu and Unaí, but none of these cases was considered autochthonous. The data obtained indicate that the "Noroeste de Minas" mesoregion continues to be non-endemic for schistosomiasis mansoni, although the presence of intermediate hosts associated with parasitized individuals emphasizes the need for epidemiological surveillance of schistosomiasis in this mesoregion.

Re-evaluation of the basic procedures involved in the storage of measles vaccine in public health units of the municipality of Niterói, state of Rio de Janeiro, Brazil

Four years after the first visit seventeen public health units were visited again and evaluated as to standards of storage recommended by the Brazilian Immunization Programme. In 100% of the units, refrigerators and proper inside location of vaccines in the refrigerator were adequatety or regularfy maintained and checked, respectively. However, when control of temperature was checked, onfy 64.7% presented adequate storage conditions. In 94.1 % of the units, health workers complained of lack of immediate technical support in emergency situations. In 55.2 % the titers vaccine samples of were under the minimal recommended potency. It is necessary that the factors concerning the cold chain be continualfy evaluated so that the quality of the vaccines that will be used is not affected.

Chemotherapeutic effects on larval stages of Schistosoma mansoni during infection and re-infection of mice

The sensitivity of the larval stages of Schistosoma mansoni to chemotherapy with praziquantel and oxamniquine was tested in mice during primary and secondary infections and after different intervals from cercarial exposure. Worm recovery by perfusion of the porto-mesenteric system, followed by counting and a morphometric study of the parasite, allowed the conclusion that the relative resistance of the larval stages of S. mansoni to schistosomicide drugs, demonstrated in primary infections, also persists when the host is already infected. This indicates that a therapeutic failure may result when an infected host is treated some time after being re-infected, because of the presence of migrating, drug-resistant, immature forms of the parasite.

Emergent and re-emergent parasites in HIV-infected children: immunological and socio-environmental conditions that are involved in the transmission of Giardia spp. and Cryptosporidium spp.

ABSTRACT INTRODUCTION: Emergent and re-emergent waterborne protozoans have become a worldwide public health problem, especially among vulnerable groups. METHODS: This cross-sectional study evaluated 17 HIV-infected children and their families. RESULTS: A high (76.5%) percentage of parasite-infected children was observed, even among children with CD4+ T-cell counts of >200 cells/mm3. Giardia spp., Cryptosporidium spp. and Cyclospora spp. were observed in 41.2% of these children Low income, poor hygiene practices, and co-infection in domestic, peridomestic and scholastic environments were significant sources of these intestinal infections. CONCLUSIONS: Early diagnosis, timely treatment, and socio-educational interventions may improve the health conditions of this vulnerable population.

Biomass equations for forest regrowth in the eastern Amazon using randomized branch sampling

Forest regrowth occupies an extensive and increasing area in the Amazon basin, but accurate assessment of the impact of regrowth on carbon and nutrient cycles has been hampered by a paucity of available allometric equations. We develop pooled and species-specific equations for total aboveground biomass for a study site in the eastern Amazon that had been abandoned for 15 years. Field work was conducted using randomized branch sampling, a rapid technique that has seen little use in tropical forests. High consistency of sample paths in randomized branch sampling, as measured by the standard error of individual paths (14%), suggests the method may provide substantial efficiencies when compared to traditional procedures. The best fitting equations in this study used the traditional form Y=a×DBHb, where Y is biomass, DBH is diameter at breast height, and a and b are both species-specific parameters. Species-specific equations of the form Y=a(BA×H), where Y is biomass, BA is tree basal area, H is tree height, and a is a species-specific parameter, fit almost as well. Comparison with previously published equations indicated errors from -33% to +29% would have occurred using off-site relationships. We also present equations for stemwood, twigs, and foliage as biomass components.

Establishing the prevalence of hypertension. Influence of sampling criteria

OBJECTIVE: To compare the prevalence of systemic hypertension in two different populations: a representative sample of the adult urban population of Porto Alegre, and individuals who sought blood pressure measurement in a hypertension prevention and control campaign. METHODS: A cross-sectional study was carried out involving a representative sample of the adult urban population of Porto Alegre and a population sample obtained from a hypertension prevention and control campaign, which included all the individuals who sought the blood pressure assessment unit at the Hospital das Clínicas in Porto Alegre. The following parameters were investigated: history of hypertension, use of antihypertensive drugs, age, and sex. Adjustments for age and sex in the prevalence rates were performed to make them comparable. RESULTS: Hypertension prevalence, defined as values > or = 160/95mmHg or treatment with antihypertensive drugs, was higher in the campaign sample (42%) as compared with the population sample (24%). Among those who were aware of their hypertensive condition and were under medication, 54% of the campaign sample and 62% of the representative population sample maintained their pressure levels <160/90mmHg. CONCLUSION: Prevalence rates of hypertension differed a lot in the campaign sample and in the representative population sample, showing that the sampling criterion may influence assessment of risk factors and bias the association between risk factors and health aggravations.

Re-hospitalizações e morte por insuficiência cardíaca: índices ainda alarmantes

FUNDAMENTO: Os pacientes com insuficiência cardíaca (IC) que necessitam ser hospitalizados para compensação constituem grupo de maior gravidade, que evoluem com alta mortalidade e alta taxa de re-hospitalizações. OBJETIVO: Procuramos avaliar a atual história natural da IC por meio da taxa de mortalidade e de re-hospitalizações, nessa nova era do bloqueio neuro-hormonal. MÉTODOS: Acompanhamos a evolução de 263 pacientes com FE média de 27,1%, internados para compensação, entre janeiro de 2005 e outubro de 2006. Foram hospitalizados somente os pacientes que após avaliação e medicação no PS não estavam em condições de ter alta. Os pacientes encontravam-se em CF III/IV, a idade média foi de 59,9±15,2 anos, a maioria homens e 63,1% necessitaram de inotrópicos para compensação na fase aguda. RESULTADOS: O tempo médio de internação foi de 25,1±16,7 dias. Durante a internação 23 (8,8%) morreram. Após a alta, no período médio de seguimento de 370 dias, dos 240 que tiveram alta, 123 (51,2%) procuraram o PS de 1 a 12 vezes (total de passagens: 350), sendo 76 re-internados, sendo a média de dias da re-hospitalização de 23,5±18,0. No primeiro ano de seguimento 62 (25,8%) pacientes morreram. CONCLUSÃO: A IC continua evoluindo com alta mortalidade e alta taxa de re-hospitalização. Ao final do primeiro ano 44,5% desses pacientes não necessitaram passar no PS ou morreram, números que indicam que devemos continuar dando grande atenção aos portadores de IC, na tentativa de mudar a história natural dos portadores dessa síndrome, cada vez mais freqüente.