Protagonismo silencioso: a presença da OPAS na formação de recursos humanos em saúde no Brasil

The aim of this study is to assess the contribution of the Pan American Health Organization (PAHO) to the field of human resources for health in Brazil. The assumption is that this organization not only influenced the development of this field, but but that it was also influenced by Brazilian institutions and by national political movements, through the interaction of its consultants with these movements. Four projects were selected, through which the contribution of PAHO was evaluated: the Program for the Strategic Preparation of Health Personnel (PPREPS), the Project for the Large Scale Formation of Middle and Low Level Personnel (Large Scale Project), the Project for Qualification in the Development of Human Resources in Health (CADRHU) and the Project for the Managerial Development of Basic Units of the National Health System (GERUS). To operacionalize the study, we used three basic complementary procedures: a bibliographic research, documental research and an interview. The time frame considered was from 1975, the year an agreement was signed between PAHO, the Ministry of Health and the Ministry of Education and Culture, establishing PPREPS. It was through this program that the first PAHO team of national human resource consultants was contracted. The period between 1975 and 1999 was marked by political and social movements that changed the course of health in the country; among these was the Movement of Sanitary Reform in Brazil, which culminated in the implementation of the National Health System (SUS). This paper shows the connections of the PAHO consultants with this movement and the implications that this had for the Program of Cooperation in the Development of Human Resources of PAHO/Brazil. It also demonstrates that as the program became contaminated by national movements of health system reorganization and of democratization of Brazilian society, it proposed, in cooperation with national institutions, an organization of determinate areas of operation of these same institutions. The manuscript further reveals that, with the Large Scale Project, the human resources program determined the pedagogical and methodological option that would be the model for various other educational projects undertaken by a number of Brazilian institutions with the technical cooperation of PAHO. And finally, the repercussions and contributions of these projects, which strengthened the the field of human resources in the public health services of the country, are identified. Data analysis was based mainly on the theories of Bourdieu, Gramsci and Freire

Modelagem de arranjos institucionais para implementação da diretriz de sistema de gestão de segurança e saúde ocupacional da organização internacional do trabalho ILO/OSH 2001 no brasil

The commitment assumed by Brazil to ILO in order to pursue actions toward the ILO/OSH-2001 adoption in the country poses the issue of modeling the institutional arrangement the set roles and relationship between government, standards organizations, health and safety organizations, professionals and other institutions to deploy the ILO/OSH-2001. This Thesis develop institutional arrangement models based on the current model and also in the ISO 9000 scheme and others. It is studied the US case with OSHA and VPP, the OHSAS 18001 and ANSI/AIHA Z-10, in addition to actual context of the regulating norms NR s. The scenarios developed are put to evaluation on feasibility, potential changes and effects on current MTE auditors work scheme. The main results are five scenarios developed and that the MTE auditors tend to be reactive to the change toward the ILO/OSH-2001.

Estratigrafia de sequências do intervalo aptiano ao albino na Bacia do Araripe, NE do Brasil

This study has as a main objective to make a detailed stratigraphic analysis of the Aptian-Albian interval in the east part of Araripe Basin, NE of Brazil which correspond, litostratigraphically, to Rio Da Batateira, Crato, Ipubi and Romualdo formations. The stratigraphic analysis was based on three different stages, the 1D, 2D and 3D analysis; these ones were adapted to the sequence stratigraphy concepts in order to create a chronostratigraphic framework for the study area within the basin. The database used in the present study contains field and well information, wells that belong to Santana Project, carried out by the Ministério de Minas e Energia- DNPM- CPRM from 1977 to 1978. The analysis 1D, which was done separately for each well and outcrop allowed the recognition of 13 sedimentary facies, mainly divided based on predominant litologies and sedimentary structures. Such facies are lithologically represented by pebble, sandstones, claystones, margas and evaporates; these facies are associated in order to characterize different depositional systems, that integrate from the continental environment (fluvial system and lacustre), paralic system (delta system and lagunar) to the marine environment (shelfenvironment). The first one, the fluvial system was divided into two subtypes: meandering fluvial system, characterized by fill channel and floodplain deposits; the facies of this system are associated vertically according to the textural thinning upward cycles (dirting-up trend pattern in well logs). Lacustrine environment is mainly related with the lithotypes of the Crato Formation, it shows a good distribution within the basin, been composed by green claystone deposits and calcareous laminated. Deltaic System represented by prodelta and delta front deposits which coarsening upward tendency. Lagunar system is characterised by the presence of anhydrite and gypsum deposits besides the black claystone deposits with vegetal fragments which do not contain a fauna typically marine. The marine platform system is composed by successions of black and gray claystone with fossiliferous fauna of Dinoflagellates (Spiniferites Mantell, Subtilisphaera Jain e Subtilisphaera Millipied genre) typical of this kind of depositional system. The sedimentary facies described are vertically arranged in cycles with progradational patterns which form textural coersening upward cycles and retrogradational, represented by textural thinning dowward cycles. Based in these cycles, in their stack pattern and the vertical change between these patterns, the systems tracks and the depositional sequences were recognized. The Low System Track (LST) and High System Track (HST) are composed by cycles with progradational stack pattern, whereas the Trangessive System Track (TST) is composed by retrogradational stack pattern cycles. The 2D stratigraphic analysis was done through the carrying out of two stratigraphic sections. For the selection of the datum the deepest maximum flooding surface was chosen, inside the Sequence 1, the execution of these sections allowed to understand the behaviour of six depositional systems along the study area, which were interpreted as cycles of second order or supercycles (cycles between 3 and 10 Ma), according to the Vail, et al (1977) classification. The Sequence 1, the oldest of the six identified is composed by the low, transgressive and high systems tracks. The first two system tracks are formed exclusively by fluvial deposits of the Rio da Batateira Formation whereas the third one includes deltaic and lacustrine deposits of the Crato Formation. The sequences 2 and 3 are formed by the transgressive systems tracks (lake spreading phase) and the highstand system track (lake backward phase). The TST of these sequences are formed by lacustrine deposits whereas HST contains deltaic deposits, indicating high rates of sedimentary supply at the time of it s deposition. The sequence 4 is composed by LST, TST and HST, The TST4 shows a significant fall of the lake base level, this track was developed in conditions of low relation between the creation rate of space of accommodation and the sedimentary influx. The TST4 marks the third phase of expansion of the lacustrine system in the section after the basin´s rift, the lacustrine system established in the previous track starts a backward phase in conditions that the sedimentary supply rate exceeds the creation rate of space accommodation. The sequence 5 was developed in two different phases, the first one is related with the latest expansion stage of the lake, (TST5), the basal track of this sequence. In this phase the base level of the lake rose considerably. The second phase (related to the TST5) indicates the end of the lacustrine domain in the Araripe Basin and the change to lagunar system ant tidal flat, with great portions in the supratidal. These systems were formed by restricted lagoons, with shallow level of water and with intermittent connections with the sea. This, was the phase when the Araripe Basin recorded the most several arid conditions of the whole interval studied, Aptian Albian, conditions that allow the formation of evaporitic deposits. The sequence 6 began its deposition after a significant fall of the sea (LST6). The sequence 6 is without any doubtlessly, the sequence that has deposits that prove the effective entrance of the sea into the Araripe Basin. The TST6, end of this sequence, represents the moment which the sea reaches its maximum level during the Aptian Albian time. The stratigraphic analysis of the Aptian Albian interval made possible the understanding that the main control in the development of the depositional sequences recognized in the Araripe Basin were the variations of the local base level, which are controlled itself by the climate changes

Avaliação da assistência ao parto em maternidade terciária do interior do Estado de São Paulo, Brasil

OBJETIVOS: avaliar a estrutura e o processo de assistência ao parto e ao recém-nascido desenvolvidos na maternidade e na unidade de neonatologia de uma instituição hospitalar de nível terciário do interior do Estado de São Paulo, Brasil. MÉTODOS: estudo descritivo, transversal, voltado para a análise da adesão às normas preconizadas pelo Ministério da Saúde e Organização Mundial da Saúde em relação ao parto, avaliando-se os recursos existentes e as atividades desenvolvidas durante a assistência. Os dados foram colhidos nos anos de 2004 e 2005, a partir de entrevista com o gestor da maternidade, análise de 293 prontuários amostradose observação de 29 partos realizados. RESULTADOS: a avaliação da estrutura evidenciou a disponibilidade de equipamentos, instrumentais e medicamentos, de obstetra, pediatra e anestesista eausência de quartos de pré-parto, parto e puerpério.Na análise do processo observouse, entre outras,frequências regulares relacionadas à verificação de pressão arterial e ausculta dos batimentos cardíacos fetais; o preenchimento do partograma foi satisfatório; na assistência ao recém-nascido, foram insatisfatórios o aleitamento na primeira hora de vida e ocontato pele a pele. CONCLUSÕES: algumas práticas úteis no partonormal foram pouco utilizadas. Percebese uma tendência à incorporação de práticas baseadas em evidências científicas, quando se considerou a realização de procedimentos como tricotomia, enteroclisma e episiotomia, demonstrando uma mudançapositiva na assistência ao parto.

Avaliação de serviços de assistência ambulatorial em aids, Brasil: estudo comparativo 2001/2007

OBJETIVO: Avaliar os serviços do Sistema Único de Saúde brasileiro de assistência ambulatorial a adultos vivendo com aids em 2007 e comparar com a avaliação de 2001. MÉTODOS: Os 636 serviços cadastrados no Ministério da Saúde em 2007 foram convidados a responder a um questionário previamente validado (Questionário Qualiaids) com 107 questões de múltipla escolha sobre a organização da assistência prestada. Analisaram-se as frequências das respostas de 2007 comparando-as com as obtidas em 2001 na forma de variação percentual (VP). RESULTADOS: Responderam o questionário 504 (79,2%) serviços. Cerca de 100,0% dos respondentes relataram ter pelo menos um médico, suprimento sem falhas de antirretrovirais e de exames CD4 e carga viral. Vários aspectos mostraram melhor desempenho em 2007 comparados a 2001: registro de número de faltas à consulta médica (de 18,3 para 27,0%, VP: 47,5%), agendamento de consulta em menos de 15 dias no início da terapia antirretroviral (de 55,3 para 66,2%, VP: 19,7%) e participação organizada do usuário (de 5,9 para 16,7%, VP: 183,1%). Houve manutenção de dificuldades: pequena variação na disponibilidade de exames especializados em até 15 dias, como endoscopia (31,9 para 34,5%, VP: 8,1%), e a piora de indicadores como tempo ideal de acesso a consultas especializadas (55,9 para 34,5% em cardiologia, VP negativa de 38,3%). O tempo médio despendido nas consultas médicas de seguimento manteve-se baixo: 15 minutos ou menos (52,5 para 49,5%, VP negativa de 5,8%). CONCLUSÕES: A avaliação de 2007 mostrou que os serviços contam com os recursos essenciais para a assistência ambulatorial. Houve melhoras em muitos aspectos em relação a 2001, mas persistem desafios. Pouco tempo dedicado à consulta médica pode estar vinculado ao número insuficiente de médicos e/ou à baixa capacidade de escuta e diálogo. A acessibilidade prejudicada a consultas especializadas mostra a dificuldade das infraestruturas locais do Sistema Único de Saúde.

Parasitismo natural de bufalinos em Botucatu, SP, Brasil: III. Dinâmica do parasitismo gastro-intestinal em vacas e suas crias

Gastro-intestinal parasitism of 24 buffalo cows before parturition, and post-parturition, their infection and that of their respective calves during the following 30 weeks were studied. Willis, Hoffmann and whenever possible, the modified Gordon & Whitlock techniques were used for fecal examinations. Toxocara vitulorum eggs were the earliest forms encountered in calves feces, as follows: during the 1st week after birth, 58.33% of the calves were positive, and in the 4th week, 100% of these animals were positive. Eggs of Strongyloides sp were in the 1st week after birth in two of the calves and in the 5th week, all for them were positive. The next parasites to appear were the Coccidia of which oocysts were detected in the feces of two calves in the 2nd week after birth, and 58.33% of the calves were positive for these in the 3rd week, and in the 6th week, all calves shed oocysts in their feces. on the other hand, eggs of Strongylids were the last forms to appear in calves feces. However, despite their sporadic appearance in the feces, eggs of these parasites were observed continuously from the 11th week onwards, and at this point, the percentage of positive samples began to increase to reach its peak. Relatively to adult animals, eggs of T. vitulorum were observed in the feces of 11 cows, one or twice at most; eggs of Strongyloides sp were seen only once in the feces of four buffalo cows and eggs of Strongylids in 21 out of 24 cows. Oocysts of Coccidia were observed in 16 cows. Mechanisms of infestation of calves with these parasites are discussed.

A fragilidade da condução política da defesa no Brasil

O presente artigo trata de avaliar em perspectiva histórica, algumas falhas na condução da política de Defesa no Brasil, fulcrais para se compreender a continuidade de um quadro de indevida participação militar e de ausência de controle civil na elaboração e implementação da mencionada pasta, incompatíveis com um contexto de governabilidade democrática. A despeito de algumas iniciativas no sentido de regulamentar os limites de atuação das Forças Armadas para que as mesmas não extrapolem suas funções e missões essenciais, e para que a política de Defesa seja revestida de um verniz público e civil - a exemplo da criação do Ministério da Defesa e da publicação da Estratégia Nacional de Defesa -, prevalece uma situação de fragilidade institucional e de vazio de poder público propícios para que a vontade militar permaneça conferindo o tom da Defesa nacional.

Trabalho, violência e morte em Campinas, São Paulo, Brasil

Neste estudo epidemiológico foram analisados óbitos decorrentes de causas externas, ocorridos nos anos 1999 e 2000 entre moradores masculinos da Cidade de Campinas falecidos com idade entre 15 e 64 anos, por intermédio de entrevistas com familiares. Buscou-se correlacionar esta incidência com a história ocupacional dos indivíduos, permitindo a caracterização de tais eventos como acidentes de trabalho. A mortalidade proporcional devido a acidentes de trabalho foi estimada em 27,0% neste grupo. em nenhuma das Declarações de Óbito analisadas estava assinalado com sim o campo Acidente de Trabalho. Com base nos resultados, estimou-se que a informação oficial do Ministério do Trabalho e Emprego sobre o número de óbitos decorrentes de acidentes de trabalho no período no Estado de São Paulo esteja subestimada em 83,4%. Constatou-se ainda que a imensa maioria dos acidentes de trabalho fatais identificados era de homicídios e acidentes de transporte, refletindo o aumento da violência nas grandes cidades brasileiras.

Mortalidade por neoplasias no Brasil (1980/1983/1985): agrupamento dos Estados, comportamento e tendências

Examinou-se a mortalidade por neoplasias no Brasil, utilizando-se dados oficiais do Ministério da Saúde, abrangendo 26 Unidades da Federação e 13 diferentes localizações neoplásicas, para os anos de 1980, 1983 e 1985. As Análises de Agrupamento e de Componentes Principais revelaram comportamento heterogêneo entre regiões do país, com relação às 13 variáveis estudadas, sendo que os principais elementos discriminantes foram as neoplasias malignas da traquéia/brônquio/pulmão, seguidas das do estômago, esôfago, cólon e pâncreas. Análises complementares evidenciaram tendência de crescimento das taxas de mortalidade para as neoplasias malignas da próstata (17,74%), da traquéia/brônquio/pulmão(15,22%), da mama (11,32%), do pâncreas (10,23%), do cólon (8,08%), do colo uterino (6,45%) e da laringe (6,36%). Houve redução da mortalidade por neoplasias benignas/carcinoma in situ/ outras (27,37%), por neoplasias malignas no reto sigmóide/ânus (7,67%), do estômago (5,31%), de outro local do útero não especificado (2,56%), por leucemia (0,70%) e por neoplasias malignas do esôfago (0,44%). As neoplasias malignas do estômago foram a principal causa de morte por câncer no Brasil, representando 21,30% do total médio, seguidas das neoplasias malignas da traquéia/brônquio/pulmão(17,49% do total médio). Destacam-se os altos índices de mortalidade por neoplasias malignas do esôfago no Estado do Rio Grande do Sul.

Diabetes mellitus: razão de prevalências nas diferentes regiões geográficas no Brasil, 2002 2007

Considerando o Diabetes mellitus (DM) como um relevante problema de saúde no Brasil e a importância das estimativas de prevalência para planejamento e estratégias em saúde pública, propôs-se este trabalho com o objetivo de estimar a razão de prevalências do DM nos diferentes estados brasileiros nos períodos de 2002 a 2004 e 2005 a 2007. Trata-se de estudo descritivo, baseado em dados da população brasileira com diagnóstico de DM cadastrada no Sistema de Informação da Atenção Básica (SIAB) junto ao Ministério da Saúde. As taxas de prevalência foram calculadas para o período de 2002 a 2004 e para 2005 a 2007, e posteriormente estimou-se a Razão de Prevalências (R) por ponto e por intervalo de 95% de confiança (IC95%). Observou-se alta prevalência de DM nos estados brasileiros com aumento significativo (R>1; IC95%>1) entre os períodos em todos os estados brasileiros, com destaque para o Distrito Federal (R=1,9800; IC95%=1,97241,9876) e o estado do Maranhão (R=1,5217; IC95%=1,51981,5235). Pode-se concluir que houve aumento significativo na prevalência de DM no Brasil de 2002 a 2007, sinalizando para a necessidade de formulação de estratégias de prevenção e controle da doença.

Fitoterapia no sistema de saúde pública (SUS) no Estado de São Paulo, Brasil

Phytotherapy is a form of familiar treatment throughout the world and recommended by the World Health Organisation to be used in all regions, especially in the poorer countries, to improve the state of health of their people. The aim of this study was to describe the use of herbal medicine as an alternative therapy in the public health system in Sao Paulo State. The fieldwork consisted in obtaining information, from all the Regional Health Authorities in the State, about which municipal health areas use this therapy and sending them a questionnaire requesting details about the application of phitotherapy: when the therapy had been adopted, which plants were used, whether the programme had been discontinued or not and if so, for what reason. The cities that use the phytotherapy are: Campinas; Canas; Guaratingueta; Herculandia; Piquete; Pindamonhangaba; Roseira e Sao Jose do Barreiro, Ribeirao Preto, Sao Lourenço da Serra, Cruzeiro e Dobrada. And the three plant more used are: Guaco (Mikania glomerate); Calendula (Calendula officinalis) e Babosa (Aloe vera) The lack of support has led some Authorities to discontinue their active in 08 programmes. Nevertheless, it is concluded that the efficacy and low cost of herbal treatments has engendered a growing interest among health professionals in placing proposals for implanting this therapy in 13 cities in the Municipal Health. Thus, there should be growing practical support for the establishment of such programmes in the future.

Políticas e instituiçoes para desenvolvimento econômico territorial: o caso do Brasil

Incluye Bibliografía

Argentina, Bolivia, Brasil y Chile: pobreza y efectos sociodemográficos de la migración interna a inicios del siglo XXI

Incluye Bibliografía

A comunicação da informação de interesse público no Ministério Público do Estado do Mato Grosso do Sul

Pós-graduação em Comunicação - FAAC

Políticas públicas e a sustentabilidade da pesca marinha no Brasil

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)