Suicide rates and income in São Paulo and Brazil: a temporal and spatial epidemiologic analysis from 1996 to 2008

Abstract Background In a classical study, Durkheim noted a direct relation between suicide rates and wealth in the XIX century France. Since that time, several studies have verified this relationship. It is known that suicide rates are associated with income, although the direction of this association varies worldwide. Brazil presents a heterogeneous distribution of income and suicide across its territory; however, evaluation for an association between these variables has shown mixed results. We aimed to evaluate the relationship between suicide rates and income in Brazil, State of São Paulo (SP), and City of SP, considering geographical area and temporal trends. Methods Data were extracted from the National and State official statistics departments. Three socioeconomic areas were considered according to income, from the wealthiest (area 1) to the poorest (area 3). We also considered three regions: country-wide (27 Brazilian States and 558 Brazilian micro-regions), state-wide (645 counties of SP State), and city-wide (96 districts of SP city). Relative risks (RR) were calculated among areas 1, 2, and 3 for all regions, in a cross-sectional approach. Then, we used Joinpoint analysis to explore the temporal trends of suicide rates and SaTScan to investigate geographical clusters of high/low suicide rates across the territory. Results Suicide rates in Brazil, the State of SP, and the city of SP were 6.2, 6.6, and 5.4 per 100,000, respectively. Taking suicide rates of the poorest area (3) as reference, the RR for the wealthiest area was 1.64, 0.88, and 1.65 for Brazil, State of SP, and city of SP, respectively (p for trend <0.05 for all analyses). Spatial cluster of high suicide rates were identified at Brazilian southern (RR = 2.37), state of SP western (RR = 1.32), and city of SP central (RR = 1.65) regions. A direct association between income and suicide were found for Brazil (OR = 2.59) and the city of SP (OR = 1.07), and an inverse association for the state of SP (OR = 0.49). Conclusions Temporospatial analyses revealed higher suicide rates in wealthier areas in Brazil and the city of SP and in poorer areas in the State of SP. We further discuss the role of socioeconomic characteristics for explaining these discrepancies and the importance of our findings in public health policies. Similar studies in other Brazilian States and developing countries are warranted.

Assistência odontológica pública e suplementar no município de São Paulo na primeira década do século XXI

Na primeira década do século XXI registra-se a ocorrência de dois movimentos importantes no âmbito da assistência odontológica pública e privada no Brasil: a entrada da saúde bucal na agenda de prioridades políticas do governo federal e o vigoroso crescimento na oferta de serviços odontológicos suplementares. Analisou-se a ocorrência desses fenômenos no município de São Paulo, mediante a busca de dados nos documentos oficiais e nas bases eletrônicas da Prefeitura Municipal de São Paulo, do Ministério da Saúde e da Agência Nacional de Saúde Suplementar (ANS), além de consulta à literatura científica. No período estudado, de janeiro de 2000 a dezembro de 2009, com base em indicadores como a Cobertura de Primeira Consulta Odontológica Programática e a Cobertura Populacional Potencial, verificaram-se percentuais que caracterizam baixa assistência pública e uma situação de grande distanciamento do princípio constitucional do acesso universal aos cuidados odontológicos. O crescimento do número de beneficiários de serviços suplementares, por meio de planos exclusivamente odontológicos e de outros planos foi expressivo em igual período, correspondendo a uma importante ampliação da cobertura populacional nesta modalidade assistencial. Constata-se que, comparativamente ao quadro geral nacional, a situação do município de São Paulo revela precariedade no acesso à assistência odontológica pública, com reduzida oferta de serviços a adultos e idosos. Considerando, ainda, as limitações do mercado de serviços suplementares para prover assistência odontológica para todos os brasileiros, reforça-se a necessidade de continuidade e expansão do Brasil Sorridente, que é a expressão programática da Política Nacional de Saúde Bucal.

Promoção automática nos anos 1950: a experiência pioneira do Grupo Experimental da Lapa (São Paulo)

O presente artigo visa apresentar o projeto pioneiro de abolição da reprovação na rede estadual paulista, elaborado no final da década de 1950 e implantado no início de 1960, em caráter experimental, no Grupo Experimental da Lapa, escola que funcionava como unidade oficial de pesquisas da Secretaria da Educação. Apesar de inaugural, tal experiência raramente comparece em publicações sobre o tema, havendo poucos registros a seu respeito. Para tanto, o artigo esboça, a princípio, um breve contexto histórico do debate em torno da então chamada promoção automática, que se inicia no Brasil em 1918, no contexto da Primeira República, e ganha força, sobretudo, na década de 1950, no período desenvolvimentista. Em seguida, o texto aborda elementos constitutivos do projeto realizado no Grupo Experimental da Lapa, justificando a pertinência e a atualidade da promoção automática, bem como delineia sua formatação, em especial no que diz respeito à organização das classes, ao currículo, à avaliação e ao papel docente. Posto isso, são revelados trechos de depoimentos dados por educadores envolvidos na construção do referido projeto, os quais revelam suas potencialidades e contradições. Também são apresentados documentos raros sobre o tema publicados no contexto dessa experiência pioneira. Ao final, são tecidas considerações sobre a experiência em questão, a qual, apesar de pouco divulgada, possui enorme importância histórica. Espera-se, com este artigo, contribuir para a construção da escola pública de qualidade, principalmente considerando a crescente implantação da política de ciclos nas redes públicas educacionais brasileiras.

A cátedra UNESCO de direito à educação da Faculdade de Direito: democracia, cidadania e direito à educação

Regimes democráticos se consolidam na medida de sua aceitação pela maioria, o que supõe conhecimento e confiança nas instituições políticas e jurídicas. A educação de qualidade é relevante para a governança democrática e para a formação da cidadania, posto propiciar o acesso a ferramentas cognitivas necessárias para a participação política relevante. As interações entre a democracia, o direito à educação e as políticas públicas de educação são analisadas pela Cátedra UNESCO no projeto de pesquisa “Brasil 25 anos de democracia” sob o ângulo da função promocional do Direito à Educação da FD, em parceria com o Núcleo de Políticas Públicas da USP, com. O foco da pesquisa é a atividade do Supremo Tribunal Federal (STF), a do Superior Tribunal de Justiça (STJ) e a do Congresso Nacional, no período compreendido entre os anos 2000 e 2010.

Valutazione dell'impatto della farmacogenetica in ambito di Sanità Pubblica. Analisi del polimorfismo genetico dell'enzima CYP2D6 metabolizzante xenobiotici.

Pharmacogenetic testing provides an outstanding opportunity to improve prescribing safety and efficacy. In Public health policy pharmacogenetics is relevant for personalized therapy and to maximize therapeutic benefit minimizing adverse events. CYP2D6 is known to be a key enzyme responsible for the biotransformation of about 25-30% of extensively used drugs and genetic variations in genes coding for drug-metabolizing enzymes might lead to adverse drug reactions, toxicity or therapeutic failure of pharmacotherapy. Significant interethnic differences in CYP2D6 allele distribution are well established, but immigration is reshaping the genetic background due to interethnic admixture which introduces variations in individual ancestry resulting in distinct level of population structure. The present thesis deals with the genetic determination of the CYP2D6 alleles actually present in the Emilia-Romagna resident population providing insights into the admixture process. A random sample of 122 natives and 175 immigrants from Africa, Asia and South America where characterized considering the present scenario of migration and back migration events. The results are consistent with the known interethnic genetic variation, but introduction of ethnic specific variants by immigrants predicts a heterogeneous admixed population scenario requiring, for drugs prescription and pharmacogenetics studies, an interdisciplinary approach applied in a properly biogeographical and anthropological frame. To translate pharmacogenetics knowledge into clinical practice requires appropriated public health policies, possibly guiding clinicians to evaluate prospectively which patients have the greatest probability of expressing a variant genotype.

Conflict affected peoples’ access to education: IDP pupils in Georgia

This work seeks to understand what kind of impact educational policies have had on the secondary school students among internally displaced persons (IDPs) and their identity reconstruction in Georgia. The study offers a snapshot of the current situation based on desk study and interviews conducted among a sample of secondary school IDP pupils. In the final chapter, the findings will be reflected against the broader political context in Georgia and beyond. The study is interdisciplinary and its methodology is based on social identity theory. I shall compare two groups of IDPs who were displaced as a result of two separate conflicts. The IDPs displaced as a result of conflict in Abkhazia in 1992–1994 are named as old caseload IDPs. The second group of IDPs were displaced after a conflict in South Ossetia in 2008. Additionally, I shall touch upon the situation of the pupils among the returnees, a group of Georgian old caseload IDPs, who have spontaneously returned to de facto Abkhazia. According to the interviews, the secondary school student IDPs identify themselves strongly with the Georgian state, but their group identities are less prevailing. Particularly the old case load IDP students are fully integrated in local communities. Moreover, there seems not to be any tangible bond between the old and new caseload IDP students. The schools have neither tried nor managed to preserve IDP identities which would, for instance, make political mobilisation likely along these lines. Right to education is a human right enshrined in a number of international conventions to which the IDPs are also entitled. Access to education or its denial has a deep impact on individual and societal development. Furthermore, education has a major role in (re)constructing personal as well as national identity.

Capacita' e formazione nel liberalismo di Amartya Sen e Martha Nussbaum. Eredita' differenti del pensiero politico per una "cittadinanza del mondo"

Il presente lavoro di ricerca si propone di discutere il contributo che l’analisi dell’evoluzione storica del pensiero politico occidentale e non occidentale riveste nel percorso intellettuale compiuto dai fondatori della teoria contemporanea dell’approccio delle capacità, fondata e sistematizzata nei suoi contorni speculativi a partire dagli anni Ottanta dal lavoro congiunto dell’economista indiano Amartya Sen e della filosofa dell’Università di Chicago Martha Nussbaum. Ci si ripropone di dare conto del radicamento filosofico-politico del lavoro intellettuale di Amartya Sen, le cui concezioni economico-politiche non hanno mai rinunciato ad una profonda sensibilità di carattere etico, così come dei principali filoni intorno ai quali si è imbastita la versione nussbaumiana dell’approccio delle capacità a partire dalla sua ascendenza filosofica classica in cui assume una particolare primazia il sistema etico-politico di Aristotele. Il pensiero politico moderno, osservato sotto il prisma della riflessione sulla filosofia della formazione che per Sen e Nussbaum rappresenta la “chiave di volta” per la fioritura delle altre capacità individuali, si organizzerà intorno a tre principali indirizzi teorici: l’emergenza dei diritti positivi e sociali, il dibattito sulla natura della consociazione nell’ambito della dottrina contrattualista e la stessa discussione sui caratteri delle politiche formative. La sensibilità che Sen e Nussbaum mostrano nei confronti dell’evoluzione del pensiero razionalista nel subcontinente che passa attraverso teorici antichi (Kautylia e Ashoka) e moderni (Gandhi e Tagore) segna il tentativo operato dai teorici dell’approccio delle capacità di contrastare concezioni politiche contemporanee fondate sul culturalismo e l’essenzialismo nell’interpretare lo sviluppo delle tradizioni culturali umane (tra esse il multiculturalismo, il comunitarismo, il neorealismo politico e la teoria dei c.d. “valori asiatici”) attraverso la presa di coscienza di un corredo valoriale incentrato intorno al ragionamento rintracciabile (ancorché in maniera sporadica e “parallela”) altresì nelle tradizioni culturali e politiche non occidentali.

Can wild ungulate carcasses provide enough biomass to maintain avian scavenger populations? An empirical assessment using a bio-inspired computational model

Background The reduction in the amount of food available for European avian scavengers as a consequence of restrictive public health policies is a concern for managers and conservationists. Since 2002, the application of several sanitary regulations has limited the availability of feeding resources provided by domestic carcasses, but theoretical studies assessing whether the availability of food resources provided by wild ungulates are enough to cover energetic requirements are lacking. Methodology/Findings We assessed food provided by a wild ungulate population in two areas of NE Spain inhabited by three vulture species and developed a P System computational model to assess the effects of the carrion resources provided on their population dynamics. We compared the real population trend with to a hypothetical scenario in which only food provided by wild ungulates was available. Simulation testing of the model suggests that wild ungulates constitute an important food resource in the Pyrenees and the vulture population inhabiting this area could grow if only the food provided by wild ungulates would be available. On the contrary, in the Pre-Pyrenees there is insufficient food to cover the energy requirements of avian scavenger guilds, declining sharply if biomass from domestic animals would not be available. Conclusions/Significance Our results suggest that public health legislation can modify scavenger population trends if a large number of domestic ungulate carcasses disappear from the mountains. In this case, food provided by wild ungulates could be not enough and supplementary feeding could be necessary if other alternative food resources are not available (i.e. the reintroduction of wild ungulates), preferably in European Mediterranean scenarios sharing similar and socio-economic conditions where there are low densities of wild ungulates. Managers should anticipate the conservation actions required by assessing food availability and the possible scenarios in order to make the most suitable decisions.

Is the Median Voter Decisive? Evidence of 'Ends Against the Middle' From Referenda Voting Patterns

This paper examines whether the voter with the median income is decisive in local spending decisions. Previous tests have relied on cross-sectional data while we make use of a pair of California referenda to estimate a first difference specification. The referenda proposed to lower the required vote share for passing local educational bonding initiatives from 67 to 50 percent and 67 to 55 percent, respectively. We find that voters rationally consider future public service decisions when deciding how to vote on voting rules, but the empirical evidence strongly suggests that an income percentile below the median is decisive for majority voting rules. This finding is consistent with high income voters with weak demand for public educational services voting with the poor against increases in public spending on education.

The experience and meaning of injury among migrant farmworkers from Starr County, Texas

Occupational injuries suffered by migrant farmworkers in the United States continue to be a significant byproduct of the hazards of the agricultural work sector. Although the fields of study involving occupational health and safety have helped to further an understanding of the importance of injury prevention in the workplace, farmworkers have typically not been the beneficiaries of significant improvement in working conditions; similarly, public health policies have generally not been successful in significantly improving their protection. The primary objective of this research was to examine more closely, through in-depth interviews, the underlying reasons attributed by migrant farmworkers to their having suffered occupational injuries. By re-contacting and re-interviewing migrant farmworkers who had reported injuries in a study entitled A Cohort Study of Injuries in Migrant Farmworker Families in South Texas, the current research study employed qualitative research methods and determined several reasons that may help to explain why this specific group has suffered injuries and may not have reported such injuries, as well as to consider what their experiences may say about injury prevention within the context of public health.^

Factors affecting prenatal care use and pregnancy outcome in Texas: A comparative study among and within Black, Anglo, and Hispanic populations

This research project is a study in the field of public health to test the relationships of demographic, socioeconomic, behavioral, and biological factors with (1) prenatal care use and (2) pregnancy outcome, measured by birth weight. It has been postulated that demographic, socioeconomic, and behavioral factors are associated with differences in the use of prenatal care services. It has also been postulated that differences in demographic, socioeconomic, behavioral, and biological factors result in differences in birth weight. This research attempts to test these two basic conceptual frameworks. At the same time, an attempt is made to determine the population groups and subgroups that are at increased risk (1) of using fewer prenatal care visits, and (2) of displaying a higher incidence of low birth weight babies. An understanding of these relationships of the demographic, socioeconomic, behavioral, and biological factors in the use of prenatal care visits and pregnancy outcome, measured by birth weight, will potentially offer guidance in the planning and policy development of maternal and child health services. The research considers four major components of maternal characteristics: (1) Demographic factors. Ethnicity, household size, maternal parity, and maternal age; (2) Socioeconomic factors. Maternal education, family income, maternal employment, health insurance coverage, and household dwelling; (3) Behavioral factors. Maternal smoking, attendance at child development classes, mother's first prenatal care visit, total number of prenatal care visits, and adequacy of care; and, (4) Biological factors. Maternal weight gain during pregnancy.^ The research considers 16 independent variables and two dependent variables.^ It was concluded that: (1) Generally, differences in demographic, socioeconomic, and behavioral factors were associated with differences in the average number of prenatal care visits between and within population groups and subgroups. The Hispanic mothers were the lowest users of prenatal care services. (2) In some cases, differences in demographic, socioeconomic, behavioral, and biological factors demonstrated differences in the average birth weight of infants between and within population groups and subgroups. (3) Differences in demographic, socioeconomic, behavioral, and biological factors resulted in differences in the rates of low birth weight babies between and within population groups and subgroups. The Black mothers delivered the highest incidence of low birth weight infants.^ These findings could provide guidance in the formulation of public health policies such as MCH services, an increase in the use of prenatal care services by prospective mothers, resulting in reduction of the incidence of low birth weight babies, and consequently aid in reducing the rates of infant mortality. ^

THE CLINICAL AND PARASITOLOGIC COURSES OF PLASMODIUM FALCIPARUM AND PLASMODIUM VIVAX INFECTIONS IN HUMANS: AN ANALYSIS OF 432 EPISODES OF INDUCED MALARIA IN THE JESSUP VOLUNTEER STUDIES, 1966-1975

The clinical records of 432 P. falciparum and P. vivax infected volunteer male inmates of the Maryland House of Corrections in Jessup, Maryland, were studied to determine (1) the clinical and parasitologic courses of infections in both parasite species, and (2) the influence of previous homologous and/or heterologous strain exposures on subsequent infections. The clinical and parasitologic courses of infection with both P. falciparum and P. vivax species indicated that: (a) there were characteristic strain related differences between P. falciparum and P. vivax. P. falciparum strains were more apt to cause severe infections than P. vivax strains. (b) Blood-induced infections produced significantly shorter prepatent and incubation periods than mosquito-induced. (c) Blacks tolerated the infections better than whites and, (d) homologous and heterologous strain immunities persisted with previous malaria history. In previously exposed cases, clinical manifestations were moderate, peak fever lowered, and peak parasitemias limited. (e) Anti-malarial drugs were effective in reducing sexual and asexual forms of the malaria parasite, and limiting peak fevers, irrespective of method of induction, race, parasite strain and species, and drug type used.^ Given these findings, and the current worldwide resurgence of malaria, this study has major implications in terms of setting malaria control and public health policies in both developed and developing countries.^

El orden político "liberal conservador" en la Argentina de la generación del '80

En Argentina, el liberalismo y el conservadorismo, constituyen el trasfondo ideológico del sistema político de la generación de 1880. A partir de 1880 se consolidan las instituciones políticas y se definen los rasgos centrales de la sociedad argentina, la que sufrirá profundas transformaciones al influjo del crecimiento económico, demográfico y de las políticas de educación pública. La empresa política es protagonizada por los hombres del "80", quienes constituyen la primera "generación argentina" que concreta ese nuevo espíritu que surge en el "53": coexistencia de amplias libertades civiles y económicas junto a una estructura con rasgos centralizadores, con claro predominio del órgano ejecutivo como reaseguro contra las tendencias anárquicas.

Éxitos y desafíos en política de transporte público : análisis comparativo de las innovaciones en la prestación del servicio de transporte público de pasajeros en las ciudades de Curitiba, Brasil; Santiago de Chile, Chile y Rosario, Argentina

En esta artículo realizamos un análisis comparativo de los sistemas de servicio de transporte público de pasajeros en las ciudades de Curitiba, Brasil; Santiago de Chile, Chile y Rosario, Argentina para poder comparar las similitudes, diferencias y dificultades que presentan estos sistemas en la etapa de implementación de las políticas públicas; como así también presentar una sistematización de las políticas, instrumentos y acciones que permitieron gestionar con éxito las reestructuraciones de los sistemas de transporte y sus aportes para el desarrollo de una Política pública de transporte en el Gran Mendoza.