Perspectives on sexual and reproductive health among women in an ancient mining area in Brazil

The purpose of this study was to describe the reproductive profile and frequency of genital infections among women living in the Serra Pelada, a former mining village in the Para state, Brazil. A descriptive study of women living in the mining area of Serra Pelada was performed in 2004 through interviews that gathered demographics and clinical data, and assessed risk behaviors of 209 randomly-selected women. Blood samples were collected for rapid assay for HIV; specimens were taken for Pap smears and Gram stains. Standard descriptive statistical analyses were performed and prevalence was calculated to reflect the relative frequency of each disease. Of the 209 participants, the median age was 38 years, with almost 70% having less than four years of education and 77% having no income or under 1.9 times the minimum wage of Brazil. About 30% did not have access to health care services during the preceding year. Risk behaviors included: alcohol abuse, 24.4%; illicit drug abuse, 4.3%; being a sex worker, 15.8%; and domestic violence, 17.7%. Abnormal Pap smear was found in 8.6%. Prevalence rates of infection were: HIV, 1.9%; trichomoniasis, 2.9%; bacterial vaginosis, 18.7%; candidiasis, 5.7%; Chlamydial-related cytological changes, 3.3%; and HPV-related cytological changes, 3.8%. Women living in this mining area in Brazil are economically and socially vulnerable to health problems. It is important to point out the importance of concomitant broader strategies that include reducing poverty and empowering women to make improvements regarding their health.

Response to AIDS in Brazil: contributions of social movements and the sanitary reform

This paper briefly outlines how the political scenario and the mobilization of different actors have contributed to the construction of a public health policy in response to the AIDS epidemics in Brazil. Three factors are presented and discussed: the political context of the 1980s, characterized by redemocratization, growth of social movements, and consolidation of the Brazilian health care reform; the socio-cultural context of the 1970s and 1980s, characterized by achievement of individual freedom, which was key to the organization of the AIDS movement; and finally the actions carried out in the international scenario to support the sustainability of the Brazilian domestic policy and the reinforcement of a global response to face the epidemics in lower-middle income economies.

Eosinophilic pneumonitis induced by aerosol-administered diesel oil and pyrethrum to mice

Objective. To confirm the episode of eosinophilic pneumonitis that occurred in March 2001 in Manaus, Amazon, northern Brazil, as secondary to home aerosolization with 2% cypermethrin diluted in diesel compared with the more conventional 1% cypermethrin and soybean solution used in prophylaxis of dengue. Methods. Four groups of Swiss mice were kept in polycarbonate cages aerosolized with one of the following solutions: diesel, diesel and cypermethrin, soy oil and cypermethrin, and saline. Three and 6 days after exposure, resistance and compliance of the respiratory system and white cell kinetics in peripheral blood and lung tissue were analyzed. Results. The group exposed to diesel and cypermethrin showed higher respiratory system resistance (p < 0.001), lower compliance (p = 0.03), and increased eosinophils in blood (p = 0.03) and lung tissue (p = 0.005) compared with the other groups. There was an increase of neutrophils in the blood of all experimental groups on the third day after exposure (p < 0.001). Conclusions. We concluded that diesel associated with cypermethrin induced lung hyperresponsiveness in this experimental model and was associated with increased polymorphonuclear cells (eosinophils and neutrophils) in blood and lungs. This effect is strongest on the third day after exposure. These results are similar to the episode that occurred in Manaus in 2001 and suggest that diesel plus cypermethrin home aerosolization for arbovirosis prophylaxis should be revised.

Characterization of autopsy-proven fatal asthma patients in Sao Paulo, Brazil

Few data are available on autopsy-proven fatal asthma patients in Sao Paulo, Brazil. We characterized 73 asthma patients who were autopsied at the Servico de Verificacao de Obitos do Universidade de Sao Paulo between 1996 and 2004. An interview with the next of kin assessed socioeconomic status, history, and treatment of asthma. There were 42 women and 31 men. Fifty-six (76.7%) of them were older than 34 years. Sixty-three percent were Caucasians, 77.3% had < 8 years of schooling, and the median income was 1.6 times the minimum wage. Twenty-two patients (30.1%) were smokers and 14 (19.2%) were ex-smokers. Only 25 (34.2%) patients were regularly followed by a doctor. Only 12.3% received inhaled steroids. Thirty-five patients (47.9%) had moderate-to-severe asthma. Fifty-five (75.3%) deaths took place outside a hospital, We conclude that this population shares characteristics of severe or poorly controlled asthma, low educational and socioeconomic levels, and lack of medical care and of inhaled steroid use.

Cost-effectiveness analysis of routine rotavirus vaccination in Brazil

Objective. The objective of this study was to conduct a cost-effectiveness analysis of a universal rotavirus vaccination program among children : 5 years of age in Brazil. Methods. Considering a hypothetical annual cohort of approximately 3 300 000 newborns followed over 5 years, a decision-tree model was constructed to examine the possible clinical and economic effects of rotavirus infection with and without routine vaccination of children. Probabilities and unit costs were derived from published research and national administrative data. The impact of different estimates for key parameters was studied using sensitivity analysis. The analysis was conducted from both healthcare system and societal perspectives. Results. The vaccination program was estimated to prevent approximately 1735 351 (54%) of the 3 210 361 cases of rotavirus gastroenteritis and 703 (75%) of 933 rotavirus-associated deaths during the 5-year period. At a vaccine price of 18.6 Brazilian reais (R$) per dose, this program would cost R$121 673 966 and would save R$38 536 514 in direct costs to the public healthcare system and R$71 778 377 in direct and indirect costs to society. The program was estimated to cost R$1 028 and R$1 713 per life-years saved (LYS)from the societal and healthcare system perspectives, respectively. Conclusions. Universal rotavirus vaccination was a cost-effective strategy for both perspectives. However, these findings are highly sensitive to diarrhea incidence rate, proportion of severe cases, vaccine coverage, and vaccine price.

Sociodemographic Correlates of Transitions from Alcohol Use to Disorders and Remission in the Sao Paulo Megacity Mental Health Survey, Brazil

Aims: To evaluate sociodemographic correlates associated with transitions from alcohol use to disorders and remission in a Brazilian population. Methods: Data are from a probabilistic, multi-stage clustered sample of adult household residents in the Sao Paulo Metropolitan Area. Alcohol use, regular use (at least 12 drinks/year), DSM-IV abuse and dependence and remission from alcohol use disorders (AUDs) were assessed with the World Mental Health version of the Composite International Diagnostic Interview. Age of onset (AOO) distributions of the cumulative lifetime probability of each alcohol use stage were prepared with data obtained from 5037 subjects. Correlates of transitions were obtained from a subsample of 2942 respondents, whose time-dependent sociodemographic data were available. Results: Lifetime prevalences were 85.8% for alcohol use, 56.2% for regular use, 10.6% for abuse and 3.6% for dependence; 73.4 and 58.8% of respondents with lifetime abuse and dependence, respectively, had remitted. The number of sociodemographic correlates decreased from alcohol use to disorders. All transitions across alcohol use stages up to abuse were consistently associated with male gender, younger cohorts and lower education. Importantly, low education was a correlate for developing AUD and not remitting from dependence. Early AOO of first alcohol use was associated with the transition of regular use to abuse. Conclusion: The present study demonstrates that specific correlates differently contribute throughout alcohol use trajectory in a Brazilian population. It also reinforces the need of preventive programs focused on early initiation of alcohol use and high-risk individuals, in order to minimize the progression to dependence and improve remission from AUD.

Knowledge and practices of medical students to prevent tuberculosis transmission in Rio de Janeiro, Brazil

Objectives. To describe knowledge, practices, and associated factors of medical students to prevent transmission of tuberculosis (TB) in five medical schools. Methods. Cross-sectional survey of undergraduate medical students in preclinical and in early and late clinical years. Information was obtained on sociodemographic profile, previous lectures on TB, knowledge about TB transmission, exposure to patients with active pulmonary TB, and use of respiratory protective masks. Results. Among 1 094 respondents, 575 (52.6%) correctly answered that coughing, speaking, and sneezing can transmit TB. Early [adjusted odds ratio = 4.0 (3.0, 5.5)] and late [adjusted odds ratio = 4.2 (3.1, 5.8)] clinical years were associated with correct answers, but having had previous lectures on TB was not. Among those who had previous lectures on TB, the rate of correct answers increased from 42.1% to 61.6%. Among 332 medical students who reported exposure to TB patients, 194 (58.4%) had not used protective masks. More years of clinical experience was associated with the use of masks [adjusted odds ratio = 2.9 (1.4, 6.1)], while knowledge was inversely associated with the use of masks [adjusted odds ratio = 0.4 (0.2, 0.6)]. Conclusions. Many medical students are not aware of the main routes of TB infection, and lectures on TB are not sufficient to change knowledge and practices. Regardless of knowledge about TB transmission, students engage in risky behaviors: more than two-thirds do not use a protective mask when examining an active TB case. We suggest innovative, effective active learning experiences to change this scenario.

Violence between intimate partners and alcohol use: prevalence and associated factors

Objective. To estimate physical violence between intimate partners and to examine the association between violence and sociodemographic variables, use of alcohol, and other related factors. Method. This epidemiologic survey included a stratified probabilistic sample representative of the population from the city of Sao Paulo in economic and educational terms. The Gender, Alcohol and Culture: An International Study (GENACIS) questionnaire was employed. The sampling unit was the home, where all individuals older than 18 years were candidates for interview. The final sample included 1 631 people. Statistical analysis employed the Rao Scott test and logistic regression. Results. The response rate was 74.5%. Most participants were female (58.8%), younger than 40 years of age (52%), or had 5 to 12 years of schooling. Of the overall group, 5.4% reported having been victims of physical violence by an intimate partner and 5.4% declared having been aggressors of intimate partners in the past 2 years. Most men declared that none of those involved had ingested alcohol at the moment of aggression. Most women reported that nobody or only the man had drunk. Being a victim or an aggressor was associated with younger age and having a heavy-drinking partner. Women suffered more serious aggression, requiring medical care, and expressed more anger and disgust at aggression than men. Conclusions. The results underscore the importance of the association between alcohol use and risk of aggression between intimate partners, and may contribute to the design of public policies aimed to control this situation.

Canine population dynamics: the potential effect of sterilization campaigns

Objective. To analyze, through mathematical modeling, the potential ability of sterilization campaigns to reduce the population density of pet dogs. Methods. Mathematical models were constructed to simulate the canine population dynamics and project the results of control strategies based on several sterilization rates. Results. Even at high sterilization rates (for example, 0.80 year(-1)), it would take approximately 5 years to reduce density by 20%. Even so, other sources of population growth, such as the importing of dogs from other geographic areas, could outweigh the effects of a sterilization program. Conclusions. A program`s effectiveness is contingent upon not only on the sterilization rate, but also the rate of population growth. Sterilization campaigns may potentially reduce population density, but this reduction may not be immediately evident.

Boletim eletr??nico de bibliografias especializadas: pol??tica energ??tica - setor el??trico

A implementa????o de uma Pol??tica Energ??tica ?? essencial para o desenvolvimento do Pa??s, na medida em que estabelece metas, meios e diretrizes para melhorar a confiabilidade e a qualidade do suprimento energ??tico. Ela define ainda o papel dos diversos agentes e institui????es que atuam na ??rea energ??tica brasileira. A exist??ncia de tal pol??tica ?? condi????o fundamental para garantir o planejamento das atividades energ??ticas, tanto do lado da produ????o quanto do consumo, sem comprometer o meio ambiente e a qualidade de vida das pr??ximas gera????es. Em fun????o da import??ncia da pol??tica energ??tica ao desenvolvimento sustent??vel e ?? melhoria do bemestar da popula????o brasileira, a 1?? edi????o de 2013 do Boletim Eletr??nico de Bibliografias Especializadas destaca o tema Pol??tica Energ??tica - Setor El??trico, com indica????es de publica????es pertencentes ao acervo da Biblioteca Graciliano Ramos/ENAP. O intuito ?? divulgar obras que possam auxiliar gestores, servidores e trabalhadores da ??rea de Energia no Brasil em seus processos decis??rios, assim como obras que tratam da rica hist??ria do setor e seus planos para o futuro.

Boletim eletr??nico de bibliografias especializadas: gest??o de crise

O terceiro Boletim de Bibliografias Especializadas apresenta o tema ???Gest??o de Crise???, com indica????es de livros e artigos de revistas sobre o tema pertencentes ao acervo da Biblioteca. Essas publica????es mostram que a gest??o de crise ?? uma problem??tica com a qual toda administra????o deve preocupar-se. Afinal, crise ?? um evento imprevis??vel capaz de provocar preju??zos significativos a uma institui????o e, consequentemente, aos seus integrantes. Uma quest??o que se apresenta ??: depois da crise instaurada, como gerenci??-la? O conhecimento das caracter??sticas de uma crise possibilitar?? compreend??-la melhor e facilitar?? o ??rduo esfor??o em gerenci??-la.

Boletim eletr??nico de bibliografias especializadas:acesso ?? informa????o p??blica

A Lei de Acesso ?? Informa????o (n??12.527/2011) entra em vigor hoje, dia 16 de maio, e traz importantes mudan??as para a administra????o p??blica. A nova legisla????o proporciona, ao cidad??o brasileiro, o acesso amplo ??s informa????es e a documentos p??blicos sob a guarda do Estado. A partir dessa data, todo cidad??o poder??, a qualquer momento, solicitar informa????es diversas, sem necessidade de motiva????o para seu uso, garantindo, assim, o exerc??cio de seu direito constitucional ao acesso ?? informa????o p??blica. A Lei estabelece que o acesso seja a regra e o sigilo, a exce????o. Diante desse cen??rio, o 5?? Boletim Eletr??nico de Bibliografias Especializadas destaca o tema ???Acesso ?? informa????o???, com indica????es de publica????es pertencentes ao acervo da Biblioteca Graciliano Ramos/ENAP. O intuito ?? divulgar obras que auxiliem servidores p??blicos na compreens??o dos princ??pios da nova Lei e na mudan??a da cultura do sigilo, ainda presente na gest??o da informa????o p??blica.

Boletim eletr??nico de bibliografias especializadas: pol??ticas p??blicas em direitos humanos

Os direitos humanos s??o os direitos essenciais a todos os seres humanos, sem que haja discrimina????o por ra??a, cor, g??nero, idioma, nacionalidade ou por qualquer outro motivo. Eles podem ser civis ou pol??ticos, como o direito ?? vida, ?? igualdade perante a lei e ?? liberdade de express??o. Podem tamb??m ser econ??micos, sociais e culturais, como o direito ao trabalho e ?? educa????o e coletivos, como o direito ao desenvolvimento. As Pol??ticas P??blicas em Direitos Humanos ?? tema deste boletim bibliogr??fico, o qual traz publica????es que mostram que estas n??o devem ser apenas programas governamentais, mas um instrumento de participa????o da sociedade civil na delimita????o do espa??o p??blico.

Boletim eletr??nico de bibliografias especializadas: gest??o de pessoas no servi??o p??blico

Diante de uma sociedade mais din??mica e complexa, a ado????o de uma pol??tica permanente de desenvolvimento do capital humano ?? o caminho para a supera????o dos desafios no setor p??blico. Dessa forma ?? poss??vel ofertar servi??os de excel??ncia aos cidad??os, bem como promover a inova????o e a melhoria na qualidade da gest??o p??blica. O presente Boletim apresenta uma sele????o de publica????es, dentre a vasta quantidade de obras sobre o tema existentes no acervo da Biblioteca Graciliano Ramos, que retratam os obst??culos existentes para o desenvolvimento de pessoas no servi??o p??blico, com o objetivo de convergir as necessidades e anseios dos quadros funcionais ??s necessidades organizacionais

Boletim eletr??nico de bibliografias especializadas: qualifica????o e valoriza????o dos servidores p??blicos

O dia do servidor p??blico ?? comemorado em 28 de outubro desde 1937, quando da cria????o do Conselho Federal do Servi??o P??blico Civil. Desde ent??o, muito se conquistou em rela????o ao reconhecimento desse profissional. Hoje, os servidores t??m consci??ncia da import??ncia de sua atua????o para o desenvolvimento econ??mico e social do pa??s. O incentivo aos servidores p??blicos, por meio de a????es voltadas ?? forma????o e ?? capacita????o permanentes, ?? fundamental para motiv??-los a prestar servi??os de excel??ncia aos cidad??os. Com base na pol??tica vigente e em homenagem ao dia do servidor, a Biblioteca Graciliano Ramos traz como tema de seu 9?? Boletim Eletr??nico de Bibliografias Especializadas uma sele????o de publica????es, pertencentes ao seu acervo, que abordam a quest??o da qualifica????o e da valoriza????o dos servidores p??blicos