Health in Brazil 2 Maternal and child health in Brazil: progress and challenges

In the past three decades, Brazil has undergone rapid changes in major social determinants of health and in the organisation of health services. In this report, we examine how these changes have affected indicators of maternal health, child health, and child nutrition. We use data from vital statistics, population censuses, demographic and health surveys, and published reports. In the past three decades, infant mortality rates have reduced substantially, decreasing by 5.5% a year in the 1980s and 1990s, and by 4.4% a year since 2000 to reach 20 deaths per 1000 livebirths in 2008. Neonatal deaths account for 68% of infant deaths. Stunting prevalence among children younger than 5 years decreased from 37% in 1974-75 to 7% in 2006-07. Regional differences in stunting and child mortality also decreased. Access to most maternal-health and child-health interventions increased sharply to almost universal coverage, and regional and socioeconomic inequalities in access to such interventions were notably reduced. The median duration of breastfeeding increased from 2.5 months in the 1970s to 14 months by 2006-07. Official statistics show stable maternal mortality ratios during the past 10 years, but modelled data indicate a yearly decrease of 4%, a trend which might not have been noticeable in official reports because of improvements in death registration and the increased number of investigations into deaths of women of reproductive age. The reasons behind Brazil`s progress include: socioeconomic and demographic changes (economic growth, reduction in income disparities between the poorest and wealthiest populations, urbanisation, improved education of women, and decreased fertility rates), interventions outside the health sector (a conditional cash transfer programme and improvements in water and sanitation), vertical health programmes in the 1980s (promotion of breastfeeding, oral rehydration, and immunisations), creation of a tax-funded national health service in 1988 (coverage of which expanded to reach the poorest areas of the country through the Family Health Program in the mid-1990s); and implementation of many national and state-wide programmes to improve child health and child nutrition and, to a lesser extent, to promote women`s health. Nevertheless, substantial challenges remain, including overmedicalisation of childbirth (nearly 50% of babies are delivered by caesarean section), maternal deaths caused by illegal abortions, and a high frequency of preterm deliveries.

Genetic variation and population structure of the endangered Hyacinth Macaw (Anodorhynchus hyacinthinus): implications for conservation

The Hyacinth Macaw (Anodorhynchus hyacinthinus) is one of 14 endangered species in the family Psittacidae occurring in Brazil, with an estimated total population of 6,500 specimens. We used nuclear molecular markers (single locus minisatellites and microsatellites) and 472 bp of the mitochondrial DNA control region to characterize levels of genetic variability in this species and to assess the degree of gene flow among three nesting sites in Brazil (Pantanal do Abobral, Pantanal de Miranda and Piaui). The origin of five apprehended specimens was also investigated. The results suggest that, in comparison to other species of parrots, Hyacinth Macaws possess relatively lower genetic variation and that individuals from two different localities within the Pantanal (Abobral and Miranda) belong to a unique interbreeding population and are genetically distinct at nuclear level from birds from the state of Piaui. The analyses of the five apprehended birds suggest that the Pantanal is not the source of birds for illegal trade, but their precise origin could not be assigned. The low genetic variability detected in the Hyacinth Macaw does not seem to pose a threat to the survival of this species. Nevertheless, habitat destruction and nest poaching are the most important factors negatively affecting their populations in the wild. The observed genetic structure emphasizes the need of protection of Hyacinth Macaws from different regions in order to maintain the genetic diversity of this species.

Description of two new species of Avicularia Lamarck 1818 and redescription of Avicularia diversipes (C. L. Koch 1842) (Araneae, Theraphosidae, Aviculariinae)-three possibly threatened Brazilian species

Avicularia diversipes (C. L. Koch 1842) known previously only from its original description is redescribed along with Avicularia sooretama sp. nov. and Avicularia gamba sp. nov. The three species are endemic to Brazilian Atlantic rainforest. With other Avicularia species, they share a procurved anterior eye row, slender embolus and medially folded spermathecae, whereas they have unusual characters, such as a very long and spiraled embolus (A. diversipes) and spermathecae with multilobular apex (A. sooretama sp. nov.). Furthermore, the three species lack a tibial apophysis in males and share a distinctive color pattern ontogeny that is not known in any other Avicularia species. The conservation status of the three species is discussed, especially with respect to endemism, illegal trafficking and habitat destruction. The creation of protected areas in southern State of Bahia, Brazil, is recommended, as well as the inclusion of these species in IUCN and CITES lists. Appendices with figures and species information are presented to facilitate correct specimen identification by custom officers, in order to limit illegal traffic.

Artificial Neural Networks and the Study of the Psychoactivity of Cannabinoid Compounds

Cannabinoid compounds have widely been employed because of its medicinal and psychotropic properties. These compounds are isolated from Cannabis sativa (or marijuana) and are used in several medical treatments, such as glaucoma, nausea associated to chemotherapy, pain and many other situations. More recently, its use as appetite stimulant has been indicated in patients with cachexia or AIDS. In this work, the influence of several molecular descriptors on the psychoactivity of 50 cannabinoid compounds is analyzed aiming one obtain a model able to predict the psychoactivity of new cannabinoids. For this purpose, initially, the selection of descriptors was carried out using the Fisher`s weight, the correlation matrix among the calculated variables and principal component analysis. From these analyses, the following descriptors have been considered more relevant: E(LUMO) (energy of the lowest unoccupied molecular orbital), Log P (logarithm of the partition coefficient), VC4 (volume of the substituent at the C4 position) and LP1 (Lovasz-Pelikan index, a molecular branching index). To follow, two neural network models were used to construct a more adequate model for classifying new cannabinoid compounds. The first model employed was multi-layer perceptrons, with algorithm back-propagation, and the second model used was the Kohonen network. The results obtained from both networks were compared and showed that both techniques presented a high percentage of correctness to discriminate psychoactive and psychoinactive compounds. However, the Kohonen network was superior to multi-layer perceptrons.

Organisationer, ojämlikhet, migration : förändringar av den etniska arbetsdelningen i svensk byggnadssektor

Organizations, Inequality, Migration – Changes of the Ethnic Division of Labour in the Swedish Construction Sector During the 1990s the number of migrants from Eastern Europe increased in the Swedish construction sector. This article examines how this change was initiated by changes in the organizational population in the construction sector. The gradual enlargement of the European Union changed the institutional framework for organizations in Sweden. This created increased opportunities for new organizational forms in the construction sector. The specific niche of the new organizations was to recruit and hire out workers from Eastern Europe that were paid lower wages than Swedish workers. The diffusion of this organizational form contributed to a change of norms and beliefs about what was legitimate and illegitimate when employing migrants. This implies that the inequalities that this organizational form introduces have gained increased legitimacy in Sweden. Or in other words, it has become increasingly socially acceptable to pay migrants lower wages than Swedish workers

Soft computing in biometrics : a pragmatic appraisal

The ever increasing spurt in digital crimes such as image manipulation, image tampering, signature forgery, image forgery, illegal transaction, etc. have hard pressed the demand to combat these forms of criminal activities. In this direction, biometrics - the computer-based validation of a persons' identity is becoming more and more essential particularly for high security systems. The essence of biometrics is the measurement of person’s physiological or behavioral characteristics, it enables authentication of a person’s identity. Biometric-based authentication is also becoming increasingly important in computer-based applications because the amount of sensitive data stored in such systems is growing. The new demands of biometric systems are robustness, high recognition rates, capability to handle imprecision, uncertainties of non-statistical kind and magnanimous flexibility. It is exactly here that, the role of soft computing techniques comes to play. The main aim of this write-up is to present a pragmatic view on applications of soft computing techniques in biometrics and to analyze its impact. It is found that soft computing has already made inroads in terms of individual methods or in combination. Applications of varieties of neural networks top the list followed by fuzzy logic and evolutionary algorithms. In a nutshell, the soft computing paradigms are used for biometric tasks such as feature extraction, dimensionality reduction, pattern identification, pattern mapping and the like.

Medical students are afraid to include abortion in their future practices : in-depth interviews in Maharastra, India

BACKGROUND: Unsafe abortions are estimated to cause eight per-cent of maternal mortality in India. Lack of providers, especially in rural areas, is one reason unsafe abortions take place despite decades of legal abortion. Education and training in reproductive health services has been shown to influence attitudes and increase chances that medical students will provide abortion care services in their future practice. To further explore previous findings about poor attitudes toward abortion among medical students in Maharastra, India, we conducted in-depth interviews with medical students in their final year of education. METHOD: We used a qualitative design conducting in-depth interviews with twenty-three medical students in Maharastra applying a topic guide. Data was organized using thematic analysis with an inductive approach. RESULTS: The participants described a fear to provide abortion in their future practice. They lacked understanding of the law and confused the legal regulation of abortion with the law governing gender biased sex selection, and concluded that abortion is illegal in Maharastra. The interviewed medical students' attitudes were supported by their experiences and perceptions from the clinical setting as well as traditions and norms in society. Medical abortion using mifepristone and misoprostol was believed to be unsafe and prohibited in Maharastra. The students perceived that nurse-midwives were knowledgeable in Sexual and Reproductive Health and many found that they could be trained to perform abortions in the future. CONCLUSIONS: To increase chances that medical students in Maharastra will perform abortion care services in their future practice, it is important to strengthen their confidence and knowledge through improved medical education including value clarification and clinical training.

The discourses on induced abortion in Ugandan daily newspapers : a discourse analysis

Background: Ugandan law prohibits abortion under all circumstances except where there is a risk for the woman's life. However, it has been estimated that over 250 000 illegal abortions are being performed in the country yearly. Many of these abortions are carried out under unsafe conditions, being one of the most common reasons behind the nearly 5000 maternal deaths per year in Uganda. Little research has been conducted in relation to societal views on abortion within the Ugandan society. This study aims to analyze the discourse on abortion as expressed in the two main daily Ugandan newspapers. Method: The conceptual content of 59 articles on abortion between years 2006-2012, from the two main daily English-speaking newspapers in Uganda, was studied using principles from critical discourse analysis. Results: A religious discourse and a human rights discourse, together with medical and legal sub discourses frame the subject of abortion in Uganda, with consequences for who is portrayed as a victim and who is to blame for abortions taking place. It shows the strong presence of the Catholic Church within the medial debate on abortion. The results also demonstrate the absence of medial statements related to abortion made by political stakeholders. Conclusions: The Catholic Church has a strong position within the Ugandan society and their stance on abortion tends to have great influence on the way other actors and their activities are presented within the media, as well as how stakeholders choose to convey their message, or choose not to publicly debate the issue in question at all. To decrease the number of maternal deaths, we highlight the need for a more inclusive and varied debate that problematizes the current situation, especially from a gender perspective.

Ethics in a capitalistic society

The problem of semantics is inherent in any discussion of ethics. The general term "ethics" is itself commonly confused. In addition, systems of ethics must be built upon assumptions, and assumptions are necessarily subject to lengthy debate. These two problems are encountered in my investigation of the ethical practices of the modern business community and to remedy the situation I have taken two steps: the first being an attempt to clarify the meaning of terms used therein;-and the second being a clear description of the assumptions utilized to further my analysis. To satisfy those who would disagree with these assumptions, I have attempted to outline the consequences of differing premises. The first assumption in my discussion is that the capitalistic economy is powered by the motivation supplied by man's self-interest. We are conditioned to basing our courses of action upon an orientation toward gratifying this self-interest. Careers are chosen by blending aptitude, interest, and remuneration. of course, some people are less materially inclined than others, but the average member of our capitalistic society is concerned with the physical rewards derived from his employment. Status and happiness are all-important considerations in pursuing a chosen course of action, yet all too often they are measured in physical terms. The normal self-interest natural to mankind is heightened in capitalism, due to the emphasis placed upon material compensation. Our thinking becomes mechanistic as life devolves into a complex game played by the rules. We are accustomed to performing meaningless or unpleasant duties to fulfill our gratifications. Thought, consequently, interferes with the completion of our everyday routines. We learn quickly not to be outspoken, as the outspoken one threatens the security of his fellow man. The majority of the people are quite willing to accept others views on morality, and indeed this is the sensible thing to do as one does not risk his own neck. The unfortunate consequence of this situation has been the substitution of the legal and jural for the moral and ethical. Our actions are guided by legal considerations and nowhere has this been more evident than in the business community. The large legal departments of modern corporations devote full time to inspecting the legality of corporate actions. The business community has become preoccupied with the law, yet this is necessarily so. Complex, modern, capitalistic society demands an elaborate framework of rules and regulations. Without this framework it would be impossible to have an orderly economy, to say nothing of protecting the best interests of the people. However, the inherent complexities, contradictions, and sometimes unfair aspects of our legal system can tempt men to take things into their own hands. From time to time cases arise where men have broken laws while acting in good faith, and other cases where men have been extremely unethical without being illegal. Examples such as these foster the growth of cynicism, and generally create an antagonistic attitude toward the law on the part of business. My second assumption is that the public, on the whole, has adopted an apathetic attitude toward business morality. when faced with an ethical problem, far too many people choose to cynically assume that, if I don't do it someone else will. "The danger of such an assumption lies in that it eliminates many of the inhibitions that normally would preclude unethical action. The preventative factor in contemplating an unethical act not only lies in it going against the "right course of action", but also in that it would display the actor as one of the few, immoral practitioners. However, if the contemplator feels that many other people follow the same course of action, he would not feel himself to be so conspicuous. These two assumptions underly my entire discussion of modern business ethics., and in my judgment are the two most important causal factors in unethical acts perpetrated by the business community. The future elimination of these factors seems improbable, if not futile, yet there is no reason to consider things worse than they ever have been before. The heightened public interest in business morality undoubtedly lies in part in the fact that examples of corporate malpractice are of such magnitude in scope, and hence more newsworthy.

Protecting Your Search Privacy: A Lesson Plan

Each year search engines like Google, Bing and Yahoo, complete trillions of search queries online. Students are especially dependent on these search tools because of their popularity, convenience and accessibility. However, what students are unaware of, by choice or naiveté is the amount of personal information that is collected during each search session, how that data is used and who is interested in their online behavior profile. Privacy policies are frequently updated in favor of the search companies but are lengthy and often are perused briefly or ignored entirely with little thought about how personal web habits are being exploited for analytics and marketing. As an Information Literacy instructor, and a member of the Electronic Frontier Foundation, I believe in the importance of educating college students and web users in general that they have a right to privacy online. Class discussions on the topic of web privacy have yielded an interesting perspective on internet search usage. Students are unaware of how their online behavior is recorded and have consistently expressed their hesitancy to use tools that disguise or delete their IP address because of the stigma that it may imply they have something to hide or are engaging in illegal activity. Additionally, students fear they will have to surrender the convenience of uber connectivity in their applications to maintain their privacy. The purpose of this lightning presentation is to provide educators with a lesson plan highlighting and simplifying the privacy terms for the three major search engines, Google, Bing and Yahoo. This presentation focuses on what data these search engines collect about users, how that data is used and alternative search solutions, like DuckDuckGo, for increased privacy. Students will directly benefit from this lesson because informed internet users can protect their data, feel safer online and become more effective web searchers.

Crime and punishment with habit formation

Moral concepts affect crime supply. This idea is modelled assuming that illegal activities is habit forming. We introduce habits in a intertemporal general equilibrium framework to illegal activities and compare its outcomes with a model without habit formation. The findings are that habit and crime presents a non linear relationship that hinges upon the level of capital and habit formation. It is possible to show that while the effect of habit on crime is negative for low levels o habit formation it becomes positive as habits goes up. Secondly habit reduces the marginal effect of illegal activities return on crime. Finally, the effect of habit on crime depends positively on the amount of capital. This could explain the relationship between size of cities and illegal activity.

The insurance function of contracts

One of the central problems in contract law is to define the frontier between legal and illegal breaches of promises. The distinction between good and bad faith is perhaps the conceptual tool most commonly used to tell one from the other. Lawyers spend a lot of energy trying to frame better definitions of the concepts of good and bad faith based on principles of ethics or justice, but often pay much less attention to theories dealing with the incentives that can engender good faith behavior in contractual relationships. By describing the economics of what Stiglitz defined as “explicit” and “implicit” insurance, I highlight the “insurance function” hidden in any promise with basically no mathematical notation. My aim is to render the subject intelligible and useful to lawyers with little familiarity with economics.

Desenvolvimento econômico e mercado de trabalho urbano no nordeste brasileiro

A história recente do Nordeste caracteriza-se por uma primeira fase de isolamento e outra de articulação. Nessa segunda fase, o dinamismo que se instala a partir da década de sessenta provocou profundas transformações na economia da região. Essas transformações implicaram em elevadas taxas de expansão do produto regional, alterações na estrutura produtiva através da adoção de novos processos de trabalho que implicou de um lado, na redução da demanda por trabalho e de outro, na sua expansão. Registrou-se, também, mudanças bastante significativas nos gêneros industriais reduzindo a participação na produção das indústrias de bens de consumo não-duráveis e aumentando de modo importante a participação das indústrias de bens intermediários voltadas para o mercado nacional e internacional, o que contribui para aumentar a dependência do Nordeste em relação as regiões mais ricas. As mudanças iniciadas no setor industrial se propagam para os setores primários, secundários e terciários. No setor agrícola, as transformações dificultaram a sobrevivência do trabalhador, ampliaram as relações capitalistas no setor manifestas na maior proletarização da mão-de-obra rural; estimularam as emigrações para. as cidades e elevaram consideravelmente a participação da população ocupada em atividades predominantemente urbanas. No setor terciário, as mudanças provocaram o incremento do subemprego, grande diferenciação nos 11 níveis de produtividade e rendimentos, gerando um quadro de aprofundamento da heterogeneidadeda estrutura produtiva e do mercado de trabalho. Adicionalmente, houve uma excessiva urbanização, aumento da concentração da renda, incremento do grau de informalidade, crescimento do número de empregados clandestinos e maior participação dos menores e adultos no mercado de trabalho. Tudo isso, ocorreu,associado ao quadro de dinamismo das atividades produtivas, sem paralelo na história recente das regiões atrasadas do pais. A análise dos dados também mostrou que o nível do desemprego aberto, é relativamente baixo tanto para os homens como para as mulheres. Isto ocorre porque na expansão ou na retração econômica as flutuações no nível de ocupação são acampanhadas por modificações da taxa de participação da PIA no mercado de trabalho. Portanto, a recente infonnalidade, fonnalidade e submersão da mão-de-obra no Nordeste estão associadas a um contexto de crescimento da economia e, por conseguinte, resultam do estilo ou padrão de acumulação de capital que, mesmo se realizando com altas taxas de expansão, não repercute positivamente no mercado de trabalho, nos tennos requeridos pela oferta de mão-de-obra. Assim, o aparecimento de um excedente relativo de população é resultado do padrão de acumulação da capital da economia regional, que está associado ao modo como o Nordeste se inseriu no contexto nacional e, nesse sentido, é o padrão de industrialização o principal fator responsável por parte importante do insucesso da economia local em absorver produtivamente a população que se apresenta no mercado de trabalho urbano

Adolescência e infecção pelo HIV : situações de risco e proteção, autoconceito e sintomatologia psiquiátrica

Esta dissertação tem como objetivo identificar, através de um estudo transversal, associações entre as características demográficas, comportamentos de risco sexual e por drogas, sintomatologia psiquiátrica e autoconceito em uma amostra de adolescentes, comparando-os pela soropositividade HIV. Foram entrevistados 388 adolescentes entre 13 e 20 anos que procuraram espontaneamente o Centro de Triagem e Avaliação (CTA) Paulo César Bonfim para realizar o teste anti-HIV. Foram utilizados os questionários CRA (Comportamentos de Risco para AIDS), SCL-90-R (The Symptom Check-List-90-R) e EFA (Escala Fatorial de Autoconceito). A média da idade foi de 17,7 anos (±2,0). A maioria da amostra era do sexo feminino, solteiro ou sem companheiro/a fixo/a, sem trabalho, com baixas escolaridade e renda familiar. Em relação ao teste sorológico, 73% estavam realizandoo pela primeira vez, e a soropositividade geral da amostra foi de 6,2%. A escolaridade foi significativamente mais baixa em soropositivos (OR= 7,8) e não houve diferença estatística entre os grupos nas demais variáveis demográficas. Houve associação direta entre soropositividade e precocidade de início da vida sexual (OR= 3,6), história de gravidez (OR=4,7), prática de aborto prévio (OR= 5,9) e relação sexual com parceiro sem preservativo (OR=3,2). Do total da amostra, 8% dos adolescentes recebeu dinheiro em troca de relação sexual, e isto foi associado à soropositividade (OR=4,5). O mesmo ocorreu nos 13,2% que tiveram relação sexual com paceiro/a possivelmente soropositivo (OR=8,3). Apenas 18,9% da amostra afirmaram usar preservativos nos 6 meses prévios à coleta e 81,4% da amostra não haviam usado preservativo nas relações sexuais ao longo da vida. A prevalência geral de uso de drogas no mês anterior à coleta foi alta, com relato freqüente de uso de múltiplas drogas, sendo as mais freqüentes o álcool (71,6 %), maconha (24,7%), cocaína intranasal (12,4%) e solventes (9,3 %). A soropositividade foi mais alta nos usuários recentes de maconha (OR= 2,8), estimulantes (OR=2,9) e solventes (OR= 7,5). A freqüência a local específico para uso de drogas ocorreu em 22,5% do total da amostra e foi estatisticamente maior nos soropositivos (OR=2,6). Os adolescentes soropositivos apresentaram siginficativamente mais sintomatologia psiquiátrica em todas as dimensões avaliadas. Não houve diferença nas dimensões de autoconceito. O Tamanho de Efeito Padronizado foi maior nas variáveis da sintomatologia psiquiátrica do que nas do autoconceito. Os resultados indicam que os adolescentes estudados ainda não possuem cuidados preventivos suficientes para diminuir o contágio pelo vírus da AIDS. São indivíduos sob risco constante por apresentarem maior freqüência de exposição ao HIV associada à baixa escolaridade, comportamento sexual, uso de drogas e sintomatologia psiquiátrica. A falta de diferenças no autoconceito dos adolescentes soropositivos e soronegativos pode estar associada ao senso de invulnerabilidade próprio da faixa etária. Os achados apontam para a necessidade de programas específicos de prevenção para adolescentes. Medidas de intervenção futuras deverão levar em conta a interação de fatores individuais, ambientais, comportamentais e psicológicos, com o objetivo de implementar mudanças efetivas no comportamento de risco para que se detenha o avanço da epidemia nessa faixa etária.

O crime de drogas e a violência em São Paulo: uma análise a partir da Lei de Drogas

O objetivo desta pesquisa é estudar o efeito da Lei nº 11.343/06 (Lei de Drogas) sobre o crime de tráfico e porte de drogas e a relação entre crimes de drogas e outros crimes. Para isso, são exploradas as variações da Lei de Drogas, através de análises de regressões com descontinuidade e com variável instrumental, além de estimações com dados em painel, em busca de um efeito causal entre drogas e violência. Como resultados, a Lei de Drogas parece não ter efeito negativo significativo sobre crimes de drogas. Por outro lado, crimes de drogas apresentam uma associação negativa sobre crimes de furto e uma relação positiva com crimes de formação de quadrilha. Para cada redução de 100 crimes de drogas (por mil habitantes) associa-se um aumento de 3,6 crimes de furto (por mil habitantes) e uma diminuição de 27 crimes de formação de quadrilha (por mil habitantes). Não são encontrados efeitos robustos sobre roubos, homicídios, latrocínios, estupros, crimes de lesão corporal e porte de arma de fogo.