Marcos regulatórios estaduais em saneamento básico no Brasil

Este artigo analisa os marcos regulatórios estaduais para o setor de saneamento básico. A pesquisa documental identificou a presença de leis estaduais em apenas cinco estados (São Paulo, Minas Gerais, Rio Grande do Sul, Rio Grande do Norte e Goiás). Os marcos legais estaduais são descritos quanto a um conjunto de atributos ou funções selecionadas: universalização, instrumentos financeiros, regulação e controle social. A principal conclusão é que o desenvolvimento dessas políticas, assim como sua regulamentação, encontra-se em estágio incipiente e poderá receber impulso com aprovação de nova lei federal de dezembro de 2006.

Multimodos e múltiplas Representações, aprendizagem significativa e subjetividade: três referenciais conciliáveis da educação científica

A linha de pesquisa em multimodos e múltiplas representações vem atualmente sendo inspiradora de ações instrucionais na educação científica. Partindo dos fundamentos que justificam um encaminhamento didático à luz dessas referências, este trabalho procura mostrar que há compatibilidade dos seus fundamentos com a teoria da aprendizagem significativa de Ausubel e com as questões levantadas pelas pesquisas que indicam a necessidade de se considerar a subjetividade dos alunos presentes numa sala de aula. Essencialmente, procuramos argumentar que a promoção de um ensino por meio de multimodos e múltiplas representações é consistente com o ambiente plural das subjetividades existentes numa sala de aula e com uma aprendizagem significativa.

Questões contemporâneas sobre natureza e cultura: notas sobre a Saúde Coletiva e a sociologia no Brasil

O presente artigo discute alguns aspectos da relação entre biológico e social, tomando por objeto o campo da Saúde Coletiva no Brasil e o campo das Ciências Sociais, mais especificamente a sociologia. Parte-se do pressuposto de que o conceito que norteia o campo da Saúde Coletiva, o da determinação social (formulado em meados dos anos 1970 e 1980), foi profundamente marcado por certa leitura do social, impregnada dos marcos teóricos clássicos das ciências sociais e marcada pelo cenário político-institucional em que os campos - da Saúde Coletiva e das Ciências Sociais - encontravam-se historicamente. O objetivo é discutir o esgotamento dessa formulação teórica tendo em vista o cenário das profundas mudanças ocorridas nas sociedades contemporâneas em sua etapa industrial tardia, pós-industrial ou tardo-moderna. Acredita-se que a discussão sobre os marcos teóricos constitutivos do campo da Saúde Coletiva contribuirá para um enfrentamento das questões de saúde mais consoante com as mudanças sociais ocorridas.

Traumas de coluna ocasionados por acidentes de transporte

Acidentes e violências são responsáveis por elevadas taxas de mortalidade e morbidade causadas pelas lesões deles decorrentes. Entre essas lesões, os traumas da coluna vertebral e, especificamente, aqueles com comprometimento da medula espinal apresentam-se como relevantes. Os acidentes de transporte em geral e os de trânsito, em especial, constituem-se, também, hoje, em um grave problema de Saúde Pública. Dados epidemiológicos sobre tais acidentes são fundamentais para que sejam feitos programas de prevenção, com a atuação de profissionais da saúde e da educação, em relação ao cumprimento de leis e normas. No caso de traumas de coluna ocasionados por acidentes de transporte, percebe-se um número elevado e preocupante. Do total de internações por traumas de coluna, 22,7 por cento no ano de 2005, foram decorrentes de acidentes de transporte. Destes, cerca de 29 por cento eram pedestres, 23 por cento ocupantes, 20 por cento não-especificados e 19,9 por cento motociclistas, quando classificados de acordo com a qualidade da vítima. É importante ressaltar que os pacientes internados por essas causas têm mortalidade hospitalar elevada e o número estimado de seqüelas é considerável

Fidedignidade de rótulos de alimentos comercializados no município de São Paulo, SP

OBJETIVO: Avaliar a fidedignidade das informações sobre dados nutricionais declarados em rótulos de alimentos comercializados. MÉTODOS: Foram avaliados 153 alimentos industrializados habitualmente consumidos por crianças e adolescentes, comercializados no município de São Paulo (SP) entre os anos de 2001 e 2005. Os teores de nutrientes informados pelos rótulos foram confrontados com os resultados obtidos por métodos analíticos (físico-químicos) oficiais, considerando a variabilidade de 20% tolerada pela legislação vigente, para aprovar ou condenar as amostras. Foram calculadas médias, desvios-padrão e intervalos com 95% de confiança para os nutrientes analisados, assim como a distribuição da freqüência percentual de amostras condenadas. RESULTADOS: Todos os produtos salgados analisados apresentaram inconformidades relativamente ao conteúdo de fibra alimentar, sódio ou de gorduras saturadas. Os produtos doces apresentaram variação de zero a 36% de condenação relativamente ao teor de fibra alimentar. Mais da metade (52%) dos biscoitos recheados foram condenados quanto à quantidade de gorduras saturadas. Os nutrientes implicados com a obesidade e suas complicações para a saúde foram aqueles que apresentaram maiores proporções de inconformidade. A falta de fidedignidade das informações de rótulos nas amostras analisadas viola as disposições da Resolução da Diretoria Colegiada 360/03 da ANVISA e os direitos garantidos pela lei de Segurança Alimentar e Nutricional e pelo Código de Defesa do Consumidor. CONCLUSÕES: Foram encontrados altos índices de não conformidade dos dados nutricionais nos rótulos de alimentos destinados ao público adolescente e infantil, indicando a urgência de ações de fiscalização e de outras medidas de rotulagem nutricional

The effectiveness of educational practice in diabetic foot: a view from Brazil

Background: The aim of the present study was to evaluate the prevention and self-inspection behavior of diabetic subjects with foot at ulcer risk, no previous episode, who participated in the routine visits and standardized education provided by the service and who received prescribed footwear. This evaluation was carried out using a questionnaire scoring from 0-10 (high scores reflect worse practice compliance). Results: 60 patients were studied (30 of each sex); mean age was 62 years, mean duration of the disease was 17 years. As for compliance, 90% showed a total score <= 5, only 8.7% regularly wore the footwear supplied; self foot inspection 65%, 28,3% with additional familiar inspection; creaming 77%; proper washing and drying 88%; proper cutting of toe nails 83%; no cuticle cutting 83%; routine shoe inspection 77%; no use of pumice stones or similar abrasive 70%; no barefoot walking 95%. Conclusion: the planned and multidisciplinary educational approach enabled high compliance of the ulcer prevention care needed in diabetic patients at risk for complications. In contrast, compliance observed for the use of footwear provided was extremely low, demonstrating that the issue of its acceptability should be further and carefully addressed. In countries of such vast dimensions as Brazil multidisciplinary educational approaches can and should be performed by the services providing care for patients with foot at risk for complications according to the reality of local scenarios. Furthermore, every educational program should assess the learning, results obtained and efficacy in the target population by use of an adequate evaluation system.

Clinical outcomes of long-acting injectable risperidone in patients with schizophrenia: six-month follow-up from the Electronic Schizophrenia Treatment Adherence Registry in Latin America

Background: Risperidone long-acting injection (RLAI) has been shown to be efficacious, improve compliance, and increase long-term retention rate on therapy. The aim of this work was to determine the effect of RLAI on clinical outcome and hospitalization rate in patients with schizophrenia or schizoaffective disorder enrolled in the electronic Schizophrenia Treatment Adherence Registry in Latin America. Methods: Data were collected at baseline, retrospectively for the 12 months prior to baseline, and prospectively every three months for 24 months. Hospitalization prior to therapy was assessed by a retrospective chart review. Efficacy and functioning were evaluated using Clinical Global Impression of Illness Severity (CGI-S), Personal and Social Performance (PSP), and Global Assessment of Functioning (GAF) scores. Relapse and treatment were also registered. Results: Patients were recruited in Mexico (n = 53), Brazil (n = 11), and Colombia (n = 15). Sixty-five percent (n = 52) were male, and mean age was 32.9 years. Patients were classified as having schizophrenia (n = 73) or schizoaffective disorder (n = 6). The mean dose of RLAI at six months was 34.1 mg (standard deviation = 10.2 mg). The percentage of hospitalized patients before treatment was 28.2% and 5.1% at six months after initiating RLAI (P < 0.001). Significant changes were registered on CGI-S, GAF, and PSP scores. Conclusions: RLAI was associated with an improvement in clinical symptoms and functioning, and a greater reduction in hospitalization.

Efficacy of a 7-day course of furazolidone, levofloxacin, and lansoprazole after failed Helicobacter pylori eradication

Background: Increasing resistance to clarithromycin and nitroimidazole is the main cause of failure in the Helicobacter pylori eradication. The ideal retreatment regimen remains unclear, especially in developing countries, where the infection presents high prevalence and resistance to antibiotics. The study aimed at determining the efficacy, compliance and adverse effects of a regimen that included furazolidone, levofloxacin and lansoprazole in patients with persistent Helicobacter pylori infection, who had failed to respond to at least one prior eradication treatment regimen. Methods: This study included 48 patients with peptic ulcer disease. Helicobacter pylori infection was confirmed by a rapid urease test and histological examination of samples obtained from the antrum and corpus during endoscopy. The eradication therapy consisted of a 7-day twice daily oral administration of lansoprazole 30 mg, furazolidone 200 mg and levofloxacin 250 mg. Therapeutic success was confirmed by a negative rapid urease test, histological examination and 14C- urea breath test, performed 12 weeks after treatment completion. The Chi-square method was used for comparisons among eradication rates, previous treatments and previous furazolidone use. Results: Only one of the 48 patients failed to take all medications, which was due to adverse effects (vomiting). Per-protocol and intention-to-treat eradication rates were 89% (95% CI-89%-99%) and 88% (88-92%), respectively. Mild and moderate adverse effects were reported by 41 patients (85%). For patients with one previous treatment failure, the eradication rate was 100%. Compared to furazolidone-nave patients, eradication rates were lower in those who had failed prior furazolidone-containing regimen(s) (74% vs. 100%, p = 0.002). Conclusion: An empiric salvage-regimen including levofloxacin, furazolidone and lansoprazole is very effective in the eradication of Helicobacter pylori, particularly in patients that have failed one prior eradication therapy.

Adherence to cervical and breast cancer programs is crucial to improving screening performance

Introduction: Cervical and breast cancer are the most common malignancies among women worldwide. Effective screening can facilitate early detection and dramatically reduce mortality rates. The interface between those screening patients and patients most needing screening is complex, and women in remote areas of rural counties face additional barriers that limit the effectiveness of cancer prevention programs. This study compared various methods to improve compliance with mass screening for breast and cervical cancer among women in a remote, rural region of Brazil. Methods: In 2003, a mobile unit was used to perform 10 156 mammograms and Papanicolaou smear tests for women living in the Barretos County region of Sao Paulo state, Brazil (consisting of 19 neighbouring cities). To reach the women, the following community outreach strategies were used: distribution of flyers and pamphlets; media broadcasts (via radio and car loudspeakers); and community healthcare agents (CHCAs) making home visits. Results: The most useful intervention appeared to be the home visits by healthcare agents or CHCAs. These agents of the Family Health Programme of the Brazilian Ministry of Health reached an average of 45.6% of those screened, with radio advertisements reaching a further 11.9%. The great majority of the screened women were illiterate or had elementary level schooling (80.9%) and were of 'poor' or 'very poor' socioeconomic class (67.2%). Conclusions: Use of a mobile screening unit is a useful strategy in developing countries where local health systems have inadequate facilities for cancer screening in underserved populations. A multimodal approach to community outreach strategies, especially using CHCAs and radio advertisements, can improve the uptake of mass screening in low-income, low-educational background female populations.

Long-acting injectable risperidone in partially adherent and nonadherent patients with schizophrenia

Background: Long-acting injectable antipsychotics may improve medication adherence, thereby improving overall treatment effectiveness. This study aimed to evaluate the effectiveness, safety, and tolerability of risperidone long-acting injection in schizophrenic patients switched from oral antipsychotic medication. Methods: In a 12-month, multicenter, open-label, noncomparative study, symptomatically stable patients on oral antipsychotic medication with poor treatment adherence during the previous 12 months received intramuscular injections of risperidone long-acting injection (25 mg starting dose) every 2 weeks. The primary endpoint was the change in Positive and Negative Syndrome Scale (PANSS) total score. Results: Of the 60 patients who were screened, 53 received at least one injection (safety population), and 51 provided at least one postbaseline assessment. Mean PANSS total scores improved significantly throughout the study and at endpoint. Significant improvements were also observed in Clinical Global Impression of Severity, Personal and Social Performance, and Drug Attitude Inventory scales. Risperidone long-acting injection was safe and well-tolerated. Severity of movement disorders on the Extrapyramidal Symptom Rating Scale was reduced significantly. The most frequently reported adverse events were insomnia (22.6%), increased prolactin (17.0%), and weight gain (13.2%). Conclusion: Risperidone long-acting injection was associated with significant symptomatic improvements in stable patients with schizophrenia following a switch from previous antipsychotic medications.

The beneficial effects of exercise in rodents are preserved after detraining: a phenomenon unrelated to GLUT4 expression

Background: Although exercise training has well-known cardiorespiratory and metabolic benefits, low compliance with exercise training programs is a fact, and the harmful effects of physical detraining regarding these adaptations usually go unnoticed. We investigated the effects of exercise detraining on blood pressure, insulin sensitivity, and GLUT4 expression in spontaneously hypertensive rats (SHR) and normotensive Wistar Kyoto rats (WKY). Methods: Studied animals were randomized into sedentary, trained (treadmill running/5 days a week, 60 min/day for 10 weeks), 1 week of detraining, and 2 weeks of detraining. Blood pressure (tail-cuff system), insulin sensitivity (kITT), and GLUT4 (Western blot) in heart, gastrocnemius and white fat tissue were measured. Results: Exercise training reduced blood pressure (19%), improved insulin sensitivity (24%), and increased GLUT4 in the heart (+34%); gastrocnemius (+36%) and fat (+22%) in SHR. In WKY no change in either blood pressure or insulin sensitivity were observed, but there was an increase in GLUT4 in the heart (+25%), gastrocnemius (+45%) and fat (+36%) induced by training. Both periods of detraining did not induce any change in neither blood pressure nor insulin sensitivity in SHR and WKY. One-week detraining reduced GLUT4 in SHR (heart: -28%; fat: -23%) and WKY (heart: -19%; fat: -22%); GLUT4 in the gastrocnemius was reduced after a 2-week detraining (SHR: -35%; WKY: -25%). There was a positive correlation between GLUT4 (gastrocnemius) and the maximal velocity in the exercise test (r = 0.60, p = 0.004). Conclusions: The study findings show that in detraining, despite reversion of the enhanced GLUT4 expression, cardiorespiratory and metabolic beneficial effects of exercise are preserved.

Metal-insulator transition in Nd(1-x) Eu(x) NiO(3) probed by specific heat and anelastic measurements

Oxides RNiO(3) (R - rare-earth, R not equal La) exhibit a metal-insulator (MI) transition at a temperature T(MI) and an antiferromagnetic (AF) transition at T(N). Specific heat (C(P)) and anelastic spectroscopy measurements were performed in samples of Nd(1-x)Eu(x)NiO(3), 0 <= x <= 0.35. For x - 0, a peak in C(P) is observed upon cooling and warming at essentially the same temperature T(MI) - T(N) similar to 195 K, although the cooling peak is much smaller. For x >= 0.25, differences between the cooling and warming curves are negligible, and two well defined peaks are clearly observed: one at lower temperatures that define T(N), and the other one at T(MI). An external magnetic field of 9 T had no significant effect on these results. The elastic compliance (s) and the reciprocal of the mechanical quality factor (Q(-1)) of NdNiO(3), measured upon warming, showed a very sharp peak at essentially the same temperature obtained from C(P), and no peak is observed upon cooling. The elastic modulus hardens below T(MI) much more sharply upon warming, while the cooling and warming curves are reproducible above T(MI). Conversely, for the sample with x - 0.35, s and Q(-1) curves are very similar upon warming and cooling. The results presented here give credence to the proposition that the MI phase transition changes from first to second order with increasing Eu doping. (C) 2011 American Institute of Physics. [doi: 10.1063/1.3549615]

Scaling properties at freeze-out in relativistic heavy-ion collisions

Identified charged pion, kaon, and proton spectra are used to explore the system size dependence of bulk freeze-out properties in Cu + Cu collisions at root s(NN) = 200 and 62.4 GeV. The data are studied with hydrodynamically motivated blast-wave and statistical model frameworks in order to characterize the freeze-out properties of the system. The dependence of freeze-out parameters on beam energy and collision centrality is discussed. Using the existing results from Au + Au and pp collisions, the dependence of freeze-out parameters on the system size is also explored. This multidimensional systematic study furthers our understanding of the QCD phase diagram revealing the importance of the initial geometrical overlap of the colliding ions. The analysis of Cu + Cu collisions expands the system size dependence studies from Au + Au data with detailed measurements in the smaller system. The systematic trends of the bulk freeze-out properties of charged particles is studied with respect to the total charged particle multiplicity at midrapidity, exploring the influence of initial state effects.

The ethical component of professional competence in nursing: An analysis

The purpose of this article is to initiate a philosophical discussion about the ethical component of professional competence in nursing from the perspective of Brazilian nurses. Specifically, this article discusses professional competence in nursing practice in the Brazilian health context, based on two different conceptual frameworks. The first framework is derived from the idealistic and traditional approach while the second views professional competence through the lens of historical and dialectical materialism theory. The philosophical analyses show that the idealistic view of professional competence differs greatly from practice. Combining nursing professional competence with philosophical perspectives becomes a challenge when ideals are opposed by the reality and implications of everyday nursing practice.

An improved continuous medium technique for structural frame analysis

This paper presents an improved constitutive equation of frame in the context of continuous medium technique. This improved constitutive equation, which is a consistent formulation of column global bending, is applicable to a complete class of frameworks including the ideal shear frame panel, for which the beams are assumed to be rigid, and the associated column system, for which the rigidity of beams is negligible. Global buckling and second-order effects of the frame structure are discussed. The main results can be extended to other types of lateral stiffening elements as built-up columns. A worked example is presented in order to compare the main results with those obtained by the classic matrix method. Copyright (C) 2007 John Wiley & Sons, Ltd.