Análise do estado da arte dos aspectos diagnóticos, periciais e jurisprudenciais das LER/DORT no contexto previdenciário das doenças do trabalho no Brasil

Objetivo: analisar o estado da arte dos aspectos diagnósticos, periciais e jurisprudenciais das LER/DORT (Lesões por Esforços Repetitivos / Distúrbios Osteomusculares Relacionados ao Trabalho) no Brasil. Materiais e Método: trata-se de pesquisa descritiva, de natureza qualitativa, com formato documental, utilizando-se a técnica de análise de conteúdo. A avaliação evolutiva da legislação previdenciária relacionada as LER/DORT foi realizada através da pesquisa no banco de dados disponibilizado pelo Governo Federal e mediante a consulta ao DATAPREV/Sislex. A avaliação dos aspectos diagnósticos foi instrumentalizada através, principalmente, de artigos científicos publicados entre 2003 e 2008, nas línguas portuguesa, inglesa, espanhola e francesa, relacionados com os métodos de diagnósticos complementares das LER-DORT (ressonância magnética, tomografia computadorizada, ultrassonografia e eletroneuromiografia). As jurisprudências foram obtidas através da busca dos julgados sobre o tema, entre 2003 e 2008, pertencentes ao Supremo Tribunal Federal, Superior Tribunal de Justiça, Tribunais Regionais Federais, Tribunal Superior do Trabalho e Tribunais Regionais do Trabalho. Resultados: foram identificados 48 artigos abordando os aspectos diagnósticos das LER-DORT, observando-se que os exames por ressonância magnética, ultrassonografia e eletromiografia demonstraram ser mais efetivos, dentro das suas especificidades, para a complementação do exame clínico de patologias relacionadas às LER-DORT. A análise das 123 jurisprudências selecionadas demonstrou, de forma geral, que as LER-DORT equiparam-se ao acidente de trabalho, devendo apresentar nexo de causalidade (atestado através de laudo médico-pericial) e, ainda, ensejam a ação por danos morais, a qual, devido à EC nº 45 passou a ser competência da Justiça do Trabalho. O Estado da arte dos aspectos periciais encontra-se representado pela vigência da Instrução Normativa n. 98/2003, a qual traz como aspecto fundamental a determinação de novos parâmetros a serem considerados na definição de um quadro de LER-DORT, dispondo, ainda, sobre a conduta ética que deve ser adotada pelo médico perito, bem como chama a atenção para a necessidade dessas doenças do trabalho serem comunicadas às autoridadades competentes, através da emissão da Comunicação de Acidente de Trabalho (CAT). Conclusão: as LER-DORT representam, hoje, um problema de importante impacto, não apenas previdenciário, mas também econômico em diversos países, nos quais o Brasil encontra-se inserido. Estudos sobre o estado da arte relacionados às LER-DORT são fundamentais para auxiliar na construção de um modelo crítico e consciente que colabore com a garantia de sustentabilidade do sistema previdenciário no Brasil

Novo sistema de aplicação de drogas em cirurgias oftalmológicas

The topical corneal application of antimitotic mitomycin-C (MMC) during refractive surgery is still characterized by a lack of standardization and considerable empirism. For this reason the creation of a system capable of reliable drug delivery represents a beneficial innovation for patients submitted to these procedures. Objective: Elaborate a new MMC delivery system during the transoperatory period of photorefractive keratectomy (PRK) followed by patent application. Methods: The project consists of an in vitro experimental study to create an MMC (0.02%) release system. The drug was impregnated in sterile Whatman® 41 paper filter discs with a diameter of 8 mm. After drying, the discs were applied to antibiogram plates seeded with Staphylococcus epidermidis (American Type Culture Collection ATCC 12228), followed by the addition of a drop of sterile water. At the end of 1 minute, the discs were removed and the plates incubated for 48 hours at 35oC. Mean drop volume in the collyrium flasks was measured using analytical balance weighing. The inhibition halo (mm) was correlated with the MMC impregnated into the disc. After completion of the invention design a patent application was lodged at the National Institute of Industrial Property. Results: The correspondence between MMC-produced inhibition halos indicated that a dose of 16μg was ideal for impregnating into the discs. The mean drop volume obtained from the collyrium flasks was 37.7 μL. A minute after the application of one drop of balanced saline solution, the system released an adequate concentration for PRK surgery. Conclusion: A new MMC delivery system was created for transoperatory application in photorefractive keratectomy (PRK). Publication of the patent application (number PI 0704739-8) gives the authors exclusive intellectual property rights. The study was sponsored by Ophthalmos Indústria e Comércio de Produtos Farmacêuticos S.A. (São Paulo-SP, Brazil) and received the indispensable scientific contribution of researchers from the fields of Pharmacy, Medicine, Biology, Statistics and Law, characterizing the work as multidisciplinary, in accordance with norms established by the Postgraduate Health Sciences Program of the Federal University of Rio Grande do Norte (UFRN)

Discursos e práticas na formação de profissionais fisioterapeutas: a realidade dos cursos de fisioterapia na região nordeste do Brasil

This study had a multidisciplinary focus, investigating the areas of health and education, and proposes to discuss the formation of health professionals, requiring their understanding of the factors involved in the production of knowledge, given that this formation has an impact on the quality of human and social life. The aim of this work was to investigate the relationship existing between the process of physical therapist formation and the practical activities developed during the undergraduate course in the Northeast of Brazil. This is an exploratory descriptive study with qualitative significance. The sample consisted of 73 subjects (33 professors and 40 students) from 6 physical therapy courses at different institutions in the Northeast of Brazil. Data collection was conducted through focus group interviews. In addition, we used a school assessment instrument from the health area. The data, analyzed using dialectical hermeneutics, showed that the Northeast of Brazil has the second largest number of physical therapy courses in the country, with 93 (11 public and 82 private) out of a total of 510. These numbers represent a growth of 1062.5% since 1991. The pedagogical projects are guided by National Curricular Directives as well as by the country s health system. The prevalent pedagogy is that of transmission, and the contents/disciplines are generally not integrated with practice, a situation that hinders the integrality and interdisciplinarity of health care. It can be concluded that there is a need for implementing integrated curricula and for better qualified professors to effectively put this process into practice

Um modelo analítico da qualidade da dieta de adolescentes estudantes da rede publica de ensino de Natal, Brasil

Conselho Nacional de Desenvolvimento Científico e Tecnológico

Crescimento e estruturas do sistema digestório de larvas de pacu alimentadas com dieta microencapsulada produzida experimentalmente

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Nutrição social no Brasil: [mais] uma estratégia biopolítica?

Inspirés par la « méthode » artisanat intellectuel propose par le sociologue Wright Mills, notre étude porte sur la formation du champ de pratiques discursives et non discursives (Michel Foucault) de la nutrition sociale dans le contexte de la société brésilienne dans lequel s insère le champ de la santé. Le travail empirique s épuise sur une source de documents normatifs de ce champ et s oriente à vérifier et à comprendre comment le praticien de la nutrition émerge dans le scènario des pratiques de la santé au Brésil à partir du milieux du 20ème siècle, tout en construisant son « regime de vérité » fondé dans des processus biopolitiques du champ de la médecine sociale. Nous avons relié deux phénomènes: a) l émergeance du champ biomédical de la nutrition comme une instance biopolitique, en approchant cette formation à l'histoire de la médecine sociale, depuis ses débuts européens jusqu'au contexte brésilien ; b) les pratiques discursives et non discursives du champ de la nutrition lequel est compris dans le Sistema Único de Saúde (SUS - Système Unique de Santé) brésilien. La démarche de recherche comprend l'élaboration et analyse d'une archive composée de publications qui contiennent l'Histoire du praticien de la nutrition au Brésil et des publications officielles disponibles dans le site web « Política Nacional de Alimentação e Nutrição » (Politique Nationale d'Alimentation et de Nutrition) lesquelles sont considérées comme des guides d actions des praticiens de la nutrition sociale dans le Sistema Único de Saúde (SUS). Le concept de biopouvoir, décrit par Michel Foucault entre 1974 et 1979, et la notion de biopolitique, dans son sens réinterprété et mis à jour par Giorgio Agamben, Antônio Negri et Michael Hardt, ont fourni le support théorique de cette recherche

Análises espaciais na identificação das áreas de risco para a esquistossomose mansônica no município de Lauro de Freitas, Bahia, Brasil

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Planejamento em saúde no Brasil: convergências e divergências entre instâncias de gestão

Trata-se de uma investigação que busca revelar convergências e divergências no processo de planificação da Política Pública de Saúde, com foco primordial na participação dos organismos de representação social na consolidação do Sistema Único (SUS), destacando a Conferência Nacional de Saúde CNS, instância que deve ter participação obrigatória na formulação de recomendações para essa política estatal. Considera que a planificação reúne elementos de concepção jurídica, técnica e política para a elaboração dos documentos intitulados Planos Nacionais de Saúde PNS. A partir de pesquisa qualitativa de base documental e argumentação com apoio de Cartografia Simbólica, põe em exame o processo de elaboração e o teor presente nos relatórios da 12ª (2003), 13ª (2007) e 14ª CNS (2011), alinhando seus eixos, diretrizes e prioridades nos correspondentes PNS nos quadriênios 2004-2007, 2008-2011 e 2012-2015. A escolha desses instrumentos, na temporalidade sugerida, tem por esteio o período em que a implantação do sistema de Planejamento do SUS PlanejaSUS, orienta normativa e tecnicamente a elaboração do PNS, tendo como uma de suas referências o que foi emanado das conferências. Propõe-se verificar as tensões existentes entre momentos distintos da definição das prioridades elencadas nas políticas públicas de saúde à luz das contribuições teóricas sobre a concepção do Estado, numa visão contemporânea associada à sua dinâmica de atuação vinculada ao modo de produção e acumulação capitalista; sobre a metodologia do Planejamento Estratégico com base na participação de atores diversos; e ainda, na análise sobre a expressão desse participacionismo na ótica dos processos democráticos representativos no SUS. Na confecção dos mapas cartográficos foi proposta a correlação entre os conteúdos dos Relatórios das 12ª a 14ª conferências de saúde com o que está expresso nas prioridades constantes nos Planos Nacionais de Saúde (2004 a 2007, 2008 a 2011 e 2012 a 2015), verificando-se aproximações e distanciamentos existentes entre o que expressa a sociedade e a política governamental. Conclui-se que, do exame crítico entre as diretrizes e prioridades contidas no acervo documental existente e sua metodologia de construção, com fundamento na argumentação do aporte teórico trabalhado, são verificadas tensões e harmonizações que revelam pontos convergentes e dissonantes das pactuações e consensos entre os atores sociais representantes dos segmentos, no qual critério da representatividade condiciona a defesa de opiniões, interesses e prioridades, de modo diverso para os que estão implicados nesse processo de planificação

Atrás das grades: redes sociais, habitus e interação social no sistema carcerário do RN

Esta tesis trata de discutir y entender los diversos tipos de redes sociales y formas de interacción social presentes en el sistema penitenciario de Rio Grande do Norte. Nuestro problema se basa en un incremento significativo en las tasas de encarcelamiento y la prisión en Brasil y el mundo en los últimos diez años. Asimismo, la aparición del crimen organizado ya, en cierta medida, el control de las prisiones brasileñas, como el Comando Vermelho (CV) y el Primeiro Comando da Capital (PCC), una consecuencia directa de las terribles condiciones de las prisiones de Brasil y aumento de la violencia y el crimen en nuestro país. Para resolver el problema, se optó por utilizar las categorías de análisis de Michel Foucault (prisión y la disciplina), Pierre Bourdieu (habitus y campo), Ervirng Goffman (institución total, de interacción, de fachada y de equipo) y Mark Granovetter, Ricardo Abramovay e João Peixoto, entre otros, la nueva sociología económica (Redes, nodos y lazos) como principal apoyo. También construyó una revisión histórica de la cárcel en Brasil y Rio Grande do Norte hasta llegar al objeto. Esto, en términos de investigación cualitativa, se sumergió en el mundo de las prisiones Dr. Francisco Nogueira Fernandes, conocido como Penitenciario de Alcaçuz, ubicado en el municipio de Nísia Bosque, Rio Grande do Norte. Penitenciaría del Estado de origen, las casas de Alcaçuz seiscientos cuarenta y tres reclusos, divididos en cinco pabellones, un total de ciento cuarenta y siete células. Mediante la observación sistemática y la entrevista cualitativa s semi-estructurada como las principales fuentes de recopilación de datos, hemos tratado de explicar el universo que acabamos de analizar por las Ciencias Sociales. Nos dimos cuenta de que, para cumplir con la escena nacional, regaliz viola de manera flagrante lo que se denomina en la Constitución de 1988 y LEP (Ley de Ejecución Penal), sin tener en cuenta los derechos de los individuos a una porción de una oración con un mínimo de dignidad. Se ha demostrado que las personas que permean el universo proviene de un ambiente de la prisión, la sociabilidad violenta, sedo también tienen un habitus precario. La prisión, espacio disciplinario y un tipo específico de interacción social marcada por el control, contribuye a la profundización de habitus, pero que muestra que no es también como un espacio cerrado en absoluto, sino un lugar donde penetran las redes y dinámicas muy social. Al mismo tiempo, se encontró que más de la presencia de "grupos organizados" es el espacio en las cárceles para la interacción social y las redes sociales que pasan dentro y fuera de su espacio

O Trabalho e o labirinto da responsabilidade socioempresarial:a experiência da cidadania empresarial do Banco do Brasil

In the current systemic crisis, economic policy is directed to correct the consequences of the functioning of this metabolism, but within the limits of the capital. From this perspective, decision makers propose trade policies, agricultural and industrial to ensure conditions for economic growth. However, as a dead end, there is failure of the State in giving efficacy to the operation of all segments of the economy, especially given the budget constraint. Public managers are forced to seek external resources, resuming the cycle of political allegiance to the interests of international financial and banking representatives, installed in so-called multilateral. The complex ideological capital comes into play in trying to convince society that the paths taken by governments are inevitable, and that capitalism can be "humanized", even with the realization of the growing inequalities caused by historical irrationalism of the production process of capital . In this sense, emerging concepts that attempt to demonstrate the compatibility of the system to real human needs. This ideological offensive is intended to legitimize the capital. The so-called third sector has a special highlight with the concept of corporate social responsibility. It creates a political environment in which the inevitable mix-up with new illusions offered by and often funding the metabolism of capital in order to perpetuate this system. In this context, political elites, and considerable portions of the academy, embark on "waves of capitalist optimism," while the sociometabolismo capital expands its historical limits, driving forces postponing their collapse, but that cause human suffering and ecological stress. Wars are disseminated to strengthen the deadly war industry and the automobile industry; and devastating the environment of which depends the capital system. In this scenario disassemble, propositions emerge around a "new social pact" in order to minimize the adverse effects of the dynamics of reproduction of capital. The business class is called to exercise its role through the discourse that appeals to social responsibility programs, in order to intervene directly in the "social question". The core of this research is precisely this point. Although there is considerable scholarship on the phenomenon of Social Responsibility and Corporate Citizenship, there is also an evident lack of this approach focused on the banking sector in Brazil. The importance of rentier capital increased ownership of shares in the wealth produced by all of Brazilian society, justifies a sociological research project on Social Responsibility in the domestic financial sector. In this sense, it was decided to perform a dynamic approach to the "Corporate Citizenship" in the banking industry, specifically in the Bank of Brazil. As this is a key institution, is important analyze of the impacts of this strategy fetish of capitalist reproduction, in order to evaluate the social legitimization of rentier capital in Brazil. In this scenario of the abundance of the discourse on social responsibility there exist a progressive impoverishment of professional work in this segment in Brazil. There is a dramatic mismatch between rhetoric and practice because of the trend of deepening vulnerability of the working conditions of the Brazilian bank worker, from the 1990's. In the specific case of the Bank of Brazil, the first initiative of the institution was to conform to the principles of the UNO and the Ethos Institute, aiming to align their domestic policies to this new strategy of domination of capital. The purpose is to place the Bank in the ideological sphere of corporate social responsibility, just as with its partners in the private financial intercapitalist competition. Indeed, in the internal ambit of the Bank of Brazil, there is a policy to adjust its functional segments to the doctrine of Social Corporate Responsibility. The concepts of this doctrine is presented as something inexorable. There are no alternatives. The Bank of Brazil operates in a highly competitive market, the segment featuring the dominance of financial capital accumulation today. For this reason it can not fail to incorporate the technological advances organizational. For employees there is no alternative but to adapt to this new set of ideas proposed by the metabolism of capital

Estimativas de mortalidade para a região nordeste do Brasil em 2010: uma associação do método demográfico equação geral de balanceamento, com o estimador bayesiano empírico

One of the greatest challenges of demography, nowadays, is to obtain estimates of mortality, in a consistent manner, mainly in small areas. The lack of this information, hinders public health actions and leads to impairment of quality of classification of deaths, generating concern on the part of demographers and epidemiologists in obtaining reliable statistics of mortality in the country. In this context, the objective of this work is to obtain estimates of deaths adjustment factors for correction of adult mortality, by States, meso-regions and age groups in the northeastern region, in 2010. The proposal is based on two lines of observation: a demographic one and a statistical one, considering also two areas of coverage in the States of the Northeast region, the meso-regions, as larger areas and counties, as small areas. The methodological principle is to use the General Equation and Balancing demographic method or General Growth Balance to correct the observed deaths, in larger areas (meso-regions) of the states, since they are less prone to breakage of methodological assumptions. In the sequence, it will be applied the statistical empirical Bayesian estimator method, considering as sum of deaths in the meso-regions, the death value corrected by the demographic method, and as reference of observation of smaller area, the observed deaths in small areas (counties). As results of this combination, a smoothing effect on the degree of coverage of deaths is obtained, due to the association with the empirical Bayesian Estimator, and the possibility of evaluating the degree of coverage of deaths by age groups at counties, meso-regions and states levels, with the advantage of estimete adjustment factors, according to the desired level of aggregation. The results grouped by State, point to a significant improvement of the degree of coverage of deaths, according to the combination of the methods with values above 80%. Alagoas (0.88), Bahia (0.90), Ceará (0.90), Maranhão (0.84), Paraíba (0.88), Pernambuco (0.93), Piauí (0.85), Rio Grande do Norte (0.89) and Sergipe (0.92). Advances in the control of the registry information in the health system, linked to improvements in socioeconomic conditions and urbanization of the counties, in the last decade, provided a better quality of information registry of deaths in small areas

Ativismo judicial e materialização das políticas públicas infanto-juvenis na constituição da república: Fixação de planos ideais de atuação para os atores do Sistema de Garantia de Direitos (SGD)

The research arose from the necessity of showing ways to be followed by the actors of the System Guaranteeing Rights of the Child and Adolescent (SGD), regarding the implementation of rights for young people, because the legislation in force in Brazil is currently considered a model around the world and, paradoxically, the fundamental rights of children and adolescents are not met, even with the constitutionally guaranteed priority. Thus, the study investigates the fundamentality rights for young people, enshrined in the Constitution of the Republic, as well as the ways of effectiveness of these rights through the actions of actors of the System Guaranteeing Rights, especially the judiciary. Focusing realized, studying theories of fundamental rights, especially Structuring a Theory of Law (Strukturiende Rechtslehre), Friedrich Müller, who emphasizes the need for analysis of social reality in the application of the rule of law. Study also the public budget and public policies concerning children and adolescents, with emphasis on preparation of budget laws and the process of discussion, deliberation, choice and implementation of public policies for children and teenagers. It then presents the typical functions of the members of System Guaranteeing Rights, as well as prepare a plan for optimum performance for each of the actors, with emphasis on analysis of the implementation of public policies at the municipal level. Finally, it analyzes the theory of separation of three powers, and discusses the positive and negative factors for judicial intervention, concluding that the Courts can consider the action activist, from finding the omission of the Executive and legislative branches, as regards the implementation of the rights of children and adolescents, as well as the rights of children and young people are not realized in most cases, due to the omission of actors of the System Guaranteeing Rights

O sistema de certificação do etanol brasileiro sob a ótica do princípio constitucional do desenvolvimento sustentável

The gradual inclusion of biofuels is a necessary change that countries must include in their energy mixes. Energy sources still widely used in the world, such as oil and coal, are endowed with a high pollution load to the environment, bringing damages to the water, to the air and to humans as well. In addition, although there are conflicting studies, they are also identified as major causes of the greenhouse effect and the global warming phenomenon. They are, moreover, finite sources of energy, given that its reserves will surely run out. However, even if the introduction of biofuels, such as ethanol, in the energy mix is crucial for the survival of the present and future populations, this insertion cannot settle so disorderly and, thus, one must ensure the quality of these resources and promote transparency in international trade. In this manner, a certification process for ethanol is essential to attest that this biofuel meets the sustainable requirements defined for its production. Hence, this study sought to address the importance of the adoption of certification in the ethanol industry, according to the principle of sustainable development, by analyzing the evolution of its concept, its combination with the fundamental objectives sculptured in the Constitution of 1988, its regulation under Brazilian laws and the need for a balance between economic activities and the mentioned principle. The work also encompassed the criteria used to establish certification standards and their participating actors, combined with a study of ongoing initiatives. Finally, the consequences of the adoption of a certification process for ethanol in Brazil were presented, both in terms of sustainable development and in international trade

Justiça restaurativa no sistema penal e processual penal como forma de concretização do estado democrático constitucional

Diante do atual modelo penal e processual penal não atender aos reclamos das partes interessadas, gerando um descrédito na Justiça de um modo geral, surge a Justiça Restaurativa como uma alternativa para solucionar tais problemas e como elemento de concretização do Estado Democrático Constitucional. A Constituição Federal de 1988 representa o símbolo maior do processo de democratização e de constitucionalização nacional. O Princípio da Dignidade da Pessoa contida no texto constitucional consiste num dos principais fundamentos da República Federativa do Brasil, funcionando como respaldo aos direitos e garantias fundamentais do cidadão, sobretudo na seara criminal. A partir do processo de constitucionalização nacional, ocorre uma releitura das legislações infra-constitucionais, que passam a ser interpretadas de acordo com o texto constitucional. Atualmente, a conjuntura jurídico-penal pátria está associada à ideia de garantismo, ligada ao conceito de Estado Democrático Constitucional. Apresenta-se a Justiça Restaurativa como um novo modelo de Justiça Penal, mais flexível e humanizado, visando além da aplicação da pena imposta pelo Estado, superar uma situação de conflito, na busca por resultados positivos no combate e redução da criminalidade, a satisfação da vítima e a mudança da cultura de violência, compatível com as diretrizes do Estado Democrático Constitucional. A partir da análise do direito internacional e de projetos e legislações nacionais envolvendo a Justiça Restaurativa, percebe-se a eficácia das medidas restaurativas na solução de conflitos dentro do Processo Penal, além da satisfação da vítima, do infrator e de familiares na participação dos encontros restaurativos, constituindo ferramenta de satisfação da dignidade humana, dentro de uma perspectiva humanista e garantista

Direito fundamental à saúde: parâmetros e alternativas para sua concretização no Brasil

If, on one hand, only with the 1988 Federal Constitution the right to health began to receive the treatment of authentic fundamental social right; on the other, it is certain since then, the level of concretization reached as to such right depicts a mismatch between the constitutional will and the will of the rulers. That is because, despite the inherent gradualness of the process of concretization of the fundamental social rights, the Brazilian reality, marked by a picture of true chaos on public health routinely reported on the evening news, denatures the priority status constitutionally drew for the right to health, demonstrating, thus, that there is a clear deficit in this process, which must be corrected. This concern regarding the problem of the concretization of the social rights, in turn, is underlined when one speaks of the right to health, since such right, due to its intimate connection with the right to life and human dignity, ends up assuming a position of primacy among the social rights, presenting itself as an imperative right, since its perfect fruition becomes an essential condition for the potential enjoyment of the remaining social rights. From such premises, this paper aims to provide a proposal for the correction of this problem based upon the defense of an active role of the Judiciary in the concretization of the right to health as long as grounded to objective and solid parameters that come to correct, with legal certainty, the named deficit and to avoid the side effects and distortions that are currently beheld when the Judiciary intends to intervene in the matter. For that effect, emerges as flagship of this measure a proposition of an existential minimum specific to the right to health that, taking into account both the constitutionally priority points relating to this relevant right, as well as the very logic of the structuring of the Sistema Único de Saúde - SUS inserted within the core of the public health policies developed in the country, comes to contribute to a judicialization of the subject more in alignment with the ideals outlined in the 1988 Constitution. Furthermore, in the same intent to seek a concretization of the right to health in harmony with the constitutional priority inherent to this material right, the research alerts to the need to undertake a restructuring in the form of organization of the Boards of Health in order to enforce the constitutional guideline of SUS community participation, as well as the importance of establishing a new culture budget in the country, with the Constitution as a compass, pass accurately portray a special prioritization directed constitutional social rights, especially the right to health