The State, the community and society in social development

President Cardoso delivered this address at the First Regional Conference in Follow-up to the World Summit for Social Development, held in Sao Paulo from 6 to 9 April 1997. On that occasion President Cardoso reviewed the issues examined at the World Summit, with special emphasis on poverty and the search for an environmentally sound, democratic form of development that will lead to a greater degree of social equity. Within this context, he discussed the relationship between economic and social factors, devoting particular attention to State reform, education, competitiveness and job creation. He also outlined the situation in Brazil with regard to economic development, education and health services, the neeed for agrarian reform based on the principle of equity, and respect for human rights. In concluding his statement, he stressed the need to overcome the traditional division between community and society and between the public and private spheres. To that end, he called for a re-examination of ethical considerations, not as an empty discussion of morality but rather as an effective means of motivating action for change.

The health insurance market: lessons on the conflict between equivalence and solidarity

Includes bibliography

Comparison of methods in oral health education from the perspective of adolescents.

To investigate whether teenagers' knowledge about oral health is influenced by educational methods and to verify the most effective method according to their perception. The study was performed in Araçatuba, São Paulo State, Brazil, with 127 teenagers from a vocational school. It was realised in 3 steps: 1. An evaluation of knowledge about oral health using a self-applied questionnaire. 2. An application of educational methods, where the students were divided into two groups (A and B). Group A participated in three educational activities that involved lectures, individual demonstration, and participatory activity. Group B was divided into three subgroups (B1, B2, B3) and each of them participated in only one of the methods. 3. The acquired knowledge was evaluated. Group A created a focus group to give their opinion about strategies. With regards to knowledge after the application of the different methods in all groups, there was a statistically significant difference concerning periodontitis, gingivitis and herpes. In group A, after the three activities, and in group B2 after the individual demonstration, an association was found between 'healthy teeth' and 'general health' (P = 0.004 and P = 0.022, respectively). After the individual demonstration, an association was shown between variables of acquired knowledge about 'harmful diet' and 'dental caries' (P = 0.002) as well as 'good diet' and 'prevention of oral diseases' (P = 0.032). The favourite method was individual demonstration, due to the contact with educational materials, followed by participatory activity because it encouraged learning in a more dynamic way. Educational methods influenced knowledge about oral health, with individual demonstration proving to be the most effective method for acquiring knowledge. In the adolescents' view, the participatory activity was the preferred method.

An assessment of the economic impact of climate change on the Agriculture, Health and Tourism sectors in Jamaica

This report analyses the agriculture, health and tourism sectors in Jamaica to assess the potential economic impacts of climate change on the sectors. The fundamental aim of this report is to assist with the development of strategies to deal with the potential impact of climate change on Jamaica. It also has the potential to provide essential input for identifying and preparing policies and strategies to help move the Region closer to solving problems associated with climate change and attaining individual and regional sustainable development goals. Some of the key anticipated manifestations of climate change for the Caribbean include elevated air and sea-surface temperatures, sea-level rise, possible changes in extreme events and a reduction in freshwater resources. The economic impact of climate change on the three sectors was estimated for the A2 and B2 IPCC scenarios until 2050. An evaluation of various adaptation strategies was also undertaken for each sector using standard evaluation techniques. The outcomes from investigating the agriculture sector indicate that for the sugar-cane subsector the harvests under both the A2 and B2 scenarios decrease at first and then increase as the mid-century mark is approached. With respect to the yam subsector the results indicate that the yield of yam will increase from 17.4 to 23.1 tonnes per hectare (33%) under the A2 scenario, and 18.4 to 23.9 (30%) tonnes per hectare under the B2 scenario over the period 2011 to 2050. Similar to the forecasts for yam, the results for escallion suggest that yields will continue to increase to mid-century. Adaptation in the sugar cane sub-sector could involve replanting and irrigation that appear to generate net benefits at the three selected discount rates for the A2 scenario, but only at a discount rate of 1% for the B2 scenario. For yam and escallion, investment in irrigation will earn significant net benefits for both the A2 and B2 scenarios at the three selected rates of discount. It is recommended that if adaptation strategies are part of a package of strategies for improving efficiency and hence enhancing competitiveness, then the yields of each crop can be raised sufficiently to warrant investment in adaptation to climate change. The analysis of the health sector demonstrates the potential for climate change to add a substantial burden to the future health systems in Jamaica, something that that will only compound the country’s vulnerability to other anticipated impacts of climate change. The results clearly show that the incidence of dengue fever will increase if climate change continues unabated, with more cases projected for the A2 scenario than the B2. The models predicted a decrease in the incidence of gastroenteritis and leptospirosis with climate change, indicating that Jamaica will benefit from climate change with a reduction in the number of cases of gastroenteritis and leptospirosis. Due to the long time horizon anticipated for climate change, Jamaica should start implementing adaptation strategies focused on the health sector by promoting an enabling environment, strengthening communities, strengthening the monitoring, surveillance and response systems and integrating adaptation into development plans and actions. Small-island developing states like Jamaica must be proactive in implementing adaptation strategies, which will reduce the risk of climate change. On the global stage the country must continue to agitate for the implementation of the mitigation strategies for developed countries as outlined in the Kyoto protocol. The results regarding the tourism sector suggest that the sector is likely to incur losses due to climate change, the most significant of which is under the A2 scenario. Climatic features, such as temperature and precipitation, will affect the demand for tourism in Jamaica. By 2050 the industry is expected to lose US$ 132.2 million and 106.1 million under the A2 and B2 scenarios, respectively. In addition to changes in the climatic suitability for tourism, climate change is also likely to have important supply-side effects from extreme events and acidification of the ocean. The expected loss from extreme events is projected to be approximately US$ 5.48 billion (A2) and US$ 4.71 billion (B2). Even more devastating is the effect of ocean acidification on the tourism sector. The analysis shows that US$ 7.95 billion (A2) and US$ 7.04 billion is expected to be lost by mid-century. The benefit-cost analysis indicates that most of the adaptation strategies are expected to produce negative net benefits, and it is highly likely that the cost burden would have to be carried by the state. The options that generated positive ratios were: redesigning and retrofitting all relevant tourism facilities, restoring corals and educating the public and developing rescue and evacuation plans. Given the relative importance of tourism to the macroeconomy one possible option is to seek assistance from multilateral funding agencies. It is recommended that the government first undertake a detailed analysis of the vulnerability of each sector and, in particular tourism, to climate change. Further, more realistic socio-economic scenarios should be developed so as to inform future benefit-cost analysis.

The cost of hunger: Social and economic impact of child undernutrition in the Plurinational State of Bolivia, Ecuador, Paraguay and Peru

The Economic Commission for Latin America and the Caribbean (ECLAC) jointly with the World Program of Food (WFP) and recognized experts of the region developed a methodology that, using secondary information, estimate the opportunity cost derived from undernutrition. This methodology has been successfully applied in Costa Rica, El Salvador, Guatemala, Honduras, Nicaragua, Panama and the Dominican Republic, where the cost of undernutrition was estimated at 6.7 billion dollars in 2004. The present study covers four countries in South America: Bolivia, Ecuador, Paraguay and Peru. The results indicate that the cost of the malnutrition in these countries reached 4.3 billion dollars in 2005, which is equivalent to 3.3 per cent of the GDP of these countries. The results strongly point out that child undernutrition is not only a problem of health or an unacceptable situation ethically, but it is a national problem, given the enormous social costs and the loss of opportunities that it imposes on the national economy.

Assessment of surface water in two Amazonian rivers impacted by industrial wastewater, Barcarena City, Pará State (Brazil)

No ano de 2007, águas superficiais foram coletadas a partir de 21 pontos de amostragem na cidade de Barcarena, Região Norte, Brasil: um ponto de amostragem localizado em um pequeno córrego que recebe descarga de resíduos a partir da indústria de beneficiamento do caulim e deságua no Rio Curuperê, três pontos de amostragens localizados próximos de fontes que emergem na margem esquerda e deságuam no Rio Curuperê, nove pontos de amostragem no Rio Curuperê, que deságua no Rio Dendê, e oito no Rio Dendê, afluente da margem esquerda do Rio Pará. Para todas as amostras de água foram quantificadas 14 variáveis físico-químicas e níveis de 12 metais. Os resultados nos pontos próximos das fontes do Rio Curuperê apresentaram perfil físico-químico e níveis de metais típicos para águas superficiais e esses valores foram utilizados como referência para comparar e identificar possíveis alterações nas características químicas para os demais pontos de amostragem. Quando os resultados das fontes do rio Curuperê foram comparados com os resultados do ponto próximo a descarga de resíduos industriais foram observadas fortes alterações nos valores de 6 variáveis físico-químicas (pH, condutividade elétrica (EC), total de sólidos suspensos (TDS), nitrogênio amoniacal (N-NH4), sulfato (SO4) e salinidade) e aumento em magnitude dos níveis de quatro metais (Al, Fe, Mn e Zn), caracterizando que esses resíduos eram descarregados no ambiente sem tratamentos adequados. Os resultados nos demais pontos de amostragem demonstraram que estas condições anômalas também foram encontradas ao longo dos Rios Curuperê e Dendê, principalmente durante a maré baixa. A partir desta caracterização química das águas foram identificadas condições prejudiciais aos ecossistemas aquáticos e potencial risco à saúde da população local que usa os rios para consumo, recreação e transporte.

Descriptive study of HTLV infection in a population of pregnant women from the state of Pará, Northern Brazil

INTRODUÇÃO: No Brasil, estudos mostram que a soroprevalência do HTLV entre gestantes varia de 0 a 1,8%. Contudo, esta soroprevalência era desconhecida no Estado do Pará, Brasil. O presente estudo descreve, pela primeira vez, a soroprevalência do HTLV entre gestantes do Estado do Pará, Norte do Brasil. MÉTODOS: 13,382 gestantes foram submetidas à triagem para HTLV durante o pré-natal, e aquelas com sorologia alterada para anti-HTLV foram submetidas ao teste de Western Blot (WB), para confirmar e discriminar portadoras do HTLV-1 e do HTLV-2. RESULTADOS: A soroprevalência do HTLV na população de gestantes foi de 0,3%, sendo o HTLV-1 identificado em 95,3% das pacientes. O perfil demográfico das portadoras do HTLV foi de: mulheres com idade entre 20-40 anos (78,4%); residentes na região metropolitana de Belém (67,6%) e com nível educacional igual ao ensino médio (56,8%). Outras variáveis relacionadas à infecção foram: início das relações sexuais compreendido entre 12-18 anos (64,9%), e ter sido aleitada mais de 6 meses (51,4%). A maior parte das mulheres estudadas teve ao menos duas gestações anteriores (35,1%); e nenhum aborto (70,3%). Co-infecções (sífilis e HIV) foram descritas em 10,8% (4/37) das gestantes. A soroprevalência da infecção pelo HTLV em gestantes atendidas em Unidades Básicas de Saúde do Estado do Pará, Norte do Brasil foi de 0,3% semelhante à descrita em outros estudos brasileiros. As variáveis relacionadas com a infecção são indicadores importantes na identificação de gestantes com maior tendência a soropositividade pelo HTLV, sendo uma estratégia de controle e prevenção, evitando a transmissão vertical.

Serological Evidence of HTLV-I and HTLV-II Coinfections in HIV-1 Positive Patients in Belém, State of Pará, Brazil

ABSTRACT: The occurrence of HTLV-I/II and HIV-1 coinfections have been shown to be frequent, probably in consequence of their similar modes of transmission. This paper presents the prevalence of coinfection of HTLV among HIV-1 infected and AIDS patients in Belém, State of Pará, Brazil. A group of 149 patients attending the AIDS Reference Unit of the State Department of Health was tested for the presence of antibodies to HTLV-I/II using an enzyme immunoassay and the positive reactions were confirmed with a Western blot that discriminates between HTLV-I and HTLV-II infections. Four patients (2.7%) were positive to HTLV-I, seven (4.7%) to HTLV-II and one (0.7%) showed an indeterminate pattern of reaction. The present results show for the first time in Belém not only the occurrence of HTLV-II/HIV-1 coinfections but also a higher prevalence of HTLV-II in relation to HTLV-I. Furthermore, it also enlarges the geographical limits of the endemic area for HTLV-II in the Amazon region of Brazil.

Likely transmission of hepatitis C virus through sharing of cutting and perforating instruments in blood donors in the State of Pará, Northern Brazil

Nós determinamos os fatores de risco à infecção pelo HCV em doadores de sangue no Estado do Pará, Brasil. Foram analisados 256 doadores de sangue atendidos na Fundação HEMOPA de 2004 a 2006, sendo divididos em dois grupos: infectados e não-infectados. O diagnóstico foi realizado por PCR em tempo real. Todos os participantes responderam a questionário sobre possíveis fatores de risco, sendo a modelagem estatística feita por regressão logística simples e múltipla. Os fatores de risco à infecção foram: uso de agulhas e seringas de vidros esterilizadas em casa (OR = 4,55), realização de tratamento dentário invasivo (OR = 3,08), compartilhamento de lâminas em domicílio (OR = 1,99), compartilhamento de lâminas descartáveis em barbearias, salões de beleza (OR = 2,34), e compartilhamento de material de manicure e pedicure (OR = 3,45). As autoridades de saúde devem conscientizar a população sobre o compartilhamento de materiais perfuro-cortantes em domicílio, salões de beleza e consultórios dentários como fatores de risco à infecção.

Between the processes of strengthening and weakening of the Family Health Strategy

This was a qualitative study with the purpose of designing a meta-model for the work process of the Family Health Strategy (FHS) team. It was based on the experience of six sample groups, composed of their members (physicians, professional nurses, dentists, dental assistants, licensed technical nurses and community health agents) in a city in São Paulo state, Brazil, totaling 54 subjects. Six theoretical models emerged from non-directive interviews. These were analyzed according to Grounded Theory and submitted to the meta-synthesis strategy, which produced the meta-model between the processes of strengthening and weakening of the FHS model: professional-team-community reciprocity as an intervening component. When analyzed in light of the Theory of Complexity (TC), it showed to be a work with a vertical and authoritarian tendency, which is largely hegemonic in the tradition of public health care policies.

Spatial distribution of dengue incidence and socio-environmental conditions in Campinas, São Paulo State, Brazil, 2007

This study aimed to analyze the spatial distribution of dengue risk and its association with socio-environmental conditions. This was an ecological study of the counts of autochthonous dengue cases in the municipality of Campinas, São Paulo State, Brazil, in the year 2007, aggregated according to 47 coverage areas of municipal health centers. Spatial models for mapping diseases were constructed with Bayesian hierarchical models, based on Integrated Nested Laplace Approximation (INLA). The analyses were stratified according to two age groups, 0 to 14 years and above 14 years. The results indicate that the spatial distribution of dengue risk is not associated with socio-environmental conditions in the 0 to 14 year age group. In the age group older than 14 years, the relative risk of dengue increases significantly as the level of socio-environmental deprivation increases. Mapping of socio-environmental deprivation and dengue cases proved to be a useful tool for data analysis in dengue surveillance systems.

Cyanobacteria detection in Guarapiranga Reservoir (São Paulo State, Brazil) using Landsat TM and ETM+ images

Algae bloom is one of the major consequences of the eutrophication of aquatic systems, including algae capable of producing toxic substances. Among these are several species of cyanobacteria, also known as blue-green algae, that have the capacity to adapt themselves to changes in the water column. Thus, the horizontal distribution of cyanobacteria harmful algae blooms (CHABs) is essential, not only to the environment, but also for public health. The use of remote sensing techniques for mapping CHABs has been explored by means of bio-optical modeling of phycocyanin (PC), a unique inland waters cyanobacteria pigment. However, due to the small number of sensors with a spectral band of the PC absorption feature, it is difficult to develop semi-analytical models. This study evaluated the use of an empirical model to identify CHABs using TM and ETM+ sensors aboard Landsat 5 and 7 satellites. Five images were acquired for applying the model. Besides the images, data was also collected in the Guarapiranga Reservoir, in São Paulo Metropolitan Region, regarding the cyanobacteria cell count (cells/mL), which was used as an indicator of CHABs biomass. When model values were analyzed excluding calibration factors for temperate lakes, they showed a medium correlation (R²=0.81, p=0.036), while when the factors were included the model showed a high correlation (R²=0.96, p=0.003) to the cyanobacteria cell count. The empirical model analyzed proved useful as an important tool for policy makers, since it provided information regarding the horizontal distribution of CHABs which could not be acquired from traditional monitoring techniques.

Spatial Distribution of the Risk of Dengue and the Entomological Indicators in Sumare, State of Sao Paulo, Brazil

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Sero-epidemiological survey for brucellosis, leptospirosis, and toxoplasmosis in free-ranging Alouatta caraya and Callithrix penicillata from Sao Paulo State, Brazil

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Hospitalizations for Conditions Sensitive to Primary Care: A Geo-Epidemiological Profile Analysis of in a Hospital in the Sao Paulo State, From July 2010 to June 2011

The primary health care has been recognized as one of the key components of an effective health system. In its most developed form, the primary health care is the first contact with the health system and the site responsible for the organization of health care over time: individuals, their families and the general population; seeks to provide balance between the two goals of a national health system, which are improving the health of the population and provide equitable distribution of resources. Hospitalizations for primary care sensitive conditions (HPCSC) may be associated with deficiencies of service coverage primary health care or its effectiveness. Hospitalization rates can and should represent a warning sign, triggering mechanisms for analysis and search for explanations for these problems. The use of hospitalization data for HPCSC can serve as indicators of inequality in the health system, contributing to the evaluation of the deployment and implementation of health policies.