A comunicação na prática homeopática: como a racionalidade homeopática se expressa na comunicação entre médico e paciente?

No atual contexto da prática médica no Brasil, observa-se o predomínio de uma comunicação de caráter informativo, normativo e com pouca ênfase na promoção da autonomia dos pacientes, secundarizando o diálogo e a compreensão do paciente sobre o processo saúde-doença-cuidado. Esse tipo de prática baseia-se fortemente no Modelo Biomédico, que enfoca prioritariamente a doença e as lesões orgânicas, o que em muitas situações colabora para a medicalização, a (super)especialização e fragmentação do cuidado, comprometendo a qualidade da relação médico-paciente e a resolutividade das ações de saúde. Em contrapartida, uma prática médica centrada no paciente e que valorize a compreensão de sua interpretação da saúde-doença favorece a construção da integralidade do cuidado e a maior efetividade das ações. A presente pesquisa exploratória, predominantemente qualitativa com componente quantitativo investiga as práticas comunicacionais na relação médico-paciente na consulta homeopática, pautada pelo paradigma Vitalista. Nessa especialidade médica oferecida desde 1988 pelo Sistema Único de Saúde, e desde 2006, integrante da Polícia Nacional de Práticas Integrativas e Complementares do Ministério da Saúde, compreender múltiplas dimensões da existência e adoecer humanos demanda competência narrativa para a prática de sua semiologia, baseada na escuta atenta e implicada dos contextos biopatográficos, valorizadora dos sentidos atribuídos às vivências pelos sujeitos. Foram gravadas oito consultas de primeira vez realizadas num ambulatório-escola por médicos experientes, transcritas e submetidas à Análise de Conteúdo, que permitiram analisar como os fundamentos da racionalidade homeopática podem contribuir para a produção compartilhada de sentidos. Os resultados estão organizados nas categorias: Tomada de Turnos e Controle de Tópicos, Concepção de Saúde-Doença-Cuidado, Itinerários Terapêuticos, Ethos científico e Ethos do Mundo da Vida, Capacidade empática (atitudes de apoio, legitimação e polidez) e O Papel do Médico. Observa-se que a comunicação que estabelecida nesse tipo de prática em saúde avança na construção da integralidade da atenção e pode contribuir para a maior resolutividade do cuidado em saúde na medida em que minimiza a dicotomia entre mental e somático, individual e social.

Meteorological and hydrologic studies in the Alaskan Arctic in support of long-term ecological research

Long-term hydrologic studies in the Arctic simply do not exist. Although the Arctic has been identified as an area that is extremely sensitive to climate change, continuous scientific research has been limited to the past seven years. Earlier research was spotty, of short duration, and directed at only one or two hydrologic elements. Immediate future research needs to encompass all the major hydrologic elements, including winter processes, and needs to address the problem of scaling from small to larger areas in hydrologic models. Also, an international program of cooperation between northern countries is needed to build a greater scientific base for monitoring and identifying potential changes wrought by the climate.

A Biogeographic assessment off North/Central California: In support of the National Marine Sanctuaries of Cordell Bank, Gulf of the Farallones and Monterey Bay. Phase II - Environmental setting and update to marine birds and animals

NOAA’s National Centers for Coastal Ocean Science (NCCOS) conducts and supports research, monitoring, assessments, and technical assistance to meet NOAA’s coastal stewardship and management responsibilities. In 2001 the Biogeography Branch of NCCOS partnered with NOAA’s National Marine Sanctuary Program (NMSP) to conduct biogeographic assessments to support the management plan updates for the sanctuaries. The first biogeographic assessment conducted in this partnership focused on three sanctuaries off north/ central California: Cordell Bank, Gulf of the Farallones and Monterey Bay. Phase I of this assessment was conducted from 2001 to 2004, with the primary goal to identify and gather the best available data and information to characterize and identify important biological areas and time periods within the study area. The study area encompasses the three sanctuaries and extends along the coastal ocean off California from Pt. Arena to Pt. Sal (35°-39°N). This partnership project was lead by the NCCOS Biogeography Branch, but included over 90 contributors and 25 collaborating institutions. Phase I results include: 1) a report on the overall assessment that includes hundreds of maps, tables and analyses; 2) an ecological linkage report on the marine and estuarine ecosystems along the coast of north/central California, and 3) related geographic information system (GIS) data and other summary data files, which are available for viewing and download in several formats at the following website: http://ccma.nos.noaa.gov/products/biogeography/canms_cd/welcome.html Phase II (this report) was initiated in the Fall of 2004 to complete the analyses of marine mammals and update the marine bird colony information. Phase II resulted in significant updates to the bird and mammal chapters, as well as adding an environmental settings chapter, which contains new and existing data and maps on the study area. Specifically, the following Phase II topics and items were either revised or developed new for Phase II: •environmental, ecological settings – new maps on marine physiographic features, sea surface temperature and fronts, chlorophyll and productivity •all bird colony or roost maps, including a summary of marine bird colonies •updated at-sea data CDAS data set (1980-2003) •all mammal maps and descriptions •new overall density maps for eight mammal species •new summary pinniped rookery/haulout map •new maps on at-sea richness for cetaceans and pinnipeds •most text in the mammal chapter •new summary tables for mammals on population status and spatial and temporal patterns

Technical and mapping support for marine spatial planning: Final report

Washington depends on a healthy coastal and marine ecosystem to maintain a thriving economy and vibrant communities. These ecosystems support critical habitats for wildlife and a growing number of often competing ocean activities, such as fishing, transportation, aquaculture, recreation, and energy production. Planners, policy makers and resource managers are being challenged to sustainably balance ocean uses, and environmental conservation in a finite space and with limited information. This balancing act can be supported by spatial planning. Marine spatial planning (MSP) is a planning process that enables integrated, forward looking, and consistent decision making on the human uses of the oceans and coasts. It can improve marine resource management by planning for human uses in locations that reduce conflict, increase certainty, and support a balance among social, economic, and ecological benefits we receive from ocean resources. In March 2010, the Washington state legislature enacted a marine spatial planning law (RCW §43.372) to address resource use conflicts in Washington waters. In 2011, a report to the legislature and a workshop on human use data provided guidance for the marine spatial planning process. The report outlines a set of recommendations for the State to effectively undertake marine spatial planning and this work plan will support some of these recommendations, such as: federal integration, regional coordination, developing mechanisms to integrate scientific and technical expertise, developing data standards, and accessing and sharing spatial data. In 2012 the Governor amended the existing law to focus funding on mapping and ecosystem assessments for Washington’s Pacific coast and the legislature provided $2.1 million in funds to begin marine spatial planning off Washington’s coast. The funds are appropriated through the Washington Department of Natural Resources Marine Resources Stewardship Account with coordination among the State Ocean Caucus, the four Coastal Treaty Tribes, four coastal Marine Resource Committees and the newly formed stakeholder body, the Washington Coastal Marine Advisory Council.

Baseline assessment of Guánica Bay, Puerto Rico in support of watershed restoration

Guánica Bay is a major estuary on the southwest coast of Puerto Rico. Significant coral reef ecosystems are present outside the bay. These valuable habitats may be impacted by transport of sediments, nutrients and contaminants from the watershed, through the bay and into the offshore waters. The National Oceanic and Atmospheric Administration’s (NOAA) National Centers for Coastal Ocean Science (NCCOS), in consultation with local and regional experts, conducted an interdisciplinary assessment of coral reef ecosystems, contaminants, sedimentation rates and nutrient distribution patterns in and around Guánica Bay. This work was conducted using many of the same protocols as ongoing monitoring work underway elsewhere in the U.S. Caribbean and has enabled comparisons among coral reef ecosystems between this study and other locations in the region. This characterization of Guánica marine ecosystems establishes benchmark conditions that can be used for comparative documentation of future change, including possible negative outcomes due to future land use change, or improvement in environmental conditions arising from management actions. This report is organized into six chapters that represent a suite of interrelated studies. Chapter 1 provides a short introduction to the study area. Chapter 2 is focused on biogeographic assessments and benthic mapping of the study area, including new surveys of fish, marine debris and reef communities on hardbottom habitats in the study area. Chapter 3 quantifies the distribution and magnitude of a suite of contaminants (e.g., heavy metals, PAHs, PCBs, pesticides) in both surface sediments and coral tissues. Chapter 4 presents results of sedimentation measurements in and outside of the bay. Chapter 5 examines the distribution of nutrients in in the bay, offshore from the bay and in the watershed. Chapter 6 is a brief summary discussion that highlights key findings of the entire suite of studies.

Support for integrated ecosystem assessments of NOAA’s National Estuarine Research Reserve System (NERRS): assessment of ecological condition and stressor impacts in subtidal waters of the Sapelo Island National Estuarine Research Reserve

A study was conducted in June 2009 to assess the current status of ecological condition and potential human-health risks throughout subtidal estuarine waters of the Sapelo Island National Estuarine Research Reserve (SINERR) along the coast of Georgia. Samples were collected for multiple indicators of ecosystem condition, including water quality (dissolved oxygen, salinity, temperature, pH, nutrients and chlorophyll, suspended solids, fecal coliform bacteria and coliphages), sediment quality (granulometry, organic matter content, chemical contaminant concentrations), biological condition (diversity and abundance of benthic fauna, fish tissue contaminant levels and pathologies), and human dimensions (fish-tissue contaminant levels relative to human-health consumption limits, various aesthetic properties). Use of a probabilistic sampling design facilitated the calculation of statistics to estimate the spatial extent of the Reserve classified according to various categories (i.e., Good, Fair, Poor) of ecological condition relative to established thresholds of these indicators, where available. Overall, the majority of subtidal habitat in the SINERR appeared to be healthy, with over half (56.7 %) of the Reserve area having water quality, sediment quality, and benthic biological condition indicators rated in the healthy to intermediate range of corresponding guideline thresholds. None of the stations sampled had one or more indicators in all three categories rated as poor/degraded. While these results are encouraging, it should be noted that one or more indicators were rated as poor/degraded in at least one of the three categories over 40% of the Reserve study area, represented by 12 of the 30 stations sampled. Although measures of fish tissue chemical contamination were not included in any of the above estimates, a number of trace metals, pesticides, polybrominated diphenyl ethers (PBDEs), and polychlorinated biphenyls (PCBs) were found at low yet detectable levels in some fish at stations where fish were caught. Levels of mercury and total PCBs in some fish specimens fell within EPA guideline values considered safe, given a consumption rate of no more than four fish meals per month. Moreover, PCB congener profiles in sediments and fish in the SINERR exhibit a relative abundance of higher-chlorinated homologs which are uniquely characteristic of Aroclor 1268. It has been well-documented that sediments and fish in the creeks and marshes near the LCP Chemicals Superfund site, near Brunswick, Georgia, also display this congener pattern associated with Aroclor 1268, a highly chlorinated mixture of PCBs used extensively at a chlor-alkali plant that was in operation at the LCP site from 1955-1994. This report provides results suggesting that the protected habitats lying within the boundaries of the SINERR may be experiencing the effects of a legacy of chemical contamination at a site over 40km away. These effects, as well as other potential stressors associated with increased development of nearby coastal areas, underscore the importance of establishing baseline ecological conditions that can be used to track potential changes in the future and to guide management and stewardship of the otherwise relatively unspoiled ecosystems of the SINERR.