Para crítica ao campo dos determinantes sociais da saúde

O presente estudo analisa as relações entre a ‘saúde’ e o ‘social’ na Saúde Pública brasileira, especificamente a partir da noção de ‘determinação social da saúde’, focando-a em dois momentos importantes: a década de 70, quando ocorre a construção dessa noção a partir da corrente médico-social latino-americana, e a retomada dessa discussão no século XXI sobre a chancela de ‘determinantes sociais da saúde’. Possuiu como objetivos: Caracterizar a noção de ‘determinação social’ a partir do positivismo nas ciências sociais; pesquisar a construção da noção de ‘determinação social da saúde’ na Saúde Pública brasileira; descrever perspectivas de análises sobre o campo dos determinantes sociais da saúde a partir da polaridade entre a ‘saúde’ e o ‘social’. Para o alcance dos objetivos, foi realizado um estudo exploratório, através da pesquisa bibliográfica (livros e bases de dados virtuais) e da pesquisa documental. Inicialmente apresentamos os pressupostos teórico-filosóficos sobre os quais a ciência moderna se assentou e que construíram a base da corrente positivista. Após, caracterizamos, em linhas gerais, essa corrente de pensamento, para, finalmente, interpretarmos a noção de ‘determinação social’ a partir de Durkheim – uma das principais análises dentro do campo das ciências sociais. Logo após, trazemos a construção da noção de determinação social da saúde a partir da crítica latino-americana da década de 70 ao discurso hegemônico do período sobre o processo saúde-doença. O pensamento latino-americano teve grande produção teórico-política brasileira em um lugar de vanguarda quando comparado a todos os países da América do Sul e Central. Entre outras agendas, a noção de determinação social da saúde, oriunda dos movimentos sociais, pautou a reforma sanitária brasileira, colocando-se como cerne do debate. Noção esta que sustentou a ‘bandeira política’ defendida pelo movimento sanitário na luta por melhores condições de vida e de saúde no Brasil. Em seguida, apresentamos a configuração político-científica mais recente do campo dos determinantes sociais da saúde, destacando que ocorre um enfoque predominantemente reducionista sobre o social. Logo após, trazemos categorias do pensamento da sociologia crítica e da sociologia contemporânea, de forma a oferecer elementos de análise para a crítica à forma como hegemonicamente vem se pautando o discurso no interior do campo dos determinantes sociais da saúde. Ambas as perspectivas apresentam-se de forma não excludentes, não hierárquicas e não concorrentes. Finalizamos tecendo considerações que, longe de serem finais, sinalizam para a necessidade de uma nova perspectiva de partida para os estudos atuais no campo dos determinantes sociais da saúde.

Nitrogen fertilization of coffee: organic compost and Crotalaria juncea L.

Information concerning the response of coffee to organic fertilizers is scarce. This study evaluates the effect of different doses of compost and Crotalaria juncea L. on growth, production and nitrogen nutrition of coffee trees. The treatments consisted of compost at rates of 25, 50, 75 and 100% of the recommended fertilization, with or without the aerial part of C. juncea. C. juncea was grown with NH4-N (2% 15N) and applied to coffee. The use of C. juncea increased growth in height and diameter of the coffee canopy. In the first year, the percentage of N derived from C. juncea reached 8.5% at seven months and 4.1% at fifteen months after fertilization. In the second year, the percentage of N derived from C. juncea reached 17.9% N at the early harvest, five months after fertilization. Increased rates of compost increased pH , P , K , Ca , Mg , sum of bases , effective CEC, base saturation and organic matter and reduced potential acidity. 15N allowed the identification of the N contribution from C. juncea with percentage of leaf N derived from Crotalaria juncea from 9.2 to 17.9%.

Kinetics of solute leachate from imbibing Caesalpinia echinata Lam. (Brazilwood) seeds

The electrical conductivity of leachates from imbibing seeds has been used as a vigor test for several species. The adaptation of this methodology to different species requires knowledge on the leaching kinetics of electrolytes. For Brazilwood seeds, the classic method was not satisfactory and rapid tests are essential because they have low storage capacity at room temperature. Leaching kinetics during seed imbibition is a function of physiological quality, presence or absence of seed coat, imbibing temperature and the initial moisture content of seed. In this study, the electrolyte leaching rate of six different categories of seeds, from two regions, was evaluated in seeds with and without seed coat and incubated with different moisture contents and at different temperatures. The results showed that the electrolyte leaching rate in Brazilwood seeds is independent of the physiological quality, the presence or absence of seed coat and imbibition temperature, but these factors changed the total amount of electrolytes leached. The leaching rate increased in the first few minutes of imbibition, suggesting that the adjustment of the methodology must consider the reduction in imbibition time, reduction in temperature, use of a controlled and slower pre-imbibition, and replacement of the imbibition solution after the first few minutes.

On universal central extensions of Hom-Leibniz algebras

In the category of Hom-Leibniz algebras we introduce the notion of Hom-corepresentation as adequate coefficients to construct the chain complex from which we compute the Leibniz homology of Hom-Leibniz algebras. We study universal central extensions of Hom-Leibniz algebras and generalize some classical results, nevertheless it is necessary to introduce new notions of α-central extension, universal α-central extension and α-perfect Hom-Leibniz algebra due to the fact that the composition of two central extensions of Hom-Leibniz algebras is not central. We also provide the recognition criteria for these kind of universal central extensions. We prove that an α-perfect Hom-Lie algebra admits a universal α-central extension in the categories of Hom-Lie and Hom-Leibniz algebras and we obtain the relationships between both of them. In case α = Id we recover the corresponding results on universal central extensions of Leibniz algebras.

Residents’ perspectives on tourism impacts of portuguese world heritage historic centers: Angra do Heroísmo and Évora

The aim of this study is twofold. First, the study analyzes local community perspectives of the importance of the World Heritage Site (WHS) classification of the historic centers of Angra do Heroísmo and Évora. Second, the study analyzes local residents’ perceived tourism impacts on the municipalities of Angra do Heroísmo and Évora. The methodology comprises quantitative research based on a self-administered survey applied to convenience samples of local residents of the two Portuguese municipalities in 2014. The main results reveal that local residents have a strongly positive perception of the WHS designation in both municipalities. With regard to the perceived tourism impacts, residents from Angra do Heroísmo have a stronger agreement about the impacts of tourism on their city than the residents of Évora, except for the negative social and cultural impacts. The comparison of the mean scores of these impacts across residents that live near and far from the historic centers reveals that the most valued and least valued impacts in the three categories of impacts (economic, social and cultural, and environmental) are common to all groups of residents. Nevertheless, residents living in or near the historic center of Angra do Heroísmo have higher means in the majority of tourism impacts (in all categories), with only one negative impact to concern the majority of respondents. Among the residents from Évora, residents living in or near the historic center have higher means in the majority of economic impacts but lower means in almost social and cultural impacts. With regard to the environmental impacts, residents living in or near the historic center have higher means scores in the positive impacts and lower means scores in the negative environmental impacts.

Representations of gender in the writings of St. Francis Xavier: an interdisciplinary approach

Francis Xavier’s Letters and Writings are eloquent narratives of a journey that absorbed the Saint’s entire life. His experiences and idiosyncrasies, values and categorizations are presented in a clear literate discourse. The missionary is rarely neutral in his opinions as he sustains his unmistakable and omnipresent objective: the conversion of peoples and the expansion of the Society of Jesus. Parallel with this objective, the reader is introduced to the individuals that Xavier meets or that he summons in his epistolary discourse. Letters and Writings presents us with a structured narrative peopled by all those who are subject to and objects of Xavier’s apostolic mission, by helpful and unhelpful persons of influence, and by leading and secondary actors. What is then the position of women, in the collective sense as well as in the individual sense, in the travels and goals that are the centre of Xavier’s Letters and Writings? What is the role of women, that secondary and suppressed term in the man/woman binomial, a dichotomy similar to the civilized/savage and European/native binomials that punctuate Xavier’s narratives and the historic context of his letters? Women are not absent from his writings, but it would be naïve to argue in favour of the author’s misogyny as much as of his “profound knowledge of the female heart”, to quote from Paulo Durão in "Women in the Letters of Saint Francis Xavier" (1952), the only paper on this subject published so far. We denote four great categories of women in the Letters and Writings: European Women, Converted Women, Women Who Profess another Religion, and Women as the Agents and Objects of Sin, the latter of which traverses the other three categories. They all depend on the context, circumstances and judgements of value that the author chooses to highlight and articulate.

Novas perspetivas sobre as identidades de classe

Há mais de uma década começou a formar-se um movimento de reconversão nos estudos sobre as classes sociais, orientado pela ideia de que é preciso dar mais relevo aos processos culturais, à formação de identidades, ao gosto e à expressão de modos de vida e proceder ao exame direto da maneira como as posições de classe são vividas. Nesta perspetiva, as culturas de classe deixam de designar apenas tipos de comportamento próprios de grupos de desigualdade e passam a ser vistas também como modos de diferenciação, em que as categorias de classe operam através de distinções individualizadas e comparações relacionais com membros de outras classes. O que o conceito de identidade de classe quer agora indicar é um sentido das distâncias sociais dentro das hierarquias, que recorre às diferenças culturais para se exprimir. Este texto recenseia os desenvolvimentos teóricos e as bases empíricas desta linha de trabalho, emergente na sociologia britânica a partir do final da década de 90, com as propostas de autores como Savage, Skeggs, Reay, ou Bottero, entre outros.

Shannon information and power law analysis of the chromosome code

This paper studies the information content of the chromosomes of twenty-three species. Several statistics considering different number of bases for alphabet character encoding are derived. Based on the resulting histograms, word delimiters and character relative frequencies are identified. The knowledge of this data allows moving along each chromosome while evaluating the flow of characters and words. The resulting flux of information is captured by means of Shannon entropy. The results are explored in the perspective of power law relationships allowing a quantitative evaluation of the DNA of the species.

Performance evaluation of hospitals that provide care in the public health system, Brazil

OBJECTIVE To analyze if size, administrative level, legal status, type of unit and educational activity influence the hospital network performance in providing services to the Brazilian Unified Health System.METHODS This cross-sectional study evaluated data from the Hospital Information System and the Cadastro Nacional de Estabelecimentos de Saúde (National Registry of Health Facilities), 2012, in Sao Paulo, Southeastern Brazil. We calculated performance indicators, such as: the ratio of hospital employees per bed; mean amount paid for admission; bed occupancy rate; average length of stay; bed turnover index and hospital mortality rate. Data were expressed as mean and standard deviation. The groups were compared using analysis of variance (ANOVA) and Bonferroni correction.RESULTS The hospital occupancy rate in small hospitals was lower than in medium, big and special-sized hospitals. Higher hospital occupancy rate and bed turnover index were observed in hospitals that include education in their activities. The hospital mortality rate was lower in specialized hospitals compared to general ones, despite their higher proportion of highly complex admissions. We found no differences between hospitals in the direct and indirect administration for most of the indicators analyzed.CONCLUSIONS The study indicated the importance of the scale effect on efficiency, and larger hospitals had a higher performance. Hospitals that include education in their activities had a higher operating performance, albeit with associated importance of using human resources and highly complex structures. Specialized hospitals had a significantly lower rate of mortality than general hospitals, indicating the positive effect of the volume of procedures and technology used on clinical outcomes. The analysis related to the administrative level and legal status did not show any significant performance differences between the categories of public hospitals.

The tricks of the trade (un)exposed

One of the filmic trends which has been neglected by the Academy Awards is the metacinema, which for practical purposes I will consider to be a cross between the complexities of the self-reflexive cinema (highly connoted with modernism) and the Hollywood Film (the classical films about the urge to ‘make it’ in Hollywood). Indeed, these films have always existed and some, as Sunset Boulevard (Billy Wilder, 1950, USA) and Mulholland Dr. (David Lynch, 2001, FRA/USA), have even made it to the ceremony, but were, predictably, defeated in the main categories, by other more ‘serious’ or less self-reflexive products. The United States has always insisted on not revealing the tricks of the trade while, ironically, generating films that deal with this theme, in order to cater to the curiosity of the metacinema-inclined spectator. For this reason such films are usually about the universe of cinema but not its medium, at least not in a way that discloses the operations of the technical apparatus. Why are these films not viewed as serious enough and artistic enough to be awarded Oscars by the Academy in the categories of Best Picture, Best Director, Best Screenplay, and Best Cinematography? Are they being discarded for the same reasons that comedy and musicals usually are? Or are they being punished for being too unveiling? Or is the industry going for commercial products that can easily be pushed on a global scale and make a profit?

Asymptomatic infections by diarrheagenic Escherichia coli in children from Misiones, Argentina, during the first twenty months of their lives

Diarrheagenics Escherichia coli are the major agents involved in diarrheal disease in developing countries. The aim of this study was to evaluate the time of appearance of the first asymptomatic infection by the different categories of diarrheagenic E. coli in 44 children since their birth and during the first 20 months of their lives. In all of the children studied, we detected at least one category of diarrheagenic E. coli through the 20 months of the study. 510 diarrheagenic E. coli (33.5%) were obtained from the 1,524 samples collected from the 44 children during the time of the study (31.4% EAggEC, 28.8% EPEC, 27.1% DAEC, and 12.7% ETEC). Neither EHEC nor EIEC were identified. The median age for diarrheagenic E. coli colonization was 7.5 months. The mean weaning period was 12.8 months and the mean age for introduction of mixed feeding (breast fed supplemented) was 3.8 months. A significantly lower incidence of diarrheal disease and asymptomatic infections was recorded among the exclusively breast-fed rather than in the supplemented and non breast-fed infants. For ETEC, EPEC and EAggEC the introduction of weaning foods and complete termination of breast-feeding were associated with an increase of asymptomatic infections.

Performance of state space and ARIMA models for consumer retail sales forecasting

Forecasting future sales is one of the most important issues that is beyond all strategic and planning decisions in effective operations of retail businesses. For profitable retail businesses, accurate demand forecasting is crucial in organizing and planning production, purchasing, transportation and labor force. Retail sales series belong to a special type of time series that typically contain trend and seasonal patterns, presenting challenges in developing effective forecasting models. This work compares the forecasting performance of state space models and ARIMA models. The forecasting performance is demonstrated through a case study of retail sales of five different categories of women footwear: Boots, Booties, Flats, Sandals and Shoes. On both methodologies the model with the minimum value of Akaike's Information Criteria for the in-sample period was selected from all admissible models for further evaluation in the out-of-sample. Both one-step and multiple-step forecasts were produced. The results show that when an automatic algorithm the overall out-of-sample forecasting performance of state space and ARIMA models evaluated via RMSE, MAE and MAPE is quite similar on both one-step and multi-step forecasts. We also conclude that state space and ARIMA produce coverage probabilities that are close to the nominal rates for both one-step and multi-step forecasts.

The new mobility paradigm: transformation of value chain and business models

We would like to thank Philipp Schwarz and Julia Gückel for their dedicated support in preparing this paper and our colleagues and students of the School of Engineering and the Business School for our fruitful discussions.

Cost of drugs manufactured by the University Hospital - role of the Central Pharmacy

The hospital pharmacy in large and advanced institutions has evolved from a simple storage and distribution unit into a highly specialized manipulation and dispensation center, responsible for the handling of hundreds of clinical requests, many of them unique and not obtainable from commercial companies. It was therefore quite natural that in many environments, a manufacturing service was gradually established, to cater to both conventional and extraordinary demands of the medical staff. That was the case of Hospital das Clinicas, where multiple categories of drugs are routinely produced inside the pharmacy. However, cost-containment imperatives dictate that such activities be reassessed in the light of their efficiency and essentiality. METHODS: In a prospective study, the output of the Manufacturing Service of the Central Pharmacy during a 12-month period was documented and classified into three types. Group I comprised drugs similar to commercially distributed products, Group II included exclusive formulations for routine consumption, and Group III dealt with special demands related to clinical investigations. RESULTS: Findings for the three categories indicated that these groups represented 34.4%, 45.3%, and 20.3% of total manufacture orders, respectively. Costs of production were assessed and compared with market prices for Group 1 preparations, indicating savings of 63.5%. When applied to the other groups, for which direct equivalent in market value did not exist, these results would suggest total yearly savings of over 5 100 000 US dollars. Even considering that these calculations leave out many components of cost, notably those concerning marketing and distribution, it might still be concluded that at least part of the savings achieved were real. CONCLUSIONS: The observed savings, allied with the convenience and reliability with which the Central Pharmacy performed its obligations, support the contention that internal manufacture of pharmaceutical formulations was a cost-effective alternative in the described setting.

Assessment of the techniques of blood pressure measurement by health professionals

OBJECTIVE: To assess blood pressure measurement by health professionals of a public hospital in São Paulo State. METHODS: Semi-structured interviews and direct observation were performed with a verification list according to the criteria reported by Perloff et al. One hundred and five health professionals took part in the study. After measuring blood pressure, the level of concordance between the way the procedure was performed and the recommended one was assessed. RESULTS: Nurses and nurse's aides abided by 40% of the recommended procedures for adequate blood pressure measurement. The other categories of health professionals (nursing and medicine teachers, physicians, residents, and nursing students) abided by approximately 70%. CONCLUSION: Permanent educational activities aiming at standardizing blood pressure measurement should be implemented among the different categories of health professionals.