Spatio-temporal patterns of throughfall and solute deposition in an open tropical rain forest

The brief interaction of precipitation with a forest canopy can create a high spatial variability of both throughfall and solute deposition. We hypothesized that (i) the variability in natural forest systems is high but depends on system-inherent stability, (ii) the spatial variability of solute deposition shows seasonal dynamics depending on the increase in rainfall frequency, and (iii) spatial patterns persist only in the short-term. The study area in the north-western Brazilian state of Rondonia is subject to a climate with a distinct wet and dry season. We collected rain and throughfall on an event basis during the early wet season (n = 14) and peak of the wet season (n = 14) and analyzed the samples for pH and concentrations of NH4+, Na+, K+, Ca2+ Mg2+,, Cl-, NO3-, SO42- and DOC. The coefficient 3 4 cient of variation for throughfall based on both sampling intervals was 29%, which is at the lower end of values reported from other tropical forest sites, but which is higher than in most temperate forests. Coefficients of variation of solute deposition ranged from 29% to 52%. This heterogeneity of solute deposition is neither particularly high nor particularly tow compared with a range of tropical and temperate forest ecosystems. We observed an increase in solute deposition variability with the progressing wet season, which was explained by a negative correlation between heterogeneity of solute deposition and antecedent dry period. The temporal stability of throughfall. patterns was Low during the early wet season, but gained in stability as the wet season progressed. We suggest that rapid plant growth at the beginning of the rainy season is responsible for the lower stability, whereas less vegetative activity during the later rainy season might favor the higher persistence of ""hot"" and ""cold"" spots of throughfall. quantities. The relatively high stability of throughfall patterns during later stages of the wet season may influence processes at the forest floor and in the soil. Solute deposition patterns showed less clear trends but all patterns displayed a short-term stability only. The weak stability of those patterns is apt to impede the formation of solute deposition -induced biochemical microhabitats in the soil. (C) 2008 Elsevier B.V. All rights reserved.

Incidence of Pressure Ulcers in the Institutionalized Elderly

PURPOSE: The aim of this study was to analyze the incidence of pressure ulcers (PUs) in elderly people living in long-term care facilities (LTCFs). DESIGN: We completed a prospective, comparison cohort study. SUBJECTS AND SETTING: Ninety-four persons, 60 years or older, participated in the study. Participants resided in 4 not-for-profit LTCFs in 3 cities in the southern region of the Brazilian state of Minas Gerais. METHODS: Participants underwent complete skin examination and Braden Scale rating every 2 days for 3 months. When a PU was detected, a careful examination was done to assess its stage, location, and size. From this moment on, the patient was included in the incidence rate and was excluded from the study. RESULTS: The incidence rate of PUs was 39.4%; 37 (77.1%) developed a single ulcer. The most common locations were the malleolus (27.1%) and the ischium (25.0%). Stage I PU were most frequent (66.7%). Females (62.8%) and whites (68.19%) prevailed, with an average age of 79.06 +/- 9.6 years. Body mass index was 20.93 +/- 4.9, with a predominance of urinary diseases (58.5%) and use of neuroleptics/psychotropics (52.1%); 28.7% had had a previous ulcer. Gender and the occurrence of a previous ulcer were found to predict the development of PU, based on logistic regression analysis (r(2) = 0.311). CONCLUSIONS: The overall incidence of PU was significant, but the incidence of stage II and higher PUs was less than 12% and no elders had stage III or IV ulcers. Factors associated with PU development include female gender, regular use of neuroleptic or psychotropic medications, and a history of pressure ulceration.

Effect of a 36-month pharmaceutical care program on pharmacotherapy adherence in elderly diabetic and hypertensive patients

Objective: The primary objective of this study was to evaluate the effect of a pharmaceutical care program on pharmacotherapy adherence in elderly diabetic and hypertensive patients. The clinical outcomes of this pharmacotherapy adherence approach were the secondary objective of the study. Setting: Public Primary Health Care Unit in a municipality in the Brazilian State of Sao Paulo. Method: A 36-month randomized, controlled, prospective clinical trial was carried out with 200 patients divided into two groups: control (n = 100) and intervention (n = 100). The control group received the usual care offered by the Primary Health Care Unit (medical and nurse consultancies). The patients randomized into the intervention group received pharmaceutical care intervention besides the usual care offered. Main outcome measure: Pharmacotherapy adherence (Morisky-Green test translated into Portuguese and computerized dispensed medication history) and clinical measurements (blood pressure, fasting glucose, A1C hemoglobin, triglycerides and total cholesterol) were evaluated at the baseline and up to 36 months. A P value < 0.05 was considered statistically significant. Results: A total of 97 patients from the intervention group and 97 patients from the control group completed the study (n = 194). Significant improvements in the pharmacotherapy adherence were verified for the intervention group according to the Morisky-Green test (50.5% of adherent patients at baseline vs. 83.5% of adherent patients after 36 months; P < 0.001) and the computerized dispensed medication history (52.6% of adherent patients at baseline vs. 83.5% of adherent patients after 36 months; P < 0.001); no significant changes were verified in the control group. Significant improvements in the number of patients reaching adequate values for their blood pressure (26.8% at baseline vs. 86.6% after 36-months; P < 0.001), fasting glucose (29.9% at baseline vs. 70.1% after 36 months; P < 0.001), A1C hemoglobin (3.3% at baseline vs. 63.3% after 36 months; P < 0.001), triglycerides (47.4% at baseline vs. 74.2% after 36 months; P < 0.001) and total cholesterol (59.8% at baseline vs. 80.4% after 36 months; P = 0.002) were verified in the intervention group, but remained unchanged in the control group. Conclusion: These results indicated the effectiveness of pharmaceutical care in improving pharmacotherapy adherence, with positive effects in the clinical outcomes of the patients studied.

Rubella Vaccination of Unknowingly Pregnant Women: The Sao Paulo Experience, 2001

Background. Rubella vaccination is contraindicated during pregnancy. During mass immunization of women of childbearing age against rubella, women unknowingly pregnant may be vaccinated. To evaluate the effects of rubella vaccination during pregnancy, the Brazilian state of Sao Paulo conducted a follow-up study of pregnant women vaccinated during a rubella campaign in 2001. Methods. Women vaccinated during pregnancy were reported to a national surveillance system. In the state of Sao Paulo, follow-up of vaccinated women included household interviews. Serum samples from vaccinated women were tested for antirubella antibodies to classify susceptibility to rubella infection. Children born to susceptible mothers were tested for evidence of congenital rubella infection and evaluated for signs of congenital rubella syndrome. Results. The Sao Paulo State Health Department received 6473 notifications of women vaccinated during pregnancy. Serology performed for 5580 women identified 811 (15%) that were previously susceptible. Incidence of spontaneous abortion or stillbirth among previously susceptible vaccinated women was similar to women with prior immunity. Twenty-seven (4.7%) of 580 newborns tested had evidence of congenital rubella infection; none had congenital rubella syndrome. Conclusions. Mass rubella vaccination of women of childbearing age was not associated with adverse birth outcomes or congenital rubella syndrome among children born to women vaccinated during pregnancy.

A trag??dia da regi??o serrana do Rio de Janeiro em 2011: procurando respostas

O estudo de caso trata do desastre natural ocorrido na regi??o serrana do Rio de Janeiro nos dias 11 e 12 de janeiro de 2011, considerado a maior cat??strofe clim??tica e geot??cnica do pa??s, causado por fortes chuvas que provocaram enchentes e deslizamentos em sete munic??pios. O caso tem por finalidade despertar a discuss??o sobre as vari??veis e atores que influenciaram o processo de gest??o da crise, contextualizando o desastre no cen??rio da regi??o e reconstituindo, especialmente, o processo de resposta imediata dada ?? trag??dia pelos ??rg??os envolvidos. O estudo pode ser utilizado em cursos que abordem, entre outros, os seguintes t??picos: gest??o de crise e gest??o de riscos, negocia????o, comunica????o e planejamento estrat??gico

A reforma do Estado, a emerg??ncia da descentraliza????o e as pol??ticas ambientais

No contexto da reforma do Estado brasileiro, a descentraliza????o das compet??ncias pol??ticas e administrativas na arena ambiental tem se mostrado um processo din??mico. Muitas inst??ncias locais j?? respondem pela quest??o ambiental. No entanto, isso n??o significa mais compet??ncia administrativa, sustentabilidade institucional, tampouco participa????o democr??tica. Dois casos de pol??tica ambiental s??o retratados no texto: o licenciamento industrial pelos munic??pios brasileiros e o a gest??o florestal pelo Estado do Mato Grosso. A descentraliza????o do licenciamento ambiental para o ??mbito municipal ainda parece fr??gil em munic??pios menores, em um processo que parece ser induzido pelo Estado e n??o pelo controle social local. Em rela????o ?? pol??tica florestal, o caso do Mato Grosso ?? emblem??tico. Ele mostra que a coopera????o com o poder p??blico federal e, em determinados momentos, sua coordena????o s??o de suma import??ncia para que as pol??ticas p??blicas ambientais n??o fiquem ?? merc?? de governos estaduais, que podem envies??-las em favor do ???desenvolvimentismo???, nem percam a legitimidade adiante da fragilidade financeira e institucional dos ??rg??os ambientais locais.

Sa??de do trabalhador: um (n??o) olhar sobre o servidor p??blico

O presente artigo pretende tecer algumas considera????es a respeito dos discursos e pr??ticas da ??rea da sa??de do trabalhador em rela????o aos trabalhadores dos servi??os p??blicos. Na primeira parte, demarca a constru????o do campo da Sa??de do Trabalhador enquanto pol??tica p??blica no Brasil, identificando como as Confer??ncias Nacionais de Sa??de do Trabalhador trataram o tema da sa??de do servidor p??blico. Em seguida, analisa entrevistas realizadas com profissionais da Per??cia M??dica de um estado brasileiro. Ao final, conclui que a????es voltadas ?? aten????o da sa??de do servidor p??blico n??o integram uma pol??tica p??blica, mas ficam ?? merc?? dos diferentes governos, sendo que os enunciados sobre a sa??de do trabalhador t??m uma fr??gil penetra????o em um campo ainda hegem??nico da medicina do trabalho. A sa??de do servidor p??blico n??o tem merecido investimento, apenas controle, em conson??ncia com um longo hist??rico de desvaloriza????o do setor p??blico.

Perman??ncia e mudan??a no setor p??blico

Por ter se convertido em espa??o e instrumento das concilia????es com o passado, o Estado brasileiro n??o p??de se tornar completamente moderno e autenticamente republicano. N??o teve como deixar de se submeter a pr??ticas e concep????es fortemente vinculadas ao tradicional privatismo das elites. Tornou-se um Estado moderno enxertado de patrimonialismo, cuja burocracia legitima seu poder atrav??s do recurso a procedimentos clientelistas e fisiol??gicos.

Insulamento burocr??tico, accountability e transpar??ncia: dez anos de regula????o da Ag??ncia Nacional de Vigil??ncia Sanit??ria

Este artigo estuda os instrumentos e mecanismos de transpar??ncia e accountability das ag??ncias reguladoras brasileiras. Por meio da caracteriza????o dos processos de controle, participa????o e acesso a informa????es da Ag??ncia Nacional de Vigil??ncia Sanit??ria (Anvisa), analisa-se como as ag??ncias t??m utilizado tais instrumentos e mecanismos para acolher e processar diversos interesses do processo regulat??rio, promover a estabilidade das regras do jogo e refor??ar a sua legitimidade no ambiente pol??tico e social em que elas est??o inseridas. Foram utilizados dados relativos aos diversos instrumentos de transpar??ncia e accountability, bem como ??s inst??ncias e mecanismos de participa????o da sociedade no processo regulat??rio da Anvisa. Conclui-se que a accountability das ag??ncias ?? um contrafluxo ?? tend??ncia de insulamento, ao mesmo tempo em que se pode configurar um esfor??o de reconhecimento pela sociedade da chegada de um novo aparato institucional no Estado brasileiro: as ag??ncias reguladoras.

Perman??ncia e mudan??a no setor p??blico

Por ter se convertido em espa??o e instrumento das concilia????es com o passado, o Estado brasileiro n??o p??de se tornar completamente moderno e autenticamente republicano. N??o teve como deixar de se submeter a pr??ticas e concep????es fortemente vinculadas ao tradicional privatismo das elites. Tornou-se um Estado moderno enxertado de patrimonialismo, cuja burocracia legitima seu poder atrav??s do recurso a procedimentos clientelistas e fisiol??gicos.

As políticas de proteção social no contexto escolar

Esta dissertação teve o objetivo de investigar como a formalização das políticas de proteção social via programas e projetos socioeducativos se articulam com a educação escolarizada. Realiza uma discussão conceitual acerca das políticas de proteção social e “vulnerabilidade e risco social” a partir de aspectos históricos situando-as na lógica societária das desigualdades e complexificações das refrações da questão social do modelo capitalista de produção e reprodução social, sobretudo no contexto das reformas do Estado brasileiro enquanto demanda dos ajustes neoliberais. O lócus da pesquisa foi uma escola da rede pública municipal de Serra/ES. As investigações foram realizadas em duas etapas. A primeira constituiu-se de um estudo exploratório de caráter qualitativo. Por meio das análises abstraídas dessa fase, foi realizado um estudo de caso como segunda etapa da pesquisa. Os instrumentos utilizados, análise de documentos, observação participante e entrevistas, evidenciam que os programas e projetos socioeducativos desenvolvidos no espaço escolar visando a uma suposta proteção social, não guardam relação concreta com a melhoria dos processos de aprendizagem dos alunos, logo, seus efeitos na vida escolar desses alunos não foram evidenciados. Verificou-se ainda profunda desarticulação entre as propostas pedagógicas da escola e dos docentes com os programas e projetos investigados. A partir dos dados da pesquisa, pudemos ainda constatar que tais programas e projetos adentram o espaço escolar por meio de demandas externas envolvendo a Secretaria Municipal de Educação e a iniciativa privada. Concluímos que a proteção social no espaço escolar via programas e projetos socioeducativos necessita voltar-se à articulação com políticas públicas que ultrapassem os muros da escola e que de fato garantam o acesso a bens materiais e simbólicos com vista à melhoria das condições de vida material e sociocultural dos alunos a quem são destinados e, consequentemente, a melhoria da qualidade da educação escolarizada.

Corpos e subjetividades : análise dos processos de embodiment dos ursos no Espírito Santo

Este trabalho vem analisar processos de subjetivação de sujeitos homossexuais que se assumem como ursos. Trazemos o debate de corpos para explicitarmos seus agenciamentos, tanto na produção imagética do que socialmente seriam aqueles sujeitos, dos locais de onde falam, dos grupos que apresentam afinidades, quanto nos processos em que constroem a si mesmos. Os processos de subjetivação não pressupõem um sujeito autônomo, pois sofrem interferências de organizações de forças e saberes que operam na sociedade (FOUCAULT, 2003). Diante disso, recorremos à analíticas de poder propostas por Michel Foucault (1995), Judith Butler (2010) e Laclau e Mouffe (1987), tanto para nos afastarmos de noções de corpos passivos, universais e objetivos, recorrentes em enfoques em hegemonia na Administração, quanto para analisarmos sua construção somente em relação à construção de um sujeito, ou seja, em processos sociais, históricos e políticos de embodiments. Foi realizada uma pesquisa qualitativa, cujos dados foram coletados por meio de entrevistas individuais semiestruturadas com 19 participantes capixabas. Os dados foram analisados sob a ótica pós-estruturalista do discurso tendo em vista as abordagens laclauniana e foucaultiana. O trabalho conclui que o discurso ursino sobredetermina práticas dispersas no campo de homoafetividades ao articular um esquema corpóreo “masculino”. Este esquema se assume como uma das práticas hegemônicas LGBT e, consequentemente, é o primeiro a ser acionado nas subjetivações dos participantes. Porém, este processo não se concretiza de forma plena, nem elimina particularidades e contingências que parodiam as demandas comportamentais emergentes das construções identitárias.

Geographical patterns of proportionate mortality for the most common causes of death in Brazil

Mortality due to chronic diseases has been increasing in all regions of Brazil with corresponding decreases in mortality from infectious diseases. The geographical variation in proportionate mortality for chronic diseases for 17 Brazilian state capitals for the year 1985 and their association with socio-economic variables and infectious disease was studied. Calculations were made of correlation coefficients of proportionate mortality for adults of 30 years or above due to ischaemic heart disease, stroke and cancer of the lung, the breast and stomach with 3 socio-economic variables, race, and mortality due to infectious disease. Linear regression analysis included as independent variables the % of illiteracy, % of whites, % of houses with piped water, mean income, age group, sex, and % of deaths caused by infectious disease. The dependent variables were the % of deaths due to each one of the chronic diseases studied by age-sex group. Chronic diseases were an important cause of death in all regions of Brazil. Ischaemic heart diseases, stroke and malignant neoplasms accounted for more than 34% of the mortality in each of the 17 capitals studied. Proportionate cause-specific mortality varied markedly among state capitals. Ranges were 6.3-19.5% for ischaemic heart diseases, 8.3-25.4% for stroke, 2.3-10.4% for infections and 12.2-21.5% for malignant neoplasm. Infectious disease mortality had the highest (p < 0.001) correlation with all the four socio-economic variables studied and ischaemic heart disease showed the second highest correlation (p < 0.05). Higher socio-economic level was related to a lower % of infectious diseases and a higher % of ischaemic heart diseases. Mortality due to breast cancer and stroke was not associated with socio-economic variables. Multivariate linear regression models explained 59% of the variance among state capitals for mortality due to ischaemic heart disease, 50% for stroke, 28% for lung cancer, 24% for breast cancer and 40% for stomach cancer. There were major differences in the proportionate mortality due to chronic diseases among the capitals which could not be accounted for by the social and environmental factors and by the mortality due to infectious disease.

Disparities in cervical and breast cancer mortality in Brazil

OBJECTIVE To analyze cervical and breast cancer mortality in Brazil according to socioeconomic and welfare indicators. METHODS Data on breast and cervical cancer mortality covering a 30-year period (1980-2010) were analyzed. The data were obtained from the National Mortality Database, population data from the Brazilian Institute of Geography and Statistics database, and socioeconomic and welfare information from the Institute of Applied Economic Research. Moving averages were calculated, disaggregated by capital city and municipality. The annual percent change in mortality rates was estimated by segmented linear regression using the joinpoint method. Pearson’s correlation coefficients were conducted between average mortality rate at the end of the three-year period and selected indicators in the state capital and each Brazilian state. RESULTS There was a decline in cervical cancer mortality rates throughout the period studied, except in municipalities outside of the capitals in the North and Northeast. There was a decrease in breast cancer mortality in the capitals from the end of the 1990s onwards. Favorable socioeconomic indicators were inversely correlated with cervical cancer mortality. A strong direct correlation was found with favorable indicators and an inverse correlation with fertility rate and breast cancer mortality in inner cities. CONCLUSIONS There is an ongoing dynamic process of increased risk of cervical and breast cancer and attenuation of mortality because of increased, albeit unequal, access to and provision of screening, diagnosis and treatment. 

Increased detection of schistosomiasis with Kato-Katz and SWAP-IgG-ELISA in a Northeastern Brazil low-intensity transmission area

INTRODUCTION: The laboratory diagnosis of schistosomiasis is based mainly on the detection of parasite eggs in stool samples through the Kato-Katz (KK) technique, reading one slide by test. However, a widely known limitation of parasitological methods is reduced sensitivity, particularly in low endemic areas. METHODS: To increase sensitivity, we conducted further slide readings from the same stool sample using the parasitological method associated with a serological test. We used the KK method (three slides) and the IgG anti-Schistosoma mansoni-enzyme-linked immunosorbent assay (ELISA) technique to diagnose schistosomiasis in low endemic areas in the Brazilian State of Ceará. Fecal samples and sera from 250 individuals were analyzed. RESULTS: Sixteen percent and 47.2% of samples were positive in parasitological tests and serological tests, respectively. Parasitological methods showed that 32 (80%) individuals tested positive on the first slide, 6 (15%) on the second slide, and 2 (5%) on the third. The performance of the ELISA test in the diagnosis, using the KK method as diagnostic reference, showed a negative predictive value of 100%, with specificity and positive predictive values of 62.8% and 33.9%, respectively. CONCLUSIONS: In this study, the increase from one to three slides analyzed per sample using the KK technique was shown to be a useful procedure for increasing the diagnostic sensitivity of this technique.