Advances and challenges in oral health after a decade of the “Smiling Brazil” Program

ABSTRACT OBJECTIVE To analyze oral health work changes in primary health care after Brazil’s National Oral Health Policy Guidelines were released. METHODS A literature review was conducted on Medline, LILACS, Embase, SciELO, Biblioteca Virtual em Saúde, and The Cochrane Library databases, from 2000 to 2013, on elements to analyze work changes. The descriptors used included: primary health care, family health care, work, health care policy, oral health care services, dentistry, oral health, and Brazil. Thirty-two studies were selected and analyzed, with a predominance of qualitative studies from the Northeast region with workers, especially dentists, focusing on completeness and quality of care. RESULTS Observed advances focused on educational and permanent education actions; on welcoming, bonding, and accountability. The main challenges were related to completeness; extension and improvement of care; integrated teamwork; working conditions; planning, monitoring, and evaluation of actions; stimulating people’s participation and social control; and intersectorial actions. CONCLUSIONS Despite the new regulatory environment, there are very few changes in oral health work. Professionals tend to reproduce the dominant biomedical model. Continuing efforts will be required in work management, training, and permanent education fields. Among the possibilities are the increased engagement of managers and professionals in a process to understand work dynamics and training in the perspective of building significant changes for local realities.

Non-Cardiac Surgery in Developing Countries: Epidemiological Aspects and Economical Opportunities - The Case of Brazil

Background: Worldwide distribution of surgical interventions is unequal. Developed countries account for the majority of surgeries and information about non-cardiac operations in developing countries is scarce. The purpose of our study was to describe the epidemiological data of non-cardiac surgeries performed in Brazil in the last years. Methods and Findings: This is a retrospective cohort study that investigated the time window from 1995 to 2007. We collected information from DATASUS, a national public health system database. The following variables were studied: number of surgeries, in-hospital expenses, blood transfusion related costs, length of stay and case fatality rates. The results were presented as sum, average and percentage. The trend analysis was performed by linear regression model. There were 32,659,513 non-cardiac surgeries performed in Brazil in thirteen years. An increment of 20.42% was observed in the number of surgeries in this period and nowadays nearly 3 million operations are performed annually. The cost of these procedures has increased tremendously in the last years. The increment of surgical cost was almost 200%. The total expenses related to surgical hospitalizations were more than $10 billion in all these years. The yearly cost of surgical procedures to public health system was more than $1.27 billion for all surgical hospitalizations, and in average, U$445.24 per surgical procedure. The total cost of blood transfusion was near $98 million in all years and annually approximately $10 million were spent in perioperative transfusion. The surgical mortality had an increment of 31.11% in the period. Actually, in 2007, the surgical mortality in Brazil was 1.77%. All the variables had a significant increment along the studied period: r square (r(2)) = 0.447 for the number of surgeries (P = 0.012), r(2) = 0.439 for in-hospital expenses (P = 0.014) and r(2) = 0.907 for surgical mortality (P = 0.0055). Conclusion: The volume of surgical procedures has increased substantially in Brazil through the past years. The expenditure related to these procedures and its mortality has also increased as the number of operations. Better planning of public health resource and strategies of investment are needed to supply the crescent demand of surgery in Brazil.

Mammography-based screening program: preliminary results from a first 2-year round in a Brazilian region using mobile and fixed units

Background: Breast cancer is the most frequently diagnosed cancer and the leading cause of cancer deaths among women worldwide. The use of mobile mammography units to offer screening to women living in remote areas is a rational strategy to increase the number of women examined. This study aimed to evaluate results from the first 2 years of a government-organized mammography screening program implemented with a mobile unit (MU) and a fixed unit (FU) in a rural county in Brazil. The program offered breast cancer screening to women living in Barretos and the surrounding area. Methods: Based on epidemiologic data, 54 238 women, aged 40 to 69 years, were eligible for breast cancer screening. The study included women examined from April 1, 2003 to March 31, 2005. The chi-square test and Bonferroni correction analyses were used to evaluate the frequencies of tumors and the importance of clinical parameters and tumor characteristics. Significance was set at p < 0.05. Results: Overall, 17 964 women underwent mammography. This represented 33.1% of eligible women in the area. A mean of 18.6 and 26.3 women per day were examined in the FU and MU, respectively. Seventy six patients were diagnosed with breast cancer (41 (54%) in the MU). This represented 4.2 cases of breast cancer per 1000 examinations. The number of cancers detected was significantly higher in women aged 60 to 69 years than in those aged 50 to 59 years (p < 0.001) or 40 to 49 years (p < 0.001). No difference was observed between women aged 40 to 49 years and those aged 50 to 59 years (p = 0.164). The proportion of tumors in the early (EC 0 and EC I) and advanced (CS III and CS IV) stages of development were 43.4% and 15.8%, respectively. Conclusions: Preliminary results indicate that this mammography screening program is feasible for implementation in a rural Brazilian territory and favor program continuation.

Phase Equilibrium and Optimization Tools: Application for Enhanced Structured Lipids for Foods

Solid-liquid phase equilibrium modeling of triacylglycerol mixtures is essential for lipids design. Considering the alpha polymorphism and liquid phase as ideal, the Margules 2-suffix excess Gibbs energy model with predictive binary parameter correlations describes the non ideal beta and beta` solid polymorphs. Solving by direct optimization of the Gibbs free energy enables one to predict from a bulk mixture composition the phases composition at a given temperature and thus the SFC curve, the melting profile and the Differential Scanning Calorimetry (DSC) curve that are related to end-user lipid properties. Phase diagram, SFC and DSC curve experimental data are qualitatively and quantitatively well predicted for the binary mixture 1,3-dipalmitoyl-2-oleoyl-sn-glycerol (POP) and 1,2,3-tripalmitoyl-sn-glycerol (PPP), the ternary mixture 1,3-dimyristoyl-2-palmitoyl-sn-glycerol (MPM), 1,2-distearoyl-3-oleoyl-sn-glycerol (SSO) and 1,2,3-trioleoyl-sn-glycerol (OOO), for palm oil and cocoa butter. Then, addition to palm oil of Medium-Long-Medium type structured lipids is evaluated, using caprylic acid as medium chain and long chain fatty acids (EPA-eicosapentaenoic acid, DHA-docosahexaenoic acid, gamma-linolenic-octadecatrienoic acid and AA-arachidonic acid), as sn-2 substitutes. EPA, DHA and AA increase the melting range on both the fusion and crystallization side. gamma-linolenic shifts the melting range upwards. This predictive tool is useful for the pre-screening of lipids matching desired properties set a priori.

Stabilization of an amylase from Neurospora crassa by immobilization on highly activated supports

The amylase from Neurospora crassa is an interesting enzyme, having higher stability than amylase from Aspergillus oryzea under a broad range of pH values. Moreover, the N. crassa enzyme may be immobilized on different supports with good retention of enzyme activity. The best stabilizations were achieved using Eupergit C 250 L or glyoxyl agarose, with which the enzyme remained fully active at 60C for 24 h while the soluble enzyme remained about 17%. The glyoxyl agarose immobilized enzyme had high thermostability, high optimal temperature (65C) and broad pH/activity profile, suggesting that this enzyme has potential for food and industrial applications for starch modification.

Institutional Development for Good Governance: the role of intermediary NGOs in Pará state, Amazonia

The paper analyses the roles of intermediary NGOs for linkages between government and rural communities in carrying out socio-environmental development programs as a mean of institutional development for good governance. In particular, the paper focuses on the Proambiente program that was carried out in Pará State, Amazonia, Brazil. This program was the first experience of a socio-environmental development program in Brazilian Amazonia that took into account local communities' demands to link environmental conservation and small-scale family-based rural production. Methodologically, the research was based on qualitative analysis and used semi-structured interviews for data collection. The paper shows that NGOs as intermediaries between government and rural communities is a significant mechanism to promote the strengthening of the power of local communities, to create bridges between federal government and local communities; and to stimulate participatory processes by engaging rural communities' culture and knowledge in socio-environmental development program as Proambiente.

Informação e conhecimento: fluxos e apropriação sob uma abordagem crítica

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Impacto do acordo de cooperação do Conselho Nacional de Pesquisas (CNPq) com a National Academy of Sciences - (NAS)

In the beginning of the 1960's, the university education in chemistry, in Brasil, represented only a professional preparation, with no official post-graduate teaching and research, as yet. The name Federal University Rio de Janeiro, evolved, since January 30, 1959, from University of Brazil, RJ, to Federal University of Guanabara, which, on August 20, 1965, became the Federal University of Rio de Janeiro. With the Resolution nº 4, of the University direction, the first Institute of Chemistry was created, to include the Centers of Mathematical and Natural Sciences, and the Medical Sciences. The strictu sensu's system was established only in 1961.

Students' preferred teaching techniques for biochemistry in biomedicine and medicine courses

The aim of this study was to investigate the students' preferred teaching techniques, such as traditional blackboard, power-point, or slide-projection, for biochemistry discipline in biomedicine and medicine courses from São Paulo State University, UNESP, Botucatu, São Paulo, Brazil. Preferences for specific topic and teaching techniques were determined from questionnaires on a Liquert scale from 1 to 5 (strongly disagree; disagree; neither agree, nor disagree; agree; strongly agree) distributed at the end of biochemistry discipline to 180 biomedical students (30 students/year) and 540 medical students (90 students/year), during the years 2000-2005. Despite of the different number of hours applied to the course topics for the two groups of students, the majority of undergraduates from biomedicine and medicine preferred metabolic topics. Although the perception of a medical student is expected to be different than that of a biomedical student, as the aims of the two programs are different, 92.4% of students from each course agreed or strongly agreed with the biochemistry topics, and 92.1% thought highly on this subject. The majority of students, a number of 139 undergraduates from biomedicine and 419 from medicine course, preferred traditional blackboard teaching than slide-projection, or power-point class. In conclusion, it is imperative that the health courses reflect on sophisticated technology and data presentation with high density of information in biochemistry discipline. The traditional classes with blackboard presentation were most favored by students from biomedicine and medicine courses. The use of students' preferred teaching techniques might turn biochemistry more easily understood for biomedical and medical students. © 2007 by The International Union of Biochemistry and Molecular Biology.

Financiamento e educação profissional: análise do Programa Brasil Profissionalizado no estado do Pará

Este estudo teve por objetivo analisar as implicações do Programa Brasil Profissionalizado no financiamento da educação profissional da rede estadual de ensino do Pará. O Brasil Profissionalizado é um programa de assistência técnica e financeira, instituído pelo MEC durante o segundo mandato do Governo Lula (2007-2010), visando expandir a educação profissional oferecida pelas redes públicas estaduais de ensino no país, tendo como foco a implementação do ensino médio integrado à educação profissional. A pesquisa foi precedida por uma revisão bibliográfica acerca da política de financiamento da educação, das políticas de educação profissional no Brasil e das estratégias do Governo Federal em efetivá-las por meio do financiamento de programas de cooperação técnica e financeira. Em seguida, a pesquisa envolveu a análise documental da legislação (decretos e resoluções) que instituiu e regulamentou o Programa Brasil Profissionalizado do MEC/FNDE e de documentos elaborados pela SEDUC/PA relacionados ao planejamento e monitoramento do Programa na rede estadual de ensino. A coleta de dados foi complementada com a realização de entrevistas semiestruturadas dirigidas à coordenação do Programa Brasil Profissionalizado no MEC e na COEP/SEDUC para avaliar o processo de implementação e financiamento do Programa e suas implicações no estado. O estudo identificou uma recorrente disputa, entre as instâncias públicas e o setor privado, pelo fundo público para financiar a educação profissional, pois não há uma definição legal e constitucional de destinação de recursos para a oferta pública do ensino profissional. As estratégias de financiamento das políticas de educação profissional são realizadas por meio de programas de governos que se efetivam de forma fragmentada e desarticulada em vários Ministérios do Governo Federal, destacando-se a falta de organização em torno dos recursos disponibilizados e a pouca coordenação entre projetos e ações destinados à formação profissional. O estudo realizado mostrou fragilidades na constituição de programas de financiamento da educação profissional que podem revelar os limites do Programa Brasil Profissionalizado por se trata de mais um Programa e não de uma política de financiamento. Os dados revelaram que a implementação do Programa no estado trouxe importantes contribuições para a consolidação da rede estadual de educação profissional, verificadas na elaboração de um planejamento da gestão da educação profissional, na expansão da rede estadual, no crescimento da oferta de vagas e cursos e na elevação das matrículas, sobretudo, no ensino médio integrado. Contudo, a formação de professores e a manutenção das escolas é responsabilidade do Estado e, portanto, se inscreve na pauta dessa discussão, a luta pela garantia de fontes de financiamento para a continuidade das políticas de educação profissional no setor público que garantam uma oferta de ensino com qualidade.

Vila Sésamo: o contexto político e educacional das duas edições audiovisuais educativas brasileiras

Pós-graduação em Televisão Digital: Informação e Conhecimento - FAAC

Informação e conhecimento: fluxos e apropriação sob uma abordagem crítica

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Resultados maternos e neonatais em centro de parto normal peri-hospitalar e hospital

OBJETIVO: Comparar os resultados maternos e neonatais em mulheres de baixo risco atendidas em centro de parto normal peri-hospitalar e hospital. MÉTODOS: Estudo transversal com amostra representativa de mulheres de baixo risco atendidas em São Paulo, SP, de 2003 a 2006. Foram incluídas 991 mulheres que tiveram o parto no centro de parto normal e 325 que deram à luz no hospital. Os dados foram obtidos dos prontuários. A análise comparativa foi realizada para o total de mulheres e estratifi cada segundo a paridade. Foram aplicados os testes qui-quadrado e exato de Fisher. RESULTADOS: Houve distribuição homogênea das mulheres segundo a paridade (45,4% nulíparas e 54,6% mulheres com um ou mais partos anteriores). Foram encontradas diferenças estatisticamente signifi cantes em relação às seguintes intervenções: amniotomia (mais freqüente entre nulíparas do hospital); utilização de ocitocina no trabalho de parto e utilização de analgésico no pós-parto (mais freqüentes no hospital entre as mulheres de todas as paridades). A taxa de episiotomia foi maior entre as nulíparas, tanto no centro de parto como no hospital. Houve maior freqüência de intervenções com o neonato no hospital: aspiração das vias aéreas superiores, aspiração gástrica, lavagem gástrica, oxigênio por máscara aberta. Também ocorreram com mais freqüência no hospital bossa serossanguínea, desconforto respiratório e internação na unidade neonatal. Não houve diferença nos valores de Apgar no quinto minuto nem casos de morte materna ou perinatal. CONCLUSÕES: A assistência no centro de parto normal foi realizada com menos intervenções e com resultados maternos e neonatais semelhantes aos do hospital.

Morphological Alterations in Newly Born Dentate Gyrus Granule Cells That Emerge after Status Epilepticus Contribute to Make Them Less Excitable

Computer simulations of external current stimulations of dentate gyrus granule cells of rats with Status Epilepticus induced by pilocarpine and control rats were used to evaluate whether morphological differences alone between these cells have an impact on their electrophysiological behavior. The cell models were constructed using morphological information from tridimensional reconstructions with Neurolucida software. To evaluate the effect of morphology differences alone, ion channel conductances, densities and distributions over the dendritic trees of dentate gyrus granule cells were the same for all models. External simulated currents were injected in randomly chosen dendrites belonging to one of three different areas of dentate gyrus granule cell molecular layer: inner molecular layer, medial molecular layer and outer molecular layer. Somatic membrane potentials were recorded to determine firing frequencies and inter-spike intervals. The results show that morphologically altered granule cells from pilocarpine-induced epileptic rats are less excitable than control cells, especially when they are stimulated in the inner molecular layer, which is the target area for mossy fibers that sprout after pilocarpine-induced cell degeneration. This suggests that morphological alterations may act as a protective mechanism to allow dentate gyrus granule cells to cope with the increase of stimulation caused by mossy fiber sprouting.

O programa de aquisição de alimentos (PAA) e as transformações socioterritoriais no Rio Grande do Norte

The Acquisition Food Program (Programa de Aquisição de Alimentos – PAA) is one of the governmental public politics proposed, in the year of 2003, that has the focus in the family-run farm in Brazil. This Program has as objectives: commercialize the familyrun farm products, bought by the government agencies; to encourage production, and promoting actions that improve quality food of people facing starving risk. This Program has been working, to some extent, as complement to the Program of family-run farm Enhancement (PRONAF). The present study has as its focus to analyse the social territorials changes observed in the state of Rio Grande do Norte, as a result of the PAA implementation. In this sense, it was promoted a discussion between territory and rules. I this work, public politics are understood as rules. This procedure was important in order to understand how the rules have influenced territorial changes, creating new social and territorial relations. In the research process was used scientific and institutional texts on the subject. It was applied a quiz with 97 PAA’s supplying farmers, and interviews were done with the Program managers in Federal (MDA), State (CONAB and EMATER) and municipal (local office of EMATER and Departments of Agriculture) levels. Social public politics were also analyzed with the aim of understand the context where PAA is situated in relation with the public politics directed to familyrun farm as a whole since 1980, within new Brazilian democratization process. With the information collected in the field, plus the secondary data, maps, charts, tables and cartograms were made. With all of this, a socio-economical profile of the family-run farm in the Rio Grande do Norte was traced, as well as the included in this research. Before this picture, we concluded that PAA indeed represents a forward in public politics directed to family-run farm. However, in spite of the importance of the Program for the family-run farmers to come of age, but in order to the rural and family-run farm reality in the Rio Grande do Norte come to present meaningful changes much still remain to be done.