Surviving sepsis campaign in Brazil

Severe sepsis and septic shock have long been a challenge in intensive care because of their common occurrence, high associated costs of care, and significant mortality. The Surviving Sepsis Campaign (SSC) was developed in an attempt to address clinical inertia in the adoption of evidence-based strategies. The campaign relies on worldwide support from professional societies and has gained consensus on the management of patients with severe sepsis. The guidelines have subsequently been deployed into two bundles, with each bundle component sharing a common relationship in time. The widespread adoption of such evidence-based practice in clinical care has been disappointingly slow despite the quantifiable benefits regarding mortality. In Brazil, a country of continental dimensions with a heterogeneous population and unequal access to health services, this reality is no different. From 2004 to 2007, four prospective studies were published describing the country`s reality. In the multicenter Promoting Global Research Excellence in Severe Sepsis (PROGRESS) Study, the in-hospital mortality rate was higher in Brazil when compared with other countries: 56% against 30% in developed countries and 45% in other developing countries. During these 2.5 years of the campaign in Brazil, 43 hospitals have been receiving the necessary training to put in practice the recommended measures in all Brazilian regions, except for the North. The idea of the campaign is based on a 25% reduction in the relative risk of death from severe sepsis and septic shock within 5 years in the SSC-participating Brazilian hospitals. Ideally, the mortality rate should come to a 41.2% level subject to the 2009 deadline. This article aims to describe the actual scenario of the SSC implementation in Brazilian institutions and to report on some initiatives that have been used to overcome barriers.

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. 

Transplante renal : desigualdades no acesso

RESUMO - Em Portugal estima-se que existam cerca de 14 mil insuficientes renais crónicos e estima-se que em 2025 sejam 24 mil. As alternativas de tratamento são: hemodiálise, diálise peritoneal ou o transplante renal. Das alternativas de tratamento, o transplante renal é considerado a melhor alternativa terapêutica proporcionando melhor qualidade de vida, aumentando a sobrevida dos doentes, caracterizando-se por ser menos oneroso e por apresentar melhor custo- efectivo, quando comparado com hemodiálise ou diálise peritoneal. Portugal situa-se entre os primeiros da Europa, relativo ao número de transplantes renais efectuados (56,1 por milhão de habitante), em 2010 efectuaram-se 573 transplantes renais. Apesar disso, muitos são os doentes que continuam em lista de espera a aguardar transplante, em média os doentes esperam cerca de dois a três anos por um transplante renal, quando o tempo ideal seria três a seis meses. Por outro lado, estudos internacionais demonstram que existem desigualdades no acesso ao transplante renal, assim à semelhança de outros países torna-se pertinente estudar a realidade portuguesa em relação à temática da desigualdade no acesso, dado o objectivo primordial do Serviço Nacional de Saúde de garantir a equidade nos cuidados de saúde. Este trabalho tem como objectivo principal avaliar se factores como o sexo, idade a localização geográfica influenciam o acesso ao transplante renal, contribuindo para desigualdades no acesso. Este trabalho baseou-se na base de dados dos doentes inscritos em lista de espera para transplante renal, respeitante à área de abrangência do Centro de Histocompatibilidade do Sul. Caracterizou-se a população quanto ao sexo, idade, concelho, região de saúde e unidade de transplantação. Determinou-se ainda, os tempos médios de espera para inscrição em lista activa e para transplante por sexo, idade, região de saúde e unidade de transplantação.Dos resultados obtidos salienta-se que as desigualdades encontradas no acesso ao transplante renal verificam-se entre o início do tratamento até à inscrição em lista activa para transplante. Depois dos doentes em lista activa, o tempo de espera médio não é influenciado significativamente pelo sexo, idade ou localização geográfica.

A publicidade na advocacia

The aim of this dissertation is the analysis of the rules on advertising in advocacy. Presently this is a controversial issue that is far from being consensual. As we will demonstrate through the text, the arguments presented are, one the one hand, a safeguard of the deontological values of the profession that govern this professional class and, on the other hand, the interests of the legal service providers, in the current context. Opinions differ substantially among professionals who exercise the profession in individual practice, that defend balanced and fair rules to assert the true brightness of the professional lawyer, and those who work in an organized structure, such as the law firms, who defend more flexible rules in advertising and promoting the offices. Currently the rules of advertising for lawyers are provided by article 89º of the Statue of the Portuguese Bar Association. However, these rules will soon suffer adjustments that will take into consideration the Law no. 2/2013 of january 10, which will extend the scope of advertising for public associations, in order to increase the competition among these, at national or European level. Following this logic, arguments such as unequal access to available means of advertising for financial reasons or that the better publicized service is not always the most advantageous to the costumer will be analyzed and criticized.

La desigualdad en el consumo familiar. Diferencias de género en la España contemporánea (1850-1930)

In the last few years, Economic Theory has revised two basic ideas around the economics of the household: that family income is the result of the individual income of each of its members (income pooling), and that all family members living in the household have equal access to its resources. Unequal access to family resources (among women and men, on the one hand, and among the elderly, adults and children, on the other), is now understood as an input (for instance, that women eat less food and of worst quality than men), and as an output (for instance that women have poorer health, higher epidemic mortality, or are less tall than men as a result, among other things, of having received less food and poorer medical care, and/or of a heavier workload). Despite the fact that inequality in intra‐family consumption has become the center of attention in academic and international agencies, it can still not be found in the agenda of Economic History. In this paper we look at some of the resources consumed by Spanish families in the 19th century: food, alcoholic beverages, clothes and shoes. Medical topographies, our main source, suggest that unequal access to family resources among household members had a strong impact on their health and wellbeing.

Les festivals francophones en Ontario : vecteurs de la vitalité culturelle d’une communauté minoritaire – une étude de cas multiples

Cette recherche consiste en un examen du rôle du festival dans une communauté linguistique en contexte minoritaire confrontée à des enjeux spécifiques tels que l’assimilation, l’exogamie, la diglossie, l’inégal accès aux services dans sa langue, de même que l’accès limité aux produits culturels de son groupe linguistique. Le cas des festivals francophones en milieu minoritaire sert à interroger concrètement et empiriquement les possibilités, les conditions, les limites et les contraintes de cette forme particulière d’événement en tant que vecteur de la vitalité culturelle d’une communauté minoritaire. Le festival est aussi exploré en lien aux grandes finalités de développement culturel et de démocratie culturelle, soit des mécanismes culturels à la source des politiques culturelles modernes, ainsi qu’en lien à son rôle aux niveaux de l’affirmation et de la consolidation identitaires. Une étude de cas multiples a été menée afin de comparer et d’analyser trois festivals francophones en milieu minoritaire ontarien qui sont mis sur pied dans différentes régions, et ont des objectifs à la fois similaires et différenciés : 1) La Nuit sur l’étang (Sudbury) ; 2) le Festival franco-ontarien (Ottawa) ; et 3) le Festival du Loup (Lafontaine-Penetanguishene). En focalisant sur chaque cas étudié, nous sommes en mesure de donner une vue d’ensemble du phénomène « festival » dans un tel contexte. Cette recherche présente, par le biais de sources documentaires, d’observations sur le terrain et d’entretiens auprès des organisateurs, des festivaliers et des artistes de ces événements, les perceptions qu’en ont et l’utilisation qu’en font ces différentes catégories d’acteurs impliqués. Elle fait plus précisément état de la contribution du festival au niveau des mécanismes culturels proposés ci-dessus. En outre, elle permet de déterminer si les acteurs directement impliqués dans ce type d’événement le perçoivent comme un enjeu important pour la francité. Bref, l’ensemble des contributions qu’apportent les festivals francophones en Ontario montrent en quoi ces événements agissent comme des vecteurs de la vitalité culturelle d’une communauté minoritaire.

Uncover the Concealed Link: Gender & Ethnicity-Divided Local Knowledge on the Agro-Ecosystem of a Forest Margin

This research is a study about knowledge interface that aims to analyse knowledge discontinuities, the dynamic and emergent characters of struggles and interactions within gender system and ethnicity differences. The cacao boom phenomenon in Central Sulawesi is the main context for a changing of social relations of production, especially when the mode of production has shifted or is still underway from subsistence to petty commodity production. This agrarian change is not only about a change of relationship and practice, but, as my previous research has shown, also about the shift of knowledge domination, because knowledge construes social practice in a dialectical process. Agroecological knowledge is accumulated through interaction, practice and experience. At the same time the knowledge gained from new practices and experiences changes mode of interaction, so such processes provide the arena where an interface of knowledge is manifested. In the process of agro-ecological knowledge interface, gender and ethnic group interactions materialise in the decision-making of production and resource allocation at the household and community level. At this point, power/knowledge is interplayed to gain authority in decision-making. When authority dominates, power encounters resistance, whereas the dominant power and its resistance are aimed to ensure socio-economic security. Eventually, the process of struggle can be identified through the pattern of resource utilisation as a realisation of production decision-making. Such processes are varied from one community to another, and therefore, it shows uniqueness and commonalities, especially when it is placed in a context of shifting mode of production. The focus is placed on actors: men and women in their institutional and cultural setting, including the role of development agents. The inquiry is informed by 4 major questions: 1) How do women and men acquire, disseminate, and utilise their agro ecological knowledge, specifically in rice farming as a subsistence commodity, as well as in cacao farming as a petty commodity? How and why do such mechanisms construct different knowledge domains between two genders? How does the knowledge mechanism apply in different ethnics? What are the implications for gender and ethnicity based relation of production? ; 2) Using the concept of valued knowledge in a shifting mode of production context: is there any knowledge that dominates others? How does the process of domination occur and why? Is there any form of struggle, strategies, negotiation, and compromise over this domination? How do these processes take place at a household as well as community level? How does it relate to production decision-making? ; 3) Putting the previous questions in two communities with a different point of arrival on a path of agricultural commercialisation, how do the processes of struggle vary? What are the bases of the commonalities and peculiarities in both communities?; 4) How the decisions of production affect rice field - cacao plantation - forest utilisation in the two villages? How does that triangle of resource use reflect the constellation of local knowledge in those two communities? What is the implication of this knowledge constellation for the cacao-rice-forest agroecosystem in the forest margin area? Employing a qualitative approach as the main method of inquiry, indepth and dialogic interviews, participant observer role, and document review are used to gather information. A small survey and children’s writing competition are supplementary to this data collection method. The later two methods are aimed to give wider information on household decision making and perception toward the forest. It was found that local knowledge, particularly knowledge pertaining to rice-forest-cacao agroecology is divided according to gender and ethnicity. This constellation places a process of decision-making as ‘the arena of interface’ between feminine and masculine knowledge, as well as between dominant and less dominant ethnic groups. Transition from subsistence to a commercial mode of production is a context that frames a process where knowledge about cacao commodity is valued higher than rice. Market mechanism, as an external power, defines valued knowledge. Valued knowledge defines the dominant knowledge holder, and decision. Therefore, cacao cultivation becomes a dominant practice. Its existence sacrifices the presence of rice field and the forest. Knowledge about rice production and forest ecosystem exist, but is less valued. So it is unable to challenge the domination of cacao. Various forms of struggles - within gender an ethnicity context - to resist cacao domination are an expression of unequal knowledge possession. Knowledge inequality implies to unequal access to withdraw benefit from market valued crop. When unequal knowledge fails to construct a negotiated field or struggles fail to reveal ‘marginal’ decision, e.g. intensification instead of cacao expansion to the forest, interface only produces divergence. Gender and ethnicity divided knowledge is unabridged, since negotiation is unable to produce new knowledge that accommodates both interests. Rice is loaded by ecological interest to conserve the forest, while cacao is driven by economic interest to increase welfare status. The implication of this unmediated dominant knowledge of cacao production is the construction of access; access to the forest, mainly to withdraw its economic benefit by eliminating its ecological benefit. Then, access to cacao as the social relationship of production to acquire cacao knowledge; lastly, access to defend sustainable benefit from cacao by expansion. ‘Socio-economic Security’ is defined by Access. The convergence of rice and cacao knowledge, however, should be made possible across gender and ethnicity, not only for the sake of forest conservation as the insurance of ecological security, but also for community’s socio-economic security. The convergence might be found in a range of alternative ways to conduct cacao sustainable production, from agroforestry system to intensification.

Reframing 'crisis' in fair trade coffee production: trajectories of agrarian change in Nicaragua

A focus on crisis provides a methodological window to understand how agrarian change shapes producer engagement in fair trade. This orientation challenges a seperation between the market and development, situating fair trade within global processes that incorporate agrarian histories of social change and conflict. Reframing crisis as a condition of agrarian life, rather than emphasizing its cyclical manifestation within the global economy, reveals how market-driven development encompasses the material conditions of peoples' existence in ambiguous and contradictory ways. Drawing on the case of coffee production in Nicaragua, experiences of crisis demonstrate that greater attention needs to be paid to the socioeconomic and political dimensions of development within regional commodity assemblages to address entrenched power relations and unequal access to land and resources. This questions moral certainties when examining the paradox of working in and against the market, and suggests that a better understanding of specific trajectories of development could improve fair trade's objective of enhancing producer livelihoods.

Occupying the margins: Labour integration and social exclusion in artisanal mining in Tanzania

This article examines the marginal position of artisanal miners in sub-Saharan Africa, and considers how they are incorporated into mineral sector change in the context of institutional and legal integration. Taking the case of diamond and gold mining in Tanzania, the concept of social exclusion is used to explore the consequences of marginalization on people's access to mineral resources and ability to make a living from artisanal mining. Because existing inequalities and forms of discrimination are ignored by the Tanzanian state, the institutionalization of mineral titles conceals social and power relations that perpetuate highly unequal access to resources. The article highlights the complexity of these processes, and shows that while legal integration can benefit certain wealthier categories of people, who fit into the model of an 'entrepreneurial small-scale miner', for others adverse incorporation contributes to socio-economic dependence, exploitation and insecurity. For the issue of marginality to be addressed within integration processes, the existence of local forms of organization, institutions and relationships, which underpin inequalities and discrimination, need to be recognized.

Metáforas do alimento no filme A fantástica fábrica de chocolate (1971 e 2005)

Pós-graduação em Educação - IBRC

Fronteiras (in)visíveis da cidade capitalista: segregação socioespacial no Conjunto Parque Modelo II/Ananindeua-PA

O presente estudo tem como objeto a análise da produção do espaço no interior da cidade capitalista, ratificado historicamente por meio da lógica de desigualdade social que perversamente estabelece a disparidade existente na distribuição de serviços públicos e habitações, através do acesso desigual à moradia, infraestrutura e serviços coletivos, estabelecendo um quadro tenso e contraditório de segregação socioespacial vivenciado por uma grande massa de trabalhadores. Tendo como objetivo apreender o processo de reprodução social dos trabalhadores residentes no Conjunto Parque Modelo II, bairro Curuçambá, no município de Ananindeua a partir das condições de acesso à moradia, infraestrutura e serviços coletivos que definem o processo de segregação socioespacial naquela área. Neste sentido, para que se alcançasse o objetivo proposto pelo trabalho, inicialmente foi desenvolvida pesquisa bibliográfica que subsidiasse a reconstrução sócio - histórica do espaço urbano no município de Ananindeua e no bairro Curuçambá, e posteriormente foi realizada pesquisa de campo estruturada por meio de formulários aplicados junto a uma amostra de 64 (sessenta e quatro) famílias residentes no Conjunto, buscando-se o levantamento de dados que possibilitasse a posterior interpretação das informações obtidas. Com base nos dados, informações e nas análises realizadas, constatou-se que o Conjunto Parque Modelo II em sua gênese e desenvolvimento acompanha a expansão do núcleo urbano central de Ananindeua, sendo constituído em sua maioria por uma população migrante que busca moradia na área visando melhores condições de vida e sobrevivência, por não possuir condições materiais (renda e trabalho) para se instalar ou se manter no centro ou em áreas próximas, e por isso se reproduzem a partir da convivência cotidiana com a violência, ausência de infraestrutura, serviços e equipamentos urbanos precários e da consequente não satisfação de necessidades básicas que revelam a essência do quadro socioeconômico de segregação socioespacial.

Black/white disparities in infant mortality rates in the U.S.: A quality of care perspective

The infant mortality rate for non-Hispanic Black infants in the U.S. is 13.63 deaths per 1,000 live births while the IMR for non-Hispanic White persons in the U.S. is 5.76 deaths per 1,000 live births. Black women are 2 times as likely as White women to deliver preterm infants and Black women are 2 times as likely as White women to deliver low birth weight infants (weighing less than 2,500 grams at birth). Differential underlying risk factors among mothers of different racial/ethnic groups for delivering pre-term and low birth weight infants have been historically accepted as the cause of racial disparities in IMRs. However, differential underlying risk status may not be the only major causative factor. Differential or unequal access to and provision of care is widely speculated to be a leading contributing factor to the wide racial disparity in infant mortality.2 This paper conducts a systematic review of existing literature investigating racial disparities in obstetrical care provided by healthcare practitioners to evaluate whether inequities in healthcare services provided to pregnant mothers and their neonates exist. The search terms "racial disparities obstetrical care," "racial differences quality of prenatal care," and "infant mortality racial disparities" were entered into the EBSCO Medline, Ovid Medline, PubMed, and Academic Search Complete databases, and articles between years 1990–2011 were selected for abstract review. The only articles included were those that used statistical methods to assess whether racial inequalities were present in the obstetrical services provided to pregnant women. My literature search returned 5 articles. Four of the five studies yielded significant racial differences in obstetrical care. However, the one study that used a large, nationally representative valid sample did not represent significant differences. Thus, this review provides initial evidence for racial disparities in obstetrical care, but concludes that more studies are needed in this area. Not all of the studies reviewed were consistent in the use and measurement of services, and not all studies were significant. The policy and public health implications of possible racial disparities in obstetrical care include the need to develop standard of care protocols for ALL obstetrical patients across the United States to minimize and/or eliminate the inequities and differences in obstetrical services provided.^

Las Políticas TIC en la educación de América Latina : Una oportunidad para saldar deudas pendientes

En los últimos años los esfuerzos de las políticas educativas de los países de América Latina dan cuenta de importantes logros, en particular en lo relativo a la inclusión . Sin embargo, es posible identificar la persistencia de algunas brechas relevantes tales como la desigualdad en el acceso al conocimiento vinculada con los procesos y los resultados académicos obtenidos por los niños, niñas y jóvenes a lo largo de sus trayectorias educativas. Este artículo analiza el potencial y también los desafíos de las políticas de integración TIC para el abordaje de este problema. Lo hace de modo articulado en tanto el aprovechamiento de este potencial supone garantizar un piso de ciertas condiciones mínimas y la construcción de otras posibles y deseables. Entre estas, se focaliza el tema pendiente de la conectividad y la cuestión del cambio en las prácticas educativas.

Territorialidades, espacios vividos y sentidos de lugar en tiempos de avance de la frontera productiva

En pleno proceso de corrimiento de la frontera productiva y emergente disputa por el uso y apropiación de los recursos, la intervención de distintos sujetos sociales en el oeste de La Pampa está redefiniendo las prácticas productivas-reproductivas de los crianceros campesinos y, en consecuencia, la construcción social del espacio. Desde la finalización de las campañas militares contra las sociedades indígenas diferentes agentes, mediante el ejercicio de poder, construyeron determinadas representaciones territoriales y pusieron en acción prácticas tendientes a articular el oeste pampeano con la economía nacional. Sin embargo la escasa valorización de este espacio posibilitó el desarrollo de cierta autonomía en las formas de organización socio-productivas y simbólicas. Ante la expansión de la frontera ganadera, el impuso hidrocarburífero en la región y creciente presencia de nuevas lógicas territoriales crecen las confrontaciones por el desigual acceso a los recursos naturales, por la apropiación del espacio y la construcción de territorialidades. En este marco, el artículo focaliza la mirada en la organización interna de los asentamientos rurales y en los usos sociales de los espacios a través del tiempo, en dos áreas del "extremo" oeste: La Humada y Chos Malal. De este modo se pretende establecer cómo se organizaron diacrónicamente los espacios doméstico, peridoméstico y monte y qué sentidos expresan los sujetos en torno a los espacios de vida y lugares en tiempos de expansión de la frontera productiva. El nuevo campo social generado producto del avance del capitalismo sobre las unidades campesinas se expresa, no sólo en las modificaciones en las formas de manejo del ganado, organización de la producción y construcción social del espacio, sino también en las formas de sociabilidad y estrategias de resistencia colectivas. Este proceso, que se está gestando en la región, tiene un desarrollo similar en otros espacios donde el avance productivo se ha generado con anterioridad o a un ritmo más acelerado. Para la realización de la investigación se articulan diferentes estrategias de metodología cualitativa que combinan el estudio de caso con historias de vida, entrevistas en profundidad y análisis de fuentes documentales.