Melipona scutellaris Geopropolis: Chemical Composition and Bioactivity.

Geopropolis has been used in traditional medicine for centuries. In this study, the botanical origin, physicochemical profile, and biological activities of geopropolis from Melipona scutellaris harvested during rainy and dry seasons were investigated. Palynological analysis identified over 50 pollen types, with Schinus terebinthifolius and Cecropia being the predominant types. The analytical results were in line with those reported in the literature. Rainy-season geopropolis exhibited higher total phenol and flavonoid content (determined using High Performance Liquid Chromatography-25.13% and 3.92%, respectively) compared to the dry season (19.30% and 2.09%); the major peaks (naringin, gallic acid, and catechin) were similar among samples. Antioxidant capacity was assessed via DPPH, reducing power, and ß-carotene/linoleic acid discoloration assays. Rainy-season samples displayed superior antioxidant activity across methods. Antimicrobial effects were determined using microdilution, while the impact on the cholinesterase enzyme was quantified using 5-thio-2-nitrobenzoic acid accumulation. Anti-inflammatory and antimutagenic activities were assessed through hyaluronidase enzyme inhibition and by utilizing Saccharomyces cerevisiae ATCC-20113 cells. Both samples exhibited anti-inflammatory and antimutagenic properties. Moreover, a significant inhibition of acetylcholinesterase was observed, with IC50 values of 0.35 µg/mL during the rainy season and 0.28 µg/mL during the dry season. Additionally, the geopropolis displayed antimicrobial activity, particularly against Staphylococcus aureus. These findings suggest the therapeutic potential of M. scutellaris geopropolis in the context of inflammatory, oxidative, and infectious diseases.

Protective effect of breastfeeding against overweight can be detected as early as the second year of life: a study of children from one of the most socially-deprived areas of Brazil.

Millions of children live in Brazil's semi-arid region, one of the most socially-deprived areas of the country, where undernutrition co-exists with obesity as a consequence of the nutrition transition. There is evidence that childhood obesity predisposes adult obesity and, thus, that obesity should be prevented as early as possible. Some studies have shown that breastfeeding is a protective factor against overweight and obesity while other studies have not found this association. There have been few studies on this association in developing countries and of children below two years of age. The present study aimed to investigate whether children exposed to exclusive breastfeeding for ≥ 6 months showed a lower prevalence of overweight in the second year of life, based on a probability sample of 2,209 children (aged 12 to 24 months). The dependent variable was overweight, defined as weight-for-length z-scores of >2, based on the WHO 2006 standard while the independent variable was exclusive breastfeeding (≥ 6 months). The prevalence ratio (PR) and its 95% CI were estimated using Poisson regression with robust adjustment of variance. After adjusting for potential confounding factors (socioeconomic, demographic and health-related variables), children on exclusive breastfeeding for ≥ 6 months showed a lower prevalence of overweight (5.7% vs 9.1%, PR 0.62, 95% CI 0.45-0.89). It was found that exclusive breastfeeding for six months or more is a protective factor against overweight in children in the second year of life living in the Brazilian semi-arid region.

Pain assessment and management in the NICU: analysis of an educational intervention for health professionals / Avaliação e manejo da dor na UTI neonatal: análise de uma intervenção educativa para os profissionais de saúde

OBJECTIVE: to study the perception of a Neonatal Intensive Care team on pain assessment and management before and after an educational intervention created and implemented in the unit. METHODS: intervention study developed as action research, in three phases. In Phase 1, a quantitative study was performed to identify how professionals perceive pain management in the unit. In Phase 2, an educational intervention was carried out, using the Operational Group (OG), which defined strategies to be adopted to seek improvements in pain assessment and management. In Phase 3, the initial questionnaire was reapplied to assess professionals' perceptions about the subject after the intervention. All professionals directly working in newborn care were included. RESULTS: the perception of professionals about pain management and assessment in the unit showed a statistically significant difference between the two phases of research, highlighting the increase in frequency of reference for evaluation and use of some method of pain relief procedures for most analyzed procedures. Participation in training (one of the strategies defined by the operational group) was reported by 86.4% of the professionals. They reported the use of scales for pain assessment, established by the protocol adopted in the service after the intervention, with a frequency of 94.4%. Changes in pain assessment and management were perceived by 79.6% of the participants. CONCLUSION: the professionals involved in the educational intervention observed changes in pain management in the unit and related them to the strategies defined and implemented by the OG. .

OBJETIVO: conhecer a percepção de uma equipe de terapia intensiva neonatal sobre a avaliação e manejo dor antes e após uma intervenção educativa construída e implementada na unidade. MÉTODOS: estudo de intervenção desenvolvido na modalidade de pesquisa-ação, desenvolvido em três fases. Na 1ª fase, foi realizado um estudo quantitativo, para identificar como os profissionais percebiam o manejo da dor na unidade. Na 2ª fase, foi realizada uma intervenção educativa, utilizando o Grupo Operativo, que definiu estratégias a serem adotadas buscando melhorias na avaliação e manejo da dor. Na 3ª fase foi reaplicado o questionário inicial, para avaliar a percepção dos profissionais acerca do tema, após a intervenção. Foram incluídos todos os profissionais que atuam nos cuidados diretos aos recém-nascidos. RESULTADOS: a percepção dos profissionais acerca do manejo e da avaliação da dor na unidade mostrou diferença estatisticamente significante entre as duas fases da pesquisa, destacando-se o aumento na referência de frequência de avaliação e de utilização de algum método de alívio da dor em procedimentos, para a maioria dos procedimentos pesquisados. A participação na capacitação (uma das estratégias definidas pelo grupo operativo) foi referida por 86,4% dos profissionais. Estes referiram a utilização das escalas para avaliação da dor, estabelecidas no protocolo adotado no serviço após a intervenção, com frequência de 94,4%. Mudanças na avaliação e manejo da dor foram percebidas por 79,6% dos participantes. CONCLUSÃO: os profissionais envolvidos na intervenção educativa perceberam mudanças no manejo da dor na unidade e ...

Os indicadores do saneamento medem a universalizacao em areas de vulnerabilidade social? / Are the indicators measuring the universal access of sanitation in social vulnerable areas?

Os indicadores de saneamento, no contexto regulatório, servem de base para avaliar a evolução temporal da eficiência da empresa regulada. Assim, demanda conceituação, definições e esclarecimentos quanto à realidade do uso de indicadores adotados para medida de universalização em áreas de vulnerabilidade social. O benchmarking é ferramenta caracterizada pela capacidade de aferir eficiência e eficácia da prestação dos serviços por meio de indicadores de produtividade das empresas, que são comparadas. Assim, o objetivo deste artigo foi trazer à discussão a aplicação de conceitos de empresa referência ou benchmarking que possam atender às peculiaridades da prestação dos serviços em áreas urbanas vulneráveis.

The Benchmarking, in the regulatory framework, provides the basis for determining the methodology to assess the temporal evolution of the efficiency of the regulated firm. Thus, it demands concepts, definitions and clarification regarding the reality of the use of models for the universalization in socially vulnerable areas. Benchmarking is a tool characterized by the ability to assess the efficiency and effectiveness of service provision by means of enterprises productivity indicators, which are compared. The objective is to analyze the peculiarities of urban areas for regulatory management, through the adoption of contractual indicators. Thus, the aim of this article was to discuss the application of concepts of regulated firms or benchmarking that can meet the peculiarities of services provision in urban vulnerable areas.

Pain assessment and management in the NICU: analysis of an educational intervention for health professionals.

OBJECTIVE: to study the perception of a Neonatal Intensive Care team on pain assessment and management before and after an educational intervention created and implemented in the unit. METHODS: intervention study developed as action research, in three phases. In Phase 1, a quantitative study was performed to identify how professionals perceive pain management in the unit. In Phase 2, an educational intervention was carried out, using the Operational Group (OG), which defined strategies to be adopted to seek improvements in pain assessment and management. In Phase 3, the initial questionnaire was reapplied to assess professionals' perceptions about the subject after the intervention. All professionals directly working in newborn care were included. RESULTS: the perception of professionals about pain management and assessment in the unit showed a statistically significant difference between the two phases of research, highlighting the increase in frequency of reference for evaluation and use of some method of pain relief procedures for most analyzed procedures. Participation in training (one of the strategies defined by the operational group) was reported by 86.4% of the professionals. They reported the use of scales for pain assessment, established by the protocol adopted in the service after the intervention, with a frequency of 94.4%. Changes in pain assessment and management were perceived by 79.6% of the participants. CONCLUSION: the professionals involved in the educational intervention observed changes in pain management in the unit and related them to the strategies defined and implemented by the OG.

Promotion of exclusive breast-feeding at scale within routine health services: impact of breast-feeding counselling training for community health workers in Recife, Brazil.

OBJECTIVE: Breast-feeding counselling has been identified as the intervention with the greatest potential for reducing child deaths, but there is little experience in delivering breast-feeding counselling at scale within routine health systems. The study aim was to compare rates of exclusive breast-feeding associated with a breast-feeding counselling intervention in which community health agents (CHA) received 20 h of training directed at counselling and practical skills with rates pre-intervention when CHA received 4 h of didactic teaching. DESIGN: Cross-sectional surveys of breast-feeding practices were conducted pre- and post-intervention in random samples of 1266 and 1245 infants aged 0-5.9 months, respectively. SETTING: Recife, Brazil, with a population of 2 million. SUBJECTS: CHA (n 1449) of Brazil's Family Health Programme were trained to provide breast-feeding counselling at home visits. RESULTS: Rates of exclusive breast-feeding improved when CHA were trained to provide breast-feeding counselling and were significantly higher by 10-13 percentage points at age 3-5.9 months when compared with pre-intervention rates (P < 0.05). Post-intervention point prevalence of exclusive breast-feeding for infants aged <4 months was 63% and for those aged <6 months was 50%. CONCLUSIONS: Multifunctional CHA were able to deliver breast-feeding counselling at scale within a routine health service and this was associated with a significant increase in rates of exclusive breast-feeding. The study reinforces the need to focus training on counselling and practical skills; a key component was an interactive style that utilized the knowledge and experience of CHA. The findings are relevant to the call by international organizations to scale up breast-feeding counselling.

Fatores associados ao atraso do desenvolvimento motor de crianças prematuras internadas em unidade de neonatologia / Factors associated with late motor development in premature children admitted to a neonatology unit

Verificar a frequência do atraso do desenvolvimento motor em crianças prematuras internadas em unidade neonatal e identificar os fatores associados. MÉTODOS: estudo descritivo e analítico, realizado na Unidade Neonatal de uma maternidade de alto risco em Recife, Brasil. Avaliou-se o desenvolvimento motor, através do Test of Infant Motor Performance, de 98 crianças nascidas pré-termo com idade pós-conceptual mínima de 34 semanas, durante a internação, entre janeiro e julho de 2009. Analisaram-se associações entre variáveis maternas, neonatais e assistenciais com desenvolvimento motor. RESULTADOS: a média de idade pós-conceptual na avaliação foi de 37 semanas e 39,8 por cento das crianças apresentaram desenvolvimento motor alterado (atípico ou suspeito). Fatores significativamente associados ao desenvolvimento motor alterado foram: menor peso ao nascer; maior idade na avaliação; maior número de consultas pré-natais; ocorrência de hipóxia e displasia broncopulmonar; maior tempo de permanência na unidade de terapia intensiva e unidade neonatal. Houve tendência significante a um pior desenvolvimento motor com uso de oxigenoterapia e ventilação mecânica prolongadas. CONCLUSÕES: crianças prematuras internadas podem apresentar atraso precoce do desenvolvimento motor, de forma grave ou limítrofe. Peso ao nascer, morbidades neonatais e assistência recebida na unidade neonatal foram os fatores que mais influenciaram o desfecho. Esses resultados justificam o início de estratégias preventivas e estimulação ainda no período de internação...

To assess the frequency of late motor development in premature children admitted to a neonatal unit and to identify associated factors. METHODS: a descriptive analytical study carried out at the Neonatal Unit of a high-risk maternity hospital in Recife, Brazil. Motor development was assessed using the Test of Infant Motor Performance, in 98 preterm children with a minimal post-conception age of 34 weeks, during admission to hospital, between January and June 2009. Associations were examined between variables relating to the mother, the newborn, the care provided and motor development. RESULTS: the mean post-conception age on evaluation was 37 weeks and 39.8 percent of the children had some kind of impaired motor development (atypical or suspected to be atypical). Factors significantly associated with changes in motor development were: lower birth weight; higher age on evaluation; greater number of prenatal sessions; occurrence of hypoxia and bronco-pulmonary dysplasia; longer stay in ICU and neonatal unit. There was a significant trend for motor development to worsen with prolonged use of oxygen-therapy and mechanical ventilation. CONCLUSIONS: premature children admitted to hospital may show early signs of delayed motor development of a severe or borderline nature. Birth weight, neonatal morbidities and care received at the neonatal unit were the factors that most strongly influenced the outcome. These results justify initiation of preventive strategies and stimulation while the child is still in hospital...

Fatores de risco para mortalidade neonatal, com especial atenção aos fatores assistenciais relacionados com os cuidados durante o período pré-natal, parto e história reprodutiva materna / Determinants of neonatal death with emphasis on health care during pregnancy, childbirth and reproductive history

OBJETIVO: Identificar fatores de risco para mortalidade neonatal, com especial atenção aos fatores assistenciais relacionados com os cuidados durante o período pré-natal, parto e história reprodutiva materna. MÉTODOS: Trata-se de um estudo caso-controle realizado em Maceió, Nordeste do Brasil. A amostra consistiu de 136 casos e 272 controles selecionados em bancos de dados oficiais brasileiros. Os casos foram todos os recém-nascidos que morreram antes de completar 28 dias de vida, selecionados no Sistema de Informações sobre Mortalidade, e os controles foram os sobreviventes neste período, selecionados no Sistema de Informações sobre Nascidos Vivos, por sorteio aleatório entre as crianças nascidas na mesma data do caso. Entrevistas domiciliares foram realizadas com as mães. RESULTADOS: A análise de regressão logística identificou como fatores determinantes para a morte no período neonatal mães com história de filhos anteriores que morreram no primeiro ano de vida (OR = 3,08), o internamento durante a gestação (OR = 2,48), o pré-natal inadequado (OR = 2,49), a não realização de ecografia durante o pré-natal (OR = 3,89), a transferência de recém-nascidos para outra unidade após o nascimento (OR = 5,06), os recém-nascidos internados em UTI (OR = 5,00) e o baixo peso ao nascer (OR = 2,57). Entre as condições socioeconômicas, observou-se uma maior chance para mortalidade neonatal em residências com menor número de moradores (OR = 1,73) e com ausência de filhos menores de cinco anos (OR = 10,10). CONCLUSÕES: Vários fatores que se mostraram associados à mortalidade neonatal neste estudo podem ser decorrentes de assistência inadequada ao pré-natal, ao parto e ao recém-nascido, sendo, portanto, passíveis de serem modificados.

OBJECTIVE: To identify risk factors for neonatal mortality, focusing on factors related to assistance care during the prenatal period, childbirth, and maternal reproductive history. METHODS: This was a case-control study conducted in Maceió, Northeastern Brazil. The sample consisted of 136 cases and 272 controls selected from official Brazilian databases. The cases consisted of all infants who died before 28 days of life, selected from the Mortality Information System, and the controls were survivors during this period, selected from the Information System on Live Births, by random drawing among children born on the same date of the case. Household interviews were conducted with mothers. RESULTS: The logistic regression analysis identified the following as determining factors for death in the neonatal period: mothers with a history of previous children who died in the first year of life (OR = 3.08), hospitalization during pregnancy (OR = 2.48), inadequate prenatal care (OR = 2.49), lack of ultrasound examination during prenatal care (OR = 3.89), transfer of the newborn to another unit after birth (OR = 5.06), admittance of the newborn at the ICU (OR = 5.00), and low birth weight (OR = 2.57). Among the socioeconomic conditions, there was a greater chance for neonatal mortality in homes with fewer residents (OR = 1.73) and with no children younger than five years (OR = 10.10). CONCLUSION: Several factors that were associated with neonatal mortality in this study may be due to inadequate care during the prenatal period and childbirth, and inadequate newborn care, all of which can be modified.

Determinants of neonatal death with emphasis on health care during pregnancy, childbirth and reproductive history.

OBJECTIVE: To identify risk factors for neonatal mortality, focusing on factors related to assistance care during the prenatal period, childbirth, and maternal reproductive history. METHODS: This was a case-control study conducted in Maceió, Northeastern Brazil. The sample consisted of 136 cases and 272 controls selected from official Brazilian databases. The cases consisted of all infants who died before 28 days of life, selected from the Mortality Information System, and the controls were survivors during this period, selected from the Information System on Live Births, by random drawing among children born on the same date of the case. Household interviews were conducted with mothers. RESULTS: The logistic regression analysis identified the following as determining factors for death in the neonatal period: mothers with a history of previous children who died in the first year of life (OR=3.08), hospitalization during pregnancy (OR=2.48), inadequate prenatal care (OR=2.49), lack of ultrasound examination during prenatal care (OR=3.89), transfer of the newborn to another unit after birth (OR=5.06), admittance of the newborn at the ICU (OR=5.00), and low birth weight (OR=2.57). Among the socioeconomic conditions, there was a greater chance for neonatal mortality in homes with fewer residents (OR=1.73) and with no children younger than five years (OR=10.10). CONCLUSION: Several factors that were associated with neonatal mortality in this study may be due to inadequate care during the prenatal period and childbirth, and inadequate newborn care, all of which can be modified.

Characteristics and factors associated with health care in children younger than 1 year with very low birth weight.

OBJECTIVES: To identify the characteristics of health care in infants with very low birth weight during the first year of life and the factors associated with this care. METHODS: This was a descriptive study with an analytical component conducted in the city of Maceió, Northeastern Brazil, with a sample of 53 children with a median age of five months at the time of the interview, and their mothers. The mothers were interviewed at home regarding socioeconomic and demographic data and health care provided for the child. Health care was assessed through an index using 16 variables related to the recommended actions for this type of care. RESULTS: Multivariate linear regression analysis showed that maternal education and family income were the variables that best explained the health care index variation (18.9%), followed by parity (6.6%), and breastfeeding at the time of the interview (6.9%). CONCLUSIONS: Considering that families with lower socioeconomic status, women with a higher number of children, and women who did not breastfeed were factors associated with poor health care of children born with very low birth weight, these variables should be included in measures of public health planning.

Características e fatores associados à assistência à saúde de crianças menores de um ano com muito baixo peso ao nascer / Characteristics and factors associated with health care in children younger than 1 year with very low birth weight

OBJETIVOS: Identificar as características da assistência à saúde de lactentes com muito baixo peso ao nascer no primeiro ano de vida e os fatores associados a esta atenção. MÉTODOS: Estudo descritivo com componente analítico foi realizado na cidade de Maceió, Nordeste do Brasil, com uma amostra de 53 crianças com idade mediana de cinco meses na época da entrevista, e suas respectivas mães. As mães foram entrevistadas no domicílio,quanto às condições socioeconômicas, demográficas e de assistência à saúde da criança. A atenção à saúde foi avaliada com a elaboração de um índice utilizando 16 variáveis relacionadas às ações preconizadas para esta assistência. RESULTADOS: A análise de regressão linear multivariada mostrou que a escolaridade materna e a renda familiar foram as variáveis que, juntas, melhor explicaram a variação do Índice de Atenção à Saúde (18,9%), seguidas da paridade (6,6%) e da prática do aleitamento materno na época da entrevista (6,9%). CONCLUSÕES: Considerando que as famílias com piores condições socioeconômicas e as mulheres com maior número de filhos e que não amamentaram foram os fatores associados a uma assistência inadequada à saúde de crianças nascidas com muito baixo peso, os mesmos deveriam ser contemplados nas ações de planejamento da saúde pública.

OBJECTIVES: To identify the characteristics of health care in infants with very low birth weight during the first year of life and the factors associated with this care. METHODS: This was a descriptive study with an analytical component conducted in the city of Maceió, Northeastern Brazil, with a sample of 53 children with a median age of five months at the time of the interview, and their mothers. The mothers were interviewed at home regarding socioeconomic and demographic data and health care provided for the child. Health care was assessed through an index using 16 variables related to the recommended actions for this type of care. RESULTS: Multivariate linear regression analysis showed that maternal education and family income were the variables that best explained the health care index variation (18.9%), followed by parity (6.6%), and breastfeeding at the time of the interview (6.9%). CONCLUSIONS: Considering that families with lower socioeconomic status, women with a higher number of children, and women who did not breastfeed were factors associated with poor health care of children born with very low birth weight, these variables should be included in measures of public health planning.

Conselhos setoriais: perfil dos conselheiros e sua influência na tomada de decisão / Sector Councils: councilors' profile and it's influence in decision making

Este artigo tem por objetivo apresentar o perfil dos conselheiros de quatro conselhos setoriais do Município de Santo André com a finalidade de compreender de que forma fatores como idade, escolaridade, gênero, entre outros, podem influenciar positiva ou negativamente na representividade destes Conselhos. Para isso, foram realizadas entrevistas e feita análise de documentos internos e atas das reuniões dos conselhos. Os resultados demonstram que, embora existam diferenças no que se refere à escolaridade dos representantes da sociedade civil e do poder público que poderiam refletir uma correlação de forças desigual dentro dos conselhos, os representantes da sociedade civil possuem forte liderança, o que facilita o retorno das informações à sociedade e vice-versa. Conclui-se que, para que os conselhos locais tornem-se um canal de participação mais equilibrado, é preciso investir na capacitação dos conselheiros e em mecanismos de incentivo à participação de jovens.

This article aims to present a profile of councilors that take part in four sector councils of the municipality of Santo André, in order to understand how factors such as age, education and gender, among others, can positively or negatively influence the council's representativeness. For this, we conducted interviews and analyzed internal documents and records of meetings when available. Results show that, although there are educational differences among representatives of civil society and public authorities which could reflect an unequal correlation of forces within the councils, representatives of civil society have strong leadership, which facilitates the exchange of information with society.. Then, we conclude that, in order to become a more balanced participation channel, it is necessary to ensure effective training and representativeness; it is necessary also tostimulate the participation of youth.

Conselhos setoriais: perfil dos conselheiros e sua influência na tomada de decisão / Sector Councils: councilors' profile and it's influence in decision making

Este artigo tem por objetivo apresentar o perfil dos conselheiros de quatro conselhos setoriais do Município de Santo André com a finalidade de compreender de que forma fatores como idade, escolaridade, gênero, entre outros, podem influenciar positiva ou negativamente na representividade destes Conselhos. Para isso, foram realizadas entrevistas e feita análise de documentos internos e atas das reuniões dos conselhos. Os resultados demonstram que, embora existam diferenças no que se refere à escolaridade dos representantes da sociedade civil e do poder público que poderiam refletir uma correlação de forças desigual dentro dos conselhos, os representantes da sociedade civil possuem forte liderança, o que facilita o retorno das informações à sociedade e vice-versa. Conclui-se que, para que os conselhos locais tornem-se um canal de participação mais equilibrado, é preciso investir na capacitação dos conselheiros e em mecanismos de incentivo à participação de jovens.(AU)

[Rationale and knowledge for the universal implementation of sanitation in areas of social vulnerability]. / Racionalidade e saberes para a universalização do saneamento em áreas de vulnerabilidade social.

The adoption of principles of equality and universality stipulated in legislation for the sanitation sector requires discussions on innovation. The existing model was able to meet sanitary demands, but was unable to attend all areas causing disparities in vulnerable areas. The universal implementation of sanitation requires identification of the know-how that promotes it and analysis of the model adopted today to establish a new method. Analysis of how different viewpoints on the restructuring process is necessary for the definition of public policy, especially in health, and understanding its complexities and importance in confirming social practices and organizational designs. These are discussed to contribute to universal implementation of sanitation in urban areas by means of a review of the literature and practices in the industry. By way of conclusion, it is considered that accepting a particular concept or idea in sanitation means choosing some effective interventions in the network and on the lives of individual users, and implies a redefinition of the space in which it exercises control and management of sewerage networks, such that connected users are perceived as groups with different interests.

Racionalidade e saberes para a universalização do saneamento em áreas de vulnerabilidade social / Rationale and knowledge for the universal implementation of sanitation in areas of social vulnerability

A adoção de princípios de equidade e universalidade previstos na legislação do setor de saneamento demanda discussões sobre inovação. O modelo existente foi capaz de suprir demandas sanitárias, mas não conseguiu atender todas as áreas do país, restando disparidades em regiões carentes. A universalização do saneamento exige identificação dos saberes que irão promovê-la e análise do modelo hoje adotado, para chegar-se a nova proposição. Exige reflexão de como diferentes visões sobre o processo de saneamento são percebidas e consideradas para definição de políticas públicas, especialmente na saúde, e na compreensão de suas complexidades e importância na confirmação de práticas sociais e de desenhos organizativos. Os modelos organizativos e dispositivos são debatidos para contribuir à universalização dos serviços em áreas urbanas por meio da revisão bibliográfica e avaliação de práticas do setor. Como conclusão, entende-se que aceitar um determinado conceito ou ideia em saneamento implica escolher certas intervenções efetivas sobre a rede e a vida dos usuários individuais, e implica uma redefinição do espaço em que se exerce o controle e gestão das redes de saneamento, de modo que os usuários conectados sejam entendidos como coletivos com diferentes interesses.

The adoption of principles of equality and universality stipulated in legislation for the sanitation sector requires discussions on innovation. The existing model was able to meet sanitary demands, but was unable to attend all areas causing disparities in vulnerable areas. The universal implementation of sanitation requires identification of the know-how that promotes it and analysis of the model adopted today to establish a new method. Analysis of how different viewpoints on the restructuring process is necessary for the definition of public policy, especially in health, and understanding its complexities and importance in confirming social practices and organizational designs. These are discussed to contribute to universal implementation of sanitation in urban areas by means of a review of the literature and practices in the industry. By way of conclusion, it is considered that accepting a particular concept or idea in sanitation means choosing some effective interventions in the network and on the lives of individual users, and implies a redefinition of the space in which it exercises control and management of sewerage networks, such that connected users are perceived as groups with different interests.

Fatores associados à displasia broncopulmonar em prematuros sob ventilação mecânica precoce / Factors associated with bronchopulmonary dysplasia in premature infants under early mechanical ventilation

Descrever os fatores neonatais e de assistência ventilatória associados à displasia broncopulmonar (DBP), e verificar sua frequência em recém-nascidos prematuros submetidos à ventilação mecânica (VM) na primeira semana de vida. MÉTODOS: coorte retrospectiva, realizada em Unidade de Terapia Intensiva Neonatal. Foram analisados prontuários de 86 prematuros, sob VM na primeira semana de vida e registrados dados neonatais, parâmetros da VM e sua relação com a DBP. Para verificar a associação entre as variáveis do estudo e a DBP utilizou-se o teste do qui-quadrado e o Exato de Fisher quando indicado. O teste t e o Kruskal Wallis foram utilizados para a comparação das médias das variáveis contínuas. RESULTADOS: a DBP ocorreu em 17,4 por cento. Foram relacionados à doença: menor peso ao nascer e idade gestacional, Apgar <7 no 1º e 5º minutos, maior tempo sob antibioticoterapia, nutrição parenteral e VM, valores elevados de fração inspirada de oxigênio (FiO2), VM como primeiro suporte respiratório, menor volume de nutrição enteral e ganho ponderal . Não houve diferença nos níveis de pressão positiva inspiratória, pressão positiva expiratória final e diferença de pressão. CONCLUSÕES: a ocorrência da DBP foi baixa e relacionada ao manejo clínico e nutricional e VM precoce e prolongada. Excetuando-se a FiO2 média não foi encontrada relação entre a doença e os demais parâmetros ventilatórios...

To describe the neonatal and assisted ventilation factors associated with bronchopulmonary dysplasia (BPD) and verify their frequency in premature newborns undergoing mechanical ventilation (MV) in the first week of life. METHODS: retrospective cohort study carried out at the Neonatal Intensive Care Unit. The medical records of 86 premature infants under MV in the first week of life were analyzed and neonatal data, MV parameters and their relationship with BPD registered. To verify the association between the variables of the study and BPD, the chi-square test and the Fisher exact test were used as appropriate. The t-test and Kruskal Wallis test were used to compare the means of the continuous variables. RESULTS: BPD occurred in 17.4 percent of cases. Factors related to the illness were: lower birth weight and gestational age, Apgar <7 at 1 and 5 minutes, greater time under antibiotic therapy, parenteral nutrition and MV, higher values of the fraction of inspired oxygen (FiO2), MV as the first respiratory aid, lower volume of enteral nutrition and ponderal gain. No difference was found in the level of positive inspiratory pressure, end positive expiratory pressure and pressure difference. CONCLUSIONS: the occurrence of BPD was low and related to clinical and nutritional management and early, prolonged MV. With the exception of mean FiO2, no relationship was found between the illness and ventilation parameters...

Inter-relações ambiente e saúde no uso de poços oficiais para consumo humano em áreas de contaminação dos recursos hídricos subterrâneos / Environment and health interrelations in the use of official wells for human consumption in areas of contamination of groundwater resources

RESUMO O presente artigo aborda o uso de fontes alternativas de abastecimento no município de São Paulo, com objetivo de analisar como a desregulamentação do setor poderá oferecer riscos à saúde da população, avaliar custos incorridos no saneamento nessas áreas e estimar custos que possam ocorrer no Sistema Único de Saúde (SUS). Foi feita revisão bibliográfica e projeção econométrica do impacto das doenças de veiculação hídrica no orçamento do SUS. Resultados demonstraram que, para cada 1.000 m3 de outorga concedida, serão 3.320 usuários em situação de vulnerabilidade, cujos subsídios foram sonegados, gerando custo social, déficit na universalização do saneamento e necessidade de criação de 180 leitos no SUS.

ABSTRACT This article discusses the use of alternative sources of water supply in São Paulo, aiming to analyze how deregulation may present a risk to public health and sanitation costs incurred to evaluate these areas and to estimate costs that may occur in the Unified Health System (SUS). Literature review and projection of the impact of waterbome diseases in the SUS budget were performed. Results showed that for every 1,000 m3 of water right concession, will be awarded 3,320 users in vulnerable situations, whose allowances were withheld, generating social cost, universal deficit in sanitation and the need to create 180 beds in the SUS.

Inter-relações ambiente e saúde no uso de poços oficiais para consumo humano em áreas de contaminação dos recursos hídricos subterrâneos / Environment and health interrelations in the use of official wells for human consumption in areas of contamination of groundwater resources

RESUMO O presente artigo aborda o uso de fontes alternativas de abastecimento no município de São Paulo, com objetivo de analisar como a desregulamentação do setor poderá oferecer riscos à saúde da população, avaliar custos incorridos no saneamento nessas áreas e estimar custos que possam ocorrer no Sistema Único de Saúde (SUS). Foi feita revisão bibliográfica e projeção econométrica do impacto das doenças de veiculação hídrica no orçamento do SUS. Resultados demonstraram que, para cada 1.000 m3 de outorga concedida, serão 3.320 usuários em situação de vulnerabilidade, cujos subsídios foram sonegados, gerando custo social, déficit na universalização do saneamento e necessidade de criação de 180 leitos no SUS.

ABSTRACT This article discusses the use of alternative sources of water supply in São Paulo, aiming to analyze how deregulation may present a risk to public health and sanitation costs incurred to evaluate these areas and to estimate costs that may occur in the Unified Health System (SUS). Literature review and projection of the impact of waterbome diseases in the SUS budget were performed. Results showed that for every 1,000 m3 of water right concession, will be awarded 3,320 users in vulnerable situations, whose allowances were withheld, generating social cost, universal deficit in sanitation and the need to create 180 beds in the SUS.

Periodontitis as a risk factor for preeclampsia.

BACKGROUND: Periodontitis is an inflammatory process caused by a specific group of microorganisms, resulting in the destruction of the tooth-supporting tissue and the resorption of the alveolar bone. Therefore, periodontitis has been considered a risk factor for preeclampsia because infection is one of the factors involved in the etiology and pathogenesis of preeclampsia. The aim of the present study is to determine whether periodontitis is a risk factor for preeclampsia and to identify other possible risk factors. METHODS: A case-control study was performed with 574 puerperae under care at the university hospital at the Universidade Federal de Pernambuco in the city of Recife, Brazil. Data collection was preceded by a training exercise and a pilot study. Biologic and socioeconomic data were collected along with medical and dental records. A periodontal examination was performed on all dental elements to determine probing depth and gingival recession. The association between periodontitis and preeclampsia was first adjusted for the variables within each block, and adjusted for the variables of all blocks in the final multivariate model. RESULTS: The multivariate logistic regression analysis showed that, after adjustment for other risk factors, periodontitis remained an independent risk factor for preeclampsia (adjusted odds ratio [OR] = 8.60, confidence interval [CI] = 3.92 to 18.88, P < 0.001 and adjusted OR = 2.03, 95% CI = 1.43 to 2.90, P < 0.001, when using the Centers for Disease Control and Prevention/American Academy of Periodontology definition). CONCLUSION: The results suggest that within the population studied, periodontitis was a risk factor for preeclampsia.

Periodontitis-associated risk factors in pregnant women.

OBJECTIVE: The main objective of this study was to investigate the risk factors associated with periodontitis in pregnant women. METHODS: This study was conducted in two stages. In Stage 1, a cross-sectional study was conducted to determine the prevalence of periodontitis among 810 women treated at the maternity ward of a university hospital. In Stage 2, the factors associated with periodontitis were investigated in two groups of pregnant women: 90 with periodontitis and 720 without. A hierarchized approach to the evaluation of the risk factors was used in the analysis, and the independent variables related to periodontitis were grouped into two levels: 1) socio-demographic variables; 2a) variables related to nutritional status, smoking, and number of pregnancies; and 2b) variables related to oral hygiene. Periodontitis was defined as a probing depth ≥ 4 mm and an attachment loss ≥ 3 mm at the same site in four or more teeth. A logistic regression analysis was also performed. RESULTS: The prevalence of periodontitis in this sample was 11%. The variables that remained in the final multivariate model with the hierarchized approach were schooling, family income, smoking, body mass index, and bacterial plaque. CONCLUSION: The factors identified underscore the social nature of the disease, as periodontitis was associated with socioeconomic, demographic status, and poor oral hygiene.