Nutritional status coverage trend registered in the SISVAN web in seven municipalities of the Zona Da Mata Mineira, Brazil, from 2008 to 2017, and its association with socio-economic, demographic and organisation of health system variables.

We analysed the coverage trend of the evaluation of the nutritional status of users of public health services registered in the Food and Nutrition Surveillance System (SISVAN) between 2008 and 2017 in seven municipalities and verified the association of the coverage trend with the socio-economic, demographic and organisational aspects of health system variables. It is an ecological time-series study performed with secondary data extracted from health information systems. Descriptive statistics, linear regression model and repeated measures analysis were performed. The coverage of evaluation of nutritional status was low over the period. Five municipalities showed a tendency to increase coverage, although small, while two remained stable. The highest annual variation in coverage increase was concentrated in the group of pregnant women and the lowest in adolescents and older adults. There was a downward trend in follow-ups from the Bolsa Family Programme and a trend towards increased follow-ups from SUS Primary Care (e-SUS AB). SISVAN coverage was positively associated with the proportion of rural population (P ≤ 0·001) and coverage of community health agents (P < 0·001); and negatively associated with total population (P < 0·001), demographic density (P = 0·006) and gross domestic product per capita (P = 0·008). Despite the tendency to increase coverage in some municipalities, SISVAN still presents low coverage of nutritional status assessment, which compromises population monitoring. Knowing the factors that influence the coverage can subsidise the elaboration of strategies for its expansion.

Programa mais médicos na fronteira: gestão em saúdeem cidades gêmeas entre Brasil e Uruguai / Programa más médicos en la frontera: gestión en salud en las ciudades gemelas entre Brasil y Uruguay / Program More Medics in the Border: Health Management of Twin Cities Between Brasil and Uruguay

ntrodução:O Programa Mais Médicos criado pela Lei nº 12.871, de 2013, surgiu estruturado em três frentes estratégicas: a primeira foi o provimento emergencial de médicos para Atenção Básica, a segunda, o investimento em infraestrutura neste nível de atenção e a última, medidas relacionadas à formação de médicos no país. O acesso da população aos cuidados médicos é essen-cial para promoção de um cuidado integral aos usuários do Sistema Único de Saúde. No Brasil há uma concentração desses profi ssionais nos grandes centros urbanos, e escassez nas regiões norte e nordeste do país, especialmente na Atenção Básica. As cidades situadas em região de fronteira também sofrem de escassez dos profi ssionais médicos, pois são consideradas áreas longínquas das grandes centros urbanos e capitais.Objetivo: descrever a percepção de seis gestores municipais sobre as potencialidades do Programa Mais Médicos na reorientação da Atenção Básica, em cidades gêmeas entre o Brasil e o Uruguai. Metodologia: Estudo de abordagem qualitativa. A coleta dos dados foi realizada de janeiro a março de 2016 mediante a entrevista semiestruturada. A análise dos dados foi embasada na análise de conteúdo prosposta por Bardin e referencial teórico do Planejamento Estratégico descrito por Matus e Testa. Resultados: Os municípios fronteiriços descentralizaram e planifi caram a atenção em saúde ao alocarem os profi ssionais médicos na Atenção Básica. O provimento e maior permanência do mé-dico nas equipes mobilizou o trabalho multiprofi ssional e ampliou o acesso dos usuários aos servi-ços e ações de saúde. Conclusão: A gestão em saúde aufere maior poder de planejamento ao dispor do profi ssional medico em seu quadro de trabalhadores. Portanto, o Programa Mais Médicos pro-piciou mudanças no modelo de atenção e enfrentamento das desigualdades sociais em saúde nos municípios fronteiriços.

Introducción: El Programa Más Médicos creado por la Ley nº 12.871, de 2013, surgió estructurado en tres frentes estratégicos: la primera fue la provisión de emergencia de médicos para Atención Básica, la segunda, la inversión en infraestructura en este nivel de atención y la última, medidas re-lacionadas con la formación de médicos en el país. El acceso de la población a la atención médica es esencial para promover un cuidado integral a los usuarios del Sistema Único de Salud. En Brasil hay una concentración de estos profesionales en los grandes centros urbanos, y escasez en las regiones norte y noreste del país, especialmente en la Atención Básica. Las ciudades situadas en región de frontera también sufren de escasez del profesional médico , pues son consideradas áreas lejanas de los grandes centros urbanos y capitales. Objetivo: describir la percepción de seis gestores municipales sobre las potencialidades del Pro-grama Más Médicos en la reorientación de la Atención Básica, en ciudades gemelas entre Brasil y Uruguay. Metodología: Estudio de enfoque cualitativo. La recolección de los datos fue realizada de enero a marzo de 2016 mediante la entrevista semiestructurada. El análisis de los datos se basó en el análisis de contenido propuesto por Bardin y referencial teórico de la Planifi cación Estratégica descrito por Matus y Testa. Resultados: Los municipios fronterizos descentralizaron y planifi caron la atención en salud al asignar a los profesionales médicos en la Atención Básica. La provisión y mayor permanencia del médico en los equipos movilizó el trabajo multiprofesional y amplió el acceso de los usuarios a los servicios y acciones de salud. Conclusión: La gestión en salud aporta mayor poder de planifi cación al disponer del profesional médico en su cuadro de trabajadores. Por lo tanto, el Programa Más Médicos propició cambios en el modelo de atención y enfrentamiento de las desigualdades sociales en salud en los municipios fronterizos

Introduction: More Doctors Program, in accordance with Law No. 12,871 of 2013, was structured on three strategic fronts: the fi rst one deal with the emergency of medical care for Basic Care, the second, an investment in infrastructure for Basic Care and the last one, these are measures related to the training of doctors in the country. Access to medical care is essential for the comprehensive health care for users of the Unifi ed Health System (called SUS in Brazil). Health professionals are concentrated in large urban centers and are lacking in the north and northeast regions of Brazil, especially in relation to Basic Care. Cities located in the border region also suff er from a shortage of doctors; as such places are considered remote areas of urban centers and capitals. Objective: " is study aims to describe the perception of six municipal managers about the poten-tial of the More Doctors Program in relation to the reorientation of Basic Care in twin cities betwe-en Brazil and Uruguay. Methodology: " is is a qualitative study with a semi-structured interview. Data collection was performed from January to March in 2016. " e analysis of the data was based on the analysis of content proposed by Bardin and the theoretical reference of Strategic Planning was described by Matus and Testa. Results: Border cities decentralized and planned health care by allocating doctors to Basic Care. " e provision of doctors and their permanence in the teams mobilized the multiprofessional work and extended the access of the users to actions and health services. Conclusion: Health manage-ment has greater planning power by having a medical professional in its workforce. " erefore, the More Doctors Program provided both changes in the care model and confrontation of social ine-qualities in health in border cities

Exclusive breast-feeding and sociodemographic characteristics are associated with dietary patterns in children aged 4-7 years.

OBJECTIVE: To identify the dietary patterns of children aged 4-7 years and verify their association with sociodemographic characteristics, lifestyle habits and exclusive breast-feeding (EBF). DESIGN: A cross-sectional study nested within a cohort, performed with Brazilian children aged 4-7 years. The children were re-evaluated at age 4 to 7 years and food patterns were identified a posteriori through principal component analysis. The predictive variables were related to socio-economic characteristics, lifestyle habits and duration of EBF. SETTING: Viçosa, Minas Gerais, Brazil.ParticipantsRepresentative sample of 403 children followed up by the Lactation Support Program from the Extension Program of the Universidade Federal de Viçosa during the first 6 months of life. RESULTS: Five dietary patterns were identified: 'Traditional', 'Unhealthy', 'Milk and chocolate', 'Snack' and 'Healthy'. Children who did not receive EBF until they were at least 4 months old had a higher adherence to the 'Unhealthy' and 'Snack' patterns, and older children also consumed more 'Unhealthy' foods. The highest income was associated with the highest consumption of foods of the patterns 'Unhealthy', 'Milk and chocolate' and 'Healthy'. CONCLUSIONS: In view of the results, we emphasize the importance of providing support and encouragement towards EBF in the first months of life, as it can positively influence lifelong eating habits.

Phytoplankton community-level bio-optical assessment in a naturally mercury contaminated Antarctic ecosystem (Deception Island).

Mercury naturally contaminated environments, like Deception Island (Antarctica), are field labs to study the physiological consequences of chronic Hg-exposure at the community level. Deception Island volcanic vents lead to a continuous chronic exposure of the phytoplanktonic communities to potentially toxic Hg concentrations. Comparing Hg-contaminated areas (Fumarolas Bay - FB, Gabriel de Castilla station - GdC station), no significant differences in chlorophyll a concentrations were detected, indicating that biomass production was not impaired by Hg-exposure despite the high Hg levels found in the cells. Moreover, the electron transport energy, responsible for energy production, also presented rather similar values in phytoplankton from both locations. Regarding FB communities, although the cells absorbed and trapped lower amounts of energy, the effect of Hg was not relevant in the photochemical work produced by the electronic transport chain. This might be due to the activation of alternative internal electron donors, as counteractive measure to the energy accumulated inside the cells. In fact, this alternative electron pathway, may have allowed FB communities to have similar electron transport energy fluxes without using respiration as photoprotective measure towards excessive energy. Hg-exposed cells also showed a shift from the energy flux towards the PS I (photosystem I), alleviating the excessive energy accumulation at the PS II (photosystem II) and preventing an oxidative burst. Our findings suggest a higher energy use efficiency in the communities exposed to volcanic Hg, which is not observable in cultured phytoplankton species grown under Hg exposure. This may constitute a metabolic adaptation, driven from chronic exposure allowing the maintenance of high levels of primary productivity under the assumingly unfavourable conditions of Deception Island.

A 28-day Sub-acute Genotoxic and Behavioural Assessment of Garcinielliptone FC.

Garcinielliptone FC (GFC) is a polyisoprenylated benzophenone isolated from Platonia insignis Mart (Clusiaceae) with promising anticonvulsant properties. However, its safe use and other effects on the central nervous system require assessment. This study assessed the toxicological effects of GFC using the comet assay and the micronucleus test in mice treated for 28 days. A behavioural model was employed to detect possible injuries on the central nervous system. Mice treated with GFC (2, 10 and 20 mg/kg; i.p.) daily for 28 days were submitted to rotarod test, open-field test and tail suspension test (TST). After the behaviour tasks, biological samples were assessed to evaluate genotoxic and mutagenic effects using the comet assay and the micronucleus test. Garcinielliptone FC did not impair the performance of the animals in the rotarod and open-field tests, with no antidepressant-like effect in TST. No genotoxic effects in blood and cerebral cortex were observable in the comet assay; however, there was a significant increase in index and frequency of damage in liver after treatment with GFC 20 mg/kg. Garcinielliptone FC did not increase micronucleus frequency in bone marrow. At the tested doses, GFC was not toxic to the CNS and did not induce genotoxic damage to blood or bone narrow cells. DNA damage to liver tissue was caused only by the highest dose, although no mutagenic potential was observed.

Environmental hazard assessment of contaminated soils in Antarctica: Using a structured tier 1 approach to inform decision-making.

Generally, Antarctica is considered to be an untouched area of the planet; however, the region's ecosystems have been subject to increased human pressure for at least the past half-century. This study assessed soils of Fildes Peninsula, where trace element pollution is thought to prevail. Four soil samples were collected from different locations and assessed following tier 1 methodologies for chemical and ecotoxicological lines of evidence (LoE) used in typical soil Environmental Risk Assessment (ERA). Trace element quantification was run on soil samples and sequential extracts, and elutriates were used to address their ecotoxicity using a standard ecotoxicological battery. The highest levels of trace elements were found for Cr, Cu, Ni and Zn, which were well above baseline levels in two sites located near previously identified contamination sources. Trace element concentrations in soils were compared with soil quality guidelines to estimate the contribution of the chemical LoE for integrated risk calculations; risk was found high, above 0.5 for all samples. Total concentrations in soil were consistent with corresponding sequentially extracted percentages, with Cu and Zn being the most bioavailable elements. Bacteria did not respond consistently to the elutriate samples and cladocerans did not respond at all. In contrast, the growth of microalgae and macrophytes was significantly impaired by elutriates of all soil samples, consistently to estimated trace element concentrations in the elutriate matrix. These results translated into lower risk values for the ecotoxicological compared to the chemical LoE. Nevertheless, integrated risk calculations generated either an immediate recommendation for further analysis to better understand the hazardous potential of the tested soils or showed that the soils could not adequately sustain natural ecosystem functions. This study suggests that the soil ecosystem in Fildes has been inadequately protected and supports previous claims on the need to reinforce protection measures and remediation activities.

Unveiling the neurotoxicity of methylmercury in fish (Diplodus sargus) through a regional morphometric analysis of brain and swimming behavior assessment.

The current study aims to shed light on the neurotoxicity of MeHg in fish (white seabream - Diplodus sargus) by the combined assessment of: (i) MeHg toxicokinetics in the brain, (ii) brain morphometry (volume and number of neurons plus glial cells in specific brain regions) and (iii) fish swimming behavior (endpoints associated with the motor performance and the fear/anxiety-like status). Fish were surveyed for all the components after 7 (E7) and 14 (E14) days of dietary exposure to MeHg (8.7µgg-1), as well as after a post-exposure period of 28days (PE28). MeHg was accumulated in the brain of D. sargus after a short time (E7) and reached a maximum at the end of the exposure period (E14), suggesting an efficient transport of this toxicant into fish brain. Divalent inorganic Hg was also detected in fish brain along the experiment (indicating demethylation reactions), although levels were 100-200 times lower than MeHg, which pinpoints the organic counterpart as the great liable for the recorded effects. In this regard, a decreased number of cells in medial pallium and optic tectum, as well as an increased hypothalamic volume, occurred at E7. Such morphometric alterations were followed by an impairment of fish motor condition as evidenced by a decrease in the total swimming time, while the fear/anxiety-like status was not altered. Moreover, at E14 fish swam a greater distance, although no morphometric alterations were found in any of the brain areas, probably due to compensatory mechanisms. Additionally, although MeHg decreased almost two-fold in the brain during post-exposure, the levels were still high and led to a loss of cells in the optic tectum at PE28. This is an interesting result that highlights the optic tectum as particularly vulnerable to MeHg exposure in fish. Despite the morphometric alterations reported in the optic tectum at PE28, no significant changes were found in fish behavior. Globally, the effects of MeHg followed a multiphasic profile, where homeostatic mechanisms prevented circumstantially morphometric alterations in the brain and behavioral shifts. Although it has become clear the complexity of matching brain morphometric changes and behavioral shifts, motor-related alterations induced by MeHg seem to depend on a combination of disruptions in different brain regions.

Mejora de la seguridad, calidad y eficacia de los medicamentos en la Región de las Américas

En la Región de las Américas, el acceso a los medicamentos y otras tecnologías sanitarias constituye una prioridad para los países en su avance hacia el acceso universal a la salud y la cobertura universal de salud. Es necesario asegurar la disponibilidad de medicamentos y tecnologías sanitarias asequibles dentro de los servicios de salud como parte del abordaje integral de la prevención y el control de las enfermedades. Mediante la adopción de políticas y estrategias farmacéuticas a nivel nacional, los gobiernos establecen el marco que garantizará el acceso equitativo y la asequibilidad de los medicamentos y las tecnologías sanitarias, al tiempo que promueve su uso racional. El principio de calidad, seguridad y eficacia ocupa un papel central en tales políticas y estrategias. El sector farmacéutico y de la tecnología sanitaria desempeña una función crucial en la promoción y protección de la salud al asegurar que los productos y tecnologías que se ponen a disposición de las personas por intermedio de los sistemas de salud respondan a las normas internacionales de calidad y seguridad. La función del gobierno y en particular del ministerio de salud, conjuntamente con los interesados directos, es crear un entorno de regulación que garantice la calidad del producto a lo largo de toda su vida útil, garantizar la seguridad para el paciente y optimizar los resultados en materia de salud...

A "Before and After" in the Use of Emergency Services in Spain? The Impact of the Economic Crisis.

The objective of this study was to analyse whether variables associated with emergency services (ES) use in Spain have changed in the period 2006-2011 using a comparative analysis of the 2006 and 2011 Spanish National Health Surveys. The measure of association was the prevalence ratio with its 95% confidence interval, obtained by Poisson regression with robust variance. We studied interactions between the explanatory variables for ES use and year and subsequently performed a stratified analysis by year. ES use declined by 2.1% in 2011. Most emergency care (approximately 60% in both surveys) was provided in public hospitals. Between 2006 and 2011, ES use increased by 9% in women (p for interaction = 0.008) [ref. men], 3% in persons with poor mental health (p for interaction = 0.072) [ref. good mental health], and 8% in individuals with limitations on activities of daily living (p for interaction = 0.006) [ref. no limitations]. The change in the effect of the variables sex, mental health, and limitations on activities of daily living on use of ES (2006 and 2011) is not explained by either demographic characteristics or individual socioeconomic indicators. These results could be associated with macroeconomic and structural changes occurring during the period 2006-2011.

Measurements of body fat distribution: assessment of collinearity with body mass, adiposity and height in female adolescents / Medidas de localização da gordura corporal: uma avaliação da colinearidade com massa corporal, adiposidade e estatura em adolescentes do sexo feminino

OBJECTIVE : To verify the correlation between body fat location measurements with the body mass index (BMI), body fat percentage (BF%) and height, according to the nutritional status in female adolescents. METHODS : A controlled cross-sectional study was carried out with 113 adolescents (G1: 38 with normal weight, but with high body fat level, G2: 40 with normal weight and G3: 35 overweight) from public schools in Viçosa-MG, Brazil. The following measures were assessed: weight, height, waist circumference (WC), umbilical circumference (UC), hip circumference (HC), thigh circumference, waist-to-hip ratio (WHR), waist-to-height ratio (WHtR), waist-to-thigh ratio (WTR), conicity index (CI), sagittal abdominal diameter (SAD), coronal diameter (CD), central (CS) and peripheral skinfolds (PS). The BF% was assessed by tetrapolar electric bioimpedance. RESULTS : The increase in central fat, represented by WC, UC, WHtR, SAD, CD and CS, and the increase in peripheral fat indicated by HC and thigh circumference were proportional to the increase in BMI and BF%. WC and especially the UC showed the strongest correlations with adiposity. Weak correlation between WHR, WTR, CI and CS/PS with adiposity were observed. The height showed correlation with almost all the fat location measures, being fair or weak with waist measurements. CONCLUSIONS : The results indicate colinearity between body mass and total adiposity with central and peripheral adipose tissue. We recommend the use of UC for assessing nutritional status of adolescents, as it showed the highest capacity to predict adiposity in each group, and also showed fair or weak correlation with height. .

OBJETIVO: Verificar a correlação entre medidas de localização da gordura corporal com índice de massa corporal (IMC), percentual de gordura corporal (%GC) e estatura, de acordo com o estado nutricional em adolescentes do sexo feminino. MÉTODOS: Realizou-se estudo transversal controlado, com 113 adolescentes (G1: 38 eutróficas mas com gordura corporal elevada; G2: 40 eutróficas e G3: 35 com excesso de peso), de 14 a 19 anos, de escolas públicas de Viçosa-MG. Aferiu-se peso, estatura, circunferência da cintura (CC), circunferência umbilical (CUm), circunferência do quadril (CQ), circunferência da coxa, relação cintura/quadril (RCQ), relação cintura/estatura (RCE), relação cintura/coxa (RCC), índice de conicidade (IC), diâmetro abdominal sagital (DAS), diâmetro coronal (DC), pregas cutâneas centrais (PCC) e periféricas (PCP). Avaliou-se o %GC por bioimpedância elétrica tetrapolar. RESULTADOS: O aumento da gordura central, representada pela CC, CUm, RCE, DAS, DC e PCC, e o aumento da gordura periférica indicado pela CQ e da coxa foram proporcionais ao aumento do IMC e %GC. A CC e principalmente CUm apresentaram as correlações mais fortes com a adiposidade, enquanto RCQ, RCC, IC e PCC/PCP as mais fracas. A estatura apresentou correlação com praticamente todas as medidas de localização de gordura, sendo de fraca a regular com as medidas da cintura. CONCLUSÕES: Os resultados indicam colinearidade entre massa corporal e adiposidade total com tecido adiposo central e periférico. Recomenda-se o emprego da CUm na avaliação do estado nutricional de adolescentes, pois ela apresentou maior capacidade para predizer adiposidade em cada grupo, além de correlação fraca a regular com a estatura. .

[Measurements of location of body fat distribution: an assessment of colinearity with body mass, adiposity and stature in female adolescents]. / Medidas de localização da gordura corporal: uma avaliação da colinearidade com massa corporal, adiposidade e estatura em adolescentes do sexo feminino.

OBJECTIVE: To verify the correlation between body fat location measurements with the body mass index (BMI), percentage of body fat (%BF) and stature, according to the nutritional status in female adolescents. METHODS: A controlled cross sectional study was carried out with 113 adolescents (G1: 38 eutrophic, but with high body fat level, G2: 40 eutrophic and G3: 35 overweight) from public schools in Viçosa-MG, Brazil. The following measures have been assessed: weight, stature, waist circumference (WC), umbilical circumference (UC), hip circumference (HC), thigh circumference, waist-to-hip ratio (WHR), waist-to-stature ratio (WSR), waist-to-thigh ratio (WTR), conicity index (CI), sagittal abdominal diameter (SAD), coronal diameter (CD), central skinfolds (CS) and peripheral (PS). The %BF was assessed by tetrapolar electric bioimpedance. RESULTS: The increase of central fat, represented by WC, UC, WSR, SAD, CD and CS, and the increase of peripheral fat indicated by HC and thigh were proportional to the increase of BMI and %BF. WC and especially the UC showed the strongest correlations with adiposity. Weak correlation between WHR, WTR, CI and CS/PS with adiposity were observed. The stature showed correlation with almost all the fat location measures, being regular or weak with waist. CONCLUSIONS: The results indicate colinearity between body mass and total adiposity with central and peripheral adipose tissue. We recommend the use of UC for assessing nutritional status of adolescents, because it showed the highest ability to predict adiposity in each group, and also presented regular or weak correlation with stature.

Burden of isolation for multidrug-resistant organisms in a tertiary public hospital in Southern Brazil.

We aimed to describe the use of isolation beds between September 2011 and August 2013 at a tertiary hospital located in Southern Brazil. The main cause for isolation was gram-negative carbapenem-resistant bacteria. Huge costs were associated with isolation practices. Considering the high burden on the isolation ward, practice of surveillance cultures and contact isolation should be balanced with other infection control practices.

Fish eyes and brain as primary targets for mercury accumulation - a new insight on environmental risk assessment.

Fish eyes and brain are highly susceptible to environmental Hg exposure but this issue is still scarcely investigated, mainly regarding methylmercury (MeHg) accumulation. Yet, Hg levels in fish lens have not been previously examined under field conditions. Total Hg (tHg), MeHg and inorganic Hg (iHg) levels were assessed in the brain, eye wall and lens of the golden grey mullet (Liza aurata) from an Hg contaminated area, both in winter and summer, together with water and sediment levels. Sampling was performed at Aveiro lagoon (Portugal) where a confined area (LAR) is severely contaminated by Hg. Fish brain, eye wall and lens accumulated higher levels of tHg, MeHg and iHg at LAR than the reference site, reflecting faithfully environmental spatial differences. The brain and eye wall responded also to the winter-summer changes found in water and sediment, accumulating higher levels of MeHg (and tHg) in winter. Contrarily, lens was unable to reflect seasonal changes, probably due to its composition and structural stability over time. The three neurosensory structures accumulated preferentially MeHg than iHg (MeHg was higher than 77% of tHg). Lens exhibited a higher retention capacity of MeHg (mean around 1 µg g(-1) at LAR), accumulating higher levels than the other two tissues. Interestingly, MeHg and iHg levels were significantly correlated for the brain and eye wall but poorly associated within the two analysed eye components. The high levels of MeHg found in the brain, eye wall and lens could compromise their functions and this needs further research.

Eating practices and habitus in mothers. A Brazilian population-based survey.

A population-based cross-sectional study was conducted with mothers living in the city of Santos, Brazil, in order to investigate their eating practices, and the interface between those practices and the concept of habitus. From a cluster analysis of the scores for dietary pattern and for food preparation and consumption, the mothers were categorised into five clusters of eating practices: practical mothers (19.8%), symbiotic mothers (3.2%), health-conscious hedonists (17.3%), traditionalists (34.6%), and family cooks (25.1%). To access the habitus of the eating-practice clusters, the following variables were compared: location of residence, profession, socioeconomic status, weight-loss practices, risk behaviours for eating disorders, disordered eating attitudes, body dissatisfaction, and cultural and technological consumption. For all the groups, the observed eating practices were permeated by responsibility for the family's diet, but with different manifestations. For symbiotic mothers, practical mothers, and family cooks, the primary function of their relation with food was to nourish their families, with little expression of their own tastes and preferences. The traditionalists and the health-conscious hedonists, on the other hand, manifested their role as mothers by providing food considered 'nutritionally proper' to their family members. Furthermore, aspects of contemporary lifestyles, such as little time for food, individualisation of meals, and consumption of processed foods, were found to coexist with the valorisation and maintenance of the traditional meals within some groups. The variety of eating practices could not be understood as a linear association between economic and cultural capitals; however, eating practices seemed to interact with those capitals, composing a habitus.

Neurotoxicological profile assessment of lobeline after acute treatment in mice.

Lobeline is a natural alkaloid with high affinity for nicotinic acetylcholine receptors, and it is a promising candidate for addiction treatment in human beings. This work evaluated the toxicological profile of lobeline with different behavioural models and investigated its effect on DNA damage (comet assay and micronucleus test) in mice. Acute administration of lobeline (5 or 10 mg/kg; i.p.) did not impair the parameters measured in the habituation and inhibitory avoidance test, suggesting that it has no effect on memory acquisition in these tasks. Lobeline did not affect the number or the latency to the first head-dip in the hole board test, indicating that it was not anxiolytic/anxiogenic in this model. No genotoxic effects were observed in blood, liver and brain tissues collected 24 hr after the single injection of lobeline (both doses). There was no increase in micronucleus frequency in mice treated with lobeline, indicating the absence of toxicity in bone marrow of the animals. Therefore, the acute treatment with high doses of lobeline did not impair the behavioural parameters measured in this work. Additionally, the drug was not able to produce DNA damage.

O ambiente de trabalho em saúde como elemento para a formação de técnico em enfermagem

Este trabalho relata parte da minha experiência como estudante do Curso Técnico em Enfermagem em atividades desenvolvidas, no turno oposto ao da formação. O texto descreve casos vivenciados por mim quando estive atuando como bolsista nos serviços de emergência clínica e de emergência de trauma, assim como o registro de um usuário da emergência do HNSC, que permaneceu no período de um mês internado e outro que estava em tratamento contínuo. Registro também os casos que acompanhei na emergência do HCR com o esmagamento da mão esquerda e, também o acompanhamento da paciente que sofreu a queda no transporte coletivo e teve o membro inferior direito quebrado. As observações e sentimentos vividos ou percebidos também estão presentes neste relatório. O olhar do paciente em relação ao trabalho desenvolvido pelo aluno se torna importante, uma vez que, através de suas opiniões é que se pode medir e direcionar a qualidade do atendimento, melhorar a comunicação entre paciente e profissional e reforçar a atuação focada em uma atenção à saúde humanizada, principalmente no ambiente de emergência. Por fim, compreende-se que o próprio ambiente de trabalho em saúde é um elemento formativo para o técnico em enfermagem.

Análise da atuação internacional da ANVISA na perspectiva de seu corpo técnico e gerencial / Analysis of ANVISA's international operations in view of its technical staff and management

As Autoridades Reguladoras de todo o mundo têm cada vez mais buscado respostas na arena internacional. Elas têm buscado estabelecer parcerias estratégicas para desenvolver soluções conjuntas aos desafios comuns enfrentados por todas elas.Parte desse esforço se refere aos desenvolvimento de normas e guias de referência internacional de caráter científico e técnico que servirão para balizar as regulamentações em nível nacional. A ANVISA faz parte desse processo e tem procurado se inserir nas discussões estratégicas internacionais.Apesar de grande parte das autoridades reguladoras de produtos sujeitos à regulação sanitária entenderem que os desafios vivenciados por elas só serão superados se forem adotadas abordagens comuns e compartilhadas globalmente, os críticos da globalização defendem que a integração das economias nacionais tem sido maléfica para a autonomia nacional. Os governos ou as agências tenderiam a enfraquecer regulamentações de serviços ou produtos sujeitos à vigilância sanitária em prol do comércio internacional, efeito comumente conhecido como Race to the Bottom - RTB. Em contraposição a essa ideia, alguns autores optam pelo modelo Race to the Top - RTT ao analisarem o impacto da globalização sobre os processos de regulamentação nacionais. Esse modelo defende que a globalização econômica vem tornando as regulamentações mais rigorosas, em âmbito nacional ou global. No Brasil, cabe à ANVISA lidar com todos os setores da economia relacionados a produtos e serviços que possam afetar a saúde da população brasileira. Trata-se de um órgão com apenas 15 anos de idade, que vem aprimorando sua atuação em todos os campos, inclusive nas atividades internacionais...

Worldwide, Regulatory Authorities have increasingly look for answers in theinternational arena. They aim to establish strategic partnerships to develop jointsolutions to common challenges faced and shared by all of them. Part of this effortrelates to the development of international scientific and technical standards andguidelines and that will serve as reference to national regulations. ANVISA is part ofthis process and has participated at international strategic discussions. Although many regulatory authorities of products subject to health regulation understand the challenges experienced by them can only be overcome if commonapproaches are adopted and shared globally, critics of globalization argue that the integration of national economies has been malefic for national autonomy. Governmentsor agencies would tend to weaken services or products regulations subject to health surveillance in support of international trade, an effect commonly known as Race to theBottom - RTB. In contrast to this idea, some authors opt for the Race to the Top - RTT Model, while examining the impact of globalization on national regulatory processes.This model affirms that economic globalization is responsible for making regulations more stringent, at national or global level. In Brazil, ANVISA is responsible for regulating all the economy sectors relatedto products and services that affect the health of Brazilian citizens. It is a 15 years old Agency that has been improving its performance in all fields, including in international activities. Nowadays, ANVISA develops a range of international activities, which canbe divided as follows: international inspections; discussion of international standards foron regulation and health surveillance; negotiations on health and its trade impacts; initiatives on international cooperation; and international institutional representation and training activities...

O ambiente de trabalho em saúde como elemento para a formação de técnico em enfermagem / The work environment in health as an element for the training of nursing technician

Este trabalho relata parte da minha experiência como estudante do Curso Técnico em Enfermagem em atividades desenvolvidas, no turno oposto ao da formação. O texto descreve casos vivenciados por mim quando estive atuando como bolsista nos serviços de emergência clínica e de emergência de trauma, assim como o registro de um usuário da emergência do HNSC, que permaneceu no período de um mês internado e outro que estava em tratamento contínuo. Registro também os casos que acompanhei na emergência do HCR com o esmagamento da mão esquerda e, também o acompanhamento da paciente que sofreu a queda no transporte coletivo e teve o membro inferior direito quebrado. As observações e sentimentos vividos ou percebidos também estão presentes neste relatório. O olhar do paciente em relação ao trabalho desenvolvido pelo aluno se torna importante, uma vez que, através de suas opiniões é que se pode medir e direcionar a qualidade do atendimento, melhorar a comunicação entre paciente e profissional e reforçar a atuação focada em uma atenção à saúde humanizada, principalmente no ambiente de emergência. Por fim, compreende-se que o próprio ambiente de trabalho em saúde é um elemento formativo para o técnico em enfermagem.

Patient prioritization in medical emergencies: an ethical analysis.

OBJECTIVE: To identify and analyze, in the light of ethical considerations, the choices and justifications of public health professionals in hypothetical situations of patient prioritization in circumstances of limited resources during emergency medical care. METHODS: Qualitative and quantitative study, carried out through interviews with 80 public health professionals, graduate students (MSc and PhD students) in public health who were faced with hypothetical situations involving the criteria of gender, age, and responsibility, asked to choose between alternatives that referred to the existence of people, equally submitted to life-threatening situations, who needed care in an emergency department. RESULTS: The choices prioritized children, young individuals, women, and married women, with decision-making invoking the ethical principles of vulnerability, social utility, and equity. CONCLUSION: The study shows a clear tendency to justify the choices that were made, guided by utilitarian ethics.

Priorização de pacientes em emergências médicas: uma análise ética / Patient prioritization in medical emergencies: an ethical analysis

OBJETIVO: Identificar e analisar, à luz de referencial ético, as escolhas e justificativas de profissionais de saúde pública em situações hipotéticas de priorização de pacientes em casos de limitações de recursos no atendimento de emergências médicas. MÉTODOS: Pesquisa qualiquantitativa, mediante entrevistas com 80 profissionais de saúde pública, pósgraduandos (mestrado e doutorado) em Saúde Pública, aos quais foram apresentadas situações hipotéticas, envolvendo os critérios de sexo, idade e responsabilidade, sendo requerido que escolhessem entre alternativas que se referiam à existência de pessoas, correndo igual risco de vida, que necessitavam de atendimento em um serviço de emergência. RESULTADOS: As escolhas priorizaram crianças, jovens, mulheres e casadas, com a tomada de decisão invocando os princípios éticos de vulnerabilidade, utilidade social e equidade. CONCLUSÃO: A pesquisa mostra clara tendência de justificativas das escolhas feitas, orientadas pela ética utilitarista.

OBJECTIVE: To identify and analyze, in the light of ethical considerations, the choices and justifications of public health professionals in hypothetical situations of patient prioritization in circumstances of limited resources during emergency medical care. METHODS: Qualitative and quantitative study, carried out through interviews with 80 public health professionals, graduate students (MSc and PhD students) in public health who were faced with hypothetical situations involving the criteria of gender, age, and responsibility, asked to choose between alternatives that referred to the existence of people, equally submitted to life-threatening situations, who needed care in an emergency department. RESULTS: The choices prioritized children, young individuals, women, and married women, with decision-making invoking the ethical principles of vulnerability, social utility, and equity. CONCLUSION: The study shows a clear tendency to justify the choices that were made, guided by utilitarian ethics.