RESUMEN
RESUMO A crescente geração de resíduos sólidos urbanos é um problema que atinge países de diversos níveis de desenvolvimento. A falta de adequados planejamento e gerenciamento de resíduos sólidos urbanos acarreta prejuízos à qualidade de vida da população e ao ambiente e elevação dos custos do manejo desses resíduos. O presente trabalho apresenta o panorama dos gastos públicos municipais despendidos entre 2009 e 2017 com os serviços de limpeza urbana de 31 dos 34 municípios que compõem a Região Metropolitana de Belo Horizonte. Os municípios foram ordenados por faixas populacionais, conforme classifica o Instituto Brasileiro de Geografia e Estatística. Realizou-se análise estatística descritiva, e a normalidade dos dados foi testada (teste de Shapiro-Wilk; α = 5%). Também avaliou-se a existência de correlação entre as receitas e as despesas municipais com o manejo de resíduos sólidos urbanos (teste de Spearman; α = 5%). Verificou-se, ainda, a existência de diferenças significativas entre grupos de municípios em função do agrupamento por faixas populacionais (teste de Kruskal-Wallis; α = 5%). Os resultados apontaram diferenças significativas do custo per capita despendido pelos municípios com os serviços de manejo de resíduos sólidos urbanos entre as seis faixas populacionais comparadas. Os gastos municipais relativos à faixa populacional "acima de 500.000 habitantes" foram significativamente superiores aos das demais faixas. Embora não discuta qualidade e cobertura dos serviços, este trabalho contribui para a área, visto a escassez de estudos envolvendo custos e resíduos sólidos urbanos, bem como possibilita a criação de estratégias direcionadas à otimização dos gastos públicos visando à sustentabilidade financeira.
ABSTRACT The growing generation of urban solid waste (USW) undistinctively affects countries having different levels of development. The lack of adequate planning and management of USW causes damage to the quality of life of the population and to the environment and increases the costs of handling this waste. This work is aimed to present a panorama of municipal public expenditures between 2009 and 2017 on urban cleaning services in 31 out of 34 municipalities comprising the Metropolitan Region of Belo Horizonte, Brazil. The municipalities were ordered by population groups, according to the classification of the Brazilian Institute of Geography and Statistics. A descriptive statistical analysis was performed and the normality of the data was tested (Shapiro-Wilk test; α = 5%). The existence of a correlation between municipal revenues and expenses relative to the management of USW was also evaluated (Spearman test; α = 5%). The existence of significant differences among groups of municipalities due to the grouping by population (Kruskal-Wallis test; α = 5%) was also verified. In general, the results showed significant differences in the per capita cost spent by municipalities with SUW management services among the six population groups compared. Municipal expenditures for the "over 500,000 inhabitants" population group were significantly higher than for other groups. Although it does not discuss quality and extension of the services, this work contributes to the area, given the scarcity of studies involving costs and SUW, as well as enables the creation of strategies aimed at optimizing public spending aimed at financial sustainability.
RESUMEN
Alpha-thalassemia is highly prevalent in the plural society of Brazil and is a public health problem. There is limited knowledge on its accurate frequency and distribution in the Amazon region. Knowing the frequency of thalassemia and the prevalence of responsible mutations is, therefore, an important step in the understanding and control program. Hematological and molecular data, in addition to serum iron and serum ferritin, from 989 unrelated first-time blood donors from Amazonas Hemotherapy and Hematology Foundation (FHEMOAM) were collected. In this study, the subjects were screened for -α 3.7/4.2/20.5, -SEA, -FIL, and -MED deletions. Alpha-thalassemia screening was carried out between 2016 and 2017 among 714 (72.1%) male and 275 (27.9%) female donors. The aims of this analysis were to describe the distribution of various alpha-thalassemia alleles by gender, along with their genotypic interactions, and to illustrate the hematological changes associated with each phenotype. Amongst the patients, 5.35% (n = 53) were diagnosed with deletion -α -3.7 and only one donor with α -4.2 deletion. From the individuals with -α -3.7, 85.8% (n = 46) were heterozygous and 14.20% (n = 7) were homozygous. The frequency of the -α -3.7 deletion was higher in male (5.89%) than in female (4.0%). There is no significant difference in the distribution of -α -3.7 by gender (p = 0.217). The -α 20.5, -SEA, and -MED deletions were not found. All subjects were analyzed for serum iron and serum ferritin, with 1.04% being iron deficient (n = 5) and none with very high levels of stored iron (>220 µg/dL). Alpha-thalassemia-23.7kb deletion was the most common allele detected in Manaus blood donors, which is a consistent result, once it is the most common type of α-thalassemia found throughout the world. As expected, the mean of hematological data was significantly lower in alpha-thalassemia carriers (p < 0.001), mainly homozygous genotype. Leukocytes and platelet count did not differ significantly. Due to the small number of individuals with iron deficiency found among blood donors, the differential diagnosis between the two types of anemia was not possible, even because minor changes were found among hematological parameters with iron deficiency and α-thalassemia. Despite this, the study showed the values of hematological parameters, especially MCV and MCH, are lower in donors with iron deficiency, especially when associated with α-thalassemia, and therefore, it may be useful to discriminate different types of microcytic anaemia. In conclusion, we believed screening for thalassemia trait should be included as part of a standard blood testing before blood donation. It should be noted that this was the first study to perform the screening for alpha deletions in blood donors from the Manaus region, and further studies are required to look at the effects of donated thalassemic blood.
RESUMEN
O uso de contraceptivos orais está associado a um risco aumentado de doenças tromboembólicas, o que pode ser explicado pelos seus efeitos sobre o sistema hemostático. Tem sido descrito que o uso de contraceptivos orais promovem alteraçöes pró-coagulantes, e que essas alteraçöes säo acompanhadas dos aumentos da atividade fibrinolítica e dos inibidores naturais da coagulaçäo, o que causaria um restabelecimento do equilíbrio hemostático. O objetivo deste estudo foi avaliar os efeitos do contraceptivo oral contendo 20 ug de etinilestradiol e 150 ug de desogestrelsobre os sistemas de coagulaçäo e fibrinólise. Participaram do estudo 11 voluntárias que foram avaliadas antes e após seis meses de uso do contraceptivo oral. Os parâmetros analisados foram: atividades dos fatores VII, VIII, IX, X e XII (plasmas deficientes em fatores com detecçäo foto-óptica do coágulo), atividades da antitrombina, plasminogênio e a2-antiplasmina (ensaios cromogênicos), quantificaçäo dos antígenos t-PA, produtos de degradaçäo da fibrina e proteínas C e S(ELISA), TP, TTPA e concentraçäo plasmática de fibrinogênico (detecçäo fotoóptica do coágulo). Observamos as seguintes alteraçöes estatisticamente significantes (nível de significância de p<0,05): aumento das atividades dos fatores VIII, IX, X e XII, reduçäo do TTPA, aumento da atividade do plasminogênio, aumento de proteína C e diminuiçäo de proteína S. Com esses resultados sugerimos que o uso do contraceptivo oral testado promove um estado pró-coagulante. Entretanto, os mecanismos de restabelecimento do equilíbrio hemostático näo podem ser garantidos, já que näo observamos alteraçöes suficientes que indiquem isso. Näo observamos aumento nos níveis dos produtos de degradaçäo da fibrina, o que indica que näo ocorreram alteraçöes na gênese e degradaçäo da fibrina. Portanto, sugerimos que o uso do contraceptivo oral pode aumentar o risco de doenças tromboembólicas, principalmente em associaçäo com outros fatores de riscos genéticos e/ou adquiridos.
