• Evaluation of health conditions in Rio Grande do Sul, Brazil Artigos Originais

    Danilevicz, Nelson; Meneghel, Stela Nazareth

    Abstract in Portuguese:

    Por meio de um conjunto de indicadores de saúde, pretendeu-se hierarquizar as delegacias regionais de saúde do Estado do Rio Grande do Sul (Brasil), no período de 1979 a 1982. Selecionaram-se cinco indicadores clássicos: mortalidade proporcional em menores de cinco anos, coeficiente de Swaroop-Uemura, coeficiente de mortalidade infantil, mortalidade proporcional por doenças infecciosas e percentual de óbitos mal definidos que apresentaram maior peso relativo usando metodologia de análise fatorial. Estes indicadores foram padronizados, utilizando a variável Z, ponderados, utilizando coeficiente de escore fatorial, e as regiões administrativas foram classificadas em sete grupos. Todos os grupos apresentaram melhora no nível de saúde, no período observado. Através do conceito de risco foram sugeridos alguns indicadores para integrarem a vigilância epidemiológica de saúde que permitiram hierarquizar as delegacias regionais de saúde, com vistas a estabelecer prioridades em termos de ações de saúde e aplicação de recursos.

    Abstract in English:

    By the use of a group of health statistics, this study classifies the health status of the administrative regions in Rio Grande do Sul (Brazil) for the period form 1979 to 1982. Five classic health parameters were chosen according to the following criteria: accessibility to a hisitorical series of three years; necessarily part of an information system currently in use and having a high rate of factorial score. Each parameter was weighed (CEF) for "Health Level", "Immunization Level" and "Medical Care Level". They were: proportional mortality under five years, Swaroop-Uemura, infant mortality rate, proportional mortality for infectious diseases and percentage of undefined deaths. The parameters were standardized by a Z-variable and weighed by factorial score rate. In this way the final score was obtained for each administrative region. Such a score is a fusion of five parameters in one, making the data comparison easier. The administrative regions were classified in seven groups. It was possible to identify regions where investment is needed, i.e., where health levels are low. Apart from this study's principal purpose, it was found that the regions with the lowest health levels are characteristically agricultural, with large rural properties and marked distinctions in social class. It is suggested that the parameters should be used as instruments in a model for epidemiological surveillance which would show the present situation of the health/disease ratio in a population.
  • An evaluation of the meals program for workers in Pernambuco State Brazil Artigos Originais

    Moura, Josenilda Barreto de

    Abstract in Portuguese:

    Foi avaliado o Programa de Alimentação do Trabalhador (PAT), no que se refere a implantação, funcionamento e resultados em empresas, no Estado de Pernambuco, Brasil. O universo pesquisado abrangeu um total de 130 empresas, sendo 85 inscritas no PAT entre 1977 e 1980 e 45 não inscritas. Neste grupo, a coleta de dados limitou-se ao ano de 1980 e teve como finalidade o estabelecimento de parâmetros para avaliar os indicadores de impacto do Programa. A análise dos cardápios sugere que um reduzido percentual de empresas fornece refeições conforme as exigências mínimas de energia e proteína estabelecidas pela Lei 6.321/76, isto é, um mínimo de 1.400 cal e NDpCal% superior a 6. O exame dos indicadores de impacto nas empresas dos dois grupos sugere que o PAT não modificou o número de acidentes de trabalho, condições de saúde e rotatividade dos trabalhadores; tendo apenas influído no absenteísmo.

    Abstract in English:

    The establishment, implementation and impact of the Meals Program for Worlkers (MPW) were evaluated in a total of 130 industries in the state of Pernambuco (Northeast Brazil). Of these, 85 had been enrolled in the Program from 1977 to 1980 (experimental group) and 45 had not (control group). The reasons for the implantation or not of the Program, as well as the health conditions, the industrial-accident, absenteeism and turn-over rates among employees, were determined, taking into consideration the economic activity and the size of the industries. In the experimental group the analysis was made from one year before the enrolment in the Program and covered industries which had enjoyed the benefits of 1, 2, 3 or 4 years of fiscal incentive. The data for the control group were collected in 1980 only and were used as a parameter for the evaluation of the impact indicators of the Program. The analysis of the menus suggests that a small number of industries were serving meals in accordance with the minimal amounts of energy and protein recommended by the Law n.° 6.321/76, that is, a minimum of 1,400 cal and NDPcal% higher than 6. The increase in the price of the meal/employee was also determined for the same period of time. It has been demonstrated that government incentives were the motivation for the industries' participation in the Program and that a high percentage of these industries already offered meals to their employees before the Program began. Ignorance of the Law and the administrative indecision were among the reasons for the non-implementation of the Program. A significant number of employees in both groups received less than two legal minimum salaries although the industries of the experimental group offered higher wages to their employees. The analysis of the impact indicators in both groups leads to the conclusion that the number of industrial accidents, health conditions and turn-over rate among employees have remained unchanged, but absenteeism had been reduced by the Program.
  • Behaviour of the T. cruzi blood forms obtained from mice used as biological filters in culture and triatomine Artigos Originais

    Ribeiro, Rosa Domingues; Belda Neto, Francisco Miguel; Prado Junior, José Clóvis do; Albuquerque, Sérgio de

    Abstract in Portuguese:

    Camundongos normais, utilizados como filtros biológicos, foram inoculados endovenosamente, com tripomastigotas sangüícolas da derivada RCL da cepa RC do T. cruzi. Decorridas 48 horas, os animais foram submetidos ao xenodiagnóstico e à punção cardíaca para semeadura do sangue em meio de Warren. No estômago dos triatomíneos e em cultura a 28°C, os tripomastigotas diferenciaram-se em formas arredondadas (esferomastigotas e/ou amastigotas). Esse comportamento das formas sangüícolas largas tem sido observado com freqüência e nos leva a inferir que a biologia do T. cruzi não estaria apenas relacionada com a cepa, mas, eventualmente, com populações do parasita.

    Abstract in English:

    The study of the behaviour of T. cruzi strains in animals as in human beings, runs into great difficulties when the attempt is made to relate the morphology of this parasite to its biological behaviour. The thin forms are able to penetrate vertebrate cells faster than the broad forms. So, faced with the biological complexity of the T. cruzi strains and substrains it was decided to investigate the behaviour of its blood forms obtained from normal mice as biological filters. These mice were endovenously inoculated with blood trypomastigotes from derivated RCL of the T. cruzi RC strain. Forty-eight hours later, the animals went through xenodiagnosis and heart punch in order to sow the blood in Warren's medium. The trypomastigotes became round (spheromastigotes and/or amastigotes) in the stomach of the triatomines and cultures at 28°C. The behaviour of the broad forms has been frequently observed and leads to the conclusion that the biology of the T. cruzi is not only related to the strain, but, sometimes, to the parasite population.
  • Comparative study of the behaviour of infection in mice, when inoculated by intraperitoneal and subcutaneous methods, using two strains of Trypanosoma cruzi Artigos Originais

    Pinto, Fernando Henriques; Ribeiro, Rosa Domingues; Belda Neto, Francisco Miguel; Prado Júnior, José Clóvis do

    Abstract in Portuguese:

    Foram utilizados camundongos brancos, pesando em média 18g e duas cepas de Trypanosoma cruzi, morfologicamente distintas: Y com predominância de formas sangüíneas delgadas e Bolívia com predomínio de formas largas. Os lotes de animais receberam 2 x 10³, 2 x 10(4) e 2 x 10(5) tripanossomos por animal e as vias de inoculação utilizadas foram a intraperitoneal e a subcutânea. Nos animais foi observado o curso de infecção. Os resultados obtidos revelaram que, nos experimentos em que se utilizou a cepa Y, existem algumas diferenças significantes, com infecções mais uniformes e virulentas, após inoculação subcutânea de 2 x 10³ e 2 x 10(4) formas sangüíneas de T. cruzi. Entretanto, isto não ocorreu com a cepa Bolívia, pois os animais apresentaram o mesmo padrão de parasitemia e os demais caracteres morfológicos, quer se utilizasse a via subcutânea ou intraperitoneal. Tal fato permite sugerir a existência de interrelação entre os fatores via de inoculação traduzida pela maior ou menor presença de macrófagos no sítio de inoculação, e a morfologia das formas sangüíneas representada pela maior ou menor capacidade de penetração celular.

    Abstract in English:

    By means of comparative studies of the infection of mice with T. cruzi using intraperitoneal and subcutaneous inoculation, it was concluded that more uniform and virulent infections are obtained after subcutaneous inoculation. This is due to an immediate cellular response, when intraperitoneal inoculations are used. With the aim of making comparative studies as between the two methods of inoculation, the intraperitoneal using two, morfologically distinct, strains of T. cruzi: Y with predominance of thin forms and Bolivia with predominance of broad forms. White mice of approximately 18g were required for these tests. The groups of animals received 2 x 10³, 2 x 10(4) and 2 x 10(5) trypanossomes per animal, and the course of the infection was subsequently observed. The results revealed that after subcutaneous inoculation when the Y strain was used in the tests, some significant differences appear, with more virulent and uniform infections. However, these did not appear when the Bolivia strain was used, because the animals showed the same standard parasitemy and other morpho-biological features, whether by subcutaneous or intraperitoneal inoculation. This incident suggests the existence of interrelation between the factors: method of inoculation represented by a greater or lesser presence of macrophages in the inoculated area, and the morphology of the blood forms represented by a greater or lesser capacity for cellular penetration.
  • Contributions from anthropology to medicine: a bibliographic review in Brazil Atualização

    Queiroz, Marcos de Souza; Canesqui, Ana Maria

    Abstract in Portuguese:

    Foi feita revisão e análise, sob um ponto de vista antropológico, da literatura mais representativa sobre saúde e doença e práticas de cura no Brasil. Nessa literatura, em primeiro lugar, houve a preocupação de coletar documentos sobre as tradições regionais do mundo rural, expressando uma ampla variedade de pontos de vista. Em geral, "medicina popular" era vista como um conjunto de práticas e idéias rudes e imitativas, provenientes tanto da medicina erudita do passado como das tradições étnicas brasileiras. Em segundo lugar, as ciências sociais exerceram uma grande influência neste tipo de estudo. Depois dos anos 30 e, principalmente, dos anos 40 aos 70, um número importante de trabalhos tiveram lugar nesse campo de estudo, influenciados pelas posturas acadêmicas como, por exemplo, o funcionalismo, a teoria da aculturação, e as teorias do desenvolvimento. Durante os anos 70 o campo atingiu a sua maturidade com um grande número de pesquisas sob várias influências teóricas. As teorias estruturalistas e funcional-estruturalistas (que variam entre o formalismo abstrato e o substantivismo) tiveram um peso mais consistente nessa década. Três importantes estudos recentes foram também analisados, e as principais tendências abertas nesse campo foram também discutidas, particularmente as tentativas marxistas de análise.

    Abstract in English:

    An analysis was made of the most representative literature both on health and illness representations and on practices of cure in Brazil from an anthropological point of view. Firsttly, there was in this litterature the concern of collecting the folk traditions from the rural world, expressing a great variety of viewpoints. In general, "popular medicine" was seen as a set of rude and imitative ideas and practices stemming from both the erudite medicine of the past and Brazilian ethnic traditions. Secondly, social sciences have had a great influence on this kind of study. After the 30's, particularly from the 40's to the 70's, a number of important studies, influenced by academic postures such as functionalism, acculturation theory and development theories took place in this field of study. During the 70's, this field reached maturity with a great amount of research carried out under diverse theoretical influences. However, the structuralist and functional-structuralist theories (which range from abstract formalism to substantivism) had a more consistent weight in that decade. Three important recent studies were also analysed and the main new theoretical trends in this field, particularly as regards Marxist theories, were also discussed.
  • Anthropology of medicine: a theoretical review Atualização

    Queiroz, Marcos de Souza; Canesqui, Ana Maria

    Abstract in Portuguese:

    Foi feita revisão e análise da literatura antropológica mais importantes sobre representações de saúde e doença e práticas de cura, tendo a Inglaterra, os Estados Unidos da América e a França como referência. Tendo representantes nas principais escolas dentro do pensamento antropológico (tais como o funcionalismo, o funcional-estruturalismo, o estruturalismo, a teoria do rótulo, o interacionismo simbólico, a etnometodologia, o criticismo cultural), a história da antropologia da medicina se confunde com a própria história da antropologia. Além de analisar a contribuição que essas várias escolas fizeram para esse campo de estudo, aponta-se o impasse atual que se está nele verificando. Atribui-se como principal razão para esse impasse à ausência de uma teoria capaz de explicar como os processos sociais de pequena escala (apropriados à metodologia antropológica) subordinam-se aos processos sociais recorrentes na sociedade capitalista.

    Abstract in English:

    An analysis was made of the most representative literature on both curing practices of cure and health and illness representations, taking England, the United State of America and France as references. With representatives of the main schools of anthropological thought (such as functionalism. functional-structuralism, structuralism, labelling theory, symbolic interactionism, ethnomethodology and cultural criticism), the history of Anthropology of Medicine runs into the history of Anthropology itself. Besides analysing the contribution these various schools have made to this area of study, the current deadlock which is arising within, it is also indicated by this article. It is considered that the absence of a theory capable of explaining how small scale social process (which are appropriate to anthropological methodology) are subordinated to the large-scale social processes which are recurrent in capitalist society is the main reason for this deadlock.
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Faculdade de Saúde Pública da Universidade de São Paulo São Paulo - SP - Brazil
E-mail: revsp@org.usp.br