Fátima Pivetta

Monitoramento biológico: conceitos e aplicações em saúde pública

This study provides an overview of the theoretical discussion on potential uses for biological monitoring of exposure to chemical substances as related to human health, considering different concepts: definitions, uses, and limitations of internal dose and biological effect indicators and their availability for the substances to be quantified; knowledge of reference values, action levels, and limits based on health and negotiated patterns in biological monitoring interpretation and perspectives; and ethical and social problems in practice and within different preventive practices and their use in public health. Biological monitoring is the result of an exposure situation with conclusions based on scientific and consensus values, rules, and legislation. Biological monitoring as a continuous process and related to actually observed cases has helped establish technological exposure reference values and consensus levels as indicators for improving the environment and the workplace. As a step in the decision-making process in risk analysis, biological monitoring needs to be critically assessed as to its ethical aspects in light of the end use of results and values, which are references for application of this methodology.

Avaliação da exposição ocupacional ao chumbo: proposta de uma estratégia de monitoramento para prevenção dos efeitos clínicos e subclínicos

In developing countries, lead-acid battery factories are one of the heaviest consumers of lead. Due to leads toxicological properties and prevalent working conditions in such factories, workers are subject to high exposure and health risk. This study discusses results obtained by lead exposure assessment of workers from a Rio de Janeiro battery factory, in light of Brazilian legislation and recent scientific data. Evaluation methods used were environmental (personal air sampling) and biological (determination of lead in blood, Pb-B) monitoring, showing a high personal exposure both in air (>0.1 mg/m3) and blood (55% of Pb-B >25µg/dl). These results confirmed the inefficiency of current control measures, with a possible 46% of workers presenting a Pb-B range of 25-60 µg/dl in risk areas. Recent data suggest that Pb-B levels above 25 µg/dl are related to subclinical alterations in human body that should be investigated during clinical examination. Finally, we propose a strategy based on environmental and biological monitoring to prevent both clinical and subclinical effects.

Segurança química, saúde e ambiente: perspectivas para a governança no contexto brasileiro

Chemical safety is acknowledged by Agenda 21 as one of the most serious problems worldwide, involving governance at the national and international levels. In Brazil, chemical safety problems have increased in intensity and extent, far beyond the capacity to deal with them. The problems are all the more serious in Brazil because issues of democracy, security, sustainability, and equity, all fundamental to governance, are still incipient and still far from being solved. New societal arrangements and a new, contextualized and more participatory science form the basis for developing and expanding strategies for governance to deal with the problem of chemical safety.

Chemical safety and governance in Brazil

Chemical safety is recognized in Agenda 21(UNCED--Rio 92), as one of the most serious problems to be faced worldwide being a problem not just of governability, restricted more to the role of states and governments, but of governance at the national and international levels. It poses greater challenges for countries like Brazil where the issues of democracy, security, sustainability and equity, which are fundamental to governance, are merely incipient and still far from solved. Taking as references the analysis of four cases in the Brazilian context, we illustrate the situation from less densely populated areas (as in the cases of mercury use by gold miners in the Amazon and pesticides in agricultural producing areas), through medium-sized towns (as in the accident with cesium 137 in Goiânia), to the major urban and industrial centers (as in the cases of lead from battery renovators and benzene in the oil and steel industries and oil refineries). What can be seen is a situation where problems connected with chemical safety have grown in intensity and extent far more than the capacity to deal with them. In industrializing countries, the formulation of chemical safety policies must take into account not only the complexity and uncertainties involved in understanding the problems, but also the aspects relating to the different modes and levels of vulnerability. This is necessary in order to attempt to build better contextualized and more participatory knowledge and decision-making processes at the local and global levels, which we take as basic prerequisites for governance.

Dispositivos de comunicação para a promoção da saúde: reflexões metodológicas a partir do processo de compartilhamento da Maleta de Trabalho “Reconhecendo Manguinhos”

O artigo busca contribuir para a educacao popular em saude, descrevendo e analisando um processo de compartilhamento de materiais produzidos por comunidades ampliadas de pesquisa acao, sobre temas de saude, ambiente e cidadania em uma favela no Rio de Janeiro. A partir dos referenciais teorico-metodologicos da promocao da saude emancipatoria e da justica ambiental, o artigo descreve o processo de compartilhamento de uma “Maleta”, apresentando os objetivos, as dinâmicas e os principais resultados de quatro oficinas realizadas junto a atores sociais: professores, jovens, conselheiros, profissionais de saude e pesquisadores. Discute a pertinencia da producao de um video-relatorio como “mecanismo” de devolucao dos resultados e tambem como novo dispositivo de comunicacao a ser incorporado a Maleta. Finalmente, analisa os desafios, limitacoes e potencialidades desta experiencia de formacao de comunidades ampliadas na producao de conhecimentos sobre os problemas e potencialidades do territorio.

Dispositivos de comunicación para la promoción de la salud: reflexiones metodológicas del proceso de intercambio de la Maleta de Trabajo “Reconociendo Manguinhos”

O artigo busca contribuir para a educacao popular em saude, descrevendo e analisando um processo de compartilhamento de materiais produzidos por comunidades ampliadas de pesquisa acao, sobre temas de saude, ambiente e cidadania em uma favela no Rio de Janeiro. A partir dos referenciais teorico-metodologicos da promocao da saude emancipatoria e da justica ambiental, o artigo descreve o processo de compartilhamento de uma “Maleta”, apresentando os objetivos, as dinâmicas e os principais resultados de quatro oficinas realizadas junto a atores sociais: professores, jovens, conselheiros, profissionais de saude e pesquisadores. Discute a pertinencia da producao de um video-relatorio como “mecanismo” de devolucao dos resultados e tambem como novo dispositivo de comunicacao a ser incorporado a Maleta. Finalmente, analisa os desafios, limitacoes e potencialidades desta experiencia de formacao de comunidades ampliadas na producao de conhecimentos sobre os problemas e potencialidades do territorio.

A presença de mercúrio em casa constitui um risco de contaminação humana e / ou ambiental? Relato de um caso

Mercury kept in a garage of a residencial building in Rio de Janeiro was accidentally released and caused local (environmental and human) contamination. The concentration of mercury in indoor air of the most critical site reached 15.5 mg/m3. Outdoor air samples showed concentrations ranging from 0.37 to 6.6 mg/m3 . Seventy five per cent of the urine samples collected from 22 residents in the contaminated building showed levels of mercury higher than those observed in non exposed individuals (>6.9 mg/L); in 30% of these samples, the concentration was higher than 20 mg/L. These values show a high level of human contamination and the final consequences were not so serious owing to the quick action taken by one of the residents.

Comunidades ampliadas de pesquisa ação como dispositivos para uma promoção emancipatória da saúde: bases conceituais e metodológicas

This article is a contribution to methodological discussions on the “participation” pillar that guides strategies for Health Promotion. It reflects the conceptual and methodological bases of the Extended Communities for Action-Research (ECAR) as a tool for the Emancipatory Promotion of Health (EPH), taking as reference the experiences from the Territorial Laboratory in Manguinhos. The ECAR brings together researchers and mainly residents who live in the territory with their knowledge and distinct viewpoints who reflect on socioenvironmental problems, public policies and alternatives in a given context. Three key aspects for EPHare discussed: social participation, social determination and shared production of knowledge. Based on the experiences of the action-research model in areas with slums, we found a massive gap between what is written in the Policy and institutional practices where there were spaces marked by borders. We also noted a lack of rights and major tensions between the parties. As a result of the ECAR findings, various tools were produced in accessible languages facilitating knowledge appropriation and the enhancement of actions in social movements. This article concludes with some thoughts and challenges for the Emancipatory Promotion of Health.This article is a contribution to methodological discussions on the “participation” pillar that guides strategies for Health Promotion. It reflects the conceptual and methodological bases of the Extended Communities for Action-Research (ECAR) as a tool for the Emancipatory Promotion of Health (EPH), taking as reference the experiences from the Territorial Laboratory in Manguinhos. The ECAR brings together researchers and mainly residents who live in the territory with their knowledge and distinct viewpoints who reflect on socioenvironmental problems, public policies and alternatives in a given context. Three key aspects for EPHare discussed: social participation, social determination and shared production of knowledge. Based on the experiences of the action-research model in areas with slums, we found a massive gap between what is written in the Policy and institutional practices where there were spaces marked by borders. We also noted a lack of rights and major tensions between the parties. As a result of the ECAR findings, various tools were produced in accessible languages facilitating knowledge appropriation and the enhancement of actions in social movements. This article concludes with some thoughts and challenges for the Emancipatory Promotion of Health.

Comunication devices for health promotion: methodological reflections from de process of sharing of Work Case “Recognizin Manguinhos”

O artigo busca contribuir para a educacao popular em saude, descrevendo e analisando um processo de compartilhamento de materiais produzidos por comunidades ampliadas de pesquisa acao, sobre temas de saude, ambiente e cidadania em uma favela no Rio de Janeiro. A partir dos referenciais teorico-metodologicos da promocao da saude emancipatoria e da justica ambiental, o artigo descreve o processo de compartilhamento de uma “Maleta”, apresentando os objetivos, as dinâmicas e os principais resultados de quatro oficinas realizadas junto a atores sociais: professores, jovens, conselheiros, profissionais de saude e pesquisadores. Discute a pertinencia da producao de um video-relatorio como “mecanismo” de devolucao dos resultados e tambem como novo dispositivo de comunicacao a ser incorporado a Maleta. Finalmente, analisa os desafios, limitacoes e potencialidades desta experiencia de formacao de comunidades ampliadas na producao de conhecimentos sobre os problemas e potencialidades do territorio.