Ricardo José Soares Pontes

Control of mother-to-child transmission of infectious diseases in Brazil: progress in HIV/AIDS and failure in congenital syphilis

In Brazil, syphilis and HIV infection are considered serious public health problems. However, in practice, epidemiological surveillance, prevention measures, and prenatal care seem to be more effective in the control of mother-to-child transmission of the HIV than in the control of transmission of the Treponema pallidum. Here we discuss the differences in surveillance, prenatal care, and care of the newborn. Important differences were identified. It is concluded that there is an urgent need to establish prevention of mother-to-child transmission of syphilis as a public health priority, using an integrated approach including womens health, childrens health, primary health care, and STD/AIDS programs on all governmental levels. These issues also need to be discussed with all stakeholders involved. Important aspects related to the problem are the training of public health professionals, as well as the participation of the community. The elimination of congenital syphilis does not require expensive drugs, and diagnostic tools, but a long-term sustainable approach.

Resistência do Aedes aegypti ao temefós em Municípios do Estado do Ceará

The susceptibility of Aedes aegypti to temefos was evaluated by means of samples of eggs and larvae from four large counties in the state of Ceara (Fortaleza, Barbalha, Juazeiro do Norte and Crato). The technique standardized by the World Health Organization for tests with larvicides was used. The CL50 of eight samples from populations of Aedes was determined, as were their respective resistance ratios, compared to the CL50 of the susceptible Rockefeller strain. All populations submitted to the experiment showed resistance to temefos, with resistance ratios varying between 8 and 16. Analysis of these results reinforces prior evidence regarding the dissemination of temefos resistance in different locations in the state, subjected to considerable pressure for control in recent decades. The larvicide may lose its effectiveness if an urgent attempt is not made to reestablish the susceptibility of Aedes aegypti in these areas, profoundly affecting control campaigns currently under way.

Dengue em localidade urbana da região sudeste do Brasil: aspectos epidemiológicos

A dengue fever epidemic which occurred in Ribeirao Preto County, S. Paulo State, Brazil, during the period November, 1990 to March, 1991 has been analysed else where. The general aspects of dengue epidemiology and control have been reviewed in this article. Emphasis is given to the analysis of some factors involved in the risk of dengue haemorrhagic fever and ecological aspects of the vector, as well as to the appropriateness of strategies for dengue eradication or control. Epidemiological characteristics of dengue, mainly those related to its occurrence in different geographical areas and periods of time are described. The Ribeirao Preto epidemic has thus, been set within the context of the spread of the disease at global level, in the Americas, and particularly in Brazil and S. Paulo State.

Uma reflexão sobre o processo de avaliação das pós-graduações brasileiras com ênfase na área de saúde coletiva

Este artigo busca promover uma reflexao acerca dos criterios adotados pelo sistema de avaliacao da Pos-graduacao em curso no pais e seu impacto no âmbito dos diferentes programas, conferindo destaque na analise a area de Saude Coletiva. Ressalta-se, por um lado, a importância que os processos avaliativos tem na consolidacao do sistema de ensino e pesquisa, contribuindo, de modo decisivo, para a promocao e monitoramento da sua qualidade. Em contrapartida, os autores convidam a uma reflexao sobre a concepcao de ciencia subjacente aos criterios adotados e seu impacto no conjunto dos cursos que compoem a pos-graduacao em Saude Coletiva. Para tanto, apontam obstaculos situados em planos distintos e as desigualdades, nao apenas regionais, mas entre instituicoes geograficamente proximas mas que desenvolvem suas praticas em contextos distintos. O texto finaliza indagando sobre a correspondencia entre o percurso historico e os compromissos que marcam a trajetoria da Saude Coletiva e os rumos atuais da avaliacao da pos-graduacao nesse campo de saberes e praticas.

Hanseníase no município de Fortaleza, CE, Brasil: aspectos epidemiológicos e operacionais em menores de 15 anos (1995-2006)

This is a sectional study that aims to analyze the occurrence of Hansens disease cases in 15 year-old minors in the Municipality of Fortaleza and notified in SINAN. The epidemiological indicators in this population show hiperendemicity. In operational terms is observed the maintenance of the service concentration in some reference units, in spite of some progress. Late diagnosis, a high degree of incapacity in the diagnosis and low degree of evaluation of contacts registered reveal the fragility of the actions of control. This study emphasizes the possibility of error diagnostic front to the characteristics of the infection in this population. The occurrence of cases of leprosy in this population represents an epidemiologic indicator of great importance and its analysis extends the discussion on operational problems in the network of health services.Estudio transversal con el objetivo de analizar las ocurrencias de los casos de lepra en menores de 15 anos de edad sitiados en la ciudad de Fortaleza y enterados en el SINAN. Los indicadores epidemicos en esta poblacion se presentaron hiperendemicos. En la operacinalizacion, se observa el mantenimiento de la concentracion de atencion en algunas unidades recomendables, a pesar de algunos avances. Diagnosticos muy tardes, gran grado de incapacidad en el diagnostico y bajo grado de evaluacion de contactos registrados, muestran la fragilidad de las acciones de control. Se resalta asi la posibilidad de error de diagnostico delante de las caracteristicas de la infeccion en esta poblacion. La ocurrencia de casos de lepra en esta poblacion representa un indicador epidemico de gran importancia y su analisis amplia la discusion sobre los problemas operacionales en la red de servicios publicos.

Competência de peixes como predadores de larvas de Aedes aegypti, em condições de laboratório

OBJETIVO: Avaliar a competencia de peixes na predacao de larvas de Aedes aegypti, em condicoes de laboratorio. METODOS: Foram testados machos e femeas de cinco especies de peixe. Os testes de predacao duravam cinco semanas para cada especie. Cada ensaio compreendia quatro caixas testes e quatro caixas controles. Das caixas controle, duas tinham somente um peixe e as outras duas, apenas larvas. Cada caixa teste continha um peixe e larvas. Na primeira semana foram expostas 100 larvas em cada caixa, e a cada semana acrescentavam-se 100 larvas por caixa/dia, ate se obter um maximo de 500 larvas/dia. Comprimento e peso dos peixes foram medidos semanalmente. RESULTADOS: Foram utilizadas 369.000 larvas no total. O Trichogaster trichopteros foi a unica especie em que ambos os sexos predaram 100% das larvas oferecidas. O Betta splendens deixou de predar apenas 15 larvas. Machos do Poecilia reticulata apresentaram baixa capacidade larvofaga quando comparados as femeas da mesma especie. Em relacao ao peso e tamanho o Betta splendens mostrou-se capaz de predar 523 larvas/grama/dia. CONCLUSOES: Femeas e machos de Trichogaster trichopteros e de Astyanax fasciatus, e femeas de Betta splendens e de Poecillia sphenops foram os peixes que apresentaram maior competencia para predar as larvas. Embora com competencia menor, machos de Poecillia sphenops e femeas de Poecilia reticulata foram capazes de eliminar o numero de larvas de Aedes aegypti que possam emergir durante 24 horas num criadouro, em condicoes naturais. Machos de Poecilia reticulata nao foram predadores eficazes.

Efeito residual de apresentações comerciais dos larvicidas temefos e Bacillus thuringiensis israelensis sobre larvas de Aedes aegypti em recipientes com renovação de água

The residual effect of temefos (commercial applications A, B and C) and Bacillus thuringiensis israelensis (D and E) on Aedes aegypti larvae was evaluated, in recipients with water renewal. Forty-four beakers of 1,000ml each (8 for each application and 4 controls) were used. In each beaker, 25 larvae were introduced daily. After 24 hours, the dead larvae were counted, the beakers emptied to 200ml and refilled to original volume, with addition of new larvae. The duration of the maximum residual effect (100% of mortality) was: A-19; B-39; C-40; D-8; E-19 days. The mortality ratio of all applications remained equivalent for 25 days; B, C and E maintained MR equivalent up to 45 days; B and C showed MR 2.40 times greater than E, between 46-95 days; B, compared with A, showed MR 1.90-7.51 times greater between 26-95 days. The conclusion was greater effectiveness of two presentations of temefos, even in an epidemiological situation with long exposure to the product and renewal of water in recipients.

Percepção de familiares e profissionais de saúde sobre os cuidados no final da vida no âmbito da atenção primária à saúde

The objective of this study is to reflect on care for people with terminal illnesses in primary health care. This study is relevant in the current context of demographic and epidemiological transition, in which there is an increase in the aging population and a rise in the prevalence of chronic degenerative diseases. By means of qualitative research with a critical hermeneutic focus, individual interviews were conducted with seven family members, three professionals from the Family Health Strategy and two professionals from the Home Care Program. The analysis established two empirical categories: end of life care from the perception of family members and that of health professionals. The results showed that, despite the humanization discourse, reflected in the prerogative of living the final moments of life with the family, a serious problem in the discontinuity of care is concealed. It was concluded that, despite the efforts, little is achieved in improving the quality of life for those who die from terminal diseases at home in the Unified Health System in municipalities distant from large centers.

Survival of Betta splendens fish (Regan, 1910) in domestic water containers and its effectiveness in controlling Aedes aegypti larvae (Linnaeus, 1762) in Northeast Brazil

Objective  In Northeast Brazil, large domestic containers used to store water are important breeding sites of Aedes aegypti, the main vector of dengue fever. The objective of this study was to estimate the survival of Betta splendens (Perciformes: Osphronemidae) fish in domestic containers in Fortaleza (Ceará State), as well as its effectiveness in the control of premature A. aegypti stages.

Campo comum de atuação dos profissionais da Estratégia Saúde da Família no Brasil: um cenário em construção

Este estudo objetiva sistematizar e analisar saberes e praticas que integram o campo comum de atuacao das equipes multiprofissionais da Estrategia Saude da Familia (ESF). Trata-se de estudo qualitativo, com construcao das informacoes atraves de entrevistas abertas e oficinas de producao de conhecimento, com 23 profissionais da ESF e das residencias medica e multiprofissional em Saude da Familia e Comunidade, no periodo de marco a agosto de 2011, no municipio de Fortaleza. O campo comum e o espaco do compartilhamento, da socializacao de praticas e saberes entre os trabalhadores que integram a atencao primaria a saude no Brasil, ou seja, profissionais das equipes da ESF, incluindo o Nucleo de Apoio a Saude da Familia (NASF). E constituido, em grande parte, por acumulos teorico-praticos da Saude Coletiva, mas tambem por outros conhecimentos, como o da clinica e o da reabilitacao, e os aportes de setores diversos, como Geografia, Pedagogia e Educacao Popular. Os saberes e praticas essenciais do campo comum da ESF foram consolidados em dez grupos. A interface do trabalho dos profissionais e complexa e cada vez mais ampla. Ha diversas acoes comuns a varias profissoes; algumas sao complementares; outras estao muito imbricadas. O que vai possibilitar estabelecer um campo comum de atuacao interprofissional e o debate democratico da equipe. Esse processo e gradativo, carece de pactuacao, nao sendo resolvido somente na disputa legal, definindo verticalmente essa interface. Configura-se num campo em permanente construcao, a medida que novas categorias profissionais vao sendo incorporadas a ESF, trazendo novos saberes e novas praticas.