Homeopatia no SUS : uma análise da controvérsia científica a partir da Política Nacional de Práticas Integrativas e Complementares

Dissertação (mestrado)—Universidade de Brasília, Instituto de Ciências Sociais, Departamento de Sociologia, 2017.A inquietude intelectual que moveu esse trabalho se traduz na seguinte pergunta: Como se cristalizam nas práticas sociais o embate entre diferentes concepções epistemológicas? Para respondê-la escolheu-se investigar a controvérsia entre medicina convencional e medicina homeopática e suas estratégias de legitimação no campo da saúde e da ciência. A Política Nacional de Práticas Integrativas e Complementares (PNPIC) se mostrou um campo fértil para essa análise. Ela é a política de saúde de âmbito nacional que rege sobre a inclusão da homeopatia no Sistema Único de Saúde, e como tal, é o grande resultado social concreto de choques, rearranjos e estratégias mobilizados por apoiadores e detratores da homeopatia. Verificar através da PNPIC de que forma a arena político-burocrática se apropriou e traduziu conflitos da arena epistemológica foi o esforço que pretendi cumprir. A metodologia escolhida para tal foi baseada em pesquisa documental e análise de discurso, numa busca por dados que exprimissem de que forma a controvérsia entre a medicina convencional e a homeopática acabariam por definir a política nacional de saúde. O documento que apresenta a Política Nacional de Práticas Integrativas e Complementares foi foco da análise, pois é essa a política que estabelece as diretrizes para o uso da homeopatia enquanto prática terapêutica dentro do Sistema Único de Saúde. Os documentos oficiais e normativos por ela citados compuseram o resto do esforço analítico do trabalho, com destaque para a Estratégia da Organização Mundial de Saúde sobre medicina tradicional, lançada em 2002. Ao final verificouse que o contexto intelectual que promoveu certa “cultura epistêmica” mais relativista foi fundamental para a reorganização das estratégias pragmáticas adotadas pelos disputantes. Notou-se uma espécie de afinidade eletiva entre essa “cultura epistêmica” e o cenário político que se desenrolava, o que acabaria por facilitar a entrada da homeopatia no Sistema Único de Saúde apesar das desconfianças da medicina convencional hegemônica.The intellectual disquietude that moved this work can be translated into the following question: How do social practices crystallize the clash between different epistemological conceptions? In order to answer it, it was chosen to investigate the controversy between conventional medicine and homeopathic medicine and its strategies in the search for legitimacy in the field of health and science. The National Policy on Integrative and Complementary Practices (PNPIC) proved to be a fertile field for this analysis. It is the national health policy that governs the inclusion of homeopathy in the Unified Health System, and as such, is a concrete social result of shocks, rearrangements and strategies mobilized by supporters and detractors of homeopathy. Using the PNPIC to verify how the political-bureaucratic arena appropriated and translated conflicts of the epistemological arena was the mean goal of this work. The methodology chosen was based on documentary research and discourse analysis, in a search for data that explain how the controversy between conventional medicine and homeopathic medicine would eventually define the national health policy. The document presenting the National Policy on Integrative and Complementary Practices was the focus of the analysis, since it is the policy that establishes the guidelines for the use of homeopathy as a therapeutic practice within the Unified Health System. The official and normative documents cited by the policy were also analyzed, in special the World Health Organization's Strategy on Traditional Medicine, launched in 2002. At the end, it was found that the intellectual context that promoted a more relativistic "epistemic culture" was fundamental to the Pragmatic strategies adopted by the disputants. There was a kind of “elective affinity” between this "epistemic culture" and the political scenario, which end up facilitating the entry of homeopathy into the Unified Health System despite the suspicions of conventional medicine

Veredicto del trabajo : bases racionales de las decisiones judiciales en casos de accidentes de trabajo

O trabalho, a depender das condições em que é exercido e do tipo de atividade, repercutirá de forma negativa sobre a saúde dos trabalhadores e desencadeará agravos e danos que exigirão a reparação ou compensação. O objetivo deste estudo é analisar as bases racionais das decisões dos juízes trabalhistas nos casos de acidente de trabalho, investigando os elementos e pressupostos utilizados pelo magistrado na construção do ato de julgar, no deferimento do pedido. O trabalho foi desenvolvido por meio de análise documental exploratória, utilizando-se metodologia qualitativa, para identificar os sentidos da palavra escrita dos magistrados trabalhistas mediante a Análise do Discurso. A fonte documental é composta por sentenças da Justiça do Trabalho de Salvador, Bahia. As análises permitiram a formulação de categorias das bases racionais que indicaram a dificuldade dos magistrados em estabelecer um conceito de dano; a necessidade de tornar a doença “invisível” em visível, como meio de prova; a complexidade em se estabelecer. _______________________________________________________________________________________ ABSTRACTWork, depending on the conditions under which it is exercised and the type of activity, reflects negatively on the health of workers, causing injuries and damage that require repair or compensation. The aim of this study is to analyze the rationale of the decisions of judges in cases of labor accidents at work, investigating the factors and assumptions used by the magistrate in the construction of the act of judging in the sense of acceptance. The work was developed through exploratory analysis of documents, through qualitative methodology to identify the meanings of the written word through the labor of judges Discourse Analysis. The source document consists of sentences of the Labour Court in Salvador, Bahia. The analysis allows the formulation of categories of rationales that indicated the difficulty magistrates had to establish a concept of damage, the need to make an “invisible” disease visible, as evidence; the difficulty to establish parameters for determination of reparation and the need for defense of prevention. _______________________________________________________________________________________ RESUMENEl trabajo, en función de las condiciones en que se ejerce y el tipo de actividad, repercutirá de forma negativa en la salud de los trabajadores, y desencadenará lesiones y daños que exigirán reparación o indemnización. El objetivo de este estudio es analizar las bases racionales de las decisiones de los jueces del trabajo en los casos de accidentes laborales, investigando los elementos y suposiciones previas utilizadas por el juez en la construcción del acto de juzgar en el sentido de lo solicitado. El trabajo fue desarrollado por medio de análisis exploratorio de los documentos, utilizando metodología cualitativa para identificar los significados de la palabra escrita de los magistrados del trabajo mediante el Análisis del Discurso. El documento original se compone de sentencias del Tribunal del Trabajo de Salvador, Bahia. Los análisis permitieron la formulación de categorías de las bases racionales que indicaron la dificultad de los magistrados para establecer un concepto de daño, la necesidad de hacer que la enfermedad “invisible” se torne visible, como medio de prueba; la dificultad de establecer parámetros para la determinación de los valores de indemnización y la necesidad de defensa de la prevención

A database and digital signal processing framework for the perceptual analysis of voice quality

Bermúdez de Alvear RM, Corral J, Tardón LJ, Barbancho AM, Fernández Contreras E, Rando Márquez S, Martínez-Arquero AG, Barbancho I. A database and digital signal processing framework for the perceptual analysis of voice quality. Pan European Voice Conferenc: PEVOC 11 Abstract Book. Aug. 31-Sept.2, 2015.Introduction. Clinical assessment of dysphonia relies on perceptual as much as instrumental methods of analysis [1]. The perceptual auditory analysis is potentially subject to several internal and external sources of bias [2]. Furthermore acoustic analyses which have been used to objectively characterize pathological voices are likely to be affected by confusion variables such as the signal processing or the hardware and software specifications [3]. For these reasons the poor correlation between perceptual ratings and acoustic measures remains to be a controversial matter [4]. The availability of annotated databases of voice samples is therefore of main importance for clinical and research purposes. Databases to perform digital processing of the vocal signal are usually built from English speaking subjects’ sustained vowels [5]. However phonemes vary from one language to another and to the best of our knowledge there are no annotated databases with Spanish sustained vowels from healthy or dysphonic voices. This work shows our first steps to fill in this gap. For the aim of aiding clinicians and researchers in the perceptual assessment of voice quality a two-fold objective was attained. On the one hand a database of healthy and disordered Spanish voices was developed; on the other an automatic analysis scheme was accomplished on the basis of signal processing algorithms and supervised learning machine techniques. Material and methods. A preliminary annotated database was created with 119 recordings of the sustained Spanish /a/; they were perceptually labeled by three experienced experts in vocal quality analysis. It is freely available under Links in the ATIC website (www.atic.uma.es). Voice signals were recorded using a headset condenser cardioid microphone (AKG C-544 L) positioned at 5 cm from the speaker’s mouth commissure. Speakers were instructed to sustain the Spanish vowel /a/ for 4 seconds. The microphone was connected to a digital recorder Edirol R-09HR. Voice signals were digitized at 16 bits with 44100 Hz sampling rate. Afterwards the initial and last 0.5 second segments were cut and the 3 sec. mid portion was selected for acoustic analysis. Sennheiser HD219 headphones were used by judges to perceptually evaluate voice samples. To label these recordings raters used the Grade-Roughness-Breathiness (GRB) perceptual scale which is a modified version of the original Hirano’s GRBAS scale, posteriorly modified by Dejonckere et al., [6]. In order to improve intra- and inter-raters’ agreement two types of modifications were introduced in the rating procedure, i.e. the 0-3 points scale resolution was increased by adding subintervals to the standard 0-3 intervals, and judges were provided with a written protocol with explicit definitions about the subintervals boundaries. By this way judges could compensate for the potential instability that might occur in their internal representations due to the perceptual context influence [7]. Raters’ perceptual evaluations were simultaneously performed by means of connecting the Sennheiser HD219 headphones to a multi-channel headphone preamp Behringer HA4700 Powerplay Pro-XL. The Yin algorithm [8] was selected as initial front-end to identify voiced frames and extract their fundamental frequency. For the digital processing of voice signals some conventional acoustic parameters [6] were selected. To complete the analysis the Mel-Frequency Cepstral Coefficients (MFCC) were further calculated because they are based on the auditory model and they are thus closer to the auditory system response than conventional features. Results. In the perceptual evaluation excellent intra-raters agreement and very good inter-raters agreement were achieved. During the supervised machine learning stage some conventional features were found to attain unexpected low performance in the classification scheme selected. Mel Frequency Cepstral Coefficients were promising for assorting samples with normal or quasi-normal voice quality. Discussion and conclusions. Despite it is still small and unbalanced the present annotated data base of voice samples can provide a basis for the development of other databases and automatic classification tools. Other authors [9, 10, 11] also found that modeling the auditory non-linear response during signal processing can help develop objective measures that better correspond with perceptual data. However highly disordered voices classification remains to be a challenge for this set of features since they cannot be correctly assorted by either conventional variables or the auditory model based measures. Current results warrant further research in order to find out the usability of other types of voice samples and features for the automatic classification schemes. Different digital processing steps could be used to improve the classifiers performance. Additionally other types of classifiers could be taken into account in future studies. Acknowledgment. This work was funded by the Spanish Ministerio de Economía y Competitividad, Project No. TIN2013-47276-C6-2-R has been done in the Campus de Excelencia Internacional Andalucía Tech, Universidad de Málaga. References [1] Carding PN, Wilson JA, MacKenzie K, Deary IJ. Measuring voice outcomes: state of the science review. The Journal of Laryngology and Otology 2009;123,8:823-829. [2] Oates J. Auditory-perceptual evaluation of disordered voice quality: pros, cons and future directions. Folia Phoniatrica et Logopaedica 2009;61,1:49-56. [3] Maryn et al. Meta-analysis on acoustic voice quality measures. J Acoust Soc Am 2009; 126, 5: 2619-2634. [4] Vaz Freitas et al. Correlation Between Acoustic and Audio-Perceptual Measures. J Voice 2015;29,3:390.e1 [5] “Multi-Dimensional Voice Program (MDVP) Model 5105. Software Instruction Manual”, Kay PENTAX, A Division of PENTAX Medical Company, 2 Bridgewater Lane, Lincoln Park, NJ 07035-1488 USA, November 2007. [6] Dejonckere PH, Bradley P, Clemente P, Cornut G, Crevier-Buchman L, Friedrich G, Van De Heyning P, Remacle M, Woisard V. A basic protocol for functional assessment of voice pathology, especially for investigating the efficacy of (phonosurgical) treatments and evaluating new assessment techniques. Guideline elaborated by the Comm. on Phoniatrics of the European Laryngological Society (ELS). Eur Arch Otorhinolaryngol 2001;258:77–82. [7] Kreiman et al. Voice Quality Perception. J Speech Hear Res 1993;36:21-4 [8] De Cheveigné A, Kawahara H. YIN, a fundamental frequency estimator for speech and music. J. Acoust. Soc. Amer. 202; 111,4:1917. [9] Shrivastav et al. Measuring breathiness. J Acoust Soc Am 2003;114,4:2217-2224. [10] Saenz-Lechon et al. Automatic Assessment of voice quality according to the GRBAS scale. Eng Med Biol Soc Ann 2006;1:2478-2481. [11] Fredouille et al. Back-and-forth methodology for objective voice quality assessment: from/to expert knowledge to/from automatic classification of dysphonia. EURASIP J Appl Si Pr 2009.Campus de Excelencia Internacional Andalucía Tech, Universidad de Málaga. Ministerio de Economía y Competitividad, Projecto No. TIN2013-47276-C6-2-R

Multidisciplinary consensus on the approach to hospital malnutrition in Spain

Rationale: Disease-related malnutrition constitutes a highly prevalent healthcare problem with high costs associated. In Spain, the prevalence of malnutrition in hospitalized patients has been reported from 30% to 50%. Objectives: Main purposes of this consensus document were to establish recommendations that facilitate decision- making and action to prevent and early-diagnose disease-related hospital malnutrition, on the management of nutritional support methods and actions to evaluate nutritional treatment compliance and efficacy. Methods: A systematic bibliographical search of authors was performed, complemented by updated bibliography by author references up to 2010. From this review, some recommendations were defined, modified and critically evaluated by the representatives of scientific societies in a consensus conference (Dec 2010) following a structured brainstorming technique: the Metaplan® technique. A double validation process was undertaken until final recommendations were obtained. Results: 30 consensus recommendations for the prevention and management of hospital malnutrition are presented in this document. Recommendations cover all clinical care settings as well as prevention, screening, diagnosis, treatment and follow-up of disease-related malnutrition. Conclusions: Nutritional screening is strongly recommended at all clinical settings when nutritional risk factors are identified or there is clinical suspicion of malnutrition. Nutritional assessment should be designed and performed according to centers’ resources, but clearly identified protocols should be available.La desnutrición relacionada con la enfermedad constituye un problema sanitario de elevada prevalencia y altos costes. En España, la prevalencia de desnutrición de los pacientes hospitalizados se ha estimado entre el 30% y el 50%. Objetivos: El objetivo principal de este consenso fue establecer recomendaciones para facilitar la toma de decisiones para la prevención y el diagnostico precoz de la desnutrición hospitalaria, el manejo del soporte nutricional, y las acciones para evaluar el cumplimiento de la intervención nutricional y su eficacia. Métodos: Se realizó una búsqueda sistemática de autor complementada por bibliografía actualizada por referencias de autor hasta el año 2010. A partir de esta revisión, se definieron algunas recomendaciones que fueron criticadas y modificadas por los representantes de las Sociedades Científicas participantes en una conferencia de consenso (Diciembre 2010) siguiendo una técnica de brainstorming estructurado: la técnica Metaplan®. Se realizaron dos vueltas de validación de las recomendaciones hasta obtener las recomendaciones finales. Resultados: Este documento presenta 30 recomendaciones para la prevención y el manejo de la desnutrición hospitalaria. Las mismas cubren todas las áreas de actuación clínica así como la prevención, cribado, diagnóstico, tratamiento y seguimiento de la desnutrición hospitalaria relacionada con la enfermedad. Conclusiones: Se recomienda enérgicamente el cribado nutricional en todas las áreas de actuación clínica cuando se identifiquen factores de riesgo nutricional o sospecha clínica de desnutrición. La valoración del estado nutricional debe diseñarse y realizarse de acuerdo a los recursos disponibles en cada centro, disponiendo de claros protocolos de actuación

Resolving the age bimodality of galaxy stellar populations on kpc scales

Galaxies in the local Universe are known to follow bimodal distributions in the global stellar populations properties. We analyze the distribution of the local average stellar-population ages of 654,053 sub-galactic regions resolved on ~1-kpc scales in a volume-corrected sample of 394 galaxies, drawn from the CALIFA-DR3 integral-field-spectroscopy survey and complemented by SDSS imaging. We find a bimodal local-age distribution, with an old and a young peak primarily due to regions in early-type galaxies and star-forming regions of spirals, respectively. Within spiral galaxies, the older ages of bulges and inter-arm regions relative to spiral arms support an internal age bimodality. Although regions of higher stellar-mass surface-density, mu*, are typically older, mu* alone does not determine the stellar population age and a bimodal distribution is found at any fixed mu*. We identify an "old ridge" of regions of age ~9 Gyr, independent of mu*, and a "young sequence" of regions with age increasing with mu* from 1-1.5 Gyr to 4-5 Gyr. We interpret the former as regions containing only old stars, and the latter as regions where the relative contamination of old stellar populations by young stars decreases as mu* increases. The reason why this bimodal age distribution is not inconsistent with the unimodal shape of the cosmic-averaged star-formation history is that i) the dominating contribution by young stars biases the age low with respect to the average epoch of star formation, and ii) the use of a single average age per region is unable to represent the full time-extent of the star-formation history of "young-sequence" regions.Comment: 17 pages, 11 figures, MNRAS accepte

Investigation of VvMybA1 and VvMybA2 berry color genes in ‘Aglianico’ biotypes

Research Not

South-South cooperation in health, by international organizations, under the perspective of critical bioethics

A Cooperação Sul-Sul em saúde apresenta-se como alternativa ao caráter assistencialista e de transferência de tecnologias que marca o antigo modelo Norte-Sul. As ações dela decorrentes têm uma dimensão ética evidente, já que envolvem alocação de recursos, relações interculturais, compartilhamento de biotecnologias e processos decisórios coletivos. No presente ensaio, é apresentado o modelo de bioética crítica a partir do qual se analisam três importantes documentos internacionais contendo diretrizes para a Cooperação Sul-Sul, com vistas a compreender em que medida favorecem a construção de programas estruturantes e emancipatórios.The South-South Cooperation in health is presented as an alternative to the welfare character and transfer of technologies that mark the old North-South model. The resulting actions that come from it have a clear ethical dimension, as they involve resources allocation, intercultural relations, biotechnology sharing and collective decision processes. In this current essay, it is presented the critical bioethics model from which are analyzed three important international documents containing guidelines for the South-South cooperation, in order to understand to which extent they favor the construction of structuring and emancipatory programs

Agroproductive Evaluation of Maize (Zea mays L) and Beans (Phaseolus vulgaris L.) Cultivated in Association, in Angonia, Mozambique

This research took place at the Center for Agricultural Research in Mozambique, on red ferrallitic soil, located at the Ntengo Umodzi Agronomy Post, Angonia District, Province of Tete, in 2012-2012. The aim was to evaluate agroproductivity indicators within a crop area of maize and beans in association. A randomized block experimental design was used, with 4 replicas and 5 treatments, consisting of maize plants, variety PAN 53; and beans, variety Diacol, in association, in 20 lots of 8 furrows each. Plant height was evaluated for the two crops. The number of kernels per ear and beans per pod were determined, along with the land equivalence ratio. SPSS 13.0 for Windows was used for statistical analysis of results, and normal distribution of each variable data was checked. Variance analysis was made as well. The Pearson correlation coefficient was performed through the Statistical Analysis System (SAS). The results showed no significant differences in terms of plant height and number of kernels per ears. The land equivalence ratio of the ass