Discursos de profesores de los ciclos iniciales de enseñanza primaria acerca de las relaciones entre escuela, salud y medio ambiente

En este trabajo analizamos los discursos que sobre educación y salud han desarrollado los alumnos de un curso de formación de profesores de los ciclos iniciales de enseñanza primaria. Dichos discursos se llevaron a cabo durante el desarrollo de proyectos educativos que relacionaban objetivos de la enseñanza de las ciencias con problemas de la comunidad. Se han analizado siguiendo la perspectiva teórica de la Filosofía del Lenguaje de Bakhtin, haciendo énfasis en la dimensión constitutiva del lenguaje y en su carácter dialógico y polifónico. Los resultados describen la pluralidad de horizontes sociales y conceptuales que se han identificado en las intervenciones de los profesores y discuten las relaciones que éstos establecen entre problemas socioambientales, comunidad y escuela, así como las posibilidades de acción de los educadores.In this paper we analyse the discourses about education and health of a group of students on an initial primary teacher training course, in the context of projects aimed at relating science education to problems in the community. Analyses were conducted according to theoretical perspectives identified with Bakhtin's Philosophy of Language with an emphasis on the concepts of dialogism and polyphony. Results describe a plurality of socio-conceptual standpoints identifi ed in the subjects' utterances and discuss the relationships they establish between socioenvironmental problems, the community and school as well as possibilities for educators' actions

Quality Of Life Assessment In Patients With Cystic Fibrosis By Means Of The Cystic Fibrosis Questionnaire.

To assess the quality of life (QoL) of patients with cystic fibrosis (CF) followed at a university referral center for CF. A cross-sectional study involving application of the Cystic Fibrosis Questionnaire (CFQ) and Shwachman score in CF patients between April of 2008 and June of 2009. The sample consisted of 75 patients. The mean age was 12.5 ± 5.1 years (range, 6.1-26.4 years). The patients were divided into three groups by age in years: group I ( 14). The highest and lowest CFQ scores were for the nutrition domain in group III (89.3 ± 16.2) and the social domain in group II (59.5 ± 22.3), respectively. Groups I and III differed significantly regarding the treatment domain (p = 0.001). Regarding Shwachman scores, there were significant differences between patients scoring 70 in the social (group I; p = 0.045), respiratory (group II; p = 0.053), and digestive (p = 0.042) domains. In group III, severity did not correlate with QoL. In groups I and II, patients with an FEV1 < 80% of predicted did not differ from other patients for any CFQ domain. However, in group III, values for the following domains were significantly lower in patients with an FEV1 < 80%: physical (p = 0.012); body image (p = 0.031); respiratory (p = 0.023), emotional (p = 0.041); and social role (p = 0.024). It is important to assess QoL in CF patients, because it can improve treatment compliance.37184-9

Saúde Mental e Justiça: questões éticas referentes ao incesto e à pedofilia

Sexual abuse is a problem that must be addressed by both the health and justice systems. A recent situation involving a ten-year-old child who was raped by her uncle and wished to terminate the pregnancy sparked off intense debate. The procedure was widely covered by the media and exposed on social networks, and while attention was turned to moral and ethical issues, the child and her family’s suffering was neglected, leading to more abuse beyond the sexual violence. Using this case as an example, this work aims to discuss the differences between incest and pedophilia and the possibilities of addressing and treating them. The Sexual Abuse Study and Treatment Center (CEARAS) of the University of São Paulo Medical School has been studying the subject and assisting families with reported cases of intrafamilial sexual abuse since 1993. This experience has shown specific characteristics of incest that characterize it as a dysfunctional family dynamics, whereas pedophilia is an individual disorder. Distinguishing pedophilia and incest is fundamental, since in the latter the whole family must adhere to the treatment to interrupt the cycle of violence. An ethical approach to child sexual abuse requires suspending moral judgements so that all the human relationships involved may be understood. The coordinated action of mental health services and the justice system when dealing with incest and pedophilia tends to be more effective. Treating the whole family in cases of incest and the individual in cases of pedophilic disorder contributes to the prevention of sexual abuse.O abuso sexual é um problema que precisa ser tratado nos âmbitos da Saúde Mental e da Justiça. Atualmente, um caso apresentado pela mídia, que envolvia o desejo de interromper a gestação de uma criança de 10 anos, grávida em consequência do estupro do tio, mobilizou uma grande discussão ética. A realização do procedimento foi cercada de conflitos éticos e morais e o caso foi exposto pela mídia e nas redes sociais. O sofrimento gerado pelo abuso sexual incestuoso na criança e em sua família foi relegado frente a estas questões e somaram-se vários outros abusos à violência sexual. O objetivo deste artigo é, utilizando o caso como exemplo, fazer uma reflexão sobre as diferenças entre incesto e pedofilia e suas possibilidades de abordagem e tratamento. O Centro de Estudos e Atendimento Relativos ao Abuso Sexual da Faculdade de Medicina da USP – CEARAS – estuda o tema do incesto e atende, desde 1993, famílias que tenham uma denúncia de abuso sexual entre seus membros. Esta experiência tem demonstrado características específicas do incesto que o configura como uma dinâmica familiar disfuncional, sendo diferente da pedofilia, caracterizada por um transtorno individual. A possibilidade de diferenciar a pedofilia do incesto é fundamental, pois neste último, é necessário o tratamento para toda a família para que seja interrompido o ciclo da violência. Uma abordagem ética do abuso sexual infantil só pode ser constituída a partir da supressão dos julgamentos morais em benefício da apreensão de todas as relações humanas envolvidas. Em ambos os casos, a abordagem da Saúde Mental aliada à da Justiça tende a ser mais efetiva, pois tratar a família em casos de incesto e o indivíduo com o transtorno pedofílico contribui para a prevenção de futuras situações de abuso sexual

Leishmania spp.: isolamento de parasitos pela inoculação de macerados de biopsias de pacientes em camundongos deficientes em interferon gama

Isolation of Leishmania parasite and species identification are important for confirmation and to help define the epidemiology of the leishmaniasis. Mice are often used to isolate pathogens, but the most common mouse strains are resistant to infection with parasites from the Leishmania (Viannia) subgenus. In this study we tested the inoculation of interferon gamma knockout (IFN&#947; KO) mice with biopsy macerates from Leishmania-infected patients to increase the possibility of isolating parasites. Biopsies from twenty five patients with clinical signs of leishmaniasis were taken and tested for the presence of parasites. Immunohistochemical assay (IHC) and conventional histopathology detected the parasite in 88% and 83% of the patients, respectively. Leishmania sp. were isolated in biopsy macerates from 52% of the patients by culture in Grace's insect medium, but 13% of isolates were lost due to contamination. Inoculation of macerates in IFN&#947; KO mice provides isolation of parasites in 31.8% of the biopsies. Most isolates belong to L. (Viannia) subgenus, as confirmed by PCR, except one that belongs to L. (Leishmania) subgenus. Our preliminary results support the use of IFN&#947; KO mice to improve the possibility to isolate New World Leishmania species.O isolamento e a identificação da espécie de parasito do gênero Leishmania são importantes para a confirmação e auxiliam na epidemiologia da leishmaniose. Os camundongos são freqüentemente utilizados para isolar patógenos, porém, as linhagens mais comuns de camundongos são resistentes à infecção por parasitos do subgênero Leishmania (Viannia). Neste estudo, avaliamos a inoculação de macerados de biópsias de pacientes infectados em camundongos deficientes do gene do interferon gama (IFN&#947; KO) como um método para aumentar a possibilidade de isolar Leishmania spp. Biópsias de 25 pacientes infectados com Leishmania sp. foram avaliadas para a presença de parasitos pelos métodos de imunohistoquímica (IHC) e histopatologia convencional. Os parasitos foram observados, respectivamente, em 88% e 83% das biópsias. Leishmania sp. foi isolada de macerados de biópsia de 52% dos pacientes infectados, quando cultivados em meio Grace, porém, 13% destes isolados foram perdidos devido a contaminações. Inoculação dos macerados em camundongos IFN&#947; KO proporcionou o isolamento de parasitos oriundos de 31,8% dos pacientes. A maioria dos isolados pertence ao subgênero L. (Viannia), exceto um que pertence ao subgênero L. (Leishmania), como confirmado pela reação da polimerase em cadeia. Nossos resultados preliminares sugerem que o uso de camundongos IFN&#947; KO pode ser útil para aumentar a possibilidade de isolamento de leishmânias encontradas nas Américas

Psychological morbidity as a moderator of intention to quit smoking : a study of smokers and former smokers

Objective: To analyze psychological morbidity as a moderator of the relationship between smoking representations and quality of life in smokers and former smokers, as well as to determine which psychological variables discriminate between smokers with and without the intention to quit smoking. Methods: This was a quantitative, correlational cross-sectional study involving a convenience sample of 224 smokers and 169 former smokers. Results: In smokers and former smokers, psychological morbidity had a moderating effect on the relationship between mental/physical quality of life and smoking representations (cognitive representations, emotional representations, and comprehensibility). Smokers with the intention to quit smoking more often presented with low comprehensibility, threatening emotional representations, behavioral beliefs, and perceived behavioral control, as well as with normative/control beliefs, than did those without the intention to quit. Conclusions: The results of this study underscore the importance of the moderating effect exerted by psychological morbidity, as well as that of sociocognitive variables, among smokers who have the intention to quit smoking.ResumoObjetivo: Analisar a morbidade psicológica como um moderador na relação entre as representações do tabaco e a qualidade de vida em fumantes e ex-fumantes, assim como conhecer as variáveis psicológicas que discriminam os fumantes com e sem intenção para deixar de fumar. Métodos: Estudo quantitativo, correlacional e transversal com uma amostra de conveniência constituída por 224 fumantes e 169 ex-fumantes. Resultados: Verificou-se um efeito moderador da morbidade psicológica na relação entre a qualidade de vida (física e mental) e as representações do tabaco (representações cognitivas e emocionais e compreensão) nos fumantes e nos ex-fumantes. Os fumantes com intenção para deixar de fumar apresentavam menor compreensão, representações emocionais mais ameaçadoras, mais crenças de comportamento, maior controle comportamental percebido e mais crenças normativas/controle do que aqueles sem essa intenção. Conclusões: Os resultados deste estudo enfatizam a importância da morbidade psicológica como moderadora, bem como das variáveis sociocognitivas, junto dos fumantes que querem deixar de fumar

Stress-Induced Reinstatement of Drug Seeking: 20 Years of Progress

In human addicts, drug relapse and craving are often provoked by stress. Since 1995, this clinical scenario has been studied using a rat model of stress-induced reinstatement of drug seeking. Here, we first discuss the generality of stress-induced reinstatement to different drugs of abuse, different stressors, and different behavioral procedures. We also discuss neuropharmacological mechanisms, and brain areas and circuits controlling stress-induced reinstatement of drug seeking. We conclude by discussing results from translational human laboratory studies and clinical trials that were inspired by results from rat studies on stress-induced reinstatement. Our main conclusions are (1) The phenomenon of stress-induced reinstatement, first shown with an intermittent footshock stressor in rats trained to self-administer heroin, generalizes to other abused drugs, including cocaine, methamphetamine, nicotine, and alcohol, and is also observed in the conditioned place preference model in rats and mice. This phenomenon, however, is stressor specific and not all stressors induce reinstatement of drug seeking. (2) Neuropharmacological studies indicate the involvement of corticotropin-releasing factor (CRF), noradrenaline, dopamine, glutamate, kappa/dynorphin, and several other peptide and neurotransmitter systems in stress-induced reinstatement. Neuropharmacology and circuitry studies indicate the involvement of CRF and noradrenaline transmission in bed nucleus of stria terminalis and central amygdala, and dopamine, CRF, kappa/dynorphin, and glutamate transmission in other components of the mesocorticolimbic dopamine system (ventral tegmental area, medial prefrontal cortex, orbitofrontal cortex, and nucleus accumbens). (3) Translational human laboratory studies and a recent clinical trial study show the efficacy of alpha-2 adrenoceptor agonists in decreasing stress-induced drug craving and stress-induced initial heroin lapse

Global, regional, and national comparative risk assessment of 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks, 1990-2015: a systematic analysis for the Global Burden of Disease Study 2015

SummaryBackground The Global Burden of Diseases, Injuries, and Risk Factors Study 2015 provides an up-to-date synthesis of the evidence for risk factor exposure and the attributable burden of disease. By providing national and subnational assessments spanning the past 25 years, this study can inform debates on the importance of addressing risks in context. Methods We used the comparative risk assessment framework developed for previous iterations of the Global Burden of Disease Study to estimate attributable deaths, disability-adjusted life-years (DALYs), and trends in exposure by age group, sex, year, and geography for 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks from 1990 to 2015. This study included 388 risk-outcome pairs that met World Cancer Research Fund-defined criteria for convincing or probable evidence. We extracted relative risk and exposure estimates from randomised controlled trials, cohorts, pooled cohorts, household surveys, census data, satellite data, and other sources. We used statistical models to pool data, adjust for bias, and incorporate covariates. We developed a metric that allows comparisons of exposure across risk factors—the summary exposure value. Using the counterfactual scenario of theoretical minimum risk level, we estimated the portion of deaths and DALYs that could be attributed to a given risk. We decomposed trends in attributable burden into contributions from population growth, population age structure, risk exposure, and risk-deleted cause-specific DALY rates. We characterised risk exposure in relation to a Socio-demographic Index (SDI). Findings Between 1990 and 2015, global exposure to unsafe sanitation, household air pollution, childhood underweight, childhood stunting, and smoking each decreased by more than 25%. Global exposure for several occupational risks, high body-mass index (BMI), and drug use increased by more than 25% over the same period. All risks jointly evaluated in 2015 accounted for 57·8% (95% CI 56·6–58·8) of global deaths and 41·2% (39·8–42·8) of DALYs. In 2015, the ten largest contributors to global DALYs among Level 3 risks were high systolic blood pressure (211·8 million [192·7 million to 231·1 million] global DALYs), smoking (148·6 million [134·2 million to 163·1 million]), high fasting plasma glucose (143·1 million [125·1 million to 163·5 million]), high BMI (120·1 million [83·8 million to 158·4 million]), childhood undernutrition (113·3 million [103·9 million to 123·4 million]), ambient particulate matter (103·1 million [90·8 million to 115·1 million]), high total cholesterol (88·7 million [74·6 million to 105·7 million]), household air pollution (85·6 million [66·7 million to 106·1 million]), alcohol use (85·0 million [77·2 million to 93·0 million]), and diets high in sodium (83·0 million [49·3 million to 127·5 million]). From 1990 to 2015, attributable DALYs declined for micronutrient deficiencies, childhood undernutrition, unsafe sanitation and water, and household air pollution; reductions in risk-deleted DALY rates rather than reductions in exposure drove these declines. Rising exposure contributed to notable increases in attributable DALYs from high BMI, high fasting plasma glucose, occupational carcinogens, and drug use. Environmental risks and childhood undernutrition declined steadily with SDI; low physical activity, high BMI, and high fasting plasma glucose increased with SDI. In 119 countries, metabolic risks, such as high BMI and fasting plasma glucose, contributed the most attributable DALYs in 2015. Regionally, smoking still ranked among the leading five risk factors for attributable DALYs in 109 countries; childhood underweight and unsafe sex remained primary drivers of early death and disability in much of sub-Saharan Africa. Interpretation Declines in some key environmental risks have contributed to declines in critical infectious diseases. Some risks appear to be invariant to SDI. Increasing risks, including high BMI, high fasting plasma glucose, drug use, and some occupational exposures, contribute to rising burden from some conditions, but also provide opportunities for intervention. Some highly preventable risks, such as smoking, remain major causes of attributable DALYs, even as exposure is declining. Public policy makers need to pay attention to the risks that are increasingly major contributors to global burden. Funding Bill & Melinda Gates Foundation