Convergências entre planejamento de atenção primária à saúde e os Objetivos de Desenvolvimento Sustentável: uma avaliação de planos municipais de saúde do Brasil e Chile

This study explores the importance of Primary Health Care (PHC) for the achievement of the Sustainable Development Goals (SDGs), assessing the convergences between two PHC municipal agendas and the global Agenda 2030. For this purpose, the PHC actions included in the municipal health plans of Santiago, Chile, and São Paulo, Brazil, were evaluated by means of content analysis. Results showed that the actions planed by Santiago’s PHC contributed to 14 SDGs, while in São Paulo, the actions identified contributed to the entire Agenda 2030, although both plans lacked references to the SDGs. In conclusion, the actions planned by the PHC municipal agendas are essential to achieve the SDGs. But this relationship is not adequately reported, which can compromise the allocation of greater resources to this sector. Therefore, greater alignment of local, national, and global action plans and policies, integrated and continuous training for communities and health teams, and greater use and diffusion of technologies already available in a regional and intersectoral approach to municipal health plans are required.O objetivo deste estudo é explorar a importância da Atenção Primária à Saúde (APS) para a consecução dos Objetivos de Desenvolvimento Sustentável (ODS), avaliando as convergências entre duas agendas municipais de APS e a Agenda global 2030. Para tanto, utilizou-se a técnica de análise de conteúdo nas ações de APS previstas nos planos municipais de saúde dos municípios de Santiago do Chile e São Paulo, Brasil. A análise de conteúdo de ambos os planos mostrou que as ações previstas pela APS de Santiago contribuíam com 14 ODS, enquanto em São Paulo foram identificadas ações que contribuíam com a totalidade da Agenda 2030, ainda quando em ambos os planos houve algumas faltas de referência aos ODS. Conclui-se que as ações previstas pela APS em um nível municipal demostram ser essenciais à consecução dos ODS. Porém, esta relação não é informada adequadamente, o que pode comprometer a injeção de maiores incentivos neste setor. Logo, se requer maior alinhamento dos planos e políticas locais, nacionais e globais de ação, uma formação integrada e continuada nas comunidades e para as equipes de saúde, e maior uso e difusão de tecnologias já disponibilizadas em abordagem territorial e intersetorial dos planos municipais de saúde

A Reflection Opposing The Massification Of Agricultural Production

1931

L\ubfATTIVAZIONE DI TSPO E DI LXR STIMOLA LA NEUROSTEROIDOGENESI ED E\ubf PROTETTIVA IN UN MODELLO DI NEUROPATIA PERIFERICA DI RATTO DIABETICO

Diabetes mellitus (DM) is one of the first leading cause of death in most high-income countries and there is evidence that it is epidemic in many economically developing and newly industrialized nations. Beside these considerations, there are epidemiologic evaluations that show a dramatic increase of the number of diabetic and with impaired glucose tollerance patients in the next years. It is also important to underline that complications from diabetes, such as coronary artery and peripheral vascular disease, stroke, diabetic neuropathy, renal failure and blindness result in increasing disability, reduced life expectancy and enormous health costs for virtually every society. In particular, diabetic peripheral neuropathy can account for the 50-75% of non traumatic amputations; diabetes is therefore undoubtedly one of the most challenging health problems of our century. Recently, in an animal model of diabetic neuropathy (i.e. the rat raised diabetic with the injection of streptozotocin - STZ), it has been demonstrated that, in plasma and in sciatic nerve, the levels of neuroactive steroids are dramatically decreased. Promising results have been obtained in the same experimental model after treatments with progesterone, testosterone and their derivatives. The use of molecules able to increase the neuroactive steroid levels directly in the nervous system could be an interesting therapeutic approach because it may avoid the endocrine side effects usually observed after systemic treatment with steroids. In order to evaluate the possible neuroprotective effects mediated by an increase of neuroactive steroid levels in the peripheral nervous system, using the model of the STZ rat we here analyzed the effects of two different pharmacological approaches. In the first part of this thesis, we analyzed the effect of Ro5-4864, a ligand of the translocator protein of 18 kDa (TSPO). TSPO is a key regulator of neuroactive steroid synthesis and it is involved in the rate limitig step of this process (i.e. the entrance of cholesterol into the mitochondria). Indeed, it has been recently demonstrated that injection of TSPO ligands, like for instance Ro5-4864, was able to increase the capability of steroidogenic machinery in adrenal cortex, placenta, testis, ovary and glial cells. In the second part of this thesis, the effect of GW3965, a ligand of the Liver X Receptor (LXR), was analyzed. The rationale of this approach was based on the finding that cholesterol homeostasis is partially controlled by the regulation of different genes activated by LXR. Moreover, LXR activation is able to increase the steroidogenesis in the adrenal glands. At 2 months after STZ injection, two different protocols of TSPO ligand administration were assessed; in particular, animals were injected every 2 days or once a week whit the ligand (i.e., they received 16 or 4 injections). In the case of GW3965 treatment, at 2 months, diabetic animals were treated once a week (i.e., they received 4 injections). Functional and behavioural parameters, like for instance hot plate test and the recording of nerve conduction velocity, as well as biochemical parameters, like Na+,K+-ATPase activity and myelin protein gene expression, were analyzed in order to assess the neuroprotective effects of treatments. Moreover, in the case of Ro5-4864 treatment, the intra-epidermal nerve fiber density was quantified in the skin of the hindpaw footpad. Furthermore, in the experiment with GW3965 treatment, the levels of gene expression of LXR targets and of steroidogenic enzimes were determined in the sciatic nerve of diabetic animals. Data obtained showed that activation of TSPO and of LXR using their ligands once a week resulted in an increased levels of neuroactive steroids and protection of the sciatic nerve from neuropathy induced by diabetes. Conversely, 16 treatments with Ro5-4864 did not produced any protective effects. The increase of neuroactive steroid levels observed in the sciatic nerve after the treatment with the two molecules was in agreement with the improve of functional and biochimical parameters observed in diabetic rats, like for istance the thermal nociceptive activity, nerve conduction velocity, and Na+,K+-ATPase activity. Moreover, a recover of the intra-epidermal nerve fiber density after Ro5-4864 injection and a significant increase of the gene expression of some enzymes of steroidogenesis after GW3965 administration were detected. In contrast to what observed after TSPO activation, treatment with GW3965 did not consistently countered the diabetes-induced decrease in expression of the myelin protein zero observed in the sciatic nerve of STZ-treated animals. This observation suggests somewhat different mechanisms of action for LXR and TSPO ligands, an issue that it should be explored in the future. In conclusion the data here reported show that Ro5-4864 and GW3965 are neuroprotective in an animal model of diabetic peripheral neuropathy. Since a pharmacological treatment for this pathology is not yet available, data here provide suggest that these two molecules may represent promising candidates for the treatment of diabetic neuropathy

Um ensaio a partir do aforismo 20 da "Mínima Moralia" - Struwwelpeter

O presente trabalho objetiva levantar algumas reflexões sobre o aforismo de número vinte, presente na obra “Mínima Moralia”. Este aforismo nos chama atenção, primeiramente, pelo nome em alemão, que é o título de um livro alemão para crianças, com histórias de cunho moral. Adorno, a partir de um dos personagens deste livro, traça uma crítica ao sistema capitalista e à formatação econômica da sociedade

Reflexões sobre água de abastecimento e saúde pública: um estudo de caso na Amazônia brasileira

Even though Amazonia displays magnificent environmental heritage and abundance of water resources, it is exactly in the Brazilian northern region, contained in this remarkable biome, that the worst indices of access to sanitation services and respective public health indicators are found. A case study carried out in the town of São Gabriel da Cachoeira, located to the northwest in the State of Amazonas, with nearly 18,000 inhabitants, a large portion of whom are Indians, revealed a complexity of factors related to water supply and public health improvement for urban centers in Amazonia. Lack of proper policies, environmental peculiarities, logistic and financial difficulties, are added to socio-cultural matters, migratory processes, and unorganized urbanization associated with environmental impacts. In order to improve the public health delivery under such circumstances, an interdisciplinary approach that will allow for water resources management, basic sanitation implementation, and the promotion of the inhabitants' support become necessary.Embora a Amazônia ostente grandioso patrimônio ambiental e abundância de recursos hídricos, é na região Norte do Brasil, contida neste notável bioma, que se verificam os piores índices de acesso a serviços de saneamento e respectivos indicadores de saúde pública. Por meio de estudo de caso efetuado na cidade de São Gabriel da Cachoeira, localizada à noroeste do Estado do Amazonas, com aproximadamente 18.000 habitantes e substancial parcela de população indígena, verificou-se a complexidade de fatores relacionados ao provimento de água e à melhoria da saúde pública para núcleos urbanos da Amazônia. A ausência de políticas concisas, as peculiaridades ambientais, as dificuldades logísticas e financeiras somam-se a questões socioculturais, a aspectos migratórios e a processo de urbanização desordenada, associada a impactos ambientais. Para melhoria da saúde pública nessas circunstâncias torna-se necessária uma abordagem interdisciplinar, que possibilite a gestão dos recursos hídricos, a implementação de saneamento básico e, não obstante, a promoção de adesão dos habitantes

TEATRO GERANDO REFLEXÃO E EFETIVAÇÃO DOS DIREITOS HUMANOS: MÉTODO AUTOBIOGRÁFICO E CONSTRUÇÃO DA SUBJETIVIDADE

This article recovers some points of two years of work with theater of oppressed ina city of Brasília. This work was done with women of this city, Paranoá, with the object of bringher impressions and situations of gender violence supported for them. For this, the human rightswere discussed and the theater stayed how a methodology of the construction of subjects of therights. Possibilities of empowerment, protagonist and subjectivities construction began to beseem and done for the theater. For this reason, thing that this women look at her selves of otherway will be possible after the autobiography method.Este artigo retoma alguns pontos de 2 anos de trabalho com oficinas de teatro dooprimido na cidade satélite do Paranoá, no Distrito Federal. Essas oficinas foram realizadas comas mulheres da cidade e com o objetivo de trazer a tona as impressões e situações de violênciadoméstica por elas suportadas ou sofridas. Por meio desse trabalho teatro fez-se possível adiscussão sobre direitos humanos por meio do teatro e, num momento seguinte, pensar ser omesmo uma ferramenta pedagógica bastante útil para a constituição de sujeitos de direitoenquanto tais. Possibilidades de ‘empoderamento’, protagonismo e construção da subjetividade ede sujeitos de direitos passaram a ser vislumbradas e geradas por meio do teatro. Por esse motivo,aventar que depois desse trabalho as mulheres nele envolvidas e por meio do método autobiográficoiniciaram o movimento de pensar sobre si mesmas de outra maneira restou cabível

Miradas múltiplas ao aborto legal no Uruguai contemporâneo

Este artigo se dispõe a refletir sobre o aborto legal no Uruguai, partindo de seu processo histórico e de sua prática contemporânea, recuperados e tecidos por múltiplos olhares. Olhares aqui a serem explorados e postos em relação, com o objetivo de se complexificar um fenômeno social para além das leis. Dessa maneira, o artigo contempla as perspectivas de feministas, divergentes entre si a depender da geração e foco de atenção, e de profissionais de saúde envolvidos com o reconhecimento do aborto legal no país. Por ser essa sua leitura, figura com uma importante leitura de umas das leis mais avançadas sobre aborto na América Latina, que acontece, entretanto, a partir de sua vida social e das bocas dos que acompanham esses processos em sua materialidade. Para tanto, recorre a pesquisa qualitativa de cunho etnográfico empreendida em Montevideo durante os meses de janeiro e fevereiro de 2019.