Sewerage as a protective factor for prevalence of hookworm infection in schoolchildren in Brazil: A multilevel ecological analysis of national prevalence surveys (1950-2018)

INTRODUCTION

The prevalence of hookworm infection in Brazil has decreased considerably in recent decades. However, there is no definitive consensus as to which changes have contributed to this reduction. A hypothesis is that improvements in environmental factors have contributed to lowering the parasite load and the level of host-parasite contact.

METHODS

This is an ecological study using unbalanced panel data from two Brazilian surveys (1947-1953 and 2010-2015), with municipalities as the analysis unit. The sample comprised 1428 municipalities, in which a total of 745,983 schoolchildren aged 7 to 14 were examined. Zero-inflated Poisson regression models, with fixed and random effects were estimated to evaluate the association of potential explanatory variables with the prevalence of hookworm infection at a significance level of 5 %.

RESULTS

We identified a significant decrease in the prevalence between the first and last analyzed periods (RR 0.096; CI 0.086-0.107); The following variables were found to have a protective effect: access to sanitary sewage systems (RR 0.984, CI 0.982-0.986), urbanization (RR 0.995, CI 0.993-0.997), and gross domestic product (RR 0.929, CI 0.912-0.945).

CONCLUSION

The findings of this study show a decrease in the prevalence of hookworm infections over six decades in schoolchildren in the Brazilian municipalities. Environmental, demographic, and economic factors were associated with this trend. A historical analysis indicates that interventions aimed at improving sanitation contributed to reducing the disease prevalence.

[Schistosomiasis, soil-transmitted helminthiases and sanitation in Latin America and the Caribbean: a systematic reviewRelación entre la prevalencia de esquistosomiasis y geohelmintiasis y las condiciones sanitarias en América Latina y el Caribe: una revisión sistemática]

Objective

To investigate the relationship between the prevalence of schistosomiasis and soil-transmitted helminthiasis with variables related to access to water, sanitation and solid waste in Latin American and Caribbean (LAC) countries.

Method

A systematic review was performed in the LILACS, PubMed, Web of Science, and SciELO databases. Studies published between 1950 and August 2021, with an ecological design and a focus on population groups (states, municipalities and/or districts), having the prevalence of infection by Schistosoma mansoni, Ancylostoma sp., Necator americanus, Ascaris lumbricoides or Trichuris trichiura as primary variable and access to water, sewage and/or solid waste as explanatory variables were included. Open access articles with full text available in English, Spanish, or Portuguese were considered. The risk of bias and the quality of the studies were assessed according to the Joanna Briggs Institute manual.

Results

Of 2 714 articles, nine were eligible, published between 1994 and 2021 and covering 22 LAC countries and 14 350 municipalities. All articles had moderate methodological quality. Environmental variables indicated an association between water supply and solid waste collection with schistosomiasis; water supply with ascariasis, trichuriasis and hookworm; and sewage with ascariasis and hookworm. Except for one article, which had regional coverage for LAC, all the others were developed in Brazil.

Conclusion

There is a clear need to expand research on the association between household and collective health conditions and parasitic diseases for all endemic countries in LAC to support environmental strategies to control these diseases.

Effect of environmental factors in reducing the prevalence of schistosomiasis in schoolchildren: An analysis of three extensive national prevalence surveys in Brazil (1950-2018)

BACKGROUND

Over seven decades, Brazil has made admirable progress in controlling schistosomiasis, and a frequent question about the explanation for this reduction refers to the effect of improving environmental factors in the country. This article seeks to identify factors related to the change in the epidemiological situation of schistosomiasis mansoni infection by analyzing three national prevalence surveys conducted since 1950.

METHODOLOGY/PRINCIPAL FINDINGS

This is an ecological study analyzing an unbalanced panel of data based on national surveys and considering the municipality as the unit of analysis. The sample consisted of 1,721 Brazilian municipalities, in which a total of 1,182,339 schoolchildren aged 7-14 were examined during the three periods corresponding to each survey (1947-1953, 1975-1979, and 2010-2015). The percentage of municipalities with zero cases of schistosomiasis was: 45.4%, 54.2% and 73.7%, respectively for those periods. A zero-inflated Poisson regression model, with fixed and random effects, was fitted to assess the association between candidate factors and disease prevalence using a significance level of 5%. There was a significant decrease in disease prevalence between the first and last periods analyzed (RR 0.214, CI 0.184-0.249), with a protective association with access to sanitation (RR 0.996, CI 0.994-0.998), urbanization (RR 0.991, CI 0.989-0.993), and living in own households (RR 0.986, CI 0.983-0.989); and an inverse association with piped water supply (RR 1.010, CI 1.008-1.011).

CONCLUSION

The findings of this study indicate a decrease in the prevalence of schistosomiasis over seven decades in schoolchildren from the analyzed Brazilian municipalities, associated with environmental factors and social conditions. The increased access to piped water in the municipalities apparently triggers other ways of contact with unsafe water bodies, generating new transmission routes and suggesting the need for a systemic approach concerning contact with water.

Responsiveness of water-sector regulation in Brazil to the Covid-19 pandemic: A view through the human rights lens

This paper provides an overview of the regulatory responses to Covid-19 from the regulatory authorities of Brazilian states. This paper aims to provide new insights into the operationalization of the human rights to water and sanitation in the Brazilian regulatory authorities' actions during a health emergency. We find that communities located in unserved areas were not mentioned in the regulatory responses, nor were people in vulnerable situations. Equity and non-discrimination principles were correlated more with economic measures. This study has also identified the absence of responses related to access to sanitation facilities, with normative contents related to the issue not appearing in the content analysis.

Water, sanitation and schistosomiasis mansoni: a study based on the Brazilian National Prevalence Survey (2011-2015)

This study aimed to explore the association between water, sanitation, and the prevalence of schistosomiasis mansoni in students aged 7 to 17 years from all 27 federative units in Brazil. It was a cross-sectional study conducted based on data on the prevalence of schistosomiasis mansoni referring to 197,567 students from 521 Brazilian municipalities, who participated in the National Survey on the Prevalence of Schistosomiasis Mansoni and Soil-transmitted Helminth Infections (2011-2015). Univariable and multivariable generalized linear models of the negative binomial type were adjusted using 25 and 5% significance levels, respectively, considering municipalities as the unit of analysis. While a protective association was found between access to filtered water in schools and schistosomiasis mansoni prevalence, sanitation in schools was indicated as a risk factor. The collection of wastewater through a network is not universal in Brazil, and even when present, it is not necessarily carried out by the treatment of collected effluents, thus often resulting in the direct discharge of raw sewage into water resources. Regarding septic tanks, only the presence of infrastructure alone does not guarantee its correct use by the population.

Worldwide Surveillance Actions and Initiatives of Drinking Water Quality: A Scoping Review

This study identified and mapped worldwide surveillance actions and initiatives of drinking water quality implemented by government agencies and public health services. The scoping review was conducted between July 2021 and August 2022 based on the Joanna Briggs Institute method. The search was performed in relevant databases and gray literature; 49 studies were retrieved. Quantitative variables were presented as absolute and relative frequencies, while qualitative variables were analyzed using the IRaMuTeQ software. The actions developed worldwide and their impacts and results generated four thematic classes: (1) assessment of coverage, accessibility, quantity, and drinking water quality in routine and emergency situations; (2) analysis of physical-chemical and microbiological parameters in public supply networks or alternative water supply solutions; (3) identification of household water contamination, communication, and education with the community; (4) and investigation of water-borne disease outbreaks. Preliminary results were shared with stakeholders to favor knowledge dissemination.

Poly(I:C) transfection induces a pro-inflammatory cascade in murine mammary carcinoma and fibrosarcoma cells

Germline-encoded pattern recognition receptors [PRRs] in mammalian cells function in the detection of molecular patterns associated with pathogen invasion or cellular damage. A PRR subset is activated by the atypical presence and location of double-stranded RNA [dsRNA] or its synthetic analogue polyinosinic-polycytidylic acid [poly(I:C)], triggering pro-inflammatory signalling and death in many cell types. Poly(I:C) has been tested as a sole or combination cancer therapy in preclinical studies and clinical trials. The purpose of this study was to evaluate the effects of poly(I:C) transfection via electroporation on cell lines from a cancer of epithelial origin, 4T1 mammary carcinoma, and a cancer of mesenchymal origin, WEHI 164 fibrosarcoma. The effects of the poly(I:C) delivery on cell metabolism implicate the induction of cell death. A pro-inflammatory response was demonstrated by mRNA upregulation and the secretion of Type I interferon and several cytokines and chemokines. The mRNAs of dsRNA sensor DExD/H-box helicase 58/retinoic acid-inducible gene I protein [Ddx58/RIG-I] and sensor/co-sensor DEAH-box helicase 9 [Dhx9] were not regulated, but the mRNAs of RNA sensors toll-like receptor 3 [TLR3], interferon-induced with helicase C domain 1/melanoma differentiation-associated protein 5 [Ifih1/MDA5] and Z-DNA binding protein 1 [Zbp1] and co-sensors DEAD (Asp-Glu-Ala-Asp) box polypeptide 60 [Ddx60] and interferon-inducible protein 204 [Ifi204] were upregulated in both cell lines. The mRNAs encoding signalling pathways components were present or upregulated in both cell types. These data demonstrate that RNA sensing effects can be amplified by electroporation delivery, potentially expanding the practicality of this immunotherapeutic approach.

Association between water and sanitation and soil-transmitted helminthiases: Analysis of the Brazilian National Survey of Prevalence (2011-2015)

Background

Most of the studies conducted in Brazil assessing the relationship between water, sanitation and hygiene (WASH) and Soil-transmitted helminth (STH) infections, have focused on cases, reflecting the reality of small areas and not of a countrywide situation. In order to fill this gap, the current paper presents an epidemiological study exploring the association between water and sanitation and STHs prevalence in students from 7 to 17 years old, in all 27 Brazilian Federation Units.

Methods

Three ecological studies were carried out considering the prevalence of ascariasis, trichuriasis, and hookworm as outcome variables. The sample consisted of 197,567 students aged 7–17 years old living in 521 Brazilian municipalities. Data were retrieved from the National Survey on the Prevalence of Schistosomiasis mansoni and Soil-transmitted helminth infections (2011–2015). The Generalized Linear Model with the negative binomial distribution was used to evaluate the statistical association between outcomes and explanatory variables. Univariate and Multivariate analyses were conducted with 25 and 5 % significance levels, respectively. Data were aggregated considering municipalities as the geographical unit for analysis.

Results

Protective association was found between access to filtered water and adequate sanitation in schools with ascariasis (RR 0.989, CI 95 % 0.983–0.996; RR 0.988, CI 95 % 0.977–0.998), access to filtered water in schools with trichuriasis (RR 0.986, CI 95 % 0.979–0.993) and adequate sanitation at home with hookworm ((RR 0.989, CI 95 % 0.982–0.996). The percentage of population served with Bolsa Família Program, used as a proxy for poverty, was the only significant variable common to all models.

Conclusions

Our findings support that WASH, both in schools and homes, are essential to schoolchildren health with regard to STHs. However, sanitary interventions will not be fully effective in preventing STH infections without promoting access to quality public services, particularly for people living in poverty, the most vulnerable group.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13690-021-00602-7.

Combined effects of conditional cash transfer program and environmental health interventions on diarrhea and malnutrition morbidity in children less than five years of age in Brazil, 2006-2016

INTRODUCTION

Governmental measures aiming at social protection, with components of disease control, have potential positive impacts in the nutritional and health outcomes of the beneficiaries. The concomitant presence of these measures with environmental sanitation interventions may increase their positive effect. The context of simultaneous improvement of social protection and environmental sanitation is found in Brazil since 2007 and an assessment of the combined effects of both programs has not been performed so far.

OBJECTIVE

To evaluate whether interaction effects between improvement of access to water, sanitation and solid waste collection with the Bolsa Família Program [PBF] were related to better responses in the reduction of morbidity due to diarrhea and malnutrition in children less than five years of age, acknowledging the positive results of these improved conditions and the PBF separately in coping with these diseases.

METHODS

Descriptive and inferential analyses were performed through Generalized Linear Models of the Negative Binomial type of fixed effects, with and without addition of zeros. Interaction models were inserted in order to evaluate the outcomes when the two public policies of interest in the current study were present simultaneously in the municipalities.

RESULTS

Interaction with negative effect when a concomitantly high municipal coverage of the Bolsa Família Program and adequate access to sanitation and solid waste collection were present. In contrast, regardless of municipal coverage by the PBF, the simultaneous presence of water and sanitation (0.028% / 0.019%); water and solid waste collection (0.033% / 0.014%); sanitation and solid waste collection (0.018% / 0.021%), all resulted in a positive effect, with a decrease in the average morbidity rates for both diseases.

CONCLUSION

Investments aimed at universalizing water, sanitation and solid waste collection services should be priorities, aiming at reducing the incidence of morbidity due to malnutrition and diarrhea and preventing deaths from these poverty-related diseases.

Explanatory Matrices on the Causes of a Tailing Dam Collapse in Brazil: The (Dis)Articulation of Epistemes

Mining tailing dam ruptures are increasingly common events in South America. Due to their high potential degree for avoidance, they are considered to be technological disasters and often have a considerable impact on local populations and communities, as well as affecting the ecosystem. The failure of the Fundão dam in 2015 in the Brazilian State of Minas Gerais (is) considered one of the largest socioenvironmental disasters in the country's history. Different explanations for the causes of the disaster were put forward by various social actors. This article critically analyzes these discourses through the theoretical-methodological reference of the social theory of discourse, with the aim of understanding the various discursive contexts of the causes of the breach of the dam. The analysis and understanding of these explanatory matrices suggested that different discourses present different epistemological approaches to the causes of the disaster, related to aspects such as sociohistorical, political, ideological, and asymmetric relations of power. The statements had different emphases, being associated with distinct epistemic positions that were often not in convergence.  Moreover, certain terms and approaches reinforce or minimize processes of vulnerability experienced by the affected populations. These discourses present consents, dissents, and contradictions and when systematically integrated can improve the planning of risk management and broaden the understanding related to technological disaster occurrence.

COVID-19 faecal-oral transmission: Are we asking the right questions?

Detection of the SARS-CoV-2 virus in stools and sewage has recently been reported, raising the hypothesis of faecal-oral transmission. If confirmed, this could have far-reaching consequences for public health and for pandemic control strategies. In this paper, we argue that a comprehensive and more nuanced analysis is required to test this hypothesis, taking into consideration both environmental dynamics and the persistence of viral infectivity. First, we examine the evidence regarding the presence of the virus in stools and sewage. Then we discuss the current framework of disease transmission through water and excreta and how the transmission of a respiratory disease fits into it. Against this background, we propose a framework to test the faecal-oral hypothesis, unpacking the different environmental routes from faeces to the mouth of a susceptible person. This framework should not be seen as a confirmation of the hypothesis but rather as an expanded view of its complexities, which could help shaping an agenda for research into a number of unanswered questions. Finally, the paper briefly discusses practical implications, based on current knowledge, for containment of the pandemic.

The right to water: Impact on the quality of life of rural workers in a settlement of the Landless Workers Movement, Brazil

Access to water for rural populations is vital not only for personal consumption and hygiene but also for food production, income generation and cultural practices. To deepening the understanding of this issue, this research addressed the access to water in a settlement of the Landless Workers Movement. The perspective of the Human Rights to Water and Sanitation was used as a theoretical framework, assessing how inadequate access to water impacts the quality of rural populations. A qualitative research was used, through participant observation and individual interviews with 12 rural workers, living at the Ulisses Oliveira settlement. The findings reflect that water is not sufficiently available to meet the community’s social, economic and cultural needs and that such conditions can lead to a loss of identity. Therefore, access to water must be understood in the light of its political, social and cultural dimensions and the Human Rights to Water and Sanitation can be used as an instrument to public policies.

Bolsa Família Program and environmental health: a systematic review of the effects on diarrhea and malnutrition

The Bolsa Família Programme and environmental health interventions are public policies that can have a combined positive effect on health inequities. The Bolsa Família Programme is designed to improve health conditions, reduce food insecurity and increase family incomes. Environmental health interventions aim to ensure public health and environmental protection. This study reviewed the literature for possible interactions between these two types of intervention that influence morbidity and mortality outcomes due to diarrhoea and malnutrition in the under-fives. A total of 1,658 articles were identified in the LILACS, SciELO and PubMed databases. The studies' methodologies were evaluated by scores on an adapted Downs & Black scale and four met all the study inclusion criteria. The findings showed evidence of the positive independent effects of the Bolsa Família Programme and of environmental health interventions in reducing illness and death from diarrhoea and malnutrition in the study age group. However, none of the articles offered results that might elucidate a joint effect of these public policies on an interaction model, revealing a gap in the literature on these diseases attributable particularly to poverty.

[Adequate solid waste management as a protection factor against dengue casesGestión adecuada de los residuos sólidos como factor de protección contra los casos de dengue]

Objetivo.

Verificar a existência de associação de indicadores de gestão de resíduos sólidos e socioeconômicos municipais com índices de incidência de dengue, Zika e Chikungunya nos municípios do estado brasileiro de Minas Gerais.

Métodos.

Este estudo de caráter exploratório, quantitativo e transversal abrangeu os 853 municípios do estado de Minas Gerais. Todos os dados utilizados foram secundários, coletados e agrupados por regionais de planejamento. Como variáveis independentes, foram consideradas a cobertura de coleta de resíduos sólidos urbanos, cobertura de coleta seletiva e massa de resíduos sólidos urbanos, além de um indicador da qualidade da destinação final de resídulos, índices de desenvolvimento humano municipal e de Gini, renda mensal per capita e porcentagem de vulneráveis à pobreza. Os fatores potencialmente associados aos desfechos – incidências municipais de dengue, Chikungunya e Zika – foram selecionados inicialmente através de análises univariadas. Posteriormente, os modelos de regressão linear para as incidências de dengue, Chikungunya ou Zika foram gerados considerando os preditores selecionados pela análise univariada.

Resultados.

Não foi observada associação entre gestão de resíduos sólidos e incidência de Chikungunya e Zika. Por sua vez, a incidência de dengue associou-se à gestão de resíduos sólidos e apresentou relação inversa significativa com o percentual de vulneráveis à pobreza. Houve também associação direta o índice de Gini, sugerindo que quanto maiores os registros de incidência de dengue de 2007 a 2016, maiores os valores de Gini dos municípios – ou seja, maior a desigualdade social. A cobertura da coleta seletiva apresentou relação inversa e significativa com os casos de dengue, sugerindo que quanto menor a cobertura da coleta de seletiva, maiores foram os casos registrados de dengue.

Conclusões.

A gestão de resíduos sólidos pode influenciar os casos de dengue e, por isso, deve ser considerada nas ações de saúde pública.

Deliberative effectiveness in municipal sanitation and health councils: a study in Belo Horizonte-MG and in Belém-PA

Deliberation in municipal councils of sanitation and health is the object of this study. Deliberation is understood as decision making and argumentative process, from the formulations of Rousseau, Habermas and Cohen. The proposed objective was to evaluate the effectiveness of the deliberative action of the councils of Belo Horizonte (MG) and Belém (PA). The evaluation included the study of variables defining the degree of institutionalization of the councils and revealing the dynamics of the deliberative process developed in them. The internal regulations of each council and the minutes and resolutions produced by them during the 2012-2014 triennium were consulted. The results showed that the four councils, in the period and according to the defined criteria of analysis, are far from the degree of deliberative effectiveness desired, considering the purposes of the social control in sanitation and in health, arranged by the specific legislation of each area. Even with broader experience, considering their years of participatory pedagogical exercise, health councils were no more effective than neophyte sanitation councils.

[Inequality and discrimination in access to water and sanitation in the Belo Horizonte Metropolitan Region, Minas Gerais State, Brazil]

Access to water and sanitation services by the population of the Belo Horizonte Metropolitan Region, Minas Gerais State, Brazil, has been marked by processes of socio-spatial segregation and social exclusion. Considering the recognition, in 2010, of the human rights to water and sanitation by the United Nations, we seek to assess the adequate access to these services in the Belo Horizonte Metropolitan Region through the principle of equality and non-discrimination. We used microdata from the demographic censuses, years 2000 and 2010, from the Brazilian Institute of Geography and Statistics. We analyzed these data through descriptive and comparative statistical analysis, spatial analysis and multivariate analysis, so as to: determine the extent of the universalization of the adequate access to those services; assess the spatial dependence between municipalities regarding this access; identify and characterize possible access discrimination, by specific population groups. Results show an increase in the proportion of households with adequate access to water and sanitation services in the intercensus period; near lack spatial association, showing inequalities among the 34 municipalities of the Belo Horizonte Metropolitan Region; access inequalities among different population groups - according to household situation, income, race or color, sex and educational level - in a possible non compliance with the principle of non-discrimination.

Human rights' interdependence and indivisibility: a glance over the human rights to water and sanitation

BACKGROUND

In 1948 the Universal Declaration of Human Rights was drawn up. The content of this document was further reflected two treaties, the Covenant on Civil and Political Rights, and the Covenant on Economic, Social and Cultural Rights. To try to maintain the interrelationship between the rights contained in each document, the idea that all rights are interdependent and indivisible was stressed. Based on this vision, this study aimed to explore the extent to which the violation of the human rights to water and sanitation interferes with the guarantee of other rights, addressing the principles of interdependence and indivisibility.

METHODS

For that, 24 homeless, in the city of Belo Horizonte, Brazil, were interviewed. Individual and group interviews were carried out in addition to participant observation. The content analysis was used in order to analyze the data collected.

RESULTS

The research found that violation of the rights to water and sanitation promotes violation of other rights, such as health and education rights, strengthening the view of rights' interdependence and indivisibility.

CONCLUSION

It is important to affirm that the protection of human rights must be consolidated at an operational and normative level, aligned to concepts of indivisibility and interdependence as it has been proposed for approximately seven decades.

Infrastructure is a necessary but insufficient condition to eliminate inequalities in access to water: Research of a rural community intervention in Northeast Brazil

Given the importance of reducing diverse forms of inequality in access to water, highlighted both in the framework of the Human Right to Water (HRW) and in the Sustainable Development Goals (SDG), this work assesses conditions of access to water and related inequalities before and after the construction of a Water Supply System (WSS) in a rural community of Brazil's semi-arid region. A quasi-experimental study was performed to assess the conditions of access to water for study and control groups (amounting to 380 households). The methodology encompassed two phases, one prior and another subsequent to the construction of a WSS in the study community. The analytical framework of the HRW was applied, specifically the normative content regarding quality, accessibility and availability. The case study's findings help to evidence the limitations and challenges of merely infrastructure-related measures to improve access to water. The construction of a new WSS in the studied community was an improvement as it provided water of good quality to the beneficiary households, which entailed a decreased or even a no-longer-existing need to collect water for children and adolescents. However, certain problems persisted, such as the continued practice of collecting water and the use, by certain families, of water that was fecally contaminated. In a different perspective, the WSS made it possible to increase the per capita volume of water consumed by families and to reduce inequalities associated with this aspect. Meanwhile, the research reveals the possible limits of the WSS in ensuring that higher volumes of water will be consumed per capita, especially among households without intra-household water distribution infrastructure.

Having a toilet is not enough: the limitations in fulfilling the human rights to water and sanitation in a municipal school in Bahia, Brazil

Background

This article addresses the enjoyment of the human rights to water and sanitation (HRTWS), in particular access to toilets, in a public school in Bahia, Brazil.

Methods

Participant observation of the school’s routine, focus groups with students in grades 8 and 9 of primary school (13 to 17 years old) and individual, semi-structured, interviews with members of school staff were applied, exploring access to water and sanitation by adolescent girls and boys.

Results

Students and school staff reported that the amount of toilets was insufficient and that their conditions were often inadequate because they were plugged or dirty. The impact on girls is greater as toilets do not offer a clean and healthy environment for menstrual hygiene management. Several elements of the normative content of the HRTWS, especially accessibility, acceptability, quality, safety and dignity, were largely not fulfilled. The study identified that, to comply with the HRTWS, it is necessary to go beyond infrastructure, as the lack of maintenance; cultural elements and student participation hinder the usage of sanitary facilities. Since schools can be privileged spaces to train critical and reflective citizens and to foster autonomy and emancipation, education oriented by human rights and citizenship is an opportunity for a more equitable society. By increasing access to social, economic and cultural rights in all phases and aspects of life, including when children and adolescents are in a school environment, people are able to enjoy better living conditions and a higher standard of health.

Conclusions

The study raised the importance of considering each community’s sociocultural aspects in analyzing access to sanitary facilities in schools, which are spaces where citizens’ rights should be exercised and fulfilled.

Electronic supplementary material

The online version of this article (10.1186/s12889-019-6469-y) contains supplementary material, which is available to authorized users.

O controle social em saneamento e em saúde: análise comparativa com base nos marcos legais federais brasileiros

Resumo A comparação entre os marcos legais federais brasileiros das áreas de saúde e de saneamento, sob a perspectiva do controle social, é o fio condutor deste trabalho, tendo em vista o pioneirismo da primeira e sua possível influência sobre a segunda. O esforço comparativo foi realizado a partir de seis critérios analíticos: mecanismos de controle social definidos; caráter conferido ao controle social; responsabilidade, recomendações e apoio para viabilizar o controle social; acesso à informação; controle sobre o uso dos recursos; controle da implementação das deliberações. Avaliaram-se possibilidades de o marco do saneamento se beneficiar das formulações no campo da saúde e lograr produzir práticas mais efetivas de controle social na condução dessa política pública. Os resultados revelam que, mesmo tendo recebido alguma influência da área de saúde, o marco do saneamento é mais restrito e tem menor potencialidade de produzir práticas mais efetivas, uma vez que apresenta: 1) mecanismos mais restritivos por não serem necessariamente deliberativos; 2) ausência de uma política de formação de conselheiros e de educação popular como incentivo e fortalecimento ao controle social; 3) ausência de mecanismos efetivos voltados para a fiscalização do uso dos recursos.

“A gente tem acesso de favores, né?”. A percepção de pessoas em situação de rua sobre os direitos humanos à água e ao esgotamento sanitário

Resumo: Os direitos humanos à água e ao esgotamento sanitário (DHAES) afirmam que todos os seres humanos têm direito ao acesso seguro à água e ao esgotamento sanitário de forma não discriminatória. No entanto, populações vulneráveis têm esses direitos frequentemente violados, repercutindo em sua saúde e qualidade de vida, e agravando a exclusão social, como é o caso das pessoas em situação de rua. Em Belo Horizonte, Minas Gerais, Brasil, existiam 1.827 pessoas nessa condição em 2013. Este artigo apresenta a avaliação das condições e da percepção dessa população sobre o acesso à água e ao esgotamento sanitário e seus direitos nessa área. Observou-se que o acesso, tanto à água quanto ao esgotamento sanitário, é precário e que os conteúdos normativos e os princípios dos direitos humanos são potencialmente violados. Como conclusão, observa-se que esse grupo sofre violações dos DHAES e que estas estão associadas com a violação de outros direitos, como o direito à cidade, à moradia e à saúde. Essas violações têm repercussões negativas na vida econômica e social desse grupo populacional, aumentando a discriminação e a exclusão. O estudo chama a atenção para a importância de estimular a participação social desse grupo nos processos de tomada de decisão sobre a gestão da água e do esgotamento sanitário, no marco dos DHAES, em sua capacidade de ser instrumento de transformação social, gerando empoderamento, promovendo saúde, dignidade e cidadania.

X-ray investigation of hillebrandite

Hillebrandite was first characterized by Wright as a white, fibrous mineral with the composition 2CaO.SiO2.H2O, optical properties αNa 1·605±0.005, γNa 1·612±0.003, moderately weak birefringence, parallel extinction, optic axial angle 2E between 60 and 80° and density 2.692. X-ray powder data were first published by Vigfusson, but these have not been substantiated by later investigators (Clark and Bunn, McMurdie and Flint, and Heller and Taylor). Synthetic dicalcium silicate β-hydrate has been found to resemble hillebrandite closely.

The human right to water and sanitation: a new perspective for public policies

The recognition of the human right to water and sanitation (HRtWS) by the United Nations General Assembly and Human Rights Council in 2010 constituted a significant political measure whose direct consequences are still being assessed. Previous to this date, the HRtWS and its link to a healthy life and adequate standard of living had been recognised in diverse legal and judicial spheres worldwide, in some cases under the pressure of the initiatives of strong social movements. However, while the HRtWS is recognised by the UN State Members, it constitutes a concept in construction that has not been approached and interpreted in consensual ways by all concerned stakeholders. The present article presents a formal definition of this right with a base in human rights regulation. It attempts to dialogue with the different existing perspectives regarding the impact of its international recognition as a human right. It then elucidates the progressive development of the HRtWS in law and jurisprudence. Finally, it considers the urgency and challenge of monitoring the HRtWS and discusses important implications for public policies.

Development cooperation in water and sanitation: is it based on the human rights framework?

The water and sanitation sector is verifiably receiving increased attention and funding through international development cooperation. Not least because of the way that it affects incentives and institutions in partner countries, development cooperation can have either positive or negative effects on human rights though. The consolidated frameworks for the human rights to water and sanitation is becoming linked to the international community's coordinated development efforts, as evidenced notably in the 2030 Agenda for Sustainable Development. However, a review of major funders' official policies for development cooperation in the sector suggests that many only partially endorse the frameworks for the human rights to water and sanitation. An observation of development cooperation flows to the sector allows the hypothesis to be advanced that worldwide inequalities in access to these services may be reduced through a full and clear application of the human rights framework in development cooperation activities. The article presents findings of this research and explores key stakes for development cooperation in the water and sanitation sector that are relevant for their ability to either negatively or positively contribute to the realization of human rights.

[The Aranãs in mid-Jequitinhonha: socioeconomic, demographic and sanitary aspects of a landless indigenous population]

The lack of epidemiological and environmental data on Brazilian indigenous populations is a challenge for the elaboration of public policy. This lack of data is more acute for "landless" indigenous groups. From this perspective, it was considered relevant to describe the Aranã, a landless indigenous group living in Minas Gerais, focusing on the demographic, socioeconomic and sanitary dimensions. A household survey was conducted. The data collected were analyzed and compared with those from other national ethnic groups. The results revealed similarities between these findings and those from the 2010 Census related to the native indigenous population, especially those not living on indigenous lands or reservations. Asymmetric results were identified within the households, mainly sanitary disparities, which suggested a relation with the location. This result indicates the need for priority intervention for the Aranã living in rural areas, bringing to light the age-old discussion about rural and urban disparities. In addition, we suggest that the Brazilian Institute of Geography and Statistics (IBGE), responsible for the 2010 census, should refine its assessment methods concerning landless indigenous groups.

DESCENTRALIZAÇÃO INSTITUCIONAL E GESTÃO DE RECURSOS HÍDRICOS SOB O ENFOQUE LEGAL: O CASO DO COMITÊ DA BACIA HIDROGRÁFICA DO RIO DAS VELHAS, MG, BRASIL

A pesquisa tem como foco o estudo da gestão institucional de recursos hídricos sob a perspectiva do enfoque legal, uma vez que o modelo de gestão pública participativa, descentralizada e integrada proposto juridicamente no país apresenta problemas e demanda constante avaliação analítica. Para tanto o objeto de estudo é o do Comitê da Bacia hidrográfica do Rio das Velhas, localizado em Minas Gerais, Brasil, sendo um dos mais antigos do Estado, pioneiro também ao utilizar diversos mecanismos burocráticos e legais de gestão hídrica. O objetivo é identificar as principais restrições e potencialidades para que um comitê de bacia hidrográfica possa atuar atualmente dentro da estrutura institucional e jurídica brasileira existente. Isso é realizado pela utilização da metodologia de triangulação de métodos de pesquisa de base qualitativa (estudo documental, observação participante e de análise de conteúdo de entrevistas com lideranças do segmento hídrico). Os resultados alcançados indicam que há um distanciamento entre o discurso e prática da gestão pública dos recursos hídricos, com a manutenção de diversas assimetrias e poderes e de capacidade de decisão. É concluído assim que as interações institucionais e sociais são fundamentais para que a dimensão legal seja melhor empregada no sistema de gestão de recursos hídricos.

Grain-resolved analysis of localized deformation in nickel-titanium wire under tensile load

The stress-induced martensitic transformation in tensioned nickel-titanium shape-memory alloys proceeds by propagation of macroscopic fronts of localized deformation. We used three-dimensional synchrotron x-ray diffraction to image at micrometer-scale resolution the grain-resolved elastic strains and stresses in austenite around one such front in a prestrained nickel-titanium wire. We found that the local stresses in austenite grains are modified ahead of the nose cone-shaped buried interface where the martensitic transformation begins. Elevated shear stresses at the cone interface explain why the martensitic transformation proceeds in a localized manner. We established the crossover from stresses in individual grains to a continuum macroscopic internal stress field in the wire and rationalized the experimentally observed internal stress field and the topology of the macroscopic front by means of finite element simulations of the localized deformation.

O direito humano à água e ao esgotamento sanitário como instrumento para promoção da saúde de populações vulneráveis

Resumo O conceito de promoção da saúde, baseado nos determinantes sociais, alinha-se com princípios dos direitos humanos como: participação social, responsabilidade, transparência e não discriminação. O Direito humano à água e ao esgotamento sanitário (DHAES) foi aprovado em 2010 pela Assembleia Geral das Nações Unidas e Conselho de Direitos Humanos, e visa garantir acesso à água e ao esgotamento sanitário sem discriminação para toda a população. Dito isso, o presente artigo tem como objetivo analisar de que forma o referencial dos direitos humanos, em especial do DHAES, pode ser mobilizado para fortalecer a promoção da saúde de populações vulneráveis. Para isso, inicia apresentando a relação entre saúde e direitos humanos, em seguida demonstra como o conceito de vulnerabilidade social se baseia nestes, e finaliza mostrando a relação entre o DHAES e a promoção da saúde de grupos vulneráveis.

Determinants in implementing a public policy for an essential volume of free water in Bogotá and Medellín, Colombia

Within the framework for the realization of the human right to water and sanitation, States have the obligation to implement programs and public policies that satisfy the basic needs of their population, especially its most vulnerable demographics. In Colombia, this challenge has been addressed through policies that provide a determined essential amount of free water to people whose access to water and sanitation services are limited due to low income. Through a review of legal and technical documents as well as relevant literature, this article presents an analysis of the particular determinants involved in implementing this program in Bogotá and Medellín, as well as some related concerns. Among such factors, we discuss the evolution and changes of the tariff model used in service provision, estimates of basic consumption, the role of social movements and collective action, and user disconnection due to non-payment. The main particularities and differences of each case highlighted the inconveniences related to the method of identifying eligible users and applying assistance to beneficiary user groups, and the need for national guidelines in implementing this policy.

Integrating surveillance data on water-related diseases and drinking-water quality; action-research in a Brazilian municipality

The Brazilian Ministry of Health proposed a research study involving municipal professional staff conducting both epidemiological and water quality surveillance to facilitate the integration of the data which they collected. It aimed to improve the intersectoral collaboration and health promotion activities in the municipalities, especially regarding drinking-water quality. We then conducted a study using the action-research approach. At its evaluation phase, a technique which we called 'the tree analogy' was applied in order to identify both possibilities and challenges related to the proposed interlinkage. Results showed that integrating the two data collection systems cannot be attained without prior institutional adjustments. It suggests therefore the necessity to unravel issues that go beyond the selection and the interrelation of indicators and compatibility of software, to include political, administrative and personal matters. The evaluation process led those involved to re-think their practice by sharing experiences encountered in everyday practice, and formulating constructive criticisms. All this inevitably unleashes a process of empowerment. From this perspective, we have certainly gathered some fruit from the Tree, but not necessarily the most visible.

An original architectured NiTi silicone rubber structure for biomedical applications

This paper deals with composite structures for biomedical applications. For this purpose, an architectured tubular structure composed of Nickel Titanium (NiTi) Shape Memory Alloy (SMA) and silicone rubber was fabricated. One of the main interests of such structures is to ensure a good adhesion between its two constitutive materials. A previous study of the authors (Rey et al., 2014) has shown that the adhesion between NiTi and silicone rubber can be improved by an adhesion promoter or plasma treatment. However, adhesion promoters are often not biocompatible. Hence, plasma treatment is favored to be used in the present study. Three different gases were tested; air, argon and oxygen. The effects of these treatments on the maximum force required to pull-out a NiTi wire from the silicone rubber matrix were investigated by means of pull-out tests carried out with a self-developed device. Among the three gases, a higher maximum force was obtained for argon gas in the plasma treatment. A tube shaped architectured NiTi/silicone rubber structure was then produced using this treatment. The composite was tested by means of a bulge test. Results open a new way of investigations for architectured NiTi-silicone structures for biomechanical applications.

[Health and environment in the rubber-tree plantations in the Bolivian Acre (1870-1903): the role of exogenous factors and processes]

A peculiar situation marks the conditions of human and environmental health in the first major cycle of rubber production in the Acre region of the Western Amazon, whereby the bulk of the boom (1870-1903) occurred in the territory that at that time still belonged to Bolivia. Based on this historical background, this work seeks to describe and comprehend how these factors and processes, which are exogenous to these two fields of analysis mediated the risks that originated in the environment, gave rise to sickness and death in the population of the "Brazilian" rubber-tree plantations established in Bolivian territory. In this manner, the inter-relations between health and environment linked to historically specific configurations of the physical-natural, socioeconomic, political, and cultural conditions, are examined. The work shows that these extrinsic factors and processes to the productive activities exerted an influence not only on its organizational but also functional aspects, while also resulting in the unhealthy conditions observed in the productive regions. It further highlights the fact that the extant infrastructure of the time was sufficient for extractive production and reproduction.

Reducing occurrence of Giardia duodenalis in children living in semiarid regions: impact of a large scale rainwater harvesting initiative

Background

In Brazil, about two million people living in rural semiarid regions were benefited with the construction of rainwater cement cisterns, as an initiative from the program “One Million Cisterns” (P1MC). Nevertheless, few epidemiological studies have been conducted to assess health risks or protection effects associated with consumption of this water source. The aim of this study was to evaluate whether access to rainwater harvesting cisterns is associated with the decrease in the occurrence of Giardia duodenalis infections in children, compared to other children living in households supplied by other water sources.

Methodology/Principal Findings

A quasi-experimental study with two concurrent cohorts was developed in two rural municipalities of the semiarid region of Brazil. A sample of 664 children, aged between 4 months and 5 years old, was followed up, of which 332 had access to rainwater cisterns (cistern group) and 332 did not, having water supplied from alternative sources (comparison group). In a period of approximately one year (2010) intestinal parasites were investigated in feces three times. The prevalence of G. duodenalis in children from the cistern group ranged from 4.8 to 10.5%, while the prevalence in the comparison group ranged from 7.6 to 16.7%. Multivariate analysis (GEE) showed a higher risk of G. duodenalis infection in children who did not have access to rainwater cisterns, when compared to children who did (OR 1.72; 95% CI 1.14–2.59). The other variables associated with G. duodenalis infection were: number of rooms per house (OR 0.89; 95% CI 0.80–0.99); family income (OR0.48; 95% CI 0.26–0.88); birth order (OR 1.72; 95% CI 1.17–2.51); preterm children (OR 1.70; 95% CI 1.19–2.43); and improper hand hygiene prior to food preparation (OR 4.78; 95% CI 1.95–11.76).

Conclusions/Significance

Ownership of a rainwater cistern is associated with a lower prevalence of G. duodenalis infection in children after adjustment for environmental and family-related factors. Nevertheless, the study suggests the necessity to complement physical interventions with actions related to personal and domestic hygiene to enable further reductions in parasite infections affecting mainly the underprivileged populations.

Currently, rainwater harvesting cisterns built up through the “One Million Cisterns” Program, coordinated by the Brazilian Government, represents the most important public policy for water supply in the rural semiarid region of Brazil. Despite the extensive use of this water provision, few studies have been performed to assess the associated health impact. To assess such impact, this study investigated factors associated with the occurrence of Giardia duodenalis (protozoan closely related to the ingestion of contaminated water) in children aged between 4 months and five years old. Two distinct groups of children, one with access to rainwater cisterns (cistern group) and the other without cisterns, with water supplied from alternative sources, including rivers, springs or dams (comparison group) were followed up for approximately one year. It was observed that the risk occurrence of G. duodenalis prevalence was greater in children from the comparison group, when compared with those from the cistern group, indicating that the odds of infection by this parasite were 1.72 times greater for comparison group children. In conclusion, the study showed health benefits related to rainwater cisterns, but also identified that other complementary sanitation interventions are needed to minimize the risk of disease in populations with limited access to drinking water.

(A falta de) Controle social das políticas municipais de saneamento: um estudo em quatro municípios de Minas Gerais

Tem sido crescentemente acentuada a ênfase normativa para a participação social e o controle das políticas públicas de saneamento no Brasil, o que recebeu reforço com o marco legal para o setor, que destaca a importância da intersetorialidade, do planejamento e do fortalecimento do controle social. Diante desse quadro, como estariam os poderes locais, titulares dos serviços, se organizando para planejar as suas políticas de saneamento? As questões de saneamento estão presentes nas discussões no âmbito de instâncias municipais destinadas ao controle social, incluindo conselhos de políticas urbanas, da saúde, das cidades, da habitação e do meio ambiente? Para essas questões, buscaram-se respostas em conselhos urbanos situados em quatro municípios de portes populacionais distintos, pertencentes à Bacia do Rio das Velhas, em Minas Gerais: Contagem, Nova Lima, Sete Lagoas e Vespasiano. O estudo é delineado pela visão da atuação dos conselheiros e sua percepção quanto à inclusão da temática do saneamento na agenda dos conselhos, bem como à importância conferida ao tema. As análises de documentos oficiais dos conselhos e de entrevistas realizadas com conselheiros mostraram que, na ausência de instâncias formais de controle social, específicas para a área, são as instâncias de participação constituídas para outras políticas públicas que recebem os temas do setor de saneamento; contudo, eles encontram-se à margem do processo de implementação das políticas. Observam-se, assim, insuficiências e precariedades no processo de participação desenvolvido, resultando em sua incapacidade de exercer controle sobre a política pública de saneamento local.

Electrotransfer of single-stranded or double-stranded DNA induces complete regression of palpable B16.F10 mouse melanomas

Enhanced tumor delivery of plasmid DNA with electric pulses in vivo has been confirmed in many preclinical models. Intratumor electrotransfer of plasmids encoding therapeutic molecules has reached Phase II clinical trials. In multiple preclinical studies, a reduction in tumor growth, increased survival or complete tumor regression have been observed in control groups in which vector or backbone plasmid DNA electrotransfer was performed. This study explores factors that could produce this antitumor effect. The specific electrotransfer pulse protocol employed significantly potentiated the regression. Tumor regression was observed after delivery of single-stranded or double-stranded DNA with or without CpG motifs in both immunocompetent and immunodeficient mice, indicating the involvement of the innate immune system in response to DNA. In conclusion, this study demonstrated that the observed antitumor effects are not due to a single factor, but to a combination of factors.