The historicity of the interpretative theories about health and disease

The interpretative theories of the health-illness process that can be identified through History have as consequence intervention projects upon the reality, in response to social needs. Until the 19 century, they could be synthesized in two main streams: ontologic and dynamic. In the ontologic conception, illness assumes the character of a natural or supernatural entity, external to the human body, that shows itself when invading it. The dynamic conception sees illness as a product of the disharmony among vital forces, and the re-establishment of the health comes of the restoration of this balance. At the end of the 18 century, the social-environmental paradigms prevailed in Europe as forms of explanation for human illness, linked to the dynamic conception, and the first evidences of the social determination of the health-illness process were formulated. The onset of the Bacteriologic Era made the ontologic conception victorious and its conquests led to the abandon of the social approaches to face the populations health problems. At the present time, one can identify the prevalence of the multicausal theory, with emphasis in the individual conditionings. This paper proposes the articulation of the individual and collective dimensions of the health-illness process, in consonance with the Theory of Nursing Praxical Intervention in Collective Health.     

Nursing in transmissible diseases: how to approach this topic in nursing graduation?

This study relates the attempts of the discipline Collective Health Nursing with focus in transmissible diseases to reorganize its teaching object, its theoretical and practical content, and its pedagogical atrategics, as a contribution to the formation of a nursing professional compromised with Collective Health. It describes the context of Collective Health in Brazil and the characteristics needed to improve the implementation of the Unified Health Care System in the Country. It also reports the content and the padagogical strategics used in the discipline and makes a critical analysis of its potentialities and limitations to the proposed goal.     

Experience and results with a lactate dehydrogenase marker in vaginal secretions of women at high risk for endometrial cancer

The authors present and discuss the results obtained with 202 Gynaegnost experiments in 161 women, between 45 and 65 years, nulliparous, or having experienced a late pregnancy, with menopause occurring after the age of 52 and undergoing or not estrogen-therapy after menopause, and presenting high blood pressure, obesity or diabetes. The purpose of this multicenter study, to be continued, was to demonstrate the efficacy of this tumor marker, in the early diagnosis of endometrial carcinoma, in high-risk women.     

Vaccine-associated paralytic poliomyelitis: a retrospective cohort study of acute flaccid paralyses in Brazil

BACKGROUND: At the present time, in Brazil and other countries in the Americas, the only cases of paralytic poliomyelitis due to poliovirus are caused by vaccine strains. The recognition of possible determinants of vaccine-associated paralytic poliomyelitis (VAPP) by public health surveillance and immunization programmes is relevant to inform the debate on criteria for case definition and vaccination strategies. METHODS: A retrospective cohort study based on the cases of acute flaccid paralysis (AFP) reported to the Ministry of Health (MoH) was designed, with the objective of studying cases of VAPP in Brazil between 1989 and 1995. Clinical, laboratory and epidemiological data from 3656 acute flaccid paralysis (AFP) cases, 30 of them diagnosed as VAPP, were analysed. RESULTS: An 8.88 risk ratio of VAPP (95% CI : 4.37-18.03) was found when comparing individuals who received oral poliovirus vaccine (OPV) between 4 and 40 days before the onset of paralysis and individuals who did not receive the vaccine within this period. A risk of 1 case/2.39 million first doses and 1 case/13.03 million OPV doses administered was estimated for the general population. CONCLUSIONS: Cases of AFP who received OPV between 4 and 40 days before the onset of paralysis and had fever, a prodrome of gastrointestinal symptoms, history of first dose of OPV, isolation of vaccine poliovirus type 2, and young age deserve careful investigation, since they are at increased risk for the condition studied.     

Paracoccidioides brasiliensis protoplast production by enzymatic treatment

The action of the enzymes novozym 234, chitinase and zymolyase 20T on the yeast-like cells of Paracoccidioides brasiliensis was studied in an attempt to obtain protoplast release. Three enzyme systems were used: the first consisted of novozym 234 and chitinase plus 0.2 m phosphate buffer, 0.9 m sorbitol and 0.5 m sodium thioglycolate; the second consisted of novozym 234, chitinase, zymolyase 20T, buffer and osmotic stabilizer, with no sodium thioglycolate; the third consisted of the same enzymes as used in the second system but at twice the concentration, plus buffer and osmotic stabilizer. Protoplasts were only released from 72-hold cells cultured on solid peptone-yeast extract-glucose medium (PYG) treated with the third enzyme system. Sodium thioglycolate used as pretreatment favoured protoplast release but had no such action when added to the enzyme solution, possibly by altering the activity of the enzymes, novozym 234 in particular. The osmotic stabilizer used, 0.9 m sorbitol, was probably one of the factors, in addition to the enzymes, responsible for the cytoplasmic changes observed by transmission electron microscopy in yeast phase cells and in their protoplasts.     

Urinary nickel as bioindicator of workers' Ni exposure in a galvanizing plant in Brazil

Objectives: We measured urinary nickel (U-Ni) in ten workers (97 samples) from a galvanizing plant that uses nickel sulfate, and in ten control subjects (55 samples) to examine the association between occupational exposure to airborne Ni and Ni absorption. Methods: Samples from the exposed group were taken before and after the work shift on 5 successive workdays. At the same time airborne Ni (A-Ni) was measured using personal samplers. Ni levels in biological material and in the airborne were determined by a graphite furnace atomic absorption spectrometry validated method. In the control group the urine samples were collected twice a day, in the before and after the work shift, on 3 successive days. Results: Ni exposure low to moderate was detected in all the examined places in the plant, the airborne levels varying between 2.8 and 116.7 μg/m³ and the urine levels, from samples taken postshift, between 4.5 and 43.2 μg/g creatinine (mean 14.7 μg/g creatinine). Significant differences in U-Ni creatinine were seen between the exposed and control groups (Student's t test, P ≤ 0.01). A significant correlation between U-Ni and A-Ni (r = 0.96; P ≤ 0.001) was detected. No statistical difference was observed in U-Ni collected from exposed workers in the 5 successive days, but significant difference was observed between pre- and postshift samples. Conclusions: Urinary nickel may be used as a reliable internal dose bioindicator in biological monitoring of workers exposed to Ni sulfate in galvanizing plants regardless of the day of the workweek on which the samples are collected. Received: 28 January 1999 / Accepted: 10 July 1999     

In search of cochlear morphologic correlates for tinnitus

A correlative study was made of the cochlear pathologic features existing in the temporal bones of 83 subjects with a clinical history of tinnitus and 33 without tinnitus. None of 24 types of pathologic change assessed by light microscope occurred in more than 40% of tinnitus cases; nor was the prevalence of any of these pathologic changes significantly greater in subjects with tinnitus compared with control subjects. For five types of morphologic alteration the prevalence was significantly greater among control subjects compared with tinnitus cases, but this is interpreted cautiously because of the challenge in retrospectively selecting an appropriate control group. Under the conditions of the study, that is, using light-microscopic techniques on tissues obtained post mortem, we could not identify a pathologic correlate for tinnitus.     

Endocervical sampling by kevorkian curette or pipelle aspiration device: A randomized comparison

Objective: Our purpose was to compare two means of endocervical sampling—the Kevorkian curette and the Pipeline aspiration device (Unimar Co., Wilton, Conn.)—with respect to patient discomfort, tissue volume, and specimen adequacy for diagnosis.Study design: Fifty-two women undergoing investigation of abnormal cervical cytologic results were assigned randomly to endocervical sampling by Kevorkian or Pipeline instruments. Pain associated with the procedure was assessed by having east subject indicate her pain level on a visual analog scale. Tissue volume was graded by examination of the microscopic slides by two investigators blinded to assignment. Adequacy for diagnosis was evaluated by reviewing pathology reports.Results: Subjects having Pipeline endocervical aspiration (n = 24) had significantly lower mean (±SEM) pain scores (27 ± 5 vs 48.5 ± 7, p = 0.02) than those in whom the Kevorkian instrument was used (n = 28). However, there were no significant differences in tissue volume obtained or in proportions considered adequate for diagnosis.Conclusions: Use of the Pipelle instrument was associated with less patient discomfort that Kevorkian curettage for endocervical sampling while providing similar tissue volume and adequacy for diagnosis.     

Involvement of Escherichia coli exonuclease III and endonuclease IV in the repair of singlet oxygen-induced DNA damage

Singlet molecular oxygen (¹O₂ has been implicated in severalbiological processes that may lead to genetic damage. The relevanceof various repair pathways in plasmid inactivation mediatedby ¹O₂ was investigated. Plasmid treated with ¹O₂, chemicallygenerated, was transfected into Escherichia coli strains deficientin genes implicated in the DNA repair of oxidative damage. Theability to transform bacteria is significantly reduced in thedouble mutant xth,nfo, deficient in both exonuclease HI andendo-nuclease IV, although it was similar to wild-type cellsin single mutants. The products of these two genes are ableto cleave DNA damaged by ¹O₂ and to remove DNA polymerizationblocks from 3'-termini enerated either directly by ¹O₂ treatmentor after the action of the formami-dopyrimidine-DNA-N-glycosylase(Fpg protein). The results indicate that the exonuclease IIIand endonuclease IV participate in the excision of lethal lesionsinduced in DNA by ¹O₂     

Pharmaceutical care in primary health care: the experience of 3 Brazilian States

In the context of recent changes in the Brazilian drug supply system at the national level, mainly the deactivation of CEME (a government agency under the Ministry of Health that dealt with drug supply policy) and the increasing decentralization of activities under the Unified National Health System (SUS), three Brazilian States - Paraná, S?o Paulo, and Minas Gerais - have established programs for the distribution of essential drugs for primary health care. A nationwide program for the procurement and supply of 32 drugs for primary health care (the so-called "Basic Pharmacy Program") is currently being implemented by the Ministry of Health, to be decentralized subsequently. This article discusses the establishment of State-level drug policies for primary health care through the analysis of the three pioneering programs encompassing drug selection, procurement, storage, distribution, and use.