Baixada Santista Research Articles

Seawater Monitoring under the Influence of SABESP Sea Outfalls in Baixada Santista (South Coast) and North Coast - São Paulo State - Brazil

Seawater Monitoring under the Influence of SABESP Sea Outfalls in Baixada Santista (South Coast) and North Coast - São Paulo State - Brazil

Monitoria acadêmica na formação em/para a saúde: desafios e possibilidades no âmbito de um currículo interprofissional em saúde

Introdução: Este artigo teve origem na pesquisa “Monitoria na universidade: um estudo no âmbito de um currículo interprofissional em saúde — experiências de estudantes do campus Baixada Santista”. O referencial teórico foi constituído pelo diálogo com a literatura sobre a monitoria na universidade, bem como com o eixo conceitual de habitus de Pierre Bourdieu. Objetivo: Discutir a monitoria desenvolvida na Universidade Federal de São Paulo (UNIFESP), Campus Baixada Santista, como potencial espaço de formação em/para a saúde a partir das percepções dos discentes sobre a experiência de ser monitor dentro da proposta de um currículo interdisciplinar e interprofissional. Métodos: Os dados foram produzidos a partir da aplicação de questionário a 41 monitores e submetidos à análise de conteúdo do tipo temática. Resultados: A monitoria contribui para o desenvolvimento pessoal do monitor, superando atitudes e posturas frente ao cotidiano acadêmico e ampliando as possibilidades de inserção nas experiências profissionais. Conclusão: O estudante que se predispõe a desempenhar a função de monitor dentro da proposta curricular do Campus Baixada Santista se depara com situações que o preparam para a prática em saúde na perspectiva da interprofissionalidade, da diversidade, do trabalho em equipe e da troca de saberes.

Peer mentoring program in an interprofessional and interdisciplinary curriculum in Brazil.

The Federal University of São Paulo, Baixada Santista Campus was founded in 2006 with five degree-granting programs in physical education, physiotherapy, nutrition, psychology, and occupational therapy. The guiding principle behind the programs' educational mission was centered on the development of health care professionals capable of working in interdisciplinary teams with an emphasis on holistic patient care. This pedagogical structure required peer-mentoring programs in order to integrate different areas of knowledge and to improve learning strategies among new generations of students. The authors' objective in the present report is to discuss the strategies and activities of the peer-mentoring program in histophysiology and gross anatomy in an interdisciplinary and interprofessional curriculum. Evaluations by students, mentors and professors are presented, along with a statistical analysis of variance comparing student performance in the module assessments according to their participation in the peer-mentoring activities. The results demonstrated that students who participated in peer-mentoring activities enjoyed a higher rate of academic success than those who did not participate. In addition, student and mentor evaluations of the peer mentoring program were highly positive. The program enabled mentors to gain a deeper knowledge of the subjects addressed in the learning modules, as well as to develop intrinsic teaching skills during their time as mentors. In short, the authors believe that the peer-mentoring program has been validated for its effectiveness in raising student academic performance.

Percepción y preocupación ambiental en distintas regiones metropolitanas del Brasil: eslabones perdidos y evidencia adicional

This article reviews patterns of perception and environmental concern in different metropolitan areas of Brazil and how these are influenced by socioeconomic level and objective environmental conditions. Building on previous findings by Nawrotzki, Guedes and Carmoy (2014), we asked whether the relationship between socioeconomic status, objective environmental conditions and degree of concern involved differences in perception regarding environmental issues and stakeholders. We think that concern might be too abstract a concept to be freely used as a synonym for environmental attitude. Moreover, factors that precede a decision (such as environmental awareness and perception) and are key components of environmental concern were not taken into consideration by Nawrotzki, Guedes and Carmoy in their analysis. This time, we use a new data set gathered in 2007 from a representative sample of inhabitants of the metropolitan regions of Campinas and Baixada Santista in the São Paulo extended metropolitan region. These are the same data used in Nawrotzki, Guedes and Carmoy (2014). Expanding the idea of evaluating the environmental profile by adding environmental awareness and perception of environmental issues, along with environmental concern, we used latent class models including a random effect, assuming that these three environmental dimensions are related and should be modelled together as a dependent latent structure. The findings from our models indicate that objective environmental problems exacerbate the perception of environmental problems, although concern for the environment clearly depends on wealth. Some groups living in poverty thus face limitations when translating their perception of pressing environmental issues into a pro-environmental attitude.

A integralidade como eixo da formação em proposta interdisciplinar: estágios de Nutrição e Psicologia no campo da Saúde Coletiva

Trata-se de relato de experiência de estágio interdisciplinar em Nutrição Social e em Psicologia da Universidade Federal de São Paulo campusBaixada Santista, com foco na integralidade da atenção. O trabalho ocorreu entre 2010 e 2012, na Atenção Básica de Saúde do Sistema Único de Saúde no território Centro/Morro do município de Santos, São Paulo. Utilizaram-se registros de campo contendo memórias de supervisões e de reuniões entre professores e equipe de saúde. Construíram-se narrativas e projetos terapêuticos singulares. Em supervisão conjunta de professores de Nutrição e Psicologia, debateram-se situações destacadas pelos estudantes e planos de trabalho construídos para cada ciclo de formação. Isto fundamentou práticas interdisciplinares, reflexões e ações consoantes ao Sistema Único de Saúde, realizadas pelos estagiários. Os resultados corroboram a importância do trabalho interdisciplinar para a promoção da integralidade, constituindo formas de escuta e atenção diferenciadas aos usuários, em estreita relação com os serviços.

Narrativas na formação comum de profissionais de saúde

Este texto relata a experiência de formação comum que ocorre desde 2007 no campus Baixada Santista da Universidade Federal de São Paulo, no terceiro semestre de graduação, do eixo curricular trabalho em saúde. A experiência articula estudantes e docentes de diferentes áreas profissionais: educação física, fisioterapia, nutrição, psicologia e terapia ocupacional. São apresentadas as diretrizes e estratégias de organização do módulo 'Prática clínica integrada: análise de demandas e necessidades de saúde', que adota a produção de narrativas de histórias de vida e de questões de saúde de pessoas selecionadas por docentes em conjunto com as equipes da rede de serviços do município de Santos, São Paulo. As narrativas foram produzidas em encontros quinzenais dos estudantes com as pessoas acompanhadas em suas residências e de supervisões com os docentes. Realizouse análise de conteúdo de 120 relatórios de conclusão do módulo elaborados pelos estudantes nos anos de 2007 e 2008 visando identificar efeitos dessa proposta de formação. A elaboração de narrativas favoreceu aos estudantes ampliar a capacidade de escuta e a percepção da complexidade do processo saúdedoençacuidado, bem como de outros aspectos do que se tem denominado de 'clínica comum' às diversas profissões em saúde.

Review Of Ecotoxicological Studies Of The Marine And Estuarine Environments Of The Baixada Santista (São Paulo, Brazil)

The aim of the present study was to identify, through ecotoxicological assays, the most critical areas in the Baixada Santista area by compiling scientific papers and technical reports of the state environmental agency. Sediment samples were assessed employing Tiburonella viscana, Leptocheirus plumulosus, Nitokra sp., and embryos of Lytechinus variegatus and Perna perna. Water column samples were assessed by using Vibrio fischeri and Lytechinus variegatus. A total of 217 samples were compiled. It was found that the frequency of acute toxicity was higher in integral sediment samples from the Santos Channel (70.68%) and the lowest frequency was obtained for Bertioga beach samples (15%). Sediment from the Santos and São Vicente Channels, Santos Bay and the area for the disposal of dredged material are the places most affected, whereas the beaches of Guarujá and Bertioga presented low levels of toxicity. No ecotoxicological studies were found in Mongaguá, Itanhaém or Peruíbe cities.

The use of health risk scores and classification in food service

Purpose– The aim of this study was to evaluate the good manufacturing practices in meal services in public schools and day care centres in Baixada Santista, Brazil using a health risk classification.Design/methodology/approach– A total of 59 public schools and day care centres in nine municipalities of Baixada Santista – Brazil were randomly selected. The sanitary conditions were evaluated by applying a validated checklist specific to school meal service. The questions were scored according to the health risks detected. A percentage of conformity to good manufacturing practices was calculated, than schools and day care centres were classified according to health risk in relation to the scores obtained for each thematic area addressed in the checklist and in relation to the overall score.Findings– It was observed that 62 per cent of the schools were classified as average health risk failing to comply with Brazilian legislation on food safety rules. The thematic areas that showed lower percentage of conformity to good manufacturing practices were: hand hygiene (33.9 per cent), pest control (3.4 per cent), food handlers (62.4 per cent) and food hygiene (65.4 per cent). The school meal service of day care centres presented higher conformity in the hand hygiene (p<0.01) and the environmental sanitation (p<0.05) than elementary schools.Practical implications– The data observed in our study highlight the need of an effective system to monitor and evaluate the hygienic sanitary conditions in Brazil. The implementation of HACCP system may be an option with good potential to produce safer meals in school environment, nevertheless, the prerequisite program must be implemented first. Professionals with expertise in food safety can act as consultants to the school meal service and may use the data from this study as a benchmark for interventions.Originality/value– This paper contain new information related the state food safety practices of Brazilian school meal service. It also presents the use of scores to determine risk. The use of health risk is a novel way to evaluate the food safety practices in school meals facilitating the implementation of corrective measures.

Affluence and objective environmental conditions: Evidence of differences in environmental concern in metropolitan Brazil.

In an age of climate change, researchers need to form a deepened understanding of the determinants of environmental concern, particularly in countries of emerging economies. This paper provides a region-specific investigation of the impact of socio-economic status (SES) and objective environmental conditions on environmental concern in urban Brazil. We make use of data that were collected from personal interviews of individuals living in the metropolitan areas of Baixada Santista and Campinas, in the larger São Paulo area. Results from multilevel regression models indicate that wealthier households are more environmentally concerned, as suggested by affluence and post-materialist hypotheses. However, we also observe that increasing environmental concern correlates with a decline in objective environmental conditions. Interactions between objective environmental conditions and SES reveal some intriguing relationships: Among poorer individuals, a decline in environmental conditions increases environmental concern as suggested by the objective problems hypothesis, while for the wealthy, a decline in environmental conditions is associated with lower levels of environmental concern.

Avaliação da qualidade das baciloscopias realizadas na Rede de Laboratórios de Tuberculose da Região Metropolitana da Baixada Santista/SP

The Brazilian Ministry of Health national program for tuberculosis (TB) control (Programa Nacional de Controle da Tuberculose) determines the sputum smear microscopy as the standard methodology for TB diagnosis. In order to achieve diagnosis quality assurance it is recommended to set up an External Quality Assessment (EQA) scheme in the TB diagnosis laboratory network. This study aimed at evaluating the quality of sputum smear microscopy performed by the local laboratory network of the metropolitan area of Baixada Santista, SP, by means of an indirect supervision. The 5,691 sputum samples stained with Ziehl-Neelsen in nine local laboratories were evaluated. The applied EQA methodology was in accordance with the National TB and Other AFB Laboratory Surveillance Manual – Ministry of Health, 2008. The analyzed parameters were: macroscopic (smear uniformity) and microscopic (staining) analyses of the sputum smears and bacilloscopic index (C%). Of 713 analyzed slides, 529 (74.2 %) were satisfactory on macroscopic features and 631 (88.5 %) on microscopic evaluation. In the slides rechecking, one laboratory showed two false-positive results and C =97.5 %. Although the general results have been acceptable, a continuous EQA activity should be carried out, emphasizing the use of correcting actions on the common sources of error that may occur in performing the AFB microscopy technique.

Dinâmica intraurbana e redes sociais na Baixada Santista

For quite some time now studies have recognized the importance of processes of spatial redistribution of the population caused by migration flows, and the consequences of migration on urban expansion. The major concern in this paper is to highlight and further circumscribe the scope of studies on flows and movements based on the notion of social networks. This notion has been used since the late 1970s, especially in studies on international migration, but it is still rarely applied to internal migration studies, especially short distance migrations such as intra-metropolitan flows. For this purpose we conducted a study on the Baixada Santista Metropolitan Area (the urban area around the Atlantic Port of Santos, Brazil), based on data from a survey conducted in 2007. This data base gives us details on population mobility in the region and provides interesting information for analyzing factors related to the impact of social networks on migration processes. The survey enabled us to analyze the dynamics of intra-urban and intra-metropolitan mobility based on the concept of vulnerability zones.

Metals in muscles of mullet (Mugil curema) from a contaminated estuary: evidences of potential risks to public health

The Sao Vicente Channel and Estuary (SVCE) system is located in Baixada Santista metropolitan region (Sao Paulo State, Brazil) that contains fairly degraded areas where metal-contaminated waters and sediments are observed. Many of these metals can be incorporated into the aquatic food webs by accumulation into organisms such as filter feeders and fishes, with unpleasant consequences for public health. The present study aimed to assess the concentrations of Fe, Cr, Ni, Zn, Mn and Cu in the muscle tissues of mullets (Mugil curema) collected in two tributaries of SVCE and to estimate the risks of intoxication resulting of human consumption of this species. Sampling sites were Branco and Mariana rivers while the Itaguare River was used as reference area. Fishes were collected with casting nets and Atomic Absorption Spectroscopy (AAS) methods were used for chemical analyses. The mean concentrations of Cr and Ni exceeded the limits established by Brazilian and International standards. The long-term risks for human health associated with fish consumption were estimated for different exposure sceneries, following the method proposed by the United States Environmental Protection Agency. In both rivers, the results evidence risks for human health due to Cr contamination, in sceneries of for frequent consumption of M. curema.

Papilomavírus humano (HPV) entre jovens: um sinal de alerta

O Papilomavírus Humano - HPV - assume especial destaque na Saúde Pública diante do reconhecimento de sua associação com a ocorrência do câncer uterino, entre outros. Levando em conta a necessidade de implementação de programas de esclarecimentos sobre a prevenção dos agravos relacionados à infecção pelo HPV, coloca-se o propósito da realização do presente diagnóstico sobre conhecimentos e práticas sexuais entre jovens. Direcionando, estrategicamente, para o segmento de universitários, o estudo foi realizado no Campus da Baixada Santista da UNIFESP, estruturado em torno da formação multiprofissional em saúde. O levantamento foi feito a partir da aplicação de questionário em sala de aula, junto aos alunos do primeiro e terceiro ano. Com uma concentração de iniciação sexual na faixa de 15 a 17 anos de idade, os alunos referiram uso de preservativos masculinos associado à preocupação com a contracepção, secundada pela prevenção de Doenças Sexualmente Transmissíveis - DSTs. O conhecimento sobre o HPV foi restrito na população investigada. Embora crescente do primeiro para o terceiro ano, sua apreciação é relativizada quanto ao conhecimento da transmissão, consequências e prevenção. A investigação apontou a necessidade de disponibilizar informações relativas ao HPV em atenção às especificidades da doença.

Grupo de Medicina de Família e Comunidade de Santos: relato de experiência

Objetiva-se a discussão de diversos aspectos relacionados à Medicina de Família e Comunidade e das experiências vividas dentro da Associação Acadêmica Grupo de Medicina de Família e Comunidade de Santos (GMFC), do Centro Universitário Lusíada (UNILUS), vinculado à Faculdade de Ciências Médicas de Santos, São Paulo, Brasil. O GMFC busca a reflexão dos acadêmicos sobre o que é a Medicina de Família e Comunidade (MFC) enquanto especialidade, a fim de desmistificar ideias errôneas sobre a área em questão. Por meio de reuniões teóricas, congressos, jornadas e pesquisas científicas, o grupo busca consolidar uma visão concreta e íntegra de conceitos teóricos e aplicá-los na comunidade da Baixada Santista. A experiência do GMFC aprimora o conhecimento teórico-prático em MFC, favorecendo a qualificação dos acadêmicos para atuarem na prestação de serviços de saúde com aplicabilidade na Atenção Primária à Saúde (APS). Além disso, consolida-se o aprendizado acerca dos princípios do Sistema Único de Saúde (SUS) e da relevância de uma Medicina centrada na pessoa, com ênfase em uma visão holística da prática médica.Conclusão: A efetiva disseminação do conhecimento em MFC em nossa Universidade e o reconhecimento de que a MFC é importante para a formação generalista são grandes obstáculos constantemente enfrentados pelo grupo. Portanto, é de grande relevância a existência de um grupo acadêmico como o Grupo de Medicina de Família e Comunidade de Santos, pois além de integrar pessoas que se preocupam com uma abordagem diferenciada da Medicina, dissemina cada vez mais, dentro da universidade, o real significado da Medicina de Família e Comunidade.

Poll - Jehovah's Witness Patient Among Baixada Santista and ABC Paulista Cardiologists

Dear Editor, In the national and international1-3 medical literature, there is a growing number of manuscripts that focus on bioethics on the medical conduct. A relevant point is the potential for conflict between the benefit (the standpoint of a prudent and diligent doctor) and the patients' autonomy (depending on their preferences and values). One of these realities is the health care to Jehovah's Witness (JW) where the transfusion of blood has an undisputable clinical indication. Grinberg and Chehaibar4 observed that only 56.7% of the Brazilian cardiologists interviewed accept to provide health care to JW and 40% of them would not transfuse blood under any circumstances. An identical research study we conducted with 85 cardiologists affiliated with the regional branches of ABC and Santos of the Cardiology Society of the State of Sao Paulo revealed, compared with the national headquarters of the Society of Cardiology, a higher percentage of colleagues who accept to provide health care to JW (65.9%) and those who, among them, would not transfuse blood under any circumstances (47.3%). A significant aspect was the identification of a trend of young cardiologists (> 50 years old) whose accepted to provide health care to JW and not performing blood transfusion compared to older cardiologists. The data suggests that in these regions of the state of Sao Paulo the more recent inclusion of young cardiologists leads to a slighter resistance to provide health care to JW and greater tolerance to religious belief.

Evaluation of anthropic influences in an estuarine system of Southeastern Brazilian Coast by applying enrichment factors

This study presents an evaluation of metals and As deposition in the Bertioga Channel (Santos Region, Southeastern Brazilian coast) along the last 150 years, which corresponds to the main anthropogenic activity in the area. The studied area is located in the so-called Baixada Santista, where the main Brazilian harbor and one of the most important industrial centers of the country are located. This work consisted of sampling five sediment cores along this channel. The cores were sliced every 2 cm, and the samples were analyzed by ICP-OES to determine the levels of heavy metals (Cd, Cr, Cu, Ni, Pb and Zn) and As. The enrichment factors (EF) were calculated to identify the relative heavy-metal toxicity of the sediments and the anthropogenic contribution of the investigated elements. EFs indicated the absence of contamination for the heavy metals but a higher input of As in two cores (B2 and B5). According to the age models of the cores, this enrichment corresponds to the end of the 19th century, when Santos harbor was inaugurated, and to the 1970s, when Santos harbor activities expanded.

Percepção dos perigos ambientais urbanos e os efeitos de lugar na relação população-ambiente

Since their beginning, environmental studies have faced the threat of the ecological fallacy. Particularly within the human sciences domain, there has always been special attention to any form of geographical determinism or interpretation that could link society’s understanding to nature’s rationale. Regarding Population and Environment (P-E) studies, the concern has always been present, and not rarely with debate over the ecological fallacy, its risks and ways to eradicate it from the scope of analyses. However, in past decades, with the growing interest of human sciences on space, the importance of spatiality and the continuous amalgamation of its dimension in analyses have renewed this concern, now within a new sociocultural context. The effects of space have taken a new dimension, as we recognize, against the globalization trend, the strength of regional and local factors upon the determination and mediation of environmental issues that affect populations and places in a specific, but not in an indiscriminate way for space. Based on this, the methodological discussion has to consider how space influences the P-E equation, taking into consideration previous debates and the new contemporaneous sociospatial arrangements. These issues were relevant in the investigation over the perception of the dangers and vulnerability in the Metropolitan Regions of Campinas and Baixada Santista, in the State of Sao Paulo. Using data from a 2007 household survey (Vulnerability Project), we aimed to reach beyond the variables commonly used to assess living conditions (income, education, vital cycle), and we attempted to understand the variables according to differentiated spatial scales, considering the effects of space as critical for the perception of urban threats within the population-space-environment relationship.

Long-term effects of oil pollution in mangrove forests (Baixada Santista, Southeast Brazil) detected using a GIS-based multitemporal analysis of aerial photographs

Oil spills are potential threats to the integrity of highly productive coastal wetlands, such as mangrove forests. In October 1983, a mangrove area of nearly 300 ha located on the southeastern coast of Brazil was impacted by a 3.5 million liter crude oil spill released by a broken pipeline. In order to assess the long-term effects of oil pollution on mangrove vegetation, we carried out a GIS-based multitemporal analysis of aerial photographs of the years 1962, 1994, 2000 and 2003. Photointerpretation, visual classification, class quantification, ground-truth and vegetation structure data were combined to evaluate the oil impact. Before the spill, the mangroves exhibited a homogeneous canopy and well-developed stands. More than ten years after the spill, the mangrove vegetation exhibited three distinct zones reflecting the long-term effects of the oil pollution. The most impacted zone (10.5 ha) presented dead trees, exposed substrate and recovering stands with reduced structural development. We suggest that the distinct impact and recovery zones reflect the spatial variability of oil removal rates in the mangrove forest. This study identifies the multitemporal analysis of aerial photographs as a useful tool for assessing a system's capacity for recovery and monitoring the long-term residual effects of pollutants on vegetation dynamics, thus giving support to mangrove forest management and conservation.

Metrópole e região: dilemas da pactuação da saúde. O caso da Região Metropolitana da Baixada Santista, São Paulo, Brasil

This paper focuses on the relationship between metropolitan and regional health planning based on the processes of regionalization and the Pact for Health in the Baixada Santista Metropolitan Area, São Paulo State, Brazil. The method used was a case study in two stages, namely during initial implementation of the Pact for Health (2007) and the Regional Administration Committees (CGR) and in 2010. Municipal and regional health systems managers and the director of the Metropolitan Agency were interviewed, and records were analyzed from ten years of meetings of the Regional Inter-Administration Committee and the Regional Development Council. Four issues emerged: financing and infrastructure; health services utilization; inefficiency of the Regional Health Administration's instruments and decision-making levels; and the relationship between different levels in the Administration. Metropolitan health management remained as an underlying issue, appearing only incidentally or tangentially to regional management. Despite some limitations, the CGR has been legitimized as a space for regional health management.

Seasonal and spatial variations of dissolved carbon and nitrogen in the Santos estuarine system, Southeastern Brazil.

We investigated the concentrations of nutrients carbon and nitrogen in Santos Estuarine System (SES). The SES is located in the region of Baixada Santista (Santos, Brazil) and is ecologically and economically important due to biological diversity, high levels of metal pollution and sewage, and the presence of the port considered the largest and most productive in Latin America. For the preparation of the nutrient flow model, limnological and oceanographic data were obtained in water and sediment of 27 stations distributed in SES between 2000 and 2008. Significant contributions especially of organic carbon and nitrogen were observed from the communities living around the estuary and the Santos bay. Equations were developed to explain the flow of nutrients based on the type estuary, tidal flows and channel. The SES was classified as a partially mixed system. The results showed that the system has a conservative behavior to salinity and non-conservative to carbon and nitrogen. Key words: Carbon, nitrogen, modeling, salinity, nutrients flow