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Esta Norma Técnica tem por objetivo estabelecer as medidas para manipulação de resíduos e materiais de descarte em Bancos de Leite Humano e Postos de Coleta de Leite Humano, visando a garantia da qualidade nestes serviços e sua certificação.

Esta Norma Técnica tiene por objetivo establecer las medidas para el manejo de residuos y materiales de descarte en los Bancos de Leche Humana y Centros de Recolección de Leche Humana, con el fin de asegurar la calidad de estos servicios y su certificación.

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The interaction between intensive animal production and the environment is complex and depends on the location and management practices. The waste generated from intensive animal production may represent a triggering factor for environmental pressures in the function of the volume and the characteristics, degrading environmental quality and affecting ecosystem services. The objective of this study was to develop a conceptual framework for the environmental description of the impacts caused by the accumulation of the waste from intensive animal production, integrating the causal chain approach of the driver–pressure–status–impact–response (DPSIR) model with the causal network and ecosystem services. Therefore, a conceptual framework was developed that makes possible a comprehensive description of a set of structures and functions that interact in complex ways. The conceptual framework was validated through a case study performed within the scope of a hydrographic microbasin with intensive pig production. The conceptual framework developed made it possible to establish connections among the DPSIR components, including environmental perceptions and changes in the socioeconomic system. The impacts caused by the waste were considered as changes in the provision of ecosystem services and the socioeconomic system, identifiable in the proposed conceptual framework. The application of the conceptual framework identified the primary drivers that exert pressure on the system and has an impact on the ecosystem services, affecting the provision and regulation services. The development of this environmental conceptual framework contributes to the selection of the indicators and ecosystem services involved. This can aid in the promotion of environmental sustainability, providing subsidies for more adequate environmental policies obtained from indicators that reflect local conditions.

A interação entre a produção intensiva de animais com seu meio ambiente é complexa e depende principalmente da localização e das práticas de gestão. Os dejetos oriundos da produção intensiva de animais, em função do volume e características, podem representar um fator desencadeador de pressões sobre o ambiente, degradando a qualidade ambiental e impactando os serviços ecossistêmicos. O objetivo deste estudo é desenvolver uma estrutura conceitual para descrição ambiental dos impactos do acumulo de dejetos da produção intensiva de animais, integrando o enfoque de cadeia causal do modelo Drive- Pressure- Status- Impact- Response (DPSIR) com rede causal e serviços ecossistêmicos. Para tanto, foi desenvolvida uma estrutura conceitual, que permite descrever de forma abrangente um conjunto de estruturas e funções que interagem de maneira complexa. A validação da estrutura conceitual foi realizada por meio de sua aplicação em um estudo de caso realizado no âmbito da uma microbacia hidrográfica com produção intensiva de suínos. A estrutura conceitual desenvolvida permitiu estabelecer vinculação entre os componentes do DPSIR, incluindo percepções ambientais bem como de mudanças no sistema socioeconômico. Os impactos causados pelos dejetos podem ser entendidos como mudanças no fornecimento de serviços do ecossistema e no sistema socioeconômico, identificáveis na estrutura de análise conceitual proposta. A aplicação da estrutura conceitual identificou o principal driver que exerce pressões no sistema e que impactam nos serviços ecossistêmicos, afetando serviços de provisão e regulação. O desenvolvimento desta estrutura conceitual contribui para a seleção de indicadores e dos serviços ecossistêmicos envolvidos, que podem auxiliar na promoção da sustentabilidade ambiental, fornecendo subsídios para políticas ambientais mais adequadas, obtidas a partir de indicadores que reflitam as condições locais.

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The interaction between intensive animal production and the environment is complex and depends on the location and management practices. The waste generated from intensive animal production may represent a triggering factor for environmental pressures in the function of the volume and the characteristics, degrading environmental quality and affecting ecosystem services. The objective of this study was to develop a conceptual framework for the environmental description of the impacts caused by the accumulation of the waste from intensive animal production, integrating the causal chain approach of the driver–pressure–status–impact–response (DPSIR) model with the causal network and ecosystem services. Therefore, a conceptual framework was developed that makes possible a comprehensive description of a set of structures and functions that interact in complex ways. The conceptual framework was validated through a case study performed within the scope of a hydrographic microbasin with intensive pig production. The conceptual framework developed made it possible to establish connections among the DPSIR components, including environmental perceptions and changes in the socioeconomic system. The impacts caused by the waste were considered as changes in the provision of ecosystem services and the socioeconomic system, identifiable in the proposed conceptual framework. The application of the conceptual framework identified the primary drivers that exert pressure on the system and has an impact on the ecosystem services, affecting the provision and regulation services. The development of this environmental conceptual framework contributes to the selection of the indicators and ecosystem services involved. This can aid in the promotion of environmental sustainability, providing subsidies for more adequate environmental policies obtained from indicators that reflect local conditions.(AU)

A interação entre a produção intensiva de animais com seu meio ambiente é complexa e depende principalmente da localização e das práticas de gestão. Os dejetos oriundos da produção intensiva de animais, em função do volume e características, podem representar um fator desencadeador de pressões sobre o ambiente, degradando a qualidade ambiental e impactando os serviços ecossistêmicos. O objetivo deste estudo é desenvolver uma estrutura conceitual para descrição ambiental dos impactos do acumulo de dejetos da produção intensiva de animais, integrando o enfoque de cadeia causal do modelo Drive- Pressure- Status- Impact- Response (DPSIR) com rede causal e serviços ecossistêmicos. Para tanto, foi desenvolvida uma estrutura conceitual, que permite descrever de forma abrangente um conjunto de estruturas e funções que interagem de maneira complexa. A validação da estrutura conceitual foi realizada por meio de sua aplicação em um estudo de caso realizado no âmbito da uma microbacia hidrográfica com produção intensiva de suínos. A estrutura conceitual desenvolvida permitiu estabelecer vinculação entre os componentes do DPSIR, incluindo percepções ambientais bem como de mudanças no sistema socioeconômico. Os impactos causados pelos dejetos podem ser entendidos como mudanças no fornecimento de serviços do ecossistema e no sistema socioeconômico, identificáveis na estrutura de análise conceitual proposta. A aplicação da estrutura conceitual identificou o principal driver que exerce pressões no sistema e que impactam nos serviços ecossistêmicos, afetando serviços de provisão e regulação. O desenvolvimento desta estrutura conceitual contribui para a seleção de indicadores e dos serviços ecossistêmicos envolvidos, que podem auxiliar na promoção da sustentabilidade ambiental, fornecendo subsídios para políticas ambientais mais adequadas, obtidas a partir de indicadores que reflitam as condições locais.(AU)

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Eight beach/dune systems located along the Atlantico Department, Caribbean coast of Colombia were surveyed to determine litter influences over its scenic quality. Application of the Coastal Scenic Evaluation System (CSES) categorized these systems into two of the five available classes. Five of the investigated beach/dune systems belong to Class IV, while three systems correspond to V. Classes I, II and III were not found. Along these beach/dune systems, a total amount of 1908 litter items were collected with average abundances of 4.2 items/m2. Currently, 82% of surveyed sites are under an unacceptable condition of cleanness. User's habits as well as bad litter management practices are directly responsible for the decline of scenic quality of the Atlantico Department beach/dune systems. Litter management must be centered on strategies to eliminate or minimize litter sources. Specific remedial actions need to be defined and developed.

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Objective: This study has aimed to analyze the waste management from health care services and the nursing professionals' background about the current legislation. Methods: It is a descriptive-exploratory research with a quantitative approach, which has been developed in three Basic Health Units from Pelotas city, Rio Grande do Sul, Brazil. The participating nursing professionals were from the Family Health Strategy. It has been applied a structured questionnaire in order to identify the management of Health Solid Waste and the units' structure, from October to November 2014. Descriptive analyzes have been done. Results: Regarding the 19 professionals, 57.8% reported not knowing the legislation about waste management; 89.5% reported carrying out the segregation of these materials, but 73.7% said they did not know the classification of these residues and 36.8% were unaware of specific care toward it. The units did not have a waste management formal plan. Conclusion: Overall, the units have significant weaknesses in the management process, both in the physical structure as well as in the professionals' knowledge

Objetivo: Analisar a gestão dos resíduos de serviços de saúde e, o conhecimento dos profissionais de enfermagem acerca da legislação vigente. Método: pesquisa quantitativa, de caráter descritivo-exploratório, desenvolvida em três Unidades Básicas de Saúde de área urbana, de Pelotas, Rio Grande do Sul. Participaram profissionais da equipe de enfermagem de Estratégia de Saúde da Família. Foi aplicado questionário para identificar a gestão de Resíduos Sólidos de Saúde e estrutura das unidades, entre outubro a novembro de 2014. Foram realizadas análises descritivas. Resultados: dos 19 profissionais, 57,8% relataram não conhecer a legislação sobre Resíduos Sólidos de Saúde; 89,5% realizar a segregação desses materiais, porém 73,7% afirmaram não conhecer sua classificação e 36,8% desconheciam os cuidados específicos para cada tipo de resíduo. Observou-se ausência de plano de gestão. Conclusão: as unidades apresentam importantes fragilidades no processo de gerenciamento dos Resíduos Sólidos de Saúde

Objetivo: Analizar la gerencia de los residuos de salud y el conocimiento de los profesionales de enfermería sobre la legislación vigente. Método: investigación cuantitativa, de carácter descriptivo-exploratorio, desarrollada en tres Unidades Básicas de Salud del área urbana, de Pelotas, Rio Grande del Sur. Participaron profesionales del staff de enfermería de Estrategia de Salud de la Familia. Fue aplicado cuestionario para identificar la gerencia de Residuos Sólidos de Salud y estructura de las unidades, entre octubre y noviembre de 2014. Fueron realizados análisis descriptivos. Resultados: de los 19 profesionales, 57,8% relataron no conocer la legislación sobre Residuos Sólidos de Salud; 89,5% realizar la segregación de los materiales, pero 73,7% afirmaron no conocer su clasificación y 36,8% desconocían los cuidados específicos para cada tipo de residuo. Conclusión: las unidades presentan importante fragilidad en el proceso de gestión de los Residuos Sólidos de Salud

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A implementação de um plano de gestão ambiental nos Serviços de Alimentação e Nutrição é relevante no contexto do Gerenciamento Integrado de Resíduos Sólidos Urbanos, pois essa atividade gera um montante cada vez maior de resíduos, que muitas vezes não têm a destinação ou a disposição final adequadas. O nutricionista do Setor de Alimentação Coletiva pode minimizar os impactos gerados ao meio ambiente por meio do uso de ferramentas de gerenciamento e controle do processo produtivo de refeições, como manutenção das Fichas Técnicas de Preparo, introdução da coleta seletiva e aplicação de checklist relacionado às Boas Práticas Ambientais. Este estudo foi desenvolvido por meio de uma revisão bibliográfica sobre a gestão de resíduos orgânicos nos Serviços de Alimentação Coletiva, para um levantamento qualitativo da situação nesse Setor em relação às adequações esperadas à luz da legislação ambiental e à adoção de práticas sustentáveis de produção de refeições. O recorte temporal dos estudos analisados compreendeu o período de 2007 a 2017 e foram utilizados os seguintes descritores para as buscas nas plataformas: alimentação coletiva; sustentabilidade; gestão ambiental; resíduos sólidos. Os resultados obtidos revelaram que ainda há barreiras para a aplicação do sistema de gestão ambiental integrado entre os gestores do Setor de Alimentação, devido a fatores como custo, falta de conhecimento, dificuldade de treinamento de colaboradores e resistência da clientela a mudanças no cardápio. No entanto, alguns profissionais efetivaram mudanças significativas no processo de produção e obtiveram certificações ambientais, além da redução do desperdício de insumos, dos custos com o uso da água e da energia e maior nível de conscientização ambiental entre os clientes e os funcionários.(AU)

The implementation of an environmental management plan in the food science and nutrition field is relevant in the context of integrated management of municipal solid organic residues since it generates an evergrowing amount of waste, which often doesn't get adequately disposed of. The nutritionist in the collective feeding sector may act in such way as to minimize it's environmental impact using management tools and production control measures, such as adequate maintenance of technical charting, introducing selective collection of such waste and implementing adequate sustainability practices. This article consists of literary revision of organic residue waste management in the collective feeding field, to gather qualitative information in regards to compliance with environmental legislature and adopting sustainable production methods. The temporal cut of the analyzed studies comprises the period from 2007 to 2017 and the following descriptors were used for the searches on the platforms: collective feeding; sustainability; environmental management; solid waste. The information gathered in this revision shows that there's still resistance in implememting the integrated environmental management system amongst food industry managers due to cost, lack of knowledge on the subject, difficulty in training personnel, and customer resistance to menu changes. However; some of the revised authors encountered businesses which made the necessary changes to the production process, and obtained environmental certification, in addition to decrease in waste of supplies, decrease in water and electricity cost and developing environmental awareness for both clients and personnel.(AU)

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The urban suburbs of Brazilian cities have grown without an adequate sanitation infrastructure. Different social groups try to overcome these shortcomings seeking local sanitation alternatives at individual or community levels, contrasting with the universal model of sewage networks. This study was developed in the suburban neighborhood of Recreio dos Bandeirantes, Rio de Janeiro, Brazil, in order to analyze the installation process of the sewage system under a territorial approach. Data facilitated the construction of territorial schemes related to conflicts during the implementation of sewage networks in this neighborhood, where middle class groups and favela residents coexist with environmental preservation areas, beaches and commercial activities. This work revealed the need for contextualized sanitation information made available by the Brazilian Institute of Geography and Statistics (IBGE) and state sewage collection company, which conceal these conflicts or the representation of residents about their sanitation problems. Overlapping territorial managing functions should be considered as one of the factors responsible for the conflicts identified in the neighborhood. Further studies are suggested as methodological complementation and data update.

O crescimento das periferias de grandes cidades do Brasil vem ocorrendo sem que disponham de infraestrutura de saneamento adequada. Diferentes grupos sociais procuram superar estas deficiências, buscando alternativas locais de saneamento, individuais ou comunitárias, que se contrapõem ao modelo universal de redes de coleta de esgoto. A pesquisa foi desenvolvida no bairro do Recreio dos Bandeirantes, Rio de Janeiro, a fim de analisar o processo de instalação do sistema de esgotamento sanitário, sob uma abordagem territorial. Os dados permitiram a construção de esquemas territoriais relacionados a conflitos durante a implantação da estrutura de esgotamento sanitário neste bairro, onde convivem grupos populacionais de classe média e moradores de favelas, áreas de preservação ambiental, praias e atividades comerciais. Foi levantada a necessidade de contextualização das informações sobre saneamento, disponibilizadas pelo IBGE e pela companhia estadual de saneamento, que não refletiam estes conflitos ou a representação dos moradores sobre seus problemas de saneamento. A sobreposição das atribuições de gestão dos territórios deve, ainda, ser considerada como um dos fatores responsáveis por parte dos conflitos levantados no bairro. Novos estudos são sugeridos como complementação metodológica e atualização de dados.

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Resumo O crescimento das periferias de grandes cidades do Brasil vem ocorrendo sem que disponham de infraestrutura de saneamento adequada. Diferentes grupos sociais procuram superar estas deficiências, buscando alternativas locais de saneamento, individuais ou comunitárias, que se contrapõem ao modelo universal de redes de coleta de esgoto. A pesquisa foi desenvolvida no bairro do Recreio dos Bandeirantes, Rio de Janeiro, a fim de analisar o processo de instalação do sistema de esgotamento sanitário, sob uma abordagem territorial. Os dados permitiram a construção de esquemas territoriais relacionados a conflitos durante a implantação da estrutura de esgotamento sanitário neste bairro, onde convivem grupos populacionais de classe média e moradores de favelas, áreas de preservação ambiental, praias e atividades comerciais. Foi levantada a necessidade de contextualização das informações sobre saneamento, disponibilizadas pelo IBGE e pela companhia estadual de saneamento, que não refletiam estes conflitos ou a representação dos moradores sobre seus problemas de saneamento. A sobreposição das atribuições de gestão dos territórios deve, ainda, ser considerada como um dos fatores responsáveis por parte dos conflitos levantados no bairro. Novos estudos são sugeridos como complementação metodológica e atualização de dados.

ABSTRACT The urban suburbs of Brazilian cities have grown without an adequate sanitation infrastructure. Different social groups try to overcome these shortcomings seeking local sanitation alternatives at individual or community levels, contrasting with the universal model of sewage networks. This study was developed in the suburban neighborhood of Recreio dos Bandeirantes, Rio de Janeiro, Brazil, in order to analyze the installation process of the sewage system under a territorial approach. Data facilitated the construction of territorial schemes related to conflicts during the implementation of sewage networks in this neighborhood, where middle class groups and favela residents coexist with environmental preservation areas, beaches and commercial activities. This work revealed the need for contextualized sanitation information made available by the Brazilian Institute of Geography and Statistics (IBGE) and state sewage collection company, which conceal these conflicts or the representation of residents about their sanitation problems. Overlapping territorial managing functions should be considered as one of the factors responsible for the conflicts identified in the neighborhood. Further studies are suggested as methodological complementation and data update.

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O correto manejo e destinação final dos resíduos sólidos ainda é um desafio de muitas cidades. A falta de gerenciamento adequado dos resíduos sólidos pelos municípios, associada aos recorrentes alagamentos dos cursos d'água da bacia do Ribeira de Iguape podem interferir de forma negativa na qualidade ambiental da região. O objetivo deste trabalho foi analisar o Plano Municipal de Gestão Integrada de Resíduos Sólidos (PMGIRS) de Cananéia, localizado no Complexo Estuarino-Lagunar de Cananéia-Iguape. A padronização desta análise foi feita com base no conteúdo mínimo estabelecido pelo artigo 19 da Lei Federal 12.305/10 que instituiu a Política Nacional de Resíduos Sólidos (PNRS). A avaliação do PMGIRS de Cananéia constatou atendimento de 68,4% dos incisos do art.19 da Lei Federal 12.305/10. Apesar das lacunas que o PMGIRS apresentou quanto aos diagnósticos e formas de gestão dos resíduos sólidos, é inegável o progresso que a PNRS trouxe ao gerenciamento de resíduos sólidos no Brasil, porque permitiu que, ao menos alguns aspectos importantes fossem considerados nas políticas públicas municipais, como a inclusão de catadores, o incentivo à reciclagem, educação ambiental, a alternativa de soluções consorciadas para alguns programas, e formas adequadas de tratamento e/ou destinação final, por exemplo.

The correct management and disposal of solid waste is still a challenge for many cities. The lack of proper management of solid waste by the municipalities in association with recurrent water way flooding of the Ribeira de Iguape basin may cause a negative impact on the environmental health of the area. The aim of this study was to evaluate the Plan for Integrated Solid Waste Management of the Municipality of Cananéia (PMGIRS), located in the Estuarine-Lagoon Complex of Cananéia-Iguape. The standards for this analysis were set according to the Article 19 of the Federal Law 12,305/10, which established the minimum requirements for the National Policy on Solid Waste (PNRS). The evaluation of the PMGIRS of Cananéia municipality revealed that it is servicing68.4% of the article19 of the Federal Law 12,305/10. Despite the shortcomings that the PMGIRS presented regarding the diagnoses and forms of solid waste management, the progress that the PNRS has brought to solid waste management in Brazil is undeniable, because it enabled some important issues to be considered in municipal public policies. For example, the inclusion of waste pickers, recycling incentives, environmental education, the alternative of consortium solutions for some programs, and appropriate forms of treatment and/or disposal.

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OBJECTIVE: To analyze the relationship of sewerage coverage and wastewater treatment with waterborne disease behaviour. METHODS: A descriptive retrospective study was conducted using secondary sources (document review and information available in databases) about basic sanitation coverage, treatment of domestic sewage in the country and the prevalence of waterborne diseases during the period 2008-2014. RESULTS: The country invested USD 1,100 million in the implementation of wastewater treatment systems from 2011 until the first half of 2013. However, the incidence of waterborne diseases, such as acute diarrheal disease, foodborne diseases and typhoid and paratyphoid fever did not decrease during the period 2008-2014; only hepatitis A registered a decrease. DISCUSSION: Investment in water supply and sewerage systems is relevant to improve health conditions of the population and to reduce the incidence and prevalence of various health conditions; however, it is necessary to address other aspects such as health education and social empowerment to address this problem more efficiently.

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'If an integrated urban waste management system includes the informal recycling sector (IRS), there is a good chance that more solid waste is recycled' is common sense. However, informal integration brings additional social, environmental, and economic benefits, such as reduction of operational costs and environmental impacts of landfilling. Brazil is a global best practice example in terms of waste picker inclusion, and has received international recognition for its recycling levels. In addition to analysing the results of inclusive recycling approaches, this article evaluates a selection of the best Brazilian inclusive recycling practices and summaries and presents the resulting knowledge. The objective is to identify processes that enable the replication of the inclusion of the informal recycling sector model as part of municipal solid waste management. Qualitative and quantitative data have been collected in 25 Brazilian cities that have contracted waste pickers co-operatives for door-to-door selective collection of recyclables. Field data was collected in action research projects that worked with waste pickers co-operatives between 2006 and 2013. The Brazilian informal recycling sector integration model improves municipal solid waste recycling indicators: it shows an increase in the net tonness recycled, from 140 to 208 t month(-1), at a much lower cost per tonne than conventional selective collection systems. Inclusive systems show costs of US$35 per tonne of recyclables collected, well below the national average of US$195.26. This inclusive model improves the quality of collected material and the efficiency of municipal selective collection. It also diminishes the negative impacts of informal recycling, by reducing child labour, and by improving the conditions of work, occupational health and safety, and uncontrolled pollution. Although treating the Brazilian experience as a blueprint for transfer of experience in every case is unrealistic, the results suggest that this approach to informal sector integration can be considered among the global best practices for informal sector integration. The article closes with recommendations for deploying technology in other urban areas throughout the world.

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The health-care wastes (HCW) represents a challenge for the animal and human health service providers, in function of the risk and the needing for a differentiated handling when compared to the urban solid residues. In function of the broad range of products and services, the analytic laboratories generate a spectrum concerning the risk nature and rank. The main objective of this document is to provide basic coming for monitoring through the performance indicators. Steps here defined for designing a monitored model to reduce the generation of waste, to minimize environmental impacts, to reduce accidents and to assist the administrators in managing the financial resources. This research could contribute to a critical analysis of the HCW, providing consistent data, which are important for decision making at tactical and operational levels(AU)

Os Resíduos de Serviços de Saúde (RSS) representam um desafio para os prestadores de serviços de saúde humana e animal, em função do risco que representam, e necessitam de tratamento diferenciado se comparado aos resíduos sólidos urbanos. Com uma larga gama de produtos e serviços, os laboratórios analíticos são locais que geram RSS de amplo espectro quanto à natureza e grau de risco. O objetivo principal deste documento é apresentar uma sistemática para introduzir o monitoramento do gerenciamento de RSS para laboratórios de saúde pública, tendo como modelo o Instituto Nacional de Controle de Qualidade em Saúde (INCQS/Fiocruz). Foram definidas etapas para concepção de um modelo de avaliação e monitoramento, para reduzir a geração dos RSS, para minimizar os impactos ambientais e auxiliar os administradores na gestão dos recursos financeiros. A sistemática proposta contribui para uma análise crítica do gerenciamento dos RSS e fornece dados consistentes para auxiliar na tomada de decisões. Constatou-se que as dificuldades de execução do plano de gerenciamento dos RSS, que geram situações de grave risco sanitário e ambiental, podem ser dirimidas com correto monitoramento de suas etapas(AU)

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The purpose of this study was to conduct a qualitative analysis of waste management practices among a group of Brazilian dental students (n=64) before and after implementing two different pedagogical methods: 1) the students attended a two-hour lecture based on World Health Organization standards; and 2) the students applied the lessons learned in an organized group setting aimed toward raising their awareness about socioenvironmental issues related to waste. All eligible students participated, and the students' learning was evaluated through their answers to a series of essay questions, which were quantitatively measured. Afterwards, the impact of the pedagogical approaches was compared by means of qualitative categorization of wastes generated in clinical activities. Waste categorization was performed for a period of eight consecutive days, both before and thirty days after the pedagogical strategies. In the written evaluation, 80 to 90 percent of the students' answers were correct. The qualitative assessment revealed a high frequency of incorrect waste disposal with a significant increase of incorrect disposal inside general and infectious waste containers (p<0.05). Although the students' theoretical learning improved, it was not enough to change behaviors established by cultural values or to encourage the students to adequately segregate and package waste material.

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Desde que las Guerras Mundiales que se escenificaron en el siglo XX, en los teatros operacionales del conflicto en Europa, Norte de Africa, medio oriente, Asia, I y II Guerras Mundiales, Corea, Viet Nam, Afganistán Guerra Arabe- Israelí obligó a los países involucrados a atender a los millones de víctimas resultantes, planificando, organizando y rediseñando a pasos acelerados las estructuras de asistencia médica, capaces de suministrar recursos de atención masivo del trauma y estrategias para tratar a sus soldados y a la población civil. La consecuencia positiva para el avance de la medicina y especialmente de la cirugía de estos tragicos sucesos, fue la aparición y el desarrollo de la "cirugía compleja" y la conquista del abordaje quirúrgico de regiones del cuerpo humano, hasta ese momento vedados a la actividad del tratamiento quirúrgico: cavidad craneal, cirugía torácica, trauma cardiovascular, cirugía intestinal de urgencia, anestesia y manejo respiratorio, antibióticos, derivados sanguíneos, resucitación cardio-respiratoria y evacuación y trasporte de heridos. Varias décadas después el desarrollo de esta cirugía compleja, produjo un aumento desmesurado de la morbi-mortalidad ocasionado principalmente por los efectos de la anestesia inadecuada, hemorragias masivas, infección-sepsis y factores de error humano. Surgen entonces nuevas líneas de investigación clínica para identificar y disminuir estos factores. Esos esfuerzos logran al final del siglo XX y comienzos del XXI, resultados tangibles y eficaces mejorando los resultados finales de la cirugía. Por estos logros surge un nuevo paradigma en el mundo de la cirugía, conocido como "el ambiente quirúrgico seguro"; que comprende estrategias operativas y organizacionales, tales como: reingeniería de quirófanos, innovaciones tecnológicas, digitalización de aparatos de registro y la protección integral de los equipos humanos interactuantes en los servicios quirúrgicos. En este ensayo se describen...

Since the occurrence of the World Wars in the 20th. Century, at the military operational theatres in Europe, North Africa, Meddle East, Korea, Viet nam, Afghanistan and Israel the countries involved in these conflicts were forced to render medical care to the million of casualities in thousands of battlefields, specially organizing massive trauma care to military personnel also to civilian populations. The positive result of this tragic scenarios was that medicine as a whole and surgery, was the development of the so called "complex surgical care", and the conquest of the surgical approach of different regions of the human body, until then impossible to reach with therapeutic efficacy: intracranial structures, thoracic surgery, cardio-vascular injuries, acute intestinal trauma anesthesia and respiratory ventilation, antibiotics, blood replacement, cardio pulmonary resuscitation; and triage and the planning of transport of wounded soldiers. Some decades later, the development of the complex surgery reachers alarming levels of morbidity and mortality, mainly due to inadequate delivered anasthesia, massive hemorrhage, uncontrolled bacterial infections-sepsis and lethal consequences of human errors. New lines of clinical investigations and research conducted in the late XX century and early XXI century gave the answers to obtain strategies to diminish and fight this adverse factors; improving better outcomes for surgical therapies. This achievement gave birth to a new paradigm into the surgical world which is identified nowadays as the "safe surgical environment", compromising new strategies to redesing surgical operating rooms, application of technological discoveries, digitalization of patient's surveillance and bio protection of the surgical personnel avoiding events as accidents, thermal injuries, and infections with transmissible diseases in this scenario. In this paper will be described fundamental definitions of novel paradigm, reviewing concepts...

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Although informal waste collectors are sometimes organized in cooperatives, their working conditions remain extremely precarious and unsafe. The paper discusses the findings of action oriented, participatory qualitative research with several recycling groups in the metropolitan region of São Paulo, Brazil. During workshops with the recyclers mapping, acting, and drawing methods helped reveal health hazards from collection, separation and transportation of recyclable materials. Major health problems relate to chemical and biological hazards, musculoskeletal damage, mechanical trauma and poor emotional wellbeing. The recent federal legislation on solid waste management opens new avenues for the inclusion of recycling cooperatives in selective waste collection. Nevertheless, we express the need to consider the distinctive characteristics and vulnerabilities of recycling groups, when developing safer work environments in these social businesses. We also suggest that the workspace be ergonomically organized and that public awareness campaigns about selective waste collection are conducted regularly to increase the quality of source separation. The introduction of electric hand pushed carts can further reduce health strains. This research has produced a better understanding of the work of the recyclers and related health risks. The interactive qualitative research methodology has allowed for the co-creation and mobilization of specific knowledge on health and safety in recycling cooperatives.

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The aim of this study was to evaluate the veterinary establishments, providers of clinical services in the city of Salvador, Bahia, regarding compliance with laws relating to waste health management, as well as assess the practice, knowledge and perception on the subject. From September 2010 to March 2011, 36 veterinary establishments were visited and their technical managers interviewed about knowledge, practice and perception on the subject. Of these, 30.6% know the current law, 2.8% have implemented the plan of waste management of health services, 19.4% has a contract with the company of collects waste and 88.9% believes that the waste health services represent some kind of risks. Other aspects were investigated too. The results show that although the technical managers unfamiliar with the resolution of the National Sanitary Surveillance Agency, they are aware of the risks associated with inappropriate practices of waste management of health services. The study revealed the need to understand and correct the gaps in vocational training in the perception of the risks posed by the waste of health services; dialogue between institutions and professional and the formulating criteria that suit the requirements of the relevant legislation and the scale of generation of waste health services in establishments veterinarians.

Objetivou-se avaliar os estabelecimentos veterinários e prestadores de serviços clínicos da cidade de Salvador Bahia, quanto ao cumprimento da legislação referente ao gerenciamento de resíduos de serviços de saúde por meio da análise da prática, do conhecimento, e da percepção dos responsáveis técnicos sobre o tema. Entre setembro de 2010 e março de 2011, 36 clínicas e consultórios veterinários foram visitados e seus respectivos responsáveis técnicos entrevistados sobre o conhecimento, a prática e a percepção sobre o tema. Desses, 30,6% conheciam a legislação vigente, 2,8% implantaram o plano de gerenciamento de resíduos de serviços de saúde, 19,4% tinham contrato com empresa de coleta especial e 88,9% atribuíam riscos aos resíduos de serviços de saúde, além de outros aspectos que foram investigados. Os resultados mostraram que embora os responsáveis técnicos desconhecessem a resolução da Agencia Nacional de Vigilância Sanitária, eles tinham consciência dos riscos associados às práticas inadequadas de gerenciamento dos resíduos de serviços de saúde. O estudo revelou a necessidade de se perceber e corrigir as lacunas na formação profissional; na percepção dos riscos representados pelos resíduos de serviços de saúde; no diálogo entre as instituições e o profissional e na formulação de critérios que adéquem a legislação pertinente às características e à escala da geração de resíduos de serviços de saúde nos estabelecimentos médicos veterinários.

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RESUMEN

The aim of this study was to evaluate the veterinary establishments, providers of clinical services in the city of Salvador, Bahia, regarding compliance with laws relating to waste health management, as well as assess the practice, knowledge and perception on the subject. From September 2010 to March 2011, 36 veterinary establishments were visited and their technical managers interviewed about knowledge, practice and perception on the subject. Of these, 30.6% know the current law, 2.8% have implemented the plan of waste management of health services, 19.4% has a contract with the company of collects waste and 88.9% believes that the waste health services represent some kind of risks. Other aspects were investigated too. The results show that although the technical managers unfamiliar with the resolution of the National Sanitary Surveillance Agency, they are aware of the risks associated with inappropriate practices of waste management of health services. The study revealed the need to understand and correct the gaps in vocational training in the perception of the risks posed by the waste of health services; dialogue between institutions and professional and the formulating criteria that suit the requirements of the relevant legislation and the scale of generation of waste health services in establishments veterinarians.(AU)

Objetivou-se avaliar os estabelecimentos veterinários e prestadores de serviços clínicos da cidade de Salvador Bahia, quanto ao cumprimento da legislação referente ao gerenciamento de resíduos de serviços de saúde por meio da análise da prática, do conhecimento, e da percepção dos responsáveis técnicos sobre o tema. Entre setembro de 2010 e março de 2011, 36 clínicas e consultórios veterinários foram visitados e seus respectivos responsáveis técnicos entrevistados sobre o conhecimento, a prática e a percepção sobre o tema. Desses, 30,6% conheciam a legislação vigente, 2,8% implantaram o plano de gerenciamento de resíduos de serviços de saúde, 19,4% tinham contrato com empresa de coleta especial e 88,9% atribuíam riscos aos resíduos de serviços de saúde, além de outros aspectos que foram investigados. Os resultados mostraram que embora os responsáveis técnicos desconhecessem a resolução da Agencia Nacional de Vigilância Sanitária, eles tinham consciência dos riscos associados às práticas inadequadas de gerenciamento dos resíduos de serviços de saúde. O estudo revelou a necessidade de se perceber e corrigir as lacunas na formação profissional; na percepção dos riscos representados pelos resíduos de serviços de saúde; no diálogo entre as instituições e o profissional e na formulação de critérios que adéquem a legislação pertinente às características e à escala da geração de resíduos de serviços de saúde nos estabelecimentos médicos veterinários.(AU)

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Healthcare waste (HCW) management and segregation are essential to ensure safety, environmental protection and cost control. Poor HCW management increase risks and costs for healthcare institutions. On-going surveillance and training are important to maintain good HCW practices. Our objectives were to evaluate and improve HCW practices at Hospital Bloom, San Salvador, El Salvador. We studied HCW disposal practices by observing waste containers, re-segregating waste placed in biohazardous waste bags, and administering a seven-itemsknowledge survey before and after training in waste management at Hospital Bloom. The training was based on national and international standards. We followed total biohazardous waste production before and after the training. The hospital staff was knowledgeable about waste segregation practices, but had poor compliance with national policies. Re-segregating waste in biohazardous waste bags showed that 61% of this waste was common waste, suggesting that the staff was possibly unaware of the cost of mis-segregating healthcare waste. After staff training in HCW management, the correct responses increased by 44% and biohazardous waste disposal at the hospital reduced by 48%. Better segregation of biohazardous waste and important savings can be obtained by HCW management education of hospital staff. Hospitals can benefit from maximising the use of available resources by sustaining best practices of HCW, especially those in hospitals in lower-middle-income countries.

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Os dados do Plano Nacional de Controle de Resíduos e Contaminantes (PNCRC) foram utilizados para identificação de áreas geográficas de ocorrência preferencial de níveis baixos de metais pesados em bovinos abatidos, no período 2002 a 2010. Critérios de inclusão definiram o período 2006 a 2010 como base para identificação de fatores de risco, ao que a distribuição de contaminações registradas pelo PNCRC é apresentada em mapas temáticos individuais para cada ano. Avaliou- se o efeito de risco das concentrações reduzidas (detecções) na ocorrência de extrapolação aos limites legais máximos (violações) no estado de São Paulo. Foram estabelecidos modelos de tendência para detecções de metais pesados nas unidades federativas e no conjunto nacional. As categorias de resultados de cada bovino amostrado (resultado negativo, detecção, violação) foram utilizadas para dividir o banco de dados em áreas de ocorrência e não ocorrência mutuamente exclusiva de arsênio (detecções) e também de chumbo e cádmio (detecções+ violações) no estado de São Paulo. Gerou-se um estudo ecológico considerando cada município como unidade de análise, utilizando-se as categorias de resultados do PNCRC como variável /"doença/" e como fator de exposição as categorias (mediana ou tercis) dos fatores produtivos do Levantamento das Unidades de Produção Agropecuária, fornecidos pela Secretaria de Agricultura do estado de São Paulo. A modelagem de regressão logística múltipla permitiu identificar variáveis que aumentam o risco de contaminações no contexto ecológico, demonstrando ser possível integrar dados do PNCRC com outras bases de dados públicas. Os fatores identificados devem ser utilizados por novos estudos com delineamento propício a avaliar o efeito de risco em propriedades individuais antes que se proponham ações preventivas específicas aos animais e seus locais de criação. Propõe-se a implantação de um sistema de vigilância epidemiológica para o PNCRC como maneira de definir metodologia objetiva para acompanhar seus resultados juntamente com o do monitoramento de fatores produtivos das propriedades rurais. Esta proposta pretende fornecer um formato de subsídios baseado na ciência, no sentido de municiar as decisões de gerenciamento de risco. Enfatiza-se a necessidade de sistemas informatizados para integração de dados que possam ser estudados como fator de exposição aos achados do PNCRC, o que se prevê como vanguarda aos sistemas de inspeção baseada em risco e que poderão habilitar os governos a darem foco à antecipação/resolução de crises de saúde pública e de comércio internacional. Reitera-se a necessidade de definir escopo objetivo de fatores produtivos a serem monitorados pelos serviços de defesa agropecuária, no âmbito dos programas de boas práticas agrícolas. Tendo-se em vista o destaque do Brasil no cenário global de fornecimento de alimentos de origem animal e a relevância crescente da demonstração de controle dos quesitos técnicos com contexto em potenciais barreiras sanitárias, abordagens no âmbito deste trabalho são promissoras em respaldar a sustentabilidade do agronegócio nacional, uma vez que se relacionam com a atualização da plataforma de gerenciamento dos controles técnicos necessários às etapas do continuum produtivo.

The National Control Plan for Residues and Contaminants (PNCRC) was searched to identify preferential geographic areas for occurrence of low levels of heavy metals in cattle slaughtered in the period 2002-2010. Period 2006-2010 enables the identification of risk factors and presents the contamination distribution by means of thematic maps for each individual year. Trend analysis was carried out for heavy metals in federative units and in the National setting. The category of results for each sampled animal (negative, detection, violation) ensures database division into mutually exclusive areas with occurrence and non-occurrence of arsenic (detections) and also of lead and cadmium (detections+violations). The effect of the low concentrations (detections) on the risk of extrapolation to the maximum legal limits (violations) was evaluated in the state of São Paulo. An ecological study was done considering each county as an analysis unit: PNCRC results depict the /"disease status/" variable while the productive factors (tertiles or median) the exposure ones. The crude variables for the latter were provided by the Secretariat of Agriculture of São Paulo state. Multiple logistic regression modeling allowed to recognition of variables that increase the risk of contamination in the ecological context, demonstrating that PNCRC integration with other public databases is in fact possible. The /"clues/" of ecological risk factors should be used as a direction to further studies to evaluate the effect on individual farms before specific preventive measures can be made for animals and their rearing sites. There is a surveillance system proposal for PNCRC as way of defining objective methodology to track their results along with the monitoring of performance in the rearing procedures at the farm, thus entailing a framework based on science as a guide for risk management decisions. This study emphasizes the need of computerized systems for data integration and as a tool for evaluate the findings of PNCRC in the light of exposure factors, which is expected by the vanguard inspection systems based on risk with reliance in anticipation / resolution of public health crisis and international trade contentions by governments. There is a need to define the scope of objective production factors to be monitored by animal health services under the programs intending good agricultural practices. The approach of this study is suitable for enhance Brazilian position in terms of agribusiness sustainability by means of an update in the platform for control management relevant in the technical barriers context on each step of the productive continuum.

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Urban surfaces receive waste deposits from natural and human sources, which create a negative visual impact and are identified as potentially significant contributors to water and air pollution. Local councils are usually responsible for the sweep of roads and footpaths to keep the environment clean and free of litter. Quality controls are useful in order to check whether the services are being executed according to the quantity, quality and performance standards that are provided. In this sense, several factors might affect the efficiency of the management of cleaning and waste collection services; however, only a few contributions are available in the literature on the various aspects associated with the level of street cleanliness. In this paper, the suitability of a Cleanliness Index has been checked, for the case of Granada (South of Spain), in order to contribute to the proper management of public expenditure, improving the quality and cost of an essential service for any municipality. Results have concluded that the city exhibits a good level of cleanliness, although the standard of cleaning varied from one area of the city to another. The Cleaning Index fits well to the general situation of the different districts of Granada and thus, it could be considered a useful tool for measuring the level of cleanliness of the streets of the city and for evaluating the organization of the cleaning service, such that an outsourced company would not be responsible for controlling all the cleaning services.

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