The new National Curriculum Guidelines aim at restructuring and adapting medical curricula. The objective is to conduct a critical-reflective analysis of the restructure of a medical course’s curricular matrix. This action research was conducted at a Brazilian federal university. The material was analyzed using the discourse analysis method. Among the results, the proposal of a curriculum that values life and transfers the biomedical paradigm to incorporate other dimensions in healthcare is highlighted. The need to strengthen a curricular matrix based on social demands and preferably focused on primary care is indicated. The establishment of longitudinal and transversal relationships among the competency areas of the 2014 National Curricular Guidelines and the curricular components is proposed. The intention is to foster the understanding of determinants and relationships between diseases and the communities’ ways of living.

Background: Breast cancer is a serious public health problem and is the second most prevalent cancer type in the world. The purpose of this article is to evaluate the association between pesticide use and breast cancer in a region of intense agribusiness activity in the state of Mato Grosso, Brazil. Methods: A case-control study was conducted on women living in the city of Rondonópolis, in the south of Mato Grosso state. There were 85 cases of women with confirmed breast cancer and 266 controls who were randomly selected from primary health care users. Bivariate and stratified analyses were performed. Multiple logistic regression was then performed, keeping in the final model the factors with a significance level lower than or equal to 0.05 or considered important according to apriori biological criteria. Results: In the final model, living near cropland with pesticides (OR: 2.37; CI: 95% 1.78–3.16) and women aged over 50 years who experienced early menarche (OR: 2.08; CI: 95% 1.06–4.12) had a higher risk of developing breast cancer compared to control subjects. Conclusion: This study highlights the importance of exposure to pesticides as an environmental risk factor for the development of breast cancer among women.

The lower valley of Jaguaribe has registered, since the XXI century, the arrival of transnational and regional companies, which led to deep transformations in this region. The increased use of the pesticides is one of the most important ones, being able to cause alterations in human procreation and leading to congenital deformations, besides premature birth and low weight newborns. This article is an ecological study related to the period from 2000 to 2010 in the population of some cities in the state of Ceará, and it was divided in two parts: the first one, a draft of historical series of morbidity and mortality databases and trend verification performed by a simple linear regression; the second one comprehends the calculation of the ratio of rates between cities that are highly exposed to pestiides and the cities selected for comparison, with history of little use of these substances. There was statistically considerable growth tendency (p = 0.026) in the number of hospitalized people with neoplasms. Analyzing the ratios of the rates in these same indicators, it is observed that the rates of hospitalized people with neoplasms were 1.76 times higher in the studied cities than in control cities (p < 0.0010). With regard to to fetal deaths, a statistically considerable increase was observed (p < 0.05) as to the mortality rates in the studied cities. Results suggest there was higher morbidity and mortality caused by neoplasms in the cities with broader use of pesticides, which could be influenced by production, environmental and social transformations associated to the process of deterritorialization induced by the expansion of the agricultural modernization over the morbidity and mortality profile of the population of lower Jaguaribe. This process is a reflex of the production chemical-dependent model adopted by the agribusiness companies, expanding the vulnerability of the country side population.

This article aims to conduct an analysis of the correlation between the management and use of water resources with the expansion of agribusiness and its reflections in environmental and human contamination, pointing toward challenges for SUS in the area of monitoring pesticides in water for human consumption. It is qualitative study with an adopted methodological framework of the case study, applied in an area of agribusiness expansion in the semi-arid region of the state of Ceará. The results demonstrate that there exists an unequal relationship in the management and use of water, in which agribusiness in Ceará is prioritized for access to water at the expense of the great majority of the rural population. As a result, pesticide contamination of surface and ground water brings challenges to surveillance of the control of pesticides in water for human consumption. In this sense, we present alternatives to develop health services with more effective actions in surveillance of health in general, and of Vigiagua in particular, such as: overcoming the fragmentation of vision and intervention regarding health problems; human exposure to multiple pesticides; the lack of laboratories and trained professionals; and enlarging the dissemination of information to the users of water.

Neste ensaio, é feita a pergunta de quem deve, pode e quer promover a saúde no campo hoje. Foi eleito, prioritariamente, o campo da ciência e o das políticas públicas como foco de diálogo. Configurou-se oito lições aprendidas sob a perspectiva dos direitos à saúde a um ambiente saudável, aqui compartilhadas: (1) para além de um risco químico isolado, a relação entre agrotóxicos e saúde deve ser estudada no contexto da modernização agrícola conservadora; (2) é necessário e urgente que se proceda ao desvelamento dos agravos à saúde relacionados aos agrotóxicos; (3) o Estado tem tido significativa eficácia no apoio ao agronegócio e significativa ineficácia nas políticas sociais de garantia de direitos dos trabalhadores e da população; (4) setores da sociedade ligados às organizações do campo vêm desempenhando importante papel na política pública de combate aos agrotóxicos e de proteção da saúde; (5) é importante que os estudos contribuam para a desconstrução dos mitos que sustentam o modelo da Revolução Verde; (6) se está diante do desafio de contribuir na construção de um paradigma emergente de ciência, fundado no compromisso ético-político com os mais vulneráveis; (7) comunidades camponesas vêm construindo alternativas agroecológicas de vida no semiárido.

Objetiva-se analisar os perímetros irrigados enquanto estratégia geopolítica para a expansão da fronteira agrícola brasileira e o "desenvolvimento" do semiárido nordestino, em sua relação com os determinantes sociais da saúde em comunidades camponesas. Trata-se de pesquisa realizada na Chapada do Apodi, nos estados do Ceará e Rio Grande do Norte, entre 2007 e 2011. Adotaram-se variados desenhos, técnicas e instrumentos de pesquisa, como pesquisa-ação, estudo etnográfico, questionário e exames laboratoriais, análise de contaminação de águas, cartografia social e grupo focal. Identificou-se que, na conjuntura da expansão do agronegócio, as políticas públicas de irrigação trouxeram consequências para a saúde, o trabalho e o ambiente, com a implantação do Perímetro Irrigado Jaguaribe-Apodi, no Ceará. São expressivos o contexto de conflito socioambiental e a resistência na fase prévia à instalação do Perímetro Irrigado Santa Cruz do Apodi no Rio Grande do Norte, o que traz consequências para o processo saúde-doença em comunidades camponesas. É importante a avaliação da política pública de irrigação considerar os impactos dos perímetros sobre o modo de vida, o trabalho, a saúde e o ambiente nesses territórios atingidos.