Organização da Atenção Primária à Saúde em um município rural remoto do norte do Brasil / Organization of Primary Health Care in a remote rural municipality in northern Brazil

RESUMO O objetivo do artigo foi caracterizar a organização da Atenção Primária à Saúde (APS) e suas interfaces com os demais serviços da rede assistencial em um Município Rural Remoto (MRR). Foi realizado estudo de caso único em Assis Brasil (AC), por meio de entrevistas com usuários, gestores e profissionais de saúde. Os resultados indicaram distribuição desigual de estabelecimentos de saúde com áreas descobertas; dificuldades de acesso por condições climáticas; barreiras econômicas para custeio de transporte; promoção de ações itinerantes na zona rural; descontinuidade e insuficiência de medicamentos; dificuldades para a fixação de profissionais; escassez de recursos tecnológicos; falta de acesso à internet; necessidade de adaptação cultural; concentração de serviços especializados do SUS na capital. Foram identificados esforços da gestão local para manutenção da Estratégia Saúde da Família (ESF) e adequação dos processos de trabalho para atendimento ao grande fluxo de demanda espontânea, estrangeiros e população indígena. Argumenta-se que o MRR e suas populações somam vulnerabilidades econômicas, sociais e de acesso aos serviços de saúde, parcialmente atendidas pelas políticas nacionais, e que o ente municipal, sem o suficiente apoio e aporte de recursos estadual e federal, mantém arranjos possíveis para a provisão de APS, nem sempre afeitos aos princípios abrangentes da ESF.

ABSTRACT The aim of the article was to characterize the organization of Primary Health Care (APS) and its interfaces with other services in the healthcare network in a Remote Rural Municipality (MRR). A single case study was carried out in Assis Brasil (AC), through interviews with users, managers and health professionals. The results indicated an unequal distribution of health facilities with uncovered areas; access difficulties due to weather conditions; economic barriers to costing transport; promotion of itinerant actions in rural areas; discontinuity and insufficiency of medications; difficulties in retaining professionals; scarcity of technological resources; lack of internet access; need for cultural adaptation; concentration of specialized services of the Unified Health System (SUS) in the capital. Local management efforts were identified to maintain the Family Health Strategy (ESF) and the adequacy of work processes to meet the large flow of spontaneous demand, foreigners and the indigenous population. It is argued that the MRR and its populations add economic, social and access to health services vulnerabilities, partially covered by national policies, and that the municipal entity, without sufficient support and allocation of state and federal resources, maintains possible arrangements for the provision of APS, not always bound by the comprehensive principles of the ESF.

Prevalence and risk factors associated with ectoparasite infestation of buffaloes in an Amazonian ecosystem.

BACKGROUND: The water buffalo (Bubalus bubalis) is well adapted in some regions of the Amazon. Of all Brazilian states, Pará contains the largest number of this species, with 510,000 animals, approximately 38% of the Brazilian buffaloes. Despite the socioeconomic importance of bubaline farming in the northern region, little is known about the prevalence of ectoparasites that affect buffalo herds. This study aimed to identify the species of buffalo ectoparasites in the municipality of Santarém, Pará, and to determine possible risk factors related to ectoparasitic infestation. A cross-sectional study was conducted by sampling 60 rural properties and 621 buffaloes for ectoparasites. When present, ectoparasites were collected for subsequent identification. RESULTS: Of all the animals sampled, 18.5% (115/621) had ectoparasites, 7.8% (49/621) had ticks from the species Rhipicephalus (Boophilus) microplus and Amblyomma cajennense (sensu stricto), and 11.5% (72/621) had lice from the Haematopinus tuberculatus species. Six animals presented mixed infestations of ticks and lice. Among the sampled farms, 51.6% (31/60) had at least one animal infested with ectoparasites. The prevalence of ticks and lice on buffaloes was associated with the farm site, with higher prevalence (11.5% ticks, 15.4% lice) in animals at dry land (OR: 16.7 and 5.7 for ticks and lice, respectively) when compared with floodplains (0.5% ticks, 3.4% lice). Buffaloes aged 1 to 12 months had more ticks whereas buffaloes aged 13 to 24 months had more lice (P < 0.05). CONCLUSIONS: Buffaloes bred in the municipality of Santarém present different levels of tick and lice infestation according to the direct influence of Amazon ecosystem characteristics. The floodplain environment, widely used for buffalo farming, contributes toward minor ectoparasite infestations in these animals.

Manifestações emocionais e motoras de ribeirinhos expostos ao mercúrio na Amazônia / Emotional and motor symptoms in riverside dwellers exposed to mercury in the Amazon

RESUMO: Introdução: A investigação dos impactos clínico-neurológicos associados às concentrações de exposição ao mercúrio em populações expostas é necessária na Amazônia. Objetivo: Analisar as manifestações emocionais e motoras de ribeirinhos expostos pela dieta nos municípios de Itaituba e Acará, ambos no Pará. Método: Foram coletadas amostras de cabelo para a determinação de mercúrio total (HgT), obtidos dados demográficos e sintomatológicos emocionais (depressão, ansiedade e insônia) e motores (parestesia, fraqueza muscular, desequilíbrio ao andar, tremor, dor nos membros e disartria). Resultados: A concentração mediana de HgT em Itaituba foi significativamente superior (p < 0,0001) àquela em Acará. As manifestações emocionais foram identificadas em 26 (26,5%) participantes de Itaituba e em 24 (52,2%) em Acará. Com relação às queixas motoras especificas, em Itaituba ocorreram em 63 (64,3%) voluntários, sendo mais referidas a dor nos membros (36,7%), a parestesia (32,6%) e a fraqueza muscular (27,5%). No Acará, 33 (71,7%) participantes apresentaram manifestações motoras, com o maior número queixando de parestesia (54,3%), dor nos membros (52,2%) e tremor (34,8%). As concentrações médias de HgT em Itaituba naqueles com manifestações emocionais e com manifestações motoras estiveram acima do considerado tolerável (6 µg/g) pela Organização Mundial de Saúde. Conclusão: Os resultados revelaram que a concentração de mercúrio nas manifestações emocionais e motoras de Itaituba são maiores do que nos ribeirinhos do Acará. Novos estudos são necessários com a aplicação de testes convencionais qualitativos e/ou quantitativos específicos, assim como também a investigação de outros sinais clínicos.

ABSTRACT: Introduction: The investigation of clinical and neurological impactations associated with exposure to mercury levels in exposed populations is necessary in the Amazon. Objective: To analyze emotional and motor symptoms of riverside dwellers exposed by diet in the municipalities of Itaituba and Acará, in Pará, Brazil. Methods: Hair samples were collected to assess the total mercury (HgT). Demographic data as well as emotional (depression, anxiety and insomnia) and motor (paresthesia, muscle weakness, loss of balance when walking, tremors, limb pain and dysarthria) symptomatology data were obtained. Results: Mean levels of HgT in Itaituba were significantly higher (p < 0.0001) than in Acará. Emotional symptoms were identified in 26 (26.5%) participants from Itaituba and in 24 (52.2%) from Acará. Specific motor complaints in Itaituba occurred in 63 (64.3%) volunteers; the most frequently mentioned afflictions were limb pain (36.7%), paresthesia (32.6%) and muscle weakness (27.5%). In Acará, 33 (71.7%) participants had motor symptoms, the majority of which complained of paresthesia (54.3%), limb pain (52.2%) and tremors (34.8%). Average HgT levels in Itaituba in those with emotional and motor symptoms were above the tolerable levels (6 µg/g) determined by the World Health Organization. Conclusion: Results showed that mercury levels in emotional and motor symptoms in Itaituba are higher than in riverside dwellers in Acará. Further studies, including the application of specific qualitative and/or quantitative standard tests, as well as the investigation of other clinical signs are necessary.