Investigation of an outbreak of disease compatible with scurvy in a male penitentiary in the state of Ceará, Brazil, 2019-2020: a case-control study.

MAIN RESULTS: An outbreak of illness compatible with scurvy occurred among male prison inmates; most frequent signs/symptoms were edema and pain in lower limbs, difficulty in walking and hematoma/ecchymosis; the associated factor was age > 40 years. IMPLICATIONS FOR SERVICES: The results can contribute to the identification and description of scurvy outbreaks in other contexts and territories. Epidemiological studies of events like this enhance the practice of field epidemiology in health services. PERSPECTIVES: It is expected that the prevention of hypovitaminosis, such as scurvy, will be based on public policies aimed at the population deprived of liberty; and that the capabilities of health services to detect and respond to cases of the disease will be improved. OBJECTIVE: to identify the occurrence of an outbreak compatible with scurvy and exposure factors associated with typical signs/symptoms of hypovitaminosis that occurred in a male penitentiary in Ceará, Brazil between 2019-2020. METHODS: this was a population-based case-control study; we used clinical records and interviews with compatible cases - based on sign/symptom onset during the study period - and with controls; we carried out multivariate analysis. RESULTS: out of 62 cases, mean age was 40.6 years (SD = 10.8); main signs/symptoms were edema and pain in the lower limbs (100.0%), difficulty in walking (91.9%), hematoma/ecchymosis in the lower limbs (90.3%) and fever (88.7%); we identified being over 40 years old as an associated factor (aOR = 1.10; 95%CI 1.05;1.17; p-value = 0.001); and as protective factors: working (aOR = 0.11; 95%CI 0.03;0.36; p-value < 0.001) and taking part in classes (aOR = 0.21; 95%CI 0.08;0.59; p-value = 0.003) in the prison. CONCLUSION: we considered the penitentiary outbreak to be compatible with scurvy due to characteristic signs/symptoms, associated with the identified factors; we recommended regular provision of a diet rich in vitamin C to all male inmates and clinical follow-up of cases.

Investigação de surto de doença compatível com escorbuto em uma penitenciária masculina do Ceará, 2019-2020: um estudo de caso-controle / Investigation of an outbreak of disease compatible with scurvy in a male penitentiary in the state of Ceará, Brazil, 2019-2020: a case-control study / Investigación de un brote de enfermedad compatible con escorbuto en una penitenciaría masculina en el estado de Ceará, Brasil, 2019-2020: un estudio de casos y controlesInvestigação de surto

Objetivo: identificar ocorrência de surto compatível com escorbuto e fatores de exposição associados aos sinais/sintomas típicos de hipovitaminose, em penitenciária masculina, Ceará, Brasil, 2019-2020. Métodos: estudo de caso-controle populacional; foram utilizados registros clínicos e entrevistas com casos compatíveis - sinais/sintomas iniciados no período - e com controles; realizou-se análise multivariável. Resultados: 62 casos; idade média de 40,6 anos (DP = 10,8); principais sinais/sintomas foram edema e dor em membros inferiores (100,0%), dificuldade para deambular (91,9%), hematoma/equimose em membros inferiores (90,3%), febre (88,7%); identificou-se, como fator de exposição, média de idade > 40 anos (ORa = 1,10; IC95% 1,05;1,17; p-valor = 0,001); e como fatores protetores, trabalho (ORa = 0,11; IC95% 0,03;0,36; p-valor < 0,001) e participação em aulas (ORa = 0,21; IC95% 0,08;0,59; p-valor = 0,003) dentro da penitenciária. Conclusão: surto da penitenciária compatível com escorbuto pelos sinais/sintomas característicos, associados aos fatores identificados; recomendou-se oferta regular de dieta rica em vitamina C para todos os internos e acompanhamento clínico dos casos.

Objective: to identify the occurrence of an outbreak compatible with scurvy and exposure factors associated with typical signs/symptoms of hypovitaminosis that occurred in a male penitentiary in Ceará, Brazil between 2019-2020. Methods: this was a population-based case-control study; we used clinical records and interviews with compatible cases - based on sign/symptom onset during the study period - and with controls; we carried out multivariate analysis. Results: out of 62 cases, mean age was 40.6 years (SD = 10.8); main signs/symptoms were edema and pain in the lower limbs (100.0%), difficulty in walking (91.9%), hematoma/ecchymosis in the lower limbs (90.3%) and fever (88.7%); we identified being over 40 years old as an associated factor (aOR = 1.10; 95%CI 1.05;1.17; p-value = 0.001); and as protective factors: working (aOR = 0.11; 95%CI 0.03;0.36; p-value < 0.001) and taking part in classes (aOR = 0.21; 95%CI 0.08;0.59; p-value = 0.003) in the prison. Conclusion: we considered the penitentiary outbreak to be compatible with scurvy due to characteristic signs/symptoms, associated with the identified factors; we recommended regular provision of a diet rich in vitamin C to all male inmates and clinical follow-up of cases.

Objetivo: identificar la ocurrencia del brote compatible con escorbuto y los factores de exposición asociados con signos/síntomas típicos de hipovitaminosis que ocurrieron en una penitenciaría masculina en Ceará, Brasil entre 2019-2020. Métodos: estudio poblacional de casos y controles; se utilizaron historias clínicas y entrevistas con casos compatibles, con inicio de signos/síntomas durante el período de estudio, y controles; se realizó análisis multivariable. Resultados: de los 62 casos, edad media fue 40,6 años (DE = 10,8); principales signos/síntomas fueron edema y dolor en miembros inferiores (100,0%), dificultad para caminar (91,9%), hematoma/equimosis en miembros inferiores (90,3%) y fiebre (88,7%); la edad mayor de 40 años se identificó como factor asociado (ORa = 1,10; IC95% 1,05;1,17; p-valor = 0,001); y como factores protectores: trabajo (ORa = 0,11; IC95% 0,03;0,36; p-valor< 0,001) y participación en clases (ORa = 0,21; IC95% 0,08;0,59; p-valor = 0,003) dentro del centro penitenciario. Conclusión: el brote en centro penitenciario fue considerado compatible con escorbuto debido a los signos/síntomas característicos, asociados a los factores identificados; se recomendó oferta regular de dieta rica en vitamina C a todos los internos y seguimiento clínico de los casos.

Seroprevalence and factors associated with SARS-CoV-2 infection among education workers after the first wave: the first cross-sectional study in Brazil.

BACKGROUND: The school community was heavily impacted by the Covid-19 pandemic, especially with the long time of school closures. This study aimed to analyze the seroprevalence of SARS-CoV-2 antibodies and possible factors associated with seropositivity for COVID-19 in teachers and other school staff, and to estimate the fraction of asymptomatic individuals by sex and age group. METHODS: We conducted a serological survey of SARS-CoV-2 infections. An analytical cross-sectional study was conducted in Fortaleza, Brazil. Teachers and other staff members from pre-schools to universities of higher education to were investigated. RESULTS: A total of 1,901 professionals participated in the study, of which 1,021 were staff and 880 were teachers. The seroprevalence of SARS-CoV-2 was 8.0% (152/1901). In the seropositive group, 48.3% were asymptomatic. There was a predominance of women (68.4%); and, 47.1% of the participants were between 31 and 45 years old. There was an increase in prevalence with increasing age. An inverse relationship was found for education level: more professionals with less education tested positive for COVID-19. The presence of an infected person living in the same household was significantly associated with positive results for COVID-19 among the professionals. CONCLUSIONS: This is the first study to report the seroprevalence of IgG against SARS-CoV-2 in Brazilian educational staff after the first wave of the disease. In this study, the seroprevalence was much lower than that in the general population. During school reopening, a small fraction of school workers showed serologically detectable signs of SARS-CoV-2 exposure.

Seroprevalence and factors associated with SARS-CoV-2 infection among education workers after the first wave: the first cross-sectional study in Brazil

ABSTRACT Background: The school community was heavily impacted by the Covid-19 pandemic, especially with the long time of school closures. This study aimed to analyze the seroprevalence of SARS-CoV-2 antibodies and possible factors associated with seropositivity for COVID-19 in teachers and other school staff, and to estimate the fraction of asymptomatic individuals by sex and age group. Methods: We conducted a serological survey of SARS-CoV-2 infections. An analytical cross-sectional study was conducted in Fortaleza, Brazil. Teachers and other staff members from pre-schools to universities of higher education to were investigated. Results: A total of 1,901 professionals participated in the study, of which 1,021 were staff and 880 were teachers. The seroprevalence of SARS-CoV-2 was 8.0% (152/1901). In the seropositive group, 48.3% were asymptomatic. There was a predominance of women (68.4%); and, 47.1% of the participants were between 31 and 45 years old. There was an increase in prevalence with increasing age. An inverse relationship was found for education level: more professionals with less education tested positive for COVID-19. The presence of an infected person living in the same household was significantly associated with positive results for COVID-19 among the professionals. Conclusions: This is the first study to report the seroprevalence of IgG against SARS-CoV-2 in Brazilian educational staff after the first wave of the disease. In this study, the seroprevalence was much lower than that in the general population. During school reopening, a small fraction of school workers showed serologically detectable signs of SARS-CoV-2 exposure.

Systemic inflammatory syndrome in children during COVID-19 pandemic in Ceará state, northeastern Brazil: an observational study.

In this study, we report the occurrence of multisystemic inflammatory syndrome among 64 children (2 deaths) with recent severe acute respiratory syndrome-related coronavirus 2 (SARS-COV-2) infections in the northeast region of Brazil. The major clinical symptoms and signs reported were exanthema (60.9%), abdominal pain (56.3%), nausea and vomiting (46.9%), diarrhea (37.5%), and dyspnea (37.5%). Laboratory findings revealed that the levels of C-reactive protein (75.0%), hemoglobin (51.6%), D-dimer (48.4%), lymphocytes (43.8%), LDH (45.3%), AST (42.2%), ALT (51.6%), and ferritin (48.4%) were above the reference values for a given age and gender. The clinical findings were similar to those observed in Kawasaki disease, although it represents a separate entity, emphasizing the need for proactive surveillance and early treatment.

High Effectiveness of SARS-CoV-2 Vaccines in Reducing COVID-19-Related Deaths in over 75-Year-Olds, Ceará State, Brazil.

In Brazil, the SARS-CoV-2 vaccination program has so far prioritized people over 75 years of age. By the end of March 2021, in Ceará State, a total of 313,328 elderly people had received at least one dose of vaccine (45% Oxford-AstraZeneca/Fiocruz and 55% CoronaVac-Sinovac/Butantan), and 159,970 had received two doses (83% CoronaVac-Sinovac/Butantan and 17% Oxford-AstraZeneca/Fiocruz). After a single dose, there was already a significant reduction in COVID 19-related deaths (protection ratio: 19.31 (95% CI: 18.20-20.48), attributable protection ratio: 94.8%); higher protection ratios were observed after the application of two doses of the vaccine (132.67; 95% CI: 109.88-160.18), with an attributable protection ratio of 99.2%. SARS-CoV-2 vaccines are highly effective in reducing the number of COVID-19-related deaths in over 75-year-olds in Brazil, one of the hardest hit countries by the current pandemic.

Systemic inflammatory syndrome in children during COVID-19 pandemic in Ceará state, northeastern Brazil: an observational study

Abstract In this study, we report the occurrence of multisystemic inflammatory syndrome among 64 children (2 deaths) with recent severe acute respiratory syndrome-related coronavirus 2 (SARS-COV-2) infections in the northeast region of Brazil. The major clinical symptoms and signs reported were exanthema (60.9%), abdominal pain (56.3%), nausea and vomiting (46.9%), diarrhea (37.5%), and dyspnea (37.5%). Laboratory findings revealed that the levels of C-reactive protein (75.0%), hemoglobin (51.6%), D-dimer (48.4%), lymphocytes (43.8%), LDH (45.3%), AST (42.2%), ALT (51.6%), and ferritin (48.4%) were above the reference values for a given age and gender. The clinical findings were similar to those observed in Kawasaki disease, although it represents a separate entity, emphasizing the need for proactive surveillance and early treatment.

Case Report: Recurrent Clinical Symptoms of COVID-19 in Healthcare Professionals: A Series of Cases from Brazil.

We describe six cases of healthcare professionals in Brazil who recovered but again presented symptoms consistent with COVID-19, with new positive reverse transcription (RT)-PCR test results. The cases reported herein presented symptom onset between March 16, 2020 and April 9, 2020. All were health professionals (four medical doctors), five were female, with a median age of 43.5 years, and three had comorbidities. All patients were confirmed for SARS-CoV-2 detection by RT-PCR in naso and/or oropharyngeal swab samples. Among the reported cases, three (50%) underwent RT-PCR testing in the period between the two symptomatic episodes, with negative results. The time elapsed between the onset of symptoms in the two episodes ranged from 53 to 70 days (median, 56.5 days). In the first episode, the main symptoms described were fever (4/6), myalgia (3/6), sore throat (3/6), and cough (3/6). Meanwhile, during the second episode, fever (4/6) and weakness (3/6) predominated. Most of the cases progressed without complications, although one individual presented hypoxemia (minimum SatO2 of 90%) in both episodes, and two, only in the second, one of which required intensive care unit admission, progressing with improvement after medication and receiving noninvasive ventilatory support. We report cases with recurrence of symptoms compatible with COVID-19, with positive RT-PCR results, that could represent the occurrence of viral reactivation or reinfection. The true nature of this phenomenon should be better clarified in future studies.

Health system collapse 45 days after the detection of COVID-19 in Ceará, Northeast Brazil: a preliminary analysis.

INTRODUCTION: COVID-19 emerged in late 2019 and quickly became a serious public health problem worldwide. This study aim to describe the epidemiological course of cases and deaths due to COVID-19 and their impact on hospital bed occupancy rates in the first 45 days of the epidemic in the state of Ceará, Northeastern Brazil. METHODS: The study used an ecological design with data gathered from multiple government and health care sources. Data were analyzed using Epi Info software. RESULTS: The first cases were confirmed on March 15, 2020. After 45 days, 37,268 cases reported in 85.9% of Ceará's municipalities, with 1,019 deaths. Laboratory test positivity reached 84.8% at the end of April, a period in which more than 700 daily tests were processed. The average age of cases was 67 (<1 - 101) years, most occurred in a hospital environment (91.9%), and 58% required hospitalization in an ICU bed. The average time between the onset of symptoms and death was 18 (1 - 56) days. Patients who died in the hospital had spent an average of six (0 - 40) days hospitalized. Across Ceará, the bed occupancy rate reached 71.3% in the wards and 80.5% in the ICU. CONCLUSIONS: The first 45 days of the COVID-19 epidemic in Ceará revealed a large number of cases and deaths, spreading initially among the population with a high socioeconomic status. Despite the efforts by the health services and social isolation measures the health system still collapsed.

História do Grupo de Trabalho em Medicina Rural da SBMFC / History of the SBMFC Working Party on Rural Medicine / Historia del Grupo de Trabajo de Medicina Rural SBMFC

Este artigo apresenta a História do Grupo de Trabalho em Medicina Rural da SBMFC, um dos mais ativos grupos de trabalho da SBMFC. São revisados os primeiros passos desde a sua criação e posteriores desenvolvimentos. Um dos principais resultados identificados foi o de ajudar a consolidar a identidade do "MFC rural" e trazer a discussão da saúde das populações rurais para a agenda da saúde, da atenção primária e da medicina de família. Este relato tem também como objetivo auxiliar outros grupos em criação ou já estabelecidos a criar estratégias de fortalecimento de seus trabalhos.

This article presents the History of the SBMFC Working Party on Rural Medicine, one of SBMFC's most active working groups. The first steps since its creation and further developments are reviewed. One of the main results identified was to help consolidate the identity of the "rural family doctor" and bring the discussion of the health of rural populations to the health, primary care and family medicine agenda. This report also aims to assist other groups in creation or already established to create strategies to strengthen their work.

Este artículo presenta la Historia del Grupo de Trabajo de Medicina Rural de SBMFC, uno de los grupos de trabajo más activos de SBMFC. Se revisan los primeros pasos desde su creación y otros desarrollos. Uno de los principales resultados identificados fue ayudar a consolidar la identidad del "MFC rural" y llevar el debate sobre la salud de las poblaciones rurales a la agenda de salud, atención primaria y medicina familiar. Este informe también tiene como objetivo ayudar a otros grupos en la creación o ya establecidos para crear estrategias para fortalecer su trabajo. Descriptores: Salud rural, Medicina Familiar y Comunitaria, Historia de La Medicina.

Health system collapse 45 days after the detection of COVID-19 in Ceará, Northeast Brazil: a preliminary analysis

Abstract INTRODUCTION: COVID-19 emerged in late 2019 and quickly became a serious public health problem worldwide. This study aim to describe the epidemiological course of cases and deaths due to COVID-19 and their impact on hospital bed occupancy rates in the first 45 days of the epidemic in the state of Ceará, Northeastern Brazil. METHODS: The study used an ecological design with data gathered from multiple government and health care sources. Data were analyzed using Epi Info software. RESULTS: The first cases were confirmed on March 15, 2020. After 45 days, 37,268 cases reported in 85.9% of Ceará's municipalities, with 1,019 deaths. Laboratory test positivity reached 84.8% at the end of April, a period in which more than 700 daily tests were processed. The average age of cases was 67 (<1 - 101) years, most occurred in a hospital environment (91.9%), and 58% required hospitalization in an ICU bed. The average time between the onset of symptoms and death was 18 (1 - 56) days. Patients who died in the hospital had spent an average of six (0 - 40) days hospitalized. Across Ceará, the bed occupancy rate reached 71.3% in the wards and 80.5% in the ICU. CONCLUSIONS: The first 45 days of the COVID-19 epidemic in Ceará revealed a large number of cases and deaths, spreading initially among the population with a high socioeconomic status. Despite the efforts by the health services and social isolation measures the health system still collapsed.

Estratégia Saúde da Família rural: uma análise a partir da visão dos movimentos populares do Ceará / Rural Family Health Strategy: an analysis from the perspective of popular movements in Ceará

RESUMO A conquista do direito constitucional à saúde não se efetivou em diversos cenários. A partir dessa realidade, em 2011, foi publicada a Política Nacional de Saúde Integral das Populações do Campo, da Floresta e das Águas (PNSIPCFA). Este artigo objetiva analisar as práticas da Estratégia Saúde da Família (ESF) em territórios rurais no Ceará. Trata-se de estudo qualitativo, descritivo, realizado com 5 movimentos populares, sendo 3 entrevistados de cada um deles, totalizando 15 participantes. Utilizaram-se entrevista semiestruturada e análise do discurso. Os movimentos apontaram que houve expansão da ESF no campo, com avanços no acesso à saúde, apesar de existirem limitações. O Programa Mais Médicos destacou-se como marco relevante. Os movimentos têm o desafio de se apropriarem da PNSIPCFA, e contribuir, juntamente com ESF, para a ampliação da participação popular em saúde e reconhecimento dos saberes e práticas populares, considerando a determinação social da saúde.

ABSTRACT The conquest of the constitutional right to health has not been enforced in various scenarios. Considering this reality, in 2011 the National Policy for Integral Health of Countryside, Forest and Water Populations (PNSIPCFA) was published. This article aims to analyze the practices of the Family Health Strategy (FHS) in agricultural territories in Ceará. This is a qualitative, descriptive study, conducted with five popular movements, with 3 respondents from each movement, totaling 15 participants. Semi-structured interview and discourse analysis were used. The movements pointed out that there was an expansion of the FHS in the Countryside, with advances in access to health, despite some restrictions. The More Doctors Program stood out as a relevant milestone. The movements have the challenge of seizing the PNSIPCFA and contribute, along with the FHS, to the expansion of popular participation in health and recognition of popular knowledge and practices, considering the social determination of health.

New National Curricular Guidelines of medical courses: opportunities to resignify education / Novas Diretrizes Curriculares Nacionais para os cursos de Medicina: oportunidades para ressignificar a formação / Nuevas Directrices Curriculares Nacionales para los cursos de Medicina: oportunidades para resignificar la formación

ABSTRACT 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.

RESUMO As novas Diretrizes Curriculares Nacionais (DCN) visam à reestruturação e adequação dos currículos médicos. Objetiva-se realizar uma análise crítico-reflexiva da reestruturação da matriz curricular para um curso de Medicina. Trata-se de uma pesquisa-ação realizada em uma universidade federal brasileira. Para a análise do material, procedeu-se com Análise de Discurso. Como resultados, destacou-se uma proposição curricular que valorize a vida, capaz de transpor o paradigma biomédico para incorporar outras dimensões no cuidado em Saúde. Apontou-se para o fortalecimento de uma matriz curricular retroalimentada pelas demandas sociais, tendo a Atenção Primária como cenário preferencial para a formação. Propõe-se o estabelecimento de relações de longitudinalidade e transversalidade entre as áreas de competência das DCN de 2014 e os componentes curriculares ofertados. Intenciona-se fomentar a compreensão dos determinantes e relações das doenças com os modos de vida das comunidades.

RESUMEN Las nuevas Directrices Curriculares Nacionales (DCN) apuntan a la reestructuración y adecuación de los currículos médicos. Objetivo: Realizar un análisis crítico-reflexivo de la reestructuración de la matriz curricular para un curso de Medicina. Se trata de una investigación-acción participativa realizada en una universidad federal brasileña. Para el análisis del material se procedió con un Análisis de Discurso. Como resultado, se destacó una proposición curricular que valorice la vida, capaz de transponer el paradigma biomédico incorporando otras dimensiones al cuidado de la salud. El objetivo fue el fortalecimiento de una matriz curricular retroalimentada por las demandas sociales, con la atención primaria como escenario preferencial para la formación. Se propone establecer relaciones longitudinales y transversales entre las áreas de competencia de las DCN de 2014 y los componentes curriculares ofertados. Se intenta fomentar la comprensión de los factores determinantes y las relaciones de las enfermedades con la forma de vida de las comunidades.

It is time for rural training in family medicine in Brazil / Es hora de la capacitación rural en medicina familiar en Brasil / Está na hora do treinamento em saúde rural para médicos de família no Brasil

The gap between health needs and the training of human resources for health is much more evident in rural areas. In Brazil, a country of continental dimensions, these differences become more challenging. The diversity of geographical and administrative barriers to access makes the health indicators of rural and remote populations worse than those of the urban population. Family Medicine could address the social determinants of health through the provision of human services and play an important role in low-income rural residents' health status. This essay is an urgent call for the debate on models for projecting heath workforce supply and requirements for rural areas in Brazil.(AU)

La brecha entre las necesidades de salud y la capacitación de los recursos humanos para la salud es mucho más evidente en las zonas rurales. En Brasil, un país de dimensiones continentales, estas diferencias se vuelven más desafiantes. La diversidad de las barreras geográficas y administrativas de acceso hace que los indicadores de salud de las poblaciones rurales y remotas sean peores que los de la población urbana. La Medicina Familiar podría abordar los determinantes sociales de la salud a través de la provisión de servicios humanos y desempeñar un papel importante en el estado de salud de los residentes rurales de bajos ingresos. Este ensayo es un llamado urgente para el debate sobre los modelos para proyectar el suministro de mano de obra de salud y los requisitos para las áreas rurales en Brasil.(AU)

A discrepância entre as necessidades de saúde e o treinamento de recursos humanos para a saúde é muito mais evidente nas áreas rurais. No Brasil, um país de dimensões continentais, essas diferenças se tornam mais desafiadoras. A diversidade das barreiras geográficas e administrativas de acesso torna os indicadores de saúde das populações rurais e remotas piores que os da população urbana. A medicina de família e comunidade pode abordar os determinantes sociais da saúde por meio da prestação de serviços humanos e desempenhar um papel importante no estado de saúde dos residentes rurais de baixa renda. Este ensaio é um apelo urgente para o debate sobre as necessidades das áreas rurais no Brasil e os modelos de projeção para o provimento de força de trabalho de saúde nesses cenários.(AU)

Como garantir o direito à saúde para as populações do campo, da floresta e das águas no Brasil? / How to ensure the right to health for 'rural, forest and water' populations in Brazil?

RESUMO A reestruturação produtiva, nas últimas décadas, gerou grandes mudanças na zona rural brasileira, destacando-se a reprimarização da economia, que provocaram conflitos pela terra e água entre o Estado, o capital e as populações rurais, acarretando doenças, mortes, violência, contaminação ambiental e riscos à saúde humana. Este ensaio objetivou problematizar a situação de saúde das populações do campo, da floresta e das águas, os desafios e as estratégias adotadas para garantir o direito à saúde. A Estratégia Saúde da Família, como porta de entrada das pessoas no SUS, ainda apresenta diversos problemas relativos à sua implantação, como: pior desempenho em áreas rurais; a territorialização que ainda não se faz na perspectiva dos espaços sociossanitários de maior risco; e apresenta fragilidade na participação social. O acesso dessas populações ao SUS requer articulação de saberes e experiências de planejamento e avaliação permanentes das ações intersetoriais, bem como das responsabilidades e informações compartilhadas, a fim de alcançar a atenção à saúde com qualidade e integralidade. Exige também um processo ágil de educação permanente dos trabalhadores de saúde e de educação popular, com uma proposta nova e diferenciada, rompendo com a lógica curativista e que considere as especificidades da influência da determinação social da saúde.(AU)

ABSTRACT Productive restructuring in the last decades has brought about great changes in the Brazilian rural area, with emphasis on the reprimarization of the economy, which induced conflicts over land and water between the State, the capital and the rural populations, causing illness, death, violence, environmental contamination and risks to human health. This essay aims at problematizing the health situation of the rural, forest and water populations, the challenges and the strategies adopted to ensure the right to health. The Family Health Strategy as a gateway for people in the SUS, still presents several problems related to its implementation, such as: worse performance in rural areas; the territorialization is still not done in the perspective of the socio-sanitary spaces of greater risk, and it presents fragility in social participation. The access of these populations to the SUS requires articulation of knowledge and experiences of planning and permanent evaluation of intersectoral actions, as well as responsibilities and shared information, in order to achieve health care with quality and comprehensiveness. It also demands an agile process of permanent education of health workers and popular education, along with a new and differentiated proposal breaking with curative logic and considering the specificities of the influence of the social determination of health.(AU)

Medicina de família e comunidade na Atenção Primária à Saúde no Brasil: potencialidades e desafios / Family medicine and community in Primary Health Care in Brazil: potentialities and challenges

Neste capítulo, apresentamos o conjunto de atributos característicos da especialidade MFC e o papel do(a) médico(a) de família e comunidade nos sistemas universais de saúde, com ênfase na consolidação do SUS.(AU)

Saúde no caminho da roça / Health on the road to the countryside

Argumenta sobre temas como diversidade e competência cultural no rural, formação em saúde para contextos rurais, e se as tecnologias da informação e comunicação reduzem ou ampliam distâncias e isolam.

Evidências advindas da implantação do PMM nos territórios indígenas

Esta súmula tem como objetivo apresentar uma síntese de experiências, resultados e apontamentos obtidos de fontes bibliográficas que versam sobre a inserção do Programa Mais Médicos na atenção à saúde da população indígena, visando fornecer substrato teórico aos gestores para a avaliação dos êxitos e dificuldades, desvelando os desafios futuros para a implantação de um sistema de saúde equânime e integral para os povos indígenas.

Manifesto de Natal - Por uma política afirmativa no recrutamento, formação, provimento, retenção e suporte para as médicas de família em contexto rural e remoto / Natal Manifest - For an affirmative policy in the establishment, recruitment, continuing education and support to the female family doctors in rural and remote contexts / Manifiesto de Natal - Por una política comprometida en la radicación, contratación, formación continuada y apoyo para las médicas de familia em contextos rurales y remotos

O presente documento foi produzido com base na oficina de Gênero sobre o trabalho das Médicas de Família em áreas rurais e remotas, durante o 13º Congresso Brasileiro de Medicina de Família e Comunidade, de 8 a 12 de julho de 2015. Objetivou o estabelecimento de importantes pressupostos para o recrutamento, formação, provimento, retenção e suporte para o trabalho das médicas de família e comunidade nas mais diversas áreas rurais, rururbanas e remotas do país, em seus mais diversos cenários, devendo servir de base para estudos e formulação de políticas públicas sobre tais aspectos.

This document was produced on the basis of the Gender workshop on the work of female Family Doctors in rural and remote areas, during the 13th Brazilian Congress of Family and Community Medicine, from July 8-12, 2015. It aimed to establish important assumptions for the recruitment, training, provision, and support for the work of female family physicians in the many rural, rururban and remote areas of the country, in its various different scenarios, and should serve as a basis for studies and formulation of public policies on such aspects.

El presente documento fue producido con base en el taller de Género sobre el trabajo de las Médicas de Familia (Cabecera) en áreas rurales y remotas, durante el 13º Congreso Brasileño de Medicina de Familia y Comunidad, de 8 a 12 de julio de 2015. Su objetivo es el estabelecimiento de importantes presuposiciones para el reclutamiento, formación, provisión, fijación y suporte para el trabajo de las médicas de familia y comunidad en las más distintas áreas rurales, rururbanas y remotas del país bajo los más diversos escenarios, debiendo servir de base para estudios y formulación de políticas públicas sobre tales aspectos.