Equality and poverty: views from managers and professionals from public services and household heads in the Belo Horizonte Metropolitan Area, Brazil.

BACKGROUND: Tackling poverty requires reconsideration of quantitative factors related to "who" is poor and by "how much" and qualitative factors addressing "what poverty means in these individuals' lives". Greater understanding is required concerning the types of access actually used by families in poverty in attempts to meet their basic needs. Poverty must be addressed based on the question: "Inequality of what?" It is in reflecting on the realities of such groups when their basic needs are not met that public policies can be improved and implemented with legitimate priorities. OBJECTIVE: Describe coverage and access to public health, education and social assistance services and the related effects on the quality of life of families in extreme poverty. METHODS: An exploratory mixed methods study was conducted applying Amartya Sen's "Basic Capability Equality" framework, with: 1) 27 interviews with managers and professionals from public services serving territories with extreme poverty; 2) Survey with a systematic proportionate stratified sample of 336 heads of households in extreme poverty from a total 2605 families. The resulting data was analyzed with thematic content analysis and descriptive statistics, respectively. RESULTS: The managers and professionals described the lives of families in extreme poverty with phrases such as, "These people suffer. Sadness weighs on their lives!" and "Depression is the most common illness". Their precarious circumstances and inadequate access were cited as causes. Quality of life was considered bad or very bad by 41.4% of heads of households. A total income of less than one-third of the minimum wage was received by 56.9% of the sample. One or more people were unemployed in the family in 55.8% of cases. For 53.3% of heads of households, public services "did not meet any or few of their needs". The main social determinants of health were described as: alcohol and drugs (68.8%); lack of good health care (60.7%); and absence of income/work (37.5%). The following were identified as solutions to improve their quality of life: (1) health (40.5%); (2) education (37.8%); and (3) employment (44.6%). CONCLUSIONS: The social determinants of poverty and health must be addressed jointly through intersectoral public policies and egalitarian mechanisms that promote investment in social protection.

A multiprofessional perspective on the principal barriers to universal health coverage and universal access to health in extremely poor territories: the contributions of nursing.

OBJECTIVE: to investigate the knowledge of managers and health professionals, social workers and education professionals regarding the principal barriers to universal health coverage and universal access to health on the part of the extremely poor population; and to point to the contributions made by nursing for the promotion of this right. METHOD: a qualitative study whose reference was, for ensuring the right to health, the reorientation of the Brazilian Unified Health System (SUS) towards universal coverage and access in these territories. Interviews were held with 27 members of the multi-professional team of a municipality with high social vulnerability. The data were worked on using thematic content analysis. RESULTS: the following were ascertained as the principal barriers to universal health coverage and access to health: failures in the expansion and strengthening of the services; absence of diagnosis of the priority demands; shortage of technology, equipment, and material and human resources; poor local infrastructure; and actions with low resolutive power and absence of interdepartmental policies. Within the multi-professional team, nursing acts in the SUS in unique health actions and social practices in these territories, presenting an in-depth perspective on this harsh reality, being able to contribute with indispensable support for confronting these disparities in universal health coverage and universal access to health. CONCLUSION: nursing's in-depth understanding regarding these barriers is essential for encouraging the processes reorienting the SUS, geared towards equality in the right to health.

A multiprofessional perspective on the principal barriers to universal health coverage and universal access to health in extremely poor territories: the contributions of nursing / Visão multiprofissional sobre as principais barreiras na cobertura e no acesso universal à saúde em territórios de extrema pobreza: contribuições da enfermagem / Visión multiprofesional sobre las principales barreras en la cobertura y acceso universal a la salud en territorios de extremada pobreza: contribuciones de enfermería

Objective: to investigate the knowledge of managers and health professionals, social workers and education professionals regarding the principal barriers to universal health coverage and universal access to health on the part of the extremely poor population; and to point to the contributions made by nursing for the promotion of this right. Method: a qualitative study whose reference was, for ensuring the right to health, the reorientation of the Brazilian Unified Health System (SUS) towards universal coverage and access in these territories. Interviews were held with 27 members of the multi-professional team of a municipality with high social vulnerability. The data were worked on using thematic content analysis. Results: the following were ascertained as the principal barriers to universal health coverage and access to health: failures in the expansion and strengthening of the services; absence of diagnosis of the priority demands; shortage of technology, equipment, and material and human resources; poor local infrastructure; and actions with low resolutive power and absence of interdepartmental policies. Within the multi-professional team, nursing acts in the SUS in unique health actions and social practices in these territories, presenting an in-depth perspective on this harsh reality, being able to contribute with indispensable support for confronting these disparities in universal health coverage and universal access to health. Conclusion: nursing's in-depth understanding regarding these barriers is essential for encouraging the processes reorienting the SUS, geared towards equality in the right to health.

Objetivo: investigar conhecimentos de gestores e profissionais da saúde, assistência social e educação sobre as principais barreiras na cobertura e acesso universal à saúde pela população extremamente pobre, e apontar as contribuições da enfermagem para promoção desse direito. Método: estudo qualitativo, tendo como referencial, para garantia do direito à saúde, a reorientação do Sistema Único de Saúde rumo à cobertura e ao acesso universal nesses territórios. Foram entrevistados 27 informantes da equipe multiprofissional de um município com elevada vulnerabilidade social. Os dados foram trabalhados pela análise de conteúdo temática. Resultados: verificaram-se, como principais barreiras na cobertura e acesso universal à saúde: falhas na expansão e fortalecimento dos serviços; ausência de diagnóstico das demandas prioritárias; carência de tecnologia, equipamentos, recursos materiais e humanos; precária infraestrutura local; ações com baixa resolutividade e ausência de políticas intersetoriais. Dentre a equipe multiprofissional, a enfermagem atua no Sistema Único de Saúde em ações de saúde e práticas sociais singulares nesses territórios, apresentando olhar aprofundado sobre essa dura realidade, podendo contribuir com subsídios indispensáveis para o enfrentamento dessas disparidades na cobertura e acesso universal. Conclusão: a compreensão aprofundada da enfermagem sobre essas barreiras é imprescindível para fomentar os processos de reorientação do Sistema Único de Saúde, direcionados à equidade no direito à saúde.

Objetivo: investigar los conocimientos de: administradores y profesionales de la salud; asistencia social; y educación, sobre las principales barreras en la cobertura y acceso universal a la salud que enfrentan la población extremadamente pobre, y apuntar las contribuciones de la enfermería para promover ese derecho. Método: estudio cualitativo, que tuvo como referencial, para garantizar el derecho a la salud, la reorientación del Sistema Único de Salud (SUS) dirigido a obtener la cobertura y al acceso universal a la salud en esos territorios. Fueron entrevistados 27 informantes del equipo multiprofesional de un municipio con elevada vulnerabilidad social. Los datos fueron trabajados a través del análisis de contenido temático. Resultados: como principales barreras en la cobertura y acceso universal a la salud, se verificaron las siguientes: fallas en la expansión y fortalecimiento de los servicios; ausencia de diagnóstico de las demandas prioritarias; carencia de tecnología, equipamientos, recursos materiales y humanos; precaria infraestructura local; acciones con baja resolutividad; y, ausencia de políticas intersectoriales. En el equipo multiprofesional, la enfermería actúa en el Sistema Único de Salud en acciones de salud y prácticas sociales singulares en esos territorios, obteniendo una visión profunda sobre esa dura realidad y pudiendo contribuir con informaciones indispensables para el enfrentamiento de esas disparidades en la cobertura y acceso universal a la salud. Conclusión: la comprensión profunda de la enfermería sobre esas barreras es imprescindible para incentivar los procesos de reorientación del Sistema Único de Salud, dirigidos a obtener la equidad en el derecho a la salud.

Diversity of Culicoides (Diptera: Ceratopogonidae) in the National Forest of Caxiuanã, Melgaço, Pará State, Brazil / Diversidade de Culicoides (Diptera: Ceratopogonidae) na Floresta Nacional de Caxiuanã, Melgaço, Estado do Pará, Brasil

The genus Culicoides is distributed worldwide and includes nearly 82 species recorded in the Brazilian Amazon. In spite of the sanitary and economic relevance of the genus, few studies have been addressed to its members in this region. This study provides a survey of Culicoides species in a research plot of the Brazilian Biodiversity Research Program in the Amazon region in Caxiuana National Forest. Collections were carried out with CDC light traps at five terrestrial sampling points from February 9 to February 13 in 2007 on the ground and at the sub-canopy level. After identifying the collected species, the frequency of species in each stratus and the Simpson's diversity index were calculated. A total of 542 specimens were collected, belonging to six species: C. foxi Ortiz, C. fusipalpis Wirth & Blanton, C. glabrior Macfie, C. guerrai Wirth & Blanton, C. hylas Macfie and C. vernoni Wirth & Blanton. The diversity of species was low in both strata {X = 0.91 on the ground; X = 0.89 in the sub-canopy). C. fusipalpis was the most abundant species at all sampling points and in both strata, corresponding to 94.8 per cent of the collected specimens. This species can be found in both floodplain ecosystems and modified areas, such as hydroelectric dams, in the Amazon Region, feeding on humans. In spite of its hematophagic activities, the species is not implicated as a vector of tropical diseases.

O gênero Culicoídes apresenta distribuição global e abrange cerca de 82 espécies registradas na Amazônia Brasileira. Apesar de sua relevância nas áreas sanitária e econômica, poucas pesquisas têm sido realizadas sobre suas espécies na região. Este estudo apresenta um levantamento das espécies de Culicoídes em um sítio de pesquisa do Programa de Pesquisa em Biodiversidade na Floresta Nacional de Caxiuanã, na Região Amazônica. As coletas foram realizadas com armadilhas luminosas tipo CDC em cinco pontos de amostragem de 9 de fevereiro a 13 de fevereiro de 2007, nos níveis do solo e subdossel. Após a identificação das espécies coletadas, a sua frequência em cada estrato e seu índice de diversidade de Simpson foram calculados. Foram coletados 542 espécimes, pertencentes a seis espécies: C. foxi Ortiz, C. fusipalpis Wirth & Blanton, C. glabrior Macfie, C. guerrai Wirth & Blanton, C. hylas Macfie e C. vernoni Wirth & Blanton. A diversidade de espécies foi baixa em ambos os estratos (X = 0,91 no solo; X = 0,89 em nível subdossel). C. fusipalpis foi a espécie mais abundante em todos os pontos de amostragem e em ambos os estratos, correspondendo a 94,8 por cento dos espécimes coletados. Na Região Amazônica, esta espécie pode ser encontrada tanto em ecossistemas de várzea como em áreas modificadas, como as localizadas no entorno de usinas hidrelétricas, alimentando-se em seres humanos. Apesar de seus hábitos hematófagos, a espécie não é apontada como vetor de doenças tropicais.

Structure of Anopheles (Diptera: Culicidae) population in areas with different degrees of human settlement: Cantá - Roraima - Brazil / Estrutura da população de Anopheles (Diptera: Culicidae) em áreas com diferentes graus de colonização humana: Cantá - Roraima - Brasil

Malaria has still been one of the most important endemic diseases in the Amazonian region. This study presents the impact of human settlements on the structure of Anopheles population. Diversity, abundance, richness and distribution of the genus Anopheles were observed in two areas with different levels of human settlement in the Cantá city, Roraima State, Northern Brazil. The influence of the dry and rainy seasons on mosquito populations was also observed. Mosquito captures were performed between 6:00 and 10:00 pm during the dry (February and November) and rainy (May and August) seasons at four different sites of each area. Among the 11 species of Anopheles identified through the adults' characteristics, An. albitarsis s.l. (45.5 percent) and An. darlingi (19.2 percent) were the most abundant in the more intensively anthropized area while An. triannulatus (19.2 percent) was more common in the less modified area. Other species found were An. nuneztovari (10.9 percent), An. oswaldoi (2.0 percent), An. evansae (1.7 percent), An. brasiliensis (0.6 percent), An. intermedius (0.3 percent), An. mediopunctatus (0.5 percent), An. periassui (0.08 percent) and An. argyritarsis (0.04 percent). The highest mosquitoes' population density was observed in May and the lowest one was observed in February and November. These results demonstrate the existence of a high diversity of anophelines in the study areas, showing that anthropic changes in the environment and climate variability affect both the population density and relative abundance of these vectors.

Malária continua sendo uma das mais importantes doenças endêmicas da região Amazônica. Esse estudo mostra o impacto da colonização humana sobre a estrutura populacional de Anopheles. Diversidade, abundância, riqueza e distribuição do gênero Anopheles foi observado em duas áreas com diferentes graus de antropização no município do Cantá, Estado de Roraima, Norte do Brasil. A influência das estações seca e chuvosa sobre a população dos mosquitos também foram investigadas. A captura dos mosquitos foi realizada entre 6:00 e 10:00 pm na estação seca (Fevereiro e Novembro) e estação chuvosa (Maio e Agosto) em quatro locais diferentes. Entre as 11 espécies de Anopheles identificadas através das características dos adultos, An. albitarsis s.l. (45.5 por cento) e An. darlingi (19.2 por cento) foram as mais abundantes nas áreas mais intensamente antropizadas, enquanto An. triannulatus (19.2 por cento) foi a espécie mais comum na área menos modificada. As outras espécies encontradas foram An. nuneztovari (10.9 por cento), An. oswaldoi (2.0 por cento), An. evansae (1.7 por cento), An. brasiliensis (0.6 por cento), An. intermedius (0.3 por cento), An. mediopunctatus (0.5 por cento), An. periassui (0.08 por cento) e An. argyritarsis (0.04 por cento). A mais alta densidade populacional de mosquitos foi observada em Maio e as mais baixas em Fevereiro e Novembro. Esses resultados demonstram a existência de uma alta diversidade de anofelinos na área estudada e que mudanças antrópicas no ambiente e variabilidade climática afetam a densidade populacional desses vetores.