Stage IV invasive breast cancer in an indigenous villager: a case report and review of literature

Breast cancer is one of the leading causes of death worldwide. Among the risk factors related to this disease, lifestyle and unhealthy diet have important relevance. In the present report, we describe the case of an indigenous villager who consumed processed foods, such as snacks, soft drinks, artificial juice and biscuits. Therefore, we were able to observe a transition in habits of the indigenous population with possible epidemiological repercussions.

Letalidade e características dos óbitos por COVID-19 em Rondônia: estudo observacional / Letalidad y características de los óbitos debidos a COVID-19 en Rondônia: un estudio observacional / Lethality and characteristics of deaths due to COVID-19 in Rondônia: an observational study

Objetivo: Descrever as características dos óbitos por COVID-19 no estado de Rondônia. Métodos: Estudo descritivo, com dados do Sistema Estratégia de Informatização do Sistema Único de Saúde Vigilância Epidemiológica (E-SUS-VE), notificados entre 1º de janeiro e 20 de agosto de 2020. Foram aplicados testes estatísticos (qui-quadrado e procedimento de Marascuilo), considerando-se como diferenças significantes quando os testes apresentaram p-valor <0,05. Resultados: Foram notificados 184.146 casos suspeitos, dos quais 49.804 foram confirmados como COVID-19, e 1.020 evoluíram para óbito (letalidade 2,1%). Observaram-se diferenças significantes estatisticamente entre as faixas etárias e a letalidade (p-valor <0,001); maior letalidade quanto maior a idade (procedimento de Marascuilo, significativo na comparação entre maiores de 60 anos com as demais faixas etárias); maior óbito no sexo masculino (letalidade de 2,7%); e maior letalidade entre as pessoas de cor preta (3,0%). Conclusão: Em Rondônia, observou-se maior letalidade entre idosos, homens e pessoas pardas e pretas.

Objetivo: Describir las características de los óbitos debidos a COVID-19 en Rondônia. Métodos: Estudio descriptivo, con datos del Sistema de Estrategia de Computación del Sistema Unificado de Salud de Vigilancia Epidemiológica (E-SUS-VE), notificados entre el 1 de enero y el 20 de agosto de 2020. Se aplicaron pruebas estadísticas (procedimiento Chi-cuadrado y Marascuilo), considerando significativas cuando las pruebas presentaron valor p<0,05. Resultados: se notificaron 184.146 casos sospechosos, con 49.804 confirmados como COVID-19 y 1.020 muertes (letalidad 2,1%). Se observaron diferencias estadísticamente significativas entre grupos de edad y letalidad (valor p <0,001); a mayor edad mayor letalidad (procedimiento de Marascuilo, significativo en la comparación entre mayores de 60 años con los otros grupos de edad); mayor óbito en el sexo masculino (letalidad del 2,7%); y mayor letalidad entre la raza negra (3,0%). Conclusión: En Rondônia, hubo una mayor letalidad entre los adultos mayores, hombres y pardos y negros.

Objective: To describe the characteristics of deaths due to COVID-19 in the state of Rondônia. Methods: This was a descriptive study, with data from the Brazilian National Health System Epidemiological Surveillance System Computerization Strategy (E-SUS-VE, notified between January 1 and August 20, 2020. Statistical tests (Chi-square and Marascuilo procedure) were applied, where differences were considered to be significant when p< 0.05. Results 184,146 suspected cases were reported, of which 49,804 were confirmed as COVID-19, and 1,020 died (lethality 2.1%). Statistically significant differences were observed between age groups and lethality (p-value <0.001); lethality was greater as age increased (Marascuilo procedure, significant in the comparison between the over 60s and the other age groups); death was higher among males (2.7% lethality); and lethality was higher among Black people (3.0%). Conclusion: Lethality was greater among the elderly, males and people of brown and black skin color in Rondônia.

Lethality and characteristics of deaths due to COVID-19 in Rondônia: an observational study. / Letalidade e características dos óbitos por COVID-19 em Rondônia: estudo observacional.

OBJECTIVE: To describe the characteristics of deaths due to COVID-19 in the state of Rondônia. METHODS: This was a descriptive study, with data from the Brazilian National Health System Epidemiological Surveillance System Computerization Strategy (E-SUS-VE, notified between January 1 and August 20, 2020. Statistical tests (Chi-square and Marascuilo procedure) were applied, where differences were considered to be significant when p< 0.05. RESULTS: 184,146 suspected cases were reported, of which 49,804 were confirmed as COVID-19, and 1,020 died (lethality 2.1%). Statistically significant differences were observed between age groups and lethality (p-value <0.001); lethality was greater as age increased (Marascuilo procedure, significant in the comparison between the over 60s and the other age groups); death was higher among males (2.7% lethality); and lethality was higher among Black people (3.0%). CONCLUSION: Lethality was greater among the elderly, males and people of brown and black skin color in Rondônia.

Lethality and characteristics of deaths due to COVID-19 in Rondônia: an observational study / La letalidad y las características de las muertes debidas a COVID-19 en Rondônia: un estudio observacional / Letalidade e características dos óbitos por COVID-19 em Rondônia: estudo observacional

Objective: To describe the characteristics of deaths due to COVID-19 in the state of Rondônia. Methods: Descriptive study, with data from the Computerization Strategy System of the Unified Health System Epidemiological Surveillance (E-SUS-VE, notified between January 1 and August 20, 2020. Statistical tests (Chi-square and Marascuilo procedure) were applied, considering as significant differences when the tests presented p-value < 0.05. Results: 184,146 suspected cases were reported, of which 49,804 were confirmed as COVID-19, and 1,020 died (lethality 2.1%). Statistically significant differences were observed between age groups and lethality (p-value <0.001); higher lethality the older the age (Marascuilo procedure, significant in the comparison between over 60 years with the other age groups); higher death in males (lethality of 2.7%); and higher lethality among black people (3.0%). Conclusion: In Rondônia, there was greater lethality among the elderly, men and brown and black people.

Objetivo: Descrever as características dos óbitos por COVID-19 no estado de Rondônia. Métodos: Estudo descritivo, com dados do Sistema Estratégia de Informatização do Sistema Único de Saúde Vigilância Epidemiológica (E-SUS-VE), notificados entre 1º de janeiro e 20 de agosto de 2020. Foram aplicados testes estatísticos (Qui-Quadrado e procedimento de Marascuilo), considerando como diferenças significantes quando os testes apresentaram p-valor <0,05. Resultados: Foram notificados 184.146 casos suspeitos, dos quais 49.804 foram confirmados como COVID-19, e 1.020 evoluíram para óbito (letalidade 2,1%). Observou-se diferenças significantes estatisticamente entre as faixas etárias e letalidade (p-valor <0,001); maior letalidade quanto maior a idade (procedimento de Marascuilo, significativo na comparação entre maiores de 60 anos com as demais faixas etárias); maior óbito no sexo masculino (letalidade de 2,7%); e maior letalidade entre as pessoas de cor preta (3,0%).  Conclusão: Em Rondônia, observou-se maior letalidade entre idosos, homens e pessoas pardas e pretas.

Health service access for tuberculosis diagnosis and treatment among indigenous peoples in Rondônia state, Brazilian Amazon, 2009-2011: a cross-sectional study. / Acesso aos serviços de saúde para o diagnóstico e tratamento da tuberculose entre povos indígenas do estado de Rondônia, Amazônia Brasileira, entre 2009 e 2011: um estudo transversal.

OBJECTIVE: to investigate access to health services for tuberculosis (TB) diagnosis and treatment among indigenous peoples in Rondônia State, Brazil, 2009-2011. METHODS: we conducted a cross-sectional study with indigenous people attending Indigenous Health Care Units (Casai) between October 2009 and February 2011; geographical, economical and functional dimensions of access to TB services were evaluated through interviews and then described. RESULTS: 52 indigenous people with TB were interviewed; in the geographical dimension, lack of transportation, distance and lack of health professionals were the main obstacles; in the economic dimension, 15 indigenous people reported cost/expense as a barrier to access; in the functional dimension, 21 arrived at the Casai using their own means; 24 reported that the time between first symptoms and arriving at the Casai was > 30days; 25 reported that time between first consultation and starting treatment was >30 days; treatment was supervised in 22 cases. CONCLUSION: the difficulties found in accessing health services in the dimensions we analyzed can contribute to TB continuing to be transmitted in indigenous villages.

[Assessment of prenatal care for indigenous women in Brazil: findings from the First National Survey of Indigenous People's Health and Nutrition]. / Avaliação da atenção pré-natal ofertada às mulheres indígenas no Brasil: achados do Primeiro Inquérito Nacional de Saúde e Nutrição dos Povos Indígenas.

This study assesses prenatal care for indigenous women 14-49 years of age with children under five years of age in Brazil. The First National Survey of Indigenous People's Health and Nutrition assessed 3,967 women who met these criteria, of whom 41.3% in the North, 21.2% in the Central, 22.2% in the Northeast, and 15% in the South/Southeast. Prenatal care was offered to 3,437 (86.6%) of these women. The North of Brazil showed the highest proportion of indigenous women who did not receive prenatal care. Coverage was 90.4%, but only some 30% began prenatal care in the first trimester, and only 60% of the eligible women were vaccinated for diphtheria and tetanus. Only 16% of indigenous pregnant women had seven or more prenatal visits. Access to at least one clinical-obstetric consultation was found in 97% of the records, except for breast examination (63%). Laboratory test rates were low (blood glucose 53.6%, urinalysis 53%, complete blood count 56.9%, Pap smear 12.9%, syphilis test 57.6%, HIV serology 44.2%, hepatitis B 53.6%, rubella 21.4%, and toxoplasmosis 32.6%), as was prescription of ferrous sulfate (44.1%). As a whole, the proportion of orders for recommended laboratory tests was only 53%. The percentages of prenatal care procedures for indigenous women are lower than for non-indigenous Brazilian women as a whole, and are even lower than among women in regions with high social vulnerability and low healthcare coverage, like the Legal Amazonia and the Northeast. The results confirm the persistence of ethnic-racial inequalities that compromise the health and well-being of indigenous mothers.

Este estudo avalia a atenção pré-natal de mulheres indígenas com idades entre 14-49 anos, com filhos menores de 60 meses no Brasil. O Primeiro Inquérito Nacional de Saúde e Nutrição dos Povos Indígenas avaliou 3.967 mulheres que atendiam a tais requisitos, sendo 41,3% da Região Norte; 21,2% do Centro-oeste; 22,2% do Nordeste; e 15% do Sul/Sudeste. O pré-natal foi ofertado a 3.437 (86,6%) delas. A Região Norte registrou a maior proporção de mulheres que não fizeram pré-natal. A cobertura alcançada foi de 90,4%, mas somente cerca de 30% iniciaram o pré-natal no 1º trimestre e apenas 60% das elegíveis foram vacinadas contra difteria e tétano. Somente 16% das gestantes indígenas realizaram 7 ou mais consultas de pré-natal. Ter acesso a pelo menos um cuidado clínico-obstétrico foi observado em cerca de 97% dos registros, exceto exame de mamas (63%). Foi baixa a solicitação de exames (glicemia 53,6%, urina 53%, hemograma 56,9%, citologia oncótica 12,9%, teste de sífilis 57,6%, sorologia para HIV 44,2%, hepatite B 53,6%, rubéola 21,4% e toxoplasmose 32,6%) e prescrição de sulfato ferroso (44,1%). No conjunto, a proporção de solicitações de exames laboratoriais preconizados não ultrapassou 53%. Os percentuais de realização das ações do pré-natal das indígenas são mais baixos que os encontrados para mulheres não indígenas no conjunto do território nacional, e até mesmo para as residentes em regiões de elevada vulnerabilidade social e baixa cobertura assistencial como a Amazônia Legal e o Nordeste. Os resultados reafirmam a persistência de desigualdades étnico-raciais que comprometem a saúde e o bem-estar de mães indígenas.

Este estudio evalúa la atención prenatal a mujeres indígenas con edades comprendidas entre los 14-49 años, con hijos menores de 60 meses en Brasil. La Primera Encuesta Nacional de Salud y Nutrición de los Pueblos Indígenas evaluó a 3.967 mujeres que reunían tales requisitos, procediendo un 41,3% de la Región Norte; un 21,2% del Centro-oeste; un 22,2% del Nordeste; y un 15% del Sur/Sudeste. El servicio prenatal se le ofreció a 3.437 (86,6%) de ellas. La Región Norte registró la mayor proporción de mujeres que no realizaron el seguimiento prenatal. La cobertura alcanzada fue de un 90,4%, pero solamente cerca de un 30% comenzaron el seguimiento prenatal durante el primer trimestre y sólo un 60% de las elegibles fueron vacunadas contra la difteria y tétanos. Solamente un 16% de las gestantes indígenas realizaron 7 o más consultas de prenatal. Alrededor de un 97% de los registros se observó que tuvieron acceso a por lo menos un cuidado clínico-obstétrico, excepto el examen de mamas (63%). Fue baja la solicitud de exámenes (glucemia 53,6%, orina 53%, hemograma 56,9%, citología oncológica 12,9%, test de sífilis 57,6%, serología para VIH 44,2%, hepatitis B 53,6%, rubeola 21,4% y toxoplasmosis un 32,6%) y la prescripción de sulfato ferroso (44,1%). En conjunto, la proporción de solicitudes de exámenes de laboratorio previstos no sobrepasó el 53%. Los porcentajes de realización de acciones del seguimiento prenatal por parte de las indígenas son más bajos que los encontrados en mujeres no indígenas, en el conjunto del territorio nacional, y hasta incluso en comparación con las residentes en regiones de elevada vulnerabilidad social y baja cobertura asistencial como la Amazonia Legal y el Nordeste. Los resultados reafirman la persistencia de desigualdades étnico-raciales que comprometen la salud y el bienestar de las madres indígenas.

Avaliação da atenção pré-natal ofertada às mulheres indígenas no Brasil: achados do Primeiro Inquérito Nacional de Saúde e Nutrição dos Povos Indígenas / Assessment of prenatal care for indigenous women in Brazil: findings from the First National Survey of Indigenous People's Health and Nutrition / Evaluación de la atención prenatal ofrecida a mujeres indígenas en Brasil: resultados de la Primera Encuesta Nacional de Salud y Nutrición de los Pueblos Indígenas

Resumo: Este estudo avalia a atenção pré-natal de mulheres indígenas com idades entre 14-49 anos, com filhos menores de 60 meses no Brasil. O Primeiro Inquérito Nacional de Saúde e Nutrição dos Povos Indígenas avaliou 3.967 mulheres que atendiam a tais requisitos, sendo 41,3% da Região Norte; 21,2% do Centro-oeste; 22,2% do Nordeste; e 15% do Sul/Sudeste. O pré-natal foi ofertado a 3.437 (86,6%) delas. A Região Norte registrou a maior proporção de mulheres que não fizeram pré-natal. A cobertura alcançada foi de 90,4%, mas somente cerca de 30% iniciaram o pré-natal no 1º trimestre e apenas 60% das elegíveis foram vacinadas contra difteria e tétano. Somente 16% das gestantes indígenas realizaram 7 ou mais consultas de pré-natal. Ter acesso a pelo menos um cuidado clínico-obstétrico foi observado em cerca de 97% dos registros, exceto exame de mamas (63%). Foi baixa a solicitação de exames (glicemia 53,6%, urina 53%, hemograma 56,9%, citologia oncótica 12,9%, teste de sífilis 57,6%, sorologia para HIV 44,2%, hepatite B 53,6%, rubéola 21,4% e toxoplasmose 32,6%) e prescrição de sulfato ferroso (44,1%). No conjunto, a proporção de solicitações de exames laboratoriais preconizados não ultrapassou 53%. Os percentuais de realização das ações do pré-natal das indígenas são mais baixos que os encontrados para mulheres não indígenas no conjunto do território nacional, e até mesmo para as residentes em regiões de elevada vulnerabilidade social e baixa cobertura assistencial como a Amazônia Legal e o Nordeste. Os resultados reafirmam a persistência de desigualdades étnico-raciais que comprometem a saúde e o bem-estar de mães indígenas.

Abstract: This study assesses prenatal care for indigenous women 14-49 years of age with children under five years of age in Brazil. The First National Survey of Indigenous People's Health and Nutrition assessed 3,967 women who met these criteria, of whom 41.3% in the North, 21.2% in the Central, 22.2% in the Northeast, and 15% in the South/Southeast. Prenatal care was offered to 3,437 (86.6%) of these women. The North of Brazil showed the highest proportion of indigenous women who did not receive prenatal care. Coverage was 90.4%, but only some 30% began prenatal care in the first trimester, and only 60% of the eligible women were vaccinated for diphtheria and tetanus. Only 16% of indigenous pregnant women had seven or more prenatal visits. Access to at least one clinical-obstetric consultation was found in 97% of the records, except for breast examination (63%). Laboratory test rates were low (blood glucose 53.6%, urinalysis 53%, complete blood count 56.9%, Pap smear 12.9%, syphilis test 57.6%, HIV serology 44.2%, hepatitis B 53.6%, rubella 21.4%, and toxoplasmosis 32.6%), as was prescription of ferrous sulfate (44.1%). As a whole, the proportion of orders for recommended laboratory tests was only 53%. The percentages of prenatal care procedures for indigenous women are lower than for non-indigenous Brazilian women as a whole, and are even lower than among women in regions with high social vulnerability and low healthcare coverage, like the Legal Amazonia and the Northeast. The results confirm the persistence of ethnic-racial inequalities that compromise the health and well-being of indigenous mothers.

Resumen: Este estudio evalúa la atención prenatal a mujeres indígenas con edades comprendidas entre los 14-49 años, con hijos menores de 60 meses en Brasil. La Primera Encuesta Nacional de Salud y Nutrición de los Pueblos Indígenas evaluó a 3.967 mujeres que reunían tales requisitos, procediendo un 41,3% de la Región Norte; un 21,2% del Centro-oeste; un 22,2% del Nordeste; y un 15% del Sur/Sudeste. El servicio prenatal se le ofreció a 3.437 (86,6%) de ellas. La Región Norte registró la mayor proporción de mujeres que no realizaron el seguimiento prenatal. La cobertura alcanzada fue de un 90,4%, pero solamente cerca de un 30% comenzaron el seguimiento prenatal durante el primer trimestre y sólo un 60% de las elegibles fueron vacunadas contra la difteria y tétanos. Solamente un 16% de las gestantes indígenas realizaron 7 o más consultas de prenatal. Alrededor de un 97% de los registros se observó que tuvieron acceso a por lo menos un cuidado clínico-obstétrico, excepto el examen de mamas (63%). Fue baja la solicitud de exámenes (glucemia 53,6%, orina 53%, hemograma 56,9%, citología oncológica 12,9%, test de sífilis 57,6%, serología para VIH 44,2%, hepatitis B 53,6%, rubeola 21,4% y toxoplasmosis un 32,6%) y la prescripción de sulfato ferroso (44,1%). En conjunto, la proporción de solicitudes de exámenes de laboratorio previstos no sobrepasó el 53%. Los porcentajes de realización de acciones del seguimiento prenatal por parte de las indígenas son más bajos que los encontrados en mujeres no indígenas, en el conjunto del territorio nacional, y hasta incluso en comparación con las residentes en regiones de elevada vulnerabilidad social y baja cobertura asistencial como la Amazonia Legal y el Nordeste. Los resultados reafirman la persistencia de desigualdades étnico-raciales que comprometen la salud y el bienestar de las madres indígenas.

Acesso aos serviços de saúde para o diagnóstico e tratamento da tuberculose entre povos indígenas do estado de Rondônia, Amazônia Brasileira, entre 2009 e 2011: um estudo transversal / Acceso a los servicios de salud para el diagnóstico y tratamiento de la tuberculosis entre pueblos indígenas del Estado de Rondônia, Amazonía Brasileña, entre 2009 y 2011: un estudio transversal / Health service access for tuberculosis diagnosis and treatment among indigenous peoples in Rondônia state, Brazilian Amazon, 2009-2011: a cross-sectional study

Objetivo: investigar o acesso aos serviços de saúde para diagnóstico e tratamento da tuberculose (TB) entre indígenas atendidos no estado de Rondônia, Brasil, 2009-2011. Métodos: estudo transversal, realizado nas Casas de Saúde Indígena (Casai), entre outubro/2009 e fevereiro/2011; investigou-se, mediante entrevistas, as dimensões geográfica, econômica e funcional do acesso aos serviços de TB, apresentadas descritivamente. Resultados: foram entrevistados 52 indígenas com TB; na dimensão geográfica, transporte, distância e ausência de profissionais foram as principais barreiras; na econômica, 15 indígenas relataram custos/despesas para receber atendimento; na funcional, 21 chegaram à Casai por conta própria; o tempo entre primeiros sintomas e chegada à Casai foi >30 dias em 24 relatos, e entre primeira consulta e início do tratamento, >30 dias em 25 relatos; houve tratamento supervisionado em 22 casos. Conclusão: as dificuldades observadas para acessar os serviços de saúde, nas dimensões analisadas, podem contribuir para a manutenção da transmissão da TB nas aldeias.

Objetivo: investigar el acceso a los servicios de salud para diagnóstico y tratamiento de la tuberculosis (TB) entre indígenas en el estado de Rondônia, Brasil, entre 2009 y 2011. Métodos: estudio transversal con indígenas atendidos en las Casas de Salud Indígenas (Casai) entre octubre/2009-febrero/2011; se evaluaron las dimensiones geográficas, económicas y funcionales que fueron presentadas descriptivamente. Resultados: fueron entrevistados 52 indígenas con TB; en la dimensión geográfica, el transporte, el dinero, y la ausencia de profesionales fueran las principales barreras; en la dimensión económica, 15 relataron gastos para recibir atención; en la dimensión funcional, 21 llegaron por su cuenta; el tiempo desde los primeros síntomas y la llegada a Casai fue >30 días en 24 personas; se reportó tratamiento supervisado en 22 casos; para 25, el tiempo entre la primera consulta hasta el comienzo del tratamiento fue >30 días. Conclusión: las dificultades enfrentadas para obtener acceso a los servicios de salud en todas las dimensiones pueden contribuir con la continuidad de transmisión en las aldeas.

Objective: to investigate access to health services for tuberculosis (TB) diagnosis and treatment among indigenous peoples in Rondônia State, Brazil, 2009-2011. Methods: we conducted a cross-sectional study with indigenous people attending Indigenous Health Care Units (Casai) between October 2009 and February 2011; geographical, economical and functional dimensions of access to TB services were evaluated through interviews and then described. Results: 52 indigenous people with TB were interviewed; in the geographical dimension, lack of transportation, distance and lack of health professionals were the main obstacles; in the economic dimension, 15 indigenous people reported cost/expense as a barrier to access; in the functional dimension, 21 arrived at the Casai using their own means; 24 reported that the time between first symptoms and arriving at the Casai was > 30days; 25 reported that time between first consultation and starting treatment was >30 days; treatment was supervised in 22 cases. Conclusion: the difficulties found in accessing health services in the dimensions we analyzed can contribute to TB continuing to be transmitted in indigenous villages.

Perfil da Formação Médica em Terapia Intensiva no Estado de Rondônia / The Profile of Medical Education on Intensive Care in the State of Rondônia, Brazil

RESUMO A Medicina Intensiva (MI) é uma especialidade que apresenta um déficit de profissionais qualificados com título em MI. Esse déficit se deve principalmente ao significativo aumento de leitos de unidade de terapia intensiva (UTI) nas últimas décadas. No Brasil, menos de 2% dos médicos possuem formação nessa especialidade. A legislação vigente preconiza um médico diarista/rotineiro com título de especialista em MI para cada dez leitos em cada turno. O Estado de Rondônia conta com 183 leitos de UTI e apenas 18 médicos intensivistas, segundo a Associação de Medicina Intensiva Brasileira. Esse quadro coloca em risco a qualidade do serviço em MI, principalmente para o usuário. O presente estudo buscou caracterizar o perfil de formação dos médicos intensivistas que atuam nas UTI dos hospitais da rede pública e privada do Estado de Rondônia. Trata-se de um estudo transversal e quantitativo, com uso de questionário autoaplicável com perguntas sobre condições sociodemográficas e perfil profissional, do qual participaram 93 profissionais. Os resultados mostram que a maior proporção é do sexo masculino, na faixa etária de 30 a 40 anos, com renda mensal acima de dez salários mínimos. Cerca de um terço relatou acúmulo de dois locais de trabalho, e menos de 20% atuam apenas em UTI. A maioria dos participantes atua em UTI pública e privada, e apenas 19,4% possuem especialização em Medicina Intensiva. A participação em eventos científicos foi significativa, mas apenas um em cada cinco participa de projeto de pesquisa, e um em cada quatro publica artigos científicos. O reduzido número de especialistas que atua nas UTI compromete a qualidade dos serviços de assistência prestados aos usuários. Esforços para correção dessa deficiência devem ser estimulados por meio do aumento da oferta de vagas do programa de residência médica local, visando à melhoria na qualidade da gestão e dos profissionais médicos que atuam nessas UTI.

ABSTRACT As a specialization, Intensive Care (IC) is currently experiencing a shortage of qualified professionals with the specific IC title. This shortage is mainly due to a significant increase in the number of beds in intensive care units (ICU) in recent decades, with less than 2% of physicians trained in this specialization in Brazil. The country’s legislation calls for one daytime/routine doctor specialized in IC for every 10 beds per shift, whereas, according to the Brazilian Intensive Care Association, the State of Rondônia only has 183 ICU beds and 18 intensive care physicians. This framework puts the quality of the IC service at risk, particularly for users. The following study sought to characterize the educational profile of intensive care physicians working in intensive care units (ICU) in public and private hospitals in state of Rondônia. Completed by 93 professionals, this transversal and quantitative study featured a self-administered questionnaire containing questions on sociodemographic conditions and professional profiles. The results showed that the highest proportion were male and aged 30-40, with a monthly income over ten minimum monthly salaries. Approximately 1/3 reported working in two different places, and less than 20% worked exclusively in ICU. Most of the participants worked in public and private ICU, and only 19.4% were specialized in Intensive Care Medicine. Participation in scientific events was significant, but only 1 out of 5 took part in research projects, with only 1 out of 4 publishing scientific articles. The small number of experts working in ICU compromises the quality of care services provided to users. Efforts to correct this deficiency should be encouraged by increasing the vacancies offered on local residency programs, improving the quality of management, as well as providing better training for medical professionals working in ICU.

Diarrhea and health inequity among Indigenous children in Brazil: results from the First National Survey of Indigenous People's Health and Nutrition.

BACKGROUND: Globally, diarrhea is the second leading cause of death among children under five. In Brazil, mortality due to diarrhea underwent a significant reduction in recent decades principally due to expansion of the primary healthcare network, use of oral rehydration therapy, reduced child undernutrition, and improved access to safe drinking water. The First National Survey of Indigenous People's Health and Nutrition in Brazil, conducted in 2008-2009, was the first survey based on a nationwide representative sample to study the prevalence of diarrhea and associated factors among Indigenous children in the country. METHODS: The survey assessed the health and nutritional status of Indigenous children < 5 years of age based on a representative sample of major Brazilian geopolitical regions. A stratified probabilistic sampling was carried out for Indigenous villages. Within villages, children < 5 years of age in sampled households were included in the study. Interviews were based on a seven day recall period. Prevalence rates of acute diarrhea were calculated for independent variables and hierarchical multivariable analyses were conducted to assess associations. RESULTS: Information on diarrhea was obtained for 5,828 children (95.1% of the total sample). The overall prevalence of diarrhea was 23.5%. Regional differences were observed, with the highest rate being in the North (38.1%). Higher risk of diarrhea was observed among younger children and those who had less maternal schooling, lower household socioeconomic status, undernutrition (weight-for-age deficit), presence of another child with diarrhea in the household, and occurrence of upper respiratory infection. CONCLUSIONS: According to results of the First National Survey of Indigenous People's Health and Nutrition, almost a quarter of Indigenous children throughout the country had diarrhea during the previous week. This prevalence is substantially higher than that documented in 2006 for Brazilian children < 5 years generally (9.4%). Due to its exceedingly multicausal nature, the set of associated variables that remained associated with child diarrhea in the final multivariable model provide an excellent reflection of the diverse social and health inequities faced by Indigenous peoples in contemporary Brazil.

Compreendendo o apoio matricial e o resultado da certificação de qualidade nas áreas de atenção à criança, mulher, diabetes/hipertensão e saúde mental / Understanding matrix support and quality certification results in the areas of care for women, care for children, hypertension and diabetes as well as mental health

Este artigo apresenta a distribuição do apoio matricial (AM) no Brasil, identificando relações entre as atividades de AM e a certificação do PMAQ-AB. Utilizaram-se dois modelos de regressão logística múltipla. As atividades de AM na Atenção Básica são significativas mas desiguais, com altos graus de AM em lugares desenvolvidos. Existe associação positiva entre o grau de apoio e o resultado obtido na certificação. Elevados graus de AM correspondem a 89%, 80%, 89% e 63% de chances de as equipes obterem uma melhor certificação na atenção à mulher, criança, hipertensão e diabetes e saúde mental, respectivamente. O AM tem ajudado a melhorar a qualidade da Atenção Básica no Brasil.

This article aims to present the distribution of matrix support (MS) in Brazil and identify relations between MS activities and PMAQ-AB certification results. Two multiple logistic regression models were run. MS activities in primary care are significant, although uneven. There is a positive association between the level of support and result obtained in certification. High degrees of MS correspond to the probabilities of 89%, 80%, 89% and 63% that teams obtain better certification on attention to woman, child, hypertension and diabetes, and to mental health, respectively. MS has progressively helped to improve primary care in Brazil.

Prevalence of anemia and associated factors among indigenous children in Brazil: results from the First National Survey of Indigenous People's Health and Nutrition.

BACKGROUND: Anemia is the most prevalent nutritional deficiency globally, affecting about a quarter of the world population. In Brazil, about one-fifth of children under five years of age are anemic. Previous case studies indicate prevalence rates much higher among indigenous peoples in the country. The First National Survey of Indigenous People's Health and Nutrition in Brazil, conducted in 2008-2009, was the first survey based on a nationwide representative sample to study the prevalence of anemia and associated factors among indigenous children in Brazil. METHODS: The survey assessed the health and nutritional status of indigenous children < 5 years of age based on a representative sample of major Brazilian geopolitical regions. A stratified probabilistic sampling was carried out for indigenous villages. Within villages, children < 5 years of age in sampled households were included in the study. Prevalence rates of anemia were calculated for independent variables and hierarchical multivariate analysis were conducted to assess associations. RESULTS: Evaluation of hemoglobin levels was conducted for 5,397 children (88.1% of the total sample). The overall prevalence of anemia was 51.2%. Higher risk of presenting anemia was documented for boys, lower maternal schooling, lower household socioeconomic status, poorer sanitary conditions, presence of maternal anemia, and anthropometric deficits. Regional differences were observed, with the highest rate being observed in the North. CONCLUSIONS: The prevalence rates of anemia in indigenous children were approximately double than those reported for non-indigenous Brazilian children in the same age group. Similarly notable differences in the occurrence of anemia in indigenous and non-indigenous children have been reported for other countries. Deeper knowledge about the etiology of anemia in indigenous children in Brazil is essential to its proper treatment and prevention.

Aspectos de la fecundidad de mujeres indígenas Suruí, Rondônia, Brasil: una aproximación / Aspects of the fertility of indigenous Suruí women in Rondônia, Brazil: an approximation

OBJETIVOS: caracterizar aspectos de la fecundidad de mujeres indígenas Suruí de la Amazonía brasilera. MÉTODOS: se levantaron y sistematizaron 88 historias reproductivas y de nacimientos, obtenidas a través de visitas domiciliarias en dos aldeas, realizadas en 2004. RESULTADOS: el promedio de edad de la menarquía fue 12 años; las edades medias de entrada a la primera unión y del nacimiento del primer hijo fueron, respectivamente, 13,8 y 15,7 años. El parto ocurrió en la aldea en su mayoría. Las mujeres Suruí presentan un intervalo intergenésico promedio próximo a los 22,8 meses. El promedio de amamantación fue 18,4 meses. El uso de contraceptivos es mínimo y el número de años de estudio de las mujeres es bajo. La tasa de fecundidad total fue de 6,3 hijos. CONCLUSIÓN: si se compara con resultados de otros estudios en pueblos indígenas, la demografía Suruí señala niveles de fecundidad entre moderados y elevados. Los autores argumentan que los hallazgos son relevantes para la prestación de servicios de salud culturalmente compatibles con la realidad Suruí.

OBJECTIVES: to analyze female fertility among Suruí Indian women in the Brazilian Amazon. METHODS: a total of 88 reproductive and birth histories were collected by means of household interviews carried out in two Suruí villages in 2004. RESULTS: the average age of menarche was 12 years-old; the average ages of first marriage and of the delivering the first child were, respectively, 13.8 and 15.7 years-old. For most women, delivery took place in their own village. The average time between pregnancies was 22.8 months and the average breast feeding duration was 18.4 months. Very few Suruí women use contraceptives and most have attended school for only a couple of years. On average, the total fertility rate was of 6.3 children per woman. CONCLUSIONS: in comparison with other populations, Suruí's demography shows a moderately high fertility rate. The authors argue that the findings of this study can be of use to better plan health services that are more culturally compatible with the reality of Suruí women.

The dynamics of transmission and spatial distribution of malaria in riverside areas of Porto Velho, Rondônia, in the Amazon region of Brazil.

UNLABELLED: The study area in Rondônia was the site of extensive malaria epidemic outbreaks in the 19(th) and 20(th) centuries related to environmental impacts, with large immigration flows. The present work analyzes the transmission dynamics of malaria in these areas to propose measures for avoiding epidemic outbreaks due to the construction of two Hydroelectric Power Plants. A population based baseline demographic census and a malaria prevalence follow up were performed in two river side localities in the suburbs of Porto Velho city and in its rural vicinity. The quantification and nature of malaria parasites in clinical patients and asymptomatic parasite carriers were performed using microscopic and Real Time PCR methodologies. Anopheles densities and their seasonal variation were done by monthly captures for defining HBR (hourly biting rate) values. MAIN RESULTS: (i) malaria among residents show the riverside profile, with population at risk represented by children and young adults; (ii) asymptomatic vivax and falciparum malaria parasite carriers correspond to around 15% of adults living in the area; (iii) vivax malaria relapses were responsible for 30% of clinical cases; (iv) malaria risk for the residents was evaluated as 20-25% for vivax and 5-7% for falciparum malaria; (v) anopheline densities shown outdoors HBR values 5 to 10 fold higher than indoors and reach 10.000 bites/person/year; (vi) very high incidence observed in one of the surveyed localities was explained by a micro epidemic outbreak affecting visitors and temporary residents. Temporary residents living in tents or shacks are accessible to outdoors transmission. Seasonal fishermen were the main group at risk in the study and were responsible for a 2.6 fold increase in the malaria incidence in the locality. This situation illustrates the danger of extensive epidemic outbreaks when thousands of workers and secondary immigrant population will arrive attracted by opportunities opened by the Hydroelectric Power Plants constructions.

Spatial heterogeneity of malaria in Indian reserves of southwestern Amazonia, Brazil.

BACKGROUND: Malaria constitutes a major cause of morbidity in the Brazilian Amazon where an estimated 6 million people are considered at high risk of transmission. Indigenous peoples in the Amazon are particularly vulnerable to potentially epidemic disease such as malaria; notwithstanding, very little is known about the epidemiology of malaria in Indian reservations of the region. The aim of this paper is to present a spatial analysis of malaria cases over a four-year time period (2003-2006) among indigenous peoples of the Brazilian State of Rondônia, southwestern Amazon, by using passive morbidity data (results from Giemsa-stained thick blood smears) gathered from the National Malaria Epidemiologic Surveillance System databank. RESULTS: A total of 4,160 cases of malaria were recorded in 14 Indian reserves in the State of Rondônia between 2003 and 2006. In six reservations no cases of malaria were reported in the period. Overall, P. vivax accounted for 76.18 of malaria cases reported in the indigenous population of Rondônia. The P. vivax/P. falciparum ratio for the period was 3.78. Two reserves accounted for over half of the cases reported for the total indigenous population in the period--Roosevelt and Pacaas Novas--with a total of 1,646 (39.57%) and 1,145 (27.52%) cases, respectively. Kernel mapping of malaria mean Annual Parasite Index--API according to indigenous reserves and environmental zones revealed a heterogeneous pattern of disease distribution, with one clear area of high risk of transmission comprising reservations of west Rondônia along the Guaporé-Madeira River basins, and another high risk area to the east, on the Roosevelt reserve. CONCLUSION: By means of kernel mapping, it was shown that malaria risk varies widely between Indian reserves and environmental zones defined on the basis of predominant ecologic characteristics and land use patterns observed in the southwestern Brazilian Amazon. The geographical approach in this paper helped to determine where the greatest needs lie for more intensively focused malaria control activities in Indian reserves in the region. It also provided a reference to assess the effectiveness of control measures that have been put in place by Brazilian public health authorities.

[Spatial analysis and determination of malaria control areas in the State of Rondônia]. / Análise espacial e determinação de áreas para o controle da malária no Estado de Rondônia.

This paper discusses the use of spatial analysis for mapping the risk of malaria in the State of Rondônia between 1994 and 2005. Morans overall and local indices were used for spatial pattern analysis. Based on the Annual Parasitic Index, it can be stated that the municipalities forming the area at greater risk are those in which the urbanization process is more recent. They are characterized by higher population growth, greater number of settled families and high percentages of deforested area. The Moran map showed that the aggregated areas of municipalities at high risk of malaria have undergone a process of spreading into the northwestern and northeastern regions of the State. Among the municipalities considered to be at low risk, this process has taken place towards the southeast. The techniques used in this study deserve to be compared with the current methodology used by the Health Surveillance Department for determining areas at risk and financial transfers for malaria control..

Aspectos culturales de la reproducción: el caso de los Suruí de Rondonia / Cultural aspects of reproduction

Este artículo pretende comunicar resultados de unestudio demográfico sobre los aspectos culturalesligados a la reproducción, realizado en indígenasSuruí, en Rondônia y Mato Grosso, Brasil. Objetivo:descubrir los aspectos culturales ligados a lafecundidad en relación con la conciencia demográficade estos pueblos. Metodología: se adoptó elenfoque etnográfico; visitamos la totalidad de lasunidades domiciliarias de las aldeas conocidascomo Linha 14 y Placa, en la Tierra Indígena “Setede Setembro” en 2004. Participaron 115 mujeres.Resultados: Hay dos prácticas de conyugalidad,la poliginia y el matrimonio interétnico. Revive lacostumbre de la reclusión ritual de las mujeresen su primera menstruación y la prohibición derelacionarse sexualmente durante la gestación,el posparto y hasta un año después de nacer elhijo. La producción de leche materna es altamentevalorada y los niños la obtienen hasta los dos años.Tener muchos niños y producir mucha leche es elideal. Lo más importante para los Suruí es la reproducciónde la sociedad para continuar como unidadétnicamente diferenciada. Discusión: analizamoslas permanencias y los cambios en la esfera dela reproducción. Comparamos con resultados deotros estudios relacionados con la etnología Suruíy con la actuación de los servicios de asistenciaen esta comunidad. Conclusión: los aspectosculturales son los elementos esenciales para laformulación de políticas de salud que valoricen alos suruí y le impriman especificidad étnica a losprogramas y proyectos.

Análise espacial e determinação de áreas para o controle da malária no Estado de Rondônia / Spatial analysis and determination of malaria control areas in the State of Rondônia

Este trabalho discute o uso de análise espacial para confecção de mapas de risco para malária no Estado de Rondônia, entre 1994 e 2005. Para análise do padrão espacial, foram utilizados os índices de Moran global e local. Com base nos valores do Índice Parasitário Anual, pode-se afirmar que os municípios que constituem a área de maior risco são os de urbanização mais recente, caracterizados por: maior crescimento populacional, maior número de famílias assentadas e elevado percentual de área desmatada. O Moran Map mostrou que os agregados de municípios com maior risco para malária sofreram processo de espalhamento para a região noroeste e nordeste do estado. Já nos municípios considerados como de menor risco, o processo se deu em direção ao sudeste. As técnicas utilizadas em nosso estudo merecem ser comparadas com a atual metodologia utilizada pela Secretaria de Vigilância Sanitária na determinação de áreas de risco e repasse financeiro para controle da malária.

This paper discusses the use of spatial analysis for mapping the risk of malaria in the State of Rondônia between 1994 and 2005. Moran’s overall and local indices were used for spatial pattern analysis. Based on the Annual Parasitic Index, it can be stated that the municipalities forming the area at greater risk are those in which the urbanization process is more recent. They are characterized by higher population growth, greater number of settled families and high percentages of deforested area. The Moran map showed that the aggregated areas of municipalities at high risk of malaria have undergone a process of spreading into the northwestern and northeastern regions of the State. Among the municipalities considered to be at low risk, this process has taken place towards the southeast. The techniques used in this study deserve to be compared with the current methodology used by the Health Surveillance Department for determining areas at risk and financial transfers for malaria control.

Aspectos epidemiológicos da tuberculose na população indígena Suruí

O artigo, publicado originalmente na Revista da Sociedade Brasileira de Medicina Tropical retrata uma análise epidemiológica do banco dedados do Programa Municipal de Controle da Tuberculose em Cacoal, Rondônia, buscando a caracterização do perfil da doença no grupo indígena Suruí. Foi conduzida análise descritiva dos casos notificados entre 1975 e 2002

Survey for tuberculosis in an indigenous population of Amazonia: the Suruí of Rondônia, Brazil.

A cross-sectional survey was carried out in 2003 to investigate the epidemiology of tuberculosis (TB) among the Suruí Indians, Brazilian Amazon. A total of 736 subjects (50.7% females) were examined (80% of the total population). TB suspects underwent standardised evaluation for the presence of signs and/or symptoms of active TB, including chest radiography, PPD skin test, sputum microscopy examination for acid-fast bacilli and mycobacterial culture. A Bacillus Calmette-Guerin vaccine scar was detected in 699 individuals (95.0%). Of all the individuals examined, 120 (16.3%) had undergone previous TB treatment (46.7% females). One hundred and nine individuals were assessed as TB suspects (52.3% females). The survey identified six new cases of TB in the Suruí (three men and three women). Five of the six cases came from only two of the ten villages. Mycobacterium tuberculosis colonies grew from 5 (4.6%) samples (only two of which were also smear-positive) and mycobacteria other than M. tuberculosis were isolated from 14 (12.8%) samples. Diagnosis of TB based exclusively on clinical grounds was established only in the case of a 4-year-old girl. Based on this survey, the prevalence of active TB in the sampled group (N=736) was 815.2 per 100000. This study highlights the urgent need to review and strengthen control strategies directed at indigenous peoples in the country, taking into consideration their social, cultural and environmental differences.