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Sci Rep ; 11(1): 17534, 2021 09 02.
Artigo em Inglês | MEDLINE | ID: mdl-34475438


The COVID-19 pandemic threatens indigenous peoples living in suburban areas of large Brazilian cities and has thus far intensified their pre-existing socio-economic inequalities. We evaluated the epidemiological situation of SARS-CoV-2 infection among residents of the biggest urban multiethnic indigenous community of the Amazonas state, Brazil. Blood samples of 280 indigenous people living in the surrounding area of Manaus were tested for the presence of anti-SARS-CoV-2 IgA or IgG antibodies. The risk factors and sociodemographic information were assessed through an epidemiological questionnaire. We found a total positivity rate of 64.64% (95% CI 59.01-70.28) for SARS-CoV-2 infection. IgA and IgG were detected in 55.71% (95% CI 49.89-61.54) and 60.71% (95% CI 54.98-66.45) of the individuals, respectively. Over 80% of positive individuals were positive for both IgA and IgG.No significant difference in positivity rates between genders or age groups was observed. Moreover, the age group ≥ 60 years old showed the highest antibody ratios (IgA mean ratio = 3.080 ± 1.623; IgG mean ratio = 4.221 ± 1.832), while the age groups 13-19 and 20-29 showed the lowest IgA (mean ratio = 2.268 ± 0.919) and IgG ratios (mean ratio = 2.207 ± 1.246), respectively. Individuals leaving the home more frequently were at higher risk of infection (Odds ratio (OD) 2.61; 95% CI 1.00-1.49; p = 0.048). Five or more individuals per household increased fivefold the risk of virus transmission (OR 2.56; 95% CI 1.09-6.01; p = 0.019). The disproportionate dissemination of SARS-CoV-2 infection observed among the study population might be driven by typical cultural behavior and socioeconomic inequalities. Despite the pandemic threat, this population is not being targeted by public policies and appears to be chronically invisible to the Brazilian authorities.

Teste Sorológico para COVID-19 , COVID-19 , Povos Indígenas , Pandemias , SARS-CoV-2/metabolismo , Adolescente , Adulto , Anticorpos Antivirais/sangue , Brasil/epidemiologia , Brasil/etnologia , COVID-19/sangue , COVID-19/epidemiologia , COVID-19/etnologia , Feminino , Humanos , Imunoglobulina A/sangue , Imunoglobulina G/sangue , Masculino , Pessoa de Meia-Idade
Sci Rep ; 11(1): 15591, 2021 08 02.
Artigo em Inglês | MEDLINE | ID: mdl-34341397


The COVID-19 pandemic continues to have a devastating impact on Brazil. Brazil's social, health and economic crises are aggravated by strong societal inequities and persisting political disarray. This complex scenario motivates careful study of the clinical, socioeconomic, demographic and structural factors contributing to increased risk of mortality from SARS-CoV-2 in Brazil specifically. We consider the Brazilian SIVEP-Gripe catalog, a very rich respiratory infection dataset which allows us to estimate the importance of several non-laboratorial and socio-geographic factors on COVID-19 mortality. We analyze the catalog using machine learning algorithms to account for likely complex interdependence between metrics. The XGBoost algorithm achieved excellent performance, producing an AUC-ROC of 0.813 (95% CI 0.810-0.817), and outperforming logistic regression. Using our model we found that, in Brazil, socioeconomic, geographical and structural factors are more important than individual comorbidities. Particularly important factors were: The state of residence and its development index; the distance to the hospital (especially for rural and less developed areas); the level of education; hospital funding model and strain. Ethnicity is also confirmed to be more important than comorbidities but less than the aforementioned factors. In conclusion, socioeconomic and structural factors are as important as biological factors in determining the outcome of COVID-19. This has important consequences for policy making, especially on vaccination/non-pharmacological preventative measures, hospital management and healthcare network organization.

COVID-19/mortalidade , Mortalidade Hospitalar , Aprendizado de Máquina , Modelos Biológicos , Pandemias , SARS-CoV-2 , Brasil/epidemiologia , Brasil/etnologia , COVID-19/etnologia , COVID-19/terapia , Feminino , Hospitalização , Humanos , Masculino , Fatores Socioeconômicos
J Anal Psychol ; 66(3): 719-728, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-34231901


This paper intends to analyse the current political and social situation in Brazil and show how this context has influenced the management of the public health crisis generated by the COVID-19 pandemic. To this end, the authors conducted an investigation into Brazil's historical roots, which have not only engendered deep class differences but, also, social psychopathologies such as dissociation and perversion. Finally, this paper presents a symbolic analysis of social exclusion and how the mythical figure of Sophia can inspire a renewed movement of inclusion and tolerance.

COVID-19 , Cultura , Política , Preconceito , Teoria Psicanalítica , Brasil/etnologia , Colonialismo , Escravização , Humanos , Inclusão Social , Isolamento Social
Recurso na Internet em Português | LIS - Localizador de Informação em Saúde | ID: lis-48232


Hábitos saudáveis têm mais chances de acompanhar a população durante a vida se começarem logo na infância. Por isso, é preciso chamar atenção para a qualidade de vida e rotina alimentar balanceada nesta quinta-feira (3), Dia da Conscientização Contra a Obesidade Mórbida Infantil

Brasil/etnologia , Obesidade Pediátrica/mortalidade , Obesidade Mórbida , Criança
Recurso na Internet em Português | LIS - Localizador de Informação em Saúde | ID: lis-48234


O número de fumantes diminuiu no Brasil e o grupo de ex-usuários de tabaco é cada vez maior. Os dados são da Pesquisa Nacional de Saúde (PNS 2019), realizada pelo Instituto Brasileiro de Geografia e Estatística (IBGE), com o apoio o Ministério da Saúde, e divulgada nesta segunda-feira (31), quando é celebrado o Dia Mundial sem Tabaco.

Tabaco , Brasil/etnologia , Fumantes/estatística & dados numéricos , Prevenção do Hábito de Fumar
Anthropol Med ; 28(2): 172-187, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-34180281


In Brazil, Black women are disproportionately denied access to timely care and are made vulnerable to death by avoidable obstetric causes. However, they have not been at the center of recent initiatives to improve maternal health. This paper contends that the effectiveness of Brazilian maternal and infant health policy is limited by failures to robustly address racial health inequities. Multi-sited ethnographic research on the implementation of the Rede Cegonha program in Bahia, Brazil between 2012 and 2017 reveals how anti-Blackness structures iatrogenic harms for Black women as well as their kin in maternal healthcare. Building on the work of Black Brazilian feminists, the paper shows how Afro-Brazilian women experience anti-Black racism in obstetric care, which the paper argues can be better understood through Dána-Ain Davis' concept of obstetric racism. The paper suggests that such forms of violence reveal the necropolitical facets of reproductive governance and that the framing of obstetric violence broadens the scales and temporalities of iatrogenesis.

Parto Obstétrico , Disparidades em Assistência à Saúde/etnologia , Doença Iatrogênica/etnologia , Serviços de Saúde Materna , Racismo/etnologia , Grupo com Ancestrais do Continente Africano , Antropologia Médica , Brasil/etnologia , Feminino , Política de Saúde , Humanos , Parto/etnologia , Gravidez
PLoS One ; 16(4): e0248740, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33861756


Brazil has a cesarean rate of 56% and low use of Intrapartum Evidence-based Practices (IEBP) of 3.4%, reflecting a medically centered and highly interventionist maternal health care model. The Senses of Birth (SoB) is a health education intervention created to promote normal birth, use of EBP, and reduce unnecessary c-sections. This study aimed to understand the use of intrapartum EBP by Brazilian women who participated in the SoB intervention. 555 women answered the questionnaire between 2015 and 2016. Bivariate analysis and ANOVA test were used to identify if social-demographic factors, childbirth information, and perceived knowledge were associated with the use of EBP. A qualitative analysis was performed to explore women's experiences. Research participants used the following EBP: birth plan (55.2%), companionship during childbirth (81.6%), midwife care (54.2%), freedom of mobility during labor (57.7%), choice of position during delivery (57.2%), and non-pharmacological pain relief methods (74.2%). Doula support was low (26.9%). Being a black woman was associated with not using a birth plan or having doula support. Women who gave birth in private hospitals were more likely not to use the EBP. Barriers to the use of EBP identified by women were an absence of individualized care, non-respect for their choices or provision of EBP by health care providers, inadequate structure and ambiance in hospitals to use EBP, and rigid protocols not centered on women's needs. The SoB intervention was identified as a potential facilitator. Women who used EBP described a sense of control over their bodies and perceived self-efficacy to advocate for their chosen practices. Women saw the strategies to overcome barriers as a path to become their childbirth protagonist. Health education is essential to increase the use of EBP; however, it should be implemented combined with changes in the maternal care system, promoting woman-centered and evidence-based models.

Prática Clínica Baseada em Evidências/tendências , Parto/psicologia , Cuidado Pré-Natal/métodos , Adulto , Brasil/etnologia , Parto Obstétrico/tendências , Intervenção Médica Precoce/métodos , Intervenção Médica Precoce/tendências , Feminino , Educação em Saúde/tendências , Humanos , Trabalho de Parto/psicologia , Serviços de Saúde Materna/tendências , Pessoa de Meia-Idade , Tocologia/tendências , Gravidez , Gestantes/psicologia , Cuidado Pré-Natal/tendências , Relações Profissional-Paciente , Inquéritos e Questionários
Int J Legal Med ; 135(4): 1329-1339, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-33884487


Human pigmentation is a complex trait, probably involving more than 100 genes. Predicting phenotypes using SNPs present in those genes is important for forensic purpose. For this, the HIrisPlex tool was developed for eye and hair color prediction, with both models achieving high accuracy among Europeans. Its evaluation in admixed populations is important, since they present a higher frequency of intermediate phenotypes, and HIrisPlex has demonstrated limitations in such predictions; therefore, the performance of this tool may be impaired in such populations. Here, we evaluate the set of 24 markers from the HIrisPlex system in 328 individuals from Ribeirão Preto (SP) region, predicting eye and hair color and comparing the predictions with their real phenotypes. We used the HaloPlex Target Enrichment System and MiSeq Personal Sequencer platform for massively parallel sequencing. The prediction of eye and hair color was accomplished by the HIrisPlex online tool, using the default prediction settings. Ancestry was estimated using the SNPforID 34-plex to observe if and how an individual's ancestry background would affect predictions in this admixed sample. Our sample presented major European ancestry (70.5%), followed by African (21.1%) and Native American/East Asian (8.4%). HIrisPlex presented an overall sensitivity of 0.691 for hair color prediction, with sensitivities ranging from 0.547 to 0.782. The lowest sensitivity was observed for individuals with black hair, who present a reduced European contribution (48.4%). For eye color prediction, the overall sensitivity was 0.741, with sensitivities higher than 0.85 for blue and brown eyes, although it failed in predicting intermediate eye color. Such struggle in predicting this phenotype category is in accordance with what has been seen in previous studies involving HIrisPlex. Individuals with brown eye color are more admixed, with European ancestry decreasing to 62.6%; notwithstanding that, sensitivity for brown eyes was almost 100%. Overall sensitivity increases to 0.791 when a 0.7 threshold is set, though 12.5% of the individuals become undefined. When combining eye and hair prediction, hit rates between 51.3 and 68.9% were achieved. Despite the difficulties with intermediate phenotypes, we have shown that HIrisPlex results can be very helpful when interpreted with caution.

Cor de Olho/genética , Genótipo , Técnicas de Genotipagem/instrumentação , Técnicas de Genotipagem/métodos , Cor de Cabelo/genética , Fenótipo , Brasil/etnologia , Genética Forense/métodos , Humanos
BMC Infect Dis ; 21(1): 396, 2021 Apr 29.
Artigo em Inglês | MEDLINE | ID: mdl-33926389


BACKGROUND: In the Brazilian Amazon, a new epidemiological profile of Chagas disease transmission, the oral route, has been detected and cited as being responsible for the increase in acute cases in Brazil. The clinical evaluation of acute Chagas disease (ACD) has been a challenge since it can progress to a chronic phase with cardiac alterations, and the follow-up by modern diagnostic methods is very difficult due to the socio-geographical characteristics of the Brazilian Amazon. Thus, alternatives should be sought to alleviate this problem. We conducted a study to evaluate subjects with ACD using the 12-lead ECG QRS score (Selvester score) as an estimative of myocardial injury progression before and after ACD treatment. METHODS: The study included indigenous subjects from the Amazon region with ACD in clinical follow-up at the Fundação de Medicina Tropical Dr. Heitor Vieira Dourado (FMT-HVD) Chagas Disease outpatient clinic in the state of Amazonas, Brazil. The control group consisted of 31 healthy volunteers with no history of heart disease and no reactive serology for Chagas disease. Baseline ECG was performed in all subjects. The Selvester scoring method was performed according to the standardized guide (< 3 points: no myocardial injury,> 3: points × 3% = % of the predicted LV infarction). RESULTS: A total of 62 subjects were included, 31 as cases and 31 as controls. The mean follow-up of the case group was 17 months. The control group presented normal ECG. The case group presented 13 alterations before treatment and 11 after. Nineteen individuals presented scores > 3 points, 6 before and 13 after. In 19.36% of subjects, myocardial injury was found before treatment and in 41.94% after treatment. CONCLUSION: This is the first study that uses the Selvester score (SS) to predict myocardial injury in subjects with ACD. The results of this study suggest the significant presence of myocardial injury from the beginning of treatment to the period post treatment of ACD, which demonstrates that the SS can be applied for stratification and follow-up of Chagas disease in the Amazon region.

Doença de Chagas/fisiopatologia , Eletrocardiografia/métodos , Coração/fisiopatologia , Adulto , Brasil/etnologia , Doença de Chagas/complicações , Doença de Chagas/tratamento farmacológico , Doença da Artéria Coronariana/diagnóstico por imagem , Feminino , Coração/diagnóstico por imagem , Humanos , Povos Indígenas , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade
Acta Trop ; 218: 105884, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-33676938


OBJECTIVE: To analyse the association between social inequalities and the leprosy burden in a low endemicity scenario in the state of São Paulo, Brazil. METHODS: This ecological study was carried out in the city of Ribeirão Preto, state of São Paulo, Brazil, considering leprosy cases notified from 2006 to 2016. Regarding social inequalities, dimensions related to high household density, literacy, home occupation conditions, health conditions, household income, ethnicity and age were considered. The generalised additive model for location, scale and shape (GAMLSS) was used to verify the association between the social inequalities and leprosy burden. RESULTS: The increase in men and women with no education and people with an income of 1 to 2 minimum wages was associated with a relative increase in the number of leprosy cases (7.37%, 7.10% and 2.44%, respectively). Regarding the ethnicity variables, the increase in the proportion of men (black) and women (mixed race) with no schooling was associated with a relative increase in the number of cases of the disease (10.77% and 4.02%, respectively). Finally, for people of mixed race or ethnicity, the increase in the proportion of households with 1/2 to 1 minimum wage was related to a relative decrease in the total number of cases (-4.90%). CONCLUSION: The results show that the determinants associated with the increase in leprosy cases are similar to those in Brazilian hyperendemic regions, and that even in cities with low endemicity, social inequality is one of the main determinants of the disease.

Doenças Endêmicas/estatística & dados numéricos , Hanseníase/epidemiologia , Fatores Socioeconômicos , Adulto , Brasil/epidemiologia , Brasil/etnologia , Cidades/epidemiologia , Cidades/etnologia , Escolaridade , Meio Ambiente , Grupos Étnicos/estatística & dados numéricos , Feminino , Humanos , Hanseníase/etnologia , Masculino , Pessoa de Meia-Idade , Adulto Jovem
Biochem Pharmacol ; 191: 114463, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-33577893


Our study aimed to assess the change in the sleep patterns during the Coronavirus lockdown in five regions (Austria/Germany, Ukraine, Greece, Cuba and Brazil), using online surveys, translated in each language. Part of the cohort (age 25-65, well-educated) was collected directly during lockdown, to which retrospective cross-sectional data from and after lockdown (retrospective) questionnaires were added. We investigated sleep times and sleep quality changes from before to during lockdown and found that, during lockdown, participants had (i) worse perceived sleep quality if worried by COVID-19, (ii) a shift of bedtimes to later hours during workdays, and (iii) a sleep loss on free days (resulting from more overall sleep during workdays in non-system relevant jobs), leading to (iv) a marked reduction of social jetlag across all cultures. For further analyses we directly compared system relevant and system irrelevant jobs, because it was assumed that the nature of the lockdown's consequences is dependent upon system relevance. System relevant jobs were found to have earlier wake-up times as well as shorter total sleep times on workdays, leading to higher social jetlag for people in system relevant jobs. Cultural differences revealed a general effect that participants from Greece and Ukraine had later bedtimes (on both work and free days) and wake-up times (on workdays) than Cuba, Brazil and Austria, irrespective of COVID-19 lockdown restrictions.

COVID-19/etnologia , Controle de Doenças Transmissíveis/tendências , Comparação Transcultural , Emprego/tendências , Sono/fisiologia , Adulto , Idoso , Áustria/etnologia , Brasil/etnologia , COVID-19/prevenção & controle , COVID-19/psicologia , Estudos de Coortes , Controle de Doenças Transmissíveis/métodos , Estudos Transversais , Cuba/etnologia , Emprego/psicologia , Feminino , Grécia/etnologia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Inquéritos e Questionários , Ucrânia/etnologia
J Ethnopharmacol ; 264: 113378, 2021 Jan 10.
Artigo em Inglês | MEDLINE | ID: mdl-32918995


ETHNOPHARMACOLOGICAL RELEVANCE: Ocotea odorifera (Vell.) Rohwer has been used in traditional medicine in the south of Brazil for the treatment of inflammatory-related conditions, such as rheumatism. However, there is not any scientific evidence for popular use. AIMS OF THE STUDY: To investigate the O. odorifera anti-inflammatory potential and identification of the main active compounds through metabolomic approaches. MATERIALS AND METHODS: In order to in vivo evaluate the inhibition of the main inflammatory pathways, the leaf decoction, leaf extract, its fractions and the essential oils from leaves and branches were submitted to the ear oedema and the neutrophils recruitment assays. The samples were chemically investigated by UHPLC-HRMS or GC-MS. The multivariate statistical analysis (PLS-DA) was used to determine the substances correlated with the anti-inflammatory properties. RESULTS: The in vivo studies indicated a promissory anti-inflammatory effect on both oedema and neutrophil recruitment for some samples including the decoction; hydroethanolic, ethyl acetate, and chloroform fractions; and the essential oils. According to the PLS-DA, the S-(+)-reticuline was evidenced as one of the three compounds of the plant most correlated with both anti-inflammatory mechanisms. Thus, S-(+)-reticuline was isolated and the anti-inflammatory activity was confirmed. Moreover, for the first time, the dual inhibition of oedema and neutrophil recruitment was uncovered and reported. Another compound positively correlated with the anti-inflammatory activity is likely to be a new compound since zero hit on the comprehensive mass database were encountered. The compounds found in the essential oils also showed significant anti-inflammatory activity, and thus indeed the plant has different classes of active substances. CONCLUSIONS: The decoction of O. odorifera and different fractions from its ethanolic extract demonstrated anti-inflammatory activity through dual inhibition of oedema and neutrophil recruitment. Thus, corroborating the popular medicinal use of the decoction of leaves from O. odorifera as an anti-inflammatory medicine. Besides, reticuline, one of the main active compounds, was isolated and proved to display the dual mechanism of action, indicating the O. odorifera as a promising source of active compounds for the treatment of inflammatory conditions.

Anti-Inflamatórios/uso terapêutico , Etnofarmacologia/métodos , Ocotea , Óleos Voláteis/uso terapêutico , Extratos Vegetais/uso terapêutico , Óleos Vegetais/uso terapêutico , Animais , Anti-Inflamatórios/isolamento & purificação , Brasil/etnologia , Edema/tratamento farmacológico , Edema/patologia , Camundongos , Óleos Voláteis/isolamento & purificação , Extratos Vegetais/isolamento & purificação , Folhas de Planta , Óleos Vegetais/isolamento & purificação
J Ethnopharmacol ; 264: 113387, 2021 Jan 10.
Artigo em Inglês | MEDLINE | ID: mdl-32918996


ETHNOPHARMACOLOGICAL RELEVANCE: Propolis has been used in folk medicine for thousands of years and, in the past few decades, it has attracted renewed interest. Although propolis has been traditionally used in many communities worldwide against parasitic diseases, its effect against Schistosoma mansoni infection remains unclear. AIM OF THE STUDY: To demonstrate the effects of Brazilian red propolis on Schistosoma mansoni ex vivo and in an animal model of schistosomiasis. MATERIALS AND METHODS: In vitro, we monitored phenotypic and tegumental changes as well as the effects of the crude extract of propolis on pairing and egg production. In a mouse infected with either immature (early infection) or adult (chronic infection) worms, propolis was administered by oral gavage and we studied the influence of this natural product on worm burden and egg production. RESULTS: Propolis 25 µg/mL reduced motility and caused 100% mortality of adult parasites ex vivo. Further analysis revealed a pronounced reduction in oviposition after exposure to propolis at sub-lethal concentrations. In addition, scanning electron microscopy showed morphological alterations in the tegument of schistosomes. In the animal model, propolis markedly reduced worm burden and egg production in both early and chronic S. mansoni infection when compared to untreated control animals. CONCLUSIONS: The efficacy of Brazilian red propolis in both in vitro and in vivo studies suggests its potential anthelmintic properties against S. mansoni infection.

Antiparasitários/uso terapêutico , Modelos Animais de Doenças , Helmintos/efeitos dos fármacos , Óvulo/efeitos dos fármacos , Própole/uso terapêutico , Esquistossomose mansoni/tratamento farmacológico , Animais , Antiparasitários/isolamento & purificação , Brasil/etnologia , Doença Crônica , Feminino , Helmintos/fisiologia , Masculino , Camundongos , Óvulo/fisiologia , Própole/farmacologia , Distribuição Aleatória , Esquistossomose mansoni/patologia
Esc. Anna Nery Rev. Enferm ; 25(4): e20210007, 2021.
Artigo em Português | LILACS, BDENF - Enfermagem | ID: biblio-1279020


Resumo Objetivo analisar a lotação e distribuição da primeira turma de oficiais enfermeiros, ao término do Curso de Formação de Oficiais, com a patente de 2º Tenente, no Hospital Central da Polícia Militar do Estado do Rio de Janeiro, em 1995. Método estudo histórico em fontes documentais escritas e orais produzidas por meio de 19 entrevistas, sendo 18 oficiais enfermeiros e um civil. Os conceitos de poder simbólico e capital de Pierre Bourdieu consubstanciaram a análise dos achados. Resultados a classificação obtida no curso de formação de oficiais e a experiência profissional, embora com menor peso, foram preponderantes na distribuição nos setores do hospital. Considerações finais e implicações para prática os critérios de antiguidade da vida militar influenciaram na configuração da equipe de enfermagem no hospital militar. Destaca-se que a ocupação das chefias pelos oficiais enfermeiros foi determinada pelo capital incorporado no estágio probatório, o qual foi institucionalizado pela patente.

Resumen Objetivo analizar la capacidad y la distribución de la primera clase de oficiales enfermeros al término del Curso de Formación de Oficiales, con el grado de 2º Teniente, en el Hospital Central da Polícia Militar do Estado do Rio de Janeiro, en 1995. Método estudio histórico en fuentes de documentos escritos y orales producidos a través de 19 entrevistas, 18 de las cuales fueron enfermeras y una civil. Los conceptos de poder simbólico y capital de Pierre Bourdieu fundamentaron el análisis de los hallazgos. Resultados la clasificación obtenida en el curso de formación para oficiales y la experiencia profesional predominaron en la distribución en los sectores hospitalarios, aunque con menor peso. Conclusión e implicaciones para práctica los criterios de antigüedad en la vida militar influyeron en la configuración del equipo de enfermería. Se destaca que la ocupación de los comandos por oficiales enfermeros fue determinada por el capital incorporado en la etapa probatoria, institucionalizada por el grado.

Abstract Objective to analyze the capacity and distribution of the first class of nurse officers, at the end of the Officer Training Course, with the rank of 2nd Lieutenant, at the Hospital Central da Polícia Militar of the State of Rio de Janeiro, in 1995. Method historical study in written and oral documentary sources produced through 19 interviews, of which 18 are nurse officers and one civilian. Pierre Bourdieu's concepts of symbolic power and capital substantiated the analysis of the findings. Results the classification obtained in the training course for officers and professional experience, although with less weight, were preponderant for the distribution in the hospital sectors. Final considerations and implications for practice the criteria of seniority in military life influenced the configuration of the nursing team at the military hospital. It is noteworthy that the occupation of the heads by the nurse officers was determined by the capital incorporated in the probationary period, which was institutionalized by the patent.

Humanos , Masculino , Feminino , Supervisão de Enfermagem/história , Hospitais Militares/história , Enfermagem Militar/história , Enfermeiras e Enfermeiros/provisão & distribuição , Brasil/etnologia , Poder Psicológico , Hospitais Militares/organização & administração , Enfermagem Militar/organização & administração , Equipe de Enfermagem/história
Esc. Anna Nery Rev. Enferm ; 25(2): e20200390, 2021. tab
Artigo em Português | LILACS, BDENF - Enfermagem | ID: biblio-1149291


Resumo Objetivo Apresentar o resultado de uma reflexão metodologicamente estruturada sobre o caminho trilhado em todas as fases de uma pesquisa internacional no Brasil sobre a implementação do Programa de Humanização do Pré-natal e do Nascimento e seus atores sociais. Método Método reflexivo de pesquisa que conduz à percepção modificada de uma dada situação levando a novas ideias, com o potencial de revelar temas de análise e engendrar propostas de possíveis soluções com desenho de um plano de ação. O objeto das reflexões concentrou-se nas participações dos copesquisadores de um estudo etnográfico internacional, multidisciplinar e multicêntrico implantado em Junho/2019-Março/2020. Resultados As reflexões indicam sensibilidade sobre o tema e silêncio imposto em relação à violência obstétrica. Sob múltiplas manifestações da violência institucionalizada, constatou-se ações como resistência ao assunto na rede hospitalar, negligência e questionamentos distorcidos nos espaços políticos de autorização para a anuência institucional. A demora por comitê de ética colocando em risco o calendário de conclusão da condução da pesquisa, exigido por agência estrangeira de fomento. Conclusão e implicação para a prática A reflexão estruturada possibilitou um processo ímpar de aprendizagem para os copesquisadores navegando em distintas culturas universitárias e sociais de pesquisa.

Resumen Objetivo Presentar resultados de una reflexión estructurada metodológicamente sobre el camino metodológico seguido en todas las fases de una investigación internacional en Brasil sobre la implementación del Programa de Humanización del Cuidado Prenatal y el Nacimiento y sus actores sociales. Método Método de investigación reflexiva que conduce a una percepción modificada de una situación dada, dando lugar a nuevas ideas, con el potencial de revelar temas de análisis y generar propuestas de posibles soluciones con el diseño de un plan de acción. El objeto de las reflexiones se centró en la participación de los co-investigadores en una investigación etnográfica internacional, multidisciplinar y multi sitio implementada en Junio / 2019-Marzo / 2020. Resultados Las reflexiones indican sensibilidad sobre el tema y silencio impuesto en relación a la violencia obstétrica. Bajo múltiples manifestaciones de violencia institucionalizada, hubo acciones como resistencia al tema en el ámbito hospitalario, negligencia y cuestionamientos distorsionados en los espacios políticos de autorización para el consentimiento institucional y demora por parte del comité de ética, poniendo en riesgo el calendario para completar la realización de la investigación requerida para una agencia de desarrollo extranjera. Conclusión e implicación para la práctica La reflexión estructurada permitió un proceso de aprendizaje único para los co-investigadores que navegaron en diferentes culturas universitarias y de investigación social.

Abstract Aim To present the results of a structured reflection on the methodological phases of an international research in Brazil regarding the implementation of the Program of Humanization of Prenatal and Childbirth, as well as, reflection on the project's social actors. Method A reflective research method that modifies the perception of a given situation, leading to new ideas, revealing themes of analysis, and engendering proposals for possible solutions with the creation of an action plan. The object of the reflection was the participation of co-investigators in an international, multidisciplinary, and multisite ethnographic study, implemented in June/2019-March/2020. Results The reflections indicate emotional sensitivity to the theme and silence about obstetric violence. There are multiple manifestations of institutionalized violence including resistance to confronting obstetric violence in hospital settings, negligence and distorted questioning in the political spaces of organizational authorization. The delay caused by a research ethics committee put the timetable for completion of research development at risk by requiring funding from a foreign agency. Conclusion and implication for practice Structured reflection allowed a unique learning process for co-investigators navigating different university and social research cultures.

Humanos , Feminino , Parto Humanizado , Humanização da Assistência , Brasil/etnologia , Canadá/etnologia , Pesquisa Metodológica em Enfermagem , Saúde Global , Pesquisa Qualitativa , Violência contra a Mulher
Esc. Anna Nery Rev. Enferm ; 25(4): e20200487, 2021. tab, graf
Artigo em Português | LILACS, BDENF - Enfermagem | ID: biblio-1154198


Resumo Objetivo caracterizar a produção Stricto sensu da pós-graduação brasileira em Enfermagem sobre a temática saúde da população rural. Método revisão compreensiva realizada por meio da Plataforma Sucupira. Estabeleceram-se, como amostra, dissertações e teses de mestrado e doutorado das quais foram extraídas informações que constituíram dois bancos de dados submetidos à análise estatística descritiva e textual. Resultados 118 relatórios de pesquisa compuseram a amostra. Identificou-se maior quantitativo de estudos produzidos do tipo dissertação de mestrado, provenientes da região Sul do Brasil, publicados entre 2015 e 2016 e que utilizaram abordagens quantitativas. A análise exploratória permitiu constatar que as pesquisas desenvolvidas versavam sobre três temáticas centrais: políticas públicas e serviços de atenção à saúde, cuidado cultural no contexto familiar e saúde do idoso rural. Conclusões e implicações para a prática a produção sobre a saúde rural em nível de pós-graduação Stricto sensu em Enfermagem no Brasil aponta para um novo leque de possibilidades de investigação e poderá contribuir para as práticas de cuidado que os enfermeiros rurais realizam.

Resumen Objetivo caracterizar la producción Stricto sensu de los cursos brasileños de posgrado en enfermería sobre la salud de la población rural. Método revisión comprensiva realizada a través de la Plataforma Sucupira. Se establecieron como muestra las disertaciones y tesis de maestría y doctorado, de las cuales se extrajo informaciones que constituyeron dos bases de datos sometidas al análisis estadístico descriptivo y textual. Resultados 118 informes de investigación conformaron la muestra. Se identificó un mayor número de estudios producidos en el tipo de tesis de maestría, del Sur de Btrasil, publicados entre 2015 y 2016 y que utilizaron enfoques cuantitativos. El análisis exploratorio mostró que la investigación desarrollada abordó tres temas centrales: políticas públicas y servicios de salud, cuidado cultural en el contexto familiar y salud del anciano rural. Conclusiones e implicaciones para la práctica la producción sobre salud rural a nivel de posgrado Stricto sensu en Enfermería en Brasil apunta a un nuevo abanico de posibilidades de investigación y puede contribuir a las prácticas de cuidado que realizan los enfermeros rurales.

Abstract Objective to characterize the Stricto sensu production of Brazilian post-graduate Nursing courses on the theme of rural population health. Method comprehensive review carried out through the Sucupira Platform. The sample consisted of masters and doctoral dissertations and theses from which information was extracted to form two databases subjected to descriptive and textual statistical analysis. Results A total of 118 research reports comprised the sample. We identified a higher number of studies produced in the form of master's dissertations, from the South region of Brazil, published between 2015 and 2016, and that used quantitative approaches. The exploratory analysis found that the research developed focused on three central themes: public policies and health care services, cultural care in the family context, and health of the rural elderly. Conclusions and implications for practice the production on rural health at the Stricto sensu post-graduate level in Nursing in Brazil points to a new range of possibilities for research and may contribute to the care practices that rural nurses perform.

Humanos , População Rural , Saúde da População Rural , Educação de Pós-Graduação em Enfermagem , Brasil/etnologia , Saúde do Idoso , Política de Saúde
Esc. Anna Nery Rev. Enferm ; 25(5): e20200546, 2021. tab
Artigo em Português | LILACS, BDENF - Enfermagem | ID: biblio-1286374


Resumo Objetivo avaliar o impacto econômico domiciliar do adoecimento pela tuberculose no Brasil. Método pesquisa transversal multicêntrica de 2016 a 2018, em cinco capitais do Brasil, em pacientes diagnosticados com tuberculose. Os custos totais foram a soma dos custos diretos e indiretos incorridos antes e durante o diagnóstico e tratamento. A regressão logística foi utilizada para estudar determinantes de custos catastróficos. A pobreza foi medida como renda familiar per capita diária < U$ 5,5. Resultados trezentos e sessenta e um pacientes foram inscritos no estudo. O custo extrapolação foi de R$3.664,47 (DP: R$ 2.667,67) e o custo total de extrapolação foi de R$22.291,82 (DP: R$ 16.259,50). No geral, 29% dos participantes do estudo foram caracterizados como pobres antes da tuberculose, e 39% depois. Em média, a renda diminuiu em 11% dos participantes e 41% tiveram custos catastróficos. Os determinantes estatisticamente significativos de experimentar custos catastróficos foram: participante ser o chefe da família, vivendo na pobreza antes da tuberculose, desemprego e interrupção do trabalho durante o tratamento (p < 0,05). Conclusão e implicações para a prática embora o tratamento seja financiado pelo governo, a tuberculose continua resultando em custos catastróficos e diminuição da renda para muitas famílias no Brasil.

Resumen Objetivo evaluar el impacto económico domiciliario de enfermarse por tuberculosis en Brasil. Método Investigación multicéntrica transversal de 2016 a 2018, en cinco capitales de Brasil, en pacientes diagnosticados con tuberculosis. Los costos totales fueron la suma de los costos directos e indirectos incurridos antes y durante el diagnóstico y el tratamiento. Se utilizó la regresión logística para estudiar los determinantes de los costos catastróficos. La pobreza se midió como un ingreso familiar diario per cápita < U$ 5,5. Resultados se inscribieron 361 pacientes en el estudio. El costo de extrapolación fue de R$ 3.664,47 (DE: R$ 2.667,67) y el costo total de extrapolación fue R$ 22.291,82 (DE: R$ 16.259,50). En general, el 29% de los participantes se caracterizaron como pobres antes de la tuberculosis y el 39%, después. En promedio, los ingresos disminuyeron en 11% de los participantes y el 41% tuvo costos catastróficos. Determinantes estadísticos de costos catastróficos: participante ser cabeza de familia; vivir en pobreza antes de la tuberculosis; desempleo; interrupción del trabajo durante el tratamiento (p<0.05). Conclusión e implicaciones para la práctica aunque el tratamiento es financiado por el gobierno, la tuberculosis sigue teniendo costos catastróficos y una disminución de los ingresos para muchas familias en Brasil.

Abstract Objective to assess the home economics impact of illness from Tuberculosis in Brazil. Method multicenter cross-sectional research from 2016 to 2018, in five capitals of Brazil, in patients diagnosed with tuberculosis. The total costs were the sum of the direct and indirect costs incurred before and during diagnosis and treatment. Logistic regression was used to study determinants of catastrophic costs. Poverty was measured as daily household income per capita < U$ 5.5. Results 361 patients were enrolled in the study. The extrapolation cost was R$ 3,664.47 (SD: R$ 2,667.67) and the total extrapolation cost was R$ 22,291.82 (SD: R$ 16,259.50). Overall, 29% of study participants were characterized as poor before tuberculosis, and 39% afterwards. On average, income declined by 11% among participants and 41% had catastrophic costs. The statistically significant determinants of experiencing catastrophic costs were: participant being the head of the family; living in poverty before tuberculosis; unemployment and interruption of work during treatment (p <0.05). Conclusion and implications for practice although treatment is financed by the government, tuberculosis continues to cause catastrophic costs and decreased of income for many families in Brazil.

Humanos , Masculino , Feminino , Adulto , Tuberculose/economia , Custos e Análise de Custo/economia , Pobreza/estatística & dados numéricos , Fatores Socioeconômicos , Tuberculose/diagnóstico , Tuberculose/terapia , Brasil/etnologia , Estudos Transversais , Custos e Análise de Custo/estatística & dados numéricos , Proteção Social em Saúde , Renda/estatística & dados numéricos
Esc. Anna Nery Rev. Enferm ; 25(spe): e20210045, 2021. tab
Artigo em Português | LILACS, BDENF - Enfermagem | ID: biblio-1281005


Objetivo: identificar e analisar medidas de proteção à criança/adolescente vulnerável à violência na epidemia de COVID-19 no Brasil e em Portugal. Método: implementou-se a pesquisa documental de diretrizes governamentais expedidas entre março e setembro de 2020. A análise hermenêutica fundamentou-se nos preceitos da vulnerabilidade em saúde e da defesa do melhor interesse de crianças/adolescentes. Resultados: recomendaram-se ações articuladas de apoio e parcerias nacionais, locais e interinstitucionais; atuação multiprofissional, intra/intersetorial como medidas de proteção à criança/adolescente vulneráveis à violência intrafamiliar. Destacam-se o estímulo a notificação, investigação, intervenção e acompanhamento de casos. Constatam­se investimentos dos países na ampliação de canais de teleatendimento e estímulo à denúncias pela sociedade e redes sociais. Contudo, há indícios de poucos registros de casos, justificado pelas campanhas publicitárias em Portugal que incentivaram denúncias aos órgãos responsáveis. A proteção à renda e ao trabalho dos provedores da família durante o isolamento social e momento de suspensão das aulas presenciais teve a intenção de protegê-los da insegurança alimentar e do contágio da doença. Conclusão: documentos determinaram ações para instituições, profissionais de saúde, familiares e sociedade no enfrentamento da violência intrafamiliar. Na pandemia de COVID-19, é dever do Estado seguir protegendo o direito à vida e à dignidade da criança e adolescente

Objective: To identify and analyze the protection measures for children/adolescent vulnerable to violence during the COVID-19 epidemic in Brazil and Portugal. Method: This documentary research of government guidelines issued between March and September 2020 was carried out. The hermeneutic analysis was based on the principles of health vulnerability of children/ adolescents. Results: Articulated support actions and partnerships were recommended at the national, local, and interinstitutional levels. A multi-professional intersectoral action was the most recommended measure to protect those children/adolescents more vulnerable to intrafamily violence. Noteworthy are the stimulus warning, investigation, intervention, and monitoring notified cases. In addition, countries' efforts were invested in expanding the call center channels and encouraging notification violence by society members and social networks. However, few cases were notified justified by advertising campaigns in Portugal that encouraged reporting to the responsible childhood agencies. The protection of family providers' income and work during social isolation and suspension of face­to-face classes were intended to protect them from food safety and contagious disease. Conclusion: Official documents determined actions for institutions, health professionals, family members, and society to face intrafamily violence. Regarding the effect of the COVID-19 pandemic on the family nucleus, the State must continue protecting children's and adolescents' rights to life and dignity

Objetivo: identificar y analizar medidas de protección para niños/adolescentes vulnerables a la violencia durante la epidemia del COVID-19 en Brasil y Portugal. Método: se realizó una investigación documental de las directrices gubernamentales emitidas entre marzo y septiembre de 2020. El análisis hermenéutico se basó en los principios de vulnerabilidad en salud en la niñez y la adolescencia. Resultados: se recomendaron acciones de apoyo articuladas y alianzas nacionales, locales e interinstitucionales; acción multiprofesional, intra e intersectorial como medida de protección para niños, niñas y adolescentes vulnerables a la violencia intrafamiliar. Destacan el fomento de la notificación, investigación, intervención y seguimiento de los casos. Hay esfuerzos de ambos países que invertirán en la expansión de los call center y fomentarán las quejas de los miembros de la sociedad y las redes sociales. Sin embargo, hay indicios de pocos casos denunciados, justificados por campañas publicitarias (especialmente en Portugal) que alentaron las denuncias a los órganos responsables. La protección de los ingresos y el trabajo de los proveedores familiares, durante el aislamiento social y en el momento de la suspensión de las clases presenciales tuve la intención de protegerlos del seguridad alimentar y del contagio de la enfermedad. Conclusión: documentos emitidos acciones específicas para instituciones, profesionales de la salud, familiares y sociedad en el abordaje de la violencia intrafamiliar. En la pandemia del COVID-19, es deber del Estado continuar protegiendo el derecho a la vida y la dignidad de los niños, niñas y adolescentes

Humanos , Criança , Adolescente , Maus-Tratos Infantis , Proteção da Criança/legislação & jurisprudência , Vulnerabilidade em Saúde , COVID-19 , Portugal/etnologia , Brasil/etnologia , Notificação , Acolhimento , Hermenêutica , Distanciamento Físico
RECIIS (Online) ; 14(4): 996-1000, out.-dez. 2020. ilus
Artigo em Português | LILACS | ID: biblio-1145597


O documentário Meia lua Falciforme retrata diversas faces e enfrentamentos no cotidiano dos pacientes e familiares que convivem com a doença falciforme no cenário brasileiro. A dor, o racismo e a resistência são pontos-chave discutidos no relevante curta-metragem, de Débora Evellyn Olimpo e Denise Kelm, que traz uma perspectiva para além do adoecimento físico e, com leveza, apresenta produções artísticas dos conviventes com a temática. No tocante à resistência e à luta, o documentário cita a grande conquista no que diz respeito ao reconhecimento e à normatização da doença no Brasil, os conflitos enfrentados rotineiramente em busca de acesso aos serviços de saúde, bem como a luta por um SUS que garanta os princípios da universalidade e equidade. A presente resenha traz algumas notas sobre o documentário e os temas que perpassam a vida dos pacientes desde o momento do diagnóstico até os itinerários e decisões terapêuticos.

The documentary entitled Meia lua Falciforme portrays different aspects and daily battles in the life of patients and their families who live with sickle cell disease in the Brazilian scenario. Pain, racism and resistance are key issues discussed in the relevant short-length film by Débora Evellyn Olimpo and Denise Kelm, which brings a perspective that extends beyond the physical illness, and presents in a dainty way some artistic productions of those living with the matter. The documentary mentions the great success regarding the resistance and the struggle for the recognition and regulation of the disease in Brazil, the conflicts routinely faced in search of access to health services, as well as the battle for a SUS that guarantees the principles of universality. and equity. This review brings some observations on the documentary and the matters that permeate the life of patients from the moment of diagnosis to the therapeutic itineraries and decisions.

El documental Meia lua Falciforme nos trae diferentes aspectos y enfrentamientos en la vida diaria de los pacientes y sus familiares que viven con la anemia de células falciformes en el escenario brasileño. El dolor, el racismo y la resistencia son puntos clave discutidos en el cortometraje relevante de Débora Evellyn Olimpo y Denise Kelm, que aporta una perspectiva más allá de la enfermedad física y con delicadeza presenta producciones artísticas de quien vive con el tema. Con respecto a la resistencia y la lucha, el documental cita el gran logro en la pelea por el reconocimiento y la regulación de la enfermedad en Brasil, los conflictos habituales que se enfrentan en busca del acceso a los servicios de salud, así como la lucha por un SUS que garantice los principios de universalidad. y equidad. Esta reseña trae algunas notas sobre el documental y los temas que atravesan la vida de los pacientes desde el momento del diagnóstico, hasta los itinerarios terapéuticos y las decisiones tomadas.

Humanos , Dor , Racismo , Saúde das Minorias Étnicas , Anemia Falciforme , Fatores Socioeconômicos , Sistema Único de Saúde , Brasil/etnologia , Equidade em Saúde , Filmes Cinematográficos
Recurso na Internet em Português | LIS - Localizador de Informação em Saúde | ID: lis-47984


O Ministério da Saúde participou nesta terça-feira (17) do lançamento da estratégia global da Organização Mundial da Saúde (OMS) para acelerar a eliminação do câncer de coloco do útero. Na oportunidade, a pasta assumiu o compromisso de erradicar a doença no Brasil com medidas de vacinação, de rastreamento e de tratamento. O evento foi promovido pela Organização Pan-Americana da Saúde (OPAS).

Neoplasias do Colo do Útero/tratamento farmacológico , Neoplasias do Colo do Útero/diagnóstico , Brasil/etnologia