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Epidemiologia da malária e estudo dos conhecimentos de garimpeiros do municipio de Oiapoque, Amapá, Brasil, antes e depois da implementação do malakit
No full textIntrodução: Dentre as áreas de transmissão de malária denominadas “especiais” pelo Ministério da Saúde, estão as áreas de garimpo. Nas minas do maciço Guianês, pouco se sabe sobre a prevalência do Plasmodium spp. nos garimpeiros provenientes dessas regiões e os principais determinantes da transmissão da doença. Os garimpeiros são uma população de alta mobilidade e difícil acesso, o que torna o controle da malária entre eles um grande desafio para as autoridades sanitárias do país. Atualmente, o município de Oiapoque é considerado de médio risco para malária e uma boa parte dos casos locais são de garimpeiros em situação de ilegalidade na Guiana Francesa. Objetivo: Analisar a epidemiologia da malária e determinar os conhecimentos, atitudes e práticas (CAPs) frente à malária por garimpeiros no município de Oiapoque-Amapá na área de fronteira entre o Brasil e a Guiana Francesa antes e depois da implementação do Malakit. Metodologia: Foi realizado um estudo seccional no município de Oiapoque-Amapá, onde ocorreram duas visitas antes (Orpal 1_2018) e depois (Orpal 2_2019) da execução do Malakit, um projeto piloto de controle de malária nos garimpeiros. Os indivíduos foram recrutados em locais de descanso e foram submetidos a um questionário com variáveis demográficas, de antecedentes de malária e de conhecimentos, atitudes e práticas frente à malária. No mesmo momento, foi feita uma avaliação clínica dos participantes e uma amostra de sangue total foi coletada para o diagnóstico parasitoscópico direto e molecular da malária Resultados: Os participantes eram em sua maioria naturais do Maranhão, Pará e Amapá, do sexo masculino e com idade média de 38 anos. A prevalência de infecção por Plasmodium spp. em nosso estudo foi de 3,36% e a principal espécie encontrada foi o P. vivax. Cerca de 56% dos participantes do Orpal 1 e 66% do Orpal 2 sabia corretamente como ocorre a transmissão da malária, mas a maioria dos entrevistados não tinha costume de se proteger contra picadas de mosquitos. No Orpal 1, 87,7% dos garimpeiros haviam tido algum episódio de malária e cerca de 62% desses indivíduos optaram por fazer o teste para confirmar a infecção antes de se medicar enquanto 35% se automedicaram sem fazer teste. Da mesma maneira, no Orpal 2, 78,9% dos garimpeiros já haviam tido algum episódio de malária, 43% fizeram o teste antes de se medicar e 39% se automedicaram sem fazer o teste. Ainda no Orpal 2, 10% dos participantes fizeram também o uso do Malakit. Também foi visto que no segundo corte, cerca de 25% (30) dos indivíduos estavam inclusos no projeto Malakit e desses, 5 (16,66%) haviam feito o uso do kit no último episódio de malária. Conclusões: Os garimpeiros do estudo são todos brasileiros com um baixo nível educacional e expostos a doenças como a malária, leishmaniose, entre outras. Trata-se de uma população com conhecimentos sobre a malária, porém não faz práticas a fim de evitar a infecção. No entanto no Orpal 2 foi visto um aumento no uso do mosquiteiro Esses garimpeiros praticam frequentemente automedicação e compram esses medicamentos no mercado ilegal; além de ser um grupo de difícil alcance devido a sua alta mobilidade, o mercado ilegal de medicamentos também dificulta o desenvolvimento de estratégias de saúde voltadas para essa população. Os dados deste estudo, junto com os dos nossos parceiros no Suriname assim como outras formas de avaliação do projeto Malakit mostram que estas informações são fundamentais para o desenvolvimento de políticas públicas de saúde direcionadas para as situações epidemiológicas encontradasBACKGROUND: Among the areas of malaria transmission nominated as “specials” by the Ministry of Health, are the gold mining sites. Little is known about the prevalence of Plasmodium spp. in the mining sites of the Guyanese massif and about the main determinants of the disease transmission among gold miners. Gold miners are a highly mobile and hard to reach population, which makes the control of the disease a major challenge for the country's health authorities. Currently, the municipality of Oiapoque is considered medium risk for malaria and a good part of the local cases consists of illegal gold miners in French Guiana. OBJECTIVES: To analyze the epidemiology of malaria and determine knowledge, attitudes, and practices (KAPs) towards the disease by gold miners in the municipality of Oiapoque-Amapá, in the border area between Brazil and French Guiana before and after the implementation of Malakit. METHODOLOGY: A cross-seccional study was conducted in the municipality of Oiapoque where two visits were carried out, one before (Orpal 1_ 2018) and other after (Orpal 2_2019) the implementation of Malakit), a pilot project to control malaria in gold miners. The individuals were recruited from resting sites and were submitted to a questionnaire with demographic variables, malaria background and knowledge, attitudes, and practices regarding malaria. At the same time, a clinical evaluation of the participants was made and whole blood sample was collected for the parasitoscopic and molecular diagnose of malaria RESULTS: The participants were mostly from Maranhão, Pará and Amapá, males, and with an average age of 39 years. The prevalence of Plasmodium spp. found in our study was 3.36% and the main species found was P. vivax. Approximately 56% of participants in Orpal 1 and 66% in Orpal 2 knew correctly how malaria is transmitted, but most of participants were not used to protect themselves against mosquito bites. In Orpal1 87.7% of the gold prospectors had at least one episode of malaria and approximately 62% of these individuals chose to be tested to confirm the infection before treatment and 35% self-medicated without a test. Similarly, in Orpal 2, 78.9% of prospectors had already had episodes of malaria, 43% had been tested before taking medication and 39% had self-medicated, without taking the test. Also, in Orpal 2, 10% of the participant used Malakit. And, still in Orpal 2, about 25% (30) of the participants were already included in the Malakit project and 5 (16.66%) of them had used the malakit at their last malaria attack. CONCLUSIONS: The gold miners of this frontier are all Brazilians with a low level of education and are exposed to diseases such as malaria, leishmaniosis among others. These individuals have a considerable knowledge of malaria but they do not use measures that could avoid the infection; however at Orpal 2 was seen an increase in the use of bed nets. These gold miners often practices self-medication and buy drugs on the illegal market, in addition to being a hard-toreach group thanks debts to their high mobility, which hinders the development of public health strategies aimed at this populations. Data from this study and researchers of our partners in Suriname and other evaluation activities of the Malakit project, show that this information is fundamental to the development of public health policies specially aimed at the epidemiological situatio
HPV: prevenção, diagnóstico e abordagem
No full textO que se deve buscar não é o diagnóstico de HPV, mas a detecção precoce do câncer de colo do útero ou de suas lesões precursoras, que tem tratamento.FiocruzText
Narratives of memory and traditional medicines: the Semente de Jurema School of Culture and Health
No full textEste estudo fundamentou-se na perspectiva da pesquisa-intervenção, e se propôs a colocar em analise temas em memória, cultura e saúde, tendo nas narrativas das medicinas da Jurema Sagrada seu principal material de reflexão. Os efeitos de saber-poder sobre o tema foram provocados através da cartografia dos arquivos de memória da Escola de Cultura e Saúde Semente de Jurema, realizando entrevistas abertas com participantes das oficinas, vivencias da escola e Juremeiros. Apresentou a pedagogia griô como uma das principais referências para a dinamização dos aprendizados acerca das medicinas dos povos tradicionais e dos lugares de saber dos mestres juremeiros, acerca dos processos saúde e doença, morte e vida. Apontou em destaque como as artes e ofícios dos povos de matriz indígena são de extrema importância para o campo das práticas integrativas e complementares em saúde, e como os processos de ensino e aprendizado em medicinas integrativas devem incluir a relevância das especificidades das artes de cuidar nas medicinas tradicionais e seus sistemas sagrados. Destacou ainda, a relevância dos estudos sobre a morte e o morrer acerca do tema dos patrimônios culturais da saúde, nos estudos transversais em memória social que deflagraram a potência de valorização, reconhecimento acadêmico e social das sabedorias sagradas no cuidado em saúde.This study is based on the perspective of research-intervention, and proposes to analyze themes in memory, culture and health, having as main material reflection the narratives of the medicines of "Jurema Sagrada”. The effects of power-knowledge on the subject's form provoked through the cartography of memory files of the School of Culture and Health Semente de Jurema, conducting open interviews with participants from the headquarters and experiences of the school and Juremeiros. Presented the pedagogy “griot” as one of the main references for promoting types of knowledge about medicines, traditional peoples and places of knowledge of the juremeiros masters’ health and teaching processes, death and life. It pointed out how arts and crafts of indigenous peoples are extremely important for the field of integrative and complementary practices in health and how the teaching and learning processes in integrative medicine must contemplate the relevance of the specificities of the arts of caring for medicines systems traditional and sacred.It also highlights the relevance of studies on death and death on the theme of the cultural heritage of health, in non-transversal studies in social memory, triggering the potential for recovery, academic and social reconquest of sacred knowledge, careless in health
Factors associated with incident cardiovascular events and cardiac risk assessment in a cohort of hiv-infected participants in Rio de Janeiro
No full textBackground: Cardiovascular events (CVEs) have emerged as an important cause of morbimortality in people
living with HIV/AIDS (PLHA). We aimed to investigate factors associated with incident CVE and compare the observed
incidence with the predicted CVE risk by three different equations. Methods: Among the 649 active participants of the INI ELSA cohort, we analysed data of 644 individuals free of CVE at baseline examinations. We used Cox regression models to
study factors associated with CVE and to assess the equation's performance we compared the observed incidence with the
overall 5-year predicted risks. Results: Over a median follow-up of 6.26-years (interquartile range [IQR] 6.01-6.47), there were
18 CVE, four deaths. Overall, 57.92% were male, median age was 43.4 years (35.82-50.73), most were on cART (88.65%).
Participants who had CVE were older, had poorer renal function, higher proportion of dyslipidemia and higher levels of
systolic blood pressure and triglycerides. The observed CVE rate was 2.90% (1.60-4.90%) whereas their overall cardiovascular
disease (CVD) risk differed depending on which score was used: 0.91 (0.42-20), 1.16 (0.38-2.78) and 1.68 (0.60-3.87),
according to Framingham, ASCVD and DAD, respectively. In the multivariable Cox analysis black race, smoking 10+ packs
years, dyslipidemia, current CD4 cell count x101
, cumulative viral load and time on NNRTI were independent predictors of
CVE. Conclusion: Both traditional and HIV-related factors were associated with incident CVE. Risk scores were inconsistent
in classifying patients who had CVE as high risk, indicating that validation studies are required to improve risk assessment of
PLHA in Brazil
The cumulative effect of multiple dimensions of lifestyle on risky drinking during the Covid-19 pandemic
No full textLifestyle impacts morbidity and mortality worldwide. Herein, we evaluated the association of a multidimensional lifestyle measure and its domains (diet/nutrition, substance use, physical activity, social, stress management, sleep, environmental exposure) with risky drinking. Also, we analyzed the cumulative effect of unhealthy domains in the likelihood of presenting risky drinking. To reach these objectives, data from a web survey conducted in Brazil and Spain was analyzed. The main outcome was risky drinking assessed by the AUDIT-C. Lifestyle was measured using the Short Multidimensional Inventory Lifestyle Evaluation (SMILE). Fixed logistic models were used to evaluate associations between lifestyle and risky drinking. Between April and May 2020, 22,785 individuals answered the survey. The prevalence of risky drinking was 45.6% in Brazil and 30.8% in Spain. The SMILE score was lower (unhealthier lifestyle) among at-risk drinkers. Worse scores on Diet, Substance use, Stress management and Environment were associated with an increased likelihood of risky drinking. The higher the number of unhealthy domains, the higher the likelihood of presenting risky drinking: adjusted odds ratio (aOR) for risky drinking was 1.15 (IC95% 0.98-1.35) and 23.42 (IC95% 3.08-178.02) for those presenting worse lifestyle in 1 and 5 domains, respectively. Finally, interactions suggest that improvement in lifestyle domains would have a larger effect in Spain than in Brazil. Our results suggest that future interventions aiming at reducing Risky drinking may benefit from strategies targeting multiple domains of lifestyle
Aumento de óbitos entre trabalhadores acende alerta para necessidade de prioridade em vacinação
No full textO índice de óbitos entre trabalhadores formais de serviços essenciais não relacionados à Saúde aumentou consideravelmente no auge da pandemia, e, em decorrência disso, eles deveriam ser grupo prioritário no Plano Nacional de Imunização. É o que indicam estudos recentes que analisaram a exposição e a taxa de óbitos entre aquela categoria de profissionais no início deste ano, em comparação com o mesmo período de 2020. Diante dos dados, a Federação Nacional dos Frentistas (Fenepospetro) publicou nota reivindicando a inclusão dos trabalhadores em postos de abastecimento e lojas de conveniência na inclusão da Fase 4 da vacinação
Disruption of active trans-sialidase genes impairs the egress from mammalian host cells and generates highly attenuated Trypanosoma cruzi parasites
No full textOs autores externos submeteram sua publicação para apresentação de trabalho no evento “International Symposium on Immunobiologicals”, que foi coordenado e organizado pelo Instituto de Tecnologia em Imunobiológicos (Bio-Manguinhos), da Fundação Oswaldo Cruz
Susceptibility of lung cancer patients to COVID-19: A review of the pandemic data from multiple nationalities
No full textSeveral studies have highlighted that cancer patients tend to be more susceptible to develop severe infection and to die from COVID-19. Certain medical conditions such as immunosuppression, presence of comorbidities, and underlying pulmonary damage are possible determinants of disease severity, especially in lung cancer patients. While recent studies have shown that lung cancer is one of the most prevalent tumor types among COVID-19 cancer patients, we still have an incomplete view of how data from several countries work as a whole. The aim of this review was to investigate COVID-19 prevalence in lung cancer patient cohorts and their probability to develop severe illness and death when compared to nonlung cancer patients from multiple nationalities, including countries that have been the epicenters of the pandemic. We also focus on some intrinsic lung cancer features that might influence COVID-19 outcomes. An integrative view of the susceptibility of lung cancer patients might be especially relevant to assist physicians in evaluating the risks of COVID-19 in these patients, and to foster better decisions on treatment delay
Subsidies for the compliance of SDG 3.1 of the 2030 Agenda: an analysis of maternal mortality in Brazil from 1996 to 2018
No full textO objetivo desta dissertação é produzir subsídios para o governo federal desenvolver políticas que viabilizem o cumprimento da Meta ODS 3.1, pelo Brasil. Para isso, foi realizado um diagnóstico no DATASUS sobre a situação da mortalidade materna nas Regiões de Saúde (CIR), em 2018, e as principais características desta mortalidade no país, entre 1996 e 2018. Com o intuito de construir um referencial teórico para a análise dos dados foi feita uma análise bibliográfica sobre a mortalidade materna no Brasil. Em 2018, das 450 CIR, 159 apresentaram RMM superior a 70,0/100.000 NV. Apesar das altas razões de mortalidade materna no Brasil, entre 1996 e 2018, houve redução entre mulheres de 30 a 49 anos. Entretanto, a faixa de 10 a 29 anos permaneceu inalterada ao longo da série estudada. A disseminação dos Comitês de Mortalidade Materna, o PHPN, a PNAISM e a Rede Cegonha influenciaram melhorias na gravidez tardia, no entanto, não foram eficazes na prevenção dos óbitos entre mães jovens. Visando aprofundar o diagnóstico, comparou-se as RMM das Regiões de Saúde aos seus respectivos Índices de Desenvolvimento Humano Municipais (IDHM) \2013 calculados a partir de dados do Atlas Brasil. Constatou-se que as CIR com níveis elevados de desenvolvimento humano tendem a apresentar mortalidade materna menos elevada; já as CIR com níveis baixos de desenvolvimento humanos apresentam mortalidade materna mais alta. Com base neste diagnóstico, construiu-se um Plano de Enfrentamento à Mortalidade Materna, a partir da organização das 450 CIR em 6 Grupos de prioridades, visando subsidiar o cumprimento da Meta ODS 3.1, pelo Brasil. Tal Plano busca: priorizar as Regiões de Saúde com alta Razão de Mortalidade Materna e baixo nível de Desenvolvimento Humano Municipal \2013 enfrentando as desigualdades regionais; propiciar diretrizes de ação para todas as Unidades da Federação e todas as CIR \2013 abordagem de âmbito nacional, com integração progressiva das UF; priorizar as Regiões Norte e Nordeste; e priorizar as CIR do Amazonas, Roraima, Amapá, Pará, Maranhão e Piauí \2013 faixa territorial considerada estratégica para a redução da mortalidade materna.This dissertation aims to produce subsidies for the federal government to develop policies that make it possible to achieve the SDG 3.1, for Brazil. To achieve this, it was carried out a diagnosis of the situation of maternal mortality in the Health Regions (CIR), in 2018, and the main characteristics of this mortality, between 1996 and 2018, in Brazil. In order to build the theoretical framework for data analysis, a bibliographic survey was made on maternal mortality in Brazil. In 2018, of the 450 CIR, 159 presented MMR higher than 70 per 100.000 live births. Despite the high mortality ratios between 1996 and 2018, in Brazil, there was a reduction among women aged 30 to 49 years. However, the range from 10 to 29 years remained unchanged throughout the studied series. The dissemination of the Maternal Mortality Committees, the \201CPHPN\201D, the \201CPNAISM\201D and the \201CRede Cegonha\201D influenced improvements in late pregnancy, however, they were inefficient in preventing deaths among young mothers. To deepen this approach, the MMR of the Health Regions was compared to their respective Municipal Human Development Indexes \2013 calculated from Atlas Brazil data. It was found that CIR with high levels of human development tend to perform lower maternal mortality; while CIR with low levels of human development have higher maternal mortality. Based on this diagnosis, a Plan for Confronting Maternal Mortality was built, through the organization of the 450 CIR into 6 Priority Groups, to support the compliance of the SDG 3.1, by Brazil. This Plan seeks: to prioritize health regions with high Maternal Mortality Ratio and low level of Municipal Human Development \2013 regional inequalities confrontation; provide framework for action for all Federation Units and all CIR \2013 national approach, with progressive integration of the States; prioritize the North and Northeast Regions; prioritize the CIR of Amazonas, Roraima, Amapá, Pará, Maranhão and Piauí \2013 strategic territorial strip for the reduction of maternal mortality in Brazil