André Monteiro Costa

A estreita porta de entrada do Sistema Único de Saúde (SUS): uma avaliação do acesso na Estratégia de Saúde da Família

Este estudo objetivou analisar a percepcao dos usuarios sobre o acesso a Estrategia de Saude da Familia (ESF) em suas dimensoes geografica, organizacional, sociocultural e economica. Fez-se uma avaliacao de processo com abordagem qualitativa por meio de entrevista aberta, observacao direta e analise documental, em Recife, Pernambuco. Os principais problemas foram: deficiente sistema de referencia e contra-referencia; demora no retorno dos resultados dos exames laboratoriais; excessivo numero de familias por equipe; dificuldades para marcar consultas; despesas com medicamentos. Foram observadas facilidades na relacao profissional-usuario, bem como na proximidade geografica da unidade de saude. A ESF revelou-se uma estreita porta de entrada do SUS, merecendo um olhar distinto, que adote como ponto de partida as necessidades dos individuos demandatarios de suas acoes, bem como as logicas que norteiam as acoes dos sujeitos envolvidos no cuidado.Este estudo objetivou analisar a percepcao dos usuarios sobre o acesso a Estrategia de Saude da Familia (ESF) em suas dimensoes geografica, organizacional, sociocultural e economica. Fez-se uma avaliacao de processo com abordagem qualitativa por meio de entrevista aberta, observacao direta e analise documental, em Recife, Pernambuco. Os principais problemas foram: deficiente sistema de referencia e contra-referencia; demora no retorno dos resultados dos exames laboratoriais; excessivo numero de familias por equipe; dificuldades para marcar consultas; despesas com medicamentos. Foram observadas facilidades na relacao profissional-usuario, bem como na proximidade geografica da unidade de saude. A ESF revelou-se uma estreita porta de entrada do SUS, merecendo um olhar distinto, que adote como ponto de partida as necessidades dos individuos demandatarios de suas acoes, bem como as logicas que norteiam as acoes dos sujeitos envolvidos no cuidado.

Aedes aegypti control in Brazil

www.thelancet.com Published online March 1, 2016 http://dx.doi.org/10.1016/S0140-6736(16)00626-7 1 Submissions should be made via our electronic submission system at http://ees.elsevier.com/ thelancet/ sanitation, with a stable supply of potable water. Relying on a chemical war against the vector tends to pacify the population with false security, while a broad programme for better sanitary urban conditions could generate social mobilisation and co-responsibility of the population. Improvement of sanitary conditions is a long-term investment in population health, while pesticide use will have to be repeated. The Brazilian Association of Collective Health calls to stop the use of chemical products against A aegypti, especially in household water reservoirs, and prioritise sanitary measures.Liberado em acesso aberto como parte do acordo para tornar publico todos os dados produzidos sobre o virus zika - Compartilhamento de dados em emergencias de saude publica - http://www.wellcome.ac.uk/News/Media-office/Press-releases/2016/WTP060169.htm

Desastres naturais e saúde: uma análise da situação do Brasil

Natural disasters are still insufficiently studied and understood within the scope of public health in this country, with impacts in the short and long term. The scope of this article is to analyze the relationship between disasters and their impact on health based on disaster data recorded in the country. The methodology involved the systematization of data and information contained in the Brazilian Atlas of Natural Disasters 1991-2010 and directly from the National Department of Civil Defense (NSCD). Disasters were organized into four categories of events (meteorological; hydrological; climatological; geophysical/geological) and for each of the latter, the data for morbidity, mortality and exposure of those affected were examined, revealing different types of impacts. Three categories of disasters stood out: the hydrological events showed higher percentages of mortality, morbidity and exposure; climatological events had higher percentages of incidents and people affected; the geophysical/geological events had a higher average of exposure and deaths per event. Lastly, a more active participation of the health sector in the post-2015 global political agenda is proposed, particularly events related to sustainable development, climate change and disaster risk reduction.

O contexto global e nacional frente aos desafios do acesso adequado à água para consumo humano

The scope of this article is to analyze the challenges involved in ensuring access to water for human consumption taking the international and national context into consideration. Based on the UN declaration that access to safe and clean drinking water is a fundamental human right, vulnerabilities are identified that can consist in restrictions to access to adequate supplies. The distribution of water and the population across the planet, pollution, inadequate policies and management lead to environmental injustice. The iniquity of access to water constitutes the contemporary water crisis. From the 1980s onwards, the transnational water market emerged for private control that occurs at three main levels: surface and underground water sources; bottled water; and public water supply services. The conflicts of the multiple uses of water resources, the market and environmental problems have contributed to rendering the health of the population and ecosystems vulnerable. Adequate public policies are essential to ensure the basic human right to access to safe and clean drinking water.

A regulação no setor público de saúde no Brasil: os (des) caminhos da assistência médico-hospitalar

Health care regulation is a fundamental action in order to achieve effectiveness in health system. This article analyses SUS [Unified Health System] main regulatory framework, in relation to historical patterns of health service delivery, observed between 1996 and 2006. Despite all those political and organizational changes required by the Brazilian health sector reform process to implement SUS, which progressed, evidences and empirical data suggest that the agreed regulatory frameworks are weak and fragile and they did not change historical patterns and the main characteristics of SUS health care. This article suggests one possible explanatory reason for this behaviour, that needs to be empirically analysed: interest groups acting inside the Brazilian health system, on behalf of social insurance health care network, could capture the regulatory process, taking public resources to this network which maintain the same pattern of heath care services for decades, jeopardizing SUS implementation and the relevant health service delivery for the Brazilian society.

Uso de agrotóxicos e a relação com a saúde na etnia Xukuru do Ororubá, Pernambuco, Brasil

Abstract This study aims to understand the use of pesticides in agricultural cultivation and its relationship with indigenous health from a case study among the Xukuru from Ororuba indians, in the town of Pes-queira, Pernambuco State, Brazil. The methodologi-cal strategies used were participatory observation, document analysis, focus groups and questionnai-res; they have given access to socio-political events and cultural ethnicity, the perception of individuals and contextual socio-historical aspects that influen-ced the inclusion of pesticides’ technology on the Xukuru indigenous land and agricultural productive process. The use of pesticides in this ethinic group is historically related to the socio-economical model introduced along with the process of industrializa-tion in the region. In the indigenous perception, pesticides were related to the meaning of medicine, but it was also perceived as a poison. The use of chemicals is done intensively and the indians do not use any personal protective equipment. The Xukuru recognize the pesticide influence on health;, however they highlight that this practice is required to guarantee the agricultural production. There is a need for the implementation of public policies to promote health, aiming to offer sustainable agri-cultural alternatives to the indigenous Xukuru that are made with their participation, respecting their cultural traditions.Keywords: Pesticides, Risk Perception, Indigenous Health, Indians of the Northeast, the Xukuru from Ororuba.

Comparison of the burden of diarrhoeal illness among individuals with and without household cisterns in northeast Brazil.

BackgroundLack of access to safe and secure water is an international issue recognized by the United Nations. To address this problem, the One Million Cisterns Project was initiated in 2001 in Brazil’s semi-arid region to provide a sustainable source of water to households. The objectives of this study were to determine the 30-day period prevalence of diarrhoea in individuals with and without cisterns and determine symptomology, duration of illness and type of health care sought among those with diarrhoea. A subgroup analysis was also conducted among children less than five years old.MethodsA face-to-face survey was conducted between August 20th and September 20th, 2007 in the Agreste Central Region of Pernambuco State, Brazil. Households with and without a cistern that had at least one child under the age of five years were selected using systematic convenient sampling. Differences in health outcomes between groups were assessed using Pearson’s Chi-squared and two-way t-tests. Demographic variables were tested for univariable associations with diarrhoea using logistic regression with random effects. P-values of 0.05 or less were considered statistically significant.ResultsA total of 3679 people from 774 households were included in the analysis (1863 people from 377 households with cisterns and 1816 people from 397 households without cisterns). People from households with a cistern had a significantly lower 30-day period prevalence of diarrhoea (prevalence = 11.0%; 95% CI 9.5-12.4) than people from households without a cistern (prevalence = 18.2%; 95% CI 16.4-20.0). This significant difference was also found in a subgroup analysis of children under five years old; those children with a cistern had a 30-day period prevalence of 15.6% (95% CI 12.3-18.9) versus 26.7% (95% CI 22.8-30.6) in children without a cistern. There were no significant differences between those people with and without cisterns in terms of the types of symptoms, duration of illness and health care sought for diarrhoea.ConclusionsOur results indicate that the use of cisterns for drinking water is associated with a decreased occurrence of diarrhoea in this study population. Further research accounting for additional risk factors and preventative factors should be conducted.

Impacto do uso da água de cisternas na ocorrência de episódios diarréicos na população rural do agreste central de Pernambuco, Brasil

OBJECTIVES: to evaluate the impact of the use of water-tanks on the occurrence of episodes of diarrhea, comparing the number and duration of episodes among the residents of households with and without water-tanks in the same geographical area. METHODS: a longitudinal prospective study, nested in a cross-section study comparing two groups (households with and without water-tanks), was carried out in 21 municipalities in the Central Agreste region of the Brazilian State of Pernambuco, in 2007. Data was gathered over 60 days and included 1,765 individuals. Descriptive analysis was carried out using mixed hierarchical models, Mann-Whitney and Kaplan-Meyer with the level of significance set at 5%. RESULTS: among the 949 individuals with water-tanks, there was a reduction in the risk of the occurrence of episodes of diarrhea of 73% compared with the 816 individuals without water-tanks (RR=0.27; p<0.001). The mean number of episodes registered among residents of households without water-tanks was 0.48 (SC=1.17), compared with 0.08 (SC=0.32) among households with water-tanks (z=-10.26; p<0.001). The mean during of episodes was 1.5 times greater in households without water-tanks (χ2=8.99; p=0.003). CONCLUSIONS: the findings of this study point to the importance of access to drinking water for the reduction of disease. The occurrence of diarrhea and its concomitant severity indicators-number of episodes and duration-were consistently higher among residents of households without water-tanks.

The narrow entrance door of Brazil's national health system (SUS): an evaluation of accessibility in the family health strategy

Este estudo objetivou analisar a percepcao dos usuarios sobre o acesso a Estrategia de Saude da Familia (ESF) em suas dimensoes geografica, organizacional, sociocultural e economica. Fez-se uma avaliacao de processo com abordagem qualitativa por meio de entrevista aberta, observacao direta e analise documental, em Recife, Pernambuco. Os principais problemas foram: deficiente sistema de referencia e contra-referencia; demora no retorno dos resultados dos exames laboratoriais; excessivo numero de familias por equipe; dificuldades para marcar consultas; despesas com medicamentos. Foram observadas facilidades na relacao profissional-usuario, bem como na proximidade geografica da unidade de saude. A ESF revelou-se uma estreita porta de entrada do SUS, merecendo um olhar distinto, que adote como ponto de partida as necessidades dos individuos demandatarios de suas acoes, bem como as logicas que norteiam as acoes dos sujeitos envolvidos no cuidado.Este estudo objetivou analisar a percepcao dos usuarios sobre o acesso a Estrategia de Saude da Familia (ESF) em suas dimensoes geografica, organizacional, sociocultural e economica. Fez-se uma avaliacao de processo com abordagem qualitativa por meio de entrevista aberta, observacao direta e analise documental, em Recife, Pernambuco. Os principais problemas foram: deficiente sistema de referencia e contra-referencia; demora no retorno dos resultados dos exames laboratoriais; excessivo numero de familias por equipe; dificuldades para marcar consultas; despesas com medicamentos. Foram observadas facilidades na relacao profissional-usuario, bem como na proximidade geografica da unidade de saude. A ESF revelou-se uma estreita porta de entrada do SUS, merecendo um olhar distinto, que adote como ponto de partida as necessidades dos individuos demandatarios de suas acoes, bem como as logicas que norteiam as acoes dos sujeitos envolvidos no cuidado.

The Aedes aegypti eradication program: useless, hazardous (and wasteful, in addition)

Senhor Ed i t o r ,No mundo das fibras opticas, da engenharia ge-netica e da informatica, no qual a ciencia aponta pa-ra novos para d i g m a s , onde a interd i s c i p l i n a r idade e ai n t e g r acao do social com o ambiente e o nucleo deseu discurso, deparamos-nos com o tragico pro g r a-ma que propaga