Leandro Luiz Giatti

Estudo da associação entre fatores socioambientais e prevalência de parasitose intestinal em área periférica da cidade de Manaus (AM, Brasil)

Este estudo teve como objetivo avaliar a associacao entre fatores socioambientais e condicoes de saneamento urbano com a prevalencia de parasitoses intestinais, em uma comunidade na periferia da cidade de Manaus. O estudo consistiu de um levantamento socioambiental e de um inquerito parasitologico. Foi encontrada uma comunidade heterogenea, apresentando diferencas em relacao aos niveis socioeconomicos e ambientais entre as micro-areas avaliadas, embora as condicoes de saneamento basico da comunidade tenham-se mostrado precarias de uma forma geral. A prevalencia de parasitose intestinal foi de 44,2%. Nao foi identificada diferenca significativa entre as micro-areas com respeito a ocorrencia de parasitoses intestinais. Houve associacao entre parasitoses intestinais e tipo de construcao residencial, faixa etaria e procedencia da agua de higiene pessoal e do lar. O despejo do esgoto a ceu aberto foi fator de risco associado a parasitoses intestinais (OR=6,72; p=0,034) e a protozoarios intestinais (OR=21,87; p=0,004). Foram fatores de risco, apenas para a presenca de protozoarios, o despejo de esgoto em igarape (OR=12,98; p=0,011) e o uso de fossa rudimentar (OR=9,54; p=0,019).

Condições de saneamento básico em Iporanga, Estado de São Paulo

OBJECTIVE To assess the pollution of water bodies by domestic sewage and to evaluate the basic sanitation conditions of residences and the knowledge of the local population concerning intestinal parasitic diseases and the hazards they present to public health. METHODS Thirteen water samples were collected from each of four sites in different water bodies of the Bairro da Serra region, in Iporanga, São Paulo State. Rates of total and fecal coliforms were measured and median values were presented so as to show domestic sewage contamination in the area. Questionnaires were administered to 50% of local households in order to obtain information on water supply and disposal of domestic sewage and solid waste, and to evaluate knowledge of the transmission, health hazards, and prevention of intestinal parasitic diseases among the local population. RESULTS The Betari river showed microbiological indexes indicative of pollution by domestic sewage. Higher levels were verified both upstream and downstream from the Bairro da Serra. Median values were even higher in two of the rivers tributary streams, indicating strong pollution by domestic sewage and lack of conformity with current legislation. In 91% of the households investigated, sewage disposal was done by means of septic tanks, most of which were rudimentary and contributed to the contamination of the environment. The knowledge of 62% of interviewed subjects concerning the transmission of helminthic diseases was considered as poor. CONCLUSIONS Our results indicate a risk of proliferation of intestinal parasitoses and of other water-transmitted diseases, an issue which is aggravated by increases in population caused by the regions vocation for ecotourism.

Reflexões sobre água de abastecimento e saúde pública: um estudo de caso na Amazônia brasileira

Embora a Amazonia ostente grandioso patrimonio ambiental e abundância de recursos hidricos, e na regiao Norte do Brasil, contida neste notavel bioma, que se verificam os piores indices de acesso a servicos de saneamento e respectivos indicadores de saude publica. Por meio de estudo de caso efetuado na cidade de Sao Gabriel da Cachoeira, localizada a noroeste do Estado do Amazonas, com aproximadamente 18.000 habitantes e substancial parcela de populacao indigena, verificou-se a complexidade de fatores relacionados ao provimento de agua e a melhoria da saude publica para nucleos urbanos da Amazonia. A ausencia de politicas concisas, as peculiaridades ambientais, as dificuldades logisticas e financeiras somam-se a questoes socioculturais, a aspectos migratorios e a processo de urbanizacao desordenada, associada a impactos ambientais. Para melhoria da saude publica nessas circunstâncias torna-se necessaria uma abordagem interdisciplinar, que possibilite a gestao dos recursos hidricos, a implementacao de saneamento basico e, nao obstante, a promocao de adesao dos habitantes.

Ecosystem approach and the Fuzzy logic: a dialectical proposal for information on Environmental Health

The ever-growing production and the problematization of Environmental Health have shown the need to apprehend complex realities and deal with uncertainties from the most diversified instruments which may even incorporate local aspects and subjectivities by means of qualitative realities, while broadening the capacity of the information system. This paper presents a view on the reflection upon some challenges and possible convergences between the ecosystemic approach and the Fuzzy logic in the process of dealing with scientific information and decision-making in Environmental Health.

Agenda 21 e Governança

(Primeiro Paragrafo do Artigo) Atualmente, o avanco rumo a sociedade sustentavel e permeado de obstaculos, na medida em que existe uma restrita consciencia na sociedade a respeito das implicacoes do modelo de desenvolvimento em curso.

Mobilização social em saúde e saneamento em processo de pesquisa-ação em uma comunidade indígena no noroeste amazônico

Abstract The living conditions of the inhabitants of Iauarete, an indigenous area in the municipality of Sao Ga-briel da Cachoeira, State of Amazonas (Northern Brazil), have been negatively affected by popula-tion density, poor sanitation and maintenance of sanitation practices that are incompatible with that reality. To improve the population’s quality of life, sanitation systems that are adequate to the local so-cio-cultural characteristics should be implemented, as well as educational processes with emphasis on social mobilization and community empowerment. The aim of this paper is to report and discuss a train -ing course on health and sanitation using action research, directed to the mobilization of the Iauarete indigenous people, with the objective of assisting other studies of this nature. In the meetings, issues related to environmental health were discussed, a Community Newspaper was constructed, the course participants made interviews and drew up claims documents. This experience has enhanced the participants’ understanding of local problems and of the importance of social mobilization for the dialogue with governmental institutions that are responsible for providing sanitation services and for seeking better living conditions. The researchers and teachers of the training course benefitted from the construction of collective knowledge resulting from interaction with subjects of the investigated situation and from the recognition and redefinition of their representations, fulfilling the fundamental premise of action research.Keywords: Social Mobilization; Popular Partici-pation; Action Research; Sanitation; Indigenous community.

Challenges to participation in action research

In order to understand and take action in complex health and environmental issues, we intend to analyse the conditions that are needed for those at risk to participate in research and intervention projects. In this study, we describe and discuss an action research experience carried out with an indigenous community in the Brazilian Amazon that suffers from serious sanitary problems, where cultural aspects in the relationship with the environment and health are particularly relevant. Different types of tools were deployed and combined and were subsequently classified according to their dialectic efficacy and ability to both conduct and steer the research and encourage the participation of social actors within a process of feedback. Even tools that were considered to be non-dialectic proved to be important sources of feedback. We present a research flow as a model of analysis and a framework for implementing action research, in which challenges to the participation of social actors are classified according to their priority through a critical review of the methodology developed. These challenges are social mobilization, co-operation, appropriation and a proactive stance. We conclude that a cyclic combination of dialectic and non-dialectic tools can increase participation, which though difficult to achieve is nevertheless necessary. During the development of this process, social mobilization is a prerequisite, whereas a proactive stance, the highest level of participation, requires continuous effort and the successive deployment of a variety of tools.

Acesso à água para consumo humano e aspectos de saúde pública na Amazônia Legal

The Legal Amazon region in Brazil presents challenges regarding access to water for its population, even with plenty of water. This study aims to explore determinants of access to drinking water, covering aspects of environmental, sociocultural, and infrastructure. For this, we analyze: the precarious sanitation coverage by region, by means of macro indicators and case studies on different spatial scales: the indigenous community, small town, riverside communities, and a large city, Manaus, the largest urban center in the Pan-Amazon Amazon. Finally, to undertake an interdisciplinary discussion about the difficulties of access to water within the public health, the importance of exploring aspects that appear so evident in the spatial scales.

A pesquisa-ação em estudos interdisciplinares: análise de critérios que só a prática pode revelar

Este artigo propoe uma reflexao sobre criterios para a metodologia da pesquisa-acao, visando contribuir para o atendimento de premissas necessarias a aplicacao e melhoria da qualidade de investigacoes participativas, em contextos socioambientais e de saude. Para a construcao desta estrutura de abordagem, foram utilizados resultados da analise de dissertacoes e teses sobre pesquisa-acao de carater interdisciplinar, na interface das areas saude, educacao e ambiental. A analise de situacoes praticas permitiu identificar elementos favoraveis ao alcance dos objetivos de uma pesquisa-acao e compreensao de sua dinâmica organizacional. Foram estabelecidos os seguintes criterios: flexibilidade metodologica; combinacao de multiplos instrumentos de pesquisa e intervencao; e o nivel de participacao e cooperacao dos/e entre sujeitos e pesquisadores. A pesquisa-acao revela-se como uma adequada proposta frente a desafios interdisciplinares quando executada contemplando os criterios aqui estudados.This paper proposes a reflection on the criteria for the methodology of action research, with the aiming of contributing towards meeting the premises required for application and improvement of the quality of participatory research in socioenvironmental and healthcare contexts. To construct this approach structure, the results from analysis of dissertations and thesis on action research were used in an interdisciplinary manner, at the interfaces between the fields of health, education and the environment. Analysis on practical situations made it possible to identify elements favoring attainment of the objectives of action research and understanding of the organizational dynamics. The following criteria were established: methodological flexibility; combination of multiple research and intervention tools; and levels of cooperation and participation among subjects and researchers. Action research was shown to be an appropriate proposal in the light of the interdisciplinary challenges when applied taking into account the criteria studied here.

A temática ambiental em representações e práticas de profissionais de saúde da família no município de Manaus - AM/Brasil

Abstract There are abundant scientific evidences showing that the increased risk of exposure to diseases is a consequence of anthropogenic environmental changes. In the Family Health Strategy, tasks with a clear environmental focus are prescribed, indicating to the professional teams that they should consider these aspects in their health practices. The objective of this research was to study representations and practices of Family Health Professionals of Ma-naus – State of Amazonas, Northern Brazil – about environmental issues and their interface with public health. Data were collected by means of participant observation and semi-structured interviews, and the qualitative analysis was carried out through Content Analysis and Methodological Triangula-tion. The results showed that most professionals do not understand the environment in a systemic way, even though they recognize the great impact that environmental factors have on human health; as interventions, the educational practices follow traditional methodologies and focus on blaming the individual and on the simple transmission of knowledge; the professionals’ relationship with the community is limited to personal and/or collective care. It is concluded that in order to the Family Health Strategy to contribute to restructure the system, it is essential to redirect this new health policy model so that it becomes effective as a social and environmental practice.Keywords: Environmental Health; Family Health; Health Personnel; Health Promotion.