Seroprevalence of hepatitis B, C and D markers in indigenous patients seen at the Native American Outpatient Clinic of Universidade Federal de São Paulo

ABSTRACT Objective To detect and treat cases of viral hepatitis B, C and D in patients seen at the Native American Outpatient Clinic of Universidade Federal de São Paulo. Methods This sample comprised 81 indigenous recruited between 2018 and 2020. Volunteers were aged 7 months to 70 years (mean age of 28±20 years), belonged to 26 ethnic groups spanning the Brazilian territory and answered a questionnaire, which was attached to their medical records. Peripheral blood samples (20mL) were collected, transported to the Clinical Laboratory of Hospital Israelita Albert Einstein, processed, and tested for markers of viral hepatitis B, C and D. Results In this study, 39 (48.1%) individuals were anti-HBs (+) only, 13 (16.0%) individuals were anti-HBs (+) and anti-HBc (+), and 28 (34.6%) individuals were negative for all markers. No anti-HBc IgM+ samples were found. No cases of hepatitis C and D were found. Conclusion This analysis provided evidence of previous infection by the hepatitis B virus. These findings led to prescription of vaccination against hepatitis B to all participants who were negative for all viral hepatitis B markers, given records of prior hepatitis B vaccination were unreliable.

Validation of an original Behavioral Changes Scale on the Use of Digital Technologies During Social Distancing

Abstract Introduction The social distancing (SD) adopted during the coronavirus disease 2019 (COVID-19) pandemic has transformed the internet from a convenience into a necessity. The behavioral changes caused by isolation range from adaptation of consumption, work, and teaching routines to altered leisure options to occupy idle time at home. Such transformations can be positive, expanding use of digital technologies (DT), but they can also have serious future physical and emotional consequences if there conscious use of technological devices is lacking. Objectives The study aimed to validate the Behavioral Changes Scale on the Use of Digital Technologies During Social Distancing (BCSDTSD), an instrument for assessing behavioral changes related to use of DT during SD. Method Validation of the BCSDTSD in five phases: 1. construction of an initial scale with 10 questions; 2. evaluation of the questions by a panel of experts; 3. application to 1,012 volunteers via the internet; 4. statistical analysis of the results; and 5. preparation of the validated final version of the BCSDTSD. Data were analyzed using the dplyr, psy , and paran packages and the REdaS statistical program. Three statistical criteria were used in the factor analysis (FA). Results FA confirmed that all 10 questions in the questionnaire should be maintained, confirming its robust construction, and Cronbach's alpha demonstrated its internal consistency with a value of 0.725, which is satisfactory for first-application questionnaires. Conclusion The BCSDTSD instrument was validated for assessment of behavioral changes related to the use of DT during SD.

Antes sós do que mal acompanhados: contato e contágio com povos indígenas isolados e de recente contato no Brasil e desafios para sua proteção e assistência à saúde / Better alone than in bad company: contact and contagion with isolated and recently contacted indigenous people in Brazil and challenges for their protection and health care

Resumo O objetivo deste artigo é apresentar e discutir a vulnerabilidade de povos indígenas em isolamento voluntário a epidemias decorrentes do contato com representantes de nossa sociedade e apontar os desafios para a assistência à saúde nas situações de contato iminente. A partir da experiência dos autores na atenção à saúde de comunidades indígenas isoladas e de contato recente e de informações existentes na literatura indigenista, são apresentados exemplos da alta mortalidade que incidiu sobre alguns povos indígenas em períodos posteriores à quebra de seu estado de isolamento. O artigo atualiza as informações existentes sobre povos indígenas isolados no Brasil, discute a política indigenista e as ameaças a que estão submetidos esses povos pelo avanço da invasão ilegal de seus territórios e alerta para a possibilidade de novos contatos entre esses grupos e a sociedade circundante no contexto atual de ataque aos direitos indígenas agravados pela epidemia de covid-19. Contextualizam-se a suscetibilidade dos povos indígenas isolados, a necessidade de preparação para futuras situações de contato e medidas para evitar o contágio quando ocorrer a quebra do estado de isolamento desses povos.

Abstract The purpose of this article is to present and discuss the vulnerability of indigenous people in voluntary isolation due to epidemics resulting from contact with representatives of our society and to point out the challenges for health care in situations of imminent contact. Based on the authors' experience in the health care of isolated and recently contacted indigenous communities and on information in the indigenous literature, examples of the high mortality that affected some indigenous peoples in periods after break of their isolation state are presented. The article updates the existing information on isolated indigenous peoples in Brazil, discusses the indigenous policy formulated for them, the threats to which they are subjected by the advance of the illegal invasion of their territories and alerts to the possibility of new contacts of these groups and the surrounding society, in current context of attack on indigenous rights aggravated by the COVID-19 pandemic. It contextualizes the susceptibility of isolated indigenous peoples, the need to be ready for future situations of contact and measures to avoid contagion when the isolation of these peoples is interrupted.

Concordância entre estado nutricional e percepção da imagem corporal em indígenas khisêdjê do Parque Indígena do Xingu / Agreement between nutritional status and perception of body image in indigenous Khisêdjê of the Xingu Indigenous Park

RESUMO: Objetivos: Verificar a concordância entre autoimagem corporal (escala de silhuetas de Stunkard et al.) e estado nutricional e avaliar a satisfação corporal em indígenas khisêdjê do Parque Indígena do Xingu. Métodos: Estudo transversal que incluiu 131 indígenas khisêdjê, com 20 anos ou mais. Coletaram-se dados sobre imagem corporal, índice de massa corporal e perímetro da cintura. Foram utilizados a estatística kappa, o teste χ2 (p < 0,05), as razões de prevalências brutas e ajustadas e o teste t de Student. Resultados: As prevalências de sobrepeso e obesidade foram, respectivamente, 42 e 5,3%. A porcentagem de satisfação com o perfil corporal foi de 61,8%, sem diferença entre os sexos. Houve boa concordância entre autoimagem real e autoimagem ideal (p < 0,001), porém baixa concordância entre a autoimagem real e ideal e o estado nutricional para ambos os sexos. Maior prevalência de insatisfação corporal por excesso de peso foi detectada entre indivíduos com obesidade central e excesso de peso. Conclusão: Os resultados sugerem que a autoimagem corporal avaliada por meio da escala de silhuetas de Stunkard et al. tem pouca aplicabilidade como indicador do estado nutricional de indígenas khisêdjê do Parque Indígena do Xingu.

ABSTRACT: Objective: To determine the agreement between body self-image (based on the Stunkard figure rating scale) and nutritional status and to evaluate body satisfaction among the Khisêdjê indigenous people of Parque Indígena do Xingu (Xingu Indigenous Park). Methods: A cross-sectional study involving 131 natives aged 20 and older. Data on body image, body mass index and waist circumference were collected. Kappa statistics, χ2 (p < 0.05), crude and adjusted prevalence ratios and Student's t-test were used for data analysis. Results: The prevalence of overweight and obesity was respectively 42 and 5.3%. The percentage of satisfaction with body profile was 61.8% with no difference between the sexes. There was good agreement between actual and ideal self-image (p < 0.001), but poor agreement between actual and ideal self-image with nutritional status for both sexes. A higher prevalence of body dissatisfaction due to overweight was detected in individuals with central obesity and overweight. Conclusion: The results suggest that body self-image evaluated by the Stunkard silhouette scale has little applicability as an indicator of nutritional status among the indigenous Khisêdjê of Xingu Indigenous Park.

Paradoxos do programa de parteiras tradicionais no contexto das mulheres Krahô / Paradoxes of the traditional midwives program in the context of Krahô women

Resumo Este artigo analisa o impacto do Programa Trabalhando com Parteiras Tradicionais no cotidiano de um grupo de mulheres indígenas Krahô. Trata-se de um estudo etnográfico que utilizou a observação e o diário de campo como suportes principais, além de entrevistas pontuais e dados secundários. O trabalho de campo ocorreu entre agosto de 2015 e dezembro de 2016 e envolveu dez mulheres de oito aldeias diferentes. Os resultados apontam uma desconexão entre o objetivo principal do Programa, centrado na valorização e no resgate do saber da parteira, e a realidade no cotidiano das aldeias. Muito embora o programa tenha como público-alvo mulheres que já atuam empiricamente no cenário do parto, houve o entendimento de que as mulheres "tornaram-se parteiras" após o curso. Por consequência, a falta de pagamento e a expectativa frustrada de contratação por parte do "governo", embora não previstas, foram interpretadas como descaso. Os resultados indicam um viés etnocentrado do Programa, focado na difusão do saber científico e na entrega de materiais fora da lógica de cuidado do grupo em análise. Estudos que avaliem o impacto das ações do Programa em outros contextos, inclusive não indígenas, podem contribuir para os ajustes necessários e a efetiva valorização do trabalho dessas mulheres.

Abstract This paper analyses the impact of the Working with Traditional Midwives Program on the daily routine of a Krahô indigenous women group. This is an ethnographic study that mainly used observation and field diary as supporting tools. Other tools were timely interviews and secondary data. Fieldwork occurred between August 2015 and December 2016 and involved ten women of eight different villages. Results point to a disassociation between the Program's main objective, which is focused on appreciating and reviving midwives' knowledge and the daily village reality. Although the Program has targeted women who already work empirically on the birth setting, there was a generalized acknowledgement in villages that women "became midwives" after taking the course. Consequently, the lack of payment and the frustrated expectation that "government" would hire them, though never assumed, were interpreted as neglect. Results reveal an ethnocentric bias of the Program, focused on disseminating scientific knowledge and delivering materials that deviate from the logic of the group under analysis. Studies that evaluate the impact of the Programs' actions in other contexts, including non-indigenous ones, may contribute to the necessary adjustments and the effective appreciation of these women's work.

Validation of a scale to evaluate the abusive use of technologies (Computer, cell phone, tablet, among others)

BACKGROUND INFORMATION: Daily, prolonged interactivity of individuals with technologies (computer, cell phone, tablet, among others) impacts life and significantly changes habits, behaviors, personal and social relationships. Technologies lead to a multitude of advantages, but attention is required concerning possible damages. OBJECTIVE: Validation of a scale to evaluate the abuse use of technologies (TAUS). METHOD: TAUS validation was carried out in 5 phases: (1) initial scale construction with 20 questions, (2) expert evaluation, (3) application to 200 volunteers, (4) statistical analysis and results, (5) preparation of the final version of the validated TAUS. We used the R statistical program and the "dplyr" package version 3.4.2 to present descriptive statistics, to test hypotheses of means differences and for factorial analysis. Factor analysis was used for the orthogonal model. The method used was Principal Components based on Spearman's correlation matrix. RESULTS: The results provided a final, validated version of a TAUS suitable for clinical and research contexts. The last step of the study was to calculate Cronbach's alpha, in order to measure the internal consistency of the scale. The value found was 0.910, which is considered good. CONCLUSIONS: This Technology Abuse Scale may contribute to future studies, to the conscious use of technologies, to a reduction of physical and emotional damage and to an improvement of the subjects' quality of life.

Validation of a scale to evaluate Digital Dependence of Employees

BACKGROUND: The evolution of technologies and mobility, new digital resources have emerged transforming human behavior. These include the abusive use of digital devices, leading to various dependences regarding the way people use technology. Collective environments also begin to exhibit symptoms of such dependences. OBJECTIVE: Validate a Digital Dependence of Employees Scale (DDES), applied to personnel not holding leadership positions in organizations. METHOD: Data were collected via Internet. The sample totaled 301 volunteers from a state-owned company, of which 294 were statistically validated. Participants were asked to answer 20 questions prepared by experts. After the collection procedure, a database was created for statistical analysis. RESULTS: Statistical analysis procedure including factorial analysis was conducted, which confirmed data adequacy. Three statistical criteria were used: Bartlett Sphericity test, Kaiser-Meyer-Olkin Criterion and Factorial analysis, including Screeplot; the latter determined adequate commonalities, indicating the cancellation of only 1 out of the 20 original scale questions. The internal consistency of the scale measured through the Cronbach Alpha Coefficient showed a positive result of 0.764. Thus, scale validation objectives were achieved. CONCLUSION: The DDES scale was considered validated to be applied to employees in organizational environments. The limitations found to apply the scale did not compromise its results.

Validation of a scale to assess Facebook dependence

BACKGROUND INFORMATION: Facebook is a social network that has become part of the everyday life of contemporary humanity and is notably the most accessed digital tool, worldwide; through it, one can simultaneously relate to millions of people, as a source of information, communication or entertainment. OBJECTIVE: To produce and validate a scale to evaluate Facebook dependence (FDS). METHOD: Validation was performed in 5 phases: 1- initial scale construction with 20 questions, 2- expert evaluation, 3- application in 200 volunteers, 4- statistical analysis and results, and 5- elaboration of the final 18-question validated version of FDS. RESULTS: We obtained a descriptive statistical analysis, a clear-cut separation of dependents vs. non-dependents and a successful factorial analysis. These results provided a validated version of FDS. CONCLUSIONS: We were able to construct the validated final version of FDS with 18 questions appropriate to the clinical contexts and to be used in conducting research on Facebook dependence. This scale will contribute to future research related to this specific digital dependence, hopefully reducing harmful effects and improving quality of life.

Validation of the scale to evaluate physical damages related to the Abusive Use of Technology in daily life (PDAUTS)

BACKGROUND INFORMATION: New computer technologies, namely smart cellphones and tablets, among others, interacting along the daily life of individuals may contribute toward the rise of problems: depression, stress and physical damage (undue postures, upper and lower extremity disorders, vision problems, obesity), all of them related to excessive time spent on technological equipment; together with inadequate furniture, quality of life can be seriously affected. OBJECTIVE: To validate a scale to evaluate physical damage related to the Abusive Use of Technology (PDAUTS) in daily life. METHODS: Validation of the PDAUTS was performed through 5 phases: (1) initial scale construction with 20 questions; (2) expert evaluation of questions; (3) application to 200 volunteers; (4) statistical analysis of the results; (5) preparation of the final validated version, retaining the 20 questions. RESULTS: We used the R statistical program, version 3.4.2 and the "dplyr" package to present the descriptive statistics, the hypothesis tests of mean differences and the factor analysis. The results provided a validated final version for PDAUTS. The last step of the study was to calculate Cronbach's alpha parameter, in order to measure the internal consistency of the scale. The value found was 0.897, which in is considered very good. CONCLUSION: The validated PDAUTS allowed us to evaluate physical damage in each subject and design adequate training and treatment programs, reducing overall impairments and contributing to the improvement in quality of life.

Validation of the Cell Phone Dependence Scale

BACKGROUND INFORMATION: The boundary between cellphone use and abuse is quite tenuous. Research is required to evaluate the use of this device interacting in the everyday life of users, whether to speak or to perform tasks. OBJECTIVE: To construct a novel and specific scale to evaluate cellphone dependence checking its psychometric properties for clarity, accuracy and reliability. METHODS: Validation of a Cellphone Dependence Scale (CPDS) was performed in 5 phases: 1- initial scale construction with 20 questions, 2- expert evaluation, 3- application to 200 volunteers, 4- statistical analysis and results, and 5- elaboration of the final version of the CPDS. RESULTS: We used the R statistical program Version 3.4.2 and the "dplyr" package to present the descriptive statistics, the hypotheses tests of differences of means and the factorial analysis. The results provided a validated and accepted final version for CPDS. The last step of the study was to calculate Cronbach's alpha, in order to measure the internal consistency of the questionnaire. The value found was 0.897, which is considered very good. CONCLUSIONS: This project resulted in the construction of the final CPDS version suitable for the clinical context and to be used in the conduct of research on cellphone dependence. CPDS may contribute to future studies, conscious use of cellphones, harm reduction, and improved quality of life vis-à-vis the cellphone.

Validation of the scale for assessing depression and its relation to technology dependence

ABSTRACT BACKGROUND: The daily coexistence with the technologies (computer, mobile phone, tablet, among others), begins to produce significant changes in human behavior. We have observed that there is an association between dependence on technologies and major depressive disorder, as well as with other mental disorders. OBJECTIVE: To validate a scale for assessing depression and its relation to dependence on everyday technologies. METHODS: Validation of a Technology Dependent Depression Scale (TDDS) was performed in 5 phases: (1) initial scale construction with 20 questions; (2) expert evaluation; (3) application to 100 volunteers, (4) statistical analysis and results, (5) preparation of the final version of the validated TDDS. RESULTS: We used the R statistical program, version 3.4.2 and the "dplyr" package to present descriptive statistics, hypotheses tests of mean differences and factorial analysis. The results provided a validated and approved final version for TDDS. CONCLUSIONS: We constructed the final version of the validated TDDS, which is adequate for clinical contexts and to be used in future research. All the psychometric properties were checked for accuracy, reliability, presentation, clarity, pertinence and comprehension of the instrument conferring validity to the end-product.

Atenção à saúde bucal no Parque Indígena do Xingu, Brasil, no período de 2004-2013: um olhar a partir de indicadores de avaliação / Oral health care in the Xingu Indigenous Park, Brazil, from 2004 to 2013: an analysis based on evaluation indicators / Atención a la salud bucal en el Parque Indígena de Xingu, Brasil, durante el período de 2004 a 2013: una observación a partir de indicadores de evaluación

A Política Nacional de Saúde Bucal redefiniu em 2011 seu modelo de atenção para os povos indígenas, preconizando o subsídio da epidemiologia e o acompanhamento do impacto das ações por meio de indicadores adequados. O objetivo deste estudo foi analisar a evolução desses indicadores, propostos pelo Ministério da Saúde, no Parque Indígena do Xingu, Brasil, no período de 2004-2013. Trata-se de pesquisa de abordagem quantitativa, com o uso de dados secundários do Distrito Sanitário Especial Indígena Xingu e do Projeto Xingu, da Universidade Federal de São Paulo. Observou-se cobertura de primeira consulta odontológica programática maior que 60% em todos os anos analisados, exceto em 2009 e 2010, cujas coberturas foram de 44,7% e 53,4%, respectivamente. O indicador de tratamento odontológico básico concluído apresentou aumento significativo, de 44,9% para 79,9%, entre 2006 e 2008. A proporção de exodontias no conjunto dos procedimentos diminuiu de 24,3% em 2004 para 3,8% em 2011. A cobertura da média da ação coletiva de escovação dental supervisionada obteve a maior variabilidade (1,2 a 23,3%) no período analisado. O acesso à saúde bucal mostrou boa cobertura e o indicador de tratamento concluído apresentou percentual mais elevado em comparação com outros povos indígenas no mesmo período. O melhor desempenho do indicador de exodontias pode decorrer de mudança no enfoque assistencial possibilitado por parcerias com universidades, ainda que os indicadores de escovação supervisionada indiquem ser necessário priorizar ações preventivas. Mudanças na gestão da saúde indígena, com fragilização ou ausência de parcerias, podem ter influenciado negativamente os indicadores do programa.

In 2011, the Brazilian National Oral Health Policy redefined its model of care for indigenous peoples, recommending the use of epidemiology and follow-up of the impact of activities using adequate indicators. The current study aimed to analyze trends in these indicators, proposed by the Brazilian Ministry of Health, in the Xingu Indigenous Park, Brazil, from 2004 to 2013. This was a quantitative study using secondary data from the Xingu Special Indigenous Health District and the Xingu Project of the Federal University of São Paulo. The coverage rate for first dental visit exceeded 60% in all the years analyzed except 2009 and 2010 (44.7% and 53.4%, respectively). The basic dental treatment indicator showed a significant increase, from 44.9% to 79.9%, between 2006 and 2008. The proportion of tooth extractions decreased from 24.3% in 2004 to 3.8% in 2011. Mean coverage of supervised collective toothbrushing showed the highest variation (1.2 to 23.3%). Access to oral health showed good coverage, and the indicator for completed treatment showed a higher percentage when compared to other indigenous peoples during the same period. Better performance on the tooth extractions indicator may have been due to the change in focus of care through partnerships with universities, although the indicators for supervised toothbrushing suggest the need to prioritize preventive measures. Changes in indigenous healthcare management, with weakening or absence of partnerships, may have negatively influenced the program's indicators.

La Política Nacional de Salud Bucal redefinió en 2011 su modelo de atención para los pueblos indígenas, preconizando el subsidio de la epidemiologia y el seguimiento del impacto de las acciones mediante indicadores adecuados. El objetivo de este estudio fue analizar la evolución de esos indicadores, propuestos por el Ministerio de la Salud, en el Parque Indígena de Xingu, Brasil, durante el período de 2004 a 2013. Se trata de una investigación de enfoque cuantitativo, con el uso de datos secundarios del Distrito Sanitario Especial Indígena Xingu y del Proyecto Xingu, de la Universidad Federal de São Paulo. Se observó una cobertura de primera consulta odontológica programática mayor que un 60% en todos los años analizados, excepto en 2009 y 2010, cuyas coberturas fueron de un 44,7% y un 53,4%, respectivamente. El indicador de tratamiento odontológico básico concluido presentó un aumento significativo, de un 44,9% a un 79,9%, entre 2006 y 2008. La proporción de exodoncias en el conjunto de los procedimientos disminuyó de un 24,3% en 2004 a un 3,8% en 2011. La cobertura de la media de la acción colectiva de cepillado dental supervisado obtuvo la mayor variabilidad (1,2 a 23,3%) durante el período analizado. El acceso a la salud bucal mostró una buena cobertura y el indicador de tratamiento concluido presentó un porcentaje más elevado, en comparación con otros pueblos indígenas durante el mismo período. El mejor desempeño del indicador de exodoncias puede producirse del cambio en el enfoque asistencial, posibilitado por colaboraciones con universidades, aunque los indicadores de cepillado supervisado indiquen que sea necesario priorizar acciones preventivas. Cambios en la gestión de la salud indígena, con fragilización o ausencia de colaboraciones, pueden haber influenciado negativamente los indicadores del programa.

The effects of motor adaptation on ankle isokinetic assessments in older drivers

OBJECTIVES: This study sought to analyze the extent of motor adaptation in ankle plantar flexors and dorsiflexors among older drivers during clinical isokinetic testing. METHODS: One hundred older adults (70.4±5.7 years) participated in two bilateral ankle plantar flexor and dorsiflexor isokinetic assessments at 30°/sec. Peak torque (PTQ), PTQ adjusted for body weight (PTQ/BW), and total work (TW) were analyzed. RESULTS: On the dominant side, PTQ/BW and TW were significantly greater for the second plantar flexion test than were those for the first such test (p<0.001), whereas PTQ, PTQ/BW, and TW (p<0.001) were significantly greater for the second dorsiflexion test than were those for the first such test. On the non-dominant side, plantar flexion PTQ and TW were significantly lower for the second test than were those for the first test (p<0.001). CONCLUSION: Older drivers demonstrated better performance with the dominant limb on the second test. The low variability in test execution showed the existence of a motor adaptation effect for the tested movements, despite the short recovery period between the assessments.

Cárie dentária em povos do Parque Indígena do Xingu, Brasil, 2007 e 2013 / Caries dental en los pueblos del Parque Indígena Xingu, Brasil, 2007 y 2013 / Dental caries in peoples of Xingu Indigenous Park, Brazil, 2007 and 2013

Objetivo: descrever a prevalência de cárie e provisão de cuidados odontológicos na população do Parque Indígena do Xingu, Brasil, aos 5, 12 e 15-19 anos de idade, 2007 e 2013. Métodos: painel de estudos transversais, com dados secundários disponibilizados pelo Distrito Sanitário Especial Indígena do Xingu e Projeto Xingu. Resultados: examinaram-se 368 (2007) e 423 (2013) indígenas no período, sem diferença significativa entre as médias do número de dentes cariados, perdidos e obturados aos 5 (6,43 [2007] e 5,85 [2013]; p=0,29) e aos 12 anos (2,54 [2007] e 2,78 [2013]; p=0,81); essa diferença foi significativa aos 15-19 anos (6,89 [2007] e 4,65 [2013]; p<0,05); o índice de cuidados odontológicos diminuiu de 21,7 para 7,1%, de 44,1 para 16,4% e de 63,1 para 41,1%, respectivamente aos 5, 12 e 15-19 anos. Conclusão: a prevalência de cárie permaneceu elevada em crianças e reduziu-se em adolescentes (15-19 anos); a provisão de cuidados odontológicos decresceu.

Objetivo: describir la prevalencia de caries y la provisión de cuidados odontológicos en la población del Parque Indígena Xingu, Brasil, a los 5, 12 y 15-19 años, en 2007 y 2013. Métodos: panel de estudios transversales, con datos secundarios disponibles por el Distrito Sanitario Indígena y Proyecto Xingu. Resultados: se examinaron 368 indígenas en 2007 y 423 en 2013; en el período, no hubo diferencia significativa entre las medias del número de dientes cariados, perdidos y obturados a los 5 (6,43 [2007] y 5,85 [2013]; p=0,29) y 12 años (2,54 [2007] y 2,78 [2013]; p=0,81); esta diferencia fue significativa a los 15 y 19 años (6,89 [2007] y 4,65 [2013]; p<0,05); el índice de atención odontológica disminuyó de 21,7% para 7,1%, de 44,1 para 16,4% y de 63,1 para 41,1%, respectivamente a los 5, 12 y 15-19 años. Conclusión: la prevalencia de caries se permaneció elevada en niños, con reducción en adolescentes de 15-19 años; hubo decrecimiento de la atención odontológica.

Objective: to describe the prevalence of dental caries and the supply of dental care in the population of Xingu Indigenous Park, Brazil, at 5, 12 and 15-19 years old, in 2007 and 2013. Methods: cross-sectional study panel, with secondary data provided by the Indigenous Special Sanitary District of Xingu and Project Xingu. Results: 368 indigenous people were examined in 2007 and 423 in 2013; there was no significant difference between the means of the number of decayed, missing and filled teeth at 5 years (6.43 [2007], 5.85 [2013]; p=0.29), and at 12 years (2.54 [2007], 2.78 [2013]; p=0.81); this difference was significant at 15-19 years (6.89 [2007], 4.65 [2013]; p<0.01); the dental care index decreased from 21.7 to 7.1%, 44.1 to 16.4%, and 63.1 to 41.1%, respectively at 5, 12, and 15-19 years. Conclusion: the prevalence of caries remained high in children, with a reduction in adolescents (15-19 years old); there was a decrease in the supply of dental care.

Prevalência de infecção por Helicobacter pylori em uma comunidade indígena em São Paulo e fatores associados: estudo transversal / Prevalence of Helicobacter pylori infection in an indigenous community in São Paulo and associated factors: cross-sectional study

ABSTRACT CONTEXT AND OBJECTIVE: The prevalence of Helicobacter pylori infection is unevenly distributed among different populations. The aim here was to evaluate the factors associated with Helicobacter pylori infection among children up to five years of age living in a high-risk community. DESIGN AND SETTING: Cross-sectional study in an indigenous community of Guarani Mbya ethnicity, Tekoa Ytu and Tekoa Pyau villages, Jaraguá district, city of São Paulo (SP), Brazil. METHODS: 74 children aged 0.4 to 4.9 years (mean 2.9 ± 1.3 years; median 3.1), and 145 family members (86 siblings, 43 mothers and 16 fathers) were evaluated for Helicobacter pylori infection using the validated 13C-urea breath test. Clinical and demographic data were collected. RESULTS: The prevalence was 8.3% among children aged 1-2 years and reached 64.3% among those aged 4-5 years (P = 0.018; overall 31.1%). The prevalence was 76.7% among siblings and 89.8% among parents. There was a negative association with previous use of antibiotics in multivariate analysis adjusted for age (odds ratio, OR: 0.07; 95% confidence interval, CI: 0.01 to 0.66; P = 0.02). The prevalence was higher among males (OR: 1.55), and was associated with maternal infection (OR: 1.81), infection of both parents (OR: 1.5), vomiting (OR: 1.28), intestinal parasitosis (OR: 2.25), previous hospitalization (OR: 0.69) and breastfeeding (OR: 1.87). CONCLUSIONS: The prevalence was high among subjects older than three years of age, thus suggesting that the incidence of infection was higher over the first three years of life. Previous use of antibiotics was inversely associated with current Helicobacter pylori infection.

RESUMO CONTEXTO E OBJETIVO: A prevalência da infecção pelo Helicobacter pylori é desigualmente distribuída entre diferentes populações. O objetivo foi avaliar fatores associados à infecção pelo Helicobacter pylori em crianças de até cinco anos de idade morando numa comunidade de alto risco. TIPO DE ESTUDO E LOCAL: Estudo transversal na comunidade indígena da etnia Guarani Mbya das aldeias Tekoa Ytu e Tekoa Pyau do distrito de Jaraguá da cidade de São Paulo (SP), Brasil. MÉTODOS: 74 crianças de 0,4 a 4,9 anos (média 2,9 ± 1,3 anos; mediana 3,1), e 145 familiares (86 irmãos, 43 mães e 16 pais) foram avaliadas quanto à infecção pelo Helicobacter pylori com o teste respiratório com ureia 13C validado. Dados clínicos e demográficos foram coletados. RESULTADOS: Prevalência foi 8,3% entre 1-2 anos, atingindo 64,3% entre 4-5 anos (P = 0,018; 31,1% globalmente). Em irmãos, foi 76,7% e 89,8% nos pais. Observou-se associação negativa com uso prévio de antibiótico em análise multivariada ajustada para idade (odds ratio, OR: 0,07; intervalo de confiança, IC: 95%: 0,01-0,66; P = 0,02). A prevalência foi maior no sexo masculino (OR: 1,55), e foi associada a infecção materna (OR: 1,81), infecção de ambos os pais (OR: 1,5), vômitos (OR: 1,28), parasitose intestinal (OR: 2,25), hospitalização prévia (OR: 0,69) e aleitamento materno (OR: 1,87). CONCLUSÕES: A prevalência foi alta entre os indivíduos com mais de três anos de idade, o que sugere incidência maior nos três primeiros anos de vida. Uso prévio de antibióticos foi inversamente associado a infecção atual por Helicobacter pylori.

Trâmites éticos, ética e burocracia em uma experiência de pesquisa com população indígena / Ethical procedures, ethics, and bureaucracy in a research experience with indigenous population

Resumo A partir de uma experiência vivenciada durante uma pesquisa de doutorado, pretende-se discutir os trâmites burocráticos da pesquisa social no Brasil e algumas implicações práticas. São levantadas questões como o lugar e o poder decisório concedido (ou não) ao indivíduo ou povo indígena, bem como reflexões acerca das resoluções da Comissão Nacional de Ética em Pesquisa, sua aplicabilidade e a (in)adequação dos formulários e modelos para as pesquisas de caráter social. Este artigo levanta as questões éticas, analisando os fluxos operacionais dos e entre os órgãos que normatizam pesquisas com indígenas e inclui reflexões sobre como o rastro deixado pela condição tutelar de povos indígenas ainda baliza as normativas em pesquisa. Pretende-se, ao compartilhar a experiência, contribuir para o debate das implicações éticas nas situações em que a neutralidade é substituída pelo vínculo, bem como desmistificar a ideia de que a simplificação de processos excessivamente burocráticos seja uma ameaça aos preceitos éticos.

Abstract Based on an experience that occurred during a doctoral research, this article aims to discuss the bureaucratic procedures of social research in Brazil and some of its practical implications. We raise some questions regarding location and the decision-making power granted (or not) to an indigenous individual or population, as well as reflections on the resolutions approved by the National Committee for Research Ethics, their applicability and the (in)adequacy of forms and models used in social research. The article focuses on ethical issues, analyzing operational flows from and among agencies responsible for regulating research carried out with indigenous populations. It also includes reflections on the trace left by the tutelary condition of indigenous people and how this condition continues to limit research guidelines. By sharing this experience, this article intends to incite debates on the ethical implications of situations in which neutrality is replaced by bonds, as well as to demystify the idea that simplifying overly bureaucratic procedures would be a threat to ethical principles.

Disparities in cancer epidemiology and care delivery among Brazilian indigenous populations / Disparidades na epidemiologia e no tratamento de câncer nas populações indígenas brasileiras

ABSTRACT Objective: To assess aspects related to cancer in indigenous population. Methods: This is a retrospective study developed in a public university hospital. We included patients with 18 or more years of age, diagnosed with solid tumors, and followed between 2005 and 2015. Clinical features were assessed by descriptive statistics, and survival was evaluated by Kaplan-Meier curves and multivariate Cox regression. Results: Fifty patients were included. The cancer incidence was 15.73 per 100,000. The mean age at diagnosis was 54 years and most patients were female (58%). Cancer of the cervix (28%) and prostate (16%) were the most common. The mean time between the onset of symptoms and the diagnosis was 9 months and from diagnosis to the treatment was 3.4 months. Disease diagnosed at stage IV (17%) had worse overall survival (HR: 11.4; p<0.05). The 5-year survival rate ranged from 88% for prostate cancer to 0% for lung cancer. All 5-year survival rates were lower as compared to other populations. Conclusion: The most prevalent cancer sites were cervix and prostate. Disease stage and primary site were prognostic factors.

RESUMO Objetivo: Avaliar os aspectos relacionados a câncer em populações indígenas. Métodos: Estudo retrospectivo conduzido em um hospital universitário público. Foram incluídos pacientes com 18 anos ou mais, diagnosticados com tumores sólidos e acompanhados entre 2005 e 2015. Os aspectos clínicos foram avaliados por meio de estatística descritiva, e a sobrevida foi avaliada por meio de curvas de Kaplan-Meier e regressão multivariada de Cox. Resultados: Foram incluídos 50 pacientes. A incidência de câncer foi 15,73 por 100 mil. A média de idade ao diagnóstico foi 54 anos, e a maioria era do sexo feminino (58%). O câncer de colo uterino (28%) e o de próstata (16%) foram os mais frequentes. O tempo médio entre o início dos sintomas e o diagnóstico foi 9 meses, e entre o diagnóstico e o tratamento, de 3,4 meses. Doença diagnosticada no estágio IV (17%) resultou em pior sobrevida global (HR: 11,4; p<0,05). A sobrevida em 5 anos variou de 88% para o câncer de próstata a 0% para pulmão. Todas as taxas de sobrevida em 5 anos foram menores em comparação a outras populações. Conclusão: Os locais mais frequentes de neoplasia foram colo de útero e próstata. O estágio da doença e o sítio primário foram fatores prognósticos.

Utilização de diferentes volumes de sêmen na realização do teste hiposmótico em touros adultos da raça nelore / Use of different semen volumes in hypoosmotic test of adult nelore bulls / El uso de diferentes volúmenes de semen en el test hiposmótico en toros adultos de la raza nelore

O objetivo deste estudo foi avaliar diferentes proporções de sêmen: solução hiposmótica na realização do teste hiposmótico e suas relações com a congelabilidade do sêmen de touros zebuínos. Utilizaram-se 15 ejaculados de três touros adultos da raça Nelore. No sêmen in natura realizou-se a avaliação física e morfológica, a coloração supravital e o teste hiposmótico. No teste hiposmótico foi utilizada uma solução com osmolaridade de 100 mOsm/Kg com 15 minutos de período de incubação a 37 ºC, tanto no sêmen in natura quanto no congelado/descongelado. Foram utilizados quatro volumes de sêmen em 1mL de solução hiposmótica: 10, 20, 50 e 100 µL. As amostras criopreservadas foram descongeladas e foram realizados os testes hiposmótico, coloração supravital, teste de termo-resistência lento e a coloração fluorescente. Os valores médios e desvios padrão do percentual de espermatozoides reativos ao teste hiposmótico em sêmen in natura e congelado/descongelado foram 69,3 ± 11,8 e 20,5 ± 6,8; respectivamente. Não houve correlação do teste hiposmótico com os aspectos físicos e morfológicos e os testes complementares realizados em sêmen in natura e congelado/descongelado. Nenhum teste de integridade de membrana plasmática dos espermatozoides foi capaz de classificar os touros quanto a sua congelabilidade do sêmen. Conclui-se que o teste hiposmótico pode ser realizado com 20 a 100 µL de sêmen in natura, e 10 a 100 µL de sêmen congelado/descongelado em 1 mL de solução hiposmótica, sem interferir em seus resultados, mas deve-se optar por 100 µL tanto para sêmen in natura e congelado/descongelado, porque melhora consideravelmente a leitura das lâminas.(AU)

The objective of this study was to evaluate different proportions of semen: hypoosmotic solution in the hypoosmotic swelling test and their relationship with semen freezability in Zebu bulls. A total of 15 ejaculates from three adult Nelore bulls were used. Physical and morphological features were analyzed in fresh semen, as well as supravital staining and hypoosmotic swelling test. In the hypoosmotic test, a hypoosmotic solution with 100 mOsm/kg osmolality using 15 minutes incubation at 37 °C was used both in fresh and frozen/thawed semen. Four semen volumes in 1-ml hyposmotic solution were used: 10, 20, 50 and 100 µL. Cryopreserved samples were thawed and submitted to hypoosmotic tests, supravital staining, slow thermo-resistance test and fluorescent staining. Mean values and standard deviations of the percentage of reactive sperm cells in the hypoosmotic test in fresh and frozen/thawed semen were 69.3 ± 11.8 and 20.5 ± 6.8, respectively. There was no correlation between the hypoosmotic test and physical and morphological features and the complementary tests performed on fresh and frozen/thawed semen. None of the plasma membrane integrity tests was able to predict bull semen freezability. It can be concluded that the hypoosmotic test can be performed with 20 to 100 µL fresh semen, and 10 to 100 µL of frozen/thawed semen in 1 mL of hypoosmotic solution without interfering with their results, but 100 µL should be used in both, because it considerably improves the view of the slides.(AU)

El objetivo de este estudio ha sido evaluar diferentes proporciones de semen: solución hiposmótica en la realización del test hiposmótico y sus relaciones con la congelabilidad del semen de toros cebú. Se utilizaron 15 eyaculados de tres toros adultos de la raza Nelore. En el semen fresco se realizó evaluación física y morfológica, la tinción supravital y test hiposmótico. En el test hiposmótico se ha utilizado una solución con osmolaridad de 100 mOsm/kg con un período de incubación de 15 minutos a 37 ºC, tanto en el semen fresco cuanto en el congelado/descongelado. Fueron utilizados cuatro volúmenes de 1 mL de solución hiposmótica: 10, 20, 50, y 100 µL. Las muestras criopreservadas fueron descongeladas y realizados los tests hiposmótico, tinción supravital, test de resistencia al fuego lento y la tinción fluorescente. Los valores medios y desvío estándar del porcentaje de espermatozoides reactivos al test hiposmótico en l semen fresco y congelado/descongelado fueron 69,3 ± 11,8 y 20,5 ± 6,8; respectivamente. No hubo correlación del test hiposmótico con las características físicas y morfológicas y pruebas adicionales en el semen fresco y congelado/descongelado. Ningún test de integridad de la membrana plasmática de los espermatozoides han sido capaz de clasificar a los toros cuanto su congelabilidad del semen. Se puede concluir que el test hiposmótico puede ser realizado con 20 a 100 µL de semen fresco, y de 10 a 100 µL de semen congelado/descongelado en 1 mL de solución hiposmótica, sin interferir en sus resultados, pero se debe optar por 100 µL para el semen fresco y congelado/descongelado, porque mejora significativamente la lectura de las láminas.(AU)

Cervical cancer screening in young and elderly women of the Xingu Indigenous Park: evaluation of the recommended screening age group in Brazil / Rastreamento do câncer de colo uterino em jovens e idosas do Parque Indígena do Xingu: avaliação quanto à faixa etária preconizada no Brasil

Objective To analyze the occurrence of atypia in the cytology/histology examinations of young women under the age of 25 years and of elderly women aged over 64 years, in the Xingu Indigenous Park and to evaluate, in a subjective manner, if the age range for screening established by the Ministry of Health and the Instituto Nacional de Câncer is appropriate for this population. Methods The Xingu/UNIFESP Project, in partnership with the Center for Gynecological Disease Prevention, develops programs to prevent cervical cancer. The exploratory, retrospective and descriptive study of cytological and histopathological examinations of young (12-24 years) and elderly (aged 64 and over) women of the Xingu Indigenous Park, between 2005 and 2011. Results There was low occurrence of cytological atypia in the elderly female population, but there were occasional high-grade lesions in the indigenous youth. Conclusion Interrupting screening at the limit age of 64 years, as established by the Ministry of Health and the Instituto Nacional de Câncer is justified. However, screening of young women should begin at an earlier age. .

Objetivo Analisar a ocorrência de atipias nos exames citológicos e histológicos de jovens e idosas indígenas, e também avaliar se a faixa etária preconizada pelo Ministério da Saúde e pelo Instituto Nacional de Câncer em rastreamento do câncer de colo uterino é adequada para essa população. Métodos O Projeto Xingu/UNIFESP, em parceria com o Núcleo de Prevenção de Doenças Ginecológicas, desenvolve programas de prevenção do câncer do colo de útero. Foi realizado estudo exploratório, retrospectivo e descritivo de exames cito/histopatológicos em jovens do Parque Indígena do Xingu de 12 a 24 anos e em idosas a partir dos 64 anos, no período de 2005 a 2011. Resultados Em idosas, houve baixa ocorrência de atipias citológicas, mas nas jovens indígenas, ocorreram casos eventuais de lesão de alto grau. Conclusão Justifica respeitar o limite de 64 anos para a interrupção do rastreamento, como o estabelecido pelo Ministério da Saúde/Instituto Nacional de Câncer, mas, nas jovens, seria importante iniciar o rastreamento mais precocemente. .