Práticas Avançadas de Enfermagem em cuidados paliativos na comunidade compassiva de favela: relato de experiência / Advanced Practice Nursing in palliative care within the compassionate favela community: an experience report

OBJETIVO: descrever a prática avançada do enfermeiro em cuidados paliativos que atua com a equipe Interdisciplinar em um projeto de extensão universitária nas favelas da Rocinha e Vidigal no Rio de Janeiro, Brasil. MÉTODO: Trata-se de um estudo descritivo do tipo relato de experiência, sobre a aplicabilidade de práticas avançadas de enfermagem, no contexto de cuidados paliativos em comunidades vulneráveis, Rocinha e Vidigal, 2019 e 2020. RESULTADOS: Enfermeiros líderes, por meio da micropolítica, buscam o alívio do sofrimento humano, mediante o controle de sinais e sintomas físicos, psicossociais e espirituais, através de raciocínio clínico, habilidade de resolução de problemas por intermédio da consulta de enfermagem e articulação junto a equipe interdisciplinar. CONCLUSÃO: A abordagem de cuidados paliativos sob a ótica do projeto de comunidade compassiva tem mostrado uma forte prática da autonomia do enfermeiro, assim como proporciona visibilidade para a vulnerabilidade social e fortalecimento da prática avançada do enfermeiro no Brasil.

OBJECTIVE: to describe the advanced practice of nurses in palliative care who work with the Interdisciplinary team in a university extension project in the favelas of Rocinha and Vidigal in Rio de Janeiro, Brazil. METHOD: This descriptive research shows an experience report on the applicability of advanced practice nursing in palliative care in vulnerable communities, Rocinha and Vidigal, 2019 and 2020. RESULTS: Through micropolitics, leading nurses seek to relieve human suffering by controlling physical, psychosocial, and spiritual signs and symptoms through clinical reasoning, problem-solving skills in nursing appointments, and articulation with the interdisciplinary team. COONCLUSION: From the perspective of the compassionate community project, the palliative care approach has shown a strong practice of nurse autonomy, provided visibility for social vulnerability, and strengthened the advanced practice of nurses in Brazil.

Epidemiological Determinants of Depression among the Geriatric Population Residing in a Slum of Urban India: A Cross-sectional Study

Background: Mental health is important at every stage of life, from childhood and adolescence through adulthood. Worldwide interest in geriatric depression has increased but studies to assess the depression among the elderly population in urban slums has hardly been done. So this study would shed light on the risk factors of depression among geriatrics in urban slums. Aim & Objective: To study the epidemiological determinants such as age, marital status, education, financial dependency, economic status and chronic illness in relation to of depression among the geriatric population (60–80 years). Settings and Design: Community-based, cross-sectional study for 24 months with a samplesize of 209. Methods & Material: Urban slum area represented by one health post was selectedas the study area which caters to around 96,630 slum residents. Pre-tested semi-structuredinterviews were conducted after selecting households by systematic random sampling. Statistical analysis: Data was analyzed using SPSS version 21. A chi-square test was applied. Result: The present study shows overall prevalence of depression among the elderly above 60 years of age to be 48.6%. Depression is found to been significantly associated with an increase in age, living alone (72.7%), lower class economic status (100%), financial dependency (54%), history of chronic family illness (54.7%) and with no formal education (62.1%) among elderly dwelling in slums. Conclusions: There is a high prevalence of depression in the community and hence, a need to sensitize Primary level Health Care Services to institute screening tests considering the association of these determinants with depression and link them to specialized services for further management.

The Burden and Risk Factors of Reproductive Tract Infections among Married Women Aged 15-49 Years in Urban Slum of Agra Uttar Pradesh

Introduction: In developing countries, reproductive tract infection among women commonly goes undiagnosed and their sequel causes various complications. Objectives: To find out the prevalence of RTI/STI through a syndromic case approach and its correlates among women of reproductive age group. Material and Methods: A community-based cross-sectional study was carried out among 500 eligible married women residing in urban slums of Agra by using WHO Syndromic case approch for diagnosis of RTIs/STIs. Results: The overall prevalence of RTI/STD was found to be 32.80% where vaginal discharge (22.60%) and lower abdominal pain (8.20%) were the most common syndromes. On multivariate analysis, religion, caste, type of absorbent used during menses, and history of IUD use were found to be significantly significant. Conclusion: The result of this study highlights the high prevalence and potential risk factors that contribute to the occurrence of RTI. It also emphasizes the need of training and education session of the participants to identify the early symptoms of RTI.

Utilization of Reproductive and Child Health Services and Client Satisfaction from Urban Primary Health Centers by Recently Delivered Women Living in Urban Slums of Lucknow, India

Background: Due to rapid urbanization, there is an increase in population in slums often lacking access to basic health services. Objective: The purpose of this study was to assess the utilization of reproductive and child health services by recently delivered women and their children residing in catchment areas of urban PHCs, to evaluate their level of satisfaction and to determine the factors associated with utilization of these services by recently delivered women. Settings and Design: The study was conducted in the catchment areas of urban primary health centre of Lucknow. Methods and Material: A cross-sectional study was conducted among 320 women having children less than 24 months in the slums covered under selected U-PHCs, sampled through a multi-stage random sampling technique using a semi-structured questionnaire. Statistical analysis used: SPSS-26 and MedCalc software were used for data analysis. Results: Utilization of RCH services by recently delivered women from UPHC was 39%. About 24% of recently delivered women availed ANC services from UPHC and 56.7% utilized family planning services and 95.8% immunization services for children. Child care services for diarrhea and ARI were availed by 9.9 and 3.1% of women, respectively. Satisfaction regarding maternal care and immunization services was seen in 84 and 95.8% of women. Poor satisfaction regarding child care was seen in 56.5% of women. Conclusions: The utilization of RCH services was found to be poor in the study population. Most recently delivered women were satisfied with all services except child care.

Intestinal parasitic infections: telephone health literacy with men in areas of poverty in the syndemic / Enteropatías parasitarias: alfabetización telefónica en salud con hombres de zonas de pobreza en la sindemia / Enteropatias parasitárias: literacia em saúde por telefonia com homens em áreas de pobreza na sindemia

ABSTRACT Objectives: to assess Popular Health Education practices on intestinal parasites, carried out by telephone contact with men living in urban communities in Rio de Janeiro, Brazil, during the COVID-19 syndemic. Method: a quasi-experimental, quantitative and descriptive study, carried out with men aged 20 to 59 years. Pre-test was applied, and participants were divided into two groups: control and experimental. Popular Education in Health practices were carried out with an experimental group, and post-test was applied for both. Results: health education practices were significant in the experimental group, with a reduction in incorrect answers. There was an increase in incorrect answers in the control group's post-test. Conclusions: the Brazilian National Policy for Popular Education in Health contributed to qualify men's health literacy on intestinal parasites. Practice by telephone contact proved to be a powerful strategy for nursing and public policies to access this group and promote health in Primary Health Care.

RESUMEN Objetivos: evaluar las prácticas de Educación Popular en Salud sobre parásitos intestinales, realizadas por contacto telefónico con hombres residentes en comunidades urbanas de Río de Janeiro, Brasil, durante la sindemia de la COVID-19. Métodos: estudio cuasiexperimental, cuantitativo y descriptivo, realizado con hombres de 20 a 59 años. Se aplicó la preprueba y se dividió a los participantes en dos grupos: control y experimental. Se realizaron prácticas de Educación Popular en Salud con un grupo experimental y a ambos se les aplicó la posprueba. Resultados: las prácticas de educación en salud fueron significativas en el grupo experimental, con reducción de respuestas incorrectas. Hubo un aumento de respuestas incorrectas en la posprueba del grupo control. Conclusiones: la Política Nacional de Educación Popular en Salud contribuyó a cualificar la alfabetización en salud de los hombres sobre parásitos intestinales. La práctica por contacto telefónico demostró ser una poderosa estrategia de enfermería y de políticas públicas para acceder a ese grupo y promover la salud en la Atención Primaria de Salud.

RESUMO Objetivos: avaliar práticas de Educação Popular em Saúde sobre parasitoses intestinais, realizadas por contato telefônico com homens residentes em comunidades urbanas do Rio de Janeiro, Brasil, durante a sindemia de COVID-19. Métodos: estudo quase-experimental, quantitativo e descritivo, realizado com homens de 20 a 59 anos. Foi aplicado o pré-teste, e os participantes, distribuídos em dois grupos: controle e experimental. Foram realizadas práticas de Educação Popular em Saúde com grupo experimental e aplicado o pós-teste para ambos. Resultados: práticas de educação em saúde foram significativas no grupo experimental, com redução das respostas incorretas. Houve aumento de respostas incorretas no pós-teste do grupo controle. Conclusões: a Política Nacional de Educação Popular em Saúde contribuiu para qualificar a literacia em saúde de homens sobre parasitoses intestinais. A prática por contato telefônico mostrou-se uma potente estratégia para a enfermagem e as políticas públicas acessarem este grupo e promoverem saúde na Atenção Primária à Saúde.

Fatores associados à dislipidemia em adultos assistidos pela Estratégia Saúde da Família em favela do Nordeste brasileiro / Factors Associated with Dyslipidemia in Adults Assisted by the Family Health Strategy in a Slum in Northeast Brazil

Dentre os fatores associados à dislipidemia, destacam-se os determinantes sociodemográficos, como escolaridade e renda e, nessa perspectiva, as populações menos favorecidas economicamente, como por exemplo as residentes em favelas, apresentam mais chances de serem acometidas pelas doenças crônicas não transmissíveis quando comparadas as de renda mais alta. Nesse sentido, considerando a escassez de estudos relacionados à prevalência de dislipidemia e seus fatores associados em habitantes de áreas faveladas, objetivou-se analisar os fatores associados à dislipidemia em adultos assistidos pela Estratégia Saúde da Família (ESF), residentes em área de favela, em Recife, Pernambuco. Estudo transversal, de base secundária. Analisaram-se possíveis associações da dislipidemia (hipercolesterolemia isolada ou hipertrigliceridemia isolada) com variáveis demográficas, socioeconômicas, comportamentais, composição corporal e morbidades, por meio de Regressão de Poisson, considerando-se valor de p<0,05. Dos 491 adultos, 46,2% apresentaram dislipidemia, sendo maior nos homens em relação às mulheres (RP=1,70; IC95%:1,41-2,03), com aumento progressivo a partir dos 30 anos, estabilizando a partir da faixa dos 40 anos. A prevalência foi maior entre aqueles insuficientemente ativos (RP=1,21; IC95%:1,01-1,45), com circunferência de cintura muito aumentada (RP=1,78; IC95%:1,36-2,34) e com pressão arterial aumentada (RP=1,35; IC95%:1,11-1,63). É preciso reforçar atividades de promoção da saúde no âmbito da ESF para a população investigada, bem como incentivar a prática de atividade física nas academias da saúde, além de divulgar informações relativas ao combate dos fatores associados à dislipidemia.

Among the factors associated with dyslipidemia, sociodemographic characteristics stand out, such as education and income and, from this perspective, less economically favored populations, such as those living in slums, are more likely to be affected by chronic non-communicable diseases when compared higher income populations. Therefore, considering the scarcity of studies related to the prevalence of dyslipidemia and its associated factors in inhabitants of slum areas, the objective of this study was to analyze the factors associated with dyslipidemia in adults assisted by the Family Health Strategy (FHS), living in slum areas, in Recife, Pernambuco. This is a cross-sectional, secondary-based study. Possible associations of dyslipidemia (isolated hypercholesterolemia or isolated hypertriglyceridemia) with demographic, socioeconomic and behavioral variables, body composition, and morbidities were analyzed using Poisson Regression, considering p<0.05. Of the 491 adults, 46.2% had dyslipidemia, which was higher in men compared to women (PR=1.70; 95%CI:1.41-2.03), with a progressive increase from the age of 30 and stabilizing around the 40-year-old range. Prevalence was higher among those who were insufficiently active (PR=1.21; 95%CI:1.01-1.45), with greatly increased waist circumference (PR=1.78; 95%CI:1.36-2.34), and with increased blood pressure (PR=1.35; 95%CI:1.11-1.63). It is necessary to reinforce health promotion activities within the scope of the FHS for the investigated population, as well as to encourage the practice of physical activity in health academies, in addition to disseminating information regarding the fight against factors associated with dyslipidemia.

Age‑Appropriate Feeding Practices and Nutritional Status of Slum‑Dwelling Young Children in Kolkata during COVID‑19 Pandemic: A Cross‑Sectional Study

Introduction: COVID‑19 pandemic was postulated to affect the infant and young child feeding (IYCF) practices and their nutritional status. This study was planned to assess IYCF practices and nutritional status of infant and young children residing in slum areas and their association with selected background characteristics. Materials and Methods: Acommunity‑based, cross‑sectional study was conducted in slums of Kolkata Municipal Corporation among 161 mother–child dyads from October to December 2020. After obtaining informed consent, mothers were interviewed to collect information about their socioeconomic status, hardship faced during pandemic, and IYCF practices of their children using indicators proposed by the World Health Organization and Government of India. Weight and height were measured using the standard operating protocol. The proportion was used to express descriptive statistics. Binary logistic regression models were used for calculating the adjusted odds ratio (AOR) using PSPP (v 1.20). Results: Only 64 (39.8%) children received age‑appropriate feeding; 73 (45.3%) had single/multiple anthropometric failure(s). Reduction of family income was reported by 142 (88.2%) respondents. Children aged 6–8 months (AOR = 17.08, 6.43–45.42) were more likely to not have appropriate feeding. Association of female gender (AOR = 2.00, 1.01–4.00), maternal education less than middle class (AOR = 2.58, 1.22–5.46), and lack of appropriate feeding (AOR = 2.57, 1.08–6.12) were statistically significant with the presence of anthropometric failure. Conclusions: The study revealed a dismal scenario of child feeding and nutritional status of young children in the urban slums of Kolkata. Pandemic and imposed restrictions hit the families hard by reducing income and increasing food‑related costs.

Direito humano à alimentação adequada e objetivos do desenvolvimento sustentável: interferências coletivas com crianças em periferias vulnerabilizadas / The human right to adequate food and sustainable development goals: collective interferences with children in vulnerable urban peripheries

Resumo Este artigo teve como objetivo analisar as relações entre o Direito Humano à Alimentação Adequada (DHAA) e os Objetivos do Desenvolvimento Sustentável (ODS) que emergem de ações dialógicas com crianças e adolescentes em periferias urbanas vulnerabilizadas de São Vicente, São Paulo. Utilizando referencial metodológico das pesquisas participativas, a observação e registros de assembleias comunitárias e da parceria entre universidade pública e movimento social apontam para espaços de acolhimento às crianças e adolescentes que viabilizam leituras diagnósticas coletivas sobre a alimentação. Esses processos dialógicos permitem problematizar as dimensões do DHAA a partir da cadeia de produção, comercialização e consumo de alimentos, além da instabilidade a que essas crianças e adolescentes estão submetidos, em uma complexa rede de determinantes que produzem má-nutrição nos territórios onde vivem. Os resultados apontam que estas dimensões dialogam com todos os ODS, na medida em que demandam a sustentabilidade cultural, econômica, social e ambiental da alimentação. A parceria e a integração entre universidade e sociedade fortalece e potencializa os espaços de controle social e formação dos atores para a luta pelo DHAA, e pode também produzir efeitos de transformação nas desigualdades nos territórios e reconhecer a criança como sujeito de direitos com profundo rigor ético na construção de escutas inclusivas e de práticas qualificadas.

Abstract This study aimed to analyze the relation between the Human Right to Adequate Food (HRAF) and Sustainable Development Goals (SDG) resulting from a dialogic experience with children and adolescents in the periphery of São Vicente, São Paulo. Using the methodological framework of participatory research, community assemblies observation, and the partnership between the university and social movements point to a caring place for children/adolescents that enable collective diagnostic readings on food. Dialogical processes enable us to problematize HRAF dimensions based on the chain of food production, trading and consumption, and the instability to which those children/adolescents are subjected in a complex network of determinants that produce hunger and malnutrition in the territories in which they live. Results show that these dimensions dialogue with all the SDGs, as they demand cultural, economic, social, and environmental sustainability of food. The partnership and integration between university and society strengthens and enhances the spaces of social control and training of actors to advocate for the HRAF. It can also change inequalities in the territories and acknowledge children as subjects of rights with deep ethical commitment in the construction of inclusive listening and qualified practices.

Prevalence of intestinal parasitic infections versus knowledge, attitudes and practices of male residents in Brazilian urban slums: a cross-sectional study

ABSTRACT Intestinal parasitic infections (IPIs) are neglected diseases caused by helminths and protozoa, with the relationships between parasite, host and environment having the potential to produce high morbidity and incapacity to work and mortality in vulnerable areas. This study assessed the prevalence of IPIs concerning socio-environmental conditions and analyzed the knowledge, attitudes and practices related to these diseases among men living in the slums of Rio de Janeiro city, Rio de Janeiro State, Brazil. A cross-sectional study was conducted in an agglomeration of urban slums between 2018 and 2019, with men aged between 20 and 59 years. A socioeconomic status questionnaire and an IPIs knowledge, attitudes and practices questionnaire (KAPQ) were applied. Coproparasitological diagnoses (n=454) were performed using four methods and samples of water for household consumption (n=392) were subjected to microbiological and physicochemical analysis. A total of 624 participants were enrolled. About 40% of the households had "water unsuitable for consumption". Only one Major Area, MA 3 was not statistically significant for IPIs (AOR=0.75; 95% CI: 0.30-1.88; p=0.55). The overall prevalence of IPIs was 23.8%. Endolimax nana (n=65, 14.3%) and hookworm (n=8, 1.7%) were the most frequently identified parasites. The analysis of the frequency of responses to the KAPQ has shown that men reported to seeking medical care if they were suspicious of IPIs, and around 35% would self-medicate. The results have shown the need to adopt integrated health education practices targeting male residents in urban slums to qualify the care with water for human consumption and promote self-care about IPIs. The household can be considered strategic for Primary Health Care activities for men.

Concessão privatista do saneamento e a incidência da Covid-19 em favelas do Rio de Janeiro / Privatizing sanitation concessions and the incidence of COVID-19 in slums in Rio de Janeiro

RESUMO O objetivo foi avaliar a relação espacial dos indicadores de saneamento (acesso à água e ao esgoto), considerando a modelagem da concessão da Companhia Estadual de Águas e Esgotos do Rio de Janeiro (Cedae), e a sua possível relação com a incidência da Covid-19, nos bairros com e sem áreas de favelas. Os dados de casos confirmados da Covid-19 analisados foram obtidos no Painel Saúde do Rio de Janeiro. Foi considerado o fracionamento do município em quatro blocos regionais. Nos 163 bairros da cidade, a taxa de incidência média foi de 9,78 casos/1.000 hab. Os bairros com as menores taxa de incidência foram aqueles com predominância de aglomerados subnormais (favelas), baixa renda per capita e cobertura de saneamento, sugerindo maior lacuna de testagem e subnotificação de casos. Reduzir a inequidade e o racismo estrutural deveria ser prioritário. A sindemia da Covid-19 contribuiu fortemente para perdas socioeconômicas e de saúde pública significativas. Em um cenário de reconstrução, é imprescindível retomar o compromisso para com os Objetivos de Desenvolvimento Sustentável da Agenda 2030 das Nações Unidas.

ABSTRACT This assessment aimed to evaluate the putative spatial relationship between sanitation indicators (access to water and sewage) considering the Rio de Janeiro State Water and Sewage Company (CEDAE) parameters and the COVID-19 incidence among districts with and without slum areas. The data of confirmed COVID-19 cases analyzed were obtained from the Rio de Janeiro Health Panel. We considered the division of the municipality into four regional blocks. The mean COVID-19 incidence was 9.78 cases/1,000 inhabitants in the 163 city districts. The lowest COVID-19 incidence rate was most reported in slum regions, with lower per capita income and sanitation coverage, suggesting a significant gap in testing and case underreporting. Reducing inequality and structural racism should be a priority. The COVID-19 syndemic strongly contributed to significant socioeconomic and public health losses. Our commitment to the Sustainable Development Goals of the 2030 agenda of the United Nations is pivotal in a backdrop of reconstruction.

Monitoramento da Covid-19 nas favelas cariocas: vigilância de base territorial e produção compartilhada de conhecimento / Monitoring COVID-19 in Rio's favelas: territorial-based surveillance and shared production of knowledge

RESUMO Apresenta-se um ensaio crítico-reflexivo sobre a ocorrência da Covid-19 em espaços periféricos do município do Rio de Janeiro, tendo como metodologia principal a análise documental dos três boletins socioepidemiológicos Covid-19 nas favelas, publicados no âmbito do Observatório Covid-19 da Fiocruz. Os resultados dos referidos boletins foram apresentados e problematizados a partir do referencial teórico da epidemiologia crítica e da determinação social do processo saúde-doença, discutindo a magnitude da doença nas favelas. Ademais, compreendeu-se que este debate visibiliza e fortalece a reflexão sobre os impactos sanitários e sociais da Covid-19 nas áreas de periferia de todo o País. Foram descritos o processo de trabalho para a elaboração dos boletins, os desafios metodológicos enfrentados para monitorar processos epidêmicos em espaços periféricos, e problematizados os principais resultados à luz das desigualdades históricas que ficaram ainda mais evidentes com a atual pandemia.

ABSTRACT This is a critical reflection essay on COVID-19 in suburban areas in Rio de Janeiro through documental analysis of the three socio-epidemiological bulletins COVID-19 in the favelas, published in FIOCRUZ COVID-19 Observatory. The results of these bulletins were presented and discussed grounded on critical epidemiology and the social determination of the health-disease process, discussing the magnitude of the disease in the favelas. Furthermore, we understood that this debate elicits and strengthens the discussion about the health and social impacts of COVID-19 in the Brazilian suburbs. We described the work process to prepare the bulletins and the methodological challenges of monitoring diseases in the suburbs. Lastly, the main results were analyzed and discussed, considering the historical inequalities that became more evident with the current pandemic.

Severe acute respiratory syndrome Coronavirus 2. Seroepidemiology study in Argentinian slum / Estudio seroepidemiológico de enfermedad por Coronavirus 2019 en un barrio de Argentina

Abstract Most countries in Latin America have already reported thousands of confirmed cases and vulnerable populations are the most affected by the coronavirus disease 2019 (COVID-19) pandemic. Preventive measures such as hygiene, social distancing, and isolation, essential to stop the spread of coronavirus, are difficult to accomplish for vulnerable populations due to their living conditions. Seroepidemiological surveys are assets to measure the transmission for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Until July 1st, the incidence rate of SARS-CoV-2 infection in Barrio Padre Mugica, one of the largest slums in Buenos Aires City, was 5.9%. This study aimed to establish the prevalence of SARS-CoV-2 antibodies immunoglobulin G (IgG) immediately after the outbreak, and to identify neighbourhood, household and individual factors associated with seroconversion. The prevalence based on IgG was 53.4% (95% CI 52.8% to 54.1%). For each polymerase chain reaction (RT-qPCR) confirmed case, nine people tested IgG positive, indicating a high rate of undetected (probably asymptomatic) infections. Hence, the high rate of undiagnosed people suggests that clinical criteria and epidemiological nexus should be considered. The high seroprevalence observed in the context of an intense epidemic in a vulnerable area might serve as a reference to other countries. This study contributes to future decision making by understanding population immunity against SARS-CoV2 and its relation to living conditions and foccus that comprehensive biosocial, household-level interventions are needed.

Resumen Muchos países de América Latina han informado miles de casos confirmados y las poblaciones vulnerables son las más afectadas por la pandemia de la enfermedad por coronavirus 2019 (COVID-19). Las medidas preventivas como la higiene, el distanciamiento social y el aislamiento, fundamentales para frenar la propagación del coronavirus, son difíciles de lograr en estas poblaciones debido a sus condiciones de vida. Los estudios seroepidemiológicos son de gran utilidad para medir la transmisión del síndrome respiratorio agudo severo coronavirus 2 (SARS-CoV-2). Hasta el 1 de julio, la tasa de incidencia de la infección por SARS-CoV-2 en el Barrio Padre Mugica, uno de los barrios marginales más grandes de la ciudad de Buenos Aires, era del 5.9%. Este estudio tuvo como objetivo estimar la prevalencia de anticuerpos inmunoglobulina G (IgG) para SARS-CoV-2 inmediatamente después del brote, e identificar factores del barrio, hogar e individuales asociados con la seroconversión. La prevalencia basada en IgG fue del 53.4% (IC del 95%: 52.8% a 54.1%). Para cada caso confirmado por reacción en cadena de la polimerasa (RT-qPCR), nueve personas dieron positivo en IgG, lo que indica una alta tasa de infecciones no detectadas y probablemente asintomáticas. La alta tasa de personas no diagnosticadas sugiere que se deben considerar los criterios clínicos y el nexo epidemiológico. La alta seroprevalencia observada en el contexto de una intensa epidemia en una zona vulnerable podría servir de referencia a otros países. Este estudio contribuye a la toma de decisiones futuras al comprender la inmunidad de la población contra el SARS-CoV2 en su relación con las condiciones de vida y por su enfoque en la necesidad de intervenciones integrales a nivel del hogar.

Estudo de avaliabilidade do programa de indução à pesquisa em saúde no Brasil para mitigar problemas relacionados à extrema pobreza / Evaluability study of the health research induction program in Brazil to mitigate problems related to extreme poverty

RESUMO A multidimensionalidade da pobreza foi premissa central do Plano Brasil Sem Miséria (2011-2014), que visava a erradicar a extrema pobreza no País. A Fundação Oswaldo Cruz coordenou um programa de indução à pesquisa em saúde que promoveu investigações destinadas a produzir conhecimento para mitigar problemas relacionados à miséria. O estudo de avaliabilidade foi orientado pelo instrumento teórico-metodológico da Teoria da Mudança, que permitiu traçar o caminho do cenário inicial para um cenário esperado, com base nos resultados da indução, representados no modelo lógico do programa, no qual também foram descritos a estrutura, os processos e os resultados. A partir da análise documental e entrevistas com stakeholders das instituições envolvidas foi possível identificar os objetivos do programa, os resultados esperados, o público beneficiado pelo programa e o público beneficiado pela avaliação dos resultados do programa. Este estudo orientou o planejamento da avaliação que se seguiu, bem como a definição do modelo canadense de mensuração do retorno de investimento em pesquisa em saúde como estratégia metodológica. As limitações foram reconhecidas, bem como os pontos que favoreceram a implantação e o desenvolvimento do programa de indução. Espera-se, ainda, que este estudo possa contribuir para avaliações e/ou pré-avaliações de outros programas com escopo semelhante.

ABSTRACT The multidimensionality of poverty was the central premise of the Brazilian Without Misery Plan (2011-2014), which aimed at eradicating misery in the country. The Oswaldo Cruz Foundation coordinated a health research induction program that promoted research aimed at producing knowledge to mitigate problems related to misery. The evaluability study was guided by the theoretical and methodological instrument of the Theory of Change, which allowed us to trace the path from the initial scenario to an expected scenario, based on the induction results, represented in the logical model of the program, in which the structure, processes, and results were also described. Through document analysis and interviews with stakeholders, it was possible to identify the objectives, expected results of the program, as well as the public benefited by it and by the evaluation of the program's results. This study guided the planning of the assessment that followed, as well as the definition of the Canadian model, to measure the return on health research investment as a methodological strategy. The limitations were recognized, as well as the issues that favored the implementation and development of the induction program. It is further hoped that this study may contribute to evaluations and/or pre-evaluations of other similarly targeted programs.

O tráfico de drogas responde à pandemia / Drug cartels respond to the pandemic / El narcotráfico responde a la pandemia

Mais de 13,6 milhões de brasileiros vivem em grandes comunidades empobrecidas, conhecidas como favelas. Historicamente, esses territórios sofrem com a insuficiência de direitos sociais e com conflitos violentos orquestrados pela polícia e pelo tráfico de drogas. Nesse contexto, o desmonte do sistema público de saúde e a negação da pandemia pelo governo federal aumentam a vulnerabilidade das favelas durante a crise da COVID-19. Apesar da negligência do governo federal em instalar medidas para conter a transmissão do SARS-Cov-2, uma organização criminosa que domina o tráfico de drogas em várias favelas brasileiras, o Comando Vermelho, impôs certas ações protetivas. Discutimos os aspectos éticos da colaboração entre os profissionais da Atenção Primária e o comando do tráfico de drogas para promover a saúde nas favelas.

More than 13.6 million Brazilians live in large poor communities known as favelas. Historically, these territories suffer due to social rights insufficiency and violent conflicts orchestrated by the police and the drug cartels. In this context, the dismantling of the public health care system and denialism of the pandemic by the federal government increases the vulnerability within the favelas during the COVID-19 crisis. Although the federal government failed to take up measures to control the transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), a criminal organization that dominates the trafficking of drugs in several Brazilian favelas, known as Comando Vermelho, instead dictated those protective actions. This study aimed to discuss the ethical aspects of the relationship between primary health care professionals and the drug cartels in order to promote health care in the favelas.

Más de 13,6 millones de brasileños viven en grandes comunidades pobres conocidas como favelas. Históricamente, estos territorios han sufrido la insuficiencia de derechos sociales y conflictos violentos orquestados por la policía y el narcotráfico. En este contexto, el desmantelamiento del sistema de salud pública y la negación de la pandemia por parte del gobierno federal aumentan la vulnerabilidad de las favelas durante la crisis de COVID-19. Aunque el gobierno federal no haya implementados medidas para contener la transmisión del SARS-Cov-2, una organización criminal que domina el tráfico de drogas en varias favelas brasileñas, conocida como Comando Vermelho, dictó las acciones de protección. Discutimos los aspectos éticos de la colaboración entre los profesionales de la Atención Primaria y los cárteles para promover salud en las favelas.

Sufrimiento de mujeres en una ocupación urbana de São Paulo, Brasil: un desafío para el trabajo en atención primaria de la salud / The suffering of women living in an informal settlement in São Paulo, Brazil: a challenge to the work of Primary Health Care

RESUMEN Entre los efectos sociales de la pandemia de COVID-19, el aumento de la pobreza, el desempleo y la desigualdad social en el país agravaron los problemas de salud, principalmente, de la población más pobre. Esta investigación buscó discutir potencialidades y limitaciones del proceso de trabajo en atención primaria de la salud, basado en la Estrategia de Salud Familiar. Para ello, entre enero y febrero de 2020, se realizaron entrevistas semiestructuradas a cuatro mujeres residentes de una ocupación urbana del interior del estado de São Paulo, Brasil. Se encontró que presentan sufrimiento relacionado con la precariedad de las viviendas, la provisoriedad, el aislamiento social y el silenciamiento. El modo en que se organiza la atención primaria de la salud y el proceso de trabajo de las y los profesionales dificulta tanto el acceso de una parte de la población a los servicios de salud, como la percepción de las y los profesionales sobre el sufrimiento de la población. Los resultados de la investigación indican la necesidad de una nueva evaluación y perfeccionamiento de la Estrategia de Salud Familiar.

ABSTRACT Among the social effects of the COVID-19 pandemic, increased poverty, unemployment, and social inequality in Brazil have led to worsening health problems, especially in the poorest citizens. The purpose of this research was to discuss the potentialities and limitations of the work process in primary health care based on the Family Health Strategy. In order to do so, we conducted semi-structured interviews with four women living in an informal settlement in the interior of the state of São Paulo, Brazil, between January and February 2020. We found that the women experienced suffering in relation to issues such as housing precariousness, transience, social isolation, and silencing. The way in which primary health care is organized and professionals' work processes make it difficult for this population to access health services and for professionals to perceive their suffering. The findings of this research point to the need to reevaluate and improve the Family Health Strategy.

Uno de nosotros cometimos un crimen*: trayectorias en la construcción de víctimas de homicidios en jóvenes / Um de nós cometeu um crime: trajetórias na construção de vítimas de homicídio em jovens / One of us committed a crime: trajectories in the construction of homicide victims in young people

Este trabajo se propone identificar trayectorias que contribuyen a que jóvenes de sectores populares sean víctimas de un homicidio. Nos ocuparemos de muertes producidas entre personas que mantienen vínculos previos al hecho y que no tienen como motivación cometer un robo u otro delito. El texto documenta y analiza la trayectoria de un joven víctima de este tipo de homicidio desde una perspectiva cualitativa. El trabajo de campo se produjo entre 2011 y 2017 en barrios populares de municipios del conurbano de la provincia de Buenos Aires, Argentina. Sostenemos que en la trayectoria existe un proceso colectivo que agudiza la vulnerabilidad del joven a la agresión letal. En su composición, destacamos acontecimientos clave que restringen las posibilidades de agencia de las víctimas y la conducen a una zona de fragilidad a la muerte en el contexto de la sociabilidad local. (AU)

Este trabalho visa identificar trajetórias que contribuem para o fato de jovens de setores populares serem vítimas de homicídio. Trataremos de mortes que ocorram entre pessoas que possuem vínculo anterior ao evento e que não têm motivação para cometer roubo ou outro crime. O texto documenta e analisa a trajetória de uma jovem vítima desse tipo de homicídio em uma perspectiva qualitativa. O trabalho de campo ocorreu entre 2011 e 2017 em bairros populares de municípios da periferia da província de Buenos Aires, Argentina. Argumentamos que há um processo coletivo ao longo da trajetória que aumenta a vulnerabilidade dos jovens às agressões letais. Em sua composição, destacamos eventos-chave que restringem as possibilidades do agenciamento para as vítimas e as conduzem a uma zona de fragilidade à morte no contexto da sociabilidade local. (AU)

This article aims to identify trajectories that contribute to the fact that young people from popular sectors are victims of homicide. We will deal with deaths that occur between people who have links prior to the event and who are not motivated to commit a robbery or other crime. The text documents and analyzes the trajectory of a young victim of this type of homicide from a qualitative perspective. The field work took place between 2011 and 2017 in popular neighborhoods of the suburbs of the province of Buenos Aires, Argentina. We maintain that there is a collective process along the trajectory that exacerbates the youth's vulnerability to lethal aggression. In its composition, we highlight key events that restrict the agency's possibilities for victims and lead them to a zone of fragility to death in the context of local sociability. (AU)

Nutrition status of primary and middle school students in poor rural areas of Ningxia during 2013 to 2017 / 中国学校卫生

Objective@#To investigate the nutritional status of the rural compulsory education students from "Rural Compulsory Education Students Nutrition Improvement Program"(hereinafter referred to "plan") in Ningxia, to provide a scientific basis for future targeted nutrition education and interventions.@*Methods@#The survey was conducted in 27 732 students aged 6 to 15 years selected by stratified samplings in 7 counties of Ningxia.@*Results@#In the 5 years of the "plan" implementation, trend in decreasing malnutrition rates across the 5 years(18.16%, 18.77%, 17.08%, 14.38%, 14.93%), with statistically significant difference(Chi-square for trend was 47.02, P<0.01). Overnutrition rate significantly increased(5.21%, 4.89%, 5.51%, 5.68%, 6.83%, Chi-square for trend was 6.66, P<0.01).@*Conclusion@#Improved nutritional status of rural primary and middle school students in Ningxia has been observed, Co-occurring of malnutrition in boys and overnutrition requires further attention.

Analysis school absenteeism in Nutrition Improvement Program for Rural Compulsory Education Students area from 2012-2017 / 中国学校卫生

Objective@#To investigate the changes of school absenteeism among students received Nutrition Improvement Program for Rural Compulsory Education Student (NIPCES), and to provide basic data for further nutritional health improvement for rural students.@*Methods@#Among 699 NIPCES monitored counties among 22 provinces across western and central China, 10%-30% of elementary and junior high schools were randomly selected as monitoring schools within each stratification according to the food supply pattern (school canteen, company and mix) in each county, school absenteeism information were collected and analyzed from 2012 to 2017.@*Results@#The total rate of student absenteeism was 26.0 per 10 000. From 2012 to 2016, it dropped from 30.8 per 10 000 to 23.4 per 10 000 year by year, but it increased again in 2017(28.2 per 10 000). The rate of school absenteeism in the western region (29.4 per 10 000) was higher than that in the central region (21.5 per 10 000); The sick leave rate (15.0 per 10 000) of primary school students was higher than that of junior high school students (13.4 per 10 000), and the rate of personal leave absences (16.9 per 10 000) of junior high school students was higher than that of elementary school students(9.9 per 10 000); the absentees rate in mixed-food supply schools (28.5 per 10 000) was higher than that in canteen food supply schools(26.4 per 10 000), the latter was higher than that of company food supply schools(25.0 per 10 000). The rate of sick leave absenteeism was highest in December(18.4 per 10 000), and the rate of personal leave absenteeism in June was highest(14.6 per 10 000).@*Conclusion@#The rate of school absenteeism among students in the NIPCES area showed an overall downward trend year by year. The absentee rate of students varies by regions, grade, food supply patterns and school locations.

Prevalence of stunting among students under the Nutrition Improvement Program for Rural Compulsory Education Students during 2012-2017 / 中国学校卫生

Objective@#To analyze the prevalence of stunting among students received subsidies of the National Nutrition Improvement Program for rural Compulsory Education Students (NNIPRCES) during 2012-2017.@*Methods@#By using the data from 2012-2017 NNIPRCES survey, students aged 6-15 with valid height records were included. Stunting was defined according to the Screening Criteria of Malnutrition for School Age Children and Adolescents (WS/T 456—2014). To explore the association of the risk of stunting between different regions, gender or age groups in rural students.@*Results@#The prevalence of stunting among students aged 6-15 who received subsidies of NNIPRCES during 2012-2017 were 8.0%, 7.9%, 6.9%, 6.5%, 6.0% and 5.3%, declined by 2.7, 1.8, 4.0 percentage points in average, as well as in central and western region, respectively. The prevalence of stunting declined with 2.7 percentage points for boys and ,2.9 percentage points for girls. The prevalence of stunting declined most at the age of 13, with 4.0 percentage points.@*Conclusion@#The prevalence of stunting of students has declined after the implementation of NNIPRCES from 2012 to 2017. However, the total prevalence of stunting was still high and the development was unbalanced between central and western region, which requires more target intervening strategies to improve the nutritional status of students.

Temporal trend in energy and macronutrients for pilot schools involved in the Nutrition Improvement Program for Rural Compulsory Education Students in 2012-2017 / 中国学校卫生

Objective@#To evaluate temporal trend in food supply among pilot schools involved in the National Nutrition Improvement Program for Rural Compulsory Education Students (NNIPRCES).@*Methods@#Ten percent of pilot schools were randomly selected and asked to report the information on food supplies. Daily intake of energy, carbohydrates and protein for each student were calculated and compared with the reference value in Nutrition Guidelines of School Meals (WS/T 554-2017).@*Results@#Energy and protein supply increased among those pilot schools. The supply of energy increased from 1 566.5 kcal in 2012 to 1 927.4 kcal in 2017, protein increased from 49.0 g to 61.0 g. The energy ratio of fat increased from 31.9% to 34.9%, while energy ratio of carbohydrate decreased significantly (F=83.38, 128.36, 20.27 and 17.28, all P<0.05). The proportion of reasonable energy supply from carbohydrate and fat in 2017 were 17.5% and 26.8%, respectively.@*Conclusion@#The supply of energy and macronutrients in the pilot areas were unreasonable, more measures including dietary guide and monitoring need to be adopted to improve students nutrition status among rural areas.