ABSTRACT
Stray dogs are associated with environment and public health impacts. São Paulo is a city with approximately 2.5 million owned dogs and until the time of writing no studies describing the distribution of the stray dog population have been conducted in this city. Therefore, no scientific support for intervention plans is available. The objective of this study was to evaluate the association of local sociodemographic and environmental factors with the population perception of presence of stray dogs in urban fragments of São Paulo city. A convenience sample of six urban fragments was selected. In-depth interviews were performe, using a systematic random sample of households in each study area, between October/2010 and January/2011 to identify socio-demographic factors of interest and determine the population's perception of stray dogs. Additionally, the presence of stray dogs was estimated by photographic mark-recapture method. The degree of human-dog proximity and environmental factors such as waste handling were associated to the sighting of stray dogs. Stray dogs were observed in two of the six study areas, agreeing with the greater population perception of this issue on those areas. Intervention in these factors and encouragement of responsible ownership are two potential solutions for management and reduction of problems associated with the presence of stray dogs.(AU)
A presença de cães errantes está associada a impactos no meio ambiente e na saúde pública. São Paulo é uma cidade com aproximadamente 2.5 milhões de cães domiciliados e até o presente momento, não foram desenvolvidos estudos que descrevam a distribuição da população errante na cidade. Desta forma, não há suporte científico para planejar intervenções. O objetivo deste estudo foi avaliar a associação entre os fatores sociodemográficos e ambientais da população local com a frequência com que relataram a visualização de cães errantes em fragmentos urbanos da cidade de São Paulo. Foi definida uma amostra de conveniência composta por seis fragmentos urbanos, onde um questionário foi aplicado em uma amostra sistemática dos domicílios de cada área de estudo. Este questionário, aplicado entre outubro de 2010 e janeiro de 2011, determinou os fatores socio-econômicos de interesse e a percepção da presença de cães errantes pela população. Também foi estimada a presença de cães pelo método de marcação e recaptura fotográfica. Foi possível estabelecer uma relação entre a visualização de cães errantes pela população local e o grau de proximidade com cães e o manejo de resíduos do domicílio. Cães errantes foram observados em duas das seis áreas trabalhadas, em concordância com a maior percepção da sua presença pela população local. Intervenções nestes fatores e incentivo a guarda responsável são duas ações com potencial de contribuir para redução dos problemas causados pela presença de cães errantes.(AU)
Subject(s)
Humans , Animals , Dogs , Statistical Data , Pets , Social Responsibility , Socioeconomic Survey , BrazilABSTRACT
BACKGROUND: Brazil boasts a health scheme that aspires to provide universal coverage, but its surgical system has rarely been analysed. In an effort to strengthen surgical systems worldwide, the Lancet Commission on Global Surgery proposed a collection of 6 standardised indicators: 2-hour access to surgery, surgical workforce density, surgical volume, perioperative mortality rate (POMR) and protection against impoverishing and catastrophic expenditure. This study aims to characterise the Brazilian surgical health system with these newly devised indicators while gaining understanding on the complexity of the indicators themselves. METHODS: Using Brazil's national healthcare database, commonly reported healthcare variables were used to calculate or simulate the 6 surgical indicators. Access to surgery was calculated using hospital locations, surgical workforce density was calculated using locations of surgeons, anaesthesiologists and obstetricians (SAO), and surgical volume and POMR were identified with surgical procedure codes. The rates of protection against impoverishing and catastrophic expenditure were modelled using cost of surgical inpatient hospitalisations and a γ distribution of incomes based on Gini and gross domestic product/capita. FINDINGS: In 2014, SAO density was 34.7/100â 000 population, surgical volume was 4433 procedures/100â 000 people and POMR was 1.71%. 79.4% of surgical patients were protected against impoverishing expenditure and 84.6% were protected against catastrophic expenditure due to surgery each year. 2-hour access to surgery was not able to be calculated from national health data, but a proxy measure suggested that 97.2% of the population has 2-hour access to a hospital that may be able to provide surgery. Geographic disparities were seen in all indicators. INTERPRETATION: Brazil's public surgical system meets several key benchmarks. Geographic disparities, however, are substantial and raise concerns of equity. Policies should focus on stimulating appropriate geographic allocation of the surgical workforce and better distribution of surgical volume. In some cases, where benchmarks for each indicator are met, supplemental analysis can further inform our understanding of health systems. This measured and systematic evaluation should be encouraged for all nations seeking to better understand their surgical systems.
ABSTRACT
BACKGROUND: A critical insufficiency of surgeons, anesthesiologists, and obstetricians exists around the world, leaving billions of people without access to safe operative care. The distribution of the surgical workforce in Brazil, however, is poorly described and rarely assessed. Though the surgical workforce is only one element in the surgical system, this study aimed to map and characterize the distribution of the surgical workforce in Brazil in order to stimulate discussion on future surgical policy reforms. METHODS: The distribution of the surgical workforce was extracted from the Brazilian Federal Medical Board registry as of July 2014. Included in the surgical workforce were surgeons, anesthesiologists, and obstetricians. RESULTS: There are 95,169 surgeons, anesthesiologists, and obstetricians in the surgical workforce of Brazil, creating a surgical workforce density of 46.55/100,000 population. This varies from 20.21/100,000 population in the North Region up to 60.32/100,000 population in the South Region. A total of 75.2% of the surgical workforce is located in the 100 biggest cities in Brazil, where only 40.4% of the population lives. The average age of a physician in the surgical workforce is 46.6 years. Women make up 30.0% of the surgical workforce, 15.8% of surgeons, 36.6% of anesthesiologists, and 53.8% of obstetricians and gynecologists. CONCLUSION: Brazil has a substantial surgical workforce, but inequalities in its distribution are concerning. There is an urgent need for increased surgeons, anesthesiologists, and obstetricians in states like Pará, Amapá, and Maranhão. Female surgeons and anesthesiologists are particularly lacking in the surgical workforce, and incentives to recruit these physicians are necessary. Government policies and leadership from health organizations are required to ensure that the surgical workforce will be more evenly distributed in the future.
Subject(s)
Health Services Needs and Demand , Health Workforce/statistics & numerical data , Registries , Surgeons/supply & distribution , Brazil , Female , General Surgery , Humans , MaleABSTRACT
BACKGROUND: Until recently, Amblyomma cajennense (Fabricius, 1787) was considered to represent a single tick species in the New World. Recent studies have split this taxon into six species. While the A. cajennense species complex or A. cajennense (sensu lato) (s.l.) is currently represented by two species in Brazil, A. cajennense (sensu stricto) (s.s.) and Amblyomma sculptum Berlese, 1888, their geographical distribution is poorly known. METHODS: The distribution of the A. cajennense (s.l.) in Brazil was determined by morphological examination of all lots of A. cajennense (s.l.) in two large tick collections of Brazil, and by collecting new material during three field expeditions in the possible transition areas between the distribution ranges of A. cajennense (s.s.) and A. sculptum. Phylogenetic analysis inferred from the ITS2 rRNA gene was used to validate morphological results. Morphological description of the nymphal stage of A. cajennense (s.s.) is provided based on laboratory-reared specimens. RESULTS: From the tick collections, a total 12,512 adult ticks were examined and identified as 312 A. cajennense (s.s.), 6,252 A. sculptum and 5,948 A. cajennense (s.l.). A total of 1,746 ticks from 77 localities were collected during field expeditions, and were identified as 249 A. cajennense (s.s.), 443 A. sculptum, and 1,054 A. cajennense (s.l.) [these A. cajennense (s.l.) ticks were considered to be males of either A. cajennense (s.s.) or A. sculptum]. At least 23 localities contained the presence of both A. cajennense (s.s.) and A. sculptum in sympatry. DNA sequences of the ITS2 gene of 50 ticks from 30 localities confirmed the results of the morphological analyses. The nymph of A. cajennense (s.s.) is morphologically very similar to A. sculptum. CONCLUSION: Our results confirmed that A. cajennense (s.l.) is currently represented in Brazil by only two species, A. cajennense (s.s.) and A. sculptum. While these species have distinct distribution areas in the country, they are found in sympatry in some transition areas. The current distribution of A. cajennense (s.l.) has important implications to public health, since in Brazil A. sculptum is the most important vector of the bacterium Rickettsia rickettsii, the etiological agent of Brazilian spotted fever.
