Faith healing: the threat of "Surucucu" and the local cure of Amazon floodplain dwellers.

BACKGROUND: Snakebites are considered a neglected tropical disease responsible for many accidents, some fatal, and are related to poverty. The Brazilian Amazon has the highest incidence of snakebites per inhabitant, with the state of Pará having the most reported cases. For those who have difficult access to hospitals and pharmacies, this issue is even more urgent. METHODS: In this research, we worked together with the population of five riverine communities in Aritapera (Santarém-PA), a fluvial island located in the Lower Amazon floodplain (várzeas), in order to identify the species of venomous snakes and create a record of snakebites in the region and treatments carried out. RESULTS: Dwellers reported a high frequency of encounters throughout the year and mentioned five venomous ethnospecies, although we identified only Bothrops atrox. Approximately 28.7% of the participants had already been bitten, and in 15.8% of the interviews, they mentioned deaths from snakebites. The treatments varied between hospitalization (42.8%), home treatments (23.8%), both together (25.4%) and healers (7.9%). There were cases where no treatment, or just religious treatment, was performed. In general, no serious sequelae were reported. Although home treatments were more common in the past, many people maintained the practice of using them before going to the hospital. Among the most used are Pau X and the fat of the Amazon River Dolphin. The latter appears to be a recent discovery by locals and is considered very efficient both for humans and animals. CONCLUSION: Difficult access to health centers, a lack of energy to store antivenom and a high rate of encounters with snake place Aritapera dwellers in a vulnerable situation regarding snakebite accidents. In this context, they discovered treatments that improved their well-being until hospitalization. As the Amazon River dolphin is an endangered species, the use of its fat requires attention. In this sense, the dissemination of this knowledge is important to encourage studies that investigate which properties of this fat act as counterpoisons. By discovering substitutes that can be incorporated in other rural and remote communities, an economic and ecologically viable option for the health of residents can be promoted, in addition to valuing traditional knowledge.

Community Engagement Mental Health Model for Home Treatment of Psychosis in Jamaica.

Economic constraints in low- and middle-income countries like Jamaica challenge health care services to identify efficient methods of mental health care. This column describes the community engagement mental health (CEMH) model in Kingston, Jamaica, for patients with mental disorders, including psychosis. The CEMH uses a task sharing methodology to deliver acute psychiatric treatment within a community setting. Preliminary results suggest high service user and provider satisfaction and good clinical outcomes. The authors discuss challenges and benefits of the CEMH in terms of its potential as a cost-effective service innovation.

The time has come for new models in febrile neutropenia: a practical demonstration of the inadequacy of the MASCC score.

Since its publication more than 15 years ago, the MASCC score has been internationally validated any number of times and recommended by most clinical practice guidelines for the management of febrile neutropenia (FN) around the world. We have used an empirical data-supported simulated scenario to demonstrate that, despite everything, the MASCC score is impractical as a basis for decision-making. A detailed analysis of reasons supporting the clinical irrelevance of this model is performed. First, seven of its eight variables are "innocent bystanders" that contribute little to selecting low-risk candidates for ambulatory management. Secondly, the training series was hardly representative of outpatients with solid tumors and low-risk FN. Finally, the simultaneous inclusion of key variables both in the model and in the outcome explains its successful validation in various series of patients. Alternative methods of prognostic classification, such as the Clinical Index of Stable Febrile Neutropenia, have been specifically validated for patients with solid tumors and should replace the MASCC model in situations of clinical uncertainty.

Aplicação de Escala de Risco Familiar como instrumento de priorização das Visitas Domiciliares / Application of the Family Risk Scale as an instrument for prioritizing home visits / Aplicación de Escala de Riesgo Familiar como instrumento de priorización de las Visitas Domiciliarias

A introdução do Programa Saúde da Família foi uma tentativa de reorganizar a atenção básica no país, que instituiu a Visita Domiciliar, como instrumento diferencial da atuação do Médico de Família. Para estabelecer prioridades na visita, elaborou-se escala de risco familiar baseada na ficha A do SIAB. Tal escala se baseia em sentinelas de risco que são avaliadas na primeira visita domiciliar pelo agente de saúde (ACS). A mesma foi aplicada em diferentes comunidades e microáreas, demonstrando diversas proporções de famílias classificadas como risco 1, 2 ou 3. Os resultados ressaltam a relação morador/cômodo como um importante indicador na avaliação do risco, bem como a aplicabilidade da escala como instrumento de priorização tanto das visitas domiciliares quanto do investimento da equipe. A escala demonstrou ser um instrumento simples e eficiente de análise do risco familiar, não necessitando a criação de nenhuma nova ficha ou escala burocrática. Os autores sugerem que somente o uso sistemático da Escala de Coelho como instrumento de reorganização da demanda, e posterior avaliação de seu impacto na comunidade, poderá confirmar sua aplicabilidade na atuação do médico de família.

The introduction of the Family Health Program was an attempt to reorganize basic care in the country, which instituted the Home Visit, as a differential instrument of the Family Doctor's work. To establish priorities in the visit, a family risk scale was elaborated based on SIAB sheet A. This scale is based on risk sentinels that are evaluated at the first home visit by the health worker (CHA). It was applied in different communities and microareas, demonstrating different proportions of families classified as risk 1, 2 or 3. The results emphasize the dwelling / habit ratio as an important indicator in the risk assessment, as well as the applicability of the scale as an instrument of prioritization of both home visits and team investment. The scale proved to be a simple and efficient instrument of family risk analysis, not requiring the creation of any new file or bureaucratic scale. The authors suggest that only the systematic use of the Rabbit Scale as an instrument of demand reorganization, and subsequent evaluation of its impact on the community, can confirm its applicability in the practice of the family doctor.

La introducción del Programa Salud de la Familia fue un intento de reorganizar la atención básica en el país, que instituyó la Visita Domiciliaria, como instrumento diferencial de la actuación del Médico de Familia. Para establecer prioridades en la visita, se elaboró ​​una escala de riesgo familiar basada en la ficha A del SIAB. Esta escala se basa en centinelas de riesgo que son evaluadas en la primera visita domiciliar por el agente de salud (ACS). La misma fue aplicada en diferentes comunidades y microáreas, demostrando diversas proporciones de familias clasificadas como riesgo 1, 2 o 3. Los resultados resaltan la relación morador / habitación como un importante indicador en la evaluación del riesgo, así como la aplicabilidad de la escala como instrumento de priorización tanto de las visitas domiciliarias como de la inversión del equipo. La escala demostró ser un instrumento simple y eficiente de análisis del riesgo familiar, no necesitando la creación de ninguna nueva ficha o escala burocrática. Los autores sugieren que solamente el uso sistemático de la Escala de Coelho como instrumento de reorganización de la demanda, y posterior evaluación de su impacto en la comunidad, podrá confirmar su aplicabilidad en la actuación del médico de familia.