Autopercepção da saúde bucal e fatores associados em pessoas idosas quilombolas: um estudo de base populacional / Self-perception of oral health and associated factors in quilombola older people: a population-based study

Resumo Objetivo investigar a autopercepção das condições bucais e fatores associados em idosos quilombolas rurais do norte de Minas Gerais, Brasil. Método Trata-se de um estudo analítico e transversal de base populacional, no qual utilizou-se uma amostragem por conglomerados com probabilidade proporcional ao tamanho (n=406). A coleta de dados envolveu a realização de entrevistas e exames clínicos odontológicos. A autopercepção das condições bucais foi avaliada por meio do GOHAI (Índice de Determinação da Saúde Bucal Geriátrica). Resultados A maioria dos idosos autopercebeu a saúde bucal como ótima (46,3%) ou regular (30,2%). Os pesquisados revelaram ainda precária saúde bucal e acesso restrito aos serviços odontológicos. Verificaram-se, na análise múltipla, associações significantes (p˂0,05) entre GOHAI regular e variáveis relativas ao local da última consulta e uso de prótese, bem como entre GOHAI ruim e variáveis atinentes ao estado conjugal, religião, motivo da última consulta, índice CPO-D e uso de prótese. Conclusão Parcela expressiva dos idosos quilombolas manifestou uma autoavaliação mais positiva da saúde bucal, divergente do quadro odontológico constatado profissionalmente. Constatou-se ainda que o relato de percepção ruim das condições bucais esteve fortemente associado a uma saúde bucal mais precária entre os investigados.

Abstract Objective to investigate self-perception of oral conditions and associated factors in rural quilombola older people in northern Minas Gerais, Brazil. Method This is an analytical and cross-sectional population-based study, in which cluster sampling with probability proportional to size (n=406) was used. Data collection involved conducting interviews and clinical dental examinations. Self-perception of oral conditions was assessed using the GOHAI (Geriatric Oral Health Determination Index). Results Most older people self-perceived oral health as excellent (46.3%) or regular (30.2%). Those surveyed also revealed precarious oral health and restricted access to dental services. In the multiple analysis, significant associations (p˂0.05) were found between regular GOHAI and variables related to the location of the last consultation and use of prosthesis, as well as between poor GOHAI and variables related to marital status, religion, reason for last consultation, CPO-D index and use of prosthesis. Conclusion A significant portion of the quilombola older people showed a more positive self-assessment of oral health, which differs from the professionally verified dental condition. It was also found that the report of poor perception of oral conditions was strongly associated with poorer oral health among those investigated.

Giardiasis in children and dogs, and the first report of assemblage E in dogs from northeastern Brazil / Giardíase em crianças e cães, e o primeiro relato de infecção por assemblage E em cães do nordeste brasileiro

Diagnosis is crucial for controlling giardiasis. We determined the prevalence and genetically characterize isolates of Giardia duodenalis of children and dogs from rural communities in northeastern Brazil. G. duodenalis cysts were concentrated by centrifugal flotation/sedimentation. Molecular characterization was carried out using the loci ssu-rRNA, bg, tpi, and gdh. By parasitological techniques, Giardia spp. infection was detected in 72/192 children (37.5%; 95% CI: 30.6%-44.7%) and 24/139 dogs (17.3%; 95% CI: 11.4%-24.6%). By molecular analysis, infection was detected in 60/141 children (42.5%; 95% CI: 34.3%-51.2%) and 26/92 dogs (28.3%; 95% CI: 19.4%-38.6%). The total prevalence of giardiasis was 54.9% in children (106/193; 95% CI: 47.1%-61.6%) and 32.9% in dogs (47/143; 95% CI: 25.2%-41.2%). Zoonotic assemblages A and B of G. duodenalis were detected in children, and assemblage E of G. duodenalis was detected in one child and two dogs. Parallel use of parasitological and molecular techniques proved to be a more effective strategy for detecting giardiasis in children and dogs from endemic areas.(AU)

O diagnóstico é crucial para o controle da giardíase. Foram determinadas as prevalências e as características genéticas isoladas de Giardia duodenalis, em crianças e cães de comunidades rurais do nordeste brasileiro. Os cistos de G. duodenalis foram concentrados por centrífugo-flutuação/sedimentação. A caracterização molecular foi realizada utilizando-se os loci ssu-rRNA, bg, tpi e gdh. Pelas técnicas parasitológicas, a infecção por Giardia spp. foi detectada em 72/192 crianças (37,5%; IC 95%: 30,6%-44,7%) e 24/139 cães (17,3%; IC 95%: 11,4%-24,6%). Molecularmente, a infecção foi detectada em 60/141 crianças (42,5%; IC 95%: 34,3%-51,2%) e 26/92 cães (28,3%; IC 95%: 19,4%-38,6%). A prevalência total de giardíase foi de 54,9% em crianças (106/193; IC 95%: 47,1%-61,6%) e 32,9% em cães (47/143; IC 95%: 25,2%-41,2%). Os assemblages zoonóticos A e B de G. duodenalis foram detectados em crianças, e o assemblage E de G. duodenalis foi detectado nas duas populações. O uso paralelo de técnicas parasitológicas e moleculares mostra-se uma estratégia mais eficaz para detecção de giardíase em crianças e cães de áreas endêmicas.(AU)

Molecular survey of Zika virus in the animal-human interface in traditional farming.

Backyard animal husbandry is common in rural communities in developing countries and, given the conditions in which it occurs, it can increase the risk of disease transmission, such as arboviruses. To determine the presence of the Zika virus (ZIKV) and abundance of its arthropod vectors we evaluated the socioeconomic implications involved in its transmission in two highly vulnerable Mayan communities in the state of Yucatan that practice backyard farming. An analytical cross-sectional study was carried out throughout 2016 to understand socioeconomic variables and seasonal patterns in mosquito populations. We selected 20 households from each community. Social exclusion indicators were analyzed, human and domestic animals were sampled, and mosquitoes were collected and identified. Four out of eight indicators of social exclusion were higher than the reported national averages. We captured 5,825 mosquitoes from 16 species being Culex quinquefasciatus and Aedes aegypti the most abundant. The presence of chickens and human overcrowding in dwellings were the most significant factors (P = 0.026) associated with the presence of Ae. aegypti. Septic tanks (odds ratio = 6.64) and chickens (odds ratio = 27.41) in backyards were the main risk factors associated with the presence of immature states of Ae. aegypti in both communities. Molecular analysis to detect ZIKV was performed in blood samples from 416 humans, 1,068 backyard animals and 381 mosquito pools. Eighteen humans and 10 pig pools tested positive for ZIKV. Forty-three mosquito pools tested positive for flavivirus. Ten of the 43 pools of positive mosquitoes were sequenced, corresponding 3/10 to ZIKV and 1/10 to Dengue virus type 2. The findings obtained indicate the continuous circulation of Flavivirus (including ZIKV) in backyard environments in vulnerable communities, highlighting the importance of studying their transmission and maintenance in these systems, due that backyard animal husbandry is a common practice in these vulnerable communities with limited access to health services.

Proposal of a Multi-Criteria Model for the Evaluation of Territorial Development Plans: An Application in Chile's Lagging Areas.

The evaluation of Territorial Development Plans (TDP) is a challenge most Latin American countries face. The problem arises in establishing a model to evaluate TDP that meets the criteria and indicators established in a national policy or regulatory framework under local needs. This study proposes an application to evaluate the TDP of the lagging areas in Chile based on the AHP multi-criteria methodology. This methodology allows to objectively unify the evaluation of the different plans, combining the different dimensions, objectives, scales, and judgments of the experts present in the evaluation process without sacrificing the quality, reliability, and participation of the actors involved. The model is flexible to changes in the criteria, as it can be updated according to the needs over time. An efficient and effective tool is provided to support decision-makers in formulating better development plans to bridge the gaps in territorial groups with high vulnerability.

Migratory phenomenon and expressive sandwork in vulnerable populations.

In these times the migratory phenomenon is a crisis with alarming dimensions worldwide. Wars, human rights violations and violence within borders have pushed many people to seek asylum or have forced internal displacement. We approach this phenomenon taking into account the cultural complexes, understanding it as a process with multiple psychological, social and existential effects for those who suffer it. We find these effects symbolized in many of the processes of the children participating in Expressive Sandwork projects. Expressive Sandwork is a transcultural, non-verbal method of therapeutic care that offers psychological support to children from vulnerable populations where psychotherapy is deficient or non-existent. The aim is to allow the emergence of images that favour reconnection with the child's creative potential, activating the process of self-regulation of the psyche. Its basis in symbolic processes and empathetic accompaniment makes it a Jungian psychosocial intervention for these times of transition. In Latin America, Expressive Sandwork projects have been implemented in Colombia and Argentina. Two examples of the participating children are presented.

A notre époque le phénomène migratoire est une crise qui a des dimensions alarmantes au niveau mondial. Les guerres, les violations des droits humains et la violence au sein même des frontières ont poussé de nombreuses personnes à chercher asile à l'étranger, ou les ont forcées à un déplacement à l'intérieur des frontières. Nous abordons ce phénomène en prenant en compte les complexes culturels. Nous le comprenons comme un processus ayant de multiples effets psychologiques, sociaux et existentiels pour les personnes qui en souffrent. Nous observons ces effets symbolisés dans de nombreux processus des enfants qui participent aux projets de travail expressif à l'aide du jeu de sable (Expressive Sandwork). L'Expressive Sandwork est une méthode de soin thérapeutique transculturelle et non-verbale qui offre du soutien psychologique à des enfants de populations vulnérables quand la psychothérapie est déficiente ou non-existante. Le but en est de permettre l'émergence d'images qui favorisent le rétablissement du potentiel créatif de l'enfant, activant ainsi le processus d'autorégulation de la psyché. Son enracinement dans les processus symboliques et l'accompagnement empathique en font une intervention Jungienne psychosociale pour notre époque de transition. En Amérique Latine, les projets de travail expressif à l'aide du jeu de sable ont été implantés en Colombie et en Argentine. Deux exemples d'enfants qui y ont participé sont présentés.

En estos tiempos el fenómeno migratorio es una crisis con dimensiones alarmantes a nivel mundial. Las guerras, la violación de los derechos humanos y la violencia al interior de las fronteras han empujado a muchas personas a buscar asilo o al desplazamiento forzado interno. Nos aproximamos a este fenómeno teniendo en cuenta los complejos culturales y comprendiéndolo como un proceso con múltiples efectos psicológicos, sociales y existenciales para quienes lo sufren. Estos efectos los encontramos simbolizados en muchos de los procesos de los niños/as participantes en los proyectos de Trabajo Expresivo con Arena. El Trabajo Expresivo con Arena es un método de cuidado terapéutico no verbal y transcultural que ofrece apoyo psicológico a niños/as de poblaciones vulnerables, donde la psicoterapia es deficiente o inexistente. El objetivo es permitir el surgimiento de imágenes que favorezcan la reconexión con el potencial creativo del niño/a, activando el proceso de autorregulación de su psique. Su base en procesos simbólicos y en el acompañamiento empático, lo constituyen en una intervención psicosocial de la psicología junguiana para estos tiempos de transición. En Latinoamérica se han implementado proyectos de Trabajo Expresivo con Arena en Colombia y Argentina. En este artículo se presentarán dos ejemplos de niños que formaron parte de estos proyectos.

Nestes tempos, o fenômeno migratório é uma crise com dimensões alarmantes em todo o mundo. Guerras, violações dos direitos humanos e violência dentro das fronteiras levaram muitas pessoas a buscar asilo ou deslocamento interno forçado. Abordamos esse fenômeno levando em consideração os complexos culturais, entendendo-o como um processo com múltiplos efeitos psicológicos, sociais e existenciais para aqueles que o sofrem. Encontramos esses efeitos simbolizados em muitos dos processos das crianças que participam de projetos Expressive Sandwork. O Expressive Sandwork é um método transcultural e não verbal de cuidados terapêuticos que oferece apoio psicológico a crianças de populações vulneráveis onde a psicoterapia é deficiente ou inexistente. O objetivo é permitir o surgimento de imagens que favoreçam a reconexão com o potencial criativo da criança, ativando o processo de autorregulação do psiquismo. Sua base em processos simbólicos e acompanhamento empático o torna uma intervenção psicossocial junguiana para esses tempos de transição. Na América Latina, projetos Expressive Sandwork foram implementados na Colômbia e na Argentina. Dois exemplos das crianças participantes são.

Using an Intervention Mapping Approach to Develop a Program for Preventing High Blood Pressure in a Marginalized Afro-Colombian Population: A Community-Based Participatory Research.

The prevention of high blood pressure (HBP) is an important public health initiative worldwide, since HBP is the main risk factor for cardiovascular diseases and increases the damage caused by coronavirus disease 2019 (COVID-19). We designed, implemented, and evaluated a program to identify effective and sustainable interventions for preventing HBP in a marginalized black population. Our study was conducted in Quibdó, a city in Colombia with the highest poverty rate and located in the Pacific coast, a subregion in Colombia with the highest prevalence of HBP. We followed an intervention mapping framework using a community-based participatory research approach. Focus groups, photovoice, literature reviews, and cross-sectional quantitative surveys were used for data collection. The community chose the time, place, and type of physical activity; led the physical activities; and strengthened their skills in seeking resources in their community to sustain the program. The evaluation was aimed at determining whether the interventions were able to achieve the program's primary aim. We used a before (September 2016) and after (December 2017) design for the evaluation. To decrease the selection bias and allow comparisons between homogeneous groups, we used a propensity score matching technique. The steps required to create a self-sustaining physical activity program were provided in detail. The pre-post test showed a decrease of the HBP (systolic, 13.4% points; p = 0.018; diastolic, 6.5% points; p = 0.002). The program may be an effective and self-sustaining intervention, and it can be replicated by policymakers and implemented in other population groups.

Global occurrence of SARS-CoV-2 in environmental aquatic matrices and its implications for sanitation and vulnerabilities in Brazil and developing countries.

This paper includes a systematic review of the SARS-CoV-2 occurrence in environmental aquatic matrices and a critical sanitation analysis. We discussed the interconnection of sanitation services (wastewater, water supply, solid waste, and stormwater drainage) functioning as an important network for controlling the spread of SARS-CoV-2 in waters. We collected 98 studies containing data of the SARS-CoV-2 occurrence in aquatic matrices around the world, of which 40% were from developing countries. Alongside a significant number of people infected by the virus, developing countries face socioeconomic deficiencies and insufficient public investment in infrastructure. Therefore, our study focused on highlighting solutions to provide sanitation in developing countries, considering the virus control in waters by disinfection techniques and sanitary measures, including alternatives for the vulnerable communities. The need for multilateral efforts to improve the universal coverage of sanitation services demands urgent attention in a pandemic scenario.

Actions during the COVID-19 pandemic to protect the most vulnerable population: what is the potency amid chaos?

By 30 May 2021, Brazil had 16 471 600 COVID-19 cases and 461 142 deaths, ranking second in the world in number of deaths and third in number of cases. Preliminary research results in Brazil and around the world show the impact of COVID-19 on more vulnerable communities. However, despite the adverse circumstances of their territories, leaders have mobilized to face the challenges. Between April and June 2020, the authors of this article interviewed informants in eight Brazilian state capitals, addressing the five points of discussion (intersectoriality, sustainability, empowerment and public participation, equity and the life cycle perspective) recently presented by EUPHA-HP, IUHPE and UNESCO Chair Global Health & Education. Official actions and documents from the Ministry of Health and Municipal Health Departments (SMS) of each capital were also analyzed. No records were found of official actions aimed at COVID-19 that addressed the territories' specificities. In total, 15 promotional actions by the communities were identified. The selection of local actors to take on specific responsibilities during the pandemic is highlighted as a relevant action. This action alone weaves together at least three of the five HP principles (equity, life cycles and empowerment). We consider that previous forms of political empowerment, such as the recognition of territories and educational initiatives, have contributed to the subjects who are leading these inventive initiatives. However, although there is scope for promotional actions, there are infrastructural limitations that only public policies could mitigate. Such actions would demand deliberate coordination between the government and social movements, which is absent in the current context of national governance.

Detección de Leptospira spp. (Spirochaetales: Leptospiraceae) en muestras ambientales de regiones habitadas por poblaciones vulnerables del norte argentino / Leptospira spp. (Spirochaetales: Leptospiraceae) detection in environmental samples from geographical regions inhabited by vulnerable communities in northern Argentina

Resumen La leptospirosis continúa siendo hoy en día un problema para la salud pública, principalmente en poblaciones de bajos recursos socioeconómicos. En este trabajo se presenta la detección de leptospiras patógenas en muestras ambientales (aguas y barros) provenientes de regiones del norte argentino (provincias de Formosa, Salta, Santiago del Estero, Misiones y Chaco) con variadas características climatológicas habitadas por poblaciones vulnerables. De las 89 muestras analizadas, en el 24,7% fue posible detectar molecularmente la presencia de leptospiras patógenas. La prevalencia por tipo de muestra fue de 27,8% para las aguas y 11,8% para los barros. Todas las localidades muestreadas presentaron al menos una muestra positiva a alguna de las pruebas realizadas, por lo que el presente trabajo refleja la necesidad de profundizar los estudios de la leptospirosis en distintas regiones de la Argentina.

Abstract Leptospirosis remains as a major public health problem nowadays, mainly affecting vulnerable communities with low socioeconomic resources. In this study, the molecular detection of pathogenic leptospires from environmental samples (water and mud) from northern Argentina (Formosa, Salta, Santiago del Estero, Misiones and Chaco provinces) is described. Samples were obtained from regions with varied climatological features, all inhabited by vulnerable communities. From the 89 samples that were analyzed, 24.7% showed molecular evidence of the presence of pathogenic leptospires. Prevalence by sample type was: 27.8% in water samples and 11.8% in mud samples. All the sampled regions showed at least one positive sample. This result highlights the need of further research regarding leptospirosis in different regions of Argentina.

Access to Health Services and Assistance Offered to the Afro-Descendant Communities in Northern Brazil: A Qualitative Study.

The remnants of quilombos, individuals of African descent, have faced several barriers throughout its history, either due to prejudice imposed by society, or the non-fulfillment of their rights guaranteed in the 1988 Constitution, such as access to health services. Thus, this study aims to evaluate the health care offered to quilombo communities in the northern region of Tocantins. This is an exploratory, descriptive study with a qualitative approach, including field research and focus group, carried out with 58 quilombo remnants people from communities in the northern region of Tocantins. Data collection was carried out between from October 2017 to July 2018, through semi-structured interviews. We found that these communities have limited access to health services, in addition to a negative perception of the assistance offered to the health of their population and the commitment of managers. Therefore, access to health and assistance received by the studied communities required to be prioritized since the care provided is not unique and has not met the health demands and needs of the remaining quilombos in northern Tocantins, Brazil.

Percepções de usuários ribeirinhos sobre a atenção à saúde no âmbito da Estratégia Saúde da Família / Riverine people's perceptions on health care concerning the family health strategy / Percepciones de usuarios ribereños en la atención de la salud en el ámbito de la estrategia salud de la familia

Objetivos: Identificar a percepção de usuários ribeirinhos sobre a atenção à saúde ofertada no arquipélago do Combú e Discutir se essa atenção considera as particularidades socioculturais dessa população. Método: Estudo qualitativo, descritivo, realizado com 26 ribeirinhos cadastrados na estratégia saúde da família da Ilha do Combú. As informações foram coletadas em agosto/setembro de 2017, por meio de entrevistas individuais e analisadas por análise de conteúdo temática. Resultados: Mediante a análise organizaram-se duas categorias: A importância da atenção à saúde ofertada em uma Estratégia Saúde da Família Ribeirinha e A cultura no contexto da Atenção à Saúde para os ribeirinhos. Conclusão: Embora a atenção à saúde considere a peculiaridade local, a carência de profissionais e insumos, não estando em consonância com as políticas públicas é fator de associação com baixa qualidade no serviço, voltando-se a uma visão curativista sem um olhar ampliado das possibilidades de oferta de atenção à saúde

Objective: The study's purpose has been to identify the riverine people's perceptions on health care provided in the Island of Combú, as well as to discuss whether this care considers the sociocultural particularities of such population. Methods: It is a descriptive study with a qualitative approach, which was performed with 26 community members registered in the Family Health Strategy from the Island of Combú. Data collection took place from August to September 2017, through individual interviews and analyzed by thematic content analysis. Results: Based on the analysis, the two following categories were organized: The importance of healthcare services provided in a Family Health Strategy of riparian communities and Culture in the context of Health Care for riparian communities. Conclusion: Although the healthcare services do consider the local peculiarity, the lack of professionals and supplies, which are not aligned with public policies, were found to be factors of association with low service quality. So, turning it into a curative standpoint lacking a broad view regarding the possibilities of health care provision

Objetivos: Identificar la percepción de usuarios ribereños sobre la atención a la salud ofrecida en el archipiélago del Combú y Discutir si esa atención considera las particularidades socioculturales de esa población. Metodo: Estudio cualitativo, descriptivo, realizado con 26 ribereños catastrados en la estrategia salud de la familia de la Isla del Combú. Las informaciones fueron recolectadas en agosto / septiembre de 2017, por medio de entrevistas individuales y analizadas por análisis de contenido temático. Resultados: Mediante el análisis se organizaron dos categorías: La importancia de la atención a la salud ofrecida en una Estrategia Salud de la Familia Ribereñas y La cultura en el contexto de la Atención a la Salud para los ribereños. Conclusión: Aunque la atención a la salud considera la peculiaridad local, la carencia de profesionales y insumos, no estando en consonancia con las políticas públicas es factor de asociación con baja calidad en el servicio, volviéndose a una visión curativista sin una visión ampliada de las posibilidades de oferta de atención a la salud

Saúde bucal e acesso aos serviços odontológicos em idosos quilombolas: um estudo de base populacional / Oral health and access to dental services in old quilombolas: a population-based study

Resumo Objetivo: investigar a condição de saúde bucal, o acesso a serviços odontológicos e fatores sociodemográficos associados a essa acessibilidade em idosos quilombolas rurais do norte do estado de Minas Gerais, Brasil. Método: trata-se de um estudo analítico e transversal de base populacional, no qual foi utilizada uma amostragem por conglomerados com probabilidade proporcional ao tamanho (n=406). A coleta de dados envolveu a realização de entrevistas estruturadas e exames clínicos odontológicos. Resultados: verificou-se que a maioria dos idosos possuía baixa renda e baixa escolaridade. Observou-se que parcela expressiva dos indivíduos relatou acesso a um cirurgião-dentista (97,5%) e que havia realizado a última consulta odontológica há três anos ou mais (60,4%). Foi verificado ainda que a maior parte dos idosos era edêntula (52,0%) e que a maioria dos pesquisados necessitava de próteses (88%). Um alto índice CPO-D foi constatado nos indivíduos estudados (valor médio de 27,25). Idade avançada, ausência de companheiro e aposentadoria se mostraram associadas ao acesso irregular aos serviços odontológicos. Conclusão: os idosos quilombolas locais possuíam uma condição precária de saúde bucal e tinham acesso restrito aos serviços odontológicos. Idade, estado conjugal e situação laboral demonstraram associação com baixa acessibilidade aos serviços de saúde bucal nos idosos investigados.

Abstract Objective:: to investigate the oral health conditions, access to dental services and sociodemographic factors associated with this acessibility in rural quilombolas elderly in the north of the state of Minas Gerais, Brazil. Method: this is an analytical and cross-sectional population-based study, in which cluster sampling was used with probability proportional to size (n=406). Data collection involved structured interviews and clinical dental examinations. Result: it was found that the majority of the elderly had low income and low level education. It was observed that a significant portion of individuals reported access to a dental surgeon (97.5%) and that they had had their last dental appointment three years or more ago (60.4%). It was also found that the majority of the elderly were edentulous (52.0%) and that the majority of respondents needen prostheses (88%). A high DMFT index was found in the individuals studied (mean value of 27.25). Advanced age, absence of partner e retirement were associated with irregular access to dental services. Conclusion: the local quilombolas elderly had poor oral health and restricted access to dental services. Age, marital status and employment status demonstrated association with low accessibility to oral health services in the elderly investigated.

Salud bucodental para comunidades vulnerables y desplazadas de Popayán que viven en condiciones de pobreza / Dental health for Popayán´s vulnerable and displaced communities that live in poverty conditions

Introducción: En el Municipio de Popayán, departamento del Cauca, Colombia, hay más de 23 asentamientos, donde viven cerca de 4 mil personas desplazadas en condición de vulnerabilidad y pobreza, quienes, en su mayoría, no están protegidos por el del sistema de salud y carecen de atención odontológica. Objetivo: Aplicar los conocimientos sobre salud oral adquiridos en la carrera de odontología, para mejorar la salud bucodental en comunidades vulnerables y desplazadas que viven en condiciones de pobreza en Popayán, Cauca, Colombia. Método: Estudio cualitativo, tipo investigación acción. La población beneficiada se conformó por 1515 personas, a las que se le aplicaron procedimientos educativos, preventivos, curativos y restaurativos, durante 5 años. Resultados: La población más beneficiada fue la vulnerable; los más atendidos fueron: en cuanto a género. el femenino; rango de edad, niños entre 3 y 8 años y adultos, de 36 y más años. El procedimiento odontológico que más se realizó en niños fue la profilaxis dental y en adultos el raspaje supragingival. Conclusiones: Aplicar el currículo de la carrera de Odontología centrado en la promoción de salud y en el aprendizaje contextualizado a partir de su aplicación en virtud del desarrollo de la comunidad, lo convierte en un currículo con mayor compromiso social. Y la comunidad que recibe los beneficios se convierte en ente activo de los procesos de promoción de salud oral. La población vulnerable y la desplazada manifiestan receptividad ante los tratamientos clínicos orales que se le ofrecen(AU)

Introduction: In the municipality of Popayán, department of Cauca, Colombia, there are more than 23 settlements, where nearly 4000 displaced people live in conditions of vulnerability and poverty, most of whom are outside the health system and lack of dental care. Objective: To apply the knowledge on oral health according to the level of academic complexity acquired during Odontology major to improve dental health of vulnerable and displaced communities living in poverty conditions in Popayán, Cauca, Colombia. Methods: Qualitative study, research-action type. The beneficiary population was formed by 1,515 people who underwent educational, preventive, curative and restorative procedures during five years. Results: The most favored population was the vulnerable one; the most attended were: female gender; children in ages from 3 to 8 years old, and adults of 36 years old and over. The dental procedure that was carried out the most in children was dental prophylaxis, and supragingival scaling in adults. Conclusions: The appliance of Odontology major´s curriculum focused in health promotion and in the contextualized learning from its use towards the development of the community makes it an entity with bigger social commitment. The community that receives the benefits becomes an active body in the processes of dental health promotion. Vulnerable and displaced populations show receptiveness to the oral clinical treatments offered to them(AU)

Prevalência autorreferida de hipertensão e fatores associados em comunidades quilombolas do Rio Grande do Sul, Brasil / Self-reported prevalence of hypertension and associated factors in quilombola communities in the State of Rio Grande do Sul, Brazil

Resumo Este estudo teve como objetivo identificar a prevalência e fatores associados à hipertensão arterial (HA) em adultos quilombolas do Rio Grande do Sul (RS). Trata-se de um estudo transversal de base populacional, realizado em 2011, com 589 adultos responsáveis por domicílios e amostragem proporcional ao tamanho. O desfecho foi obtido com a pergunta: "Algum médico já lhe disse que você tem hipertensão?". Foi empregada regressão de Poisson, com variância robusta e entrada hierarquizada das variáveis. Por fim, foram calculadas as frações atribuíveis populacionais por componente (FAPC) para fatores modificáveis associados à HA. A prevalência autorreferida de HA foi de 38,3% (IC95% 31,4%-45,1%). A análise ajustada revelou associação do desfecho com faixa etária, escolaridade, consumo excessivo de álcool, circunferência da cintura acima do adequado e presença de diabetes. A análise dos FAPC revelou que, se os indivíduos tivessem maior escolaridade, a prevalência de HA seria reduzida. Diante da elevada prevalência de HA e da extrema vulnerabilidade social dessa população, políticas públicas que garantam seu acesso a direitos fundamentais (saúde, renda e escolaridade) poderiam ter impacto importante na diminuição desse desfecho.

Abstract The study sought to identify the prevalence of arterial hypertension (AH) and possible associated factors in adults residing in quilombola communities in the State of Rio Grande do Sul (RS). A transversal population-based study, carried out in 2011, included 589 adult households in quilombola communities in the State of RS, by sampling proportional to the size. The outcome was obtained by the question: "Has a doctor ever told you that you have hypertension?" Poisson regression with robust variance and hierarchical input variables were used. Finally, the population attributable fractions per component (PAFC) were calculated for modifiable factors associated to AH. The self-reported prevalence of AH was 38.3% (CI95% 31.4%-45.1%). Adjusted analysis revealed an association of the outcome with age group, education, excessive alcohol consumption, waist circumference and the presence of diabetes. PAFC analysis revealed that if the individuals had greater schooling, the prevalence of AH would be reduced. Given the high prevalence of AH and the extreme social vulnerability of this population, public policies that guarantee their access to fundamental rights (health, income and schooling) could have a significant impact in reducing this outcome.

Percepción de la contaminación ambiental y los riesgos para la salud en la comunidad de Villa Inflamable / Perception of environmental pollution and health risks in "villa inflamable" neighborhood

Villa Infamable es una de las zonas más contaminadas del país por la presencia de empresas petroleras y químicas. Las autoridades locales e interjurisdiccionales hicieron pública su preocupación por la contaminación por plomo y sus efectos sobre la salud y el desarrollo infantil. El objetivo de esta investigación fue explorar la percepción comunitaria de la contaminación ambiental, de sus efectos sobre la salud y el conocimiento de medidas de prevención, desde una aproximación cualitativa. Realizamos 16 entrevistas semiestructuradas en 4 puntos estratégicos del barrio. Hallamos que la contaminación ambiental está altamente naturalizada. La contaminación por plomo es la menos percibida por la comunidad que, en pocos casos la menciona y, en menos aún, muestra preocupación por sus efectos sobre la salud infantil. Principalmente, la comunidad identifica la contaminación ambiental a partir de su experiencia sensorial (sabor o turbidez en el agua, humos y olores en el aire) y por las molestias físicas que ocasiona. Las enfermedades más mencionadas en relación a la contaminación ambiental son las respiratorias (bronquitis, neumonía, asma), dermatológicas (alergias, sarpullido, forúnculos), diarreas, cáncer y malformaciones de nacimiento. No obstante, buena parte de los entrevistados duda o, incluso, niega que dichas enfermedades puedan estar causadas por la contaminación ambiental. La incertidumbre tiñe el discurso de los vecinos y vecinas. La no percepción de los efectos dañinos de los contaminantes ambientales sobre la salud puede conducir a no tomar medidas de prevención, a tomar medidas no efectivas o aún, contraproducentes. Discutimos las implicancias de los hallazgos para la formulación de políticas públicas sanitarias y ambientales y reflexionamos sobre los mismos a la luz del concepto de "justicia ambiental".

"Villa Infamable" is one of the most polluted places in the country because of the presence of oil and chemical industries. Local and interjurisdictional authorities made public their especially concerned about lead contamination and its effects on health and child development. The objective of this research was to explore the community perception of environmental pollution, its effects on health and the knowledge of prevention practices, through a qualitative approach. We made 16 semi-structured interviews in four strategic places in the neighborhood. We found that the environment pollution is not questioned. Lead pollution is the least perceived by the community, who hardly mentions it, and their perceptions of children's health problems that are consequence of lead are even less perceived. Mainly, community identifies pollution from its sensorial experience (water favor and turbidity, smoke and air scent) and because of the discomfort that causes in the body. The most mentioned diseases related to environment pollution are respiratory diseases (bronchitis, pneumonia, asthma), skin diseases (allergies, rashes, boils), diarrhea, cancer and birth malformations. However, much of the interviewed doubt or even deny that these deseases may be caused by environmental pollution. Uncertainty is the main feature present in their speech. The lack of perception of the harmful effects on health of the polluting elements may lead to not acting preventively, or taking not effective or counterproductive actions. We discuss the implications of the findings for public health and environmental policies and reflect on the findings considering the concepts of "Environmental justice".

Socioeconomic and health conditions associated with quality of life of elderly quilombolas / Condiciones socioeconómicas y de salud asociadas con la calidad de vida de ancianos quilombolas / Condições socioeconômicas e de saúde associadas à qualidade de vida de idosos quilombolas

ABSTRACT This study aimed to identify the socioeconomic and health conditions associated with quality of life of elderly quilombolas. Cross-sectional, epidemiological and census study, conducted with 427 elderly individuals of a quilombola population enrolled in Family Health Strategies of 17 quilombas communities in Vitória da Conquista, Bahia, four districts of the region. Data collection was performed using tools and analyzed based on descriptive statistics and Spearman correlation (rsp). The factors associated with some areas of Quality of Life and the General Quality of Life Index included the per capita income, the self-assessment of health status and the classification of depression cases, which most strongly affected the quality of life of the elderly quilombolas investigated. The expanded access to health services and the integrality of health care for this group are essential, particularly involving Family Health Teams.

RESUMEN Este estudio tuvo como objetivo identificar las condiciones socioeconómicas y de salud relacionadas con la calidad de vida de ancianos quilombolas. Estudio epidemiológico, con censo, y transversal, efectuado con 427 ancianos quilombolas, registrados en Estrategias Salud de la Familia de 17 comunidades quilombolas de Vitória da Conquista, Bahía, cuatro distritos de la región. La recogida de datos se realizó con los instrumentos, analizados por estadística descriptiva y correlación de Spearman (rsp). Entre los factores asociados con algunas áreas de la Calidad de Vida y con el Índice General de la Calidad de Vida, se encontraron renta per capita, autoevaluación del estado de salud y clasificación de los casos de depresión, que más afectó a la calidad de vida de los ancianos quilombolas investigados, por lo que se hace imprescindible ampliar el acceso a servicios de salud y haber integralidad en la asistencia ofrecida a este grupo, especialmente por los Equipos de Salud de la Familia.

RESUMO Este estudo objetivou identificar as condições socioeconômicas e de saúde associadas à qualidade de vida de idosos quilombolas. Estudo epidemiológico, censitário e transversal, realizado com 427 idosos quilombolas, cadastrados na Estratégia Saúde da Família de 17 comunidades quilombolas de Vitória da Conquista - Bahia, e em quatro distritos da região. A coleta de dados foi realizada com os dois instrumentos, analisados a partir da estatística descritiva e de correlação de Spearman(rsp). Entre os fatores associados com alguns domínios da Qualidade de Vida e com o Índice Geral de Qualidade de Vida, estiveram a renda per capita, a autoavaliação do estado de saúde e a classificação dos casos de depressão, condições de saúde que mais impactaram na qualidade de vida dos idosos quilombolas pesquisados. É essencial a ampliação do acesso aos serviços de saúde e integralidade da assistência oferecida a esse grupo, em especial pelas Equipes de Saúde da Família.

Autopercepção de saúde em quilombolas do norte de Minas Gerais, Brasil / Self-perceived health among ‘quilombolas’ in northern Minas Gerais, Brazil

ResumoComunidades quilombolas vivenciam situação de vulnerabilidade social, mesmo mais de um século da abolição da escravatura, principalmente em relação aos cuidados de saúde. O estudo objetivou conhecer a autopercepção da saúde (APS) em comunidades quilombolas do Norte de Minas Gerais e os fatores associados à percepção negativa da própria saúde. Inquérito domiciliar com amostra representativa das comunidades quilombolas da região estudada. Foram utilizados instrumentos validados para coleta de dados sobre a APS, condições socioeconômicas e demográficas, hábitos de vida e morbidade autorreferida. Após análise bivariada, conduziu-se análise de regressão logística hierarquizada. A prevalência de APS negativa foi de 46,0%. As seguintes variáveis mostraram-se estatisticamente associados a uma APS negativa: idade e escolaridade, como variáveis distais e hipertensão, diabetes, artrite, depressão e problemas de coluna como variáveis proximais. A APS mostrou-se associada a dimensões demográficas, socioeconômicas e, especialmente, à morbidade autorreferida. O conceito de saúde para as comunidades quilombolas estudadas parece estar intimamente ligado à ausência de doenças, especialmente as crônicas.

AbstractOver a century has passed since slavery was abolished in Brazil, yet quilombola communities remain socially vulnerable, especially when it comes to health. The goal of this study was to understand self-perceived health (SPH) in quilombola communities in Northern Minas Gerais, and the factors associated with their negative -perceived their own health. A household survey of a representative sample of quilombola communities in the study region. Validated tools were used to gather data about SPH, socioeconomic conditions, demographics, lifestyle and self-referred morbidity. Following a bivariate analysis, we proceeded to conduct a hierarchical logistics regression analysis. The prevalence of negative SPH was 46.0%. The following variables were statistically associated with negative SPH: age and years of schooling as distal variables, and high blood pressure, diabetes, arthritis, depression and back problems as proximal variables. SPH is associated with demographic and socioeconomic dimensions, and in particular with self-referred morbidity. The concept of health among the quilombola communities included in this study seems to be intimately linked to the absence of disease, especially chronic disease.

Unawareness of hypertension and its determinants among 'quilombolas' (inhabitants of 'quilombos' - hinterland settlements founded by people of African origin) living in Southwest Bahia, Brazil / Desconhecimento da hipertensão arterial e seus determinantes em quilombolas do sudoeste da Bahia, Brasil

This study sought to evaluate the prevalence of unawareness of arterial hypertension (AH) and associated factors among the quilombola population and to describe aspects of the non-pharmacological management of AH. It involved a cross-sectional study with a sample of 358 people with AH aged 18 years or more. AH was considered systolic blood pressure (BP) ≥ 140 mmHg and/or diastolic blood pressure ≥ 90 mmHg and/or reported use of antihypertensive drugs. Unawareness of AH was classified as persons answering negatively when asked if they suffered from AH. Poisson regression was then used. The prevalence of unawareness of AH was 44.1% (95% CI: 38.9-49.3). Among those who already knew the diagnosis and had drug treatment only 24.8% had controlled BP. The unawareness of AH was positively associated with the male sex and Stage 1 of AH and negatively with increasing age, overweight, negative self-perception of health and medical visits. For non-pharmacological management, low percentages of quilombola reported appropriate standard recommendations of care. Arterial hypertension is a serious public health issue among the quilombola population, revealing great vulnerability in health due to poor levels of awareness, treatment and control.

Objetivou-se avaliar a prevalência de desconhecimento da hipertensão arterial (HA) e fatores associados em quilombolas e descrever aspectos do manejo não farmacológico da HA. Estudo transversal com amostra de 358 indivíduos hipertensos com 18 anos ou mais, definida como aqueles com pressão arterial (PA) sistólica ≥ 140mmHg e/ou pressão arterial diastólica ≥ 90 mmHg e/ou relataram uso de medicamentos anti-hipertensivos. Foram classificados com desconhecimento da HA aqueles que responderam negativamente a pergunta sobre conhecer o diagnóstico de HA. Empregou-se regressão de Poisson. A prevalência de desconhecimento da HA foi de 44,1% (IC95%: 38,9-49,3). Entre os que já sabiam do diagnóstico e estavam em tratamento medicamentoso apenas 24,8% tinha a PA controlada. O desconhecimento da HA associou-se positivamente com sexo masculino e estágio 1 da HA e, negativamente, com maior faixa etária, sobrepeso, autopercepção negativa da saúde e realização de consulta médica. Para o manejo não farmacológico foi observado baixos percentuais de solicitação de exames e seguimento das recomendações adequadas. A HA destaca-se como um problema de saúde pública nesta população, descortinando grande vulnerabilidade em saúde devido aos níveis insatisfatórios de conhecimento, tratamento e controle.

Inquérito de Saúde em Comunidades Quilombolas de Vitória da Conquista, Bahia, Brasil (Projeto COMQUISTA): aspectos metodológicos e análise descritiva / Health survey in Quilombola communities (descendants of Afro-Brazilian slaves who escaped from slave plantations that existed in Brazil until abolition in 1888) in Vitória da Conquista in the state of Bahia (COMQUISTA Project), Brazil: methodological aspects and descriptive analysis

O objetivo deste artigo foi apresentar a metodologia, resultados descritivos preliminares e a confiabilidade dos instrumentos utilizados no Projeto COMQUISTA. Estudo transversal com indivíduos adultos (>18 anos) e crianças (até cinco anos) de comunidades quilombolas de Vitória da Conquista, Bahia. A coleta de dados compreendeu a realização de entrevistas individuais e domiciliares, aferição de medidas antropométricas e pressão arterial. Utilizou-se o questionário semiestruturado da Pesquisa Nacional de Saúde (PNS), adaptado para a população quilombola, e as entrevistas foram realizadas em computadores portáteis. Foram visitados 397 domicílios e entrevistados 797 adultos e 130 crianças. O perfil demográfico dos quilombolas foi semelhante ao dos brasileiros quanto ao sexo e idade, porém, eles apresentaram precário acesso ao saneamento básico e baixo nível socioeconômico. A análise de confiabilidade demonstrou a adequação das estratégias adotadas para garantia e controle de qualidade no estudo. A metodologia empregada foi considerada adequada para o alcance dos objetivos e pode ser utilizada em outras populações. Os resultados sugerem a necessidade da implantação de estratégias para melhorar a qualidade de vida e reduzir o grau de vulnerabilidade dos quilombolas.

The scope of this article was to present the methodology, preliminary descriptive results and the reliability of the instruments used in the COMQUISTA Project. It involved a cross-sectional study with adults (>18 years) and children (up to 5 years old) of Quilombola communities in Vitória da Conquista, Bahia. Data collection consisted of individual and household interviews, anthropometric and blood pressure measurements. A semi-structured questionnaire adapted from the Brazilian National Health Survey (PNS) was used and the interviews were conducted using handheld computers. 397 housing units were visited and 797 adults and 130 children were interviewed. The demographic profile of the Quilombolas was similar to the Brazilian population with respect to sex and age, however, they had precarious access to basic sanitation and a low socioeconomic status. The analysis of reliability revealed the adequacy of strategies adopted for quality assurance and control in the study. The methodology used was considered adequate to achieve the objectives and can be used in other populations. The results indicate the need for implementing strategies to improve the quality of life and reduce the degree of vulnerability of the Quilombolas.