Made available in DSpace on 2015-04-22T22:06:19Z (GMT). No. of bitstreams: 1 INARA CAVALCAANTE.pdf: 3883238 bytes, checksum: 8ee251556494013f2f879216e196df45 (MD5) Previous issue date: 2011-02-25 / CAPES - Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / The quilombola populations are among the most vulnerable groups of Brazil related to health services. This qualitative study aimed to know the access and accessibility to the health services in quilombos in the Paraense Amazonia, in three communities, África/Lanranjituba in Abaetetuba, Santo Antonio/Foz do Cravo in Concórdia do Pará and Mangueiras, in Salvaterra in the Marajó island. The subjects of the research were the residents and the managers and health professionals of the municipal district. Other sources were: the primary data of the socioeconomic conditions of the families and documental analysis of reports and information from the Ministry of Health. The research describes the access to the health services from four dimensions, Geographical, Functional, Cultural and Economical, and presents a transverse analysis of the access while analytical category of the planning and administration of the services in agreement with the re-interpretation of welfare care models in health. It was detected the difficulty and/or impossibility of the quilombolas in having access and accessibility to all the levels of complexity of health attendance, being this a result of a group of processes that involve several aspects as the distance of the urban centers and the lack of services that offer access by land and fluvial; the high financial costs (transport, feeding, medicines, permanence in the city, etc.) of the search for health services; the adaptation lack to the afro-descending habits from the managers and health professionals that assist them; and the functionality of the health services offered. We concluded that the health services are just offered by the municipal managers that adopt the Economic and ―Planificador‖ Models due to the Brazilian system of allocation of budgets for health, so there is not a National Politics of access and accessibility to health services that allows the National Politics of Integral Health of the Black Population to become real. Therefore it is fundamental the planning of health public politics of access and accessibility starting from a participative and promoter of the health equity logic, compatible with the geographical and socio-cultural dynamics of the Brazilian Amazonia. / As populações quilombolas estão entre os grupos em situação de vulnerabilidade no Brasil, no que diz respeito a serviços de saúde. Este estudo qualitativo se desenvolveu com o objetivo de conhecer o acesso e a acessibilidade aos serviços de saúde em quilombos na Amazônia Paraense, em três comunidades: África/Lanranjituba, em Abaetetuba, Santo Antonio/Foz do Cravo, em Concórdia do Pará e Mangueiras, em Salvaterra, na ilha do Marajó. Os sujeitos da pesquisa foram os moradores, os gestores e os profissionais de saúde dos municípios. Outras fontes foram os dados das condições socioeconômicas das famílias do ―Projeto Corpo Presente‖ e análise documental de relatórios e informações do Ministério da Saúde. A pesquisa descreve o acesso aos serviços de saúde a partir de quatro dimensões, Geográfica, Funcional, Cultural e Econômica. Faz uma análise transversal do acesso enquanto categoria do planejamento e gestão dos serviços de acordo com a re-interpretação de modelos assistenciais em saúde. Constatou-se a dificuldade e/ou impossibilidade dos quilombolas em terem acesso e acessibilidade a todos os níveis de complexidade de assistência em saúde, sendo isto, resultado de um conjunto de processos que envolvem vários aspectos como: a distância dos centros urbanos; a falta de serviços que ofereçam acesso a estes por via terrestre e fluvial; os elevados custos financeiros (transporte, alimentação, medicamentos, estadia na cidade, etc.) da busca por serviços de saúde; a falta de adequação aos hábitos e costumes afrodescendentes por parte dos gestores e profissionais de saúde que os atendem e a funcionalidade dos serviços de saúde ofertados. Conclui-se que os serviços de saúde são apenas ofertados pelos gestores municipais a partir dos Modelos Economista e Planificador em virtude do sistema brasileiro de alocação de verbas para saúde, portanto, não existe uma Política Nacional de acesso e acessibilidade aos serviços de saúde que permita concretizar a Política Nacional de Saúde Integral da População Negra. Assim, é fundamental o planejamento de políticas públicas de saúde de acesso e acessibilidade a partir de uma lógica participativa e promotora da equidade em saúde, compatíveis coma a dinâmica geográfica e sócio-cultural da Amazônia Brasileira.

Submitted by Renata Lopes (renatasil82@gmail.com) on 2017-04-03T13:51:17Z No. of bitstreams: 1 elisabethcamposdeandrade.pdf: 1614173 bytes, checksum: 02bbfb073bbecc90f3e7f67d2c386c90 (MD5) / Approved for entry into archive by Adriana Oliveira (adriana.oliveira@ufjf.edu.br) on 2017-04-03T19:01:36Z (GMT) No. of bitstreams: 1 elisabethcamposdeandrade.pdf: 1614173 bytes, checksum: 02bbfb073bbecc90f3e7f67d2c386c90 (MD5) / Made available in DSpace on 2017-04-03T19:01:36Z (GMT). No. of bitstreams: 1 elisabethcamposdeandrade.pdf: 1614173 bytes, checksum: 02bbfb073bbecc90f3e7f67d2c386c90 (MD5) Previous issue date: 2009-03-26 / FAPEMIG - Fundação de Amparo à Pesquisa do Estado de Minas Gerais / As parasitoses intestinais são um importante problema de saúde pública principalmente nos países subdesenvolvidos ou em desenvolvimento. Embora o parasitismo intestinal seja amplamente reconhecido como relevante no contexto epidemiológico de diversas comunidades, os estudos sobre o assunto são ainda insuficientes, principalmente no Brasil. Em vista da dificuldade de diagnóstico específico das parasitoses, muitas vezes são realizados tratamentos empíricos com mais de uma droga. O objetivo principal do presente estudo foi avaliar a efetividade e segurança do uso de nitazoxanida no tratamento de poliparasitoses comparado à terapêutica tradicional ofertada pelo serviço público. Além deste objetivo, foi possível investigar a prevalência e os fatores associados às parasitoses intestinais na população de Colônia do Paiol, uma comunidade quilombola, na Zona da Mata, Minas Gerais. Na comunidade analisada, procedeuse um estudo transversal por censo, sendo que dos 425 moradores, 391 (92%) foram avaliados através de questionário estruturado e exame coproparasitológico. Os resultados mostraram uma alta positividade (63,8%), sendo as espécies patogênicas mais freqüentes Ascaris lumbricoides (22,4%) e Trichuris trichiura (17,9%). O poliparasitismo ocorreu em 36,5% dos investigados. O ensaio clínico, controlado, duplo cego, randomizado avaliou 65 indivíduos em dois grupos de tratamento. A taxa de cura foi de 32,4% e 38,7% com a nitazoxanida e com o tratamento convencional, respectivamente, mas esta diferença não foi estatisticamente significativa (p=0,599). A ocorrência de vômito (p= 0,031) esteve associada ao tratamento convencional e de urina esverdeada ao uso de nitazoxanida (p=0,002). Os outros efeitos adversos foram independentes da droga. Houve diferença estatisticamente significativa em relação à cor da pele e a taxa de cura para ambos os tratamentos. A menor eficácia efetividade foi apresentada pelos indivíduos de cor preta. São necessários outros estudos para esclarecer a baixa efetividade nos casos de poliparasitismo, assim como, reavaliar as práticas preventivas e terapêuticas, com o uso de novas drogas e de agentes de largo espectro, podendo a nitazoxanida ser uma droga alternativa neste contexto. Agrega-se às novas possibilidades terapêuticas, a necessidade de políticas públicas que garantam qualidade de vida, através de saneamento básico, educação para saúde e acesso ao sistema público de saúde, minimizando as iniqüidades na sociedade. / Intestinal parasitism is an important public health concern, chiefly in underdeveloped or developing countries. Although widely recognized as a relevant community epidemiological issue, intestinal parasitism has not been sufficiently studied in Brazil. Because specific diagnosis is difficult and generally cumbersome, empiric treatment, sometimes with more than one drug, is frequently employed. The main aim of this study was the assessment of the effectiveness and safety of nitazoxanide for the treatment of intestinal polyparasitism, as compared to traditional therapy provided by the public service. The study also investigated the prevalence of and factors associated with intestinal parasitism in the population of Colônia do Paiol, a quilombola community from the Zona da Mata, Minas Gerais, Brazil. A census-based cross-sectional study used a structured questionnaire and stool examination to assess 391 people (92%) of the 425 inhabitants of the community. The frequency of intestinal parasitism was as high as 63.8%, with predominance of Ascaris lumbricoides (22.4%) and Trichuris trichiura (17.9%). Polyparasitism occurred in 36.5% of those investigated. A double-blind randomized controlled trial assessed 65 individuals in two treatment groups. Cure rates were 32.4% and 38.7% with nitazoxanide and conventional treatment, respectively, but the difference was not statistically significant (p = 0.599). Vomiting (p = 0.031) was associated with conventional treatment and greenish urine with nitazoxanide use (p = 0.002). Other untoward effects were independent of which drug was used. There was a statistically significant difference concerning skin color and cure rates for both treatments. Dark-skinned subjects had lower cure rates. Further studies are necessary to clarify the reasons for the low effectiveness found in these cases of polyparasitism, and to reevaluate preventive and therapeutic approaches with new and broad-spectrum drugs, nitazoxanide being an option in this context. In addition to new therapeutic approaches, there is a clear need to develop public policies that, through the provision of basic sanitation, health education and access to the public health system, assure quality of life and minimize inequity.

BACKGROUND: Initiation of breast feeding and duration of any breast feeding are known to differ by ethnic group, but there are limited data on differences in exclusive breast feeding. This study aimed to determine if there are ethnic differences in the initiation and duration of any and exclusive breast feeding. METHODS: Breast-feeding data were obtained from a subsample of 1365 women recruited to a multi-ethnic cohort study (Born in Bradford) between August 2008 and March 2009. Poisson regression was used to investigate the impact of socio-economic, life style and birth factors on ethnic differences in the prevalence of breast feeding. RESULTS: Compared with white British mothers, initiation of breast feeding was significantly higher in all ethnic groups and this persisted after adjustment for socio-economic, life style and birth factors [Pakistani: prevalence rate ratio (PRR) = 1.19 (95% confidence interval 1.10, 1.29); Other South Asian: PRR = 1.29 (1.18, 1.42); Other ethnicities: PRR = 1.33 (1.21, 1.46)]. There were no differences in exclusive breast feeding at 4 months [Pakistani: PRR = 0.77 (0.54, 1.09); Other South Asian: PRR = 1.55 (0.99, 2.43); Other ethnicities: PRR = 1.50 (0.88, 2.56)]. Any breast feeding at 4 months was significantly higher in mothers of all non-white British ethnicities [Pakistani: PRR = 1.27 (1.02, 1.58); Other South Asian: PRR = 1.99 (1.52, 2.62); Other ethnicities: 2.45 (1.86, 3.21)]. CONCLUSIONS: Whilst women of ethnic minority groups were significantly more likely to initiate breast feeding and continue any breast feeding for 4 months compared with white British women, the rates of exclusive breast feeding at 4 months were not significantly different once socio-economic, life style and birth factors were accounted for.

No / 90009335 / School leavers with intellectual disabilities (ID) often face difficulties in making a smooth transition from school to college, employment or more broadly to adult life. The transition phase is traumatic for the young person with ID and their families as it often results in the loss of friendships, relationships and social networks. The aim of this study was to explore the family carers' views and experiences on transition from school to college or to adult life with special reference to ethnicity. Forty-three families (consisting of 16 White British, 24 Pakistani, 2 Bangladeshi and one Black African) were interviewed twice using a semi-structured interview schedule. The carers were interviewed twice, Time 1 (T1) and Time 2 (T2), T2 being a year later to observe any changes during transition. The findings indicate that although transition planning occurred it was relatively later in the young person's school life. Parents were often confused about the process and had limited information about future options for their son or daughter. All family carers regardless of ethnicity, reported lack of information about services and expressed a sense of being excluded. South Asian families experienced more problems related to language, information about services, culture and religion. The majority of families lacked knowledge and awareness of formal services and the transition process. Socio-economic status, high levels of unemployment and caring for a child with a disability accounted for similar family experiences, regardless of ethnic background. The three key areas relevant for ethnicity are interdependence, religion and assumptions by service providers.