Health care for people with sickle cell disease in a medium-sized Brazilian city

The objective of the study was to evaluate the access, assistance and satisfaction of people with sickle cell disease in relation to the health care provided by the Unified Health System in the Uberlândia city, Minas Gerais, Brazil. Thirty-four people with sickle cell disease were recruited using the snowball sampling method and submitted to semi-structured interview, with collection of demographic, clinical and relationship data and satisfaction with health care. Forty-four percent were not included in the Primary Health Care network, which did not provide several procedures/actions recommended by the Ministry of Health. Ninety-four percent were unsatisfied/partially satisfied with the emergency care provided in the Integrated Care Units. The main reasons for this unsatisfied were ignorance of sickle cell disease by the health team (87.5%), delay in care (81.3%) and inadequate conduct by the health team (59.5%). In conclusion, the access and quality of care provided to people with sickle cell disease by the Primary Health Care network and the Urgency and Emergency Network need to be improved and this improvement is directly related to the training of health teams

A relação entre desenvolvimento sustentável e imagem de lugar de um destino turístico: proposição de um modelo estrutural

In the 1960s tourism began its advance as an economic sector and went on to be promoted in developing countries as a possible solution to some of their problems. Given this fact, marketing has started to become a key element in the management of tourism and tourist destination, well prepared to bring attractiveness to the place, given the intensification of competition between tourist destinations strategies are necessary. However, when considering the success of the tourist destination in the long term, one must take into account the importance of the sustainability of the place, adopting strategies to make the competitive tourist destination without compromising their survival. Based on these facts, the study looked at the relationship between sustainable development and the image of the tourist destination in order to contribute to making strategic actions that promote the competitiveness of the place. A survey was done with 280 tourists, from which statistical analyzes and structural equation modeling were applied. The results showed the direct and positive influence of sustainable development on the image of the tourist destination, confirming its relevance as a factor to be considered in the marketing strategies for the competitiveness of the place.En la década de 1960 el turismo comenzó su avance como sector económico y pasó a ser promovido en los países en desarrollo como una posible solución a algunos de sus problemas. Ante este hecho, el marketing ha comenzado a convertirse en un elemento clave en la gestión del turismo y destino turístico, se necesitando estrategias bien preparadas para llevar atractividad al lugar, dada la intensificación de la competencia entre los destinos turísticos. Sin embargo, al considerar el éxito del destino turístico en el largo plazo, debe tener en cuenta la importancia de la sostenibilidad del lugar, la adopción de estrategias para hacer el destino turístico competitivo sin comprometer su supervivencia. Em base a estos hechos, el estudio se centró en la relación entre el desarrollo sostenible y la imagen del destino turístico, con el fin de contribuir a que las acciones estratégicas promuevan la competitividad del lugar. Se realizó una encuesta con 280 turistas, desde la que se aplicaron análisis estadísticos y modelos de ecuaciones estructurales. Los resultados mostraron la influencia de manera directa y positiva de desarrollo sostenible sobre la imagen del destino turístico, lo que confirma su importancia como un factor a tener en cuenta en las estrategias de marketing para la competitividad del lugar.Na década de 1960 o turismo iniciou seu avanço enquanto setor econômico e passou a ser promovido em países em desenvolvimento como solução possível para alguns de seus problemas. Diante desse fato, o marketing começou a se tornar elemento-chave para o gerenciamento do turismo e do destino turístico, sendo necessárias estratégias bem elaboradas para trazer atratividade ao lugar, dada a intensificação da competitividade entre destinos turísticos. Entretanto, ao se considerar o sucesso do destino turístico no longo prazo, é preciso levar em conta a importância da sustentabilidade do lugar, adotando estratégias que tornem o destino turístico competitivo sem comprometer sua sobrevivência. Baseado nesses fatos, o estudo buscou verificar a relação existente entre o desenvolvimento sustentável e a imagem do destino turístico, de forma a contribuir para a tomada de ações estratégicas que favoreçam a competitividade do lugar. Realizou-se uma survey com 280 turistas, a partir da qual foram aplicadas análises estatísticas e modelagem de equações estruturais. Os resultados apontaram a influência de forma direta e positiva do desenvolvimento sustentável sobre a imagem do destino turístico, confirmando sua relevância enquanto fator a ser considerado nas estratégias de marketing para a competitividade do lugar

High anti-SARS-CoV-2 antibody seroconversion rates before the second wave in Manaus, Brazil, and the protective effect of social behaviour measures: results from the prospective DETECTCoV-19 cohort

Background: The city of Manaus, Brazil, has seen two collapses of the health system due to the COVID-19 pandemic. We report anti-SARS-CoV-2 nucleocapsid IgG antibody seroconversion rates and associated risk factors in Manaus residents before the second wave of the epidemic in Brazil. Methods: A convenience sample of adult (aged ≥18 years) residents of Manaus was recruited through online and university website advertising into the DETECTCoV-19 study cohort. The current analysis of seroconversion included a subgroup of DETECTCoV-19 participants who had at least two serum sample collections separated by at least 4 weeks between Aug 19 and Oct 2, 2020 (visit 1), and Oct 19 and Nov 27, 2020 (visit 2). Those who reported (or had no data on) having a COVID-19 diagnosis before visit 1, and who were positive for anti-SARS-CoV-2 nucleocapsid IgG antibodies at visit 1 were excluded. Using an in-house ELISA, the reactivity index (RI; calculated as the optical density ratio of the sample to the negative control) for serum anti-SARS-CoV-2 nucleocapsid IgG antibodies was measured at both visits. We calculated the incidence of seroconversion (defined as RI values ≤1·5 at visit 1 and ≥1·5 at visit 2, and a ratio >2 between the visit 2 and visit 1 RI values) during the study period, as well as incidence rate ratios (IRRs) through cluster-corrected and adjusted Poisson regression models to analyse associations between seroconversion and variables related to sociodemographic characteristics, health access, comorbidities, COVID-19 exposure, protective behaviours, and symptoms. Findings: 2496 DETECTCoV-19 cohort participants returned for a follow-up visit between Oct 19 and Nov 27, 2020, of whom 204 reported having COVID-19 before the first visit and 24 had no data regarding previous disease status. 559 participants were seropositive for anti-SARS-CoV-2 nucleocapsid IgG antibodies at baseline. Of the remaining 1709 participants who were seronegative at baseline, 71 did not meet the criteria for seroconversion and were excluded from the analyses. Among the remaining 1638 participants who were seronegative at baseline, 214 showed seroconversion at visit 2. The seroconversion incidence was 13·06% (95% CI 11·52–14·79) overall and 6·78% (5·61–8·10) for symptomatic seroconversion, over a median follow-up period of 57 days (IQR 54–61). 48·1% of seroconversion events were estimated to be asymptomatic. The sample had higher proportions of affluent and higher-educated people than those reported for the Manaus city population. In the fully adjusted and corrected model, risk factors for seroconversion before visit 2 were having a COVID-19 case in the household (IRR 1·49 [95% CI 1·21–1·83]), not wearing a mask during contact with a person with COVID-19 (1·25 [1·09–1·45]), relaxation of physical distancing (1·31 [1·05–1·64]), and having flu-like symptoms (1·79 [1·23–2·59]) or a COVID-19 diagnosis (3·57 [2·27–5·63]) between the first and second visits, whereas working remotely was associated with lower incidence (0·74 [0·56–0·97]). Interpretation: An intense infection transmission period preceded the second wave of COVID-19 in Manaus. Several modifiable behaviours increased the risk of seroconversion, including non-compliance with non-pharmaceutical interventions measures such as not wearing a mask during contact, relaxation of protective measures, and non-remote working. Increased testing in high-transmission areas is needed to provide timely information about ongoing transmission and aid appropriate implementation of transmission mitigation measures. Funding: Ministry of Education, Brazil; Fundação de Amparo à Pesquisa do Estado do Amazonas; Pan American Health Organization (PAHO)/WHO.World Health OrganizationRevisión por pare

Os parlamentos e as relações internacionais

A competência legal do poder legislativo na execução da política exterior é descrita pelo autor. O parlamento brasileiro tem tido participação relativamente pequena na formulação da política externa. Tal fato influenciou na demora das conquistas democráticas do país neste final de século