Articulación entre servicios de salud y “medicina indígena”: reflexiones antropológicas sobre política y realidad en Brasil

Este artículo contribuye al diálogo entre las ciencias sociales y la medicina social en América Latina a través de la exploración del pluralismo terapéutico en las políticas y servicios de salud indígena en Brasil. Revisa las investigaciones recientes en antropología, así como los conceptos y debates actuales, para examinar críticamente las políticas de salud indígena en Brasil y su concepto de “atención diferenciada”, que propone la articulación entre las prácticas oficiales de salud y las terapias indígenas. Varias contradicciones y tensiones están presentes entre la organización estructural del subsistema de salud indígena en el nivel nacional y las prácticas cotidianas de los equipos de salud en el nivel local. Guiados por la ideología hegemónica de la biomedicina, los profesionales de salud no reconocen las dinámicas y la agencia expresada en las practicas indígenas de salud.This paper contributes to the dialogue between the social sciences and social medicine in Latin America by exploring therapeutic pluralism in indigenous health policies and services in Brazil. It reviews recent anthropological research, concepts and current debates to critically examine Brazilian indigenous health policy and its concept of “differentiated care,” which proposes articulation between official health practices and indigenous therapies. A number of contradictions and tensions are present in the structural organizational of the indigenous health subsystem at the national level and in the daily practices of health teams at the local level. Guided by the hegemonic ideology of biomedicine, health professionals fail to recognize the dynamics and agency expressed in indigenous health practices

Entre mundos:: homens, serpentes e peixes em dois mitos baniwa

The mythical indigenous narratives collected and published since the 19th century have proved to be a fertile ground for discussions that have been established predominantly in Anthropology. Gradually, literary studies have been taking part in this discussion, expanding the research of oral narratives and the place of myth in the writings produced by Amazonian indigenous populations. Supported by both literary studies and anthropology, this article seeks to interpret two myths that compose the collection Culture, school, tradition: myth library at Baniwa School (2004).Las narrativas míticas indígenas recolectadas y publicadas desde el siglo XIX se han mostrado como un campo fértil para discusiones que se establecieron predominantemente en la antropología, mas también en áreas como la literatura. Poco a poco, los estudios literarios vienen participando en dicha discusión, ampliando la investigación sobre narrativas orales y el lugar del mito en los escritos producidos por los pueblos indígenas amazónicos. Apoyado tanto en los estudios literarios como en publicaciones de la antropología, el presente artículo busca interpretar dos mitos recolectados de la etnia baniwa, examinando su conocimiento y las simbolizaciones del ambiente acuático y sus habitantes, que hacen parte de la recopilación Cultura, escola, tradição: mitoteca na escola Baniwa (2004).As narrativas míticas indígenas coletadas e publicadas desde o século XIX têm se mostrado um campo fértil para discussões que se estabeleceram predominantemente na antropologia, mas também em áreas como a literatura. Aos poucos, os estudos literários vêm tomando parte nessa discussão, ampliando a pesquisa sobre narrativas orais e o lugar do mito nos escritos produzidos pelas populações indígenas amazônicas. Apoiado tanto nos estudos literários quanto em publicações da antropologia, o presente artigo busca interpretar dois mitos coletados da etnia Baniwa, versando sobre seu conhecimento e simbolizações do ambiente aquático e seus habitantes, bem como o caráter constitutivo das sociedades humanas que interagem com o domínio na alteridade na natureza.&nbsp

Articulación entre servicios de salud y “medicina indígena”: reflexiones antropológicas sobre política y realidad en Brasil

This paper contributes to the dialogue between the social sciences and social medicine in Latin America by exploring therapeutic pluralism in indigenous health policies and services in Brazil. It reviews recent anthropological research, concepts and current debates to critically examine Brazilian indigenous health policy and its concept of “differentiated care,” which proposes articulation between official health practices and indigenous therapies. A number of contradictions and tensions are present in the structural organizational of the indigenous health subsystem at the national level and in the daily practices of health teams at the local level. Guided by the hegemonic ideology of biomedicine, health professionals fail to recognize the dynamics and agency expressed in indigenous health practices.Este artículo contribuye al diálogo entre las ciencias sociales y la medicina social en América Latina a través de la exploración del pluralismo terapéutico en las políticas y servicios de salud indígena en Brasil. Revisa las investigaciones recientes en antropología, así como los conceptos y debates actuales, para examinar críticamente las políticas de salud indígena en Brasil y su concepto de “atención diferenciada”, que propone la articulación entre las prácticas oficiales de salud y las terapias indígenas. Varias contradicciones y tensiones están presentes entre la organización estructural del subsistema de salud indígena en el nivel nacional y las prácticas cotidianas de los equipos de salud en el nivel local. Guiados por la ideología hegemónica de la biomedicina, los profesionales de salud no reconocen las dinámicas y la agencia expresada en las practicas indígenas de salud

Extensão de Cobertura ou Reorganização da Atenção Básica? A trajetória do Programa de Saúde da Família de Manaus-AM

This paper analyzes seven years of implementation of Programa Saúde da Família (PSF - Family Health Program) in the city of Manaus, state of Amazonas, aiming at identifying its influence on changes in the municipal health care system that are capable of contributing to the reduction in health care inequalities. It contextualizes the genesis of the PSF in the municipality, its characteristics, contradictions and limitations, thus investigating whether the program has built only a coverage extension history or whether it has effectively contributed to the reorganization of the primary health care model. The analysis categories prioritized specific management principles of the PSF: substitutive nature, integration with institutions and social organizations, territorialization, situational planning based on the family and community, popular participation and social control. The methodology was qualitative-quantitative, including the analysis of data from two studies evaluating the implementation of the PSF in the municipality, carried out in 2001 and 2006. The results show that, in Manaus, the PSF is a coverage extension strategy, with partial superposition on the preexisting primary medical care structure and parallelism of actions. Given the conditions of its implementation we conclude that the PSF expresses itself as an isolated program within the municipal health care system, with the potentiality to become a restructuring strategy of primary health care in Manaus. The confluence with the implementation of the Sanitary Districts may be able to contribute to redirect the medical attention model, thus assuring integral care and concretizing the right to health.Este trabalho analisa sete anos de implantação do Programa de Saúde da Família (PSF) de Manaus, procurando identificar mudanças no sistema municipal de saúde a ele relacionadas e capazes de contribuir para a redução de desigualdades em saúde. Contextualiza a gênese do PSF no município, suas características, contradições e limitações, investigando se o programa construiu apenas uma trajetória de extensão de cobertura ou contribuiu efetivamente para a reorganização do modelo de atenção básica à saúde. As categorias de análise priorizaram princípios específicos de gestão do PSF: caráter substitutivo, integração com instituições e organizações sociais, territorialização, planejamento situacional com base na família e na comunidade, participação popular e controle social. A metodologia utilizada foi quali-quantitativa, compreendendo a análise dos dados de duas pesquisas avaliativas da implementação do PSF no município, realizadas em 2001 e em 2006. Os resultados mostram que, em Manaus, o PSF se constitui em uma estratégia de extensão de cobertura, com parcial superposição à estrutura assistencial de atenção básica (AB) preexistente e paralelismo de ações. Dadas as condições de sua implantação, conclui-se que o PSF se expressa como um programa isolado dentro do sistema municipal de saúde, com potencialidade para se converter em estratégia reestruturadora da AB em Manaus. A confluência com a implantação dos Distritos Sanitários poderá contribuir para um caminho de reorientação do modelo assistencial que garanta atenção integral e concretize o direito à saúde

Association of physical performance and sarcopenia with use of health services in elderly people living in rural riverside areas in the Amazon: a cross-sectional study

Introduction: Access is considered one of the necessary conditions for achieving effectiveness and quality in health services. However, it represents a complex construct, with several interpretations, and can be understood as the ease or degree of difficulty with which people obtain effective and timely care. Barriers to access can be related to individual characteristics and those of health systems and services. Regarding elderly people living in rural riverine localities, these limitations are exacerbated due to the territorial dispersion of households and the difficulty of obtaining the necessary care near their homes. The aim of this study was to describe and test the association of sarcopenia and physical performance with primary healthcare attributes and the use of health services by elderly people living in rural riverside areas in the Amazon, Brazil. Methods: This cross-sectional observational study was carried out in households with individuals aged 60 years or older living in nine communities located on the left bank of the Negro River, in the rural riverside area of the municipality of Manaus, Amazonas, Brazil. The study evaluated socioeconomic and demographic conditions, health services utilization and the primary care attributes related to the use of and access to services, assessed by components of the Primary Care Assessment Tool instrument (PCATool-Brazil), a reduced version validated for Brazilian adult users. Physical performance was assessed using the Short Physical Performance Battery scale, and handgrip strength was also assessed, according to a dynamometer. The Sarcopenia Formulary (SARC-F) and calf circumference (CC) were used to assess sarcopenia (SARC-CalF). The association of sarcopenia and physical performance with the study outcomes was evaluated using hierarchical logistic regression for health services utilization (having had a medical consultation in the last year), and hierarchical linear regression for the continuous outcomes of the PCATool-Brazil (total score and each of the domains). The sociodemographic variables were inserted in model 1 and the clinical variables in model 2. Variables with p<0.20 were kept in the models. Results: A total of 98 elderly people (55.1% men; mean age 70±7.4 years) were included in the study. Low physical performance and suggestive signs of sarcopenia were observed in 52.5% and 28.9% of the study participants, respectively. Elderly with better physical performance reported more health services utilization (odds ratio (OR)=1.37; 95% confidence interval (CI)=1.03-1.81) and higher scores in the affiliation (β=1.67; 95%CI=0.37-2.98), utilization (β=1.19; 95%CI=0.06-2.33) and longitudinality (β=0.99; 95%CI=0.09-1.90) domains of the PCATool-Brazil. Conclusion: The study findings showed high prevalence of impairment in physical performance and suggestive signs of sarcopenia in elderly people living in the studied rural riverside localities. Better physical performance was associated with use of health services in the previous year and with better evaluation of some primary care attributes

Anemia among indigenous women in Brazil:findings from the First National Survey of Indigenous People's Health and Nutrition

BACKGROUND: Anemia is recognized as a major public health problem that disproportionately affects vulnerable populations. Indigenous women of reproductive age in Brazil are thought to be at high risk, but lack of nationwide data limits knowledge about the burden of disease and its main determinants. This study aimed to assess the prevalence of anemia and associated factors in this population using data from The First National Survey of Indigenous People’s Health and Nutrition in Brazil. METHODS: Data were collected from Indigenous women between 15 and 49 years old based on a nationwide sample of villages. The outcomes of interest were hemoglobin levels (g/dL) and anemia (< 12 g/dL for nonpregnant and < 11 g/dL for pregnant women). Multilevel models were used to explore associations with contextual (village) and individual (household/woman) level variables. RESULTS: Based on data for 6692 Indigenous women, the nationwide mean hemoglobin level was 12.39 g/dL (95 % CI: 12.29–12.50). Anemia prevalence was high (33.0 %; 95 % CI: 30.40–35.61 %) and showed pronounced regional disparities. No village-level characteristics were associated with anemia or hemoglobin levels in the multilevel model. Even after controlling for upper level variables, socioeconomic status, parity, body mass index, and having been treated for malaria were associated with anemia and hemoglobin levels. CONCLUSION: The prevalence of anemia in Brazilian Indigenous women was 12 % greater than the national estimates for women of reproductive age. Anemia prevalence and mean hemoglobin levels among Indigenous women appear to be partly explained by some previously recognized risk factors, such as socioeconomic status, body mass index, and malaria; however, part of the variability in these outcomes remains unexplained. Knowledge of health status and its potential determinants is essential to guide public policies aimed at controlling anemia burden in Indigenous communities

Imunização contra a influenza em idosos residentes em áreas rurais ribeirinhas: implicação dos achados frente à pandemia de COVID-19

Objective: To identify the proportion of unvaccinated elderly people and the reasons that interfere with influenza immunization in rural riverside locations and potential implications for vaccination against COVID-19. Method: Cross-sectional home-based survey carried out in 38 rural riverside locations on the left bank of the Negro river, Manaus, Amazonas. The selected elderly people answered a questionnaire that investigated living conditions, health status and access to health services. For this study, the outcomes related to influenza immunization in the last 12 months and the main reason given for non-vaccination were analyzed. Descriptive data analysis was performed, followed by logistic regression to identify the factors associated with non-vaccination. Results: Of the 102 elderly people included in the study, 28 (27.5%) reported no vaccination against influenza in the previous year. The main reasons were related to the lack of information on vaccination (60.71%) and barriers to accessing health services (28.58%). A greater chance of non-vaccination was identified among the elderly who did not consult the doctor in the last year (OR=4.18; 95%CI=1.57-11.11) and among those with the highest household income (OR=1.08; 95%CI=1.02-1.14). Conclusion: A high proportion of elderly people who have not been immunized against influenza have been identified. The reasons given for non-vaccination may persist and negatively interfere with the vaccination of this group against COVID-19. Thus, it is necessary to reorganize vaccination planning in rural riverside contexts, in order to achieve adequate coverage to one of the main risk groups for respiratory diseases.Objetivo:&nbsp;Identificar a proporção de idosos não vacinados e os motivos que interferem na imunização contra a influenza em localidades rurais ribeirinhas e potenciais implicações na vacinação contra COVID-19.&nbsp;Método:&nbsp;Inquérito transversal de base domiciliar realizado em 38 localidades rurais ribeirinhas da margem esquerda do rio Negro, Manaus, Amazonas. Os idosos selecionados responderam a um questionário que investigou as condições de vida, saúde e acesso aos serviços de saúde. Para este estudo foram selecionados os desfechos relacionados à imunização contra a Influenza nos últimos 12 meses e o principal motivo alegado pelos que não tomaram a vacina. Foi realizada análise descritiva dos dados, seguida de análise de regressão logística para identificar os fatores associados à não vacinação.&nbsp;Resultados:&nbsp;Dos 102 idosos incluídos no estudo, 28 (27,5%) referiram não vacinação contra a influenza no ano anterior. Os principais motivos foram relacionados à falta de informação sobre a vacinação (60,71%) e às barreiras de acesso aos serviços de saúde (28,58%). Foi identificada maior chance de não vacinação entre os idosos que não consultaram o médico no último ano (RC=4,18; IC95%=1,57-11,11) e entre aqueles com maior renda domiciliar (RC=1,08; IC95%=1,02-1,14).&nbsp;Conclusão:&nbsp;Foi identificada uma elevada proporção de idosos não imunizados contra a influenza. Os motivos referidos para a não vacinação podem persistir e interferir negativamente na vacinação deste grupo contra a COVID-19. Dessa forma, faz-se necessário reordenar o planejamento da vacinação em contextos rurais ribeirinhos, de forma a oferecer uma cobertura adequada à um dos principais grupos de risco para doenças respiratórias