Social determinants of leprosy in a hyperendemic State in North Brazil

OBJECTIVE To identify the socioeconomic, demographic, operational, and health service-related factors associated with the occurrence of leprosy in a hyperendemic State in North Brazil. METHODS This is an ecological study based on secondary data from the Sistema de Informações de Agravos de Notificação in municipalities of the State of Tocantins from 2001 to 2012. Units of analysis were the 139 municipalities of the State. Negative binomial log linear regression models were used to estimate incidence rate ratios. RESULTS In bivariate analysis, the incidence rate ratios were significantly higher for municipalities with higher income ratio of the poorest 20.0% (1.47; 95%CI 1.19–1.81) and better Municipal Human Development Index (1.53; 95%CI 1.14–2.06). In multivariate analysis, the incidence rate ratios were significantly higher in municipalities with higher proportion of immigrants (1.31; 95%CI 1.11–1.55) and higher proportion of households with waste collection (1.37; 95%CI 1.11–1.69). There was a significant reduction in the incidence rate ratio with increased coverage of the Bolsa Família Program (0.98; 95%CI 0.96–0.99). CONCLUSIONS Control programs need to focus on activities in municipalities of greater social vulnerability with intersectoral investment for the improvement of the living conditions of the population.OBJETIVO Identificar fatores socioeconômicos, demográficos, operacionais e de serviços de saúde associados à ocorrência da hanseníase em um estado hiperendêmico do norte do Brasil. MÉTODOS Estudo ecológico com dados secundários do Sistema de Informações de Agravos de Notificação em municípios do estado do Tocantins de 2001 a 2012. As unidades de análise foram os 139 municípios do estado. Modelos de regressão log linear binomial negativa foram utilizados para estimar as razões de taxas de incidência. RESULTADOS Na análise bivariada, a razão de taxa de incidência foi significativamente maior para os municípios com maior razão de renda dos 20,0% mais pobres (1,47; IC95% 1,19–1,81) e melhor Índice de Desenvolvimento Humano Municipal (1,53; IC95% 1,14–2,06). Na múltipla, a razão de taxa de incidência foi significativamente superior em municípios com maior concentração de imigrantes (1,31; IC95% 1,11–1,55) e proporção de domicílios com coleta de lixo (1,37; IC95% 1,11–1,69). Houve redução significativa da razão de taxa de incidência com o aumento da cobertura do programa bolsa família (0,98; IC95% 0,96–0,99). CONCLUSÕES Os programas de controle precisam focar as atividades em municípios de maior vulnerabilidade social com investimentos intersetoriais para a melhoria das condições de vida da população

Factors Associated with Repeated Suicide Attempts Preliminary Results of the WHO Multisite Intervention Study on Suicidal Behavior (SUPRE-MISS) from Campinas, Brazil

Background: This study compares sociodemographic and clinical characteristics of 102 first-time hospital-treated suicide attempters (first-evers) with a group of 101 repeat suicide attempters (repeaters) consecutively admitted to a general hospital in Brazil, during the intake phase of the WHO Multisite Intervention Study on Suicidal Behaviors (SUPRE-MISS). Aims: To compare sociodemographic and clinical characteristics of first-time hospital-treated suicide attempters (first-evers) with a group of repeat suicide attempters (repeaters). Methods: A standardized interview and psychometric scales were administered to all patients. Results: Repetition was associated with being of female sex ( OR = 2.7; 95% confidence interval (CI) = 1.2-6.2), a housewife (OR = 3.8; 95% CI = 1.2-11.8), and having a score above median on the Beck Depression Inventory (OR = 5.2; 95% CI = 1.7-15.6). Conclusions: The findings suggest that repeaters, namely, depressed housewives who have attempted suicide previously, need specific treatment strategies in order to avoid future suicide attempts.302737

Acidente rural ampliado: o caso das "chuvas" de agrotóxicos sobre a cidade de Lucas do Rio Verde - MT Major rural accident: the pesticide "rain" case in Lucas do Rio Verde city - MT

O artigo aborda o acidente ambiental causado por derivas de pulverizações aéreas de agrotóxico que atingiram o espaço urbano de Lucas do Rio Verde-MT, em março de 2006. Caracterizou-se como "acidente rural ampliado" de caráter ocupacional e ambiental, cuja gravidade e extensão ultrapassaram a unidade produtiva rural, causando impactos sanitários, sociais e ambientais. Este estudo de caso objetivou conhecer o cenário sociotécnico do acidente e o processo de vigilância em saúde-ambiente, numa dinâmica de pesquisa-ação. As informações foram colhidas através de entrevistas, documentos e registro de observações do cotidiano. Referenciou-se ainda na análise interdisciplinar e participativa de acidentes, com envolvimento de instituições locais de Saúde, Agricultura e Ambiente, lideranças sindicais e políticas, chacareiros e fazendeiros, Promotoria de Justiça, jornalistas e a Universidade. O estudo mostra que as ações de vigilância do "uso e abuso" de agrotóxicos ampliaram-se para "movimento pelo desenvolvimento sustentável da região", apoiado na vigilância participativa, articulada com a luta pela democracia e justiça social, na busca de uma agricultura e/ou ambiente sustentável.<br>The article reports the environmental accident caused by aerial pesticide spraying that reached the urban space of Lucas do Rio Verde-MT, in March 2006. It was characterized as a "major rural accident" of environmental and occupational aspects whose seriousness and extension crossed the agriculturally productive unit boundaries causing sanitary, social and environmental impact. This case study had as its objective the understanding of the social-technical scene of the accident and the monitoring process in health-environment in a research-action dynamic. The information was collected through interviews, documents and daily observation reports. It also referred to accidents, multidisciplinary and participatory analyses with the participation of local institutions of health, agriculture and environment, political and union leaderships, ranchers and farmers, the public prosecutor's office, journalists and the University. The study shows that the pesticide "use and abuse" monitoring actions have been extended to [a] "movement for the sustainable development of the region" supported by the participative monitoring and the fight for democracy and social justice in the search of a sustainable agriculture and/or environment