SAÚDE INDÍGENA E DIFICULDADES NO ACESSO AO SISTEMA PÚBLICO DE SAÚDE NO AMAZONAS.

RESUMO: Há vários fatores para os povos indígenas na Amazônia Brasileira ter dificuldades de acesso ao Sistema Público de Saúde no Estado do Amazonas, em especial, pelas distâncias geográficas e pelas poucas informações sobre o perfil epidemiológico dos povos indígenas. Neste sentido, o objetivo deste artigo é descrever as mudanças a respeito da dificuldade do acesso à saúde pública da população indígenas presente na região amazônica brasileira, além de abordar as principais implicações sobre o fazer e o pensar da saúde no Estado do Amazonas para os povos indígenas. Utilizou-se a pesquisa dedutiva, qualitativa e de levantamento bibliográfico. Portanto, pode-se afirmar que o perfil de saúde indígena no estado do Amazonas é de alta complexidade, onde este deve ser adaptar às especificidades regionais e das etnias. PALAVRAS-CHAVE: Saúde Indígena. Saúde Pública. SUS. Acesso aos serviços de Saúde. Amazonas. Igualdade de tratamento. Saúde de Populações Indígenas. ABSTRACT: There are several factors for indigenous peoples in the Brazilian Amazon to have difficulties accessing the Public Health System in the State of Amazonas, in particular, due to geographical distances and little information about the epidemiological profile for indigenous people. In this sense, the objective of this article is to describe the changes regarding the difficulty of access to public health of the indigenous population present in the Brazilian Amazon region, in addition to addressing the main implications on the doing and thinking of health in the State of Amazonas for the peoples indigenous peoples. Deductive, qualitative and bibliographic research was used. Therefore, it can be said that the profile of indigenous health in the state of Amazonas is highly complex, where it must be adapted to regional and ethnic specificities. KEYWORDS: Indigenous Health. Public health. SUS. Access to health services. Amazonas. Equal treatment. Health of Indigenous Populations

TUDO SE TRANSFORMA: UMA ABORDAGEM INVESTIGATIVA PARA O ENSINO DE TRANSFORMAÇÕES QUÍMICAS

Recently, there has been a renewed interest in science teaching by inquiry. In this sense, several studies point to the importance of this teaching in the formation of students with a more critical and scientific look at reality. Thus, this work discusses the importance of teaching by investigation and contextualization in science teaching, and its main objective is to sharpen students' perception of the chemical changes present in everyday life. This work proposes a didactic sequence, applying the investigative method, for the teaching of chemical transformations aimed at students in the 7th grade of elementary school II of a school in the Federal District. For this, a didactic sequence of two classes was used, with moments of exposure of problem situations, discussion of hypotheses, systematization of knowledge and final activity. The teaching sequence was all remotely developed due to the covid19 pandemic. The results obtained indicated that the adopted methodology provided significant learning on the subject, encouraging students to expose arguments, discuss hypotheses and understand the main concepts about the content worked. As a point of improvement, the results show that, due to the great generality of the topic, it was noticed that some students still had difficulty in grasping the concepts in a scientific way, although they were able to distinguish chemical from physical transformations.Recentemente, houve um interesse renovado no ensino de Ciências por investigação. Nesse sentido, diversos estudos apontam a importância desse ensino na formação de alunos com o olhar mais crítico e científico sobre a realidade. Assim, este trabalho discute a importância do ensino por investigação e da contextualização no ensino de ciências, e tem como objetivo principal aguçar a percepção dos alunos sobre as transformações químicas presentes no cotidiano. Este trabalho propõe uma sequência didática, aplicando o método investigativo, para o ensino de transformações químicas voltada para estudantes do 7o ano do ensino fundamental II de uma escola do Distrito Federal. Para isso, utilizou-se uma sequência didática de duas aulas com momentos de exposição de situações problemas, discussão de hipóteses, sistematização do conhecimento e atividade final. A sequência didática foi toda desenvolvida de forma remota devido à pandemia da covid-19. Os resultados obtidos indicaram que a metodologia adotada proporcionou a aprendizagem significativa sobre o tema, incentivando que os alunos a expor argumentos, discutir hipóteses e compreender os principais conceitos acerca do conteúdo trabalhado. Como ponto de melhoria, os resultados apontam que, devido à grande generalidade do tema, percebeu-se que alguns alunos ainda apresentaram dificuldade em apreender os conceitos de forma científica, embora conseguissem distinguir as transformações químicas das físicas

Sepse e IAM: conhecimento da população frequentadora de parques e acompanhantes de pacientes

Objetivo: Identificar o conhecimento da população referente aos termos “sepse” e “infartoagudo do miocárdio” (IAM).Método: Estudo transversal, quantitativo. Coleta de dados realizada com aplicação de umquestionário, para dois grupamentos de participantes distintos: frequentadores de parquesselecionados de Porto Alegre/RS e acompanhantes de pacientes internados em um hospitaluniversitário de Porto Alegre/RS. A análise dos resultados foi realizada pela estatísticadescritiva e inferencial.Resultados: A amostra constitui-se de 1986 entrevistados, 1455 de parques e 531acompanhantes de pacientes internados no hospital. Em relação ao conhecimento de sepse,apenas 19,1% dos entrevistados já tinham ouvido falar sobre o tema, já, em comparação aoconhecimento do IAM, 98,7% souberam responder sobre o termo.Conclusões: Evidenciou-se que o déficit de conhecimento da população sobre o termo“sepse” está diretamente relacionado com o nível social dos entrevistados, demonstrando umdéficit no acesso à informação no cuidado em saúde.Palavras-chave: Sepse. Educação em saúde. Conhecimento. População. Infarto domiocárdio

Síndrome de Alport: Alport syndrome

Introdução: Síndrome de Alport (SA) é uma doença hereditária caracterizada por nefropatia hemorrágica familiar, surdez neurossensorial e alterações oculares. Sua patologia está relacionada a mutações nos genes COL4A3, COL4A4, COL4A5 os quais são responsáveis por codificar síntese do colágeno tipo IV, que é essencial para a formação da membrana basal de diversos órgãos. Apresentação do caso: 23 ANOS, sexo masculino, natural do Rio de Janeiro - RJ, procurou atendimento médico com queixa de hipoacusia bilateral, diminuição da acuidade visual e edema progressivo de membros inferiores. Discussão: sua clínica é composta por manifestações renais como hematúria e/ou proteinúria, que com o tempo evoluem para falência renal; manifestações oculares, como lentecone anterior, catarata, “flecks” na retina, nistagmo e miopia; e manifestações auditivas nas quais ocorrem o desenvolvimento de perda auditiva neurossensorial de alta frequência.O diagnóstico da síndrome é suspeitado quando existem familiares com histórico de insuficiência renal, surdez e perda visual. Em 15% dos casos, não há histórico familiar associado, sendo necessária a realização de biópsia renal. Conclusão: quando o prognóstico do paciente é desfavorável, é necessário um adequado suporte clínico em medidas preventivas e terapêuticas, tanto farmacológicas quanto dietéticas, para que se possa retardar as complicações, principalmente a piora da função renal e uma necessidade de diálise ou até mesmo transplante dos rins

Gist ileal: Ileal Gist

Introdução: Os tumores estromais gastrointestinais (GISTs) são os tumores mesenquimatosos mais comuns no trato gastrointestinal, podendo acometer qualquer parte do trato gastrointestinal, embora sejam mais frequentemente diagnosticados no estômago. Apresentação do caso:  Paciente do sexo masculino, 63 anos de idade, com uma massa abdominal localizada em região epigástrica descoberta em exame físico e biopsiada através de endoscopia digestiva alta (EDA) realizada em caráter de urgência. Foi confirmado GIST por imuno-histoquímica (CD117) e feita pesquisa em linfonodos, com resultado negativo para acometimento. Realizada a ressecção total do tumor e margens cirúrgicas livres. Discussão: Os tumores estromais gastrointestinais (GIST) possuíam outras denominações que foram sendo modificadas de acordo com as descobertas a respeito desse grupo neoplásico. Inicialmente, acreditava-se que tinham origem na musculatura lisa e, por isso, foram chamados de leiomiomas, leiomiossarcomas e schwannomas. O nome GIST foi estabelecido apenas ao descobrir a origem nas células intersticiais de Cajal, que possuem a expressão de mutação do proto-oncogene codificador do receptor-kit. Aproximadamente 85% dessas neoplasias resultam de mutações ativas nos receptores da proteína tirosina quinase. Conclusão: Seu tratamento é realizado por remoção cirúrgica. Por serem os tumores mais comuns do trato gastrointestinal, devem ser diagnosticados e tratados para melhor sobrevida dos pacientes

Pervasive gaps in Amazonian ecological research

Biodiversity loss is one of the main challenges of our time,1,2 and attempts to address it require a clear un derstanding of how ecological communities respond to environmental change across time and space.3,4 While the increasing availability of global databases on ecological communities has advanced our knowledge of biodiversity sensitivity to environmental changes,5–7 vast areas of the tropics remain understudied.8–11 In the American tropics, Amazonia stands out as the world’s most diverse rainforest and the primary source of Neotropical biodiversity,12 but it remains among the least known forests in America and is often underrepre sented in biodiversity databases.13–15 To worsen this situation, human-induced modifications16,17 may elim inate pieces of the Amazon’s biodiversity puzzle before we can use them to understand how ecological com munities are responding. To increase generalization and applicability of biodiversity knowledge,18,19 it is thus crucial to reduce biases in ecological research, particularly in regions projected to face the most pronounced environmental changes. We integrate ecological community metadata of 7,694 sampling sites for multiple or ganism groups in a machine learning model framework to map the research probability across the Brazilian Amazonia, while identifying the region’s vulnerability to environmental change. 15%–18% of the most ne glected areas in ecological research are expected to experience severe climate or land use changes by 2050. This means that unless we take immediate action, we will not be able to establish their current status, much less monitor how it is changing and what is being lostinfo:eu-repo/semantics/publishedVersio

Global age-sex-specific mortality, life expectancy, and population estimates in 204 countries and territories and 811 subnational locations, 1950–2021, and the impact of the COVID-19 pandemic: a comprehensive demographic analysis for the Global Burden of Disease Study 2021

Background: Estimates of demographic metrics are crucial to assess levels and trends of population health outcomes. The profound impact of the COVID-19 pandemic on populations worldwide has underscored the need for timely estimates to understand this unprecedented event within the context of long-term population health trends. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 provides new demographic estimates for 204 countries and territories and 811 additional subnational locations from 1950 to 2021, with a particular emphasis on changes in mortality and life expectancy that occurred during the 2020–21 COVID-19 pandemic period. Methods: 22 223 data sources from vital registration, sample registration, surveys, censuses, and other sources were used to estimate mortality, with a subset of these sources used exclusively to estimate excess mortality due to the COVID-19 pandemic. 2026 data sources were used for population estimation. Additional sources were used to estimate migration; the effects of the HIV epidemic; and demographic discontinuities due to conflicts, famines, natural disasters, and pandemics, which are used as inputs for estimating mortality and population. Spatiotemporal Gaussian process regression (ST-GPR) was used to generate under-5 mortality rates, which synthesised 30 763 location-years of vital registration and sample registration data, 1365 surveys and censuses, and 80 other sources. ST-GPR was also used to estimate adult mortality (between ages 15 and 59 years) based on information from 31 642 location-years of vital registration and sample registration data, 355 surveys and censuses, and 24 other sources. Estimates of child and adult mortality rates were then used to generate life tables with a relational model life table system. For countries with large HIV epidemics, life tables were adjusted using independent estimates of HIV-specific mortality generated via an epidemiological analysis of HIV prevalence surveys, antenatal clinic serosurveillance, and other data sources. Excess mortality due to the COVID-19 pandemic in 2020 and 2021 was determined by subtracting observed all-cause mortality (adjusted for late registration and mortality anomalies) from the mortality expected in the absence of the pandemic. Expected mortality was calculated based on historical trends using an ensemble of models. In location-years where all-cause mortality data were unavailable, we estimated excess mortality rates using a regression model with covariates pertaining to the pandemic. Population size was computed using a Bayesian hierarchical cohort component model. Life expectancy was calculated using age-specific mortality rates and standard demographic methods. Uncertainty intervals (UIs) were calculated for every metric using the 25th and 975th ordered values from a 1000-draw posterior distribution. Findings: Global all-cause mortality followed two distinct patterns over the study period: age-standardised mortality rates declined between 1950 and 2019 (a 62·8% [95% UI 60·5–65·1] decline), and increased during the COVID-19 pandemic period (2020–21; 5·1% [0·9–9·6] increase). In contrast with the overall reverse in mortality trends during the pandemic period, child mortality continued to decline, with 4·66 million (3·98–5·50) global deaths in children younger than 5 years in 2021 compared with 5·21 million (4·50–6·01) in 2019. An estimated 131 million (126–137) people died globally from all causes in 2020 and 2021 combined, of which 15·9 million (14·7–17·2) were due to the COVID-19 pandemic (measured by excess mortality, which includes deaths directly due to SARS-CoV-2 infection and those indirectly due to other social, economic, or behavioural changes associated with the pandemic). Excess mortality rates exceeded 150 deaths per 100 000 population during at least one year of the pandemic in 80 countries and territories, whereas 20 nations had a negative excess mortality rate in 2020 or 2021, indicating that all-cause mortality in these countries was lower during the pandemic than expected based on historical trends. Between 1950 and 2021, global life expectancy at birth increased by 22·7 years (20·8–24·8), from 49·0 years (46·7–51·3) to 71·7 years (70·9–72·5). Global life expectancy at birth declined by 1·6 years (1·0–2·2) between 2019 and 2021, reversing historical trends. An increase in life expectancy was only observed in 32 (15·7%) of 204 countries and territories between 2019 and 2021. The global population reached 7·89 billion (7·67–8·13) people in 2021, by which time 56 of 204 countries and territories had peaked and subsequently populations have declined. The largest proportion of population growth between 2020 and 2021 was in sub-Saharan Africa (39·5% [28·4–52·7]) and south Asia (26·3% [9·0–44·7]). From 2000 to 2021, the ratio of the population aged 65 years and older to the population aged younger than 15 years increased in 188 (92·2%) of 204 nations. Interpretation: Global adult mortality rates markedly increased during the COVID-19 pandemic in 2020 and 2021, reversing past decreasing trends, while child mortality rates continued to decline, albeit more slowly than in earlier years. Although COVID-19 had a substantial impact on many demographic indicators during the first 2 years of the pandemic, overall global health progress over the 72 years evaluated has been profound, with considerable improvements in mortality and life expectancy. Additionally, we observed a deceleration of global population growth since 2017, despite steady or increasing growth in lower-income countries, combined with a continued global shift of population age structures towards older ages. These demographic changes will likely present future challenges to health systems, economies, and societies. The comprehensive demographic estimates reported here will enable researchers, policy makers, health practitioners, and other key stakeholders to better understand and address the profound changes that have occurred in the global health landscape following the first 2 years of the COVID-19 pandemic, and longer-term trends beyond the pandemic

Pervasive gaps in Amazonian ecological research

Biodiversity loss is one of the main challenges of our time,1,2 and attempts to address it require a clear understanding of how ecological communities respond to environmental change across time and space.3,4 While the increasing availability of global databases on ecological communities has advanced our knowledge of biodiversity sensitivity to environmental changes,5,6,7 vast areas of the tropics remain understudied.8,9,10,11 In the American tropics, Amazonia stands out as the world's most diverse rainforest and the primary source of Neotropical biodiversity,12 but it remains among the least known forests in America and is often underrepresented in biodiversity databases.13,14,15 To worsen this situation, human-induced modifications16,17 may eliminate pieces of the Amazon's biodiversity puzzle before we can use them to understand how ecological communities are responding. To increase generalization and applicability of biodiversity knowledge,18,19 it is thus crucial to reduce biases in ecological research, particularly in regions projected to face the most pronounced environmental changes. We integrate ecological community metadata of 7,694 sampling sites for multiple organism groups in a machine learning model framework to map the research probability across the Brazilian Amazonia, while identifying the region's vulnerability to environmental change. 15%–18% of the most neglected areas in ecological research are expected to experience severe climate or land use changes by 2050. This means that unless we take immediate action, we will not be able to establish their current status, much less monitor how it is changing and what is being lost