Problematizando as alteridades para uma compreensão feminista e decolonial da Saúde Única em Periferias

Neste trabalho, refletimos sobre o modo como diversas figuras de alteridade são alvo de marginalização e o que isso implica em termos de reconhecimento nas gramáticas políticas que estabelecem quem pode se tornar um sujeito da saúde. A partir de contribuições feministas e decoloniais, discutimos algumas premissas ontológicas acerca da relação entre humanos, não humanos e a natureza, para alargar o entendimento da Saúde Única em Periferias. Também incorporamos narrativas de adolescentes que moram na favela Jardim São Remo (São Paulo, SP) e atuam como Agentes Mirins da Saúde Única em Periferias. Em diálogo com eles, exploramos o processo de exclusão constitutiva das favelas, apoiado em retóricas que não reconhecem a pluralidade das configurações coletivas e reforçam a figura das favelas como ameaça à segurança pública. Em contraposição a esse projeto, trazemos os princípios de reflorestamento e da confluência de alteridades significativas para reforçar a justiça multiespécie promovida pela práxis da Saúde Única em Periferias.In this work, we reflect on how different figures of alterity are targets of marginalization and what this implies in terms of recognition in political grammars that establish who can become a subject of health. Based on feminist and decolonial contributions, we discuss some ontological assumptions about the relationship between humans, non-humans, and nature to broaden the understanding of the One Health of Peripheries. We also incorporate some narratives of adolescents who live in the Jardim São Remo favela (São Paulo, SP) and act as One Health of Peripheries Young Agents. In dialogue with them, we explore the process of constitutive exclusion of favelas, based on rhetorics that do not recognize the plurality of collective configurations and reinforce the figure of favelas as a threat to public security. In contrast to this project, we bring the principles of reforestation and confluence of significant alterities to reinforce the multispecies justice promoted by the praxis of One Health of Peripheries

From Modern Planetary Health to Decolonial Promotion of One Health of Peripheries

The concept of Planetary Health has recently emerged in the global North as a concern with the global effects of degraded natural systems on human health. It calls for urgent and transformative actions. However, the problem and the call to solve it are far from new. Planetary health is a colonial approach that disregards alternative knowledge that over millennia have accumulated experiences of sustainable and holistic lifestyles. It reinforces the monolog of modernity without realizing that threats to “planetary health” reside precisely in its very approach. It insists on imposing its recipes on political, epistemological, and ontological peripheries created and maintained through coloniality. The Latin American decolonial turn has a long tradition in what could be called a “transformative action,” going beyond political and economic crises to face a more fundamental crisis of civilization. It deconstructs, with other decolonial movements, the fallacy of a dual world in which the global North produces epistemologies, while the rest only benefit from and apply those epistemologies. One Health of Peripheries is a field of praxis in which the health of multispecies collectives and the environment they comprise is experienced, understood, and transformed within symbolic and geographic peripheries, ensuing from marginalizing apparatuses. In the present article, we show how the decolonial promotion of One Health of Peripheries contributes to think and advance decentralized and plural practices to attend to glocal realities. We propose seven actions for such promotion

From modern Planetary Health to decolonial promotion of One Health of Peripheries

The concept of Planetary Health has recently emerged in the global North as a concern with the global effects of degraded natural systems on human health. It calls for urgent and transformative actions. However, the problem and the call to solve it are far from new. Planetary health is a colonial approach that disregards alternative knowledge that over millennia have accumulated experiences of sustainable and holistic lifestyles. It reinforces the monologue of modernity without realizing that threats to “planetary health” reside precisely in its very approach. It insists on imposing its recipes on political, epistemological, and ontological peripheries created and maintained through coloniality. The Latin American decolonial turn has a long tradition in what could be called a “transformative action”, going beyond political and economic crises to face a more fundamental crisis of civilization. It deconstructs, with other decolonial movements, the fallacy of a dual world in which the global North produces epistemologies, while the rest only benefit from and apply those epistemologies. One Health of Peripheries is a field of praxis in which the health of multispecies collectives and the environment they comprise is experienced, understood, and transformed within symbolic and geographic peripheries, ensuing from marginalizing apparatuses. In the present article, we show how the decolonial promotion of One Health of Peripheries contributes to think and advance decentralized and plural practices to attend to local realities. We propose seven actions for such promotion

Environmental and socioeconomic analysis of malaria transmission in the Brazilian Amazon, 2010–2015: Malaria

OBJECTIVE: To analyze the environmental and socioeconomic risk factors of malaria transmission at municipality level, from 2010 to 2015, in the Brazilian Amazon. METHODS: The municipalities were stratified into high, moderate, and low transmission based on the annual parasite incidence. A multinomial logistic regression that compared low with medium transmission and low with high transmission was performed. For each category, three models were analyzed: one only with socioeconomic risk factors (Gini index, illiteracy, number of mines and indigenous areas); a second with the environmental factors (forest coverage and length of the wet season); and a third with all covariates (full model). RESULTS: The full model showed the best performance. The most important risks factors for high transmission were Gini index, length of the wet season and illiteracy, OR 2.06 (95%CI 1.19–3.56), 1.73 (95%CI 1.19–2.51) and 1.10 (95%CI 1.03–1.17), respectively. The medium transmission showed a weaker influence of the risk factors, being illiteracy, forest coverage and indigenous areas statistically significant but with marginal influence. CONCLUSIONS: As a disease of poverty, the reduction in wealth inequalities and, therefore, health inequalities, could reduce the transmission considerably. Besides, environmental risk factors as length of the wet season should be considered in the planning, prevention and control. Municipality-level and fine-scale analysis should be done together to improve the knowledge of the local dynamics of transmission

Effectiveness of Reversible Contraception in Dog Population Management

Background: Dog fertility depends on human-influenced factors such as sterilization. Uncontrolled fertility can result in unwanted births and overpopulation, which causes problems of public health and animal welfare. Surgical sterilization has been the traditional means of reproduction control but its cost and time can be prohibitive for mass sterilization programs. Non-surgical sterilization alternatives exist, but most of them are reversible and their effectiveness as a population management tool is unknown. To better understand the consequences of reversible contraception, the fertility dynamics was modeled in a hypothetical dog population in a steady-state condition.Materials, Methods & Results: The effect of reversible contraception was simulated using a coupled system of ordinary differential equations. A hypothetical steady-state population of 1000 animals was considered. It was formed by two compartments, one of fertile dogs and the other of infertile dogs. Natality compensated for a fraction of mortality, and the immigration rate compensated for the remaining fraction. The group of immigrant dogs was composed of fertile and infgertile dogs. The dog flow between compartments was given by both the contraception and fertility recovery rate. It was assumed that fertility reversibility in animals of the immigrant group was equal to that of animals already present in the population. Global sensitivities were calculated to assess the uncertainties of fertility dynamics associated with estimation of parameters. In addition, the local sensitivities were calculated to assess the influence of each parameter on fertility dynamics. The treatment effectiveness were expressed in terms of the total number of dogs treated for 20 years by taking a given irreversible contraception rate divided by the total number of dogs treated during the same period, and using the corresponding reversible contraception rate. The global sensitivity analysis consistently indicated a reduction in the number of fertile dogs. The local sensitivity analysis indicated that contraception rate was the most influential parameter, followed by the fertility recovery rate. The fraction of mortality compensated by natality was more influential than the fraction of infertile immigrants. Simulated scenarios indicated that the higher the contraception rate, the greater the difference between the effects of different fertility recovery rates. Variations in the proportion of infertile immigrants minimally changed the number of fertile dogs and the accumulated number of treated dogs. The increase in the fertility recovery rate caused effectiveness to decrease, especially when contraception rates were higher.Discussion: In certain scenarios, reversible contraception can be a viable option for reproduction control. Evaluation of effectiveness of the reversible contraception showed both the importance of duration of the contraceptive effect and the interaction between the contraception and fertility recovery rates. Although the contraception rate is the main determinant of population fertility dynamics, the fertility recovery rate modulates the effect of contraception and determines its viability. Reversible contraception is a viable alternative when loss in effectiveness is compensated by a reduction in costs and ease of application of contraceptive treatments. The lower the contraception rate, the higher the similarity between the effects of reversible and irreversible contraception

Problematizando as alteridades para uma compreensão feminista e decolonial da Saúde Única em Periferias

Resumo Neste trabalho, refletimos sobre o modo como diversas figuras de alteridade são alvo de marginalização e o que isso implica em termos de reconhecimento nas gramáticas políticas que estabelecem quem pode se tornar um sujeito da saúde. A partir de contribuições feministas e decoloniais, discutimos algumas premissas ontológicas acerca da relação entre humanos, não humanos e a natureza, para alargar o entendimento da Saúde Única em Periferias. Também incorporamos narrativas de adolescentes que moram na favela Jardim São Remo (São Paulo, SP) e atuam como Agentes Mirins da Saúde Única em Periferias. Em diálogo com eles, exploramos o processo de exclusão constitutiva das favelas, apoiado em retóricas que não reconhecem a pluralidade das configurações coletivas e reforçam a figura das favelas como ameaça à segurança pública. Em contraposição a esse projeto, trazemos os princípios de reflorestamento e da confluência de alteridades significativas para reforçar a justiça multiespécie promovida pela práxis da Saúde Única em Periferias

Spatio-temporal dynamics of dengue-related deaths and associated factors

Since the reintroduction of dengue viruses in 1987, Sao Paulo State (SP), Brazil, has experienced recurrent epidemics in a growing number of municipalities, each time with more cases and deaths. In the present study, we investigated the spatio-temporal dynamics of dengue-related deaths and associated factors in SP. This was an ecological study with spatial and temporal components, based on notified dengue-related deaths in the municipalities of SP between 2007 and 2017. A latent Gaussian Bayesian model with Poisson probability distribution was used to estimate the standardized mortality ratios (SMR) for dengue and relative risks (RR) for the socioeconomic, demographic, healthcare-related, and epidemiological factors considered. Epidemiological factors included the annual information on the number of circulating serotypes. A total of 1,019 dengue-related deaths (0.22 per 100,000 inhabitant-years) between 2007 and 2017 were confirmed in SP by laboratory testing. Mortality increased with age, peaking at 70 years or older (1.41 deaths per 100,000 inhabitant-years). Mortality was highest in 2015, and the highest SMR values were found in the North, Northwest, West, and coastal regions of SP. An increase of one circulating serotype, one standard deviation in the number of years with cases, and one standard deviation in the degree of urbanization were associated with increases of 75, 35, and 45% in the risk of death from dengue, respectively. The risk of death from dengue increased with age, and the distribution of deaths was heterogeneous in space and time. The positive relationship found between the number of dengue serotypes circulating and years with cases at the municipality/micro-region level indicates that this information can be used to identify risk areas, intensify surveillance and control measures, and organize healthcare to better respond to this disease

Spatial pattern of mortality from breast and cervical cancer in the city of São Paulo

OBJETIVOS: Verificar o padrão espacial da mortalidade pelos cânceres de mama e do colo do útero, em áreas da atenção primária à saúde, levando em consideração as condições socioeconômicas. MÉTODOS: O estudo é ecológico, de janeiro de 2000 a dezembro de 2016. A área de estudo é o município de São Paulo, Brasil, e suas 456 áreas de abrangência das unidades básicas de saúde. As informações sobre óbitos de mulheres com 20 anos ou mais de idade foram geocodificadas segundo endereço de residência. Foram calculadas as taxas de mortalidade, padronizadas por idade, e suavizadas pelo método bayesiano empírico local, além de agrupadas em três ou dois anos para reduzir a flutuação aleatória dos dados. Além disso, foram calculados os índices de Moran global e local bivariados, para verificar a existência de aglomeração espacial das taxas de mortalidade padronizadas com um domínio de condição socioeconômica, elaborado a partir do Índice Paulista de Vulnerabilidade Social. RESULTADOS: A taxa de sucesso da geocodificação foi de 98,9%. A mortalidade por câncer de mama, sem estratificação por tempo, apresentou um padrão com maiores taxas localizadas nas regiões centrais e com melhores condições socioeconômicas. Apresentou queda ao final do período e mudança de padrão espacial, com aumento da mortalidade nas regiões periféricas. Já a mortalidade por câncer do colo do útero manteve-se com as maiores taxas nas regiões periféricas e com piores condições socioeconômicas, apesar de apresentar redução ao longo do tempo. CONCLUSÃO: O padrão espacial da mortalidade pelos cânceres do estudo, ao longo do tempo, sugere associação com as melhores condições socioeconômicas do município, seja como proteção (colo) ou risco (mama). Esse conhecimento pode direcionar recursos para a prevenção e a promoção da saúde nos territórios.OBJECTIVE: To verify the spatial pattern of mortality from breast and cervical cancer in areas of primary health care, considering socioeconomic conditions. METHODS: Th is i s a n e cological s tudy, f rom J anuary 2 000 t o D ecember 2 016. Th e s tudy area is the municipality of São Paulo, Brazil, and its 456 coverage areas of primary health units. Information on deaths of women aged 20 years or over were geocoded according to residence address. We calculated mortality rates, standardized by age, and smoothed by the local empirical Bayesian method, and grouped into three or two years to reduce the random fluctuation of the data. In addition, bivariate global and local Moran indexes were calculated to verify the existence of spatial agglomeration of standardized mortality rates with a domain of socioeconomic condition, elaborated based on the Índice Paulista de Vulnerabilidade Social (IPVS – São Paulo Index of Social Vulnerability). RESULTS: The success rate of geocoding was 98.9%. Mortality from breast cancer, without stratification by time, showed a pattern with higher rates located in central regions with better socioeconomic conditions. It showed a decrease at the end of the period and a change in spatial pattern, with increased mortality in peripheral regions. On the other hand, mortality from cervical cancer remained with the highest rates in peripheral regions with worse socioeconomic conditions, despite being reduced over time. CONCLUSION: The spatial pattern of mortality from the studied cancers, over time, suggests association with the best socioeconomic conditions of the municipality, either as protection (cervical) or risk (breast). This knowledge may direct resources to prevent and promote health in the territories

HANSENÍASE E VULNERABILIDADE DA SAÚDE EM BELO HORIZONTE, MINAS GERAIS

RESUMO O objetivo deste estudo foi analisar a distribuição espacial da hanseníase e sua relação com o Índice de Vulnerabilidade da Saúde (IVS). Tratase de estudo ecológico de múltiplos grupos de caráter analítico, realizado em Belo Horizonte, Brasil, utilizando os setores censitários como unidades de análise. Os dados dos casos de hanseníase, notificados entre 2004 e 2013, foram obtidos do Sistema de Informação de Agravos de Notificação. Para refletir as condições de vida adversas, utilizou-se o IVS 2012, indicador composto elaborado pela Secretaria Municipal de Saúde de Belo Horizonte. Por meio do método bayesiano empírico global, obteve-se uma taxa suavizada. Os resultados revelam que as medianas das taxas de detecção de hanseníase tenderam a ser maiores à medida que se aumentava a vulnerabilidade segundo o IVS, sendo que nos setores pertencentes à categoria de risco muito elevado e elevado risco as medianas das taxas foram significativamente superiores às dos setores classificados em baixo e médio risco (

Caracterização de casos de agressão canina em Campinas, São Paulo, Brasil

A retrospective study was conducted with information on the cases of canine aggression notified in 2009 in the municipality of Campinas, state of São Paulo, Brazil. Information was obtained from 87 (3.8%) out of 2,281 cases. Cumulative incidence of canine aggression was 2.42% per year (CI95%: 2.32-2.51) per 1000 inhabitants. Most victims of aggressive dogs were men (53.0%), adults (72.0%), and owners (52.9%). The attacks occurred mainly in the street (55.2%), while the victim was interacting with the dog (79.3%), and the upper limbs were the most affected part of the body (49.4%). Most of these dogs were males (74.7%), adults (74.3%), mixed-breed (65.5%), not castrated (98.9%), restricted (55.2%), without training (98.1%), and half of them had already bitten. Canine aggression was not associated to sex, breed, reproductive status, type of restrain, and training, because frequency distribution of these variables among the canine population of Campinas is unknown. In order to develop preventive protocols for dog bites, populational studies assessing the characteristics and prevalence of dog aggression are needed.Foi realizado um estudo retrospectivo com os dados sobre casos de agressão canina notificados em 2009 em Campinas, São Paulo, Brasil. Foram obtidas informações de 87 (3,8%) entre 2.281 casos. A incidência acumulada de agressões foi de 2,42% por ano (IC95%: 2,32-2,51) para cada mil habitantes. A maior parte das vítimas de cães agressores eram homens (53,0%), adultos (72,0%) e os próprios proprietários (52,9%). Os ataques ocorreram principalmente na rua (55,2%), enquanto a vítima interagia com o cão (79,3%) e os membros superiores foram a parte do corpo mais acometida (49,4%). Os cães eram majoritariamente machos (74,7%), adultos (74,3%), sem raça definida (65,5%), não castrados (98,9%), domiciliados (55,2%), sem adestramento (98,1%) e a metade deles já havia causado agressão com mordedura. A agressão canina não foi atribuída a sexo, raça, estado reprodutivo, tipo de restrição, ou adestramento dos animais, pois a distribuição da frequência destas variáveis na população canina do município era desconhecida. Para desenvolver protocolos de prevenção de mordeduras, devem ser realizados estudos populacionais para avaliar as características e a prevalência da agressão canina