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Background: Brazil is one of the countries with the highest rates of caesarean sections (CS), reaching almost 90% of births in the private sector. A quality improvement project called "Adequate Childbirth Project (PPA)" was conceived to reduce CS in the private sector. This project consisted of four primary components: "Governance", "Participation of Women", "Reorganization of Care" and "Monitoring". This paper aims to evaluate: (1) which specific activities of the PPA had the largest effect on the probability of a woman having a vaginal delivery; (2) which primary component of the PPA had the largest effect on the probability of vaginal delivery and (3) which scenarios combining the implementation of different activities planned in the PPA had a higher effect on the probability of vaginal delivery. Methods: A sample of 12 private hospitals participating in the PPA was evaluated. We used a Bayesian Network (BN) to capture both non-linearities and complex cause-effect relations. The BN integrated knowledge from experts and data from women to estimate 26 model parameters. The PPA was evaluated in 2473 women belonging to groups 1–4 of the Robson classification, who were divided into two groups: those participating or not participating in the PPA. Results: The probability of a woman having a vaginal delivery was 37.7% higher in women participating in the PPA. The most important component of the project that led to an increase in the probability of vaginal delivery was "Reorganization of Care", leading to a 73% probability of vaginal delivery among women in labor. The activity that had the greatest effect on the type of delivery was access to best practices during labor, with a 72% probability of vaginal delivery. Considering the 12 scenarios combining the different activities of the PPA, the best scenarios included: a non-scheduled delivery, access to information about best practices, access to at least 4 best practices during labor and respect of the birth plan, with an 80% probability of vaginal delivery in the best combinations. Conclusion: PPA has been shown to be an effective quality improvement program, increasing the likelihood of vaginal delivery in private Brazilian hospitals. Plain English Summary: Introduction: Brazil boasts one of the highest rates of caesarean sections (CS) globally, with nearly 90% of births in private facilities being delivered via CS. In response, the 'Adequate Childbirth Project – PPA' was launched as a quality improvement initiative aimed at curbing CS rates in private healthcare. Its goal is to improve the quality of childbirth and reduce the number of CS in private healthcare. The project has four main parts: 'Governance', 'Participation of Women', 'Reorganization of Care', and 'Monitoring'. Method: an evaluative study was conducted across 12 private hospitals involved in the PPA, involving 2473 women who were categorized into PPA participants and non-participants. They used a method called a cause-effect network to see which parts of the PPA helped more women have vaginal deliveries. Results: They found that women in the PPA were 37.7% more likely to have a vaginal delivery. Giving women access to good practices during labor and birth was really important. Also, 'Reorganization of Care' was the most important part of the project. It led to a 73% chance of vaginal delivery for women in labor. Conclusion: The PPA is effective in helping more women in private hospitals have vaginal deliveries. This means it's a good program for improving childbirth in Brazil's private hospitals. [ABSTRACT FROM AUTHOR]

Background: Snakebites are considered a neglected tropical disease responsible for many accidents, some fatal, and are related to poverty. The Brazilian Amazon has the highest incidence of snakebites per inhabitant, with the state of Pará having the most reported cases. For those who have difficult access to hospitals and pharmacies, this issue is even more urgent. Methods: In this research, we worked together with the population of five riverine communities in Aritapera (Santarém-PA), a fluvial island located in the Lower Amazon floodplain (várzeas), in order to identify the species of venomous snakes and create a record of snakebites in the region and treatments carried out. Results: Dwellers reported a high frequency of encounters throughout the year and mentioned five venomous ethnospecies, although we identified only Bothrops atrox. Approximately 28.7% of the participants had already been bitten, and in 15.8% of the interviews, they mentioned deaths from snakebites. The treatments varied between hospitalization (42.8%), home treatments (23.8%), both together (25.4%) and healers (7.9%). There were cases where no treatment, or just religious treatment, was performed. In general, no serious sequelae were reported. Although home treatments were more common in the past, many people maintained the practice of using them before going to the hospital. Among the most used are Pau X and the fat of the Amazon River Dolphin. The latter appears to be a recent discovery by locals and is considered very efficient both for humans and animals. Conclusion: Difficult access to health centers, a lack of energy to store antivenom and a high rate of encounters with snake place Aritapera dwellers in a vulnerable situation regarding snakebite accidents. In this context, they discovered treatments that improved their well-being until hospitalization. As the Amazon River dolphin is an endangered species, the use of its fat requires attention. In this sense, the dissemination of this knowledge is important to encourage studies that investigate which properties of this fat act as counterpoisons. By discovering substitutes that can be incorporated in other rural and remote communities, an economic and ecologically viable option for the health of residents can be promoted, in addition to valuing traditional knowledge. [ABSTRACT FROM AUTHOR]

Background: Health is recognized as a fundamental right in Brazil's constitution. In the absence of a clearly defined benefit packages of healthcare services that are financed under the Unified Health System (Sistema Único de Saúde, SUS), courts have become important in adjudicating coverage decisions. Empirical assessments of equity and the right to health tend to focus on simple measures of access. However, these empirical perspectives belie the significant inequalities and rights violations that arise in the case of more complex health needs such as cancer. To shed light on these issues, this paper focuses on the care pathways for breast and cervical cancer and explores access and quality issues that arise at different points along the care pathway with implications for the realization of the right to health in Brazil. Method: A mixed method approach is used. The analysis is primarily based on a quantitative analysis of national representative administrative data principally from the cervical and breast cancer information systems and the hospital cancer registry. To gain more insights into the organization of cancer care, qualitative data was collected from the state of Bahia, through document analysis, direct observation, roundtable discussions with health workers (HWs), and structured interviews with health care administrators. Results: The paper reveals that the volume of completed screening exams is well below the estimated need, and a tendency toward lower breast cancer screening rates in poorer states and for women in the lowest income brackets. Only 26% of breast cancer cases and 29% of cervical cancer cases are diagnosed at an early stage (stage 0 or I), thereby reducing the survival prospects of patients. Waiting times between confirmed diagnosis and treatment are long, despite new legislation that guarantees a maximum of 60 days. The waiting times are significantly longer for patients that follow the recommended patient pathways, and who are diagnosed outside the hospital. Conclusion: The study reveals that there are large variations between states and patients, where the poorest states and patients fare worse on key indicators. More broadly, the paper shows the importance of collecting data both on patient characteristics and health system performance and carry out detailed health system analysis for exposing, empirically, rights violations and for identifying how they can be addressed. [ABSTRACT FROM AUTHOR]

Background: Reptiles are considered one of the most popular pets in the world and are often associated with an incorrect belief that they are simple, highly adaptable, and easy to keep animals when compared with other pets, such as dogs and cats. However, keeping reptiles as pets can pose several challenges in meeting their needs in a domestic setting, requiring specific conditions and effort to maintain their health, well-being, and survival. Methods: During 2015, using online semi-structured questionnaires applied to 719 Brazilian pet reptile keepers who participated in online groups of reptile breeders on the social network Facebook, this study aimed to identify Brazilian keepers' motivations for maintaining reptiles as pets, investigate their monthly expenses, and the husbandry practices for the maintenance, such as housing and feeding conditions, handling of the animal, health issues, and treatment provided. Results: We found multiple motivations for keeping reptiles as pets (mostly snakes, lizards, and chelonians), the main motivation being emotional reasons, followed by entertainment and convenience reasons. The great majority of keepers (69%) declared to spend less than or up to US$30 per month in maintaining their reptiles. Most reptiles were kept alone in terrarium/aquarium enclosures, with basic environmental complexity in terms of physical elements. Lizards and chelonians were fed with a few insect species, cultivated fruits and vegetables, while snakes were fed mainly with domestic rodents, rabbits, or birds. Keepers declared frequent cleaning of the enclosure, but inappropriately handled their animals directly with their hands, which might result in potential threats to human and reptile health and safety. Several diseases or injuries were mentioned and 55.6% of the keepers declared taking the reptile to the vet for treatment. Conclusions: Overall, our findings revealed several challenges that reptiles face when kept in domestic environments, including issues related to housing, nutrition, and healthcare. Even though keepers demonstrated positive feelings toward their pets, suggesting a positive relationship and a willingness to provide them with proper care, it seems that without the proper knowledge and awareness, reptiles may unintentionally be kept with poor husbandry. Addressing these challenges on husbandry practices is essential for improving reptiles' welfare and promoting a responsible pet ownership. [ABSTRACT FROM AUTHOR]

Introduction: The prevalence of undernutrition, which is closely associated with socioeconomic and sanitation conditions, is often higher among indigenous than non-indigenous children in many countries. In Brazil, in spite of overall reductions in the prevalence of undernutrition in recent decades, the nutritional situation of indigenous children remains worrying. The First National Survey of Indigenous People's Health and Nutrition in Brazil, conducted in 2008-2009, was the first study to evaluate a nationwide representative sample of indigenous peoples. This paper presents findings from this study on the nutritional status of indigenous children < 5 years of age in Brazil. Methods: A multi-stage sampling was employed to obtain a representative sample of the indigenous population residing in villages in four Brazilian regions (North, Northeast, Central-West, and Southeast/South). Initially, a stratified probabilistic sampling was carried out for indigenous villages located in these regions. Households in sampled villages were selected by census or systematic sampling depending on the village population. The survey evaluated the health and nutritional status of children < 5 years, in addition to interviewing mothers or caretakers. Results: Height and weight measurements were taken of 6,050 and 6,075 children, respectively. Prevalence rates of stunting, underweight, and wasting were 25.7%, 5.9%, and 1.3%, respectively. Even after controlling for confounding, the prevalence rates of underweight and stunting were higher among children in the North region, in low socioeconomic status households, in households with poorer sanitary conditions, with anemic mothers, with low birthweight, and who were hospitalized during the prior 6 months. A protective effect of breastfeeding for underweight was observed for children under 12 months. Conclusions: The elevated rate of stunting observed in indigenous children approximates that of non-indigenous Brazilians four decades ago, before major health reforms greatly reduced its occurrence nationwide. Prevalence rates of undernutrition were associated with socioeconomic variables including income, household goods, schooling, and access to sanitation services, among other variables. Providing important baseline data for future comparison, these findings further suggest the relevance of social, economic, and environmental factors at different scales (local, regional, and national) for the nutritional status of indigenous peoples. [ABSTRACT FROM AUTHOR]

Background: Health systems have a critical role in a multi-sectoral response to domestic violence against women (DVAW). However, the evidence on interventions is skewed towards high income countries, and evidence based interventions are not easily transferred to low-and middle-income countries (LMIC) where significant social, cultural and economic differences exist. We evaluated feasibility and acceptability of implementation of an intervention (HERA—Healthcare Responding to Violence and Abuse) to improve the response to DVAW in two primary health care clinics (PHC) in Brazil. Methods: The study design is a mixed method process and outcome evaluation, based on training attendance records, semi-structured interviews (with 13 Primary Health Care (PHC) providers, two clinic directors and two women who disclosed domestic violence), and identification and referral data from the Brazilian Epidemiological Surveillance System (SINAN). Results: HERA was feasible and acceptable to women and PHC providers, increased providers' readiness to identify DVAW and diversified referrals outside the health system. The training enhanced the confidence and skills of PHC providers to ask directly about violence and respond to women's disclosures using a women centred, gender and human rights perspective. PHC providers felt safe and supported when dealing with DVAW because HERA emphasised clear roles and collective action within the clinical team. A number of challenges affected implementation including: differential managerial support for the Núcleo de Prevenção da Violência (Violence Prevention Nucleus—NPV) relating to the allocation of resources, monitoring progress and giving feedback; a lack of higher level institutional endorsement prioritising DVAW work; staff turnover; a lack of feedback from external support services to PHC clinics regarding DVAW cases; and inconsistent practices regarding documentation of DVAW. Conclusion: Training should be accompanied by system-wide institutional change including active (as opposed to passive) management support, allocation of resources to support roles within the NPV, locally adapted protocols and guidelines, monitoring progress and feedback. Communication and coordination with external support services and documentation systems are crucial and need improvement. DVAW should be prioritised within leadership and governance structures, for example, by including DVAW work as a specific commissioning goal. [ABSTRACT FROM AUTHOR]

Background: Research on the needs of people with disability is scarce, which promotes inadequate programs. Community Based Inclusive Development interventions aim to promote rights but demand a high level of community participation. This study aimed to identify prioritized needs as well as lessons learned for successful project implementation in different Latin American communities. Methods: This study was based on a Community Based Inclusive Development project conducted from 2018 to 2021 led by a Columbian team in Columbia, Brazil and Bolivia. Within a sequential mixed methods design, we first retrospectively analyzed the project baseline data and then conducted Focus Group Discussions, together with ratings of community participation levels. Quantitative descriptive and between group analysis of the baseline survey were used to identify and compare sociodemographic characteristics and prioritized needs of participating communities. We conducted qualitative thematic analysis on Focus Group Discussions, using deductive main categories for triangulation: 1) prioritized needs and 2) lessons learned, with subcategories project impact, facilitators, barriers and community participation. Community participation was assessed via spidergrams. Key findings were compared with triangulation protocols. Results: A total of 348 people with disability from 6 urban settings participated in the baseline survey, with a mean age of 37.6 years (SD 23.8). Out of these, 18 participated within the four Focus Group Discussions. Less than half of the survey participants were able to read and calculate (42.0%) and reported knowledge on health care routes (46.0%). Unemployment (87.9%) and inadequate housing (57.8%) were other prioritized needs across countries. Focus Group Discussions revealed needs within health, education, livelihood, social and empowerment domains. Participants highlighted positive project impact in work inclusion, self-esteem and ability for self-advocacy. Facilitators included individual leadership, community networks and previous reputation of participating organizations. Barriers against successful project implementation were inadequate contextualization, lack of resources and on-site support, mostly due to the COVID-19 pandemic. The overall level of community participation was high (mean score 4.0/5) with lower levels in Brazil (3.8/5) and Bolivia (3.2/5). Conclusion: People with disability still face significant needs. Community Based Inclusive Development can initiate positive changes, but adequate contextualization and on-site support should be assured. [ABSTRACT FROM AUTHOR]

Background: Mentoring programmes in health research are beneficial for both mentors and mentees and are essential for the development of the next generation of research leaders. This study describes the self-assessment of research skills in health professionals participating in a research mentoring programme and determines the correlation between the participants' self-assessment of research skills and professional characteristics. Method: This was a quasi-experimental, time-series study conducted in a Brazilian tertiary hospital. Thirty-five health professionals holding a master's or PhD degree were included. The participants answered a survey in which they self-assessed their research skills distributed into eight domains, with one group responding before training and another group responding after training. The level of significance was set at 5% (p < 0.05). Results: Those who received training scored better in research skills related to two domains: critical analysis of the literature and identification of appropriate research methods (p = 0.0245). Conclusion: Trained professionals performed better in the domains of critical thinking and knowledge and management of steps in the research process. [ABSTRACT FROM AUTHOR]

Background: Hunting is a vital means of obtaining animal in various human populations. Hunters rely on their knowledge of species ecology and behavior to develop and employ hunting techniques and increase their chances of success. The comparison of the hunting practices of different human societies can shed light on the sustainability of hunting and the impact it has on species' populations. In this study, we examine and compare the techniques, modalities, and baits used by urban and rural hunters in Rondônia, a state in southwestern Amazonia, Brazil. We expected that rural hunters would use these elements and have greater knowledge when compared to urban hunters. We also expect that the use of specific hunting techniques and modalities will have greater selectivity and specificity of capture for rural hunters and that this knowledge will differ between groups. Methods: We conducted 106 semi-structured interviews with rural and urban hunters from October 2018 to February 2020. We analyzed the data using PERMANOVA and Network analyses to compare and contrast the hunting practices of each group. Results: We recorded four main hunting techniques divided into ten modalities with three techniques and seven modalities being the preferred choices among hunters. Waiting for at a Fruit Tree was cited as the primary technique employed by hunters living in urban and rural areas indicated. While the techniques and modalities were similar among hunters, the composition of species targeted and baits used differed between groups. Our network approach showed that modularity in urban areas was numerically lower than in rural areas. All species had one to more techniques associated with their capture. Conclusions: Hunters living in urban and rural environments showed high similarity in their practices, probably due to sharing similar environments to hunt containing similar species, as well as targeting preferably the same species. [ABSTRACT FROM AUTHOR]

Background: Estimates of completeness of death registration are crucial to produce estimates of life tables and population projections and to estimate the burden of disease. They are an important step in assessing the quality of data. In the case of subnational data analysis in Brazil, it is important to consider spatial and temporal variation in the quality of mortality data. There are two main sources of data quality evaluation in Brazil, but there are few comparative studies and how they evolve over time. The aim of the paper is to compare and discuss alternative estimates of completeness of death registration, adult mortality (45q15) and life expectancy estimates produced by the National Statistics Office (IBGE), Institute for Health Metrics and Evaluation (IHME), and estimates presented in Queiroz et al. (2017) and Schmertmann and Gonzaga (2018), for 1980 and 2010. Methods: We provide a descriptive and comparative analysis of aforementioned estimates from four (4) sources of estimates at subnational level (26 states and one Federal District) in Brazil from two different points in time. Results: We found significant differences in estimates that affect both levels and trends of completeness of adult mortality in Brazil and states. IHME and Queiroz et al. (2017) estimates converge by 2010, but there are large differences when compared to estimates from the National Statistics Office (IBGE). Larger differences are observed for less developed states. We have showed that the quality of mortality data in Brazil has improved steadily overtime, but with large regional variations. However, we have observed that IBGE estimates show the lowest levels of completeness for the Northern of the country compared to other estimates. Choice of methods and approaches might lead to very unexpected results. Conclusion: We produced a detailed comparative analysis of estimates of completeness of death registration from different sources and discuss the main results and possible explanations for these differences. We have also showed that new improved methods are still needed to study adult mortality in less developed countries and at a subnational level. More comparative studies are important in order to improve quality of estimates in Brazil. [ABSTRACT FROM AUTHOR]

Background: Tackling poverty requires reconsideration of quantitative factors related to "who" is poor and by "how much" and qualitative factors addressing "what poverty means in these individuals' lives". Greater understanding is required concerning the types of access actually used by families in poverty in attempts to meet their basic needs. Poverty must be addressed based on the question: "Inequality of what?" It is in reflecting on the realities of such groups when their basic needs are not met that public policies can be improved and implemented with legitimate priorities. Objective: Describe coverage and access to public health, education and social assistance services and the related effects on the quality of life of families in extreme poverty. Methods: An exploratory mixed methods study was conducted applying Amartya Sen's "Basic Capability Equality" framework, with: 1) 27 interviews with managers and professionals from public services serving territories with extreme poverty; 2) Survey with a systematic proportionate stratified sample of 336 heads of households in extreme poverty from a total 2605 families. The resulting data was analyzed with thematic content analysis and descriptive statistics, respectively. Results: The managers and professionals described the lives of families in extreme poverty with phrases such as, "These people suffer. Sadness weighs on their lives!" and "Depression is the most common illness". Their precarious circumstances and inadequate access were cited as causes. Quality of life was considered bad or very bad by 41.4% of heads of households. A total income of less than one-third of the minimum wage was received by 56.9% of the sample. One or more people were unemployed in the family in 55.8% of cases. For 53.3% of heads of households, public services "did not meet any or few of their needs". The main social determinants of health were described as: alcohol and drugs (68.8%); lack of good health care (60.7%); and absence of income/work (37.5%). The following were identified as solutions to improve their quality of life: (1) health (40.5%); (2) education (37.8%); and (3) employment (44.6%). Conclusions: The social determinants of poverty and health must be addressed jointly through intersectoral public policies and egalitarian mechanisms that promote investment in social protection. [ABSTRACT FROM AUTHOR]

Background: Cultural and religious practices of African origin have decisively influenced traditional health practices in the Americas since the African diaspora. Plants are core elements in the religions of African origin. Compared with other parts of Brazil where the Afro-Brazilian presence is widely recognized, in Southern Brazil, these cultural practices are often socially invisible. Yet, there are several terreiros of three Afro-Brazilian religions: Candomblé, Umbanda, and Ritual deAlmas e Angola. We hypothesize that the importance of plants in Afro-Brazilian religions is linked not only to spiritual and magical issues but also to the medicinal properties of these plants. We seek to answer the following questions: (a) Which plants are used in the terreiros and what are their indications for use?; (b) Are there plants that stand out culturally in these religious groups?; and (c) What is the importance of the adaptive maintenance and replacement process in the use of plants in these religions, considering the Neotropical and African plants? Methods: We performed a census of the existing terreiros on the Island of Santa Catarina to collect information on the knowledge and use of plants. In all terreiros that consented to participate in the research, we collected data through semi-structured interviews, guided tours for plant collection, and participant observation. We identified the botanical species through expert consultations and botanical literature. Results: We interviewed 27 spiritual leaders, who cited 93 plants belonging to 86 botanical species. We identified 14 categories of use, with emphasis on liturgical ritual use (59%), general and unspecified diseases (32%), and digestive diseases (27%). In most liturgics uses, direct contact between plant and patient occurs, as in the case of bathing and the cleansing use of smoke. Sixteen plants were cited in all terreiros, configuring a set of species that can be considered as culturally important plants for these religious groups. Conclusions: These groups have extensive knowledge about a highly consensual set of therapeutic plants that should be further investigated pharmacologically to understand the effect of their external use. Also, we emphasize the importance of recognizing and valuing this ancestral Afro-Brazilian knowledge and learning also from these people about their broader vision of health which also adds more spirituality in health care. [ABSTRACT FROM AUTHOR]

Background: Due to the influence of several factors on the hunting of game meat, we investigated how the seasonality of the environment, the abundance, and the biomass of wild animals, as well as the proximity to these resources, can affect the hunting. Methods: The research was developed with the Fulni-ô people in the municipality of Águas Belas, Agreste of Pernambuco, Northeast of Brazil. In order to do this, we applied snowball sampling to select the participants. Data from potentially useful game species were obtained from lists and semi-structured interviews to register their particular kind of uses, capture periods (daytime, night, or both), preferences, and perceived abundance. The hunters who allowed their game meat captured to be weighed and identified were followed for 1 year. Results: Our records pointed to a vast repertoire of potentially hunting animals. However, we did not verify relationships between the abundance, seasonality, and biomass of the animals that were hunted by the Fulni-ô. We observed a total of 209,866 (kg) of game meat hunted in the studied group, belonging to 23 species, distributed in three taxonomic groups, the birds being the most representative group with 59% of total reported. Conclusion: Such consumption by the group is well below in terms of biomass when compared to other ethnic or local groups in other regions of Brazil, or in Caatinga areas, characterizing an activity much more of cultural character than subsistence. Also, the use of game meat among the Fulni-ô seems to be actively directed to the preferred species, suggesting that in the case of an urbanized indigenous community, where other sources of income are available, the demand for game meat is lower when compared to other ethnic groups. [ABSTRACT FROM AUTHOR]

Background: Although multiple studies advocate the advantages of participatory research approaches for ethnoscience, few provide solid contributions from case studies that involve residents in all of the project phases. We present a case study of a participatory approach whose aim is to register ethnobotanical knowledge on the use of plants in two quilombola communities (maroon communities), an important biodiversity hotspot in the Atlantic Forest, Southeast Brazil. Our aim is to provide tools that will empower decision-making related to sustainable use and management among residents. Methods: In phase I, the objectives and activities were defined in meetings with residents to carry out ethnobotanical surveys between two quilombola communities—the Quilombo da Fazenda (QF) and Quilombo do Cambury (QC). In phase II, we offered community partners training courses on how to collect plants and ethnobotanical data. In coordination with the university team and using ethnobotanical methods, community partners interviewed specialists on plants and their uses. In phase III, using the participatory mapping method, residents indicated plot locations and collected plants to calculate the Conservation Priority Index for native species recorded in phase II. Results: In 178 days of fieldwork, two community partners from the QF and three from the QC selected 8 and 11 respondents who reported 175 and 195 plant species, respectively, corresponding to 9 ethnobotanical categories. Based on requests from the local community, booklets and videos with these data were collaboratively produced. A large percentage of species were found to be of great conservation priority—82.1% in the QC and 62.5% in the QF. Virola bicuhyba, Cedrela fissilis, Plinia edulis, and Tabebuia cassinoides are the species most at risk and will be the focus of phase IV, when a participatory management plan will be carried out. Additionally, we present both challenges and opportunities with the hope that others can learn from our successes and failures. Conclusions: Our experience shows that it is possible to train community members who wish to document their knowledge to support the process of ensuring that local knowledge is highly regarded, further ensuring its perpetuation. In this context, the project may be of great interest to development programs in promoting community-based management strategies for useful plants. [ABSTRACT FROM AUTHOR]

Background: Health systems organized as networks and coordinated by the Primary Health Care (PHC) may contribute to the improvement of clinical care, sanitary conditions, satisfaction of patients and reduction of local budget expenditures. The aim of this study was to adapt and validate a questionnaire - COPAS - to assess the coordination of Integrated Health Service Delivery Networks by the Primary Health Care. Methods: A cross sectional approach was used. The population was pooled from Family Health Strategy healthcare professionals, of the Alfenas region (Minas Gerais, Brazil). Data collection was performed from August to October 2013. The results were checked for the presence of floor and ceiling effects and the internal consistency measured through Cronbach alpha. Construct validity was verified through convergent and discriminant values following Multitrait-Multimethod (MTMM) analysis. Results: Floor and ceiling effects were absent. The internal consistency of the instrument was satisfactory; as was the convergent validity, with a few correlations lower then 0.30. The discriminant validity values of the majority of items, with respect to their own dimension, were found to be higher or significantly higher than their correlations with the dimensions to which they did not belong. Conclusion: The results showed that the COPAS instrument has satisfactory initial psychometric properties and may be used by healthcare managers and workers to assess the PHC coordination performance within the Integrated Health Service Delivery Network. [ABSTRACT FROM AUTHOR]

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Background: Traditional methods to measure oral health based on clinical standards are limited because they do not consider psychosocial and functional aspects of oral health. It has been recommended that these measures need to be supplemented by data obtained from patients regarding their individual perceptions on oral health-related quality of life (OHRQoL). Happiness is a multidimensional construct comprising both emotional and cognitive domains, and has been defined as "the degree to which an individual judges the overall quality of his or her life as a whole favorably". It has been associated with several health outcomes, including oral health. The aim of this study was to assess the impact of oral health conditions, oral health-related quality of life (OHRQoL), and socioeconomic factors on the subjective happiness of Brazilian adolescents. Methods: A cross-sectional study was conducted in 2012 on a representative sample of 12-year-old schoolchildren in Santa Maria-RS, Brazil. The data were collected through dental examinations and structured interviews. The participants underwent an evaluation aimed at detecting dental caries, traumatic dental injuries, malocclusion, and gingival bleeding. They also completed the Brazilian versions of the Child Perceptions Questionnaire-short form (CPQ11--14 -- ISF: 16) and the Subjective Happiness Scale (SHS), which was our outcome variable. Socioeconomic conditions were evaluated through a questionnaire that was completed by the participants' parents. Poisson regression analysis was used to determine the association between the explanatory variables and the outcome. Moreover, a correlation analysis was performed to determine the relationship between the SHS scores and the overall and domain scores of the CPQ11--14 --ISF: 16. Results: A total of 1,134 children were evaluated. Unadjusted analyses showed that happiness was associated with socioeconomic indicators, the use of dental services, clinical status, and scores on the OHRQoL measure. After adjustment, household overcrowding (RR: 0.96; 95% CI: 0.93-0.98), dental caries (RR: 0.98; 95% CI: 0.97-0.99), malocclusion (RR: 0.98; 95% CI: 0.96-0.99), and the severity associated with the CPQ11-14 (RR: 0.95; 95% CI: 0.93-0.97) still showed a significant association with lower levels of the mean SHS score. Conclusions: Happiness is influenced by oral conditions, socioeconomic status, and OHRQoL. [ABSTRACT FROM AUTHOR]

Background: The objective of this study was to evaluate the convergent validity between the domains of the Autoquestionnaire Qualité de Vie Enfant image (AUQUEI) and the Child Perceptions Questionnaire instrument (CPQ11-14) among schoolchildren and to assess the difference between socio-economic and clinical variables associated with their scores. Methods: An analytical cross-sectional study was conducted in Juiz de Fora, Minas Gerais, Brazil, with 515 schoolchildren aged 12 years from 22 public and private schools, selected with the use of a random multistage sampling design. They were clinically examined for dental caries experience (DMFT and dmft index) and orthodontic treatments needs (DAI index) and were asked to complete the Brazilian versions of Child Perception Questionnaire (CPQ11-14) and Autoquestionnaire Qualité de Vie Enfant image (AUQUEI). In addition, a questionnaire was sent to their parents inquiring about their socio-economic status and home characteristics. The convergent validity of the Brazilian versions of CPQ11-14 and AUQUEI instruments was analyzed by Spearman's correlation coefficients. For comparison between the summarized scores of each questionnaire with regard to the schoolchildren's socio-environmental and clinical aspects the nonparametric Mann--Whitney was used at level of significance of 5%. Results: The mean DMFT index was 1.09 and 125 (24.3%) children had orthodontic treatment needs (DAI ≥ 31). There was a similarity and a weak correlation between the scores of the domains of CPQ11-14 and AUQUEI (r ranged between -0.006 and 0.0296). In addition, a significant difference was found between the scores of the two instruments according to the socio-economic variables (p < 0.05) and presence of teeth with carious lesions (p < 0.05). Conclusions: The general and oral health-related quality of life instruments AUQUEI and CPQ11-14 were both found to be useful, and significant influence of socio-economic and clinical variables were detected with both instruments. [ABSTRACT FROM AUTHOR]

Background: Teas from the husk fiber of Cocos nucifera are used in the folk medicine to treat arthritis and other inflammatory processes. Some works show that some varieties have biological activities. However, one of the main variety of the species, C. nucifera var. typica, known in Brazil as “gigante”, was not studied yet. Thus, this study evaluates if this variety has the anti-inflammatory and antimicrobial activities already reported in other varieties. Methods: C. nucifera aqueous crude extract (10, 50, and 100 mg/kg) and the reference drugs morphine (1 mg/kg) and acetylsalicylic acid (100 mg/kg) were evaluated in models of inflammation (formalin-induced licking and subcutaneous air pouch). The antioxidant activity was evaluated by 2,2-diphenyl-1-picryl-hydrazyl-hydrate (DPPH) photometric assay and compared with those of the standards (quercetin, rutin, and ascorbic acid). The extract was also screened against Candida albicans, Escherichia coli, Staphylococcus aureus, and methicillin-resistant Staphylococcus aureus (MRSA), in the agar diffusion method. The minimal inhibitory concentration (MIC) and minimal bactericidal concentration (MBC) were determined by the broth micro-dilution assay. Activities of combinations of the extract and antibiotics (methicillin or vancomycin) against MRSA were evaluated using checkerboard assays. Results: The extract significantly inhibited the time that the animals spent licking the formalin-injected paws (second phase). The extract also inhibited the inflammatory process induced by subcutaneous carrageenan injection by reducing cell migration, protein extravasation, and TNF-α production. Additionally, the extract showed an antioxidant potential in vitro as good as standards in their antioxidant activity. The extract was active only against S. aureus and MRSA. MIC and the bactericidal concentrations were identical (1,024 μg/ml). The extract and methicillin acted synergistically against the clinical MRSA isolate, whereas an indifferent effect was detected when the extract was combined with vancomycin. Conclusions: The extract exhibits anti-inflammatory activity through the inhibition of the cell migration. The mixture of extract constituents and methicillin could lead to the development of a new combination antibiotic against MRSA infections. [ABSTRACT FROM AUTHOR]

Background: This study characterized the botanical knowledge of artisanal fishers of the Lami community, Porto Alegre, southern Brazil based on answers to the following question: Is the local botanical knowledge of the artisanal fishers of the rural-urban district of Lami still active, even since the district's insertion into the metropolitan region of Porto Alegre? Methods: This region, which contains a mosaic of urban and rural areas, hosts the Lami Biological Reserve (LBR) and a community of 13 artisanal fisher families. Semi-structured interviews were conducted with 15 fishers, complemented by participatory observation techniques and free-lists; in these interviews, the species of plants used by the community and their indicated uses were identified. Results: A total of 111 species belonging to 50 families were identified. No significant differences between the diversities of native and exotic species were found. Seven use categories were reported: medicinal (49%), human food (23.2%), fishing (12.3%), condiments (8%), firewood (5%), mystical purposes (1.45%), and animal food (0.72%). The medicinal species with the highest level of agreement regarding their main uses (AMUs) were Aloe arborescens Mill., Plectranthus barbatus Andrews, Dodonaea viscosa Jacq., Plectranthus ornatus Codd, Eugenia uniflora L., and Foeniculum vulgare Mill. For illness and diseases, most plants were used for problems with the digestive system (20 species), followed by the respiratory system (16 species). This community possesses a wide botanical knowledge, especially of medicinal plants, comparable to observations made in other studies with fishing communities in coastal areas of the Atlantic Forest of Brazil. Conclusions: Ethnobotanical studies in rural-urban areas contribute to preserving local knowledge and provide information that aids in conserving the remaining ecosystems in the region. [ABSTRACT FROM AUTHOR]

Background: The use of ethnoecological tools to evaluate possible damage and loss of biodiversity related to the populations of species under some degree of threat may represent a first step towards integrating the political management of natural resources and conservation strategies. From this perspective, this study investigates fishermen's ecological knowledge about sea turtles and attitudes towards the conservation and bycatch in Ilhéus, Southern Bahia, Brazil. Methods: Fishermen experts semi-structured interviews were performed using snowball sampling method. The interviews consisted of a series of questions relating to the fishermen's profile, structure and work equipment, the local ecological knowledge of fishermen about sea turtles and bycatch, a projective test, attitudes towards turtle conservation and beliefs and taboos regarding turtles. Indicators for quantitative comparisons of respondents in terms of their broad knowledge and attitudes towards turtle conservation were created. Correlation analyses were made between indicators of knowledge and attitude as well as the relationship between education level and knowledge and attitudes. Results: Thirty experts were interviewed for the study. The local ecological knowledge and attitudes of fishermen towards the conservation of sea turtles were respectively medium (0.43) and moderate (0.69) according to experts (based on Likert scale and Cronbach's Alpha). Potential areas of spawning were reported from Barra Grande to Una covering the entire coast of Ilhéus. Methods for identifying the animal, behavior, and popular names were described by fishermen. The most recent captures of turtles were attributed to fishing line, but according to the respondents, lobster nets and shrimp traps are more likely to capture turtles. Knowledge and attitudes were weakly inversely correlated (r = ?0.38, p = 0.04), and the education level of the respondent showed a positive correlation with positive attitudes towards turtle conservation (H = 8.33; p = 0.04). Life history, habitat, specific and exogenous taboos, beliefs and the use of hawksbill turtle to make glasses and other handcrafts are also reported in the study. Conclusions: Monitoring of spawning areas, preservation of traditional practices, strategies to moderate the use of fishery resources and the local ecological knowledge/attitudes can provide data to improve the conservation practices and management of sea turtles. [ABSTRACT FROM AUTHOR]

The article discusses on techniques involved in testing distribution of knowledge in ethnobiology. It states that how outliers interfere with the analyses and how other analyses may be conducted using indices, such as determining the distance between the knowledge of a community and that of experts, as well as exhibiting the importance of these individuals' communal information of biological resources.The primary applications of these indices is for evaluating the behavior of the collected data.

Background: Registered causes in vital statistics classified as garbage codes (GC) are considered indicators of quality of cause-of-death data. Our aim was to describe temporal changes in this quality in Brazil, and the leading GCs according to levels assembled for the Global Burden of Disease (GBD) study. We also assessed socioeconomic differences in the burden of different levels of GCs at a regional level. Methods: We extracted data from the Brazilian Mortality Information System from 1996 to 2016. All three- and four-digit ICD-10 codes considered GC were selected and classified into four categories, according to the GBD study proposal. GC levels 1 and 2 are the most damaging unusable codes, or major GCs. Proportionate distribution of deaths by GC levels according selected variables were performed. Age-standardized mortality rates after correction of underreporting of deaths were calculated to investigate temporal relationships as was the linear association adjusted for completeness between GC rates in states and the Sociodemographic Index (SDI) from the GBD study, for 1996–2005 and 2006–2016. We classified Brazilian states into three classes of development by applying tertiles cutoffs in the SDI state-level estimates. Results: Age-standardized mortality rates due to GCs in Brazil decreased from 1996 to 2016, particularly level 1 GCs. The most important GC groups were ill-defined causes (level 1) in 1996, and pneumonia unspecified (level 4) in 2016. At state level, there was a significant inverse association between SDI and the rate of level 1–2 GCs in 1996–2005, but both SDI and completeness had a non-expected significant direct association with levels 3–4. In 2006–2016, states with higher SDIs tended to have lower rates of all types of GCs. Mortality rates due to major GCs decreased in all three SDI classes in 1996–2016, but GC levels 3–4 decreased only in the high SDI category. States classified in the low or medium SDI groups were responsible for the most important decline of major GCs. Conclusion: Occurrence of major GCs are associated with socioeconomic determinants over time in Brazil. Their reduction with decreasing disparity in rates between socioeconomic groups indicates progress in reducing inequalities and strengthening cause-of-death statistics in the country. [ABSTRACT FROM AUTHOR]

Background: Depression is one of the major causes of disability worldwide. The objective of this study was to analyze the results of the Global Burden of Disease Study 2017 (GBD-2017) for depressive disorders in Brazil and its Federated Units (FUs) in 1990 and 2017. Methods: We used GBD-2017 study methodology to evaluate the prevalence estimates, the disability-adjusted life-year (DALY), and the years lived with disability (YLDs) for depressive disorders, which include major depressive disorder and dysthymia. The YLD estimates and the position of these disorders in the DALY and YLD rankings were compared to those of seven other countries. The observed versus expected YLD, based on the sociodemographic index (SDI), were compared. Results: In GBD-2017, the prevalence of depressive disorders in Brazil was 3.30% (95% uncertainty interval [UI]: 3.08 to 3.57), ranging from 3.79% (3.53 to 4.09) in Santa Catarina to 2.78% in Pará (2.56 to 3.03), with significant differences between the Federated Units. From 1990 to 2017, there was an increase in number of YLD (55.19%, 49.57 to 60.73), but a decrease in the age-standardized rates (− 9.01%, − 11.66 to − 6.31). The highest proportion of YLD was observed in the age range of 15–64 years and among females. These disorders rank 4th and 13th as leading causes of YLD and DALY, respectively, in Brazil. In the other countries evaluated, the ranking of these disorders in the YLD classification was close to Brazil's, while in the DALY classification, there was higher variability. All countries had YLD rates similar to the overall rate. The observed/expected YLD ratio ranged from 0.81 in Pará to 1.16 in Santa Catarina. Morbidity of depressive disorders was not associated with SDI. Conclusions: Depressive disorders have been responsible for a high disability burden since 1990, especially in adult women living in the Southern region of the country. The number of people affected by these disorders in the country tends to increase, requiring more investment in mental health aimed at advancements and quality of services. The epidemiological studies of these disorders throughout the national territory can contribute to this planning and to making the Brazilian health system more equitable. [ABSTRACT FROM AUTHOR]

Background: Tuberculosis (TB) continues to be an important cause of fatal and non-fatal burden in Brazil. In this study, we present estimates for TB burden in Brazil from 1990 to 2017 using data from the Global Burden of Diseases, Injuries, and Risk Factors Study 2017 (GBD 2017). Methods: This descriptive study used GBD 2017 findings to report years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life years (DALYs) of TB in Brazil by sex, age group, HIV status, and Brazilian states, from 1990 to 2017. We also present the TB burden attributable to independent risk factors such as smoking, alcohol use, and diabetes. Results are reported in absolute number and age-standardized rates (per 100,000 inhabitants) with 95% uncertainty intervals (UIs). Results: In 2017, the number of DALYs due to TB (HIV-negative and HIV-positive combined) in Brazil was 284,323 (95% UI: 240,269–349,265). Among HIV-negative individuals, the number of DALYs was 196,366 (95% UI: 189,645–202,394), while 87,957 DALYs (95% UI: 50,624–146,870) were estimated among HIV-positive individuals. Between 1990 and 2017, the absolute number and age-standardized rates of DALYs due to TB at the national level decreased by 47.0% and 68.5%, respectively. In 2017, the sex–age-specific TB burden was highest among males and in children under-1 year and the age groups 45–59 years. The Brazilian states with the highest age-standardized DALY rates in 2017 were Rio de Janeiro, Pernambuco, and Amazonas. Age-standardized DALY rates decreased for all 27 Brazilian states between 1990 and 2017. Alcohol use accounted for 47.5% of national DALYs due to TB among HIV-negative individuals in 2017, smoking for 17.9%, and diabetes for 7.7%. Conclusions: GBD 2017 results show that, despite the remarkable progress in reducing the DALY rates during the period, TB remains as an important and preventable cause of health lost to due premature death and disability in Brazil. The findings reinforce the importance of strengthening TB control strategies in Brazil through integrated and multisectoral actions that enable the access to prevention, early diagnosis, and timely treatment, with emphasis on high-risk groups and populations most vulnerable to the disease in the country. [ABSTRACT FROM AUTHOR]

Background: This study aimed to survey the knowledge and use of mammals by the residents of the rural community of Capivara in the municipality of Solânea (Paraíba State, Northeast Brazil) and to propose a new method of using the use value as a tool for data analysis in ethnozoological surveys. Methods: The uses attributed to mammals were recorded through semi-structured interviews conducted with the breadwinners (men and women) living in the community. The species were identified through guided tours, by descriptions made by the interviewees, and using specimens donated by them, as well as by comparison with the pertinent scientific literature (morphological and ecological). Through the use value differentiated analysis, it was possible to distinguish the current use value of the species (effective use) from their potential use value (knowledge, but no effective use) to determine their real importance related to the uses cited by the studied group. Results: Nineteen species were cited; however, only 17 of them were identified and then distributed in 13 families. The other species were identified at the genus level Leopardus sp. and order Rodentia. The species were classified into 6 categories of use: food, captive breeding, zootherapeutic, artisanal, magic/religious, and veterinary purposes. Conclusions: This article discusses possible conservation solutions, given the irregular exploitation of some species, warning about the biodiversity, and traditional knowledge conservation. [ABSTRACT FROM AUTHOR]

Background: Traditional raft (jangada), piúba wood raft (jangada de pau de piúba), six-log raft (jangada de seis paus), and wooden raft (jangada de pau) are some of the names given to the traditional Brazilian watercrafts created from the buoyancy of bound logs. The traditional raft is a watercraft used and built by artisan fishermen who have, throughout generations, kept and improved knowledge related to this practice and the use of the plant species they need as raw materials. Active groups of these fishermen and their watercrafts are distributed along 200 km of the coast of the state of Bahia. The fishermen interviewed in this study are at the southern limit of distribution for the use of this type of vessel. Methods: This study aimed to characterize the use of the arboreal species applied in the construction of the traditional raft in the municipalities of Uruçuca, Ilhéus, and Canavieiras in the southern State of Bahia, Brazil. For this purpose, structured and semi-structured interviews were individually conducted with 36 fishermen, and walking tours were conducted with specialists in the construction of the watercraft. Results: We observed that the raftsmen use 21 species to construct the traditional raft. The features of the wood, such as density, flexibility, and availability, are the main criteria applied to choose the arboreal species. Some species are preferred, such as pau de jangada (Apeiba tibourbou) and biriba (Eschweilera ovata), which are the most frequently employed in watercraft manufacturing. Conclusions: The southern Bahia population is familiar with the different tree species that are linked to their fishing activities. The main link between the fishermen and the useful species is present in the practice of raft construction. Currently, the restricted access to raw materials limits this practice, which consequently results in the cultural erosion of this community. [ABSTRACT FROM AUTHOR]

Background: Accessing folk knowledge from small-scale fishers is an affordable and reliable approach to understand the dynamic and diversity of shark species worldwide, especially of those eventually caught. In this context, ethnotaxonomy (folk identification and classification) may represent an alternative to support sharks fisheries management, especially in data-poor places. This study aimed to investigate fishing and ethnotaxonomy of the main shark species caught by small-scale fisheries from the coastal waters of the Brazilian Northeast. Methods: Semi-structured and structured interviews were conducted with fishers targeting general aspects of fishing activities and specific topics regarding ethnotaxonomy, capture, and commercialization of sharks. For species identification, an ethnobiological systematic perspective was used to analyze the folk nomenclature and classification criteria. Non-parametric statistical tests were used to verify associations between species caught, fishing gear, and harvest period. Results: Fishers mentioned 73 binomial names, 21 main folk species, and eight synonymies. Some species belonging to the same scientific genus are often named and grouped by the same folk name, with no distinction between species by fishers. Sharks are most landed as bycatch and correspond to less than 5% of the total commercial fisheries in the communities, with socioeconomic value for subsistence consumption and local commercialization. Sharks were said to be mainly caught with hand line and surface long line during the rainy season, while gillnet captures were associated to the dry season. At least three of the species most mentioned by fishers are currently classified as vulnerable and endangered worldwide. Conclusions: Even though landed sharks account for a small proportion of the fishing catches, their biological and life history features place sharks among the most vulnerable organisms globally. Such an ethnobiological approach towards shark identification may contribute to generate basic information on species caught, their frequency in the landings, and how different species belonging to the same genus can be landed and sold together. This type of information can generate subsidies to the development of conservation and management plans for these fishing resources, where knowledge is scarce. [ABSTRACT FROM AUTHOR]