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Background: Data on food intake at the individual level and its statistical distribution in population groups defined by age, gender, or geographic areas are important in planning public health and nutrition programs. However, individual-based surveys in representative population samples are expensive to perform. Methods/Design: In Brazil, an individual based survey is under consideration to be conducted alongside the household budget survey (HBS), which will be carried out in 2008-2009. This paper presents the methodological framework of dietary data collection and indicates the directions to combining both sources of data. The 2008-2009 Brazilian HBS sample will include 60,000 households. Of the selected HBS households, 30% will be randomly sampled to gather data on individual food intake. Therefore, individual dietary intake data is expected to be gathered for 70,000 individuals. Data collection procedures will comprise: completion of a diary with information regarding food purchases during a seven-day period; registration of all items consumed during two non-consecutive days for all 10 year-old or older members of the household. The sample will be large enough to capture the variation between individuals, and the two records will assure the estimation of the variation within individuals for food groups, energy and nutrients. Data on individual dietary intake and food family budget will be stratified by the five regions of the country and by rural or urban. A pilot study has been conducted in two states, and it indicated that combining individual and budgetary data in a survey is feasible. Discussion: This kind of study will allow us to estimate correlations between individual intake and household purchases, overcoming the limitations of individual dietary surveys, and enhancing the HBS with information on eating out and intra-familiar distribution of food. [ABSTRACT FROM AUTHOR]

In an earlier paper (Dressler, 2001), I suggested that medical anthropology as a research enterprise could not ignore either meaning or structure in human social life in the production of health. Rather, drawing on the early work of Bourdieu, I argued that we need to take into account both how the world is configured by the collective meanings we impose upon it, as well as the social structural (and physical) constraints on our behaviour that exist outside those meanings. Human health can be understood, in part, as the intersection of meaning and structure. Here, my aim is to extend this perspective in three ways. Firstly, I present an expanded theoretical framework within which collectivei meaning and social structure can be conceptualised. A useful theoretical framework must take into account paradoxical features of culture, including the seeming contradiction that it is a property both of social aggregates and of individuals, and that, ultimately, social structural constraints external to individuals depend on shared meaning. Secondly, I review recent research employing this perspective conducted in Brazil, the southern United States and Puerto Rico. These studies have all employed a 'structural-constructivist' theoretical orientation, using especially the concept of 'cultural consonance', or the degree to which individuals incorporate shared meaning into their own beliefs and behaviour. Where individual efforts to attain a higher cultural consonance are frustrated by structural constraints, poor health results. Thirdly, I consider some of the policy implications of this perspective. While much work in traditional public health focuses on a highly individualised notion of meaning (as in 'health beliefs'), it seems unlikely that the health of populations can be altered substantially without taking into account the structures that constrain individual action. [ABSTRACT FROM AUTHOR]

Abstract: Recent years have seen a burgeoning of intergenerational programmes aiming to improve the well being of participants. However, very few programmes have been formally evaluated. In this paper we report results from a randomised controlled trial of a school-based intergenerational intervention undertaken in Brazil. Randomly selected samples of 253 adolescents and 266 elders aged 60 and over resident in the school''s catchment area were administered a questionnaire including questions on cognitive components of social capital, family relationships, and self-rated health. Participants were then randomly allocated to control and intervention groups. The intervention comprised participation in a 4 month programme of intergenerational activities in which the elders shared their memories with the students. At the end of the intervention the questionnaire was re-administered to the samples. High proportions (85–95%) of both samples completed the questionnaires but compliance with the intervention was low in the elderly group. In the analysis of results from the elderly sample, we therefore compared the control group with the group assigned to the intervention (intention to treat analysis). Results showed that adolescents in the intervention group were nearly three times more likely to rate their health as good than those in the control group, but also more likely to judge that most people were selfish. In the elderly sample, those from the intervention group were over twice as likely as those from the control group to report positively on the helpfulness of neighbours; judge most people to be honest or consider their family relationships as good. There were no significant differences between groups on other outcome measures. These results suggest that structured intergenerational activities may have positive effects on some aspects of social capital for both adolescents and elderly people, although further research is needed to elucidate the processes involved and the extent to which the findings are context specific. This study is the first to use a controlled trial design to evaluate this type of intervention and is valuable in showing that this design can be used in interventions of this kind, and also the difficulties involved. [Copyright &y& Elsevier]

Whether, how, and when children's HIV/AIDS diagnosis needs to be disclosed to them has received growing attention. This paper describes and conceptualizes how communication about HIV/AIDS influences disease knowledge and psychosocial development in a group of children and adolescents living with perinatally acquired HIV infection in an AIDS institution in São Paulo, Brazil. Data consist of the lived experience of 36 children ages 1 to 15 and was gathered through ethnographic research methodologies: participant observation and semistructured informal interviews. Results show that AIDS diagnosis is not disclosed to children, who experience a growing confusion about the interconnected meanings of sickness, medications, living at a house/institution, and having AIDS. Children younger than 6 learn to accept medication taking and to silence illness-related questions. Seven to 9-year olds perceive that the word AIDS and/or being sick are considered negative attributes, but are confused about how these relate to their lives. Preadolescents' growing awareness of the relationship between their lives and negative social values associated with AIDS produces shame and anger. Adolescents exhibit a poor understanding of the implications of HIV/AIDS for their lives and cynicism toward AIDS care, their future, and information about risks to their health. In conclusion, lack of communication about HIV/AIDS creates a context of confusion and mistrust, is detrimental to psychosocial development and coping, compromises disease knowledge, and increases vulnerability to risk behavior. Providing developmentally appropriate information about HIV/AIDS that matches children's illness experiences at all ages would eliminate the need for disclosure and reduce children's emotional distress. [ABSTRACT FROM AUTHOR]

The story of Brazil's evolution in sexual and reproductive health and rights during the 1990s documents not only a decade of change in the population field, but the powerful role of social movements in a democracy. Between October and December 2002, 23 people were interviewed about where they believe progress has been made in Brazil and where there are still needs in relation to population trends, sexual and reproductive rights, and health policies. This paper contains excerpts from the full report and covers the economic and political background of Brazil; the role of non-governmental and women's organisations in influencing the national agenda; the intersection of national and international agendas on population and development, HIV/AIDS, human rights, racism and other issues; changes in sexual and reproductive health policies; HIV/AIDS policy progress, perhaps most importantly mandatory free treatment for people with HIV/AIDS; recent progress in women's health, especially in relation to antenatal and obstetric services, and services addressing violence against women. Finally it describes the role of policy accountability mechanisms that aim to ensure that the many excellent policies that have been passed since 1990 are implemented in a decentralised health system of national, state and local management and services. L'histoire de l'évolution du Brésil en matière de santé et de droits génésiques pendant les années 90 met en lumière des changements dans le domaine démographique et l'influence des mouvements sociaux dans une démocratie. Entre octobre et décembre 2002, on a demandé à 23 personnes d'indiquer les secteurs où le Brésil avait progressé et ceux où des lacunes demeuraient en rapport avec les tendances démographiques, les droits génésiques et les politiques de santé. Cet article, contenant des extraits du rapport, décrit l'environnement économique et politique du Brésil ; l'influence des organisations féminines et des ONG sur les politiques nationales ; l'intersection des priorités nationales et internationales en matière de population et développement, VIH/SIDA, droits de l'homme, racisme et autres questions ; les changements dans les politiques de santé génésique ; les progrès de la lutte contre le VIH/SIDA, avec le traitement gratuit obligatoire des séropositifs ; les récents progrès dans la santé des femmes, particulièrement les services prénatals et obstétriques, et les services spécialisés dans la violence à l'égard des femmes ; et enfin le rôle des mécanismes de responsabilité politique pour que les excellentes politiques adoptées depuis 1990 soient aussi appliquées dans un système de santé décentralisé avec une gestion et des services aux niveaux national, des États et local. La historia de la evolución de Brasil en salud y derechos sexuales y reproductivos durante los años noventa documenta una década de cambios en el campo de la población, y el poder de los movimientos sociales en una democracia. Entre octubre y diciembre de 2002, se entrevistaron a 23 personas respecto a los avances logrados en Brasil y las carencias aãn existentes con relación a las tendencias demográficas, los derechos sexuales y reproductivos y las políticas de salud. Este artículo contiene pasajes del informe y abarca los antecedentes económicos y políticos de Brasil; la influencia de las ONG y organizaciones de mujeres en la agenda nacional; la intersección de las agendas nacionales e internacionales respecto a la población y el desarrollo, el VIH-sida, los derechos humanos, el racismo y otros temas; los cambios en las políticas de salud sexual y reproductiva; los avances en políticas de VIH-sida, destacada la prestación obligatoria de tratamiento gratuito para las personas con VIH-sida; los recientes avances en la salud de la mujer, especialmente con relación a los servicios antenatales y obstétricos y los servicios que tratan la violencia contra las mujeres; y, por ãltimo, los mecanismos destinados a garantizar que las numerosas excelentes políticas aprobadas a partir de 1990 sean aplicadas en un sistema de salud descentralizado de administración y servicios nacionales, estatales y locales. [ABSTRACT FROM AUTHOR]

The provision of care and support to persons living with human immunodeficiency virus (HIV) in Brazil who also use drugs and/or alcohol represents special challenges because of the combined effects of addiction, poverty, stigma, and discrimination. This paper presents details on a program providing both clinic- and field- based care to HIV-infected injection drug users, highlighting the use of a specialized case management approach to address the clinical and psychosocial needs of this population. This program includes both a mobile case management team that fosters group discussions and provides individual counseling, and provision of medical consultations at 2 major drug treatment centers in Rio de Janeiro. The article also describes the experience of working with injection drug users who regularly attend an outpatient clinic serving marginalized communities through the use of mutual self-help groups and specialized support groups to address to issue of adherence to antiretroviral therapies for the treatment of HIV/acquired immunodeficiency syndrome. [ABSTRACT FROM AUTHOR]

BACKGROUND: Recent mortality profiles in Brazil show that circulatory diseases are the leading cause of death in Brazil. These disorders contribute to 34% of deaths, with 50% of those deaths occurring in people under 50 years of age, that is, in people who are still active in the workforce. We assume that the growing incidence of cardiovascular diseases has occurred as the globalization of Brazil continues and brings with it the associated health risk factors of modern lifestyles, including stress. AIM: This paper reports the evidence on the influence of stress in the development, onset and progress of cardiovascular diseases. We aim to define the concept of stress and to point systematically to the interrelationships between its emotional and bodily manifestations through a discussion of the history and study of stress. We then suggest that factors leading to the experience of stress in Brazil are no different than in any other modern nation. We further offer a perspective on nursing interventions currently undertaken in Brazil in both hospital and community settings, with their more recent emphasis on health promotion and prevention. METHODS: An extensive literature review was undertaken. The data presented here were selected from reviews and clinical studies described in MEDLINE, LILACS, SciELO databases, as well as in the classical literature. We also refer to the current Brazilian literature on the prevalence of cardiovascular diseases and their associated risk factors. CONCLUSIONS: The incidence of cardiovascular diseases in Brazil is rising. Because of the globalization of Brazilian society, with its consequent competitiveness and accelerated modern lifestyles, Brazilians are no less immune to the usual health risk factors associated with cardiovascular diseases. Stresses associated with a modern lifestyle, however, are emerging as a new and major risk for developing cardiovascular diseases in Brazil. [ABSTRACT FROM AUTHOR]

This paper compares anti-hookworm campaigns conducted in the early twentieth century in France, Germany, Brazil and West India. The populations that suffer from hookworm are not identical in the North and in the South. In tropical and semi-tropical regions hookworm is mainly found among poor peasants and is related to lack of hygiene, while in temperate climates hookworm was a professional disease of miners, a highly organized professional segment. Nevertheless, major disparities in the pattern of hookworm control did not reflect the North-South divide, but a difference between campaigns. These aimed at the eradication of hookworm infection (Germany and West-India) and at alleviating the effects of this infection on populations (France and Brazil). Maps that represented the prevalence of hookworm mirrored the aims of the sanitary campaign in which they were used: eradication of parasitic worms versus the reduction of the handicap induced by these worms. In public health as well, representing is intervening. And vice versa: patterns of intervention shape representations. [ABSTRACT FROM AUTHOR]

In this paper, we propose an approach to investigate the hypothesis that the residential concentration of poverty affects health status more deeply than when poverty is randomly scattered in a given geographical area. To characterize the geographic pattern of poverty in the city of Rio de Janeiro, Brazil, an index that measures the heterogeneity of poverty concentration among sub-areas was proposed. We used census data and defined poverty by means of the household head monthly income. The 153 neighborhoods that compose the city were used as the geographic units, and the census tracts as the sub-areas. The proposed index measures differences of poverty concentration across census tracts within a neighborhood. The effects of geographic poverty clustering on infant mortality related variables (early neonatal mortality rate; post-neonatal mortality rate; proportion of adolescent mothers; and fertility rate among adolescents) were estimated by partial correlation coefficients, controlling for the neighborhood poverty rate. Our study revealed that intra-city variations of the post-neonatal mortality rate are associated with geographic patterns of poverty, and that pregnancy in adolescence is strongly and contextually correlated with intra-neighborhood poverty clustering, even after adjustment for the poverty rate. The evidence of relevant health differences associated with the spatial concentration of poverty supports the hypothesis that properties of the environment of residence contextually influence health. Our findings suggest that prevention of some infant mortality related problems has to be focused directly on features of communities, considering their physical, cultural and psychosocial characteristics, being of particular concern the health of communities segregated from the society at large by extreme poverty. [Copyright &y& Elsevier]

Background: Pathways to care are actions and strategies employed by individuals in order to get help for health-related distress and the related processes of care providers. On several systematic reviews regarding pathways to mental health care (PMHC), studies regarding South American countries were not present. This review synthesizes qualitative and quantitative research about PMHC in Brazil. Methods: LILACS, MEDLINE and SCIELO databases were searched for papers regarding PMHC in Brazil. The results were organized in pathway stages, based on Goldberg and Huxley's 'model of Levels and Filters' and on Kleinman's framework of 'Popular, Folk and Professional health sectors'. Analysis also considered the changes in national mental health policy over time. Results: 25 papers were found, with data ranging from 1989 to 2013. Complex social networks were involved in the initial recognition of MH issues. The preferred points of first contact also varied with the nature and severity of problems. A high proportion of patients is treated in specialized services, including mild cases. There is limited capacity of primary care professionals to identify and treat MH problems, with some improvement from collaborative care in the more recent years. The model for crisis management and acute care remains unclear: scarce evidence was found over the different arrangements used, mostly stressing lack of integration between emergency, hospital and community services and fragile continuity of care. Conclusions: The performance of primary care and the regulation of acute demands, especially crisis management, are the most critical aspects on PMHC. Although primary care performance seems to be improving, the balanced provision and integration between services for adequate acute and long-term care is yet to be achieved. [ABSTRACT FROM AUTHOR]

: This paper is a country case study for the Universal Health Coverage Collection, organized by WHO. Mauricio Barreto and colleagues illustrates progress towards UHC and its monitoring and evaluation in Brazil. Please see later in the article for the Editors' Summary [ABSTRACT FROM AUTHOR]

In 1988, a new Constitution was adopted in Brazil in which guidelines for community participation in the development and implementation of the national health system were delineated. The health and welfare of women and children were given priority. Implementation of these guidelines presents a major challenge in a city such as São Paulo with a population of 15 million, of which an estimated 5.8 million are women of childbearing age. In order to determine the extent to which community organizations are actively participating in planning health services for women and children in São Paulo, a study was undertaken to examine the experience of community and professional organizations in public health advocacy. This paper describes a sample of these organizations, their constituents, membership, history, funding, advocacy objectives, and strategies used and results obtained. The information gathered indicates that the community organizations are involved in activities that include major efforts to improve access to health care by providing specialized courses in women's health, including the status of women's work, sexuality, discrimination, family planning, and the politics of health; publishing newsletters; producing radio programs; engaging in legal action; and using petitions, demonstrations, and public meetings to garner public support on specific issues. [ABSTRACT FROM AUTHOR]

This article explores the mobilization of power by health workers during policy implementation, showing how in a context of discretion and resource scarcity they can reproduce inequalities in access to health services. The argument innovates theoretically by supplementing the 'street-level bureaucracy' literature, which emphasizes frontline worker discretion, with a conceptualization of power as domination encompassing the shaping of behavior, the constitution of subjects and the reproduction of inequality. Empirically, the article focuses on Brazilian community health workers (agentes comunitários de saúde , CHWs). CHWs are a neglected but highly important segment of the health workforce that traditionally functions as a link between the health system and disadvantaged groups. The article examines how Brazilian CHWs act as street-level bureaucrats mobilizing power in their interactions with users. They operate within a severely under-resourced public health system, the Sistema Único de Saúde , which places constraints upon their action and forces them to make allocation decisions with little training and support. The article highlights the ways in which inequalities in access to health services are reproduced (inadvertently or not) through the practices, discursive styles and classifications of CHWs. Methodologically, the paper is based on ethnography with 24 CHWs and interviews with 77 other CHWs in Brazil. • Develops a novel framework for analysing health worker discretion and power. • Supplements the street-level bureaucracy approach with the concept of domination. • Explores the mobilization of power by Brazilian community health workers. • Shows how policy implementation can reproduce inequality in access to healthcare. [ABSTRACT FROM AUTHOR]

Objectives. This paper measured the extent to which human immunodeficiency virus (HIV) infection has spread among the male working-class population of Santos, Brazil. Methods. Questionnaires on risk behaviors and blood tests were administered to a random sample (n = 395) of male port workers employed by the Santos Port Authority. Results. Although the rate of HIV infection among these men--the working-class male population of Santos--remains low (1.1%), self-reported behavioral risks for HIV infection are common. Conclusions. There is still time to prevent a widespread outbreak of HIV infection among the heterosexual population of Santos and of the transportation corridors emanating from that city. [ABSTRACT FROM AUTHOR]

Chikungunya Virus (CHIKV) is a well-described alpha virus that causes infection in humans. The main symptoms are fever, rash and arthralgia and recently neurological disorders have been reported, in particular encephalitis. It is uncertain whether neurological symptoms are due to persistence of the virus or an ineffective immune response. One rarely described neurologic syndrome is myositis. In this paper, we report the case of a 19-year-old woman with mental confusion and aggressiveness two days after complaints of fever and arthralgia. On clinical evaluation, the patient had power 5/5 in the upper limbs and 3/5 in the lower limbs. Electromyography revealed the presence of myogenic potentials with reduced amplitudes and early recruitment predominantly in the proximal muscle. Two weeks later, she complained of muscle weakness of the lower limbs that started 15 days after acute Chikungunya infection. The patient improved within two months with only supportive care. [ABSTRACT FROM AUTHOR]

The author talks about challenge of health inequality in Brazil and progress made in the same field. Topics discussed include a paper showing non-communicable diseases as more common in people of lower social position, implementation of the Brazilian Unified Health System that has eliminated inequalities and need of development of systems to monitor health inequalities and social determinants.