Abstract: In developing countries, such as Brazil, the progressive growth of Acute Coronary Syndromes (ACS) is a source of concern within the health system, as they can cause high costs to public coffers, compromising pre-established development goals. The basis of good practices in relation to Acute Coronary Syndromes, in a broad and specific way, enables the development of prevention and health promotion management. Furthermore, this research is responsible for analyzing the epidemiology and spatio-temporal distribution of Acute Coronary Syndromes in a cardiology reference hospital in the State of Pará. This is a quantitative, descriptive, analytical cross-sectional study, with cohort characteristics hospital retrospective. The study was carried out in the Acute Coronary Syndromes Registry Sector of the Medical Archive and Statistics Service (SAME) of the Fundação Hospital de Clínicas Gaspar Vianna, located in the State of Pará. During the years 2018 to 2020 there were a total of 6.026 cases of Acute Coronary Syndromes, of which 904 were considered Unstable Angina and 5122 were Acute Myocardial Infarction. The present study verified a heterogeneous spatial distribution of SCA, where the Metropolitan mesoregion of Belém and the Northeast of Pará had higher incidence rates during the study period. It was found that prevalence rates varied independently of the Human Development Indexes of each municipality during the study period. The results found are relevant for understanding the epidemiological scenario and spatial distribution of SCA in the state of Pará.

Health Literacy translates into skills to access and use health information and services.
Health Literacy subsidizes decision-making, generating autonomy and motivation for the
individual. It represents the skills to exercise critical judgment of health resources and
information, in addition to the communication and interaction skills to express social
needs for health promotion. Education in and for health is related to Literacy, favoring
reflections on the interrelationship with educational health training policies, in which all
workers in higher education institutions play a leading role in transforming teaching into
a professional practice of assistance provided to the population. Objective: To evaluate
the health literacy conditions of professors linked to the Institute of Health Sciences at
the Federal University of Pará. Methods: analytical cross-sectional study developed at
the Institute of Health Sciences of the Federal University of Pará in the Amazonian
municipality of Belém do Pará. The validated Brazilian version of the Health Literacy
Questionnaire was applied to analyze the Health Literacy of professors linked to the
institute, in addition to a sociodemographic questionnaire. The data was descriptively
arranged and the association tests was performed statistically using the SPSS software.
The product of this analysis originated the scientific paper titled: Health Literacy
potentials and weaknesses of teachers linked to a health institute in the Amazon. The
questionnaires were applied to 109 teachers. The main potentialities identified were in
relation to the evaluation of health information and understanding of information. 

Regarding limitations, difficulty was observed in actively managing health and
navigating the health system. A statistically significant difference was found in white
and non-white groups regarding dimensions 8 and 9 of the HLQ, in addition to time in
the institution and COVID-19, in addition to other diseases. Final considerations: This
study allowed greater visibility regarding the panorama of professors in the northern
Amazon of Brazil, generating subsidies to discuss new training and teaching strategies to
strengthen HL in health education and mitigate health inequities.
Keywords: Health Literacy, Universities, Faculty.

Introduction: In March 2020, the World Health Organization declared the Coronavirus Disease 2019 (COVID-19) pandemic. In Brazil, lethality in children and adolescents reaches 8%, one of the highest rates in the world, and factors increase the risk of death, such as being infants under 1 year of age, being a resident of the North and Northeast regions and/or be indigenous. Objective: To analyze the factors associated with neonatal hospital mortality due to severe acute respiratory syndrome (SARS) due to COVID-19 in the Amazon. Method: A retrospective cohort of SARS cases due to COVID-19, reported in the Influenza Epidemiological Surveillance Information System, was carried out from March 11, 2020 to May 5, 2023, where data from newborns from the federative entities in the Northern region of Brazil, located in the Amazon. Microsoft Excel 2017 software was used to enter data and BioEstat 5.3 software was used to carry out descriptive analyzes and hypothesis tests. Results: The sociodemographic profile of the cases included in this research was composed of newborns of both sexes, mostly of mixed race and from urban areas, with an average age of 7 ± 8.12 days of life. The clinical profile found was cases with an average time from symptom onset to hospitalization of 5 ± 9.22 days, with the highest occurrence of comorbidities categorized as “other”, which did not require ICU admission and did not use ventilatory support. Most mothers were not vaccinated, but breastfed. The cure outcome was greater than death, with a statistically significant difference. The risk factors associated with death were early neonatal age, needing ICU admission and using ventilatory support. Having “other” comorbidities was associated with cure. Final considerations: This cohort showed that the factors associated with neonatal mortality due to SARS due to COVID-19 were age and severity of the disease, through the association of death with early neonatal cases, with admission to the ICU and with the use of ventilatory support.

Objective: To determine the prevalenceof Arterial Hypertension in people aged 18

years and older, of both sexes, from quilombola communities in Salvaterra-Marajó-
Pará, in Eastern Amazon. Methods: Community-based cross-sectional study in 15

remaining quilombola communities in the municipality of Salvaterra-located on
Marajó Island, Pará. The proportional stratified sample with a sampling error of 6%,
CI=95%, and na increase of 20%, totaled 240 households. In each home, na average
of 2 people aged 18 years and older were selected to be interviewed, observing a
minimum sample of 571 people, and a final sample of 741 individuals. The household
survey took place in June-July/2021 and a standardized questionnaire, blood
pressure check, and anthropometric assessment (weight and height) to calculate BMI
and waist circumference were utilized for said objective. Arterial hypertension was
admitted in cases of self-reported hypertension and/or use of antihypertensive
medication and/or systolic blood pressure ≥140mmHg and/or diastolic blood pressure
≥90mmHg. Results: The prevalence of Arterial Hypertension was 37.2% and that of
new cases was 16.3%, with no statistical difference in relation to gender, marital
status, race/self-declared black/brown color and quilombola self-definition.
Participants with SAH are older, have less education, are more likely to deny their
quilombola ancestry, are more likely to be in the economically active population and
in the self-employed group. Diabetes, Acute Myocardial Infarction, Angina, Stroke,

overweight/obesity, high Abdominal Circumference (≥80-Women/≥94-Men) and self-
perceived poor or very poor health status were associated with SAH in these

communities. As for the Prevalence Ratio (PR), it was found that age between 18
and 24 years is a protective factor, with approximately 2% less chance of having
SAH; up to 8 years of study are 2 times more likely to have SAH; being economically
active is a protective factor for the prevalence of hypertension, with 3% less likely to
have hypertension; obesity (≥30Kg/m2) are 2 times more likely to have SAH; and
abdominal circumference ≥80-Women/≥94-Men are 2 times more likely to have SAH.
Conclusion: The Quilombola Katuana showed a high prevalence of SAH in the
quilombola communities of Salvaterra-Marajó-Pará, with a predominance of
individuals aged 45 years and over, less study time, greater chance of denying
quilombola ancestry, greater probability of being in the economically active
population and in the self-employed group. In the study, it was identified that
Diabetes Mellitus, Acute Myocardial Infarction, Angina, CVA, obesity, centripetal
obesity and self-perception of fair and poor/very poor health status were associated
with SAH in these communities.

Objective: To evaluate Paulo Freire's Culture Circles as a health education strategy for self-care management in individuals with Diabetes Mellitus (DM). Method: A clinical trial with a simple random sample was conducted in two districts of Belém-PA in the Eastern Amazon, comprising individuals aged 30 years and older with type 2 diabetes (DM2), of both genders. The intervention group (IG) was selected from district 1, and the control group (CG) from district 2. Six Culture Circles (CC), based on Freire's conception, were conducted with 7 groups. A household survey included the application of a sociodemographic questionnaire and the  Summary of Diabetes Self-Care Activities Questionnaire (SDSCA, blood pressure measurement, and measurements of weight, height, and waist circumference (WC), as well as the collection of samples for lipid tests, HbA1c, fasting blood glucose, and microalbuminuria. The measurements were repeated 4 months after the CC. Results: The sample consisted of 61 participants in the IG and 101 in the CG, similar at baseline. The majority were women, self-identified as black/mixed-race, married or in a stable relationship, with a mean age of 62.5 and 61.3 years, and an average education duration of 9 and 6 years, respectively. Over 60% belonged to economic strata D-E, with a per capita income of up to half the minimum wage. In the IG, after the CC, there was an adherence to self-care, as observed through the QAD items: reduction in the consumption of fats, red meat, and dairy products, and an increase in the consumption of fruits, vegetables, and the drying time between toes. Furthermore, a reduction in HbA1c, microalbuminuria, BMI, weight, WC, and an increase in HDL-c were observed. The IG showed an increase in days engaged in physical activity and drying between toes, as well as higher HDL-c levels and lower microalbuminuria compared to the CG, which increased the consumption of sweets compared to the IG. Conclusion: The Culture Circles stimulated critical thinking through the problematization of lived situations, leading to adherence to self-care practices related to diet, physical activity, and foot care, resulting in a reduction in HbA1c and microalbuminuria, as well as an increase in HDL-c levels.

Quilombo communities are social groups whit social and historical identity
distinct from the rest of the Brazilian society do to the ancestral enslavement experience.
This identity is the basis for their forms of organization, their relationships with other
groups and their political actions. The way in which these social groups define their own
identity is the result of a sum of factors which include a common African ancestry, forms
of political, social and land tenure organization, linguistic and religious elements.
The objective of this work is to carry out a research to evaluate the dental mortality rate
of the adult population in the quilombola communities of Africa and Laranjituba, in the
state of Pará. The methodology adopted is an analytical and cross-sectional population-
based study, the methodological procedures used in the research have a quantitative
character, with the use of primary and secondary data. Primary data will be collected
through field work, application of questionnaires and oral exams, identifying the main
socioeconomic problems and vulnerabilities of the individuals and communities. It is
noteworthy that oral health plays a key role in people's general health and quality of life.
The impairment of oral conditions can affect the nutritional level, physical and mental
well-being, as well as negatively interfere in people's social lives. In view of this
scenario, there is a need to identify the oral health problems which have as an
outcome dental mortality in the adult population of the quilombola communities of
Africa and Laranjituba, and to recognize these weaknesses to enable the adoption of
public policies that address the right to full health access to health care.

This is research with a qualitative approach from a bioanthropological and collective health perspective
involving mother-infant dyads of high and low socioeconomic status (SES) in the municipality of Belém, 

Pará, with the objective of understanding the challenges brought by the pandemic of Covid-19 in the self-
care of pregnant and puerperal women, the impacts on parental care in the puerperium and which strategies
are most commonly used by women during this special period. Different socioeconomic strata are analyzed
to identify the self-care conditions considered necessary by women in the pregnancy period, as well as
baby care during the puerperium in the midst of a pandemic. The research is part of a larger study to
understand the formation of the infant gut microbiome in the Amazon, which coincided with the peak
period of the pandemic in the country. A protocol was then developed considering all international
epidemiological recommendations, using face-to-face interviews, when possible, and also online, with
mothers of babies in the first two months of life. Data collection took place between July 2021 and March
2022, in order to allow a comparison between the practices developed by mothers from different SES to
deal with the challenges of pregnancy, childbirth and the puerperium during the pandemic. It was observed
that the mothers encountered difficulties in social interaction, in helping family members, in prenatal care,
in income, in consultations in their pregnancy-puerperal period in the midst of the Covid-19 pandemic, but
they found some ways to alleviate difficulties reported with use of means of communication such as E-
mail, WhatsApp, Instagram and Youtube for consultation, information and to earn some income. This
study offers an overview of how the height of the pandemic affected mothers and babies from different
SES in Belém and how they reacted, and may contribute to the planning of public policies aimed at
maternal and childcare during periods of prolonged crises, such as epidemics and pandemics.

The present study, entitled EXPERIENCES OF TEACHERS IN HOSPITAL CLASSES
IN BELÉM/PA, aims to analyze how experiences with students/patients affect teachers
who work in Hospital Classes in Belém/PA. The Hospital Class exists due to medium
and long-term hospitalizations, with the teacher having to deal with feelings involved in
the affection/education/life/mourning phenomena. Presence and absence are perspectives
to be considered daily in this teaching, in particular. Just as healings take place, partings
are also present occurrences. In this sense, Hospital Education, in addition to pedagogical
work, involves a whole context of affections experienced by professors in their
relationship with students/patients who fight for a cure for an illness. The work in
question is a qualitative research, with a descriptive character, having as participants
teachers who work in Hospital Classes for at least two years, in Institutions that have this
space in the city of Belém/PA. The organization and analysis of data was performed
using Content Analysis. In terms of results, the interviewees demonstrated that entering
the hospital class represented a major challenge in their career, whose initial training
does not contemplate the reality found in hospital classes, and considering that this space
differs greatly from the regular class. It was also found that affectations are common in
this context, however the level of affectation and the respective results have to do with
the professor's profile and his availability to live the Hospital Class experience. The
research made it possible to perceive that the reality found by the teachers in the Hospital
Classes – above all the context of illnesses, suffering, losses – raises different feelings in
them, which is why staying in this context required a lot of courage to achieve the

Introduction: Patients with severe to profound hearing loss are indicated for treatment
with a Cochlear Implant (CI) that allows the improvement of hearing levels to values
close to those of a normal listener. However, it is essential to have post-cochlear implant
follow-up to carry out the activation of the implanted electrodes, adjustments, when
necessary, stimulus programs and auditory training, so that the treatment successful.
Objective: To analyze assistance to cochlear implant users in a Reference Hospital in the
North region of Brazil. Methodology: This is a quantitative and descriptive cross-
sectional study referring to cochlear implants performed at the University Hospital
Bettina Ferro de Souza from January 2011 to December 2021, whose sample will be
collected from medical records of patients aged 18 years to over 60 years old (72) data
obtained from the system of the outpatient monitoring unit, Sector of Regulation and
Health Assessment and database of the Cochlear Implant program. For the application of
the study, a specific form was used. And the data will be stored in a bank in Microsoft
Excel 2007® spreadsheets, and later interpreted and presented in the form of tables and
graphs. Statistical analysis will be descriptive performed in the statistical program Epi
Info® version 7.4.2.0, considering measures of central tendency and dispersion, as well
as relative and absolute frequencies Result: it was identified that in the period from 2011
to 2021 the largest number of procedures occurred in the year 2015, with the highest
costs, with most CI performed in young adults n=46.9 years (± 14.9%) male n=44
(50.5%), brown n=74 (85%), with 9 years of study n=13 (14.9%), being Belém the
municipality with the highest number of implanted. Furthermore, the patients who
received the implant did not regularly undergo consultations with the multidisciplinary
team and speech therapy. Also, it is worth mentioning that not all speech therapy
equipment in the program was complete and functioning in accordance with the
ministerial ordinance. Conclusion: In this study, it was possible to know how the
assistance to users after cochlear implantation is carried out in the last 10 years in a
reference service in the northern region. With regard to the organization of the service,
the investments transferred, the profile and monitoring of users. The collected data can
contribute to reduce the barriers and limitations faced by users, as well as to carry out the
organization of the network in terms of referral and access by the population to services;
, expansion of agreements between municipalities, increased dissemination of the
reference service; adaptations of multidisciplinary teams, active search for absent users,
better management of resources, in addition to the improvement of public policies that
favor the proper functioning of the auditve health care network

Sexual violence is a public health and social problem with implications for
security and access to justice, which can occur in different cultural and
socioeconomic contexts, with meaning encompassing whatever the attempt or
acts carried out against another person's sexuality. In Brazil, the development of
the Notifiable Diseases Information System allowed obtaining data on this type
of violence in underexplored populations, such as the indigenous population that
became the object of study in this research. The objective was to analyze the
evolution of notifications of cases of sexual violence against the indigenous
population in Brazil according to the database of the Notifiable Diseases
Information System in the period from 2009 to 2018. A descriptive and ecological
time series study was developed with 2361 notifications of sexual violence 

against the indigenous population, with data collected from the TABNET platform
and analyzed using Microsoft Excel Software and Epi Info Software. The result
showed that there was an increase in notifications and reporting locations in the
country and that the victims were mostly women (93.4%), aged between 10 and
19 years (52.4%), with low education, being rape is the most perpetrated type of
violence, most frequently caused by known perpetrators and against these
women in more than 90% of occurrences, commonly taking place in their homes
(57.7%). The aggressors were men (90.7%), in adulthood, with whom they
reported intimate and family contact in 34% of the notifications and with
repetition of violence being related to this proximity between the parties, having
no relation to the use of alcohol in 42.6% of cases. The study recommends
investments for the expansion of notification services in the country, promotion of
permanent education and the creation of intersectoral public policies to combat
sexual violence and sensitive to indigenous autonomy and rights.

Introduction: Diabetic peripheral neuropathy is among the most common complications of type 2 diabetes mellitus, according to the progression of the disease, there may be a gradual loss of protective sensation in the skin and joints of the foot, increasing the risk of injury. This study aims to verify whether socioeconomic and health risk factors, as well as self-care, influence the level of foot neuropathy in patients with type 2 diabetes. 2 without neurological diseases randomly selected in two FHS units in the city of Belém-PA. The Michigan Neuropathy Screening Instrument questionnaire was applied to define the presence of diabetic neuropathy. Descriptive analysis was performed considering means and standard deviation for variables with normal distribution and median and 95% confidence interval for variables with non-normal distribution. The chi-square test was applied to identify the difference between the groups considering the presence or absence of diabetic neuropathy, then binary logistic regression and multivariate logistic regression were applied to verify the predictor variables of diabetic neuropathy. Statistical significance considered p-value ≤ 0.05 and 95% confidence interval. Result: The prevalence of diabetic neuropathy according to the MSNI was 66.6%. The presence of neuropathy is associated with sex, dyslipidemia and increased microalbuminuria. Logistic regression analysis revealed that male subjects, increased BMI and HDL levels were significantly associated with diabetic peripheral neuropathy. Conclusion: The prevalence of diabetic peripheral neuropathy in the population studied was high, and significantly associated with men, and with an increase in BMI and HDL.

Objetivo: Avaliar a sobrevida, preditores e mortalidade em indivíduos com Infarto Agudo do Miocárdio com Supradesnivelamento do Seguimento ST (IAMCSST) e Síndrome Cardiorrenal Tipo 1 (SCR1) de acordo com fatores sociodemográficos e clínicos na Amazônia Oriental. Método: Este é um estudo observacional, retrospectivo, de caso controle, com análises descritivas e inferenciais. Foram avaliadas duas populações de pacientes com IAMCSST (n = 683) e com Insufucuência Cardíaca Aguda (ICA) (n = 183) com idade> 18 anos internados no período de janeiro de 2017 a maio de 2021 em um hospital público referência em nefrologia e cardiologia. Os pacientes foram categorizados em dois grupos, na população com IAMCSST: os que sobreviveram (n = 646) e os que foram a óbito (n = 37); na população com ICA os com SCR1(n = 72) e os sem SCR1 (n = 111). Resultados: Os pacientes com IAMCSST que tiveram maior chance de mortalidade foram frequentemente os mais velhos (G1: 61,58 ± 10,74 anos; G2: 69,57 ± 9,02 anos; t = -4,492; P = 0,001), com classificações Killip III-IV (OR = 0,13; IC 95% = 0,02–0,71; P = 0,03) e com doenças como insuficiência cardíaca (OR = 0,07; IC 95% = 0,004–1,50; P = 0,168) ou insuficiência renal (OR = 0,03; IC 95% = 0,006– 0,16; P = 0,0001). Além disso, sexo feminino (taxa de risco = 2.073; IC 95% = 1.413–5.170), classificações Killip III-IV (taxa de risco = 4.041; IC 95% = 1.703–18.883) e a presença de insuficiência cardíaca (taxa de risco = 34,10; IC 95% = 4,41–263,68) ou insuficiência renal (hazard ratio = 14,27; IC 95% = 3,27–62,25) influenciaram na redução da sobrevida hospitalar. Já dos pacientes com ICA, 72 (39,3%) deles apresentaram SCR1, e 33 (16,6%) evoluíram com Insuficiência Renal Aguda (IRA) dialítica. Identificou-se prevalência da Insuficiência Renal Crônica (IRC) (p = 0,003), hipertensão não controlada (p = 0,005), não adesão alimentar/hídrica (p = 0,043), idade avançada (p = 0,004) e elevação da PA sistólica (p= 0,021) no grupo com SCR1. Dos fatores de descompensação que contribuíram para o agravamento da ICA, apenas a não adesão alimentar/hídrica foi considerada preditora para SCR1 (p = 0,003; OR = 81.45; IC95%: 4,38 – 1513,13). Estes fatores não foram considerados preditores de letalidade intra-hospitalar, sendo apenas identificado como fator a IRA dialítica nestes pacientes (p = 0,010; OR = 15,5; IC95%: 1,93 – 124,35). Conclusões: As análises feitas com indivíduos diagnosticados com as doenças cardiovasculares estudadas (IAMCST e ICA/SCR1), e fatores sociodemográficos e clínicos, forneceram resultados relevantes para a compreensão epidemiológica do comportamento das doenças no segmento populacional da Amazônia Orinetal. O que pode contribuir para gerar evidências, basear e fortalecer políticas públicas, reestruturar estratégias para a execução de serviços de saúde e promover assistência cardiológica de qualidade.

Objective: First, to investigate the association between sociodemographic and organizational
factors of oral health services and mortality from oral and oropharyngeal cancer. Then, analyze
the evolution of time to treatment initiation of these neoplasms, according to sociodemographic,
socioeconomic, clinical and therapeutic factors. Method: Initially, an ecological study was
designed that investigated deaths caused by oral and oropharyngeal cancer, from 2000 to 2019.
Mortality rates were standardized and compared between age groups, sex and regions. The
association between variables related to oral health services and mortality was analyzed with
correlation tests. The survival analysis considered the race/ethnicity variable and included
Kaplan-Meier estimates, Log Rank tests and Cox regression. Then, another ecological study
was carried out with the time to treatment initiation as the study’ object, based on secondary
data from the Hospital Cancer Records. To identify the association between time and the
variables evaluated, Kruskal-Wallis and Wilcoxon tests were used. To assess the temporal
trend, the Spearman correlation test was used. Results: As for mortality, rates increased with
age and were higher in men. The South and Southeast regions had the highest rates for men,
and the Northeast and Southeast regions for women. Men, black individuals and residents of
the South Region were more associated with death. The correlation of oral health teams
coverage was high and negative, while for the number of dental specialty centers and soft tissue
biopsies, the correlation was high and positive. Regarding the time to start treatment, in both
cancers there was a tendency to increase, longer intervals in individuals over 39 years of age,
in individuals considered black, brown and indigenous, in those with a level of education < 8
years, in residents of the North, Southeast and Northeast regions, in those in staging III and IV
and in those submitted to radiotherapy first. Conclusions: Mortality and survival patterns of
individuals with oral and oropharyngeal cancer are associated with sociodemographic factors
such as sex, age, geographic region and race/ethnicity. Furthermore, preventive procedures
have not been widely performed. Likewise, the time to treatment initiation is associated with
sociodemographic, socioeconomic and clinical factors, it is suggested that due to technological
advances in diagnosis and treatment, the organization of cancer network points and
socioeconomic and geographic barriers, reflexes of the Social Determinants of Health.

Visceral leishmaniasis is an emerging zoonosis with wide distribution in countries with tropical and subtropical climate. It is considered a disease neglected by the WHO and has a worldwide distribution, reaching about 50 to 90 thousand individuals per year. It has expanded and urbanized, and its transmission and expansion are associated with several factors. In Brazil, it has great relevance in public health, with high rates of incidence and lethality. Therefore, this study aims to describe the epidemiological profile of patients with Visceral Leishmaniasis in the state of Pará in the period from 2010 to 2019. It will be a described and retrospective study. The study will be developed from information contained in the database on the Diseases and Diseases Notification System (SINAN) provided by the Pará State Department of Public Health (SESPA) and by the Epidemiological Surveillance Center of the João de Barros Barreto Hospital. The inclusion criteria will be: all cases of VL notified with an Individual Notification Form (FNI) confirmed and closed at SINAN in the state of Pará in the period 2015-2019. And as an exclusion criterion: cases with incomplete Individual Notification Form for Visceral Leishmaniasis or with inconsistent data. This study will make it possible to add new knowledge about this pathology, analyze the triggering factors, the evolution, as well as generate results that can subsidize effective actions in public health to control and prevent the disea

In Brazil, the pandemic of COVID-19 has presented high incidence and mortality rates,
placing the country in the first places in number of cases and deaths in the world. In the
population of pregnant and postpartum women, mortality is possibly affected by
characteristics inherent to physiological adaptations in the maternal organism, by the presence
of comorbidities, and by delays in receiving adequate health care. The study aimed to analyze
which are the risk factors associated with mortality by COVID-19 in women in the gravidic-
puerperal cycle, compare the results between survivors and non-survivors, distributed
between the years 2020 and 2021, and evaluate the spatial distribution of the number of
deaths. Secondary analysis of the Influenza Epidemiological Surveillance Information System
- SIVEP-Gripe database was performed. Pregnant and postpartum women hospitalized with a
diagnosis of Severe Acute Respiratory Syndrome caused by COVID-19 and notified in the
period from February 26, 2020 to July 25, 2021 were included. Demographic data, clinical
characteristics, intensive care resource use, and and case outcomes (cure and death) were
collected. Statistical analysis was performed using the Statistical Package for Social Science,
version 21 software and the Whitney-Mann, Fisher, and Chi-square tests. A total of 1. 685
deaths and multivariate logistic regression showed that for the obstetric population in Brazil
the main risk factors for death caused by COVID-19 were (OR/ 95% CI) being young under
the age of 35 years (1.03/ 0.98-1.05), being postpartum at the time of notification (2.46/ 1, 84-
2.60), have obesity (1.42/ 1.11-1.83) as comorbidity, followed by cardiovascular disease
(1.12/ 0.76-1.65) and diabetes (1.03/ 0.94-1.05), have been admitted to intensive care unit
(2.13/ 1.56-2.90) with non-invasive (8.82/ 5.32 -14.61) and invasive (2.90/ 1.82-4.63)
ventilation support. Being of the race/color white was shown to be a protective factor (0.58/
0.34-0.99). The spatial distribution of deaths was concentrated in municipalities within 100
km of the notifying unit (85.40%) and in the south-central region of Brazil (43.67%). Covid-
19 mortality in the Brazilian obstetric population is affected by clinical characteristics, but
social determinants and barriers to health care access also appear to play a role. There is an
urgent need to strengthen containment measures targeting the obstetric population and ensure
quality care throughout pregnancy and the puerperium.

Objetivo: Determinar a prevalência de (in)segurança alimentar e nutricional de comunidades quilombolas
marajoaras no período anterior ao início da imunização para COVID- 19. Método: Trata-se de estudo
transversal de base comunitária com abordagem familiar com amostra composta por 434 famílias,
desenvolvido em 15 comunidades remanescentes de quilombos, localizadas no município de Salvaterra,
ilha do Marajó-Pará. Foi realizado inquérito domiciliar para aplicação do questionário padronizado sobre
dados sociodemográficos e o questionário da Escala Brasileira de Insegurança Alimentar (EBIA). Foi
realizada a classificação em categorias segurança (S), insegurança leve (L), moderada (M) e grave (G), as
categorias leve e moderada foram associadas, resultando em 3 categorias. Para verificar a associação entre
as variáveis foi utilizado o teste de Qui-Quadrado de Pearson e teste Kruskal-Wallis. Resultados: Dentre
as 434 famílias entrevistadas, 88,9% estavam em insegurança alimentar e nutricional. Foram associadas a
insegurança alimentar de qualquer intensidade, o maior número de moradores na casa (S=3,0; L-M=4,0;
G=4,0), presença membros com idade ≤ 18 anos (S=;43,8% L-M=72,3%; G=72,2%) , baixa renda familiar
per capita (S=10,4%; L-M=23,1%; G=38,9%), estar no estrato econômico D/E (S=77,1%; L-M=93,4%;
G=96,5%) , além de receber bolsa família (S=68,3%; L-M=68,6%; G=79,9%) ou auxílio COVID-19
durante a pandemia (S=60,4%; L-M=67,8%; G=81,3%). O recebimento de aposentadoria foi associado
com segurança alimentar (S=56,3%; L-M=24,8%; G=20,8%) e Conclusão: A prevalência de insegurança
alimentar nas comunidades foi elevada, grave em 33,2%, moderada em 21,4% e leve 34,3%. Segurança
ocorreu apenas para 11,1%.

Excess weight has increased, especially among people from developing countries, at a very fast pace, a worrying situation due to its direct and consolidated relationship with chronic non-communicable diseases (NCDs), which are responsible for the increase in morbidity rates and mortality around the world. Given this scenario, it is evident the need at a global level to create, implement and monitor public policies for the prevention and combat of what is already considered an epidemic. The objective of this study is to assess the prevalence of overweight and obesity and associated factors in Brazil based on data from the 2019 National Health Survey. This is an observational cross-sectional study with secondary data and a population composed of residents in private households surveyed, aged 18 or over, from all over Brazil. Socio-demographic data such as gender, age, census status and income will be used, as well as nutritional status, based on the calculation of the Body Mass Index (BMI) and information about the presence of NCDs such as hypertension, Diabetes Mellitus, hypercholesterolemia and Cardiovascular Diseases.

Key-words:  Health Surveys; Overweight; Obesity; Noncommunicable Diseases.

With the many problems of oral health in the Brazilian population, it is necessary
to understand the conditions of access to dental services in order to analyze the dynamics
between the population and the oral health teams present in these services. The aim of this study was to identify access to oral health through data from the 3rd cycle of the PMAQ-AB. From the data obtained with the PMAQ-AB, in which an important indicator of dental access was monitored, the coverage of the first programmatic dental appointment was carried out, and data was collected regarding the service actions of the oral health teams working in the care primary health care, the population's main gateway to these services.

The variables related to Module VI ± Interview with the professional of the Oral Health
Team were used for the research. All external evaluation variables were stratified by the
adequate and inadequate access indicator. Subsequently, regression analysis was
performed using binomial logistic regression on the variables of each subdimension,
defining a 95% confidence interval (CI) in all analyses, where the odds ratios were
calculated in the crude and adjusted form, using a significance level of 5% (p < 0.05). The
greatest chance of access is with teams that are well integrated with the primary care team
to which they are linked and carry out planning, monitoring and evaluation actions, in
addition to offering scheduled clinical care and spontaneous demand, demonstrating the
coordination of care in the host and organized flow of users. Greater chances of access are
found in the teams that provide emergency clinical care and prescribe medication
prescriptions. Regarding the form of scheduling the first appointment, making
appointments through the reception of the UBS and the ACS increase the chance of access.
On the main flow to the host, the chance of access is reduced for users who arrive early
and queue up. By identifying factors associated with access to dental services in PHC, it
is possible to understand the need to implement and implement public policies aimed at
improving the work processes of teams to ensure access for all to oral health services.

Este estudo teve como objetivo analisar o potencial preditor de determinados
aspectos do processo de trabalho de equipes de NASF-AB sobre o desempenho destas.
Tratou-se de um estudo transversal de abordagem quantitativa, utilizando dados
secundários públicos, provenientes das respostas do módulo IV do 3º ciclo de avaliações
externas do Programa de Melhoria do Acesso e Qualidade da Atenção Básica (PMAQ-
AB) no Brasil. Em primeiro momento, foram calculadas frequências absolutas e relativas
dos dados referentes às variáveis selecionadas para representar o processo de trabalho
dos NASF-AB respondentes. Em seguida, as certificações recebidas pelas equipes foram
divididas em dois grupos: Melhor desempenho (Ótimo, Muito bom e Bom) e Pior
desempenho (Regular e Ruim). Por fim, foi realizada análise de regressão logística
bivariada para verificar o potencial preditor de cada aspecto do processo de trabalho e
atividades selecionadas em alcançar os melhores desempenhos. De 3960 equipes
participantes do estudo, 71,3% alcançaram certificações classificadas como “Melhor
Desempenho”. Equipes que refletiam sobre o próprio processo de trabalho, promoviam
atividades de educação em saúde, educação permanente e vigilância em saúde, atendiam
demanda espontânea, realizavam grupos terapêuticos e construíam projetos terapêuticos
singulares apresentaram maiores chances de ter um melhor desempenho. Os mecanismos
que levam ao aumento das chances precisam ser elucidados por meio de mais estudos.

Introduction: The ultra-neoliberal agenda present in Brazil from the 1990s onwards posed great difficulties for municipal managers in hiring health professionals for PHC, forcing them to increasingly opt for large-scale outsourcing in the SUS. The variety of precarious links offered by outsourcing produces work overload, high turnover, impacts on the health of the worker and reduces the resolution of PHC. This study started from this problem and compared the data found by nurses interviewed in the 3^rd cycle of the PMAQ-AB with the theoretical support of the labor sociologist Ricardo Antunes to obtain a more translucent analysis of the work of nursing in PHC in Brazil. Method: This is an evaluative, exploratory, descriptive research with a quantitative approach. Secondary microdata referring to the unfolding of the external evaluation research of the 3^rd cycle of the PMAQ-AB were used. The survey was conducted in 2017 and 2018 and has national coverage. Data from teams interviewed only by nurses as key informants in the external evaluation were analyzed, Module II – Interview with the health professional, distributed by region as follows: North Region (2,846), Northeast (13,389), Midwest ( 2,508), Southeast (11,516) and South (5,112). Teams where the questionnaire was not applied and where the nurse was not the key respondent were excluded. Data debugging was performed using Microsoft Office Excel 2016 Software and then transported to SPSS Statistics software (v.20, IBM SPSS, Chicado IL). Results: With the exception of the North Region (33.70%), all other regions had the statutory civil servant as the main respondent: South (66.20%), Midwest (56.50%), Northeast (40.33 %), Southeast (36.69). Temporary contract for the public administration and temporary contract for service provision had important participation in the Northeast (29.51% and 19.33%) and Midwest (16.03% and 17.86%). CLT contract and CLT employee in the APS had more expression in the Southeast (23.54% and 8.27%) and the South (5.93% and 19.31%). There was a predominance of direct administration as a contracting agent of nurses in PHC, therefore, in the Southeast, the participation of workers hired by OSS and other types of links in PHC was expressive. Only 48.7% of the nurses in the survey entered via public examination. The lowest percentages were observed in the North Region (34.36%), Northeast (40.94%) and Southeast (44.88%). Only 26.3% of nurses interviewed in PHC have a career plan, the lowest percentages were in the Northeast (17.2%), North (18.6%) and Southeast (27.3%). Final Considerations: The data reveal a trend of retraction of stable bonds for nurses in Primary Health Care in Brazil and the rise of temporary bonds for commissioned positions, via the Consolidation of Labor Laws, among others that suggest a scenario of informality in these services. The new flexible relationships of work, working hours and remuneration, established by temporary contracts, without stability, without registration, in jobs inside or outside a physical space, announce what Ricardo Antunes calls the new morphology of work. This social phenomenon harmful to the SUS and to the nursing worker, produced in this phase of financialized capital, fulfills the role of self-worth of capital through the exploitation of a surplus workforce, not only in the private sector, but also in the state sphere. Breaking this logic requires a new morphology of forms of organization of nursing workers capable of stopping the ultra-neoliberal offensive and guaranteeing advances such as the regulation of the minimum wage and working hours for the category, social justice and democracy.

Uma vez hospitalizado, o paciente passa por momentos de tensão emocional, os quais
dificultam a sua recuperação. Trata-se de uma mudança na rotina, no ambiente físico e social,
que afeta os seus afazeres diários. Inserida no contexto da humanização hospitalar, a terapia
por meio da leitura tem por objetivos diminuir a sensação de isolamento, aliviar o estresse e as
tensões diárias, ajudar a lidar com sentimentos de raiva, frustração e angústia, facilitar a
socialização, estimular a criatividade e a imaginação, incentivar o hábito da leitura e
proporcionar momentos de alegria, lazer e bem-estar. A biblioterapia é especialmente
indicada para indivíduos de qualquer idade, que permanecerão hospitalizados por longo
período de tempo, afastados de seu ambiente familiar. O objetivo desse estudo foi identificar e
analisar as produções científicas publicadas e indexadas sobre a prática biblioterápica no
ambiente hospitalar. Trata-se de uma revisão integrativa da literatura, com abordagem
qualitativa, na qual delimitou-se a seguinte pergunta: quais as evidências científicas sobre a
contribuição da biblioterapia para o cuidado humanizado em saúde? A busca dos dados foi
feita nas bases BVS, Portal de Periódicos da Capes, SciELO e BRAPCI, valendo-se dos
descritores: biblioterapia, pacientes internados, unidades hospitalares, humanização da
assistência. Foram considerados os artigos publicados no período de 2005 a 2021. Após
análise, as publicações selecionadas foram discutidas de acordo com quatro categorias: fonte
de lazer, aprendizagem e informação; bem-estar físico, mental e emocional; melhora na
comunicação e no relacionamento entre o paciente e a equipe multiprofissional e
humanização do cuidado ao paciente. Os resultados evidenciaram os benefícios e a
importância da prática biblioterapêutica desenvolvida com pacientes hospitalizados e seus
acompanhantes. A biblioterapia funciona como atividade recreativa para esses sujeitos, mas
também demonstrou ser fonte de conhecimento e aprendizagem. A contação de histórias é
capaz de educar crianças, ensinar-lhes valores humanos, bem como promover a ampliação do
universo cultural. Quando a biblioterapia se utiliza de jornais e revistas, permite a atualização
do indivíduo acerca dos acontecimentos do mundo. A biblioterapia incentiva a leitura, prática
que está diretamente ligada ao conhecimento, uma necessidade indispensável para
humanização e o equilíbrio social. Foi observado que a biblioterapia proporciona bem-estar,
uma vez que durante as sessões as pessoas deixam de lado suas preocupações, tiram o foco da
doença e dos problemas que estão passando, compartilham seus sentimentos, passam a se
socializar e se relacionar melhor com as pessoas e, principalmente, com a equipe
multiprofissional. De modo geral, observa-se que a leitura auxilia positivamente na
recuperação da saúde. Diante disso, fica a reflexão acerca da relevância da prática
biblioterapêutica nos hospitais públicos, a qual deve ser vista como um complemento a outras
terapias, que além de trabalhar a promoção à saúde de forma integral, também promove a
humanização no ambiente hospitalar.

INTRODUCTION: In the development process of chronic liver diseases, regardless of the causative agent, there is a break in the balance between immune response and cell regeneration, characterized by aggression and necrosis. The condition of chronic hepatitis is characterized by liver inflammation for more than six months. Hepatitis B and C viruses are important etiological agents of chronic viral hepatitis, with unfavorable clinical-pathological evolution to cirrhosis and hepatocellular carcinoma. Genomic alterations in the patient are factors that can contribute to this worsening or unfavorable outcome. OBJECTIVE: To investigate the role of Insertion/Deletion-type (INDEL) functional variants in the CASP8 (rs3834129) and ACE (rs4646994) genes in the prediction of liver cirrhosis in patients with chronic hepatitis caused by viruses B and C. METHODOLOGY: Cross-sectional, retrospective study, observational and descriptive, carried out in patients from two reference hospitals for liver diseases. The studied sample consisted of 76 patients with chronic hepatitis, characterized by clinical alterations and liver function tests, divided into subgroups with and without liver cirrhosis, and submitted to detection of infection by virus B and virus C. Genotyping of genetic variants was performed by Polymerase Chain Reaction (PCR) Multiplex in an ABI Verity thermocycler (Applied Biosystems, Foster City, CA, USA). DNA amplification products were separated using the ABI PRISM 3130 Genetic Analyzer (Life Technologies). Ancestry analysis in the studied sample was performed with 48 informative ancestry markers (AIMs). Statistical analyzes were performed using the SPSS Program, v.25.0 (SPSS, Chicago, IL. USA). Group comparisons for categorical variables were tested two by two using Pearson's chi-square test, and Student's t test was applied for the analysis of continuous variables. The Mann-Whitney test was used to compare the ancestry index between samples. The effect of genetic variants on the risk of developing liver cirrhosis was assessed by logistic regression, controlled for age and smoking. All statistical tests were based on a two-tailed probability and a p-value ≤0.05 was considered. RESULTS. No association was observed between genotypic frequencies and markers of inflammation or degree of liver fibrosis in the studied sample. There was also no statistically significant difference between genotypes and advanced degrees of liver fibrosis in patients with chronic hepatitis. CONCLUSIONS: The results suggest that the Ace and Casp-8 SNPs evaluated in the study are not direct genetic markers of liver fibrosis in patients with HCV and HBV.

A fibrose cística é uma doença genética autossômica recessiva caracterizada pela
disfunção do gene Cystic Fibrosis Transmembrane Condutance Regulator, que codifica
uma proteína reguladora de condutância transmembrana de cloro. A manutenção de um
estado nutricional adequado é fundamental para o prognóstico e a qualidade de vida dos
fibrocísticos, assim como melhores condições neonatais e sociodemográficas
favoráveis. Por ser uma doença multissistêmica e de alto custo para o SUS, é
imprescindível que haja políticas públicas para o controle da doença, aumentando o
número de centros especializados em tratar desta doença. O objetivo de estudo foi
verificar a associação entre o estado nutricional e os fatores sociodemográficos e
clínicos dos pacientes com fibrose cística. Tratou-se de um estudo epidemiológico,
observacional, transversal e analítico, realizado no ambulatório de fibrose cística do
Hospital Universitário João de Barros Barreto, no período de outubro de 2019 a abril de
2020. Foram coletados dados antropométricos, sociodemográficos e clínicos. Foram
incluídos os pacientes com diagnóstico confirmado de FC. A estatística descritiva
compreendeu a frequência das variáveis em valores absolutos e proporção. Comparou-
se as frequências por meio teste qui-quadrado ou teste G. Aplicou-se o teste de
regressão logística múltipla para analisar associação dos fatores clínicos com o estado
nutricional. O tratamento estatístico foi realizado no Bioestat versão 5.1, adotando-se o
nível de significância de 5%. Foram avaliados 105 pacientes, agrupados em quatro
categorias: crianças (25,7%), adolescentes (40,9%), adultos (29,5%) e idosos (3,8%).
Na amostra do estudo, a frequência de homens (59,0%) foi superior à de mulheres
(40,9%), a maioria procedeu da região metropolitana de Belém (54,3%), prevaleceram
significativamente a moradia com três a cinco residentes (76,2%), um a dois salários-
mínimos de renda familiar mensal (76,2%), mais de oito anos de educação formal
(78,1%) e ocupação do lar (42,8%). Sintoma respiratório (84,7%) foi a manifestação
clínica presente de maneira significativa ao diagnóstico e 82,8% dos pacientes não
apresentaram colonização pulmonar. O tipo de mutação mais prevalente foi a F508del
(39,0%). A maioria usava terapia enzimática (72,4%). O uso de suplemento alimentar
foi relatado por 51,4% e 73% apresentaram grau bom a excelente segundo o escore de
Shwachman. Do total, 48,7% dos pacientes encontravam-se eutróficos e 35,2%
apresentaram risco nutricional significativo em relação aos desnutridos, entretanto não
houve diferença significativa entre pacientes com nutrição adequada e risco nutricional.
A partir da análise de regressão logística múltipla, observou-se dois fatores associados
ao estado nutricional, o escore de Shwachman-kulczycki (OR: 2,97; p = 0,0218) e o
tratamento enzimático (OR: 0,28; p = 0,0238). Houve prevalência de eutrofia e risco
nutricional entre os pacientes avaliados, o uso de terapia de reposição enzimática
reduziu a chance de os pacientes apresentarem desnutrição e os pacientes com escore de
shwachman- kulczycki mais baixo, tinham chance três vezes maior de estarem
desnutridos.

A partir da relevância social da temática “segurança medicamentosa” surge questões como o uso seguro
de medicamentos, e o conhecimento dos profissionais envolvidos na terapia medicamentosa para evitar
erros. A equipe de enfermagem é importante para segurança medicamentosa do paciente, já que está
diretamente envolvida em todas as fases do processo medicamentoso, mais especificamente no preparo
e administração de medicamentos. E por ser essa, uma atividade complexa, pode estar sujeita a erros
no desenrolar das respectivas ações. Tais erros podem assumir dimensões significantes e impor custos
relevantes ao sistema de saúde, pois podem causar efeitos deletérios como reações adversas, lesões
temporárias e permanentes e até morte. Assim sendo, é importante que essa práxis seja abordada,
observada e discutida, o que viabiliza a identificação dos possíveis erros, fatores relacionados, bem
como a obtenção de subsídios para adoção de medidas de prevenção e controle, visando a excelência na
assistência medicamentosa e a segurança do paciente. Trata-se de estudo de revisão integrativa, cujo
buscou responder a seguinte questão norteadora: Quais são as evidências disponíveis na literatura sobre
as estratégias de Enfermeiros para a promoção de boas práticas no preparo e administração de
medicamentos? Dentre os nove estudos selecionados, a maioria das publicações utilizadas neste estudo
foram publicadas em português e tiveram sua origem no Brasil, o que pode ser consequência das
políticas públicas de saúde inclusas no Sistema Único de Saúde (SUS), dentre elas o Programa
Nacional de Segurança do Paciente, cujo vem sendo intensamente institucionalizado, como ferramenta
de gestão da qualidade, nos serviços de saúde mediante as metas de segurança do paciente . Quanto aos
níveis de evidência verificou-se a predominância de estudos de nível VI com enfoque em estudos
descritivos não experimentais diante da temática. No entanto, apesar disto pôde-se identificar dois
estudos internacionais com nível de evidência III. Os principais resultados dos estudos selecionados
nesta revisão foram organizados segundo similaridade semântica e deram origem a duas categorias
temáticas: Estratégias voltadas para a promoção das boas práticas no preparo e administração de
medicamentos; Experiências exitosas da utilização de tecnologias para mediar as boas práticas no
preparo e administração de medicamentos. Evidenciamos que apesar de poucas produções
identificadas, estratégias educativas e tecnologias em saúde estão sendo utilizadas e tendo significância
para a promoção da meta de segurança do paciente, espera-se que esta revisão possa fomentar o
desenvolvimento de novos estudos acerca da temática.

A comunicação efetiva nas instituições de saúde é, atualmente, considerada
uma importante ferramenta utilizada no cuidado e segurança do paciente. Devido a sua
importância, é uma das ações dispostas dentro das competências do Comitê de
Implementação do Programa Nacional de Segurança do Paciente, cuja criação surgiu em
decorrência de estudos que evidenciaram elevada ocorrência de Eventos Adversos como
consequência do cuidado ao paciente. O CTI é o local onde os riscos e danos acabam
sendo mais graves pelas suas características próprias. É dentro do CTI que estão os
pacientes mais críticos, e onde se utilizam equipamentos e tecnologias mais específicas,
de monitoramento e de diagnóstico. Procedimentos invasivos são realizados,
medicamentos específicos são mais utilizados. É, também, onde a equipe é mais
diversificada nos seus saberes, experiências e competências, o que pode criar algumas
dificuldades de comunicação entre os profissionais e, portanto, levar a equipe a não
convergir para a segurança do paciente. Portanto, o objetivo desta pesquisa é avaliar a
comunicação interprofissional e a notificação de eventos adversos como estratégia de
promoção do cuidado e segurança do paciente. Consiste em um estudo descritivo
exploratório, com abordagem qualitativa e quantitativa. A pesquisa foi segmentada em
dois artigos que estão expostos ao decorrer do trabalho.

As urgências oftalmológicas são uma das principais causas de morbidade e
cegueiras preveníveis, sendo um dos grandes problemas de saúde pública, devido a
pouca oferta de serviço especializado. A regulação de acesso nos serviços
oftalmológicos, quando estruturada com processos, protocolos e fluxos bem
estabelecidos garante a organização do acesso, da oferta e da demanda dos serviços,
oferecendo qualidade e resolutividade na assistência em tempo hábil a população. Para
isso, buscou-se identificar a Regulação do acesso à assistência das Urgências e
Emergências Oftalmológicas sob a ótica dos profissionais do setor em um Hospital
Universitário em Belém, PA. Foi realizado um estudo quali-quantitativo e descritivo no
setor de Oftalmologia do Hospital Universitário Bettina Ferro de Souza (HUBFS). Para
coleta de dados, utilizou-se um questionário próprio com 15 perguntas abertas e fechadas
aplicado com 29 profissionais atuantes no setor de Oftalmologia. A análise quantitativa
foi realizada com base na estatística descritiva, cujos dados numéricos captados serão
armazenados em bancos de dados numéricos do Microsoft Excel 2007. A maioria dos
entrevistados tinha como tempo de atuação de 1 a 5 anos na Oftalmologia do HUBFS
(75%). Segundo os entrevistados, 58,6% acredita que exista um espaço adequado para o
atendimento do paciente em situação de U/E no HUBFS, 61,5% disseram desconhecer
protocolo assistencial para o atendimento de um paciente em situação de U/E no
HUBFS. Quanto a priorização do atendimento de U/E em relação aos pacientes
ambulatoriais, 82,7% afirmou acontecer. E 71,4% afirmaram que o serviço de
Oftalmologia tem acesso imediato ao Centro Cirúrgico em situações que necessitam de
intervenção cirúrgica de U/E. A U/E Oftalmológicas atendidas no HUBFS, houve uma
frequência de 30% com relatos de trauma. Quanto ao conhecimento dos profissionais
sobre U/E Oftalmológicas no HUBFS, 68,9% acreditam que o HUBFS tem capacidade
de atender U/E nas 24 horas, 82,7% desconhecem o número de U/E em Oftalmologia
atendidos mensalmente no HUBFS e 51,7% tem conhecimento do fluxo externo de
demanda do atendimento U/E Oftalmologia. Para os profissionais, as mudanças para a
melhoria do atendimento da U/E Oftalmológicas devem ser nos aspectos de estrutura

Pessoal e Física. Conclui-se que a maioria dos profissionais do setor reconhecem a
importância das U/E Oftalmológicas para comunidade, desconhecem os protocolos,
porém destacam a necessidade de melhorias nos processos de trabalho.

A incorporação de tecnologia em saúde busca solucionar muitos problemas que
se avolumam diariamente na gestão de hospitais universitários, entre os quais
estruturas insuficientes no atendimento de média e alta complexidade, além de
problemas de gestão, segurança estrutural (do paciente) e central de energia.
Assim, o objetivo geral desta pesquisa foi descrever a incorporação de
tecnologia em saúde no Programa Nacional de Reestruturação desenvolvido em
Hospital Universitário no Norte do Brasil, no período de 2011 a 2018. De modo
específico se buscou analisar a matriz da distribuição de recursos financeiros de
capital do REHUF ao HU, e ainda avaliar o alcance das metas e os critérios de
compra de equipamentos médico-hospitalares, os impactos da incorporação do
aparelho de radiografia Axion Iconos MD 07721819º, a partir de preceitos da
economia em saúde. Foi feita uma pesquisa bibliográfica, documental,
descritiva, com abordagem quantitativa, focada na incorporação de tecnologia
em saúde e na avaliação custo-efetividade. Os resultados apontaram, após
analisar os valores da produção aprovada de média e alta complexidade, que no
3º ano de uso do equipamento, o retorno do investimento foi efetivo,
confirmando o impacto financeiro, social e ambiental positivo na receita do HU.

O diabetes é uma condição clínica definida como um grupo de doenças metabólicas caracterizadas por hiperglicemia resultante de defeitos na secreção ou na ação da insulina. A nível mundial o diabetes tem prevalência entre 8,8% e 14,2%, com expectativa de aumento nos próximos anos, enquanto no Brasil apresentou aumento na prevalência, que passou de 5,5% para 7,4%, especialmente entre mulheres e pessoas adultas com 65 anos ou mais. Os pacientes com diabetes Mellitus necessitam de cuidados de saúde especializados por se tratar de doentes crônicos, com propensão a desenvolvimento de complicações da doença, a baixa escolaridade, a prevalência desta doença em pessoas com idade maior que 40 anos, bem como a associação do diabetes com outras comorbidades, são fatores primordiais para o desenvolvimento de complicações do diabetes, por conta das dificuldades que este público apresenta em realizar e compreender as ações de autocuidado em relação ao controle do diabetes. Nesse sentido é de fundamental importância a atuação do profissional de Enfermagem para o empoderamento dessas pessoas no diz respeito ao desenvolvimento de práticas de promoção e prevenção de complicações para a melhoria da qualidade de vida, e principalmente para a adaptação, reabilitação e enfrentamento destes pacientes diante da doença e das novas condições de vida mediante ao desenvolvimento de complicações. Trata-se de estudo de revisão integrativa que tem por escopo resumir as pesquisas já realizadas sobre as intervenções e tecnologias educativas desenvolvidas por enfermeiros para pessoas com diabetes Mellitus, para tanto buscou-se utilizar a estratégia PICO, dessa maneira, esse estudo buscou responder a seguinte questão norteadora: Quais são as evidências disponíveis na literatura sobre as intervenções e tecnologias educativas desenvolvidas por enfermeiros para a pessoa com diabetes Mellitus? Para a busca das evidências científicas utilizou-se os descritores: “Diabetes Mellitus” (em inglês: “Diabetes Mellitus”; em espanhol: “Diabetes Mellitus”); “Cuidados de Enfermagem” (em inglês: “Nursing Care”, em espanhol: “Atención de Enfermería”), “Educação de Pacientes como assunto” (em inglês: “Patient Education as Topic”, “em espanhol: “Educación del Paciente como Asunto”). O período temporal de busca definido foi de artigos publicados no período de 2017 a 2020. As buscas ocorreram nas seguintes bases de dados que são Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS); Medical Literature Analysis and Retrieval Sisten On-line (MedLine)/ PubMed (via National Library of Medicine); SCielo e BDENF. Dez estudos foram incluídos nesta revisão, estes foram compreendidos no período de 2016 a 2020, a maioria das publicações utilizadas neste estudo (n=6) foi publicado em português e teve sua origem no Brasil, o que demonstra certa fragilidade e lacuna na publicação internacional em relação à temática. Quanto aos níveis de evidência verificou-se a predominância de estudos de nível V com enfoque em estudos descritivos não experimentais diante da temática. No entanto, apesar disto pôde-se identificar um estudo nacional com nível de evidência III. Os principais resultados dos estudos selecionados nesta revisão foram organizados segundo similaridade semântica e derem origem a duas categorias temáticas: Experiências educativas exitosas voltadas a pessoas com diabetes; Recursos tecnológicos utilizados para mediar o processo educativo de pessoas com diabetes. A revisão das produções acerca da temática evidenciou que os estudos desenvolvidos por enfermeiros sobre a educação do paciente diabético como tema de pesquisa, ainda é pouco explorada em níveis de maior evidência científica. Necessitando de aprofundamento nos métodos de pesquisa para as produções desenvolvidas com esta temática. Um dos pontos positivos encontrados nesta revisão, é o fato de que as produções nacionais foram predominantesneste estudo, o que pode ser justificado pelo cuidado dessas pessoas ser instituído pelas políticas públicas de atenção à saúde do idoso e pela instituição do programa HIPERDIA no âmbito da Atenção Primária do Sistema Único de Saúde (SUS) brasileiro. Como contribuições para a pesquisa em enfermagem e em saúde pública espera-se que esta revisão integrativa, venha a embasar futuros estudos que abordem a proposição de atividades e de tecnologias educativas voltas para o cuidado de pessoas com diabetes Mellitus e principalmente para fundamentação da prática educativa e clínica de enfermeiros para a realização de ações de promoção, prevenção e da instituição de políticas públicas para a minimização das complicações advindas do diabetes Mellitus.

Introdução: A espinha bífida é um defeito congênito que ocorre quando os ossos da coluna não se formam completamente, resultando em uma abertura na região posterior da coluna, geralmente no final da coluna (região sacral). No Brasil, não existem estudos abrangentes que descrevam a associação de características sociais, demográficas e clínicas em relação à espinha bífida.
Objetivos: Este estudo visa verificar possíveis associações de fatores sociodemográficos e clínicos em nascidos vivos com espinha bífida.
Delineamento e Métodos: Foi realizado um estudo analítico (descritivo e inferencial), ecológico e retrospectivo com base em dados secundários de 11.308 nascidos vivos com espinha bífida registrados no Sistema de Informação de Nascidos Vivos (SINASC) no Brasil de 1999 a 2019. Dados sócio-demográficos os fatores analisados foram a idade, escolaridade, estado civil das mães e a região geográfica. Os fatores clínicos analisados foram a duração, o tempo de gestação, o peso ao nascer e o número de atendimentos pré-natais.
Resultados: Há um aumento no número de casos de espinha bífida nos últimos anos no Brasil com variação percentual anual de 3,52%. Porém, no período de 2005: 2009 apresentou redução de nascidos vivos com espinha bífida. Os estados com maior incidência foram: Rondônia, Rio Grande do Norte, Pernambuco, Sergipe, São Paulo, Rio Grande do Sul e Mato Grosso. Porém, nas unidades da federação a maior incidência foi nas regiões Sul (São Paulo) e Sudeste (Rio Grande do Sul). O risco aumentou em mães nascidas após 1980, com idade superior a 30 anos e alto nível de escolaridade. O risco aumentou em nascidos vivos: brancos e negros, gravidez dupla e peso corporal inferior a 3.000 gramas. A ausência do pré-natal resultou em maior incidência.
Conclusão: Assim, os fatores sociodemográficos e clínicos apresentam características específicas que podem predizer Espinha bífida em recém-nascidos no Brasil.

Em decorrência do processo de descentralização da gestão das políticas
públicas, fez-se necessário a participação da sociedade civil nas tomadas de decisões e na
fiscalização da utilização de recursos públicos, resultando, no âmbito do Programa
Nacional de Alimentação Escolar (PNAE), na exigência da composição do Conselho de
Alimentação Escolar (CAE). Assim, esse estudo objetivou caracterizar a atuação, os
desafios e potencialidades dos conselheiros de alimentação escolar, por meio de
indicadores de controle social e análise de conteúdo de conselheiros atuantes em 04
municípios paraenses. Estudo documental, descritivo de delineamento transversal, a
partir da análise documental de Relatórios Técnicos referentes às atividades de assessoria
e monitoramento executados pelo CECANE/UFPA, no ano de 2019, adotando uma
abordagem quali-quantitativa. As informações qualitativas foram obtidas a partir da
análise das entrevistas com os conselheiros, sobre os possíveis obstáculos e/ou
potencialidades vivenciados por eles. Os dados quantitativos foram tabulados e
analisados no Programa Microsoft Excel versão 2016 e Epi Info versão 7.2.4. Foi
utilizada a estatística descritiva, a partir da elaboração de gráficos e tabelas com
frequências absolutas e relativas. No que se refere à análise das entrevistas, foram
utilizados os preceitos da Análise de Conteúdo clássica, proposto por Bardin. A partir
dos resultados, observou-se que a maioria era mulheres, estavam na faixa etária de 40 a
49 anos, média de 42,2 (±7,8), tinham mais de 12 anos de estudo e representavam o
segmento de pais de alunos, seguido de representantes de entidades de trabalhadores da
educação e discentes. Os conselhos estão funcionando conforme determina as legislações
vigentes, assim como, os conselheiros estavam desempenhando suas atribuições dentro
do esperado e possuem conhecimento sobre o papel fundamental que desenvolvem na
execução dessa política promotora da SAN no Brasil. Entretanto, identificou-se alguns
entraves para o desenvolvimento e articulação de algumas atividades que competem aos
conselheiros de alimentação escolar, principalmente no que se refere ao processo de
composição, funcionamento e infraestrutura do CAE. Dessa forma, evidencia-se a
importância de participação dos conselheiros em ações estratégicas de formações e
capacitações continuadas sobre aspectos gerais de execução do PNAE e suas atribuições.

ESTE ESTUDO SE DIRECIONA PELAS TEMÁTICAS DA ALIMENTAÇÃO, DA SAÚDE E DA CULTURA. TEM COMO PROPOSTA DE ESTUDO A COMPREENSÃO DAS PRÁTICAS ALIMENTARES EM UMA COMUNIDADE INDÍGENA NO SUDESTE PARAENSE. AS PRÁTICAS ALIMENTARES REPRESENTAM UMA AÇÃO CONCRETA DE INCORPORAÇÃO TANTO DAS CATEGORIAS PARA OS DIFERENTES ALIMENTOS COMO DO ESTABELECIMENTOS DE SEUS SIGNIFICADOS, PERMEADA POR TROCAS SIMBÓLICAS, ENVOLVENDO UMA INFINIDADE DE ELEMENTOS E DE ASSOCIAÇÕES CAPAZES DE EXPRESSAR E CONSOLIDAR A POSIÇÃO DO SUJEITO SOCIAL EM SUAS RELAÇÕES COTIDIANAS. O OBJETIVO DA PESQUISA É COMPREENDER COMO SE CONFIGURAM AS PRÁTICAS ALIMENTARES E DE QUE FORMA ELAS SE RELACIONAM COM A SAÚDE E A CULTURA DOS SUJEITOS ENVOLVIDOS NO CONTEXTO DA COMUNIDADE INDÍGENA SURUÍ/AIKEWARA; CARACTERIZAR O CONTEXTO SOCIODEMOGRÁFICO E AMBIENTAL DESSA ALDEIA, CONSIDERANDO SEU PROCESSO HISTÓRICO DE FORMAÇÃO; CONHECER AS MEMÓRIAS FAMILIAR E COMUNITÁRIA DAS PRÁTICAS ALIMENTARES, OBSERVANDO AS MUDANÇAS E PERMANÊNCIAS AO LONGO DE UM DETERMINADO PERÍODO DE TEMPO; OBSERVAR E ANALISAR AS PRÁTICAS ALIMENTARES A PARTIR DAS FALAS DOS PARTICIPANTES ENVOLVIDOS, COMPREENDENDO SUA RELAÇÃO COM A SAÚDE E A CULTURA DESSE GRUPO. TRATA-SE DE UM ESTUDO DE ABORDAGEM QUALITATIVA, DO TIPO DESCRITIVO E EXPLORATÓRIO E A PERSPECTIVA TEÓRICA INTERPRETATIVISTA PARA FUNDAMENTAR A ANÁLISE. A CONSTRUÇÃO DOS DADOS SERÁ POR MEIO DE LEVANTAMENTO BIBLIOGRÁFICO E DOCUMENTAL, BEM COMO ATRAVÉS DE OBSERVAÇÃO E ENTREVISTA DO TIPO SEMIESTRUTURADA E GRAVADAS CONFORME O CONSENTIMENTO DOS ENTREVISTADOS, ESTABELECENDO UMA CONVERSA AMIGÁVEL. A INTERPRETAÇÃO DOS DADOS OBTIDOS POR MEIO DAS INFORMAÇÕES RELATADAS PELOS PARTICIPANTES SERÁ PELA ADAPTAÇÃO DA ANÁLISE DE CONTEÚDO, USADO COM O OBJETIVO DE DESCREVER E INTERPRETAR O CONTEÚDO A PARTIR DAS NARRATIVAS DE MORADORES DA COMUNIDADE. A POPULAÇÃO ESTUDADA SERÁ COMPOSTA POR MORADORES DA COMUNIDADE INDÍGENA SURUÍ AIKEWARA E PETENCENTES A TRÊS DIFERENTES GERAÇÕES, ENCONTRADOS NO MOMENTO DA VISITA, QUE ACEITAREM PARTICIPAR DO ESTUDO MEDIANTE À APRESENTAÇÃO DO TERMO DE CONSENTIMENTO LIVRE E ESCLARECIDO (TCLE).

The general objective of this research is to identify the evolution of approaches to autonomy in children
with disabilities through the analysis of the main official documents dedicated to people with disabilities.
The documents analyzed are: National Health Policy for Persons with Disabilities (Ordinance No. 1,060,
of June 5, 2002), Convention on the Rights of Persons with Disabilities (Decree No. 6,949, of August 25,
2009), National Plan for Rights of Persons with Disabilities – Plano Viver sem Limite (Decree no 7612, of
November 17, 2011), Statute of Persons with Disabilities - Brazilian Law for the Inclusion of Persons
with Disabilities (Law no 13.146, of July 6, 2015), Public Prosecution Guide: People with disabilities -
Right to accessibility, priority care, public procurement, inclusive education, health care, supported
decision-making and trusteeship (2016). The choice of such documents was based on the impact on the
issue of autonomy in children with disabilities, comprehensiveness and the arrangement of health
programs aimed at the care of this segment. It is proposed to discuss the presence and scope of the
following aspects in the aforementioned official documents: the arrangement of programs and public
policies that focus on the monitoring and care of children with disabilities; the presence of the principle of
integrality and actions promoting autonomy in children with disabilities; mention of notions of protection
and autonomy relating to such children. In addition to the analysis of these documents, data relating to the
profile of the Care Network for People with Disabilities in the State of Pará are presented as an example.
Based on documentary analysis, the methodology employed is of a qualitative and exploratory nature. In
relation to the Brazilian legal field, the research shows that the constitutional and infraconstitutional
provisions that aim to protect the fundamental rights of people with disabilities are treated in the selected
documents in a very fragmented way. Although it has evolved over the past two decades, the Brazilian
governmental agenda does not systematically and sufficiently contemplate the actions required by
children with disabilities with regard to autonomy and the principle of integrality. Despite the robust
structure of the Unified Health System, the scarcity of hiring professionals and financial resources
strongly compromises that the legislative guidelines are effective instruments of social change for people,
particularly children, with disabilities.

Analyze the Ministry of Health's Contracting Policy in Teaching Hospitals in Brazil will make it possible to design a bibliographic parameter of the advances, proposals for interventions and perspectives for teaching, research, assistance and management of SUS in these institutional spaces. The experience of contracting with hospitals, at SUS, began in 2004, with the restructuring program of teaching hospitals and philanthropic hospitals. The contracting policy is established by the Ministry of Health as a process where the municipal / state manager of the Unified Health System (SUS) and representative hospital, establishes indicators, quantitative and qualitative targets for health care health and hospital management, formalized through a contractual instrument. It is necessary to reframe the practice of managing, making it imperative to establishment of managerial and technical-scientific instruments to qualify management, with the objective of guaranteeing its sustainability, to meet the needs of health of the referenced population, offer services and streamline assistance to users of the SUS, thus contributing to the organization of the system. For this, it is of great importance to use of mechanism and instrument such as the Document described, the Programming Physical - budgetary (FPO) and service production reports to subsidize the management practice. The Document Described instrument constituted in the process of contractualization (Ministry of Health, 2010).

Introduction: Primary Health Care takes on the challenge of organizing and articulating Health Care Networks. There are distinct differences in the way of organizing and conducting the work process of PHC teams, as well as difficulties in adopting management tools for the conduct of activities in relation to the different realities of performance determined by the location of the teams. Objective: To analyze the work process of primary care teams in Brazilian municipalities. Methodology: Research of an evaluative nature of an exploratory nature with a quantitative approach, using secondary data from the 3rd cycle of the National Program for the Improvement of Access and Quality of Primary Care. The variables related to the External Evaluation, “Module II - Interview with the health professional” and the Rural-Urban Classification of the Brazilian Institute of Geography and Statistics, both open access, were used. The teams that participated in all moments of the external evaluation, corresponding to 37,350 teams, were included in the study. After obtaining the databases on the Ministry of Health website, the information was organized into a data matrix in the Microsoft® Office Excel® 2016 software and a link was made between the IBGE database and the PMAQ database. -AB. Using the SPSS Statistics software (v.20, IBM SPSS, Chicado IL), a descriptive analysis of the variables was carried out according to the rural-urban classification in 3 axes: Territorialization, Action planning and Monitoring and Self-assessment. Then, the relationships between the axes of variables and the rural – urban classification were verified using a Multiple Correspondence Analysis. Results: It was observed that the adjacent rural municipalities have the lowest percentage of teams with an uncovered population in the territory (21.0%), the urban municipalities showed a higher percentage of teams with a reference population above 3,500 people / team (43.0%). Action planning is not carried out by 15.1% of the participating teams, with the highest percentage of achievement observed in the urban stratum (85.7%). Monitoring and analysis of the indicators is carried out by 87.9% of the teams, with approximation of the values between the municipal strata with similar location characteristics, whereas the self-assessment performed had a higher percentage in the adjacent intermediate strata (90.4%). The Multiple Correspondence Analysis made it possible to identify three groups of teams with distinct territorial characteristics and two groups in relation to planning, monitoring and self-assessment. Conclusion: The results presented in this study suggest that there are important differences in the work process of the Primary Health Care teams that vary according to the characteristics of the municipality in which they are located.

Introduction: Tuberculosis is a highly endemic bacterial disease in Brazil and still remains a major public health problem, especially in the northern region. However, the municipality of Ananindeua has presented disparities in relation to the regional incidence of the disease. Objective: Analyze the spatial and temporal distribution of Tuberculosis and its relationship with socioeconomic characteristics and demographic in the municipality of Ananindeua-PA, from 2010 to 2017. Methods: An ecological and cross-sectional study was carried out based on data from the Information System for Notifiable 

Diseases (SINAN) of the Ministry of Health and the 2010 Demographic Census of the Brazilian Institute of Geography and Statistics (IBGE). Socioeconomic, demographic and epidemiological variables were analyzed. For the epidemiological profile, the Chi-Square test for adherence was used with the BioEstat 5.3 software. Thematic maps were made to visualize the distribution of the disease in the urban space of the municipality where geoprocessing techniques were used. Results: A decreasing trend was observed in the number of cases of tuberculosis. The profile of the most affected individuals was male (59.41%), adult age group (83.18%), with incomplete fundamental level (36.14%), mixed race (75.06%) and with outcome of cure (64.92%). The analysis also showed that the disease is not evenly distributed in the municipality and shows evidence of an epidemiological silence in certain geographical areas. Conclusion: This study provided a better understanding of the epidemiological profile of tuberculosis cases in the municipality of Ananindeua, in the state of Pará. Furthermore, it was observed that tuberculosis is still a major public health problem and needs more health promotion and prevention programs.

Keywords: Tuberculosis. Epidemiology. Public Health.

Breastfeeding is essential for the child's full development, ensuring that the individual
reaches its full potential for evolution. Therefore, it is essential to defend breastfeeding
through legal protection, so that mother and baby have their right to breastfeed. This
study aimed to assess the most frequent forms of infringement of the Brazilian Standard
for the Marketing of Food for Infants and Early Childhoods, Nipples, Pacifiers, Bottles
and Nipple Protectors - NBCAL, regarding the sale of infant formulas whose commercial
promotion is prohibited. A cross-sectional study was carried out in 2019, in pharmacies
and supermarkets in the cities of Belém and São Paulo, which market the products
covered by NBCAL, interviewers trained at NBCAL used a structured electronic form
for direct observation of establishments, in order to verify the infractions present in these
establishments. The data description was made by absolute, relative frequency and 95%  CI. 200 establishments in Belém and 199 in São Paulo were evaluated, of which 11% had

an infraction in the city of Belém and 9.5% violated the Standard in São Paulo. The most
frequent infractions were: price promotion (52%) in Belém, (46.2%) and São Paulo, and
special exposure (10%) in belém and (35.9%) in São Paulo, it was also possible to verify
the simultaneous occurrence of the two infractions in (38%) Belém and (17.9%) in São
Paulo. Although 32 years have elapsed since the establishment of NBCAL, there are still
recurring infractions of the Legislation on products whose commercial promotion is
prohibited, the present study reinforces the need for greater inspection in commercial
establishments and the Companies that commercialize the products object of the
NBCAL.

The Therapeutic Republic of Passage (RTP) is a temporary shelter service that houses people with mental disorders who have had a conflict with the law. The objective of this institution is to resuscitate the graduates of the General Penitentiary Hospital (HGP), which complied with a security measure in the state of Pará. The general objective of this study is to understand the experiences of the graduates of the HGP during the fulfillment of the safety measure in that hospital and comparing them to the experiences in RTP, a substitutive service to prolonged hospitalization. This will be a qualitative ethnographic study to be carried out at RTP from August 2018 to May 2019. The research will be composed of six interlocutors, two managers, two residents and two caregivers. The data will be obtained through participant observation, recorded in field diary, and the UNIVERSIDADE FEDERAL DO PARÁ INSTITUTO DE CIÊNCIAS DA SAÚDE PROGRAMA DE PÓS-GRADUAÇÃO EM SAÚDE, AMBIENTE EM SOCIEDADE NA AMAZÔNIA. Praça Camilo Salgado, nº 1, Umarizal, Belém, Pará, CEP 66.050-060, Belém, PA. Fone: (91) 3201-6806 application of semistructured interviews, recorded and later submitted to content analysis. The expected results are that this research contributes to the emancipation of new knowledge in the area of mental health and the implementation of new public policies in this context.

One way to critically improve public health management strategies is to study the Brazilian

Unified Health System (SUS) with emphasis in the Health Assistance Regulation. The general goal of this research

was to analyze the regulation process of hospital assistance access in SUS, in Belém, state of Pará, by means of a 

descriptive, case study type investigation with qualitative approach. The evidence sources were documental, consisting

 of normative elements about assistance regulation, scientific articles, books within the subject and semi-structured

 interviews with managers and SUS users. Seven interviews were conducted: four of them with public health 

managers working with access regulation, and three with SUS users who were hospitalized in the same period. 

From the interview content analysis, the extracted subcategories for SUS managers were: Necessity of consolidating 

Assistance Regulation in RAS; Operationalize regulatory flows between health establishments of RAS, based in current 

contract- and pact-formations and Lack of hospital beds for user needs. From SUS users, the extracted 

subcategories were: Waiting time for hospital bed and User perception about the received assistance. 

The results of this study prompted reflections about the necessary changes in public health strategies of the city. 

Given that the possibilities of overcoming difficulties include the identification of different related aspects, this 

investigation proposes three suggestions for improving the regulation of hospital assistance access in Belém: consta

nt education in health offered to the assistance and SUS health management teams about access regulations; 

stimulation of serial meetings involving the health establishments participating in RAS regulatory flows of SUS in

 order to debate, to dimension, and to qualify them, thus offering more dynamism to the act of regulating; and 

finally, monitoring and sequential evaluation of offered services from the SUS user perspective, aiming to improve

 these services for fully fulfilling the population needs. 

Overweight in adolescence represents one of the most serious health problems public in Brazil and in the world. Adolescents are exposed to various risk situations at this stage, such as the adoption of eating habits and inappropriate eating behavior, physical inactivity and physical inactivity, which can directly affect the development of overweight and comorbidities, which can negatively impact their health conditions. short and long term. Given this scenario, this study aims to identify the prevalence and factors associated with excess weight in school adolescents enrolled in public and private schools in Brazil. This is an analytical, observational, cross-sectional study that will be carried out based on secondary data obtained in the National School Health Survey, 2015, conducted with adolescents from public and private schools in the country. The data were collected through an electronic questionnaire. To check the association between the dependent variable and the explanatory variables, the Chi-square test and Logistic Regression were used, estimating the prevalence ratio with 95% confidence intervals, with the aid of the Stata version 14.0 program. According to Table 2, other significant prevalences occurred with adolescent students who were overweight and did not consume beans regularly (27.15%), who consumed vegetables regularly (27.61%), consumed fruits regularly (26 , 42%), did not consume fried snacks regularly (25.98%), did not consume sweets regularly (27.74%), did not consume soft drinks regularly (25.76%), did not consume ultra-processed foods regularly (26.16%) , and did not consume fast food regularly (25.51%). From the results of the simple logistic regression, it was verified through the gross prevalence ratios that the variables associated with excess weight were: Geographic region; Administrative dependency of the school; Age group (in years); Maternal schooling; Regular consumption of breakfast; Bean consumption; Consumption of vegetables; Consumption of fried snacks and Consumption of sweets.

Cryptococcal meningitis has been characterized as one of the emerging invasive fungal diseases that causes an extraordinary burden to public health, having in its causative agent one of the pathogens that most produce infections in humans, due to an increase of susceptible hosts including those with HIV, leading to severe morbidity and high mortality worldwide, and its insurgency with continuous outbreaks in individuals with no apparent immune defects. Some fungal species may compromise human hosts with some immunosuppression, while others may affect immunocompetent patients and in this sphere the genus Cryptococcus sp. Although it is closely linked to the main cause of disease in both populations, and may be triggered by different factors, it is one of those related to the host, having in Cryptococcus gattii and neoformans excellent species of interest to global public health. Due to their chronicity, invasive fungal diseases maintain their morbidity and mortality slower than other infectious agents, being potentially lethal due to greater resistance to treatment, increasing their cost due to the time available for cure ranging from months to years and its form of contagion that has aroused little interest in public health authorities, having a negative or under informed impact on its incidence and prevalence in relation to other conditions in which contagion is much more immediate. The number of deaths caused by this disease when associated mainly with HIV patients is extraordinarily high and even with the use of antiretroviral treatment this condition has shown an unacceptable advance with an estimated 220,000 cases per year worldwide, with 181,000 deaths per year being listed. as one of the most frequent causes of death in adult patients and more recently in pre-pubertal as identified in the state of Pará. Therefore, specific public policies for this fungal disease should be better planned and employed mainly in the paraense region, due to Its vast territory, surrounded by several rivers, which makes its diagnosis and treatment costly for public rulers, however to correct the damage caused by this disease, a change of behavior is required with the participation of health authorities, scientific community and especially the SUS user, which element It will define the necessary changes for the environment where it lives and what actions will be necessary to maintain its health as a citizen.

A nível mundial, o câncer ainda é um problema de saúde pública presente em países desenvolvidos e em desenvolvimento. O (CG) Câncer Gástrico é considerado o quinto tipo mais frequente e a terceira causa de morte por câncer no mundo. A frequência de casos de CG é elevada no país, na região norte este tipo de câncer ocupa a segunda posição, excluindo-se os tumores de pele não-melanomas. OBJETIVO: Caracterizar o padrão sociodemográfico e o perfil de consumo alimentar em pacientes com adenocarcinoma gástrico (ADNG) atendidos em um hospital de referência em oncologia. METODOLOGIA: Participaram do estudo 110 pacientes atendidos no Hospital Ophir Loyola em Belém/Pará no período de novembro de 2017 a abril de 2019. Foram aplicados três questionários, um sobre frequência alimentar, um sobre dados sociodemográficos (sexo, idade, etnia, escolaridade, profissão, saneamento básico) e outro sobre dados sociocomportamentais (histórico médico pessoal e familiar, consumo de álcool e tabaco). RESULTADOS: A análise descritiva demonstrou que a maioria dos pacientes eram do sexo masculino, de cor parda, com nível fundamental incompleto e trabalhadores rurais. Observou-se também que a conservação dos alimentos sob refrigeração foi um hábito recente, há aproximadamente vinte anos. A maioria dos pacientes relatou ter tido algum parente de 1º grau com neoplasia. A aplicação da análise por correspondência, possibilitou a confirmação de associações entre os tipos de ADNG e as variáveis sociodemográficas, sociocomportamentais e o consumo alimentar dos pacientes. Dessa forma, pode-se afirmar que o ADNG tipo intestinal associa-se mais com o tabagismo, 89,65%, e o tipo difuso com o etilismo, de 94,24%.  O ADNG do tipo difuso apresentou maior associação com idades menos avançadas, 99,51%. Além disso, o tipo intestinal, mostrou estar mais associado com o sexo masculino, 98,37%. Quanto ao consumo médio de alimentos considerados de risco para o ADNG, estes estão associados aos dois tipos histológicos, no entanto com o tipo intestinal apresentou uma maior significância estatística, 84,38%. Com relação aos alimentos considerados de proteção, o baixo consumo também apresentou associação aos dois tipos de ADNG, porém o tipo intestinal destacou-se, com confiança de 79,46%. CONCLUSÃO: As taxas de incidência do CG vêm reduzindo, no entanto, suas taxas de mortalidade são elevadas. O CG é uma doença altamente incapacitante em anos de vida perdidos e necessita de ações permanentes que auxiliem no declínio de sua incidência, visando a difusão de informações sobre seus principais fatores de risco.

Excessive salt intake is a major risk factor for high blood pressure. The World Health Organization recommends consuming less than 5g of salt per day, but, in most countries, it is consumed more than twice the recommended. In Brazil, the average salt intake is 12g per day and around a quarter of the adult population is hypertensive. Bragança is a Brazilian city with about 120,000 inhabitants, located in the northeast of the State of Pará, which has social, economic and cultural peculiarities due to its coastal characteristics. Due to intense maritime fishing activity, it is expected that its population has a high level of salt consumption and, consequently, a high prevalence of hypertension. The objective of the research was to measure salt consumption in Bragança-PA, to investigate the influence of social determinants and eating habits, and to evaluate the association with body mass index and blood pressure. Therefore, a crosssectional study was conducted through a household survey, whose sampling was random and stratified by census sector, gender and age group. From March to August 2018, 393 individuals from all 108 census sectors, men and women, aged between 30 and 59 years were surveyed. Salt intake and blood pressure were assessed by urinary sodium excretion in 12-hour night urine and 24-hour ambulatory blood pressure monitoring, respectively. Most of the study population had low education and poor socioeconomic status, especially among rural participants. Men had significantly higher income and occupancy 

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This work aims to understand the functioning of the School Health Program and the progress of school health in municipal public schools in Belém, PA, based on the perception of its teachers. For that, a theoretical reference was made to the project, proportional draw of the agreed schools, by administrative district, submission to the Research Ethics Committee of the Health Sciences Institute of the Federal University of Pará and qualitative research, using a questionnaire and an interview as tools of analysis. Previously to the research subjects, a pilot study was conducted with similar subjects, to adjust the interview script. Subsequently, the incursions were made in the schools, totaling 22 interviewees participating in the research. The profile of the interviewees consisted of a majority of women, with different educational backgrounds and postgraduate studies at the specialization level, with a mean of 43.4 years of age, 19.9 years of total service time, 239.3 hours of monthly work. The interviews will be analyzed using the content analysis method

Objective general: To evaluate the dietary intake pattern and its association with the risk of coronary artery disease in urban population over 30 years old. Specific: to describe the cardiovascular risk profile by the Framingham score; verify the food and food groups consumed in the study population; to analyze the association between dietary intake and the high and low risk groups by the Framingham score. Methodology: A cross-sectional study involving 267 individuals from the periphery of the city of Belém do Pará. A questionnaire on socioeconomic characteristics at home and a food frequency questionnaire (FFQ) was carried out. Biological samples were collected for biochemical tests and.  measures of weight, height and blood pressure were taken. Cardiovascular risk was calculated from clinical and biochemical data and using the Framingham cardiovascular risk scale, classifying subjects into two groups of high and low cardiovascular risk. Food consumption was measured by means of a food frequency questionnaire (FFQ) and the consumption of food analyzed in daily and non-daily. Results: 22.5% of the group had a high risk of developing coronary artery disease and 77.5% were low risk according to the Framingham score. Of the population that presented high risk, 65% were women, 91.7% had the predominant brown or black color; 68.3% belonged to classes B and C; the median per capita income was R$ 300,70; the median age was 47 years; the median number of years of study was 8 years; 65.9% had a marital relationship; 76.7% were overweight and 41.7% had increased waist circumference. Concerning daily food consumption of the studied population, 62.9% consumed whole milk, 13.9% red meat, 50.2% margarine, 65.5% cassava flour, 8.6% soda, 10.5% skimmed milk, 38, 6% beans and 15.7% consumed fruit and vegetables five times a day. Conclusion: The present study observed that the population studied presented a fairly homogeneous diet, probably due to the similarities of purchasing power and eating habits. Thus, this study did not find statistical association between cardiovascular risk and food consumption in this population group

Adolescent; food behavior; physical inactivity; obesity

Chronic Obstructive Pulmonary Disease (COPD) is an important public health issue, with high morbimortality and causing a huge economic and social impact, representing a loss in quality of life for the disease carriers. Subdiagnosis of COPD constitutes one of the worse aggravations of the disease. The development of a simple risk model to stratify and predict the respiratory comorbidity would help prevent Subdiagnosis and progression of the disease. Objective: Identifying prevalence of COPD, identifying non-pulmonary comorbidities related to the prevalence of this disease in the attended patients in an ambulatory of cardiovascular diseases, developing a tool to predict risk factors for COPD in patients carrying cardiovascular diseases. Methods: Explanatory, transversal and prospective study of carrier patients for vascular cardiopathies in the cardiology ambulatory of a reference hospital in Belém, Pará, Brazil, from July/2018 to September/2018. Patients with respiratory symptoms were selected, from both sexes, aging 40 years or more, history of being exposed to risk factors for COPD and those with a previous diagnosis for COPD. We excluded patients with a previous diagnosis for other chronic respiratory diseases, allergic diseases and patients that were unable to perform spirometry. COPD diagnosis was given after spirometry, obeying the criteria established by GOLD, where the FEV1/FVC ratio < 0.70 or by the FEV1/FVC ratio under the limit inferior of normality. Statistical analysis was conducted using the chi-square test. Results: Amongst the assessed patients, 76 fulfilled the criteria for COPD; out of these, 2 were previously diagnosed with COPD and 35 were only diagnosed with COPD starting from this study. COPD prevalence was of 48.68% and underdiagnosis was of 46.05% among patients with risk factors for the disease. We compared the group With a diagnosis for COPD with the group Without a diagnosis for COPD according to sociodemographic variables, respiratory symptoms and comorbidities. Sex ratio (p = 0.1159, not significant) has shown that in the group With COPD there were 78.4% patients from the male sex, and in the group Without COPD they were 41%. Distribution of patients with a smoking track (p = 0.1642, not significant) has shown that in the group With CPOD there were 78.4% former smokers, while in the group Without COPD there were 59%. Age comparison has not shown any real distinction between groups: With COPD (67.1± 8.6 years) and Without COPD (63.3 ± 10 years). Comparison of BMI also did not present any difference between groups: With COPD (28.6 ± 5.3 kg/m2 ) and Without COPD (29.50 ± 5.0 kg/m2 ). Comparison of Smoking history did not present any distinction between the group With COPD (44.4 ± 50.5) and the group Without COPD (49.6 ± 51.2). Comparison of Oxygen Saturation also did not present distinctions between the groups: With COPD (97.5 ± 1.6) and Without COPD (97.3 ± 1.7). When comparing the dyspnea scale we observed that, in the group With COPD the category Grade 3 was more frequent (43%), and in the group Without COPD the category Grade 1 prevailed (48.1%); however, statistical analysis has shown that there is no significant difference between groups (p = 0.0827). When we assessed the severity of COPD based on spirometry values, most were on the GOLD Stage 1 – mild (p-value = 0.0365). The most common comorbidities in patients with COPD were SAH (89.2%), Dyslipidemias (67.6%), Ischemic Cardiopathy (64.9%) and Diabetes Mellitus (29.7%). Due to the high prevalence of underdiagnosis of COPD and its association with non-pulmonary comorbidities, it was necessary to develop a predictor UNIVERSIDADE FEDERAL DO PARÁ INSTITUTO DE CIÊNCIAS DA SAÚDE PROGRAMA DE PÓS-GRADUAÇÃO EM SAÚDE, AMBIENTE EM SOCIEDADE NA AMAZÔNIA. Praça Camilo Salgado, nº 1, Umarizal, Belém, Pará, CEP 66.050-060, Belém, PA. Fone: (91) 3201-6806 score to predict respiratory comorbidity. Conclusion: Our study has shown a high prevalence of COPD underdiagnosis among patients carrying cardiovascular diseases, raising awareness to the importance of early diagnosis and adequate treatment. Keywords: Chronic obstructive pulmonary disease (COPD), COPD Underdiagnosis, Cardiovascular Diseases, Spirometry

A síndrome metabólica (SM) é definida como o conjunto de alterações metabólicas inter-relacionadas presente no organismo que incluem resistência à insulina, resistência à glicose, dislipidemia, gordura abdominal aumentada e hipertensão arterial sistêmica. Visto que a adolescência é um período muito especial no desenvolvimento humano, considerada a transição entre a infância e a idade adulta, caracterizada por intenso crescimento e desenvolvimento que se manifesta por marcantes transformações anatômicas, fisiológicas, psicológicas e sociais.  Hábitos alimentares inadequados na adolescência podem ser fatores de risco para a presença de doenças crônicas não transmissíveis, tanto na vida atual como na futura. A presença de alterações metabólicas na infância e adolescência pode contribuir para o desenvolvimento deste processo, já que estudos longitudinais clássicos mostram uma forte associação entre o excesso de peso nas primeiras décadas de vida e a alta taxa de morbimortalidade na vida adulta por doenças cardiovasculares. Assim, torna-se necessário, a partir da proposta de estudo, o conhecimento da prevalência da SM em nossa população de adolescentes, que frequentam escolas pública e privada pertencentes no município de Belém do estado Pará a partir dos fatores sociodemográficos, comportamentais e de saúde associados à SM em escolares, com idade entre 12 e 17. Os dados foram coletados por meio de três questionários: um destinado aos alunos, um para os responsáveis e outro referente à escola. Trata-se de um estudo transversal, realizado a partir de dados secundários obtidos no Estudo de Riscos Cardiovasculares em Adolescentes – ERICA, realizado junto a adolescentes em escolas públicas e privadas, no município de Belém do Pará

Noncommunicable Diseases are on the global agenda as one of the greatest health and challenge problems of the 21st century, and several modifiable factors are associated with them, such as: smoking, inadequate nutrition, physical inactivity and alcohol. Poor diet and lifestyle changes have contributed to the increased prevalence of obesity. Studies suggest that there is an association between obesity and smoking, which is often used as an alternative in weight control, believing that smoking influences weight. Objective: To verify the association between overweight and smoking, considering sociodemographic and behavioral factors, in the adult population of Brazil, based on data from VIGITEL 2016. Methods: Cross-sectional, population-based study, based on data from 2016, of the Surveillance System for Risk Factors and Protection for Chronic Diseases by Telephone Inquiry (VIGITEL) with adults (≥ 18 years of age), living in the capitals of the 26 in the Brazilian states and in the Federal District. The total sample consisted of 53,210 people interviewed, but for this study only data from people aged ≥ 20 years and ≤ 59 years old will be used, and pregnant women will be excluded at the time of the interview, people who did not know their weight and / or their current height, as well as people who declare themselves indigenous and / or yellow. The variables used will be: overweight, smoking, age, schooling, marital union, consumption of alcoholic beverages, physical activity, sedentary behavior, food consumption and hypertension, diabetes, cholesterol or high triglycerides. Overweight will be considered as the outcome variable (dependent), classified as BMI ≥ 25 Kg/m², derived from self-reported weight and height. The smoking behavior will be the explanatory variable (independent), in which it will be considered: current smoker, ex-smoker and never smoker. The variables will be stratified by sex, and the population distribution (total and by sex), considering all variables studied, both considering the 95% confidence interval (CI). The Chi-square test will be applied to all variables and the variables with p <0.02 will be selected for the multivariate analysis using Poisson Regression. STATA version 12.0 software will be used for data analysis. VIGITEL has the approval of the National Commission for Ethics in Research for Human Beings of the Ministry of Health, and free and informed consent was obtained verbally at the moment of telephone contact with the people interviewed (BRAZIL, 2016; 2017)

The process of habilitation of health services is the act of the Federal Manager that ratifies the accreditation of the Full Manager of the Municipal or State System of SUS, duly referred to the Ministry of Health by the respective State Manager. The present study is focused on the verification of supposed difficulties to enable medium and high complexity services in hospitals in the Metropolitan Area I of the State of Pará, which function as referenced services in public health, and it is important to understand and carry out an integrative approach to the variables that intervene in the habilitation, in the implantation or in the expansion of services to be financed by the state. In this way a systematic bibliographic survey on the subject was made and later a field research through semi-structured interviews in 4 hospitals, being 2 public and 2 private, using a descriptive and analytical methodology, on the qualitative data collected in the field research. It was observed that there are services operating without financing coverage and that they are the direct and concrete consequence of the practical rupture of the habilitation process, causing consequently other secondary problems of the most diverse orders, and no less serious than the first. The difficulty in qualifying the services with the SUS should be considered a major problem, especially because it still keeps a model of organization and self-centered functioning, based on the control of the means and without the proper monitoring of the ends. Such mismatch between the declared national ideals and objectives, at least nominally, incite the evaluation of the way the public machine operates, not infrequently marked by regulatory fragility of the State and Municipal Health Secretariats, low technological incorporation, and consequent corrosion of the capacity to offer quality services and integral, inclusive and transversal, to the Brazilian population.

Patients with cardiovascular diseases may have altered quality of life as a consequence of their health, either because of their physical or psychological deficiencies. OBJECTIVE: To evaluate the Quality of Life of patients with cardiovascular diseases admitted to a referral hospital in cardiology. METHOD: Prospective cross-sectional study conducted from April to May 2018 through the application of the SF-36 Sociodemographic and Clinical Profile and Medical Outcomes Short-form Health Survey questionnaires. The SF-36 Scale is a generic instrument consisting of 36 questions covering eight domains or dimensions with scores ranging from 0 (poorer health status) to 100 (better health status) and which measure Quality of Life. The domains are identified by: Functional capacity, Physical aspects, Pain, General state of health, Vitality, Social aspects, Emotional aspects and Mental health. The sample corresponded to 70 patients randomly and voluntarily interviewed, admitted to the Cardiology Clinic. RESULTS: Of the 70 patients interviewed, 70% (49/70) of the individuals were male, 32.8% (23/70) aged over 70 years, 44.3% (31/70) married and 35, 7% (25/70) with study through incomplete primary education. Although 62.9% (44/70) had a previous diagnosis of heart disease, only 40% (28/70) underwent some drug treatment. Acute infarction was diagnosed in 54.3% (38/70) of the patients and heart failure in 12.9% (9/70), and the other patients had different diagnoses for cardiovascular diseases. Risk factors such as smoking (55.7%), hypertension (47.1%) and diabetes (31.4%) were reported. The mean values for SF-36 domains that measure Quality of Life ranged from 40 to 50. Mental health received the highest mean (62.6) and the lowest was for Physical aspects limitation (23.6) and emotional aspects (23,6). Previous diagnosis of the disease was reported by 36 individuals, 9 of whom had less than two years of disease and presented better Quality of Life. Compared a year ago, 24 patients rated their health as almost the same as a year. CONCLUSION: The study allowed to characterize the sociodemographic profile of hospitalized patients and to identify clinical variables. The evaluation of the Quality of Life of the patients verified that the domains Limitation by emotional aspects and limitations by physical aspects were the most compromised, followed by the Social aspects. The General and Vitality domains were more preserved. Individuals with less than two years of diagnosis of cardiovascular disease presented better quality of life than patients diagnosed for more than three years. When compared to current health and a year ago, most said it is almost identical a year ago

Comover Cuidado: amor, arte e indisciplina para a saúde das comunidades

As doenças cardiovasculares são responsáveis por altas taxas de
morbimortalidade em todo mundo e os médicos vêm se tornando vítimas frequentes
desses agravos. Foi realizado um estudo transversal, analítico, exploratório, com
objetivo de identificar os fatores de risco cardiovasculares em médicos do quadro de
profissionais da Fundação Pública Estadual Hospital de Clínicas Gaspar Vianna -
FPEHCGV, referência em Cardiologia, no Estado do Pará. Participaram da pesquisa
148 profissionais médicos efetivos e contratados, em atividade na FPEHCGV,
localizado em Belém/PA, com idade média de 45±10 anos (28 a 72 anos), com
predomínio do sexo feminino (60.8%) e mais de 20 anos de formado (47,3%) com
boa auto avaliação da saúde (62.8%). Observou-se alta prevalência de sobrepeso e
obesos, bem como de pré diabéticos. Após análise estatística por regressão
univariada e múltipla que as medidas antropométricas (IMC, CC e RCE) tiveram
correlação positiva com a maioria das variáveis, sendo bons preditores de risco
cardiovascular. A proteína C reativa de alta sensibilidade apesar de alterada em
grande parte (62,1%) dos médicos mostrou pouca correlação com as variáveis
clinicas e metabólicas estudadas. Médicos pré-hipertensos e hipertensos
apresentaram maior risco de obesidade e hiperglicemia. Neste estudo, portanto,
ficou bem demonstrado a alta prevalência de fatores de risco modificáveis para
doenças cardiovasculares entre os profissionais médicos da Fundação Pública
Estadual Hospital das clinicas Gaspar Vianna (FPPEHCGV) com destaque para
obesidade, sobrepeso, sedentarismo hipertensão arterial e risco aumentado de
desenvolver DM. Os médicos como profissionais de saúde esclarecidos devem estar
mais atentos as suas condições de saúde e conscientes de que a alteração do estilo
de vida trará resultados efetivos no risco de desenvolvimento de doenças
cardiovasculares.

The health promotion provides for the involvement of all the actors of doing and being health, in order to be protagonists and active participants in its implementation and continuity in care. Health promotion brings a new perspective that involves political, social, ethical, cultural, spiritual aspects to ensure health in a universal, equitable and integral way. The effective and efficient implementation of its policy in primary care focuses on changes of conduct in the treatment of users, through actions that tend to reach the individual's complete health, considering the determinants of health that make up this universe. In primary care, collective action is essential, where all are protagonists for health production. For this action to become concrete health professionals need to be aware of the process of health promotion to users, producing their actions with conscience, actually promote health and non-compliance with agenda and / or assitentialism, as deigned with this study. There is an urgent need for a real change in the praxis and paradigms of health care models, emphasizing the importance of intersectoriality and multiprofessional work in the logic of total health promotion, its concepts and functioning should be capillary to the professionals and doers of SUS in all its activities and levels of performance and / or management

Abstract- Taking as a reference the scientific evidence that inadequate food results in a variety of health problems, as well as the fact that, from 2010, food has been elevated to the category of social law set forth in the Federal Constitution through Constitutional Amendment number 64, the present study is directed to the research about the effective observation of this right in relation to the student population that receives school meals in the city of Belém from the year of validity of said Amendment, delimiting the period from February 2010 to February 2018. Therefore, it assumed as a premise that the full realization of the social right to food only occurs if the food has nutritional value and that this condition is in the drafting of normative instruments (Bidding Documents and Public Call Records) governing the acquisition of food intended for school lunches in the municipality. The study focused on the poor quality of school meals in some schools in Belém, analyzing the normative instruments of municipal public acquisition of food for school meals in the light of the quality criteria recommended by the National School Feeding Program (PNAE) and of the dispositions of the current legislation, and proposes alternatives for the mitigation of the mentioned problem.

Estudo analítico, observacional de delineamento transversal que objetivou estimar a
prevalência de Insegurança Alimentar e Nutricional (IAN) entre as famílias de crianças
matriculadas na rede municipal de educação infantil, Belém-Pa. Como instrumentos para
essa mensuração foi utilizada a Escala Brasileira de medida de Insegurança Alimentar
(EBIA), e, para avaliar o perfil familiar, utilizou-se formulário sócio demográfico.
Procedeu-se também à avaliação antropométrica das crianças para análise do estado
nutricional. Foram pesquisadas 368 famílias do município de Belém-Pa, distribuídas
proporcionalmente entre seis distritos administrativos. A técnica de amostragem
considerou um erro de 5% e foi do tipo aleatória estratificada proporcional. Na análise
estatística da associação entre indicadores sócio demográficos e insegurança alimentar,
utilizou-se os testes Qui-quadrado e teste G. Para estimar os valores de razões de chance
(Odds ratio) e respectivos intervalos de confiança (IC 95%), usou-se a regressão logística
múltipla considerando a categoria de desfecho insegurança alimentar de acordo com a
EBIA. Em todos os testes foi adotado o nível de significância (α) igual a 5%. O programa
estatístico usado nas análises foi BioEstat 5.3. Como resultado, encontrou-se prevalência
de IAN de 85,6%, que se distribuiu, de acordo com o gradiente de severidade, em 36,4%
de IAN leve, 28,8% moderada e 20,4% grave. Verificou-se associação estatisticamente
significativa entre insegurança alimentar e renda familiar per capita (p = 0,0001), 

escolaridade do chefe da família (p=0,0040), recebimento do Bolsa Família (p=0,0540) e
tipo de material empregado na construção do domicílio (p=0,0370). No modelo de
regressão logística múltipla, observou-se que a renda familiar per capita menor que meio
salário mínimo e a condição de não possuir trabalho remunerado pelo entrevistado,
associou-se, respectivamente, a chances 6 e 2 vezes maiores de a família apresentar
insegurança alimentar. O estudo se apresenta como um instrumento importante na
identificação do público pesquisado como um grupo de risco, no que se refere a IAN,
para o qual estratégias de intervenção e enfrentamento devem ser prioritárias e, também,
favorece a criação e a análise de políticas públicas municipais de promoção de segurança
alimentar e nutricional, além de permitir o reconhecimento das causas contemporâneas
do problema investigado.

Due the economic crises occurred in Brazil, in the 1980s and 1990s, international development institutions, FMI and the World Bank, proposed a model of public management characterized by privatizations, public-private partnerships and management outsourcing of public services, including the SUS, alleging add quality to the activities of the State. In this context, emerged the OSS, private law entities, that currently in the Pará State, are in charge of the management of several hospitals in the state public health network, but there are still hospitals managed by the indirect public administration, that is by public foundations or autarchies, which are references in their specialties of attention. Beyond the legal question that covers the discussion about the outsourcing of management in the SUS, this research project objective to investigate if, in the Pará State, the OSS provide health services with higher quality, in relation to a public foundation of the state health network, corroborating the justification of the adoption of this management model or denying it, showing that the State is able to provide good health services

Congenital heart diseases are the most frequent among congenital malformations and present high mortality in the first year of life, being an important global health problem. This ecological, descriptive, retrospective, population - based study aimed to describe the clinical - epidemiological profile and the spatial distribution pattern of cases of congenital heart disease treated at a referral hospital in the state of Pará - Brazil. Data from the census of the patients served between January 2012 and December 2016 were used, and for the decoding of information from the cities of origin, a database of the 2010 Census and the millionth system of the IBGE were used. All patients had a diagnosis confirmed by at least one echocardiogram. The variables observed were: gender, age, type of cardiopathy, treatment performed, waiting time and spatial distribution. Of the 905 cases observed, 52% were older than 1 year at diagnosis, 75.1% had acyanotic heart disease, and ventricular septal defect was the most frequent (21%). Among the cyanotic heart diseases, Tetralogy of Fallot was the most frequent (12%). There was no predominance of gender. At the time of the evaluation, 55.7% of the patients were awaiting treatment, 33.8% had undergone surgery, 5.3% had undergone surgery and underwent hemodynamic treatment, and 5.2% had undergone treatment alone hemodynamic. The lethality during the study period was 9.61%, of which 83.9% had undergone surgical treatment. The spatial distribution of the cases was not homogeneous, with the formation of clusters in the areas closest to the referal hospital, implying different types of flows, and allowing the conclusion that there are difficulties in accessing diagnosis and treatment, particularly at the cities farther from the state capital

The Mais Médicos Program was established in October 2013 in Brazil, one of the propuses was to strengthen the Primary Health and decrease the inqueties on the acess to health services, for this one of the measures was the increase of human resources. After the low adherence of Brazilian physicians, vacancies were made available to foreign physicians, among them Cuban exchange doctors. On the last years have been performed many researches about pmm, but are few the studies about the perception of the other health professionals and managers about the cooperated physicians. Therefore, the objective of this study was to analyze the perception of health professionals and managers about to cooperative doctors in the state of Pará. In this study, was made a content analysis of the interviews conducted with 32 health professionals and 16 managers was carried out in two stages, in 2015 and 2016, as part of subproject 5 "case study in 32 municipalities enrolled" that is included in the national multicenter project "Analysis of the Effectiveness of the More Medical Initiative in the Realization of the Universal Right to Health and in the Consolidation of Health Services Networks". The results of this analysis are presented in the form of two scientific articles, the first is about the managers' perceptions, in which the results highlight that there was an improvement in access, the resolution of PHC, and the provision of doctors in an exclusive dedication to municipalities. It can be affirm that the interviewed managers are satisfied with the Mais Médicos Program and with the cooperated doctors, and that it is possible to perform a Primary Health Care with quality in Brazil. And the second one was about the perception of other health professionals, where it was found that there is a good inter-professional relationship between the cooperative doctors and the health professionals, the perception of a more humanized care by the cooperative doctors, improvements such as the presence of the doctor in the community, the attempt to solve health problems in the basic units, forwarding only when necessary and the accuracy of the diagnoses. From these results, it can be said that the professionals and managers perceptions regarding the cooperative doctors are good and that the Mais Médicos Program provided very good results for PHC in Brazil.

In order to identify characteristics of suicide in the state of Pará, as well as to study the
correlation of cases with the Psychosocial Attention Centers (CAPS), data obtained from
the Mortality Information System (SIM), the National Registr y of Health Establishments
(CNES) and the Brazilian Institute of Geography and Statistics (IBGE) were used to
calculate suicide rates and CAPS coverage between the years 2006 to 2015. It was
observed that suicide occurs in a 4:1 ratio between the sexes male and female, one-third
of the deaths are concentrated in the age group of young adults, aged 20 to 29, most of
them of brown race/color and single marital status. Hanging was the most commonly used
method of suicide (65%) in both sexes, followed by firearm shooting (16.7%) among men
and exogenous intoxication (24.3%) among women. State suicide rates as a whole rose
44%, from 2.25 (deaths/100,000 inhabitants) in 2006 to 3.24 (deaths/100,000 inhabitants)
in 2015, more than doubling the national increase in the same period. This occurred
despite the significant improvement in CAPS coverage in the state, which was 0.48
(CAPS/100 thousand inhabitants) in 2006, considered as a regular/low level, and
increased to 1.06 (CAPS/100 thousand inhabitants) in 2015, a better level of coverage
according to the Ministry of Health (MS) criteria. The cartographic distribution, however,
revealed that the phenomenon is not homogeneous within the state. Some municipalities
presented growth or maintained high rates of suicide despite the improvement in CAPS
coverage; while others, even with high suicide death rates, did not receive any investment
in CAPS coverage during the study period. The claim that suicides rates in the state of
Pará have increased can’t be generalized even with the significant improvement in the
coverage of mental health services.

ARAÚJO, Marizete Santos. Epidemiological clinical Profile of patients with endocarditis met in hospital of reference: nursing strategies for self-care.Dissertation (master's thesis)-Universidade Federal do Pará, Institute of Health Sciences, graduate program in health, environment and society in the Amazon, Belem, 2018.

Infective endocarditis (EI), still stands with significant morbidity and mortality, although the available technologies in healthcare exhibiting high resolution, helping to the diagnosis I need. Consequently has contributed to a more effective action in order to provide efficient care for patients in the various segments of society. However, some factors tend to complicate the definition of the diagnosis, that more effective action, as in the case of difficult access and the precariousness of health services. Endocarditis is still a challenge to what has been keeping the morbidity and mortality rates still quite high. In the present research sought to characterize the profile of inpatients, whereas the clinical epidemiological profile plotting strategies for technical monitoring and self-care of patients with endocarditis, listing possible demographic and clinical variables, describing the clinical epidemiological profile and proposing technical note with high recommendations and outpatient follow-up, as well as indicate a protocol recommendations for self-carein a referral hospital in the cardiac area over a period of seven years. Material and methods: data Were carried out based on the International statistical classification of diseases and Related Health Problems- ICD-10chapter IX, diseases of the appliance circulatory system (I00-I99) taking into consideration the following grouping (I30-I52) other forms of heart diseaseamong these only were included, I33 acute and subacute Endocarditis; I38 unspecified valve endocarditis, part. Results: the age group studied runs from ≤19 to <,60 years, male, 53 (61.63%) and female (38.37%) 33. Marital status: single (as), 40 (46.61%), married (as), 25 (29.07%), 13 (15.12%) had stable and separated and widowed (the) 4 (4.65%). origin: 49 (56.96%), Immediate geographic region Belem, statement: essential incomplete, 51 (59.31%). Middle complete, 17 (19.77%) medium incomplete, 8 (9.30%) 5 (5.81%). Religion: Catholic, 41 (47.67%), higher than incomplete, 2 (2.33%) complete 3 (2.33%) fundamental illiterate, and without information 1 (1.16%), Tan color, 68 (79.07%), white, 13 (15.12%) black evangelicals, 38 (44.19%), no religion (8.14%) 7. Comorbidities other CVD, 27 (31.40%), no Comorbidities, 22 (25.58%), other diseases, 9 (10.47%), it HAS/DM/IRC, 8 (9.30%), HAS 4 (4.65%),, IRC, 4 (4.65%), and other CVD, 3 (3.49%), it HAS/IRC, 3 (3.49%), it HAS/DM, 2 (2.33%), rheumatic heart disease, 1 (1.16%), DM/ IRC), 1 (1.16%), rheumatic disease, 1 (1.16%), IRC and Other CVD 1 (1.16%). Blood culture: 49 (56.98%), unpaid, 31 (36.05%) negative, 2 (2.33%) Acinetobacter, 1 (1.16%),K. pneumonie, P. auereginosa, Streptococcus. sanguinis and Streptococcus bovis, high, 59 (68.61%) improved, 23 (26.74%) death, 3 (3.49%), at the request and 1 (1.16%). aortic vegetation, 32 (37.21%), 19 (22.09%) No, 14 (16.28%) mitral vegetation, 11 (12.79%) 7 (8.14%) tricuspid and mitral and aortic 3 (3.49 %). Conclusions: the clinical epidemiological profile can be observed and mapped out in the present study, which studied population allowed to view what is being treated, and that the hospital does not meet exclusively to cardiology area, but also the areas of Nephrology, psychiatry and obstetrics, which may be related to cardiology. The presence of specific Comorbidities leading to a more serious picture of infective endocarditis, emphasizing the care that can be applied by the nurse, since the primary, always obeying the criteria of health prevention.

Malaria is one of the major infectious diseases that can lead to death, affecting mainly children under five years of age. Older children and adolescents in endemic areas may also present complications that merit attention from the health system. Nutrition, in addition to physiological function, plays an important role in the recovery of the individual infected with malaria. The objective of this study was to study the nutritional and hematological characteristics of children and adolescents diagnosed with malaria for Plasmodium vivax in the city of Anajás, State of Pará. Methodology: A cross-sectional epidemiological study occurred during the period from January 2014 to December 2016, with children and adolescents, divided into two groups: group 1 "with malaria" and group 2 "without malaria". Sociodemographic and epidemiological data were recorded in the semistructured research protocol. Data were collected from anthropometry, weight in kg and height in m, and consumption by means of the Food Frequency Questionnaire (FFQ), a blood collection in a fasting period of 12 hours. Data were analyzed in programs WHO AnthroPlus, version 1.0.3, Epi Info 3.5.1. and Bio Estat 5.0. The accepted level of significance was p <0.05. Results: A total of 144 individuals participated in the study, of which 66.67% were children and 33.33% were adolescents. Overall, 69 patients were diagnosed with malaria and 75 were in group 2. Those responsible for the participants were mothers (87.50%) with a mean age of 31.16 y (±7.62). A high percentage of illiterate mothers (17.39%) was found among infected patients, with p <0.0001 between the two groups. There was also a statistical difference (p <0.0001) between the employment situation, although the majority of those in group 1 and 2 declared themselves "at home", 81.16% and 42.67%, respectively. A percentage of 41.33% of employees/retirees for group 2, noting that 72.46% of group 1 had Family Income less than a minimum wage, and 88.41% received the “Bolsa Família” benefit. More than half of the patients with malaria had already had four or more malaria episodes (p <0.0001), and the parasitemia level was between 501-10,000 mm³. Regarding the nutritional status, it was verified that 17.71% of the total children were stunting for age, being 18.60% of group 1 and 16,98% of group 2 and for adolescents stunting for age was present in 19.23% and 4.55%, respectively for groups 1 and 2. Body mass index for age showed a high frequency of overweight for group 2, for children (20.75%) and adolescents (22.73%), without statistical difference. The mean hemoglobin level was 11.37 (±1.63) g/dL for the "group malaria" and 12.20 (± 1.30) g/dL for the second group (p = 0.0011), also with significant statistical difference children (p = 0.0116) and adolescents (p = 0.0028) of both groups. In "group malaria", 50.72% had anemia, beging 74.29% were of the moderate type and the "without malaria" group was 20.00%, of these 60.00% of the mild type (p = 0.0002).

The National Policy for Civil Servant’s Health and Work Security (Política Nacional de Atenção à Saúde e Segurança do Trabalho do Servidor Público Federal – PASS) is an established state policy, and is used as a legal tool for promoting and surveilling health among the public organs of the Federal Public Administration in the executive. PASS leads three principles: health assistance for civil servants; health and vigilance expertise; and health promotion. The latter recommends that changing actions must be developed in the workplace in order to reflect health gain for the servants. Methodology: Descriptive and exploratory study; qualitative research approach with a theoretical and methodological support based on the discursive practices by Spink (2010). The research consisted of a semi-structured interview, and aimed at investigating civil servants’ production of meanings on health promotion in the workplace. 17 (seventeen) federal civil servants from UFPA’s personnel took part in the interview. Result and discussion: The interviews were analyzed through two distinct processes: servants’ knowledge on “health” and “health promotion” – which was highlighted by terms/words – and the elaboration of four categories that appeared a posteriori about participants’ speech, considering: 1- the meanings about health promotion in the workplace; 2- health gain in the workplace due to health promotion; 3- health promotion, vigilance and intervention; and 4- information as a support for health gain. The categories were interpreted based on the narratives in light of the five main fields of health promotion proposed by the Ottawa charter, the guidelines that comprise the set of actions from PASS, and the theoretical background. The research result indicated the need of improving the theoretical discussions on health, risks, vulnerability, territory, intersectorality, critical autonomy, empowerment, and social participation as a way to face situations that prevent health gain. The interlocutors aim at gaining health from new social and environmental attitudes, social interactions, and health service reorientations. From the narratives, there was the need for an institutional planning that prioritizes programs and projects with the purpose of: improving UFPA’s campus infrastructure in Belém; promoting life quality in the workplace; and qualifying the servants about the policy for civil servants’ health and work security (PASS), which includes vigilance to environment and work process, and health promotion to servants. Conclusion: In the civil service, outside the healthcare sector, actions for health promotion aim at improving environment, organization, and work process in order to promote a health valuation culture through changing habits and behavioral attitudes individually and collectively, and to reduce morbimortality in the workplace. However, it can only happen through changes in social and environmental attitudes, social interactions, and health service reorientations. Furthermore, the institutional planning must have programs and projects to enhance life quality promotion in the workplace, and qualify the servants to develop their personal skills suitable for health gain.

With the creation of Law No. 11,947 / 09, it became compulsory to purchase products from family agriculture for the National School Feeding Program (PNAE), in at least 30% of the total resource passed on for school feeding. Thus, the present study sought to report from the perspective of family farmers, in two municipalities located in the Northeast region of the State of Pará, the difficulties and opportunities in the supply process for PNAE. Interviews and application of instruments were carried out with family farmers who were already accessing the PNAE. To obtain data on the purchase of PNAE, we analyzed the public call process provided by the Executing Entities (EEx) of the municipalities studied. According to the results, it was observed that in one of them the process of acquiring family farming still occurred in disagreement with the law. In addition, it was found that the difficulties were mainly related to the supply logistics issues and articulation among the actors involved in the execution of the program. In addition, the opportunities stand out mainly in what concerns the strengthening of family farming and the guarantee of healthy eating in schools. With this, there is a need for greater visibility in this scenario so that the policy is executed in order to achieve its objectives. 

Currently, efforts to eliminate leprosy have been intensified at a global and local level, causing a considerable reduction of the disease, but there are some clusters of the endemic, the Region of Health of Marajó presents with a high number of cases. Objective: To analyze the spatial and temporal distribution of leprosy and its relation with the Municipal Human Development Index, from 2010 to 2014 in the Marajó health region. Method: The study was ecological, composed of all cases of leprosy reported in the Information System and Notification Diseases (SINAN), from 2004 to 2014, in the 16 municipalities of the Marajó Health Region, software used: Excell 2010, for table production and ArcGIS 10.2. For the production of maps. Partial results: In the first phase of the study, the incidence rates of leprosy were calculated and presented on maps per year as partial results. In 2010, the rate was 31.62 per 100 thousand inhabitants, in 2012, it was 32.91. In 2012, of 32.78. In 2013, from 38.10 and 2014 from 33.5. All rates considered with very high parameter. Partial conclusions: It is observed that the incidence of leprosy in the health region of Marajó is a major public health problem, involving all the municipalities in question, most of them with very high and hyperendemic incidence rates

To evaluate the physical structure and the implantation of the care unit in primary health care units in the municipalities of the Marajó health region, using data from the National Program for Improving Access and Quality of Primary Care (PMAQ). Methodology: This is an evaluative research carried out based on secondary data belonging to the External Evaluation component available in the PMAQ-PA database. For this study, data from the PMAQ First (2012-2013) and Second Cycle (2014) will be used, referring to the evaluations carried out in the Marajó health region, with 16 municipalities in the First Cycle and 9 municipalities in the Second Cycle. In order to evaluate the physical structure of the units, the data of module I of the first and second cycle of the PMAQ will be used with items that correspond to "Identification of the Mode and Professionals of the Health Team", "Unit Infrastructure”, Offices, restrooms, etc.) in 16 units in the period 2012-2013 and 9 units in 2014. In order to evaluate the reception structure in the health units, the data of module II of the first and second cycle of the PMAQ will be used, with items That correspond to "Welcoming the spontaneous demand (if it is implemented, it meets the spontaneous demand, if the professionals are qualified to assess user risks and vulnerabilities) in the period 2012-2013 and 2014, respectively. In the comparative analysis between the first (2012-2013) and second (2014) cycle of the PMAQ will be used the data of only 9 municipalities. Partial Results: In the first cycle, 133 primary care units were included in the National Registry of Health Establishments, where the municipality of the Marajó health region with the largest number of health units was Breves with 22 units. Some of the 133 units are home to 81 Family Health Strategies, where most have oral health care. In most The number of clinics is less than the number of units, indicating that there are units without offices. Dental office does not exist in most units. Concerning the internal physical structure of rooms, reception room, waiting room, curative and vaccine, there are in most units; Room specific to host, procedure, observation, nebulization, sterilization, washing, purging and local to common waste do not exist in most units. Regarding the adequate structure of toilets, these present themselves in less than half of the units, highlighting a very small number of toilets adapted for people with disabilities, observed in only 3 units. Regarding the results for the host, the majority of the units with shelter are in the first cycle and the health needs are met with spontaneous demands; And the minority of the health teams were trained to assess the risks and vulnerabilities of families

The policy of fluoridation of public water supply is considered one of the ten greatest public health achievements of the twentieth century. Its importance as an intervention measure is the prevention of up to 60% of dental caries.
In addition, it is an inclusive policy, as it also provides access to treated water, which can be considered as one of the most important public health actions. The objective of this study will be to analyze the governance of the fluoridation policy of public water supply in the city of Belém-PA. To analyze the governance of the policy, a qualitative cross-sectional study will be carried out, with semi-structured interviews based on a script with open questions. The sample will be composed of the oral health managers of the state and the municipality of Belém, those responsible for the fluoridation of the water supply in the state and municipal sanitation companies, and the heads of the entities of the dental class. The data processing will be done through the technique of content analysis proposed by Bardin. Through this study it is expected to know the perception of the main actors involved in the process and how governance has been developed in the planning, execution and control of the fluoridation of public water supply in Belém

The Primary Health Care should use strategies that overcome the traditional model of health education, which does not consider relevant the knowledge, experience and culture of the user, since it is observed that the practice of health education is still focused on the professional, Which has prescriptive attitudes emphasized in the disease. It identifies the need for a problematizing, user-centered health education, considering its social and cultural aspects and not only the disease, encouraging people with diabetes through dialogue, active listening and reflections, adequate glycemic control and Self-care. Thus, this project aims to evaluate if the health education carried out through the Culture Circles of Paulo Freire improves the knowledge about the self-care of patients with Diabetes Mellitus. This is a randomized clinical trial to be developed with users with diabetes mellitus, 30 to 60 years of age, of both sexes, accompanied at the Family Health Strategies units of the city of Bragança, Pará. Will be advised to carry out the routine consultations, every three months, receiving individual orientations from the professionals working in the Family Health Strategies. Participants in the intervention group will be submitted to health education activities based on the Culture Circles method and will also be directed to continue their individual care in the Family Health Strategies, as routine, every three months. The culture circles will be developed in the phases: a thematic survey conducted by the researcher that will use informal conversations and the analysis of the answers of the questionnaires applied individually to raise and select the generative themes used by the participants regarding diabetes; Choice of generating themes by the group, from the reflection of the question: what are the challenges in having diabetes?; Problematization of the situations lived by the group, through the codification and decoding of the generating themes debated by the participants and to generate the debates will be used photos, drawings on the themes; Critical unveiling, that by taking a critical conscience of the experience in diabetes, transform their reality. An evaluation of the culture circles will be carried out through the dynamic "Tree of Self-Care". A sociodemographic questionnaire and the Diabetes-QAD Self-Care Activity Questionnaire will be applied, and capillary glycemia will be collected, a measure of weight and height for calculation of Body Mass Index, waist circumference and blood pressure. The softwear SPSS 20.0 will be used for the statistical analyzes, in which the values of p <0.05 will be considered statistically significant. The project was submitted to the Ethics and Research Committee of the Health Sciences Institute of the Federal University of Pará and is guided by the ethical principles of Resolution 466/2012, with approval on 05/07/2016 with CAEE 57049416.9.0000.0018. A pilot project was carried out with seven users with diabetes from an Family Health Strategies, six women and one man, with a mean age of 50 years, who participated in four Culture Circles. Firstly, there was a survey of seven generating themes by the researcher. These themes were presented to the group in the 1st circle, which chose three themes: diabetes / complications, feeding and foot care. The subjects were debated and unveiled in the 2nd, 3rd and 4th round, using photos of complications of diabetes, EVA illustrations of the bloodstream, pancreas, insulin and glucose, healthy dish design, food pyramid with food replicas, photos of Feet with complications. The group debated and reflected on the generative themes, problematizing situations experienced in diabetes treatment: "Very expensive integral food"; "There are shoes that give some calluses, but I use them anyway." Critically unveiled the themes and building a different perspective on self-care with diabetes: "If I was already taking care of myself, I will take care of myself even more so I do not have these complications"; "I know I will not take the flour out of it like that, but I'll eat more vegetables and fruit to make up for it." In assessing cultural circles, participants reported on the importance of the user in building knowledge: "I had never participated in a circle; it was good that you asked us to speak our thoughts and to talk with our colleagues." Carrying out the pilot project along the lines of the Culture Circle was extremely important, since it enabled dialogue, listening and interaction between the users and the researcher, contributing to the participants being active subjects in the debates, reflecting on the generated themes chosen and increasing knowledge about self-care related to diabetes.

Homicide is a harmful phenomenon in any society. Brazil has tragically and precociously lost its young people. This situation makes necessary studies on social violence, especially in a city based on the legal amazona, North region in Brazil. This municipality still lacks statistical data and more efficient public policies regarding local homicides. We aimed to analyze the spatial and temporal distribution of homicides from 2005 to 2013 in Belém City, Para State/Brazil, in order to identify its main socioeconomic determinants and to draw an epidemiological profile. This is a ecological, observational, descriptive / analytical and retrospective study. Data were obtained from the State Department of Public Health / Department of Epidemiology from Pará State, (Secretaria de Estado de Saúde do Pará, SESPA) available in the Mortality Information System – (Sistema de Informação sobre Mortalidade, SIM). Data were later georeferenced for Geostatistics analysis. A total of 5,487 homicides were reported, the predominant gender being male (94%), mean age 22 years, black / brown skin color (77%), primary school (74%). We found a strong correlation between homicide rate and life-condition index (índie de condição de vida, ICV), as showed by the Pearson's correlation of r = 0.93 (p = 0.001), Based on a linear regression model, we also observed significant trends and oscillations of incidence rates per 100 thousand inhabitants. Statistical and Geostatistical techniques revealed that the Guamá and Terra Firme neighborhood (D´ÁGUA) had very high homicide rates and low ICV, while in DAMOS, two out of 19 neighborhoods had a very high homicide rate (Farol and Maraú), both with low ICV. Our time series showed an increasing and alarming average homicide rate in the city of Belém, with higher rates than the average rates of the State of Pará, North Region, Brazil, and values recommended by the WHO. In addition, they demonstrated seasonal changes  associated with festivities and an inverse relationship with the living conditions of the population. The greater predominance of homicides was observed among young men. Thus, we suggest further studies to evaluate different strategies in public safety, aiming to reduce

Support Center For Family Health (NASF) is a basic care strategy that aims to support, expand and improve health care and management in Basic Health Care (BHC)/Family Health Strategy (FHS). It must also be commited to promoting transformation in attitude and performance of FHS professionals and among its own team members (NASF), including in its performance intersectoral and interdisciplinary actions, promotion, prevention, health rehabilitation and healing, as well as humanization Services, permanent education, promotion of integrality and territorial organization of health services. Thanks to its importance in Primary Care, especially in the studied municipality whose implementation of this service only happened in 2014, it was important to know the vision of the NASF multiprofessional team about the changes that have occurred since its implementation, in order to understand their opinion on the NASF, its activities, process of permanent education in health and relationship between teams. For this, a qualitative approach, case-study-based, was conducted with a semi-structured interview with NASF professionals from the Dagua District in Belém/Pa and participant observation of their practices. The treatment of the results was performed using the content analysis of the answers, in the thematic modality. The results indicated that the professionals understand NASF as an important device for BHC, being able to support actions of prevention and health promotion in the scope territory; they also emphasize that the training process is necessary and it does happen, however the process of permanent education in health left much to be desired as practice and understanding of the team. They emphasize that multiprofissional team work is a daily construction that brings benefits to the work process, but it has many challenges to overcome. The data also indicate that professionals evaluate their actions as positive, showing that the health service users adhere to various activities, actions, attendances and follow-up activities  proposed, especially group visits with objectives of health promotion and quality of life

ESTUDO DA DISTRIBUIÇÃO ESPAÇO-TEMPORAL DA LEISHMANIOSE TEGUMENTAR AMERICANA NO MUNICÍPIO DE BRAGANÇA, PARÁ.

Diabetes Mellitus (DM) is nowadays a worldwide epidemic, posing a major challenge for health systems around the world. Diabetes management should be done within a hierarchical health system, with its base being the primary level. The strengthening of Primary Health Care (PHC) is identified as a strategic action to confront the crisis that the Health Systems are undergoing. The Ministry of Health (MS) has prioritized the execution of public management based on actions to monitor and evaluate processes and results. The present study focused on the evaluation of the quality of health services provided in primary care for people with diabetes, based on the Donabedian Theory, focusing on structure and process as determinants of quality. It was verified that the Basic Health Units (BHU) and the Family Health Strategies (FHT) of the DAGUA district of the Municipality of Belém, present Intermediate quality of the services provided to Diabetes Mellitus patients, identifying weakness in several analyzed categories that characterized these dimensions. Through the Structure dimension, a weakness in infrastructure and human resources was identified in the two types of services addressed, with a greater commitment to the qualification of FHT. Consequently, through the approach of the Process of Service, a greater commitment was created in the assistance model presented by the PHUs, which reached an incipient classification in most of the indicators evaluated. The findings of the research allow the conclusion, and agreement with Donabedian, that a structure of good quality does not guarantee quality in the service process, but can become influential. In the qualitative approach, the lack of consensus among the professionals in relation to the care line was identified in both the BHU and the FHS, establishing diversity of action plans with impacts that are not always significant to improve the results of health indicators.

This current study evaluated the impact of dental caries and periodontal disease on the quality of life of adolescents and young adults from an urban area and from two riverine communities of the Amazon region, located at different distances from downtown. The occurrence of dental caries and periodontal disease was examined through the DMFT / IDC index (Index of the Dental Condition) and CPI (Community Periodontal Index). The impact of oral health conditions on quality of life was examined through a simplified version OHIP-14 (Oral Health Impact Profile) questionnaire. The data collected from 212 individuals (15-25 years old), residents from the urban area of Abaetetuba-Pará, were compared to those from 186 inhabitants of the nearest riverine community (Maracapucu), and from another riverine population (n=166), further located from the city (Tucumanduba River). The quality of life was analyzed as a dependent outcome, while dental caries, bleeding, calculus, periodontal pocket depth, as well as sex and age, were analyzed as independent variables, determined through multilevel and Poisson analysis. The worst indicators of quality of life and the highest DMFT scores were found in the riverine populations. Based on the adjusted multivariate model, variables such as the contextual variable (location), individual demographic variables (sex and age), DMFT and the presence of periodontal pockets were significantly related to OHIP. Women (IRR 1.19, p <0.0001), age (IRR 1.04, p <0.0001), and students from riverine schools reported the poorest qualify of life (IRR 1.33, p <0.0001), especially those students from the riverine community far from de urban center (p <0.001). The results of this study confirms that dental caries and periodontal disease negatively impact the quality of life, however, these diseases seem to impact the individuals of remote communities in a more significant way.

The aim of this study was to evaluate the first contact access attribute of primary health care
in the QuilombolaCommunity of Abacatal in Ananindeua-PA, in order to identify the
primary care reference service recognized by the community as a care device, assess
utilization and accessibility of the Family Health Strategy Using PCATool for the adult
population of said community. The quantitative descriptive cross-sectional study involved
the participation of 92 residents of the Quilombola Community of Abacatal, over 30 years
old, who, after consent, answered the Instrument of Assessment of Primary Care (PCATool)
adult version, which consists of 87 Items divided into ten components related to the
attributes of Primary Health Care (PHC), three dimensions were used for the study: Degree
of affiliation (5 items) that sought to assess the degree of affiliation, that is, how much the
patient feels " Belonging "to the service; Whether there is a health service that is usually
sought when there is a need; If there is a service that knows the user better and if there is a
service that is considered responsible for the user's care, first contact - utilization (3 items),
which sought to evaluate if the doctor or nurse of the FHS indicated in the component
degree of affiliation Is the first to be sought for a review query; If the referred service is the
first place that the interviewee would look for if he / she has a health problem that has not
yet occurred or a new episode of a chronic problem and if the service under evaluation is the
only means of referral to a specialist or specialized service , And Accessibility (12 items)
that sought to evaluate if the user gets access on weekends and night to the referred service;
If the FHS attends its users with agility when they have acute illness or aggravation of a
chronic or telephone problem in these circumstances or for doubts as to their health situation
/ treatments; If you have a means of communication when this service is closed, not
including other services that the interviewee can access; If the doctor / nurse or someone in
the service under evaluation would attend the patient during the weekend or at night;
Evaluate the time spent in the waiting room, until the patient is seen in consultation by the
doctor or nurse; If there is difficulty for medical care; If you need to miss work or school on
the day of the consultation. The results show that most residents turn to the FHS when they
become ill or need advice on their health; And some have reported using other services,
negatively evaluating the usage attribute. Regarding the availability of services, care and
communication with the FHS, the answers had a negative majority. It is concluded that there
is no recognition of the community about the local FHS as its gateway, because it is not
considered resolutive, the study contributed to the fact that, when evaluating, it is indicated
punctually where it is necessary to move towards reaching Comprehensive and quality
assistance. From these findings, it is also a necessity for policies to be established, to be
implemented.

This study investigated the susceptibility to chronic periodontitis, edentulism and its association between polymorphisms in the IL10 gene in the indigenous population of the Xikrin do Cateté villages. Oral health is an integral and essential part of general health and, as such, is a determining factor for quality of life. Chronic periodontitis has a slow progression, similar to diseases with complex and chronic nature. The environmental factors that most relate to the disease are smoking, alcoholism and stress, and genetic factors. Somehow the genes or group of genes modify the periodontal response to environmental etiological factors and essential for periodontitis. The community is characterized by being a population affected early by tooth loss and edentulism. There is a relation between the increase in age with the presence of periodontal disease and edentulism. The sex issue was decisive for the course of the disease, both male and female presented the disease, however the male presented a majority of individuals with periodontal disease 62.5% and the female with 52.3% Edentulous individuals. Both smoking and diabetes had an impact on the course of periodontal disease, but found that smoking increases the chances of developing periodontal disease (22.4%) and dental loss (24.5%). Diabetes is related to loss of the dental element, raising the risk for edentulism in 43.36%. There is an association of the genetic mutation in IL-819 studied with the presence of periodontal disease in the Xikrin indigenous population of Cateté, where the mutant (risk) genotype is observed in 81% of the sample. That is, IL-819 is a risky SNP for the development of periodontal disease and subsequent dental loss. More studies are needed to verify the action and the relationship of existing genetic polymorphisms with periodontal disease in the indigenous population of the Cateté Xikrin. In indigenous oral health, there is a need to promote research on these peoples, with the intention of generating information for the planning and organization of health services, with the purpose of ensuring the establishment of care in the oral health program, with a non-mutilating character , Universal, integral, and that considers the cultural values related to the hygienic, dietary practices of the Xikrin people of Cateté.

This work aimed to evaluate the outcome of patients with resistant tuberculosis

multidrug (MDR-TB) in the State of Pará from the assessment of disease indicators in

the State Department data system Para Health (SESPA) and of medical records of

patients admitted to a reference hospital in the state, the University hospital João de

Barros Barreto. This research took place in stages: first sought to give reasons in the

studies on the subject in research, where origin gave to an integrative literature

review, in the second stage held a historic series of MDR-TB in Pará in 2005 2014

and there was a reduction in the percentage of high cure and in 2006 was the highest

rate (92.6%) and in 2014 the lowest (46.7%). There was also an increase in the

percentage abandonment of treatment in this period. The failure had the highest

percentage in 2013 (8.8%), followed by the year of 2014 (6.7%). Regarding the

deaths, the peak occurred in 2008 (18.9%) followed by 2007 (13.6%). The incidence

rate of the disease was shown to be reduced over the period analyzed, the third

stage, developed a research on the clinical course of patients with MDR-TB treated

at a university hospital in the 2010-2014 period from information contained in

records, predominantly male and the most affected age group was the one in the

most productive years (18-55 years), the secondary form of the disease was present

in 94.1% of cases, the diagnostic time and the start of treatment for MDR-TB 1 to 10

days, the profile of resistance to drugs that prevailed were rifampicin, isoniazid and

streptomycin and was most associated comorbid diabetes. In the fourth and final

stage held the lifting of antituberculosis resistance profile of these patients treated at

the referral center in the period 2010-2014, where most of the samples were from

men, the age group between 18-55 years, most was not HIV positive, healing

endpoint was the highest (77.4%), the most resistance pattern introduced drug

resistance 3 (41.9%) and of these, the pattern that was introduced to rifampicin (R ),

isoniazid (H) and ethambutol (E) (16.13%), the drug most widely used in treatments

was E with 28 treatments and the most used scheme was that contains levofloxacin

(LFX), terizidone (TRZ), and , amikacin (Am) and metronidazole (Mtr) with 22.6% of

the schemes. With the research it was possible to trace the profile of the disease in

the state, demonstrating how the disease still affects negatively on the indicators

which shows the need for more effective public policies to combat and control the

disease and also more investments in more treatments efficient and of short duration.

NUTRICIONAL SITUATION OF QUILOMBOLA ADOLESCENTS IN
THE STATE OF PARÁ, AMAZONIA, BRAZIL
ABSTRACT
Quilombola (afrodescendant) communities are frequently absent from national research about
health, resulting in a lack of data about their reality, making it difficult to construct
epidemiological indicators for them. Historically, these groups have been constantly faced
with situations of socioecological vulnerability. These difficulties are reflected in the different
age groups and eventually have negative consequences, particularly in the early stages of life,
childhood and adolescence, periods that occur the main changes that will project the
individual's potential in adulthood. It is already recognized in epidemiologic studies
worldwide that the nutritional transition has reached more traditional populations, increasing
the rates of overweight. However, there are still few studies investigating the nutritional status
of quilombola adolescents in Amazonia. Monitoring the nutritional status in this period,
adapting the study tools already used in other populations to the local reality of the
quilombola, is a way to understand the possible causes of the development overweight during
adolescence and its persistence into adulthood besides providing subsidies for public health
planning. This study has as main objective to analyse the problem of overweight among
adolescent quilombolas from Pará state, verifying the influence of socio-demographic
conditions in the nutritional status of this population. A transversal study was made, where
participated 150 adolescents between 10 and 19 years old, with a mean age of 14,37 (±3,02)
years old. These belonged to 54 families from nine quilombo communities located in three
municipalities of Pará- Oriximiná, Cametá and Ananindeua- It was measured, weight, height
and body composition, besides the application of a socio-economic survey per family.
Quilombos belonging to the Oriximiná municipality are located at the banks of Trumpets and
Erepecuru river, being accessible only by river. The communities of Cametá and Ananindeua,
there is road access, but the roads have no paving, with plenty of slopes, there is no public
transportation, being motorcycles the primary means of driving used. In all communities,
subsistence agriculture, based on family labor, with the production of flour, acts as the main
source of income, supplemented by financial assistance received from government. Only
9,3% had some kid of sanitation and in relation the householders, most part of then (55,3%)
had even three years of schooling. Homes with electricity comprised 44.67% of the sample. In
relation to the nutritional transition, 22% of the population of adolescents are overweight, and
there are still 16.7% of deficit of stature among young people, suggesting a past of
malnutrition condition. In relation to body composition of adolescents, it was found that
83.65% having body fat percentage within the average. The correspondence analysis showed
that the indicator BMI/I had association with all the surveyed socioeconomic conditions
(Community, income, education of the householder, household income and sanitation), about
E / I, this was not influenced by the variable income and sanitation (p= 0,165 and
p=0,345,respectively). The present study, even not using a methodology that verify the
clinical situation and integral adolescent health corroborates other studies that point to the
vulnerability of the quilombo population.

In the state of Pará, the municipality of Ulianópolis, located in the southeastern region has recorded high prevalence of American Cutaneous Leishmaniasis (ACL) cases in recent years. In order to know the distribution of the localities involved in the infection, the aim of this study was to analyze the spatiotemporal form the of American Cutaneous Leishmaniasis (ACL) distribution in the municipality of Ulianópolis, in the period 2010 to 2014. SINAM data were obtained for epidemiological, socioeconomic and environmental analysis; survey of cartographic databases and satellite images geostatistical analysis based on kernel density estimator, interpolation technique and self spatial autocorrelation using the Moran index were performed. The prevalence rate of LTA was higher in males (334/406), aged between 15-45 years with low education (5th to 8th incomplete grade of elementary school) and predominance of cutaneous form (99.26%). The distribution of LTA cases was observed throughout the municipality, with a displacement of the disease over the years. The localities “Assentamento Nova Vida”, “Fazenda São Marcos”, “Colônia Bom Jesus” and “Km 60” had higher expressivity in numbers of cases and in its vicinity were perceived secondary vegetation, forest, shieling and agriculture. Several focus of occurrences and LTA clusters were identified in different areas of the municipality during the study period, suggesting that the ideal conditions for the establishment and maintenance of transmission are found in these places and that the pattern of occurrence of LTA is not static and diseases may occasionally spread to other areas of the county. The use of tools such as geoprocessing technology provides understand the epidemiological dynamics of LTA that is established in Ulianópolis, which will enable the prevention and promotion activities in priority areas.

Leishmaniasis; Epidemiology; Geographic Information System; Spatial analysis; Multiple regression.

The health and quality of life are dimensions of human life strongly

influenced by the social context. For populations in vulnerable situations, such

as riverside communities, it is essential to know how the social determinants are

expressed in the construction of health perception by the individual in their

midst. The oral health is part of the overall health of the individual, and the

elderly, oral conditions influence the physiological and psychosocial function,

and therefore act to determine the quality of life. This research aims to evaluate

the impact of tooth loss in quality of life, according to the GOHAI, bordering the

elderly Combu Island, Belém-PA. This is an observational study with over 65

elderly enrolled in the Health Strategy Combu family. socioeconomic conditions

were assessed by socio demographic indicators; quality of life, according to the

Geriatric Index Determination of Oral Health (GOHAI); and edentulism through

oral examination for use and need of prosthesis according to the protocol

adopted by the National Survey of Oral Health, SB 2100. Brazil were evaluated

53 subjects with a mean age of 71.6 years (± 6.68) to five years of schooling

and maximum income of two minimum wages. There was a high prevalence of

edentulism: 58% of the elderly are totaling edentulous and 42% have lost at

least one tooth. There was a higher proportion of edentulos among the elderly

aged over 70 years and with less education. Quality of life was considered poor,

with a mean score of 25.9 GOHAI. The rehabilitated elderly had better quality of

life compared to non-rehabilitated. Increased life expectancy of Brazilian

citizens reports a special look to old problems, such as the development of a

health policy that includes the preservation of tooth and rehabilitation so that

they can live with quality and better inclusion in society.

It talks about the attention network to the health focused to the person with disability that
aims to analyze the challenges to the process of formation of the care network to the person
with disability from the health politics to the person with disability in the state of Pará,
identify the current state of the attention network of care to the person with disability from
their components: basic attention; specialized attention in auditive rehabilitation, physics,
intellectual, visual, ostomy and in multiple deficiencies; and hospital attention and of urgency
and emergency, as well as analyze the processes of implementation, problems and challenges
related to the care politics recommended by the state from the rights established related to the
person with disability. This study was based in a qualitative study with a hybrid approach held
through the analysis of documents, 8 semi-structured interviews with managers of the units of
health references in attention to the person with disability and contribution of critical literature
about the theme. The attention network to the person with disability in Pará is unstructured,
and was identified that it is concentrated in the capital, a fact that undermines the guarantee of
access to health services and treatments, as well as prejudicing the social inclusion and hinder
the integral care to the health of people with disabilities. It is a significant network but still
incipient.

A presente pesquisa retrata a saúde da população quilombola no estado do Pará,
considerando as diretrizes e princípios estabelecido no SUS. Deste modo, analisa-se que
são vários os aspectos a serem observados na construção da saúde de populações
quilombolas, entre esses aspectos observamos a incidência de anemia como um importante
fator a ser levado em consideração nessas populações, bem como a incidência de
hemoglobinopatias que podem afetar a qualidade de vida. Portanto, buscou-se analisar a
classificação dos parâmetros eritrocitários e a prevalência de hemoglobinopatias
hereditárias em comunidades afrodescendentes de Óbidos e Oriximiná, região do baixoamazonas, Pará. A amostra foi composta de comunidades quilombolas de dois municípios
do estado do Pará, Óbidos com três comunidades (239 indivíduos) e Oriximiná com nove
comunidades (368 indivíduos). Elas foram categorizadas de acordo com o sexo e a faixa
etária para analise e comparação dos dados. O município de Oriximiná teve um total de
29,9% de sua população com quadro de anemia e Óbidos apresentou 7,5% com anemia,
observando os valores de hemoglobina, sendo que 46,6% das crianças das comunidades de
Oriximiná abaixo de 5 anos estavam com anemia e com um percentual maior em
comparação com Óbidos; 58,1% das crianças entre 6 – 11 anos de Oriximiná e 25% em
Óbidos apresentaram quadro de anemia. Com relação à distribuição das hemoglobinas
variantes o maior percentual em Oriximiná foi observado para a HbAS com 5,2% da
população, seguido de indivíduos com interação Talβ/S com 1,9%, foi observado 1,4% de
casos sugestivos de Talassemia beta; a distribuição em Óbidos teve sua maior frequência
também para HbAS com 4,2% da população, seguido de casos sugestivos de Talassemia
beta e interação Talβ/S, ainda foi observado casos de HbC. Os percentuais observados
apontam para a necessidade de politicas publicas para reverter esse quadro, contudo a
saúde da população negra em nosso país perpassa por várias esferas e que estão
correlacionadas entre si, levando a disparidade no que se diz respeito ao acesso à saúde e
equidade. Portanto, além dos serviços de saúde a há necessidade de politicas que venham
empoderar essas populações acerca de seus direitos como indivíduos inclusos na
sociedade, bem como dos possíveis agravos de saúde que podem ocorrer em decorrência
da sua origem ou composição genética.

Mental health; Attention to workers' health; Labor; Servers public; Federal University of Pará.

Chagas disease is endemic in the Amazon region, but it has always been poorly documented. In the recent decades, Pará State is where most of these cases of this disease were recorded, mainly from the micro-region of Belém. In this context, this study focused to develop the disease scenario, from 2007 to 2014, in order to comprehend the relationships with environmental and socioeconomic variables at Barcarena municipality, which is located in the above-mentioned micro-region. Barcarena was selected because it has been confirmed 83 cases of Chagas in this period, with a prevalence rate of 89.38 cases/100,000 inhabitants. Thus, many scenarios were developed to assess the factors related with the risk of Chagas disease. In this way, the municipality of Barcarena was divided into 5 political and administrative areas because of the different intra-regional characteristics of these areas, which are: Headquarter, Morucupi, Vila do Conde, islands and roads. Furthermore, there were interrelated basis of epidemiological, environmental and socioeconomic data, all debugged and then indexed with geographic coordinates obtained in the study areas. For epidemiological and socioeconomic analysis were used statistical techniques, for environmental analysis were used satellite image classification technique with Artificial Neural Networks, and for the analysis of spatial autocorrelation among the variables mentioned above were used geostatistical techniques. The historical series of the disease has shown an increasing trend of cases, with maximum impact in the years of 2013 and 2014 with 40.9/100,000 inhabitants, also was observed a seasonal pattern with higher notification in the second semester. The epidemiological profile for of Chagas disease was male, adult, mixed race, illiterate, living in urban and rural areas, and the oral transmission was the most responsible for the infection in urban areas, such as in regions Headquarters, Morucupi and Vila do Conde. Also, the vector transmission was higher in rural areas, as in the regions of the Islands and Roads a cluster pattern was observed from this disease in deforested. Finally, the use of techniques Statistical and geostatistical proved satisfactory and allowed us to identify regions with different levels of risk. Considering these results, we could emphasize the importance of using these techniques applying to studies in Public Health, because of that, the use of them in this work contributed to the construction of possible eco-epidemiological scenarios of Chagas, providing important information for health managers and planners in order control and surveillance of this disease

Burnout is an occupational disease that is expressed in three dimensions: emotional

exhaustion (EE), depersonalization (DP) and low personal accomplishment (RP), causing

damage to worker health. Objectives: To evaluate the characteristics of the disease in workers

at a university hospital in the city of Belem, State of Para, Brazil. Methods: A descriptive and

observational study using quantitative approach to cross-sectional design. 2 questionnaires

were applied, being a socio-occupational characterization protocol and the Maslach Burnout

Inventory (MBI) with 62 professionals. Data analysis was descriptive and inferential statistics

used. The presentation of the data was performed using absolute and relative frequency

distributions. The inferential statistics were performed by Kruskal-Wallis test, since the

samples were not Gaussian, as the result of the test D'Agostino-Pearson. The chi-square test

was used to evaluate the qualitative variables. Quantitative variables were compared by

Kruskal-Wallis ANOVA with Dunn's post-test, since they were not compatible with the

normal range. significance level were considered (alpha level) of 5%. Overall result: 48.3%

had medium or high degree in EE; 40.03% medium or high in low PR and 38.7% had medium

or high degree DP, with 45.16% of the workers had at least one dimension at a critical level

and 8.06% had all three dimensions criticism. It was found statistically significant

associations between being single and higher EE levels (p = 0.0285) and RP (p = 0.0082);

income above 10 minimum wages and high levels of EE (p = 0.0122) and PD (p = 0.0498),

lack of interest in work and higher levels of RP (p = 0.0011) and PD (p = 0, 0046) and other

gainful activity and high levels of EE (p = 0.0373). Discussion: Although some results did not

confirm the literature, it should be noted that most of the professional categories had not been

investigated by adopting the methodology, which prevented us from establishing more

consistent comparisons. Final Thoughts: The prevalence rate was found to be high among

workers. How much of the studied associations did not achieve statistical significance, it is

possible to suggest that working conditions may be responsible for the symptoms of burnout

more than isolated features of professional or your workplace.

This study aimed to know the perception of elderly in a Family Health Strategy from the District of Guamá, Belém, Pará (FHS) about the embracement, as well as the difficulties they have faced and their expectations, starting from the knowledge of these users on this topic and observation of the service at FHG. Considering the reality of the growing number of elderly in health services and the need for specific service for these people, the Ministry of Health has appointed as a priority the expansion and the qualification of the basic health care through Family Health Strategy, as well as has invested in the formulation and implementation of policies in this direction. In this context, the embracement has a very important role because, by enabling users the listening to their problems and their resolution in a qualified manner, it is characterized as a technology that contributes to the organization of the service, in order to ensure universal access and efficaciousness. Therefore it is important to identify experiences about the embracement in the brazilian public health system (Sistema Único de Saúde). The design of this study consisted of quantitative and qualitative approaches, conducted in the period from June to August, 2015 in the FHS Parque Amazônia I of ADMINISTRATIVE DISTRICT of Guamá, Belém, Pará. The quantitative data were obtained through a questionnaire concerning to the sociodemographic profile of users, which were analysed in a descriptive way. The qualitative data were gathered by using semi structured interviews and the participant observation technique. 20 elderlies were interviewed. Qualitative analysis was conducted using the Thematic Content Analysis proposed by Bardin. It was observed that most elderlies were female. They aged 60 to 70 years old, with a family income of only a minimum wage. 50% of them were illiterate and most of participants had a spouse. By using qualitative analysis it was obtained 11 categories, which were grouped into four themes: Embracement: the meaning of this word in elderly view; Embracement as technology to the service reorganization; Professional health-user relationship: empathetic attitude that promotes the embracement; Embracement: technology that contributes to the achievement of a health care model based on extended clinic. The embracement concept that emerged from the speaking of the users was translated in the desire to be treated well, to be received with affection, patience, conviviality and respect. These characteristics showed the relational side of the embracement and how important is the relationship between health care professional and user. In the field of practical attitudes, passing beyond the conceptual view, it was reported the long wait for the service and for scheduling clinical appointments and tests, inadequate physical space, lack of some drugs, which results in the need to go to other locations, overcoming geographical and financial barriers, characterized as difficulties to the implementation of the embracement. In addition, unfortunately, the reductionist logic - "curativist" – based on abundance of medicine and doctors, it is installed, however all the efforts for the transformation of this health care model in SUS. Thus, the embracement, if it is carried out effectively, represents an instrument that can contribute significantly to this great revolution in the design of health care, considering that through it, the user is placed in the center, bringing better results to his health. Therefore, the study allowed a reflection on concepts and characteristics related to embracement that are evident in practice, or are yet to improve, bringing new perspectives to the improvement of the health under this guideline.

To identify sociodemographic and economic determinants of quilombolas populations living in the state of Pará and its potential interference with the growth of children aged 0- 3 years old. Methods: The sample consisted of 120 children under 3 years of age and 87 people over 18 who represented the parents and/or guardians of children, totaling 207 people. The research instrument used for data collection was a home visit questionnaire with qualitative and quantitative questions about socioeconomic, housing data and sewerage, obtained through interviews with each family head and an individual questionnaire in order to get anthropometric measurements of children. Weight for age (W/A), Height for age (H/A) and body mass index (BMI) for age (BMI/A) were descriptors of nutritional status of children and for this study was considered as an outcome, in other words, variable dependent, the score-z values below -2 for these index and demographic and economic determinants are configured as independent variables, which were categorized to the chi-square test, whose correlation is significant to the values that have p ≤ 0,05. Results and Discussion: The quilombos communities of Pará showed very impressive results, highlighting the poor infrastructure that still characterizes them, marked by difficult access to potable water and non-existent sewage system. The nutritional status of children suggests the nutritional transition process, where there is still prevalence of underweight children and stunting, while it realizes the trend of overweight among children under 3 years. Conclusion: This study shows that not only is the population with economically favorable conditions that are going through the process of nutritional transition, but those people in precarious situations may be experiencing this process too, and reinforces the importance of conducting studies of this type of design in vulnerable populations such as the quilombolas, who despite being a significant population in Brazil and especially in the Amazon, are still supporting the scientific research and national and international literature.

The aging of the world population, including the Amazon, is a phenomenon that causes

researchers, health managers and policy makers need to look into the specific demands of an

increasingly long-lived society. This fact, along with the change of the current family

dynamics, has reflected in an increase in the number of elderly people living in long-stay

institutions (ILPI's). The transfer of the elderly in your home for ILPI causes it has to adapt to

a new reality, which includes changes in habits, routines, environments and personal and

social relationships. This may result in changes in health and quality of life of older people,

which is an important issue for public health. In Brazil, little has been investigated on the

impact of family separation on the health of aged people. This study aims to investigate the

potential relationship between institutionalization, family separation and health perception.

This is an observational and descriptive study using a qualitative approach linked to the

phenomenological perspective. Participated 26 seniors, six men and 20 women, aged 62-95

years, living in two ILPI's, Bethlehem, PA. An elderly characterization questionnaire was

applied and held a semi-structured interview with each, as well as participant observation

during everyday activities. Data were analyzed using the technique of content analysis. It was

observed that 50% of seniors assess their health condition as good, and that men have

apparent lack of interest in relation to health; that family visits do not occur frequently, even

among those who have cited family life, and that even when the very elderly

institutionalization opts for this choice is made due to some external necessity to the subject.

It was also observed that the removal of family life is understood as contentment agent and /

or distress, depending on each subject and experienced contexts, which interferes with the

perception of subjective well-being. The study found that the elderly differentiate health

condition and well-being, and that the health of institutionalized elderly in addition to being

influenced by physical and biological factors of their own age is also affected by their

perception of the separation from family life. Other factors that potentially influence the

health perceptions are personal and social experiences, expectations, socioeconomic and

environmental factors that have. It is concluded that the self-perceived health in the elderly

results from a complex set of factors that must be considered when analyzing the quality of

life of residents and when planning public policies aimed at this segment of the population.