RESUMO
BACKGROUND: It is important to understand the dynamics of SARS-CoV-2 transmission in close-contact settings such as households. We hypothesized that children would most often acquire SARS-CoV-2 from a symptomatic adult caregiver. METHODS: This prospective cohort study was conducted from April 2020 to July 2022 in a low-resource, urban settlement in Brazil. We recruited families who brought their children to a public clinic. We collected nasopharyngeal and oral swabs from household members and tracked symptoms and vaccination. RESULTS: In total, 1256 participants in 298 households were tested for SARS-CoV-2. A total of 4073 RT-PCR tests were run with 893 SARS-CoV-2 positive results (21.9%). SARS-CoV-2 cases were defined as isolated cases (N = 158) or well-defined transmission events (N = 175). The risk of household transmission was lower if the index case was a child (OR: 0.3 [95% CI: 0.16-0.55], P < .001) or was vaccinated (OR: 0.29 [95% CI: 0.1-0.85], P = .024), and higher if the index was symptomatic (OR: 2.53 [95% CI: 1.51-4.26], P < .001). The secondary attack rate for child index cases to child contacts was 0.29, whereas the secondary attack rate for adult index cases to child contacts was 0.47 (P = .08). CONCLUSIONS: In this community, children were significantly less infectious to their household contacts than adolescents or adults. Most children were infected by a symptomatic adult, usually their mother. There was a double benefit of vaccination as it protected the vaccine from severe illness and prevented onward transmission to household contacts. Our findings may also be valid for similar populations throughout Latin America.
Assuntos
COVID-19 , SARS-CoV-2 , Adulto , Feminino , Adolescente , Criança , Humanos , COVID-19/epidemiologia , Estudos Prospectivos , Pandemias/prevenção & controle , Características da FamíliaRESUMO
RESUMO O estudo analisa a implantação e implementação das práticas integrativas e complementares (PIC), bem como limites e potencialidades desse processo, nos serviços de Atenção Primária à Saúde (APS) de uma região de saúde do estado de São Paulo, na perspectiva de profissionais dos Núcleos Ampliados de Saúde da Família (NASF). Trata-se de estudo de abordagem quanti-qualitativa cujos dados foram coletados por meio de questionário e entrevista semiestruturada on-line e analisados com uso de estatística descritiva e análise de conteúdo modalidade temática. Do conjunto de dados emergiram três unidades temáticas: (des)estrutura para compra de materiais para as PIC; PIC enquanto cuidado ampliado, resolutivo e integral; e (Des)estrutura na alocação de profissionais para oferta de PIC. Em um contexto marcado por políticas de desmonte do NASF e do Sistema Único de Saúde (SUS), a continuidade do cuidado com a oferta de PIC por profissionais do NASF emerge como prática de resistência que reafirma a vida e reitera a longitudinalidade, o acolhimento e a integralidade, essenciais à APS e ao SUS.
Abstract This study analyzes the implantation and implementation of Complementary Therapies (CT), as well as its limits and potentialities in Primary Health Care (PHC) services of a São Paulo health region, from the perspective of NASFExtended Family Health Centers (NASF) professionals. A quantitative and qualitative study was conducted with data collected by means of a questionnaire and online semi-structured interview, and examined using descriptive statistics and thematic content analysis. Three thematic units emerged from the data set: (Un)structured purchase of CT-related materials; CT as expanded, resolutive and integral care; and (un)structured allocation of professionals to CT. In a context marked by policies aimed at dismantling the NASF and SUS, continuity of care with CT offered by NASF professionals emerges as resistance practice that reaffirms life and reiterates longitudinality, embracement and integrality, essential to PHC and SUS.
Assuntos
Terapias ComplementaresRESUMO
Resumo Este artigo analisa as possibilidades e os limites da colaboração interprofissional no âmbito do cuidado em saúde mental, considerando-se as articulações entre as equipes do Núcleo Ampliado de Saúde da Família e Atenção Básica e da Estratégia de Saúde da Família em um município do estado do Rio de Janeiro. Trata-se de uma pesquisa qualitativa, baseada na abordagem hermenêutica filosófica, que se pautou em um estudo de caso, utilizando como estratégias metodológicas a observação participante, grupos focais narrativos e entrevistas semiestruturadas. Os resultados indicam a indissociabilidade dos elementos estruturais, organizacionais e intersubjetivos na colaboração interprofissional, com fortes tensionamentos no que diz respeito à organização dos processos de trabalho tanto em sua dimensão formal quanto intersubjetiva. Identificou-se que o compartilhamento de alguns objetivos do cuidado, como a desmedicalização, fomentava a construção de parcerias entre as equipes. Por outro lado, a partir do diálogo com os referenciais utilizados, compreendeu-se que regras construídas com o intuito de induzir a cooperação tiveram efeito paradoxal, gerando participação desimplicada em parte dos trabalhadores. Conclui-se que as relações de confiança no trabalho mostraram-se um elemento fundamental para a colaboração, o que exige a configuração de um ambiente organizacional capaz de aglutinar interesses e lidar com conflitos.
Abstract This article analyzes the possibilities and limits of interprofessional collaboration in mental health care, considering the articulations between the teams of the Extended Family Health and Primary Care Center and the Family Health Strategy in a city in the state of Rio de Janeiro, Brazil. This is a qualitative research, based on the philosophical hermeneutic approach, which was based on a case study, using as methodological strategies participant observation, narrative focus groups, and semi-structured interviews. The results indicate the inseparability of structural, organizational, and intersubjective elements in interprofessional collaboration, with strong tensions regarding the organization of work processes in both their formal and intersubjective dimensions. It was identified that the sharing of some care goals, such as demedicalization, fostered the construction of partnerships among the teams. On the other hand, from the dialog with the references used, it was understood that rules constructed with the intention of inducing cooperation had a paradoxical effect, generating unimplicated participation on part of the workers. It is concluded that trust at work has proven to be a fundamental element for collaboration, which requires the configuration of an organizational environment capable of bringing together interests and dealing with conflicts.
Resumen Este artículo analiza las posibilidades y los límites de la colaboración interprofesional en el ámbito de la atención de salud mental, considerando las articulaciones entre los equipos del Núcleo Ampliado de Salud de la Familia y Atención Primaria y de la Estrategia de Salud de la Familia en un municipio del estado de Río de Janeiro. Se trata de una investigación cualitativa, basada en un enfoque hermenéutico filosófico, que se basó en un estudio de caso, utilizando como estrategias metodológicas la observación participante, grupos focales narrativos y entrevistas semiestructuradas. Los resultados indican la indisociabilidad de los elementos estructurales, organizacionales e intersubjetivos en la colaboración interprofesional, con fuertes tensiones en cuanto a la organización de los procesos de trabajo tanto en su dimensión formal como intersubjetiva. Se identificó que el intercambio de algunos objetivos de la atención, como la desmedicalización, fomentaba la construcción de asociaciones entre los equipos. Por otro lado, a partir del diálogo con las referencias utilizadas, se entendió que las reglas construidas con el objetivo de inducir la cooperación tuvieron un efecto paradójico, generando una participación desinteresada en parte de los trabajadores. Se concluye que las relaciones de confianza en el trabajo demostraron ser un elemento fundamental para la colaboración, lo que requiere la configuración de un entorno organizacional capaz de aglutinar intereses y tratar conflictos.
Assuntos
Atenção Primária à Saúde , TrabalhoRESUMO
INTRODUCTION: Celiac disease (CD) is an autoimmune enteropathy associated with gluten ingestion. In extended families of celiac patients that live in close proximity of one another, shared genetic and environmental factors can predispose them to CD. AIM: The aim of this study was to provide evidence about the genetic and environmental factors involved in the development of CD in the extended family of a pediatric patient. METHODS: The medical history, environmental conditions, and participant weight, height, and peripheral blood samples were evaluated. The HLA-DQ2/DQ8 haplotypes were genotyped through qPCR testing and the IgA anti-gliadin and anti-transglutaminase antibodies were quantified using the ELISA test. RESULTS: Twelve close-living maternal relatives of the index case participated in the study. Eight of them presented with the HLA-DQ2 haplotype, inherited from the grandfather, and 7/12 and 9/12 were positive for IgA anti-gliadin and IgA anti-transglutaminase antibodies, respectively. The main intestinal symptoms stated by the participants were abdominal bloating, excess flatulence, constipation, and gastroesophageal reflux. The most frequent extra-intestinal symptoms were fatigue, stress, and anxiety. In addition, 6/13 participants had bronchial asthma. CONCLUSION: The extended family living in close proximity of one another shared a genetic predisposition, environmental conditions, and asthma, which could have predisposed them to celiac disease.
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Asma/complicações , Doença Celíaca/etiologia , Meio Ambiente , Predisposição Genética para Doença , Antígenos HLA-DQ/genética , Adulto , Asma/genética , Doença Celíaca/diagnóstico , Criança , Família , Feminino , Marcadores Genéticos , Haplótipos , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de RiscoRESUMO
Resumen Este trabajo tiene por objetivo identificar las dimensiones de la agencia (presente, pasado y futuro) de personas con VIH (PV) en comunidades de Chiapas, México. La agencia es la capacidad para responder a los desafíos que se suscitan en la vida con los recursos que se disponen. Se realizaron 20 entrevistas (12 hombres y 8 mujeres) a personas que viven con el virus (PV) que habían recibido el diagnóstico al menos un año antes de la entrevista; rango de edad 21 a 59 años. Se siguió un guión de preguntas abiertas. Resultados: las PV, participan en la familia extensa para cubrir necesidades que trae el padecimiento. Discusión: Las PV no carecen de poder para enfrentar los desafíos relacionados con la salud y el estigma asociado al VIH.
Abstract This paper aims to identify the dimensions of the agency (present past and future) in people with HIV (PV) in communities of Chiapas/México. The agency is the capacity to respond to the challenges that arise in life with resources that are available. Twenty interviews were conducted (12 men and 8 women) to people that lve with the virus (PV) who had received the diagnosis at least one year earlier with an age range from 21 to 59 years. A script of open questions followed. Results: PV participate within the extended family to meet the needs of the disease. Discussion: People with HIV do not lack the power to address health challenges and HIV-related stigma.
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Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Pobreza , Família/psicologia , Síndrome da Imunodeficiência Adquirida/psicologia , HIV , Discriminação Social/psicologia , MéxicoRESUMO
A anemia falciforme caracteriza-se como quadro hemolítico hereditário que evolui cronicamente causando danos físicos e emocionais às pessoas acometidas. Até o presente momento não se dispõe de tratamento curativo, a não ser o transplante de medula óssea, que ainda tem sido realizado de maneira experimental. A triagem neonatal de hemoglobinopatias, principalmente da anemia falciforme, tem sido essencial ao diagnóstico precoce e à instituição de medidas preventivas e promotoras de saúde. No entanto, o Ministério da Saúde do Brasil recomenda o exame dos pais a partir da identificação de heterozigotos, mas não faz alusão quanto à ampliação da triagem para outros familiares. Uma família que possua uma criança afetada com estas síndromes passa a ter um marcador para um grupo genético de risco. Neste caso, a triagem ampliada para os familiares mais próximos (avós, pais, irmãos, tios e primos) poderá identificar muitos portadores ou casais em risco, antes do casamento e procriação, além de servir de base a programas de assessoramento genético e de controle epidemiológico das hemoglobinopatias, uma herança genética bastante freqüente em nossa população.
Sickle cell anemia is a hereditary condition that evolves to a chronic illness, causing physical and emotional disorders to those involved. As yet there is no cure except for bone marrow transplantation which is still in the experimental stage. Neonatal screening for hemoglobin disorders, particularly sickle cell anemia, has been crucial for ensuring early diagnosis and the application of preventive and health-promoting measures. The Brazilian Health Ministry recommends testing parents thereby identifying heterozygotes, but does not propose extending this screening to other family members. A family that has a child affected by one of these syndromes is a marker for an at-risk group. In this case extending screning to close relatives (grandparents, siblings, aunts and uncles, and cousins) may identify individuals affected by the disease or couples at risk before marriage and reproduction and serve as the basis for programs providing genetic evaluation and epidemiological control of hemoglobin diseases that are relatively common in the Brazilian population.
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Anemia Falciforme , Hemoglobina Falciforme , Características da Família , Transplante de Medula Óssea , Triagem Neonatal , HemoglobinopatiasRESUMO
PIP: The incidence of complex families and households in sixteenth-century Mexico is analyzed using data from the Nahuatl censuses, specifically the censuses of two villages in Morelos translated into English by S. L. Cline in 1993. The author concludes that high mortality was no obstacle to the formation of complex families in this population.^ieng
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Demografia , Características da Família , Família , América , Países em Desenvolvimento , América Latina , México , América do Norte , Ciências SociaisRESUMO
"This paper seeks to (1) identify socioeconomic variables that are expected to generate fertility differentials; (2) hypothesize the direction and magnitude of the effect of each variable by reference to a demand-for-children model; and (3) test empirically the model using evidence from Costa Rica. The estimates are obtained from a ten-percent systematic random sample of all Costa Rican individual-family households. There are 15,924 families in the sample...." The authors specifically seek "to capture the effects of changing relative prices and available income and time constraints on parental preferences for children. Least-squares estimates show statistically significant relationships between household fertility and opportunity cost of time, parental education, occurrence of an extended family, medical care, household sanitation, economic sector of employment, and household stock of nonhuman capital."
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Atitude , Criança , Custos e Análise de Custo , Tomada de Decisões , Economia , Escolaridade , Emprego , Características da Família , Família , Fertilidade , Serviços de Saúde , Renda , Saneamento , Fatores Socioeconômicos , Fatores de Tempo , América , Comportamento , América Central , Costa Rica , Atenção à Saúde , Demografia , Países Desenvolvidos , Países em Desenvolvimento , Saúde , América Latina , Marketing de Serviços de Saúde , América do Norte , População , Dinâmica Populacional , Psicologia , Saúde Pública , Classe SocialRESUMO
PIP: Ethical questions have been at the heart of the ongoing debate over population policies and programs since the inception of organized family planning services in Latin America in the early 1960s. An ethically acceptable balance needs to be found between the well-being of and respect for the individual and the welfare of the family within the larger society. In Latin America the family is the most enduring and respected institution. All indications are that the family will continue to dominate the life of Latin Americans long after the societies become modernized. The extended family has prevailed because it has met the needs of individuals in the group and in the community. The place of the individual in the extended kin network and in this type of society is determined by several conditions, not the least of which is the ability to adjust personal needs to the needs of the extended family. Women, especially, if they are married, are expected to bear children and thus reinforce and perpetuate family ties. Despite considerable talk and some action giving men equal responsibility for raising and supporting children, traditionally this is considered the major prerogative and obligation of Latin women. Latin women's movements, particularly in Brazil, Mexico, and Venezuela, have been at the forefront in redefining women's rights and responsibilities. This is especially the case in the area of reproductive rights. Such redefinitions, involving a new perspective on ethical values, will not be soon or easily accepted. Instrumental in ending traditions and discarding ethical orientations is the fast pace of social change. Out of the social ferment and rapid modernization and the questioning of traditions, new definitions of ethical issues concerning reproductive roles and responsibilities toward family and community are slowly emerging. The definitions and their practical meanings cluster in 4 main groups: the freedom to make reproductive choices; individual and community betterment; social justice; and individual dignity. In all these questions, there are legitimate rationales for childbearing or for contraceptive use from the individual's perspective, but from the point of view of the global community, continued high fertility appears to be a longterm plan for disaster. By taking into account the greater good of the community, the exercise of individual choices takes on new meaning.^ieng
Assuntos
Ética , Características da Família , Serviços de Planejamento Familiar , Família , Mudança Social , Direitos da Mulher , América , Região do Caribe , América Central , Países em Desenvolvimento , Economia , América Latina , América do Norte , Fatores Socioeconômicos , América do SulRESUMO
The authors describe "a human ecosystem model, NUNOA, [which] simulates the yearly energy balance of individuals, families, and extended families in a hypothetical farming and herding community of Quechua Indians in the high Andes. The yearly energy demand of each family, based on the caloric requirements of its members, is computed by simulation of agricultural and herding activities in response to stochastic environmental conditions. The family energy balance is used in determining births, deaths, marriages, and resource sharing." The model can be used "to investigate the effect of changes in marriage patterns, resource sharing patterns, or subsistence activities on the ability of the human population to survive in the harsh Andean environment. Results from the model suggest that the substructuring of a population into extended families provides a mechanism for sheltering the population from control by exogenous influences. A population without substructures for resource sharing is shown to be unstable in such an unpredictable environment."
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Conservação dos Recursos Naturais , Ecologia , Fontes Geradoras de Energia , Etnicidade , Características da Família , Família , Abastecimento de Alimentos , Indígenas Sul-Americanos , Modelos Teóricos , América , Cultura , Demografia , Países Desenvolvidos , Países em Desenvolvimento , Meio Ambiente , Fertilidade , América Latina , Casamento , Mortalidade , População , Características da População , Pesquisa , América do SulRESUMO
PIP: The family life cycle concept developed by Meyer Fortes is tested using data from the 1970 Mexican census. The results indicate that this concept is not wholly applicable because of the wide prevalence of extended family households and because childbearing in Mexico is spread over an extended period, with the result that childbearing periods for mother and older daughters may overlap.^ieng