Remote Areas Of Brazil Research Articles

Quasi-dynamic operation and maintenance plan for photovoltaic systems in remote areas: The framework of Pantanal-MS

Off-grid photovoltaic energy systems (PESs) are increasingly being used for the electrification of remote areas in Brazil, owing to the need for carbon emission avoidance, potential approval of solar resources, and cost-effective expansion limits for conventional distribution systems. However, the complex environment, social, economic, and geographical aspects turn the operation and maintenance (O&M) of PES into a logistic and technical challenge in remote areas. Therefore, this study presents an O&M plan for rural electrification of the Pantanal of the Mato Grosso do Sul (MS) region in Brazil. A quasi-dynamic heuristic approach is proposed, which considers not only the PES requirements but also the environmental constraints, given by the consumer locations, the flood period variation, and the different logistical strategies for off-road assessment. The quasi-dynamic O&M plan was designed based on space, time, and costs, with five main goals: task scheduling, transport route planning, team dispatch, inventory, and vehicle estimation.

Away from Home Studying in Brazil: Bulgarian Children’s Experiences of Brazilian Education

<p style="text-align:justify">This paper presents findings from an extensive study conducted in Brazil. The main subjects of the study were Bulgarian children living and studying in Brazilian schools. The main goal was to indicate what kind of problems and obstacles they experience during the school time in Brazil and how the Brazilian government and people support these Bulgarian children. The data was collected by a Bulgarian research team that travelled to the remote regions of Brazil where many Bulgarian citizens live and work. The researchers took interviews with the Bulgarian children and their parents as well as school staff at the schools in Brazil with a high population of Bulgarian children. The analysis revealed many different problems that Bulgarian children and their parents highlighted, such as problems with the language of instructions, misunderstandings of school rules and general problems related to living in the remote areas of Brazil, such as weather and heat-related issues. Although many Bulgarian families reported some problems, they were still determined to continue their life and career in Brazil, and they want to continue to pursue their dreams.</p>

Assessing the impact of a doctor in remote areas of Brazil.

The More Doctors Program (MDP) is an ongoing Brazilian policy that aims to improve healthcare by providing physicians to the most vulnerable municipalities. We aimed to measure the impact of MDP in mortality and infant mortality rate, the proportion of live births with low weight, prenatal appointments, childbirths at first and fifth min Apgar, public health investment and immunization in Brazil. Municipal health indicators were collected before and after the intervention (2012 and 2015). Effects were measured by applying propensity score matching with difference-in-differences. Our findings show that infant mortality presented the highest improvement during the period (a decrease in 11 infant deaths per 1000 live births, p < 0.01). A significant effect, albeit smaller, was also found for the age-standardized total mortality (a decrease in five deaths per 10,000 residents), proportion of children with Apgar score lower than 8 in the fifth min and children with low birth weight. MDP contributed to improve important health indicators, highlighting the importance of a doctor in remote areas of Brazil.

Community-based approaches for malaria case management in remote communities in the Brazilian Amazon.

INTRODUCTION Malaria case management is a pivotal intervention in malaria elimination. However, many remote areas in Brazil still lack access to basic health services. This study describes a community-based approach (CBA) for malaria case management in the large remote area of the Jaú National Park (JNP), Amazonas, Brazil. METHODS In 2001, a general health CBA was initiated with a motor group (MG); a participative community health diagnosis (PCHD) was subsequently implemented between 2001 and 2005. In 2006, a CBA for malaria case management started with an expanded MG including all sectors with a stake in malaria control, from the local residents to the federal government. In 2008, community microscopists were selected and trained to diagnose hemoparasites. A full malaria strategy was implemented in 2009 with subsequent quality control follow-up. RESULTS Two educational materials were co-created with local communities. The MG identified malaria as a major health problem and the malaria MG planned the control activities. Ten communities selected a resident to become malaria microscopists, and ten solar-operated health centers were built. The number of slide readings increased from 923 in 2006 to 1,900 in 2009, while malaria infections decreased from 354 cases in 2005 to 20 cases in 2015. The excess time (≥ 48 hours) between first symptoms and diagnosis/treatment decreased from 68.9% of cases in 2005 to 14.3% in 2010. CONCLUSIONS While many factors were likely involved in the reduction of malaria transmission in the JNP, the CBA played an important role in the sustained success of the initiative.

P1812Speckle tracking echocardiography for early detection of left ventricular systolic dysfunction in patients with Chagas disease

Abstract Introduction Longitudinal strain by speckle tracking echocardiography (STE) imaging is a reliable tool for quantitative measurement of myocardial contractility. Assessment of left ventricular (LV) systolic function has a central role in the evaluation of patients with Chagas disease, particularly for identification of subtle changes that could predict disease progression. Purpose We aimed to detect early LV dysfunction using LV global longitudinal strain (GLS) in patients with Chagas disease and its relationship to other echocardiographic and laboratory parameters. Methods Eight-hundred and fifty patients with Chagas disease (mean age of 60±12 years, 70% female) who live in remote areas in Brazil were enrolled. Clinical evaluation, ECG, N-terminal pro-brain natriuretic peptide (NT-ProBNP), and echocardiogram were performed. LV GLS was assessed offline on the four-, three- and two-chamber views. Patients were divided into tertiles according to the LV strain. Data were analyzed using One-way ANOVA. Results The ECG was normal in 19%, whereas typical ECG abnormalities related to Chagas cardiomyopathy were found in 58% of the patients. Overall mean LV ejection fraction (LVEF) was 59±11%, and LV GLS was - 14.1±4.4%. Apical aneurysm was detected in 34 patients (4%).The prevalence of LV systolic dysfunction, defined as LVEF &lt;54% and GLS ≤ |16|%, was 19% and 66%, respectively. Abnormal GLS was observed in 408 (48%) patients despite a normal LVEF. Stratified according to tertiles of LV GLS, patients in the first tertile (strain &lt;|10.7|%), had a significantly decreased in LVEF (Fig 1, A), increased E/e' ratio (Fig 2,B), left atrial volume (Fig 1,C), and NT-proBNP levels (Fig 1,D), indicating severity of LV dysfunction (n=215). Similarly, the patients in the third tertile (strain &gt;|17|%), had normal standard echo parameters and NT-proBNP levels (n=210). However, patients in the second tertile (|10.7|% to |17|%; n=425), the strain was abnormal while other parameters were normal, showing LV impairment that was not evidenced by conventional exams. Conclusions LV longitudinal strain assessed by STE in a general population of Chagas disease provided diagnostic information beyond conventionally measured LVEF. Early detection of ventricular impairment may help to identify Chagas disease patients at risk for development of heart failure.

Analysis of a decade of skin cancer prevention using a mobile unit in Brazil.

For the past 10 years, skin cancer has been the most frequent malignant neoplasm in Brazil and worldwide. Each year, there are more new cases of skin cancer than the combined incidence of cancers of the breast, prostate, lung and colon. There were an estimated 188 000 new cases of skin cancer in Brazil in 2016. The prevention department of Barretos Cancer Hospital (BCH) runs some prevention programs for cancer such as breast, prostate, cervical, oral, colon and skin cancers. The skin cancer prevention program comprises educational activities and medical assistance conducted at the hospital and at a mobile unit (MU). The objective of this study is to evaluate the use of the MU as part of a skin cancer prevention program, 10 years after the implementation of this prevention program, using an MU in remote areas of Brazil. The database of the BCH was used. These data refer to data collected by the BCH Prevention MU. A total of 45 872 patients with suspected skin cancer were evaluated at the MU from 2004 to 2013. Of these, 8954 surgical procedures (excisions and/or biopsy) were performed. This study demonstrated a significant number of skin cancer cases diagnosed and treated by the MU. This study showed that the MU positively contributes to the early diagnosis and treatment of skin cancer among populations residing in remote areas of Brazil.

History and perspectives on how to ensure antivenom accessibility in the most remote areas in Brazil

A plan to achieve self-sufficiency in manufacturing biologicals for public health has been structured for the last 40 years in Brazil, in the context of a reform in the health system. Industrial plants of the national public laboratories have been modernized, and a program for reducing morbidity and mortality of venomous snakebite has been created, as part of the National Epidemiological Surveillance System. The epidemiological data are essential to plan for the antivenom production of 400,000 vials of snake antivenoms per year, and the acquisition by the Ministry of Health, which is the exclusive purchaser in the country. Distribution is decentralized to reach hospitals in almost 3000 municipalities, and to provide free of charge antivenom treatment. The National Sanitary Surveillance Agency organized the regulatory environment to implement rules and supervise compliance of GMP procedures, elevating the quality of the biologicals that are produced, as well as reducing the costs in production. Despite all the advances in the health system, antivenom availability and accessibility is not uniform in regards to the most vulnerable parts of the populations, which inhabit remote areas in the Brazilian Amazon region. Better logistics and transportation of liquid form antivenoms is an issue to be addressed and realistic and comprehensive health programs for indigenous groups should be effectively structured, in order to reduce the high morbidity and mortality rates associated with snakebite envenoming.

Correction, article no. 3671: Importance of the patient's clinical questionnaire for the diagnosis of skin cancer through teledermatology in remote areas of Brazil.

Correction, article no. 3671: Importance of the patient's clinical questionnaire for the diagnosis of skin cancer through teledermatology in remote areas of Brazil.

Importance of the patient's clinical questionnaire for the diagnosis of skin cancer through teledermatology in remote areas of Brazil

Importance of the patient's clinical questionnaire for the diagnosis of skin cancer through teledermatology in remote areas of Brazil

Brazil’s PROFORMAÇÃO Project: A Case Study of an Integrated Virtual System for Delivering In-Service Teacher Education

ABSTRACTA systems methodology was employed to design and deliver a highly successful demonstration of the effectiveness of distance education as a means of providing high quality training to tens of thousands of teachers in the most remote areas of Brazil. Key elements in the success of the program were significant funding, top political buy–in, and application of the best knowledge about division of labor in design and delivery, utilizing the best human and technological resources from across the country.

The Responsible Use of Minimally Invasive Surgery in Remote Areas of Brazil: Feasibility and Safety of a Temporary Gynecologic Operative Expedition

Abstract Objective: To evaluate the feasibility and safety of a novel model for providing minimally invasive surgical (MIS) care to underserved populations. Design: A prospective pilot study with patients affected by diverse benign pathologies of the female urogenital tract undergoing MIS in the context of a temporary expedition. Methods: In 2013, the Bandeira Cientifica Project implemented the use of MIS in one of the most underserved areas of Brazil. Results: During 4 days, 54 different procedures were performed on a cohort of 30 selected women. The mean age of the patients was 44.5 years (SD 8.3), while body mass index averaged 28.4 kg/m2 (SD 4.3). The primary indications for surgery were as follows: 14 symptomatic uterine leiomyomatosis/adenomyosis, 6 stress urinary incontinence, 6 endometriosis, and 4 pelvic floor defects. Forty percent of the patients underwent laparoscopy, 53% vaginal surgery, and 7% combined procedures. The mean estimated blood loss and operative time were 148 cc (0–1000) and 94 (...

Cancer in Indigenous Populations and Remote Areas in Brazil: Experience of the Federal University of Sao Paulo.

e17607 Background: Brazil has a significant number of Indigenous communities that are undergoing an epidemiological transition, with increasing incidence of chronic diseases. According to scarce pu...

Digital photography in skin cancer screening by mobile units in remote areas of Brazil.

BackgroundNon-melanoma skin cancer (NMSC) is one of the most common neoplasms in the world. Despite the low mortality rates, NMSC can still cause severe sequelae when diagnosed at advanced stages. Malignant melanoma, the third most common type of skin cancer, has more aggressive behavior and a worse prognosis. Teledermatology provides a new tool for monitoring skin cancer, especially in countries with a large area and unequal population distribution.This study sought to evaluate the performance of digital photography in skin cancer diagnosis in remote areas of Brazil.MethodsA physician in a Mobile Prevention Unit (MPU) took four hundred sixteen digital images of suspicious lesions between April 2010 and July 2011. All of the photographs were electronically sent to two oncologists at Barretos Cancer Hospital who blindly evaluated the images and provided a diagnosis (benign or malignant). The absolute agreement rates between the diagnoses made by direct visual inspection (by the MPU physician) and through the use of digital imaging (by the two oncologists) were calculated. The oncologists’ accuracy in predicting skin cancer using digital imaging was assessed by means of overall accuracy (correct classification rate), sensitivity, specificity and predictive value (positive and negative). A skin biopsy was considered the gold standard.ResultsOncologist #1 classified 59 lesions as benign with the digital images, while oncologist #2 classified 27 lesions as benign using the same images. The absolute agreement rates with direct visual inspection were 85.8% for oncologist #1 (95% CI: 77.1-95.2) and 93.5% for oncologist #2 (95% CI: 84.5-100.0). The overall accuracy of the two oncologists did not differ significantly.ConclusionsGiven the high sensitivity and PPV, Teledermatology seems to be a suitable tool for skin cancer screening by MPU in remote areas of Brazil.

Performance of rapid hepatitis C virus antibody assays among high- and low-risk populations

BackgroundRapid tests for the detection of antibodies to hepatitis C virus (anti-HCV) can facilitate access to diagnosis. ObjectivesThis study aimed to evaluate the performance of rapid tests for anti-HCV detection in the sera, whole blood, and oral fluid samples from individuals with different endemicity profiles and risk behaviors. Study designThree groups donated biological samples that were tested using three anti-HCV rapid tests (WAMA, Bioeasy and OraSure): (I) suspected cases of hepatitis C, (II) individuals who were living in remote areas in Brazil and (III) crack users and beauty professionals. Reproducibility, repeatability and cross-reactivity to other infectious agents (dengue, HIV, malaria, and syphilis) were also evaluated. ResultsIn group I, specificities varied from 93.75% to 100% and sensitivities varied from 76.03% to 93.84% according to the EIA results. When anti-HCV/HCV RNA-reactive sera samples were considered true-positive HCV cases, the sensitivities and specificities varied from 86.3% to 99.09% and 93.75% to 100%, respectively. In group II, the OraSure rapid test presented the best performance. In group III, the Bioeasy assay performed best using saliva and whole blood and the OraSure assay performed best using oral fluid samples. The reproducibility and repeatability of the WAMA and Bioeasy tests were excellent. The level of concordance between the HCV EIAs and the rapid tests using samples that were reactive for other infectious agents varied from 82.35% to 100% for the WAMA assay and 94.11% to 100% for the Bioeasy assay. ConclusionAll of the rapid tests could be used to identify active HCV infection among individuals with different endemicity profiles and risk behaviors.

A teleophthalmology system for the diagnosis of ocular urgency in remote areas of Brazil.

To validate a teleophthalmology mobile system aimed at improving and providing eye urgency screenings in remote and poor area settings in Brazil. The system enables one or more ophthalmologists to remotely examine a patient's condition and submit a decision describing the gravity of the case. If necessary, the patient can be forwarded to a hospital for further consultation. A cellphone (Nexus One model, with a 5 megapixel camera) was used to collect data and pictures from 100 randomly selected patients at the Ophthalmology Emergency Room located at the General Hospital of the Federal University of São Paulo (UNIFESP). Data was then sent remotely to an online recording system to be reviewed by an ophthalmologist who provided feedback regarding the state of ocular urgency. RESULTS were then compared to the gold standard diagnosis provided at the hospital. The diagnosis of urgency was given by two ophthalmologists: one in the hospital (gold standard) and one remotely. When we compared both diagnoses we obtained results of 81.94% specificity, 92.85% sensitivity, and 85% accuracy, with a negative predictive value of 96.72%. This work also included a processing time analysis, resulting in an average time of 8.6 min per patient for remote consultations. This study is the first that has used only a cellphone for diagnosing the urgency of ocular cases. Based on our results, the system can provide a reliable distinction between urgent and non-urgent situations and can offer a viable alternative for the servicing of underprivileged areas. In screening techniques, the most important outcome is to identify urgent cases with a high level of sensitivity and predictive negative value. Thus, our results demonstrate that this tool is robust and we suggest that a major study aimed to verify its efficiency in resource-poor areas should be initiated.

Teledermatology for primary care in remote areas in Brazil

Teledermatology for primary care in remote areas in Brazil

Implementation of a cardiology care program in remote areas in Brazil: influence of governability

A telecardiology remote cardiology medical care system was implemented in 82 municipalities of Minas Gerais State, Brazil to support basic network services in the early diagnosis and management of cardiovascular diseases. To investigate the factors associated with the implementation of this program in the municipalities. This 2006 ecological study involved 393 candidate municipalities to implement the system. The municipalities were divided into two groups: non-random intervention (n = 82) and comparative (n = 311). The social, structure, healthcare needs, and governability indexes of the two groups of municipalities were compared by descriptive and multiple regression analysis using the generalized estimation equation model. After fitting for other characteristics, participation of the municipalities in the intervention was associated with a higher social responsibility index (OR: 2.44, CI: 1.50-3.96) and lower healthcare needs (OR: 2.29, CI: 1.24-4.22). Greater efforts by municipality management was the key to attracting and implementing the remote cardiology intervention, even when fitted for lower healthcare needs, which suggests greater municipal political and social engagement. This translated to improved access to cardiovascular health care for Brazilian rural and remote populations in the intervention municipalities.

Mission from the Margins to the Margins: Two Case Studies from Latin America

The shift of Christianity to the South means that missionary initiative moves to countries and regions that are marginal from the viewpoint of economic development and cultural hegemony. Consequently, there is a search for new models of mission “from the margins” that will be closer to the models of New Testament times and the pre-Constantinian church. This article explores two case studies of Protestant mission that emerged from the margins of North American society at the beginning of this century. The stories of Pentecostal and Seventh-Day Adventist missionaries, who started their work among marginalized sectors in remote areas of Brazil and Perú, provide suggestive examples of methodology and approach.