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Pereira C.C.D.A.,Escola Nacional de Saude Publica | Rabello R.D.S.,INI | Elias F.T.S.,Fiocruz
International Journal of Technology Assessment in Health Care | Year: 2017

Objectives: Hospital-based health technology assessment (HTA) has become increasingly important in Brazil due to its strategic importance to promote adoption, incorporation, dissemination, and disinvestment of technologies. A strategy to foster hospital-based HTA was implemented in 2009 by creating hospital-based HTA nuclei (NATS) at university hospitals and other strategic hospitals. Methods: Between 2011 and 2012, we interviewed board members in twenty-three NATS located in all geographic regions of Brazil to assess their general characteristics, scientific output, and challenges. Results: Of the total, 65 percent of the NATS belonged to teaching institutions, with 44 percent associated with federal universities. The bulk of their output was in the form of mini-HTA reports. Centers in the Southeast and South of Brazil had the highest production compared with other regions. Lack of expertise and low levels of advanced training were identified as limiting factors in the majority of centers. Conclusions: The experience of the initial twenty-three NATS could be considered positive and has led to the creation of new ones around Brazil. Regional disparities in workload, production, and technical training should be targeted by new policies toward hospital-based HTA in Brazil. The limits and possibilities for intensifying the strategy relate to continuous investment in priority studies, which simultaneously, allow professionals who work in hospitals to receive continued education and produce relevant HTA work in a timely manner. Copyright © Cambridge University Press 2017

Grant R.M.,Gladstone | Grant R.M.,University of California at San Francisco | Grant R.M.,San Francisco AIDS Foundation | Anderson P.L.,Aurora University | And 20 more authors.
The Lancet Infectious Diseases | Year: 2014

Background: The effect of HIV pre-exposure prophylaxis (PrEP) depends on uptake, adherence, and sexual practices. We aimed to assess these factors in a cohort of HIV-negative people at risk of infection. Methods: In our cohort study, men and transgender women who have sex with men previously enrolled in PrEP trials (ATN 082, iPrEx, and US Safety Study) were enrolled in a 72 week open-label extension. We measured drug concentrations in plasma and dried blood spots in seroconverters and a random sample of seronegative participants. We assessed PrEP uptake, adherence, sexual practices, and HIV incidence. Statistical methods included Poisson models, comparison of proportions, and generalised estimating equations. Findings: We enrolled 1603 HIV-negative people, of whom 1225 (76%) received PrEP. Uptake was higher among those reporting condomless receptive anal intercourse (416/519 [81%] vs 809/1084 [75%], p=0·003) and having serological evidence of herpes (612/791 [77%] vs 613/812 [75%] p=0·03). Of those receiving PrEP, HIV incidence was 1·8 infections per 100 person-years, compared with 2·6 infections per 100 person-years in those who concurrently did not choose PrEP (HR 0·51, 95% CI 0·26-1·01, adjusted for sexual behaviours), and 3·9 infections per 100 person-years in the placebo group of the previous randomised phase (HR 0·49, 95% CI 0·31-0·77). Among those receiving PrEP, HIV incidence was 4·7 infections per 100 person-years if drug was not detected in dried blood spots, 2·3 infections per 100 person-years if drug concentrations suggested use of fewer than two tablets per week, 0·6 per 100 person-years for use of two to three tablets per week, and 0·0 per 100 person-years for use of four or more tablets per week (p<0·0001). PrEP drug concentrations were higher among people of older age, with more schooling, who reported non-condom receptive anal intercourse, who had more sexual partners, and who had a history of syphilis or herpes. Interpretation: PrEP uptake was high when made available free of charge by experienced providers. The effect of PrEP is increased by greater uptake and adherence during periods of higher risk. Drug concentrations in dried blood spots are strongly correlated with protective benefit. © 2014 Elsevier Ltd.

One of the most serious complications of diabetes, heart arrhythmias, is now on its way to be prevented and combated. Researchers from the Federal University of Rio de Janeiro (UFRJ) in partnership with investigators from University of Bonn, Universidad del Pais Vasco, Universidad de La Plata, FIOCRUZ and UNICAMP, show how the disease affects the heart and how the process can be reversed with two promising drugs. The findings have just been published in the October issue of the journal Nature Communications (EMBARGO DATE: 24th November 2016). Heart problems are responsible for 65% of the deaths related to diabetes. The most common disorder in these cases is ventricular tachycardia (a dysregulation in the heart rhythm). This work, coordinated by Prof. Emiliano Medei, from the Institute of Biophysics Carlos Chagas Filho and CENABIO at UFRJ, confirms that the increase in blood glucose causes a specific inflammation, which directly affects the heart. To investigate this process, researchers caused diabetes in wild-type mice and mutant animals unable to produce a specific type of inflammation related to production of IL-1-beta substance. Both had similar increases in blood glucose, but only those typically inflamed- the wild-type mice -- had altered heart rate. Furthermore, mutants which do not produce IL-1 beta suffered much less from arrhythmias even when under effect of caffeine or dobutamine, drugs that promote ventricular tachycardia. The researchers found a large amount of circulating IL-1-beta and especially in the hearts of common diabetic mice. They also observed that IL-1-beta alone altered heart function when given to healthy rat hearts (without diabetes), or human heart cells. The good news is that the group also tested successfully two drugs that specifically inhibit this inflammatory process: MCC-950 and anakinra. The first blocks IL1-beta production, while the latter prevents it from having active effects in the body cells and is already being used to treat some autoimune diseases, such as rheumatoid arthritis. The team managed to even reverse the cardiac alterations in diabetic mice. "It is noteworthy that inflammation is an important tool to fight infections, which usually ends when the 'intruder' is removed. In the case of diabetes, there is no infection. Persistent hyperglycemia stimulates the immune system to produce a constant inflammation, with great production of IL-1-beta -- "we found inflammation to be the link between arrhythmias and diabetes", explains Medei. "I believe that the new therapeutic tools that we propose in this study are very promising to treat the heart disease caused by diabetes" he says. The present work was funded by FAPERJ, CENABIO/IDOR, CNPq, CAPES, Deutsche Forschungsgemeinschaft, Stem Cell Factory II co-founded by the European Union, German federal state North Rhine-Westphalia and FONCYT (Argentina).

Silva J.E.S.,University of Pernambuco | Moura A.M.A.,FIOCRUZ | Nogueira R.A.,University of Pernambuco
Arquivo Brasileiro de Medicina Veterinaria e Zootecnia | Year: 2012

The effect of different sources of omega-3 and omega-6 essential fatty acids on serum lipid profile in Japanese quails and on vascular growth in the embryos vitelline membrane was verified. The birds were supplemented with fish oil, 2% and 4%, and soybean oil, 2% and 4%, and one control diet, without lipid supply. The enzymatic method with colorimetric reaction was used to estimate the profile of serum total cholesterol, triglycerides and HDL of the birds. Vitelline membrane vascularization was measured using the box-counting fractal dimension. The cholesterol concentration of the treated and control groups showed no difference. For HDL, the group treated with a higher proportion of fish oil, 4%, differed from other groups. The triglycerides levels of quails supplemented with fish oil were higher than the other groups. The fractal dimension of quail embryos vitelline membrane from the groups treated with 4% fish oil and 4% soybean oil was lower than the other groups, indicating antiangiogenic effects on the vascular formation process.

Cotlear D.,The World Bank | Gomez-Dantes O.,National Institute of Public Health of Mexico | Knaul F.,Harvard University | Atun R.,Boston University | And 10 more authors.
The Lancet | Year: 2015

Summary Latin America continues to segregate different social groups into separate health-system segments, including two separate public sector blocks: a well resourced social security for salaried workers and their families and a Ministry of Health serving poor and vulnerable people with low standards of quality and needing a frequently impoverishing payment at point of service. This segregation shows Latin America's longstanding economic and social inequality, cemented by an economic framework that predicted that economic growth would lead to rapid formalisation of the economy. Today, the institutional setup that organises the social segregation in health care is perceived, despite improved life expectancy and other advances, as a barrier to fulfilling the right to health, embodied in the legislation of many Latin American countries. This Series paper outlines four phases in the history of Latin American countries that explain the roots of segmentation in health care and describe three paths taken by countries seeking to overcome it: unification of the funds used to finance both social security and Ministry of Health services (one public payer); free choice of provider or insurer; and expansion of services to poor people and the non-salaried population by making explicit the health-care benefits to which all citizens are entitled. © 2015 Elsevier Ltd.

Pan American Health Care Exchanges, PAHCE 2011 - Conference, Workshops, and Exhibits. Cooperation / Linkages: An Independent Forum for Patient Care and Technology Support | Year: 2011

Given the continued advancement of technology in the Health Care Institutions in recent years has contributed significantly to improving quality of life of the world population, however the management of this technology does not come with the same rate of investment, efficiency, productivity, among others. Even though the above mentioned challenges before the health manager, what are the viable alternatives in the management of health technology in the world today? © 2011 IEEE.

Rasoanaivo P.,IMRA Inc | Wright C.W.,University of Bradford | Willcox M.L.,RITAM | Willcox M.L.,University of Oxford | Gilbert B.,Fiocruz
Malaria Journal | Year: 2011

Background: In traditional medicine whole plants or mixtures of plants are used rather than isolated compounds. There is evidence that crude plant extracts often have greater in vitro or/and in vivo antiplasmodial activity than isolated constituents at an equivalent dose. The aim of this paper is to review positive interactions between components of whole plant extracts, which may explain this. Methods. Narrative review. Results: There is evidence for several different types of positive interactions between different components of medicinal plants used in the treatment of malaria. Pharmacodynamic synergy has been demonstrated between the Cinchona alkaloids and between various plant extracts traditionally combined. Pharmacokinetic interactions occur, for example between constituents of Artemisia annua tea so that its artemisinin is more rapidly absorbed than the pure drug. Some plant extracts may have an immunomodulatory effect as well as a direct antiplasmodial effect. Several extracts contain multidrug resistance inhibitors, although none of these has been tested clinically in malaria. Some plant constituents are added mainly to attenuate the side-effects of others, for example ginger to prevent nausea. Conclusions: More clinical research is needed on all types of interaction between plant constituents. This could include clinical trials of combinations of pure compounds (such as artemisinin + curcumin + piperine) and of combinations of herbal remedies (such as Artemisia annua leaves + Curcuma longa root + Piper nigum seeds). The former may enhance the activity of existing pharmaceutical preparations, and the latter may improve the effectiveness of existing herbal remedies for use in remote areas where modern drugs are unavailable. © 2011 Rasoanaivo et al; licensee BioMed Central Ltd.

Confalonieri U.E.C.,Fiocruz | Costa Neto C.,PMAGS
Interdisciplinary Perspectives on Infectious Diseases | Year: 2012

This paper presents a study based on ecological parameters represented by diversity and richness indices applied in a community of mosquitoes (Diptera: Culicidae), at the National Forest of Caxiuanã, Melgaço municipality, state of Pará, in the Brazilian Amazon. A total of 25,433 specimens of culicids were collected in the study, from five field collection periods, over 10 months, between 2005 and 2006. Specimens were collected in four heights of the forest (ground level, 8 m, 16 m, and 30 m-canopy). Diversity indices of Shannon and Berger-Parker were obtained, and indicators of dominance of species were calculated. The species Culex portesi was dominant in this site, representing about 84 of specimens. Measures of richness and similarity (Jaccard) were obtained for the five strata of time and four height levels. According to the richness estimator abundance-based covered estimator (ACE) the greatest value occurred in April (2006), considering the levels of height to 16 m and on the ground. The estimates obtained have shown quantitative parameters of mosquito populations in the region of the Forest of Caxiuanã. © 2012 Ulisses E. C. Confalonieri and Cristina Costa Neto.

Organic micropollutants are often found in domestic and industrial effluents. Thus, it is important to learn their fate, the metabolites generated and their sorption during biological treatment processes. This work investigated the biodegradation of 14C-dicofol organochloride during wastewater aerobic treatment and sludge anaerobic biodigestion. The performance of these processes was evaluated by physical-chemical parameters. Radioactivity levels were monitored in both treatments, and residues of dicofol (DCF) and dichlorobenzophenone (DBP) were quantified by HPLC/UV. The efficiency of the aerobic and anaerobic processes was slightly reduced in the presence of DCF and DBP. After aerobic treatment, only 0.1% of DCF was mineralized, and 57% of radioactivity remained sorbed on biological sludge as DBP. After 18 days of anaerobiosis, only 3% of DCF and 5% of DBP were detected in the sludge. However, 70% of radioactivity remained in the sludge, probably as other metabolites. Dicofol was biodegraded in the investigated process, but not mineralized.

De Almeida P.F.,Federal University of Recôncavo da Bahia | Fausto M.C.R.,Fundacao Oswaldo Cruz FIOCRUZ | Giovanella L.,FIOCRUZ
Revista Panamericana de Salud Publica/Pan American Journal of Public Health | Year: 2011

Objective. To describe and analyze the actions developed in four large cities to strengthen the family health strategy (FHS) in Brazil. Methods. Case studies were carried out in Aracaju, Belo Horizonte, Florianópolis, and Vitória based on semi-structured interviews with health care managers. In addition, a cross-sectional study was conducted with questionnaires administered to a sample of FHS workers and services users. Results. Actions needed to strengthen primary health care services were identified in all four cities. These include increasing the number of services offered at the primary health care level, removing barriers to access, restructuring primary services as the entry point to the health care system, enhancing problem-solving capacity (diagnostic and therapeutic support and networking between health units to organize the work process, training, and supervision), as well as improving articulation between surveillance and care actions. Conclusions. The cities studied have gained solid experience in the reorganization of the health care model based on a strengthening of health primary care and of the capacity to undertake the role of health care coordinator. However, to make the primary care level the customary entry point and first choice for users, additional actions are required to balance supplier-induced and consumer-driven demands. Consumerdriven demand is the biggest challenge for the organization of teamwork processes. Support for and recognition of FHS as a basis for primary health care is still an issue. Initiatives to make FHS better known to the population, health care professionals at all levels, and civil society organizations are still needed. © 2011 Organización Panamericana de la Salud.

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