Showing papers by "Oswaldo Cruz Foundation published in 2000"

Qualidade de vida e saúde: um debate necessário

Abstract: This paper discusses the relationships between quality of life and health by applying the discourses emerging in the health sector to other fields and other disciplines. These relationships constitute social representation based on subjective parameters (well-being, happiness, love, pleasure, personal satisfaction), and on objective ones such as satisfaction of basic needs and of the needs created by the degree of economical and social development of a given society. The text presents the main instruments which have been constructed during the last years for measuring quality of life, as well as the debate they cause. It also debates the semantic field where the representations and actions in favour of quality of life - such as the concept of development, democracy, quality, way and conditions of life - develop. In relation to the field of health, this article discusses the tendency to restrict the concept of quality of life to the biomedical area, associated with an economic assessment. It shows the variety of instruments created for measuring quality of life in accordance with the concept. Health promotion is considered one of the most relevant strategies in this field in order to avoid medical reductionism and to develop an interdisciplinary dialogue. It is argued that this proposal, however, still needs to be refined and tested in sanitary practices.

Promoção da saúde e qualidade de vida

Abstract: Several scientific evidences show the contribution of health to the quality of life of either individuals or populations. Similarly, many of the social life components that contribute to quality in life are also essential for individuals and populations to attain an adequate health standard. For individuals and populations to achieve appropriate health standards it is necessary not only access to quality medical-health services. Health determinants must be considered widely, thus requiring healthy public policies (concerned with its impacts on health), an effective intersectoral articulation, and the population's engagement. In this paper, the author reviews the emergency and development of health promotion by focusing his analysis on the above strategies, which according to the health sector's propositions would be the most promising strategies to improve the quality of life, especially in social formations where social-public health inequities are so many, as in Brazil. These strategies are materialized in the bases and practices of the healthy towns movement, which are strictly associated with public management innovations for the integral and sustainable local development, as well as with the local Agenda 21.

Uptake of apoptotic cells drives the growth of a pathogenic trypanosome in macrophages.

Abstract: After apoptosis, phagocytes prevent inflammation and tissue damage by the uptake and removal of dead cells. In addition, apoptotic cells evoke an anti-inflammatory response through macrophages. We have previously shown that there is intense lymphocyte apoptosis in an experimental model of Chagas' disease, a debilitating cardiac illness caused by the protozoan Trypanosoma cruzi. Here we show that the interaction of apoptotic, but not necrotic T lymphocytes with macrophages infected with T. cruzi fuels parasite growth in a manner dependent on prostaglandins, transforming growth factor-beta (TGF-beta) and polyamine biosynthesis. We show that the vitronectin receptor is critical, in both apoptotic-cell cytoadherence and the induction of prostaglandin E2/TGF-beta release and ornithine decarboxylase activity in macrophages. A single injection of apoptotic cells in infected mice increases parasitaemia, whereas treatment with cyclooxygenase inhibitors almost completely ablates it in vivo. These results suggest that continual lymphocyte apoptosis and phagocytosis of apoptotic cells by macrophages have a role in parasite persistence in the host, and that cyclooxygenase inhibitors have potential therapeutic application in the control of parasite replication and spread in Chagas' disease.

Neuroendocrine Control of Thymus Physiology

Abstract: The thymus gland is a central lymphoid organ in which bone marrow-derived T cell precursors undergo differentiation, eventually leading to migration of positively selected thymocytes to the peripheral lymphoid organs. This differentiation occurs along with cell migration in the context of the thymic microenvironment, formed of epithelial cells, macrophages, dendritic cells, fibroblasts, and extracellular matrix components. Various interactions occurring between microenvironmental cells and differentiating thymocytes are under neuroendocrine control. In this review, we summarize data showing that thymus physiology is pleiotropically influenced by hormones and neuropeptides. These molecules modulate the expression of major histocompatibility complex gene products by microenvironmental cells and the extracellular matrix-mediated interactions, leading to enhanced thymocyte adhesion to thymic epithelial cells. Cytokine production and thymic endocrine function (herein exemplified by thymulin production) are als...

Highly purified glycosylphosphatidylinositols from Trypanosoma cruzi are potent proinflammatory agents.

Abstract: Intracellular protozoan parasites are potent stimulators of cell‐mediated immunity. The induction of macrophage proinflammatory cytokines by Trypanosoma cruzi is considered to be important in controlling the infection and the outcome of Chagas9 disease. Here we show that the potent tumour necrosis factor‐α‐, interleukin‐12‐ and nitric oxide‐inducing activities of T.cruzi trypomastigote mucins were recovered quantitatively in a highly purified and characterized glycosylphosphatidylinositol (GPI) anchor fraction of this material. The bioactive trypomastigote GPI fraction was compared with a relatively inactive GPI fraction prepared from T.cruzi epimastigote mucins. The trypomastigote GPI structures were found to contain additional galactose residues and unsaturated, instead of saturated, fatty acids in the sn ‐2 position of the alkylacylglycerolipid component. The latter feature is essential for the extreme potency of the trypomastigote GPI fraction, which is at least as active as bacterial endotoxin and Mycoplasma lipopeptide and, therefore, one of the most potent microbial proinflammatory agents known.

Desigualdades geográficas e sociais na utilizaçäo de serviços de saúde no Brasil

Abstract: O consumo de servicos de saude e funcao das necessidades e do comportamento dos individuos em relacao a seus problemas de saude, bem como das formas de financiamento e dos servicos e recursos disponiveis para a populacao. A Constituicao brasileira de 1988 estabelece o Sistema Unico de Saude (SUS) com base na institucionalizacao da universalidade da cobertura e do atendimento. O sistema foi implementado em 1990 e pode ser traduzido como igualdade de oportunidade de acesso aos servicos de saude para necessidades iguais. Este trabalho estuda a equidade no uso de servicos de saude a partir de duas dimensoes: a geografica e a social. Os dados utilizados sao de pesquisas realizadas em 1989 e 1996-1997, pelo IBGE. Para avaliar as desigualdades geograficas no consumo de servicos de saude foram calculadas taxas padronizadas de utilizacao de servicos. Comparou-se tambem a dimensao do gasto privado domiciliar com medicamentos e com planos de saude. Para avaliar as desigualdades sociais, estimou-se a razao de odds para tres grupos de renda e para as pessoas com e sem cobertura de plano de saude. Observou-se pequena reducao dos niveis de desigualdades no periodo analisado (1989-1996/1997), com o sistema de saude atual mantendo-se caracterizado por marcadas iniquidades.

Possible primary ecological niche of Cryptococcus neoformans.

Abstract: To study hollows of living trees as natural habitats of Cryptococcus neoformans in an endemic area of cryptococcosis in the northeastern region of Brazil, samples of decaying wood were collected inside 32 hollows of living trees and plated on niger seed agar. Identification of C. neoformans was based upon morphological and physiological tests. Canavanine-glycine-bromothymol medium was used to screen the varieties and Crypto Check Iatron Kit to serotype the isolates. A total of 123 C. neoformans colonies were recovered from samples of six (18.5%) out of 32 hollow trees. C. neoformans var. neoformans and C. neoformans var. gattii were found occurring alone (pink shower tree, fig tree and pottery tree) or sharing the same hollow (pink shower tree). Long lasting positivity (19-36 months) and significant number of cfu of C. neoformans per gram of decaying wood (0.15-21.7 x 10(3) cfu g(-1)) inside hollows of pink shower tree, fig tree and pottery tree were observed, indicating colonization of these habitats by the fungus. For the first time, C. n. var. neoformans and C. n. var. gattii were found sharing the same natural biotope, thus establishing a possible link between them in their life cycle in nature and suggesting the primary natural niche for the species.

The Bambuí health and ageing study (BHAS): methodological approach and preliminary results of a population-based cohort study of the elderly in Brazil.

Abstract: OBJETIVO: Um estudo de coorte esta sendo desenvolvido para identificar fatores preditores de eventos adversos a saude em idosos Sao apresentados a metodologia do estudo e os resultados descritivos preliminares METODOS: A populacao estudada e constituida por todos os residentes na cidade de Bambui, Minas Gerais, com 60 ou mais anos de idade (n=1742) Destes, 92,2% foram entrevistados e 85,9% foram submetidos a exames hematologicos e bioquimicos, sorologia para Trypanosoma cruzi , medidas antropometricas e de pressao arterial e eletrocardiograma Aliquotas de soro, plasma e DNA foram estocadas para futuras investigacoes A entrevista da linha de base do estudo incluiu: caracteristicas sociodemograficas, percepcao da saude e morbidade auto-referida, uso de medicamentos, acesso a servicos de saude e a planos de saude, atividades fisicas, uso de fumo e de alcool, habitos alimentares, historia reprodutiva, funcao fisica, eventos da vida, recursos sociais e saude mental Os participantes estao sendo acompanhados anualmente RESULTADOS: As seguintes caracteristicas predominaram entre os participantes: mulheres (60%), casados (48,9%) ou viuvos (35,4%), residentes em domicilios com ate 2 pessoas (73,8%), chefes de familia (76,7%), pessoas com renda mensal entre 1 e 2,99 salarios-minimos (62%) e pessoas com 4 ou menos anos de escolaridade (89,1%) A mediana da idade foi igual a 68 anos Somente 1,7% dos membros da coorte foram perdidos no primeiro acompanhamento CONCLUSOES: Em geral, as caracteristicas da populacao estudada foram muito semelhantes as de participantes de outros estudos epidemiologicos sobre envelhecimento, desenvolvidos em grandes cidades brasileiras A pequena perda para acompanhamento mostra que a escolha de Bambui foi adequada, garantindo a viabilidade de um estudo prospectivo de longa duracao

Activities of the triazole derivative SCH 56592 (posaconazole) against drug-resistant strains of the protozoan parasite Trypanosoma (Schizotrypanum) cruzi in immunocompetent and immunosuppressed murine hosts.

Abstract: We have studied the in vivo activity of the new experimental triazole derivative SCH 56592 (posaconazole) against a variety of strains of the protozoan parasite Trypanosoma (Schizotrypanum) cruzi, the causative agent of Chagas' disease, in both immunocompetent and immunosuppressed murine hosts. The T. cruzi strains used in the study were previously characterized as susceptible (CL), partially resistant (Y), or highly resistant (Colombiana, SC-28, and VL-10) to the drugs currently in clinical use, nifurtimox and benznidazole. Furthermore, all strains are completely resistant to conventional antifungal azoles, such as ketoconazole. In the first study, acute infections with the CL, Y, and Colombiana strains in both normal and cyclophosphamide-immunosuppressed mice were treated orally, starting 4 days postinfection (p.i.), for 20 consecutive daily doses. The results indicated that in immunocompetent animals SCH 56592 at 20 mg/kg of body weight/day provided protection (80 to 90%) against death caused by all strains, a level comparable or superior to that provided by the optimal dose of benznidazole (100 mg/kg/day). Evaluation of parasitological cure revealed that SCH 56592 was able to cure 90 to 100% of the surviving animals infected with the CL and Y strains and 50% of those which received the benznidazole- and nifurtimox-resistant Colombiana strain. Immunosuppression markedly reduced the mean survival time of untreated mice infected with any of the strains, but this was not observed for the groups which received SCH 56592 at 20 mg/kg/day or benznidazole at 100 mg/kg/day. However, the overall cure rates were higher for animals treated with SCH 56592 than among those treated with benznidazole. The results were confirmed in a second study, using the same model but a longer (43-dose) treatment period. Finally, a model for the chronic disease in which oral treatment was started 120 days p.i. and consisted of 20 daily consecutive doses was investigated. The results showed that SCH 56592 at 20 mg/kg/day was able to induce a statistically significant increase in survival of animals infected with all strains, while benznidazole at 100 mg/kg/day was able to increase survival only in animals infected with the Colombiana strain. Moreover, the triazole was able to induce parasitological cures in 50 to 60% of surviving animals, irrespective of the infecting strain, while no cures were obtained with benznidazole. Taken together, the results demonstrate that SCH 56592 has in vivo trypanocidal activity, even against T. cruzi strains naturally resistant to nitrofurans, nitroimidazoles, and conventional antifungal azoles, and that this activity is retained to a large extent in immunosuppressed hosts.

AIDS e pauperização: principais conceitos e evidências empíricas

Abstract: O artigo discute as estrategias metodologicas que vem sendo usadas na analise das inter-relacoes entre a vulnerabilidade ao HIV/AIDS e as desigualdades sociais, o preconceito e a marginalizacao, ressaltando-se as dificuldades metodologicas e as estrategias alternativas de investigacao encontradas. Os principais achados da literatura internacional e brasileira foram revistos, enfatizando-se os temas: dimensoes economicas e macropoliticas da difusao do HIV/ AIDS; papel do consumo e da politica de drogas; desigualdade e preconceito de genero; desigualdade e preconceito racial/origem etnica; interacao com as demais infeccoes sexualmente transmissiveis e sua relacao com a pobreza; padroes de assistencia a saude e HIV/AIDS, em especial, acesso a anti-retrovirais; e violacao dos direitos humanos. Apesar da restrita producao academica brasileira e dos dilemas metodologicos envolvidos no exame das inter-relacoes entre variaveis psicossociais, culturais, socio-politicas e vulnerabilidade ao HIV/AIDS, tais temas devem ser investigados em detalhe - considerando especificidades sociais e culturais do Brasil - e beneficiados pelas novas estrategias de pesquisa.

Human immune response to sand fly salivary gland antigens: a useful epidemiological marker?

Abstract: Antibody (IgG) responses to salivary gland homogenate and to a recombinant salivary protein from the sand fly Lutzomyia longipalpis were investigated using sera from children living in an endemic area of visceral leishmaniasis in Brazil. We classified children into four groups according to their responses to Leishmania antigen: (Group I) positive serology and positive delayed type hypersensitivity (DTH), (Group II) positive serology and negative DTH, (Group III) negative serology and positive DTH, and (Group IV) negative serology and negative DTH. A highly significant correlation was found between anti-salivary gland IgG levels and DTH responses. An L. longipalpis salivary recombinant protein used as an antigen in an enzyme-linked immuno sorbent assay (ELISA) gave a significant but different result. A positive correlation was found between anti-Leishmania IgG and anti-recombinant protein IgG titers. The results indicate that sand fly salivary proteins may be of relevance to the study the epidemiology of leishmaniasis.

A B-cell mitogen from a pathogenic trypanosome is a eukaryotic proline racemase.

Abstract: Lymphocyte polyclonal activation is a generalized mechanism of immune evasion among pathogens. In a mouse model of Trypanosoma cruzi infection (American trypanosomiasis), reduced levels of polyclonal lymphocyte responses correlate with resistance to infection and cardiopathy. We report here the characterization of a parasite protein with B-cell mitogenic properties in culture supernatants of infective forms, the cloning of the corresponding gene and the analysis of the biological properties of its product. We characterized the protein as a co-factor-independent proline racemase, and show that its expression as a cytoplasmic and/or membrane-associated protein is life-stage specific. Inhibition studies indicate that availability of the racemase active site is necessary for mitogenic activity. This is the first report to our knowledge of a eukaryotic amino acid racemase gene. Our findings have potential consequences for the development of new immune therapies and drug design against pathogens.

[The spread of the AIDs epidemic in Brazil from 1987 to 1996: a spatial analysis]

Abstract: Mean AIDS incidence rates were calculated for three time periods, 1987-89, 1990-92, and 1993-96, using reported adult AIDS cases by county. The analysis included the following variables: "population of counties for resident AIDS cases"; "proportion of population residing in urban areas", and "concentration of poverty", stratifying by gender and exposure categories. The Southeast region has experienced the lowest increase, contrasting with the steep rise observed in the North and South between the second and third study periods. Comparing variations in incidence rates from 1990-92 and 1993-96 by region or population, the greatest increase was among women. In the larger cities, AIDS cases among "homo/bisexual men" predominate, although the proportion of cases among men who have sex with men has decreased as heterosexual cases have undergone a continuous increase. IDUs have been the core stratum in medium-sized counties. For the smallest counties, heterosexual transmission has been the basic element in local dynamics. Even though AIDS is still an urban phenomenon in Brazil, the epidemic is spreading to rural counties. Until recently it has mainly affecting relatively more affluent areas, but there is now an evident spread of the epidemic to poorer areas.

Cyclooxygenase-2-Derived Prostaglandin E2 and Lipoxin A4 Accelerate Resolution of Allergic Edema in Angiostrongylus costaricensis-Infected Rats: Relationship with Concurrent Eosinophilia

Abstract: In noninfected rats, challenge with allergen following local IgE sensitization induced a pleurisy marked by intense protein exudation that plateaued from 30 min to 4 h after challenge, reducing thereafter. Infection of rats with Angiostrongylus costaricensis induced a 5-fold increase in blood eosinophil numbers by 25 days postinfection, whereas the numbers of eosinophils in the pleural cavity ranged from normal to a weak increase. In infected rats, identically sensitized, challenge with Ag induced a much shorter duration of pleural edema with complete resolution by 4 h, but no change in the early edema response. In parallel, infection increased the number of eosinophils recovered from the pleural cavity at 4 h, but not at 30 min, following allergen challenge. Pretreatment with IL-5 (100 IU/kg, i.v.) also increased eosinophil numbers in blood and, after allergen challenge, shortened the duration of the pleural edema and increased pleural eosinophil numbers. There were increases in the levels of both PGE2 and lipoxin A4 (LXA4) in pleural exudate. Selective cyclooxygenase (COX)-2 inhibitors, NS-398, meloxicam, and SC-236, did not alter pleural eosinophilia, but reversed the curtailment of the edema in either infected or IL-5-pretreated rats. Pretreatment of noninfected animals with the PGE analogue, misoprostol, or two stable LXA4 analogues did not alter the magnitude of pleural exudation response, but clearly shortened its duration. These results indicate that the early resolution of allergic pleural edema observed during A. costaricensis infection coincided with a selective local eosinophilia and seemed to be mediated by COX-2-derived PGE2 and LXA4.

Caracterização dos casos de violência doméstica contra a mulher atendidos em dois hospitais públicos do Rio de Janeiro

Abstract: This paper aims at: (a) to analyze the distribution of the cases of domestic violence against women (adolescent and adult) in relation to emergency care due to external causes; (b) to characterize the victims and the rendered care; (c) to analyze the circumstances in which events happened. In methodological terms, it tries to articulate the quantitative and qualitative approaches. The study was developed in two public hospitals of reference placed in the city of Rio de Janeiro. Of the 72 assisted women, most referred to the husband, the partner or the boyfriend as the aggressor (69,4%) and were beaten (70.4%), especially on the face and on the head. The study cames to the conclusion that the health services should provide a good clinical care and promote prevention's actions.

AIDS e grau de escolaridade no Brasil: evolução temporal de 1986 a 1996

Abstract: Este trabalho analisa a evolucao temporal dos casos de AIDS por grau de escolaridade como variavel identificadora do nivel socio-economico do caso. Todos os casos de AIDS em individuos com idades entre 20 e 69 anos, notificados ate 29 de maio de 1999, diagnosticados entre 1986 e 1996, foram incluidos no estudo. As taxas de incidencia para ambos os sexos foram calculadas segundo dois graus de escolaridade - "grau 1" (casos com ate oito anos de estudo) e "grau 2" (com mais de oito anos de estudo) -, por regiao e ano de diagnostico. Entre os homens, as taxas de incidencia de AIDS para aqueles com menor escolaridade ultrapassam (sendo mais evidente na Regiao Sudeste) ou se aproximam das taxas dos homens com maior escolaridade. Para as mulheres, a evolucao temporal das taxas mostrou maior ritmo de crescimento entre as mulheres de menor escolaridade para todas as regioes, sendo que, na Sudeste, as taxas entre as mulheres com menor escolaridade ultrapassa as taxas daquelas com maior escolaridade em anos anteriores a 1989. Concluindo, a presente analise mostra, de forma consistente, que a epidemia de AIDS no Brasil se iniciou nos estratos sociais de maior escolaridade, com progressiva disseminacao para os estratos sociais de menor escolaridade.

Saúde, minorias e desigualdade: algumas teias de inter-relações, com ênfase nos povos indígenas no Brasil

Abstract: No Brasil, nao ha uma producao sistematica acerca do peso da dimensao etnico-racial na expressao diferenciada dos agravos a saude. No cotidiano, minorias vivenciam situacoes de exclusao, marginalidade e discriminacao que as colocam em posicao de maior vulnerabilidade frente a agravos a saude. Neste texto e enfocada, em particular, a situacao dos povos indigenas. Coeficientes de morbi-mortalidade mais altos do que os registrados em nivel nacional, fome e desnutricao, riscos ocupacionais e violencia social sao apenas alguns dos multiplos reflexos sobre a saude decorrentes da persistencia de desigualdades. E importante que sejam realizados esforcos no sentido de reverter uma preocupante invisibilidade demografica e epidemiologica resultante da ausencia de informacoes confiaveis para as populacoes indigenas nas bases de dados oficiais. Isso possibilitara compreender melhor a genese, determinantes e formas de reproducao das desigualdades em saude no Brasil. Tais conhecimentos sao fundamentais para o embasamento tanto de atuacoes politicas, inclusive por parte de liderancas indigenas, como de intervencoes com vistas a promocao da equidade em saude.

Mutation Analysis and Embryonic Expression of the HLXB9 Currarino Syndrome Gene

Abstract: The HLXB9 homeobox gene was recently identified as a locus for autosomal dominant Currarino syndrome, also known as hereditary sacral agenesis (HSA). This gene specifies a 403-amino acid protein containing a homeodomain preceded by a very highly conserved 82-amino acid domain of unknown function; the remainder of the protein is not well conserved. Here we report an extensive mutation survey that has identified mutations in the HLXB9 gene in 20 of 21 patients tested with familial Currarino syndrome. Mutations were also detected in two of seven sporadic Currarino syndrome patients; the remainder could be explained by undetected mosaicism for an HLXB9 mutation or by genetic heterogeneity in the sporadic patients. Of the mutations identified in the 22 index patients, 19 were intragenic and included 11 mutations that could lead to the introduction of a premature termination codon. The other eight mutations were missense mutations that were significantly clustered in the homeodomain, resulting, in each patient, in nonconservative substitution of a highly conserved amino acid. All of the intragenic mutations were associated with comparable phenotypes. The only genotype-phenotype correlation appeared to be the occurrence of developmental delay in the case of three patients with microdeletions. HLXB9 expression was analyzed during early human development in a period spanning Carnegie stages 12-21. Signal was detected in the basal plate of the spinal cord and hindbrain and in the pharynx, esophagus, stomach, and pancreas. Significant spatial and temporal expression differences were evident when compared with expression of the mouse Hlxb9 gene, which may partly explain the significant human-mouse differences in mutant phenotype.

Cutting edge: lipoxin (LX) A4 and aspirin-triggered 15-epi-LXA4 block allergen-induced eosinophil trafficking.

Abstract: Tissue eosinophilia prevention represents one of the primary targets to new anti-allergic therapies. As lipoxin A4 (LXA4) and aspirin-triggered 15-epi-LXA4 (ATL) are emerging as endogenous “stop signals” produced in distinct pathologies including some eosinophil-related pulmonary disorders, we evaluated the impact of in situ LXA4/ATL metabolically stable analogues on allergen-induced eosinophilic pleurisy in sensitized rats. LXA4/ATL analogues dramatically blocked allergic pleural eosinophil influx, while concurrently increasing circulating eosinophilia, inhibiting the earlier edema and neutrophilia associated with allergic reaction. The mechanisms underlying this LXA4/ATL-driven allergic eosinophilia blockade was independent of mast cell degranulation and involved LXA4/ATL inhibition of both IL-5 and eotaxin generation, as well as platelet activating factor action. These findings reveal LXA4/ATL as a novel class of endogenous anti-allergic mediators, capable of preventing local eosinophilia.

Avaliação da contaminação humana por hidrocarbonetos policíclicos aromáticos (hpas) e seus derivados nitrados (nhpas): uma revisão metodológica

Abstract: Polycyclic aromatic hydrocabons (PAHs) and their nitroderivatives (NPAHs) are ubiquitous in the environment and they are produced in several industrial and combustion processes. Some of these compounds are potent carcinogens/mutagens and their determination in biological samples is an important step for exposure control. A review of the analytical methodologies used for the determination of PAHs and their metabolites in biological samples is presented.

A interação entre prescritores, dispensadores e pacientes: informação compartilhada como possível benefício terapêutico

Abstract: The article presents a critical view of the interaction between prescribers, dispensers, and patients, considering information one of the key issues in enhancing the qualitative aspects involved in this complex relationship. It describes the acquisition of information by health professionals, possible sources of this information, and the process involved in transforming it into knowledge. Briefly discussed are the physician's and pharmacist's roles, the patient's expectations as recipient, and consequences of pertinent health interventions.

Health sector reform in Brazil: a case study of inequity.

Abstract: Health sector reform in Brazil built the Unified Health System according to a dense body of administrative instruments for organizing decentralized service networks and institutionalizing a complex decision-making arena. This article focuses on the equity in health care services. Equity is defined as a principle governing distributive functions designed to reduce or offset socially unjust inequalities, and it is applied to evaluate the distribution of financial resources and the use of health services. Even though in the Constitution the term "equity" refers to equal opportunity of access for equal needs, the implemented policies have not guaranteed these rights. Underfunding, fiscal stress, and lack of priorities for the sector have contributed to a progressive deterioration of health care services, with continuing regressive tax collection and unequal distribution of financial resources among regions. The data suggest that despite regulatory measures to increase efficiency and reduce inequalities, delivery of health care services remains extremely unequal across the country. People in lower income groups experience more difficulties in getting access to health services. Utilization rates vary greatly by type of service among income groups, positions in the labor market, and levels of education.

General situation and perspectives of Chagas disease in Northeastern Region, Brazil

Abstract: Primary and secondary data show the importance and distribution of human Chagas disease (HCD) in Northeast Brazil. Among the 27 detected vector species, Triatoma infestans, Panstrongylus megistus, Triatoma brasiliensis and Triatoma pseudomaculata are epidemiologically important. Major medical impact is attributed to T. infestans and P. megistus, the most domiciliated and vulnerable species, while the other two are native and more difficult to control. Regional differences in transmission and medical impact of HCD exist in the Northeast, where in general the disease appears to be less harmful than in other Brazilian regions like the Southeast and State of Goias. There is a downward trend in HCD transmission and morbidity in the Northeast, its control in the region is a cause of concern because of the decommissioning of the National Health Foundation without a corresponding assimilation of its routine activities by regional and municipal institutions.

Prenatal exposure to misoprostol and vascular disruption defects: a case-control study.

Abstract: Prenatal exposure to misoprostol has been associated with Moebius and limb defects. Vascular disruption has been proposed as the mechanism for these teratogenic effects. The present study is a multicenter, case-control study that was designed to compare the frequency of prenatal misoprostol use between mothers of Brazilian children diagnosed with vascular disruption defects and matched control mothers of children diagnosed with other types of defects. A total of 93 cases and 279 controls were recruited in eight participating centers. Prenatal exposure was identified in 32 infants diagnosed with vascular disruption defects (34.4%) compared with only 12 (4.3%) in the control group (P<0.0000001). Our data suggest that prenatal exposure to misoprostol is associated to the occurrence of vascular disruption defects in the newborns.