Showing papers by "Oswaldo Cruz Foundation published in 2004"

Uma revisão sobre os conceitos de acesso e utilização de serviços de saúde

Abstract: The purposes of this article are to review the concepts of health services access and utilization and to analyze how these concepts interrelate. Access is a complex concept (often used inaccurately) which changes over time and according to the context. Health services utilization is at the core of health systems functioning. Despite some disagreement, according to this review the prevailing perspective is that access is related to characteristics of services supply. Health care services utilization can be applied as a measure of access, but use of services depends on other factors. Individual and contextual factors influence the use of services. The article shows that the concept of access is becoming more comprehensive and is changing its focus from entry into the health system to outcome of care. Access is valued in relation to its impact on health and depends on the effectiveness of care delivered. As an outcome measure, access becomes multidimensional and difficult to operationalize. Finally, the article discusses how health determinants differ from those of health services utilization, which impacts directly on illness, but only indirectly on health.

Interferon regulatory factor 6 (IRF6) gene variants and the risk of isolated cleft lip or palate.

Abstract: Background Cleft lip or palate (or the two in combination) is a common birth defect that results from a mixture of genetic and environmental factors. We searched for a specific genetic factor contributing to this complex trait by examining large numbers of affected patients and families and evaluating a specific candidate gene. Methods We identified the gene that encodes interferon regulatory factor 6 (IRF6) as a candidate gene on the basis of its involvement in an autosomal dominant form of cleft lip and palate, Van der Woude's syndrome. A single-nucleotide polymorphism in this gene results in either a valine or an isoleucine at amino acid position 274 (V274I). We carried out transmission-disequilibrium testing for V274I in 8003 individual subjects in 1968 families derived from 10 populations with ancestry in Asia, Europe, and South America, haplotype and linkage analyses, and case–control analyses, and determined the risk of cleft lip or palate that is associated with genetic variation in IRF6. Results ...

Leishmaniose visceral no Brasil: quadro atual, desafios e perspectivas

Abstract: No Brasil, a importância da leishmaniose visceral reside nao somente na sua alta incidencia e ampla distribuicao, mas tambem na possibilidade de assumir formas graves e letais quando associada ao quadro de ma nutricao e infeccoes concomitantes. A crescente urbanizacao da doenca ocorrida nos ultimos 20 anos coloca em pauta a discussao das estrategias de controle empregadas. Neste artigo foram analisados os principais aspectos biologicos, ambientais e sociais que influenciaram no processo de expansao e urbanizacao dos focos da doenca. Os metodos disponiveis para o diagnostico e tratamento nao apresentam a eficacia e aplicabilidade desejadas, embora avancos promissores tenham sido alcancados com as pesquisas de novos testes diagnosticos e drogas terapeuticas. As medidas de controle da doenca ate agora implementadas foram incapazes de eliminar a transmissao e impedir a ocorrencia de novas epidemias. E feita uma breve analise destas medidas e dos desafios a serem enfrentados. A prevencao da doenca nos caes atraves da imunoprofilaxia aparece como uma alternativa para o controle. Uma nova vacina para caes, ja testada em campo, esta sendo industrializada e sera comercializada no Brasil a partir de 2004. Apesar da existencia de inumeros estudos sobre a leishmaniose visceral humana e canina, muitas lacunas ainda precisam ser preenchidas.

Susceptibility to leprosy is associated with PARK2 and PACRG.

Abstract: Leprosy is caused by Mycobacterium leprae and affects about 700,000 individuals each year1. It has long been thought that leprosy has a strong genetic component2, and recently we mapped a leprosy susceptibility locus to chromosome 6 region q25–q26 (ref. 3). Here we investigate this region further by using a systematic association scan of the chromosomal interval most likely to harbour this leprosy susceptibility locus. In 197 Vietnamese families we found a significant association between leprosy and 17 markers located in a block of approx. 80 kilobases overlapping the 5′ regulatory region shared by the Parkinson's disease gene PARK2 and the co-regulated gene PACRG. Possession of as few as two of the 17 risk alleles was highly predictive of leprosy. This was confirmed in a sample of 975 unrelated leprosy cases and controls from Brazil in whom the same alleles were strongly associated with leprosy. Variants in the regulatory region shared by PARK2 and PACRG therefore act as common risk factors for leprosy.

Comparative Genomics of Two Leptospira interrogans Serovars Reveals Novel Insights into Physiology and Pathogenesis

Abstract: Leptospira species colonize a significant proportion of rodent populations worldwide and produce life-threatening infections in accidental hosts, including humans. Complete genome sequencing of Leptospira interrogans serovar Copenhageni and comparative analysis with the available Leptospira interrogans serovar Lai genome reveal that despite overall genetic similarity there are significant structural differences, including a large chromosomal inversion and extensive variation in the number and distribution of insertion sequence elements. Genome sequence analysis elucidates many of the novel aspects of leptospiral physiology relating to energy metabolism, oxygen tolerance, two-component signal transduction systems, and mechanisms of pathogenesis. A broad array of transcriptional regulation proteins and two new families of afimbrial adhesins which contribute to host tissue colonization in the early steps of infection were identified. Differences in genes involved in the biosynthesis of lipopolysaccharide O side chains between the Copenhageni and Lai serovars were identified, offering an important starting point for the elucidation of the organism's complex polysaccharide surface antigens. Differences in adhesins and in lipopolysaccharide might be associated with the adaptation of serovars Copenhageni and Lai to different animal hosts. Hundreds of genes encoding surface-exposed lipoproteins and transmembrane outer membrane proteins were identified as candidates for development of vaccines for the prevention of leptospirosis.

Human Hookworm Infection in the 21st Century

Abstract: The scientific study of human hookworm infection began at the dawn of the twentieth century. In recent years, there have been dramatic improvements in our understanding of many aspects of this globally widespread parasite. This chapter reviews recent advances in our understanding in the biology, immunology, epidemiology, public health significance and control of hookworm, and to look forward to the study of this important parasite in the 21st century. Advances in molecular biology has lead to the identification of a variety of new molecules from hookworms, which have importance either in the molecular pathogenesis of hookworm infection or in the host-parasite relationship; some are also promising vaccine targets. At present, relatively little is known about the immune responses to hookworm infection, although it has recently been speculated that hookworm and other helminths may modulate specific immune responses to other pathogens and vaccines. Our epidemiological understanding of hookworm has improved through the development of mathematical models of transmission dynamics, which coupled with decades of field research across multiple epidemiological settings, have shown that certain population characteristics can now be recognised as common to the epidemiology, population biology and control of hookworm and other helminth species. Recent recognition of the subtle, but significant, impact of hookworm on health and education, together with the simplicity, safety, low cost and efficacy of chemotherapy has spurred international efforts to control the morbidity due to infection. Large-scale treatment programmes are currently underway, ideally supported by health education and integrated with the provision of improved water and sanitation. There are also on-going efforts to develop novel anthelmintic drugs and anti-hookworm vaccines.

Transição epidemiológica e o estudo de carga de doença no Brasil

Abstract: No Brasil, a transicao epidemiologica nao tem ocorrido de acordo com o modelo experimentado pela maioria dos paises desenvolvidos. Velhos e novos problemas em saude coexistem, com predominância das doencas cronico-degenerativas, embora as doencas transmissiveis ainda desempenhem um papel importante. Neste estudo, os diferenciais, em relacao ao padrao epidemiologico, sao descritos para o Brasil e grandes regioes, para o indicador de saude dos estudos da carga de doenca, o DALY. Entre os principais resultados encontrados, para o Brasil, destaca-se que o grupo das doencas nao-transmissiveis, infecciosas/parasitarias/maternas/perinatais/nutricionais, e das causas externas representaram, respectivamente, 66,3%, 23,5% e 10,2% da carga total de doenca estimada. A utilizacao do indicador DALY propicia a identificacao de prioridades em funcao do perfil epidemiologico, facilitando a tomada de decisoes e destinacao adequada de recursos por parte dos gestores.

Cat-Transmitted Sporotrichosis Epidemic in Rio de Janeiro, Brazil: Description of a Series of Cases

Abstract: Sporotrichosis is the most common subcutaneous mycosis in South America. Classic infection is associated with traumatic inoculation of soil, vegetables, and organic matter contaminated with Sporothrix schenckii. Zoonotic transmission has been described in isolated cases or in small outbreaks. Since 1998, we have been observing an increasing number of cases of sporotrichosis in persons from the city of Rio de Janeiro, Brazil, and surroundings. From 1998 to 2001, 178 cases of culture-proven sporotrichosis had been diagnosed. Female patients predominated, and the median age was 39 years. The most frequent clinical presentation was lymphocutaneous disease. Of the 178 patients, 156 reported domiciliary or professional contact with cats with sporotrichosis, and 97 of these patients had a history of receipt of cat scratch or bite. The patients received itraconazole as first-line treatment. This study suggests that feline transmission of sporotrichosis was associated with a large and long-lasting outbreak of the disease in Rio de Janeiro.

Aspectos das práticas alimentares e da atividade física como determinantes do crescimento do sobrepeso/obesidade no Brasil

Abstract: Data from Brazilian national surveys conducted since the 1970s have indicated an increase in the prevalence of overweight/obesity. The two most frequently cited causes of this trend have been dietary changes and reduction in physical activity, characterizing a "contemporary Western lifestyle". The objective of this paper is to identify and assess some indicators associated with changes in eating habits and physical activity patterns in the Brazilian population in the last 30 years. Despite the lack of detailed data, the following factors appear to play an important role in the process: internal migration; dining out; increased consumption of fast food; labor changes; transportation; and the use of home appliances. More information on dietary and physical activity patterns in association with anthropometric data on the Brazilian population are needed for a better understanding of each factor's role in these relationships. Meanwhile, inter-sector programs and projects with well-defined targets and outcomes are needed for the population's adherence to a healthier lifestyle, in order to control the increase in overweight/obesity.

Prevalence of sexual dysfunctions and correlated conditions in a sample of brazilian women: results of the Brazilian study on sexual behavior (BSSB)

Abstract: The objective of this study was to assess the prevalence and risk factors of female sexual dysfunctions across a selection of social groups. In all, 1219 women in the community, aged 18 y or older, answered a 38-question self-applicable questionnaire. Statistical analysis was performed using multivariate logistic regression. The average age was 35.6 y (s.d.=12.31) and the average number of sexual intercourses was 2.8 (s.d.=1.94) a week. At least one sexual dysfunction was reported by 49% of the women; lack of sexual desire (LSD) by 26.7%; pain during sexual intercourse (PSI) by 23.1% and orgasmic dysfunction (OD) by 21%. Women aged over 40 y represented an LSD and OD risk factor, whereas women aged over 25 y showed less likelihood of presenting PSI. The educational level was inversely correlated with the risk of LSD, OD and PSI. Depression and cardiopathies increased PSI occurrences and women with diabetes mellitus showed a higher probability of developing LSD and OD. In conclusion, almost half the women had at least one sexual dysfunction, and prevalence increased with age and lower educational levels. Preventive medical care for the female population, mainly for patients with chronic and/or degenerative diseases, considerably reduced the chances of sexual dysfunction.

Macrophage Interactions with Neutrophils Regulate Leishmania major Infection

Abstract: Macrophages are host cells for the pathogenic parasite Leishmania major . Neutrophils die and are ingested by macrophages in the tissues. We investigated the role of macrophage interactions with inflammatory neutrophils in control of L. major infection. Coculture of dead exudate neutrophils exacerbated parasite growth in infected macrophages from susceptible BALB, but killed intracellular L. major in resistant B6 mice. Coinjection of dead neutrophils amplified L. major replication in vivo in BALB, but prevented parasite growth in B6 mice. Neutrophil depletion reduced parasite load in infected BALB, but exacerbated infection in B6 mice. Exacerbated growth of L. major required PGE2 and TGF-β production by macrophages, while parasite killing depended on neutrophil elastase and TNF-α production. These results indicate that macrophage interactions with dead neutrophils play a previously unrecognized role in host responses to L. major infection.

On the Take: How Medicine's Complicity with Big Business Can Endanger Your Health

Abstract: We all know that doctors accept gifts from drug companies, ranging from pens and coffee mugs to free vacations at luxurious resorts. But as the former Editor-in-Chief of The New England Journal of Medicine reveals in this shocking expose, these innocuous-seeming gifts are just the tip of an iceberg that is distorting the practice of medicine and jeopardizing the health of millions of Americans today. In On the Take, Dr. Jerome Kassirer offers an unsettling look at the pervasive payoffs that physicians take from big drug companies and other medical suppliers, arguing that the billion-dollar onslaught of industry money has deflected many physicians' moral compasses and directly impacted the everyday care we receive from the doctors and institutions we trust most. Underscored by countless chilling untold stories, the book illuminates the financial connections between the wealthy companies that make drugs and the doctors who prescribe them. Kassirer details the shocking extent of these financial enticements and explains how they encourage bias, promote dangerously misleading medical information, raise the cost of medical care, and breed distrust. A brilliant diagnosis of an epidemic of greed, On the Take offers insight into how we can cure the medical profession and restore our trust in doctors and hospitals.

The concept and measurement of race and their relationship to public health: a review focused on Brazil and the United States

Abstract: Race has been widely used in studies on health and healthcare inequalities, especially in the United States. Validity and reliability problems with race measurement are of concern in public health. This article reviews the literature on the concept and measurement of race and compares how the findings apply to the United States and Brazil. We discuss in detail the data quality issues related to the measurement of race and the problems raised by measuring race in multiracial societies like Brazil. We discuss how these issues and problems apply to public health and make recommendations about the measurement of race in medical records and public health research.

[Comprehensive health care and integrated health services: challenges for evaluating the implementation of a "system without walls"].

Abstract: The premise of this paper is that comprehensive health care is a major component in the investigation and evaluation of health services and systems, structured as inter-organizational health care networks articulating clinical, functional, normative, and systemic dimensions in their operationalization and based on the understanding that no organization combines all the necessary resources and capabilities to solve the health problems of a population with its various life cycles. Given the complex nature of this "system without walls", eliminating barriers to access in the various health care levels in response to local and regional health, we take this opportunity to share a few "preliminary lessons" from our experience and from the literature on integrated health services which may interest researchers and managers concerned with the implementation of such services.

Substrate specificity, environmental degradation and disturbance structuring macroinvertebrate assemblages in neotropical streams

Abstract: Structure and composition of benthic macroinvertebrate assemblages were investigated in seven sampling sites with a gradient of environmental integrity and water quality conditions. Composite samples of the four most representative substrates were collected in order to characterize the riffle-pool dynamic in each sampling site. Spatial and temporal variability of macroinvertebrate assemblages were analyzed at two scales: using substrates and grouping samples for comparing sampling sites. Distribution of macroinvertebrates was influenced primarily by substrate type, but also by environmental integrity, water quality and sampling period. Species occurrence was highly dependent on substrate type. At local spatial scale, environmental degradation measured by the Riparian Channel Environmental Inventory and water chemistry were the determinants of assemblage patterns. We evaluated to which extent the substrates were influenced by environmental integrity and water chemistry, and we found that degradation influenced significantly the macroinvertebrate fauna on the four substrate types, although they were not responding to the same variables. Our results show that qualitatively communities were not influenced by seasonal changes, but abundance was stochastically dependent on rainfall.

Combating Tropical Infectious Diseases: Report of the Disease Control Priorities in Developing Countries Project

Abstract: Infectious diseases are responsible for >25% of the global disease toll. The new Disease Control Priorities in Developing Countries Project (DCPP) aims to decrease the burden of these diseases by producing science-based analyses from demographic, epidemiologic, disease intervention, and economic evidence for the purpose of defining disease priorities and implementing control measures. The DCPP recently reviewed selected tropical infectious diseases, examined successful control experiences, and defined unsettled patient treatment, prevention, and research issues. Disease elimination programs against American trypanosomiasis (Chagas disease), onchocerciasis, lymphatic filariasis, leprosy, trachoma, and measles are succeeding. Dengue, leishmaniasis, African trypanosomiasis, malaria, diarrheal diseases, helminthic infections, and tuberculosis have reemerged because of inadequate interventions and control strategies and the breakdown of health delivery systems. Application of technologies must be cost-effective and intensified research is essential if these and other scourges are to be controlled or eliminated in the 21st century.

Aedes aegypti resistance to temephos during 2001 in several municipalities in the states of Rio de Janeiro, Sergipe, and Alagoas, Brazil

Abstract: For more than 30 years temephos, an organophosphate insecticide, has been the sole larvicide used in Brazil in the control of Aedes aegypti. Organophosphates were also used for adult control, being replaced by pyrethroids since l999. In this same year, the Brazilian Health Foundation started the coordination of the Ae. aegypti Insecticide Resistance Monitoring Program. In the context of this program, our group was responsible for the detection of temephos resistance in a total of 12 municipalities in the states of Rio de Janeiro (RJ), Alagoas (AL), and Sergipe (SE) during 2001. In each municipality, a pool of mosquitoes collected from different districts was used, with the exception of Rio de Janeiro city, where eight districts have been separately evaluated. Exposure of larvae to the diagnostic dose of temephos revealed resistance in all localities examined, with mortality levels ranging from 4% (Pilares district, Rio de Janeiro, RJ) to 61.9% (Campos dos Goytacazes, RJ). Quantification of mortality showed resistance ratios from 6.1 (Aracaju, SE) to 16.8 (Sao Goncalo, RJ and Penha district, Rio de Janeiro, RJ). The national dengue control program is presently using these data to subside insecticide resistance management.

Impaired production of proinflammatory cytokines and host resistance to acute infection with Trypanosoma cruzi in mice lacking functional myeloid differentiation factor 88

Abstract: Studies performed in vitro suggest that activation of Toll-like receptors (TLRs) by parasite-derived molecules may initiate inflammatory responses and host innate defense mechanisms against Trypanosoma cruzi. Here, we evaluated the impact of TLR2 and myeloid differentiation factor 88 (MyD88) deficiencies in host resistance to infection with T. cruzi. Our results show that macrophages derived from TLR2 (-/-) and MyD88(-/-) mice are less responsive to GPI-mucin derived from T. cruzi trypomastigotes and parasites. In contrast, the same cells from TLR2(-/-) still produce TNF-alpha, IL-12, and reactive nitrogen intermediates (RNI) upon exposure to live T. cruzi trypomastigotes. Consistently, we show that TLR2(-/-) mice mount a robust proinflammatory cytokine response as well as RNI production during the acute phase of infection with T. cruzi parasites. Further, deletion of the functional TLR2 gene had no major impact on parasitemia nor on mortality. In contrast, the MyD88(-/-) mice had a diminished cytokine response and RNI production upon acute infection with T. cruzi. More importantly, we show that MyD88(-/-) mice are more susceptible to infection with T. cruzi as indicated by the higher parasitemia and accelerated mortality, as compared with the wild-type mice. Together, our results indicate that T. cruzi parasites elicit an alternative inflammatory pathway independent of TLR2. This pathway is partially dependent on MyD88 and necessary for mounting optimal inflammatory and RNI responses that control T. cruzi replication during the early stages of infection.

Risco e proteção: em busca de um equilíbrio promotor de resiliência

Abstract: The article analyzes the relationship of the resilience with unfavorable life events and protection factors The sample of that study belonged to 997 school adolescents of the public schools of Sao Goncalo/RJ As measure of resilience was used the Resilience Scale developed by Wagnild & Young (1993) To measure Life Events were used scale of physical violence (Straus, 1979) and psychological violence (Pitzer & Drummond, 1997), violence items in the school and in the place, violence among siblings and among parents, sexual violence and others As protection factors were used the Scale of Social Support of Shebourne e Stewart (Chor, Grip, Lopes & Farstein, 2001), the Scale of Self-Esteem of Rosemberg (1989), family supervision, relationship with friends and teachers It was observed that the negative life events didn't present relationship with the resilience On the other hand, the appraised protection factors were shown all correlated with the resilience

Evaluation of an epidemic of sporotrichosis in cats: 347 cases (1998-2001).

Abstract: OBJECTIVE: To evaluate characteristics of a large epidemic of sporotrichosis in cats. DESIGN: Retrospective study. ANIMALS: 347 cats with naturally acquired infection with Sporothrix schenckii. PROCEDURE: Medical records were reviewed for data regarding clinical, mycologic, histopathologic, and routine hematologic and serum biochemical findings; assays for FIV-specific antibodies and FeLV antigen; antifungal treatment; and follow-up. RESULTS: Lesions varied from small papules to extensive zones of necrosis. Ten cats had no skin lesions, 114 had skin lesions at a single site, 86 had skin lesions in 2 sites, and 137 had skin lesions in 3 or more sites. Respiratory tract signs were observed in 154 cats and were the most frequent extracutaneous sign. Anemia, leukocytosis with neutrophilia, hypoalbuminemia, and hyperglobulinemia were the main blood abnormalities. Antibodies against FIV were detected in 28 cats, FeLV antigen was detected in 2 cats, and both were detected in 1 cat among 142 cats tested. During the study, 118 cats were lost to follow-up and 124 died. Of 266 cats that were treated, 68 were cured. Complete healing of the lesions was observed regardless of the presence of extracutaneous signs, general condition, treatment schedule, or coinfection with FIV. CONCLUSIONS AND CLINICAL RELEVANCE: Feline sporotrichosis was evident in subclinical to severe forms; however, cats can respond well to regular and prolonged antifungal treatment.

Melissopalynology in Brazil: a review of pollen analysis of honeys, propolis and pollen loads of bees

Abstract: This paper reviews current knowledge on the occurrence of several types of pollen grains in the sediments of honey samples, propolis and bee loads of Apiinae and Meliponinae in Brazil. After a short historical introduction about research activities in Melissopalynology using Brazilian samples, bee products were analyzed in respect to the greater Brazilian regions (South, Southeast, Northeast and North), emphasizing monofloral honeys and the green propolis. Numerous bibliographic references and a short glossary of the technical terms used is presented.

Production of L-asparaginase by filamentous fungi

Abstract: L-asparaginase production was investigated in the filamentous fungi Aspergillus tamarii and Aspergillus terreus. The fungi were cultivated in medium containing different nitrogen sources. A. terreus showed the highest L-asparaginase (activity) production level (58 U/L) when cultivated in a 2% proline medium. Both fungi presented the lowest level of L-asparaginase production in the presence of glutamine and urea as nitrogen sources. These results suggest that L-asparaginase production by of filamentous fungi is under nitrogen regulation.