Showing papers by "Oswaldo Cruz Foundation published in 2010"

Preexposure Chemoprophylaxis for HIV Prevention in Men Who Have Sex with Men

Abstract: The study subjects were followed for 3324 person-years (median, 1.2 years; maximum, 2.8 years). Of these subjects, 10 were found to have been infected with HIV at en rollment, and 100 became infected during follow-up (36 in the FTC–TDF group and 64 in the placebo group), indicating a 44% reduction in the incidence of HIV (95% confidence interval, 15 to 63; P = 0.005). In the FTC–TDF group, the study drug was detected in 22 of 43 of seronegative subjects (51%) and in 3 of 34 HIV-infected subjects (9%) (P<0.001). Nausea was reported more frequently during the first 4 weeks in the FTC–TDF group than in the placebo group (P<0.001). The two groups had similar rates of serious adverse events (P = 0.57). Conclusions Oral FTC–TDF provided protection against the acquisition of HIV infection among the subjects. Detectable blood levels strongly correlated with the prophylactic effect. (Funded by the National Institutes of Health and the Bill and Melinda Gates Foun dation; ClinicalTrials.gov number, NCT00458393.)

Urinary, circulating, and tissue biomonitoring studies indicate widespread exposure to bisphenol A.

Abstract: BackgroundBisphenol A (BPA) is one of the highest-volume chemicals produced worldwide, and human exposure to BPA is thought to be ubiquitous. Thus, there are concerns that the amount of BPA to whic...

Global research priorities for sea turtles: informing management and conservation in the 21st century

Abstract: Over the past 3 decades, the status of sea turtles and the need for their protection to aid population recovery have increasingly captured the interest of government agencies, non-governmental organisations (NGOs) and the general public worldwide. This interest has been matched by increased research attention, focusing on a wide variety of topics relating to sea turtle biology and ecology, together with the interrelations of sea turtles with the physical and natural environments. Although sea turtles have been better studied than most other marine fauna, management actions and their evaluation are often hindered by the lack of data on turtle biology, human–turtle interactions, turtle population status and threats. In an effort to inform effective sea turtle conservation a list of priority research questions was assembled based on the opinions of 35 sea turtle researchers from 13 nations working in fields related to turtle biology and/or conservation. The combined experience of the contributing researchers spanned the globe as well as many relevant disciplines involved in conservation research. An initial list of more than 200 questions gathered from respondents was condensed into 20 metaquestions and classified under 5 categories: reproductive biology, biogeography, population ecology, threats and conservation strategies.

A genome-wide association study of cleft lip with and without cleft palate identifies risk variants near MAFB and ABCA4

Abstract: Case-parent trios were used in a genome-wide association study of cleft lip with and without cleft palate. SNPs near two genes not previously associated with cleft lip with and without cleft palate (MAFB, most significant SNP rs13041247, with odds ratio (OR) per minor allele = 0.704, 95% CI 0.635-0.778, P = 1.44 x 10(-11); and ABCA4, most significant SNP rs560426, with OR = 1.432, 95% CI 1.292-1.587, P = 5.01 x 10(-12)) and two previously identified regions (at chromosome 8q24 and IRF6) attained genome-wide significance. Stratifying trios into European and Asian ancestry groups revealed differences in statistical significance, although estimated effect sizes remained similar. Replication studies from several populations showed confirming evidence, with families of European ancestry giving stronger evidence for markers in 8q24, whereas Asian families showed stronger evidence for association with MAFB and ABCA4. Expression studies support a role for MAFB in palatal development.

A central role for free heme in the pathogenesis of severe sepsis.

Abstract: Low-grade polymicrobial infection induced by cecal ligation and puncture is lethal in heme oxygenase-1-deficient mice (Hmox1(-/-)), but not in wild-type (Hmox1(+/+)) mice. Here we demonstrate that the protective effect of this heme-catabolizing enzyme relies on its ability to prevent tissue damage caused by the circulating free heme released from hemoglobin during infection. Heme administration after low-grade infection in mice promoted tissue damage and severe sepsis. Free heme contributed to the pathogenesis of severe sepsis irrespective of pathogen load, revealing that it compromised host tolerance to infection. Development of lethal forms of severe sepsis after high-grade infection was associated with reduced serum concentrations of the heme sequestering protein hemopexin (HPX), whereas HPX administration after high-grade infection prevented tissue damage and lethality. Finally, the lethal outcome of septic shock in patients was also associated with reduced HPX serum concentrations. We propose that targeting free heme by HPX might be used therapeutically to treat severe sepsis.

Malaria in Brazil: an overview

Abstract: Malaria is still a major public health problem in Brazil, with approximately 306 000 registered cases in 2009, but it is estimated that in the early 1940s, around six million cases of malaria occurred each year. As a result of the fight against the disease, the number of malaria cases decreased over the years and the smallest numbers of cases to-date were recorded in the 1960s. From the mid-1960s onwards, Brazil underwent a rapid and disorganized settlement process in the Amazon and this migratory movement led to a progressive increase in the number of reported cases. Although the main mosquito vector (Anopheles darlingi) is present in about 80% of the country, currently the incidence of malaria in Brazil is almost exclusively (99,8% of the cases) restricted to the region of the Amazon Basin, where a number of combined factors favors disease transmission and impair the use of standard control procedures. Plasmodium vivax accounts for 83,7% of registered cases, while Plasmodium falciparum is responsible for 16,3% and Plasmodium malariae is seldom observed. Although vivax malaria is thought to cause little mortality, compared to falciparum malaria, it accounts for much of the morbidity and for huge burdens on the prosperity of endemic communities. However, in the last few years a pattern of unusual clinical complications with fatal cases associated with P. vivax have been reported in Brazil and this is a matter of concern for Brazilian malariologists. In addition, the emergence of P. vivax strains resistant to chloroquine in some reports needs to be further investigated. In contrast, asymptomatic infection by P. falciparum and P. vivax has been detected in epidemiological studies in the states of Rondonia and Amazonas, indicating probably a pattern of clinical immunity in both autochthonous and migrant populations. Seropidemiological studies investigating the type of immune responses elicited in naturally-exposed populations to several malaria vaccine candidates in Brazilian populations have also been providing important information on whether immune responses specific to these antigens are generated in natural infections and their immunogenic potential as vaccine candidates. The present difficulties in reducing economic and social risk factors that determine the incidence of malaria in the Amazon Region render impracticable its elimination in the region. As a result, a malaria-integrated control effort - as a joint action on the part of the government and the population - directed towards the elimination or reduction of the risks of death or illness, is the direction adopted by the Brazilian government in the fight against the disease.

Bone Disease in HIV Infection: A Practical Review and Recommendations for HIV Care Providers

Abstract: Low bone mineral density (BMD) is prevalent in human immunodeficiency virus (HIV)-infected subjects. Initiation of antiretroviral therapy is associated with a 2%-6% decrease in BMD over the first 2 years, a decrease that is similar in magnitude to that sustained during the first 2 years of menopause. Recent studies have also described increased fracture rates in the HIV-infected population. The causes of low BMD in individuals with HIV infection appear to be multifactorial and likely represent a complex interaction between HIV infection, traditional osteoporosis risk factors, and antiretroviral-related factors. In this review, we make the point that HIV infection should be considered as a risk factor for bone disease. We recommend screening patients with fragility fractures, all HIV-infected post-menopausal women, and all HIV-infected men ⩾50 years of age. We also discuss the importance of considering secondary causes of osteoporosis. Finally, we discuss treatment of the more severe cases of bone disease, while outlining the caveats and gaps in our knowledge.

Lipid droplets in inflammation and cancer

Abstract: Accumulation of lipid droplets (also known as lipid bodies or adiposomes) within leukocytes, epithelial cells, hepatocytes and other non-adipocytic cells is a frequently observed phenotype in infectious, neoplastic and other inflammatory conditions. Lipid droplet biogenesis is a regulated cellular process that culminates in the compartmentalization of lipids and of an array of enzymes, protein kinases and other proteins, suggesting that lipid droplets are inducible organelles with roles in cell signaling, regulation of lipid metabolism, membrane trafficking and control of the synthesis and secretion of inflammatory mediators. Enzymes involved in eicosanoid synthesis are localized at lipid droplets and lipid droplets are sites for eicosanoid generation in cells during inflammation and cancer. In this review, we discuss the current evidence related to the biogenesis and function of lipid droplets in cell metabolism and signaling in inflammation and cancer. Moreover, the potential of lipid droplets as markers of disease and targets for novel anti-inflammatory and antineoplastic therapies will be discussed.

Sexual behaviours and the risk of head and neck cancers: a pooled analysis in the International Head and Neck Cancer Epidemiology (INHANCE) consortium

Abstract: Author(s): Heck, Julia E; Berthiller, Julien; Vaccarella, Salvatore; Winn, Deborah M; Smith, Elaine M; Shan'gina, Oxana; Schwartz, Stephen M; Purdue, Mark P; Pilarska, Agnieszka; Eluf-Neto, Jose; Menezes, Ana; McClean, Michael D; Matos, Elena; Koifman, Sergio; Kelsey, Karl T; Herrero, Rolando; Hayes, Richard B; Franceschi, Silvia; Wunsch-Filho, Victor; Fernandez, Leticia; Daudt, Alexander W; Curado, Maria Paula; Chen, Chu; Castellsague, Xavier; Ferro, Gilles; Brennan, Paul; Boffetta, Paolo; Hashibe, Mia | Abstract: BackgroundSexual contact may be the means by which head and neck cancer patients are exposed to human papillomavirus (HPV).MethodsWe undertook a pooled analysis of four population-based and four hospital-based case-control studies from the International Head and Neck Cancer Epidemiology (INHANCE) consortium, with participants from Argentina, Australia, Brazil, Canada, Cuba, India, Italy, Spain, Poland, Puerto Rico, Russia and the USA. The study included 5642 head and neck cancer cases and 6069 controls. We calculated odds ratios (ORs) of associations between cancer and specific sexual behaviours, including practice of oral sex, number of lifetime sexual partners and oral sex partners, age at sexual debut, a history of same-sex contact and a history of oral-anal contact. Findings were stratified by sex and disease subsite.ResultsCancer of the oropharynx was associated with having a history of six or more lifetime sexual partners [OR = 1.25, 95% confidence interval (CI) 1.01, 1.54] and four or more lifetime oral sex partners (OR = 2.25, 95% CI 1.42, 3.58). Cancer of the tonsil was associated with four or more lifetime oral sex partners (OR = 3.36, 95 % CI 1.32, 8.53), and, among men, with ever having oral sex (OR = 1.59, 95% CI 1.09, 2.33) and with an earlier age at sexual debut (OR = 2.36, 95% CI 1.37, 5.05). Cancer of the base of the tongue was associated with ever having oral sex among women (OR = 4.32, 95% CI 1.06, 17.6), having two sexual partners in comparison with only one (OR = 2.02, 95% CI 1.19, 3.46) and, among men, with a history of same-sex sexual contact (OR = 8.89, 95% CI 2.14, 36.8).ConclusionsSexual behaviours are associated with cancer risk at the head and neck cancer subsites that have previously been associated with HPV infection.

STROBE initiative: guidelines on reporting observational studies

Abstract: Reporting of observational studies is often inadequate, hampering the assessment of their strengths and weaknesses and, consequently, the generalization of study results. The initiative named Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) developed a checklist of 22 items, the STROBE Statement, with recommendations about what should be included in a more accurate and complete description of observational studies. Between June and December 2008, a group of Brazilian researchers was dedicated to the translation and adaptation of the STROBE Statement into Portuguese. The present study aimed to show the translation into Portuguese, introduce the discussion on the context of use, the potential and limitations of the STROBE initiative.

Iniciativa STROBE: subsídios para a comunicação de estudos observacionais

Abstract: Frequentemente, a descricao de pesquisas de natureza observacional e inadequada, dificultando a avaliacao de seus pontos fracos e fortes e, em consequencia, a generalizacao de seus resultados. A iniciativa denominada Strengthening the Reporting of Observational Studies in Epidemiology (STROBE), formulou uma lista de verificacao que contem 22 itens, denominada STROBE Statement ("Declaracao STROBE"), com recomendacoes sobre o que deveria ser incluido em uma descricao mais precisa e completa de estudos observacionais. Entre junho e dezembro de 2008, um grupo de pesquisadores brasileiros dedicou-se a traducao e adaptacao da "Declaracao STROBE" para o portugues. O objetivo do estudo foi apresentar a traducao para o portugues, bem como introduzir a discussao sobre o contexto de utilizacao, as potencialidades e limitacoes da Iniciativa STROBE.

Targeting Robo4-Dependent Slit Signaling to Survive the Cytokine Storm in Sepsis and Influenza

Abstract: The innate immune system provides a first line of defense against invading pathogens by releasing multiple inflammatory cytokines, such as interleukin-1β and tumor necrosis factor–α, which directly combat the infectious agent and recruit additional immune responses. This exuberant cytokine release paradoxically injures the host by triggering leakage from capillaries, tissue edema, organ failure, and shock. Current medical therapies target individual pathogens with antimicrobial agents or directly either blunt or boost the host’s immune system. We explored a third approach: activating with the soluble ligand Slit an endothelium-specific, Robo4-dependent signaling pathway that strengthens the vascular barrier, diminishing deleterious aspects of the host’s response to the pathogen-induced cytokine storm. This approach reduced vascular permeability in the lung and other organs and increased survival in animal models of bacterial endotoxin exposure, polymicrobial sepsis, and H5N1 influenza. Thus, enhancing the resilience of the host vascular system to the host’s innate immune response may provide a therapeutic strategy for treating multiple infectious agents.

On the Cytoadhesion of Plasmodium vivax–Infected Erythrocytes

Abstract: Background Plasmodium falciparum and Plasmodium vivax are responsible for most of the global burden of malaria. Although the accentuated pathogenicity of P. falciparum occurs because of sequestration of the mature erythrocytic forms in the microvasculature, this phenomenon has not yet been noted in P. vivax. The increasing number of severe manifestations of P. vivax infections, similar to those observed for severe falciparum malaria, suggests that key pathogenic mechanisms (eg, cytoadherence) might be shared by the 2 parasites. Methods Mature P. vivax-infected erythrocytes (Pv-iEs) were isolated from blood samples collected from 34 infected patients. Pv-iEs enriched on Percoll gradients were used in cytoadhesion assays with human lung endothelial cells, Saimiri brain endothelial cells, and placental cryosections. Results Pv-iEs were able to cytoadhere under static and flow conditions to cells expressing endothelial receptors known to mediate the cytoadhesion of P. falciparum. Although Pv-iE cytoadhesion levels were 10-fold lower than those observed for P. falciparum-infected erythrocytes, the strength of the interaction was similar. Cytoadhesion of Pv-iEs was in part mediated by VIR proteins, encoded by P. vivax variant genes (vir), given that specific antisera inhibited the Pv-iE-endothelial cell interaction. Conclusions These observations prompt a modification of the current paradigms of the pathogenesis of malaria and clear the way to investigate the pathophysiology of P. vivax infections.

In vitro and in vivo experimental models for drug screening and development for Chagas disease

Abstract: Chagas disease, a neglected illness, affects nearly 12-14 million people in endemic areas of Latin America. Although the occurrence of acute cases sharply has declined due to Southern Cone Initiative efforts to control vector transmission, there still remain serious challenges, including the maintenance of sustainable public policies for Chagas disease control and the urgent need for better drugs to treat chagasic patients. Since the introduction of benznidazole and nifurtimox approximately 40 years ago, many natural and synthetic compounds have been assayed against Trypanosoma cruzi, yet only a few compounds have advanced to clinical trials. This reflects, at least in part, the lack of consensus regarding appropriate in vitro and in vivo screening protocols as well as the lack of biomarkers for treating parasitaemia. The development of more effective drugs requires (i) the identification and validation of parasite targets, (ii) compounds to be screened against the targets or the whole parasite and (iii) a panel of minimum standardised procedures to advance leading compounds to clinical trials. This third aim was the topic of the workshop entitled Experimental Models in Drug Screening and Development for Chagas Disease, held in Rio de Janeiro, Brazil, on the 25th and 26th of November 2008 by the Fiocruz Program for Research and Technological Development on Chagas Disease and Drugs for Neglected Diseases Initiative. During the meeting, the minimum steps, requirements and decision gates for the determination of the efficacy of novel drugs for T. cruzi control were evaluated by interdisciplinary experts and an in vitro and in vivo flowchart was designed to serve as a general and standardised protocol for screening potential drugs for the treatment of Chagas disease.

Severe Plasmodium vivax malaria exhibits marked inflammatory imbalance

Abstract: Despite clinical descriptions of severe vivax malaria cases having been reported, data regarding immunological and inflammatory patterns are scarce. In this report, the inflammatory and immunological status of both mild and severe vivax malaria cases are compared in order to explore immunopathological events in this disease. Active and passive malaria case detections were performed during 2007 in Buritis, Rondonia, in the Brazilian Amazon. A total of 219 participants enrolled the study. Study individuals were classified according to the presence of Plasmodium vivax infection within four groups: non-infected (n = 90), asymptomatic (n = 60), mild (n = 50) and severe vivax infection (n = 19). A diagnosis of malaria was made by microscopy and molecular assays. Since at present no clear criteria define severe vivax malaria, this study adapted the consensual criteria from falciparum malaria. Patients with severe P. vivax infection were younger, had lived for shorter time in the endemic area, and recalled having experienced less previous malaria episodes than individuals with no malaria infection and with mild or asymptomatic infection. Strong linear trends were identified regarding increasing plasma levels of C reactive protein (CRP), serum creatinine, bilirubins and the graduation of disease severity. Plasma levels of tumour necrosis factor (TNF), interferon-gamma(IFN-gamma) and also IFN-gamma/interleukin-10 ratios were increased and exhibited a linear trend with gradual augmentation of disease severity. Both laboratory parameters of organ dysfunction and inflammatory cytokines were reduced during anti-parasite therapy in those patients with severe disease. Different clinical presentations of vivax malaria infection present strong association with activation of pro-inflammatory responses and cytokine imbalance. These findings are of utmost importance to improve current knowledge about physiopathological concepts of this serious widespread disease.

Developing vaccines to combat hookworm infection and intestinal schistosomiasis.

Abstract: Hookworm infection and schistosomiasis rank among the most important health problems in developing countries. Both cause anaemia and malnutrition, and schistosomiasis also results in substantial intestinal, liver and genitourinary pathology. In sub-Saharan Africa and Brazil, co-infections with the hookworm, Necator americanus, and the intestinal schistosome, Schistosoma mansoni, are common. The development of vaccines for these infections could substantially reduce the global disability associated with these helminthiases. New genomic, proteomic, immunological and X-ray crystallographic data have led to the discovery of several promising candidate vaccine antigens. Here, we describe recent progress in this field and the rationale for vaccine development.

Cessation of alcohol drinking, tobacco smoking and the reversal of head and neck cancer risk

Abstract: Background Quitting tobacco or alcohol use has been reported to reduce the head and neck cancer risk in previous studies. However, it is unclear how many years must pass following cessation of these habits before the risk is reduced, and whether the risk ultimately declines to the level of never smokers or never drinkers. Methods We pooled individual-level data from case–control studies in the International Head and Neck Cancer Epidemiology Consortium. Data were available from 13 studies on drinking cessation (9167 cases and 12 593 controls), and from 17 studies on smoking cessation (12 040 cases and 16 884 controls). We estimated the effect of quitting smoking and drinking on the risk of head and neck cancer and its subsites, by calculating odds ratios (ORs) using logistic regression models. Results Quitting tobacco smoking for 1–4 years resulted in a head and neck cancer risk reduction [OR 0.70, confidence interval (CI) 0.61–0.81 compared with current smoking], with the risk reduction due to smoking cessation after ≥20 years (OR 0.23, CI 0.18–0.31), reaching the level of never smokers. For alcohol use, a beneficial effect on the risk of head and neck cancer was only observed after ≥20 years of quitting (OR 0.60, CI 0.40–0.89 compared with current drinking), reaching the level of never drinkers. Conclusions Our results support that cessation of tobacco smoking and cessation of alcohol drinking protect against the development of head and neck cancer.

Synthesis, biological activity, and molecular modeling studies of 1H-1,2,3-triazole derivatives of carbohydrates as alpha-glucosidases inhibitors.

Abstract: A class of drugs in use for treating type II diabetes mellitus (T2D), typified by the pseudotetrasaccharide acarbose, act by inhibiting the alpha-glucosidase activity present in pancreatic secretions and in the brush border of the small intestine. Herein, we report the synthesis of a series of 4-substituted 1,2,3-triazoles conjugated with sugars, including D-xylose, D-galactose, D-allose, and D-ribose. Compounds were screened for alpha-glucosidase inhibitory activity using yeast maltase (MAL12) as a model enzyme. Methyl-2,3-O-isopropylidene-beta-D-ribofuranosides, such as the 4-(1-cyclohexenyl)-1,2,3-triazole derivative, were among the most active compounds, showing up to 25-fold higher inhibitory potency than the complex oligosaccharide acarbose. Docking studies on a MAL12 homology model disclosed a binding mode consistent with a transition-state-mimicking mechanism. Finally, the actual pharmacological potential of this triazole series was demonstrated by the reduction of postprandial blood glucose levels in normal rats. These compounds could represent new chemical scaffolds for developing novel drugs against T2D.

Biomass Residues in Brazil: Availability and Potential Uses

Abstract: Agroindustrial and forestry residues, which are by-products of key industrial and economical activities, stand out as potential raw materials for the production of renewable fuels, chemicals and energy. The use of wastes is advantageous as their availability is not hindered by a requirement for arable land for the production of food and feed. In addition, waste utilization prevents its accumulation, which is of great environmental concern due to its potential for contamination of rivers and underground water. In Brazil, the agroindustry of corn (13767400 ha), sugarcane (7080920 ha), rice (2890930 ha), cassava (1894460 ha), wheat (1853220 ha), citrus (930591 ha), coconut (283205 ha), and grass (140000 ha) collectively occupies an area of 28840726 ha (FAOSTAT, http://www.faostat.fao.org/site/567/default.aspx#ancor) and generates 597 million tons of residue per year. By itself, this scale of operation calls for new solutions aiming for the appropriate utilization of these valuable resources. However, innovative dealings must be environmentally and economically acceptable and, most importantly, have social meaning. Indeed, great social benefits could draw from novel year-round activities as alternatives for the typical seasonal jobs in agroindustry. Considering the production of biomass ethanol, the abundance of feedstock near the site of processing must be taken into account, as low-density biomass involves significant handling and transportation costs. Within this context, the crushed stalk of sugar cane (bagasse) and straw are obvious choices, although bagasse is often burned for the production of steam (heat) and power/electricity in sugar-ethanol mills and important amounts of straw are needed to keep the soil nutrients balance. Other agricultural by-products of importance in Brazil, such as corn straw, wheat straw, rice straw and rice hulls, grass and forestry materials and residues from citrus, coconut and cassava processing, also deserve attention as local feedstock for the development of new and profitable activities. As each type of feedstock demands the development of tailor-made technology, the diversity of the aforementioned raw materials could allow for new solutions for the production of chemicals, fuels and energy in accordance with the local availability of these materials.

Adherence to Antiretroviral Therapy Among HIV-Infected Drug Users: A Meta-Analysis

Abstract: We conducted a meta-analysis of studies assessing adherence to highly active antiretroviral therapy (HAART) and a qualitative systematic review of factors associated with better HAART outcomes among HIV+ drug users (DU). Thirty-eight studies were considered, which analyzed 14,960 patients (11,394 HIV+ DU, 76.2%). Overall adherence (pooled percent of DU classified as adherent in each study) was 0.60 (95% CI: 0.52-0.68), similar to levels identified by studies conducted with HIV+ patients who are not drug users. Time frame used to measure adherence was an independent predictor of inter-study heterogeneity. The systematic review identified better HAART outcomes among former DU, those with less severe psychiatric conditions, those receiving opioid substitution therapy and/or psychosocial support. Patients initiating HAART with lower viral load and higher CD4 counts, and those without co-infections also had better treatment outcomes. Our findings suggest that HIV+ DU tend to be inappropriately assumed to be less adherent and unlikely to achieve desirable treatment outcomes, when compared to their non-DU cohort.

Confiabilidade em Questionários para Qualidade: Um Estudo com o Coeficiente Alfa de Cronbach

Abstract: O setor de servicos ocupa na sociedade atual um papel de destaque em relacao ao setor industrial, uma vez que os produtos industrializados tendem a possuir uma qualidade intrinseca semelhante, tornando o servico oferecido junto com este produto um importante diferencial competitivo. O setor de servico tambem se destaca em empresas que oferecem a sociedade servicos puros, ou seja, nao agregados a nenhum outro produto. Dada a importância deste setor, e preciso avaliar se a qualidade dos servicos ofertados esta de acordo com as expectativas dos clientes. Este trabalho faz uma analise de confiabilidade de questionarios para avaliar a qualidade de servicos em geral, por meio de um experimento realizado em um estudo de caso. Os resultados sao significativos e levam a conclusao que o coeficiente utilizado deve ser mais difundido pela literatura nacional.

Proinflammatory clearance of apoptotic neutrophils induces an IL-12(low)IL-10(high) regulatory phenotype in macrophages

Abstract: Clearance of apoptotic exudate neutrophils (efferocytosis) induces either pro- or anti-inflammatory responses in mouse macrophages depending on host genetic background. In this study, we investigated whether neutrophil efferocytosis induces a stable macrophage phenotype that could be recalled by late restimulation with LPS. Bone marrow-derived macrophages previously stimulated by pro- but not anti-inflammatory neutrophil efferocytosis expressed a regulatory/M2b phenotype characterized by low IL-12 and high IL-10 production following restimulation, increased expression of LIGHT/TNF superfamily 14, Th2-biased T cell responses, and permissive replication of Leishmania major. Induction of regulatory/M2b macrophages required neutrophil elastase activity and was partially dependent on TLR4 signaling. These results suggested that macrophage differentiation to a regulatory phenotype plays a role in resolution of inflammation but could contribute to increased humoral Ab responses and parasite persistence in the infected host.

O homem na atenção primária à saúde: discutindo (in)visibilidade a partir da perspectiva de gênero

Abstract: Este trabalho apresenta estudo de carater etnografico acerca da relacao entre homens e a assistencia a saude na Atencao Primaria, realizado em oito servicos de quatro estados brasileiros. Seu objetivo e compreender a (in)visibilidade dos homens no cotidiano da assistencia a partir da perspectiva de genero, que discute os mecanismos promotores de desigualdades presentes no trabalho em saude. Foram identificadas, nesse contexto, diferentes dimensoes desta (in) visibilidade: os homens como alvo de intervencoes no campo das politicas publicas de saude; como usuarios que enfrentam dificuldades na busca por atendimento e no estimulo a sua participacao efetiva; como sujeitos do cuidado (de si e de terceiros). O trabalho reforca a importância dos estudos de genero e sua relacao com a saude, na medida em que discute a producao das iniquidades sociais (re) produzidas pelas desigualdades de genero presentes no imaginario social e nos servicos de saude.

Major Expansion Of Primary Care In Brazil Linked To Decline In Unnecessary Hospitalization

Abstract: In 1994 Brazil launched what has since become the world’s largest community-based primary health care program. Under the Family Health Program, teams consisting of at least one physician, one nurse, a medical assistant, and four to six trained community health agents deliver most of their services at community-based clinics. They also make regular home visits and conduct neighborhood health promotion activities. This study finds that during 1999–2007, hospitalizations in Brazil for ambulatory care–sensitive chronic diseases, including cardiovascular disease, stroke, and asthma, fell at a rate that was statistically significant and almost twice the rate of decline in hospitalizations for all other causes. In municipalities with high Family Health Program enrollment, chronic disease hospitalization rates were 13 percent lower than in municipalities with low enrollment, when other factors were held constant. These results suggest that the Family Health Program has improved health system performance in Brazil...

Food consumption and eating behavior among Brazilian adolescents: National Adolescent School-based Health Survey (PeNSE), 2009

Abstract: The objective of this article is to describe the characteristics of food consumption and eating behavior of adolescents and its association with socio-demographic factors. In 2009, a random sample of students in 9th grade of elementary education at public and private schools from 26 Brazilian state capitals and Federal District was studied. It was applied a self-administered questionnaire with socio-demographic attributes, food consumption and eating behavior, among others. Estimates of the constructed indicators were presented for the total population and by sex. The association of each indicator with socio-demographic variables was examined by logistic regression. The results showed that over half of adolescents presented frequent consumption of beans (62.6%), milk (53.6%) and sweets (50.9%), and held at least lunch or dinner with the mother or responsible (62.6%) and watching television or studying (50.9%). In general, girls were more exposed to undesirable eating habits and higher socioeconomic status was associated with a higher prevalence of the indicators studied. The results revealed regular consumption of unhealthy diet markers and consumption of less than the recommended for a healthy diet, pointing the need for strengthening health promotion activities targeting young people.

As instituições de longa permanência para idosos no Brasil

Abstract: O envelhecimento populacional está ocorrendo em um contexto de grandes mudanças sociais, culturais, econômicas, institucionais, no sistema de valores e na configuração dos arranjos familiares. Para o futuro próximo, espera-se um crescimento a taxas elevadas da população muito idosa (80 anos e mais), como resultado das altas taxas de natalidade observadas no passado recente e da continuação da redução da mortalidade nas idades avançadas. No entanto, a certeza do crescimento desse segmento populacional está sendo acompanhada pela incerteza das condições de cuidados que experimentarão os longevos. Embora a legislação brasileira estabeleça que o cuidado dos membros dependentes deva ser responsabilidade das famílias, este se torna cada vez mais escasso, em função da redução da fecundidade, das mudanças na nupcialidade e da crescente participação da mulher – tradicional cuidadora – no mercado de trabalho. Isto passa a requerer que o Estado e o mercado privado dividam com a família as responsabilidades no cuidado com a população idosa. Diante desse contexto, uma das alternativas de cuidados não-familiares existentes corresponde às instituições de longa permanência para idosos (ILPIs), sejam públicas ou privadas. No entanto, a residência em instituições não é uma prática comum na sociedade brasileira. Faltava, até então, uma visão agregada sobre as ILPIs brasileiras. Não se conhecia quantos idosos viviam em instituições, suas características – como sexo, idade, renda, condições de saúde/autonomia, laços familiares, tempo de permanência na instituição – e tampouco o número de instituições existentes, a infraestrutura, os serviços oferecidos, a estrutura de custos, os recursos com que contam, os modelos de assistência praticados, etc. A falta de informações sobre essa modalidade de serviços, bem como a expectativa de que a sua demanda tende a crescer, foi a principal motivação para a realização da pesquisa nacional, de caráter censitário, aqui descrita.