A produção do conhecimento em doenças negligenciadas no Brasil : uma análise bioética dos dispositivos normativos e da atuação dos pesquisadores brasileiros

Tese (doutorado)—Universidade de Brasília, Faculdade de Ciências da Saúde, Programa de Pós-Graduação em Bioética, 2015.As doenças negligenciadas são demonstradas como um flagelo persistente no histórico das populações excluídas, portanto de interesse da bioética. São classificadas como um grupo de doenças infecciosas que estão fortemente associadas às condições de pobreza verificadas, em sua grande maioria, nos países de baixa e média renda. Na intenção de aproximar duas áreas do conhecimento por meio de um diálogo a fim de demonstrar que, apesar de específicas, elas podem atuar de maneira sinérgica, esta tese teve como objetivo principal a análise quantitativa e qualitativa da produção do conhecimento em doenças negligenciadas no Brasil, considerando os dispositivos normativos relativos ao tema e a atuação dos pesquisadores da área. O presente estudo utilizou documentos públicos e dados estatísticos para obtenção dos seus resultados, que foram os seguintes: as ações de indução para as doenças negligenciadas tornou-se uma prioridade para Agenda Nacional de Prioridades de Pesquisa em Saúde, instrumento construído a partir da instituição da Política Nacional de Ciência, Tecnologia e Inovação em Saúde. 140 projetos foram contemplados pelos dois editais. Houve uma equiparação na participação do gênero masculino e feminino na coordenação das pesquisas. O maior número de projetos contemplados foi procedente das instituições de ensino superior e institutos de pesquisa que, na sua grande maioria, tinham caráter público. A maior parte dos estudos foi proveniente da área das ciências da saúde e concentrou-se principalmente nas instituições situadas na região Sudeste e não naquelas regiões de maior prevalência das doenças negligenciadas (Norte, Nordeste e Centro-Oeste). No primeiro edital, os estudos biomédicos corresponderam a maior parte dos projetos. No caso do segundo, as pesquisas clínicas foram lideraram do ranking dos estudos realizados por meio de apoio público. Em relação à atuação dos pesquisadores analisados por esta tese, ela ocorreu por um enfoque biológico e individualizado acerca da doença, que foi o hegemônico, e por um enfoque social e coletivo. Os autores expoentes da área da saúde também demonstraram influência na atuação do grupo dos pesquisadores analisados por esta tese. Apesar das iniquidades relacionadas à distribuição regional do número de projetos e da hegemonia da atuação constatada, concluiu-se que a ação de enfrentamento assumida pelo Estado brasileiro conjuntamente com parte dos integrantes da comunidade científica nacional pode ser considerada como uma ação moralmente justificada e eticamente comprometida. A atitude tomada pelo país trouxe para o centro das atenções da pesquisa em saúde um tema que, apesar de relevante para as condições de desenvolvimento de uma nação, tem sido vilipendiado, principalmente, pelos que julgam que aqueles que se encontram sob o estado de vulnerabilidade social devam ser negados do acesso aos cuidados à saúde de qualidade e a medicamentos que sejam essenciais a sua sobrevivência.Neglected diseases have been demonstrated over the years as a persisting scourge for excluded population, thus, they have been a bioethical interest. They are classified as a group of infectious diseases, which are strongly linked with the poverty conditions verified in most of low and middle-income countries. In intention to approach two knowledge areas through a dialogue in order to demonstrate that despite being very specific, they can operate synergistically, the main purpose of this dissertation was to analyze quantitative and qualitative the knowledge production of in neglected diseases in Brazil, taking into account normative devices concerning to the topic and the researchers acting area. The present research used public documents and statistical data to obtain the results, which were the inducted actions to neglected diseases became a priority to National Health Researches Priority Agenda which started from Science, Technology and Health Innovation National Politics. 140 projects have been included in two issues. There was an equalization in male and female participation in researches coordination. Most included projects were from higher education institutions and researcher institutions, which were public institutions. Most of the researches became health and science area and concentrated more particularly in institutions from Southeastern region in spite of regions which neglected diseases happened mostly (North, Northeast and Midwest regions). In the first issue, biomedical studies represented the most part of the projects. In second issue, clinical researches were leading the study ranking which were developed by public support. In relation to the researchers’ activities analyzed by this dissertation, it happened in biological and individualized focus about the disease, which was hegemonic and through a social and collective focus. The health exponent authors also have shown influence in researchers group analyzed by this dissertation. In spite of iniquities related to the regional distribution of the number of projects and hegemonic focus made, it was concluded that plain of action assumed by Brazilian State and part of national scientific community might been considered as morally justified and ethically compromised. The attitude taken by the country brought to the center of health research attention an issue that, despite relevant to the developing conditions of a nations, has been vilified, especially, by the ones who believes that the people who live in a social vulnerability state might have been denied to the access of a quality health care and medication which are necessary for the survival

Enfermedades desatendidas y bioética : diálogo de un viejo problema con una nueva área de conocimiento

As doenças negligenciadas representam flagelo persistente no histórico das populações excluídas, sendo, portanto, objeto de interesse da bioética. São classificadas como grupo de doenças infecciosas fortemente associadas às condições de pobreza verificadas, em sua grande maioria, nos países periféricos. O objetivo deste estudo foi aproximar duas áreas do conhecimento por meio de diálogo, a fim de demonstrar que, apesar de específicas, ambas podem atuar de maneira sinérgica. Trata-se de estudo de revisão bibliográfica que procurou aprofundar o tema a partir dos seguintes eixos: 1) conceitos e visões das doenças negligenciadas e da bioética; 2) consequências e contexto das doenças negligenciadas; 3) doenças negligenciadas nos estudos de bioética. Verificou-se o estabelecimento do diálogo, bem como a emergência de elementos que ratificaram a bioética como campo de mediação a ser utilizado na superação do conflito ético que permeia o tema das doenças negligenciadas.Neglected diseases have long been the scourge of excluded populations, and are therefore of particular relevance to the field of bioethics. Neglected diseases are classified as a group of infectious diseases that are strongly associated with conditions of poverty, and are mostly found in peripheral countries. The aim of the present study was to bring together bioethical knowledge and existing knowledge of such diseases, demonstrating that, while they are different, such areas of knowledge can be used synergistically. A bibliographic review was performed with the aim of expanding knowledge of the following areas: 1) concepts and visions of neglected diseases and bioethics; 2) consequences and context of neglected diseases; 3) neglected diseases in bioethical studies. It was found that a dialogue between the two areas exists, and elements were identified confirming the value of bioethics as a mediation tool for overcoming the ethical conflict that permeates the issue of neglected diseases.Las enfermedades desatendidas se muestran como un flagelo persistente históricamente en las poblaciones excluidas, por lo tanto, son de un especial interés para la bioética. Se las clasifican como un grupo de enfermedades infecciosas que están fuertemente asociadas a las condiciones de pobreza verificadas, en su gran mayoría, en los países periféricos. Este estudio tuvo como objetivo aproximar dos áreas de conocimiento por medio de un diálogo abierto con el fin de demostrar que, a pesar de específicas, ellas pueden actuar de manera sinérgica. Se trata de un estudio de revisión bibliográfica que procura profundizar los siguientes ejes: 1) conceptos y visiones de las enfermedades desatendidas y la bioética; 2) consecuencias y contexto de las enfermedades desatendidas; 3) enfermedades desatendidas en los estudios de la bioética. Se verificó que hay un diálogo posible y también la necesidad de elementos que ratifican la bioética como un campo de mediación que debe ser utilizado para la superación del conflicto ético que permea el tema de las enfermedades desatendidas

Algorithms to predict cerebral malaria in murine models using the SHIRPA protocol

<p>Abstract</p> <p>Background</p> <p><it>Plasmodium berghei </it>ANKA infection in C57Bl/6 mice induces cerebral malaria (CM), which reproduces, to a large extent, the pathological features of human CM. However, experimental CM incidence is variable (50-100%) and the period of incidence may present a range as wide as 6-12 days post-infection. The poor predictability of which and when infected mice will develop CM can make it difficult to determine the causal relationship of early pathological changes and outcome. With the purpose of contributing to solving these problems, algorithms for CM prediction were built.</p> <p>Methods</p> <p>Seventy-eight <it>P. berghei</it>-infected mice were daily evaluated using the primary SHIRPA protocol. Mice were classified as CM+ or CM- according to development of neurological signs on days 6-12 post-infection. Logistic regression was used to build predictive models for CM based on the results of SHIRPA tests and parasitaemia.</p> <p>Results</p> <p>The overall CM incidence was 54% occurring on days 6-10. Some algorithms had a very good performance in predicting CM, with the area under the receiver operator characteristic (_auROC) curve ≥ 80% and positive predictive values (PV+) ≥ 95, and correctly predicted time of death due to CM between 24 and 72 hours before development of the neurological syndrome (_auROC = 77-93%; PV+ = 100% using high cut off values). Inclusion of parasitaemia data slightly improved algorithm performance.</p> <p>Conclusion</p> <p>These algorithms work with data from a simple, inexpensive, reproducible and fast protocol. Most importantly, they can predict CM development very early, estimate time of death, and might be a valuable tool for research using CM murine models.</p

A evolução clínica do paciente portador de abscesso pulmonar: Clinical evolution of patients with lung abscess

Atualmente, com a era da antibioticoterapia e demais meios terapêuticos, o abscesso pulmonar decaiu em termos de morbimortalidade, mas ainda permanece como um desafio em termos diagnósticos e manejo clínico. O abscesso pulmonar corresponde a uma cavidade com pus no pulmão, envolvido por tecido inflamado e geralmente oriunda de uma infecção. O artigo objetivou descrever de modo narrativo a evolução clínica do portador de abscesso pulmonar, ressaltando os principais dados para a compreensão deste fenômeno. Um abscesso pulmonar é causado principalmente por bactérias existentes na boca ou garganta, a qual são aspiradas até os pulmões. A sintomatologia é inespecífica, abordando fadiga, inapetência, sudorese noturna, febre, perda ponderal e tosse com expectoração. O quadro clínico geralmente necessita do complemento de exames de imagem, principalmente a radiografia torácica para diagnóstic

Pervasive gaps in Amazonian ecological research

Biodiversity loss is one of the main challenges of our time,1,2 and attempts to address it require a clear un derstanding of how ecological communities respond to environmental change across time and space.3,4 While the increasing availability of global databases on ecological communities has advanced our knowledge of biodiversity sensitivity to environmental changes,5–7 vast areas of the tropics remain understudied.8–11 In the American tropics, Amazonia stands out as the world’s most diverse rainforest and the primary source of Neotropical biodiversity,12 but it remains among the least known forests in America and is often underrepre sented in biodiversity databases.13–15 To worsen this situation, human-induced modifications16,17 may elim inate pieces of the Amazon’s biodiversity puzzle before we can use them to understand how ecological com munities are responding. To increase generalization and applicability of biodiversity knowledge,18,19 it is thus crucial to reduce biases in ecological research, particularly in regions projected to face the most pronounced environmental changes. We integrate ecological community metadata of 7,694 sampling sites for multiple or ganism groups in a machine learning model framework to map the research probability across the Brazilian Amazonia, while identifying the region’s vulnerability to environmental change. 15%–18% of the most ne glected areas in ecological research are expected to experience severe climate or land use changes by 2050. This means that unless we take immediate action, we will not be able to establish their current status, much less monitor how it is changing and what is being lostinfo:eu-repo/semantics/publishedVersio

Impact of COVID-19 on cardiovascular testing in the United States versus the rest of the world

Objectives: This study sought to quantify and compare the decline in volumes of cardiovascular procedures between the United States and non-US institutions during the early phase of the coronavirus disease-2019 (COVID-19) pandemic. Background: The COVID-19 pandemic has disrupted the care of many non-COVID-19 illnesses. Reductions in diagnostic cardiovascular testing around the world have led to concerns over the implications of reduced testing for cardiovascular disease (CVD) morbidity and mortality. Methods: Data were submitted to the INCAPS-COVID (International Atomic Energy Agency Non-Invasive Cardiology Protocols Study of COVID-19), a multinational registry comprising 909 institutions in 108 countries (including 155 facilities in 40 U.S. states), assessing the impact of the COVID-19 pandemic on volumes of diagnostic cardiovascular procedures. Data were obtained for April 2020 and compared with volumes of baseline procedures from March 2019. We compared laboratory characteristics, practices, and procedure volumes between U.S. and non-U.S. facilities and between U.S. geographic regions and identified factors associated with volume reduction in the United States. Results: Reductions in the volumes of procedures in the United States were similar to those in non-U.S. facilities (68% vs. 63%, respectively; p = 0.237), although U.S. facilities reported greater reductions in invasive coronary angiography (69% vs. 53%, respectively; p < 0.001). Significantly more U.S. facilities reported increased use of telehealth and patient screening measures than non-U.S. facilities, such as temperature checks, symptom screenings, and COVID-19 testing. Reductions in volumes of procedures differed between U.S. regions, with larger declines observed in the Northeast (76%) and Midwest (74%) than in the South (62%) and West (44%). Prevalence of COVID-19, staff redeployments, outpatient centers, and urban centers were associated with greater reductions in volume in U.S. facilities in a multivariable analysis. Conclusions: We observed marked reductions in U.S. cardiovascular testing in the early phase of the pandemic and significant variability between U.S. regions. The association between reductions of volumes and COVID-19 prevalence in the United States highlighted the need for proactive efforts to maintain access to cardiovascular testing in areas most affected by outbreaks of COVID-19 infection

Pervasive gaps in Amazonian ecological research

Biodiversity loss is one of the main challenges of our time,1,2 and attempts to address it require a clear understanding of how ecological communities respond to environmental change across time and space.3,4 While the increasing availability of global databases on ecological communities has advanced our knowledge of biodiversity sensitivity to environmental changes,5,6,7 vast areas of the tropics remain understudied.8,9,10,11 In the American tropics, Amazonia stands out as the world's most diverse rainforest and the primary source of Neotropical biodiversity,12 but it remains among the least known forests in America and is often underrepresented in biodiversity databases.13,14,15 To worsen this situation, human-induced modifications16,17 may eliminate pieces of the Amazon's biodiversity puzzle before we can use them to understand how ecological communities are responding. To increase generalization and applicability of biodiversity knowledge,18,19 it is thus crucial to reduce biases in ecological research, particularly in regions projected to face the most pronounced environmental changes. We integrate ecological community metadata of 7,694 sampling sites for multiple organism groups in a machine learning model framework to map the research probability across the Brazilian Amazonia, while identifying the region's vulnerability to environmental change. 15%–18% of the most neglected areas in ecological research are expected to experience severe climate or land use changes by 2050. This means that unless we take immediate action, we will not be able to establish their current status, much less monitor how it is changing and what is being lost

Erratum: Global, regional, and national comparative risk assessment of 84 behavioural, environmental and occupational, and metabolic risks or clusters of risks for 195 countries and territories, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017

Interpretation: By quantifying levels and trends in exposures to risk factors and the resulting disease burden, this assessment offers insight into where past policy and programme efforts might have been successful and highlights current priorities for public health action. Decreases in behavioural, environmental, and occupational risks have largely offset the effects of population growth and ageing, in relation to trends in absolute burden. Conversely, the combination of increasing metabolic risks and population ageing will probably continue to drive the increasing trends in non-communicable diseases at the global level, which presents both a public health challenge and opportunity. We see considerable spatiotemporal heterogeneity in levels of risk exposure and risk-attributable burden. Although levels of development underlie some of this heterogeneity, O/E ratios show risks for which countries are overperforming or underperforming relative to their level of development. As such, these ratios provide a benchmarking tool to help to focus local decision making. Our findings reinforce the importance of both risk exposure monitoring and epidemiological research to assess causal connections between risks and health outcomes, and they highlight the usefulness of the GBD study in synthesising data to draw comprehensive and robust conclusions that help to inform good policy and strategic health planning