Brazilian recommendations on the safety and effectiveness of the yellow fever vaccination in patients with chronic immune-mediated inflammatory diseases

Background: In Brazil, we are facing an alarming epidemic scenario of Yellow fever (YF), which is reaching the most populous areas of the country in unvaccinated people. Vaccination is the only effective tool to prevent YF. In special situations, such as patients with chronic immune-mediated inflammatory diseases (CIMID), undergoing immunosuppressive therapy, as a higher risk of severe adverse events may occur, assessment of the risk-benefit ratio of the yellow fever vaccine (YFV) should be performed on an individual level. Main body of the abstract: Faced with the scarcity of specific orientation on YFV for this special group of patients, the Brazilian Rheumatology Society (BRS) endorsed a project aiming the development of individualized YFV recommendations for patients with CIMID, guided by questions addressed by both medical professionals and patients, followed an internationally validated methodology (GIN-McMaster Guideline Development). Firstly, a systematic review was carried out and an expert panel formed to take part of the decision process, comprising BRS clinical practitioners, as well as individuals from the Brazilian Dermatology Society (BDS), Brazilian Inflammatory Bowel Diseases Study Group (GEDIIB), and specialists on infectious diseases and vaccination (from Tropical Medicine, Infectious Diseases and Immunizations National Societies); in addition, two representatives of patient groups were included as members of the panel. When the quality of the evidence was low or there was a lack of evidence to determine the recommendations, the decisions were based on the expert opinion panel and a Delphi approach was performed. A recommendation was accepted upon achieving ≥80% agreement among the panel, including the patient representatives. As a result, eight recommendations were developed regarding the safety of YFV in patients with CIMID, considering the immunosuppression degree conferred by the treatment used. It was not possible to establish recommendations on the effectiveness of YFV in these patients as there is no consistent evidence to support these recommendations. Conclusion: This paper approaches a real need, assessed by clinicians and patient care groups, to address specific questions on the management of YFV in patients with CIMID living or traveling to YF endemic areas, involving specialists from many areas together with patients, and might have global applicability, contributing to and supporting vaccination practices. We recommended a shared decision-making approach on taking or not the YFV

Norma jurídica da despesa pública

Analisa a norma jurídica da despesa pública, avaliando os modais deônticos que podem ser atribuídos a ela e observando o fenômeno jurídico sob o prisma da teoria da linguagem e da teoria da norma, de Kelsen e Lourival Vilanova

Budget law judicial review: the use of consequentialist arguments in the Brazilians Supreme Court Decisions

A hipótese do trabalho é a de que o Supremo Tribunal Federal utiliza argumentos consequencialistas para admitir e julgar o controle de constitucionalidade de leis e normas orçamentárias. A tese é dividida em duas partes. Na primeira são tratados os temas que fundam a análise argumentativa das decisões judiciais. A argumentação jurídica é proposta como lente de exame das decisões judiciais, especialmente o ramo da retórica. De acordo com esse referencial teórico, os tribunais e juízes buscam convencer o auditório de que produzem a decisão mais adequada possível. É ressaltada a importância do argumento na formação do precedente, no que há de fundamental nas decisões (ratio decidendi) e no que é periférico (obiter dictum). O argumento consequencialista é visto diante de diversas teorias que o propõem, como o utilitarismo e o pragmatismo, com destaque, em capítulo próprio, para a teoria de Neil MacCormick, que propõe um consequencialismo essencialmente jurídico. Em sua segunda parte, a tese explora os temas que levarão às conclusões da hipótese. Em primeiro lugar, as características marcantes da produção de leis e normas orçamentárias, sua natureza jurídica e seu fundamento de validade. É revisto o controle de constitucionalidade dessas normas no ordenamento brasileiro, sendo pontuadas as particularidades e limites pertinentes ao seu controle principal. E por fim, no último capítulo, são analisadas pormenorizadamente as decisões que o Supremo Tribunal Federal produziu no controle principal de leis e normas orçamentárias, demarcando a presença de argumentos consequencialistas e buscando estabelecer quais são os precedentes vigentes no direito brasileiro. Ao fim, conclui-se que o controle de constitucionalidade principal é a via mais adequada nas matérias orçamentárias; que o precedente estabelecido no Supremo Tribunal Federal é o de possibilidade de controle de constitucionalidade principal de normas orçamentárias por ADI e ADO, não por ADPF; e que o tribunal usa adequadamente, na maioria das vezes, os argumentos consequencialistas, porquanto estes predominam (ratio decidendi) nas decisões mais importantes sobre a matéria.The hypothesis of this work is that the Supreme Court uses consequentialist arguments to admit the judicial review of budgetary laws. The thesis is divided in two parts. In the first, the themes that underlie the argumentative analysis of judicial decisions are discussed. Legal argumentation is proposed as a lens for examining decisions, especially rhetoric. According to this theoretical framework, the courts and judges seek to convince the audience that they produce the most appropriate decisions possible. It highlights the significance of the argument in shaping the precedent, in what is crucial in decisions (ratio decidendi), and what is peripheral (obiter dictum). The consequentialist argument is analyzed according to the various theories that underlie it, such as utilitarianism and pragmatism, especially, in a separate chapter, according to Neil MacCormicks theory, that offers an essentially legal consequentialism. In its second part, the thesis explores the issues that lead to the conclusions of the hypothesis. Firstly, the salient features of the production of budget laws, its legal status and fundament of validity. The judicial review of these laws in the Brazilian legal system is revised, and the limits and particularities of its main control are punctuated. And finally, in the last chapter, the decisions produced by the Supreme Court in the main judicial review of budgetary laws are minutely explored, the existence of consequentialist arguments is indicated, and it seeks to establish the precedents existing in Brazilian law. It concludes, lastly, that the abstract judicial review is the most suitable option in budget matters; that the precedent set in the Supreme Court is about the possibility of the abstract judicial review of budgetary laws by ADI and ADO, but not ADPF; and that the court properly uses, most often, consequentialist arguments, and they predominate (ratio decidendi) in the most important decisions about it

Comentários ao caso Artavia Murillo e outros vs. Costa Rica (“Fertilização in vitro”) e seus possíveis reflexos no ordenamento jurídico brasileiro

O artigo tem como objetivo analisar a sentença da Corte Interamericana de Direitos Humanos (Corte IDH) no caso Artavia Murillo e outros vs. Costa Rica (“Fertilização in vitro”), tecendo comentários aos principais argumentos lançados pela Corte IDH para determinar a interpretação do direito à vida, especialmente quando este se encontra em conflito com outros direitos humanos previstos na Convenção Interamericana de Direitos Humanos. Pretende ainda refletir sobre os efeitos que tal interpretação poderá ter sobre o ordenamento jurídico brasileiro, no qual a questão do início da proteção do direito fundamental à vida permanece em debate

The Influence of Income and Formal Education on Damage in Brazilian Patients With Systemic Lupus Erythematosus

Objective: The aim of this study was to evaluate the association of socioeconomic status and American College of Rheumatology/Systemic Lupus International Collaborating Clinics Damage Index (SDI) score in Brazilian patients with systemic lupus erythematosus (SLE). Methods: Five hundred twenty-three patients (SLE ACR criteria) 18 years or older who were at 12 months or greater since diagnosis were included. Socioeconomic status was assessed by per-capita income and years of education. Race was categorized as white and nonwhite. The SDI and Mexican SLE Disease Activity Index were used. Statistical Analysis: Mean +/- SD and median were used for descriptive analysis. Student t test, Mann-Whitney U test, chi(2) test, and Spearman rank correlation coefficient and univariate and multivariate regression analyses were performed. The level of significance was set at 5% for all statistical tests. Results: Ninety-six percent were female, 51.2% were nonwhite, and the mean age was 37.8 +/- 1.4 years. Disease duration was 8.2 +/- 10.3 years and formal education was 10.2 +/- 3.5 years. Unemployment among patients was 63.7%, with median monthly per-capita income of US $276. Mean SDI score was 1.4 +/- 1.52, and 65.6% had some type of damage (SDI >= 1). Patients with SDI of 1 or greater had lower income (P = 0.039). Nonwhite patients had higher SDI than did white patients (P = 0.005). The SDI presented a positive correlation with disease duration (P < 0.001) and age (P < 0.001) and a negative correlation with years of education (P = 0.001). Working patients had lower SDI than did inactive ones (P = 0.001). In a multivariate analysis, older age, higher disease duration, nonwhite race, low income, and out-of-work profile were associated with damage. Conclusions: Besides nonmodifiable characteristics such as longer disease duration and older age, low income was also associated with damage. Therefore, interventions to give adequate socioeconomic support are necessary to improve outcome, mainly in poorer and nonwhite SLE patients.Univ Estadual Ciencias Saude Alagoas UNCISAL, Dept Internal Med, Maceio Alagoas, BrazilUniv São Paulo, Dept Internal Med, São Paulo, BrazilHosp Santa Casa Maceio, Dept Internal Med, Maceio Alagoas, BrazilUniv Fed São Paulo UNIFESP, Dept Internal Med, Escola Paulista Med, São Paulo, BrazilUniv Fed São Paulo UNIFESP, Dept Internal Med, Escola Paulista Med, São Paulo, BrazilWeb of Scienc

Changing rate of serious infections in biologic-exposed rheumatoid arthritis patients : data from South American registries BIOBADABRASIL and BIOBADASAR

Most reports on serious infections (SI) in rheumatoid arthritis (RA) patients treated with biological disease-modifying antirheumatic drugs (bDMARDs) are from the USA and Western Europe. Data from other regions are largely missing. We report data from South American countries with different backgrounds and health-care systems but similar registries. We merged 2010-2016 data from two registries, BIOBADABRASIL (Brazil) and BIOBADASAR (Argentina), which share the same protocol, online platform and data monitoring process. Patients with active RA were included when they began the first bDMARD or a conventional synthetic DMARD (csDMARD, control group). The SI incidence rate (IR) per 1000 patient/years and adjusted IR ratio (aIRR) were estimated for bDMARDs and csDMARDs. Data were analysed for 3717 RA patients with an exposure of 13,380 patient/years. The 2591 patients treated with bDMARDs (64% tumour necrosis factor-alpha inhibitors (TNFi)) had a follow-up of 9300years, and the 1126 treated with csDMARDs had an exposure of 4081 patient/years. The SI IR was 30.54 (CI 27.18-34.30) for all bDMARDs and 5.15 (CI 3.36-7.89) for csDMARDs. The aIRR between the two groups was 2.03 ([1.05, 3.9] p=0.034) for the first 6months of treatment but subsequently increased to 8.26 ([4.32, 15.76] p<0.001). The SI IR for bDMARDs decreased over time in both registries, dropping from 36.59 (28.41-47.12) in 2012 to 7.27 (4.79-11.05) in 2016. While SI remains a major concern in South American patients with RA treated with bDMARDs, a favourable trend toward a reduction was observed in the last years3882129213