Stakeholders y factores críticos em las alianzas público privadas del Gobierno Federal

This study identifies the relationship between stakeholders and critical success factors in the Brazilian Government Public Private Partnerships (PPPs). We have studied two Brazilian Government PPPs using an exploratory and descriptive qualitative approach. Stakeholders were categorized based on the Mitchell et al. (1997) and Frooman (1999) models. We have showed that i) the models are complementary since some of the most influential stakeholders are also the most powerful; ii) beyond stakeholders and critical factors already mentioned in literature, we have found one new stakeholder (UNDP) and one new critical factor (compliance with recommendations of oversight bodies). This research has a practical contribution as it identifies critical factors associated with the most important stakeholders, enabling decision makers to design a relationship strategy for dealing with such players, taking into account the factors that facilitate or hinder the PPP structuring process.Este estudo identifica a relação entre stakeholders e os fatores críticos em Parcerias Público-Privadas (PPPs) do Governo Federal. Foram estudadas duas PPPs usando uma abordagem qualitativa exploratória e descritiva. As partes interessadas foram categorizadas com base nos modelos de Mitchell et al. (1997) e Frooman (1999). Os resultados demostram que: i) os modelos são complementares já que alguns dos stakeholders mais influentes são também os mais poderosos; ii) além dos stakeholders e fatores críticos já mencionados na literatura, encontramos neste estudo um novo ator (PNUD) e um novo fator crítico (atendimento às recomendações dos órgãos de fiscalização). Esta pesquisa tem importância prática, pois identifica fatores críticos associados aos stakeholders mais importantes, permitindo que os tomadores de decisão elaborem uma estratégia de relacionamento para lidar com tais atores, levando em consideração os fatores que facilitam ou dificultam o processo de estruturação da PPP.Este estudio identifica la relación entre los stakeholders y los factores críticos de las Alianzas Público Privadas (PPPs) del Gobierno Federal. Se estudiaron dos PPPs usando un abordaje cualitativo exploratorio y descriptivo. Las partes interesadas se clasificaron según los modelos de Mitchell et al. (1997) y Frooman (1999). Los resultados demuestran que: i) los modelos son complementarios ya que algunos de los stakeholders más influyentes son también los más poderosos; (ii) además de los stakeholders y factores críticos ya mencionados en la literatura, encontramos en este estudio un nuevo actor (PNUD) y um nuevo factor crítico (atención a las recomendaciones de los órganos de fiscalización). Esta investigación tiene importancia práctica, pues identifica factores críticos asociados a los stakeholders más importantes, permitiendo que los tomadores de decisión elaboren una estrategia para lidiar con tales actores, teniendo en cuenta los factores que facilitan o dificultan el proceso de estructuración de la PPP.Revista do Serviço Público - RSP, v. 70, n. 3, p. 371-401Gestão PúblicaISSN Eletrônico: 2357-8017ISSN Impresso: 0034-924

Metodologias aplicadas na identidicacao e diferenciacao da entamoeba histolystica e entamoeba dispar: uma revisão narrativa / Methodologies applied in the identification and differentiation of entamoeba histolystica and entamoeba dispar: a narrative review

Introdução: A Entamoeba histolytica, única espécie definitivamente associada a danos patológicos, é um protozoário patogênico intestinal invasivo causador da amebíase. A observação microscópica para identificação de cistos e trofozoítos nas fezes é ainda o exame mais realizada para o diagnóstico da amebíase. Entretanto, este procedimento tem sido reavaliado desde que foi demonstrado que existem duas espécies distintas de Entamoeba, que apesar de possuírem características morfológicas semelhantes, apresentam capacidade diferentes de causar a doença. Objetivo: Realizar um levantamento sobre o processo de descoberta, identificação e diferenciação das espécies E. histolytica e E. dispar. Metodologia: Foi realizada uma busca na literatura utilizando as bases de dados ScienceDirect, PubMed e Scopus. As palavras-chave utilizadas foram “Entamoeba”, “diagnóstico” e “história”. Resultados e Discussão: O diagnóstico da amebíase tem sido tradicionalmente feito pela aplicação da coproscopia, que é incapaz de diferenciar a E. histolytica da E. díspar. A distinção entre as duas espécies vem sendo alvo de vários estudos provando que a espécie patogênica e a não patogênica podem ser distinguidas individualmente usando eletroforese isoenzimática. Conclusão: As duas espécies podem ser diferenciadas por métodos de biologia molecular, bioquímicos e imunológicos, sendo esse, um instrumento preciso, viável e rápido para a confirmação da infecção pela E. histolytica

Occupational socioeconomic risk associations for head and neck cancer in Europe and South America: individual participant data analysis of pooled case–control studies within the INHANCE Consortium

Background: The association between socioeconomic disadvantage (low education and/or income) and head and neck cancer is well established, with smoking and alcohol consumption explaining up to three-quarters of the risk. We aimed to investigate the nature of and explanations for head and neck cancer risk associated with occupational socioeconomic prestige (a perceptual measure of psychosocial status), occupational socioeconomic position and manual-work experience, and to assess the potential explanatory role of occupational exposures. Methods: Pooled analysis included 5818 patients with head and neck cancer (and 7326 control participants) from five studies in Europe and South America. Lifetime job histories were coded to: (1) occupational social prestige-Treiman's Standard International Occupational Prestige Scale (SIOPS); (2) occupational socioeconomic position-International Socio-Economic Index (ISEI); and (3) manual/non-manual jobs. Results: For the longest held job, adjusting for smoking, alcohol and nature of occupation, increased head and neck cancer risk estimates were observed for low SIOPS OR=1.88 (95% CI: 1.64 to 2.17), low ISEI OR=1.74 (95% CI: 1.51 to 1.99) and manual occupations OR=1.49 (95% CI: 1.35 to 1.64). Following mutual adjustment by socioeconomic exposures, risk associated with low SIOPS remained OR=1.59 (95% CI: 1.30 to 1.94). Conclusions: These findings indicate that low occupational socioeconomic prestige, position and manual work are associated with head and neck cancer, and such risks are only partly explained by smoking, alcohol and occupational exposures. Perceptual occupational psychosocial status (SIOPS) appears to be the strongest socioeconomic factor, relative to socioeconomic position and manual/non-manual work

Alcohol Drinking in Never Users of Tobacco, Cigarette Smoking in Never Drinkers, and the Risk of Head and Neck Cancer: Pooled Analysis in the International Head and Neck Cancer Epidemiology Consortium

Background At least 75% of head and neck cancers are attributable to a combination of cigarette smoking and alcohol drinking. A precise understanding of the independent association of each of these factors in the absence of the other with the risk of head and neck cancer is needed to elucidate mechanisms of head and neck carcinogenesis and to assess the efficacy of interventions aimed at controlling either risk factor. Methods We examined the extent to which head and neck cancer is associated with cigarette smoking among never drinkers and with alcohol drinking among never users of tobacco. We pooled individual-level data from 15 case-control studies that included 10244 head and neck cancer case subjects and 15227 control subjects, of whom 1072 case subjects and 5775 control subjects were never users of tobacco and 1598 case subjects and 4051 control subjects were never drinkers of alcohol. Odds ratios (ORs) and 95% confidence intervals (CIs) were estimated using unconditional logistic regression models. All statistical tests were two-sided. Results Among never drinkers, cigarette smoking was associated with an increased risk of head and neck cancer (OR for ever versus never smoking = 2.13, 95% CI = 1.52 to 2.98), and there were clear dose-response relationships for the frequency, duration, and number of pack-years of cigarette smoking. Approximately 24% (95% CI = 16% to 31%) of head and neck cancer cases among nondrinkers in this study would have been prevented if these individuals had not smoked cigarettes. Among never users of tobacco, alcohol consumption was associated with an increased risk of head and neck cancer only when alcohol was consumed at high frequency (OR for three or more drinks per day versus never drinking = 2.04, 95% CI = 1.29 to 3.21). The association with high-frequency alcohol intake was limited to cancers of the oropharynx/hypopharynx and larynx. Conclusions Our results represent the most precise estimates available of the independent association of each of the two main risk factors of head and neck cancer, and they exemplify the strengths of large-scale consortia in cancer epidemiolog

Body mass index and risk of head and neck cancer in a pooled analysis of case-control studies in the International Head and Neck Cancer Epidemiology (INHANCE) Consortium

Background Head and neck cancer (HNC) risk is elevated among lean people and reduced among overweight or obese people in some studies; however, it is unknown whether these associations differ for certain subgroups or are influenced by residual confounding from the effects of alcohol and tobacco use or by other sources of biases. Methods We pooled data from 17 case-control studies including 12 716 cases and the 17 438 controls. Odds ratios (ORs) and 95% confidence intervals (CIs) were estimated for associations between body mass index (BMI) at different ages and HNC risk, adjusted for age, sex, centre, race, education, tobacco smoking and alcohol consumption. Results Adjusted ORs (95% CIs) were elevated for people with BMI at reference (date of diagnosis for cases and date of selection for controls) ≤18.5 kg/m2 (2.13, 1.75-2.58) and reduced for BMI >25.0-30.0 kg/m2 (0.52, 0.44-0.60) and BMI ≥30 kg/m2 (0.43, 0.33-0.57), compared with BMI >18.5-25.0 kg/m2. These associations did not differ by age, sex, tumour site or control source. Although the increased risk among people with BMI ≤18.5 kg/m2 was not modified by tobacco smoking or alcohol drinking, the inverse association for people with BMI > 25 kg/m2 was present only in smokers and drinkers. Conclusions In our large pooled analysis, leanness was associated with increased HNC risk regardless of smoking and drinking status, although reverse causality cannot be excluded. The reduced risk among overweight or obese people may indicate body size is a modifier of the risk associated with smoking and drinking. Further clarification may be provided by analyses of prospective cohort and mechanistic studie

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

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 cance

A rare truncating BRCA2 variant and genetic susceptibility to upper aerodigestive tract cancer

© The Author 2015. Published by Oxford University Press. This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact [email protected] Funding This work was supported the National Institutes of Health (R01CA092039 05/05S1) and the National Institute of Dental and Craniofacial Research (1R03DE020116). Notes The authors thank all of the participants who took part in this research and the funders and technical staff who made this study possible. We acknowledge and thank Simone Benhamou (INSERM, France) for sample contributions. We also acknowledge and thank The Cancer Genome Atlas initiative, whose data contributed heavily to this study.Peer reviewedPublisher PD