Revolving doors and conflicts of interest in health regulatory agencies in Brazil

Regulatory health agencies exist in most public health systems (PHS) and play a crucial role in enacting regulation and overseeing economic activities in order to ensure the quality of health systems, goods and services.1 Multiple practices of corruption such as bribery or fraud have been reported in health policy and systems.2 Public health agencies are particularly susceptible to ‘regulatory capture’,3 4 a process by which an agency advances the special interests of the industries and of other actors it is entrusted with regulating. One of the mechanisms that can potentially lead to an agency capture is the so-called ‘revolving door’,5 the situation where an exchange of roles between public regulators and regulated institutions may result in health policy decisions which are biased in favour of industry interests. Revolving doors have previously been described in the USA and Europe, with an emphasis on legislative, energy, financial and patent agencies. However, there is little empirical evidence on the scale and scope of this problem in PHS. In this commentary, we explore the extent of the revolving doors phenomenon in Brazil by analysing the professional trajectories of public agents who held high positions at the two key health regulatory agencies in the country between 1999 and 2018

El control del tratamiento superficial de los tapones de corcho

Es bien sabido que el corcho como material posee una serie de características que le hacen susceptible de múltiples aplicaciones industriales (ligereza, elasticidad, compresibilidad, impermeabilidad, elevado rozamiento, aislante térmico etc.) de las cuales la más importante es la fabricación de tapones para el embotellado de los mejores caldos. Esto no solamente se debe al punto de vista económico (por el valor añadido que aporta), sino a lo que representa culturalmente en el mundo del vino. Un buen comportamiento de los tapones en el proceso de encorchado, así como de su permanencia en botella hasta el destapado, está íntimamente ligado a una serie de características de naturaleza físico-mecánica inherentes al corcho, al riguroso y cuidado proceso de fabricación y, de forma muy importante, a los tratamientos superficiale

The Aalborg University PO-PBL Model from a Socio-cultural Learning Perspective

Since the 1970’s, Aalborg University has been developing a new pedagogical model in higher education: The Project Oriented – Problem Based Learning (PO-PBL). In particular, the Faculty of Engineering and Science has developed a pedagogical proposal that introduces students to a different type of learning. One of the theoretical frameworks underpinning the understanding of learning is the socio-cultural perspective. This paper aims at exploring and analyzing the PO-PBL model from this theoretical perspective. In addition, this reading may also open a new viewpoint in science teaching for other universities

Ultrastructural studies on dengue virus type 2 infection of cultured human monocytes

BACKGROUND: Early interaction of dengue virus and monocyte/macrophages could be an important feature for virus dissemination after its initial entry via the mosquito vector. Since ultrastructural analysis of this interaction has not been reported, dengue type 2 (DEN2) virus-infected human monocyte cultures were studied at 1, 2, 4 and 6 hours after infection. RESULTS: Typical dengue particles and fuzzy coated viral particles were 35 to 42 nm and 74 to 85 nm respectively. Viruses were engulfed by phagocytosis and macropicnocytosis leading to huge vacuoles and phagosomes inside the monocytes. Interaction of monocytes with DEN2 virus induced apoptosis, characterized by nuclear condensation and fragmentation, cellular shrinkage, blebbing and budding phenomena and phagocytosis of apoptotic cells by neighboring monocytes. This finding was confirmed by TUNEL. Ultrastructural features associated to DEN2 virus replication were not observed. CONCLUSION: These data suggest that clearance of the virus by monocytes and cellular death are the main features during the initial interaction of DEN2 virus and monocytes and this could be important in the rapid elimination of the virus after infection by mosquito vector

In-hospital mortality among incident hemodialysis older patients in Peru.

BACKGROUND: Understanding the pattern of mortality linked to end stage renal disease (ESRD) is important given the increasing ageing population in low- and middle-income countries. METHODS: We analyzed older patients with ESRD with incident hemodialysis, from January 2012 to August 2017 in one large general hospital in Peru. Individual and health system-related variables were analyzed using Generalized Linear Models (GLM) to estimate their association with in-hospital all-cause mortality. Relative risk (RR) with their 95% confidence intervals (95% CI) were calculated. RESULTS: We evaluated 312 patients; mean age 69 years, 93.6% started hemodialysis with a transient central venous catheter, 1.7% had previous hemodialysis indication and 24.7% died during hospital stay. The mean length of stay was 16.1 days (SD 13.5). In the adjusted multivariate models, we found higher in-hospital mortality among those with encephalopathy (aRR 1.85, 95% CI 1.21-2.82 vs. without encephalopathy) and a lower in-hospital mortality among those with eGFR ≤7 mL/min (aRR 0.45, 95% CI 0.31-0.67 vs. eGFR>7 mL/min). CONCLUSIONS: There is a high in-hospital mortality among older hemodialysis patients in Peru. The presence of uremic encephalopathy was associated with higher mortality and a lower estimated glomerular filtration rate with lower mortality

Estado actual de los mecanismos alternativos de resolución de conflictos en santa marta y su conosimiento y credibilidad en la comunidad educativa Jorge Eliécer Gaitan

Para realizar el Estudio de los Mecanismos Alternativos de Resolución de Conflictos, se hizo necesario en primera instancia definirlos, como herramientas que el Estado consagró para que los ciudadanos resuelvan sus divergencias por vías pacíficas diferentes a la judicial. Se clasifican en Institucionales (Arbitramento, Casa de Justicia, Conciliación), Comunitarios (Mediación. Arreglo Directo y Jueces de Paz), de Acciones de Protección y Aplicación del Derecho (Acción de Tutela, Acciones Populares, Acciones de Cumplimiento y Acciones de Grupo) y los de Democráticos de Participación Ciudadana (Iniciativa Popular Legislativa y Normativa, Cabildo Abierto, Revocatoria del Mandato, Referendo, Veeduría Ciudadana, Derecho de Petición y Consulta Popular). Para conocer sobre el estado actual de los MARC en Santa Marta, se tuvo como fundamento la cultura de violencia en que se encuentra inmersa la ciudad, debido a la pluridiversidad de razas y cultural, al clientelismo político, la incredulidad en las instituciones estatales, al desconocimiento de los MARC y la ausencia de respeto a la diferencia. Tal realidad determinó la necesidad de que se conocieran los mecanismos como herramientas en la construcción de una cultura de paz y convivencia pacífica; se conscientizó acerca del respeto y credibilidad en las instituciones gubernamentales, de la Ley y la ética ciudadana; en procura no de evitar el conflicto, sino de afrontarlo de manera positiva. Se destacó al hombre como contribuyente principal en el control de la agresividad y la no violencia. Se logró lo anterior gracias al manejo de los datos estadísticos de las entidades, la comunidad Liceo Jorge Eliécer Gaitán y la muestra de las Juntas de Acciones Comunales. Con las entidades se determinó la efectividad, eficacia y eficiencia que algunos mecanismos tuvieron en los años 2.001 y 2.002, y en los líderes comunitarios y la comunidad educativa el grado de conocimiento, credibilidad y manejo de los MARC; resultado que permitió el desarrollo de 16 talleres en el Liceo, con una intensidad horaria de 48 horas y con los líderes 3 talleres con intensidad de 12 horas; programa formativo que generó un cambio conductual y una concepción de lo que son los MARC.It was nesessary to define MARC, as tools that the state consagred to citizens resolve their divergences through different pacific ways to the judicial, to study them. This mechanisms are classified in institucionales (Arbitramento, Casa de Justicia, Conciliación), Comunitarios (Mediación, Arreglo Directo y Jueces de Paz), of Acciones de Protección y Aplicación del Derecho (Acción de Tutela, Acciones Populares, Acciones de Cumplimiento and Acciones de Grupo) and the Democráticos de Participación Ciudadana (Iniciativa Popular Legislativa y Normativa, Cabildo Abierto, Revocatoria del Mandato, Referendo, Veeduría Ciudadana, Derecho de Petición y Consulta Popular). It bore in mind the city culture of violence, due to race and culture pluridiversity, politic clientelism, incredulity in statels, institucions, ingnorance about MARC, and adsence of respect to the difference. Such reality determined the necesity to know this mechanisms as tools in the new peace culture and pacific living together costruction; it made concience about respect and credibility in the gubernamentals institucions, of the law and the civil ethics; without trying to avoid the conflict, but confront it positively. It stood out the man as principal contributing in the control of the agresivity and the no-violence. It achieved the previous thank to the entities statistical facts manegement, the communtiy Liceo Jorge Eliécer Gaitán and the JAC samples. With the entities, it determined the effectiveness, effcacy and efficiency that some mechanisms had in 2.001 y 2.002, and the commutaries leaders and the educative community the knowledge, credibility and MARC manegement grade this result allowed the development of 16 activities of the Liceo, with a hourly intensity of 48 hours and with leaders 3 activities, with an intensity of 12 hours; formative program that generated a behavoir change and a conception about MARC

Pharmacogenetics of efficacy and safety of HCV treatment in HCV-HIV coinfected patients: significant associations with IL28B and SOCS3 gene variants.

Background and Aims This was a safety and efficacy pharmacogenetic study of a previously performed randomized trial which compared the effectiveness of treatment of hepatitis C virus infection with pegylated interferon alpha (pegIFNα) 2a vs. 2b, both with ribavirin, for 48 weeks, in HCV-HIV coinfected patients. Methods The study groups were made of 99 patients (efficacy pharmacogenetic substudy) and of 114 patients (safety pharmacogenetic substudy). Polymorphisms in the following candidate genes IL28B, IL6, IL10, TNFα, IFNγ, CCL5, MxA, OAS1, SOCS3, CTLA4 and ITPA were assessed. Genotyping was carried out using Sequenom iPLEX-Gold, a single-base extension polymerase chain reaction. Efficacy end-points assessed were: rapid, early and sustained virological response (RVR, EVR and SVR, respectively). Safety end-points assessed were: anemia, neutropenia, thrombocytopenia, flu-like syndrome, gastrointestinal disturbances and depression. Chi square test, Student's T test, Mann-Whitney U test and logistic regression were used for statistic analyses. Results As efficacy is concerned, IL28B and CTLA4 gene polymorphisms were associated with RVR (p<0.05 for both comparisons). Nevertheless, only polymorphism in the IL28B gene was associated with SVR (p = 0.004). In the multivariate analysis, the only gene independently associated with SVR was IL28B (OR 2.61, 95%CI 1.2-5.6, p = 0.01). With respect to safety, there were no significant associations between flu-like syndrome or depression and the genetic variants studied. Gastrointestinal disturbances were associated with ITPA gene polymorphism (p = 0.04). Anemia was associated with OAS1 and CTLA4 gene polymorphisms (p = 0.049 and p = 0.045, respectively), neutropenia and thromobocytopenia were associated with SOCS3 gene polymorphism (p = 0.02 and p = 0.002, respectively). In the multivariate analysis, the associations of the SOCS3 gene polymorphism with neutropenia (OR 0.26, 95%CI 0.09-0.75, p = 0.01) and thrombocytopenia (OR 0.07, 95%CI 0.008-0.57, p = 0.01) remained significant. Conclusions In HCV-HIV coinfected patients treated with PegIFNα and ribavirin, SVR is associated with IL28B rs8099917 polymorphism. HCV treatment-induced neutropenia and thrombocytopenia are associated with SOCS3 rs4969170 polymorphism

Energy Intake, Macronutrient Profile and Food Sources of Spanish Children Aged One to < 10 Years-Results from the EsNuPI Study

The present study aimed to assess energy intake, nutrient profile and food sources in Spanish children participating in the EsNuPI ("Estudio Nutricional en Poblacion Infantil Espanola") study. Plausibility of energy intake and adequacy of nutrient intakes to international recommendations were analyzed in a final sample of 1448 subjects (728 boys and 720 girls) and one group representative of the 1 to <10 years old urban Spanish children (reference sample (n = 707)) who consumed milk and one of the same age who consumed adapted milk over the last year (adapted milk consumers sample (n = 741)) were compared. Both groups completed data of a face-to-face and a telephone 24-h dietary recalls. Both the reference and the adapted milk consumers samples reported an adequate daily energy intake (1503 kcal/day and 1404 kcal/day); and a high contribution to total energy from protein (16.5% and 15.6%) and fat (36.5% and 35.9%). Also, a high percentage of children from both samples were below the lower limit of the recommendations for carbohydrates (47.8% and 39.3%). As the percentage of plausible energy reporters was high for both groups (84.7% and 83.5%, respectively), data for the whole sample were analyzed. Milk and dairy, cereals, meat and derived products, fats and oils, bakery and pastry, fruits and vegetables contributed to about 80% of the total energy intake in both groups. However, the reference sample reported significantly more contribution to energy from cereals, meat and meat products, bakery and pastry and ready to cook/eat foods; meanwhile, the adapted milk consumers sample reported significantly more energy from milk and dairy products, fruits and eggs. Those results suggest that adapted milk consumers have better adherence to the food-based dietary guidelines. Further analyses are warranted to characterize food patterns and the quality of the diet in the EsNuPI study population

Mobile application designed by and for older persons

[EN] This article describes how older persons can be integrated in the innovation activities within the development of a mobile application aimed at making the access to the information society and promoting the social interaction. IBV methodology named `Person Oriented Innovation¿ (IOP) has been used to include their experiences, values, hopes and preferences in the whole development process: problem definition; need analysis and specs preparation; and product validation.[ES] Este artículo explica cómo se puede integrar de manera activa a las personas mayores en las actividades de innovación relacionadas con el desarrollo de una aplicación para dispositivos móviles destinada a facilitar el acceso a las tecnologías de la información y a promover la interacción social. Para alcanzar este objetivo se ha utilizado la metodología desarrollada por el Instituto de Biomecánica (IBV), denominada ¿Innovación Orientada por las Personas¿ (IOP), como forma de incluir las experiencias, valores, expectativas y preferencias de las personas mayores en el proceso completo de desarrollo de la aplicación: definición del problema, análisis de necesidades y elaboración de especificaciones y validación del producto.El proyecto SI-Screen (AAL-2009-2-088) está financiado por la Comisión Europea y las organizaciones miembros del programa AAL (Ambient Assisted Living). En el caso de España por el Instituto de Salud Carlos III y el Ministerio de Industria y Comercio. El IBV ha desarrollado de forma conjunta este trabajo con las siguientes entidades: InnovationManufaktur, VIOS, Universität München der Bundeswehr, Brainware, Porsche Design Studio, Helios, FATEC, Tioman&Partners y ST-Servicios de TeleasistenciaBarbera Guillem, R.; Campos Soriano, N.; Bollain Pastor, C.; López Torres, M.; Soler Valero, A.; Tito Malone, M.; Poveda Puente, R.... (2013). Aplicaciones móviles pensadas por y para los mayores. Revista de biomecánica. 60:32-34. http://hdl.handle.net/10251/38638S32346