Comprehensiveness and universality of the pharmaceutical assistance in times of judicialization of health care

A Lei nº 12.401/2011 e o Decreto nº 7.508/2011 são celebrados, entre outros motivos, por introduzir regras inéditas para a política de assistência farmacêutica que teriam o potencial de racionalizar a judicialização da saúde no Brasil. Este estudo visa analisar qual seria o impacto da observância dos critérios de acesso universal à assistência farmacêutica integral, delimitados pelos marcos normativos, no cenário da judicialização de medicamentos em Minas Gerais de 1999 a 2009. Trata-se de um estudo retrospectivo que analisa os litígios judiciais deferidos contra o estado no período. Se os critérios instituídos em 2011 estivessem normalizados e fossem acatados pelo Judiciário no intervalo em pauta, entre 68,84% e 85,77% dos medicamentos judicializados em Minas Gerais teriam sido indeferidos. Contudo, apesar de demonstrar potencial para racionalizar a judicialização, as normativas ainda não parecerem ter influenciado as decisões em saúde de forma determinante.Law no. 12,401/2011 and Decree no. 7,508/2011 are celebrated, among other reasons, for introducing new rules for the pharmaceutical assistance policy that would have the potential to streamline the judicialization of health care in Brazil. This study aims to analyze the effects of the universal access to the comprehensive pharmaceutical assistance established by these legislations considering the judicialization of medicines in the state of Minas Gerais from 1999 to 2009. This is a retrospective study that analyzes the legal disputes deferred against Minas Gerais during the period. If the criteria established in 2011 were normalized and respected by the Judiciary in this interval, between 68.84% and 85.77% of the medicines judicialized in Minas Gerais would have been rejected. However, despite having the potential to streamline the judicialization, the legislations do not seem to have influenced the judicial decisions permanently

The end of patent extensions and the Productive Development Partnerships: effects on access to medicines in Brazil

The COVID-19 pandemic has shed light on the negative impact of intellectual property on health and has given new relevance to the Direct Action of Unconstitutionality 5529/DF, which was ruled by the Supreme Court in 2021, resulting in the extinction of automatic patent extensions in Brazil. This documentary case study analyzes the effects of the judicial decision on patent applications and patents of interest for Productive Development Partnerships (PDP), investigating the progress of 90 patent applications related to 15 PDPs drugs of interest until Decembre 31, 2020. Variables for comparing the drug patent scenario with that of the PDPs were researched on the websites of the National Institute of Industrial Property, the Ministry of Health, ANVISA, and the Brazilian Medicines Market Regulation Chamber. Of 88 valid applications, 28 patents were granted, 17 of which had been extended to more than 20 years (24 years and 09 months average). The court decision resulted in a loss of over 68 years of monopoly, potentially opening alternatives for generic production. This resumption of the PDP policy should incorporate strategies to overcome patent barriers.A covid-19 jogou luz sobre o impacto negativo da propriedade intelectual na saúde e deu nova relevância à Ação Direta de Inconstitucionalidade 5529/DF, que, acatada pelo Supremo Tribunal Federal em 2021, culminou na extinção da extensão automática de patentes no Brasil. Este estudo busca analisar o efeito do julgamento histórico da ADI 5529/DF sobre pedidos de patente e as patentes de interesse das Parcerias para Desenvolvimento Produtivo (PDP). Trata-se de um estudo com base em uma pesquisa documental de análise do andamento, até 31 de dezembro de 2020, de 90 pedidos de patente relacionados a 15 medicamentos objetos de PDP. Nos sites do Instituto Nacional de Propriedade Industrial, do Ministério da Saúde, da Anvisa e da Câmara de Regulação do Mercado de Medicamentos, foram pesquisadas variáveis para comparar o cenário patentário dos medicamentos com o das PDP. De 88 pedidos válidos, 28 patentes foram concedidas, das quais dezessete foram estendidas para mais de vinte anos (média de 24 anos e nove meses). A decisão do STF resultou em mais de 68 anos de monopólio perdidos, potencialmente desanuviando alternativas para a produção de genéricos no país. Neste momento de retomada das PDP, estratégias para a superação de barreiras patentárias deveriam ser incorporadas à política

Judicialization and jurisprudence: Suspension of advance relief on collegiate decisions in healthcare in the state of Minas Gerais, Brazil

Após audiência pública em 2009, o Supremo Tribunal Federal consolidou conclusões no julgamento da Suspensão de Tutela Antecipada 175/CE, estabelecendo parâmetros que orientariam o Judiciário e racionalizariam o fenômeno da judicialização da saúde no Brasil. Desconhece-se, contudo, em que medida tal jurisprudência tem influenciado as decisões judiciais. O presente trabalho tem como objetivo investigar o uso da suspensão como referência a embasar as decisões finais colegiadas em saúde do Tribunal de Justiça do Estado de Minas Gerais. Trata-se de estudo de caso baseado em dados secundários obtidos nos acórdãos com citação da Suspensão de Tutela Antecipada 175/CE na ementa. Identificou-se 106 acórdãos. A suspensão foi citada em todos os anos desde 2009 [..]. A distribuição das citações entre relatores e órgãos julgadores foi heterogênea, e o principal contexto de uso da jurisprudência foi para declarar a necessidade de priorização dos tratamentos ofertados pelo Sistema Único de Saúde e comprovação da excepcionalidade dos casos inadequados a eles. Estimou-se que os 106 acórdãos representaram 0,1% do universo de acórdãos sobre o direito à saúde proferidos no período. Concluiu-se que a Suspensão não foi referência fortemente utilizada nos acórdãos do Tribunal de Justiça do Estado de Minas Gerais. Embora a literatura indique uma tendência à racionalidade na jurisprudência brasileira em relação ao deferimento de demandas judiciais em saúde, o frágil uso da jurisprudência do Supremo Tribunal Federal pela corte mineira não confirma, na prática, tal tendência, pondo em questão a efetividade de tal recurso na intervenção sobre o fenômeno da judicialização da saúde.After a public hearing in 2009, the Brazilian Federal Supreme Court consolidated conclusions in the decision about the Suspension of Advance Relief 175/CE, establishing parameters that would guide the Judiciary and rationalize the judicialization of health in Brazil. Nevertheless, it’s still not known to what extent the jurisprudence has influenced juridical decisions. This work aims to investigate the usage of the suspension as a reference to give base to the final collegiate decisions on health of the Court of Justice of the State of Minas Gerais. This is a case study based on secondary data found within collegiate judgments that cited the Suspension of Advance Relief 175/CE in their abstracts. 106 judgments were identified. The suspension was cited every year since 2009, especially in 2015, 2016 and 2017. The distribution of quotations among rapporteurs and courts was heterogeneous and the main context where the jurisprudence was used (90,6%) was to establish the need to prioritize treatments offered by the Brazilian National Health System and to prove cases that are an exception to this. It was estimated that the 106 judgments represented 0,1% of the universe of collective judgments about the right to health during the studied period. The conclusion was that the suspension was not a reference strongly used in collective judgments by the Court of Justice of the State of Minas Gerais. Although the literature indicates a rational trend within the Brazilian jurisprudence when it comes to favorable decisions to judicial demands involving health issues, the scarce use of the suspension by the Court of Justice of the State of Minas Gerais does not confirm this tendency and rises questions on its effectiveness in the interventions in cases of judicialization of health

Checklist of the birds of Mato Grosso do Sul state, Brazil: diversity and conservation

Several phytogeographic regions (Cerrado, Pantanal, Atlantic Forest, Gran Chaco, and Chiquitano Dry Forests) converge in the state of Mato Grosso do Sul, Brazil, and influence regional biodiversity. Despite a list of birds in the state of Mato Grosso do Sul being published by Nunes et al. (2017), it is necessary to update and critically review avifauna records. In this study, we gathered the results of several records obtained from species lists and online data platforms of the 336 sites in this state over the last decades and grouped them into Main (Primary and Secondary) and Tertiary Lists. The avifauna of Mato Grosso do Sul is composed of 678 species, of which 643 (95%) have records proving their occurrence (Primary List), whereas 34 still lack documentation (Secondary List). The number of related species for Mato Grosso do Sul represents 34% of the Brazilian avifauna. Some species stand out for their unique occurrence in Mato Grosso do Sul, such as Melanerpes cactorum, Celeus lugubris, Phaethornis subochraceus, and Cantorchilus guarayanus, reflecting the influence of different phytogeographic regions of the Chaco and Chiquitano Dry Forests. Migrants represent 20% of the bird community occurring in the state, of which 93 species correspond to migrants from various regions of South America (south and west) and 40 to boreal migrants. Thirty-three species perform nomadic movements across the Pantanal Plain and other regions of the state. Thirty-one species are included in some conservation-threatened categories of global and/or national endangered species lists. Other 30 species are included in the near-threatened category at the global level and 23 at the national level. In addition, species typical of dry forests (in Serra da Bodoquena and Maciço do Urucum) and those from the Atlantic Forest in the south of the state deserve attention due to their restricted distribution and the high anthropogenic pressure on their habitat

Checklist of the birds of Mato Grosso do Sul state, Brazil: diversity and conservation

Several phytogeographic regions (Cerrado, Pantanal, Atlantic Forest, Gran Chaco, and Chiquitano Dry Forests) converge in the state of Mato Grosso do Sul, Brazil, and influence regional biodiversity. Despite a list of birds in the state of Mato Grosso do Sul being published by Nunes et al. (2017), it is necessary to update and critically review avifauna records. In this study, we gathered the results of several records obtained from species lists and online data platforms of the 336 sites in this state over the last decades and grouped them into Main (Primary and Secondary) and Tertiary Lists. The avifauna of Mato Grosso do Sul is composed of 678 species, of which 643 (95%) have records proving their occurrence (Primary List), whereas 34 still lack documentation (Secondary List). The number of related species for Mato Grosso do Sul represents 34% of the Brazilian avifauna. Some species stand out for their unique occurrence in Mato Grosso do Sul, such as Melanerpes cactorum, Celeus lugubris, Phaethornis subochraceus, and Cantorchilus guarayanus, reflecting the influence of different phytogeographic regions of the Chaco and Chiquitano Dry Forests. Migrants represent 20% of the bird community occurring in the state, of which 93 species correspond to migrants from various regions of South America (south and west) and 40 to boreal migrants. Thirty-three species perform nomadic movements across the Pantanal Plain and other regions of the state. Thirty-one species are included in some conservation-threatened categories of global and/or national endangered species lists. Other 30 species are included in the near-threatened category at the global level and 23 at the national level. In addition, species typical of dry forests (in Serra da Bodoquena and Maciço do Urucum) and those from the Atlantic Forest in the south of the state deserve attention due to their restricted distribution and the high anthropogenic pressure on their habitat

ADESÃO AO TRATAMENTO NOS AMBULATÓRIOS PSIQUIÁTRICOS: REVISÃO SISTEMÁTICA

Adherence to treatment in psychiatric laboratories, especially in low-income communities, is a complex challenge that requires innovative, patient-centered approaches. This study aimed to study the benefits of treatment adherence in psychiatric outpatient clinics. To this end, a systematic literature review was conducted, selecting scientific articles published between 2019 and 2024, available in the Scielo, Medline and Lilacs databases. From the critical analysis of the results, it was concluded that adherence to treatment in psychiatric outpatient clinics is fundamental for promoting mental health and the well-being of patients. However, in order to maximize the benefits and overcome the challenges associated with treatment adherence, more integrated approaches, ongoing research and a deeper understanding of patients' needs and experiences are needed.A adesão ao tratamento em ambulatórios psiquiátricos, especialmente em comunidades de baixa renda, é um desafio complexo que requer abordagens inovadoras e centradas no paciente. Este estudo teve como objetivo estudar os benefícios da adesão ao tratamento em ambulatórios psiquiátricos. Para isso, foi conduzida uma revisão sistemática da literatura, selecionando artigos científicos publicados entre 2019 e 2024, disponíveis nas bases de dados Scielo, Medline e Lilacs. A partir da análise crítica dos resultados, concluiu-se que a adesão ao tratamento em ambulatórios psiquiátricos é fundamental para a promoção da saúde mental e o bem-estar dos pacientes. No entanto, para maximizar os benefícios e superar os desafios associados à adesão ao tratamento, são necessárias abordagens mais integradas, pesquisa contínua e uma compreensão mais aprofundada das necessidades e experiências dos pacientes

Avaliação Ecológica Rápida de Qualidade de Água e Bioindicadores Bentônicos no Parque Nacional da Serra do Gandarela, Minas Gerais

Durante uma disciplina de pós-graduação, realizamos uma Avaliação Ecológica Rápida sobre qualidade de água e biodiversidade de bioindicadores bentônicos no Parque Nacional (PARNA) da Serra do Gandarela, MG. Os objetivos foram: (a) capacitar profissionais na utilização de metodologias atuais em Rapid Assessment Protocols (RAP) para estudos de diagnóstico e monitoramento de integridade ecológica de ecossistemas aquáticos em regiões de cabeceira de bacias hidrográficas; (b) contribuir ao conhecimento da biodiversidade aquática em corpos d’água no PARNA Serra do Gandarela; (c) fomentar intercâmbio e colaboração entre mestrandos, doutorandos, guarda-parques, visitantes, membros de comitês de bacia, gestores ICMBio, moradores e interessados na conservação de biodiversidade no Quadrilátero Ferrífero; (d) gerar informações de base sobre qualidade de água, biodiversidade de macroinvertebrados bentônicos bioindicadores de qualidade de água no PARNA Serra do Gandarela. Os principais resultados revelam que o PARNA Serra do Gandarela é guardião de riachos de cabeceira em condições de referência, com elevada diversidade de hábitats aquáticos e ótima qualidade de água, onde vivem organismos bentônicos sensíveis, tolerantes e resistentes à poluição. Sendo a Serra do Gandarela responsável pela segurança hídrica de grande parte dos municípios do Quadrilátero Ferrífero de Minas Gerais, é extremamente importante que estes riachos em condições de referência sejam conservados e utilizados em futuros estudos de avaliação de impactos ambientais e programas de monitoramento de condições ecológicas de longo prazo. As condições de alta preservação devem servir como baliza de referência para tomadores de decisão em processos de licenciamento ambiental de empreendimentos potencialmente causadores de impactos ambientais e riscos à biodiversidade

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

Polymorphisms in the MBL2 gene are associated with the plasma levels of MBL and the cytokines IL-6 and TNF-α in severe COVID-19

IntroductionMannose-binding lectin (MBL) promotes opsonization, favoring phagocytosis and activation of the complement system in response to different microorganisms, and may influence the synthesis of inflammatory cytokines. This study investigated the association of MBL2 gene polymorphisms with the plasma levels of MBL and inflammatory cytokines in COVID-19.MethodsBlood samples from 385 individuals (208 with acute COVID-19 and 117 post-COVID-19) were subjected to real-time PCR genotyping. Plasma measurements of MBL and cytokines were performed by enzyme-linked immunosorbent assay and flow cytometry, respectively.ResultsThe frequencies of the polymorphic MBL2 genotype (OO) and allele (O) were higher in patients with severe COVID-19 (p< 0.05). The polymorphic genotypes (AO and OO) were associated with lower MBL levels (p< 0.05). IL-6 and TNF-α were higher in patients with low MBL and severe COVID-19 (p< 0.05). No association of polymorphisms, MBL levels, or cytokine levels with long COVID was observed.DiscussionThe results suggest that, besides MBL2 polymorphisms promoting a reduction in MBL levels and therefore in its function, they may also contribute to the development of a more intense inflammatory process responsible for the severity of COVID-19