Cost effectiveness of OptiMal® rapid diagnostic test for malaria in remote areas of the Amazon Region, Brazil

<p>Abstract</p> <p>Background</p> <p>In areas with limited structure in place for microscopy diagnosis, rapid diagnostic tests (RDT) have been demonstrated to be effective.</p> <p>Method</p> <p>The cost-effectiveness of the Optimal^®and thick smear microscopy was estimated and compared. Data were collected on remote areas of 12 municipalities in the Brazilian Amazon. Data sources included the National Malaria Control Programme of the Ministry of Health, the National Healthcare System reimbursement table, hospitalization records, primary data collected from the municipalities, and scientific literature. The perspective was that of the Brazilian public health system, the analytical horizon was from the start of fever until the diagnostic results provided to patient and the temporal reference was that of year 2006. The results were expressed in costs per adequately diagnosed cases in 2006 U.S. dollars. Sensitivity analysis was performed considering key model parameters.</p> <p>Results</p> <p>In the case base scenario, considering 92% and 95% sensitivity for thick smear microscopy to <it>Plasmodium falciparum </it>and <it>Plasmodium vivax</it>, respectively, and 100% specificity for both species, thick smear microscopy is more costly and more effective, with an incremental cost estimated at US$549.9 per adequately diagnosed case. In sensitivity analysis, when sensitivity and specificity of microscopy for <it>P. vivax </it>were 0.90 and 0.98, respectively, and when its sensitivity for <it>P. falciparum </it>was 0.83, the RDT was more cost-effective than microscopy.</p> <p>Conclusion</p> <p>Microscopy is more cost-effective than OptiMal^®in these remote areas if high accuracy of microscopy is maintained in the field. Decision regarding use of rapid tests for diagnosis of malaria in these areas depends on current microscopy accuracy in the field.</p

Home care in the Federal District : factors associated with the first occurrence of acute lower respiratory infection and death

INTRODUCTION: We aimed to evaluate the frequency and associated factors of acute respiratory infection and death among home care patients in Sobradinho/DF, Brazil. METHODS: Data were obtained from patients’ medical records. Bivariate and multivariate analyses were performed. Odds ratio and 95% confidence interval were estimated. RESULTS: Factors associated with respiratory infection were ages 80 years and accommodation. Female sex was a protective factor. Age >30 years and dependency for daily activities were associated with death. CONCLUSIONS: These factors can improve clinical results in this specific home care and open new opportunities and questions for future research

Relações federativas e acesso educacion

Este texto analisa as decisões tomadas pelo Governo municipal de Campo Grande, Capital do Estado de Mato Grosso do sul (Ms), em relação à concepção e execução da política educacional, por meio da investigação da parceria firmada entre o governo do município e o instituto Ayrton Senna (ias), no período de 2001 a 2004, na condução do Programa Escola Campeã e as decorrências para a efetivação do direito à educação. Partese do pressuposto de que, no contexto federativo brasileiro, as decisões tomadas por parte das esferas subnacionais, no que concerne ao exercício público, revelam, por um lado, a interdependência dessas esferas com a União e, por outro, a autonomia de poder e gestão local. a investigação baseia-se na legislação federal e municipal pertinente que norteou a política educacional de gestão municipal no referido período, em dados educacionais do município e na literatura da área

QUADAS e STARD: avaliação da qualidade de estudos de acurácia de testes diagnósticos

OBJETIVO: Comparar duas abordagens baseadas em critérios do Quality Assessment of Diagnostic Accuracy Studies (QUADAS) e do Standards for Reporting Studies of Diagnostic Accuracy (STARD) na avaliação de qualidade de estudos de validação do teste rápido OptiMal®, para diagnóstico de malária. MÉTODOS: Foi realizada busca de artigos de validação do teste rápido na base bibliográfica Medline acessada pelo PubMed, no ano de 2007. Treze artigos foram recuperados na busca. Foram combinados 12 critérios do QUADAS e três do STARD para comparação com os critérios do QUADAS isoladamente. Foi considerado que artigos de regular a boa qualidade atenderiam pelo menos 50% dos critérios do QUADAS. RESULTADOS: Dos 13 artigos recuperados, 12 cumpriram pelo menos 50% dos critérios do QUADAS, e apenas dois atenderam à combinação dos critérios. Considerando-se a combinação dos dois critérios (>; 6 QUADAS e >; 3STARD), dois estudos (15,4%) apresentaram boa qualidade metodológica. A seleção de artigos usando a combinação proposta variou de dois a oito artigos, dependendo do número de itens considerados como ponto de corte. CONCLUSÕES: A combinação do QUADAS com o STARD tem o potencial de conferir maior rigor nas avaliações da qualidade de artigos publicados sobre validação de testes diagnósticos em malária, por incorporar a checagem de informações relevantes não alcançáveis pelo uso do QUADAS isoladamente.OBJETIVO: Comparar dos abordajes basados en criterios del Quality Assessment of Diagnostic Accuracy Studies (QUADAS) y del Standards for Reporting Studies of Diagnostic Accuracy (STARD) en la evaluación de calidad de estudios de validación de la prueba rápida OptiMal®, para diagnóstico de malaria. MÉTODOS: Se realizó búsqueda de artículos de validación de la prueba rápida en la base bibliográfica Medline accedida por el PubMed, en el año de 2007. Trece artículos fueron recuperados en la búsqueda. Se combinaron 12 criterios del QUADAS y tres del STARD para comparación con los criterios del QUADAS aisladamente. Se consideró que artículos de regular a buena calidad atenderían al menos 50% de los criterios del QUADAS. RESULTADOS: De los 13 artículos recuperados, 12 cumplieron con al menos 50% de los criterios del QUADAS, y sólo dos atendieron la combinación de los criterios. Considerándose la combinación de los dos criterios (>; 6 QUADAS e >; 3STARD), dos estudios (15,4%) presentaron buena calidad metodológica. La decisión cuanto a la selección de artículos utilizando la combinación utilizada varió de dos a ocho artículos, dependiendo del ponto de corte considerado. CONCLUSIONES: La combinación del QUADAS con el STARD tiene el potencial de conferir mayor rigor en las evaluaciones de la calidad de artículos publicados sobre validación de pruebas diagnósticas en malaria, por incorporar el chequeo de informaciones relevantes no alcanzables por el uso del QUADAS aisladamente.OBJECTIVE: To compare the performance of two approaches, one based on the Quality Assessment of Diagnostic Accuracy Studies (QUADAS) and another on the Standards for Reporting Studies of Diagnostic Accuracy (STARD), in evaluating the quality of studies validating the OptiMal® rapid malaria diagnostic test. METHODS: Articles validating the rapid test published until 2007 were searched in the Medline/PubMed database. This search retrieved 13 articles. A combination of 12 QUADAS criteria and three STARD criteria were compared with the 12 QUADAS criteria alone. Articles that fulfilled at least 50% of QUADAS criteria were considered as regular to good quality. RESULTS: Of the 13 articles retrieved, 12 fulfilled at least 50% of QUADAS criteria, and only two fulfilled the STARD/QUADAS criteria combined. Considering the two criteria combination (>; 6 QUADAS and >; 3 STARD), two studies (15.4%) showed good methodological quality. The articles selection using the proposed combination resulted in two to eight articles, depending on the number of items assumed as cutoff point. CONCLUSIONS: The STARD/QUADAS combination has the potential to provide greater rigor when evaluating the quality of studies validating malaria diagnostic tests, given that it incorporates relevant information not contemplated in the QUADAS criteria alone

Controle de plantas daninhas por meio da consorciação com Gliricídia. II. Cultura do milho

Um dos principais interesses da agricultura moderna é a redução no uso de herbicidas; para isso, diversas alternativas estão sendo investigadas, inclusive a consorciação. A cobertura do solo com ramos de gliricídia (Gliricidia sepium) não tem efeito alelopático sobre o milho ou feijão, mas diminui significativamente a população de algumas espécies de plantas daninhas. O objetivo deste estudo foi avaliar os rendimentos de espigas verdes e de grãos de cultivares de milho, em resposta ao controle de plantas daninhas, por meio da consorciação com gliricídia. Utilizou-se o delineamento de blocos ao acaso com parcelas subdivididas e cinco repetições. Os cultivares 1051, AG 2060, BRS 2020 e PL 6880 (atribuídos às parcelas) foram submetidos aos seguintes tratamentos: sem capina, duas capinas (realizadas aos 20 e 40 dias após a semeadura) e consorciação com gliricídia. Esta planta foi cultivada em um sistema de transplantio, para garantir germinação uniforme e rápido estabelecimento no campo. A semeadura foi feita em bandejas de 200 células, com uma semente por célula (volume de 35 mL). As plantas emergiram dois a três dias após a semeadura e foram transplantadas para o local definitivo dois a três dias após a emergência. O milho foi semeado no mesmo dia em que a gliricídia foi transplantada. Dezesseis espécies de plantas daninhas ocorreram em diferentes frequências, com distribuição desuniforme na área experimental. Os cultivares AG 1051 e AG 2060 foram os melhores quanto à maioria das características avaliadoras do rendimento de milho verde. O cultivar AG 1051 foi o melhor quanto ao rendimento de grãos. Os maiores rendimentos de espigas verdes e de grãos foram obtidos com duas capinas. Todavia, o fato de as parcelas consorciadas terem apresentado médias intermediárias às médias das parcelas não-capinadas e capinadas – em algumas características avaliadoras do rendimento de espigas verdes e no rendimento de grãos – indica que a gliricídia foi benéfica ao milho e exerceu certo controle sobre as plantas daninhas. _________________________________________________________________________________ ABSTRACTA reduction in herbicide use is one of modern agriculture’s main interests and several alternatives are being investigated with this objective, including intercropping. Gliricídia (Gliricidia sepium) mulch has no allelopathic effect on corn or beans but significantly decreased the population of some weed species. The objective of this study was to evaluate green ear and grain yield in corn cultivars as a response to weed control achieved via intercropping with gliricidia. A completely randomized block design with five replicates and split-plots was used. Cultivars AG 1051, AG 2060, BRS 2020, and PL 6880 (assigned to plots) were submitted to the following treatments: no hoeing, hoeing (performed at 20 and 40 days after sowing the corn), and corn intercropped with gliricidia. Gliricidia was grown in a transplanting system to ensure uniform germination and fast establishment in the field. Seeding was made in 200-cell trays with one seed per cell (35 mL volume). The plants emerged two to three days after sowing and were transplanted to a permanent site two to three days after emergence. Corn was sown on the same day gliricidia was transplanted. Sixteen weed species occurred at different frequencies, with uneven distribution in the experimental area. Cultivars AG 1051 and AG 2060 were the best with reference to most characteristics employed to evaluate green corn yield. Cultivar AG 1051 provided the highest grain yield. The highest green ear yield and grain yield values were obtained with hoeing. However, the fact that intercropped plots showed intermediate yield between the values obtained for hoed and non-hoed plots indicates that gliricidia was beneficial to corn, and exerted a certain level of weed control

Systematic Review of Health Economic Evaluations of Diagnostic Tests in Brazil: How accurate are the results?

The aim of this study is to identify and characterize the health economic evaluations (HEEs) of diagnostic tests conducted in Brazil, in terms of their adherence to international guidelines for reporting economic studies and specific questions in test accuracy reports. We systematically searched multiple databases, selecting partial and full HEEs of diagnostic tests, published between 1980 and 2013. Two independent reviewers screened articles for relevance and extracted the data. We performed a qualitative narrative synthesis. Forty-three articles were reviewed. The most frequently studied diagnostic tests were laboratory tests (37.2%) and imaging tests (32.6%). Most were non-invasive tests (51.2%) and were performed in the adult population (48.8%). The intended purposes of the technologies evaluated were mostly diagnostic (69.8%), but diagnosis and treatment and screening, diagnosis, and treatment accounted for 25.6% and 4.7%, respectively. Of the reviewed studies, 12.5% described the methods used to estimate the quantities of resources, 33.3% reported the discount rate applied, and 29.2% listed the type of sensitivity analysis performed. Among the 12 cost-effectiveness analyses, only two studies (17%) referred to the application of formal methods to check the quality of the accuracy studies that provided support for the economic model. The existing Brazilian literature on the HEEs of diagnostic tests exhibited reasonably good performance. However, the following points still require improvement: 1) the methods used to estimate resource quantities and unit costs, 2) the discount rate, 3) descriptions of sensitivity analysis methods, 4) reporting of conflicts of interest, 5) evaluations of the quality of the accuracy studies considered in the cost-effectiveness models, and 6) the incorporation of accuracy measures into sensitivity analyses

Epidemiological features, echocardiographic findings, and parasite load in patients with Chagas disease

INTRODUCTION Chagas disease is a major public health problem that is endemic in Brazil and Latin America. This study aimed to determine the socioeconomic, demographic, and clinical characteristics of 171 patients (mean age, 45 years; female, 65%) with Chagas disease at Hospital Universitário de Brasília, Federal District, Brazil. METHODS We implemented this cross-sectional study using a clinical epidemiological questionnaire, electrocardiography, echocardiography, and quantitative detection of Trypanosoma cruzi DNA in blood using qRT-PCR. RESULTS Among the patients, 26.3% had a full elementary education, and 13.2% were illiterate. Most (63.6%) were economically classified as class C, and 51.5% were born in Bahia state. A total of 62.0% participants reported previous contact with the triatomine bug. The clinical forms of the disease were indeterminate (69.51%), cardiac (15.24%), digestive (10.37%), and mixed (4.88%). The most common electrocardiographic abnormality was complete right bundle branch block in association with a divisional anterosuperior block. Only 14.6% of the patients complied with benznidazole medication for at least 60 days, and 164 of them were assessed by echocardiography. The parasite load was positive in 56% of the patients. CONCLUSIONS: Chagas disease affected mostly women, with the indeterminate chronic form of the disease

Phytochemical analysis of Turnera Diffusa Willd

Turnera diffusa WILLD is a plant used in folk medicine as a natural stimulant, and the objective of this research is to perform the phytochemical analysis of the secondary metabolites of the damiana of occurrence in the Juazeiro region, northern Bahia - Brazil. A phytochemical screening was performed from three Crude Ethanol Extracts (BSE), EEB1: leaves and flowers; EEB2: stems and EEB3: root. A thin analytical layer chromatography was performed using specific developers to detect each chemical class. Alkaloids, coumarins, anthranic derivatives, phenolic compounds, mono, sequi and diterpenes, naphthoquinones, triterpenes and steroids, saponins, hydrolyzed tannins and xanthines were identified in the three extracts. Only in the BSE of leaves and flowers observed the presence of antroquinones and aglycones. The secondary metabolites identified in the study evidence the pharmacological potential of Turnera diffusa. Phytochemical screening concluded the presence of fourteen classes of secondary metabolites in damiana, indicating important medicinal potential with pharmacological effects reported in the literature

Identification of anaerobic threshold using heart rate response during dynamic exercise

The objective of the present study was to characterize the heart rate (HR) patterns of healthy males using the autoregressive integrated moving average (ARIMA) model over a power range assumed to correspond to the anaerobic threshold (AT) during discontinuous dynamic exercise tests (DDET). Nine young (22.3 ± 1.57 years) and 9 middle-aged (MA) volunteers (43.2 ± 3.53 years) performed three DDET on a cycle ergometer. Protocol I: DDET in steps with progressive power increases of 10 W; protocol II: DDET using the same power values as protocol 1, but applied randomly; protocol III: continuous dynamic exercise protocol with ventilatory and metabolic measurements (10 W/min ramp power), for the measurement of ventilatory AT. HR was recorded and stored beat-to-beat during DDET, and analyzed using the ARIMA (protocols I and II). The DDET experiments showed that the median physical exercise workloads at which AT occurred were similar for protocols I and II, i.e., AT occurred between 75 W (116 bpm) and 85 W (116 bpm) for the young group and between 60 W (96 bpm) and 75 W (107 bpm) for group MA in protocols I and II, respectively; in two MA volunteers the ventilatory AT occurred at 90 W (108 bpm) and 95 W (111 bpm). This corresponded to the same power values of the positive trend in HR responses. The change in HR response using ARIMA models at submaximal dynamic exercise powers proved to be a promising approach for detecting AT in normal volunteers

La INTERDISCIPLINARIEDAD INTRÍNSECA EN LAS ACCIONES DESARROLLADAS EN EL PIBID

This research analyzes issues related to the implementation of interdisciplinary approaches in the different subprojects under development in PIBID/UEL. For this purpose, we deepen in teacher training and the concept of interdisciplinarity. Theoretically, we approach how the interdisciplinarity is presented in the official documents which rule PIBID, so the methodological choice was the&nbsp;documentary analysis. Empirically, we collected data from the reports of the participants during an event and we focused on the study of a project developed in the area of Mathematics, with the African Culture theme. The data analysis points out that the interdisciplinarity included in PIBID / UEL materializes from projects and/or subjects under the regency of the teacher of specific areas. We are faced with the challenge of understanding such transdisciplinary actions and expanding them to other subprojects.Esta investigación analiza cuestiones relativas a la efectividad de enfoques interdisciplinarios en los diferentes subproyectos en desarrollo en el PIBID / UEL. Por lo tanto, profundizamos el estudio de la temática en formación de profesores y en el concepto de interdisciplinariedad. Teóricamente, abordamos cómo la interdisciplinaridad es presentada en los documentos oficiales sobre el PIBID, luego la elección metodológica sea el análisis documental. Empíricamente, reconectamos datos junto a los relatos de los participantes de un evento y profundizamos en el estudio de un proyecto desarrollado en el área de matemáticas, con el tema Cultura Africana. El análisis de los datos apunta que la interdisciplinaridad presente en el PIBID / UEL se concreta a partir de proyectos y / o temas bajo la dirección del profesor de áreas específicas. Nos situamos frente al desafío de la necesidad de comprender tales acciones multiciplinares y expandirlas.Esta pesquisa analisa questões relativas à efetivação de abordagens interdisciplinares nos diferentes subprojetos em desenvolvimento no PIBID/UEL. Para tanto, aprofundamos o estudo da temática em formação de professores e no conceito de interdisciplinaridade. Teoricamente, abordamoscomo a interdisciplinaridade é apresentada nos documentos oficiais sobre o PIBID, logo a escolha metodológica foi a análise documental. Empiricamente, coletamos dados junto aos relatos dos participantes de um evento e afunilamos no estudo de um projeto desenvolvido na área de Matemática,com o tema Cultura Africana. A análise dos dados aponta que a interdisciplinaridade presente no PIBID/UEL concretiza-se a partir de projetos e/ou temas sob a regência do professor de áreas específicas. Colocamo-nos frente ao desafio da necessidade de compreender tais ações como transdisciplinares e expandi-las