Occupational pesticide exposure and the risk of death in patients with Parkinson’s disease : an observational study in southern Brazil

Background: Multiple studies have suggested that various pesticides are associated with a higher risk of developing Parkinson’s disease (PD) and may influence the progression of the disease. However, the evidence regarding the impact of pesticide exposure on mortality among patients with PD is equivocal. This study examines whether pesticide exposure influences the risk of mortality among patients with PD in Southern Brazil. Methods: A total of 150 patients with idiopathic PD were enrolled from 2008 to 2013 and followed until 2019. In addition to undergoing a detailed neurologic evaluation, patients completed surveys regarding socioeconomic status and environmental exposures. Results: Twenty patients (13.3%) reported a history of occupational pesticide exposure with a median duration of exposure of 10 years (mean = 13.1, SD = 11.2). Patients with a history of occupational pesticide exposure had higher UPDRS-III scores, though there were no significant differences in regards to age, sex, disease duration, Charlson Comorbidity Index, and age at symptom onset. Patients with occupational pesticide exposure were more than twice as likely to die than their unexposed PD counterparts (HR = 2.32, 95% CI [1.15, 4.66], p = 0.018). Occupational pesticide exposure was also a significant predictor of death in a cox-proportional hazards model which included smoking and caffeine intake history (HR = 2.23, 95% CI [1.09, 4.59], p = 0.03)) and another which included several measures of socioeconomic status (HR = 3.91, 95% CI [1.32, 11.58], p = 0.01). Conclusion: In this prospective cohort study, we found an increased all-cause mortality risk in PD patients with occupational exposure to pesticides. More studies are needed to further analyze this topic with longer follow-up periods, more detailed exposure information, and more specific causes of mortality

Epidemiologia da exposição pré-natal à cocaína e suas repercussões no recém-nascido

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Estudo da proteína S100B na doença de Parkinson e no parkinsonismo atípico

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Genes principais e genes predisponentes à doença de Parkinson : estudo sobre os genes PARK2, PARK6, PARK7, PARK8, SCA1, SCA2, SCA3, SCA6, SCA7 e o gene da glucocerebrosidase

A doença de Parkinson é freqüente no mundo todo, atingindo indivíduos de todas as idades e etnias. Embora comum e muito estudada, seus mecanismos causais ainda não são plenamente conhecidos e ainda não há tratamento curativo. Atualmente, são conhecidos alguns fatores ambientais e genéticos associados ao desenvolvimento da doença de Parkinson. Dentre os fatores genéticos, foram identificados diversos genes que podem, ou determinar a ocorrência da doença de forma mendeliana (genes principais), ou apenas aumentar o risco de seu surgimento (genes de suscetibilidade). Embora os fatores genéticos, em conjunto, sejam responsáveis por uma minoria dos casos, permanece relevante esta investigação, para promover um aconselhamento genético adequado para os portadores de formas mendelianas, para adequar medidas de tratamento e reconhecer características clínicas e de prognóstico, oportunizando, inclusive, ampliar o entendimento dessa condição. O presente estudo analisou pacientes portadores de doença de Parkinson em acompanhamento no Hospital de Clínicas de Porto Alegre, que apresentavam baixa idade de início dos sintomas, história familiar positiva ou presença de manifestações atípicas da doença. Essas características foram utilizadas como critério de seleção dos pacientes por estarem associadas com maior probabilidade de detecção de causas genéticas. Os pacientes foram submetidos à avaliação clínica e à testagem molecular para diversos genes principais e de suscetibilidade. Foram, posteriormente, comparadas as características clínicas dos pacientes positivos com relação aos demais pacientes estudados. Os resultados são apresentados sob a forma de três artigos, que descrevem, respectivamente, os achados moleculares da investigação para os genes causais autossômicos recessivos (genes PARK2, PARK6, PARK7 e PARK8), autossômicos dominantes (genes SCA1, SCA2, SCA3, SCA6 e SCA7) e o gene de suscetibilidade (gene GBA)

Between Policy and Justice: The Brazilian National Policy on Pharmaceuticals

With around 190 million inhabitants, Brazil is one of the fastest growing pharmaceutical markets in the world. Annually, domestic pharmaceutical sales amount to approximately U.S. $15 billion and the country also imports an estimated U.S.$4 billion in pharmaceuticals (SINDUSFARMA 2010). The consumption of medicines is unequally distributed, with the richest 15 percent of the population consuming 48 percent, and the bottom 51 percent consuming only 16 percent (Dias 2006). To remedy this, the public healthcare system, Sistema Único de Saúde (SUS), provides medicines for free for those individuals who cannot afford them but have a medical prescription confirming their need. In 2007, SUS distributed more than 443 million free medicines throughout the country (DATASUS 2007). In recent years, Brazil has seen a dramatic increase in the number of individuals who attempt to procure access to medicines through judicial lawsuits. Lawsuits generally involve individuals who were eligible for free medicines but failed to obtain medicines through the public healthcare system, either because the required medication was not covered under public pharmaceutical distribution lists or because covered medicines were not dispensed in a timely and consistent manner. Courts, by and large, have tended to rule in favor of the plaintiffs and mandate the provision of treatment by the state. While the judiciary has an important role in guaranteeing access to medicines for the population in Brazil, its role in case-by-case treatment decisions may interfere with the implementation of state health policies. This paper explores the relationship between the state and the judiciary in the provision of medicines in Brazil. It assesses strategies through which the state can improve efficiency in providing medicines and recommends that, in addition to guaranteeing individual rights, courts should also enforce the effective implementation of state health policies