Novos desafios na avaliação de tecnologias em saúde (ATS): o caso Zolgensma / New challenges in health technology assessment (HTA): the case of Zolgensma

Resumo As doenças raras ou órfãs entraram de modo importante nos negócios da indústria farmacêutica. Por outro lado, o impacto das novas tecnologias derivadas da pesquisa genômica vêm tendo presença crescente nessa indústria, com novos medicamentos sendo lançados no mercado a preços não sustentáveis para sistemas de saúde e pacientes. Essa dupla tendência coloca desafios importantes e crescentes para as políticas públicas de avaliação e incorporação de tecnologias, cujo racional hegemônico está lastreado em análise de custo-benefício entre terapias. Os preços muito altos desses medicamentos exigem revisitar esse racional e a recente tratativa entre o Ministério da Saúde e a Novartis relativa a um possível acordo de compartilhamento de risco para a incorporação do medicamento Zolgensma é uma oportunidade para essa revisita.

Abstract Rare or orphan diseases have played an important role in the pharmaceutical industry. On the other hand, the impact of new technologies derived from genomic research has been growing in this industry, with new drugs being launched on the market at unsustainable prices for health systems and patients. This double tendency poses important and growing challenges to public policies on Health Technology Assessment, whose hegemonic rationale is based on cost-benefit analysis between therapies. The very high prices of these drugs require revisiting this rationale and the recent negotiations between the Brazilian Ministry of Health and Novartis regarding a possible risk-sharing agreement for the incorporation of the drug Zolgensma is an opportunity for this revisitation.

(In)sustentabilidade financeira municipal: a frágil metodologia proposta pela PEC do Pacto Federativo / (In)sostenibilidad financiera municipal: la metodología frágil propuesta por la PEC del Pacto Federativo / Municipal financial (in)sustainability: the fragile methodology proposed by the Federative Pact PEC

Resumo A partir da Constituição da República Federativa do Brasil de 1988, os municípios foram promovidos à condição de entes federativos brasileiros. Atualmente, o Brasil conta com 1.307 pequenos municípios, com população de no máximo 5 mil habitantes. Em 2019, entrou no cenário político e legislativo a Proposta de Emenda à Constituição n° 188 (PEC 188), tendo como uma de suas proposições a extinção/incorporação de pequenos municípios considerados insustentáveis. O presente estudo tem por objetivo evidenciar fragilidades/vulnerabilidades na metodologia proposta pela PEC 188/2019 para a mensuração da sustentabilidade financeira dos pequenos municípios brasileiros. Para o alcance do objetivo, tal modelo foi analisado e aplicado a todos os 5.570 municípios brasileiros, utilizando como base os períodos de 2015 a 2020. O estudo se fundamenta em pesquisa bibliográfica e documental, com abordagens descritiva e quantitativa. Para o tratamento e a análise dos dados, foram empregadas técnicas de estatísticas descritivas e medidas de tendência central. Os resultados evidenciam que, aplicada a metodologia da PEC 188, a média nacional de sustentabilidade dos municípios brasileiros é de 5%, reduzindo-se para menos de 3% quando analisados apenas os pequenos, com até 5 mil habitantes. Tem-se ainda que mais de 85% dos municípios brasileiros, em média, são classificados como "insustentáveis" com base na metodologia da PEC, elevando para 98% essa condição se analisados apenas os pequenos. A metodologia proposta pela PEC 188 carrega fragilidades que, se não sanadas previamente a uma possível promulgação, poderão ocasionar a extinção de aproximadamente 1.224 pequenos municípios.

Resumen A partir de la Constitución de la República Federativa del Brasil de 1988, los municipios fueron promovidos a la condición de entidades federativas brasileñas. Actualmente, Brasil tiene 1.307 pequeños municipios con una población máxima de 5.000 habitantes. En 2019, entró en el escenario político y legislativo la Propuesta de Reforma a la Constitución nº 188 (PEC 188) que, entre otras, propone la extinción/incorporación de pequeños municipios considerados insostenibles. Por lo tanto, el presente estudio tiene como objetivo resaltar las debilidades/vulnerabilidades existentes en la metodología propuesta por la PEC 188/2019 para medir la sostenibilidad financiera de los pequeños municipios brasileños. Para alcanzar el objetivo, la metodología propuesta por la PEC fue analizada y aplicada en los 5.570 municipios brasileños, tomando como base los períodos de 2015 a 2020. El estudio se basa en una investigación bibliográfica y documental, con enfoques descriptivos y cuantitativos. Para el tratamiento y análisis de los datos se utilizaron técnicas de estadística descriptiva y medidas de tendencia central. Los resultados muestran que, cuando se aplica la metodología PEC-188, el promedio nacional de sostenibilidad de los municipios brasileños es del 5%, reduciéndose a menos del 3% cuando se analizan solo municipios pequeños con hasta 5.000 habitantes. Asimismo, más del 85% de los municipios brasileños, en promedio, están clasificados como insostenibles con base en la metodología PEC, y dicha condición asciende al 98% al analizar solamente los municipios pequeños. La metodología propuesta por la PEC 188 tiene debilidades que, de no ser resueltas antes de una posible promulgación, podrían llevar a la extinción de aproximadamente 1.224 pequeños municipios brasileños.

Abstract From the Constitution of the Federative Republic of Brazil of 1988, municipalities were promoted to the condition of Brazilian federative entities. Currently, Brazil has 1,307 small municipalities with a maximum population of 5,000 inhabitants. In 2019, the Proposal for Amendment to the Constitution nº 188 (PEC 188) entered the political and legislative scene, with one of its propositions being the extinction/incorporation of small municipalities considered unsustainable. Thus, this study aims to highlight existing weaknesses/vulnerabilities in the methodology proposed by PEC 188/2019 for measuring the Financial Sustainability of small Brazilian municipalities. The methodology proposed by the PEC was analyzed and applied to all 5,570 Brazilian municipalities, using the periods from 2015 to 2020 as a basis. The study is based on bibliographical and documentary research with descriptive and quantitative approaches. For data treatment and analysis, descriptive statistics and measures of central tendency techniques were used. The results show that, when the PEC-188 methodology is applied, Brazilian municipalities' national average of "sustainability" is 5%, reducing to less than 3% when only small municipalities with up to 5,000 inhabitants are analyzed. Furthermore, more than 85% of Brazilian municipalities, on average, are classified as "unsustainable" based on the PEC methodology, increasing this condition to 98% if only the stratum of small municipalities is analyzed. The methodology proposed by PEC 188 has weaknesses that, if not resolved prior to a possible enactment, could lead to the extinction of approximately 1,224 small Brazilian municipalities.

Incorporation of nurse initiated management of antiretroviral treatment course within the undergraduate nursing programme North West province

Background: According to the 90-90-90 strategy, the focus is on 90% of people living with HIV and/or AIDS knowing their HIV status, initiated on antiretroviral treatment and achieving viral suppression. The challenge is that only 74% of people living with HIV and/or AIDS are on antiretroviral treatment, and HIV mortality still occurs. Literature recommends the incorporation of a Nurse Initiated Management of Antiretroviral Treatment (NIMART) course within the undergraduate nursing programme to capacitate new nurses to manage people living with HIV and/or AIDS immediately after completion of their training. However, the NIMART course is still not incorporated, and there is dearth of information on this topic in North West Province (NWP). Aim: To explore and describe nurse educators' perceptions regarding the incorporation of NIMART course within the undergraduate nursing programme in NWP. Setting: The setting of this research study was nursing education institutions of the NWP. Methods: Phenomenography qualitative research design was followed. Twelve nurse educators underwent purposive selection and unstructured individual interviews were conducted. The research co-coder verified the findings. There were ethical considerations and trustworthiness maintained throughout the study. Results: Main themes that emerged in this study depicted benefits and challenges associated with NIMART course incorporation within the undergraduate nursing programme as stated in Table 1. Conclusion: This study concluded that NIMART course incorporation within the undergraduate nursing programme is a good and relevant idea, which requires human and non-human resources.

Determination of deuterium incorporation of new drug donafenib tosilate by two methods of LC-MS with natural isotope abundance correction and 1H NMR relative quantitative method / 药学学报

An LC-MS method with natural isotope abundance correction and a 1H NMR relative quantitative method were established to determine the deuterium incorporation of donafenib tosilate, a new deuterated drug molecule. First, the peak areas of isotopic impurities (non-deuterated and incompletely deuterated impurities) and deuterated drug were recorded through the single ion monitoring (SIM) mode of the established LC-MS method and then corrected in terms of the natural isotope abundance offered by ChemDraw soft, removing the nature isotope interference from 13C, 37Cl, etc. The corrected areas were subsequently used to calculate mol% of isotopologues (D0, D1, D2, D3) and Atom% D, namely, deuterium incorporation. In addition, a 1H qNMR experiment was conducted with the aromatic proton at δ 8.63 and the residual proton of isotopic impurities at δ 2.79 as quantitative peaks. The mixture of DMSO-d6 and D2O (10∶1) was employed as the solvent to change the spin-coupling between the residual proton and active hydrogen so that the residual proton could be measured as the single peak, and the sensitivity was greatly improved. The acquisition parameters were also optimized, and Atom% 1H and the deuterium incorporation were then calculated. The two methods were applied to samples of three commercial batches, and the testing results were almost consistent. Both methods proved accurate, sensitive, fast and independent of standard substances and accurate weighing, which could be applied to the determination of the deuterium incorporation of donafenib tosilate and provide a reference for other deuterated drugs.

Factores relacionados con la duración de lactancia materna exclusiva en madres trabajadoras de una institución universitaria ecuatoriana

RESUMEN Introducción: Ecuador no cubre las recomendaciones de mantener la lactancia materna hasta los seis meses de edad del recién nacido. Objetivo: Analizar los factores relacionados con la duración de la lactancia materna exclusiva en madres trabajadoras de una institución universitaria ecuatoriana. La población de estudio. Métodos: Estudio cuantitativo, descriptivo, transversal, con carácter retrospectivo mediante un cuestionario diseñado ad hoc que se invitó a cumplimentar a todas las madres trabajadoras que lo habían sido en los últimos 10 años de la institución. El período de ejecución del estudio fue de septiembre 2018 a junio de 2019. Resultados: Participaron 316 madres, 62,8 % recibió información sobre lactancia materna y proveniente del médico 55,6 %. La primera hora de vida amamantaron 63,9 %. Más de la mitad de las participantes amamantaron durante un periodo de 6 meses (56,9 %), con lactancia materna exclusiva una media de 4,56 meses. El principal motivo para el abandono fue hipogalactia (26,9 %); incorporación al trabajo (19,2 %); enfermedad materna (5,1 %). La media de lactancia materna exclusiva fue mayor en las madres docentes e investigadoras 4,79 (DE ± 1,8) que en las administrativas y de servicios 4,2 (DE ± 2,05), p= 0,012. Conclusiones: Entre los factores que favorecen la lactancia materna están la información durante el embarazo, así como instaurarla en la primera hora de vida. La situación laboral de la mujer influye en el mantenimiento de dicha lactancia por más tiempo y es una causa de abandono, aunque la más frecuente son los problemas de salud de la madre o del recién nacido.

ABSTRACT Introduction: Ecuador does not cover the recommendations to maintain breastfeeding until six months of age of the newborn. Objective: Analyze the factors related to the duration of exclusive breastfeeding in working mothers of an Ecuadorian university institution. The study population. Methods: Quantitative, descriptive, cross-sectional study, with retrospective character using a questionnaire designed ad hoc; all working mothers who had been in the last 10 years in the institution were invited to fill it. The study was carried out from September 2018 to June 2019. Results: 316 mothers participated, 62.8% received information on breastfeeding and 55.6% from the doctor. The first hour of life, 63.9% mothers breastfed. More than half of the participants breastfed for a period of 6 months (56.9%), and with exclusive breastfeeding during an average of 4.56 months. The main reason for not breastfeeding was hypogalactia (26.9%); work placement (19.2%); maternal disease (5.1%). The mean of exclusive breastfeeding was higher in mother who are teachers and researchers (4.79) (SD ± 1.8) than in mothers with administrative and service positions 4.2 (SD ± 2.05), p = 0.012. Conclusions: Among the factors that favor breastfeeding are information during pregnancy, as well as establishing it in the first hour of life. The employment situation of women influences the maintenance of breastfeeding for longer and is a cause of dropout, although the most frequent are the health problems of the mother or the newborn.

Incorporación laboral de migrantes sur-sur y sus hijos e hijas en Argentina: intersecciones de género, generaciones y trabajo / Incorporação laboral de migrantes sul-sul e seus filhos na Argentina: interseções de gênero, gerações e trabalho / Labor incorporation of south-south migrants and their sons and daughters in Argentina: intersections of gender, generations and work

El objetivo de este artículo es analizar los patrones generales de incorporación laboral de migrantes sur-sur y sus hijos e hijas en Argentina. En primer lugar, detallamos las características de la incorporación laboral de los migrantes y sus hijos en comparación con la población nativa y sus hijos. En segundo lugar, analizamos las formas de la incorporación en los diferentes segmentos laborales de la sociedad argentina. Los resultados obtenidos sugieren una incorporación estructurada por los vectores de género y generaciones. Las generaciones más jóvenes dentro del hogar (hijas e hijos tanto de población nativa como migrante) se incorporan en los segmentos más precarios y esta incorporación interactúa, de manera complementaria, con el género. Las mujeres hijas de hogares migrantes se insertan mayoritariamente en los segmentos más bajos de la estructura laboral mientras que, en el otro extremo, los hombres nativos se incorporan en mayor proporción en los segmentos más altos de la estructura laboral.

O objetivo deste artigo é analisar os padrões gerais de incorporação laboral dos migrantes sul-sul e seus filhos e filhas na Argentina. Primeiro, detalhamos as características de incorporação laboral dos migrantes e seus filhos em comparação com a população nativa e seus filhos. Em segundo lugar, analisamos as formas de incorporação nos diferentes segmentos laborais da sociedade argentina. Os resultados obtidos sugerem uma incorporação estruturada pelos vetores de gênero e de gerações. As gerações mais jovens dentro do lar (filhas e filhos tanto da população nativa como da migrante) são incorporadas nos segmentos mais precários e, de forma complementar, esta incorporação interage com o gênero. As mulheres filhas de lares migrantes inserem-se, maiormente, nos segmentos mais baixos da estrutura laboral, enquanto, no outro extremo, os homens nativos incorporam-se nos segmentos mais altos da estrutura laboral.

The objective of this article is to analyze the general patterns of labor incorporation of migrants and children of south-south migrants in Argentina. Firstly, we detailed the characteristics of the labor incorporation of migrants and their children in comparison with the native population and their children. Secondly, we analyzed the forms of incorporation into the different labor segments of Argentine society. The results obtained suggest an incorporation structured by the vectors of gender and generations. The younger generations within the household (daughters and sons of both native and migrant populations) are incorporated into the most precarious segments and in a complementary way, this incorporation interacts with gender. Women who are daughters of migrant households are mostly inserted in the lower segments of the labor structure, while at the other extreme, native men are incorporated in a greater proportion in the higher segments of the labor structure.

Decline in Public Spending on Biopharmaceutics in Brazil

Abstract Biopharmaceuticals, mainly monoclonal antibodies, and fusion proteins are drugs that have gained notoriety in the treatment of various chronic and inflammatory diseases and have high prices. The study aimed to verify which monoclonal antibodies and fusion proteins were most incorporated into the Unified Health System (SUS), which therapeutic indication most benefited from them and to analyze public spending on these biopharmaceuticals from January 2012 to September 2019. This study performed a qualitative and quantitative analysis of biopharmaceuticals incorporated by SUS. The data were collected on the websites of CONITEC and the Health Price Bank. The results demonstrated that subcutaneous adalimumab was most frequently incorporated, and the most requested therapeutic indication was rheumatoid arthritis. Public spending on biopharmaceuticals exceeded R$ 28 billion (more than US$ 140 billion). However, a downward trend was confirmed (-266.7%) in the period evaluated. Despite the increase in demand and public spending on biologics in general, in Brazil and worldwide, the results of this research show that there was a drop in public spending on the biopharmaceuticals studied in the last seven years.

The Effects of Three and Six Sessions of Low Energy Extracorporeal Shockwave Therapy on Graft Incorporation and Knee Functions Post Anterior Cruciate Ligament Reconstruction

@#Introduction: One session of high energy extracorporeal shockwave therapy (ESWT) was found to improve the healing of anterior cruciate ligament (ACL) after reconstruction in animal and human studies. This study investigated the effects of three and six sessions of low energy ESWT on graft incorporation and knee functions post ACL reconstruction in humans. Materials and methods: Thirty participants with ACL injuries were recruited and assigned equally into three groups with 10 participants per group (n=10). Participants in the control group received physiotherapy alone without low energy ESWT. Participants in the 3ESWT group underwent three sessions of low energy ESWT (one session per week) combined with physiotherapy, and participants in the 6ESWT group received six sessions of low energy ESWT (one session per week) combined with physiotherapy. However, five participants were lost to follow-up. Evaluations of graft incorporation of the tibial tunnel using magnetic resonance (MRI) and Lysholm score were carried out before ACL reconstruction and after six months post ACL reconstruction. Results: The number of grafts with partial incorporation in the tibia tunnel in 6ESWT was significantly higher compared with the number of grafts with non-incorporation at six months post-operatively, X2 (1, N=9) =5.44, p =0.02. However, there was no significant difference between frequencies of graft incorporation in tibia tunnel in the control and 3ESWT groups, X2 (1, N=7) =3.57, p =0.06 and X2 (1, N=9) =2.78, p =0.10, respectively at 6 months postoperatively. Lysholm scores were significantly higher at 6 months post ACL reconstruction compared to the baseline value for each group (p<0.002, respectively). However, there was no significant difference in the Lysholm score between each group (F = 2.798, p = 0.083). Conclusions: Six sessions of low energy ESWT improved graft incorporation in the tibial tunnel. Both three and six sessions of low energy of ESWT does not affect the knee function score at six months post ACL reconstruction.

Política de Ciência, Tecnologia e Inovação em Saúde (CT& I/S): uma atualização para debate / Health Science, Technology and Innovation Policy (ST& I/H): an update for debate

Resumo O texto contém uma proposta atualizada de política de Ciência, Tecnologia e Inovação em Saúde no Brasil e a pertinência da atualização decorre do desastre nas atividades nesse terreno verificadas no país desde o início do atual governo federal em 2019, bem como dos desafios colocados pela emergência da pandemia COVID-19 desde 2020. Ele está organizado em cinco seções, a saber: Pesquisa em Saúde; Inovação Produtiva; Avaliação e Incorporação de Tecnologias em Saúde; Propriedade Intelectual em Saúde; Novos desafios colocados pela Pandemia. Os autores fazem parte do Comitê de Assessoramento em Ciência, Tecnologia e Inovação da Abrasco.

Abstract The text presents an updated proposal for a Health Science, Technology and Innovation Policy in Brazil, following the huge political turmoil in the country since 2019 and the COVID-19 pandemic since 2020. The proposal is presented in five sections: Scientific Research; Productive Innovation; Health Technology Assessment and Incorporation; Intellectual Property in Health; New challenges posed by the Pandemic. The authors take part in the Advisory Committee in Science, Technology and Innovation of the Brazilian Association of Collective Health.

Study of intracellular anabolism of 5-fluorouracil and incorporation in nucleic acids based on an LC-HRMS method / 药物分析学报

5-Fluorouracil(5-FU)is an anticancer drug extensively used for different cancers.Intracellular metabolic activation leads to several nucleoside and nucleotide metabolites essential to exert its cytotoxic activity on multiple cellular targets such as enzymes,DNA and RNA.In this paper,we describe the development of a method based on liquid chromatography coupled with high resolution mass spectrometry suitable for the simultaneous determination of the ten anabolic metabolites(nucleoside,nucleotide and sugar nucleotide)of 5-FU.The chromatographic separation was optimized on a porous graphitic carbon column allowing the analysis of the metabolites of 5-FU as well as endogenous nucleotides.The detection was performed on an Orbitrap? tandem mass spectrometer.Linearity of the method was verified in intra-cellular content and in RNA extracts.The limit of detection was equal to 12 pg injected on column for nucleoside metabolites of 5-FU and 150 pg injected on column for mono-and tri-phosphate nucleotide metabolites.Matrix effect was evaluated in cellular contents,DNA and RNA extracts for nucleoside and nucleotides metabolites.The method was successfully applied to i)measure the proportion of each anabolic metabolite of 5-FU in cellular contents,ii)follow the consequence of inhibition of enzymes on the endogenous nucleotide pools,iii)study the incorporation of metabolites of 5-FU into RNA and DNA,and iv)to determine the incorporation rate of 5-FUrd into 18 S and 28 S sub-units of rRNA.

Sources and management of nitrogen before or after irrigation on the winter wheat and bean production / Fontes de nitrogênio e manejo antes ou após a irrigação nas culturas do trigo e feijoeiro "de inverno"

Studies that demonstrate the effects of sources of nitrogen (N) applied before or after irrigation on the yield of winter crops are limited in literature. In this sense, the objective of this study was to compare the effect of sources of N applied immediately before or after 13 mm irrigation of wheat and bean winter crops. It was used a randomized complete block design, with 4 replicates, in a 5 × 2 + 1 factorial scheme, and 11 treatments consisted of five N sources: urea, polymer-coated urea, urea + ammonium sulfate, ammonium sulfate, and ammonium nitrate and a control treatment (without N fertilization). For wheat, although ammonium nitrate provided great N content in the leaves, the grain yield was lower due to the lodging of the plants; since the application of N either before or after irrigation did not influence the grain yield. Regarding the bean, N fertilization increased productivity, but there were no differences among N sources and, despite the greater N content in the leaves observed with the N supply before irrigation the greatest grain yield was observed when N was applied after the irrigation.

Estudos que demonstram os efeitos de fontes de nitrogênio (N) aplicadas antes ou após a irrigação na produtividade das culturas de inverno são limitados na literatura. Neste sentido, o objetivo deste trabalho foi comparar o efeito de fontes de N aplicadas imediatamente antes ou após a irrigação de 13 mm nas culturas do trigo e feijão de inverno. Utilizou-se o delineamento de blocos casualizados, com 4 repetições, em esquema fatorial incompleto 5 × 2 + 1, sendo 11 tratamentos com cinco fontes de N: ureia, ureia revestida com polímero, ureia + sulfato de amônio, sulfato de amônio e nitrato de amônio e um tratamento controle (sem adubação nitrogenada). Para o trigo, embora o nitrato de amônio tenha proporcionado maior teor de N nas folhas, a produtividade de grãos foi menor devido ao acamamento das plantas; já a aplicação de N antes ou após a irrigação não influenciou a produtividade de grãos. Com relação ao feijão, a adubação nitrogenada aumentou a produtividade, mas não houve diferenças entre as fontes de N e, apesar do maior teor de N nas folhas observadas com o suprimento de N antes da irrigação, a maior produtividade de grãos foi observada com a adubação após a irrigação.

Effect of nitrogen application through urea and Azolla on yield, nutrient uptake of rice and soil acidity indices in acidic soil of Meghalaya

Aim: To investigate the effect of nitrogen application through urea and Azolla on yield, nutrient uptake of rice (Oryza sativa L.) cv. Shasharang and to assess the improvement in soil acidity indices in acidic soil of Meghalaya.Methodology: A field experiment was conducted with six treatments viz., control (T1), Azolla incorporation @ 1.6 tonnes ha-1 (T2), 30 kg N ha-1 through urea (T3), 60 kg N ha-1 through urea (T4), 30 kg N ha-1 through urea + Azolla incorporation @ 1.6 tonnes ha-1 (T5) and 60 kg N ha-1 through urea with Azolla incorporation @ 1.6 tonnes ha-1 (T6). The experiment was laid out in RBD and replicated four times. The physico-chemical properties of the experimental soil were pH 5.1, SOC 1.75 percent, available N, P and K as 288.62, 17.23 and 201.46 kg ha-1, respectively. Results: The application of 60 kg N ha-1 through urea along with Azolla incorporation @ 1.6 tonnes ha-1 (T6) recorded highest dry matter i.e. 58. 15 g hill-1 at maturity of rice. Similarly, 60 kg N ha-1 through urea with Azolla incorporation @ 1.6 tonnes ha-1 produced highest grain and straw yield i.e. 4.2 t ha-1 and 7.68 t ha-1 followed by T5 and T4. The magnitude of increase in N, P and K concentration and uptake in grain was 28.57, 97.02; 26.09, 84.21 and 15.69, 76.47 percent in T6 over T1. The analysis of soil acidity indices indicated that highest improvement in pH was observed in T2 over all other treatments. Further, pH increased significantly in the treatments receiving Azolla incorporation (T2, T5 and T6) compared with the sole application of urea/control (T1, T3 and T4). The exchangeable calcium and magnesium (meq 100 g-1), CEC (meq 100 g-1) and base saturation percentage also showed the same trends and the highest values were observed as 1.92, 7.90 and 24.30 in T2. However, in contrast to this, the lowest values of exchangeable aluminium, exchangeable acidity and acidity saturation percentage were observed in T2 indicating that the sole application of Azolla improved soil acidity indices. Interpretation: It may be concluded from the present study that Azolla-urea nitrogen system may be suitable for getting optimum production of rice under tropical conditions and improving soil acidity indices because of its ability to fix atmospheric nitrogen.

Evaluation of Erythrocyte Iron Incorporation in Beijing Prepubertal Children Using a Single Stable Isotope Tracer Method / 生物医学与环境科学（英文）

Objective@#To analyze the rate of erythrocyte iron incorporation and provided guidance for the iron nutrition for prepubertal children.@*Methods@#Fifty-seven prepubertal children of Beijing were involved in this study and each subject was orally administered 3 mg of Fe twice daily to obtain a total of 30 mg Fe after a 5-d period. The stable isotope ratios in RBCs were determined in 14th day, 28th day, 60th day, and 90th day. The erythrocyte incorporation rate in children was calculated using the stable isotope ratios, blood volume and body iron mass.@*Results@#The percentage of erythrocyte Fe incorporation increased starting 14 th day, reached a peak at 60 d (boys: 19.67% ± 0.56%, girls: 21.33% ± 0.59%) and then decreased. The erythrocyte incorporation rates of Fe obtained for girls in 60th day was significantly higher than those obtained for boys ( < 0.0001).@*Conclusions@#The oral administration of Fe to children can be used to obtain erythrocyte iron incorporation within 90 d. Prepubertal girls should begin to increase the intake of iron and further studies should pay more attention to the iron status in prepubertal children.

Corporalidad y discapacidad intelectual: aportes a la comprensión de la dimensión social de la discapacidad desde la sociología del cuerpo / Corporality and Intellectual Disability: Contributions to the Understanding of the Social Dimension of Disability from the Sociology of the Body / Corporalidade e intelectuais deficiência: contribuições para a compreensão da dimensão social da deficiência da sociologia do corpo

Resumen Introducción: En el artículo se pretende explorar la forma en la que el proceso de incorporación de la discapacidad, el cual tiene como epicentro el cuerpo de las personas y conjuga la tensión entre las estructuras y la agencia, se vuelve fundamental para comprender la dimensión social de la discapacidad intelectual. Desarrollo: Como primer paso, se deconstruye el proceso de incorporación de la discapacidad intelectual al analizar las implicaciones que este proceso tiene para el cuerpo. A partir de esto, se exploran los mecanismos de manifestación corporal de la discapacidad intelectual. Finalmente, se indaga por la forma en la que la incorporación de la discapacidad y la manifestación corporal de esta permiten a la persona vivirla de maneras particulares. Conclusiones: Se concluye que la discapacidad no es solo una característica que se le impone a la persona desde afuera de su singularidad, sino que esta tiene la capacidad de construirla y transformarla constantemente mediante el uso de su cuerpo individual. De esta manera, la comprensión de la dimensión social de la discapacidad parte por reconocer las repercusiones, negociaciones y manifestaciones diferenciadas de la discapacidad intelectual.

Abstract Introduction: The article explore the way in which the process of incorporation of disability, which has as its epicenter the body and combines the tension between the social structures and the agency of the social actors, becomes fundamental for the understanding of the social dimension of intellectual disability. Development: This start by de-constructing the process of incorporation of the intellectual disability analyzing the implications that this process has for the body. From this, explore the mechanisms of corporal manifestation of intellectual disability. Finally, I explore the way in which the incorporation of the disability and the corporal manifestation of this allow the person who lives it in particular ways. Conclusions: It conclude that disability is not only a characteristic that is imposed on the person from outside his singularity, but that he has the capacity to build and transform it constantly through the use of his individual body. In this way, the understanding of the social dimension of disability starts by recognizing the repercussions, negotiations and different manifestations of intellectual disability.

Resumo Introdução: O artigo pretende explorar as formas em que o processo de integração da discapacidade tornase fundamental para a compreensão da dimensão social da deficiência intelectual. Desenvolvimento: Comece de-construindo o processo de incorporação da deficiência intelectual analisando a implicação que este processo tem para o corpo. A partir daí, explorei os mecanismos de manifestação corporal de deficiência intelectual. Finalmente, indagei como a integração da deficiência corporal e a manifestação da mesma permite à pessoa que a vive usá-la e vivê-la de forma particular. Conclusões: Destacou como a deficiência não é apenas uma característica que é imposta ao indivíduo sobre sua individualidade, senão que também o sujeito tem a capacidade de construí-la e transformá-la constantemente usando seu corpo. Assim, compreender a dimensão social da deficiência começa por reconhecer o impacto, negociações e diferentes manifestações da deficiência intelectual.

Evaluación de Tecnologías en Salud: Un Enfoque Hospitalario para la Incorporación de Dispositivos Médicos / Assessment of Health Technologies: A Hospital Approach for the Incorporation of Medical Devices

Resumen Este artículo presenta el estado del arte acerca de las evaluaciones de tecnología y los aportes que han sido realizados a nivel hospitalario en diversos países del mundo. La incorporación de tecnologías sanitarias está enfocado al mejoramiento de la calidad y la eficiencia en la prestación de los servicios de salud. La evaluación de tecnología son un proceso científico, multidisciplinario y multidimensional que tiene como objetivo contribuir y mejorar la toma de decisiones en los procedimientos de adquisición e incorporación tecnológica, mediante la evaluación comparativa de los efectos positivos y negativos de las tecnologías en hospitales. El propósito generalmente considera diversas alternativas, proporcionando la mejor selección de tecnología que compense las necesidades médicas en instituciones de salud. A nivel mundial han trabajado constantemente para mejorar los procesos de evaluación de tecnología en el ámbito nacional y hospitalario. La implementación de las metodologías de evaluación en hospitales permite contribuir a la disminución de los riesgos generados por el uso de los dispositivos o equipos médicos en relación con la seguridad de los pacientes implementando tecnologías eficaces para diversos tratamientos. En conclusión, la evaluaciones de tecnología es un proceso fundamental que proporciona información relevante para la toma de decisiones para las incorporaciones de nuevos dispositivos médicos en hospitales.

Abstract This article presents the state of the art about the evaluations of technology and the contributions that have been made at a hospital level in different countries of the world. The incorporation of health technologies is focused on the improvement of quality and efficiency in the provision of health services. The evaluation of technology is a scientific, multidisciplinary and multidimensional process that aims to contribute and improve decision making in the procedures of acquisition and technological incorporation, through the comparative evaluation of the positive and negative effects of technologies in hospitals. The purpose generally considers various alternatives, providing the best selection of technology that compensates for medical needs in health institutions. At the global level, they have constantly worked to improve the technology assessment processes at the national and hospital levels. The implementation of evaluation methodologies in hospitals allows contributing to the reduction of the risks generated using medical devices or equipment in relation to patient safety by implementing effective technologies for various treatments. In conclusion, the technology assessment is a fundamental process that provides relevant information for decision making for the incorporation of new medical devices in hospitals.

Migración sur-sur y desigualdad: alteraciones en la incorporación laboral de migrantes peruanos en la Ciudad de Córdoba, Argentina, 2001-2010 / South-South migration and inequality: alterations in the labor incorporation of peruvian migrants in the City of Córdoba, Argentina, 2001-2010

Resumen Objetivo: analizar la incorporación laboral de los migrantes peruanos en la ciudad de Córdoba, Argentina, en el periodo 2001-2010. Métodos: Se realiza análisis estadístico descriptivo en la primera fase y análisis de correspondencias múltiples en la segunda fase (ACM), ambos en perspectiva comparada con la población nativa. Resultados: los hombres aumentan la participación en la industria, tanto los nativos como los migrantes. Sin embargo, en mayor magnitud para los hombres peruanos. Las mujeres nativas ven poco alterada su estructura ocupacional en el periodo. Para las mujeres nacidas en Perú el movimiento hacia el sector de la industria también se aprecia. Sin embargo, el rasgo más destacable para este grupo es la desconcentración de la categoría más frecuente: el trabajo doméstico, en un proceso que va en dirección a diversificar el espectro de ocupaciones. Conclusiones: en relación a los migrantes peruanos, el clivaje de género presenta estabilidad como un mecanismo que explica las inserciones diferenciales, donde las mujeres persisten en ocupaciones específicas en el periodo considerado. Esto apoya la hipótesis de una incorporación segmentada para las mujeres. Sin embargo, también se observa una variación, ya que aunque la categoría más frecuente sea el trabajo doméstico en ambos momentos censales, la menor proporción de ellas allí empleadas en el 2010, indica que otras ocupaciones adquieren relevancia. En el caso de los hombres el principal rasgo es el trasvase hacia la industria.

Abstract Objective: to analyze the labor incorporation of Peruvian migrants in the city of Córdoba, Argentina, in the period 2001-2010. Methods: We use descriptive statistical analysis in the first step and analysis of multiple correspondences in the second step (MCA), both in comparative perspective with the native population. Results: men increase participation in the industry, both natives and migrants. However, the magnitude is greater for Peruvian men. For native women, the change in the occupational structure is small. For women born in Peru the movement towards the industry sector is also appreciated. However, the most remarkable feature for this group is the scattering of the most frequent category: domestic work, in a process that goes in the direction of diversifying the spectrum of occupations. Conclusions: in relation to Peruvian migrants, gender cleavage presents stability as a mechanism that explains differential incorporation, where women persist in specific occupations in the period considered. This supports the hypothesis of a segmented incorporation for women. However, there is also a variation, since although the most frequent category is domestic work in both census periods, the lower proportion of them employed there in 2010 indicates that other occupations acquire relevance. In the case of men, the main feature is the transfer to industry.

Biosynthesis of antibiotic chuangxinmycin from

Chuangxinmycin is an antibiotic isolated from CPCC 200056 in the 1970s with a novel indole-dihydrothiopyran heterocyclic skeleton. Chuangxinmycin showed antibacterial activity and efficacy in mouse infection models as well as preliminary clinical trials. But the biosynthetic pathway of chuangxinmycin has been obscure since its discovery. Herein, we report the identification of a stretch of DNA from the genome of CPCC 200056 that encodes genes for biosynthesis of chuangxinmycin by bioinformatics analysis. The designated cluster was then confirmed to be responsible for chuangxinmycin biosynthesis by direct cloning and heterologous expressing in M1146. The cytochrome P450 CxnD was verified to be involved in the dihydrothiopyran ring closure reaction by the identification of seco-chuangxinmycin in M1146 harboring the gene cluster with an inactivated . Based on these results, a plausible biosynthetic pathway for chuangxinmycin biosynthesis was proposed, by hijacking the primary sulfur transfer system for sulfur incorporation. The identification of the biosynthetic gene cluster of chuangxinmycin paves the way for elucidating the detail biochemical machinery for chuangxinmycin biosynthesis, and provides the basis for the generation of novel chuangxinmycin derivatives by means of combinatorial biosynthesis and synthetic biology.

Corpo pulsional e seus desvarios: voz e corpo anoréxico / Drive body and its ravings: voice and anorexic body

Resumo: Na clínica psicanalítica, observa-se que, embora a ideologia que entroniza a magreza como um ideal esteja sempre bem representada no discurso da anoréxica, também está presente na anorexia a voz de um supereu feroz que incita à obediência, e cujos mandatos de auto-destruição, muitas vezes, levam efetivamente à morte. A anorexia visa abrir um furo no Outro, promovendo uma separação entre o sujeito e o Outro materno que possibilite o desejo. Entretanto, a pulsão de morte, presente em diferentes amálgamas com a libido e representada pelo ódio do supereu, é um obstáculo de monta para a ação do psicanalista.

Abstract: Drive and its madness: voice and the anorexic body. In the psychoanalytic clinic, we observe that, although the ideology that enthrones slimness as a contemporary ideal is always represented in the discourse of the anorexic, the voice of a cruel superego is also present in anorexia, in which the mandates of self-destruction, very often, lead effectively to death. Anorexia aims to open a hole in the Other, promoting a separation between the subject and the maternal Other, which makes desire possible. However, the death drive, amalgamated in different proportions to Eros and represented by the hatred of the superego, is an obstacle for the action of the psychoanalyst.

Pesquisadores brasileiros na pós-graduação de Antropologia Médica na Espanha: relato de experiência / Investigadores brasileños en el post-grado de antropología médica en España: relato de experiencia / Brazilian researchers in Medical Anthropology Postgraduate Studies in Spain: Experience Report

O objetivo do manuscrito foi relatar e discutir a experiência de pesquisadores brasileiros, do campo da saúde, em um programa da área da antropologia. Trata-se de relato de experiência elaborado na perspectiva de se reconhecerem e discutirem, de maneira crítica, as experiências dos pesquisadores no campo antropológico da educação continuada e permanente, tendo como cenário o doutorado em Antropologia e Comunicação da Universitat Rovira i Virgil em Tarragona, Espanha. O relato da imersão dos pesquisadores nos estudos sobre antropologia médica e saúde global revelou a ampliação de horizontes sobre a compreensão do processo de saúde-enfermidade-atenção, possibilitando a análise do fenômeno sob outra perspectiva, onde os valores da sociedade e da cultura estão fortemente presentes.

El objetivo del manuscrito fue relatar y discutir la experiencia de investigadores brasileños, del campo de la salud, en un programa del área de la antropología. Se trata de un relato de experiencia elaborado desde la perspectiva de reconocer y discutir, de manera crítica, las experiencias de los investigadores en el campo antropológico de la educación continuada y permanente, teniendo como escenario el doctorado en Antropología y comunicación de la Universitat Rovira i Virgil en Tarragona, España. El relato de la inmersión de los investigadores en los estudios sobre antropología médica y salud global reveló la ampliación de horizontes sobre la comprensión del proceso de salud-enfermedad-atención, posibilitando el análisis del fenómeno bajo otra perspectiva, en donde los valores de la sociedad y de la cultura están fuertemente presentes.

The purpose of this manuscript was to report and discuss the experience of Brazilian health researchers, going through a program in the area of anthropology. This experience report aims to acknowledge and critical discuss the experiences of the researchers in the anthropology field of continued and permanent education, in the background of the PhD course in Anthropology and Communication of the Universitat Rovira i Virgili in Tarragona, Spain. The immersion studies on medical anthropology and global health done by the researchers widened their understanding of the health-disease-care process, enabling the analysis of the phenomenon from another perspective, where the society and cultural values are strongly present.

Evaluation of demands of inclusion, exclusion and alteration of technologies in the Brazilian Health System submitted to the National Committee on Technology Incorporation

ABSTRACT The steady increase in the number of health technologies and advances in associated research generate management challenges in the choice of technologies to be made available to the public. From 2011, the process of inclusion, exclusion and alteration of technologies to the Brazilian Unified Health System (SUS) has undergone major transformations, such as the creation of the National Committee on Technology Incorporation (CONITEC). This study analyzed the decisions of CONITEC since its inception until July 2015. The analyzed variables were: type of technology, reason for application, name of the technology, indication, claimant and CONITEC decision status. We found that the Government was the main claimant, accounting for 58.1% of the 420 cases. The most frequent request was inclusion (93.8%) and the technology type was medicine (61.4%). Of the incorporated medicines, the classes of antineoplastic/immunomodulatory were the most frequent (39.47%). Society's desire for inclusion of an increasing amount of health technology contrasts with the limited resources available to management, which causes budget concerns. Using Health Technology Assessment (HTA), advances resulting from these innovations in the process were highlighted, and challenges were identified for the management and the academic community.