Pests, development and inequalities. / Pestes, desenvolvimento e desigualdades.

This article discusses questions concerning the future of humanity in the face of threats to the health of populations, whose impact has been exacerbated in the course of inequalities in all parts of the world, pari passu with global development in the hegemonized model since last century. The COVID-19 pandemic is a good example that illustrates this dissonance between development and inequalities. Questions were formulated to be debated about the construction of the future of world society, based on the understanding of the evolutionary character of life on the planet vis-à-vis the evils that affect large contingents of the population and represent powerful risks for this evolutionary process. These questions call attention to the discussion around social participation in the definition and control of public policies, as opposed to the hegemony of private interests in the formulation and execution of these policies, both in the scenarios of each country and in the international context.

O artigo discute questões sobre o futuro da humanidade ante as ameaças que rondam a saúde das populações, cujo impacto vem se exacerbando no curso das desigualdades em todas as partes do mundo, pari passu o desenvolvimento global no modelo hegemonizado a partir do século passado. A pandemia de COVID-19 foi tomada como um caso que bem ilustra essa dessintonia entre desenvolvimento e desigualdades. Formulam-se perguntas a serem postas em debate sobre a construção do futuro da sociedade mundial, com base na acepção sobre o caráter evolucional da vida no planeta vis-à-vis os males que acometem grandes contingentes populacionais e representam poderosos riscos para esse processo evolutivo. São indagações que apontam para a discussão em torno da participação social na definição e no controle das políticas públicas, em contrapartida à hegemonia dos interesses privados na formulação e execução dessas políticas, tanto nos cenários de cada país como no contexto internacional.

Pestes, desenvolvimento e desigualdades / Pests, development and inequalities

Resumo O artigo discute questões sobre o futuro da humanidade ante as ameaças que rondam a saúde das populações, cujo impacto vem se exacerbando no curso das desigualdades em todas as partes do mundo, pari passu o desenvolvimento global no modelo hegemonizado a partir do século passado. A pandemia de COVID-19 foi tomada como um caso que bem ilustra essa dessintonia entre desenvolvimento e desigualdades. Formulam-se perguntas a serem postas em debate sobre a construção do futuro da sociedade mundial, com base na acepção sobre o caráter evolucional da vida no planeta vis-à-vis os males que acometem grandes contingentes populacionais e representam poderosos riscos para esse processo evolutivo. São indagações que apontam para a discussão em torno da participação social na definição e no controle das políticas públicas, em contrapartida à hegemonia dos interesses privados na formulação e execução dessas políticas, tanto nos cenários de cada país como no contexto internacional.

Abstract This article discusses questions concerning the future of humanity in the face of threats to the health of populations, whose impact has been exacerbated in the course of inequalities in all parts of the world, pari passu with global development in the hegemonized model since last century. The COVID-19 pandemic is a good example that illustrates this dissonance between development and inequalities. Questions were formulated to be debated about the construction of the future of world society, based on the understanding of the evolutionary character of life on the planet vis-à-vis the evils that affect large contingents of the population and represent powerful risks for this evolutionary process. These questions call attention to the discussion around social participation in the definition and control of public policies, as opposed to the hegemony of private interests in the formulation and execution of these policies, both in the scenarios of each country and in the international context.

Neglected tropical diseases and systemic racism especially in Brazil: from socio-economic aspects to the development of new drugs.

Neglected tropical diseases (NTDs) are highly prevalent communicable diseases in tropical and subtropical countries, generally not economically attractive for drug development and related to poverty. In Brazil, more specifically, socioeconomic inequalities and health indicators are strongly influenced by skin color, race, and ethnicity, due to the historical process of slavery. In this context, it is important to understand the concept of systemic racism: a form of indirect racial discrimination present in many institutions, which determines the process of illness and death of the black population, the ethnic group most affected by these diseases. The main objective of this paper was to carry out a literature review on the socioeconomic aspects of these diseases, relating them to institutional racism, and to encourage reflection on the influence of this type of racism in the NTDs context. Therefore, we present a paper that brings a evident correlation between racism versus neglected populations, which are affected by equally neglected diseases. A more humane and comprehensive view is needed to realize that these illnesses affect neglected and vulnerable populations, who require decent living conditions, health, and social justice. We hope to provide, with this paper, enough, but not exhaust, knowledge to initiate the discussion about neglected diseases, their socioeconomic aspects and institutional racism.

Entrevista: desigualdade é o conceito-chave para a discussão da saúde no contexto internacional / Interview: inequality the key concept when discussing health internationally

O desenvolvimento econômico, científico, tecnológico e a inovação influenciam as desigualdades entre os países, especialmente nas condições de saúde e de bem-estar de suas populações. Este é um fenômeno que ocorre entre países e dentro deles. Como essas desigualdades podem ser diminuídas e como analisar a saúde no contexto internacional são os temas dessa entrevista com Gastão Wagner, presidente da Associação Brasileira de Saúde Coletiva (Abrasco).

[Netnography and the bioethical analysis of therapeutic tourism blogs for stem cells]. / Netnografia e análise bioética de blogs de turismo terapêutico com células-tronco.

Therapeutic tourism is a recent phenomenon in public health and has had repercussions among people with disabilities. Virtual social networks have enabled people to organize themselves to discover ways and means of seeking unconventional treatments in China. In this context, foreign biotech companies have offered experimental cell treatment therapies. In this work, netnography (conducting ethnographic research online) was conducted on the blogs of 58 people who organized campaigns to carry out treatment in China. In the analysis it was found that the main motivation for mobilization of resources and people in order to submit a disabled child to a treatment with stem cells without scientific proof is the rhetoric of hope promoted by stem cell laboratories. The conclusion drawn is that due to the ethical, legal and health implications, debate on the subject should be broadened in order to protect vulnerable individuals against inadvertent exposure to health risks due to treatments without proven control or rigor.

Netnografia e análise bioética de blogs de turismo terapêutico com células-tronco / Netnography and the bioethical analysis of therapeutic tourism blogs for stem cells

Resumo O turismo terapêutico é um fenômeno sanitário recente e tem repercutido entre as pessoas com deficiência. As redes sociais virtuais têm permitido que pessoas se organizassem para descobrir rotas e meios de buscar tratamentos não convencionais na China. Nesse contexto, empresas estrangeiras de biotecnologia têm ofertado terapias celulares experimentais. Neste trabalho realizou-se netnografia de 58 blogs de pessoas que organizaram campanhas para realizar tratamento na China. Na análise verificou-se que a principal motivação para a mobilização de recursos e pessoas a fim de submeter um filho com deficiência a um tratamento com células-tronco sem comprovação científica é a retórica de esperança aportada por tais empresas. Concluímos que, pelas implicações éticas, legais e sanitárias deve-se ampliar o debate sobre o tema a fim de proteger os sujeitos vulnerados de uma exposição inadvertida a riscos de saúde por tratamentos sem controle ou rigor.

Abstract Therapeutic tourism is a recent phenomenon in public health and has had repercussions among people with disabilities. Virtual social networks have enabled people to organize themselves to discover ways and means of seeking unconventional treatments in China. In this context, foreign biotech companies have offered experimental cell treatment therapies. In this work, netnography (conducting ethnographic research online) was conducted on the blogs of 58 people who organized campaigns to carry out treatment in China. In the analysis it was found that the main motivation for mobilization of resources and people in order to submit a disabled child to a treatment with stem cells without scientific proof is the rhetoric of hope promoted by stem cell laboratories. The conclusion drawn is that due to the ethical, legal and health implications, debate on the subject should be broadened in order to protect vulnerable individuals against inadvertent exposure to health risks due to treatments without proven control or rigor.

Reducing child global undernutrition at scale in Sofala Province, Mozambique, using Care Group Volunteers to communicate health messages to mothers.

BACKGROUND: Undernutrition contributes to one-third of under-5 child mortality globally. Progress in achieving the Millennium Development Goal of reducing under-5 mortality is lagging in many countries, particularly in Africa. This paper shares evidence and insights from a low-cost behavior-change innovation in a rural area of Mozambique. INTERVENTION: About 50,000 households with pregnant women or children under 2 years old were organized into blocks of 12 households. One volunteer peer educator (Care Group Volunteer, or CGV) was selected for each block. Approximately 12 CGVs met together as a group every 2 weeks with a paid project promoter to learn a new child-survival health or nutrition message or skill. Then the CGVs shared the new message with mothers in their assigned blocks. METHODS OF EVALUATION: Household surveys were conducted at baseline and endline to measure nutrition-related behaviors and childhood nutritional status. FINDINGS: More than 90% of beneficiary mothers reported that they had been contacted by CGVs during the previous 2 weeks. In the early implementation project area, the percentage of children 0-23 months old with global undernutrition (weight-for-age with z-score of less than 2 standard deviations below the international standard mean) declined by 8.1 percentage points (P<0.001), from 25.9% (95% confidence interval [CI] = 22.2%-29.6%) at baseline to 17.8% at endline (95% CI = 14.6%-20.9%). In the delayed implementation area, global undernutrition declined by 11.5 percentage points (P<0.001), from 27.1% (95% CI = 23.6%-30.6%) to 15.6% (95% CI = 12.6%-18.6%). Total project costs were US$3.0 million, representing an average cost of US$0.55 per capita per year (among the entire population of 1.1 million people) and US$2.78 per beneficiary (mothers with young children) per year. CONCLUSION: Using the Care Group model can improve the level of global undernutrition in children at scale and at low cost. This model shows sufficient promise to merit further rigorous testing and broader application.

Indicadores Socioeconômicos e Assistenciais como Preditores da Adequação das Informações sobre Mortalidade em Alagoas / Assistance and socioeconomic indicators as predictors of adequacy of information on mortality in Alagoas

O Sistema de Informação sobre Mortalidade (SIM) deve dispor de boa cobertura, regularidade e qualidade dos dados. Avaliou-se a capacidade de indicadores socioeconômicos e assistenciais (ISA) predizerem a adequação das informações sobre mortalidade (IM) em municípios de Alagoas no período de 2007-2009. Realizou-se estudo ecológico associando ISA e a adequação das IM (desfecho), avaliado através do método de Andrade;Szwarcwald (2007). Os ISA foram: Produto Interno Bruto per capita (R$), cobertura de leitos, assistência médica e da estratégia saúde da família, índice de Gini e de pobreza. Utilizaram-se dados secundários para os óbitos não fetais e ISA. O estado apresentou-se 'adequado' quanto às IM: Coeficiente Geral de Mortalidade Padronizado (CGMP) (5,72), Desvio Médio Relativo do CGMP (DMR_CGMP) (1,67) e proporção de óbitos com causas mal definidas ( por centoOCMD) (7,1). Os municípios foram classificados como satisfatórios: CGMP (65,7 por cento), DMR_CGMP (84,3 por cento) e por centoOCMD (86,3 por cento). Dos 102 municípios, 50 foram 'adequados' e 52, 'não adequados'. Na análise univariada os indicadores que apresentaram p = 20 por cento foram: índice de Gini, cobertura de leitos e de assistência médica, e apenas o último apresentou associação na multivariada, OR (2,143) e pvalor (0,006). O teste apresentou acurácia (73,5 por cento) sensibilidade (75 por cento) e especificidade (52 por cento). Um município de Alagoas que tenha três ou mais dos ISA 'ruins' tem três vezes mais chance de apresentar falhas nas IM (p-valor <1 por cento) e se pelo menos um desses for cobertura de leitos ou de assistência médica essa chance aumenta para quatro vezes. (IC:1,75- 9,11 e p 0,001). O estudo mostra a relação dos ISA com adequação das IM, aponta para a importância do médico na assistência e a presença de serviços acessíveis, para a qualidade das IM. Para melhoria efetiva da notificação e qualidade das IM deve-se considerar a organização da rede de serviços como aspecto para valorização da informação e o correto preenchimento da declaração de óbito.

Vinculação das metas institucionais ao controle social na rede pública: o plano de investimentos do Grupo Hospitalar Conceição

A idéia de descentralização da gestão em saúde pública no Brasil surge a partir da VIII Conferência Nacional de Saúde, que incluiu a participação da sociedade civil e o controle pelos usuários, na Constituição Federal de 1988. O surgimento de um modelo universal de assistência à saúde, que pressupõe a inclusão representativa da população e de trabalhadores de saúde no processo decisório e no controle dos serviços, resulta em transformações no GHC, um grupo hospitalar ligado ao MS, com atendimento 100% pelo SUS. O processo de democratização da gestão na instituição tem início em 2003, quando foram criados ou reformulados seus mecanismos de controle social , entre eles o Plano de Investimentos. A partir do ano de 2007, foi criada uma Agenda Estratégica, que estabelece as metas a serem atingidas pela instituição anualmente, em cada uma das unidades do grupo. Este trabalho tem como objetivo geral investigar a vinculação entre a aquisição de equipamentos e materiais, pelo PI, às metas institucionais estabelecidas por esta agenda, a partir da visão dos atores envolvidos, considerando seu conhecimento acerca destas metas e as prováveis dificuldades e/ou conflitos resultantes desta tentativa de vinculação, bem como o contexto de democratização da gestão no qual se insere. Assim, ao investigar o conhecimento dos indivíduos acerca destes processos, estaremos também refletindo sobre seu estágio de consciência sócio-moral e, por conseguinte, sobre a forma como eles enxergam o processo do qual participam, a empresa onde trabalham e os usuários deste sistema. O exercício da cidadania, através da gestão participativa, é um processo que se desenvolve e transforma aqueles que dele participam, em diferentes níveis de consciência moral, refletindo diretamente em suas escolhas. Neste sentido, trata-se de trazer à tona, não apenas as escolhas que os sujeitos fazem em relação ao orçamento da instituição, mas, essencialmente, o significado destas escolhas.

Correlates of sleep-onset REM periods during the Multiple Sleep Latency Test in community adults.

The diagnosis of narcolepsy without documented cataplexy is based on the observation of two or more sleep-onset REM periods (SOREMPs) during the Multiple Sleep Latency Test (MSLT). We report on the prevalence and correlates of SOREMPs in the community-based Wisconsin Sleep Cohort Study. MSLTs were conducted following nocturnal polysomnography (NPSG) and daily sleep diaries in 289 males and 267 females (age 35-70, 97% Caucasians). Multiple SOREMPs were observed in 13.1% of males and 5.6% of females. An MSLT mean sleep latency < or =8 min and > or =2 SOREMPs (diagnostic of narcolepsy) was observed in 5.9% (males) and 1.1% (females), all without cataplexy. Because of significant sex interactions, analyses were stratified by sex. Increased prevalence of HLA-DQB1*0602, a marker of narcolepsy, was observed in males but not in females with > or =2 SOREMPs. Males with multiple SOREMPs compared with those with no SOREMPs had shorter rapid eye movement (REM) latency during NPSG, were sleepier on the MSLT and reported increased sleepiness, hypnagogic hallucinations and cataplexy-like symptoms, suggesting a narcolepsy-like phenotype. In males only, the occurrence of SOREMPs increased with shift work and some indirect markers of sleep restriction, such as shorter sleep a day before NPSG. SOREMPs were unrelated to age, body mass index, depression (Zung Scale), anxiety (State-Trait Anxiety Scale) and the number of apnea and hypopnea events per hour of sleep (AHI), but were associated with decreased mean lowest oxygen saturation in males. Finally, we found that both males and females with SOREMPs reported taking more antidepressants, but those were of the types known not to suppress REM sleep. These results suggest a high prevalence of narcolepsy without cataplexy, as defined by the International Classification of Sleep Disorders, and/or a large number of false-positives for the MSLT.

Sleepwalking, a disorder of NREM sleep instability.

BACKGROUND AND PURPOSE: Thirty-two chronic sleepwalkers who were part of a larger, previously reported sleepwalking group all achieved control of sleepwalking after undergoing treatment for an associated sleep disorder. In the current study, all records were blindly scored to perform a cyclic alternating pattern (CAP) analysis. PATIENTS AND METHODS: Thirty-two young adult chronic sleepwalkers had polysomnography (PSG) on initial nights without sleepwalking events, as did age-matched normal controls and patients with mild sleep-disordered breathing (SDB). More than 90% of these patients with mild SDB had upper airway resistance syndrome (UARS). Ten randomly selected PSGs for sleepwalkers and matched controls also had quantitative electroencephalographic (EEG) analysis using Fast Fourier Transformation (FFT) with determination of delta power for each non-rapid eye movement (NREM)-REM sleep cycle. RESULTS: Compared to normal controls, an investigation of CAP in sleepwalkers demonstrated the presence of an abnormal CAP rate with a decrease in phase A1 and an increase in phases A2 and A3 on non-sleepwalking nights. The results of CAP analysis in sleepwalkers were similar to those obtained in age-matched UARS patients. Furthermore, the analysis of the first four NREM-REM sleep cycles reconfirmed the presence of an important decrease in delta power in sleep cycles 1 and 2 during a non-sleepwalking night in sleepwalkers compared to normal controls. CONCLUSIONS: The presence of both 'hypersynchronous slow delta' and 'burst of delta waves' have been reported in sleepwalkers, but their significance is controversial. These EEG patterns are similar to phase A1 (and possibly A2) of the CAP. Proper analysis of the sleep EEG of sleepwalkers should integrate CAP analysis. Sleepwalkers on a non-sleepwalking night present instability of NREM sleep, as demonstrated by this analysis. This instability is similar to the one noted in UARS patients. Subtle sleep disorders associated with chronic sleepwalking constitute the unstable NREM sleep background on which sleepwalking events occur. A subtle associated sleep disorder should be systematically searched for and treated in the presence of sleepwalking with abnormal CAP.