How effective is dog culling in controlling zoonotic visceral leishmaniasis? a critical evaluation of the science, politics and ethics behind this public health policy

INTRODUCTION: Zoonotic kala-azar, a lethal disease caused by protozoa of the genus Leishmania is considered out of control in parts of the world, particularly in Brazil, where transmission has spread to cities throughout most of the territory and mortality presents an increasing trend. Although a highly debatable measure, the Brazilian government regularly culls seropositive dogs to control the disease. Since control is failing, critical analysis concerning the actions focused on the canine reservoir was conducted. METHODS: In a review of the literature, a historical perspective focusing mainly on comparisons between the successful Chinese and Soviet strategies and the Brazilian approach is presented. In addition, analyses of the principal studies regarding the role of dogs as risk factors to humans and of the main intervention studies regarding the efficacy of the dog killing strategy were undertaken. Brazilian political reaction to a recently published systematic review that concluded that the dog culling program lacked efficiency and its effect on public policy were also reviewed. RESULTS: No firm evidence of the risk conferred by the presence of dogs to humans was verified; on the contrary, a lack of scientific support for the policy of killing dogs was confirmed. A bias for distorting scientific data towards maintaining the policy of culling animals was observed. CONCLUSIONS: Since there is no evidence that dog culling diminishes visceral leishmaniasis transmission, it should be abandoned as a control measure. Ethical considerations have been raised regarding distorting scientific results and the killing of animals despite minimal or absent scientific evidence

Critical analysis of the allocation policy for liver transplantation in Brazil

Liver transplantation is now the standard treatment for end-stage liver disease. Given the shortage of liver donors and the progressively higher number of patients waiting for transplantation, improvements in patient selection and optimization of timing for transplantation are needed. Several solutions have been suggested, including increasing the donor pool; a fair policy for allocation, not permitting variables such as age, gender, and race, or third-party payer status to play any role; and knowledge of the natural history of each liver disease for which transplantation is offered. To observe ethical rules and distributive justice (guarantee to every citizen the same opportunity to get an organ), the "sickest first" policy must be used. Studies have demonstrated that death has no relationship with waiting time, but rather with the severity of liver disease at the time of inclusion. Thus, waiting time is no longer part of the United Network for Organ Sharing distribution criteria. Waiting time only differentiates between equally severely diseased patients. The authors have analyzed the waiting list mortality and 1-year survival for patients of the State of São Paulo, from July 1997 through January 2001. Only the chronological criterion was used. According to "Secretaria de Estado da Saúde de São Paulo" data, among all waiting list deaths, 82.2% occurred within the first year, and 37.6% within the first 3 months following inclusion. The allocation of livers based on waiting time is neither fair nor ethical, impairs distributive justice and human rights, and does not occur in any other part of the world.

Bacia 3 - Inventário Florestal Comercial

Inventário Florestal da Bacia 3 do projeto "Manejo Ecológico e Exploração da Floresta Tropical Úmida" para a avaliação dos potenciais quantitativo e qualitativo da cobertura florestal existente na área, com base em medições e observações em árvores com diâmetro a altura do peito (DAP) maior ou igual a 25 cm, de uma população florestal de 96 hectares. A área coberta pelo inventário é composta de 4 blocos de 24 hectares cada, os quais serão destinados às pesquisas de manejo da regeneração natural enriquecimento da floresta natural e regeneração artificial. Localiza-se entre o km 21 e o km 24 na margem esquerda da vicinal ZF-2, no Distrito Agropecuário da SUFRAMA (Superintendência da Zona Franca de Manaus).

Desembarque e esforço de pesca da frota pesqueira comercial de Manicoré (Médio Rio Madeira), Amazonas, Brasil

A adequação das estratégias do pescador à sazonalidade existente na Amazônia atesta o nível de conhecimento tradicional em relação à ecologia dos peixes e às variações da pesca nesse ambiente, como ocorre em outras regiões do Brasil. Nesse sentido, este trabalho teve como objetivo analisar a utilização dos ambientes de captura e a distribuição do esforço de pesca pela frota comercial em função do ciclo hidrológico. Foram coletados diariamente, entre junho de 2003 e maio de 2004, dados de desembarque e das expedições de pesca que ocorreram na região do Médio rio Madeira e submetidos à estatística descritiva. Os resultados mostraram que existiu uma tendência de aumento no esforço de pesca durante o período da enchente pelas embarcações da frota local, para compensar a queda na produção capturada. Os barcos de pesca e canoas motorizadas apresentaram valores médios de CPUE de 22,9 e 20,6 kg/pescador*dia, respectivamente. Ficou evidenciada também a maior utilização dos ambientes igarapés e lagos pelos pescadores de canoas motorizadas e do rio pelos pescadores dos barcos.

Validade comercial e aceitabilidade da carne de tartaruga-da-amazônia (P.expansa)

Esse experimento foi elaborado em parceria com o CENAQUA (Centro Nacional de Quelônios do Amazonas) e a Pró-Fauna (localizada em Iguape - SP) objetivando o estudo da validade comercial e a aceitabilidade da carne de tartaruga-da-amazônia criada em cativeiro. Foi avaliado o efeito do tempo de estocagem de amostras de carne de 14 tartarugas (7 fêmeas e 7 machos) nos dias 01, 30, 60 e 120, estocadas a -10 ºC, nos valores de pH e de Bases Voláteis Totais (BVT), cor, textura, odor e prova de cocção. Observou-se diferença significativa entre os valores de pH em relação ao tempo de estocagem nos dias 01 (5,81 e 5,81), 30 (6,04 e 6,05), 60 (6,22 e 6,23) e 120 (6,30 e 6,30), respectivamente para a carne das fêmeas e machos. Entre os sexos não houve diferença significativa. Quanto a BVT o tempo de estocagem influenciou significativamente entre os dias 01 (11,34 e 11,74 g/100g), 30 (13,92 e 13,90 g/100g) e 120 (17,62 e 17,82 g/100g); entre os dias 30 (13,92 e 13,90 g/100g) e 60 (14,02 e 14,06 g/100g) não observou-se diferença significativa, respectivamente para a carne de fêmeas e machos. Entre os sexos não ocorreu diferenças significativas. A cor, textura, odor e a prova de cocção não apresentaram alteração ao longo do tempo de estocagem. A carne de tartaruga obteve media de aceitabilidade global de 7,04. De acordo com os resultados obtidos concluímos que, pelas provas de pH e BVT, a carne de tartaruga pode ter uma validade comercial de 120 dias, quando embaladas a vácuo e estocadas a -10 ºC, e que a os provadores gostaram muito desse tipo de carne.

A pesca comercial na bacia do rio Madeira no estado de Rondônia, Amazônia brasileira

Este estudo caracteriza quali e quantitativamente a atividade pesqueira comercial na bacia do rio Madeira, afluente do rio Amazonas, no trecho entre Guajará-Mirim e Porto Velho, estado de Rondônia. No período de janeiro a dezembro/2004, foram registrados 460 t, correspondendo 935 viagens. A análise dos dados oriundos do monitoramento dos desembarques demonstrou que a pesca na região tem caráter artesanal de pequena escala, destacando a maior participação das canoas motorizadas (131 unidades) do que barcos pesqueiros (45 unidades; capacidade média: 3.000kg) na frota pesqueira. Os peixes migradores jaraqui (Semaprochilodus spp.), dourada (Brachyplatystoma rousseauxii), sardinha (Triportheus spp.), jatuarana/matrinxã (Brycon amazonicus e B. cephalus), curimatã (Prochilodus nigricans) e filhote (Brachyplatystoma filamentosum) se destacaram na composição das espécies desembarcadas. As informações técnicas geradas são importantes para subsidiar ações de ordenamento pesqueiro, bem como para avaliar futuras variações que possam ocorrer na atividade frente aos impactos dos empreendimentos hidrelétricos em construção na região.

Fertilizer policy in the developing countries: the case of Brazil

This paper deals initially with the role of mineral fertilizers in increasing agricultural production: the relationship between the two variables is illustrated within global, regional national and local contexts. The pattern and trends in fertilizer usage in Brazil are presented next, namely: increase in consumption in the period 1950/72; regional distribution; consumption as related to crops and cultivated land. It is shown that in less than a quarter or century fertilizer use has increased in the country nearly 12 fold, whereas world consumption was raised 7 fold, thus exceeding estimates based in several criteria. Steps taken to secure the raise in fertilizer consumption above the historical trend are discussed: research experience for outlining fertilization recomendations; the transfer of the knowledge to the farmer by the extension work both official and private; the credit policy and special incentives for the purchase of fertilizer; the national policy for minumum proces of agricultural products; the implantation of a national fertilizer industry. It is considered that the Brazilian experience adapted to similar local conditions in other developing countries, presents a possibility for achieving beneficial results without inflationary reflexes in the economy.

Current epidemiological trends for Chagas disease in Latin America and future challenges in epidemiology, surveillance and health policy

Chagas disease, named after Carlos Chagas, who first described it in 1909, exists only on the American Continent. It is caused by a parasite, Trypanosoma cruzi, which is transmitted to humans by blood-sucking triatomine bugs and via blood transfusion. Chagas disease has two successive phases: acute and chronic. The acute phase lasts six-eight weeks. Several years after entering the chronic phase, 20-35% of infected individuals, depending on the geographical area, will develop irreversible lesions of the autonomous nervous system in the heart, oesophagus and colon, and of the peripheral nervous system. Data on the prevalence and distribution of Chagas disease improved in quality during the 1980s as a result of the demographically representative cross-sectional studies in countries where accurate information was not previously available. A group of experts met in Brasilia in 1979 and devised standard protocols to carry out countrywide prevalence studies on human T. cruzi infection and triatomine house infestation. Thanks to a coordinated multi-country programme in the Southern Cone countries, the transmission of Chagas disease by vectors and via blood transfusion was interrupted in Uruguay in 1997, in Chile in 1999 and in Brazil in 2006; thus, the incidence of new infections by T. cruzi across the South American continent has decreased by 70%. Similar multi-country initiatives have been launched in the Andean countries and in Central America and rapid progress has been reported towards the goal of interrupting the transmission of Chagas disease, as requested by a 1998 Resolution of the World Health Assembly. The cost-benefit analysis of investment in the vector control programme in Brazil indicates that there are savings of US$17 in medical care and disabilities for each dollar spent on prevention, showing that the programme is a health investment with very high return. Many well-known research institutions in Latin America were key elements of a worldwide network of laboratories that carried out basic and applied research supporting the planning and evaluation of national Chagas disease control programmes. The present article reviews the current epidemiological trends for Chagas disease in Latin America and the future challenges in terms of epidemiology, surveillance and health policy.

Plasmodium falciparum gametocyte carriage, sex ratios and asexual parasite rates in Nigerian children before and after a treatment protocol policy change instituting the use of artemisinin-based combination therapies

The effects of artemisinin-based combination therapies (ACTs) on transmission of Plasmodium falciparum were evaluated after a policy change instituting the use of ACTs in an endemic area. P. falciparum gametocyte carriage, sex ratios and inbreeding rates were examined in 2,585 children at presentation with acute falciparum malaria during a 10-year period from 2001-2010. Asexual parasite rates were also evaluated from 2003-2010 in 10,615 children before and after the policy change. Gametocyte carriage declined significantly from 12.4% in 2001 to 3.6% in 2010 (@@χ² for trend = 44.3, p < 0.0001), but sex ratios and inbreeding rates remained unchanged. Additionally, overall parasite rates remained unchanged before and after the policy change (47.2% vs. 45.4%), but these rates declined significantly from 2003-2010 (@@χ² for trend 35.4, p < 0.0001). Chloroquine (CQ) and artemether-lumefantrine (AL) were used as prototype drugs before and after the policy change, respectively. AL significantly shortened the duration of male gametocyte carriage in individual patients after treatment began compared with CQ (log rank statistic = 7.92, p = 0.005). ACTs reduced the rate of gametocyte carriage in children with acute falciparum infections at presentation and shortened the duration of male gametocyte carriage after treatment. However, parasite population sex ratios, inbreeding rates and overall parasite rate were unaffected.

Respiratory syncytial virus seasonality in Brazil: implications for the immunisation policy for at-risk populations

Respiratory syncytial virus (RSV) infection is the leading cause of hospitalisation for respiratory diseases among children under 5 years old. The aim of this study was to analyse RSV seasonality in the five distinct regions of Brazil using time series analysis (wavelet and Fourier series) of the following indicators: monthly positivity of the immunofluorescence reaction for RSV identified by virologic surveillance system, and rate of hospitalisations per bronchiolitis and pneumonia due to RSV in children under 5 years old (codes CID-10 J12.1, J20.5, J21.0 and J21.9). A total of 12,501 samples with 11.6% positivity for RSV (95% confidence interval 11 - 12.2), varying between 7.1 and 21.4% in the five Brazilian regions, was analysed. A strong trend for annual cycles with a stable stationary pattern in the five regions was identified through wavelet analysis of the indicators. The timing of RSV activity by Fourier analysis was similar between the two indicators analysed and showed regional differences. This study reinforces the importance of adjusting the immunisation period for high risk population with the monoclonal antibody palivizumab taking into account regional differences in seasonality of RSV.

Nursing performance in the policy transfer of directly observed treatment of tuberculosis

Objective Analyzing the policy transfer of directly observed treatment of tuberculosis from the perspective of nursing. Method This is a descriptive study with qualitative approach, which had 10 nurses of the Family Health Strategy in São Paulo as subjects. The interviews were carried out between May and June 2013, and were adopted the technique of thematic content analysis and the referential of policy transfer. Results On the signification of this treatment, are related the senses of disciplinary monitoring, the bond and approximation to the context of patients’ lives. Operationally, nurses, community health agents and nursing technicians stand out as agents of implementation of this policy, developing multiple actions of user embracement. The nurse is evidenced as an educator in health, leader in the family health team, and capable of creating emotional bond with users. Conclusion It was found that the innovations proposed in the treatment are incipient in the daily work of nurses.

The Brazilian policy for reduction of accidents and violence aligns with international perspectives?

The study analyzed The Brazilian Policy for Reduction of Morbidity and Mortality from Accidents and Violence, in the socio-political perspective. We used as a base the chapter “Violence: a global public health problem” from the World Report on Violence and Health. The analysis revealed convergent and divergent elements of the Brazilian Policy in comparison with the international perspectives. We verified that the Brazilian Policy tried to converge to the international policies, however: it emphasizes the health promotion actions, but are limited to the context and behavior of individuals and individual communities; the performance of health professionals is expected without providing more structural investments, as the improvement in work conditions, the increase of financial and material resources; there are few clear definitions of the government and economical sector responsibilities.