A clinical trial for uniform multidrug therapy for leprosy patients in Brazil: rationale and design

Leprosy will continue to be a public health problem for several decades. The World Health Organization (WHO) recommends that, for treatment purposes, leprosy cases be classified as either paucibacillary or multibacillary (MB). A uniform leprosy treatment regimen would simplify treatment and halve the treatment duration for MB patients. The clinical trial for uniform multidrug therapy (U-MDT) for leprosy patients (LPs) in Brazil is a randomised, open-label clinical trial to evaluate if the effectiveness of U-MDT for leprosy equals the regular regimen, to determine the acceptability of the U-MDT regimen and to identify the prognostic factors. This paper details the clinical trial methodology and patient enrolment data. The study enrolled 858 patients at two centres and 78.4% of participants were classified as MB according to the WHO criteria. The main difficulty in evaluating a new leprosy treatment regimen is that no reliable data are available for the current treatment regimen. Relapse, reaction and impaired nerve function rates have never been systematically determined, although reaction and impaired nerve function are the two major causes of nerve damage that lead to impairments and disabilities in LPs. Our study was designed to overcome the need for reliable data about the current treatment and to compare its efficacy with that of a uniform regimen.

Identification, assessment and ordering of concepts for agro-energy planning and possibilities of spatial analysis

ABSTRACT The present study aims to present the main concepts of the sugarcane straw to energy planning. Throughout the study, the subject is contextualized highlighting broader aspects of sustainability, which is considered the main driver towards agro-energy modernization. Concerning sugarcane straw, we first evaluated its availability regarding technical and economic aspects, and then it summarized the straw production chain for energy supply purposes. As a proposal to support agro-energy planning, it is presented some spatial tools that have been barely used in the Brazilian energy planning context so far. Therefore, working on straw to electricity associated with supply chain basis, we developed a conceptual model to spatially assess this bioenergy system. Using the model proposed, it is described the whole supply chain at state level, which accounted the potential of a single mill to explore straw, as well as main costs associated with straw acquisition, investments on the straw recovery routes and electricity transmission. Bearing these concepts in mind, it is fully believed that spatial analysis can bring important information for agro-energy action plans.

Prediction of free-stall occupancy rate in dairycattle barns through fuzzy sets

The goal of this study was to develop a fuzzy model to predict the occupancy rate of free-stalls facilities of dairy cattle, aiding to optimize the design of projects. The following input variables were defined for the development of the fuzzy system: dry bulb temperature (Tdb, °C), wet bulb temperature (Twb, °C) and black globe temperature (Tbg, °C). Based on the input variables, the fuzzy system predicts the occupancy rate (OR, %) of dairy cattle in free-stall barns. For the model validation, data collecting were conducted on the facilities of the Intensive System of Milk Production (SIPL), in the Dairy Cattle National Research Center (CNPGL) of Embrapa. The OR values, estimated by the fuzzy system, presented values of average standard deviation of 3.93%, indicating low rate of errors in the simulation. Simulated and measured results were statistically equal (P>0.05, t Test). After validating the proposed model, the average percentage of correct answers for the simulated data was 89.7%. Therefore, the fuzzy system developed for the occupancy rate prediction of free-stalls facilities for dairy cattle allowed a realistic prediction of stalls occupancy rate, allowing the planning and design of free-stall barns.

BASS 4: a software system for ergonomic design and evaluation of working hours

OBJECTIVE: To extend an existing computer programme for the evaluation and design of shift schedules (BASS 3) by integrating workload as well as economic aspects. METHODS: The redesigned prototype BASS 4 includes a new module with a suitable and easily applicable screening method (EBA) for the assessment of the intensity of physical, emotional and cognitive workload components and their temporal patterns. Specified criterion functions based on these ratings allow for an adjustment of shift and rest duration according to the intensity of physical and mental workload. Furthermore, with regard to interactive effects both workload and temporal conditions, e.g. time of day, are taken into account. In a second new module, important economic aspects and criteria have been implemented. Different ergonomic solutions for scheduling problems can now also be evaluated with regard to their economic costs. RESULTS: The new version of the computer programme (BASS 4) can now simultaneously take into account numerous ergonomic, legal, agreed and economic criteria for the design and evaluation of working hours. CONCLUSIONS: BASS 4 can now be used as an instrument for the design and the evaluation of working hours with regard to legal, ergonomic and economic aspects at the shop floor as well as in administrative (e.g. health and safety inspection) and research problems.

Notes on health care planning in Latin America and the Caribbean

Attention is called to the fact that the efforts to improve health of populations in Latin America have generally failed. The inequality in the distribution of ill-health is great. The authors accept the fact that the lack of resources available to the health sector may be a restriction towards the improvement of the situation, but they argue that a much more important issue is the misuse of such resources and their maldistribution within the health sector. The lack of integration and coordination between the health services, the conflict of public and private health systems, the under-utilization of existing services and the gap between planning and real implementation are discussed.

Epidemiology and control of malaria and other arthropod born diseases

Malaria and other arthropod born diseases remain a serious public health problem affecting the lives and health of certain social groups when the two basic strategies to control fail due to : (1) the lack of effective chemoprophylaxis/chemotherapy or the rapid development of drug resistance of the infectious agents and (2) the ineffectiveness of pesticides or the arthropod vectors develop resistance to them. These situations enhances the need for the design and implementation of other alternatives for sustainable health programmes. The application of the epidemiological methods is essential not only for analyzing the relevant data for the understanding of the biological characteristics of the infectious agents, their reservoirs and vectors and the methods for their control, but also for the assessment of the human behaviour, the environmental, social and economic factors involved in disease transmission and the capacity of the health systems to implement interventions for both changes in human behaviour and environmental management to purpose guaranteed prevention and control of malaria and other arthropod born diseases with efficiency, efficacy and equity. This paper discuss the evolution of the malaria arthropod diseases programmes in the American Region and the perspectives for their integration into health promotion programs and emphasis is made in the need to establish solid basis in the decision-making process for the selection of intervention strategies to remove the risk factors determining the probability to get sick or die from ABDs. The implications of the general planning and the polices to be adopted in an area should be analyzed in the light of programme feasibility at the local level, in the multisectoral context specific social groups and taking in consideration the principles of stratification and equity

Karl Polanyi, Athens and us: the contemporary significance of Polanyi's thought

Karl Polanyi is considered one of the most prominent social scientists of the 20th century. In his writings, an important concern was the relationship between the markets and the society (therefore, the state) as a whole; to discuss it, he introduced the concept of "embeddedness", fundamental for his study of the origins and consequences of the Industrial Revolution. An important part of his heritage is the study of the economic history of what he called "ancient societies," especially of Classical Greece. Polanyi used these studies to compare the ancient societies with his own times, in an effort to understand them all. This paper aims to relate Polanyi's work on the Athenian society with his studies about the modern times, showing that it is possible to draw lessons from Polanyi's thought on the relationship between the society, the state and the market that can help to design a political agenda for our days. In the first part, we present the most important aspects o the life and work of Polanyi, and in the second we discuss the most important aspects of his worldview. Then, in the third part, we study his view of the early Athenian economy; mainly, we focus on the coexistence of a kind of state planning and a market, showing how this understanding is crucial for the whole Polanyian legacy, with its emphasis in the comparison of different societies and times. We conclude by underlining the relevance of this interpretation advanced by Polanyi to understand the societies of our days, focusing on some proposals to extend his approach to deal with our contemporary problems.