The Challenges of Antimicrobial Resistance in Brazil

Brazil is a country with continental proportions with high geographic and economic diversity. Despite its medical centers of excellence, antimicrobial resistance poses a major therapeutic challenge. Rates of methicillin-resistant Staphylococcus aureus are up to 60% and are related to an endemic Brazilian clone. Local resistance to vancomycin in Enterococci was first related to Enterococcus faecalis, which differs from European and American epidemiology. Also, local Klebsiella pneumoniae and Escherichia coli isolates producing extended-spectrum beta-lactamases have a much higher prevalence (40%-50% and 10%-18%, respectively). Carbapenem resistance among the enterobacteriaceae group is becoming a major problem, and K. pneumoniae carbapenemase isolates have been reported in different states. Among nonfermenters, carbapenem resistance is strongly related to SPM-1 (Pseudomonasaeruginosa) and OXA-23 (Acinetobacter baumannii complex) enzymes, and a colistin-only susceptible phenotype has also emerged in these isolates, which is worrisome. Local actions without loosing the global resistance perspective will demand multidisciplinary actions, new policies, and political engagement.

The South American Plasmodium falciparum var gene repertoire is limited, highly shared and possibly lacks several antigenic types

The Plasmodium falciparum var gene family encodes large variant antigens, which are important virulence factors, and also targets of the humoral host response. The frequently observed mild outcomes of falciparum malaria in many places of the Amazon area prompted us to ask whether a globally restricted variant (var) gene repertoire is present in currently circulating and older isolates of this area. By exhaustive analysis of var gene tags from 89 isolates and clones taken during many years from all over the Brazilian Amazon, we estimate that there are probably no more than 350-430 distinct sequence types, less than for any similar sized area studied so far. Detailed analysis of the var tags from genetically distinct clones obtained from single isolates revealed restricted and redundant repertoires suggesting either a low incidence of infective bites or restricted variant gene diversity in inoculated parasites. Additionally, we found a structuring of var gene repertoires observed as a higher pairwise typing sharing in isolates from the same microregion compared to isolates from different regions. Fine analysis of translated var tags revealed that certain Distinct Sequence Identifiers (DSIDs) were differently represented in Brazilian/South American isolates when compared to datasets from other continents. By global alignment of worldwide var DBL alpha sequences and sorting in groups with more than 76% identity, 125 clusters were formed and more than half of all genes were found in nine clusters with 50 or more sequences. While Brazilian/South American sequences were represented only in 64 groups, African sequences were found in the majority of clusters. DSID type 1 related sequences accumulated almost completely in one single cluster, indicating that limited recombination occurs in these specific var gene types. These data demonstrate the so far highest pairwise type sharing values for the var gene family in isolates from all over an entire subcontinent. The apparent lack of specific sequences types suggests that the P. falciparum transmission dynamics in the whole Amazon are probably different from any other endemic region studied and possibly interfere with the parasite`s ability to efficiently diversify its variant gene repertoires. (C) 2010 Elsevier B.V. All rights reserved.

Yellow fever vaccination coverage among children in Brazilian capitals

Brazil recommends universal yellow fever (YF) vaccination for children who reside in or travel to endemic areas. We conducted a household survey to calculate YF vaccine coverage among children 18-30 months of age in 27 capital cities. A total of 9285 children were surveyed in the 15 cities with YF fever universal vaccination; 7290(79%) had documented evidence of YF vaccination by 12 months of age, 7996 (86%) by 18 months of age, and 8479 (91%) prior to the survey. In 12 cities with selective YF vaccination coverage was only 1% by 18 months of age. YF fever vaccination can be improved to reach all children where vaccine is recommended. (C) 2010 Elsevier Ltd. All rights reserved.

False-positive results of a rapid K39-based strip test and Chagas disease

Background: The definitive diagnosis of visceral. leishmaniasis (VL) requires invasive procedures with demonstration of amastigotes in tissue or promastigotes in culture. Unfortunately, these approaches require laboratory materials not available in poor countries where the disease is endemic. The correct diagnosis of VL is important, and made more difficult by the fact that several common tropical diseases such as malaria, disseminated tuberculosis, and enteric fever share the same clinical presentation. Serological tests have been developed to replace parasitological diagnosis in the field. A commercially available K39-based strip test for VL has been developed for this purpose. The endemic area of leishmaniasis in Brazil overlaps the endemic area of Chagas disease, a disease that can cause false-positive serological test results. The aim of this study was to evaluate the incidence of false-positive exams using a rapid test for VL in patients with Chagas disease. Methods: A rapid test based on the recombinant K39 antigen of Leishmania was used in: (1) 30 patients with confirmed Chagas disease, (2) 30 patients with a serological diagnosis of Chagas disease by ELISA, indirect immunofluorescence, indirect hemagglutination, and chemiluminescence, (3) 30 healthy patients from a non-endemic area as the control group, (4) 30 patients with confirmed VL, and (5) 20 patients with proved cutaneous leishmaniasis. Results: The sensitivity and specificity of the rapid strip test were 100% when compared with healthy volunteers and those with confirmed Chagas disease. One false-positive result occurred in the group with Chagas disease diagnosed by serological tests (specificity of 96%). Conclusion: The rapid test based on recombinant K39 is a useful diagnostic assay, and a false-positive result rarely occurs in patients with a serological diagnosis of Chagas disease. (C) 2008 International Society for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.

ACE inhibition by astilbin isolated from Erythroxylum gonocladum (Mart.) OE Schulz

Erythroxylum species have several traditional uses in different countries, including the treatment of hypertension. The ethanol extract from E. gonocladum aerial parts, a species endemic to the Brazilian cerrado, elicited a concentration-dependent inhibition of angiotensin converting enzyme (ACE) (pIC(50)=4.53 +/- 0.05). Extract fractionation led to the isolation of two compounds, whose structures were assigned by spectrometric data as astilbin and beta-sitosterol, along with a mixture of palmitic, stearic and linolenic acids. This is the first report on the occurrence of these compounds on E. gonocladum. Astilbin promoted significant ACE inhibition in vitro (pIC(50)=5.86 +/- 0.33) and its activity did not differ from captopril, when both compounds were assayed at 10 mu M concentration. (C) 2009 Elsevier GmbH. All rights reserved.

Wickedness, Governance and Collective Sanctions: : Can Corruption be Tamed?

Tackling a problem requires mostly, an ability to read it, conceptualize it, represent it, define it, and then applying the necessary mechanisms to solve it. This may sound self-evident except when the problem to be tackled happens to be “complex, “ “ill-structured,” and/or “wicked.” Corruption is one of those kinds of problems. Both in its global and national manifestations it is ill-structured. Where it is structural in nature, endemic and pervasive, it is perhaps even wicked. Qualities of the kind impose modest expectations regarding possibilities of any definitive solution to this insidious phenomenon. If so, it may not suffice to address the problem of corruption using existing categories of law and/or good governance, which overlook the “long-term memory” of the collective and cultural specific dimensions of the subject. Such socio-historical conditions require focusing on the interactive and self-reproducing networks of corruption and attempting to ‘subvert’ that phenomenon’s entire matrix. Concepts such as collective responsibility, collective punishment and sanctions are introduced as relevant categories in the structural, as well as behavioral, subversion of some of the most prevalent aspects of corruption. These concepts may help in the evolving of a new perspective on corruption fighting strategies.

Corruption, governance and collective sanctions: : can a wicked problem be tamed?

Tackling a problem requires mostly, an ability to read it, conceptualize it, represent it, define it, and then applying the necessary mechanisms to solve it. This may sound self-evident except when the problem to be tackled happens to be “complex, “ “ill-structured,” and/or “wicked.” Corruption is one of those kinds of problems. Both in its global and national manifestations it is ill-structured. Where it is structural in nature, endemic and pervasive, it is perhaps even wicked. Qualities of the kind impose modest expectations regarding possibilities of any definitive solution to this insidious phenomenon. If so, it may not suffice to address the problem of corruption using existing categories of law and/or good governance, which overlook the “long-term memory” of the collective and cultural specific dimensions of the subject. Such socio-historical conditions require focusing on the interactive and self-reproducing networks of corruption and attempting to ‘subvert’ that phenomenon’s entire matrix. Concepts such as collective responsibility, collective punishment and sanctions are introduced as relevant categories in the structural, as well as behavioral, subversion of some of the most prevalent aspects of corruption. These concepts may help in the evolving of a new perspective on corruption fighting strategies.

Os gêneros Nicotiana L., Bouchetia Dunal e Nierembergia Ruiz & Pav.(Solanaceae) no Rio Grande do Sul, Brasil

Os gêneros Nicotiana L., Bouchetia Dunal e Nierembergia Ruiz & Pav. da tribo Nicotianeae G.Don (Solanaceae), presentes no estado do Rio Grande do Sul, apresentam diversas características em comum, como o hábito predominantemente herbáceo, fruto seco, capsular, com numerosas sementes. Estes gêneros distinguem-se basicamente por Nicotiana apresentar prefloração geralmente contorcido-conduplicada ou conduplicada, corola infundibuliforme, tubular ou hipocrateriforme, anteras dorsifixas e um disco nectarífero presente, enquanto que Bouchetia e Nierembergia apresentam prefloração imbricadoconduplicada ou imbricada e anteras ventrifixas. Em Bouchetia a corola é campanulado-infundibuliforme e um disco nectarífero está presente, enquanto que em Nierembergia a corola é hipocrateriforme e o disco nectarífero está ausente. O gênero Nicotiana, da subtribo Nicotianineae, está representado no Estado por seis espécies nativas: N. alata Link & Otto, N. bonariensis Lehm., N. forgetiana Hemsl., N. langsdorffii Weinm., N. longiflora Cav. e N. mutabilis Stehmann & Semir. Duas outras espécies, provavelmente originárias da Argentina, são também encontradas no Estado: N. glauca Graham, que ocorre de forma ruderal ou cultivada e N. tabacum L., também cultivada, de importância econômica por ser fonte de matéria prima para a indústria do fumo. A única espécie do gênero Bouchetia, presente no Estado, é Bouchetia anomala (Miers) Britton & Rusby, endêmica da região sul do Brasil, Uruguai, Paraguai e nordeste da Argentina. Pertence à subtribo Nierembergiinae Hunz., junto com Nierembergia, com quem apresenta maior afinidade. Nierembergia está representado no Rio Grande do Sul por cinco espécies nativas: N. linariifolia Graham, N. micrantha Cabrera, N. pinifolia Miers, N. riograndensis Hunz. & A.A.Cocucci e N. scoparia Sendtn. Chaves analíticas para identificação dos gêneros da tribo Nicotianeae G.Don e para os da subtribo Nierembergiinae, assim como para as espécies de Nicotiana, Bouchetia e Nierembergia, são apresentadas. Descrições para os três gêneros e suas espécies, ilustrações, mapas de distribuição geográfica no Estado, considerações quanto ao hábitat, observações sobre a fenologia, variabilidade morfológica e outros comentários também são referidos.

Introdução da truta arco-íris (Oncorhynchus mykiss) e suas conseqüências para a comunidade aquática dos rios de altitude do sul do Brasil

A introdução de espécies exóticas é uma prática que acompanha a história da humanidade, sendo as espécies introduzidas a base da nutrição e economia em vários países. Porém, esse processo contínuo tem levado a uma homogeneização da flora e fauna global. Os ecossistemas aquáticos, que têm recebido menor atenção que os terrestres, têm sofrido perda de diversidade, hibridação, introdução de patógenos, degradação do habitat além da necessidade e alto custo de controle das espécies introduzidas. O desenvolvimento da aqüicultura tem acelerado a introdução de peixes exóticos, que são a base dessa produção em países como o Brasil. Além desta, entre as razões para a introdução citam-se o esporte, a manipulação ecológica com controle de organismos indesejáveis, o melhoramento dos estoques, a ornamentação ou ainda introduções acidentais. No Rio Grande do Sul, nos rios dos Campos de Cima da Serra estão ocorrendo introduções da espécie exótica truta arco- íris (Oncorhynchus mykiss) desde meados da década de 90 como forma de estímulo ao turismo rural. O objetivo dessa prática é a pesca esportiva, que atrai turistas de várias regiões. Porém, os rios da região possuem várias espécies de peixes endêmicas e as conseqüências dessa prática sobre a biota aquática são desconhecidas. O objetivo do presente trabalho é avaliar o efeito da introdução da truta arco-íris sobre o ecossistema de rios de baixa ordem no município de São José dos Ausentes – RS, Brasil. Para tanto foi descrita a biologia da truta arco- íris no novo ambiente, verificando sua alimentação, movimentação, presença e viabilidade da reprodução. A ictiofauna autóctone dos rios com ausência e presença de trutas foi comparada, bem como o efeito da predação sobre a macrofauna bentônica. A ictiofauna foi amostrada com o uso da pesca elétrica, sendo o conteúdo estomacal das trutas avaliado sazonalmente. Três trutas foram marcadas e acompanhadas por ii biotelemetria para determinação da sua área de vida. Um experimento com ninhos artificiais foi conduzido para verificação da sobrevivência de ovos de trutas nas condições dos rios de São José dos Ausentes. O experimento de exclusão de peixes foi feito a fim de avaliar o efeito da predação sobre a macrofauna bentônica, comparando a macrofauna em rios com e sem trutas. Os resultados indicaram que a truta arco- íris tem como alimento principal os invertebrados bentônicos, porém as maiores classes de tamanho incluem peixes em seus alimentos principais. Logo após sua introdução a movimentação é restrita, porém alguns exemplares foram capturados em um rio onde não foi feita introdução dessa espécie. Apesar de baixa, a sobrevivência dos adultos ocorre, assim como a reprodução. A sobrevivência dos ovos também é baixa, porém, uma pós-larva foi encontrada. A ictiofauna autóctone é diferenciada nos rios com presença de truta, apresentando menor riqueza e diversidade e uma tendência a diminuição da biomassa. A macrofauna bentônica também é diferenciada, apesar de não ser possível atribuir essa diferença somente à presença das trutas.

Proposta e avaliação de uma política pública contra a desigualdade econômica no Brasil: a sociedade de participantes

Este trabalho propõe e avalia ex-ante uma política pública, denominada Sociedade de Participantes, para reduzir a desigualdade econômica no Brasil. Para tanto, inicialmente se discute os efeitos da desigualdade no tecido social e no desenvolvimento econômico de um país. Em seguida, apresenta os conceitos básicos de justiça distributiva, contrapondo os ideais da direita liberal e os da esquerda distributiva, e sustentando que a política proposta equilibra os desejos destas duas correntes. O passo seguinte é a quantificação do fenômeno econômico em pauta, a desigualdade, sendo então apresentada uma metodologia inédita no Brasil, que permite analisar a contribuição para a desigualdade de cada setor econômico e unidade geográfica da federação. Também são expostas medidas éticas de desigualdade, até agora não discutidas em nossa literatura, que possibilitam avaliar o bem-estar de uma população. A proposta é então discutida detalhadamente, sendo analisadas as políticas semelhantes que estão sendo implantadas em outros países, levantando-se os prós e contras em relação à política de renda mínima garantida e dialogando-se com as críticas contra a política proposta existentes na literatura. Para a avaliação ex-ante da Sociedade de Participantes é necessário um ferramental específico, que inclui conceitos de microssimulação e demografia, discutidos na etapa seguinte. Para sua implementação discute-se também uma mudança no sistema tributário nacional, fortemente embasado em tributos indiretos com características regressivas, e a adoção de um imposto sobre riquezas, que é quantificado no estudo. Finalmente, são apresentados os resultados, simulados entre 2008 e 2080, da avaliação ex-ante da Sociedade de Participantes, na qual se conclui que ela é altamente efetiva para combater a desigualdade e a pobreza endêmica no Brasil.

Cálculo da eficiência na prestação de serviço usando o método de fronteira estocástica para a atividade de imunização e controle de pragas 2005-2008.

A falta de eficiência das organizações compromete no longo prazo o desenvolvimento de toda a economia. No caso do mercado de saúde ambiental, uma maior coordenação entre os programas públicos e privados aumentaria a universalização do serviço de controle de endemias para a sociedade. A falta do domínio da tecnologia (como produzir; como atender à preferência do consumidor; como obter ganho de escala; como coordenar e motivar os públicos envolvidos e como fortalecer as instituições de longo prazo) gera perdas de até 49% segundo esta estimativa. Para contribuir com a hipótese acima e para incentivar e promover a eficiência das empresas deste setor, este trabalho calcula a eficiência na prestação de serviço com o método de fronteira estocástica de produção com dados em painel (2005-2008) para a atividade de imunização e controle de pragas. A fronteira de produção retraiu-se neste período. As variáveis: idade da empresa, foco da formação do líder e meta de lucratividade mostram-se significativas para a eficiência da amostra.

O peão e o acidente de trabalho na construção civil do Rio de Janeiro: elementos para uma avaliação do papel da educação nas classes trabalhadoras

This dissertation seeks to identify specifications bu which the Subsection cf Buildings c f the Civil Construction os Rio de Janeiro could be improved. It attempt to determine the factors that make construction workers both victims of accidents, as well as the cause of these accidents. It a150 seeks t o identify the means af the capitalist way that as the producer specific kind af society, creates this type af invisible of a worker. Further more, to verify the violent ar disguised ways, that lead the worker to have a guilty consclence relative to himself and to the other workers , and maklng him feel responsible even for accident - related deaths on the job. A revolting factor is that malnutrition and endemic hunger, are in large part responsible for accidents at work in the capitalist production system, ln which production relations are still primitive. Therefore, the accidents at work are a product of society, especially caused by conditions in the construction sector . This fac 19 often masked, and responsibility is put on the worker ln 77,5~ of work related accident . Under these specific working conditions the cumulative overtime hours of work and tasks make the rythm and working hours extreme and overburdensome. The large and modern firms subcantract to smoller construc~i ns firms who have more dangeraus working condictions which result in more frequent and mayor accidents. These are not computed in the statistics of the large firms and the workers of the subcontractors do not appear on the builging construction lists, and are therefore a non - existent entities. Even opressed, the workers still continue to work under these conditions mak1ng there resistence a form af struggle. The Education that intends to be transformed in to an instrument of the workers struggle, should stimulated the participation in the daily educational and political practices and try to reconstructed what the dominant knowledge has fragmented: the ptoduction of existence as an integrated whole.

Citizens vs. banks: institutional drivers of financial market litigiousness in Brazil

This article analyzes the institutional drivers of Brazil’s alarmingly high levels of litigation between clients and financial institutions. Most of the policy oriented literature that explores that phenomenon discusses the impacts of a perceived debtor-friendly bias of Brazilian courts on generating feedback loops of litigation that further increases interest rates and creates adverse selection within the pool of potential debtors. This literature therefore addresses the way courts behave once disputes reach their doorstep; conversely, we take a step back to understand the underlying reasons for why such a large number of disputes end up in courts in the first place. We accordingly attribute endemic litigation in Brazilian financial markets to a framework of political, economic and legal institutions and circumstances, which this article aims to unbound and explain.

Chronic disease burden and human capital investment: evidence from the chagas disease campaign in Brazil

We investigate the effects of augmented life expectancy and health improvements on human capital investment, labor supply and fertility decisions. Our main motivation is the prediction of human capital theory that a longer and healthier life encourages educational investment and female labor force participation, while discouraging fertility. To assess the magnitude of these effects, we explore a national campaign against Chagas disease in Brazil as an exogenous source of adult mortality decline and improvement in health conditions. We show that, relative to non-endemic areas, previously endemic regions saw higher increases in educational investment, measured by literacy, school attendance and years of schooling, following the campaign. Additionally, we find that labor force participation increased in high prevalence areas relative to low prevalence ones. Furthermore, we estimate a substantially higher effect on female labor force participation relative to male, suggesting that longevity gains and health improvements affected women's incentives to work, encouraging women to join the labor force. We do not find significant effects on fertility decisions.

Spatio-temporal variation in seed production in three Euphorbia species and the role of animals on seed fate

Comparative studies on the reproductive biology of co-occurring related plant species have provided valuable information for the interpretation of ecological and evolutionary phenomena, with direct application in conservation management of plant populations. The aims of this thesis were to identify the causes of pre-dispersal reproductive losses in three Euphorbia species (the Mediterranean E. characias and the narrow endemics E. pedroi and E. welwitschii) and evaluate the variation of their effects in time, space and between individuals and species. Furthermore, we intended to study elaiosomes’ fatty acid profiles for the three Euphorbia and assess the role played by the elaiosome in ant attraction. Finally, we aimed to identify the major seed dispersal agents for each Euphorbia species in each site and study differences in short term seed fate due to differences in ant behaviour. The results indicated that intact seed production differed significantly between the three Euphorbia, mostly due to differences in cyathia production. Losses to pre-dispersal seed predators were proportionately larger for the endemic species which also suffered higher losses resulting in flower, fruit (in E. welwitschii) and seed abortion (in E. pedroi). The elaiosomes of E. pedroi are poor in fatty acids and for this reason seeds of this species were removed in lower proportion by mutualistic dispersers than those of their congeners, being more prone to seed predation. Two larger ant species – Aphaenogaster senilis and Formica subrufa – were responsible for a larger percentage of removals with seeds being transported at larger distances and being discarded in the vicinity of their nests following elaiosome removal. Our results highlight the role of insect-plant interactions as major determinants of seed survival for the three study plants and call for the need to include more information on insect-plant interactions in plant conservation programmes.