Effectiveness of artemether-lumefantrine provided by community health workers in under-five children with uncomplicated malaria in rural Tanzania : an open label prospective study

Background: Home-management of malaria (HMM) strategy improves early access of anti-malarial medicines to high-risk groups in remote areas of sub-Saharan Africa. However, limited data are available on the effectiveness of using artemisinin-based combination therapy (ACT) within the HMM strategy. The aim of this study was to assess the effectiveness of artemether-lumefantrine (AL), presently the most favoured ACT in Africa, in under-five children with uncomplicated Plasmodium falciparum malaria in Tanzania, when provided by community health workers (CHWs) and administered unsupervised by parents or guardians at home. Methods: An open label, single arm prospective study was conducted in two rural villages with high malaria transmission in Kibaha District, Tanzania. Children presenting to CHWs with uncomplicated fever and a positive rapid malaria diagnostic test (RDT) were provisionally enrolled and provided AL for unsupervised treatment at home. Patients with microscopy confirmed P. falciparum parasitaemia were definitely enrolled and reviewed weekly by the CHWs during 42 days. Primary outcome measure was PCR corrected parasitological cure rate by day 42, as estimated by Kaplan-Meier survival analysis. This trial is registered with ClinicalTrials.gov, number NCT00454961. Results: A total of 244 febrile children were enrolled between March-August 2007. Two patients were lost to follow up on day 14, and one patient withdrew consent on day 21. Some 141/241 (58.5%) patients had recurrent infection during follow-up, of whom 14 had recrudescence. The PCR corrected cure rate by day 42 was 93.0% (95% CI 88.3%-95.9%). The median lumefantrine concentration was statistically significantly lower in patients with recrudescence (97 ng/mL [IQR 0-234]; n = 10) compared with reinfections (205 ng/mL [114-390]; n = 92), or no parasite reappearance (217 [121-374] ng/mL; n = 70; p <= 0.046). Conclusions: Provision of AL by CHWs for unsupervised malaria treatment at home was highly effective, which provides evidence base for scaling-up implementation of HMM with AL in Tanzania.

Practice location of physicians: a discrete choice model approach

Economists and policymakers have long been concerned with increasing the supply of health professionals in rural and remote areas. This work seeks to understand which factors influence physicians’ choice of practice location right after completing residency. Differently from previous papers, we analyse the Brazilian missalocation and assess the particularities of developing countries. We use a discrete choice model approach with a multinomial logit specification. Two rich databases are employed containing the location and wage of formally employed physicians as well as details from their post-graduation. Our main findings are that amenities matter, physicians have a strong tendency to remain in the region they completed residency and salaries are significant in the choice of urban, but not rural, communities. We conjecture this is due to attachments built during training and infrastructure concerns.

Credit union correspondents and financial inclusion in Brazil: an exploratory study

A rede de correspondentes bancários do Brasil tem sido estudada há mais de uma década, em particular por causa da sua importância no aumento do alcance de serviços financeiros para regiões distantes dos maiores centros urbanos. O uso de correspondentes por cooperativas de crédito não tem recebido destaque, apesar do papel importante das cooperativas na inclusão financeira. Esta dissertação adota uma abordagem “multimétodo” para efetuar uma pesquisa exploratória dos correspondentes de cooperativas de crédito no Brasil. A pesquisa visa, por um lado, alargar a compreensão dos incentivos que levam cooperativas a usarem correspondentes, e por outro, avaliar se esses correspondentes merlhoram a inclusão financeira. A pesquisa é formada por um estudo de caso assim como por análise de dados relativos ao registro de correspondentes bancários e de dados financeiros das cooperativas. Os resultados apontam que o uso de correspondentes bancários por cooperativas está relacionado à busca de maior eficiência e redução de filas nas agências. A melhoria da inclusão financeira por esses correspondentes limita-se a um serviço único – o recebimento de pagamentos. Não obstante, em 2014, cooperativas de correspondentes de crédito tinham um papel importante no fornecimento de serviços de recebimento de contas em 690 municípios brasileiros, dos quais 200 tinham baixos níveis de inclusão financeira. Apesar da escassa disponibilidade de serviços dos correspondentes das cooperativas, os resultados sugerem que esses atores poderiam adquirir uma importância maior na promoção de inclusão financeira no futuro.

Programa alfabetização solidária: um estudo sobre a experiência no município de Lagoa de Pedras/RN (1997 - 2003)

The educational reform of the 90 s was tainted by the objectives of the fiscal adjustments, resulting in the redefinition of the state s role in the financing and offering of teaching services, and bringing about a shuffling of the responsibility between the public and private sectors to promote education to young people and adults. The 90 s also highlighted the proliferation of providers and the multiplication of Educational Programs for Youths and Adults (EJA), implemented through partnerships between governmental and nongovernmental agencies. During this period of time, the agenda of educational responsibilities concerning analphabetism was organized in a process of decentralized of the state, with the following political, social, and economic objectives: to reduce the public deficit, increasing public savings and the financial capacity of the state to concentrate resources in areas considered indispensable to direct intervention; to increase the efficiency of the social services moffered or funded by the state, giving citizens more at a lower cost, and spreading services to more remote areas, expanding access to reach those most in need; to increase the participation of citizens in public management, stimulating communitarian acts as well as developing efforts towards the effective coordination of public figures in the implementation of associated social services. Thus, Assistance Programs co-financed by the government try to deal with the problem of analphabetism. Within the sphere of the 90 s educational policy decentralization, we come to see how the agenda dedicated to the reduction of analphabetism was formed by the Solidarity Alphabetization Program (PAS). Between 1997 and 2003, the latter agenda s decentralizing proposal was integrated in the management partnership for the operationalization of tasks and resources faced with the execution of the formal objectives. In this study, we identify the dimensions of the implantation and progress of the tasks carried out by PAS, in the municipality of Lagoa de Pedras/RN. However, we consider these Programs to assist in the process without guaranteeing the reduction of the causes or substituting the responsibility of the system once the monetary resources for program maintenance provided by the partners is exhausted

Protótipo de uma unidade com tri-geração de energia para utilizações remotas: aplicação de módulo secondutivo gerador termoelétrico

The generation for termoeletricity is characterized as a solid process of conversion of thermal energy (heat) in electric without the necessity of mobile parts. Although the conversion process is of low efficiency the system presents high degree of trustworthiness and low requisite of maintenance and durability. Its principle is based on the studies of termogeneration carried through by Thomas Seebeck in 1800. The frank development of the technologies of solid state for termoeletricity generation, the necessity of the best exploitation of the energy, also with incentive the cogeneration processes, the reduction of the ambient impact allies to the development of modules semiconductors of high efficiency, converge to the use of the thermoeletric generation through components of solid state in remote applications. The work presents the development, construction and performance evaluation of an prototype, in pilot scale, for energy tri-generation aiming at application in remote areas. The unit is composed of a gas lamp as primary source of energy, a module commercial semiconductor for thermoelectric generation and a shirt for production of the luminosity. The project of the device made compatible a headstock for adaptation in the gas lamp, a hot source for adaptation of the module, an exchanger of to be used heat as cold source and to compose first stage of cogeneration, an exchanger of tubular heat to compose second stage of cogeneration, the elaboration of a converter dc-dc type push pull, adequacy of a system of acquisition of temperature. It was become fullfilled assembly of the prototype in group of benches for tests and assay in the full load condition in order to evaluate its efficiency, had been carried through energy balance of the unit. The prototype presented an electric efficiency of 0,73%, thermal of 56,55%, illumination of 1,35% and global of 58,62%. The developed prototype, as the adopted methodology of assay had also taken care of to the considered objectives, making possible the attainment of conclusive results concerning to the experiment. Optimization in the system of setting of the semicondutor module, improvement in the thermal insulation and design of the prototype and system of protection to the user are suggestions to become it a commercial product

Emerging infectious diseases in cetaceans worldwide and the possible role of environmental stressors

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Metodologia para o cálculo de harmônicas em conversores de potência no sistema HVDC

Pós-graduação em Engenharia Elétrica - FEIS

Novas centralidades e novos habitats: caminhos para a fragmentação urbana em Marília (SP)

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Planejamento energético para pequenas comunidades da Amazônia: um estudo de caso da comunidade quilombola de Genipaúba - Abaetetuba - Pará

O atendimento energético a comunidades isoladas foi sempre uma atividade de difícil execução e tem sido alvo de críticas pelas autoridades em planejamento energético. Este trabalho visa contribuir com as discussões realizadas no tema de eletrificação de regiões isoladas através da apresentação do diagnóstico social e o planejamento energético realizado para a comunidade de Genipaúba, localizada na região das ilhas de Abaetetuba, município do Estado do Pará. Uma discussão sobre a relação existente entre energia e desenvolvimento inicia a dissertação, posteriormente, apresenta-se um inventário dos recursos energéticos da região, baseado na literatura existente. Os programas governamentais de eletrificação rural (Luz no Campo, Ribeirinhas, PRODEEM, e Luz para Todos) são apresentados. Os modelos de gestão pesquisados (PRISMA e ROSA) foram idealizados através de observações de implementação de projetos de eletrificação. Os diagnósticos social e energético da comunidade de Genipaúba foram realizados através da aplicação de questionários em campo. O processo de implantação do projeto de atendimento energético de Genipaúba é apresentado, em seguida, comparado com os modelos estudados a fim de dar consistência ao mesmo.

Discursos do conflito entre os diferentes agentes mediadores dos movimentos envolvidos no caso Eldorado do Carajás: novas tendências e práticas políticas

A tese teve como objetivo analisar a atuação e os discursos dos diversos agentes mediadores de entidades não-governamentais envolvidos com as causas e a defesa dos movimentos, na luta pela terra, no estado do Pará. Os fundamentos que sustentam a análise pertencem à análise do discurso da linha francesa. A pesquisa é de natureza qualitativo-descritiva. A entrevista e questionário serviram de instrumentos para a produção de dados. Os resultados indicam que há nos diversos discursos e atuações um enfoque na luta por direitos à terra, créditos, justiça e contestação da ordem social vigente. Por isso, as lutas dos movimentos no campo têm caráter político, lutam por direitos coletivos e uma proposta política alternativa para a sociedade. Conclui-se que existem litígios discursivos convergentes, dos mediadores quanto à luta e à garantia de direitos ao acesso à terra, aos movimentos e de conflitos frente a políticas do Estado na Amazônia. Tem-se discursos “contestadores” de natureza positiva acerca da relevância da luta como estratégia de sustentação dos mesmos no conflito agrário paraense, como “moeda” de troca frente a seus oponentes. E estabelece a possibilidade de realização de políticas públicas em áreas esquecidas pelo poder público ou de criminalização das lutas.

Ensino da reanimação neonatal para parteiras tradicionais - do aprendizado à prática nas Regiões Norte e Nordeste do Brasil

Pós-graduação em Ginecologia, Obstetrícia e Mastologia - FMB

Injuries by marine and freshwater stingrays: history, clinical aspects of the envenomations and current status of a neglected problem in Brazil

Stingrays are a group of rays - cartilaginous fish related to sharks - that have whiplike tails with barbed, usually venomous spines and are found around the world, especially the marine species. Despite recent reports of accidents involving these fish, they are not aggressive, reacting only when stepped on or improperly handled. Injuries by stingrays are seldom mentioned by historians, although they have always been present in riverine communities of inland waters and in South American coasts. Indeed, envenomations by stingrays are quite common in freshwater and marine fishing communities. Although having high morbidity, such injuries are neglected because they have low lethality and usually occur in remote areas, which favor the use of folk remedies. In the present review article, historical aspects of injuries caused by stingrays in Brazil and their distribution on the coast of Sao Paulo state and riverine communities of the North, Midwest and Southeast regions were studied. In addition, other aspects were analyzed such as clinical features, therapeutic methods, preventive measures and trends in occurrence of these accidents in the country, particularly in areas in which freshwater stingrays had not been previously registered, being introduced after breaching of natural barriers.

Os sentidos da casa própria: condomínios horizontais populares fechados e novas práticas espaciais em Presidente Prudente e São Carlos

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Saúde e qualidade de vida de adolescentes de um assentamento rural no Pontal do Paranapanema-SP

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Entre livres e oficiais: a expansão do ensino normal em São Paulo (1927-1933)

Pós-graduação em Educação - FFC