Navegando por Palavras-chave "Developing countries"

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    Biopharmaceutical industry-sponsored global clinical trials in emerging countries
    (Associação Médica Brasileira, 2010-01-01) Alvarenga, Lenio Souza; Martins, Elisabeth Nogueira [UNIFESP]; Laboratório Pfizer; Universidade Federal de São Paulo (UNIFESP)
    OBJECTIVE: To evaluate biopharmaceutical industry-sponsored clinical trials placed in countries previously described as emerging regions for clinical research, and potential differences for those placed in Brazil. METHODS: Data regarding recruitment of subjects for clinical trials were retrieved from www.clinicaltrials.gov on February 2nd 2009. Proportions of sites in each country were compared among emerging countries. Multiple logistic regressions were performed to evaluate whether trial placement in Brazil could be predicted by trial location in other countries and/or by trial features. RESULTS: A total of 8,501 trials were then active and 1,170 (13.8%) included sites in emerging countries (i.e., Argentina, Brazil, China, Czech Republic, Hungary, India, Mexico, Poland, Russia, South Korea, and South Africa). South Korea and China presented a significantly higher proportion of sites when compared to other countries (p<0.05). Multiple logistic regressions detected no negative correlation between placement in other countries when compared to Brazil. Trials involving subjects with less than 15 years of age, those with targeted recruitment of at least 1,000 subjects, and seven sponsors were identified as significant predictors of trial placement in Brazil. CONCLUSION: No clear direct competition between Brazil and other emerging countries was detected. South Korea showed the higher proportion of sites and ranked third in total number of trials, appearing as a major player in attractiveness for biopharmaceutical industry-sponsored clinical trials.
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    Breastfeeding training for health professionals and resultant changes in breastfeeding duration
    (Associação Paulista de Medicina - APM, 2000-11-09) Taddei, Jose Augusto de Aguiar Carrazedo [UNIFESP]; Westphal, Marcia Faria [UNIFESP]; Venancio, Sonia; Bogus, Cláudia; Souza, Sonia [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Universidade de Santo Amaro Maternal and Child Health Graduate Program; State of São Paulo State Health Secretariat Health Institute
    CONTEXT: Promotion of breastfeeding in Brazilian maternity hospitals. OBJECTIVE: To quantify changes in the breastfeeding duration among mothers served by hospitals exposed to the Wellstart-SLC course, comparing them with changes among mothers attended by institutions not exposed to this course. DESIGN: Randomized Institutional Trial. SETTING: The effects of training on breastfeeding duration was assessed in eight Brazilian hospitals assigned at random to either an exposed group (staff attending the Wellstart-SLC course) or a control group. SAMPLE: For each of the eight study hospitals, two cohorts of about 50 children were visited at home at one and six months after birth. The first cohort (n = 494) was composed of babies born in the month prior to exposure to the Wellstart-SLC course, and the second cohort (n = 476) was composed of babies born six months subsequent to this exposure. MAIN MEASUREMENTS: Kaplan-Meier curves were plotted to describe the weaning process and log-rank tests were used to assess statistical differences among survival curves. Hazard ratio (HR) estimates were calculated by fitting Cox proportional hazard regression models to the data. RESULTS: The increases in estimated, adjusted rates for children born in hospitals with trained personnel were 29% (HR = 0.71) and 20% (HR = 0.80) for exclusive and full breastfeeding, respectively. No changes were identified for total breastfeeding. CONCLUSION: This randomized trial supports a growing body of evidence that training hospital health professionals in breastfeeding promotion and protection results in an increase in breastfeeding duration.
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    A cost evaluation of peritoneal dialysis and hemodialysis in the treatment of end-stage renal disease in São Paulo, Brazil
    (Multimed Inc, 2013-05-01) Abreu, Mirhelen Mendes de [UNIFESP]; Walker, David R.; Sesso, Ricardo C. [UNIFESP]; Ferraz, Marcos Bosi [UNIFESP]; Universidade Federal de São Carlos (UFSCar); Baxter Healthcare Corp; Universidade Federal de São Paulo (UNIFESP)
    Objective: Conventional hemodialysis (HD) predominates over peritoneal dialysis (PD) around the world. Prospective and comparative studies comparing the costs of these modalities are scarce. in the present prospective assessment, we describe the resources used and total patient costs for both HD and PD.Methodology: We assessed 249 patients on HD and 228 on PD. All patients were 18 years of age or older and on stable dialysis. the information was collected at three points over 1 year, using standard questionnaires. the sources for costs were the Brazilian public and private health care systems. Societal perspective was considered.. Statistical Analysis: Core trends and dispersions were measured. Regression models assessed the impact of modality on the average total cost per patient per year.Results: of the 249 HD patients and 228 PD dialysis patients, 189 (74%) and 160 (70%) respectively completed follow-up. the mean age for women was 55.8 years; for men, it was 59.8 years (p = 0.001). the average total cost per patient-year was US$28 570 for HD and US$27 158 for PD. By category, the costs consisted of direct medical-hospital costs (82.3% for HD, 86.5% for PD), direct nonmedical costs (5.3% for HD, 3.7% for PD), and indirect costs (12.4% for HD, 9.8% for PD). Overall costs were less for PD patients than for their HD counterparts (p = 0.025).Conclusions: Maintenance dialysis represented the most important source of costs for both modalities; loss of productivity incurred significant costs. Future studies should contemplate the social consequences arising from each modality.
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    Early vulnerabilities for psychiatric disorders in elementary schoolchildren from four Brazilian regions
    (Springer Heidelberg, 2018) Paula, Cristiane Silvestre de [UNIFESP]; Mari, Jair de Jesus [UNIFESP]; Bordin, Isabel Altenfelder Santos [UNIFESP]; Miguel, Euripedes Constantino [UNIFESP]; Fortes, Isabela; Barroso, Natalia [UNIFESP]; Rohde, Luis Augusto; Coutinho, Evandro da Silva Freire
    The purpose of the study is to identify early vulnerabilities for psychiatric disorders among Brazilian elementary school children, controlling for familial and community adversities. This is a cross-sectional study examining the association between child psychiatric disorders and potential early vulnerabilities (disability, low intellectual quotient, and negative dimensions of the temperament trait self-directedness (low resourcefulness, low purposefulness, low enlightened second nature), controlling for the potential confounders: familial and community adversities. Sample: Four probabilistic samples of second-to-sixth grade students from public schools in four towns from different Brazilian regions (N = 1620). The following instruments were applied: the K-SADS-PL (to assess child/adolescent psychiatric disorders)
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    Energy expenditure of stunted and nonstunted boys and girls living in the shantytowns of Sao Paulo, Brazil
    (Amer Soc Clinical Nutrition, 2000-10-01) Hoffman, Daniel Jay; Sawaya, Ana Lydia [UNIFESP]; Coward, W. Andrew; Wright, Antony; Martins, Paula Andrea [UNIFESP]; Nascimento, Celia de; Tucker, Katherine L.; Roberts, Susan B.; Universidade Federal de São Paulo (UNIFESP); Tufts Univ; MRC
    Background: Stunting increases the risk of obesity in developing countries. particularly in girls and women, but the underlying reason is not known.Objective: Our objective was to test the hypothesis that stunted children have lower energy expenditure than do nonstunted children, a factor that has predicted an increased risk of obesity in other high-risk populations.Design: A cross-sectional study was conducted in shantytown children from Sao Paulo, Brazil. Twenty-eight stunted children aged 8-11 y were compared with 30 nonstunted children with similar weight-for-height. Free-living total energy expenditure (TEE) was measured over 7 d by using the doubly labeled water method. In addition, resting energy expenditure (REE) was measured by indirect calorimetry and body composition was measured by dual-energy X-ray absorptiometry.Results: There were no significant associations between stunting and any measured energy expenditure parameter, including REE adjusted for weight ((x) over bar +/- SEM: 4575 +/- 95 compared with 4742 +/- 91 kJ/d, in stunted and nonstunted children, respectively) and TEE adjusted for weight (8424 +/- 239 compared with 8009 +/- 221 kJ/d, in stunted and nonstunted children, respectively). In multiple regression models that included fat-free mass and fat mass, girls had significantly lower TEE than did boys (P < 0.05) but not significantly lower REE (P = 0.17).Conclusions: There was no association between stunting and energy expenditure after differences between groups in body size and composition were accounted for. However, the girls had lower TEE than did boys, which may help to explain the particularly high risk of obesity in stunted adolescent girls and women in urban areas of developing countries.
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    Gambling in Brazil Lifetime prevalences and socio-demographic correlates
    (Elsevier B.V., 2010-11-30) Tavares, Hermano; Carneiro, Elizabeth; Sanches, Marcos; Pinsky, Ilana [UNIFESP]; Caetano, Raul; Zaleski, Marcos; Laranjeira, Ronaldo [UNIFESP]; Natl Council Technol & Sci Dev CNPq; Addict & Other Impulse Control Disorders Unit; Ipsos Reid; Universidade Federal de São Paulo (UNIFESP); Univ Texas Dallas; Universidade Federal de Santa Catarina (UFSC); Universidade de São Paulo (USP)
    Gambling has experienced world-wide growth the current study is the first national survey into household gambling conducted in a developing country the sample was a three-stage probabilistic one designed to cover individuals 14 years old or older of both genders and from all regions of the national territory 325 census sectors were visited including rural areas DSM-IV-based instruments were used to assess problem and pathological gambling individuals were asked to estimate their monthly gambling expenditure the lifetime prevalences were pathological gambling 1 0% and problem gambling 1 3% Maximum gambling expenditure corresponded to 5 4% of the household income for social gamblers 16 9% for problem gamblers and 20 0% for pathological gamblers the male female ratio among adults for pathological gambling was 3 2 1 the data suggest the existence of two subgroups of pathological gamblers one younger (33 9 +/- 4 19) and severe (7 or more DSM-IV criteria) another older (47 8 +/- 6 01) and less severe (5-6 criteria) in a multinomial logistic regression problematic gambling was associated with gender age education employment region of origin and living in metropolitan areas the data suggest that feeling active and socially inserted protects against problematic gambling Individuals who are young male unemployed or not currently pursuing further education may be at special risk for severe pathological gambling (C) 2010 Elsevier Ireland Ltd All rights reserved
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    The impact of medical education and networking on the outcome of leukemia treatment in developing countries. the experience of International Consortium on Acute Promyelocytic Leukemia (IC-APL)
    (Maney Publishing, 2012-04-01) Rego, Eduardo M.; Kim, Haesook T.; Ruiz-Argueelles, Guillermo J.; del Rosario Uriarte, Maria; Jacomo, Rafael H.; Gutierrez-Aguirre, Homero; Melo, Raul A. M.; Bittencourt, Rosane; Pasquini, Ricardo; Pagnano, Katia; Fagundes, Evandro M.; Chauffaille, Maria de Lourdes [UNIFESP]; Chiattone, Carlos; Martinez, Lem; Meillon, Luis A.; Gomez-Almaguer, David; Kwaan, Hau; Garces-Eisele, Javier; Gallagher, Robert; Niemeyer, Charlotte M.; Lowenberg, Bob; Ribeiro, Raul; LoCoco, Francesco; Sanz, Miguel A.; Universidade de São Paulo (USP); Dana Farber Canc Inst; Clin Ruiz de Puebla; Asociac Espanola Primera Socorros Mutuos; Univ Hosp; HEMOPE; Univ Fed Rio Grande do Sul; Univ Fed Parana; Universidade Estadual de Campinas (UNICAMP); Universidade Federal de Minas Gerais (UFMG); Universidade Federal de São Paulo (UNIFESP); Santa Casa Med Sch; Ctr Med Nacl Siglo XXI; Northwestern Univ; Albert Einstein Canc Ctr; Univ Med Ctr; Erasmus Univ; St Jude Childrens Rsch Hosp; Univ Roma Tor Vergata; Hosp Univ La Fe
    Objectives: Several clinical trials conducted in Europe and US reported favorable outcomes of patients with APL treated with the combination of all trans retinoic acid (ATRA) and anthracyclines. Nevertheless, the results observed in developing countries with the same regimen was poorer, mainly due to high early mortality mainly due bleeding. the International Consortium on Acute Promyelocytic Leukemia (IC-APL) is an initiative of the International Members Committee of the ASH and the project aims to reduce this gap through the establishment of international network, which was launched in Brazil, Mexico and Uruguay.Methods: the IC-APL treatment protocol is similar to the PETHEMA 2005, but changing idarubicin to daunorubicin. All patients with a suspected diagnosis of APL were immediately started on ATRA, while bone marrow samples were shipped to a national central lab where genetic verification of the diagnosis was performed. the immunofluorescence using an anti-PML antibody allowed a rapid confirmation of the diagnosis and, the importance of supportive measures was reinforced.Results: the interim analysis of 97 patients enrolled in the IC-APL protocol showed that complete remission (CR) rate was 83% and the 2-year overall survival and disease-free survival were 80% and 90%, respectively. of note, the early mortality rate was reduced to 7.5%.Discussion: the results of IC-APL demonstrate the impact of educational programs and networking on the improvement of the leukemia treatment outcome in developing countries.
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    Implementation of sepsis bundles in public hospitals in Brazil: a prospective study with heterogeneous results
    (Biomed Central Ltd, 2017) Machado, Flavia Ribeiro [UNIFESP]; Ferreira, Elaine Maria; Schippers, Pierre|'|de Paula, Ilusca Cardoso; Vendrame Saes, Leticia Sandre; de Oliveira, Francisco Ivanildo, Jr.; Tuma, Paula; Nogueira Filho, Wilson; Piza, Felipe; Guare, Sandra; Mangini, Claudia; Guth, Gustavo Ziggiatti; Pontes Azevedo, Luciano Cesar [UNIFESP]; Resende Freitas, Flavio Geraldo [UNIFESP]; Gomes do Amaral, Jose Luiz [UNIFESP]; Mansur, Nacime Salomao [UNIFESP]; Salomao, Reinaldo [UNIFESP]
    Background: Public hospitals in emerging countries pose a challenge to quality improvement initiatives in sepsis. Our objective was to evaluate the results of a quality improvement initiative in sepsis in a network of public institutions and to assess potential differences between institutions that did or did not achieve a reduction in mortality. Methods: We conducted a prospective study of patients with sepsis or septic shock. We collected baseline data on compliance with the Surviving Sepsis Campaign 6-h bundles and mortality. Afterward, we initiated a multifaceted quality improvement initiative for patients with sepsis or septic shock in all hospital sectors. The primary outcome was hospital mortality over time. The secondary outcomes were the time to sepsis diagnosis and compliance with the entire 6-h bundles throughout the intervention. We defined successful institutions as those where the mortality rates decreased significantly over time, using a logistic regression model. We analyzed differences over time in the secondary outcomes by comparing the successful institutions with the nonsuccessful ones. We assessed the predictors of in-hospital mortality using logistic regression models. All tests were two-sided, and a p value less than 0.05 indicated statistical significance. Results: We included 3435 patients from the emergency departments (50.7%), wards (34.1%), and intensive care units (15.2%) of 9 institutions. Throughout the intervention, there was an overall reduction in the risk of death, in the proportion of septic shock, and the time to sepsis diagnosis, as well as an improvement in compliance with the 6-h bundle. The time to sepsis diagnosis, but not the compliance with bundles, was associated with a reduction in the risk of death. However, there was a significant reduction in mortality in only two institutions. The reduction in the time to sepsis diagnosis was greater in the successful institutions. By contrast, the nonsuccessful sites had a greater increase in compliance with the 6-h bundle. Conclusions: Quality improvement initiatives reduced sepsis mortality in public Brazilian institutions, although not in all of them. Early recognition seems to be a more relevant factor than compliance with the 6-h bundle.
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    Influence of psychosocial risk factors on the trajectory of mental health problems from childhood to adolescence: a longitudinal study
    (Biomed Central Ltd, 2013-01-17) Fatori, Daniel; Bordin, Isabel Altenfelder Santos [UNIFESP]; Curto, Bartira Marques [UNIFESP]; Paula, Cristiane Silvestre de [UNIFESP]; Universidade de São Paulo (USP); Universidade Federal de São Paulo (UNIFESP); Univ Prebiteriana Mackenzie
    Background: Longitudinal epidemiological studies involving child/adolescent mental health problems are scarce in developing countries, particularly in regions characterized by adverse living conditions. We examined the influence of psychosocial factors on the trajectory of child/adolescent mental health problems (CAMHP) over time.Methods: A population-based sample of 6- to 13-year-olds with CAMHP was followed-up from 2002-2003 (Time 1/T1) to 2007-2008 (Time 2/T2), with 86 out of 124 eligible children/adolescents at T1 being reassessed at T2 (sample loss: 30.6%). Outcome: CAMHP at T2 according to the Child Behavior Checklist/CBCL's total problem scale. Psychosocial factors: T1 variables (child/adolescent's age, family socioeconomic status); trajectory of variables from T1 to T2 (child/adolescent exposure to severe physical punishment, mother exposure to severe physical marital violence, maternal anxiety/depression); and T2 variables (maternal education, child/adolescent's social support and pro-social activities).Results: Multivariate analysis identified two risk factors for child/adolescent MHP at T2: aggravation of child/adolescent physical punishment and aggravation of maternal anxiety/depression.Conclusions: the current study shows the importance of considering child/adolescent physical punishment and maternal anxiety/depression in intervention models and mental health care policies.
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    Internal tandem duplication of the FLT3 gene confers poor overall survival in patients with acute promyelocytic leukemia treated with all-trans retinoic acid and anthracycline-based chemotherapy: an International Consortium on Acute Promyelocytic Leukemia study
    (Springer, 2014-12-01) Lucena-Araujo, Antonio R.; Kim, Haesook T.; Jacomo, Rafael H.; Melo, Raul A.; Bittencourt, Rosane; Pasquini, Ricardo; Pagnano, Katia; Fagundes, Evandro M.; Chauffaille, Maria de Lourdes [UNIFESP]; Chiattone, Carlos S.; Lima, Ana Silvia; Ruiz-Argueelles, Guillermo; Soledad Undurraga, Maria; Martinez, Lem; Kwaan, Hau C.; Gallagher, Robert; Niemeyer, Charlotte M.; Schrier, Stanley L.; Tallman, Martin S.; Grimwade, David; Ganser, Arnold; Berliner, Nancy; Ribeiro, Raul C.; Lo-Coco, Francesco; Lowenberg, Bob; Sanz, Miguel A.; Rego, Eduardo M.; Universidade de São Paulo (USP); Ctr Cell Based Therapy; Dana Farber Canc Inst; Fundacao HEMOPE; Univ Fed Rio Grande do Sul; Univ Fed Parana; Universidade Estadual de Campinas (UNICAMP); Universidade Federal de Minas Gerais (UFMG); Universidade Federal de São Paulo (UNIFESP); Santa Casa Med Sch; Clin Ruiz Puebla; Hosp Salvador; Asociac Espanola Primera Socorros Mutuos; Northwestern Univ; Albert Einstein Canc Ctr; Univ Med Ctr; Stanford Univ; Weill Cornell Med Coll; Kings Coll London; Hannover Med Sch; Harvard Univ; St Jude Childrens Res Hosp; Univ Roma Tor Vergata; Santa Lucia Fdn; Erasmus Univ; Univ Valencia
    Activating internal tandem duplication (ITD) mutations in the fms-like tyrosine kinase 3 (FLT3) gene (FLT3-ITD) are associated with poor outcome in acute myeloid leukemia, but their prognostic impact in acute promyelocytic leukemia (APL) remains controversial. Here, we screened for FLT3-ITD mutations in 171 APL patients, treated with all-trans retinoic acid (ATRA) and anthracycline-based chemotherapy. We identified FLT3-ITD mutations in 35 patients (20 %). FLT3-ITD mutations were associated with higher white blood cell counts (P < 0.0001), relapse-risk score (P = 0.0007), higher hemoglobin levels (P = 0.0004), higher frequency of the microgranular morphology (M3v) subtype (P = 0.03), and the short PML/RARA (BCR3) isoform (P < 0.0001). After a median follow-up of 38 months, FLT3-ITDpositive patients had a lower 3-year overall survival rate (62 %) compared with FLT3-ITDnegative patients (82 %) (P = 0.006). the prognostic impact of FLT3-ITD on survival was retained in multivariable analysis (hazard ratio: 2.39, 95 % confidence interval [CI] 1.17-4.89; P = 0.017). Nevertheless, complete remission (P = 0.07), disease-free survival (P = 0.24), and the cumulative incidence of relapse (P = 0.94) rates were not significantly different between groups. We can conclude that FLT3-ITD mutations are associated with several hematologic features in APL, in particular with high white blood cell counts. in addition, FLT3-ITD may independently predict a shorter survival in patients with APL treated with ATRA and anthracycline-based chemotherapy.
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    Lower resting metabolic rate and higher velocity of weight gain in a prospective study of stunted vs nonstunted girls living in the shantytowns of São Paulo, Brazil
    (Nature Publishing Group, 2005-07-01) Grillo, Luciane Peter; Siqueira, Antonieta Ferro Antunes de [UNIFESP]; Silva, Antonio Carlos da [UNIFESP]; Martins, Paula Andrea [UNIFESP]; Verreschi, Ieda Therezinha do Nascimento [UNIFESP]; Sawaya, Ana Lydia [UNIFESP]; Univ Vale Itajai; Universidade Federal de São Paulo (UNIFESP)
    Objective: Previous studies have shown that stunting increases the risk of obesity in developing countries, particularly among girls and women, but the underlying reasons are not known. This study aimed to investigate the relationship between stunting, weight gain, and resting metabolic rate.Design and subjects: A prospective study was conducted over 36 months with girls from shantytowns in São Paulo, Brazil. A total of 15 stunted girls ( S) were compared with 15 nonstunted (N) ones of similar weight for height ratio. Interventions: Resting metabolic rate was measured using indirect calorimetry, and the socioeconomic status was determined by interviews in the household. in addition, body composition was measured by skinfold thickness, while the growth rate was calculated dividing the change in weight and the change in height by the follow-up period.Results: the results of the present study, when combined, revealed that the S group had a lower resting metabolic rate throughout the follow-up period with the differences being significant at 24 and 36 months of follow-up, associated with an increase in the rate of weight gain and a decrease in lean mass, when compared to the N group.Conclusions: These changes are known to be risk factors for obesity and may help to explain the particularly higher prevalence of obesity in women in urban areas of developing countries.
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    Management of late-preterm and term infants with hyperbilirubinaemia in resource-constrained settings
    (Biomed Central Ltd, 2015-04-12) Olusanya, Bolajoko O.; Ogunlesi, Tinuade A.; Kumar, Praveen; Boo, Nem-Yun; Iskander, Iman F.; Almeida, Maria Fernanda Branco de [UNIFESP]; Vaucher, Yvonne E.; Slusher, Tina M.; Ctr Hlth Start Initiat; Olabisi Onabanjo Univ; Postgrad Inst Med Educ & Res; Univ Tunku Abdul Rahman; Cairo Univ; Universidade Federal de São Paulo (UNIFESP); Univ Calif San Diego; Univ Minnesota; Hennepin Cty Med Ctr
    Hyperbilirubinaemia is a ubiquitous transitional morbidity in the vast majority of newborns and a leading cause of hospitalisation in the first week of life worldwide. While timely and effective phototherapy and exchange transfusion are well proven treatments for severe neonatal hyperbilirubinaemia, inappropriate or ineffective treatment of hyperbilirubinaemia, at secondary and tertiary hospitals, still prevails in many poorly-resourced countries accounting for a disproportionately high burden of bilirubin-induced mortality and long-term morbidity. As part of the efforts to curtail the widely reported risks of frequent but avoidable bilirubin-induced neurologic dysfunction (acute bilirubin encephalopathy (ABE) and kernicterus) in low and middle-income countries (LMICs) with significant resource constraints, this article presents a practical framework for the management of late-preterm and term infants (>= 35 weeks of gestation) with clinically significant hyperbilirubinaemia in these countries particularly where local practice guidelines are lacking. Standard and validated protocols were followed in adapting available evidence-based national guidelines on the management of hyperbilirubinaemia through a collaboration among clinicians and experts on newborn jaundice from different world regions. Tasks and resources required for the comprehensive management of infants with or at risk of severe hyperbilirubinaemia at all levels of healthcare delivery are proposed, covering primary prevention, early detection, diagnosis, monitoring, treatment, and follow-up. Additionally, actionable treatment or referral levels for phototherapy and exchange transfusion are proposed within the context of several confounding factors such as widespread exclusive breastfeeding, infections, blood group incompatibilities and G6PD deficiency, which place infants at high risk of severe hyperbilirubinaemia and bilirubin-induced neurologic dysfunction in LMICs, as well as the limited facilities for clinical investigations and inconsistent functionality of available phototherapy devices. the need to adjust these levels as appropriate depending on the available facilities in each clinical setting and the risk profile of the infant is emphasised with a view to avoiding over-treatment or under-treatment. These recommendations should serve as a valuable reference material for health workers, guide the development of contextually-relevant national guidelines in each LMIC, as well as facilitate effective advocacy and mobilisation of requisite resources for the optimal care of infants with hyperbilirubinaemia at all levels.
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    Mental health and psychiatric care in Bolivia: what do we know?
    (Biomed Central Ltd, 2014-05-15) Jaen-Varas, Denisse [UNIFESP]; Ribeiro, Wagner Silva [UNIFESP]; Whitfield, Jessie; Mari, Jair de Jesus [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); St Louis Univ
    Background: Recently Bolivia has implemented a universal health system, but their mental health policy is still emerging.Objectives: To investigate the current state of the mental health care system in Bolivia and discuss challenges for structuring a coordinated network of services that can effectively meet the needs of the Bolivian population.Methods: This review was conducted by searching for scholarly articles through the databases Lilacs, Medline OPS, HISA and IBECS REPIDISCA via the search portal in the Virtual Health Library - NLM (www.bireme.br).Results: Bolivia has a National Mental Health Plan that is intended to guide mental health promotion, prevention, treatment and rehabilitation of mental illness, but the resources for this area of health are limited. There are 1.06 psychiatrists and 0.46 psychologists per 100, 000 inhabitants. Information on psychiatric morbidity in Bolivia and the impact of mental disorders on the global burden of disease is scarce. Admission statistics reported by psychiatric hospitals in the country show that the main cause of hospitalization is substance abuse (30%). Alcohol consumption is responsible for 90% of these admissions, in addition to being a major cause of deaths in traffic and one of the main risk factors for domestic violence. Almost one in two women in Bolivia (47%) experienced some form of violence from their partner in the last year. Nineteen percent of women living with a partner reported being physically abused, while 7% were sexually abused by their partners. Isolated studies report that suicide rates are disproportionately high in Bolivia.Conclusions: Although there is a shortage of epidemiological data in Bolivia, it is clear the impact of alcohol addiction in psychiatric admissions, domestic violence and traffic accidents. Violence against women and suicides are important issues to be tackled. Among the proposed strategies to afford human resources for mental health in Bolivia, task shifting, the delegation of tasks to non-specialists should be extensively adopted in the country to improve mental health care.
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    Premature rupture of membranes before 28 weeks managed expectantly: Maternal and perinatal outcomes in a developing country
    (Informa Healthcare, 2012-01-01) Fernandes, G. L.; Torloni, M. R.; Hisaba, W. Jou; Klimke, D.; Novaes, J.; Sancovski, M. [UNIFESP]; Peixoto, S. [UNIFESP]; Hosp Municipal Univ; Fac Med ABC; Universidade Federal de São Paulo (UNIFESP)
    This study aimed to assess outcomes of expectant management for early preterm premature rupture of membranes (PPROM). This retrospective cohort involved 66 women with PPROM <28 weeks managed in a single hospital (1999-2006). Main outcomes were chorioamnionitis, severe maternal morbidity (maternal sepsis, haemorrhage/blood transfusion, hysterectomy or admission to intensive care unit), maternal mortality, low birth weight, preterm birth, neonatal infection and perinatal mortality. Mean gestational ages at PPROM and delivery were 21.7 +/- 4.2 and 28.4 +/- 5.9 weeks, respectively. Chorioamnionitis was diagnosed in 47%; no cases of severe maternal morbidity or mortality occurred. Stillbirth rate was 25.7% and >80% of infants were delivered before 34 weeks. Neonatal infection was diagnosed in 42.9% of the 49 live-births. Overall survival rate was 57.6%. Expectant management of PPROM <28 weeks resulted in high rates of chorioamnionitis and preterm deliveries but in over half of the cases, a live infant was discharged home.
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    Production and marketing of drugs in Brazil
    (Elsevier B.V., 1991-01-01) Castelo Filho, Adauto [UNIFESP]; Colombo, Arnaldo Lopes [UNIFESP]; Holbrook, Anne M.; MCMASTER UNIV; Universidade Federal de São Paulo (UNIFESP)
    Brazil is typical of many developing countries in its struggle to provide basic healthcare for its citizens in face of national economic instability. Since pharmaceuticals represent a major component of modern healthcare, their production, regulation and use become an area of concern.It appears that any change in the current production patterns will require a major commitment from governments, understanding external economic pressures. There are pros and cons in a policy directed towards pharmaceutical self-sufficiency. Aside from production, efforts directed towards extending access to essential drugs and improving the appropriateness of use, would appear to be warranted.
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    Promoting editorial capacity in psychiatric journals in low and middle income countries (LAMIC)
    (In House Publications, 2011-03-01) Mari, Jair de Jesus [UNIFESP]; Szabo, C. P.; Wu, C.; Lam, L. C. W.; Wang, L.; Midin, M.; Irfan, M.; Kieling, C.; Herrman, H.; Universidade Federal de São Paulo (UNIFESP); Univ Witwatersrand; Shanghai Arch Psychiat; E Asian Arch Psychiat; Asean Journal Psychiatr; Hosp Clin Porto Alegre Porto Alegre; Journal Pakistan Psychiat Soc; Univ Melbourne; World Hlth Org Collaborating Ctr Mental Hlth; World Psychiat Assoc
    Under the auspices of the WPA section for publications, the WPA Task Force on publications has been actively involved in promoting editorial capacity in LAMIC countries through workshops. The workshops review selected journals from regions within the LAMIC group. The current workshop focused on Africa and Asia, with selected editors presenting content related to their journals. The aim was to establish the readiness for indexation in international databases, and to provide strategic input to facilitate this process. However, beyond indexation the workshop provided an opportunity to contribute towards improving quality of publications that would lead to a positive impact on mental health content in these regions. A further workshop is planned for Central and South American publications.
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    Risk factors for overweight and obesity in adolescents of a Brazilian university: a case-control study
    (Aula Medica Ediciones, 2009-01-01) Menezes, Ida Helena Carvalho Francescantonio; Neutzling, Marilda Borges; Taddei, Jose Augusto de Aguiar Carrazedo [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Univ Fed Pelotas; Universidade Federal de Goiás (UFG)
    Objective: To analyze the risk factors associated to overweight and obesity in freshmen of a public university in the Center-West region of Brazil.Methods: A case-control study comprising 1,465 adolescents, identifying 106 cases (Body Mass Index (BMI) > = 85(th) percentile of National Center for Health Statistics -NCHS) and 233 controls (BMI > 5(th) and < 85(th) percentile of NCHS). Interviews were made to collect information on socioeconomic data, eating habits, physical activity and health habits. Information on parents' height and weight were obtained over the telephone.Results: Non-conditional multivariate and hierarchical logistic regression showed that overweight and obesity were positively associated to males (odds ratio (OR) 2.25, 95% confidence interval (CI) 1.37-3.69), mother's BMI (OR 3.45,95% CI 2.16-5.8), overweight in childhood (OR 2.81, 95% CI 1.62-4.85), consumption of fruits less than once a day (OR 1.84, 95% CI 1.05-3.21) and the habit of weight-loss dieting (OR 6.33,95% CI 2.68-14.94).Conclusion: Results emphasize the need for educational interventions at early ages involving the whole family to control the excess of weight.
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    Scarcity and inequity of mental health research resources in low-and-middle income countries: A global survey
    (Elsevier B.V., 2010-03-01) Razzouk, Denise [UNIFESP]; Sharan, Pratap; Gallo, Carla; Gureje, Oye; Lamberte, Exaltacion E.; Mari, Jair de Jesus [UNIFESP]; Mazzotti, Guido; Patel, Vikram; Swartz, Leslie; Olifson, Sylvie; Levav, Itzhak; Francisco, Andres de; Saxena, Shekhar; WHO Global Forum Hlth Res; Universidade Federal de São Paulo (UNIFESP); Kings Coll London; All India Inst Med Sci; Univ Peruana Cayetano Heredia; Univ Ibadan; De La Salle Univ; London Sch Hyg & Trop Med; Univ Stellenbosch; Human Sci Res Council; Global Forum Hlth Res; Minist Hlth; WHO
    Objective: To map mental health research capacity and resources in low-and-middle-income countries (LAMIC) for the years 1993-2003.Method: Mental health researchers from 114 LAMIC in three continents were identified through their publications in two databases (Medline and PsycInfo) and from local grey literature. A questionnaire was developed and sent to authors to elicit information about researchers' background, available resources and details of up to three recent projects.Results: 4208 researchers from 83 countries were identified through 6340 mental health indexed-publications and 3598 publications from the grey literature. 912 researchers from 52 countries completed the questionnaires. Researchers and publications were concentrated in 10% of the countries. Respondents reported participation in 1847 projects, most of which were devoted to depression and anxiety disorders, substance misuse and psychoses. Epidemiologic studies, social, psychological and clinical research accounted for 80% of all projects. Two-thirds of projects had received external funding, and less than one-third of them were conducted in collaboration with other countries.Conclusion: Mental health research capacity is scarce and unequally distributed in LAMIC. Global agencies for health research as well as LAMIC with higher concentrations of
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    Survey of calcium supplementation to prevent preeclampsia: the gap between evidence and practice in Brazil
    (Biomed Central Ltd, 2013-11-11) Camargo, Erika Barbosa [UNIFESP]; Moraes, Luci Fabiane Scheffer; Souza, Celsa Moura; Akutsu, Rita; Barreto, Jorge Maia; Silva, Edina Mariko Koga da [UNIFESP]; Betran, Ana Pilar; Torloni, Maria Regina [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); South Santa Catarina Univ UNISUL; Amazonas Fed Univ UFAM; Brasilia Fed Univ UnB; Univ Fed Piaui; WHO
    Background: Preeclampsia is a major cause of maternal and perinatal morbidity and mortality worldwide and especially in Latin America. High quality evidence indicates that calcium supplementation during pregnancy significantly reduces the incidence of preeclampsia and its consequences, including severe maternal morbidity and death. Few studies have assessed the implementation of this intervention in clinical practice. the study aimed to assess the proportion of pregnant women who received calcium supplements in Brazilian public antenatal care clinics.Methods: This cross-sectional study interviewed women waiting for antenatal care visits in 9 public clinics in 4 Brazilian cities in 2010-2012. Trained interviewers used a standardized anonymous questionnaire to collect socio demographic and obstetric data, information on ingestion of dairy products and on prescriptions received during current pregnancy.Results: A total of 788 valid questionnaires were analyzed. Participants were young (mean age 25.9), mostly multiparous (71.3%) and in the 2nd or 3rd trimesters of pregnancy at the time of interview (87.6%). Only 5.1% (40/788) had received a prescription for calcium supplements. Based on their reported ingestion of dairy products, the mean daily dietary calcium intake of the participants was 210 (+ 265) mg/day and over 90% consumed less than 1 g of calcium/day.Conclusions: Despite good quality evidence indicating the benefits of this practice especially for women with low calcium diets, less than 6% of a sample of women receiving antenatal care in Brazilian public clinics received a prescription for calcium supplements. There is an urgent need to upscale the implementation of this life-saving intervention.
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    Ten-year growth in the scientific production of Brazilian Psychiatry: the impact of the new evaluation policies
    (Associação Brasileira de Psiquiatria - ABP, 2010-03-01) Gerolin, Jerônimo [UNIFESP]; Bressan, Rodrigo Affonseca [UNIFESP]; Pietrobon, Ricardo; Mari, Jair de Jesus [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Instituto Israelita de Ensino e Pesquisa Albert Einstein; Duke University Health System; King's College London Institute of Psychiatry
    OBJECTIVE: Developed by the Ministry of Education, the Qualis evaluation criteria have strongly impacted the scientific production of Post-Graduation Programs. A new set of more stringent criteria has been proposed for Qualis. Our aim was to evaluate the impact of the new Qualis criteria on the scientific production of Post-Graduation Programs in psychiatry over the last 10 years. METHOD:We extracted data from annual reports published between 1998 and 2008, and compared performance measured in terms of the old Qualis rating criteria and the new set of criteria. RESULTS: There was a 25% increase in the number of Information Science Institute-indexed articles in the second five-year period, which rose from 1,213 to 1,518. While, according to the old Qualis criteria, 84% of the Information Science Institute production would have been classified as highly-rated (IF > 1), only 17% of the papers were classified as highly-rated (A1) according to the new Qualis rating criteria. Most papers (65%) were assigned to intermediate categories (B1 and B2) with an IF < 2.29. DISCUSSION:All psychiatric Post-Graduation Programs have increased their production, but by favoring quality over quantity, the new rules have proved to be more useful for discriminating among the scientific production.