Deliberately introduced dung beetles in Australia: 12 years of occurrence and abundance records from 2001 to 2022.

Since 1968, the Australian Dung Beetle Project has carried out field releases of 43 deliberately introduced dung beetle species for the biological control of livestock dung and dung-breeding pests. Of these, 23 species are known to have become established. For most of these species, sufficient time has elapsed for population expansion to fill the extent of their potential geographic range through both natural and human-assisted dispersal. Consequently, over the last 20 years, extensive efforts have been made to quantify the current distribution of these introduced dung beetles, as well as the seasonal and spatial variation in their activity levels. Much of these data and their associated metadata have remained unpublished, and they have not previously been synthesized into a cohesive dataset. Here, we collate and report data from the three largest dung beetle monitoring projects from 2001 to 2022. Together, these projects encompass data collected from across Australia, and include records for all 23 species of established dung beetles introduced for biocontrol purposes. In total, these data include 22,718 presence records and 213,538 absence records collected during 10,272 sampling events at 546 locations. Most presence records (97%) include abundance data. In total, 1,752,807 dung beetles were identified as part of these data. The distributional occurrence and abundance data can be used to explore questions such as factors influencing dung beetle species distributions, dung beetle biocontrol, and insect-mediated ecosystem services. These data are provided under a CC-BY-NC 4.0 license and users are encouraged to cite this data paper when using the data.

Which roads lead to access? A global landscape of six COVID-19 vaccine innovation models.

BACKGROUND: Unequal and inequitable access to Covid-19 vaccines in low- and middle-income countries (L&MICs) was a major political, ethical and public health failure in the pandemic. However, vaccine developers' practices were not monolithic, but rather, took diverse approaches to supplying different countries, with important implications for global access. RESULTS: Using data on R&D investments, regulatory approvals, manufacturing and purchase agreements, and vaccine deliveries, we identified six distinct innovation models that apply across the 14 COVID-19 vaccines with more international presence from 2020-2022. "Western Early Arrivers" Pfizer/BioNTech and Moderna supplied the largest volumes quickly and prioritized high-income countries (HICs) from registration to vaccine delivery. "Western Latecomers" Janssen and Novavax supplied intermediate volumes later, also prioritizing HICs but with a greater proportion to L&MICs. "Major Chinese Developers" Sinopharm and Sinovac supplied intermediate volumes early, primarily to middle-income countries (MICs). "Russian Developer" Gamaleya completed development early but ultimately supplied small volumes, primarily to middle-income countries (MICs). "Cosmopolitan Developer" Oxford/AstraZeneca supplied large volumes early to HICs and MICs at the lowest prices. Finally, "Small MIC Developers" CanSino, Bharat Biotech, Medigen, Finlay Institute and the Center for Genetic Engineering and Biotechnology (CGEB), exported relatively small volumes to a few MICs. Low-income countries (LICs) were not targeted by any developer, and received far fewer doses, later, than any other income group. Almost all developers received public funding and other forms of support, but we found little evidence that such support was leveraged to expand global access. CONCLUSIONS: Each of the six innovation models has different implications for which countries get access to which vaccines, how quickly, and at which prices. Each offers different strengths and weaknesses for achieving equitable access. Our findings also suggest that Western firms had the greatest capacity to develop and deliver vaccines quickly during the pandemic, but such capacity is rapidly becoming more globally distributed with MICs playing a significant role, especially in supplying other MICs. Given the critical role of public support in enabling pandemic vaccine development and supply, governments have both the capacity and responsibility to craft international rules that will make responses to future pandemics more equitable and effective.

Finger-Prick Whole Blood Cryptococcal Antigen Lateral Flow Assay for the Diagnosis of Cryptococcosis in HIV-Negative Patients: A Case Series Study in Two Tertiary Centers in São Paulo, Brazil.

Cryptococcosis in HIV-negative patients can be an opportunistic or endemic disease. There are no published studies on the use of the finger-prick whole blood (point-of-care) cryptococcal antigen lateral flow assay (CrAg LFA) for diagnosing cryptococcosis in HIV-negative patients. We conducted a case series study of HIV-negative patients with cryptococcosis in two centers in São Paulo, Brazil. The objectives were to identify the sensitivity of a finger-prick whole blood CrAg LFA and to describe the main characteristics of this population. We identified 30 HIV-negative patients with cryptococcosis [19 (63%), male; median age, 47 years]. Ten (33%) patients were immunosuppressed, ten (33%) had other comorbidities, and ten (33%) were apparently immunocompetent and without comorbidities. The distribution of the sites of cryptococcosis was as follows: the central nervous system, 90% (n = 27); pulmonary, 43% (n = 13); and other extrapulmonary sites, 40% (n = 12). The sensitivity of the finger-prick whole blood CrAg LFA for the diagnosis of cryptococcosis was 97% (29/30). Among 26 participants with cryptococcal meningitis, the sensitivity of testing cerebrospinal fluid was as follows: CrAg latex agglutination, 77% (20/26); CrAg LFA, 96% (25/26); and culture, 81% (21/26). Culture speciation identified Cryptococcus gattii in 16 (62%) cases, and all had a positive finger-prick whole blood CrAg LFA. This test presented high sensitivity to the diagnosis of cryptococcosis in HIV-negative patients, including those caused by C. gattii.

Rising pharmaceutical innovation in the Global South: a landscape study.

BACKGROUND: There is growing interest in pharmaceutical innovation in low- and middle-income countries (LMICs), but information on existing activities, capacities, and outcomes is scarce. We mapped available data at the global level, and studied the national pharmaceutical innovation systems of Bangladesh and Colombia to shed light on pharmaceutical research and development (R&D) in the Global South, including challenges and prospects, to help fill existing knowledge gaps. METHODS: We gathered and analyzed data from three types of sources: literature, semi-structured interviews with key informants, and publicly available data on R&D funding, R&D scientific capacity measured by human resources, and clinical trial activities. RESULTS: Pharmaceutical R&D activities are occurring in many LMICs, but 16 countries have emerged as frontrunners. Investment in R&D in LMICs has increased in the past decade, particularly from middle-income countries (MICs). Capacity is also growing, with an increase in the number of research organizations and the amount of funding available from external sources. The total number of clinical trials and the proportion of trials in LMICs increased markedly, and there is also growing activity in the earlier, more innovative and riskier Phase 1 and 2 trials. Non-commercial entities comprise the majority of clinical trial funders and sponsors in LMICs. Finally, investments have borne fruit, as indicated by a number of innovative medicines developed in LMICs. The Bangladesh and Colombia country studies showed that there is still a need for both targeted R&D policies to strengthen capacities in the pharmaceutical sector, and more government support to overcome the challenges of a lack of funding and coordination among different actors. CONCLUSIONS: By triangulating between the data sources, it was possible to paint a broad picture of who was involved in pharmaceutical R&D in LMICs, in which particular countries, for which diseases, in which R&D phases, and with what results-as well as how these trends have changed over time. Prioritizing pharmaceutical R&D is an important strategy for better meeting health needs. The trendlines are promising, but focused attention is still needed to realize the potential for greater innovation in the Global South.

Acesso e utilização dos serviços de saúde e raça/cor/etnia entre mulheres: uma metanálise / Access to and utilization of health services and race/color/ethnicity among women: a meta-analysis / Acceso y utilización de los servicios de salud y raza/color/etnia entre las mujeres: un metaanálisis

Diversas barreiras podem comprometer o acesso aos serviços de saúde no Brasil, especialmente entre as mulheres negras, evidenciando a urgência em discutir esse tema à luz das iniquidades raciais e de gênero. O objetivo deste estudo foi realizar uma revisão sistemática com metanálise para avaliar as evidências científicas da associação entre raça/cor de pele/etnia e acesso e utilização dos serviços de saúde entre mulheres. A busca dos estudos foi realizada em cinco bases eletrônicas, incluindo literatura cinzenta, até março de 2022 e, após a extração de dados, foi realizada a avaliação da qualidade dos artigos. A metanálise estimou a medida de associação global (odds ratio) e seu intervalo de confiança de 95%. Também foi avaliado o indicador de Higgins e Thompson (I2) para classificação da heterogeneidade estatística dos dados. Foram identificados 428 registros, mas apenas três estudos atenderam aos critérios de elegibilidade. A raça/cor de pele/etnia negra esteve associada a desfechos negativos relacionados ao acesso/utilização dos serviços de saúde no Brasil (OR = 1,49; IC95%: 1,26-1,76; I2 = 24,01%). Neste estudo, verificou-se que existem iniquidades raciais no acesso/utilização dos serviços de saúde entre mulheres. No entanto, destaca-se a necessidade de mais estudos rigorosos para elucidar a influência da raça/cor/etnia e de elaboração de políticas públicas.

Several barriers can compromise access to health services in Brazil, especially among black women, highlighting the urgency of discussing this topic in the light of racial and gender inequalities. This study aimed to carry out a systematic review with meta-analysis to assess the scientific evidence on the association between race/skin color/ethnicity and access and use of health services among women. The search for studies was carried out in five electronic databases, including the gray literature, until March 2022, and, after data extraction, the quality of the articles was evaluated. The meta-analysis estimated the global association measure (odds ratio) and its 95% confidence interval. The Higgins and Thompson indicator (I2) was also evaluated to classify the statistical heterogeneity of the data. A total of 428 records were identified, but only three studies met the eligibility criteria. Black race/skin color/ethnicity was associated with negative outcomes related to access/use of health services in Brazil (OR = 1.49; 95%CI: 1.26-1.76; I2 = 24.01%). This study showed the presence of racial inequalities in the access/use of health services among women. However, it highlights the need for more rigorous studies to elucidate the influence of race/color/ethnicity and the elaboration of public policies.

Diversos obstáculos pueden dificultar el acceso a los servicios de salud en Brasil, principalmente para las mujeres negras, lo que muestra la necesidad de discutir el tema de las inequidades racial y de género. Este estudio tiene por objetivo realizar una revisión sistemática con metaanálisis para evaluar la evidencia científica de la asociación entre raza/color/etnia y el acceso y uso de los servicios de salud por las mujeres. Se realizó una búsqueda en cinco bases de datos electrónicas, incluida la literatura gris, en el periodo hasta marzo de 2022; y tras evaluados los datos, se llevó a cabo una evaluación de la calidad de los artículos. El metaanálisis estimó la asociación global (Odds Ratio) y su intervalo de confianza del 95%. También se evaluó el indicador de Higgins y Thompson (I²) para clasificar la heterogeneidad estadística de los datos. Se identificaron 428 registros, de los cuales solo tres estudios cumplieron los criterios de elegibilidad. La raza/color de piel/etnia negra se asoció con desenlaces negativos relacionados al acceso/uso de los servicios de salud en Brasil (OR = 1,49; IC 95%: 1,26-1,76; I² = 24,01%). Estos hallazgos destacan las inequidades raciales en el acceso/uso de los servicios de salud entre mujeres brasileñas. Sin embargo, se necesitan investigaciones más rigurosas sobre la influencia de la raza/color/etnia y la implementación de políticas públicas efectivas.

Pharmaceutical policy and innovation for rare diseases: A narrative review.

This article aims to synthesize the existing literature on the implementation of public policies to incentivize the development of treatments for rare diseases, (diseases with very low prevalence and therefore with low commercial interest) otherwise known as orphan drugs. The implementation of these incentives in the United States (US), Japan, and in the European Union (EU) seems to be related to a substantial increase in treatments for these diseases, and has influenced the way the pharmaceutical research & development (R&D) system operates beyond this policy area. Despite the success of the Orphan Drug model, the academic literature also highlights the negative implications that these public policies have on affordability and access to orphan drugs, as well as on the prioritization of certain disease rare areas over others. The synthesis focuses mostly on the United States' Orphan Drug Act (ODA) as a model for subsequent policies in other regions and countries. It starts with a historical overview of the creation of the term "rare diseases", continues with a summary of the evidence available on the US ODA's positive and negative impacts, and provides a summary of the different proposals to reform these incentives in light of the negative outcomes described. Finally, it describes some key aspects of the Japanese and European policies, as well as some of the challenges captured in the literature related to their impact in Low- and Middle-Income Countries (LMICs).

Non-commercial pharmaceutical R&D: what do neglected diseases suggest about costs and efficiency?

Background: The past two decades have witnessed significant growth in non-commercial research and development (R&D) initiatives, particularly for neglected diseases, but there is limited understanding of the ways in which they compare with commercial R&D. This study analyses costs, timelines, and attrition rates of non-commercial R&D across multiple initiatives and how they compare to commercial R&D. Methods: This is a mixed-method, observational, descriptive, and analytic study. We contacted 48 non-commercial R&D initiatives and received either quantitative and/or qualitative data from 13 organizations. We used the Portfolio to Impact (P2I) model's estimates of average costs, timelines, and attrition rates for commercial R&D, while noting that P2I cost estimates are far lower than some previous findings in the literature. Results: The quantitative data suggested that the costs and timelines per candidate per phase (from preclinical through Phase 3) of non-commercial R&D for new chemical entities are largely in line with commercial averages. The quantitative data was insufficient to compare attrition rates. The qualitative data identified more reasons why non-commercial R&D costs would be lower than commercial R&D, timelines would be longer, and attrition rates would be equivalent or higher, though the data does not allow for estimating the magnitude of these effects. Conclusions: The quantitative data suggest that costs and timelines per candidate per phase were largely in line with (lower-end estimates of) commercial averages. We were unable to draw conclusions on overall efficiency, however, due to insufficient data on attrition rates. Given that non-commercial R&D is a nascent area of research with limited data available, this study contributes to the literature by generating hypotheses for further testing against a larger sample of quantitative data. It also offers a range of explanatory factors for further exploration regarding how non-commercial and commercial R&D may differ in costs and efficiency.

Ointment of Ximenes americana promotes acceleration of wound healing in rats1.

PURPOSE: To evaluate the healing potential of the Ximenia americana hydroalcoholic extract in 10% cream in excisional wound models in rats. METHODS: Sixty male adults Wistar rats were submitted to skin and subcutaneous tissue surgery in the right and left thoracic regions, divided into three experimental groups: Standard submitted to treatment with only the base vehicle, Treated wounds treated with hydroalcoholic extract of X. americana applied on 10%, Lanette base and Control, untreated wounds. The treatment was performed daily and the wounds evaluated microscopically by the quantification of fibroblasts, collagen fibers and blood vessels. RESULTS: The histomorphometric analysis showed a significant increase in the number of fibroblasts, collagen fibers and blood vessels in the treated group. CONCLUSION: The topical action of the cream based on Ximenia americana shows angiogenic effects and improves the replacement of collagen, suggesting its use for the development of herbal remedy in the treatment of cutaneous wound healing.

Caloric restriction prevents the development of airway hyperresponsiveness in mice on a high fat diet.

We have previously shown that high fat diet (HFD) for 2 weeks increases airway hyperresponsiveness (AHR) to methacholine challenge in C57BL/6J mice in association with an increase in IL-1ß levels in lung tissue. We hypothesize that obesity increases AHR via the IL-1ß mechanism, which can be prevented by caloric restriction and IL-1ß blockade. In this study, we fed C57BL/6J mice for 8 weeks with several hypercaloric diets, including HFD, HFD supplemented with fructose, high trans-fat diet (HTFD) supplemented with fructose, either ad libitum or restricting their food intake to match body weight to the mice on a chow diet (CD). We also assessed the effect of the IL-1ß receptor blocker anakinra. All mice showed the same total respiratory resistance at baseline. All obese mice showed higher AHR at 30 mg/ml of methacholine compared to CD and food restricted groups, regardless of the diet. Obese mice showed significant increases in lung IL-1 ß mRNA expression, but not the protein, compared to CD and food restricted mice. Anakinra abolished an increase in AHR. We conclude that obesity leads to the airway hyperresponsiveness preventable by caloric restriction and IL-1ß blockade.

Ointment of Ximenes americana promotes acceleration of wound healing in rats

Abstract Purpose: To evaluate the healing potential of the Ximenia americana hydroalcoholic extract in 10% cream in excisional wound models in rats. Methods: Sixty male adults Wistar rats were submitted to skin and subcutaneous tissue surgery in the right and left thoracic regions, divided into three experimental groups: Standard submitted to treatment with only the base vehicle, Treated wounds treated with hydroalcoholic extract of X. americana applied on 10%, Lanette base and Control, untreated wounds. The treatment was performed daily and the wounds evaluated microscopically by the quantification of fibroblasts, collagen fibers and blood vessels. Results: The histomorphometric analysis showed a significant increase in the number of fibroblasts, collagen fibers and blood vessels in the treated group. Conclusion: The topical action of the cream based on Ximenia americana shows angiogenic effects and improves the replacement of collagen, suggesting its use for the development of herbal remedy in the treatment of cutaneous wound healing.

High fat diet induces airway hyperresponsiveness in mice.

The experiment was conducted to examine the effect of a high fat diet (HFD) on airway hyperresponsiveness (AHR) in mice. Twenty-three adult male C57BL/6 J mice were fed with HFD or regular chow diet for two weeks. The total respiratory resistance was measured by forced oscillation technique at baseline and after methacholine aerosol challenge at 1, 3, 10 and 30 mg/mL. Bronchoalveolar lavage (BAL) was performed. Lipid levels and lipid peroxidation in lung tissue were measured along with gene expression of multiple cytokines. Lungs were digested, and IL-1ß secretion by pulmonary macrophages was determined. HFD feeding resulted in 11% higher body weight compared to chow. HFD did not affect respiratory resistance at baseline, but significantly augmented airway responses to methacholine compared to chow diet (40.5 ± 17.7% increase at 30 mg/ml methacholine, p < 0.05). HFD induced a 3.2 ± 0.6 fold increase in IL-1ß gene expression (p < 0.001) and a 38 fold increase in IL-1ß secretion in the lungs. There was no change in BAL and no change in any other cytokines, lipid levels or lipid peroxidation. Hence, HFD induced AHR in mice prior to the development of significant obesity which was associated with up-regulation of pulmonary IL-1ß.

Mast cell concentration and skin wound contraction in rats treated with Ximenia americana L.

PURPOSE: To evaluate wound contraction and the concentration of mast cells in skin wounds treated with wild plum (Ximenia americana) essential oil-based ointment in rats. METHODS: Sixty rats were submitted to two cutaneous wounds in the thoracic region, on the right and left antimeres. Thereon, they were divided into three groups: GX (wounds treated once a day with hydro alcoholic branch extract of Ximenia americana), GP (wounds that received vehicle), and GC (wounds without product application). Wounds were measured immediately after the injury as well as 4, 7, 14 and 21 days post-topical application of the extract. At these days, five rats from each group were euthanatized. Thereafter, samples were fixed in 10% formaldehyde and processed for paraffin embedding. Sections were stained with H.E, Masson's Trichrome and toluidine blue for morphological, morphometrical and histopathological analysis, under light microscopy. The degree of epithelial contraction was measured and mast cell concentrations were also evaluated with an image analyzer (Image Pro-plus®software) . RESULTS: The extract treated group showed lower mast cell concentrations in the 4th day of lesion, as compared to GP (GX GP = GC; p<0.05) . CONCLUSION: Ointment containing 10% X. americana induces a decrease in mast cell concentration, at the beginning of the healing process, and promotes early skin wound contraction in rats.

Functional capacity, independence and home affordances of premature children attending daycare centers / Capacidade funcional, independência e estimulação domiciliar de prematuros frequentadores de creches

Abstract Introduction: Child development is the result of the interaction between biological and environmental factors. Objective: The aim of this study is to evaluate and compare the Functional Capacity, Independence and Home Affordances Level of Stimulation of premature children between 18 and 42 months, attending or not daycare centers. Methods: Cross-sectional study with a convenience sample of 26 premature children between 18 and 42 months, paired and divided into two groups: attending (study group) and not attending daycare centers (control group). Data was collected from the questionnaires AHEMD-SR, PEDI and an identification questionnaire. Data analysis was performed by descriptive statistics, and Chi-square, Fisher, Mann-Whitney and Univariate Analysis tests, considering the level of significance of α = 0.05 and tendency of differentiation when α < 010. Results: There was a significant difference in the AHEMD-SR`s Variety of Stimulation (p = 0.036), higher in the control group, and tendency in the Gross Motor Toys (p = 0.086), more available in the study group. In PEDI, there was significant difference in Self-care (p = 0.045) and tendency of differentiation in Mobility (0.068), both of the Caregiver Assistance part (greater to the study). The sample showed low stimulation opportunities regarding Fine and Gross Motor Toys and high percentages of delay in Functional Skills (Mobility) and Independence (Self Care and Mobility), especially in the control group. Conclusion: Daycare centers seem to positively affect the Functional Capacity and Independence in premature children between 18 and 42 months.

Resumo Introdução: O desenvolvimento infantil é resultado da interação de fatores biológicos e ambientais. Objetivo: Verificar e comparar a Capacidade Funcional, a Independência e a Estimulação Presente no Ambiente Domiciliar de prematuros entre 18 e 42 meses, frequentadores e não frequentadores de creche. Métodos: Estudo transversal com amostra de conveniência de 26 prematuros entre 18 e 42 meses, pareados e divididos em frequentadores e não frequentadores de creche. Os dados foram coletados a partir do AHEMD-SR, do PEDI e de um questionário de identificação. A análise foi realizada por meio de estatística descritiva e testes Qui-quadrado, Fisher, Mann-Whitney e Análise Univariada, com nível de significância de α = 0,05 e tendência de diferenciação α < 0,1. Resultados: No AHEMD-SR, houve diferença significativa na Variedade de Estimulação (p = 0,036), maior para não frequentadores de creche, e tendência nos Materiais de Motricidade Grossa (p = 0,086), mais disponível para os frequentadores. No PEDI, na Assistência do Cuidador houve diferença significativa no Autocuidado (p = 0,045) e tendência de diferenciação na Mobilidade (0,068), melhor entre os frequentadores de creche. A amostra apresentou baixas oportunidades de estimulação no domicílio em relação a Materiais para Motricidade Fina e Grossa e altos percentuais de atraso nas Habilidades Funcionais (Mobilidade) e na Independência (Autocuidado e Mobilidade), principalmente nos que não frequentavam creche. Conclusão: A creche parece interferir positivamente na Capacidade Funcional e na Independência de nascidos prematuros entre 18 e 42 meses de idade.

Mast cell concentration and skin wound contraction in rats treated with Ximenia americana L

Abstract Purpose: To evaluate wound contraction and the concentration of mast cells in skin wounds treated with wild plum (Ximenia americana) essential oil-based ointment in rats. Methods: Sixty rats were submitted to two cutaneous wounds in the thoracic region, on the right and left antimeres. Thereon, they were divided into three groups: GX (wounds treated once a day with hydro alcoholic branch extract of Ximenia americana), GP (wounds that received vehicle), and GC (wounds without product application). Wounds were measured immediately after the injury as well as 4, 7, 14 and 21 days post-topical application of the extract. At these days, five rats from each group were euthanatized. Thereafter, samples were fixed in 10% formaldehyde and processed for paraffin embedding. Sections were stained with H.E, Masson's Trichrome and toluidine blue for morphological, morphometrical and histopathological analysis, under light microscopy. The degree of epithelial contraction was measured and mast cell concentrations were also evaluated with an image analyzer (Image Pro-plus®software) . Results: The extract treated group showed lower mast cell concentrations in the 4th day of lesion, as compared to GP (GX<GP=GC, p=0.029), as well as with increased contraction at 7th and 14th days, respectively (7th and 14th days, GX > GP = GC; p<0.05) . Conclusion: Ointment containing 10% X. americana induces a decrease in mast cell concentration, at the beginning of the healing process, and promotes early skin wound contraction in rats.

Gestão da rede de suporte social de idosos institucionalizados / Management of the social support network of institutionalized elderly

Estudo transversal, descritivo, de caráter quanti - qualitativo e amostra por conveniência. Objetivo: identificar a rede de suporte social dos idosos institucionalizados em um Residencial localizado no município de São Paulo; conhecer a experiência de viver e de se relacionar em uma Instituição de Longa Permanência para Idosos, bem como identificar as motivações que levam os idosos a participarem das atividades desenvolvidas nesse local. Métodos: participaram do estudo 30 idosos institucionalizados. Foi utilizado como instrumento um questionário sociodemográfico e um roteiro semiestruturado com as seguintes questões norteadoras: Conte-me sobre a experiência de viver em uma Instituição de Longa Permanência para Idosos LPI. Conte-me como é a experiência de relacionar-se com os outros idosos. E com os funcionários? Qual atividade de lazer/convivência que o senhor participa? Por quê? Qual atividade o senhor gostaria de sugerir no Residencial? Além disso, utilizou-se o instrumento gráfico "Mapa Mínimo de Relações do Idoso" para identificar a rede de suporte social dos idosos. Resultados: A maioria é do sexo feminino (80%), idade média de 85,17 (dp=7, 1),90% não possui cônjuge. Ao que diz respeito à escolaridade, a média em anos de estudo foi de 11,03 (dp=3, 16). A maioria dos participantes (90%) apresentou um tamanho de rede de suporte pequeno. Grande parte dos idosos entrevistados relatou que gostam de viver na ILPI. Entretanto, os mesmos apresentam dificuldade de se relacionar com os demais moradores, principalmente, por serem de nacionalidades diferentes. Conclusão: Os idosos possuem uma rede de suporte social pequena, sendo a instituição onde eles residem a principal rede de apoio. Descritores: Envelhecimento; Idosos; Institucionalização; Rede de Suporte Social.

Transversal, descriptive, study, from a quantitative and qualitative aspect and samples by convenience. Objective: identify the social network from institutionalized elderly on a Residential located in the São Paulo's country; know the experience in living and keeping up a relationship in an Institution of Long Permanence for Elderly, as how to identify the motivations that can make the elderly to participate of the activities developed in that place. Methods: 30 institutionalized elderly did participate. As instrument, it was utilized a socio demographic questionnaire and a half-structured script with the following helping questions: Tell me about your experience about living at en Elderly Long Permanence Institution (ELPI). Tell me how's the experience of having relationships with another elderly. And with the employees? Which leisure/ acquaintanceship activity do you participate? Why7 Which activity you would like to suggest at the Residential? Furthermore, it was used the graphic instrument Minimum Map of Elderly Affairs (MMEA) to identify the elderly social network. Results: Most of them belongs to the female gender (80%), average age 85,17 (sd=7,1). 90% do not have spouse. About schooling, the average in years of studies was 11,03 (sd=3,16) The majority of the participants (90%) presented a small sized support network. The large part of the elderly respondents said they like to like in the ELPI. However, the same seems to have difficulty about interact with the others hosts, especially for being from different nationalities. Condusion: The elderly own a small sized social network, being the Institution were they live the main support network.

Transversal, descriptivo de la muestra cuantitativa y cualitativa y conveniencia. Objetivo: identificar la red de apoyo social de los ancianos institucionalizados en un residencial ubicado en São Paulo; conocer la experiencia de vivir y de relacionarse en un Instituciones cuidado a largo plazo para ancianos e identificar las motivaciones que llevan a las personas mayores a participar en Ias actividades allí. Métodos: Los participantes fueron 30 ancianos institucionalizados. Se estaba utilizando como instrumento un cuestionario sociodemográfico y un guión semiestructurado con las siguientes preguntas guía: Háblame de la experiencia de vivir en una institución de larga estancia para personas mayores LPI? Oime cómo es Ia experiencia de relacionarse con otras personas mayores? Y con los empleados? Qué Ocio /interacción que participas? L Por qué? L Qué actividad te gustaría sugerir en el Residencial? Además, se utilizó el instrumento gráfico" Mapa Ancianos mínimo Asuntos" para identificar Ia red de apoyo social de Ias personas mayores. Resultados: La mayoría son mujeres (80%), edad de 85,17 (SO = 7,1) significa, el 90% no tiene cónyuge. Cuando se trata de la educación, el promedio de anos de educación fue 11,03 (SO = 3,16). La mayoría de los participantes (90,0%) tenían un pequeno tarnano de Ia red de apoyo. La mayoría de los encuestados informaron que las personas mayores les gusta vivir en ILPI. Sin embargo, tienen dificultades para relacionarse con otros residentes, principalmente porque son nacionalidades diferentes. Conclusão: Las personas mayores tienen una red de apoyo social a poco, la institución en la que residen y la red de apoyo principal.

Método Pilates versus Escola de Postura: análise comparativa de dois protocolos de tratamento para lombalgias / Pilates versus Back School: comparative analysis of two treatment protocols for low back pain

A dor lombar é uma disfunção que atinge a região baixa da coluna vertebral, podendo comprometer quadris e pernas. A Organização Mundial da Saúde estima que 80% dos sujeitos tem ou terão lombalgia e, em 40% dos casos, a dor inicial tende a se tornar crônica. O exercício é um dos poucos tratamentos baseados em evidências para a lombalgia crônica, mas a melhor forma de aplicar este tratamento é desconhecida. Este estudo teve como objetivo comparar dois protocolos de intervenção para o manejo da dor lombar crônica não-específica em mulheres de 25 a 50 anos quanto à dor, à funcionalidade e à qualidade de vida dos indivíduos. Um protocolo foi baseado em exercícios do método Pilates e o outro na Escola de Postura. Os instrumentos de avaliação foram o questionário de Roland Morris, O SF-36 e a Escala Visual Analógica para dor. A maior parte das mulheres apresentou diminuição da dor, melhora da funcionalidade e da qualidade de vida. O grupo tratado com a Escola de Postura obteve resultados melhores quando comparados com os resultados do grupo tratado com o método Pilates. Entretanto, devido ao pequeno número de voluntárias, não é possível afirmar as diferenças entre os dois grupos.

Promoção do acesso e inovação em saúde: alternativas ao modelo baseado na proteção à proriedade intelectual em discussão na Organização Mundial de Saúde / Promoting access and innovation in health: alternatives to the model based on intellectual property protection within the World Health Organization

O modelo de promoção da inovação em saúde predominante na atualidade é baseado na proteção da propriedade intelectual por meio da concessão de patentes. A patente permite ao seu titular explorar o objeto protegido com exclusividade por um determinado período de tempo, no qual seria obtido o retorno do investimento feito na pesquisa e desenvolvimento do produto. A obtenção de retorno do custo da P&D pela comercialização do produto final, potencializada pelo monopólio conferido pela patente, faz com o que o detentor da tecnologia estabeleça preço de venda elevado. O sistema de patentes potencializa, assim, a maximização de lucros das empresas farmacêuticas, ampliando seu interesse no desenvolvimento de produtos rentáveis e na mercantilização da saúde. Foram identificadas e sistematizadas evidências que demonstram que a aplicação do sistema de patente na área da saúde tem gerado problemas de inovação, ao direcionar recursos de P&D voltados para a produção de produtos rentáveis e não voltados a atender necessidades de saúde; e de acesso, uma vez que o preço elevado excluí milhões de pessoas do consumo do produto. Ficou demonstrada a necessidade de busca de medidas para superação desses problemas. Identificou-se medidas existentes dentro do sistema de patentes que poderiam ser utilizadas para minimizar os problemas identificados em curto e médio prazo, com uma abordagem caso a caso. Optou-se por utilizar uma abordagem sistêmica, demonstrando a necessidade de medidas alternativas ao sistema de patentes para resolução dos problemas identificados a longo prazo. A identificação de medidas alternativas foi realizada por meio da revisão de mais de uma centena de propostas enviadas em chamada aberta e recomendações feitas por diferentes órgãos da Organização Mundial de Saúde no período de 2003 a 2012. As medidas identificadas foram descritas, sistematizadas e analisadas. Conclui-se que a principal proposta atualmente em discussão é a criação de um Fundo Global de P&D, no marco de uma Convenção Global de P&D em saúde, que financiaria a P&D mediante a concessão de prêmios, e não de patentes. Os resultados da P&D seriam tratados como bens públicos, e poderiam ser produzidos por qualquer interessado. Esse modelo visa desvincular os custos da P&D do preço final do produto. Com isso, tem o potencial de solucionar os problemas de inovação e acesso à saúde identificados no sistema de patentes. No entanto, enfrenta grande oposição dos defensores do sistema de patentes, principalmente grandes empresas farmacêuticas interessadas na ampliação da mercantilização da saúde.

The model for promoting innovation in health prevalent nowadays is based on the protection of intellectual property by granting patents. The patent allows the holder to exploit the protected object with exclusivity for a certain period of time, in which he could obtain the return of investment made in research and development. The need to obtain the return of the investments made on R&D by selling the final product, boosted by the monopoly conferred by the patent, allows the patent holder to establish high price. The patent system maximizes profits of pharmaceutical companies, expanding its interest in developing profitable products and in health commodification. We identified and systematized evidence to show that the application of the patent system in the health sector has generated innovation problems, by directing R&D resources to the production of profitable products and not driven by health needs; and access, since the high price excludes millions of product consumption. It was demonstrated the need for seeking measures to overcome these problems. We identified existing measures within the patent system that could be used to alleviate the problems identified in the short and medium term, with a case-by-case approach. We chose to use a systemic approach, demonstrating the need for alternative measures to the patent system to resolve the problems identified in the long-term. The identification of alternative measures was conducted through review of more than a hundred proposals submitted in open call and recommendations made by different bodies of the World Health Organization from 2003 to 2012. The measures identified have been described, systematized and analyzed. It is concluded that the main proposal currently under discussion is the creation of a Global R&D Fund, as part of a Global R&D Convention on health, which would finance R&D by granting prizes, and not patents. The results of R&D would be treated as public goods, and could be produced by any interested party. This model aims to delink the costs of R&D from the final price of the product. Thus, it has the potential to solve the problems of innovation and access to health identified in the patent system. However, it faces strong opposition from advocates of the patent system, especially large pharmaceutical companies interested in expanding health commodification.

Oportunidades de estimulação no domicílio e habilidade funcional de crianças com potenciais alterações no desenvolvimento / Pacing opportunities at home and skill of children with potential changes in functional development

INTRODUÇÃO: a característica multifatorial do desenvolvimento motor é reforçada pela combinação de fatores de risco biológicos e ambientais, que aumentam a probabilidade de comprometimento do desenvolvimento motorOBJETIVOS: este estudo verificou a associação entre habilidade funcional de mobilidade e oportunidade de estímulos domiciliares de crianças com fatores de risco, e se esta é afetada por fatores biológicos e socioeconômicosMÉTODO: foram avaliadas 112 crianças, na faixa etária de 18 a 42 meses, acompanhadas em serviços de follow-up. Para avaliar as oportunidades domiciliares foi utilizado o Affordance in the Home Environment for Motor Development (AHEMD-SR), e para a habilidade funcional o Inventário de Avaliação Pediátrica de Disfunção (PEDI). A análise estatística foi realizada através do Teste t de Student e análise de regressão linear múltiplaRESULTADOS: houve o predomínio de desempenho "adequado" para as habilidades funcionais, e de "nível médio" para as oportunidades de estímulos domiciliares. No entanto, a associação destas não foi significativa. Encontrou-se significância (p = 0,004) entre as habilidades funcionais e a presença de "problema de saúde". Participantes que apresentavam problema de saúde tiveram menor média no escore normativo do PEDI nessa dimensão. Na análise de regressão linear múltipla a variável problema de saúde apresentou associação (p = 0,003), quando considerada a interação entre o ambiente, as variáveis de controle e o desfechoCONCLUSÃO: não houve associação entre as oportunidades domiciliares e a habilidade funcional de mobilidade. No entanto, a presença de "problema de saúde" levou a desempenhos significativamente inferiores nas habilidades funcionais.

INTRODUCTION: the multifactorial nature of motor development is reinforced by the combination of biological and environmental risk factors, which intensify the chances of impaired motor development OBJECTIVES: to verify the relationship between functional mobility skills of children with risk factors and motor stimulus opportunities in their home environment METHODS: transversal study conducted with 112 patients aged 18-42 months from follow-up services. Motor stimulus opportunities were evaluated by the Affordance in the Home Environment for Motor Development (AHEMD-SR) and Functional mobility skills by the Pediatric Evaluation Disability Inventory (PEDI). Student t test and multiple linear regression analysis were carried out RESULTS: predominance of good performance of functional mobility skills and "average level" of environmental stimulus opportunities were observed. There was no significant association between HFM-PEDI and AHEMD-SR. The results showed significant association only between HFM-PEDI and presence of health problems (p = 0.004). Children with health problems had lower mean PEDI normative score. Multiple linear regression analysis showed significant result for health problems in the interaction among environment, control variables and HFM-PEDI (p = 0.003 CONCLUSION: there was no association between functional mobility skills of children with risk factors and motor stimulus opportunities in their home environment. On the other hand, children with some health problem showed lower performance in functional mobility skills.