Acciones judiciales que exigen tecnologías en salud en Brasil: una revisión sistemática de métodos mixtos / Lawsuits demanding health technologies in Brazil: a systematic review of mixed methods / Ações judiciais que demandam tecnologias em saúde no Brasil: uma revisão sistemática de métodos mistos

Objetivos: conocer el perfil y comprender el contexto descrito en las publicaciones sobre la judicialización del acceso a tecnologías en salud en Brasil. Metodología: revisión sistemática de métodos mixtos. Se consultaron 5 bases de datos y se incluyeron artículos que presentaran datos de procesos judiciales demandando tecnologías en salud del SUS en Brasil, o que analizaran este fenómeno, publicados en portugués, inglés y español, hasta 2019. La calidad metodológica fue evaluada con un enfoque convergente segregado. La caracterización de los datos de los estudios y el análisis e integración de la evidencia cuali-cuantitativa se realizó usando la síntesis realista. Resultados: 27 estudios fueron incluidos en la revisión. Se identificaron 76.666 procesos judiciales en que se solicitaba alguna tecnología en salud, en su mayoría medicamentos (65%); la mayoría de los procesos presentaron una representación jurídica privada (68%) y la mayoría de las acciones fue contra los estados (65%). Los enfoques de análisis de judicialización más frecuentes fueron Social Positivo (32%) y Normativo Negativo (32%), seguidos de 29% para el abordaje de Normativo Positivo. El abordaje Social Negativo (7%) fue el menos frecuente. Conclusiones: se identificó que existen evidencias cuantitativas que soportan las evidencias cualitativas. Estas demuestran que el desconocimiento del Poder Judicial sobre las políticas de salud lleva a un aumento de las desigualdades en salud; al fomento del paternalismo del Estado, así como que el aumento de acciones judiciales explica la necesidad de la búsqueda de alternativas para acceder a tecnologías en salud.

Objectives: to know the profile and understand the context described in publications on the judicialization of access to health technologies in Brazil. Methods: systematic review of mixed methods. Five databases were consulted, and articles were included that presented data from lawsuits demanding health technologies from the SUS in Brazil, or that analyzed this phenomenon, published in Portuguese, English and Spanish, until 2019. The methodological quality was evaluated using the convergent segregated approach. The characterization of data from the studies and the analysis and integration of qualitative-quantitative evidence were conducted through realistic synthesis. Results: 27 studies were included in the review. A total of 76,666 lawsuits were identified in which some health technology was requested, mainly medicines (65%); most lawsuits had private legal representation (68%) and most lawsuits were against the states (65%). The most frequent judicialization analysis approaches were Positive Social (32%) and Negative Normative (32%), followed by 29% for the Positive Normative approach. The Social Negative approach (7%) was the least frequent. Conclusions: it was identified that there is quantitative evidence that supports qualitative evidence. These demonstrate that the Judiciary's lack of knowledge about health policies leads to an increase in health inequalities; to the promotion of state paternalism, as well as the fact that the increase in lawsuits explains the need to seek alternatives for accessing health technologies.

Objetivos: conhecer o perfil e compreender o contexto descrito nas publicações sobre a judicialização do acesso às tecnologias em saúde no Brasil. Metodologia: Revisão sistemática de métodos mistos. Foram consultadas cinco bases de dados e incluídos artigos que apresentassem dados de processos judiciais demandando tecnologias em saúde do SUS no Brasil, ou que analisassem esse fenômeno, publicados em português, inglês e espanhol, até 2019. A qualidade metodológica foi avaliada com a abordagem convergente segregada. A caracterização dos dados dos estudos e a análise e integração das evidências qualitativos-quantitativas foram realizadas por meio da síntese realista. Resultados: 27 estudos foram incluídos na revisão. Foram identificados 76.666 processos judiciais em que foi solicitada alguma tecnologia em saúde, principalmente medicamentos (65%); a maioria dos processos apresentou representação legal privada (68%) e a maioria das ações foi contra os estados (65%). As abordagens de análise de judicialização mais frequentes foram Social Positiva (32%) e Normativa Negativa (32%), seguidas de 29% para a abordagem Normativa Positiva. A abordagem Social Negativa (7%) foi a menos frequente. Conclusões: identificou-se que há evidências quantitativas que sustentam as evidências qualitativas. Estes demonstram que o desconhecimento do Judiciário sobre as políticas de saúde leva ao aumento das desigualdades em saúde; à promoção do paternalismo estatal, bem como o fato de que o aumento das ações judiciais explica a necessidade de buscar alternativas de acesso às tecnologias em saúde.

Vaccines in Brazil: historical analysis of the Sanitary registration and vaccine availability in the Brazilian Unified Health System. / Vacinas no Brasil: análise histórica do registro sanitário e a disponibilização no Sistema de Saúde.

Given the COVID-19 pandemic and the importance of public social protection policies, health issues, including immunizations, have gained prominence. This paper aims to analyze the dynamics of vaccine registration in Brazil and the vaccines made available through the National Immunization Program (PNI in Portuguese), with emphasis on the 2004-2018 vaccination schedule. This descriptive, exploratory, documentary research analyzed vaccine registration procedureswith the Brazilian Health Regulatory Agency (ANVISA, in Portuguese) and the incorporation of vaccine products into the PNI. The study drew on information from the national sanitary registration database, made available by ANVISA; a document analysis of official/normative publications; and data from published literature. The data shows the incorporation of vaccines into the PNI, evidencing that Brazil is a country with industrial potential for vaccine production but that is still focused on the transfer of technologies and in need of public attention and investments for developing new technologies as a way to ensure the sector's independence.

Com a pandemia da COVID-19 e a importância das políticas públicas de proteção social, questões sanitaristas incluindo as imunizações se tornaram destaque. O estudo tem o objetivo de analisar a dinâmica dos registros sanitários de vacinas no país e as vacinas disponibilizadas por meio do Programa Nacional de Imunização (PNI), com destaque para o calendário vacinal no período entre 2004 e 2018. Realizou-se um estudo descritivo, documental e exploratório dos processos de registro sanitário na Agência Nacional de Vigilância Sanitária (Anvisa) e a incorporação dos produtos no PNI. Como base da pesquisa foram utilizados o banco de dados de registro sanitário disponibilizado pela Anvisa, a análise documental de publicações oficiais/normativas e os dados da literatura. Os dados demonstram a incorporação das vacinas no PNI, assim como um país com potencial industrial para a produção das vacinas, no entanto ainda centrado na transferência de tecnologias, necessitando de investimentos e atenção pública no desenvolvimento de novas tecnologias, garantindo a independência do setor.

Vacinas no Brasil: análise histórica do registro sanitário e a disponibilização no Sistema de Saúde / Vaccines in Brazil: historical analysis of the Sanitary registration and vaccine availability in the Brazilian Unified Health System

Resumo Com a pandemia da COVID-19 e a importância das políticas públicas de proteção social, questões sanitaristas incluindo as imunizações se tornaram destaque. O estudo tem o objetivo de analisar a dinâmica dos registros sanitários de vacinas no país e as vacinas disponibilizadas por meio do Programa Nacional de Imunização (PNI), com destaque para o calendário vacinal no período entre 2004 e 2018. Realizou-se um estudo descritivo, documental e exploratório dos processos de registro sanitário na Agência Nacional de Vigilância Sanitária (Anvisa) e a incorporação dos produtos no PNI. Como base da pesquisa foram utilizados o banco de dados de registro sanitário disponibilizado pela Anvisa, a análise documental de publicações oficiais/normativas e os dados da literatura. Os dados demonstram a incorporação das vacinas no PNI, assim como um país com potencial industrial para a produção das vacinas, no entanto ainda centrado na transferência de tecnologias, necessitando de investimentos e atenção pública no desenvolvimento de novas tecnologias, garantindo a independência do setor.

Abstract Given the COVID-19 pandemic and the importance of public social protection policies, health issues, including immunizations, have gained prominence. This paper aims to analyze the dynamics of vaccine registration in Brazil and the vaccines made available through the National Immunization Program (PNI in Portuguese), with emphasis on the 2004-2018 vaccination schedule. This descriptive, exploratory, documentary research analyzed vaccine registration procedureswith the Brazilian Health Regulatory Agency (ANVISA, in Portuguese) and the incorporation of vaccine products into the PNI. The study drew on information from the national sanitary registration database, made available by ANVISA; a document analysis of official/normative publications; and data from published literature. The data shows the incorporation of vaccines into the PNI, evidencing that Brazil is a country with industrial potential for vaccine production but that is still focused on the transfer of technologies and in need of public attention and investments for developing new technologies as a way to ensure the sector's independence.

Tutorial do Ambiente Virtual de Ensino e Aprendizagem do Curso de Gestão da Assistência Farmacêutica - EaD

O tutorial do Curso de Gestão da Assistência Farmacêutica - EaD apresenta a organização do AVEA e os procedimentos para organização dos estudos no moodle.

Tutorial do Curso de gestão da assistência farmacêutica - EaD

O tutorial do Curso de Gestão da Assistência Farmacêutica - EaD apresenta a organização do Curso, o conteúdo ofertado e a metodologia de avaliação adotada, com destaque para as avaliações presenciais, o Plano Operativo e o TCC.

Módulo 3 - Seleção de medicamentos

Este Módulo está organizado em 2 unidades de aprendizagem: O uso de ferramentas da epidemiologia na assistência farmacêutica e Seleção de medicamentos. Aborda temas como: Usos e aplicações da epidemiologia; Medidas de frequência de doenças; Indicadores de saúde; Informações em saúde; Sistemas de informação em saúde; Importância da seleção de medicamentos; Construção de lista de medicamentos; Informação sobre medicamentos; Evidência como norteadora de conduta; Formas de conduzir o processo de seleção de medicamentos; e Formalização do processo de seleção de medicamentos no âmbito público.

Tópicos especiais em ética, avaliação de tecnologias em saúde e aspectos técnicos e legais relacionados aos medicamentos alopáticos

O módulo 7, do curso Gestão da Assistência Farmacêutica, está organizado em três unidades de aprendizagem: Ética e medicalização, Avaliação econômica de tecnologias em saúde e Estudos dos aspectos técnicos e legais relacionados aos medicamentos e seus impactos na assistência farmacêutica. Tais conteúdos objetivam complementar a formação do aluno em Gestão da Assistência Farmacêutica. Desta forma, a primeira unidade objetiva aprofundar o conceito de ética e bioética, fazendo a ligação com a prática profissional. Na segunda unidade são discutido os princípios gerais da economia em saúde e sua importância dentro do SUS. E por fim, a unidade 3 objetiva apresentar os conceitos básicos e os aspectos técnicos e legais relacionados aos medicamentos alopáticos e fitoterápicos e seus impactos na assistência farmacêutica.

Probucol affords neuroprotection in a 6-OHDA mouse model of Parkinson's disease.

Parkinson's disease (PD) is a neurodegenerative disorder characterized by the degeneration of dopaminergic nigrostriatal neurons. Although the etiology of the majority of human PD cases is unknown, experimental evidence points to oxidative stress as an early and causal event. Probucol is a lipid-lowering phenolic compound with anti-inflammatory and antioxidant properties that has been recently reported as protective in neurotoxicity and neurodegeneration models. This study was designed to investigate the effects of probucol on the vulnerability of striatal dopaminergic neurons to oxidative stress in a PD in vivo model. Swiss mice were treated with probucol during 21 days (11.8 mg/kg; oral route). Two weeks after the beginning of treatment, mice received a single intracerebroventricular (i.c.v.) infusion of 6-hydroxydopamine (6-OHDA). On the 21st day, locomotor performance, striatal oxidative stress-related parameters, and striatal tyrosine hydroxylase and synaptophysin levels, were measured as outcomes of toxicity. 6-OHDA-infused mice showed hyperlocomotion and a significant decrease in striatal tyrosine hydroxylase (TH) and synaptophysin levels. In addition, 6-OHDA-infused mice showed reduced superoxide dismutase activity and increased lipid peroxidation and catalase activity in the striatum. Notably, probucol protected against 6-OHDA-induced hyperlocomotion and striatal lipid peroxidation, catalase upregulation and decrease of TH levels. Overall, the present results show that probucol protects against 6-OHDA-induced toxicity in mice. These findings may render probucol as a promising molecule for further pharmacological studies on the search for disease-modifying treatment in PD.

Evidence that LPS-reactive arthritis in rats depends on the glial activity and the fractalkine-TNF-α signaling in the spinal cord.

It is known that primary afferent central terminal sensitization can influence peripheral inflammation, however, it remains to be understood whether spinal cord glia can also contribute to this process. Our aim was to investigate the effect of spinal cord glia inhibition on the pathogenesis of LPS-induced knee-joint monoarthritis in rats and also to investigate the role of fractalkine and TNF-α. LPS was injected into the knee-joint previously primed with carrageenan to cause articular incapacitation, edema, synovial leukocyte infiltration, and GFAP and CD11b/c spinal immunoreactivity (glia-IR) increase. Articular edema was more sensitive to the inhibition by intrathecal fluorocitrate and minocycline than nociception and synovial leukocyte content. The higher doses of both drugs were ineffective when given by intraperitoneal route. Corticosteroid synthesis inhibition by aminoglutethimide did not change the glia inhibitors effect. The inhibitory effect of the dorsal root potential inhibitor, furosemide, was not additive to that caused by fluorocitrate and minocycline. Intrathecal anti-fractalkine and anti-TNF-α inhibited edema, nociception, and synovial leukocytes, while fractalkine caused the opposite effects. The fractalkine effect was inhibited by fluorocitrate and anti-TNF-α. Finally, fluorocitrate, minocycline and anti-fractalkine attenuated, but fractalkine increased, GFAP and CD11b/c IR. The evidence reported herein supports the hypothesis that spinal fractalkine release is involved in glia activation, which via the spinal release of TNF-α, seems to be involved in the development and maintenance of this arthritis model. A possible modulation of the dorsal root reflexes is discussed. This article is part of a Special Issue entitled 'Post-Traumatic Stress Disorder'.

Sustained virological response to treatment of chronic hepatitis C with peginterferon alfa and ribavirin

This study aimed to evaluate the rate of sustained virological response (SVR) and the clinical and treatment characteristics of patients with chronic hepatitis C (CHC). A retrospective uncontrolled cohort study was conducted among patients who received treatment for CHC between 2005 and 2008 attended at the Center for the Application and Monitoring of Injectable Medications, in Florianopolis, SC, Brazil. The inclusion criteria were: patients over 18 years of age, with a confirmed diagnosis of chronic hepatitis C according to Brazilian guidelines, treated with PEG-IFN alfa-2a or 2b associated with RBV. A total of 188 patients were included in the study: 70% men, 59% genotype 1, 27% coinfected with HIV, 31% with cirrhosis. The SVR rate, calculated by probability theory, was determined as 26% (max=57.4% and min=12.8%) and the intention to treat was 12.8%. Associations between Sustained Virological Response (SVR) and the variables sex (p=0.017), age (p=0.003), genotype (p=0.648) and cirrhosis (p=0.275), were determined in the bivariate analysis and only sex and age were significantly associated with SVR. The SVR rate was considered low, which can be partially explained by patients' unfavorable pretreatment characteristics.

O objetivo do estudo foi avaliar a taxa de resposta viral sustentada (RVS) e as características clínicas e do tratamento dos pacientes portadores de hepatite C crônica. Realizou-se uma coorte retrospectiva não controlada com recorte temporal dos anos de 2005 a 2008, dos pacientes atendidos no Polo de Aplicação e Monitoramento de Medicamentos Injetáveis, em Florianópolis, SC. Os critérios de inclusão foram: pacientes maiores de 18 anos, com diagnóstico confirmado de hepatite C crônica de acordo com o protocolo brasileiro, tratados com PEG-IFN alfa-2a ou 2b associado a ribavirina. Total de 188 pacientes foi incluído no estudo, 70% homens, 59% genótipo 1, 27% co-infectados com o HIV e 31% apresentando cirrose. A taxa de RVS calculada através da teoria das probabilidades foi de 26% (max=57,4% and min=12,8%) e por intenção de tratamento de 12,8%. Verificou-se a associação da RVS com as variáveis: sexo (p=0,017), idade (p=0,003), genótipo (p=0,648) e presença de cirrose (p=0,275). Somente sexo e idade foram associados significativamente com a RVS. A taxa de RVS foi considerada baixa e, em parte, pode ser explicada pelas características desfavoráveis dos pacientes para a obtenção de RVS.

Epigallocatechin-3-gallate protects rat brain mitochondria against cadmium-induced damage.

Many health claims have been made about the medicinal benefits of drinking green tea, including neuroprotection. This study mainly focuses on Epigallocatechin 3-gallate (EGCG), a potent antioxidant, which is abundantly found in green tea. Cadmium [Cd(2+)] is a toxic pollutant that leads to neurotoxicity in both animals and humans. Although the entrance of Cd(2+) in the adult central nervous system is limited, developmental neurotoxicity has been evidenced as result of the blood-brain barrier (BBB) immaturity. Moreover, high Cd(2+) levels are known to impair BBB function. Furthermore, the molecular mechanisms related to its neurotoxic properties remain unknown. This study evaluates the potential protective effect of the major green tea polyphenol, EGCG, against Cd(2+)-induced mitotoxicity under in vitro conditions, using mitochondrial-enriched fractions from rat brain. Co-incubation of EGCG with Cd(2+) prevented the Cd(2+)-induced mitochondrial dysfunction (capacity to reduce MTT to formazan). In addition, EGCG completely prevented mitochondrial lipid peroxidation induced by Cd(2+) but did not affect non protein thiols levels. Spectroscopic studies have shown EGCG able to form a chemical complex with Cd(2+), in an equimolar ratio. In this study we demonstrate EGCG effectiveness in protecting against Cd(2+)-induced mitochondrial dysfunction and lipid peroxidation probably due to its antioxidant and chelating effects.

Effects of K074 and pralidoxime on antioxidant and acetylcholinesterase response in malathion-poisoned mice.

The organophosphorus (OP) pesticide malathion is a highly neurotoxic compound and its toxicity is primarily caused by the inhibition of acetylcholinesterase (AChE), leading to cholinergic syndrome. Although oximes have been used as potential antidotal treatments in malathion poisoning because of their potential capability to reactivate the inhibited enzyme, the clinical experience with the clinically available oximes (e.g. pralidoxime) is disappointing and their routine use has been questioned. In the present study, we investigated the potency of pralidoxime and K074 in reactivating AChE after acute exposure to malathion, as well as in preventing malathion-induced changes in oxidative-stress related parameters in mice. Malathion (1.25 g/kg, s.c.) induced a significant decrease in cortico-cerebral, hippocampal and blood AChE activities at 24h after exposure. Oxime treatments (1/4 of LD(50), i.m., 6h after malathion poisoning) showed that pralidoxime significantly reversed malathion-induced blood AChE inhibition, although no significant effects were observed after K074 treatment. Interestingly, both oximes tested were unable to reactivate the cortico-cerebral and hippocampal enzymes after intramuscular or intracerebroventricular injection (1/4 of LD(50), 6h after malathion poisoning). Biochemical parameters related to oxidative stress (cerebro-cortical and hippocampal glutathione peroxidase, glutathione reductase and catalase activities, as well as lipid peroxidation) were not affected in animals treated with malathion, oximes or atropine alone. However, pralidoxime and K074, administered intramuscularly 6h after malathion poisoning, were able to increase the endogenous activities of these antioxidant enzymes in the prefrontal cortex and hippocampus. Taken together, the results presented herein showed that pralidoxime (the most common clinically used oxime) and the recently developed oxime K074, administered 6h after malathion poisoning, were unable to reactivate the inhibited AChE in mouse prefrontal cortex and hippocampus. However, only pralidoxime significantly reversed the blood AChE inhibition induced by malathion poisoning. This indicates that peripheral and central AChE activities are not necessarily correlated after the treatment of OP compounds and/or oximes, which should be taken into account in the diagnosis and management of OP-exposed humans. In addition, considering that the available treatments to malathion poisoning appear to be ineffective, the present study reinforce the need to search for potential new AChE reactivators able to efficiently reactivate the brain and blood AChEs after malathion poisoning.