ABSTRACT
Resumo: A dificuldade de acesso aos serviços de atenção ao parto está associada à mortalidade infantil e neonatal e à morbimortalidade materna. Neste estudo, dados do Sistema Único de Saúde (SUS) foram utilizados para mapear a evolução da acessibilidade geográfica ao parto hospitalar de risco habitual no Estado do Rio de Janeiro, Brasil, correspondentes a 418.243 internações nos biênios 2010-2011 e 2018-2019. Foram estimados os fluxos de deslocamento, as distâncias percorridas e o tempo de deslocamento intermunicipal entre o município de residência e de internação das gestantes. Houve um crescimento de 15,9% para 21,5% na proporção de gestantes que precisaram se deslocar. A distância percorrida aumentou de 24,6 para 26km, e o tempo de deslocamento de 76,4 para 96,1 minutos, com grande variação entre as Regiões de Saúde (RS). As gestantes residentes na RS Centro Sul se deslocaram mais frequentemente (37,4-48,9%), e as residentes nas RS Baía da Ilha Grande e Noroeste percorreram as maiores distâncias (90,9-132,1km) e levaram mais tempo para chegar ao hospital no último biênio (96-137 minutos). A identificação dos municípios que receberam gestantes de muitos outros municípios e daqueles que atenderam maior volume de gestantes (núcleos e polos de atração, respectivamente) refletiu a indisponibilidade e as disparidades no acesso aos serviços. As desigualdades regionais e a redução da acessibilidade alertam para a necessidade de adequar a oferta à demanda e de revisar a distribuição dos serviços de atenção ao parto no Rio de Janeiro. O estudo contribui para as pesquisas e o planejamento sobre o acesso a serviços de saúde materno-infantil, além de servir como referência para outros estados do país.
Abstract: Difficult access to birth care services is associated with infant and neonatal mortality and maternal morbidity and mortality. In this study, data from the Brazilian Unified National Health System (SUS) were used to map the evolution of geographic accessibility to hospital birth of usual risk in the state of Rio de Janeiro, Brazil, corresponding to 418,243 admissions in 2010-2011 and 2018-2019. Travel flows, distances traveled, and intermunicipal travel time between the pregnant women's municipality and hospital location were estimated. An increase from 15.9% to 21.5% was observed in the number of pregnant women who needed to travel. The distance traveled increased from 24.6 to 26km, and the travel time from 76.4 to 96.1 minutes, with high variation between Health Regions (HR). Pregnant women living in HR Central-South traveled more frequently (37.4-48.9%), and those living in the HRs Baía da Ilha Grande and Northwest traveled the largest distances (90.9-132.1km) and took more time to get to the hospital in 2018-2019 (96-137 minutes). The identification of municipalities that received pregnant women from many other municipalities and municipalities that treated a higher number of pregnant women (hubs and attraction poles, respectively) reflected the unavailability and disparities in access to services. Regional inequalities and reduced accessibility highlight the need to adapt supply to demand and review the distribution of birth care services in the state of Rio de Janeiro. This study contributes to research and planning on access to maternal and child health services and can be used as a reference study for other states in the country.
Resumen: La dificultad para acceder a los servicios de atención al parto está asociada con la mortalidad infantil y neonatal, y con la morbimortalidad materna. En este estudio, se utilizaron datos del Sistema Único de Salud (SUS) para mapear la evolución de la accesibilidad geográfica al parto hospitalario de riesgo habitual en el estado de Río de Janeiro, Brasil, correspondiente a 418.243 hospitalizaciones en los bienios 2010-2011 y 2018-2019. Se estimaron los flujos de desplazamiento, las distancias recorridas y el tiempo de desplazamiento intermunicipal entre el municipio de residencia y la hospitalización de las mujeres embarazadas. Hubo un aumento del 15,9% al 21,5% en la proporción de mujeres embarazadas que necesitaron desplazarse. La distancia recorrida aumentó de 24,6 a 26km y el tiempo de desplazamiento de 76,4 a 96,1 minutos, con gran variación entre las Regiones de Salud (RS). Las mujeres embarazadas residentes en la RS Centro Sul se desplazaron con mayor frecuencia (37,4-48,9%), y las residentes en las RS Baía da Ilha Grande y Noroeste recorrieron las mayores distancias (90,9-132,1km) y tardaron más en llegar al hospital en el últimos bienio (96-137 minutos). La identificación de los municipios que recibieron mujeres embarazadas de muchos otros municipios y de aquellos que atendieron a un mayor volumen de mujeres embarazadas (núcleos y polos de atracción, respectivamente) reflejó la indisponibilidad y las disparidades en el acceso a los servicios. Las desigualdades regionales y la reducida accesibilidad alertan sobre la necesidad de adaptar la oferta a la demanda, y de revisar la distribución de los servicios de atención al parto en el estado de Rio de Janeiro. El estudio contribuye a las investigaciones y a la planificación sobre el acceso a los servicios de salud materno-infantil, y puede servir como referencia para otros estados del país.
ABSTRACT
BACKGROUND The Global Virome Project (GVP) was proposed in 2018 as an evolution of the USAID PREDICT project and was presented as a "collaborative scientific initiative to discover zoonotic viral threats and stop future pandemics". The immediate response was mixed, with public health and scientific communities representatives showing skepticism, if not direct opposition. OBJECTIVES The economic, social, and health consequences of the coronavirus disease 2019 (COVID-19) pandemic demonstrated how unprepared the world was in the face of new pandemics. This paper analyses the impact of the GVP on the scientific and public health communities. METHODS Published scientific articles that cited the two 2018 seminal publications proposing the project were analysed using social network analysis methods. FINDINGS Encompassing the periods before and after the onset of the Covid-19 pandemic, the results indicate that (i) the concepts of the GVP have received more support than opposition in the scientific literature; (ii) its foundations should be updated to address the specific criticisms. MAIN CONCLUSIONS Shifting focus to national virome projects can provide tangible, regional benefits that can positively contribute towards a consensus on achieving a high level of preparedness for the ever-present possibility of the following global viral pandemic.
ABSTRACT
BACKGROUND Despite the current global trend of reduction in the morbidity and mortality of neglected diseases, dengue’s incidence has increased and occurrence areas have expanded. Dengue also persists as a scientific and technological challenge since there is no effective treatment, vaccine, vector control or public health intervention. Combining bibliometrics and social network analysis methods can support the mapping of dengue research and development (R&D) activities worldwide. OBJECTIVES The aim of this paper is to map the scientific scenario related to dengue research worldwide. METHODS We use scientific publication data from Web of Science Core Collection - articles indexed in Science Citation Index Expanded (SCI-EXPANDED) - and combine bibliometrics and social network analysis techniques to identify the most relevant journals, scientific references, research areas, countries and research organisations in the dengue scientific landscape. FINDINGS Our results show a significant increase of dengue publications over time; tropical medicine and virology as the most frequent research areas and biochemistry and molecular biology as the most central area in the network; USA and Brazil as the most productive countries; and Mahidol University and Fundação Oswaldo Cruz as the main research organisations and the Centres for Disease Control and Prevention as the most central organisation in the collaboration network. MAIN CONCLUSIONS Our findings can be used to strengthen a global knowledge platform guiding policy, planning and funding decisions as well as to providing directions to researchers and institutions. So that, by offering to the scientific community, policy makers and public health practitioners a mapping of the dengue scientific landscape, this paper has aimed to contribute to upcoming debates, decision-making and planning on dengue R&D and public health strategies worldwide.
Subject(s)
Humans , Dengue , Biomedical Research/statistics & numerical data , Bibliometrics , Global HealthABSTRACT
Haematological and cytokine alterations in malaria are a broad and controversial subject in the literature. However, few studies have simultaneously evaluated various cytokines in a single patient group during the acute and convalescent phases of infection. The aim of this study was to sequentially characterise alterations in haematological patters and circulating plasma cytokine and chemokine levels in patients infected with Plasmodium vivax or Plasmodium falciparum from a Brazilian endemic area during the acute and convalescent phases of infection. During the acute phase, thrombocytopaenia, eosinopaenia, lymphopaenia and an increased number of band cells were observed in the majority of the patients. During the convalescent phase, the haematologic parameters returned to normal. During the acute phase, P. vivax and P. falciparum patients had significantly higher interleukin (IL)-6, IL-8, IL-17, interferon-γ, tumour necrosis factor (TNF)-α, macrophage inflammatory protein-1β and granulocyte-colony stimulating factor levels than controls and maintained high levels during the convalescent phase. IL-10 was detected at high concentrations during the acute phase, but returned to normal levels during the convalescent phase. Plasma IL-10 concentration was positively correlated with parasitaemia in P. vivax and P. falciparum-infected patients. The same was true for the TNF-α concentration in P. falciparum-infected patients. Finally, the haematological and cytokine profiles were similar between uncomplicated P. falciparum and P. vivax infections.
Subject(s)
Adult , Female , Humans , Male , Convalescence , Cytokines/blood , Malaria, Falciparum/blood , Malaria, Vivax/blood , Acute Disease , Brazil , Case-Control Studies , /blood , Chemokines/blood , Granulocyte Colony-Stimulating Factor/blood , Hematocrit , Inflammation , Interferon-gamma/blood , Interleukin-1beta/blood , /blood , /blood , /blood , /blood , /blood , /blood , Malaria, Falciparum/immunology , Malaria, Vivax/immunology , Parasitemia , Plasmodium falciparum/isolation & purification , Plasmodium vivax/isolation & purification , Statistics, Nonparametric , Tumor Necrosis Factor-alpha/bloodABSTRACT
A new multiplex assay platform was evaluated to detect Trypanosoma cruzi infection using the recombinant antigensCRA, FRA, CRAFRA fusion and parasite lysate. The antigens presented different sensitivity and specificity in a singleplex test when compared to a serial dilution of two pools comprising 10 positive serum samples and one pool of 10 negative samples. The recombinant protein CRA presented lower sensitivity (55%) in contrast to the 100% specificity and sensitivity of FRA, CRAFRA and T. cruzi lysate. These antigens also showed good results in a duplex test and the duplex test with CRAFRA/T. cruzi lysate showed better performance with 100% specificity and sensitivity, as well as a lower cut-off value in comparison to the other duplex test, FRA/T. cruzi lysate. Hence, when the antigens were used in duplex format, both tests showed decreased cut-off values and no interference between different bead sets, resulting in increasing sensitivity and specificity. The results of these multiplex tests show that they could be an alternative to singleplex detection for Chagas disease, and also indicate the necessity of using multiplex diagnostic tools to increase the sensitivity and specificity for diagnostic tests. Emerging data from the T. cruzi genome and from its ORFeome project will also allow the identification of new antigens for this disease detection application.