El Proyecto de la fundación fotilles en la región del norte araguaia: desde 1996 a 2013 / No disponible

No disponible

A campanha contra a broca-do-café em São Paulo (1924-1927) / The campaign against the coffee borer in São Paulo (1924-1927)

Quando o café constituía a principal riqueza brasileira e São Paulo detinha a liderança absoluta na sua produção e comércio, uma praga veio colocar sob ameaça toda aquela pujança econômica. Conhecida como broca-do-café, era causada por um minúsculo inseto aparecido em fazendas de Campinas. De lá partiu a notificação ao governo paulista, em maio de 1924. A gravidade da situação levou o governo estadual a compor uma comissão científica chefiada por Arthur Neiva, responsável por levar a cabo o plano de combate. A campanha contra a broca combinou a implementação de um vigoroso aparato de pesquisa e fiscalização com amplo trabalho de divulgação científica, que lançou mão de estratégias vanguardistas de difusão, como o cinema. Em fins de 1927, a Comissão foi formalmente extinta após a criação de uma instituição permanente de pesquisa agrícola: o Instituto Biológico de Defesa Agrícola e Animal.

When coffee was Brazil's chief source of wealth and São Paulo was the absolute leader in its production and trade, a plague suddenly came to threaten this mighty economic asset. The cause was a tiny insect called the coffee borer, which began showing up on plantations in the Campinas area. The São Paulo state government learned of the pest in May 1924 via news from Campinas. The situation was so serious that the state government formed a scientific commission, headed by Arthur Neiva, who was to lead the battle against the borer. The ensuing campaign put in place a sound system of research and surveillance, complemented by broad-reaching scientific education that relied on such vanguard tools as cinema. In late 1927, the Commission was officially dissolved, following creation of a permanent agricultural research center: the Instituto Biológico de Defesa Agrícola e Animal (Biological Institute for Agricultural and Animal Defense).

Combating tropical infectious diseases: report of the Disease Control Priorities in Developing Countries Project.

Infectious diseases are responsible for >25% of the global disease toll. The new Disease Control Priorities in Developing Countries Project (DCPP) aims to decrease the burden of these diseases by producing science-based analyses from demographic, epidemiologic, disease intervention, and economic evidence for the purpose of defining disease priorities and implementing control measures. The DCPP recently reviewed selected tropical infectious diseases, examined successful control experiences, and defined unsettled patient treatment, prevention, and research issues. Disease elimination programs against American trypanosomiasis (Chagas disease), onchocerciasis, lymphatic filariasis, leprosy, trachoma, and measles are succeeding. Dengue, leishmaniasis, African trypanosomiasis, malaria, diarrheal diseases, helminthic infections, and tuberculosis have reemerged because of inadequate interventions and control strategies and the breakdown of health delivery systems. Application of technologies must be cost-effective and intensified research is essential if these and other scourges are to be controlled or eliminated in the 21st century.

Managed care, deficit financing, and aggregate health care expenditure in the United States: a cointegration analysis.

We applied a battery of cointegration tests comprising those of Johansen and Juselius [19], Phillips and Hansen [35], and Engle and Granger [6], to model aggregate health care expenditure using 1960-96 US data. The existence of a stable long-run economic relationship or cointegration is confirmed, in the United States, between aggregate health care expenditure and real GDP, population age distribution, managed care enrollment, number of practicing physicians, and government deficits. The evidence of cointegration among these variables, chosen on the theoretical basis of prior studies, implies that while they are individually non-stationary in levels, together they are highly correlated and move, in the long run to form an economic equilibrium relationship of US aggregate health care expenditure. More specifically, and for the first time in this line of inquiry, (i) managed care enrollment is found to be negatively associated with the level of health care spending, (ii) supply disinduced demand effects of physicians tend to moderate health expenditure, and (iii) government deficit financing is positively related to health care spending. The observed sign and magnitude of the income coefficient are consistent with health care being a luxury good.

Overcoming prejudice.

PIP: People of African descent comprise a large proportion of Brazil's population. While racism exists in the country, it is commonly denied. Most Afro-Brazilians live in poor areas, with poor health care services, sanitation, schools, and transport. Since HIV is linked to poverty, Afro-Brazilians are more affected by HIV than is the overall population. Although Afro-Brazilians contribute to Brazil's culture, they do not benefit from that contribution. Recognizing this considerable social problem, Project Araye was created in 1996 to address issues of race and HIV. Building upon religious and cultural traditions, the project is staffed by Afro-Brazilians who are knowledgeable in both health issues and Afro-Brazilian culture. Project Araye supports a wide range of diverse community leaders in linking sexual health and HIV with other health concerns which affect Afro-Brazilians such as sickle-cell anemia, diabetes, and leprosy. One important challenge has been overcoming the target population's denial of HIV and encouraging Afro-Brazilians to accept that HIV also affects them. Community leaders include religious leaders, rap musicians, artists, and other people respected by various communities. Activities include visits to samba dance schools, Umbanda and Candomble temples, and street youth groups to provide HIV-related information.^ieng

In sickness or in health: TDR's parners. 7. Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.

PIP: Mahidol University's Faculty of Tropical Medicine, Bangkok, Thailand, established in 1960, is one of 14 faculties, 5 institutions, 5 centers, and 2 colleges within Mahidol University. It consists of the following departments: Helminthology, Medical Entomology, Microbiology and Immunology, Protozoology, Social and Environmental Medicine, Tropical Hygiene, Tropical Medicine, Tropical Nutrition and Food Science, Tropical Pediatrics, Tropical Pathology, and Tropical Radioisotopes. The UNDP/World Bank/WHO Special Program for Research and Training in Tropical Diseases (TDR) has been associated with the Faculty since 1977, collaborating mainly upon malaria research, but also in filariasis, leprosy, and schistosomiasis research. Early TDR support was directed at research training and institutional strengthening, although by the early 1980s, the Faculty played an increasingly important role in TDR's research and development program. In recent years, the Faculty has focused upon researching malaria, parasitic and bacterial diseases, nutrition and food sciences, and environmental health. The Faculty's malaria-related research is described. The Faculty also conducts research in many other areas of tropical medicine outside of those of interest to TDR.^ieng

Social marketing to eliminate leprosy in Sri Lanka.

PIP: Leprosy is a chronic infectious disease which, if untreated, can lead to permanent and progressive nerve damage and thus to deformities of the limbs, eyes, and face. People with leprosy have long been ostracized by society. The clinical signs of leprosy include insensitive skin lesions and thickened peripheral nerves. Untreated infectious leprosy cases are the main source of infection, transmitting the disease through nasal secretions. People with low cell-mediated immunity are at risk of developing clinically active leprosy irrespective of gender, age, or social class. The World Health Organization (WHO) has, since 1982, recommended multiple drug therapy (MDT) against leprosy, an approach capable of curing the disease within 1 year and interrupting its transmission. According to WHO, leprosy is currently a public health problem in 55 countries and more than 20% of the estimated 1.15 million cases of leprosy worldwide remain undetected. Although Sri Lanka was the first country in South Asia to provide MDT to all registered leprosy patients, first making it available in 1984, the disease continues to be transmitted due to the large number of undetected cases in the country. An ongoing social marketing program was therefore launched in 1990 by the local health ministry and the Novartis Foundation for Sustainable Development to eliminate leprosy from Sri Lanka. The program encourages people with suspicious skin lesions to seek diagnosis and care, teaches health care providers to recognize leprosy and refer cases for treatment, and helps the general public to understand that leprosy is just a normal disease. The socially marketed product is MDT, provided free-of-charge by the Novartis Foundation to all leprosy patients.^ieng

Health promotion in South East Asia.

PIP: The countries of the South East Asia region, which includes Bangladesh, Bhutan, Pakistan, Korea, India, Indonesia, Maldives, Myanmar, Nepal, Sri Lanka, and Thailand, have undertaken a variety of strategies to address the health challenges in the region. The ever-growing pressure of population in the region has allowed rapid transmission of communicable diseases like malaria, tuberculosis (TB), leprosy, and HIV/AIDS. One of the innovative community-based health initiatives in response to this problem is Indonesia's Primary Health Care Project. This project aimed to develop a sustainable health infrastructure by training medical staff, coordinators, village cadres, midwives and those working for TB programs; provision of ongoing guidance and education in this area; and provision of medicines and funds. The project has pioneered a process towards positive changes. Another strategy is the collaboration of youth groups, island development committees, and health workers in Maldives which has led to the declaration of two islands (Madifushi and Haa Alif Berinmadhoo) as 'no smoking' islands. In addition, Sarvodaya has successfully developed a methodology to involve Buddhist monks in AIDS prevention and control through "the Buddhist approach to AIDS prevention in Sri Lanka."^ieng

Tuberculosis prevention: where do we go from here?

PIP: The Karonga (Malawi) Prevention Trial revealed that repeat BCG vaccinations did not protect against pulmonary tuberculosis (TB) but appeared to provide some protection against glandular TB. They increased protection against leprosy. In fact, a single BCG vaccination conferred 50% protection against leprosy and a repeat BCG vaccination increased protection by another 50%. This trial's findings confirm the need for maintaining BCG vaccination programs in countries where leprosy is a public health problem, for individuals at high risk of leprosy (i.e., contacts of leprosy cases), and because BCG provides some protection against severe forms of TB (i.e., miliary disease and TB meningitis). An alternative TB vaccine needs to be developed, however. The protective efficacy of BCG against pulmonary TB is higher at latitudes far from the equator (80% in northern Europe vs. 0% in India and Malawi). It appears that the immunologic effects of environmental mycobacteria compromise BCG's protective effect against pulmonary TB. There is heterologous immunity between various mycobacterial infections. Low-level delayed-type hypersensitivity (DTH) to tuberculin in non-BCG vaccinated people reflects exposure to environmental mycobacteria. These people are at lower risk of TB than are people with either no DTH or strong DTH to tuberculin. Intradermal exposure to different mycobacteria provides varying degrees of protection against TB in guinea pigs. The warmer and the wetter the environment, the more widespread is colonization by mycobacteria. An area of future research is mapping the distribution of environmental mycobacteria, correlating it with the pattern of DTH responses to tuberculin, and then laboratory work to isolate relevant antigens of the mycobacteria. Another approach is identifying mycobacterial antigens that elicit protective immune responses in vitro so researchers can then identify which antigens and responses are associated with patterns of DTH known to reflect low risk of TB and which response patterns are elicited by BCG against leprosy but not TB antigens. New vaccines are not on the imminent horizon, however.^ieng

Burma.

PIP: Demographic, political, and physical characteristics of Burma are outlined, the largest country on the Southeast Asian mainland. The population of Burma is predominantly rural with the most prevalent ethnic group being the Burmans. Theravada Buddhism is the religion of approximately 85% of the Burmese. Burma was unified in the 11th century by King Anawrahta. In 1988, General U Ne Win, the country's president, stepped down from his position after a series of violent riots protesting severe economic conditions. That same year, military rule was established and 2 new parties came into being: the National Unity Party and the National League for Democracy. Since August 1988, the issuance of tourist visas has been halted due to the unrest. Longterm visas for business purposes can be obtained, however. For those travelling to Burma, yellow fever inoculation certification is required. Cholera, tuberculosis, plague, leprosy and typhoid are all endemic as well, and dengue fever is present. A fairly inaccessible country, all international flights enter and exit through the country's capital, Rangoon. The tourist visiting Burma will see an agricultural nation. Approximately 70% of the country's exporting economy comes from the sale of rice and teak.^ieng

Health resources and management in Korea: development in the past, current issues and perspectives.

PIP: Korea's health system has undergone major changes since the late 1970's due to massive economic growth developments. Compulsory health insurance was initiated for all wage earners in 1977 and was expanded to all rural and urban residents in 1980 and 1989. Health resources in the form of human and physical resources and health expenditures are very important to the success of any health insurance system. Korean economic growth in the past 40 years is staggering. It has gone from a per capita income of US $70 in the 50's to over US $2000 in the 80's. Korea is now an upper middle-income country. Population has more than doubled since 1949. Urbanization has increased from 28% in 1960 to 65% in 1985. Reduction of fertility through family planning practices is currently being promoted. Korea has developed 5 health care plans over a 25 year period -- from the 1954-60 allocation of funds for leprosy and tuberculosis control to the 1982-86 'health for all by 2000" policy. The National Health Insurance Program will be initiated in 1989. Communicable diseases were the major cause of death in the 60's, cardiovascular disease in the 70's, and chronic degenerative diseases in the 80's. Incidences of communicable diseases, tuberculosis and parasite infection have all decreased dramatically in the past few decades. Perceived unhealthiness has increased from 1981-87. The 1980's has ushered in a higher utilization of curative care, safe deliveries and immunizations. Inequalities in health care still exist and result from socioeconomic inequalities. Medical resources must be distributed adequately to alleviate inequality. Middle-level health personnel is lacking in Korea at this time, while upper-level personnel has increased. Physical resources tend to be wasted -- there is a high nonoccupancy rate of hospital beds. Other physical resource problems can be partially eliminated by a more equal distribution of health facilities relative to demand. Health insurance utilization has grown annually, however low income populations usually show a low usage rate. Payment-reimbursement methods include fee-for-service (FFS), capitation, salary, case payment, or a combination. In the future this payment system must be improved in order to achieve comprehensive care. Important policy issues are consensus on rising health expenditure; equity and efficiency of health services; role of the hospital and clinic; priority of primary care; rural health care delivery; rural hospitals; health care delivery system; payment-reimbursement scheme; governmental financial input; primary care reinforcement; and measures for the changes in disease patterns.^ieng

USAID in Nepal.

PIP: The USAID's mission in Nepal is to assist development until the people can sustain their own needs: although the US contributes only 5% of donor aid, USAID coordinates donor efforts. The mission's theme is to emphasize agricultural productivity, conserve natural resources, promote the private sector and expand access to health, education and family planning. Nepal, a mountainous country between India and Tibet, has 16 million people growing at 2.5% annually, and a life expectancy of only 51 years. Only 20% of the land is arable, the Kathmandu valley and the Terai strip bordering India. Some of the objectives include getting new seed varieties into cultivation, using manure and compost, and building access roads into the rural areas. Rice and wheat yields have tripled in the '80s relative to the yields achieved in 1970. Other ongoing projects include reforestation, irrigation and watershed management. Integrated health and family planning clinics have been established so that more than 50% of the population is no more than a half day's walk from a health post. The Nepal Fertility Study of 1976 found that only 2.3% of married women were using modern contraceptives. Now the Contraceptive Retail Sales Private Company Ltd., a social marketing company started with USAID help, reports that the contraceptive use rate is now 15%. Some of the other health targets are control of malaria, smallpox, tuberculosis, leprosy, acute respiratory infections, and malnutrition. A related goal is raising the literacy rate for women from the current 12% level. General education goals are primary education teacher training and adult literacy. A few descriptive details about living on the Nepal mission are appended.^ieng

New approaches to vaccine development. Proceedings of a meeting organized by the World Health Organization. Book review.

PIP: The Proceedings here reviewed are those of the meeting held in Geneva in October, 1983, which led to the establishment of the World Health Organization's Program for the Accelerated Development of New Vaccines. These papers reflect the state of the art in the development of vaccines for cholera, leprosy, pertussis, salmonella, shigella, dengue, foot-and-mouth disease, hepatitis B, herpes simplex, influenza, poliomyelitis, Chagas' disease, malaria, and schistosomiasis. The identification and isolation of epitopes and other antigenic fragments is presented, as well as considerations of mucosal immunity, antigenic determinants and antigenic variations, antigen presentation and T-cell activation, the use of anti-idiotypes as antigens, the development of recombinant viruses for use in vaccines, and the use of circumsporozoite antigens in the preparation of a malaria vaccine.^ieng