Un ensayo clínico no ético y la politización de la pandemia de COVID-19 en Brasil: El caso de Prevent Senior

El Senado Federal de Brasil creó una Comisión Parlamentaria de Investigación (CPI) para investigar las irregularidades del gobierno de Bolsonaro en la gestión de la pandemia de COVID-19. Uno de los casos que llamó la atención fue la investigación llevada a cabo por Prevent Senior, una empresa privada de seguros de salud, sobre el tratamiento temprano de COVID-19. Este artículo analiza la validez científica de la investigación y los problemas éticos relacionados con su implementación. Se basa en un análisis del informe del estudio clínico de Prevent Senior, de los registros de ensayos clínicos de Brasil y Estados Unidos, del informe de la CPI del Senado y de información difundida por los medios de comunicación. Este caso de fraude científico y sesgo político-ideológico ejemplifica cómo Prevent Senior, utilizando un protocolo cuestionable para mejorar su reputación y obtener el apoyo del gobierno, contribuyó a la construcción de la narrativa de "tratamiento temprano" para COVID-19, y muestra cómo sirvió de base para una política pública del gobierno que promovió el uso de medicamentos ineficaces.

Advanced Practice Nursing: "Training" Pillar in Supporting the Proposal in Brazil

OBJECTIVES

to present the pillars that support what has been called Advanced Practice Nursing and discuss the necessary training for its implementation.

METHODS

elements contained in assessment documents for graduate programs proposals, reports of presentations by international professors in countries and selected scientific publications were gathered to compose the argument.

RESULTS

practice/competency (adds broad and in-depth knowledge about health processes and scientific evidence, clinical reasoning and clinical skills for therapeutic indications); 3) professional regulation (corresponding legislation and monitoring); and 4) funding (broad training and professional practice policy).

FINAL CONSIDERATIONS

the agenda for implementing Advanced Practice Nursing in Brazil involves joining efforts to identify stakeholders for a work to legitimize their importance in the country's health and education overview.

Perceptions about exposure to pesticides among rural school students: identified controversies

OBJECTIVES

to identify, according to students' perception, controversies related to the term "pesticide" and its influence on health.

METHODS

field research, with qualitative analysis via discursive textual analysis. Collective interviews were carried out with students of ninth grade of elementary school from four rural schools in the western region of Paraná.

RESULTS

when analyzing students' statements, it was identified that pesticides are part of their reality and that of the local community Controversies related to pesticides and health arose, with emphasis on the form of production and the understanding of the real harm generated by exposure and use of pesticides.

CONCLUSIONS

approaching pesticides in the context of education and health is essential so that there is a strengthening of discussions, in a critical and contextualized way, in school spaces, expanding the look at the topic as a way of enriching understandings and discourses on the subject.

Uma pesquisa clínica não ética e a politização da pandemia da COVID-19 no Brasil: o caso da Prevent Senior

O Senado Federal brasileiro criou uma Comissão Parlamentar de Inquérito (CPI) para investigar as irregularidades do governo Bolsonaro na gestão da pandemia da COVID-19. Um dos casos que chamou a atenção foi a pesquisa realizada pela Prevent Senior, uma seguradora privada de saúde, sobre o tratamento precoce da COVID-19. O artigo analisa a validade científica da pesquisa e os problemas éticos relacionados à sua implementação. Baseia-se na análise do relatório do ensaio clínico da Prevent Senior, dos registros do ensaio clínico em plataformas do Brasil e dos EUA, do relatório da CPI do Senado e nas informações divulgadas pela mídia. Esse caso de fraude científica e viés político-ideológico exemplifica como a Prevent Senior, usando um protocolo questionável para melhorar sua reputação e ganhar o apoio do governo, foi fundamental na construção da narrativa do "tratamento precoce" para a COVID-19, e mostra como serviu de base para uma política pública governamental que promoveu o uso de drogas ineficazes.

From population viability analysis to coviability of farmland biodiversity and agriculture

Substantial declines in farmland biodiversity have been reported in Europe for several decades. Agricultural changes have been identified as a main driver of these declines. Although different agrienvironmental schemes have been implemented, their positive effect on biodiversity is relatively unknown. This raises the question as to how to reconcile farming production and biodiversity conservation to operationalize a sustainable and multifunctional agriculture. We devised a bioeconomic model and conducted an analysis based on coviability of farmland biodiversity and agriculture. The coviability approach extended population viability analyses by including bioeconomic risk. Our model coupled stochastic dynamics of both biodiversity and farming land-uses selected at the microlevel with public policies at the macrolevel on the basis of financial incentives (taxes or subsidies) for land uses. The coviability approach made it possible for us to evaluate bioeconomic risks of these public incentives through the probability of satisfying a mix of biodiversity and economic constraints over time. We calibrated the model and applied it to a community of 34 common birds in metropolitan France at the small agricultural regions scale. We identified different public policies and scenarios with tolerable (0-0%) agroecological risk and modeled their outcomes up to 2050. Budgetary, economic, and ecological (based on Farmland Bird Index) constraints were essential to understanding the set of viable public policies. Our results suggest that some combinations of taxes on cereals and subsidies on grasslands could be relevant to develop a multifunctional agriculture. Moreover, the flexibility and multicriteria viewpoint underlying the coviability approach may help in the implementation of adaptive management.

Equity in health: tuberculosis in the Bolivian immigrant community of São Paulo, Brazil

OBJECTIVES

To analyse the profile of tuberculosis (TB) among Bolivian immigrants, investigate the impact that this population has on the trends of TB and assess equity in access to TB treatment, in the city of São Paulo, Brazil.

METHODS

Descriptive study of the epidemiological profile of TB in four city districts with large Bolivian populations, comparing cases among Brazilians and Bolivians, during the 1998-2008 period was carried out. We used logistic regression to adjust the treatment outcome for potential confounders.

RESULTS

We identified 2056 new TB cases: 65.7% in Brazilians, 32.1% in Bolivians and 2.2% among other nationalities. Although TB incidence remained stable (high) over the study period, the annual proportion of cases among Bolivians increased from 15.0% to 53.0%. In comparison with the Brazilians, the Bolivians were younger (median age, 24 vs. 40 years; P < 0.0001) and presented a lower unemployment rate (3.1%vs. 11.6%; P < 0.0001), a lower rate of HIV co-infection (1.5%vs. 28.5%; P< 0.001), a higher proportion of individuals receiving supervised treatment (81.5%vs. 62.0%; P < 0.0001) and a higher proportion of cures (71.6%vs. 63.2%; P< 0.0001). After having been adjusted for potential confounder, cure after treatment was not associated with nationality.

CONCLUSIONS

  Bolivian immigrants influenced the incidence but not the trends of TB among Brazilians in the study area. We found no significant differences between Bolivians and Brazilians regarding healthcare access or treatment outcome. Guaranteed universal health care access for all, including undocumented individuals, contributes to health equity. Specific intervention strategies are warranted for immigrants with tuberculosis.