Browsing by Subject "Brazil"
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Item A Comparison of HIV/AIDS Management in the US and Brazil: Historical Context and Lessons Learned(2020-03-16) Zou, Michael; Mihalic, Angela; Kitchell, Ellen; Lazarte, SusanaBACKGROUND: Since its initial appearance in the early 1980s, the HIV pandemic has presented a worldwide challenge not just in biomedical innovation but in social and political mobilization as well. The groundbreaking innovation of HAART (highly active antiretroviral therapy) in 1996 was buttressed by an era of public health mobilization to limit the scale of the epidemic prior to 1996 and an era to ensure access to this treatment. The actions taken in these two eras have shaped the current character of the epidemic in all countries; the US and Brazil are no different. On the one hand, the US lags behind its countries in metrics such as the UN AIDS 90-90-90 initiative. In contrast, Brazil has emerged as the leader in Latin America in the 90-90-90 metric, achieving marks that are comparable to the US despite differing levels of development. OBJECTIVE: Brazil implemented bold public health policies that led to it becoming one of the leaders in Latin America in HIV management. This thesis will explore the historical context and implementation of these policies with an eye towards possible application in the US. METHODS: Historical analysis was performed on the public health policies of Brazil and the US regarding HIV/AIDS management. Sources include but are not limited to contemporaneous newspapers, presidential recordings and speeches, congressional legislation and briefings, documentaries, epidemiologic figures, interviews, government and activist images and posters, mathematical models of the HIV epidemic, and other studies comparing the two countries. RESULTS: To a much greater extent in the United States, there was alignment in values and action between federal and local governments, civil society, the Constitution, and international donors. This led to the historic and controversial decree in 1996, proclaiming universal and free HAART for all Brazilians. Since then, Brazil has maintained a successful and solvent HIV program through partnerships with community leaders to increase outreach, aggressive negotiation for medication pricing internationally, and sophisticated centralized databases permitting cutting-edge patient care and research. In contrast, the early HIV movement in the United States was characterized by conflict between the federal government and activists who fought for recognition and treatment for people living with HIV (PLWHIV). Other branches of the federal government in addition to local governments provided some leadership, but the lack of a unified response led to an increase in the scope of the epidemic, ultimately making it more difficult to manage. Both countries find their HIV programs at a crossroads. In Brazil, an increasingly conservative government and a defunding of the public health system (SUS) has led to a disturbing increase in incidence, especially among the youth of Brazil. In contrast, the United States has reinvigorated its domestic response to AIDS with the 'National HIV/AIDS Strategy' of President Obama and the 'Ending the Epidemic' initiative of President Trump. However, ultimate success in the HIV epidemic in the US may require a more fundamental rethinking of the healthcare system. CONCLUSION: Prior work comparing the the the Brazilian and American response to the HIV epidemic have centered on the roles of activism, executive leadership, and international factors that have shaped policies, in particular the policy of universal and free HAART in Brazil. This thesis builds on this work by examining interventions that Brazil has implemented in the last decade with an examination of recent policies enacted by the Obama, Trump, and Bolsonaro administrations. Such a comparative approach may prove useful to policymakers interested in using the experiences of other nations to devise innovative approaches to the HIV epidemic.Item Imapct [sic] of Pesticide Exposure on Motor Function and Mortality Among Patients with Parkinson's Disease in Southern Brazil(2020-05-01T05:00:00.000Z) Reddy, Sumanth Palvai; Dewey, Richard B., Jr.; Chang, Mary; Chitnis, ShilpaBACKGROUND: Multiple studies have suggested that various pesticides are associated with a higher risk of developing Parkinson's disease (PD). However, few studies have examined the impact of pesticide exposure on motor impairment and the risk of mortality among patients with PD. This study takes place in the context of growing pesticide use in Brazil as well as many other low- and middle-income countries around the world. OBJECTIVE: This study examines whether occupational pesticide exposure influences motor impairment and the risk of mortality among patients with PD in Southern Brazil, when accounting for socioeconomic status, disease-specific factors, nicotine exposure, and caffeine exposure. METHODS: 150 patients with idiopathic PD in Porto Alegre, Brazil were enrolled from 2008-2013 and followed until 2019. In addition to undergoing a detailed neurologic evaluation, patients completed surveys regarding environmental exposures. 105 of these patients also completed an additional survey regarding socioeconomic factors. The primary outcomes were whether occupational pesticide exposure was associated with motor impairment (as measured by linear regression with UPDRS-III score) and mortality (as determined by the log-rank test and Kaplan-Meier testing). Secondary analyses included models that accounted for relevant socioeconomic and disease specific characteristics (multiple linear regression for motor function, and multivariate cox proportionate hazards regressions for mortality). RESULTS: Of the 150 patients in this prospective cohort, 20 (13.3%) reported a history of occupational pesticide exposure, with an average duration of exposure of 14.3 years (SD = 10.6, median = 10). In the univariate analysis, occupational pesticide exposure was associated with a 16.10 point increase in the UPDRS-III (motor function) score (95% CI: [7.11, 25.02], p < 0.001). Similarly, in the multiple linear regression which controlled for several socioeconomic and disease-related covariates, pesticide exposure was associated with a 16.84 point increase in the UPDRS-III score (95% CI: [8.84, 24.85], p < 0.001). Patients with occupational pesticide exposure were more than two times as likely to die than their unexposed PD counterparts (HR = 2.32, 95% CI [1.15, 4.66], p = 0.22). This was significant when controlling for smoking history, caffeine intake, and socioeconomic factors such as historical monthly income, education, and a history of working predominately in agricultural professions. Patients with 10 or more years of occupational pesticide exposure had a significantly elevated risk of mortality (HR = 2.81, 95% CI [1.17, 6.73], p = 0.02), in contrast to patients with fewer than 10 years of exposure. CONCLUSION: In addition to providing a broad overview of the socioeconomic breakdown of a contemporary cohort of patients with PD in South America, this study implicates occupational pesticide exposure as an independent risk factor for poor motor function and mortality among patients with PD when controlling for disease-specific and socioeconomic confounding factors. This is especially important in the Brazilian market, and perhaps in other developing countries, where new pesticides continue to be introduced without the corresponding research output necessary to understand the impact on human health.Item Leprosy in Brazil: How Can Brazil Meet the World Health Organization's Goal of Leprosy Control?(2016-03-15) Johnson, Trevor; Mihalic, Angela; Swancutt, Mark; Southern, PaulBACKGROUND: Leprosy causes a high social and economic cost on communities. Brazil has the second most cases of leprosy in the world. Brazil's incidence of leprosy decreased significantly with the start of multi drug therapy in 1981, but over the past ten years, the incidence has remained fairly fixed. OBJECTIVE: Brazil has not met the World Health Organization's leprosy goal for a prevalence of less than one patient per 10,000 inhabitants. The purpose of this literature review is to evaluate the progress of Brazil's leprosy control measures and highlight the areas in which Brazil can concentrate to meet this goal. METHODS: An online literature search was performed through the Ovid and PubMed databases describing leprosy in Brazil and management practices. Publications in Portuguese were translated into English. RESULTS: Several studies were found that identified various factors impeding the progress of Brazil toward its prevalence target. These general categories include: society and culture, stigma and isolation, vaccination and chemoprophylaxis, decentralization of resources and the leprosy control action, molecular tools, and relapses and non-adherence. CONCLUSION: Leprosy continues to be a public health problem in Brazil and the incidence rates are not improving. The various factors impeding Brazil can be grouped into three main areas: prevention, diagnosis, and treatment. Optimizing resources in the ten clusters with the highest incidence rates will allow Brazil to reach its WHO prevalence goal.Item [Southwestern News](1996-04-08) Mullen, Kris