RESUMO
The aim of this study was to examine the requirement of luteal progesterone or luteal estrogen for the establishment of pregnancy in the Cebus monkey and to test in a primate species the synergism between RU 486 and letrozole (LTZ) found in rodents for inhibiting implantation. Exposure of target tissues to either hormone was suppressed during the mid-luteal phase of mating cycles by subcutaneous administration of the antiprogestin (RU 486), the aromatase inhibitor LTZ or the antiestrogen (ICI 182780) on days 4-7 of the luteal phase. Administration of 0.1 or 0.5 mg/kg of LTZ on days 5-7 of the luteal phase caused a profound drop in the levels of E(2) in all animals, whereas administration of ICI 182780 0.2 mg/kg on days 4-6 of the luteal phase had the opposite effect. The pregnancy rate in vehicle treated cycles of the same females was (58.3%). Treatment with RU 486, 0.8 mg/kg/day on days 5-7 of the luteal phase-induced endometrial bleeding in 3/5 mated females none of which became pregnant, whereas pregnancy was confirmed in one of the two animals that did not bled. Treatment with RU 486, 0.4 mg/kg/day alone or with LTZ on days 5-7 or ICI 182780 alone, on days 4-6 of the luteal phase failed to induce bleeding, allowing the establishment of pregnancy in 50.0-66.6% of the animals in these groups. We conclude that in Cebus monkeys, progesterone but not luteal estradiol is required for the establishment of pregnancy and that RU 486 and LTZ do not exhibit in this species the synergism found in rodents.
Assuntos
Cebus/metabolismo , Estradiol/metabolismo , Fase Luteal/metabolismo , Prenhez/metabolismo , Progesterona/metabolismo , Animais , Inibidores da Aromatase/farmacologia , Implantação do Embrião/efeitos dos fármacos , Estradiol/análogos & derivados , Estradiol/sangue , Estradiol/farmacologia , Antagonistas de Estrogênios/farmacologia , Feminino , Fulvestranto , Letrozol , Fase Luteal/efeitos dos fármacos , Masculino , Mifepristona/farmacologia , Nitrilas/farmacologia , Gravidez , Taxa de Gravidez , Progesterona/antagonistas & inibidores , Progesterona/sangue , Triazóis/farmacologiaRESUMO
Market-led economic reforms are usually viewed as being in conflict with government-stimulated socioeconomic development for disadvantaged groups. Nevertheless, Ceará, a poor state in the Northeast of Brazil, has since 1987 pursued both of those strategies simultaneously. One part of that approach has been a program of nurse-directed auxiliary health workers serving about 5 million people--almost all the persons outside the capital city and half of those in the capital. The system requires that the auxiliaries, called agentes de saúde, live in the local communities that they serve. The health agents visit each home once a month to carry out a small number of priority health activities. While health agent positions are in high demand, the minimum-wage salary that the agents receive makes up only a small portion of the state budget. A key aspect of the system is timely and comprehensive information, which is based on agent visits and is managed by trained nurses. Since the health agents system was launched, there has been a rapid decline in infant mortality, a rapid rise in immunization, identification of bottlenecks limiting the utilization of other medical resources, and timely interventions in times of crisis. The health agents system has combined administrative decentralization with financial centralization during a period of electoral democratization. The system has strengthened Ceará's commitment to primary care even as market-oriented changes have reduced the overall role of government. The Ceará program is being copied throughout the Northeast and other regions of Brazil. The key role that nurses play in the Ceará program in organizing and leading a system of basic primary care in poor neighborhoods and rural areas may provide useful lessons for other countries. In addition, Ceará does not have many of the favorable characteristics of other countries that have successfully invested in primary health care. Ceará thus represents a more achievable model for other countries, where, like Brazil, income, educational levels, and land tenure equity are limited.
Assuntos
Agentes Comunitários de Saúde , Atenção à Saúde/métodos , Atenção à Saúde/organização & administração , Atenção Primária à Saúde/organização & administração , Avaliação de Programas e Projetos de Saúde , Brasil , Custos e Análise de Custo , Atenção à Saúde/economia , Humanos , Atenção Primária à Saúde/economiaRESUMO
Since 1990, health services decentralization in Nicaragua has been accompanied by structural adjustment, resulting in reduced equity and accountability. Sandinista efforts in the 1980s to extend access to primary care and reduce class and regional disparities in the delivery of health services were accompanied by modest attempts to increase local-level accountability and responsiveness. The escalation of war in the late 1980s transformed this effort into greater de facto decentralization. Over the past decade, Nicaragua has used decentralization policy to restructure the health system through health spending cuts and the favoring of curative over preventive services; privatization and the promotion of user fees; and confusion of lines of accountability. The authors analyze the 1990s' health policies in Nicaragua, paying particular attention to the blending of decentralization policy with the fiscal and administrative reforms advanced by the International Monetary Fund, World Bank, and other international agencies. They conclude that analyzing decentralization as a sector-specific reform that can be ameliorated through technocratic modifications is insufficient. A full understanding of the problems and possibilities of decentralization requires an analysis of the political and economic context that conditions these policies.
Assuntos
Atenção à Saúde/organização & administração , Política de Saúde , Política , Mudança Social , Nível de Saúde , Humanos , Nicarágua , Previdência Social/organização & administraçãoRESUMO
OBJECTIVES: This report examines the impact of an economic embargo from 1991 to 1994 on health, well-being, and human rights in Haiti. METHODS: Data from surveillance systems for nutrition, reportable diseases, and hospital diagnoses were combined with survey data and interviews with affected women, governmental representatives, diplomats, and staff of nongovernmental organizations. RESULTS: Changes included declining income, rising unemployment, poorer nutrition, declining infant mortality, rising mortality among 1- to 4-year-olds, decreased attention to children's well-being and education, and family breakdown. Survival strategies among poor Haitians included changed dietary habits, informal-sector economic activity, moving in with relatives, selling domestic goods, increased informal unions among couples, decreased school attendance, and indentured servitude among children. CONCLUSIONS: The implementation of economic sanctions in Haiti resulted in extensive violations of rights; the impact was greatest on the most disadvantaged Haitians. Many Haitian and international supporters of democracy were unaware of the extensive negative impact that sanctions could have. The impact continues now, 5 years after sanctions ended. Modified policies reduced some of the burden of sanctions, and international assistance prevented what otherwise might have become a humanitarian disaster during sanctions.
Assuntos
Economia , Direitos Humanos , Saúde Pública , Política Pública , Serviços de Saúde da Criança , Pré-Escolar , Surtos de Doenças , Educação , Feminino , Haiti , Acessibilidade aos Serviços de Saúde , Humanos , Lactente , Mortalidade Infantil , Cooperação Internacional , Serviços de Saúde Materna , Fenômenos Fisiológicos da Nutrição , Gravidez , Socorro em Desastres , SaneamentoRESUMO
Throughout Central America, a traditional malaria control strategy (depending on heavy use of organic pesticides) became less effective during the 1970s. In Nicaragua, an alternative strategy, based on frequent local epidemiological assessments and community participation, was developed in the 1980s. Despite war-related social instability, and continuing vector resistance, this approach was highly successful. By the end of the contra war, there finally existed organisational and ecological conditions that favoured improved malaria control. Yet the expected improvements did not occur. In the 1990s, Nicaragua experienced its worst recorded malaria epidemics. This situation was partly caused by the country's macroeconomic structural adjustment programme. Volunteers now take fewer slides and provide less treatment, malaria control workers are less motivated by the spirit of public service, and some malaria control stations charge for diagnosis or treatment. To "roll back malaria", in Nicaragua at least, will require the roll-back of some erroneous aspects of structural adjustment.
PIP: This paper examines the social and political influences on malaria transmission and control activities in Nicaragua. In politically unstable Central America, methods that depend on community participation and planning on the basis of routine surveillance data may be sufficient to control malaria transmission. The Nicaraguan experience in the 1980s and 1990s shows how an integrated approach can prove to be effective where social stability, health education, and strong program administration exists. During the Contra war in the 1980s, implementation of the community-based strategy was limited, resulting in increasing rates of P. vivax transmission in the war zone. The loss of timely epidemiological reporting and the decrease in use of local volunteers for blood slide detection and directly observed therapy resulted in a greater epidemic. More recently, WHO has initiated "Roll Back Malaria" and "Roll Back Structural Adjustment" programs which aim to make more efficient use of limited resources in the health sector to help eradicate malaria. Several components were needed for the strategy: the technical capacity of the national staff needed strengthening, the staff needed to be re-evaluated, additional funds were needed to assure competitive salaries, and malaria control programs needed to be identified for appropriation of funds as essential components to national development planning during structural adjustment. National leadership and the establishment of public service and social solidarity will help mobilize volunteers to work toward the goal of preventing malaria transmission.
Assuntos
Países em Desenvolvimento , Malária/prevenção & controle , Política , Fatores Socioeconômicos , Humanos , Malária/mortalidade , Malária/transmissão , Malária Falciparum/mortalidade , Malária Falciparum/prevenção & controle , Malária Falciparum/transmissão , Malária Vivax/mortalidade , Malária Vivax/prevenção & controle , Malária Vivax/transmissão , Controle de Mosquitos/tendências , Nicarágua , Vigilância da PopulaçãoRESUMO
OBJECTIVES: This paper examines the combined effects of a severe economic decline since 1989 and a tightening of the US embargo in 1992 on health and health care in Cuba. METHODS: Data from surveillance systems for nutrition, reportable diseases, and hospital diagnoses were reviewed. These sources were supplemented with utilization data from the national health system and interviews with health leaders. RESULTS: Changes in Cuba include declining nutritional levels, rising rates of infectious diseases and violent death, and a deteriorating public health infrastructure. But despite these threats, mortality levels for children and women remain low. Instead, much of the health impact of the economic decline of Cuba has fallen on adult men and the elderly. CONCLUSIONS: To be consistent with international humanitarian law, embargoes must not impede access to essential humanitarian goods. Yet this embargo has raised the cost of medical supplies and food Rationing, universal access to primary health services, a highly educated population, and preferential access to scarce goods for women and children help protect most Cubans from what otherwise might have been a health disaster.
Assuntos
Atenção à Saúde/tendências , Economia/tendências , Nível de Saúde , Cooperação Internacional , Adolescente , Adulto , Criança , Pré-Escolar , Cuba/epidemiologia , Atenção à Saúde/normas , Democracia , Economia/legislação & jurisprudência , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Morbidade , Inquéritos Nutricionais , Vigilância da População , Saúde Pública , Estados UnidosRESUMO
The United States embargo against Cuba, which makes trade illegal, contributes to that country's death and disease. The policy is obsolete, counterproductive and should be changed to bring peace between the two nations and help restore the health of the Cuban people. Along with the ban on trade is the ban on traveling. The United States' controls contradict the most fundamental values upon which this country stands. Despite current restrictions, physicians can travel to Cuba and they should in order to observe the island's system for themselves.