Challenges In Brazil Research Articles

Unveiling the Landscape of Brazilian Clinical Oncologists: Challenges, Diversity, and Quality Care

AbstractCancer remains a significant public health challenge in Brazil, with an estimated 704 thousand new cases annually. Clinical oncology, a pivotal specialty in cancer diagnosis and treatment, has evolved since its formal establishment in 1946. Recent recognition by the Brazilian Federal Board of Medicine solidified its status, culminating in normative resolution nr. 2,162/2017. The present study aims to characterize Brazilian clinical oncologists and analyze their epidemiological and structural contexts using data from the Brazilian Society of Clinical Oncology's 2023 census and secondary sources, including the National Cancer Institute (Instituto Nacional de Câncer [INCA], in Portuguese) and Brazilian Institute of Geography and Statistics (Instituto Brasileiro de Geografia e Estatistica [IBGE], in Portuguese). A cross-sectional design employing qualitative-quantitative methods surveyed 761 clinical oncologists, revealing insights into demographics, workload, stress levels, and challenges. The results highlight regional disparities in cancer mortality rates despite the concentration of oncology services in the South and Southeast. Challenges include access to new treatments, late diagnoses, and systemic underfunding. Moreover, this study underscores gender and racial disparities within the specialty, indicating a predominantly white and heterosexual profile among practitioners. Addressing these issues is crucial for enhancing healthcare equity and improving patients' outcomes in oncology practice.

Massive Education in Prison Health in Brazil: A Look Beyond the Walls

Equal access to health initiatives and services under the principles of universal and comprehensive care remains a challenge in Brazil. The realization of public health policies is further intricate when one examines the health situation of people deprived of liberty. This study showcases the “Prison System: Beyond the Walls” educational pathway, available on the Virtual Learning Environment of the Brazilian National Health System (AVASUS). The action research methodological strategy guided the pathway development, emphasizing dialogic learning. The goal was to address the need for massive training on the topic of prison health, with the model focusing on engagement through spontaneous, non-mandatory participation in the pathway courses. The pathway comprised four modules, whose educational offerings were based on the self-learning model. Students were free to choose which courses to take and in what order, as there was no prerequisite for participating in modules. Hence, students could either take all the courses or only those with which they identify their learning needs, regardless of work demands or personal interests. Structuring the pathway through action research facilitated a massive, cohesive, and continuous training process. This approach expanded knowledge and established meaningful relationships among the related topics and the key players involved: health professionals, prison officers, and people deprived of liberty. Notably, the pathway courses have surpassed the 50,000-enrollment mark, spanning all five regions of Brazil. In this context, this article presents and discusses the development of the “Prison System: Beyond the Walls” pathway, emphasizing the massive improvement of health within Brazil’s prison system and highlighting the results achieved.

Assessment of Green Hydrogen as Energy Supply Alternative for Isolated Power Systems and Microgrids

The energy supply for isolated systems remains a current challenge in Brazil and worldwide, particularly when known solutions are compared regarding their cost, ability to supply energy on demand, and sustainability. In this context, green hydrogen, which has been considered one of the main paths for the decarbonization of the energy chain, is also seen as a potential energy supply solution in isolated systems. Based on a literature review of articles addressing the topics of green hydrogen and isolated systems, an analysis is conducted on the application of green hydrogen as an energy supply solution for isolated systems. The review identified and collected data on important parameters for comparing solutions, such as CAPEX, OPEX, energy cost, and the price per kilogram of hydrogen. Using these data, analyses were performed to provide an overview of the application of green hydrogen in isolated systems. One of the objectives of this work is to present a comprehensive analysis of the green hydrogen chain and its application in the context of electricity generation, particularly for isolated systems in Brazil.

Circular Economy in the steel sector: future trends and challenges in Brazil

Purpose: Examine the role of the circular economy in the steel sector, highlighting trends and challenges faced in its transition to a more sustainable practices. Methodology/approach: This research is centered on a qualitative analysis of the steel production chain in Brazil. Information was gathered using in-depth interviews and was examined through an abductive approach involving purposive sampling. Originality/relevance: This study highlights the main trends, examines the challenges, and outlines the best practices within the Brazilian industry steel sector, framed within the context of the circular economy. Key findings: The results show that Brazil is aligned with global sustainability and circularity trends in the steel industry, albeit with particular challenges. Theoretical/methodological contributions: The findings of this investigation are intended to establish a basis for mapping out the trends in Brazil's steel industry by 2035.

Hybrid developmental follow-up for preterm infants in Brazil: A feasibility study

IntroductionThe low attendance of families in child developmental follow-up programs for at-risk preterm children is a challenge in Brazil. ObjectiveThis study evaluates the feasibility of implementing a developmental follow-up program for Brazilian preterm infants in a hybrid format. MethodsThis is an observational, prospective cohort study, involving preterm infants. Longitudinal developmental test results, the participation frequency in the program, and the number of referrals to early intervention programs were used to assess feasibility. The General Movements (GMs) assessment, Alberta Infant Motor Scale (AIMS) and, Survey of Wellbeing of Young Children (SWYC) Milestones were administered via telehealth. The Bayley-III was administered in-person. ResultsThirty-four preterm infants attended the follow-up until 12 months of corrected age and 18 (52.9 %) concluded all follow-up assessments. Twenty-six (76.5 %) attended all assessments via telehealth, and 26 (76.5 %) attended the in-person assessment. Eighteen (52.9 %) infants showed at least one altered result in development tests. Infants exhibiting abnormal results in the GMs assessment, motor developmental delay according to the AIMS, or developmental delay based on Balley-III were promptly referred to early intervention services. ConclusionThis study demonstrated high participation rate and low dropout in a developmental follow-up program employing a hybrid format. The substantial number of identified infants with developmental delay emphasizes the importance of timely detection of motor delays to referral to early intervention services.

Clinical characteristics and treatment outcomes of advanced penile squamous cell carcinoma: Real-world evidence from a tertiary cancer center in Brazil.

e17025 Background: Penile cancer is a rare disease worldwide. However, Brazil has an annual incidence of 1.5 cases per 100,000 inhabitants, representing 2% of male cancers. This study aims to evaluate clinical characteristics and treatment outcomes of patients (pts) with advanced penile squamous cell carcinoma (SCC) in a large tertiary cancer center in Brazil. Methods: We performed a retrospective database analysis of pts with advanced penile squamous cell carcinoma (SCC) treated at Instituto do Cancer do Estado de Sao Paulo between January 2008 and October 2023. Medical records were reviewed for demographic, clinicopathological features and treatment outcomes data. Cumulative survival probabilities were computed using the Kaplan-Meier method. Prognostic factors associated with survival were evaluated through univariate analyses, using the Cox regression model. Results: We identified 91 pts with advanced penile SCC eligible for analysis. Median age was 62 years (IQR 44.5-64.5), most were married (53.8%), diagnosed with stage T3/T4 (60.4%), and N2/N3 (64.9%) SCC. At diagnosis, 65% were classified as stage IV (T4, N3, or M1 disease). De novo metastasis occurred in 35% pts. Neoadjuvant chemotherapy was given to 30.8%, mainly ITP regimen containing paclitaxel, ifosfamide, and cisplatin (46.4%). First-line palliative chemotherapy was given to 50.5%, being carboplatin and paclitaxel the predominant choice (47.8%). Disease progression occurred in 54% pts, after a median follow-up of 21.8 months. At the last follow-up, 61.5% had nodal disease. Most common sites of metastasis were lung (50.5%) and liver (19.8%). Overall survival (OS) was 12.9 months (95% CI 9.8 - 18.3). Prognostic factors significantly correlated with OS were ECOG 0-1 (HR 0.40, 95% CI 0.21 - 0.74, p=0.003) and complete response post-chemotherapy (HR 0.14; 95% CI 0.02 - 0.80, p=0.02). No association with survival was found for region/state of origin, distance from patient’s home to the hospital, marital status, education level, and age. Conclusions: Advanced penile squamous cell carcinoma (SCC) presents significant challenges in Brazil, with high rates of advanced disease at diagnosis. OS correlated with complete response to chemotherapy and performance status.

Social determinants of gastrointestinal malformation mortality in Brazil: a national study

IntroductionIn Brazil, approximately 5% are born with a congenital disorder, potentially fatal without surgery. This study aims to evaluate the relationship between gastrointestinal congenital malformation (GICM) mortality, health indicators, and...

The energy quadrilemma challenges - Insights from the decentralized energy transition in Brazil

The energy trilemma concept provides an important framework for understanding the multidimensional nature of energy policy and planning. It captures three fundamental challenges that highlight the complex interrelationships among energy security, equity, and sustainability. However, effectively addressing these challenges requires a refined understanding of local contexts, regional differences, and governance. This study expands this framework by introducing a context dimension that includes socioeconomic, environmental, and governance factors to complement the Energy Trilemma Index, resulting in the "energy quadrilemma." This framework allows for a more comprehensive examination of regional energy transition challenges in Brazil. The results reveal significant regional disparities, highlighting energy access as a source of socio-spatial inequality in Brazil. The Northeast region excels in energy security, while the Southeast lags in electricity independence. The South, Southeast, and Midwest have outstanding energy equity and environmental sustainability scores. Context indicators exhibit low scores in all regions, particularly in the North and Northeast. In addition, areas with the highest poverty scores have also limited digital access. These findings highlight the need for effective strategies and policies to address the multifaceted challenges of the energy quadrilemma, integrating socioeconomic and governance dimensions to advance energy transitions and planning at the regional level.

Efficacy of prenatal care in preventing congenital syphilis: a retrospective longitudinal analysis in Araçatuba, São Paulo

Introduction: Congenital syphilis stands as one of the primary causes of abortion worldwide, presenting a public health challenge in Brazil, where its incidence has been on the rise for the past 10 years, despite its preventable nature. Aim: To assess the effectiveness of prenatal care in averting congenital syphilis and mitigating adverse complications for newborns. Design: An observational, longitudinal, retrospective study was conducted, involving 65 newborns with congenital syphilis and their respective mothers. Data were gathered from the Notifiable Diseases Information System of Araçatuba-SP, spanning from 2018 to 2021. Results: A significant correlation was observed between attendance of prenatal care and neonatal outcomes. It was discovered that delayed diagnosis of infection in pregnant women was linked to more severe clinical manifestations in newborns. While only 13.7% of infants born to mothers diagnosed during prenatal care exhibited early symptoms, this figure rose to 57.1% in cases where diagnosis occurred during delivery. Implications: Despite endeavors to eradicate congenital syphilis, the persistent uptick in its incidence indicates deficiencies in prenatal care, underscoring the urgent necessity for interventions in primary healthcare.

Immigration and work, considerations about the challenges in Brazil: bibliographic review of the literature

Introduction: Migratory flows towards countries that have more labor supply are not recent. In this sense, the arrival of immigrants in host countries, in many cases, makes this population more susceptible to health risk situations because of work activities, lack of integration with the local population and the immigration process itself. Methods: The study used a bibliographic review of the literature as a method. In this context, integration policies and the recognition of educational training in the country of origin can contribute to improving the living conditions of this population in Brazil. Results: In this context, this study aims to provide a summary of the challenges faced by immigrants in search of improved living conditions. Furthermore, this study contributes to identifying the main challenges facing immigrants recently arrived in Brazil and the difficult process of integration into local society. It is observed that the authors highlight in common that, worldwide, in the different receiving countries, regardless of the social, political, and economic context in which the immigrants find themselves, there is some destructive process that conditions the health-disease process of this population, resulting from the various factors mentioned above. Conclusion: Yet the positive contribution of migration to development is increasingly recognized, and these targeted policies will maximize their benefits in both countries of origin and destination.

Cocoa agroforestry in Brazil through a public-private partnership

Historically, Brazil was a significant cocoa producer, primarily in the Amazon region, but since the 1970s, cocoa production became increasingly replaced by extensive livestock farming. What production remained, was halted by a fungal epidemic, resulting in Brazil becoming a net importer of cocoa beans. Thanks to recent sustainable development programmes and the emergence of the bioeconomy, Brazil has since experienced renewed interest in cocoa cultivation, especially in cocoa agroforestry. Initiatives such as Mondelez's Sustainable Cocoa Production project aim to promote sustainable cocoa production, with a focus on environmental regulations and good agricultural practices. The project focuses on two regions, Bahia and Pará. In Bahia, efforts are directed towards rejuvenating cocoa crops in cabruca systems, a traditional agroforestry system where cocoa is cultivated beneath native tree canopies. Small-scale farmers received training and experimental plots demonstrated that proper management practices could control fungal disease and increase cocoa production significantly, generating increased income. In Pará, cocoa agroforestry systems are promoted as an alternative to cattle ranching, which destroyed forests to create, now degraded, pasturelands. While restoration efforts are challenging, agroforestry systems showed promising financial returns compared to cattle ranching. Local farmer organisations also benefitted from workshops and ongoing mentoring regarding their management and business capacities. A failure of the project was that in some instances, agroforestry systems were promoted more as a way to produce cocoa than as an opportunity to diversify, which must be the priority. New due diligence initiatives in Europe have also highlighted the importance of traceability and sustainability in cocoa production, posing new challenges for Brazil’s small-scale farmers. The cocoa agroforestry systems in Bahia and Pará have, nonetheless, shown potential for sustainable local development in Brazil. To ensure their success and sustainability in the long term, there must be continued support systems for farmers and value must be ascribed to the immense product diversity of cocoa agroforestry.

Understanding the Determinants of Poverty in Brazil: A Household Level Analysis

ABSTRACT: This study aims to comprehensively examine the determinants of household poverty in Brazil, placing a specific emphasis on the heads of households as the primary unit of analysis. Household poverty is a critical and multifaceted issue in developing countries, a reality that holds true for Brazil as well. Understanding the intricate web of factors that contribute to household poverty is of paramount importance to policymakers, researchers, and advocates dedicated to poverty alleviation and socioeconomic development. Household poverty remains a persistent challenge in Brazil, with far-reaching social and economic consequences. To address this issue effectively, it is essential to identify the factors that contribute to poverty among households, particularly those led by individuals who are the primary income earners. These households often face unique economic and social challenges that demand targeted interventions. To analyze household poverty determinants, this study utilizes data from the "Pesquisa Nacional por Amostras de Domicílios Contínua" (Continuous National Household Sample Survey) (PNADC). The dataset provides comprehensive information on the individual characteristics of the household head and household-level attributes, offering a nuanced view of the factors at play. A probit model is employed to estimate the probability of a household head experiencing poverty, allowing for a examination of various factors. The research findings reveal several significant determinants of household poverty in Brazil. Firstly, households led by men are found to be less likely to be in a situation of poverty, shedding light on gender-related disparities in income and opportunities. Secondly, households with heads who have attained higher levels of education exhibit a lower probability of being in poverty, underscoring the importance of education as a pathway out of poverty. Moreover, urban households are found to be less prone to poverty compared to their rural counterparts, since households led by individuals who work in agricultural-related activities are more likely to experience poverty. This emphasizes the need for targeted rural development strategies. Additionally, households located in the North and Northeast regions of Brazil face a higher likelihood of poverty, possibly due to regional economic disparities that require specific policy attention. These findings have important policy implications for poverty alleviation efforts in Brazil. Policymakers should consider targeted interventions that focus on improving access to education, particularly in regions with higher poverty rates, as education is a powerful tool for poverty reduction. Efforts to promote gender equality and enhance economic opportunities in rural areas are also essential to address the diverse causes of poverty. Additionally, regional disparities in poverty should be addressed through comprehensive regional development initiatives that take into account the unique challenges faced by different areas of the country. Our results also highlight the importance of community-specific social programs, including conditional-cash transfers and incentives for childhood education, which can play a pivotal role in breaking the cycle of poverty in Brazil's diverse communities.

Disputed expertise and chaotic disinformation: COVID-19 and denialist physicians in Brazil.

This article aims to show how incorrect ideas about COVID-19 were promoted by physicians in Brazil, contributing to a catastrophic response at the cost of hundreds of thousands of lives, and to examine the implications of this episode for the social studies of science, technology and medicine. The literature on the relationship between science and society takes two broad approaches, which are sometimes at odds with each other: (i) there is a traditional critique of science that points to unsupported claims of certainty and thus undue interference in general human affairs; (ii) there are many examples of attempts to undermine reasonable scientific claims, when they clash with economic and/or political interests of certain groups. Navigating those extremes is particularly critical in situations in which accurate knowledge is necessary for intervening in people's lives, as is the case in health-related issues. Determining who has actual epistemic expertise is a key factor in solving this conundrum. This became painfully clear during the unfolding of the COVID-19 pandemic, which highlighted the uncertainties of science in guiding decisions being made in real time, and provided opportunities for many forms of disinformation and conspiracy theories that hampered public health measures and promoted useless or even dangerous "treatments". This article discusses an instructive example of such developments in the chaotic response to the pandemic challenge in Brazil, which saw, among other unfortunate situations, physicians aligned with the denialist federal government advocating for unproven - or proven as ineffective - treatments and disseminating unfounded doubts about vaccines. Presumed expertise on the basis of professional training clearly did not translate into actual expertise in the necessary domains to ascertain the validity of such claims and scientific advice was overridden by ideology.

Long COVID challenges in Brazil: an unfinished agenda for the Brazilian Unified National Health System

Long COVID challenges in Brazil: an unfinished agenda for the Brazilian Unified National Health System

A proof-of-concept study: Determining the geographical origin of Brazilwood, (Paubrasilia echinata) with the use of strontium isotopic fingerprinting

The illicit exploitation of Brazilwood (Paubrasilia echinata) presents a significant challenge in Brazil, given its substantial value in the global production of bows for musical instruments. To address timber provenance, the use of strontium (Sr) isotope ratios as indicators of bedrock signatures has emerged as a robust tool in forensic investigations. In this study, we critically evaluate the efficacy of this approach using Sr isotope data derived from bulk soils and trees collected at two distinct sites in Brazil. Despite the statistically indistinguishable 87Sr/86Sr ratios observed in the investigated tree species, the compiled 87Sr/86Sr isotope ratios of Brazilwood from Brazilwood National Park (PNPB) and the ES Group provide valuable insights into the potential application of this method for tracing forensic timber seizures. This pilot study also addresses crucial sampling considerations.While the regional signatures exhibit clear distinctions, the limited sample sizes underscore the necessity for supplementary methods to confidently attribute timber to a specific source forest. In isolation, this method proves most effective in refuting presumed timber provenances rather than definitively confirming them. The discussion delves into the nuances of the Sr isotope data, emphasizing the importance of increasing the number of samples and exploring complementary techniques for a more comprehensive and reliable assessment of timber origin.

UNRAVELING HUNTINGTON'S DISEASE: CONCEPTS, TREATMENTS AND HEALTH POLICY CHALLENGES

Huntington's disease (HD) is an inherited, rare neurodegenerative disorder caused by repeated mutations in the huntingtin gene. In Brazil, there are estimated to be 13,000 to 19,000 carriers. A literature review highlighted specific challenges in Brazil, including the absence of curative treatments, the demand for a specialized and sensitive approach for HD patients in the Unified Health System (SUS), and the scarcity of epidemiological studies. The 2014 National Policy for Comprehensive Care of People with Rare Diseases (PNAIDR) endeavors to provide access to diagnosis, treatment, rehabilitation, and palliative care for individuals with HD. However, meeting these patients' specific needs poses significant challenges. Effective implementation of strategies to improve early diagnosis, patient support, and quality of life necessitates close collaboration between health professionals, researchers, and policymakers.

Biological evaluation of 1,3-benzodioxole acids points to 3,4-(methylenedioxy) cinnamic acid as a potential larvicide against Aedes aegypti (Diptera: Culicidae)

Aedes aegypti serves as the primary vector for viruses like dengue, Chikungunya, Zika, and yellow fever, posing a significant public health challenge in Brazil. Given the absence of approved vaccines for these diseases, effective mosquito control becomes paramount in preventing outbreaks. However, currently available chemical insecticides face issues related to toxicity and the emergence of resistance, necessitating the exploration of new active compounds. Drawing inspiration from natural products, we identified the 1,3-benzodioxole group as a key pharmacophore associated with insecticidal activity. Therefore, this study aimed to synthesize and assess the larvicidal activity of 1,3-benzodioxole acids against Ae. aegypti, as well as their toxicity in mammals. Among the compounds evaluated, 3,4-(methylenedioxy) cinnamic acid (compound 4) demonstrated larvicidal activity. It exhibited LC50 and LC90 values of 28.9 ± 5.6 and 162.7 ± 26.2 μM, respectively, after 24 h of exposure. For reference, the positive control, temephos, displayed both LC50 and LC90 values below 10.94 μM. These findings underline the significance of the 3,4-methylenedioxy substituent on the aromatic ring and the presence of a double bond in the aliphatic chain for biological activity. Furthermore, compound 4 exhibited no cytotoxicity towards human peripheral blood mononuclear cells, even at concentrations up to 5200 μM. Lastly, in mice treated with 2000 mg kg−1, compound 4 showed mild behavioral effects and displayed no structural signs of toxicity in vital organs such as the kidney, liver, spleen, and lungs.

Opportunities to overcome the Ocean Decade Challenges in Brazil's ocean and coastal governance system

The United Nations Decade of Ocean Science for Sustainable Development, aka Ocean decade (OD), was established with the slogan “The ocean we need for the future we want''. This great effort aims to strengthen the knowledge, health and management of the ocean, as well as to articulate various organizations, public and private entities involved in this matter. Established in the Ocean Decade Implementation Plan, the Ocean Decade Challenges (ODCs) represent the immediate priorities for the OD. Although OD national strategies already integrate different agencies and organizations, it is often done without a full consideration of existing knowledge from different national management programs and tools. This paper reviews the existing opportunities from Brazil's governance system that can contribute to ODCs. To carry out this investigation we applied the Decalogue for Coastal Management (DCM), which is recognized as a framework for describing key aspects of a public management system. Our analysis indicates that the country is taking actions linked to all of the ODCs, in which the ODC 2, 9 and 10 are the ones with better scores, and ODC 3 and 7 with lower scores. In the DCM analysis, Brazil showed strong policy and management tools that contribute to the ODCs, with relevant capacity building initiatives. In contrast, citizen participation and economic resources were key limiting aspects. While Brazil has many initiatives that deal with ODCs issues, the lack of integration and coordination can be a great challenge to overcome in the OD actions. Our paper highlights the need to integrate data and knowledge, advance transparency, and the importance of implementing policy into the management process.

Withdrawal: Wastewater reuse: A global review focusing on opportunities and challenges for Brazil

AbstractThe above article, published online on 25 April 2023 in Wiley Online Library (wileyonlinelibrary.com), has been withdrawn by agreement between the journal Editor in Chief, Ana Soares, and John Wiley & Sons Ltd.

Unveiling inclusive education: teachers’ perspectives in Rio de Janeiro

This study examines inclusive education challenges in Brazil's West Zone of Rio de Janeiro. Despite legal guarantees and policy efforts, student dropout and exclusion persist. Ethnomethodology is used to understand daily practices and perspectives of teachers and managers. The research aims to bridge the gap between policy ideals and implementation realities. Findings highlight persistent challenges due to social disparities. While legal frameworks ensure access, implementation falls short. Educators and administrators stress the need for training, improved communication, and better infrastructure. Comprehensive interventions are crucial for inclusive education success. This study offers insights into the hurdles and suggests strategies for aligning policy goals with practice.