Fabio Zicker

Defining research to improve health systems.

Robert Terry and colleagues present working definitions of operational research, implementation research, and health systems research within the context of research to strengthen health systems.

Alum-precipitated autoclaved Leishmania major plus bacille Calmette-Guérrin, a candidate vaccine for visceral leishmaniasis: safety, skin-delayed type hypersensitivity response and dose finding in healthy volunteers

In a previous efficacy study, autoclaved Leishmania major (ALM) + bacille Calmette-Guérrin (BCG) vaccine was shown to be safe, but not superior to BCG alone, in protecting against visceral leishmaniasis. From June 1999 to June 2000, we studied the safety and immunogenicity of different doses of alum-precipitated ALM + BCG vaccine mixture administered intradermally to evaluate whether the addition of alum improved the immunogenicity of ALM. Twenty-four healthy adult volunteers were recruited and sequentially allocated to receive either 10 microg, 100 microg, 200 microg, or 400 microg of leishmanial protein in the alum-precipitated ALM + BCG vaccine mixture. Side effects were minimal for all doses and confined to the site of injection. All volunteers in the 10 microg, 100 microg, and 400 microg groups had a leishmanin skin test (LST) reaction of > or = 5 mm by day 42 and this response was maintained when tested after 90 d. Only 1 volunteer out of 5 in the 200 microg group had a LST reaction of > or = 5 mm by day 42 and the reasons for the different LST responses in this group are unclear. This is the first time that an alum adjuvant with ALM has been in used in humans and the vaccine mixture was safe and induced a strong delayed type hypersensitivity (DTH) reaction in the study volunteers. On the basis of this study we suggest that 100 1 microg of leishmanial protein in the vaccine mixture is a suitable dose for future efficacy studies, as it induced the strongest DTH reaction following vaccination.

Anti-HBc testing for blood donations in areas with intermediate hepatitis B endemicity

En otros estudios se ha evaluado el menor riesgo de infecciones transmitidas por transfusion sanguinea que acarrea el tamizaje de anticuerpos contra los antigenos nucleares de la hepatitis B (anti-HBc), sumado a la prueba detectora de antigenos de superficie (HbsAg). No obstante, la mayoria de estos estudios se basaron en datos procedentes de zonas con baja endemicidad por hepatitis B o de bancos de sangre de paises desarrollados, donde la mayoria de la sangre proviene de personas que han donado previamente. A fin de examinar los pros y los contras del tamizaje de anticuerpos anti-HBc en el Brasil, los autores describen los antecedentes y la interpretacion de las pruebas de tamizaje para prevenir la hepatitis postransfusion. Tambien presentan los datos sobre el tamizaje de la hepatitis B en todas las regiones del Brasil. No hay pruebas suficientes para suspender el tamizaje de los anticuerpos anti-HBc en el pais. Debe darse alta prioridad a comparar el costo-efectividad de un marcador basado en la biologia molecular con el de la actual prueba detectora de anticuerpos anti-HBc aplicada comunmente, a fin de mejorar las medidas de tamizaje que garantizan la inocuidad de la sangre.

Target Product Profile (TPP) for Chagas Disease Point-of-Care Diagnosis and Assessment of Response to Treatment

A first and critical step to address the research and development gap for Chagas disease is to establish a consensus on the desirable product profiles in different conditions of use. To foster and inform the development of these much needed tools, the Pan American Health Organization (PAHO), in collaboration with DNDi, Medecins sans Frontieres (MSF), and the Special Programme for Research and Training in Tropical Diseases (TDR), convened a multidisciplinary group of experts in Rio de Janeiro, Brazil (April 2010), to review the evidence and initiate discussions. The meeting established the basis for the development of target product profiles (TPPs), which are reported in this paper.

Safety of blood supply in the Caribbean countries: Role of screening blood donors for markers of hepatitis B and C viruses

BACKGROUND Blood transfusions carry risks of untoward reactions, including the transmission of infections, such as hepatitis B and C. Proper blood donor recruitment and selection, and adequate laboratory screening for infectious markers diminish the risk of transfusion-transmitted infections. OBJECTIVES To estimate the potential risk of acquiring transfusion-transmitted infections by hepatitis B or hepatitis C in 24 Caribbean countries during the period of 1996 to 2003. STUDY DESIGN Official national reports for 1996, 2000-2003 of the yearly number of blood donors, screening coverage, and prevalence of serological markers for infectious diseases were used to estimate the risk of patients receiving an HBV- or HCV-positive unit of blood, and of developing an infection after receiving a positive unit. Estimates of number of infections transmitted through transfusion and number of infections prevented by screening of blood were also obtained. RESULTS During the period analyzed, HBV screening coverage among blood donors was 100% in all countries with the exception of Grenada (0% in 1996) and Saint Lucia (99.5% in 2002). For HCV, only 10 countries reported universal screening in 1996, while 15 did in 2003. The number of countries that did not screen any units for HCV decreased from 11 in 1996 to five in 2003. In general, high prevalence rates of HBV (10-75 per 1000 donors) and HCV (7-19.3 per 1000 donors) markers were found in the majority of countries. We estimated that 235 infections by HCV (1:12471 donations) and two infections by HBV (1:1465373) were transmitted through transfusion because of lack of screening. On the other hand, screening of blood for transfusion prevented 21 005 HCV and 22 100 HBV infections. CONCLUSIONS Blood donor recruitment and coverage of screening for transfusion-transmitted infections, especially HCV, must be improved in the Caribbean countries.

Co-authorship network analysis in health research: method and potential use

Scientific collaboration networks are a hallmark of contemporary academic research. Researchers are no longer independent players, but members of teams that bring together complementary skills and multidisciplinary approaches around common goals. Social network analysis and co-authorship networks are increasingly used as powerful tools to assess collaboration trends and to identify leading scientists and organizations. The analysis reveals the social structure of the networks by identifying actors and their connections. This article reviews the method and potential applications of co-authorship network analysis in health. The basic steps for conducting co-authorship studies in health research are described and common network metrics are presented. The application of the method is exemplified by an overview of the global research network for Chikungunya virus vaccines.

Strengthening research capacity--TDR's evolving experience in low- and middle-income countries.

review the programme’s scientific and technical activities. TDR’s placement within the United Nations system provides close collaboration with country offices of not only the World Health Organization but also of other co-sponsoring agencies UNICEF and UNDP, and with the World Bank. As a consequence, those who are supported by TDR often work closely with disease control programmes as well as other international organizations. Regular reviews of TDR’s research capacity strengthening programmes have helped reorient the strategy as needed, shifting focus from institutional strengthening in the 1980s to human resources strengthening in the 1990s [1], as well as identifying the need to move to a more demand-driven model of national health research systems [4]. Over the years, TDR has continued to support multidisciplinary research, particularly to bring social science research and biomedical research together through different mechanisms [6], and has reinforced this effort through training in implementation research [7] and operations research [8].

Ensaio clínico com mebendazole nas teníases

Foram, tratados 31 pacientes com teniases pelo mebendazole. Utilizando-se os esquemas de 100 mg, duas vezes ao dia, por 4 dias consecutivos, 200 mg, duas vezes ao dia por 2 e 200 mg, duas vezes ao dia, por 4 dias, o percentual de cura foi de respectivamente 20,0, 72,7 e 90,0%. Nao houve diferenca significativa quando foram tratados pacientes com Taenia solium e Taenia saginata. A ausencia de efeitos colaterais e a ampla atividade anti-helmintica do mebendazole, recomendam seu uso tambem, como um novo agente tenicida.

Dengue research networks: building evidence for policy and planning in Brazil

BackgroundThe analysis of scientific networks has been applied in health research to map and measure relationships between researchers and institutions, describing collaboration structures, individual roles, and research outputs, and helping the identification of knowledge gaps and cooperation opportunities. Driven by dengue continued expansion in Brazil, we explore the contribution, dynamics and consolidation of dengue scientific networks that could ultimately inform the prioritisation of research, financial investments and health policy.MethodSocial network analysis (SNA) was used to produce a 20-year (1995–2014) retrospective longitudinal evaluation of dengue research networks within Brazil and with its partners abroad, with special interest in describing institutional collaboration and their research outputs.ResultsThe analysis of institutional co-authorship showed a significant expansion of collaboration over the years, increased international involvement, and ensured a shift from public health research toward vector control and basic biomedical research, probably as a reflection of the expansion of transmission, high burden and increasing research funds from the Brazilian government. The analysis identified leading national organisations that maintained the research network connectivity, facilitated knowledge exchange and reduced network vulnerability.ConclusionsSNA proved to be a valuable tool that, along with other indicators, can strengthen a knowledge platform to inform future policy, planning and funding decisions. The paper provides relevant information to policy and planning for dengue research as it reveals: (1) the effectiveness of the research network in knowledge generation, sharing and diffusion; (2) the near-absence of collaboration with the private sector; and (3) the key central organisations that can support strategic decisions on investments, development and implementation of innovations. In addition, the increase in research activities and collaboration has not yet significantly affected dengue transmission, suggesting a limited translation of research efforts into public health solutions.

Shaping the Research Agenda

Despite the global efforts in research, training, and control over the years, tropical diseases remain a major cause of ill-health in poor populations. An estimated 2.7 billion people living on less than US