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  • Primum non nocere – Are chloroquine and hydroxychloroquine safe prophylactic/treatment options for SARS-CoV-2 (covid-19)? Comments

    Biguetti, Claudia; Marrelli, Mauro Toledo; Brotto, Marco

    Abstract in English:

    ABSTRACT Chloroquine (CQ) and its analog hydroxychloroquine (HCQ) were recently included in several clinical trials as potential prophylactic and therapeutic options for SARS-COV-2 infection/covid-19. However, drug effectiveness in preventing, treating, or slowing the progression of the disease is still unknown. Despite some initial promising in vitro results, rigorous pre-clinical animal studies and randomized clinical trials have not been performed yet. On the other hand, while the potential effectiveness of CQ/HCQ is, at best, hypothetical, their side effects are factual and most worrisome, particularly when considering vulnerable groups of patients being treated with these drugs. in this comment, we briefly explain the possible mechanisms of action of CQ/HCQ for treating other diseases, possible actions against covid-19, and their potent side effects, in order to reinforce the necessity of evaluating the benefit-risk balance when widely prescribing these drugs for SARS-COV-2 infection/covid-19. We conclude by strongly recommending against their indiscriminate use.
  • Does Vitamin D play a role in the management of Covid-19 in Brazil? Comments

    Ribeiro, Helena; Santana, Keila Valente de Souza de; Oliver, Sofia Lizarralde; Rondó, Patricia Helen de Carvalho; Mendes, Marcela Moraes; Charlton, Karen; Lanham-New, Susan

    Abstract in English:

    ABSTRACT The study discusses the possible role of adequate vitamin D status in plasma or serum for preventing acute respiratory infections during the Covid-19 pandemic. Our arguments respond to an article, published in Italy, that describes the high prevalence of hypovitaminosis D in older Italian women and raises the possible preventive and therapeutic role of optimal vitamin D levels. Based on literature review, we highlight the findings regarding the protective role of vitamin D for infectious diseases of the respiratory system. However, randomized controlled trials are currently lacking. Adequate vitamin D status is obtained from sun exposure and foods rich in vitamin D. Studies in Brazil have shown that hypovitaminosis D is quite common in spite of high insolation. Authors recommend ecological, epidemiological and randomized controlled trials studies to verify this hypothesis.
  • Liberties, rights, public policies and water fluoridation Comments

    Souza Neto, Antonio Carlos de; Frazão, Paulo

    Abstract in Portuguese:

    RESUMO OBJETIVO Discutir os conceitos negativo e positivo de liberdade e postular sua relação de interdependência e complementariedade na avaliação da política pública intersetorial, tomando como caso a fluoretação da água. MÉTODO Descrevem-se os alcances e limites relativos à distinção formulada por Isaiah Berlin nos anos 1950, demonstrando sua validade para enfrentar os efeitos nocivos decorrentes tanto de uma economia de mercado sem controle quanto de um regime político autocrático. RESULTADOS Reconhece-se que são igualmente cruciais tanto os direitos que protegem os cidadãos contra um Estado poderoso quanto os direitos que protegem o Estado contra os cidadãos poderosos. CONCLUSÃO Argumenta-se que, em um contexto de equilíbrio entre a liberdade negativa e positiva, a política regulatória tem duplo sentido, e deve buscar um balanço entre o estabelecimento de regras necessárias para a proteção do público e de limites além dos quais as regras não devem violar os direitos dos indivíduos.

    Abstract in English:

    ABSTRACT OBJECTIVE To discuss the negative and positive concepts of liberty and postulate its interdependent and complementary relationship in the evaluation of public policy intersectoral actions, taking water fluoridation as a case. METHOD To describe scopes and limits regarding 1950s Isaiah Berlin’s distinction, showing its validity in facing the harmful effects of an uncontrolled market economy and an autocratic political regime. RESULTS Both the rights that protect citizens against a powerful state and the rights that protect the state against powerful citizens were equally acknowledged as crucial. CONCLUSION We argued that, in a context in which negative and positive liberties are balanced, regulatory policies have double meaning. Thus, there should be a balance between the establishment of necessary rules for social protection and limits for them not to violate individuals’ rights.
  • Diabetes and covid-19: more than the sum of two morbidities Comments

    Pititto, Bianca de Almeida; Ferreira, Sandra Roberta G.

    Abstract in English:

    ABSTRACT The coronavirus disease 2019 (covid-19) pandemic has caused a public health emergency worldwide. Risk, severity and mortality of the disease have been associated with non-communicable chronic diseases, such as diabetes mellitus. Accumulated evidence has caused great concern in countries with high prevalence of this morbidity, such as Brazil. This text shows the picture of diabetes in Brazil, followed by epidemiological data and explanatory hypothesis for the association between diabetes and covid-19. We emphasized how the burden of these two morbidities in a middle-income country has aggravated this pandemic scenario. The comprehension of this association and biological plausibility may help face this pandemic and future challenges.
  • Translating transmissibility measures into recommendations for coronavirus prevention Comments

    Diaz-Quijano, Fredi Alexander; Rodriguez-Morales, Alfonso Javier; Waldman, Eliseu Alves

    Abstract in English:

    ABSTRACT The rapid increase in clinical cases of the new coronavirus disease, COVID-19, suggests high transmissibility. However, the estimates of the basic reproductive number reported in the literature vary widely. Considering this, we drew the function of contact-rate reduction required to control the transmission from both detectable and undetectable sources. Based on this, we offer a set of recommendations for symptomatic and asymptomatic populations during the current pandemic. Understanding the dynamics of transmission is essential to support government decisions and improve the community’s adherence to preventive measures.
  • Democracy and Health: reflections and challenges before the 16th Brazilian National Health Conference Comments

    Bispo Júnior, José Patrício; Morais, Marciglei Brito

    Abstract in Portuguese:

    RESUMO Este texto teve por objetivo analisar as características e os desafios da 16ª Conferência Nacional de Saúde a partir dos três eixos temáticos da conferência: Saúde como direito; Consolidação dos princípios do Sistema Único de Saúde (SUS); Financiamento adequado e suficiente para o SUS. Diante das iniciativas de desmonte do modelo de seguridade social e dos retrocessos das políticas de proteção social, a delimitação da saúde em sentido ampliado é fundamental para a defesa do projeto do SUS. Analisamos a proposta da Cobertura Universal de Saúde como alternativa aos sistemas universais. Apresentamos as restrições da cobertura universal e as ameaças que podem significar aos princípios do SUS. Discutimos a insuficiência do financiamento do SUS e os possíveis agravamentos diante das políticas de austeridade fiscal. É necessário o fortalecimento da participação social e o monitoramento das propostas aprovadas na conferência.

    Abstract in English:

    ABSTRACT This text aimed to analyze characteristics and challenges of the 16th Brazilian National Health Conference based on the conference three thematic axes: Health as a right; Consolidation of the Brazilian Unified Health System (SUS) principles; Adequate and enough funding for SUS. Given the initiatives to dismantle the social security model and the setbacks of social protection policies, to delimitate health in an expanded sense is essential to defend the SUS project. We analyzed the proposal of Universal Health Coverage as an alternative to universal systems. We then presented the restrictions of universal coverage and how the restrictions can threaten the SUS principles. We also discussed insufficient SUS funding and possible worsening in the face of fiscal austerity policies. To strengthen social participation and to monitor the proposals approved at the conference are necessary.
  • Whither social determinants of health? Comments

    Nedel, Fúlvio Borges; Bastos, João Luiz

    Abstract in Portuguese:

    RESUMO Este comentário crítico retoma o debate sobre a determinação social da saúde e da doença. Seu principal argumento é o de que, se por um lado, são desnecessárias novas pesquisas que procurem conferir maior consistência aos resultados que fundamentam essa interpretação, por outro, é escassa, nesses estudos, uma análise pautada pela noção de que a pobreza e outras formas de opressão são escolhas políticas da sociedade, que devem ser situadas historicamente. Essa noção deve orientar a pesquisa e o debate na área, sob pena de que as associações encontradas supostamente para denunciar a injustiça terminem por naturalizá-la. A pesquisa pautada por esses princípios pode superar o alcance limitado de abordagens multicausais do tipo caixa-preta, que não analisam as inter-relações entre os determinantes e pouco contribuem para a construção de sociedades saudáveis.

    Abstract in English:

    Abstract This critical commentary extends the debate on social determinants of health and disease. Its main argument is that while further studies are unnecessary to demonstrate the fundamentally social distribution of health outcomes, extant analyses rarely engage with the fact that poverty and other forms of oppression are political choices made by societies, which are both contemporaneously contingent and historically situated. This view must guide research and debate in the area so that studies intending to bring injustice to light do not end up naturalizing it. Research based on this fundamental understanding may help to overcome the narrow scope of multicausal black box approaches, which do not analyze the interrelations among determinants and make only a limited contribution to the construction of healthy societies.
Faculdade de Saúde Pública da Universidade de São Paulo São Paulo - SP - Brazil
E-mail: revsp@org.usp.br