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      Research on chronic noncommunicable diseases in Brazil: meeting the challenges of epidemiologic transition Translated title: Investigación sobre las enfermedades crónicas no transmisibles en el Brasil: responder a los retos de la transición epidemiológica

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          Abstract

          In Brazil, chronic noncommunicable diseases (CNCDs) are the leading cause of death and a major contributor to the national disease burden. This article describes CNCD research funded by the Ministry of Health Department of Science and Technology (DECIT) to support the production and dissemination of scientific evidence for the national health system, in accordance with the National Agenda of Priorities in Health Research, and within the context of Brazil's epidemiologic transition. Data were obtained from Ministry of Health database management systems. CNCD-related projects financed by DECIT from 2002 to 2009 were analyzed by research theme (cancer, obesity, hypertension, diabetes, cardiovascular diseases, CNCDs in general, and CNCD risk factors) and geographic region. In terms of funding and number of projects, the most-supported research theme was cancer, and the most-supported region was the Southeast. Project type varied widely, ranging from basic scientific studies to highly technological research and development. Results obtained included epidemiologic profiles and surveillance, cost, and quality-of-life data.

          Translated abstract

          En el Brasil, las enfermedades crónicas no transmisibles (ECNT) son la principal causa de mortalidad y un factor contribuyente muy importante a la carga de morbilidad nacional. En este artículo se describe la investigación en ECNT financiada por el Departamento de Ciencia y Tecnología del Ministerio de Salud (DECIT) para apoyar la producción y la difusión de información científica destinada al sistema nacional de salud, en conformidad con el Programa Nacional de Prioridades en Investigación de Salud y dentro del contexto de la transición epidemiológica del Brasil. Los datos se obtuvieron a partir de los sistemas de manejo de bases de datos del Ministerio de Salud. Los proyectos relacionados con las ECNT financiados por el DECIT entre el 2002 y el 2009 fueron analizados por tema de investigación (cáncer, obesidad, hipertensión, diabetes, enfermedades cardiovasculares, ECNT en general y factores de riesgo de ECNT) y por región geográfica. En cuanto al financiamiento y el número de proyectos, el tema de investigación más apoyado fue el cáncer, y la región más apoyada fue el sudeste del país. El tipo de proyecto varió ampliamente, e incluyó desde estudios científicos básicos hasta estudios de investigación y desarrollo muy técnicos. Los resultados obtenidos incluyeron perfiles epidemiológicos y datos de vigilancia, costos y calidad de vida.

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          Most cited references42

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          Pesquisa de orçamentos familiares 2008 e 2009: antropometria e estado nutricional de crianças, adolescentes e adultos no Brasil

          (2010)
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            Vigitel Brasil 2011: vigilância de fatores de risco e proteção para doenças crônicas por inquérito telefônico

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              C-peptide levels and insulin independence following autologous nonmyeloablative hematopoietic stem cell transplantation in newly diagnosed type 1 diabetes mellitus.

              In 2007, the effects of the autologous nonmyeloablative hematopoietic stem cell transplantation (HSCT) in 15 patients with type 1 diabetes mellitus (DM) were reported. Most patients became insulin free with normal levels of glycated hemoglobin A(1c) (HbA(1c)) during a mean 18.8-month follow-up. To investigate if this effect was due to preservation of beta-cell mass, continued monitoring was performed of C-peptide levels after stem cell transplantation in the 15 original and 8 additional patients. To determine C-peptide levels after autologous nonmyeloablative HSCT in patients with newly diagnosed type 1 DM during a longer follow-up. A prospective phase 1/2 study of 23 patients with type 1 DM (aged 13-31 years) diagnosed in the previous 6 weeks by clinical findings with hyperglycemia and confirmed by measurement of serum levels of anti-glutamic acid decarboxylase antibodies. Enrollment was November 2003-April 2008, with follow-up until December 2008 at the Bone Marrow Transplantation Unit of the School of Medicine of Ribeirão Preto, Ribeirão Preto, Brazil. Hematopoietic stem cells were mobilized via the 2007 protocol. C-peptide levels measured during the mixed-meal tolerance test, before, and at different times following HSCT. Secondary end points included morbidity and mortality from transplantation, temporal changes in exogenous insulin requirements, and serum levels of HbA(1c). During a 7- to 58-month follow-up (mean, 29.8 months; median, 30 months), 20 patients without previous ketoacidosis and not receiving corticosteroids during the preparative regimen became insulin free. Twelve patients maintained this status for a mean 31 months (range, 14-52 months) and 8 patients relapsed and resumed insulin use at low dose (0.1-0.3 IU/kg). In the continuous insulin-independent group, HbA(1c) levels were less than 7.0% and mean (SE) area under the curve (AUC) of C-peptide levels increased significantly from 225.0 (75.2) ng/mL per 2 hours pretransplantation to 785.4 (90.3) ng/mL per 2 hours at 24 months posttransplantation (P < .001) and to 728.1 (144.4) ng/mL per 2 hours at 36 months (P = .001). In the transient insulin-independent group, mean (SE) AUC of C-peptide levels also increased from 148.9 (75.2) ng/mL per 2 hours pretransplantation to 546.8 (96.9) ng/mL per 2 hours at 36 months (P = .001), which was sustained at 48 months. In this group, 2 patients regained insulin independence after treatment with sitagliptin, which was associated with increase in C-peptide levels. Two patients developed bilateral nosocomial pneumonia, 3 patients developed late endocrine dysfunction, and 9 patients developed oligospermia. There was no mortality. After a mean follow-up of 29.8 months following autologous nonmyeloablative HSCT in patients with newly diagnosed type 1 DM, C-peptide levels increased significantly and the majority of patients achieved insulin independence with good glycemic control. clinicaltrials.gov Identifier: NCT00315133.
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                Author and article information

                Journal
                rpsp
                Revista Panamericana de Salud Pública
                Rev Panam Salud Publica
                Organización Panamericana de la Salud (Washington, Washington, United States )
                1020-4989
                1680-5348
                March 2012
                : 31
                : 3
                : 240-245
                Affiliations
                [03] Brasília orgnameMinistério da Ciência e Tecnologia Brazil
                [01] Brasília orgnameMinistério da Saúde Brazil erly.mourasaude.gov.br, erlycm@ 123456usp.br
                [05] orgnameUniversidade do Estado do Rio de Janeiro
                [02] Brasília orgnameUniversidade de Brasília orgdiv1Departamento de Saúde Coletiva Brazil
                [04] Montevideo orgnameOrganização Pan-americana da Saúde orgdiv1Centro Latino-americano de Perinatologia / Saúde da Mulher e Reprodutiva Uruguay
                Article
                S1020-49892012000300009 S1020-4989(12)03100309
                10.1590/s1020-49892012000300009
                22569699
                eccfda23-8214-4c66-84b1-886d3109ad29

                This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

                History
                : 03 March 2011
                : 01 August 2011
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 23, Pages: 6
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                SciELO Public Health

                Self URI: Full text available only in PDF format (EN)
                Categories
                Brief Communication

                Chronic disease,health policy,health research policy,information systems,health transition,Brazil,Enfermedad crónica,política de salud,política de investigación en salud,sistemas de información,transición de la salud,Brasil

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