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Assessment of the Indirect Cost of Drug Resistant Tuberculosis Treatment to Patients in a High Burden, Low Income Setting in Mozambique

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Journal of Tuberculosis Research 2024年第2期12卷 91-104页

作者： Júlia Malache António Domingas Pacala Isabelle Munyangaju Isaías Benzana Claudia Mutaquiha Dulce Osório Benedita José Edy Nacarapa pereira Zindoga Faculdade de Cincias de Sade Universidade Catlica de Moambique Beira Moambique Programa Nacional de Controlo da Tuberculose Ministrio da Sade de Moambique Maputo Moambique ISGlobal Hospital Clnic Universitat de Barcelona Barcelona Spain Tinpswalo Association Vincentian Association to Fight AIDS and TB Chokwe Mozambique Centro de Estudos e Apoio Psicolgico (CEAP) Universidade Eduardo Mondlane Maputo Moambique

Introduction: Tuberculosis is closely linked to poverty, with patients facing significant indirect treatment costs. Treating drug-resistant tuberculosis further increases these expenses. Notably, there is a lack of published data on the indirect costs incurred by patients with drug-resistant tuberculosis in Mozambique. Objective: To assess the indirect costs, income reduction, and work productivity incurred by patients undergoing diagnosis and treatment for Drug-Resistant Tuberculosis (DRTB) in Mozambique during their TB treatment. Methods: As part of a comprehensive mixed-methods study conducted from January 2021 to April 2023, this research utilized a descriptive cross-sectional approach, incorporating both quantitative and qualitative methods. The primary goal was to evaluate the costs incurred by the national health system due to drug-resistant TB. Additionally, to explore the indirect costs experienced by patients and their families during treatment, semi-structured interviews were conducted with 27 individuals who had been undergoing treatment for over six months. Results: All survey participants unanimously reported a significant decline in labour productivity, with 70.3% experiencing a reduction in their monthly income. Before falling ill, the majority of respondents (33.3%) earned up to $76.92 monthly, representing the minimum earnings range, while 29.2% had a monthly income above $230.77, the maximum earnings range. Among those who experienced income loss, the majority (22.2%) reported a decrease of up to $76.92 per month, and 18.5% cited a loss exceeding $230.77 per month. Notably, patients with Drug-Resistant Tuberculosis (DRTB) have not incurred the direct costs of the disease, as these are covered by the government. Conclusion: The financial burden of treating Drug-Resistant Tuberculosis (DRTB), along with the income reduction it causes, is substantial. Implementing a patient-centred, multidisciplinary, and multisector approach, coupled with strong psy

关键词： Economic Costs Drug Resistance Tuberculosis Catastrophic Costs

An Analysis of the Accounting Costs Associated with 20-Month DR TB Regimens in Maputo City, Mozambique

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Journal of Tuberculosis Research 2024年第2期12卷 73-90页

作者： Júlia Malache António Isaías Benzana Isabelle Munyangaju Benedita José Dulce Osório Edy Nacarapa Claudia Mutaquiha Simeão Nhabinde pereira Zindoga Universidade Catlica de Moambique Beira Moambique Centro de Estudos e Apoio Psicolgico (CEAP) Universidade Eduardo Mondlane Maputo Moambique ISGlobal Hospital Clnic Universitat de Barcelona Barcelona Spain Tinpswalo Association Vincentian Association to Fight AIDS and TB Chokwe Mozambique Programa Nacional de Controlo da Tuberculose Ministrio da Sade de Moambique Maputo Mozambique Faculdade de Economia Universidade Eduardo Mondlane Maputo Moambique

Introduction: Socioeconomic and demographic conditions in a country can influence tuberculosis incidence and mortality, with nearly 95% of tuberculosis-related deaths occurring in poorer countries. Mozambique is among the 30 countries with the highest TB burden. Objective: The study aimed to estimate the average direct medical cost of treating drug-resistant tuberculosis in 19 health centers in Maputo City, Mozambique. Methods: A retrospective analysis of direct medical costs was conducted on patients aged 18 and older who completed 20-month drug-resistant tuberculosis treatment regimens in Maputo City in 2019. Results: This analysis covered 140 patients who completed a 20-month treatment regimen, with 64.3% (78) being male and 35.7% (62) female. Approximately 50% of the participants were aged between 29 and 47. The average direct medical cost of DRTB treatment was $4789.43, reaching up to $6568.00, with a standard deviation of $753.26, including clinical interventions and treatment. Conclusion: The direct medical costs for a basic treatment package for a patient with drug-resistant TB in Mozambique equal 36 minimum wages. Developing alternative and innovative funding mechanisms and identifying ways to mitigate costs through the use of generic medicines would be beneficial.

关键词： Antitubercular Agents Multidrug-Resistant Healthcare Costs Tuberculosis Mozambique

Atlantic Forest Hotspot: Why We Should Consider Mature Forests a Conservation Priority in the São Paulo Metropolitan Region, Southeastern Brazil

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Journal of Environmental Protection 2022年第1期13卷 69-83页

作者： eduardo Hortal pereira Barretto eduardo Luís Martins Catharino Sã o Paulo City Herbarium S&atilde o Paulo SP Brazil Sã o Paulo Botanical Institute S&atilde o Paulo SP Brazil

The Atlantic Forest is among the 35 hotspots on the planet, and yet few floristic or structural studies have been conducted on mature forest fragments of that biome in Brazil. In view of this knowledge gap and of the need to further comprehend the importance of conserving mature forests, we surveyed the arboreal component of three little-altered forest remnants from the S?o Paulo metropolitan region (SPMR), southeastern Brazil, and compared our data with the one from other phytosociological studies performed in the region. Mature forests showed a different floristic composition from one of young forests. Overall, the former has a higher number and percentage of threatened and endemic species than the latter, and also a higher exclusivity of occurrence of threatened species. In areas up to twice as smaller, mature forests have 1.5 to 4.3 times more endemic species to the Atlantic Forest and up to 9 times more species threatened with extinction than young forests. These facts, along with the scarcity of remnants of mature forests, led us to consider such forests as hotspots within the Atlantic Forest hotspot in the SPMR, as well as to categorize them as of high relevance for conservation.

关键词： Threatened Species Endemic Species Primary Forest Tropical Forest Forest Succession Biodiversity Phytosociology

Iron toxicity resistance strategies in tropical grasses:The role of apoplastic radicular barriers

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Journal of Environmental Sciences 2019年第4期31卷 257-266页

作者： Advanio Inacio Siqueira-Silva Camilla Oliveira Rios eduardo Gusmao pereira Institute of Biological and Health Sciences Federal University of Vicosa (UFV)Campus Florestal Minas Gerais Brazil Federal University of Western Para (UFOPA) University Campus of JurutiPara Brazil Postgradute Program in Management and Conservation of Natural and Agrarian Ecosystems UFV Campus Florestal Florestal Minas Gerais Brazil

The revegetation of mined areas poses a great challenge to the iron ore mining *** initial recovery process in degraded areas might rely on the use of Fe-resistant *** grasses, such as Paspalum densum and Echinochloa crus-galli, show different resistance strategies to iron toxicity; however, these mechanisms are poorly *** Fe-resistance mechanisms and direct iron toxicity as a function of root apex removal were investigated. To achieve this purpose, both grass species were grown for up to 480 hr in a nutrient solution containing 0.019 or 7 mmol/L Fe-EDTA after the root apices had been removed or maintained. Cultivation in the presence of excess iron-induced leaf bronzing and the formation of iron plaque on the root surfaces of both grass species, but was more significant on those plants whose root apex had been removed. Iron accumulation was higher in the roots, but reached phytotoxic levels in the aerial parts as well. It did not hinder the biosynthesis of chloroplastidic pigments. No significant changes in gas exchange and chlorophyll a fluorescence occurred in either grass when their roots were kept intact; the contrary was true for plants with excised root apices. In both studied grasses, the root apoplastic barriers had an important function in the restriction of iron translocation from the root to the aerial plant parts, especially in E. crus-galli. Root apex removal negatively influenced the iron toxicity resistance mechanisms(tolerance in P. densum and avoidance in E. crus-galli).

关键词： Paspalum densum Echinochloa crus-galli Apoplastic barrier Iron toxicity

Lithic soils in the semi-arid region of Brazil:edaphic characterization and susceptibility to erosion

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Journal of Arid Land 2022年第1期14卷 56-69页

作者： Carlos R PINHEIRO JUNIOR Conan A SALVADOR Tiago R TAVARES Marcel C ABREU Hugo S FAGUNDES Wilk S ALMEIDA eduardo C SILVA NETO Lúcia H C ANJOS Marcos G pereira Federal Rural University of Rio de Janeiro(UFRRJ) Department of SoilsSeropédicaRio de Janeiro 23890Brazil Center for Nuclear Energy in Agriculture(CENA) University of São Paulo(USP)PiracicabaSão Paulo 13416Brazil Federal Institute of Education Science and Technology of Rondônia(IFRO)Rural ZoneAriquemesRondônia 78930Brazil

Soils(Leptosols or Epileptic Regosols)with lithic contact at a depth of 50 cm occupy almost 20%of the Brazilian semi-arid *** lithic soils are susceptible to erosion due to faster saturation of water-holding capacity during rainfall,which accelerates the beginning of ***,erosion traits of lithic soils in the semi-arid region of Brazil are less *** aim of this study was to characterize the soil and landscape attributes in areas with Neossolos Litólicos(Entisols)in the Caatinga biome to identify region of high susceptibility to *** showed that the soils were characterized by a sandy texture,soil structure with poor development and low content of organic *** attributes increase susceptibility to erosion and reduce water storage capacity,especially in the states of Cearáand *** these states,the content of rock fragments in the soil reaches 790 g/*** contents of silt and fine sand,high silt/clay ratio,predominance of Leptosols and strong rainfall erosivity were observed in Piauíand northwestern Ceará.A very high degree of water erosion was observed in the states of Pernambuco and Paraí*** the low degree of erosion observed in the state of Bahia,it is highly susceptible to erosion due to the predominance of very shallow soils,rugged relief and high values of rainfall *** vulnerability was observed in the state of Alagoas because of its more smoothed relief,greater effective soil depth,thicker A horizon of soil and lower rainfall *** general,the characteristics that intensify the susceptibility to erosion in the Caatinga biome are those soil structures with poor development or without aggregation,low contents of organic carbon,high contents of silt and fine sand,high values of silt/clay ratio and rugged relief in some *** study collected information contributing to a better characterization of soils with lithic contact in the semi-arid region of *** addition,regions with

关键词： Caatinga biome drylands erosive processes leptosols soil degradation

Experimental and numerical characterization of 3D‑printed scaffolds under monotonic compression with the aid of micro‑CT volume reconstruction

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Bio-Design and Manufacturing 2021年第2期4卷 222-242页

作者： R.Baptista M.F.C.pereira A.Maurício D.Rechena V.Infante M.guedes CDP2T Departamento de Engenharia MecanicaEscola Superior de Tecnologia de SetúbalInstituto Politécnico de Setúbal2910‑761 SetúbalPortugal CERENA DECivilInstituto Superior TécnicoUniversidade de LisboaAv.Rovisco Pais11049‑001 LisbonPortugal IDMEC Instituto Superior TécnicoUniversidade de LisboaAv.Rovisco Pais11049‑001 LisbonPortugal IPFN Instituto Superior TécnicoUniversidade de Lisboa1049‑001 LisbonPortugal CeFEMA Instituto Superior TécnicoUniversidade de LisboaAv.Rovisco Pais11049‑001 LisbonPortugal

Even when damaged by injury or disease bone tissue has the remarkable ability to *** this process is limited by large size bone defects,tissue engineering is responsible for restoring,maintaining or improving tissue *** are support structures,designed to be implanted in the damaged site,supporting mechanical loads and protecting the regenerating bone *** this paper,3D-printed PLA scaffolds with three different porosity values and two different geometries were experimentally and numerically ***-CT analysis showed that fused filament fabrication can be used to produce scaffolds with the desired porosity and 100%of interconnected *** monotonical compression,scaffolds apparent compressive modulus increased from 89 to 918 MPa,while yield stress increased from 2.9 to 27.5 MPa as porosity decreased from 70 to 30%.Open porosity decreased up to 8%on aligned scaffolds and 14%on staggered scaffolds,after compression,while scaffold’s surface-to-volume ratio highest reduction(7.48 to 4.55 mm−1)was obtained with aligned low porosity ***-CT volume reconstruction allowed for scaffold simplified numerical models to be built and *** agreement was found when predicting scaffold’s apparent compressive ***,it can be concluded that 3D printing is a viable scaffold manufacturing technique for trabecular bone replacement.

关键词： Scaffold Pore design Mechanical behavior Micro-CT analysis Finite element method

Hydrometeorological Modeling of Limpopo River Basin in Mozambique with TOPMODEL and Remote Sensing

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Open Journal of Modern Hydrology 2022年第2期12卷 55-73页

作者： Tomásio eduardo Januário Augusto José pereira Filho Marcos Figueiredo Salviano Department of Atmospheric Sciences Institute of Astronomy Geophysics and Atmospheric Sciences University of S&#227 o Paulo S&#227 o Paulo Brazil Geological Survey of Brazil S&#227 o Paulo Brazil

The Limpopo River basin (LRB) is known for its vulnerability to floods, high rates of evapotranspiration, and droughts that cause significant losses to the local community. The present study aimed to perform simulations of flood events occurring in two Mozambican sub-basins of LRB, namely Chókwè and Xai-Xai from 2000 to 2015 with TOPography-based hydrological MODEL (TOPMODEL) and satellite remote sensing data. As input in TOPMODEL, data from two high-resolution global satellite-based precipitation products: Climate Prediction Center MORPHing technique (CMORPH) and Integrated Multi-Satellite Retrievals for the Global Precipitation Mission (GPM) algorithm (IMERG), 8-day MOD16 evapotranspiration product and surface runoff data estimated by Global Land Data Assimilation System (GLDAS) were used. The sensitivity tests of TOPMODEL parameters were applied using the Monte Carlo simulation. Calibration and validation of the model were performed by the Shuffled Complex Evolution (SCE-UA) method and were evaluated with the Kling-Gupta Efficiency (KGE) index. The results indicated that simulations with the GPM-IMERG (KGE: 0.59 and 0.65) tended to underestimate the stream flows, while with the CMORPH product the performance was much better (KGE: 0.66 and 0.77) in both sub-basins. Thus, TOPMODEL can help to develop flood monitoring systems from satellite remotely sensed data in similar regions of Mozambique.

关键词： Floods Simulations Limpopo River TOPMODEL CMORPH IMERG

Conflicts in passive building performance:Retrofit and regulation of informal neighbourhoods

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Frontiers of Architectural Research 2021年第3期10卷 625-638页

作者： Gonçalo Araújo Inês pereira António Leitão Manuel Correia guedes INESC-ID/Instituto Superior Tećcnico University of LisbonLisbonPortugal Instituto Superior Tećcnico University of LisbonLisbonPortugal

Urbanization growth in developing countries raises concerns regarding these countries’ability to consider slums,underdeveloped communities,and neighbourhoods in economic,health,and climatic *** research proposes a methodology that integrates algorithmic design and analysis strategies to define,study,and measure key parameters that affect the rehabilitation of these *** scenarios and design dimensions are analysed to establish design and comfort thresholds,and alternatives are simulated and tested to identify possible *** methodology includes an optimisation step integrated in the workflow that maximizes thermal comfort,minimizes costs,and ensures fairness in the rehabilitation of large sets of *** step identifies improvements in thermal comfort for different construction scenarios from which a two-staged rehabilitation plan is *** first stage comprises a sensitivity analysis to identify building materials regarding their improvement and cost of application,and the second defines the most suitable construction scenarios considering the results from the optimisation process for each ***,we research and document guidelines regarding the parameters tested for building design,revealing the existing conflicts between performance objectives,and the architect’s role in their prioritization.

关键词： Urban regeneration Informal housing Algorithmic design Optimisation Simulation

Does cypermethrin affect enzyme activity, respiration rate and walking behavior of the maize weevil （Sitophilus zeamais）？

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Insect Science 2013年第3期20卷 358-366页

作者： Ronnie Von Santos Veloso Eliseu Jose G. pereira Raul Narciso C. guedes Maria Goreti A. Oliveira Departamento de Entomologia Departamento de Bioquimica e Biologia Molecular Universidade Federal de Vicosa Brazil

Insecticides cause a range of sub-lethal effects on targeted insects, which are frequently detrimental to them. However, targeted insects are able to cope with insecti- cides within sub-lethal ranges, which vary with their susceptibility. Here we assessed the response of three strains of the maize weevil Sitophilus zeamais Motschulsky （Coleoptera.＂ Curculionidae） to sub-lethal exposure to the pyrethoid insecticide cypermethrin. We ex- pected enzyme induction associated with cypermethrin resistance since it would aid the resistant insects in surviving such exposure. Lower respiration rate and lower activity were also expected in insecticide-resistant insects since these traits are also likely to favor survivorship under insecticide exposure. Curiously though, cypermethrin did not affect ac- tivity of digestive and energy metabolism enzymes, and even reduced the activity of some enzymes （particularly for cellulase and cysteine-proteinase activity in this case）. There was strain variation in response, which may be （partially） related to insecticide resistance in some strains. Sub-lethal exposure to cypermethrin depressed proteolytic and mainly cellulolytic activity in the exposed insects, which is likely to impair their fitness. However, such exposure did not affect respiration rate and walking behavior of the insects （except for the susceptible strain where walking activity was reduced）. Walking activity varies with strain and may minimize insecticide exposure, which should be a concern, particularly if associated with （physiological） insecticide resistance.

关键词： insecticides insecticide resistance pyrethroids stored grain insect sub-lethal effects