Made available in DSpace on 2016-03-22T17:27:28Z (GMT). No. of bitstreams: 1 Carla Katz Santo.pdf: 620674 bytes, checksum: 9ee8fe2322bda03880382d2331998384 (MD5) Previous issue date: 2014-08-12 / This study has as main objective to characterize the behavior of the Judicial Power regarding the demand for medicaments in the city of Pelotas instated in the State Courts in the second semester of 2012. This research was structured upon a literature review, where we attempted to observe the behavior adopted by the Brazilian judiciary and its implications in public health policies. The data were obtained through analysis of judgments issued by the State Courts in order to identify whether there is interference from the Judiciary in relation to the access to medicines in the city of Pelotas, trying to rescue awareness of the judges of this district about the National Drug Policy, checking whether the medicines pleaded are inserted in the official lists and if that produces any legal consequence to the detriment of the right to health that is part of the right to life itself. Starting from the evoked rights it was extremely important to analyze what are the criteria adopted by the Judiciary in granting or not the pleaded medicines and finally be able to note the implications of judgments in the National Drug Policy in Pelotas. Among the obtained results, the research demonstrated that the Judiciary is bound to the law itself, the letter of the law, disregarding, in most cases, the existing health public policies / O presente trabalho tem como objetivo principal caracterizar o comportamento do Poder Judiciário frente às demandas por medicamentos no Município de Pelotas, ingressadas na Justiça Estadual no segundo semestre de 2012. Esta pesquisa foi estruturada a partir de uma revisão de literatura, onde se buscou observar o comportamento adotado pelo Judiciário brasileiro e suas implicações nas políticas de saúde pública. Os dados foram obtidos através da análise das sentenças judiciais expedidas pela Justiça Estadual, visando identificar se existe a interferência do Poder Judiciário em relação ao acesso a medicamentos no Município de Pelotas, procurando resgatar o conhecimento dos juízes desta comarca sobre a Política Nacional de Medicamentos, verificando se os medicamentos pleiteados estão inseridos nas listas oficiais e se isso produz alguma consequência jurídica em detrimento do direito à saúde que faz parte do direito à própria vida. Partindo dos direitos evocados foi de extrema relevância analisar quais os critérios adotados pelo Poder Judiciário na concessão ou não dos medicamentos pleiteados e enfim, poder constatar as implicações das decisões judiciais na política nacional de medicamentos no município de Pelotas. Dentre os resultados obtidos, a pesquisa demonstrou que o Poder Judiciário se vincula ao direito em si, a letra da lei, desconsiderando, na maior parte das vezes, as políticas públicas de saúde existentes

Drug trade is a part of non-observed economy in the system of national accounts. Estimations of drug trade were made from demand side based on estimation of drug consumption. This needs estimations of drug users, which was possible to estimate from drug use prevalence in last year. Several surveys done in society were the data source. Other information from the surveys was information about frequency of drug use. Several research studies gave information about consumed drug quantity by one opportunity. Police and customs have a common database about drug seizures. The database is source for information about import and export of drugs, drug purities by production or import and by consumption or export. Police reports drug prices also. The physical indicators of the drug trade are recalculated by wholesale and retail prices into financial indicators, which are possible to record into system of national accounts.

This study consisted of a qualitative analysis of articles from two Canadian newspapers related to North America’s only safe injection facility for drug users, Vancouver’s Insite, and examined the texts for latent themes derived from a review of harm reduction and governmentality literature. The investigation asked “In what ways are Insite and its clients represented in the media and what implications do those portrayals have in terms of Insite’s operation as a harm reduction practice as well as a governmental strategy designed to direct the conduct of drug users who visit the site?” The analysis revealed conflicting representations, some which have positive potential in terms of Insite’s adherence to the fundamental principles of harm reduction and others that undermined those principles and suggested that the site may have traditional governmental functions, perhaps indicating less distance between the harm reduction and governmentality philosophies in the discourse surrounding the SIS than expected.

This study consisted of a qualitative analysis of articles from two Canadian newspapers related to North America’s only safe injection facility for drug users, Vancouver’s Insite, and examined the texts for latent themes derived from a review of harm reduction and governmentality literature. The investigation asked “In what ways are Insite and its clients represented in the media and what implications do those portrayals have in terms of Insite’s operation as a harm reduction practice as well as a governmental strategy designed to direct the conduct of drug users who visit the site?” The analysis revealed conflicting representations, some which have positive potential in terms of Insite’s adherence to the fundamental principles of harm reduction and others that undermined those principles and suggested that the site may have traditional governmental functions, perhaps indicating less distance between the harm reduction and governmentality philosophies in the discourse surrounding the SIS than expected.

This study consisted of a qualitative analysis of articles from two Canadian newspapers related to North America’s only safe injection facility for drug users, Vancouver’s Insite, and examined the texts for latent themes derived from a review of harm reduction and governmentality literature. The investigation asked “In what ways are Insite and its clients represented in the media and what implications do those portrayals have in terms of Insite’s operation as a harm reduction practice as well as a governmental strategy designed to direct the conduct of drug users who visit the site?” The analysis revealed conflicting representations, some which have positive potential in terms of Insite’s adherence to the fundamental principles of harm reduction and others that undermined those principles and suggested that the site may have traditional governmental functions, perhaps indicating less distance between the harm reduction and governmentality philosophies in the discourse surrounding the SIS than expected.

This thesis is composed of two economic evaluations: one trial-based study and one model-based study. In a recent study published in Clinical Infectious Diseases in 2011, a team of OUCRU investigators found that immediate antiretroviral therapy (ART) was not associated with improved 9-month survival in HIV-associated TBM patients (HR, 1.12; 95% CI, .81 to–1.55; P = .50). An economic evaluation of this clinical trial was conducted to examine the cost-effectiveness of immediate ART (initiate ART within 1 week of study entry) versus deferred ART (initiate ART after 2 months of TB treatment) in HIV-associated TBM patients. Over 9 months, immediate ART was not different from deferred ART in terms of costs and QALYs gained. Late initiation of ART during TB and HIV treatment for HIV-positive TBM patients proved to be the most cost-effective strategy. Increasing resistance of Plasmodium falciparum malaria to artemisinin is posing a major threat to the global effort to eliminate malaria. Artesmisinin combination therapies (ACT) are currently known as the most efficacious first-line therapies to treat uncomplicated malaria. However, resistance to both artemisinin and partner drugs is developing and this could result in increasing morbidity, mortality, and economic costs. One strategy advocated for delaying the development of resistance to the ACTs is the wide-scale deployment of multiple first-line therapies. A previous modeling study examined that the use of multiple first-line therapies (MFT) reduced the long-term treatment failures compared with strategies in which a single first-line ACT was recommended. Motivated by observed results of the published modelling study in the Lancet, the cost-effectiveness of the MFT versus the single first-line therapies was assessed in settings of different transmission intensities, treatment coverages and fitness cost of resistance using a previously developed model of the dynamics of malaria and a literature –based cost estimate of changing antimalarial drug policy at national level. This study demonstrates that the MFT strategies outperform the single first-line strategies in terms of costs and benefits across the wide range of epidemiological and economic scenarios considered. The second analysis of the thesis is not only internationally relevant but also with a focus towards healthcare practice in Vietnam. These two studies add significant new cost-effectiveness evidence in Vietnam. This thesis presents the first trial-based economic evaluation in Vietnam considers patient-health outcome measures as the participants have cognitive limitations (tuberculous meningitis), dealing with missing data along with the potential ways to handle this common problem by the use of multiple imputation, and the issues of censored costs data. Having identified these issues would support the decision makers or stakeholders including the pharmaceutical industry to devise a new guideline on how to implement a well-design trial-based economic evaluation in Vietnam in the future. Another novelty of this thesis is the introduction of the detailed of costing of drug regimens change in which the economic evaluations considering the drug policy change often do not include. This cost could be substantial to the healthcare system for retraining the staff and publishing the new guidelines. This thesis will document the costs incurred by the Vietnamese government by changing the first-line treatment of malaria, from single first-line therapy (ACT) to multiple first-line therapies.

The main aim of this graduation thesis is to define the term of secondary prevention of drug addiction, which is sometime apprehended in different ways in The Czech Republic. I try to include this new definition to our drug policy and classify target groups and bring new methods to the secondary prevention of drug addiction. The thesis is focused on the terms drug, dependence syndrome and prevention and I use various definitions and opinions. I describe and briefly evaluate the system of drug policy and the place of secondary prevention. The occasional users and their families and friends are defined as a target group. The motivational interviewing is the main method in the secondary prevention. The thesis is structured into six parts and in the last part there are some practical examples from two low-thershold facilities for children and youth.

O estudo analisa a regulação sanitária de medicamentos no Brasil, nos anos 1999 a 2013, exercida pela Agência Nacional de Vigilância Sanitária (Anvisa). Para tanto, foram utilizadas as Resoluções da Diretoria Colegiada (RDC), sob a perspectiva da análise documental. As resoluções expressam as decisões dessa diretoria para fins normativos ou de intervenção e são estratégicas para a regulação sanitária exercida pela Anvisa, pois a partir delas a agência informa à sociedade brasileira (população em geral, Ministério da Saúde, complexo econômico industrial da saúde e indústria farmacêutica) sobre as decisões tomadas no âmbito da regulação sanitária. O objetivo do estudo é analisar, com base nas RDCs editadas pela Anvisa entre 1999 e 2013, o papel da agência na Política Nacional de Medicamentos. Do ponto de vista metodológico, o estudo se fundamenta na análise de documentos oficiais e tem caráter exploratório. A principal conclusão é que a atuação da agência na regulação sanitária de medicamentos se aproximou das diretrizes da Política Nacional de Medicamentos. Assim, apesar dos desafios inerentes ao processo de regulação sanitária para a área de medicamentos, os 15 anos de criação da Anvisa foram decisivos para a implementação dessa política. / The study analyzes the sanitary regulation of medicines in Brazil, in the years 1999 to 2013, carried out by the Brazilian Health Surveillance Agency (Anvisa). Therefore, the resolutions of the Board of Directors were used (RDCs), from the perspective of documentary analysis. The resolutions express the decisions of that board for regulatory purposes or intervention and are strategic for the sanitary regulation exerted by Anvisa, because from them the agency informs the Brazilian society (the general population, Ministry of Health, industrial health complex economic and industry pharmaceutical) on decisions taken within the sanitary regulation. The objective is to analyze, based on RDCs issued by Anvisa between 1999 and 2013, the role of the agency in the National Drug Policy. From a methodological standpoint, the study is based on analysis of official document and has exploratory character. The main conclusion is that the agency operating in the sanitary regulation of medicines approached the guidelines of the National Drugs Policy. Thus, despite the challenges of health regulation process for the area of drugs, 15 years of creation of Anvisa were decisive for the implementation of this policy.

Trata-se de estudo sobre a política de criminalização imposta aos jovens residentes das comunidades carentes do Estado do Rio de Janeiro. Pretende-se identificar as visões antagônicas sobre essa questão e as discussões sobre o aumento do uso de drogas, associado à criminalidade e ao interesse de amplos setores da sociedade no combate a esse consumo e ao tráfico. Destacam-se os motivos que pressionam o Estado a construir uma política de combate às drogas, assim como a economia da droga influenciando e determinando os rumos de uma mentalidade que persegue uma eficácia questionável de consumo zero de drogas nas sociedades. Para melhor entendimento dessa questão, pretende-se examinar a influência da política norte-americana antidrogas numa economia globalizada. A análise está fundamentada nos estudos teóricos sobre economia das drogas, redução de danos e na legislação brasileira. Também foram consideradas as fontes orais, extraídas de discursos de parlamentares e especialistas em criminalização de comportamentos transgressores sociais. Os relatos, retirados de periódicos, discursos e entrevistas, receberam a forma de texto-relato, seguindo os métodos utilizados pelas Ciências Sociais. / This is a study on the criminalization politics imposed on young residents of poor communities in the State of Rio de Janeiro. It is intended to identify the opposing views on this issue and discussions on the increasing use of drugs, the associated crime and the interest of broad sectors of society in combating this trafficking and consumption. Noteworthy are the reasons that push the state to build a policy to combat drugs, and the drug economy influencing and determining the direction of a mindset that pursues a questionable efficacy of zero consumption of drugs in society. To better understand this issue, we intend to examine the influence of U.S. antidrug policy in a globalized economy. The analysis is based on theoretical studies on economics of drugs, harm reduction and Brazilian law. Also considered were oral sources, taken from speeches of parliamentarians and experts on criminalization of offensive social behavior. The reports, drawn from journals, speeches and interviews, given the form of text-report, following the methods used by the Social Sciences.

O estudo analisa a regulação sanitária de medicamentos no Brasil, nos anos 1999 a 2013, exercida pela Agência Nacional de Vigilância Sanitária (Anvisa). Para tanto, foram utilizadas as Resoluções da Diretoria Colegiada (RDC), sob a perspectiva da análise documental. As resoluções expressam as decisões dessa diretoria para fins normativos ou de intervenção e são estratégicas para a regulação sanitária exercida pela Anvisa, pois a partir delas a agência informa à sociedade brasileira (população em geral, Ministério da Saúde, complexo econômico industrial da saúde e indústria farmacêutica) sobre as decisões tomadas no âmbito da regulação sanitária. O objetivo do estudo é analisar, com base nas RDCs editadas pela Anvisa entre 1999 e 2013, o papel da agência na Política Nacional de Medicamentos. Do ponto de vista metodológico, o estudo se fundamenta na análise de documentos oficiais e tem caráter exploratório. A principal conclusão é que a atuação da agência na regulação sanitária de medicamentos se aproximou das diretrizes da Política Nacional de Medicamentos. Assim, apesar dos desafios inerentes ao processo de regulação sanitária para a área de medicamentos, os 15 anos de criação da Anvisa foram decisivos para a implementação dessa política. / The study analyzes the sanitary regulation of medicines in Brazil, in the years 1999 to 2013, carried out by the Brazilian Health Surveillance Agency (Anvisa). Therefore, the resolutions of the Board of Directors were used (RDCs), from the perspective of documentary analysis. The resolutions express the decisions of that board for regulatory purposes or intervention and are strategic for the sanitary regulation exerted by Anvisa, because from them the agency informs the Brazilian society (the general population, Ministry of Health, industrial health complex economic and industry pharmaceutical) on decisions taken within the sanitary regulation. The objective is to analyze, based on RDCs issued by Anvisa between 1999 and 2013, the role of the agency in the National Drug Policy. From a methodological standpoint, the study is based on analysis of official document and has exploratory character. The main conclusion is that the agency operating in the sanitary regulation of medicines approached the guidelines of the National Drugs Policy. Thus, despite the challenges of health regulation process for the area of drugs, 15 years of creation of Anvisa were decisive for the implementation of this policy.