Doenças causadas por agentes infecciosos e parasitários são chamadas negligenciadas por não despertarem interesse das indústrias farmacêuticas para o desenvolvimento de novas alternativas terapêuticas. Essas doenças são responsáveis por levar milhões de pessoas à morte todos os anos e afetam principalmente os países pobres e em desenvolvimento. Dentre estas, a doença de Chagas e as leishmanioses, parasitoses causadas por parasitas flagelados pertencentes à família Trypanosomatidae, T. cruzi e Leishmaina sp., respectivamente, se apresentam como um sério problema de saúde pública mundial. Endêmicas em vários países e causando milhões de mortes anualmente, ainda hoje não existem fármacos eficientes e seguros para o tratamento dessas doenças. Este panorama torna eminente a necessidade de pesquisa e desenvolvimento de novos fármacos para essas parasitoses. A busca por agentes quimioterápicos envolve a seleção de vias metabólicas essenciais à sobrevivência dos parasitas. Dentre estas, destacamse cisteíno-proteases presentes nesses tripanossomatídeos, deste modo a cruzaína no T. cruzi, e a CPB2.8 na Leishmania mexicana, se mostram como alvos bioquímicos promissores. A disponibilidade de estruturas cristalográficas da cruzaína e do sequenciamento genômico da CPB2.8, nos permite utilizar estratégias de planejamento de fármacos baseado no receptor (SBDD) na identificação de candidatos a fármacos para essas doenças. Entre as técnicas modernas de SBDD utilizadas, a triagem virtual possibilita identificar promissores candidatos a novos fármacos. Assim neste trabalho, obteve-se por meio da técnica de modelagem comparativa o modelo da enzima CPB2.8 de L. mexicana, visto a indisponibilidade da estrutura cristalográfica no Protein Data Bank (PDB). De modo a refinar o modelo construído realizou-se a simulação por dinâmica molecular de 100ns, apresentando estabilização a partir de 80ns. A simulação por dinâmica molecular foi validada por meio do gráfico de Ramachandran, gráfico de raio de giro, RMSD, gráfico de superfície hidrofóbica. Foram calculados os mapas de interação molecular no programa GRID das seguintes proteínas: cruzaína, CPB2.8, catepsina B e catepsina L, e, posteriormente, foi construído um modelo farmacofórico baseado no sítio ativo das enzimas cruzaína e CPB2.8. O modelo farmacofórico da cruzaína foi validado por curva ROC apresentando valor de AUC 61%. A triagem virtual foi realizada para ambas as proteínas e foram obtidos 369 compostos para a cuzaína e 225 compostos para a CPB2.8. Foi realizado o ancoramento molecular desses compostos obtidos pela triagem virtual a fim de diminuir a quantidade de compostos a serem avaliados experimentalmente. / Neglected diseases are caused by parasites and infectious agents and affect mainly people in poor areas being prevalent in 149 countries and causing 534,000 deaths per year. Among neglected diseases we can highlight Chagas Disease and Leishmaniasis, both have a high rate of morbidity and mortality and both are addressed in this project in the search of new drugs against a NTD. Nowadays, the search for new drugs involves the selection of biological pathways essential for parasite survival, in this class of parasites we can suggest the cysteine proteases, a proteases family present in Trypanosoma cruzi and and Leishmania ssp. In order to obtain a new agent against Neglected Disease in this work was obtained the model of the enzyme CPB2.8 of L. mexicana using the comparative modeling technique, due to the unavailability of the crystallographic structure in the Protein Data Bank (PDB). In order to refine the constructed model was performed the molecular dynamics simulation of 100ns, stabilization was achieved from 80ns. Molecular dynamics simulation was validated using the Ramachandran graph, radius of rotation graph, RMSD, hydrophobic surface area graph. The molecular interaction fields were calculated in the GRID program to cruzain, CPB2.8, cathepsin B and cathepsin L. Based on molecular interaction fields generated pharmacophoric models were constructed using information about the active site of the enzymes cruzain and CPB2.8. The pharmacophoric model of cruzain was validated by ROC curve presenting AUC value of 61%. Virtual screening was performed for both proteins and 369 compounds were obtained for cuzain and 225 compounds for CPB2.8. Docking studies of these compounds was performed in order to decrease the amount of compounds to be evaluated experimentally.

A presente investigação constitui um estudo de caso sobre a tripanossomíase americana, conhecida como doença de Chagas, em seus aspectos epistemológicos e sociais, articulados através da análise de diferentes valores envolvidos nas pesquisas sobre essa enfermidade. Na elaboração de uma biografia procuramos enfatizar dois aspectos dessa patologia. Por um lado, que a tripanossomíase americana pode ser interpretada como um agente histórico, na medida em que a identidade dessa entidade nosológica não pode ser dissociada de sua caracterização científica e social, tampouco reduzida a apenas uma dessas dimensões. Por outro lado, colocar a doença como protagonista dessa história nos permite evidenciar de que modo o predomínio da narrativa das instituições médicas e científicas legitimou a invisibilização da perspectiva das pessoas afetadas por essa patologia. A primeira parte da tese está centrada sobre a faceta científica e médica da doença, a qual permitiu que a nova patologia humana fosse estabelecida como um fato. Com relação aos aspectos sociais da doença, estes são focalizados na segunda parte da tese, onde examinamos as ideias envolvidas nas representações dos trópicos e das populações rurais como sinônimos de atraso. / The present investigation is a case study of American trypanosomiasis, known as Chagas disease, in its epistemological and social aspects, articulated through an analysis of the different values involved in research on this disease. In the elaboration of a biography, we aim to emphasize two aspects of this pathology. On the one hand, American trypanosomiasis can be interpreted as a historical agent, to the extent that the identity of this nosological entity cannot be dissociated from its scientific and social characterization, nor can it be reduced to just one of these dimensions. On the other hand, to put the disease as the protagonist of this history allows us to show the ways in which the predominance of medical and scientific institutions narrative has legitimated the invisibility of the perspectives of the ones affected by this pathology. The first part of this thesis is centered on the scientific and medical facet of the disease, which allowed the new human pathology to be established as a fact. The social aspects of the disease will be focalized in the second part of the thesis, where we examine the ideas involved in representations of the tropics and of rural populations as synonyms of backwardness.

Doenças causadas por agentes infecciosos e parasitários são chamadas negligenciadas por não despertarem interesse das indústrias farmacêuticas para o desenvolvimento de novas alternativas terapêuticas. Essas doenças são responsáveis por levar milhões de pessoas à morte todos os anos e afetam principalmente os países pobres e em desenvolvimento. Dentre estas, a doença de Chagas e as leishmanioses, parasitoses causadas por parasitas flagelados pertencentes à família Trypanosomatidae, T. cruzi e Leishmaina sp., respectivamente, se apresentam como um sério problema de saúde pública mundial. Endêmicas em vários países e causando milhões de mortes anualmente, ainda hoje não existem fármacos eficientes e seguros para o tratamento dessas doenças. Este panorama torna eminente a necessidade de pesquisa e desenvolvimento de novos fármacos para essas parasitoses. A busca por agentes quimioterápicos envolve a seleção de vias metabólicas essenciais à sobrevivência dos parasitas. Dentre estas, destacamse cisteíno-proteases presentes nesses tripanossomatídeos, deste modo a cruzaína no T. cruzi, e a CPB2.8 na Leishmania mexicana, se mostram como alvos bioquímicos promissores. A disponibilidade de estruturas cristalográficas da cruzaína e do sequenciamento genômico da CPB2.8, nos permite utilizar estratégias de planejamento de fármacos baseado no receptor (SBDD) na identificação de candidatos a fármacos para essas doenças. Entre as técnicas modernas de SBDD utilizadas, a triagem virtual possibilita identificar promissores candidatos a novos fármacos. Assim neste trabalho, obteve-se por meio da técnica de modelagem comparativa o modelo da enzima CPB2.8 de L. mexicana, visto a indisponibilidade da estrutura cristalográfica no Protein Data Bank (PDB). De modo a refinar o modelo construído realizou-se a simulação por dinâmica molecular de 100ns, apresentando estabilização a partir de 80ns. A simulação por dinâmica molecular foi validada por meio do gráfico de Ramachandran, gráfico de raio de giro, RMSD, gráfico de superfície hidrofóbica. Foram calculados os mapas de interação molecular no programa GRID das seguintes proteínas: cruzaína, CPB2.8, catepsina B e catepsina L, e, posteriormente, foi construído um modelo farmacofórico baseado no sítio ativo das enzimas cruzaína e CPB2.8. O modelo farmacofórico da cruzaína foi validado por curva ROC apresentando valor de AUC 61%. A triagem virtual foi realizada para ambas as proteínas e foram obtidos 369 compostos para a cuzaína e 225 compostos para a CPB2.8. Foi realizado o ancoramento molecular desses compostos obtidos pela triagem virtual a fim de diminuir a quantidade de compostos a serem avaliados experimentalmente. / Neglected diseases are caused by parasites and infectious agents and affect mainly people in poor areas being prevalent in 149 countries and causing 534,000 deaths per year. Among neglected diseases we can highlight Chagas Disease and Leishmaniasis, both have a high rate of morbidity and mortality and both are addressed in this project in the search of new drugs against a NTD. Nowadays, the search for new drugs involves the selection of biological pathways essential for parasite survival, in this class of parasites we can suggest the cysteine proteases, a proteases family present in Trypanosoma cruzi and and Leishmania ssp. In order to obtain a new agent against Neglected Disease in this work was obtained the model of the enzyme CPB2.8 of L. mexicana using the comparative modeling technique, due to the unavailability of the crystallographic structure in the Protein Data Bank (PDB). In order to refine the constructed model was performed the molecular dynamics simulation of 100ns, stabilization was achieved from 80ns. Molecular dynamics simulation was validated using the Ramachandran graph, radius of rotation graph, RMSD, hydrophobic surface area graph. The molecular interaction fields were calculated in the GRID program to cruzain, CPB2.8, cathepsin B and cathepsin L. Based on molecular interaction fields generated pharmacophoric models were constructed using information about the active site of the enzymes cruzain and CPB2.8. The pharmacophoric model of cruzain was validated by ROC curve presenting AUC value of 61%. Virtual screening was performed for both proteins and 369 compounds were obtained for cuzain and 225 compounds for CPB2.8. Docking studies of these compounds was performed in order to decrease the amount of compounds to be evaluated experimentally.

Made available in DSpace on 2016-04-25T16:44:11Z (GMT). No. of bitstreams: 1 Aldemir Evangelista da Cruz.pdf: 328390 bytes, checksum: af4df7d7d4e1cb9a8b3170bc5b8b0d31 (MD5) Previous issue date: 2010-09-16 / The aim of this research was to investigate why, in Brazil, the neglected diseases are still neglected, as well as the reasons for this persistence. Such diseases are malaria, tuberculosis, Chagas disease, lepra, dengue and Leisshimaniosis/ kalazar. Through the literature, it was possible to verify that the persistence of those diseases occurs because of a sequence of flaws in the public and private health system. The development of science and investments is insufficient or even inexistent concerning this. When there is medicine or when there are vaccines for treatment, their prices are extremely high for a great part of the population living in developing countries. Moreover, public services for preventing such diseases and the medicine distribution management are inefficient. The neglected diseases do not call much attention from global pharmaceutical companies; furthermore, developed and developing countries governments do not invest a lot in prevention and treatment of these diseases. Therefore, focusing on medicine demands and vaccines for treatment of the neglected diseases could be a very profitable market for the national pharmaceutical industry. When taking into account the difficulties for research and the volume of money needed for the production of such treatment medicines, it is clear that the partnership between governments and private companies might be a possible solution for this problem / O objetivo desta pesquisa é investigar o motivo pelo qual, no Brasil, as doenças negligenciadas persistem como tal, quais as causas da persistência da negligência, com permissão para a redundância da expressão. As doenças negligenciadas são malária, tuberculose, doença de Chagas, hanseníase, dengue e leishmaniose. A literatura examinada mostra que a persistência dessas doenças se dá pela sucessão de deficiências do sistema de saúde público e privado. A produção de ciência e investimentos são insuficientes ou mesmo inexistentes. Quando o medicamento ou vacinas existem, os preços são proibitivos para maioria das populações residentes nos países em desenvolvimento. Os serviços públicos para a prevenção das doenças e a gestão da distribuição dos medicamentos são inadequados. As doenças negligenciadas despertam pouco interesse por parte das empresas farmacêuticas mundiais, os governos dos países desenvolvidos e em desenvolvimento também pouco investem na prevenção e tratamento dessas doenças. Nesse quadro, o atendimento da demanda por medicamentos e vacinas para as doenças negligenciadas pode ser um mercado significativo para a indústria farmacêutica nacional. Ao se considerar as dificuldades de pesquisa e o volume de dinheiro necessários para a produção desses bens, entende-se que as parcerias entre governos e indústrias privadas fazem parte do quadro de soluções para o problema

Les parasites de la classe des Kinetoplastidae, comprenant notamment les trypanosomes et les leishmanies, sont responsables pour plusieurs maladies d’importance socio-économique et de santé publique. La maladie du sommeil, la maladie de Chagas et la leishmaniose, classées comme maladies tropicales négligées (NTD) par l’Organisation mondiale de la santé (OMS) et la Surra, reportée par l’Organisation pour l’alimentation et l’agriculture, des Nations Unies (FAO). La Trypanosomiase Animale Africain sub-saharienne entraîne la mort de 3 millions bovins par an accompagné d'une perte annuelle de l'économie de 4,5 milliards de dollars américains. La leishmaniose cutanée, une maladie zoonose, présente 1,5 millions de nouveaux cas chaque année.Trypanosoma brucei (T. brucei) est un ancien eucaryote, utilisé comme organisme modèle dans le laboratoire pour l’étude des cils et des flagelles. Le remodelage du cytosquelette des trypanosomes est essentiel pour la morphologie cellulaire, le positionnement et la division des organites. L’étude des protéines essentielles du cytosquelette permet de mieux comprendre les processus cellulaires. Ces protéines pourraient également constituer des cibles potentielles pour des traitements thérapeutiques. Les trypanosomes échappent au système immunitaire de l’hôte en modifiant périodiquement les antigènes de présent à leur surface. En effet ces antigènes de surface sont endocytés, ainsi que les anticorps de l’hôte qui y sont attachés, au niveau d’une structure appelée la poche flagellaire (FP). TbBILBO1 est une protéine structurelle du collier de la poche flagellaire (FPC), essentielle à la biogenèse du FPC et à la survie du parasite. En raison du rôle majeur de la protéine TbBILBO1 dans le parasite, des partenaires de TbBILBO1 ont été recherchés.Dans ce travail, j’ai pu caractériser une nouvelle protéine essentielle du cytoskelette, la protéine FPC6, partenaire de TbBILBO1, qui se situe au niveau du complexe FPC/Complexe du Hook de T. brucei. L’ARN interférence de FPC6 conduit à une mort rapide des formes sanguines des trypanosomes, accompagnée d’un blocage de l’endocytose. Ensuite, j’ai produit un nanobody (Nb48), dirigé contre TbBILBO1, dans le système d’expression bactérien. Je l’ai également exprimé dans les lignées de trypanosomes. Le Nb48 reconnait TbBILBO1 sur les trypanosomes fixés par immunofluorescence et dans les extraits totaux de protéines dénaturées. L’analyse par résonance plasmonique de surface (SPR) a confirmé une haute affinité du Nb48 pour TbBILBO1. L’expression de Nb48 dans le parasite T. brucei en tant qu’intrabody demontrant que ce nanobody pouvait être exprimé de manière fonctionnelle, capable de reconnaitre spécifiquement sa cible protéique, TbBILBO1, intra-cellulaire et de bloquer sa fonction conduit à un effet trypanocide rapide. Ces études ouvrant ainsi la voie pour de nouvelles utilisations potentielles thérapeutiques dans le traitement des trypanosomiases. / Kinetoplastid parasites, including trypanosomes and leishmania, are responsible for several diseases of socio-economic and public health importance worldwide. These include the Neglected Tropical Diseases: Sleeping Sickness, Chagas disease and Leishmaniasis, as classified by the World Health Organisation (WHO) and the global wasting disease of animals, Surra, as reported by the Food and Agricultural Organisation of the United Nations (FAO). Animal African Trypanosomiais (AAT) causes the death of 3 million cattle per year in sub-Saharan Africa, with an annual loss of 4.5 billion US dollars to the African economy. Cutaneaous leishmaniasis is a zoonotic disease, with 1.5 million new cases reported globally each year.Trypanosoma brucei is an ancient, early diverging eukaryote, used as a model organism in the laboratory for studying eukaryotic cilia and flagella. Remodelling of the trypanosome cytoskeleton is essential for cell morphology, organelle positioning and division. Study of essential proteins of the cytoskeleton provides insight into intracellular processes and could provide potential targets for therapeutic interventions. Trypanosomes evade the host immune system by periodically changing their external surface coat, which is endocytosed, along with any attached host antibodies, via a structure called the flagellar pocket. TbBILBO1 is a structural protein of the Flagellar Pocket Collar (FPC) that is essential for FPC biogenesis and parasite survival. Due to the importance of TbBILBO1 for the parasite, protein partners were investigated.In my thesis, I describe, firstly, the characterisation of a novel and essential cytoskeletal protein, FPC6, of the FPC/Hook complex of T. brucei; FPC6 is a partner of TbBILBO1. RNAi Knock-down of FPC6 protein leads to rapid cell death in the blood-stream form of the parasite accompanied with a block in endocytosis. Secondly, I describe the purification and intracellular expression of a nanobody (Nb48), raised against TbBILBO1. The purified Nb is able to identify TbBILBO1 in fixed trypanosomes and denatured protein. Surface Plasmon Resonance analysis confirmed a high affinity of Nb48 to TbBILBO1. Expression of Nb48 as an intrabody in T. brucei, reveals that it binds precisely to its target, TbBILBO1 and leads to rapid cell death. Further exploration of the potential uses of this trypanocidal nanobody is warranted.

Les kinétoplastidés sont des protozoaires flagellés responsables de maladies tropicales négligées mortelles telles que la leishmaniose viscérale (L. donovani et L. infantum) ou la trypanosomiase humaine africaine (T. brucei), pour lesquelles les traitements disponibles sont très limités. Depuis quelques années, on observe un regain d'intérêt pour le développement de nitrohétérocycles aromatiques anti-infectieux tels que le delamanide et le féxinidazole. De récentes études indiquent que l'activité anti-kinétoplastidés de ces dérivés repose sur leur bioactivation sélective par des nitroréductases parasitaires, conduisant à la formation de métabolites réduits électrophiles, fortement cytotoxiques. Suite à des études préliminaires réalisées dans notre équipe en série 8-nitroquinoléin-2(1H)-one, ces travaux de thèse portent sur la synthèse et l'étude in vitro de l'activité antiparasitaire de 80 dérivés notamment fonctionnalisés en positions 3 et 6 du pharmacophore par divers motifs, notamment via la mise au point de réactions d'halogénation sélective et de couplages pallado-catalysés. Ainsi, 5 nouvelles molécules hits (4 anti-kinétoplastidés et 1 sélective de T. brucei) ont été identifiées (0,01 µM ≤ CI50 ≤ 7 µM et 13 < IS < 1500), trois d'entre-elles étant des substrats sélectifs des nitroréductases parasitaires de type I. Afin de préciser les relations structure-activité, une étude des potentiels de réduction a également été menée. Des études physico-chimiques (solubilité, test de perméabilité PAMPA) et pharmacocinétiques in vitro (stabilité microsomale et fixation à l'albumine humaine) sont venues compléter ce travail. Enfin, des évaluations de la mutagénicité et de la génotoxicité de ces hits sur des cellules procaryotes et humaines ont été conduites, dans le but de statuer sur leur potentiel pharmaceutique antiparasitaire humain et vétérinaire. / Kinetoplastids are flagellated protozoan parasites responsible for lethal neglected tropical diseases, such as visceral leishmaniasis (L. donovani and L. infantum) or sleeping sickness (T. brucei brucei), for which very few drugs are available. Nowadays, nitroheterocyclic compounds present a renewed interest as anti-infective agents, as illustrated by the development of fexinidazole and delamanid. Some recent studies demonstrated that the antikinetoplastid activity of these derivatives involves their selective bioactivation by parasitic nitroreductases, leading to the formation of electrophilic reduced metabolites, highly cytotoxic. Based on preliminary studies conducted in our team in 8-nitroquinolin-2(1H)-one series, this PhD work is about the synthesis and in vitro antiparasitic study of 80 derivatives mainly functionalized at positions 3 and 6 of the pharmacophore by various substituents, especially via the optimization of selective halogenation and pallado-catalyzed cross coupling reactions. Thereby, 5 new hit compounds (4 antikinetoplastid and 1 selective of T. brucei) were identified (0.01 µM ≤ IC50 ≤ 7 µM and 13 < SI < 1500), three of them being selective substrates of type I parasitic nitroreductases. In order to refine the structure-activity relationship studies, an analysis of reduction potentials was also conducted. In vitro physicochemical (solubility, PAMPA permeability assay) and pharmacokinetic (microsomal stability and human albumin binding) experiments completed this work. Finally, the mutagenicity and genotoxicity evaluations of these new hit compounds toward prokaryotic and human cells were realized, in order to assess their human and veterinary antiparasitic pharmaceutical potential.

<p><strong>Syfte:</strong> Syftet med uppsatsen är dels att ge förståelse till problematiken med underhåll. Dels att ge upplysningar och förslag som kan bidra till lösningar kring användningen av avdragsgilla underhållsfonder i praktiken, för att främja och strukturera underhållsfinansieringen i kommunala bostadsföretag.  </p><p><strong>Metod: </strong>Till denna undersökning har jag använt mig av en genomgripande datainsamling. Jag har använt mig av en kvalitativ metod i form av åtta intervjuer, och detta har även varit undersökningens primärdata. Undersökningens sekundärdata avser litteratur och ett stort antal dokument. Arbetsmetoden har varit en kreativ process. </p><p><strong>Resultat & slutsats:</strong> Jag har kommit fram till att underhållsfonder, underhållsplaner och ombyggnationer minskar det eftersatta underhållet. Underhållsfonder utjämnar stora utgifter och gör att intäkterna kan matcha kostnaderna när de kommer. Underhållsplanen synliggör kostnader, vilket underlättar i förhandlingarna, skapar en ekonomisk förberedelse och minskar akuta åtgärder med lägre kostnader på sikt. Planen skapar även en uppfattning om det framtida underhållsbehovet. Ombyggnader förlänger fastighetens brukstid, återställer standarden, höjer fastighetsvärdet och driftnettot. För att finansiera underhållet krävs ett högre hyresuttag men marknaden och betalningsviljan kan försvåra detta inom vissa orter i landet.</p><p><strong>Förslag till fortsatt forskning:</strong> Frågor som inte besvaras i denna undersökning är; huruvida avskrivningarna bör höjas eller inte, hur uppföljning av underhållsplaner sker, portföljteori i upphandlingar och försäljning samt företags arbete med underhållsplaneringssystem.</p><p><strong>Uppsatsens bidrag:</strong> Med denna undersökning vill jag delge tillförlitlig information och upplysningar som kan vara till hjälp för vidare utredningar av underhållsfonder samt till hjälp för underhållsarbetet. Jag anser att ett långsiktigt tänk måste tillämpas i företagen för att möta framtida underhåll så att historien inte upprepar sig. Bostadsföretagen bör använda långsiktiga underhållsplaner även om underhållsfonder införs eller inte.</p> / <p><strong>Aim:</strong> This essay aims partly to provide an understanding to the problems regarding maintenance. Partly to give information and produce proposals that can contribute with a solution to the use of maintenance funds in practice, promote and structure finance of maintenance in municipal housing corporations.  </p><p><strong>Method:</strong> For this investigation I have used a major gathering of information. I have been using a qualitative research method with eight interviews, which is the primary data of the investigation. The secondary data of this investigation refers to literature together with a large number of documents. The working method has been a creative process. </p><p><strong>Result & Conclusions: </strong>I have come up with a conclusion that maintenance<strong> </strong>funds, maintenance plans and rebuilding can reduce the<strong> </strong>neglected maintenance. Maintenance funds equalize large costs and make it easier to match income with costs when they arrive. Maintenance plans make costs visible which makes it easier in negotiations, creates an economic preparation and decreases immediate measures that results in further decreased costs. They also provide an understanding for the future need of maintenance. Rebuilding extend the useful life span of properties, restore standard, raise property value and operating net value. A higher rent requires to being able to finance the maintenance, but the market and the will to pay may complicate this achievement in different places in the country. </p><p><strong>Suggestions for future research: </strong>Questions that has not being answered through this investigation is; whether depreciation should be increased or not,<strong> </strong>how the maintenance plans are being followed up, portfolio theory in purchase and selling and corporations work with maintenance systems. </p><p><strong>Contribution of the thesis: </strong>With this investigation I want to illustrate reliable information that can help future investigations of maintenance funds and the corporations work with maintenance. I think that a long-term thinking must be incorporated in the housing corporations to handle future maintenance so that the history not repeats itself. The housing corporations should use long-term maintenance plans even if the funds will be introduced or not.</p><p><strong>Key words: </strong>"Miljonprogrammet"[1], neglected maintenance, maintenance fund, financing, municipal housing corporations.   </p><p>[1] A large scale planning project, which set out to build one million new residences in ten years.</p>

Syfte: Syftet med uppsatsen är dels att ge förståelse till problematiken med underhåll. Dels att ge upplysningar och förslag som kan bidra till lösningar kring användningen av avdragsgilla underhållsfonder i praktiken, för att främja och strukturera underhållsfinansieringen i kommunala bostadsföretag.   Metod: Till denna undersökning har jag använt mig av en genomgripande datainsamling. Jag har använt mig av en kvalitativ metod i form av åtta intervjuer, och detta har även varit undersökningens primärdata. Undersökningens sekundärdata avser litteratur och ett stort antal dokument. Arbetsmetoden har varit en kreativ process.  Resultat &amp; slutsats: Jag har kommit fram till att underhållsfonder, underhållsplaner och ombyggnationer minskar det eftersatta underhållet. Underhållsfonder utjämnar stora utgifter och gör att intäkterna kan matcha kostnaderna när de kommer. Underhållsplanen synliggör kostnader, vilket underlättar i förhandlingarna, skapar en ekonomisk förberedelse och minskar akuta åtgärder med lägre kostnader på sikt. Planen skapar även en uppfattning om det framtida underhållsbehovet. Ombyggnader förlänger fastighetens brukstid, återställer standarden, höjer fastighetsvärdet och driftnettot. För att finansiera underhållet krävs ett högre hyresuttag men marknaden och betalningsviljan kan försvåra detta inom vissa orter i landet. Förslag till fortsatt forskning: Frågor som inte besvaras i denna undersökning är; huruvida avskrivningarna bör höjas eller inte, hur uppföljning av underhållsplaner sker, portföljteori i upphandlingar och försäljning samt företags arbete med underhållsplaneringssystem. Uppsatsens bidrag: Med denna undersökning vill jag delge tillförlitlig information och upplysningar som kan vara till hjälp för vidare utredningar av underhållsfonder samt till hjälp för underhållsarbetet. Jag anser att ett långsiktigt tänk måste tillämpas i företagen för att möta framtida underhåll så att historien inte upprepar sig. Bostadsföretagen bör använda långsiktiga underhållsplaner även om underhållsfonder införs eller inte. / Aim: This essay aims partly to provide an understanding to the problems regarding maintenance. Partly to give information and produce proposals that can contribute with a solution to the use of maintenance funds in practice, promote and structure finance of maintenance in municipal housing corporations.   Method: For this investigation I have used a major gathering of information. I have been using a qualitative research method with eight interviews, which is the primary data of the investigation. The secondary data of this investigation refers to literature together with a large number of documents. The working method has been a creative process.  Result &amp; Conclusions: I have come up with a conclusion that maintenance funds, maintenance plans and rebuilding can reduce the neglected maintenance. Maintenance funds equalize large costs and make it easier to match income with costs when they arrive. Maintenance plans make costs visible which makes it easier in negotiations, creates an economic preparation and decreases immediate measures that results in further decreased costs. They also provide an understanding for the future need of maintenance. Rebuilding extend the useful life span of properties, restore standard, raise property value and operating net value. A higher rent requires to being able to finance the maintenance, but the market and the will to pay may complicate this achievement in different places in the country.  Suggestions for future research: Questions that has not being answered through this investigation is; whether depreciation should be increased or not, how the maintenance plans are being followed up, portfolio theory in purchase and selling and corporations work with maintenance systems.  Contribution of the thesis: With this investigation I want to illustrate reliable information that can help future investigations of maintenance funds and the corporations work with maintenance. I think that a long-term thinking must be incorporated in the housing corporations to handle future maintenance so that the history not repeats itself. The housing corporations should use long-term maintenance plans even if the funds will be introduced or not. Key words: "Miljonprogrammet"[1], neglected maintenance, maintenance fund, financing, municipal housing corporations.    [1] A large scale planning project, which set out to build one million new residences in ten years.

Every year, through mass drug administration (MDA), hundreds of millions of the world’s poorest people receive a single annual dose of one or more drugs to eliminate certain parasitic worm or bacterial infections. Some of these infections, mostly prevalent in tropical areas, have traditionally been neglected from the public health and research point of view. These conditions, collectively known as the neglected tropical diseases (NTDs), still cause, at the cusp of the second decade of the 21st century, a significant amount of morbidity and mortality. The existing control measures for NTD have an enormous potential, although there are still some challenges that require further investigation. For some diseases, alternative strategies may be needed, including longer duration of MDA programmes or modified drug regimens. For other diseases, such as yaws, the work must start almost from scratch, since little has been achieved in terms of control of this disease in the past 50 years. Although eight NTDs affect the region, two diseases pose a major public health problem in the South Pacific Islands, namely yaws and lymphatic filariasis and are the basis for his thesis. These two infections were selected for a number of reasons. First, they affect the South Pacific region disproportionately. Secondly, little research has been conducted in the past years. And third, but more importantly, several epidemiological, technological and historical factors make these two diseases amenable to elimination. Safe and effective tools and interventions to achieve these targets are available and concerted efforts to scale them up are likely to lead to success. Yaws is one of the most neglected of the NTDs. Yaws was one of the first diseases to be targeted for eradication on a global scale, efforts which almost led to the disease disappearance as a result of a massive treatment program started in the 1950s. After the successful eradication campaigns the primary health care systems were supposed to give the last push towards eradication of yaws. However a combination of various factors including poor political commitment and limited funding resulted in a progressive abandonment of efforts and the resurgence of the disease. Every new case of yaws was the disappointing confirmation that the public health world had missed a great opportunity. Today yaws has resurged in many tropical areas and presents new challenges including its unknown epidemiological situation, the attenuated clinical forms of the disease, a poor awareness and knowledge among health care workers, the lack of knowledge about the effectiveness of classic treatment with penicillin and, an obvious need for research into simplified administration schemes or new antibiotic treatments, particularly oral ones. There is an enormous knowledge gap regarding current reliable epidemiological information about the disease. Certainly we know little about the burden in the three Melanesian countries where the disease is highly endemic, Papua New Guinea, Solomon Islands and, Vanuatu. In Solomon Islands and Vanuatu there are indications that Yaws is widespread and prevalent, but we know that the diagnosis is unreliable. This takes us to the next point, what does a diagnosis of yaws mean? Overall the natural history of the disease in this era, where it is often subject to inadequate antibiotic pressure, is very unclear. Some authors have suggested that yaws appears to be attenuated in both Solomon Islands and Vanuatu. They state that bone involvement in yaws is now rare and implies that yaws is a mild disease not requiring efforts for elimination. However, the first paper of this thesis describes the epidemiology of yaws in Lihir Island (Papua New Guinea, PNG) and shows a high rate of classical primary ulcers (almost 60%) and significant bone and periosteal involvement (more than 15%), suggesting that “attenuation” is not an important issue. When we look at the diagnostic criteria for yaws, signs and symptoms alone are still used often in many areas to diagnose the disease. This reliance on clinical findings was the result of the difficulty of performing serological tests in remote areas. Today, available rapid serological tests are simple, rapid, inexpensive and useful for guiding confirmation of cases, making them adequate tools for the diagnosis and monitoring of the disease. The clinical diagnosis of yaws is complicated because its clinical manifestations may be unspecific. Thus, it is possible that a significant proportion of yaws cases may in fact have been falsely diagnosed. We show, in the first article, that in our experience only 60% of the cases with a clinical suspicion of yaws were finally confirmed by serologic tests. Therefore, a proper diagnosis of yaws requires the interpretation of clinical findings with reference to laboratory results and the epidemiologic history of the patient. Serological testing in yaws is not only important for diagnostic accuracy, but also is very helpful in defining the disease’s evolution and eventual cure after treatment. Rapid plasma regain (RPR) titres should decline within 6-12 months, becoming negative in less than 2 years. The second article of this thesis combines a clinical and serological approach to assess the response after treatment with benzathine benzylpenicillin, and it identifies an overall 20% treatment failure. This could be related to resistance to the antimicrobial drug used or to re-infection caused. The distinction between re-infection and true resistance to antibiotic treatment is difficult to make but these failures are worrisome. This article also proposes a multivariate model performed to identify independent determinants of failure that affected the outcome after treatment. The risk for reinfection caused by repeated contact with infected children seems to be a pivotal predictor of failure. Low baseline titters (<1:32) of RPR are also an important and independent predictor of failure, possibly as a result of the greater difficulty in resolving chronic infections which are usually accompanied by low titters. With yaws re-emerging, the development of new strategies against this infection aimed at simplifying its treatment and potentially re-focussing strategies towards its eradication seems essential. Injectable penicillin is still effective but management with an oral drug that can be easily administered on a large scale should be the preferred method for treatment. To date, there had been no studies that directly compared the efficacy of penicillin with any of the potentially alternative agents shown to work in the treatment of the non-venereal treponematoses. The fourth paper in this thesis has shown that a single-dose of oral azithromycin is non-inferior to benzathine benzylpenicillin for the treatment of yaws in children in PNG. In an open-label randomised trial, at 6-month follow-up, 96% of patients treated with azithromycin were cured, as were 93% in the benzathine benzylpenicillin group. The prospects of eliminating and eventually eradicating yaws may now be enhanced by the use of a single-dose of oral azithromycin in mass drug administration campaigns. Community based mass administration of azithromycin has been widely used in many locations for the control of trachoma, which, like yaws, is a disease of poor rural communities in developing countries, and has been used in a more limited way to control granuloma inguinale and outbreaks of venereal syphilis. Elimination of yaws and lymphatic filariasis in the South-Pacific Islands is now considered biologically feasible and programmatically attainable. The Global Programme to Eliminate Lymphatic Filariasis (GPELF) has expanded quickly to reach the target of elimination by 2020. On the other hand the strategy to eliminate yaws is again at the centre of discussions and given that infected humans are the only source of disease, its eradication could be achieved within a very relatively short time. The fifth article of the thesis comprehensively reviews antimicrobial treatments and elimination strategies against yaws. In order to control yaws and push it towards elimination, we propose to move away from penicillin to azithromycin and use mass treatment campaigns of the entire population in endemic communities irrespective of the prevalence. Also, to make sure all cases are tracked down and treated, strict follow-up measures and selective mass treatment will be required until zero case prevalence is reached. Importantly, we suggest testing the principle of interrupting transmission in pilot implementation studies, including prevalence surveys to assess the impact of the intervention and macrolide resistance monitoring which in our opinion will be essential evaluation tools to guide us towards a sustainable elimination. Lymphatic filariasis (LF), caused by the mosquito-borne nematode Wuchereria Bancrofti, is a major public-health problem in the Melanesian countries. Annual MDA over five years is currently the WHO’s recommended strategy to eliminate lymphatic filariasis. This approach aims to suppress microfilaraemia in infected individuals and bring the infection below a threshold that leads to interruption of transmission. However theoretical work and clinical field experience has highlighted how the ecological diversity between different endemic regions can result in elimination thresholds that vary between local communities. This means that the duration required might be different for different areas. Other variables have also been previously identified as potentially having an influence on the outcome of the program, including baseline prevalence of infection, vector density or the treatment coverage. The last article of this thesis provides data about the impact of a five-year filariasis control program in Papua New Guinea. The findings reported support this strategy for areas with low-to-moderate rates of transmission in regions where anopheline mosquitoes transmit this infectious disease. Additional measures or longer periods of treatment may be necessary in areas with a high rate of transmission. The experience acquired on Lihir Island in MDA programs during the campaigns for the elimination of filariasis, will be very valuable when implementing a pilot strategy for yaws control. Also, in the near future it might be important to link yaws mass treatment with other mass programmes to increase efficiency. The plan for elimination of lymphatic filariasis in PNG was approved as a pilot project in 2005 but the program still needs to be extended to the total of 20 provinces in the country where filariasis is endemic. In this context, an integrated approach to NTD control could represent an important global public health solution in PNG and other South Pacific Islands. Little has been achieved in the past decade in NTDs. We are now in a good position to translate into policies the results of our research projects. A new elimination policy for yaws around the azithromycin pillar has been sketched a WHO consultation meeting held in Morges, Switzerland last March. In the intentions of the organization, a last global mass campaign to tackle yaws should permit to reach zero cases in 2017, and the subsequent certification of worldwide interruption of transmission by 2020. / Cada año, a través de la administración masiva de medicamentos (MDA), cientos de millones de personas, las más pobres del mundo, reciben una dosis única de uno o más medicamentos para eliminar ciertas infecciones, parasitarias o bacterianas. Algunas de estas infecciones, frecuentes sobre todo en las zonas tropicales, han sido tradicionalmente desatendidas desde el punto de vista de salud pública e investigación. Estas enfermedades, conocidas comúnmente como las enfermedades tropicales desatendidas (ETD), aún causan, en el inicio de la segunda década del siglo 21, una cantidad significativa de morbilidad y mortalidad. Las medidas de control actuales para ETDs tienen un enorme potencial, pero todavía existen algunas cuestiones que requieren investigación. Para algunas de estas infecciones, son necesarias estrategias alternativas, incluyendo una mayor duración de los programas de MDA o regímenes modificados de medicamentos. Para otras enfermedades, como la enfermedad de pián, el trabajo debe comenzar casi desde cero, ya que poco se ha logrado, en términos de control de esta enfermedad, en los últimos 50 años. Aunque ocho ETDs afectan a la región, dos enfermedades constituyen un problema importante de salud pública en las Islas del Pacífico Sur, a saber: el pián y la filariasis linfática y son la base de esta tesis. Estas dos infecciones fueron elegidas por muchas razones. En primer lugar, afectan a la región del Pacífico Sur de forma desproporcionada. En segundo lugar, pocas investigaciones se han llevado a cabo en los últimos años. Y en tercer lugar, pero lo más importante, varios factores epidemiológicos, tecnológicos e históricos hacen que estas dos enfermedades sean susceptibles de eliminación. Existen armas terapéuticas seguras y eficaces para lograr este objetivo, y esfuerzos coordinados para ejecutar los programas de control pueden conducir al éxito. El pián es una de las más olvidadas de las ETDs. Ésta fue una de las primeras enfermedades en ser objetivo de erradicación a escala global. Los esfuerzos de un programa de tratamiento masivo, que se inició en la década de 1950, casi llevaron a la desaparición de la enfermedad. Después de las exitosas campañas de erradicación, los sistemas de salud de atención primaria debían dar el último empujón hacia la erradicación del pián. Sin embargo, una combinación de varios factores, incluyendo un pobre compromiso político y una financiación limitada, dieron como resultado el abandono progresivo de los esfuerzos y el resurgimiento de la enfermedad. Cada nuevo caso de pián era la decepcionante confirmación de que el mundo de la salud pública había perdido una gran oportunidad. Hoy la enfermedad de pián ha resurgido en muchas áreas tropicales con nuevos desafíos: una situación epidemiológica desconocida, formas clínicas atípicas o atenuadas, poco conocimiento de la enfermedad entre el personal sanitario, la falta de datos acerca de la eficacia del tratamiento clásico con penicilina inyectable y la necesidad de desarrollar esquemas terapéuticos simplificados o investigar en nuevos tratamientos antibióticos, en especial de administración oral. Actualmente hay una enorme brecha de conocimiento entorno a la información epidemiológica fiable sobre la enfermedad. Ciertamente, sabemos poco acerca de la incidencia en los tres países melanesios, donde la enfermedad es altamente endémica, Papúa Nueva Guinea (PNG), Islas Salomón y Vanuatu. En las Islas Salomón y Vanuatu, las cifras de incidencia son muy altas lo que demuestra que el pián es una enfermedad frecuente y ampliamente extendida, pero sabemos que el diagnóstico no es muy fiable. Esto nos lleva al siguiente punto: ¿Cuáles son los criterios diagnósticos del pián? En general, la historia natural de la enfermedad en la época actual, donde la bacteria es objeto de presión antibiótica inadecuada, no es muy clara. Algunos autores han escrito que el pián parece presentar manifestaciones “atenuadas” en las Islas Salomón y Vanuatu. Afirman que la afectación ósea en el pián es poco frecuente, lo que implica que el pián es una enfermedad leve que no requeriría esfuerzos para su eliminación. Sin embargo, el primer trabajo de esta tesis describe la epidemiología del pián en la Isla de Lihir (Papúa Nueva Guinea) y muestra una alta tasa de úlceras primarias clásicas (casi el 60% de casos) y una afectación significativa del hueso y periostio (más del 15%) que sugiere que la "atenuación" no es un tema importante. Cuando nos fijamos en los criterios diagnósticos, únicamente signos y síntomas todavía se utilizan en muchas áreas para el diagnóstico de la enfermedad. Esta confianza en los hallazgos clínicos fue el resultado de la dificultad de realizar pruebas serológicas en las zonas remotas. Hoy en día, las pruebas serológicas rápidas son simples, rápidas, económicas y útiles para orientar la confirmación de los casos. El diagnóstico clínico del pián es complicado debido a que sus manifestaciones pueden ser inespecíficas. Así, es posible, que una proporción significativa de los casos de pián puedan haber sido falsamente diagnosticados. En el primer artículo, presentamos que, en nuestra experiencia, sólo el 60% de los casos con sospecha clínica de pián fueron finalmente confirmados por pruebas serológicas. Por lo tanto, un diagnóstico adecuado del pián requiere la interpretación de los hallazgos clínicos con referencia a los resultados de laboratorio y la historia epidemiológica de los pacientes. Las pruebas serológicas en el pián no sólo son importantes para el diagnóstico de la enfermedad, también son muy útiles en la definición de curación después del tratamiento. En la prueba de la Reagina plasmática rápida (RPR) los títulos deben descender a los 6-12 meses, llegando a ser negativa en menos de 2 años. El segundo artículo de esta tesis combina un enfoque clínico / serológico para evaluar la respuesta a bencilpenicilina benzatina, e identifica una tasa de fracaso terapéutico del 20% a los 12 meses del tratamiento. Esto podría estar relacionado con resistencia al fármaco antimicrobiano, o bien indicar una re-infección por re-exposición. La distinción entre la re-infección y la resistencia verdadera al tratamiento es difícil, pero estos fracasos terapéuticos son preocupantes. En este artículo se describe un modelo multivariante realizado para identificar los factores determinantes del fracaso terapéutico. El riesgo de re-infección causado por el contacto repetido con otros niños infectados parece ser un predictor fundamental de fracaso. También es un factor de riesgo, los títulos basales bajos (< 1:32) de RPR. Este último factor podría estar relacionado con la mayor dificultad para resolver infecciones crónicas (en estadio secundario), habitualmente acompañadas de títulos bajos. Con la enfermedad de pián re-emergiendo, el desarrollo de nuevas estrategias contra la infección para hacer más fácil los esfuerzos de erradicación es esencial. La penicilina inyectable sigue siendo eficaz, pero el tratamiento con un fármaco por vía oral que pueda ser fácilmente administrado a gran escala es el método preferido para el tratamiento, prevención y finalmente eliminación en todas las regiones endémicas del mundo. Hasta la fecha, no ha habido estudios que comparen directamente la eficacia de la penicilina con cualquiera de los agentes alternativos en el tratamiento de las treponematosis no venéreas. El cuarto artículo de esta tesis ha demostrado que una dosis única de azitromicina por vía oral no es inferior a la bencilpenicilina benzatina intramuscular, para el tratamiento del pián en niños en Papúa Nueva Guinea. En un ensayo abierto, aleatorio, el 96% de los pacientes tratados con azitromicina estaban curados a los 6 meses de seguimiento, al igual que el 93% en el grupo de bencilpenicilina benzatina. Las perspectivas de finalmente erradicar el pián son ahora mayores, mediante el uso de una dosis única de azitromicina oral en campañas masivas de tratamiento. El tratamiento masivo con azitromicina ha sido ampliamente utilizado para el control del tracoma, que, al igual que el pián es una enfermedad de comunidades rurales pobres de países en desarrollo. También se ha utilizado de una manera más limitada para controlar el granuloma inguinal y brotes de sífilis venérea. En general, el uso de azitromicina ha demostrado ser seguro, y de hecho ha habido beneficios inesperados de salud en algunos programas. La eliminación del pián y la filariasis linfática en las Islas del Pacífico Sur se considera ahora biológicamente factible y operacionalmente alcanzable. El Programa Global para Eliminar la Filariasis Linfática (GPELF) se ha expandido rápidamente para alcanzar la meta de eliminación en el año 2020. Por otro lado la estrategia para eliminar el pián es nuevamente centro de atención. Además, dado que los seres humanos infectados son la única fuente de la enfermedad, su eliminación podría lograrse en un plazo relativamente corto. El quinto artículo de la tesis revisa de forma integral el tratamiento con antimicrobianos y las estrategias de eliminación contra el pián. Con el fin de controlar el pián hasta la erradicación, se propone pasar de la penicilina a la azitromicina, y el uso de campañas de tratamiento masivo de toda la población en todas las comunidades endémicas. Además, para asegurar que todos los casos son encontrados y tratados, serán necesarias medidas estrictas de seguimiento y tratamiento masivo selectivo hasta llegar al objetivo de cero casos clínicos. Es importante destacar que el principio de interrupción de la transmisión se debe probar en estudios piloto, incluyendo estudios de prevalencia, para monitorizar el impacto de la intervención, y también la valoración de resistencia a macrolidos, que en nuestra opinión, serán herramientas fundamentales que nos guíen en el camino hacia una eliminación sostenible La filariasis linfática (FL), causada por el nematodo Wuchereria bancrofti, es otro de los grandes problemas de salud pública en los países de la Melanesia. Un curso de MDA anual, durante cinco años, es la estrategia que la OMS recomienda para eliminar la FL. Este enfoque tiene como objetivo suprimir la microfilaremia en los individuos infectados y disminuir los niveles de infección por debajo de un umbral que conduzca a la interrupción de la transmisión. Sin embargo, trabajo teórico y experiencia práctica clínica han puesto de relieve cómo la diversidad ecológica, entre diferentes regiones endémicas, puede resultar en que los umbrales de eliminación varíen en diferentes comunidades. Esto significa que la duración requerida podría ser diferente para diferentes áreas. Algunas variables que han sido previamente identificadas como potenciales determinantes en el resultado de un Programa para la eliminación de FL (PELF) son la prevalencia basal de infección por filariasis, la densidad de vectores (mosquitos) o la cobertura del tratamiento en la población. El último artículo de esta tesis, proporciona datos sobre el impacto de un PELF de cinco años en PNG. Los resultados obtenidos apoyan la estrategia descrita para las zonas con baja a moderada tasas de transmisión en regiones donde mosquitos anofelinos transmiten la infección (pe. Melanesia, África). Medidas adicionales o períodos más largos de tratamiento pueden ser necesarios en áreas con una alta tasa de transmisión. La experiencia adquirida en la Isla de Lihir en los programas de tratamiento masivo durante las campañas para la eliminación de la filariasis, será muy valiosa en la aplicación de una estrategia piloto para el control del pián. Además, en un futuro próximo podría ser importante vincular los programas para el control del pián con otros programas de tratamiento masivo (por ejemplo, filariasis) para aumentar la eficiencia y reducir los costos. El plan para la eliminación de la filariasis linfática en PNG fue aprobado como proyecto piloto en 2005 en la provincia de Milne Bay. El programa todavía tiene que ser extendido a un total de 20 provincias en el país, donde la filariasis es endémica. En este contexto, un enfoque integrado para el control de enfermedades tropicales olvidadas podría representar una importante solución global de salud pública en PNG. Poco se ha logrado en la última década en enfermedades tropicales desatendidas. Ahora estamos en una buena posición para traducir los frutos de nuestra investigación en políticas de salud. Durante una consulta celebrada en la sede de la OMS en Ginebra el pasado mes de marzo, ya se ha esbozado una nueva política de eliminación para el pián que toma como pilar el tratamiento con azitromicina. La intención de la OMS es que una última campaña global debe permitir llegar a cero casos de pián en 2017, y la posterior certificación de la interrupción de la transmisión en todo el mundo en el año 2020.

Made available in DSpace on 2015-07-22T20:49:40Z (GMT). No. of bitstreams: 0 Previous issue date: 2010-09-29 / As Leishmanioses são classificadas pela OMS como uma das dez doenças negligenciadas tropicais (DNT), as quais apresentam alta incidência, atingem segmentos empobrecidos da população e não obtêm visibilidade social, portanto o investimento em diagnóstico, terapêutica e imunização é precário. As Leishmanioses fazem parte das doenças tropicais em expansão e não existem mecanismos adequados para sua prevenção e controle. Representam um problema de saúde pública mundial: 88 países apresentam pelo menos uma das trinta espécies de Leishmania e 350 milhões de indivíduos estão expostos à contaminação. Em algumas espécies, a letalidade das Leishmanioses pode alcançar 100% em pacientes sem tratamento. Diante desse quadro, realizou-se uma investigação com o objetivo de identificar o perfil da produção científica brasileira sobre o tema das Leishmanioses, no período 2004-2008, a fim de subsidiar o processo de formulação de políticas e tomada de decisões da gestão governamental, no tocante ao fomento à pesquisa em saúde nessa área do conhecimento. A pesquisa se refere a um estudo descritivo, elaborado com emprego da análise bibliométrica e da pesquisa documental. A Bibliometria consiste em um conjunto de leis e princípios empíricos que compõem os fundamentos teóricos da Ciência da Informação. A análise bibliométrica compreendeu a consulta, coleta e recuperação de informações quantitativas, em bases de dados da ciência da saúde no Brasil, seguida da organização dos dados coletados, sistematização em categorias de indexação, registro da coleta em banco de dados Excel e análise interpretativa das informações científicas e tecnológicas obtidas. A pesquisa documental constou de coleta e análise de dados em acervos institucionais de setores do órgão governamental federal de saúde. Em todas as bases consultadas, foram localizadas 749 publicações, produzidas no período 2004-2008 sobre o tema das Leishmanioses, das quais 521 atenderam aos critérios de inclusão. Foram publicados 415 artigos científicos por pesquisadores brasileiros em revistas indexadas, nacionais e internacionais. No diretório dos grupos de pesquisa da Plataforma Lattes, foi identificado o cadastro de 214 grupos dedicados ao tema. Receberam títulos nessa linha de pesquisa (Leishmanioses) 43 mestres e 44 doutores. A análise bibliométrica e documental permitiu identificar tendências de crescimento da produção científica brasileira sobre as Leishmanioses, no período 2004-2008, de grande relevância para a saúde pública, por tratar-se de doença negligenciada tropical. O Brasil detém o maior número de centros de pesquisa sobre Leishmanioses no mundo e atua em cooperação técnico-científica em âmbito nacional e internacional. Pode-se afirmar, portanto, que existe capacidade de médio porte instalada no país para a pesquisa sobre a doença. Além disso, foram identificados estudos em rede e multicêntricos, que podem favorecer a expansão e fortalecimento dos grupos voltados à pesquisa sobre Leishmaniose em âmbito nacional. Entende-se que seja oportuna a indução de ações e políticas públicas de fomento à pesquisa sobre estudos clínicos de fases I, II e III e sobre desenvolvimento tecnológico, a fim de propiciar o incremento do diagnóstico e tratamento das Leishmanioses no país. / The Leishmaniasis are classified by WHO as one of ten tropical neglected diseases (NTD), which have high incidence, affecting impoverished segments of the population and do not get social visibility, so the investment in diagnostic, therapeutic and immunization are poor. The Leishmaniasis is part of the tropical diseases in expansion process and there aren’t appropriate mechanisms for its prevention and control. They represent a public health problem worldwide: 88 countries have at least one of the thirty species of Leishmania and 350 million individuals are exposed to contamination. In some species, the lethality of Leishmaniasis may reach 100% in untreated patients. Given this situation, we carried out an investigation to identify the profile of Brazilian scientific literature on the subject of Leishmaniasis in the period 2004-2008 in order to support the process of policy formulation and decision making of government administration, with regard to development of health research in this area of knowledge. The survey refers to a descriptive study with use of bibliometric analysis and documentary research. The Bibliometrics consists of a set of empirical laws and principles that form the theoretical foundations of information science. Bibliometric analysis included query, collection and recovery of quantitative information in the databases of health science in Brazil, then organization of the data collected, systematized into categories of indexing, record collection in Excel database and interpretative analysis of scientific and technological information obtained. The collection consisted of desk research and data analysis in institutional sectors of the federal government body health. In all of the following databases were located 749 publications produced in the period 2004-2008 on the theme of Leishmaniasis, of which 521 met the inclusion criteria. 415 scientific articles were published by Brazilian researchers in indexed journals, national and international. In the directory of research groups of the Lattes Platform, were identified from the register 214 groups dedicated to the theme. Received titles in this line of research (Leishmaniasis) 43 masters and 44 doctors. Bibliometric analysis and documentation identified growth trends of the Brazilian scientific production on Leishmaniasis, in the period 2004-2008, of great relevance to public health, because it is neglected tropical disease. Brazil has the largest number of research centers on Leishmaniasis in the world and serves on scientific-technical cooperation in national and international areas, so it can be stated that there is midsize capacity for research on the disease installed in the country. Identified studies in multi-center network can promote the expansion and strengthening of the groups directed to research on Leishmaniasis nationwide. It is understood that is desirable the induction of actions and policies to encourage research on clinical trials of phases I, II and III and on technological development in order to facilitate the increase in diagnosis and treatment of Leishmaniasis in the country. / TEDE / BV UNIFESP: Teses e dissertações