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This is a comparative bibliometric study of the two main scientific journals in the Public Health field in Brazil: Cadernos de Saúde Pública (CSP) and Revista de Saúde Pública (RSP). Twenty-four issues of each periodical were analyzed, published from 1996 to 2003, comprising a sample of 819 articles (496 from CSP and 323 from RSP). The following elements in the articles were identified and analyzed: thematic area of the article and citation pattern of publications (articles in periodicals, books and/or book chapters, theses/dissertations, Internet documents, "gray" literature, and other types of publications). The resulting data showed that the majority of the articles represent the sub-area of "epidemiology". The citation pattern in the journals showed articles in periodicals in first place, followed by citations of books and/or book chapters. Papers in the sub-area "social sciences in health" published in CSP are exceptions, since books and chapters are the most frequently cited. The authors discuss the implications of the findings for the characterization and evaluation of scientific output in Public Health in Brazil.

The aim of this paper was to analyze two Brazilian scientific journals included in the SciELO Library of Public Health, using a group of bibliometric indicators and scrutinizing the articles most viewed. Cadernos de Saúde Pública was accessed 3,743.59 times per month, with an average of 30.31 citations per article. The 50 articles most viewed (6.72 to 524.5 views) were mostly published in Portuguese (92%). 42% were theoretical essays, 20% surveys, and 16% descriptive studies. 42% used argumentative techniques, 34% quantitative techniques, 18% qualitative techniques, and 6% mathematical modeling. The most common themes were: health and work (50%), epidemiology (22%), and environmental health (8%). Revista de Saúde Pública was accessed 1,590.97 times per month, with an average of 26.27 citations per article. The 50 articles most viewed (7.33 and 56.50 views) were all published in Portuguese: 46% were surveys, 14% databases analysis, and 12% systematic reviews. Quantitative techniques were adopted in 66% of such articles, while mathematical modeling was the same as observed in Cadernos de Saúde Pública, as were qualitative techniques. The most common themes were health services organization (22%), nutrition (22%), health and work (18%), epidemiology (12%), and environmental health (12%).

Death is an implicit subject in both health practice and health professionals' training. There is a tendency by health professionals to reduce this analysis merely to technical aspects. This paper analyzes the importance of adopting quality care at the end of life as a guide for public health care. We highlight relevant aspects for training health professionals to respect moral differences and to be prepared to discuss their own points of view.

The purpose of this paper was to demonstrate an application of geostatistical methods to public health risk maps through the identification of areas with elevated concentrations of heavy metals. The study focused on the element lead (Pb) from aerial transportation or loading of particles due to soil leaching in an area with major urban and industrial concentration in the Baixada Santista on the coastland of São Paulo State, Brazil. Maps with the spatial distribution of lead were produced using ordinary kriging; subsequently indicative kriging was performed to identify soil sites with contamination levels higher than the maximum acceptable level defined by the Sao Paulo State Environmental Control Agency. The resulting maps showed areas with increased probability of public health risk. The methodology proved to be a promising approach for decision-making related to health public policies and environmental planning.

This paper analyzes the current status of address data in the Brazilian Health Information System (SIS), with a view towards mapping large-city health events in geographic information systems (GIS) for risk analysis and evaluation. It is thus necessary to geocode these events to small geographic areas inside city limits. This study used a sample from the Reportable Health Events Information System (SINAN) database and also proposes alternatives to work with this large amount of events. Approximately 50% of addresses were referenced automatically and another 19% through conventional search. Data losses occurred mainly due to incomplete or inconsistent address data.

The idea of health promotion predates the use of the actual term. However, the incorporation of this idea and the practice of health promotion were influenced by the Canadian health reform movement, which echoed the voices of many others who were concerned with the influence of the physical and social environment on health. This provided the basis for the World Health Organization to launch a series of conferences beginning with the Alma Ata Conference in 1977 and followed by the Ottawa Conference, from which resulted the first international document on health promotion, known as the Ottawa Charter. Although health promotion has been the subject of a wide range of studies, the concept is still not well understood and its explicit practice is limited. Health conferences have been important for keeping the notion of equity in health alive, while the gap between the rhetoric of these conferences and practice remains to be bridged. However, the rise of social epidemiology and the development of the concept of social capital for health could bring new insights into traditional epidemiology in order to narrow this gap. The purpose of this paper is to elucidate these concepts and to describe the roles they play in public health in order to stimulate further debate.

Starting with a review of the literature and documents pertaining to health promotion in the developed countries, highlighting the Canadian output, the author reflects on the multiple meanings ascribed to the "empowerment" category/strategy. After a summary of the conceptual development of health promotion ideals, the paper analyzes the theoretical aspects of "empowerment", suggesting its classification into two main approaches: psychological and community-based. The author contends that community "empowerment" helps define health promotion as a proposal aimed at transforming the status quo and the production of healthy subjects. The paper concludes by exploring the potential contributions of social/community "empowerment" to health education practices and reorganization of the Brazilian National Health System (SUS).

After a brief review of the relations between philosophy and health, this paper proposes two complementary philosophical methods to be used by Public Health: the philosophical genealogy method and the philosophical-conceptual method. The first method (deconstructive) allows us to denaturalize ideas to which a truth value has customarily been ascribed. The second (constructive) promotes new concepts whose value does not depend on the notion of truth. Both serve the purpose of reflection on concepts used by health policy and practice.

This paper discusses the impact of globalization on public health practice. Neoliberal supremacy has resulted in both greater interdependence between countries and increasing inequalities. Globalization of health risks and the dependence of local health conditions on external forces precludes the use of local/national solutions for global problems. In this context, the classical organization of public health services in a hierarchical pyramid based on geographically defined areas (from the local to the regional and national levels) no longer makes sense. We thus suggest some characteristics of a different type of organization based on new information technologies: a transnational network, horizontally shaped, more independent from political power, allowing for exchange of information and good practices, promoting dissemination of knowledge and producing "glocal" solutions. Through the creation of work opportunities between health professionals, the model will permit the creation of common strategies and increase the power of their political demands, perhaps allowing for the collective development of a more equitable world.

Identification of molecular biomarkers is a common result of current cancer epidemiological research. Both genetic and molecular epidemiology have enjoyed impressive developments in recent decades, with important repercussions on traditional epidemiological approaches. In this paper we evaluate the new frontiers of cancer epidemiology, incorporating both genetic and molecular biology approaches. We examine the current knowledge of molecular biomarkers for exposure and susceptibility to cancer, the role of gene mutations in carcinogenesis, and their application to epidemiological studies. By exploring the status of relevant biomarkers, these approaches become effective in evaluating exposure and susceptibility and show enormous potential for elucidating mechanisms of carcinogenesis and the effect of risk factors in cancer. However, these approaches are necessarily more invasive and raise several ethical issues for consideration by both researchers in public health and society as a whole.

Based on a literature review, the paper calls attention to public and occupational health problems related to poor municipal solid waste management resulting from a development model that views environmental protection, public health, and workers' health as secondary issues. The authors emphasize the need for research to support a new waste management model highlighting the importance of environmental preservation and protection of human health, in addition to suggesting measures to achieve such goals. The discussion aims to incorporate solid waste management into the public health agenda.

This paper comments on Sokal and Bricmont's stance towards interdisciplinary approaches between the human and natural sciences, as stated in their controversial book Impostures Intellectuelles (Fashionable Nonsense) (1999). It happens that interdisciplinary is a subject of major importance to "new paradigms" in Public Health. First, the paper identifies different types of interaction between these "two cultures", such as transdisciplinary trends and the "Science Wars", and emphasizes their unproductive aspects. Second, it proposes a re-evaluation of pragmatism as a suitable way of including philosophical considerations in interdisciplinary Public Health research, exemplified by a correlation between the ideas of Henri Atlan (1991) and notions of risk theory (or model).

This paper reports on an experience in teaching mathematics in a graduate course in public health, intermingled with reflections and concepts. Students enrolled in such courses generally feel uneasy about learning mathematics. Without underrating the usual obstacles and even affinities in developing abstractions, the results suggest that a major portion of the difficulties derives not from mathematics itself, but from an oppressive experience in the past. Difficulties also relate to the construction of space in the classroom. Such a perspective involves understanding experiments and life experiences in which the subjects are involved. In short, the work focuses on how to transmit mathematics in the development of a pedagogical approach.

The purpose of this study was to discuss the implementation of nutritional education in public health services from the perspective of health professionals (physicians and nurses) working in them. The study was conducted in the Municipality of Campinas, São Paulo State, Brazil, from October 1993 to July 1995, using action-based research methodology. The results describe the construction of nutritional knowledge in training and professional institutions; behavior towards food-related problems in daily professional experience as compared to personal life; the contradiction between the apparently trivial act of eating and the complexity of dietary problems; the interface between the acceptance of this work and the incorporation of nutritional education activities and their actual institutionalization; and health professionals' opinions concerning situations permeating the implementation of activities. The paper concludes by referring to the need to implement nutritional education activities, difficulties experienced by physicians and nurses in approaching nutritional problems, and the importance of including nutrition in the curricula of health courses.

This paper analyzes the results of a follow-up study and evaluation of the Specialization Course in Public Health administered from 1993 to 1995 by the Department of Preventive and Social Medicine at the School of Medical Sciences, Universidade de Campinas, Brazil. The study was conducted during the course and with a follow-up several months later. Students reported on their professional activities, difficulties and facilities in performing them, and their commitment to the public health services in which they worked. They also expounded on their needs and expectations regarding specialized training in public health. At the end of the required course load (first semester) and the optional courses (second semester), students evaluated the course content's relevance, their own understanding, and the strengths and weaknesses of the respective teaching strategies. Finally, six and eight months after the courses, the professionals evaluated how they were able to apply their new knowledge to their work. Various research instruments were used, including group dynamics, individual questionnaires, and focal groups, comprising a broad methodological approach. A single sample of individuals was thus studied at different moments with regard to this experience.

Epidemiology's conceptual and methodological shortcomings have placed constraints on the study of health phenomena related to human communities, thus posing a challenge to the field. This paper presents some basic principles resulting from the observation of the field of geography in defining its object - space - and the application of this object to medicine and epidemiology. Such principles state the pertinence of a conceptual and methodological strategy focusing on an approach to geographic space as expressing the population's living conditions. Application of this concept to epidemiological studies is still limited, although such proposals have already been developed in other areas of knowledge. Ecological studies, whose unit of analysis is the group, and the ecological model, based on the idea of an inter-relationship of factors, if improved, could become a promising alternative in this direction. The authors emphasize that researchers should have wholeness as their scientific reference in order to guarantee the non-separation of the complex interactive processes determining health phenomena in the population.

Este trabalho aborda a questão da cidadania e da participação popular em saúde, tendo por base a análise das concepções de um grupo específico: os usuários que freqüentam as Unidades de Cuidados Básicos da Área Programática 3.1 do Município do Rio de Janeiro, Brasil. Analisa-se suas concepções referentes ao tema em estudo, confrontando-as com as que orientam o texto constitucional no capítulo referente à saúde, ao mesmo tempo em que se discute o papel dos usuários em sua relação com os profissionais que os assistem, em face do desafio da construção de uma 'consciência sanitária'. As informações foram obtidas a partir da aplicação de técnicas qualitativas e apontam importantes elementos nas concepções dos usuários; se por um lado, constata-se um distanciamento da condição de cidadãos, por outro, indica-se a existência de aspectos que, situados no plano subjetivo, aguardam a construção de canais que possibilitem a sua expressão, sobretudo no nível das práticas. Neste sentido, a análise aponta, ainda, para o papel estratégico desempenhado pelas relações cotidianas no processo de mudança social e construção dos direitos, buscando simultaneamente elucidar a viabilidade deste processo tendo em vista a subjetividade dos agentes que lhe dão vida.This paper deals with issues of citizenship and people's participation in health services, based on an analysis of concepts displayed by a specific group, i.e., users of Primary Care Clinics in Program Area 3.1 in the city of Rio de Janeiro, Brazil. The paper analyzes health care users' ideas as the ones most heavily influencing the chapter on health in the Brazilian Constitution. The historical context is the discussion underway on the role of patients in the relationship to professional health care providers, who in turn face the challenge of building a "health and hygiene mentality" among the people. Data were gathered through a field study using a qualitative social research methodology and identify salient points among the ideas of people receiving care. There was a gap (or distortion) in their concept of citizenship alongside aspects which, if analyzed according to the subjective plane of these social agents, show that they expect channels to be created by which they can express their opinions, particularly at the practical level. The analysis thus points to the strategic role of day-to-day relationships in the social change process and the acquisition of rights, meanwhile seeking to shed light on the feasibility of this process in view of the subjectivity of the agents giving it life.

Este artigo tem dois objetivos: o primeiro é refletir sobre o significado do suicídio enquanto questão sociológica, comentando um artigo produzido por E. D. Nunes (1998) sobre a célebre obra de Durkheim. O segundo é discutir a mesma problemática no campo da saúde pública, analisando as contribuições do pai da sociologia, as abordagens epidemiológicas e das áreas da psicologia, psiquiatria e psicanálise, ressaltando as contribuições de autores nacionais. O texto apresenta informações sobre o quadro epidemiológico brasileiro e conclui, mostrando as causas violentas, apenas do ponto de vista analítico, podem ser estudadas separadamente, necessitando sempre de uma vigilância epistemológica e epidemiologica para a construção de indicadores que possam contribuir para transformações. Sim, porque os dados de violência hoje necessitam ser vistos no quadro de crise social e de mudanças pelas quais o país está passando.This paper has two objectives. The first is to reflect on the meaning of suicide as a sociological issue, commenting on an article by E.D. Nunes (1988) on the famous work by Durkheim. The second is to discuss the same issue within the field of public health, analyzing the contributions by the father of sociology and approaches by the fields of epidemiology, psychology, psychiatry, and psychoanalysis, highlighting the work of Brazilian authors. The paper presents information on the Brazilian epidemiological context and concludes by demonstrating that only from an analytical point of view can violent causes as a whole can be studied separately. Thus, they constantly require epistemological and epidemiological surveillance to construct indicators capable of contributing to change. This is all the more true because data on current violence need to be viewed within the context of the social crisis and changes Brazil is undergoing.

We conducted a research project aimed at strengthening local government and the community for a sustainable malaria control strategy. The project began with a baseline diagnosis of malaria prevalence, a KAP survey, entomology, and health services delivery, after which an epidemiological study was performed to identify risk factors associated with malaria, thereafter used to plan intervention measures. A program evaluation was conducted five years later. By using an ecosystem approach to reanalyze data, this paper discusses how malaria arises from a complex interaction of cultural, economic, ecological, social, and individual factors. Intervention measures require an intersectorial and transdisciplinary approach that does not exist at the moment. Health sector leadership is limited, and there is no true community participation. Implications for research, including the use of qualitative and quantitative methods, study design, and complexity of data analysis are discussed. Finally, implications for malaria control are discussed, stressing the differences between the ecosystem and integrated disease control approaches.

A total of 187 different species of arboviruses and other viruses in vertebrates were identified at the Evandro Chagas Institute (IEC) from 1954 to 1998, among more than 10,000 arbovirus strains isolated from humans, hematophagous insects, and wild and sentinel vertebrates. Despite intensive studies in the Brazilian Amazon region, especially in Pará State, very little is known about most of these viruses, except for information on date, time, source, and method of isolation, as well as their capacity to infect laboratory animals. This paper reviews ecological and epidemiological data and analyzes the impact of vector and host population changes on various viruses as a result of profound changes in the natural environment. Deforestation, mining, dam and highway construction, human colonization, and urbanization were the main manmade environmental changes associated with the emergence and/or reemergence of relevant arboviruses, including some known pathogens for humans.

This paper reviews the role of situational variables in health risk behaviors and the literature on the impact of context and situation in public health. Three postulates for a situational model are presented: that the situation can account for additional variance in explanation of health risk behaviors; that the power of the situation is reciprocal to the degree of individual autonomy; and that the situation is definable and measurable. A situational presentation methodology is presented for measuring situations in public health with preliminary data on its efficacy in the context of sexual behavior and injecting drug use as HIV transmission risks. Interventions which maximize the use of situationally-based information are discussed. It is concluded that situational presentations may offer additional explanatory power in public health and a means for intervening at a situational level.Os autores fazem uma revisão do papel das variáveis situacionais nos comportamentos de risco para a saúde, assim como, da literatura sobre os impactos do contexto e da situação na saúde pública. São apresentados três postulados para um modelo situacional: que a situação possa explicar a variância adicional nos comportamentos de risco; que o poder da situação seja recíproca em relação ao grau de autonomia individual e que a situação possa ser definida e mensurada. Uma metodologia situacional é apresentada para medir as situações na saúde pública a partir de dados preliminares sobre sua eficácia no contexto do comportamento sexual e uso de drogas injetáveis como fatores de risco para a transmissão do HIV. São discutidas intervenções que maximizam o uso da informação com base situacional. Conclui-se que as apresentações situacionais podem oferecer poder explanatório adicional na saúde pública, assim como, servir como meio para intervir ao nível situacional.

This paper reviews the role of situational variables in health risk behaviors and the literature on the impact of context and situation in public health. Three postulates for a situational model are presented: that the situation can account for additional variance in explanation of health risk behaviors; that the power of the situation is reciprocal to the degree of individual autonomy; and that the situation is definable and measurable. A situational presentation methodology is presented for measuring situations in public health with preliminary data on its efficacy in the context of sexual behavior and injecting drug use as HIV transmission risks. Interventions which maximize the use of situationally-based information are discussed. It is concluded that situational presentations may offer additional explanatory power in public health and a means for intervening at a situational level.

In this paper I discuss the application of the principles of medical ethics and of medical research to the case of children and others whose consent to treatment and to research is problematic. Public health depends substantially on the possibility of ongoing research into all conditions which affect the health of the people. Constraints on this research are therefore a public health issue. Moreover and more importantly the possibility of predictive testing and indeed of screening for health-relevant conditions is an important public health tool, and limitations on the use of this tool are of great significance to public health medicine. Having considered the particular problems created by research and predictive testing on children for late-onset conditions I go on to discuss research on those whose consent is problematic more generally. I conclude with radical recommendations for the reform of The Declaration of Helsinki and of the International Ethics Guidelines for Biomedical Research Involving Human Subjects, prepared by the Council for International Organizations of Medical Sciences (CIOMS).

Este artigo apresenta os resultados preliminares de uma pesquisa sobre os limites e possibilidades de aplicação do enfoque de planejamento estratégico em organizações de saúde de nível local. Desenvolve-se uma análise comparada de duas experiências de adoção do método de Planejamento Estratégico-Situacional (PES) para a gestão de um Centro de Saúde e de uma unidade hospitalar. Entre as questões discutidas destacam-se: a de dificuldade de aplicação da categoria ator no nível local de saúde; a possibilidade de construção de um projeto coletivo a partir da multiplicidade de racionalidades presentes em organizações de saúde; a possibilidade de se ampliarem os processos comunicativos a partir da adoção do PES; as dificuldades relativas à cultura organizacional e aos baixos níveis de responsabilidade, além daquelas inerentes à complexidade do método, e à possibilidade de simplificá-lo, garantindo-se a análise estratégica-situacional e a ampliação da capacidade gerencial das organizações.This paper presents the preliminary results from a study on the limits and possibilities of the strategic planning approach for local health organizations. A comparative analysis is developed between two experiences concerning the application of the strategic situational planning method (PES method) in the management of a health center and hospital. Questions include the following: difficulties with the use of the category actor in local health organizations; possibility of drafting a collective project based on the multiple rationalities existing in such organizations; possibility of improving communications processes with the use of the PES method; difficulties related to organizational culture; and low levels of responsibility, as well as difficulties pertaining to the method's complexity and the possibility of simplifying it, maintaining strategic situational analysis and improving organizations' managerial capacity.

Este trabalho tem por objetivo apresentar uma revisão de estudos que enfocam o tema da acessibilidade a ações e serviços de saúde. Tem-se demonstrado que indivíduos infectados pelo vírus da imunodeficiência humana (HIV) podem apresentar uma melhor sobrevida dependendo do tipo de acesso que tenham às ações e serviços de saúde, como, por exemplo, acesso a medicamentos profiláticos (por exemplo, zidovudina, pentamidina). Desta forma, o presente trabalho enfatiza e utiliza dados da epidemia do HIV como forma de abordar o tema proposto. O artigo inicia-se com uma exposição do marco teórico sobre acessibilidade, seguida de uma revisão bibliográfica estruturada em quatro tópicos, a saber: 1) aspectos epidemiológicos da AIDS; 2) avaliação de qualidade dos serviços de saúde; 3) acessibilidade às ações e serviços de saúde e 4) estudos de acessibilidade em pacientes infectados pelo HIV. Considerações finais sobre o tema enfocado apontam para a necessidade de se compreender as implicações das diversas barreiras de acesso aos serviços, levando-se em conta os custos sociais e humanos da infecção pelo HIV, as necessidades e demandas dos indivíduos infectados e as conseqüências que o não-atendimento em tempo hábil pode ter para estes indivíduos.The aim of this paper is to provide a review of studies on accessibility to health care. It has been shown that patients infected by the human immunodeficiency virus (HIV) may present better survival estimates depending upon their access to adequate health care, such as the availability of prophylactic therapy (e.g. zidovudine, pentamidine). The present review has emphasized access to health care in light of data from the current HIV epidemic. Theorical aspects pertaining to accessibility are presented, followed by a brief literature review on four main topics: 1. epidemiological aspects of HIV; 2. evaluation of health service quality; 3. accessibility to health care; and 4. accessibility studies on HIV-infected patients. Final considerations indicate the need to understand the various consequences of barriers to health care, taking into account the social and human costs of HIV infection, the needs and demands of HIV-infected patients, and the consequences of delays in care for these individuals.

El presente trabajo es una reflexión sobre cuál de los posibles modelos en salud pública contribuiría más para el entendimiento de la ocurrencia de brotes de rabia humana transmitida por murciélagos. En un primer momento se hace una breve revisión sobre los modelos más utilizados para analizar nuestro objeto de estudio. Posteriormente se presenta la investigación de un brote de rabia humana transmitida por murciélagos con base en el modelo epidemiológico social. Este mismo brote se analiza nuevamente utilizando como marco teórico la teoría de sistemas complejos, como forma de un ejercicio teórico-práctico para intentar una aproximación a esta teoría, como un posible modelo para estudiar el problema presentado.This paper analyzes which of the possible public health models could contribute to an understanding of human rabies outbreaks transmitted by bats. First, we present a short review of the most common pertinent models. Second, we present an investigation of a human rabies outbreak transmitted by bats based on the socio-epidemiological model. The same outbreak is analyzed again using the complex system theory as a theoretical framework, as both a theoretical-practical exercise seeking an approximation to this theory and a model to study this problem.

O artigo discute a pertinência, as especificidades e as potencialidades da perspectiva antropológica na abordagem da saúde e da doença. A antropologia médica é apresentada como uma perspectiva complementar e enriquecedora na abordagem dos problemas de saúde pública. A influência do universo social e cultural sobre as percepções e ações em saúde é exemplificada e comentada em referência a estudos realizados junto a diferentes populações. Elementos conceituais e metodológicos centrais são apresentados e integrados à proposta de sistematização do estudo "das maneiras de pensar e de agir" face a diferentes problemas de saúde. A contribuição específica da abordagem antropológica é discutida em termos da efetividade dos programas saúde pública.This paper discusses the relevance, specificity, and potential of the anthropological approach to health and illness. Medical anthropology is shown as complementary to other approaches that currently deal with public health problems. The impact of social and cultural factors on health-related perceptions and behaviors is illustrated and commented. A conceptual and methodological framework is also proposed to systematize the study of representations and practices of communities in the area of public health. The specific contribution of the anthropological approach is discussed in terms of the effectiveness of public health programs.

Este trabalho resume um debate metodológico em processo na Escola Nacional de Saúde Pública, Brasil, sobre as duas formas de abordagem mais correntes nas investigações da área de saúde: o método quantitativo e o método qualitativo. Os autores - uma antropóloga sanitarista e um bioestatístico - demonstram, com argumentações teóricas e práticas, que esses métodos são de natureza diferenciada, mas se complementam na compreensão da realidade social. Num mundo onde o que distingue o ser humano é a linguagem comunicativa, o acento deste debate recai sobre a possibilidade, o significado e os limites da linguagem matemática e da linguagem de uso comum na experiência cotidiana.This paper summarizes a methodological debate underway at the Brazilian National School of Public Health concerning the two major approaches for investigations in the field of health: the quantitative and qualitative methods. The authors - a public health anthropologist and a biostatistician - used theoretical and practical arguments to demonstrate that these methods are differentiated in nature, but that they complement each other in the understanding of social reality. In a world where human beings are distinguished by communicative language, this debate focuses on the possibility, meaning, and limits of both mathematical language and the language commonly used in everyday life.

Neste artigo discute-se a influência do modelo de desenvolvimento brasileiro sobre o meio ambiente e a saúde da população, apontando suas características centrais e suas conseqüências, as denominadas eco-desigualdades. Relaciona-se dados que procuram ilustrar as relações entre desenvolvimento, meio ambiente e saúde. Considera-se que a crise econômica da última década, bem como a aproximação do Estado brasileiro ao modelo neo-liberal, dificultam acentuadamente os investimentos nos setores sociais e públicos, antevendo-se enormes prejuízos para a população, com a acentuação das desigualdades sociais no país. Enfatiza-se, por fim, a necessidade de uma nova ética nas relações entre os indivíduos, indivíduos e Estado e entre Nações.This article discusses the influence of the Brazilian development model on the environment and on the population's health, focusing on the major characteristics as well as the consequences of this model - the so-called eco-inequalities. This paper presents data that attempt to illustrate the relationships between development, environment and health. The economic crisis of the last decade and the move to a neoliberal model by the Brazilian State are seen as factors that strongly hamper investments in the social and public sectors, promoting huge losses for the population and increased social inequalities in the country. Finally, emphasis is given to the need for a new ethics in the relationships among individuals, between individuals and State, and among Nations.

A total of 187 different species of arboviruses and other viruses in vertebrates were identified at the Evandro Chagas Institute (IEC) from 1954 to 1998, among more than 10,000 arbovirus strains isolated from humans, hematophagous insects, and wild and sentinel vertebrates. Despite intensive studies in the Brazilian Amazon region, especially in Pará State, very little is known about most of these viruses, except for information on date, time, source, and method of isolation, as well as their capacity to infect laboratory animals. This paper reviews ecological and epidemiological data and analyzes the impact of vector and host population changes on various viruses as a result of profound changes in the natural environment. Deforestation, mining, dam and highway construction, human colonization, and urbanization were the main manmade environmental changes associated with the emergence and/or reemergence of relevant arboviruses, including some known pathogens for humans.Um total de 187 diferentes espécies de arbovírus, além de outros vírus de vertebrados, foram identificados pelo Instituto Evandro Chagas (IEC) no período de 1954 a 1998, entre as mais de 10.000 cepas de vírus isoladas de seres humanos, insetos hematófagos e vertebrados-sentinela e silvestres. Apesar dos estudos intensivos realizados na Amazônia brasileira, sobretudo no Estado do Pará, pouco se sabe a respeito da maioria desses vírus, com exceção de dados a respeito de data, hora, fonte e método de isolamento, assim como a capacidade de infectar animais laboratoriais. Os autores fazem uma revisão dos dados ecológicos e epidemiológicos e procuram associar o impacto, sobre os diversos vírus, das mudanças populacionais dos vetores e hospedeiros induzidas por profundas alterações no meio ambiente. O desmatamento, o uso do subsolo, a construção de represas e de rodovias, a colonização humana e a urbanização foram as principais modificações ambientais introduzidas pelo homem e associadas à emergência ou reemergência de importantes arbovírus, inclusive alguns com atividade patogênica em seres humanos.

We conducted a research project aimed at strengthening local government and the community for a sustainable malaria control strategy. The project began with a baseline diagnosis of malaria prevalence, a KAP survey, entomology, and health services delivery, after which an epidemiological study was performed to identify risk factors associated with malaria, thereafter used to plan intervention measures. A program evaluation was conducted five years later. By using an ecosystem approach to reanalyze data, this paper discusses how malaria arises from a complex interaction of cultural, economic, ecological, social, and individual factors. Intervention measures require an intersectorial and transdisciplinary approach that does not exist at the moment. Health sector leadership is limited, and there is no true community participation. Implications for research, including the use of qualitative and quantitative methods, study design, and complexity of data analysis are discussed. Finally, implications for malaria control are discussed, stressing the differences between the ecosystem and integrated disease control approaches.Os autores implementaram um projeto de pesquisa voltado ao fortalecimento do governo local e da comunidade com vistas à estratégia sustentável de controle da malária. O projeto iniciou com diagnóstico prévio, incluindo prevalência da malária, entomologia, KAP (conhecimentos, atitudes e práticas) e oferta de serviços de saúde; a seguir, realizou-se inquérito epidemiológico para identificar fatores de risco associados à malária e a escolha de medidas de intervenção adequadas. O programa foi avaliado após cinco anos. Ao adotar a abordagem ecossistêmica para re-analisar os dados, o artigo discute como a malária surge a partir da interação complexa entre fatores culturais, econômicos, ecológicos, sociais e individuais. Medidas de intervenção exigem abordagem intersetorial e transdisciplinar ainda não existente. A liderança do setor de saúde é limitada e não há participação comunitária de fato. Os autores examinam os envolvimentos para a pesquisa, incluindo o uso de métodos qualitativos e quantitativos, o desenho metodológico e a complexidade da análise dos dados. Por fim, discutem as implicações para o controle da malária, enfatizando diferenças entre abordagens ecossistêmicas e de controle integrado da doença.

In this paper I discuss the application of the principles of medical ethics and of medical research to the case of children and others whose consent to treatment and to research is problematic. Public health depends substantially on the possibility of ongoing research into all conditions which affect the health of the people. Constraints on this research are therefore a public health issue. Moreover and more importantly the possibility of predictive testing and indeed of screening for health-relevant conditions is an important public health tool, and limitations on the use of this tool are of great significance to public health medicine. Having considered the particular problems created by research and predictive testing on children for late-onset conditions I go on to discuss research on those whose consent is problematic more generally. I conclude with radical recommendations for the reform of The Declaration of Helsinki and of the International Ethics Guidelines for Biomedical Research Involving Human Subjects, prepared by the Council for International Organizations of Medical Sciences (CIOMS).Nesse artigo, discuto a aplicação dos princípios de ética médica e da pesquisa médica ao caso de crianças e outros cujo consentimento a tratamento e pesquisa é problemático. A saúde pública depende substancialmente da possibilidade da continuidade de pesquisas dirigidas a todas as condições que afetam a saúde da população. Restrições nessas pesquisas são, portanto, uma questão de saúde pública. Além disso, e mais importante, testagens preditivas e, especialmente, screening para condições relevantes (para) à saúde constituem-se em valiosos instrumentos de saúde pública. Limitações no uso desses instrumentos são da maior significância à medicina ligada à saúde pública. Levando em consideração os problemas particulares criados pela pesquisa e testagem preditiva para crianças no que se refere a condições que se manifestam tardiamente, prossigo discutindo investigações naqueles cujo consentimento é problemático em termos mais gerais. Concluo com recomendações radicais para a reforma da Declaração de Helsinki e das Orientações Éticas Internacionais para Pesquisa Biomédica Envolvendo Sujeitos Humanos, preparadas pelo Council for International Organizations of Medical Sciences (CIOMS).

O artigo consiste num recorte de uma pesquisa que aborda a relação entre prostituição infantil, processo saúde-doença ligado à sexualidade e violência, configurada no ambiente de meninas que vivem nas ruas. Neste trabalho são apresentados apenas os resultados sobre violência revelados na fala das meninas. Para uma compreensão destes dados, inicialmente são tecidas considerações básicas sobre a .violência e sobre a pesquisa em geral. Após esta discussão procura-se caracterizar, de forma sintética, o cenário dos atores sociais estudados. Dentro deste cenário analisam-se aspectos da história de vida das meninas, bem como a fala delas sobre a violência, dentro de uma dimensão social. A partir desta análise conclui-se que as situações de violência vividas pelas meninas comprometem a saúde, deixando marcas profundas em seus corpos e em suas mentes.This article is a part of a study focusing on the relationship between child prostitution and the health/disease process as related to sexuality and violence, considering the three categories in the context of street girls. The paper analyzes the violence revealed by the girls themselves. Considerations on violence in general and the research as a whole are introduced first to facilitate an understanding of the purposes of the study. The social actors under study are then characterized. Within that scenario, aspects of the girls' life histories and their views on violence are analyzed in the social context. The conclusion is that such violent situations damages their health directly, leaving deep scars on their bodies and minds.

We conducted a research project aimed at strengthening local government and the community for a sustainable malaria control strategy. The project began with a baseline diagnosis of malaria prevalence, a KAP survey, entomology, and health services delivery, after which an epidemiological study was performed to identify risk factors associated with malaria, thereafter used to plan intervention measures. A program evaluation was conducted five years later. By using an ecosystem approach to reanalyze data, this paper discusses how malaria arises from a complex interaction of cultural, economic, ecological, social, and individual factors. Intervention measures require an intersectorial and transdisciplinary approach that does not exist at the moment. Health sector leadership is limited, and there is no true community participation. Implications for research, including the use of qualitative and quantitative methods, study design, and complexity of data analysis are discussed. Finally, implications for malaria control are discussed, stressing the differences between the ecosystem and integrated disease control approaches.

In this paper I discuss the application of the principles of medical ethics and of medical research to the case of children and others whose consent to treatment and to research is problematic. Public health depends substantially on the possibility of ongoing research into all conditions which affect the health of the people. Constraints on this research are therefore a public health issue. Moreover and more importantly the possibility of predictive testing and indeed of screening for health-relevant conditions is an important public health tool, and limitations on the use of this tool are of great significance to public health medicine. Having considered the particular problems created by research and predictive testing on children for late-onset conditions I go on to discuss research on those whose consent is problematic more generally. I conclude with radical recommendations for the reform of The Declaration of Helsinki and of the International Ethics Guidelines for Biomedical Research Involving Human Subjects, prepared by the Council for International Organizations of Medical Sciences (CIOMS).