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Introduction: Vitamin D is required for bone and mineral metabolism and participates in the regulation of the immune response. It is also linked to several chronic diseases and conditions, usually in populations of European descent. Brazil presents a high prevalence of vitamin D deficiency and insufficiency despite the widespread availability of sunlight in the country. Thus, it is important to investigate the role of vitamin D as a risk factor for disease and to establish causal relationships between vitamin D levels and health-related outcomes in the Brazilian population., Objective: To examine genetic variants identified as determinants of serum vitamin D in genome-wide association studies of European populations and check whether the same associations are present in Brazil. If so, these single nucleotide polymorphisms (SNPs) could be developed locally as proxies to use in genetically informed causal inference methods, such as Mendelian randomization., Materials and Methods: We extracted SNPs associated with vitamin D from the genomewide association studies catalog. We did a literature search to select papers ascertaining these variants and vitamin D concentrations in Brazil., Results: GC was the gene with the strongest association with vitamin D levels, in agreement with existing findings in European populations. However, VDR was the most investigated gene, regardless of its non-existing association with vitamin D in the genomewide association studies., Conclusions: More research is needed to validate sound proxies for vitamin D levels in Brazil, for example, prioritizing GC rather than VDR.

Objective: to identify the factors associated with the use and reuse of masks among Brazilian individuals in the context of the COVID-19 pandemic., Method: cross-sectional study conducted in the five Brazilian regions, among adult individuals, via an electronic form disseminated in social media, addressing general information and the use of masks. Bivariate analysis and binary logistic regression were used to identify the factors associated with the use and reuse of masks., Results: 3,981 (100%) individuals participated in the study. In total, 95.5% (CI 95%: 94.8-96.1) reported using masks. Fabric masks were more frequently reported (72.7%; CI 95%: 71.3-74.1), followed by surgical masks (27.8%; CI 95%: 26.5-29.2). The percentage of reuse was 71.1% (CI 95%: 69.7-72.5). Most (55.8%; CI 95%: 51.7-60.0) of those exclusively wearing surgical masks reported its reuse. Being a woman and having had contact with individuals presenting respiratory symptoms increased the likelihood of wearing masks (p≤0.001). Additionally, being a woman decreased the likelihood of reusing surgical masks (p≤0.001)., Conclusion: virtually all the participants reported the use of masks, most frequently fabric masks. The findings draw attention to a risky practice, that of reusing surgical and paper masks. Therefore, guidelines, public policies, and educational strategies are needed to promote the correct use of masks to control and prevent COVID-19.

From the analysis of a specific conjuncture, "Cracolândia" in São Paulo, Brazil, and the "De Braços Abertos" program, this article discusses the complex relationships between drug use and the formulation of public policies directed to the care of users. In methodological terms, this work is based on the qualitative research by using semi-structured interviews with thirteen key informants. The empirical material was analyzed from the content thematic analysis and the intersectionality perspective, especially from the theoretical contributions of the "difference" category. The results point out that "differences" are marked by gender, race and social position in the society, reinforcing stigmas and their different impacts on social relations. This paper contributes to the debate on the need to formulate different approaches to the specific needs and demands of populations or social classification categories regarding drug public policy.

Hegemonic masculinity has distanced heterosexually active men from the responses to the HIV epidemic. However, with the combined prevention paradigm, post-exposure prophylaxis offers new ways to manage the risks of HIV infection, while at the same time bringing about new challenges. The aim of this paper is to discuss - through the lens of gender and masculinities - how heterosexually active men perceive their HIV risk and how they manage prevention methods and strategies, including post-exposure prophylaxis. Employing qualitative methods, 16 heterosexually active men in five health services from different Brazilian cities were interviewed. The analysis indicates that condom use - the main prevention method - was conditioned by subjective and contextual factors, and its failure stands out as the primary reason for seeking out post-exposure prophylaxis. We argue that ideals of hegemonic masculinity permeate perceptions and risk management discourses in the current context of the HIV/AIDS epidemic.

This paper provides estimates of mortality rates from Alzheimer's disease dementia (AD) in the elderly Brazilian population. Data were obtained from the 2010 Population Census by Brazilian Institute of Geography and Statistics (IBGE) and microdata on mortality in Brazil's 27 state capitals recorded in the Brazilian Mortality Information System (SIM) for the population 65 years or older by place of residence for the years 2009 to 2013. Corrections were obtained for underreporting of mortality, and final adjustments were made to the specific mortality rates based on Bayesian methods with prior probability distributions built on the basis of information obtained from a meta-analysis. The mortality rates from all dementias and from AD in Brazil were higher than in developed countries. The mortality rates from Alzheimer's disease in 2013 were 140.03 (95%CI: 117.05; 166.4) and 127.07 (95%CI: 103.74; 149.62) per 100,000 inhabitants, respectively, in men and women. The contribution of AD to mortality in elderly Brazilians was 4.4% (95%CI: 3.25; 5.72) in the group with 0 to 3 years of schooling, independently of age and sex. The study aimed to increase knowledge on corrected estimates of mortality rates from Alzheimer's disease based on vital statistics, providing more precise and pertinent evidence-based estimates.

Introduction and Objective: Oral benign neoplasms (OBNs) exhibit some features that can guide the professionals to the correct diagnosis and best treatment. Through retrospective studies, medical records can be reviewed to better describe a given population and, furthermore, help clinicians in routine practice. In this context, the objective of this paper was to analyze the cases of OBNs of an oral pathology referral department, from 2003 to 2017, in order to better understand their epidemiological and clinicopathological characteristics., Methods: A total of 8355 histopathological reports were analyzed. Lesions diagnosed as OBNs were selected and the following variables were recorded: gender, age, histological type of the lesion, anatomical location, rate and pattern of growth, type of base, color, symptomatology and diagnostic hypotheses on clinical examination., Results: OBNs represented 9.4% of all lesions diagnosed. The most frequent histopathological types were fibroma (39.9%), papilloma (22%), fibroblastoma (13.1%), lipoma (10.2%) and hemangioma (6.1%). Overall, most cases affected females (n=518; 65.6%) and in the fifth decade of life (n=148; 18.7%). The oral mucosa was the most common site (n=265; 33.5%). The most common features of each OBN were also highlighted., Conclusion: The most common OBNs were fibroma, papilloma, fibroblastoma, lipoma and hemangioma. Overall, the OBN presented common clinical features; however, in particular cases, there are some characteristics that can lead the professionals to the correct diagnosis. Nevertheless, in general, histopathological analysis must be performed to confirm diagnosis. Intraosseous tumors and large lesions may require imaging tests to help diagnosis., (Copyright © 2018 Sociedad Española de Otorrinolaringología y Cirugía de Cabeza y Cuello. Publicado por Elsevier España, S.L.U. All rights reserved.)

This paper describes and analyzes the psychiatric reform process in three Latin American countries (Brazil, Chile and Colombia) based on the Caracas Declaration of 1990. It compares the psychiatric reform processes in these three countries and highlights the role of national mental health laws in these processes. Our goal when investigating the experiences in other countries of Latin America is to draw conclusions for the Argentine psychiatric reform and for the future of such reforms in the region.

This paper develops the methodological principles of pooled analysis design, using it to study situations of vulnerability among drug users at a regional level. Data from thirteen cross-sectional studies carried out in Argentina, Brazil and Uruguay between 1998 and 2004 were integrated. A critical review of the concept of data matrix which identifies four structural components, allowed us to: define the units of analysis spanning the different original populations; identify a core of common variables (social and demographic characteristics, drug use, sexual practices, serology of blood-borne and sexually transmitted diseases) with their respective values; examine the indicators, dimensions and procedures used to measure the variables; and establish their compatibility with a thematic and comparative analysis of data collection tools. The main result was a new data matrix with 3,534 cases. Multidisciplinary collaboration between teams and institutions from the three countries made it possible to maximize the available sources in order to analyze characteristics of the local contexts and of the overall regional.

Homicides occur the world over, but they are not homogeneously distributed by geographical areas (continents, countries, regions), either over long or short periods of time, or in social groups, namely age, gender, social class or ethnicity. Why are there more homicides in some countries than in others? Why do killings increase in some countries, while they decrease in others? There are two fundamental schools of thought for social explanations of crime and violence: those attributing its origins to poverty and inequality and those blaming institutionalization or social norms. To discuss these theories, this paper analyzes and compares the changes in Colombia, Venezuela and Brazil in the first decade of the twenty-first century, where the homicide rate has decreased, increased and remained the same, respectively. Using the measurement of six variables (poverty, inequality, unemployment, national wealth, human development and the rule of law) and the technique of trajectory analysis, the results revealed that institutionalization is more to blame for the change than poverty and inequality. The text concludes that poverty and inequality affect crime and homicides, although not directly, but mediated by the institutions instead.

This paper addresses the issue of uncertainty in the measurements used in public health analysis and decision-making. The Shannon-Wiener entropy measure was adapted to express the uncertainty contained in counting causes of death in official vital statistics from Chile. Based on the findings, the authors conclude that metrological requirements in public health are as important as the measurements themselves. The study also considers and argues for the existence of uncertainty associated with the statistics' performative properties, both by the way the data are structured as a sort of syntax of reality and by exclusion of what remains beyond the quantitative modeling used in each case. Following the legacy of pragmatic thinking and using conceptual tools from the sociology of translation, the authors emphasize that by taking uncertainty into account, public health can contribute to a discussion on the relationship between technology, democracy, and formation of a participatory public.

The mangrove oyster Crassostrea rhizophorae is important fishery resource along the entire Brasilian coast with excellent potential for marine culture. The purpose of this paper was to examine the reproductive characteristics of the oyster of the Maraú river estuary in Camamu Bay, Bahia, Brasil. The samples were collected monthly, from September 2006 to August 2007, at two points (I and II) in Camamu Bay. At each site 20 oysters were collected for histological analysis, fixed in Davidson's solution, embedded in paraffin, dehydrated in an ethanol series, sectioned (7 microm thick) and stained with Harris hematoxylin and Eosin (HE). Additionally, 30 oysters were sampled, at each point, for a condition index analysis. The water temperature ranged from 23.5 degrees C to 30 degrees C and the salinity from 15 to 25 ups at Point I (Maraú) and from 25 to 35 at Point II (Tanque Island). The oyster's height ranged from 30 to 92 mm at Point I and from 27 to 102 mm at Point II, with an average of 49.0 mm +/- 9.1 (n = 230) and 49.9 mm +/- 9.9 (n = 237), respectively. Among the sampled oysters at Point I, 59.1% were females, 31.3% males, 1.3% hermaphrodites and 8.2% of the oysters of undetermined sex. At Point II, 66.2% were females, 30.4% males, 0.8% hermaphrodites and 2.5% (n = 237) of undetermined sex. The gonadic stage analysis indicated that the reproduction period of the C. rhizophorae in the Maraú Peninsula was continuous all year, without any regressive phase. The condition index (R) ranged from 8.0% to 17.7%. The peak periods of R coincided with the expressive oyster's percentage in the maturation and liberation gametic stages. The results of these findings will contribute information for the oyster spat collection and to the process installation of the oyster culture in Camamu Bay.

Southern Cone Sub-Regional Project on Cystic Echinococcosis Control and Surveillance: Argentina, Brasil, Chile and Uruguay, is a joint and collaborative tool with the aim of promoting the implementation or the strengthening of programs for disease control. The paper describes the background, the institutional aspects that regulates the structure and functions, as well as the guidelines defined in the technical and operational project. The article emphasize the achievements through Projects of Technical Cooperation among Countries, and the development of integrated and innovative approaches for prevention and control of the disease and training of human resources of the control programs. Some of the challenges are: to achieve the sustainability of the project, implementation of technical groups for analysis and assessment at request of the countries, improvement of the regional information systems, to continue training human resources of the control programs and to expand and strengthen the technical cooperation among countries.

This paper discusses the contribution of the concept of governance, combined with traditional approaches to primary health care (PHC) analysis, in a multicentre study covering Argentina, Brazil, Paraguay and Uruguay. Considering health systems’ variety of configurations and their segmented context, it aims to compare PHC implementation and performance characteristics in each country so as to explain them according to different determinants and compare them to governance models. Each country’s segmented context is presented, identifying public, private and social insurance sub-sectors’ arrangements. The PHC concept and its potential role in reorganizing equity- and access-based health systems are discussed. Five dimensions for PHC study are then defined: stewardship, financing, resources, comprehensiveness and intersectorality. Governance analysis revealed state-society relationships and is thus proposed as a tool for understanding such dimensions’ dynamic relationships.

The present article analyzes the problematic of hygiene in the Luso-Brazilian medicine during the second half of 18th century. The chosen context to analysis is related to the changes of medical thought in Portugal along the period related to the appropriation of medical theories that circulated around the Enlightenment Europe. Besides, this paper approaches the ideas presented in medicine treatises of that time related to body care and health conservation, calling attention to the central role of hygiene along that period.

Conditional cash transfers are becoming the standard approach to reducing poverty levels; the Brazilian Bolsa Familia Program, in particular, is the largest program of this kind, and the evaluation of its impact allows for drawing some interesting conclusions, which may apply to other countries. In this paper, the lack of positive results in terms of both health status and modification of unhealthy habits is underlined. Among different causes, which are discussed here, the existence of barriers on the supply side appears as the most important limitation for obtaining better results. The positive impact of this program on both education and poverty reduction however, allows for predicting improvements in health status in the long run.

This paper attempts to provide a general overview about the way in which Brazilian medicine and physical anthropology gave a naturalistic approach to the idea of race and to the "problem" posed by the mixture of races in the country during the second half of the 19th century and the beginning of the 20th century, coinciding with the introduction of evolutionism in Brazil.

Jabuticaba, Myrciaria cauliflora Berg, is a native Brazilian fruit; very little is known about the chemistry of its components, specially the bioactives compounds. The purpose of this paper was to determine the centesimal composition and some bioactives compounds of the whole fruit and fractions of two varieties of jabuticaba (Paulista and Sabará). The experiment was conducted in a completely randomized design on a 4 x 2 x 3 factorial scheme (4 factors: whole fruit, skin, pulp and seed; 2 varieties: Paulista e Sabará, and 3 replicates). The fruits were sampled, selected, weighted, sanitized and fractionated into whole fruit, skin, pulp and seed that were grinded, frozen and lyophilized to a constant weight. Protein contents and of ether extract were low for all fractions. The ash contents indicate elevated levels of minerals, specially on the Sabará variety. The content of alimentary fibers differed widely among fractions, with no differences between varieties. The skin fractions presented the highest levels of fiber, 33.80 g/100 g on Paulista and 33.23 g/100 g on Sabará, most of it was insoluble fibers. The greatest amount of non nitrogen extract was found in the pulp fraction, while the lowest was found in the skin, with no differences between varieties. Regarding bioactives compounds, only polyphenols were presented at considerable levels in all the fractions but the pulp one, showing the need for better characterization before using the fruit in the food industry.

Introduction: The physical activity and adequate food plays a key role in improving health and the control of diseases., Objective: This paper aims at determining the nutritional state through anthropometric measures, socioeconomic level, the most common illnesses and type of physical activity, beyond food consumption and the place where meals are taken, of under-graduate students of the Nutrition course in UFPE., Methods: The sample is constituted of 68 female students, of different periods and at ages between 18 and 27 years old. The process of selection of the sample was for convenience. The students voluntarily participated and answered three questionnaires, respectively, on their socioeconomic level (income of the family) and possible illnesses they had, measures of the cutaneous folds and type of practiced physical activity; register of consumed foods and local where the meals were carried. Statistical analysis was performed by absolute frequency, percentage, average and standard deviation. The margin of error used in the testing employees was 5%., Results: In relation to the incomes, they had predominated above three minimum wages (86%), the parents have a predominant role in the expenditure of their study (46%), followed by the father (24%), mother (9%), husband (4%), other responsible ones (10%); 7% did not give information. The most common illnesses were: allergic rhinitis, tonsillitis, sleeplessness and intestinal constipation. The weight, the height, the index of body mass and the relation waist hip of the students were within normal standards. The abdominal circumference varied only in 2.57 cm between the studied age range. In relation to the practice of physical activities, 67% were sedentary, 20% practiced light activity and 13% moderate. In relation to where the meals are had, breakfast, in its majority (76%), was carried at home, followed by supper (56%), while lunch (41%) and snack 1 (34%), at University. Among the pupils who did not inform the place where they had their meals there was a high percentage for the big meals and a small one for the minor ones. The main kinds of consumed meals were breakfast, lunch and supper (98%). For the small meals, the values were: snack 1 (54%), snack 2 (61%), snack 3 (45%). The analysis of food consumption for three days disclosed ingestion of energy with deficit of 21% in relation to the recommended one (p < 0.001); the macro-nutrients showed percentages within the standards; the intake of fiber (11.8 g/day) was less than recommended (p < 0.001). Meat, eggs and cereals were ingested daily (for about 80%); vegetables (40%), legumes, fruits and candies (25% 30%), around four or six days a week. Roots and tubercles, salty, embedded and non alcoholic drinks were consumed from one to three days weekly (70%). Animal guts were not consumed by 50% of the studied population., Conclusions: Having analyzed all this, the studied students need to modify their food habits, acquiring knowledge on the importance of a balanced diet, as well as the practice of physical activity systematically, to prevent illnesses and attain a better quality of life.

Introduction: Type b Haemophilus influenzae (Hib) continues to be an important causative agent of various infectious processes, and its encapsulated strains cause invasive disease. In some aboriginal populations, the incidence of Hib infections in children under five is greater than 400 per 100,000. In the seventies and eighties, vaccines against Hib were developed after antibodies against the capsular component were identified. The objective of this paper was to estimate the impact that the vaccine against Hib has had in Brazil's Federal District since it was introduced in March of 1998., Methods: Using population-based data obtained from Brazil's Federal District's Ministry of Health's Surveillance System, rates of incidence of meningitis during the three years that preceded and that followed the introduction of the anti-Hib vaccine were compared. Comparisons were also drawn between changes in the trends observed., Results: A comparison of the data from the two periods showed a decrease of approximately 90% in the incidence of Hib meningitis, but no concomitant decrease in other forms of bacterial meningitis was noted. There was also a proportional increase in the number of cases among infants 6 months of age and under due to a drop in the incidence of the disease in children older than 6 months., Conclusion: As a result of the introduction of the conjugated anti-Hib vaccine in Brazil's Federal District, the incidence of Hib meningitis among children 7 months to 35 months of age dropped from 168 per 100,000 to 15 per 100,000 (91.1%).

Dentists who treat children must be alert to the possibility of finding diseases of the oral mucosa, especially in younger children. The present study aimed to review the most updated information and the experience of our group in order to yield epidemiological data that assist diagnosis of the most common diseases of the oral mucosa in children. Recent epidemiologic studies have shown a wide variability in the prevalence of oral mucosal lesions in different regions of the world and have led researchers to draw disparate conclusions. Moreover, studies have not been designed using standard criteria, further explaining the wide variability in the percentage of different groups of children with oral lesions, which ranges from 4.1 to 52.6%. The lesions most frequently considered by authors and that most often appear in the different studies are: recurrent aphthous stomatitis (0.9-10.8%), labial herpes (0.78-5.2%), fissured tongue (1.49-23%), geographic tongue (0.60-9.8%), oral candidiasis (0.01-37%) and traumatic injury (0.09%-22.15%). Dentists must be able to detect any of the numerous possible disorders and perform the correct differential diagnosis, key to the treatment plan. The aim of this paper, based on a review of the different national and international studies, is to contribute data on the most important oral mucosal diseases in the paediatric population in terms of prevalence and differential diagnosis.

By analyzing the influence of early Pasteurian thought on health discourse and practice, this paper discusses the thesis postulating an opposition between pre- and post- Pasteurian hygiene. Focusing on an analysis of the sanitary strategies to control lower-class housing that were proposed by Argentine and Brazilian hygienists, the author identifies the breaks and continuities between classical hygiene and hygiene reorganized by microbiology.

In order to begin mass producing the nematode Romanomermis iyengari Welch, a bioprocessing plant was designed and set up on the grounds of Universidad Federal in the State of Roraima, Brazil, after reaching an agreement with the State's Health Department. The objective of this paper was to establish the basic process for mass breeding the parasite in order to apply it to anopheline breeding sites. Cultures were obtained at a rate of 68 during every seven-day cycle, making for a total of 272 cultures a month. Before treatments were applied in the field, laboratory tests were conducted that showed the great susceptibility of anopheline larvae to infestation by R. iyengari, with parasitism rates ranging from 71 to 98%. In order to assess the parasitizing capacity of R. iyengari in actual field conditions, 12 natural anopheline breeding sites were chosen, each ranging in size between 50 and 450 m2. The species Anopheles albitarsis Lynch-Arribálzaga and Anopheles rondoni Neiva-Pinto were detected there, at densities that ranged from 34 to 66 larvae/m2. The biolarvicide was sprayed in all 12 breeding sites with a domestically manufactured pump set at a pressure of two atmospheres and a dose of 2,000 preparasites/m2. Seven days after treatments were performed, anopheline populations were markedly reduced (85 to 97%). Results obtained point to the feasibility of using R. iyengari to control larval populations of both species of anophelines.

During the last two decades Brazil has produced more than 80 scientific papers on carotenoids, most of which dealing with food composition, development of analytical methodology and the factors that influence composition. Varietal differences, agricultural practices, climate and stage of maturity, as well as food storage, processing and preparation are the main influencing factors. Studies on bioavailability and the functions and actions in health have also been carried out and are expanding. Recently, interest has grown on the degradation of carotenoids with the production of either desirable or undesirable aroma/flavor in foods. For the future, analytical and compositional studies should continue to enlarge the basis for agronomic, nutritional, medical and biotechnological projects. It is fundamental that the quality of analytical data continues to receive top priority, for this can mean the difference between reliable and confounding results, regardless of the sub-area of application.

Schistosoma mansoni partially develops its life cycle into snails of the Family Planorbid. Biomphalaria glabrata represents an important host-intermediate. This paper reports experimental infection with miracidia vs. snail in sympatric and parapatric combination. The infection assay to sympatric combination were: BH snail (Belo Horizonte, Brasil) vs. a common geographic origin parasite, and Barbula, Carabobo State, Venezuela vs. SM Venezuela parasitic. The parapatric combination were: BH snail vs. SM; Barbula vs. BH; Caripe Monagas State, Venezuela vs. SM and Caripe vs. SM. During the study period was observed not miracid penetration. The infection percentage ranged from 88.89% in Barbula vs. SM combination to 0.00% in the Caripe vs. BH and BH vs. SM combination. We concluded which different existence of susceptibility from evaluated combination.

Leprosy, a disease that used to be shrouded in darkness and fear, can now be cured thanks to a multidrug treatment schedule with rifampicin, clofazimine, and dapsone which has been in use since 1981. In 1991 the World Health Assembly, encouraged by the efficacy of this treatment regimen, established the goal of eliminating the disease as a public health problem globally and nationally by the year 2000. This goal, which calls for reducing disease prevalence to less than one case per 10,000 inhabitants, should not be confused with the goal of eradicating the disease, which implies a complete interruption of its transmission. Eliminating leprosy is an attainable goal which will depend on the forceful and massive use of the multidrug treatment regimen. This paper describes and discusses the various initiatives that have been launched in Latin America for the purpose of achieving this goal and the results obtained so far. It also explores the factors that impact on the feasibility of eradicating the disease.

This article analyzes the relationship between population growth and ethical principles relating to poverty. The paper is a critical approach to the thesis presented by Peter Singer in his book Practical Ethics. The first part briefly examines the principal topics of his thesis. The author then analyzes the basis of Singer's theory with respect to the following questions: 1. Is overpopulation the main reason for poverty? Is it possible to establish an association between the poverty phenomenon and population growth? 2. Is Singer s demographic perspective valid? 3. Can problems of resource distribution be ignored when talking about poverty from an ethical perspective? 4. Is it true that birth control policy was successfully implemented in Mexico, Colombia, and Brazil? 5. Does Singer s position on population growth have a negative influence on the "collective imagination"? The paper concludes by suggesting some useful arguments for understanding an ethical perspective towards poverty.

Since the 1970s, when malaria had seemed at the threshold of eradication, its incidence has increased in several countries of the world. This situation posed a series of questions, and for some time malariologists and public health authorities scarcely understood what was happening. In order to better comprehend the process, the author of this article studied the frequency of malaria cases in São Paulo, Brazil, from 1930 to 1990, attempting to examine the following factors in each of the periods studied: the importance of malaria in the society, the conditions under which the disease occurred, the epidemiologic knowledge of the time, the available technical instruments, and the control strategies that were used. Through the construction of technological models based on these factors, it became clear that the occurrence of the disease, knowledge about it, and, consequently, the ways it was dealt with changed over time. In light of this research, the paper discusses current options for the control of malaria.

The production of articles resulting from biomedical, clinical, and public health studies that originated in Argentina, Brazil, Chile, Cuba, Mexico, and Venezuela from 1973 through 1992 was analyzed to discover trends in health research in Latin America. From the database of the Institute for Scientific Information (ISI), 41,238 articles with first authors who resided in those countries were extracted. These articles were analyzed by subject area, type of study, country, number of authors and institutions that participated in the investigation, and citations received by each article. Also analyzed were 95 articles in epidemiology selected from a pool of 570 published by authors from the six countries in 11 public health journals that enjoy international prestige. The results showed that the number of published works increased by 117% between the first and last five-year periods within the study period. Clinical research was distributed the most evenly among the countries, and public health research was the most concentrated (60.7% originated in Brazil). The numbers of biomedical and public health research articles showed relatively more growth than those reporting on clinical research throughout the period. A relative decrease was found in articles by only one author, which suggests a greater frequency of team efforts, and an increase was seen in articles with authors tied to two or more national or foreign institutions, which indicates greater cooperation between institutions and countries. The average number of citations received by each article was 3, which was less than half the number received by the articles in the ISI database (7.78). Regarding the subset of 95 articles in epidemiology, the great majority (96%) dealt with infectious diseases or maternal and child health, while in the international literature 78% of such articles were about chronic diseases. This group of articles gave evidence of more cooperation with international institutions and had a citation index of 4.36 per article. It is concluded that, despite the inherent limitations, this type of study reveals some general trends in the development of research in the six Latin American countries with the greatest scientific production and makes it possible to formulate hypotheses on the factors that influence these trends. Taken with the paper caution, the results of studies like this one can be of great value in defining health science and technology policies.

Objectives: This paper was meant to analyse distribution of HbS carriers in Brazil, comprising its regional prevalence and the relationship with racial settlement and age groups., Material and Methods: 67,667 blood samples from 48 Brazilian towns were analysed from 1976 to 1988. Such samples were classified as Caucasoid and Negroid. The diagnosis was defined by means of qualitative electrophoresis in alkaline and acid pH, quantification of haemoglobin fractions, cytological studies and some cases were confirmed after examination of the parents., Results: The study of those 67,667 samples allowed us to detect 1,492 HbS carriers (2.2%). That frequency is higher among Negroids (5.16%) than among Caucasoids (1.22%): Z = 22.1397 (Zcritical; 0.05 = 1.9600). Taking the HbS carrier distribution into consideration, we noticed that it is relatively homogeneous among Negroids and higher than 5% in 9 out of the 16 areas involved in the study. By classifying the age group of the areas in the general sample and by comparing the proportions, we found out that there are significant differences (chi 2 = 50.88; chi 2 critical; 0.05; 5 gl = 11.070)., Conclusions: Sickle-cell anaemia diseases play an important role among the pathologies found in several countries, including Brazil. This paper shows that the carriers prevalence varies in the several areas under study and is higher among Negroids in almost all of them. The decreasing frequency occurring from North to South in the general samples and among Caucasoids may be assigned to the contribution of the Negroes in the interracial crossing, particularly in the Northeast.

"This paper reports on an attempt to use census data from Brazil in 1970 and 1980 to investigate a rise in household headship by unmarried mothers 15-49.... Demographic analysis can be useful in decomposing the change into that due to a changed propensity of women 15-49 years of age to be unmarried, to have children if unmarried, and to head their own household if an unmarried mother. This was further analyzed in terms of age, marital status (whether single, divorced/separated or widowed), region of residence, and urban-rural status....However, the research encountered data problems that make firm conclusions impossible...." This is a translation of a paper originally presented at the 1992 Annual Meeting of the Population Association of America. (SUMMARY IN ENG), (excerpt)

"Given the importance of information on the population age structure when planning short, medium and long-term needs within the different social strata, this paper is a proposal to deepen...the study of changes in the population pyramids.... Based on the most recent methodologies a study of age discontinuities is carried out and a method of follow-up by cohorts is suggested, taking the 15-19 and 20-24 age groups as an example. The purpose is to show that, as a...cohort ascends in the age pyramid, new and different necessities arise and also different responses are demanded on the part of the social system." Data are for Brazil as a whole and for the state of Sao Paulo. (SUMMARY IN ENG), (excerpt)

In Brazil, as in other Latin American countries, there was a sharp increase in the number of medical schools in the past 20 years. The result was a steep increase in the number of physicians. These professionals are in many cases, however, poorly trained. As a consequence, public, as well as private health services, are exposed to professionals of great diversity of qualification. Few effective solutions have been proposed for this health services management problem. This paper presents a potential solution. It exposes preliminary results of field tests of an Expert System based on the first author's (Rozenbojm) three decades of experiences as a clinician, and medical residency advisor. The system was developed using ESE IBM Expert Systems language and a mainframe hardware. It was designed to support diagnosis based only in anamnesis and physical examination data, without lab or X ray support. Its original purpose was to increase the primary care physician's diagnostic and therapeutic accuracy. An initial test with specialist panels (endocrinology, cardiology, nephrology, G.O., gastroenterology, pediatrics and pneumology) revealed spell out a diagnostic and therapeutic concordance rate over 95 percent (based on real everyday practice cases brought by the specialists). A second test was performed in a private Health Care Network, at primary care level. In this case, concordance rate was over 83 percent in diagnostic aspects and 95 percent in the clinical orientation aspects. This expert system may be very useful for Health Services providing, first encounter standardization, medical graduate basic education and cost containment. The next proposed steps includes transcription of the software for personal computer utilization and an evaluation of its economic impacts.

This paper covers a population from 0 up to 50 years old, considered as 'handicapped', at the A.P.A.E. in São Paulo, Brazil. Many differences in the characteristics of both social and family environment were analyzed, as well as diagnosis and etiologies regarding associated problems. An appraisal of the different influences on both social and individual factors was outlined so that strategies of attendance could be modified accordingly.

The article considers certain characteristics of 74 Brazilian medical journals listed in the Index Medicus Latino-Americano (IMLA) compiled by the Regional Library of Medicine and Health Science (BIREME). After remarking on the low survival rate of these publications, of which other studies list almost 2,000 titles between 1827 and 1978, the author cites the coverage of too many specialties, a lack of planning and of adherence to publishing schedules, and an overproportion of papers of dubious quality to promote sales of medical products as some of the reasons for the flight of Brazilian scientific articles to foreign publications. He also notes that, despite the disregard in which Brazilian journals are widely supposed to be held in the international scientific community, those that maintain acceptable standards of scientific quality, are published regularly and comply with international standards for the presentation of articles are cited often in collections of abstracts and indexes of international standing. Another aspect considered is the emergence in the structure of biomedical information in Brazil of an alternative medical press for the discussion of problems in the delivery of health services.

"This paper describes the historical evolution of five populations and analyzes the circumstances under which data on maternal and paternal orphanhood of couples at the moment of marriage were collected and compiled." The data, which concern historical populations in Mexico, Chile, Peru, Brazil, and Argentina, are used to construct life tables for male and female adults. Consideration is given to mortality differentials by sex. (summary in ENG), (excerpt)

An experiment in the teaching of public health for interns in the sixth year of medical training was launched in 1978 on the basis of the clinical practice of health services in Botucatu and neighboring municipalities. The course was designed to promote the practice of primary medical care, contacts with the different health professionals, analysis of the relations between health and the social structure, and an understanding of the organization of medical care in Brazil through discussions of day-to-day activities in health services, and of the role of medicine and medical care in the present capitalistic production structure of Brazil. The paper reports on the teaching experiment in 1978 and 1979, when the supervised training was taken by 85 and 95 interns, respectively, in groups of seven or eight for periods of 18 working days at the Botucatu Health Center-School (CSE) and the Anhembi and Itatinga Health Services. A comparison of the answers to tests given before and after the training and the opinions recorded by the students on the activities carried on show an improvement in their perceptions of team-work and of health education in the role of medicine and medical care in society. Most of the students expressed open approval of the training as a whole.

This paper offers a quantitative evaluation of the scientific information produced in Brazil on several endemic diseases: Chagas' disease, schistosomiasis, leishmaniasis, leprosy, malaria and filariasis. The source of data was the Index Medicus Latino Americano (IMLA), and the published scientific information was analyzed in general and specifically, by type of disease and year of publication. The indexed production of articles on the material of the Latin American countries as a whole increased from 3,506 articles in 1978 to 5,528 in 1982 (for an increase of 52.7%), whereas that of Brazil alone rose from 1,781 to 2,531 (an increase of 42.1%) during the same period. The output of articles on endemic diseases totaled 703 papers (6.3% of the total indexed production). Of this total, 441 (62.7%) was on applied research and 262 (37.3%) were on basic research, and these proportions held relatively constant. Chagas' disease and schistosomiasis accounted for 75.2% of that total over the period considered. The production of papers on the diseases of interest grew 79.2%, at the same rate as that of all biomedical information published in Brazil over the period. An equilibrium was reached between the numbers of basic and applied papers. The analysis also identified the core of Brazilian periodicals that most frequently publish information on those endemics. It was also found that a large proportion of articles by Brazilian authors are published in journals of international circulation, and the foreign journals that publish papers by researchers in Brazil were identified.