Dina Czeresnia

The concept of health and the difference between prevention and promotion

In this article the author presents a point of view which she considers central to understanding the difference between prevention - associated with the traditional discourse of public health - and health promotion, an idea in connection with which proposals are now being presented for rethinking and redirecting public health practices. This perspective relates to the limits of the health and disease concepts in relation to the concrete experiences of health and illness. On the one hand, practical awareness of this limit implies far-reaching changes in the way scientific knowledge is related to (and used in) the formulation and organization of health practices; on the other, health promotion projects also avail themselves of the concepts guiding the discourse of prevention. This leads to certain difficulties that appear as inconsistencies or gray areas in the operationalization of promotion projects, which do not always succeed in asserting their nature as distinct from traditional preventive practices.

Factors associated with malocclusions in children and adolescents with Down syndrome

INTRODUCTION Our aims in this study were to determine the prevalence of malocclusion stemming from vertical or transversal occlusal alterations in subjects with Down syndrome (DS) and the associations with individual, socioeconomic, and behavioral factors. METHODS A cross-sectional study was carried out with 112 pairs of mothers and their children with DS between 3 and 18 years of age attending a genetics clinic at a public hospital in Rio de Janeiro, Brazil. Data were collected with a questionnaire given to the mothers and a clinical examination of the child or adolescent. Univariate, bivariate, and multiple logistic regression (backward stepwise) analyses were conducted. RESULTS The results showed a prevalence of malocclusion in 74% of the sample. After the adjustment of the logistic regression model, these variables--age, nail or finger biting habit, mouth posture, and cold or sore-throat episodes in the previous 6 months--were associated with the prevalence of malocclusions in these subjects. CONCLUSIONS The data demonstrate a high prevalence of malocclusions stemming from vertical or transversal occlusal alterations in children and adolescents with DS. Age, nail or finger biting, mouth posture, and upper airway infections were related to malocclusions in these patients.

Ciência, técnica e cultura: relações entre risco e práticas de saúde

This article discusses the cultural consequences of discourses and practices aimed at training subjects for a rational, informed choice in relation to risks, calculated on the basis of scientific knowledge. The epidemiological risk concept is a central element in this process, especially in the context of health practices. The article begins by briefly characterizing the epidemiological risk concept, emphasizing that as an abstract model, it reduces the complexity of the phenomena it studies. Grasping reality through this abstraction generates values and meanings. Canguilhems reflection on the relations between science, technique, and life is further discussed from the perspective of deepening an understanding of the cultural consequences of this process, contributing to the transformation of classical concepts of individuality, autonomy, and sociability. Such vital themes as individuality, alterity, and the relationship with death are present (albeit disguised) in issues that involve the central nature of risk in the contemporary world.

A interiorização da epidemia de HIV/AIDS e o fluxo intermunicipal de internação hospitalar na Zona da Mata, Minas Gerais, Brasil: uma análise espacial

The aim of this article was to analyze the decentralization of the HIV/AIDS epidemic (a shift towards rural areas or away from the coast) and to investigate access to HIV/AIDS services from 1988 to 2002 in the Zona da Mata, Minas Gerais State, Brazil. An ecological study was performed using temporal and spatial approaches. A hospital admissions flow between municipalities developed, and the reference group was AIDS patients over 15 years of age admitted in 1996 and 2004, residing in municipalities in the Zona da Mata. There were 2,469 reported AIDS cases in individuals over 15 during the period. Mean incidence and mortality rates were calculated and recalculated by a local empirical Bayesian method in order to more clearly represent the municipalities with the highest concentration of cases and deaths. Decentralization of the epidemic was observed. Juiz de Fora was the municipality with the most cases and may have acted as a hub for spread of HIV in the region. Hospital care for AIDS cases in the Zona da Mata was concentrated in that municipality. There is a strong need to further investigate why referral hospitals in other municipalities in the region have not participated in providing management and care for HIV/AIDS patients.

Spatial analysis for stratification of priority malaria control areas, Mato Grosso State, Brazil

The goal of this study was to stratify priority areas for malaria control in the State of Mato Grosso, Brazil, based on spatial analysis. The variables used were: Annual Parasite Index (API), Plasmodium falciparum/Plasmodium vivax ratio, population variation, number of families settled, and percent of deforested area. The Morans I and Local Moran Test were applied, visualized with the Box Map and Moran Map, for 1986- 1991, 1992-1997, and 1998-2003. Box Map identified areas with high, low, and intermediate priority for control, and Moran Map identified municipalities with significant autocorrelation. In the high priority area, located in the North of Mato Grosso, malaria incidence decreased drastically despite the increase in the number of municipalities from the first to the last period. Other municipalities were added to the lower priority area, from the Southeast, Southwest, and Central-South of the State. The intermediate priority area was located along the border with neighboring States and municipalities classified as high and low priority. Spatial analysis showed the importance of the neighboring phenomenon between municipalities in defining priority areas, thus highlighting the techniques advantages for use in malaria control and surveillance.

Considerações sobre os discursos do aconselhamento nos centros de testagem anti-HIV

O objetivo do trabalho foi analisar a incorporacao da pratica de aconselhamento nos centros de testagem anti-HIV, como decorrencia da construcao discursivo-social da AIDS, no contexto da modernidade tardia e com base na proposicao expressa pelo Programa Nacional de DST/AIDS do Brasil. Como principal referencia analitica, foram tomadas as influencias globais no processo de democratizacao dos discursos e das praticas modernas, contextualizadas por Fairclough. Utilizou-se tambem como referencia teorica a evolucao dos discursos preventivos veiculados desde a identificacao da infeccao e as tecnologias de poder disciplinar e de confissao. O aconselhamento contempla temas importantes, como tecnologizacao, reflexividade e dialogo. Pode-se identificar, nele, um jogo de ambiguidades entre os sistemas democratico e coercitivo, conjugando modos liberadores e disciplinares. Compreender o aconselhamento sob o ponto de vista dessa ambiguidade gera questionamentos ainda pouco investigados. E necessario entender a pratica do aconselhamento do ponto de vista do usuario, a quem a proposta e dirigida.

Avaliação do programa de prevenção e promoção da saúde de fenilcetonúricos

OBJETIVO: Avaliar os resultados de acoes preventivas e de promocao a saude institucionalizadas para criancas fenilcetonuricas. METODOS: Foram avaliados os resultados alcancados pelo Programa de Triagem Neonatal, do Estado do Parana, entre os fenilcetonuricos, no periodo de 1996 a 2001. Foram investigados dados socioeconomicos e aplicado instrumento de medicao da funcao motora grossa para determinar as habilidades motoras de 32 criancas fenilcetonuricas com diagnostico e tratamento precoces. Optou-se pela utilizacao do coeficiente de correlacao de Pearson para verificar a relacao entre a variavel de interesse (escore motor) e as demais variaveis quantitativas (nivel medio de fenilalanina pos-tratamento, escolaridade do pai e da mae, idade da crianca no inicio do tratamento e renda familiar). RESULTADOS: Dentre as criancas avaliadas, 93,7% apresentaram desenvolvimento de acordo com os parâmetros de normalidade referenciados na literatura. O tratamento foi iniciado no primeiro mes em 71,9% dos casos de fenilcetonuria. A pesquisa socioeconomica registrou 39,5% de pais com instrucao ate o quarto ano escolar. Foi encontrada correlacao significativa entre o escore motor da crianca e a escolaridade dos pais (N=32), e entre o escore motor e a precocidade do tratamento (N=27). CONCLUSOES: Os resultados evidenciaram a alta efetividade do programa avaliado. A baixa escolaridade dos pais e sua relacao com o escore motor ressaltam a importância do apoio aos pais na dietoterapia. A relacao encontrada entre o escore motor e o inicio do tratamento confirma a necessidade da adesao imediata ao programa. A inexistencia na literatura de outros estudos de avaliacao dificulta a generalizacao dos resultados.

Comportamento epidemiológico da malária no Estado de Mato Grosso, 1980-2003

The temporal and spatial evolution of malaria in Mato Grosso was determined in periods from 1980-1985, 1986-1991, 1992-1997 and 1998-2003 and distributed by homogeneous microregion. The annual parasitic index of the state rose until 1992 and then diminished to 1.9 cases/1,000 inhabitants in 2003, the ratio of mortality and the lethality rate were greater in the 1980s. Of the 22 microregions, 13 presented an API inferior to 10 cases/1,000 inhabitants in all periods. Cases were concentrated in the microregions of Colíder, Alta Floresta, Aripuanã and Alto Guaporé. In 2003, only the microregion of Aripuanã continued to present an API superior to 50 cases/1,000 inhabitants. The microregions of Colíder, in 1983, 1985 to 1988 and 1990 and Alta Floresta, in 1991 presented deaths over 50/100,000 inhabitants, mainly in males aged 20-49 years. The distribution of the disease in microregions showed that malaria is predominantly found in concentrated sites.

O conceito de vulnerabilidade e seu caráter biossocial

Um dos exercicios teoricos da Saude Publica diz respeito a necessaria e continua tarefa de se discutirem os conceitos nos quais se ancoram suas praticas. Uma analise critica sobre os usos do conceito de vulnerabilidade em saude, com base em uma revisao sistematica, serve de suporte para uma discussao sobre seu conteudo, alcances e limites, no sentido de fortalecer a potencialidade teorica e pratica do conceito e o dialogo entre as distintas areas de conhecimento implicadas. O conceito de vulnerabilidade apresenta alta capacidade heuristica e aplicacao diferenciada. Neste artigo, ele e caracterizado com base em complexos processos de fragilizacao biossocial que exprimem, de maneira inextrincavel, valores biologicos, existenciais e sociais. Esta perspectiva considera vulnerabilidade como dimensao ontologica constitutiva e constituinte da vida humana, que reclama distintos e complexos sistemas de seguranca.

Interfaces do corpo: integração da alteridade no conceito de doença

A cultura ocidental fragmentou o corpo em redutoras perspectivas teoricas que fizeram aparecer diferentes ordens de realidade: biologica, psiquica e social. Este artigo identifica o limite da biomedicina em integrar a alteridade no conceito de doenca, como uma das lacunas importantes para a aproximacao entre os conceitos de psiquismo e corpo biologico. Apresenta a proposicao de que as interfaces do corpo sao centrais para a compreensao da constituicao do corpo biologico em seus processos de individuacao. Levanta a possibilidade de ocorrer uma transformacao epistemologica na medicina, a partir da valorizacao dos estudos sobre fenomenos biologicos que ocorrem nestas interfaces. Ressalta, mediante analise da literatura medica recente, indicios de uma possivel integracao da alteridade no conceito de doenca. Esta analise se detem na crescente elaboracao de um discurso sobre a relacao com os microorganismos e sua importância na constituicao ontogenica do organismo humano e, por consequencia, na etiologia das doencas.