Luis David Castiel

Processo saúde/doença e complexidade em epidemiologia

O emprego da ideia de complexidade em epidemiologia serve para assinalar as crises, tanto no dominio interno da disciplina - resultante de uma cada vez mais evidente limitacao de seus instrumentos conceituais (modelos e teorias) para lidar com a realidade concreta da saude - como no dominio do contexto cultural (paradigmas, quadro epistemico, Zeitgeist, Weltanschauung) no qual os problemas de saude estao inscritos. Apesar de ambas as abordagens serem pertinentes, sob a otica do sistema e do ambiente, sua separacao leva a uma apreensao restrita dos atuais desafios no campo sanitario, e, portanto, insuficiente para promover a saude e o bem-estar de individuos, populacoes e biosfera. A ideia de complexidade propoe-se a ultrapassar esta precariedade, apontando o reducionismo das dicotomias oriundas da era moderna, que tende a nao estar equipado para perceber o universo composto por relacoes e emergencias de novas propriedades ao se transitar por niveis diferenciados de organizacao. Alem disso, discute modos de encarar os processos que ocorrem entre os seres vivos de maneira a incluir dimensoes dinâmicas, evolutivas e historicas. Assim, ha indicios de crise da Epidemiologia que apontam para a necessidade da complexificacao de seus instrumentos pratico-discursivos, de forma a viabilizar construcoes mais satisfatorias do processo saude-doenca.

New information technologies and health consumerism

Concepts related to consumption have shifted to include social processes not previously covered by traditional categories. The current review analyzes the application of classical concepts of consumerism to practices recently identified in the health field, like the phenomenon of cyberchondria. The theoretical challenge relates to the difficulty in extrapolating from the economic perspectives of consumerism to self-care issues in the context of information and communication technologies (ICTs). Drawing on recent anthropological categories, the study seeks to understand the phenomenon of self-care commodification under the imperative of self-accountability for health. New consumer identities are described in light of the unprecedented issues concerning technical improvements currently altering the nature of self-care. The study concludes that health is consumed as vitality, broken down into commercial artifacts in the context of a new bioeconomy - no longer linked to the idea of emulation and possession, but to forms of self-perception and self-care in the face of multiple risks and new definitions of the human being.

Medicina Baseada em Evidências: "novo paradigma assistencial e pedagógico"?

A denominada ‘medicina baseada em evidencias’ (MBE) originou-se do movimento da epidemiologiaclinica anglo-saxonica, iniciado na Universidade McMaster no Canada no inicio dos anos noventa. Edefinida em termos genericos como o “processo de sistematicamente descobrir, avaliar e usar achadosde investigacoes como base para decisoes clinicas” (Evidence Based Medicine Working Group, 1992).Atualmente, a MBE esta bastante em voga no âmbito biomedico, ai assumindo um papel de destaque, detal modo que suas influencias nas condutas medicas se manifestam significativamente. Basta consultar oMedline para obter profusas referencias, atestando a difusao da proposta.Vale ressaltar que os adeptos da MBE propoem uma escala tipologica da forca das evidencias quedeve ser considerada para os processos decisorios nas praticas biomedicas.

Insegurança, ética e comunicação em saúde pública

Insecurity and some aspects that affect contemporary societies are described. They are approached analytically as a question of public health concern. Some topics are brought into discussion regarding the relationship between health workers and various levels of information and public communication of risks and health issues, using biotechnological problems as examples. Finally, it is pointed out the need to further development global ethics for public health problems related to social inequalities and vulnerabilities of large populations worldwide.

LAS TECNOLOGÍAS DE LA INFORMACIÓN Y LA COMUNICACIÓN EN SALUD PÚBLICA: LAS PRECARIEDADES DEL EXCESO

A critique of the possible side-effects of the current use of communications and information technologies in health and the implications thereof for Public Health theory and practice. The idea of excess and it scarcities is invoked from the sociological perspectives of Ellul, Illich and Bauman, as a way of monitoring the changes wrought by the general use of technical objects and the communication strategies. Particular emphasis is placed on the role of scientific journalism in the dissemination of biotechnology-related subject matter. Some suggestions are also made for setting out guidelines for regulating this activity. Additionally, under the heading of framing, relevant persuasive dimensions are presented which may interfere with the modern communication-related practices in health. By virtue of the involvement of other aspects within the scope of excess and its scarcities in Public Health, such as in the case of nutrition or the emerging diseases, emphasis is placed on the role played by public health specialists in studying health-related matters from this viewpoint as perhaps one of the ways of contributing toward a global epidemiology.

Jesus tem dentes metal-free no país dos banguelas?: odontologia dos desejos e das vaidades

This paper describes how dentistry in Brazil currently participates in the transformations of the object of its activity into commodities with which consumers can indulge their aesthetic desires. It explores the construction of the dental object of desires and its relationship with the dentist and the patient-consumer in the contemporary world. The paper makes explicit the role of the mega-dental congresses, which provide a biotechnological self-service that allure and seduce, creating uniform consumer values eager for the new offerings from dental surgeons. Also analyzes the role of the media in dental practices. It concludes that the individuation of the dental surgeon has generated a petrified ontology and fragmented epistemology. The paper presents some pressing tasks for the academic and professional sectors and society as a whole, such as the development of strategies and discussion about communication related to oral health.

Cancer prevention campaigns and Internet access: promoting health or disease?

Background: The Internet has become the most popular source of reference on health-related issues. However, little has been invested in studies that use it as a tool to evaluate health-related cultural events as cancer prevention campaigns. Aims: To correlate audience patterns on the web pages of a Brazilian Ministry of Health (MOH) cancer institute (http://www.inca.gov.br) with government campaigns in this area. Methods: 24 consecutive months of observational study of a cancer site sponsored by the MOH, using a commercial software package to analyse electronic records (log files) of all visitors’ movements. Variables observed included number of visits, time spent on each visit and the monthly return rate at six selected pages (three relating to cancer as a disease and three to prevention measures). Results: The audience was observed to grow gradually over the 2 years, with peaks in the periods around the campaigns. The topics of most interest were concentrated in pages on cancer diagnostic and treatment technology. Pages on preventive measures were less visited during the campaigns, and their audience varied little over the 24 months. Conclusion: A historical analysis of log files for reference sites revealed interesting patterns that may be helpful for planning and evaluating institutional campaigns. Practical implications: in view of the results of this study, the website was improved to offer better information on preferred topics and to include more links with prevention-related pages. Log file assessment after health campaigns could provide useful input to planning.

Proliferação das rupturas paradigmáticas: o caso da medicina baseada em evidências

The present study describes the phenomenon of paradigmatic ruptures proliferation in the biomedical literature. The current distortion is discussed, which has conferred in the last decades an opposite meaning to the term originally proposed by Thomas Khun. In most part, it is realized that pseudo-ruptures refer to technical details associated to specific contexts. It is pointed out the case of evidence- based medicine (EBM), proclaimed as one of these paradigmatic ruptures, but which essentially corroborates old concepts. Some conceptual errors are stressed as well as attempts to apply EBM assumptions to phenomena associated to subjectivity and social dynamics and other particular study subjects of social sciences. Twelve inconclusive meta-analyses are described to exemplify the paradoxes emerging from this approach. The criticism to some EBM features is summarized through the effects of epistemological bafflement, producing conceptual inaccuracies of the term; the defensive effect to which other disciplines are induced for not being adequate to such rationality; and the tendency of universal understanding of phenomena through the perspective of randomized double-blind studies.

Uma saúde pública molecular

This article focuses on the relationship between Public Health and Molecular Genetics. Both the notion of Public Health and correlate expressions are discussed in an attempt to establish their respective objects of investigation and fields of practice. In addition, a brief description is given of the precarious health conditions in Brazil. The author remarks on the limited social effectiveness of the role ascribed to public health professionals in Brazil. Techniques and concepts developed by Molecular Genetics are presented and their importance for Public Health is analyzed. Genetic risk is discussed and compared to the idea of inherited disposition to disease, with special emphasis on ethical and epistemological points of view. The notion of expert is considered in terms of its adequacy for training health professionals to deal with issues pertaining to Molecular Biology and Human Genetics in Public Health matters. Lastly, the author argues for the role of the state in defining social priorities in health.

Planejamento em Saúde e Epidemiologia no Brasil: casamento ou divórcio?

O presente artigo discute a relacao entre o instrumental epidemiologico e os metodos de planejamento das atividades de Saude Publica no Brasil Para isso, sao apresentadas, de forma resumida, concepcoes e atuais tendencias de ambas disciplinas. Tambem e considerado um esquema de analise da racionalidade no processo de planejamento. Por fim, aventa razoes para explicar o fracasso do planejamento em saude no Brasil e o papel da epidemiologia nesta situacao.