Reinaldo Guimarães

Desafios da pós-graduação em saúde humana no Brasil

Se discute el reconocimiento del papel creciente de demandas y actores extra academicos en la dinamica de la formacion de recursos humanos para el mercado y, en particular, para la investigacion, asi como la actuacion en sinergia con el movimiento de madurez del sistema sectorial de innovacion en salud y con las prioridades del Sistema Unico de Salud de Brasil. Se analiza la adecuacion de la metodologia del proceso de evaluacion de la Coordinacion de Perfeccionamiento de Personal de Nivel Superior a tales tendencias, lo que significara, de manera general, agregar nuevos indicadores de productividad tecnologica y social a los criterios predominantemente academicos ya existentes. Discute la continuidad y la profundizacion de las iniciativas en curso en el sentido de admitir nuevos formatos de programas y cursos de postgrado, cursos adaptados a las demandas del mercado extra academico, entre otros, sean sociales o tecnologico-empresariales, asi como la profundizacion de las iniciativas para estimular estudios postdoctorales, escasos en Brasil.Recognition for the growing role of extra-academic demands and players in the dynamics of human resource training for the market and, in particular, for research is discussed. Their synergies with the movement towards maturation of the sectoral system of healthcare innovation and with the priorities of the Sistema Único de Saúde (Brazilian National Health System) are discussed. The methodological adequacy of the process for evaluating these trends used by the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (Coordination Office for Advancement of University-level Personnel) is analyzed. In a general manner, these trends mean adding new indicators for technological and social productivity to the predominantly academic criteria that already exist. The continuation and deepening of ongoing initiatives aimed at bringing in new formats for postgraduate programs and courses and new courses customized for the demands of the extra-academic market, among other markets, either of a social or technological-business nature, are discussed. In addition, the deepening of initiatives for stimulating postdoctoral training work, which is scarce in Brazil, is discussed.

Epidemiological research in Brazil

The current epidemiological research in Brazil is described. Secondary data sources were consulted, such as the year 2000 database of the Brazilian Directory of Research Groups and the National Board of Scientific and Technological Development (CNPq). The criterion to identify a group as a research one relies on the existence of at least one research line in the field of epidemiology, as defined by the group leader. After identifying the defined universe of epidemiological research, which included 176 groups and 320 different research lines, the following issues were presented and discussed: the relationships between research financing and health research, focusing on CAPES (Coordination Center for the Advance of University Professionals) graduation programs, public health research and epidemiological research, geographic and institutional distribution and outreach of the current epidemiological research, the researchers and students directly participating in epidemiological research, research topics and patterns of disseminating research findings; the journals where papers in its fullness were published; the financial support of the epidemiological research focusing on the 23 officially recognized graduate programs in public health field.

Pesquisa no Brasil: a reforma tardia

This article examines the science and technology reform currently underway. This reform, sponsored by the Brazilian federal government, is set in a historical context, allowing for a discussion of the particular characteristics of the science and technology sphere during each period.

O papel da pesquisa na consolidação do Sistema Único de Saúde (SUS)

The challenge of providing quality while maintaining costs at affordable levels for society has motivated the implementation of health system reforms in various countries, seeking “allocative efficiency”, namely, prioritizing actions with the best cost-effectiveness ratio. This situation assigns increasing value to the adoption of evidence-based practices and policies. In Brazil, however, there was a persistent mismatch between scientific output and the use of its results in defining health policies and services. The Department of Science and Technology (DECIT), strengthened by the creation of the Secretariat of Science, Technology, and Strategic Inputs under the Ministry of Health in 2003, has contributed to identifying and promoting strategic research for the SUS. The main guidelines for the work by DECIT are provided by the National Agenda for Research Priorities in Health and the National Policy for Science, Technology, and Innovation in Health (PNCTIS), both approved during the 2 nd National Thematic Conference in 2004. The Conference included extensive involvement by health researchers, professionals, managers, and users of the National Health System (Guimaraes R, et al., Cad Saude Publica 2006; 22:1775-94). Participation by SUS managers has been crucial for including health problems on the scientific research agenda. An example is the growing participation by State health departments in the management of the Research Program for the SUS, implemented in all States of Brazil financed by DECIT and State Foundations to Support Research. The presence of the DECIT in the national coordination of health research has also allowed Brazil to establish multicenter studies and collaborative networks that require broad dialogue among many stakeholders. The Longitudinal Study on Adult Health (ELSA) and the National Networks for Clinical Research and Cell Therapy are examples of this exercise, demonstrating maturity in the management of health research investments. From 2003 to 2009, DECIT financed more than 3,700 research projects and made available R

Challenges of postgraduate human health programs in Brazil

650 million in funds, 60% of which from its own budget and the rest from partner institutions. In the area of specialized care, the strengthening of the scientific basis for incorporating products and services into the SUS requires serious attention, without which the system’s sustainability will be in jeopardy. Considering the need to guarantee the Constitutional right to health, the high costs of new diagnostic and therapeutic techniques, and the growing recourse to court injunctions by users of the SUS to ensure their access to treatment and medicines, decisions by health managers at the 3 levels of government must be backed by cost-effectiveness and cost-utility estimates. In this sense, the creation of the Commission for the Incorporation of Technologies by the Ministry of Health in 2006, the consolidation of the Division for Health Technology Assessment under DECIT, the establishment of the Brazilian Network for Health Technology Assessment (REBRATS), and the approval of the Technology Management Policy in the SUS are important initiatives. Specifically, DECIT has already issued three calls for research projects on health technology assessment and hired 278 studies. These efforts notwithstanding, much remains to be done. In the current context, perhaps the main challenge is to define an organizational structure to promote technology research and assessment in the SUS, ensuring the continuity and extension of the actions under way. Dealing with this challenge requires participation not only by health managers, professionals, and community representatives of social control in the SUS, but also by members of the scientific community.

Research on chronic noncommunicable diseases in Brazil: meeting the challenges of epidemiologic transition

Se discute el reconocimiento del papel creciente de demandas y actores extra academicos en la dinamica de la formacion de recursos humanos para el mercado y, en particular, para la investigacion, asi como la actuacion en sinergia con el movimiento de madurez del sistema sectorial de innovacion en salud y con las prioridades del Sistema Unico de Salud de Brasil. Se analiza la adecuacion de la metodologia del proceso de evaluacion de la Coordinacion de Perfeccionamiento de Personal de Nivel Superior a tales tendencias, lo que significara, de manera general, agregar nuevos indicadores de productividad tecnologica y social a los criterios predominantemente academicos ya existentes. Discute la continuidad y la profundizacion de las iniciativas en curso en el sentido de admitir nuevos formatos de programas y cursos de postgrado, cursos adaptados a las demandas del mercado extra academico, entre otros, sean sociales o tecnologico-empresariales, asi como la profundizacion de las iniciativas para estimular estudios postdoctorales, escasos en Brasil.Recognition for the growing role of extra-academic demands and players in the dynamics of human resource training for the market and, in particular, for research is discussed. Their synergies with the movement towards maturation of the sectoral system of healthcare innovation and with the priorities of the Sistema Único de Saúde (Brazilian National Health System) are discussed. The methodological adequacy of the process for evaluating these trends used by the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (Coordination Office for Advancement of University-level Personnel) is analyzed. In a general manner, these trends mean adding new indicators for technological and social productivity to the predominantly academic criteria that already exist. The continuation and deepening of ongoing initiatives aimed at bringing in new formats for postgraduate programs and courses and new courses customized for the demands of the extra-academic market, among other markets, either of a social or technological-business nature, are discussed. In addition, the deepening of initiatives for stimulating postdoctoral training work, which is scarce in Brazil, is discussed.

A eficácia do exame telerradiográfico de tórax como técnica de "screening" em população hospitalar

In Brazil, chronic noncommunicable diseases (CNCDs) are the leading cause of death and a major contributor to the national disease burden. This article describes CNCD research funded by the Ministry of Health Department of Science and Technology (DECIT) to support the production and dissemination of scientific evidence for the national health system, in accordance with the National Agenda of Priorities in Health Research, and within the context of Brazils epidemiologic transition. Data were obtained from Ministry of Health database management systems. CNCD-related projects financed by DECIT from 2002 to 2009 were analyzed by research theme (cancer, obesity, hypertension, diabetes, cardiovascular diseases, CNCDs in general, and CNCD risk factors) and geographic region. In terms of funding and number of projects, the most-supported research theme was cancer, and the most-supported region was the Southeast. Project type varied widely, ranging from basic scientific studies to highly technological research and development. Results obtained included epidemiologic profiles and surveillance, cost, and quality-of-life data.

Moral dilemmas and health practices

The author analyses the efficacy of the AP chest telerradiograph as a screening technique in a Hospital - based population. It is shown that the AP chest X-Ray is of little value to the patient at the time of admission, first out-pacient visit and during pre-operatory evaluation. Only 7% of the patients studied showed a relevant assymptomatic pathology diagnosed by the examination. In patients aged 0-19 years, no abnormalities were identified by this procedure. The author suggests that AP chest X-Rays be discontinued for this age group and recommends its substitution by roentgen photography (35 mm) for older age groups.

Dilemas morales y practicas de salud

The emergence of moral dilemmas in health care practices, in view of the rapid demographic transition in developing countries, and skyrocketing public health care costs, is discussed. The focus is on two aspects of health care that have occupied an important place in the generation of these dilemmas. On the one hand, the tension between commercial strategies involving the health products market and the expansion of access to them and, on the other, the growth of techno-sciences in health care practices. In conclusion, the importance of the political, social and juridical arbitration on the ethical codifi cation of those dilemmas and the role of a Democratic State of Law in that arbitration is discussed.Discute-se a emergencia de dilemas morais nas praticas de saude, tendo em vista a acelerada transicao demografica nos paises em desenvolvimento e os crescentes custos dos sistemas publicos de saude. Sao focalizadas duas dimensoes do cuidado a saude que tem ocupado um lugar importante na geracao desses dilemas: a tensao entre as estrategias comerciais que contornam o mercado de produtos de saude e a expansao do acesso a esses produtos, por um lado, e o aumento da importância das tecnociencias nas praticas de cuidado a saude, por outro. Em conclusao, e discutida a importância da arbitragem politica, social e juridica na codificacao etica desses dilemas e o papel do Estado Democratico de Direito nessa arbitragem.

Dilemas morais e praticas de saude

The emergence of moral dilemmas in health care practices, in view of the rapid demographic transition in developing countries, and skyrocketing public health care costs, is discussed. The focus is on two aspects of health care that have occupied an important place in the generation of these dilemmas. On the one hand, the tension between commercial strategies involving the health products market and the expansion of access to them and, on the other, the growth of techno-sciences in health care practices. In conclusion, the importance of the political, social and juridical arbitration on the ethical codifi cation of those dilemmas and the role of a Democratic State of Law in that arbitration is discussed.Discute-se a emergencia de dilemas morais nas praticas de saude, tendo em vista a acelerada transicao demografica nos paises em desenvolvimento e os crescentes custos dos sistemas publicos de saude. Sao focalizadas duas dimensoes do cuidado a saude que tem ocupado um lugar importante na geracao desses dilemas: a tensao entre as estrategias comerciais que contornam o mercado de produtos de saude e a expansao do acesso a esses produtos, por um lado, e o aumento da importância das tecnociencias nas praticas de cuidado a saude, por outro. Em conclusao, e discutida a importância da arbitragem politica, social e juridica na codificacao etica desses dilemas e o papel do Estado Democratico de Direito nessa arbitragem.