EDITORIAL
José da Rocha Carvalheiro
In this issue we are going back to an initiative announced during the first year of publication of Revista Brasileira de Epidemiologia, the Debate Section. It was introduced at the time, with an article by Maurício Barreto "For an epidemiology of the collective health". Despite the quality of the contribution, it did not reach the expected success in terms of promoting debate. We believe that the lack of response to the implicit challenge in the article was due to three major factors. On one hand, the new journal, still on the second issue of its first year, had little penetration. On the other hand, we made the tactical mistake of considering that the novelty of some of the ideas expressed by the author would be enough to attract debaters, who would come forth spontaneously. Finally, the lack of a more expeditious means of promotion in virtual media, that could enable the participation of debaters from anywhere in the world. In the Editorial of that same issue, we announced a debate, which was then as is the case now, very current: the double standard of research ethics in humans, in the first world and in the peripheral world. It was not fruitful either.
This time, we are going back to an issue that somehow coincides with the theme of Barreto's article. It is a contribution by Juan Gérvas and Mercedes Pérez Fernandez, from CESCA's Team in Madrid, Spain, discussing "The scientific basis for the gatekeeping role of general practicioners". "Scientific basis" means to the authors the hegemonic contribution of epidemiology. Their reflections on the (positive and negative) predictive values of the actions of generalist and specialist physicians, particularly, deserve a careful reflection on the meaning that both these "statistics" can give to the shape healthcare models take (an organized social response to diseases and aggravations). This analysis somehow takes us back to the texts of Ricardo Bruno Mendes Gonçalves, especially his PhD thesis in the 1980's. Gonçalves' reflection on the dynamic relationship of the clinic with epidemiology takes into account that the latter, understood as non-material technology, is capable of putting an order to the practice of the former: and it is not true the other way around. In the more current Brazilian scenario, it is essential to delve into the paths that the Unified Health System (SUS) is taking, especially if we consider initiatives such as the Family Health Program (PSF) and its community agents, physicians, nurses, dentist, and others; the action of the Supplementary Health Regulatory Agency (ANS) in face of health plans and insurance, operators and caregivers; the growing emphasis on health innovations and their spread into individual and collective practice actions. In order to avoid the mistakes of the previous initiative: first, RBE is not so unknown now; after seven years, we are already on many databases, especially the SciELO, which provides us the opportunity to encourage debate, at least within the scope covered by this network; secondly, we have already ordered responses from specialists, which will be published next issue (September), keeping the channel open to spontaneous contributions. The debate will be mediated by the authors of the original article, published in the present issue.
Other controversial themes are being prepared for the September issue. The first is to resume the debate on research ethics in humans, again mediated by Dirceu Greco. We had already published a Special Editorial by this author in 2003, discussing the difficult issue of the treatment to be offered to volunteers of clinical studies that may present health problems. Particularly, those who may be infected by the HIV in preventive vaccine trials, where this issue is more intensely debated. In a recent "Survey", conducted in March 2005, in Blantyre, Malawi, Africa, sponsored by the "Global Forum on Bioethics in Research" and the "Wellcome Trust", a matrix of actions was produced contextualizing the provision of healthcare and treatment to the volunteers of studies and introduced a new approach ("Research Governance") to approach the debate on best practices. This matrix is submited to a type of public survey, and journals with peer review, like ours, are being called to contribute. Professor Greco will mediate the debate.
The second, which is about to emerge, is the requirement for "Mandatory Registration of Clinical Trials". This requirement was strengthened by the ultimatum given by the Editors Committee of the leading health journals to pharmaceutical companies: they will only publish, after July 1st, this year, the scientific papers that were previously registered in public databases and made available to the entire society. There were successive meetings: in New York, at the Rockefeller Foundation, in October 2004; in the Health Ministers Summit, in Mexico, in November 2004; in Geneva in April 2005; and then in the WHO's World Health Assembly, in May. The deadline has already become more flexible, considering that ongoing trials will have until September to comply. Many issues are still pending, but the most important within the context of Latin America is to know the role we can play: production laboratories that do not belong to the "big pharma"; scientific editors of the SciELO network; and, especially researchers on this side of the planet. The seminal text in this debate can be the manifest of the "Editors Committee", which has been published in Editorials of all "big pharma". We are going to request authorization to reproduce it in our next issue, but it can already be accessed for free in those journals.
We are also publishing a Special Editorial, written by health statistics experts from USP's School of Public Health (Laurenti, Mello Jorge, Lebrão, Gotlieb & Almeida) "Vital Statistics: counting births and deaths". In it, authors comment the article published in March 2005 in the WHO Bulletin, describing an evaluation of death registration in 115 countries "that sent data". Particularly striking is the classification of our Mortality Information System (SIM), which is almost thirty years old, among the 55 countries classified as having "medium quality". In Latin America, Chile, Colombia, Costa Rica, and Uruguay fall in the same category; some European countries like Germany, Austria, Belgium, France, Denmark, and Sweden, which have tradition in the area of health statistics, share the same classification. We are not in bad company.
In the continuing flow, strictly dictated by the peer review system, this issue presents ten original papers, all of them Brazilian. Most of them are from the southeast, five of them from São Paulo, one from Rio de Janeiro, and another one from Minas Gerais. Two papers are from the northeast, from Maranhão and Rio Grande do Norte, and only one comes from the south, Paraná. Maintaining our traditional number of authors, only one paper has been written by one author alone, with an average of 3.1 authors per paper; the majority of two thirds of them are women (20/31).
We are featuring papers on methodology. One of them addresses the myth of considering that only in rare diseases it is possible to approximate the odds ratio to the measure of relative risk in case-control studies. In the other paper, artificial neural networks and logistic regression are used to predict the sero-prevalence of hepatitis A.
Another study analyzes the results of the "Health, well-being and aging" project (SABE), in the city of São Paulo. It addresses the "worrying health status of the elderly" and the insufficient social security.
In a study conducted in Natal, Rio Grande do Norte, the diagnosis of pulmonary tuberculosis is facilitated by the identification of factors associated to TB in medical records, in the facilities which have low-sensitivity sputum smear. Another study uses information of SUS hospital admissions to analyze hospitalizations due to pneumoconiosis all over Brazil in the past two decades.
Lip and palate clefts in an institution in São José dos Campos, São Paulo, are analyzed in relation to gender, socioeconomic status, and association with other known syndromes. A literature review examines the relationship between factors associated to work, especially type of exposure, with shoulder disorders.
The reliability of an instrument that seeks to find the level of satisfaction of blood donors in a blood center in Ribeirão Preto, São Paulo, is assessed. Another paper analyzes the paradigm for addressing impairment and disability, by replacing the negative focus of the traditional classification with a positive approach, focusing what people can do, in the new "International Classification of Functioning, Disability and Health", which comprises the new "family" of WHO classifications.
Finally, a study conducted in Londrina, Paraná, analyzes morbidity and mortality due to external causes among people under 15 years of age, with data obtained from the medical records of Emergency Rooms and from the City Mortality Information Centre.
Enjoy your reading.
The Editor
Publication Dates
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Publication in this collection
12 June 2007 -
Date of issue
June 2005
