História do Centro Docente Assistencial de Fonoaudiologia da Universidade Federal da Bahia / History of the Speech-Language Pathology Teaching Assistance Center at the Federal University of Bahia / Historia del Centro de Asistencia Docente de Logopedia de la Universidad Federal de Bahía

Introdução: As clínicas-escolas de fonoaudiologia exercem papel fundamental na formação dos futuros profissionais. O Centro Docente Assistencial de Fonoaudiologia (CEDAF) foi criado com o intuito de ser uma clínica-escola do Curso de Graduação em Fonoaudiologia da Universidade Federal da Bahia. Objetivo: Descrever a história do CEDAF, a fim de contextualizar as mudanças pelas quais passou, destacando os principais acontecimentos a partir do olhar de atores que fazem parte desse percurso. Método: Trata-se de um estudo qualitativo, caracterizado como exploratório e descritivo, realizado na clínica CEDAF. Foram utilizadas fontes de dados orais, coletadas por meio de entrevistas e grupo focal, gravadas em áudio, transcritas e analisadas conforme categoria temática, buscando identificar os núcleos de sentido. Resultados: Foi possível perceber a intensa transformação pela qual o CEDAF passou ao longo dos seus vinte anos de história. Entre as mudanças mais significativas estão a ampliação do espaço físico, aumento do número de alunos do curso e a contratação de novos docentes, a admissão de fonoaudiólogas na clínica e o convênio firmado com a rede municipal de saúde. Conclusão: Deixar registrada uma primeira versão da história do CEDAF pode contribuir para fazer deste local um campo de pesquisa em contínuo aperfeiçoamento na formação dos futuros profissionais de fonoaudiologia e na prestação de serviço.

Introduction: Speech therapy clinic-schools play a fundamental role in the training of future professionals. The Speech-Language Pathology Teaching Assistance Center (CEDAF) was created with the intention of being a clinic-school of the Graduation Course in Speech Therapy at the Federal University of Bahia. Purpose: Describe the history of CEDAF, to contextualize the changes it has gone through, highlighting the main events from the perspective of actors who are part of this path. Method: This is a qualitative study, characterized as exploratory and descriptive, carried out at the CEDAF clinic. Oral data sources were used, collected through interviews and focus groups, recorded in audio, transcribed, and analyzed according to thematic category, seeking to identify the core meanings. Results: It was possible to perceive the intense transformation that CEDAF has undergone throughout its twenty years of history. Among the most significant changes are the expansion of the physical space, the increase in the number of students in the course and the hiring of new professors, the admission of speech therapists in the clinic and the agreement signed with the municipal health network. Conclusion: Registering a first version of the history of CEDAF can contribute to making this place a field of research in continuous improvement in the training of future professionals in speech therapy and service provision.

Introducción: Las clínicas-escuelas de logopedia juegan un papel fundamental en la formación de los futuros profesionales. El Centro de Asistencia Docente de Logopedia (CEDAF) se creó con la intención de ser clínica-escuela del Curso de Graduación en Logopedia de la Universidad Federal de Bahía.Objetivo: Describir la historia del CEDAF, con el fin de contextualizar los cambios que ha atravesado, destacando los principales hechos desde la perspectiva de los actores que forman parte de este camino. Método: Se trata de un estudio cualitativo, caracterizado como exploratorio y descriptivo, realizado en la clínica CEDAF. Se utilizaron fuentes de datos orales, recolectadas a través de entrevistas y grupos focales, grabadas en audio, transcritas y analizadas según categoría temática, buscando identificar los significados centrales. Resultados: Se pudo percibir la intensa transformación que ha experimentado CEDAF a lo largo de sus veinte años de historia. Entre los cambios más significativos se encuentran la ampliación del espacio físico, el aumento del número de alumnos en el curso y la contratación de nuevos profesores, la admisión de logopedas en la clínica y el convenio suscrito con la red municipal de salud. Conclusión: Registrar una primera versión de la historia del CEDAF puede contribuir a hacer de este lugar un campo de investigación en mejora continua en la formación de los futuros profesionales en logopedia y prestación de servicios.

In Honor of Dr. Abdul Hussein Taba: Iranian Physician and Former Director of the Eastern Mediterranean Region of the World Health Organization.

The honorable Abdul Hussein Tabatabaei was born in 1911 in Iran and received his medical education in the United Kingdom. Famously known as Dr. A.H. Taba, he was a well-respected man for his significant impact on the improvement of the national and global healthcare services and support for social justice. Before joining the World Health Organization (WHO), he was twice elected to the Iranian national assembly and served as the under-secretary of health services in Iran. Later, he joined the WHO and was elected as the Director of the Eastern Mediterranean Region (EMRO) in Alexandria in 1957 - a position he maintained for 25 years. During his tenure as the Regional Director, he rendered valuable assistance to the development and expansion of major health issues such as development and expansion of the health workforce, improvement of the national health services and controlling of various communicable diseases in the member countries and across the WHO regional offices.

Global health in the making: health demonstration areas in Europe, 1950s and 1960s.

Global health is a multifaceted concept that entails the standardization of procedures in healthcare domains in accordance with a doctrine agreed upon by experts. This essay focus on the creation of health demonstration areas by the World Health Organisation (WHO) to establish core nodes for integrated state-of-the-art health services. It explores the origins, theoretical basis and aims of this technique and reviews several European experiences during the first 20 years of the WHO. Particular attention is paid to the historical importance of technical cooperative activities carried out by the WHO in regard to the implementation of health services, a long-term strategic move that contributed to the thematic upsurge of primary health care in the late 1970s.

Global health in the making: health demonstration areas in Europe, 1950s and 1960s / Construcción de la salud global: zonas de demostración sanitaria en Europa, décadas de 1950 y 1960

Abstract Global health is a multifaceted concept that entails the standardization of procedures in healthcare domains in accordance with a doctrine agreed upon by experts. This essay focus on the creation of health demonstration areas by the World Health Organisation (WHO) to establish core nodes for integrated state-of-the-art health services. It explores the origins, theoretical basis and aims of this technique and reviews several European experiences during the first 20 years of the WHO. Particular attention is paid to the historical importance of technical cooperative activities carried out by the WHO in regard to the implementation of health services, a long-term strategic move that contributed to the thematic upsurge of primary health care in the late 1970s.

Resumen Salud global es un concepto complejo que implica la normalización de los procedimientos de actuación sanitaria siguiendo una doctrina acordada por expertos. Este trabajo se ocupa del establecimiento de zonas de demostración sanitaria por la Organización Mundial de la Salud (OMS) a modo de núcleos de modernos servicios sanitarios integrados. Revisa el origen, las bases téoricas y los objetivos de esta técnica y examina diversas experiencias europeas durante los primeros veinte años de la OMS. Pone de manifiesto la importancia histórica de las actividades de cooperación técnica de la OMS en la puesta en marcha de servicios sanitarios, una estrategia de largo plazo que ayuda a entender la aparición de la atención primaria de salud a finales de la década de 1970.

Universal health coverage and capital accumulation: a relationship unveiled by the critical political economy approach.

OBJECTIVES: To analyze the fundamentals of the global health agenda from 1944 to 2018, especially regarding Universal Health Coverage, in order to unveil its relations with capital accumulation in health services and to contribute to world social mobilization to change this tendency. METHODS: A historical study was carried out based on a purposeful selection of primary sources on the global health agenda from multilateral organizations and secondary sources about the changes of capitalism from the study period. RESULTS: The global health agenda changed from the state responsibility for health to an insurance healthcare system based on markets. The medical-industrial complex pressured national economies, broke postwar pacts, and urged economic globalization. The neoliberal, neoclassical, and neo-institutional discourse that promoted a new state-market relationship eased the new capital accumulation in healthcare into financial and cognitive capitalism. CONCLUSIONS: Understanding these relationships allows us to provide elements for social mobilization geared to transform the healthcare sector toward a new vision of health with a nature-society relationship that contributes to socially constructing human and environmental health, rather than gaining profits based on illness and chronic suffering.

"Everything Possible Is Being Done": Labour, Mobility, and the Organization of Health Services in Mid-20th Century Newfoundland.

This article is the Presidential Address to the 2018 meeting of the Canadian Society for the History of Medicine at the University of Regina. It examines the organization of the nursing service in Newfoundland during the 1950s and 1960s, as well as the recruitment and retention of nurses in cottage hospitals and nursing stations in outport communities. A number of interconnected strategies were used by the Newfoundland government to staff the nursing service, including recruiting internationally educated nurses, adjusting expectations with respect to registration standards, and using both trained and untrained workers to support nurses' labour. Although this article is intended more as a reconnaissance suggesting the possibilities of such research, it does analyze the interconnected issues of geography, funding and pay, the nursing shortage, and the renegotiation of nursing labour that characterized this period. Furthermore, although this is a case study of Newfoundland and Labrador, it is worth considering how, or whether, the linked strategies used in the province were transferable to other communities across rural, remote, or northern Canada.

Use of Computed Tomography scanning in a 'virtual' bioarchaeology of care analysis of a Central Coast Peruvian mummy bundle.

BACKGROUND: CT scanning was utilized to investigate an intact mummy bundle within the bioarchaeology of care framework. The project sought to ascertain whether a 'virtual' analysis was feasible, thereby avoiding physical disturbance to bundle structure and contents. METHODS: The bundle selected for this study contained an adult male (FA 54), Ichma culture, Peru, displaying evidence for two pathologies: chronic osteomyelitis of the right tibia, and cranial trauma. CT images provided the basis for bioarchaeology of care analysis, which followed Index of Care protocols. RESULTS: CT images enabled description and diagnosis of FA 54, and revealed human neonate remains and material artifacts within the bundle. Probable disease impacts were identified, and likely forms of care provided were inferred. CT scanning was of limited value in identifying characteristics of textile wrapping (a clue to cultural identity) and in resolving questions regarding funerary treatment (primary vs. secondary burial), and this constrained consideration of wider social implications of caregiving. CONCLUSION: 'Virtual' examination of FA 54 achieved an advanced stage of bioarchaeology of care analysis, but building on this would require physical examination of bundle elements. Further investigation of CT imaging potential for bioarchaeology of care research in mummy studies is recommended.

Therapeutic tattooing in the Arctic: Ethnographic, archaeological, and ontological frameworks of analysis.

This essay describes the potential for using ethnographic evidence and mummified tattooed skin to reflect on past therapeutic tattoo practice in the Arctic. It also considers the ways in which circumpolar concepts of disease emerged in relation to the agency of nonhuman entities. I argue that specific forms of curative tattooing offer interpretive models for the paleopathological and bioarchaeological study of care through an ontological framework of analysis.

Mummy studies and the bioarchaeology of care.

The bioarchaeology of care is a framework through which researchers can begin to infer the level of care an individual may have required based on the presence of paleopathological evidence. To date, all of the research that has employed the framework has been based on evidence derived from skeletal material. This special issue was organized in order to highlight how the analysis of mummified soft tissue, as well as other sources of data commonly associated with mummified remains, such as coprolites and intestinal contents, has the potential to provide valuable insight into the reconstruction of care in the past.

A 'cold case' of care: Looking at old data from a new perspective in mummy research.

In 1973, analysis of the mummified remains of a young boy dated to 700AD and from the Late Nasca period (Peru) identified (i) chronic Pott's disease, leading to loss of lower body mobility, and (ii) acute miliary tuberculosis, affecting most organs and the immediate cause of death (Allison et al., 1973). This report was the first to establish, beyond dispute, the presence of tuberculosis in the Americas before the arrival of Europeans. Here, we revisit the 'Nasca Boy' from a bioarchaeology of care perspective. Contextualising the original study's results within what is known of contemporary lifeways, we apply the bioarchaeology of care methodology in considering the Nasca Boy's experience of living with tuberculosis; the type of care he required and how this may have evolved over a period of deteriorating health; and what such caregiving may suggest both about social organisation within his community and some of the more everyday aspects of Nasca existence. Up to now, the bioarchaeology of care approach has been employed almost exclusively with skeletal evidence; in this analysis of the Nasca Boy's remains, and in the accompanying wider-ranging discussion, we illustrate the potential of preserved soft tissue evidence to contribute to research into disability and care in the past. Although this report functions as a stand-alone case study, to obtain maximum benefit it should be read in conjunction with the Introduction to the special International Journal of Paleopathology issue on 'mummy studies and the bioarchaeology of care' (Nystrom and Tilley, 2018).

Possible evidence for care and treatment in the Tyrolean Iceman.

The Tyrolean Iceman is the world's oldest glacier mummy. He was found in September 1991 in the Italian part of the Ötztal Alps. Since his discovery a variety of morphological, radiological and molecular analyses have been performed that revealed detailed insights into his state of health. Despite the various pathological conditions found in the Iceman, little is known about possible forms of care and treatment during the Copper Age in Northern Italy. A possible approach to this topic is the presence of tattoos on the mummified body. In previous work, it was already believed that the tattoos were administered as a kind of treatment for his lower back pain and degenerative joint disease of his knees, hip and wrist. In other studies, the tattoos of the Iceman have been related to an early form of acupuncture. We carefully re-evaluated the various health issues of the Iceman, including joint diseases, gastrointestinal problems and arterial calcifications and compared them to the location and number of tattoos. Together with the finding of medically effective fungi and plants, such as the birch polypore or fern in his equipment and intestines, we suggest that care and treatment was already common during the Iceman's time.

The importance of pathophysiology to the understanding of functional limitations in the bioarchaeology of care approach.

This article presents a partial bioarchaeology of care case study of a mummified adult female with chronic obstructive pulmonary disease (COPD) from late historic period United States. It examines likely clinical and functional impacts of disease and corresponding need for provision of care, stopping short of Stage 4 Interpretation/analysis. The case study illustrates and argues for the importance of an interdisciplinary research team for achieving a comprehensive understanding of disability and care. The article highlights the necessity of knowledge of pathophysiology for identifying the potential interventions (supports) dictated by the associated functional limitations. inter alia, this case is a powerful illustration of the way analysis of preserved soft tissue can provide insights into disease and likely care that are inaccessible using skeletal analysis alone. The article represents an interesting contribution to the theory and methodology of both the bioarchaeology of care approach and mummy studies.

Bioarchaeological evidence of care provided to a physically disabled individual from Pachacamac, Peru.

This paper presents a bioarchaeology of care case study based on the skeletonized remains of an elderly female with a congenital condition that compromised both mobility and independence in undertaking certain basic tasks, and which generated requirements for long-term care in the form of both direct support and accommodation. The remains show evidence of bilateral cervical ribs, severe osteoarthritic destruction in the right shoulder joint, and a healed skull trepanation. The remains were recovered from a cemetery dating to the initial part of the Late Intermediate Period at the archaeological site of Pachacamac, Peru. The subject has been identified as belonging to an Ychsma ayllu. This paper applies the bioarchaeology of care methodology in considering the implications of care provision within the Ychsma socialcontext, and suggests that caregiving may have been a relatively common practice in this complex society. This case study is a good example of how the application of social theory through the bioarchaeology of care approach can enrich bioarchaeological studies.

Using evidence from hair and other soft tissues to infer the need for and receipt of health-related care provision.

The Bioarchaeology of Care approach developed by Tilley is usually applied to skeletalized human remains, given the usual constraints of preservation bias that are seen with archaeological assemblages. However, other tissues, such as hair are sometimes preserved and can provide a wealth of information that can supplement the skeletal data. Archaeological hair has been analysed for drug compounds for almost thirty years. This article integrates data from hair analyses for coca metabolites, stable light isotope analysis and aDNA to expand the potential of the Bioarchaeology of Care approach using the example of a spontaneously mummified adult female from northern Chile.

The Skiles Mummy: Care of a debilitated hunter-gatherer evidenced by coprolite studies and stable isotopic analysis of hair.

The Skiles Mummy (SMM), a naturally mummified adult male from the late archaic period of Lower Pecos Canyonlands of South Texas, represents a unique case of care. SMM is an exceptional mummy within this region due to both the retention of a full head of hair, and having a diagnosed case of megacolon, a complication commonly associated with Chagas disease caused by Trypanosoma cruzi. Stable isotopic analysis of his hair is consistent with a diet incorporating of C4/CAM plants with some C3 plants, freshwater resources, and higher trophic level animals. However, the segments of hair most proximal to the scalp exhibited elevated δ15N values. Data from previous research indicate starvation and malnutrition can cause δ15N values to rise. The presence of large fecal boluses in the digestive tract suggest peristalsis ceased in the last four to five months of life, and this, together with results from coprolite analysis, indicate he would not have been able to adequately absorb protein and nutrients during this time. His condition would have rendered him immobile. Following Tilley's index of care, someone would have had to bring him food resources, as well as attending to his daily needs.

Creating Occupational Therapy: The Challenges to Defining a Profession.

The creation of a new profession in the early 20th century, such as occupational therapy, required a commitment to certain ideas and a willingness to accept certain challenges. This study examines the commitment to the idea of therapeutic and health supporting occupation by the early leaders and proponents of the profession and the challenges they faced in gaining acceptance of occupational therapy as a profession capable of delivering a valued health care service to society. Six challenges are reviewed as they occurred in the history of the profession and as they continue to challenge the profession into the present era.

The Canadian Army Medical Corps affair of 1916 and Surgeon General Guy Carleton Jones.

SUMMARY: The rapid expansion of military medical service in the First World War, successfully completed under the direction of Surgeon General Guy Carleton Jones, remains an extraordinary achievement in Canada's history. In 1916, a conflict of personalities threatened confidence in the service. Eventually Prime Minister Sir Robert Borden's intervention restored the status quo, but the affair eclipsed Jones's outstanding career.