Temporal trends in BMI in Argentina by socio-economic position and province-level economic development, 2005-2009.

OBJECTIVE: We investigated temporal trends in BMI, and assessed hypothesized predictors of trends including socio-economic position (SEP) and province-level economic development, in Argentina. DESIGN: Using multivariable linear regression, we evaluated cross-sectional patterning and temporal trends in BMI and examined heterogeneity in these associations by SEP and province-level economic development with nationally representative samples from Argentina in 2005 and 2009. We calculated mean annual changes in BMI for men and women to assess secular trends. RESULTS: Women, but not men, exhibited a strong cross-sectional inverse association between SEP and BMI, with the lowest-SEP women having an average BMI 2.55 kg/m(2) greater than the highest-SEP women. Analysis of trends revealed a mean annual increase in BMI of 0.19 kg/m(2) and 0.15 kg/m(2) for women and men, respectively, with slightly greater increases occurring in provinces with greater economic growth. No significant heterogeneity in trends existed by individual SEP. CONCLUSIONS: BMI is increasing rapidly over time in Argentina irrespective of various sociodemographic characteristics. Higher BMI remains more common in women of lower SEP compared with those of higher SEP.

[Plays and practices as micropolitics in State social institutions]. / Juegos y prácticas como micropolíticas en las instituciones sociales del Estado.

The aim of this essay is to analyze plays as a central element in the practices that construct micropolitics within the social institutions of the State. The main concepts addressed are: plays, practices, and micropolitics. The analysis focuses on institutions within social fields, emphasizing material size. The hypothesis posits that the size of the organization is inversely proportional to the development of plays within the institutions. This discussion takes place in a context marked by a strong detachment from the public and the state, exacerbating profound social inequalities, nihilism, and aporophobia, alongside a crisis of legitimacy of public institutions in the face of the advance of non-democratic ideas in democratically elected governments in several countries in Latin America and other continents.

El objetivo de este ensayo es analizar el juego como un elemento central en las prácticas que construyen micropolíticas en las instituciones sociales del Estado. Los principales conceptos que se trabajan son: juego, prácticas y micropolíticas. El análisis se recorta a las instituciones de los campos sociales haciendo énfasis en el tamaño material. La hipótesis es que el tamaño de la organización es inversamente proporcional al desarrollo del juego en las instituciones. Esta discusión se da en un contexto marcado por un fuerte desapego a lo público y a lo estatal, lo cual no hace más que agravar las profundas desigualdades sociales, el nihilismo y la aporofobia, con una crisis de legitimidad de las instituciones públicas frente al avance de ideas no democráticas en gobiernos elegidos democráticamente en varios países de América Latina y de otros continentes.

From the factory model to the classroom-workshop: Learning from practice in the fields of health and education.

In this article, we engage in a dialogue about structural competencies based on the proposal of the classroom-workshop, aimed at educational and work environments in the fields of health and education. Our starting point is the notion that practical experiences do not merely represent a collection of specialised technical knowledge, as they are part of the complexity of the social game. Drawing from the theoretical frameworks of Pierce, Gadamer, Freire, and others, the proposal of the classroom-workshop recovers the power of collective praxis. Learning from and with others becomes central in the social game in order to collectively appropriate knowledge by making the autonomy of learning as horizontal as possible. By centering the relational world of learning and working, the classroom-workshop recovers the circular structure of understanding that enables a reflective appropriation of the territory - understood as the social space where life takes place - while de-instrumentalizing the reading of theoretical traditions and resignifiying the practice of writing. It establishes connections, links, and anchors that enable a dialogue between theory and practice, so often dissociated and fragmented.

[Interest in disinterestedness in the epidemiology of health systems and services]. / El interés del desinterés en la epidemiología de servicios y sistemas de salud.

This article intends to critique of the cultural authority of the medical sciences, opening up a discussion on its publicization from a political standpoint. At the same time, from a more technical standpoint, it proposes the implementation of an epidemiology of health systems and services. Based on Pierre Bourdieu's concept of interest in disinterestedness and Joseph Gusfield's notion of the cultural authority of public problems, it analyzes why epidemiological information is so rarely used in the evaluation and monitoring of clinical, population, institutional, and territorial practices. That is, why does the dominant culture of decision making eschew epidemiological information? Within this conceptual framework, a body of documental evidence is analyzed that sheds light on the weak scientific basis that upholds or that has underpinned certain practices in the health field at different historical moments. The discussion is organized around three major themes: assistentialist professional practice, medication, and biomedical technologies.

Este trabajo se propone problematizar, discutir y publicizar la autoridad cultural de la medicina científica, desde una dimensión política, y la implementación de la epidemiología de los servicios y sistemas de salud, desde una dimensión técnica. A partir de los conceptos de interés del desinterés, de Pierre Bourdieu, y de autoridad cultural de los problemas públicos de Joseph Gusfield se analiza ¿por qué la información epidemiológica es tan poco utilizada para la evaluación y monitoreo de las prácticas clínicas, poblacionales, institucionales y territoriales?, ¿por qué domina una cultura de toma de decisiones sin información epidemiológica? Desde este marco conceptual, se aborda un cuerpo documental que permite recuperar la débil cientificidad que sustentaron o sustentan algunas prácticas del campo de la salud en diferentes momentos históricos, organizado en tres ejes temáticos: la práctica profesional asistencial, los medicamentos y las tecnologías biomédicas.

Studies on the ecology of medical care: a comparative analysis in historical perspective, 1928-2018. / Estudios de ecología de la atención médica: análisis comparado en dimensión histórica, 1928-2018.

In the definition of health policies and decision-making on the part of health officials, there is often a prevailing separation between clinical practice, epidemiology, and public health. Although this division is naturalized from the viewpoint of hospitals and public agencies, it is artificial in the context of concrete territories and communities, where problems are not structured according to the fragmentation of knowledge, but rather express the complexities of the problems faced by individuals and population groups. In this context, this article compiles and analyzes studies on the ecology of medical care carried out between 1928 and 2018 that have revisited the pioneering study "The ecology of medical care" by White, Williams and Greenberg. The discussion is structured around three central issues: 1) recurrent themes in studies on the ecology of medical care; 2) health information systems and health surveys; and 3) the institutional hegemony of hospitals in the health field.

En la definición de las políticas de salud y en la toma de decisiones por parte de la gestión suele primar una separación entre clínica, epidemiología y salud pública, situación naturalizada desde la mirada de los hospitales y ministerios, pero artificial en los territorios, donde los problemas no se estructuran siguiendo la fragmentación de saberes, sino que se expresan en la complejidad de los problemas de las personas y los conjuntos poblacionales. Desde esa concepción, este trabajo recopila y analiza los estudios de ecología de la atención médica, realizados entre 1928 y 2018, que retoman el estudio precursor "The ecology of medical care", de White, Williams y Greenberg, para centrar la discusión en tres ejes: 1) las regularidades presentes en los estudios de ecología de la atención médica, independientemente del año y el país; 2) los sistemas de información en salud y las encuestas de salud; y 3) la hegemonía institucional del hospital en el campo de la salud.

[Abraham Flexner: the life trajectory of an educator]. / Abraham Flexner: trayectoria de vida de un educador.

This article centers on the life of Abraham Flexner, widely known in the field of health for the Flexner Report published in 1910, which is considered one of the most important theoretical discussions in the history of medical education. Flexner was first and foremost an educator, belonging to the progressive education movement led by John Dewey in the United States. The text analyzes the historical moment in which the health field began to consolidate in the United States, as well as the actors involved, the interests at play, the construction of doxa, and the role of philanthropic organizations and the American Medical Association. Flexner's critiques in the field of education were primarily focused on pedagogical approaches at different stages of education; he was particularly critical of the university level, postgraduate programs, and the absence of humanistic training, which had been supplanted by research. The article closes by raising the question of whether or not the problems related to education - and medical education in particular - identified by Flexner between the late 19th and early 20th century are still relevant to medical schools and universities in Latin American countries today.

Este trabajo se enfoca en la trayectoria de vida de Abraham Flexner, conocido en el campo de la salud por el Informe Flexner, publicado en 1910, considerado como una de las discusiones teóricas más importantes en la historia de la educación médica. Flexner fue ante todo un educador, perteneciente al movimiento progresista de educación en EEUU, encabezado por John Dewey. A lo largo del texto se analiza el momento histórico en que se inicia la conformación del campo de la salud en EEUU, sus actores, los intereses en juego, la constitución de la doxa, el rol de las fundaciones filantrópicas y de la American Medical Association. Las críticas de Flexner en el campo de la educación se centraron en los métodos pedagógicos en los diferentes niveles educativos, siendo especialmente crítico de la universidad, los posgrados y la ausencia de una formación humanista, desplazada por la investigación. La pregunta final del artículo es si los problemas enunciados por Flexner sobre la educación en general y la educación médica en particular entre fines del siglo XIX y principios del siglo XX, tienen aún vigencia en las escuelas de medicina y universidades de los países de América Latina.

Socioeconomic gradients in chronic disease risk factors in middle-income countries: evidence of effect modification by urbanicity in Argentina.

OBJECTIVES: We investigated associations of socioeconomic position (SEP) with chronic disease risk factors, and heterogeneity in this patterning by provincial-level urbanicity in Argentina. METHODS: We used generalized estimating equations to determine the relationship between SEP and body mass index, high blood pressure, diabetes, low physical activity, and eating fruit and vegetables, and examined heterogeneity by urbanicity with nationally representative, cross-sectional survey data from 2005. All estimates were age adjusted and gender stratified. RESULTS: Among men living in less urban areas, higher education was either not associated with the risk factors or associated adversely. In more urban areas, higher education was associated with better risk factor profiles (P < .05 for 4 of 5 risk factors). Among women, higher education was associated with better risk factor profiles in all areas and more strongly in more urban than in less urban areas (P < 0.05 for 3 risk factors). Diet (in men) and physical activity (in men and women) were exceptions to this trend. CONCLUSIONS: These results provide evidence for the increased burden of chronic disease risk among those of lower SEP, especially in urban areas.

Socioeconomic patterning in tobacco use in Argentina, 2005.

INTRODUCTION: Globally, tobacco is the number one preventable cause of death, killing 1 in 10 adults. By 2030, 80% of all tobacco deaths will occur in developing countries. Social factors drive the adoption and cessation of smoking in high-income countries, but few studies have examined the socioeconomic patterning of smoking in developing countries. METHODS: Using data from the 2005 National Survey of Risk Factors for Non-communicable Diseases in Argentina, we investigated gender-specific socioeconomic patterning of current, former, and never-smoking status; the intensity of smoking; and smokers' readiness for cessation using multinomial logistic and ordinary least squares regression. We also investigated heterogeneity in the patterning by age. RESULTS: Higher socioeconomic position (SEP) was associated with less smoking for men in all age groups, although the results were most pronounced for men at younger ages (odds ratio [OR] of current vs. never smoking = 0.57, 95% CI 0.51-0.63 for higher vs. lower education at ages 18-24 years). For women, higher SEP was associated with more smoking in older age groups but less smoking in younger age groups (OR = 1.51, CI 1.41-1.62 and OR = 0.86, CI 0.78-0.96 for higher vs. lower education at ages 50-64 and 18-24 years, respectively). Higher SEP was also associated with higher odds of recently quitting compared to not considering quitting for men regardless of age group but for women only in younger age groups. DISCUSSION: The higher burden of smoking among those of lower SEP, especially in younger age groups, is a troubling pattern that is certain to impact future disparities in chronic disease outcomes unless interventions are undertaken.

[Reference birthweights for the Argentine population by multiplicity of birth, sex, and gestational age]. / Referencias poblacionales argentinas de peso al nacer según multiplicidad del parto, sexo y edad gestacional.

OBJECTIVE: To develop new and improved reference birthweights for the Argentine population as a whole with a breakdown by gestational age (GA), sex and multiplicity of birth. METHODS: The population studied included all live births resulting from single (n = 3,478,286) and double (n = 57,654) births in Argentina during the period 2003- 2007. The probable errors in classifying GA on the basis of last menstruation were corrected using normal mixture models. The percentiles were obtained by quantile regression, which also made it possible to smooth out the curves. RESULTS: Birthweight curves for single births were obtained between weeks 22 and 43 of gestation, and curves for double births between weeks 24 and 41, with a breakdown by the sex of the neonate. Compared with those of previous studies, these reference birthweights do not overestimate the proportion of live births large for their GA. An increase in birthweight was also observed during the period of study. CONCLUSIONS: The proposed curves have the advantages of being based on large numbers, of being representative of the most recent Argentine births, of distinguishing the number of births and the sex of the neonates, and of minimizing GA classification errors. They are therefore a useful tool for measuring inequalities and thus identifying population groups at higher risk of adverse perinatal events.

[Homicides among youths: local sociabilities in fostering lethal interpersonal aggression]. / Homicidios en jóvenes: sociabilidades locales en la habilitación de la agresión interpersonal letal.

This paper seeks to understand why interpersonal aggressions that lead to homicides in young people can be tolerated, claimed or acclaimed in the contexts of sociability in which they occur. The methodology developed was qualitative, namely it sought to document and analyze the meanings and experiences of the actors from their perspectives. The field work was carried out with young men from popular sectors that inhabit six municipalities in the Buenos Aires suburbs between 2014 and 2017. Among the results, we argue that empowerment of lethal aggressions is linked to a reduction in youth sociability in peer groups with strong territorial inks. This reduction is expressed as a consequence of the weakness of family, work and institutional ties in shaping the social experience of young people. In peer groups, responses to insults can be valued not only as a way of intervening in conflicts, but also as a source of belonging and social recognition. We conclude that these reduced sociabilities express socio-political inequalities that contribute to homicide being an exceptional event with recurrent spaces for interaction.

Este trabajo se propone comprender por qué las agresiones interpersonales que conducen a homicidios en jóvenes pueden ser toleradas reclamadas o aclamadas en los contextos de sociabilidad en las que se suceden. La metodología desarrollada fue cualitativa, es decir que procuró documentar y analizar los significados y experiencias de los actores desde sus perspectivas. El trabajo de campo se realizó con jóvenes varones de sectores populares que habitan seis municipios del conurbano bonaerense entre 2014 y 2017. Entre los resultados sostenemos que la habilitación a las agresiones letales se vincula con una reducción de la sociabilidad juvenil a grupos de pares con fuertes anclajes territoriales. Esta reducción se expresa como una consecuencia de la debilidad de los vínculos familiares, laborales e institucionales en la conformación de la experiencia social de los jóvenes. En los grupos de pares las repuestas a las afrentas pueden ser valoradas no sólo como forma de intervenir en los conflictos, sino como fuente de pertenencia y reconocimiento social. Concluimos que estas sociabilidades reducidas expresan desigualdades sociopolíticas que contribuyen a que el homicidio sea un acontecimiento excepcional de espacios de interacción recurrentes.

[Constructing a new institutional hegemony in the health field]. / Construir una nueva hegemonía institucional en el campo de la salud.

This article argues for the construction of a new institutional hegemony with a rhizomatic design based on health centers with direct relations to a network of hospitals with increasing levels of complexity, which are put at the service of these health centers and not the other way around. The proposal for these centers includes community-based teams of workers carrying out humanized practice centered on the shift from health services to care within the community, respecting the particularities and idiosyncrasies of its residents and their cultures. First, a brief historical revision of the genesis of health centers and of hospitals is presented. Second, technical recommendations to restructure models of care and institutional organization in the health field are put forth, and technical-political proposals for this new institutional hegemony are outlined, which are developed along three dimensions: organization, policy, and service and care processes. Lastly, some barriers to the construction of this new hegemony are identified.

Este texto propone la construcción de una nueva hegemonía institucional de configuración rizomática basada en los centros de salud y en relación directa con una red hospitalaria de complejidad creciente al servicio de estos centros de salud y no a la inversa. Propone equipos de trabajadores para esos centros con anclaje territorial, que desarrollen prácticas humanizadas centradas en el paso de la atención al cuidado en cada territorio, respetando las singularidades e idiosincrasia de los habitantes y sus culturas. En primer lugar, se realiza una breve síntesis histórica del devenir de los centros de salud y de los hospitales. En segundo lugar, se realizan propuestas técnicas para reformular los modelos de atención y organización en las instituciones del campo de la salud y propuestas tecno-políticas para la nueva hegemonía institucional, que se desarrolla en tres dimensiones: organización, políticas y procesos de atención y cuidado. Por último, se identifican obstáculos en la construcción de esta nueva hegemonía.

["We see them from Monday to Friday:" Births by day of the week in the Autonomous City of Buenos Aires, 2004-2013]. / "Las atendemos de lunes a viernes": nacimientos según días de la semana en la Ciudad Autónoma de Buenos Aires, 2004-2013.

The objective of this article is to describe births according to their distribution by day of the week in order to characterize the scheduled or non-scheduled aspect of the labor and delivery process. A descriptive epidemiological study of the temporal distribution of the days of the week on which births occurred in the Autonomous City of Buenos Aires was carried out for the period 2004-2013, based on the Statistical Reports of Live Births database of the Directorate of Statistics and Health Information at the National Ministry of Health. The following variables were analyzed using descriptive statistics: establishment (public or private sector), gestational age, maternal age, and mother's level of education. The analysis reveals that births decrease significantly on Saturdays and Sundays in both public and private establishments, with a greater decrease being observed in private establishments. Births at week 37 are more frequent in private establishments and decrease on non-working days. For mothers with higher levels education, fewer births occurred on weekends. Analyzing the day of the week on which births occur reveals the medicalization of the delivery process and could indicate that the scheduling and induction of births occur in private establishments to a greater extent than in public establishments.

El objetivo de este trabajo es describir los nacimientos según su distribución en días de la semana a fin de caracterizar el aspecto programado o no del proceso de parto y nacimiento. Se realizó un estudio epidemiológico descriptivo de la distribución temporal de los días de la semana en que ocurrieron los nacimientos en la Ciudad Autónoma de Buenos Aires, para el período 2004-2013, a partir de la base de datos del Informe Estadístico de Nacido Vivo de la Dirección de Estadísticas e Información de Salud del Ministerio de Salud de la Nación. Se analizaron las siguientes variables: establecimiento (público o privado), edad gestacional, edad y nivel de instrucción de la madre. El análisis muestra que los nacimientos disminuyen significativamente los sábados y domingos en los establecimientos públicos y privados, siendo mayor la disminución en los establecimientos privados; que los nacimientos en la semana 37 son más frecuentes en los establecimientos privados y disminuyen en los días no laborables; y que a mayor nivel de instrucción materna son menores los nacimientos durante los fines de semana. Analizar el día de la semana en el que ocurren los nacimientos transparenta la medicalización del proceso de parto e indicaría que la programación e inducción de los nacimientos ocurre en los establecimientos privados en mayor medida que en los establecimientos públicos.

Plans and plays. / Planes y juegos.

This article is structured around two concepts - planning (as the attempt to predict the future through reason) and play (as freedom in the present) - used to discuss work processes, organizational forms, institutionality and the management of public institutions in the social field, with an emphasis on the fields of health and education. Based on Nietzche's reflection regarding the mythological figures of Dionysus and Apollo, a synthesis of the development of planning in Latin America is carried out with the aid of works by Carlos Matus and Mario Testa. From this perspective, play is analyzed over the course of history, in addition to the proposal of Homo ludens and the unrecognized role of play in the day life of social institutions. However, understanding the game does not guarantee that the forms of playing it will change. Therein lie the complexity and challenges that must be considered in relation to structures that are both structuring and structured by the actions of their agents, in the framework of processes of reproduction and social domination that naturalize current institutional forms.

Este artículo se estructura sobre dos conceptos: la planificación (como intento de predicción del futuro a través de la razón) y el juego (en tanto libertad en el presente), desde los cuales se discuten los procesos de trabajo, las formas organizativas, la institucionalidad y la gestión de las instituciones públicas del campo social, con énfasis en las del campo de la salud y la educación. A partir del planteo de Nietzsche sobre las figuras mitológicas griegas Dionisio y Apolo, se realiza una síntesis del desarrollo de la planificación en América Latina a través de Carlos Matus y Mario Testa para, desde allí, analizar el juego a lo largo de la historia, la propuesta del Homo ludens y la presencia no reconocida del juego en el cotidiano de las instituciones sociales. Entender el juego no garantiza que se cambien las formas en que se lo juega. Allí reside la complejidad y el desafío que debe ser pensado en la relación de estructuras que son estructurantes pero que, a su vez, son estructuradas por la acción de sus agentes, en el marco de procesos de reproducción y dominación social que naturalizan las formas institucionales vigentes.

[Machines and artisanal health workers]. / Máquinas y arte-sanos.

This work discusses the dominant models and tensions within the health field regarding the conceptualization of the human body (as a machine), the process of health work (industrial and artisanal models), institutions (hospitals and health centers) and primary agents (the medical corporation and the medical industrial complex). The context of analysis is the United States from the end of the 19th century to the present. Economic-political, ideological-cultural, and scientific-technical dimensions are discussed, which permeate the historicity of the field. The purpose is to illustrate how the health field has transformed over time, as well as the role instrumental reason and financial capital has played in this process, to the detriment of relational aspects.

Este trabajo discute los modelos dominantes y las tensiones, al interior del campo de la salud, entre la concepción del cuerpo humano (máquina); el proceso de trabajo médico (modelos industriales o artesanales); las institucionalidades (hospitales y centros de salud) y los principales agentes (corporación médica y complejo médico industrial). El análisis se contextualiza en EEUU desde fines del siglo XIX a la actualidad. Se discuten dimensiones económico-políticas, ideológico-culturales y científico-técnicas, que atraviesan la historicidad del campo. El propósito es elucidar cómo se viene transformando el campo de la salud, y qué peso tiene la razón instrumental y el capital financiero en ese proceso, en detrimento de lo relacional.

El interés del desinterés en la epidemiología de servicios y sistemas de salud / Interest in disinterestedness in the epidemiology of health systems and services

RESUMEN Este trabajo se propone problematizar, discutir y publicizar la autoridad cultural de la medicina científica, desde una dimensión política, y la implementación de la epidemiología de los servicios y sistemas de salud, desde una dimensión técnica. A partir de los conceptos de interés del desinterés, de Pierre Bourdieu, y de autoridad cultural de los problemas públicos de Joseph Gusfield se analiza ¿por qué la información epidemiológica es tan poco utilizada para la evaluación y monitoreo de las prácticas clínicas, poblacionales, institucionales y territoriales?, ¿por qué domina una cultura de toma de decisiones sin información epidemiológica? Desde este marco conceptual, se aborda un cuerpo documental que permite recuperar la débil cientificidad que sustentaron o sustentan algunas prácticas del campo de la salud en diferentes momentos históricos, organizado en tres ejes temáticos: la práctica profesional asistencial, los medicamentos y las tecnologías biomédicas.

ABSTRACT This article intends to critique of the cultural authority of the medical sciences, opening up a discussion on its publicization from a political standpoint. At the same time, from a more technical standpoint, it proposes the implementation of an epidemiology of health systems and services. Based on Pierre Bourdieu's concept of interest in disinterestedness and Joseph Gusfield's notion of the cultural authority of public problems, it analyzes why epidemiological information is so rarely used in the evaluation and monitoring of clinical, population, institutional, and territorial practices. That is, why does the dominant culture of decision making eschew epidemiological information? Within this conceptual framework, a body of documental evidence is analyzed that sheds light on the weak scientific basis that upholds or that has underpinned certain practices in the health field at different historical moments. The discussion is organized around three major themes: assistentialist professional practice, medication, and biomedical technologies.

Estudios de ecología de la atención médica: análisis comparado en dimensión histórica, 1928-2018 / Studies on the ecology of medical care: a comparative analysis in historical perspective, 1928-2018

RESUMEN En la definición de las políticas de salud y en la toma de decisiones por parte de la gestión suele primar una separación entre clínica, epidemiología y salud pública, situación naturalizada desde la mirada de los hospitales y ministerios, pero artificial en los territorios, donde los problemas no se estructuran siguiendo la fragmentación de saberes, sino que se expresan en la complejidad de los problemas de las personas y los conjuntos poblacionales. Desde esa concepción, este trabajo recopila y analiza los estudios de ecología de la atención médica, realizados entre 1928 y 2018, que retoman el estudio precursor "The ecology of medical care", de White, Williams y Greenberg, para centrar la discusión en tres ejes: 1) las regularidades presentes en los estudios de ecología de la atención médica, independientemente del año y el país; 2) los sistemas de información en salud y las encuestas de salud; y 3) la hegemonía institucional del hospital en el campo de la salud.

ABSTRACT In the definition of health policies and decision-making on the part of health officials, there is often a prevailing separation between clinical practice, epidemiology, and public health. Although this division is naturalized from the viewpoint of hospitals and public agencies, it is artificial in the context of concrete territories and communities, where problems are not structured according to the fragmentation of knowledge, but rather express the complexities of the problems faced by individuals and population groups. In this context, this article compiles and analyzes studies on the ecology of medical care carried out between 1928 and 2018 that have revisited the pioneering study "The ecology of medical care" by White, Williams and Greenberg. The discussion is structured around three central issues: 1) recurrent themes in studies on the ecology of medical care; 2) health information systems and health surveys; and 3) the institutional hegemony of hospitals in the health field.

[The epidemiological approach to health inequalities at the local level]. / El abordaje epidemiológico de las desigualdades en salud a nivel local.

What are the advantages and limitations of epidemiology for decreasing health inequalities at the local level? To answer this question, the current article discusses the role of epidemiology. The hypothesis is that epidemiology produces useful knowledge for local management of interventions aimed at reducing health inequalities, expressed in spaces built by human communities through social and historical processes. Local production of epidemiological knowledge should support action by social actors in specific situations and contexts, thus renewing the appreciation for ecological designs and georeference studies. Such knowledge output and application are also an organizational phenomenon. Organizations can be seen as "conversational networks". In conclusion, strategic and communicative actions by health workers should provide the central thrust for defining new health care and management models committed to decreasing health inequalities, with epidemiology playing a key role.

[Administration: practices, myths and ideologies]. / Gestión: prácticas, mitos e ideologías.

Administration in the social field is examined based on an analysis of its practices, the rationalist myth and its ideological dimensions. In this way, the article discusses the most frequently utilized concepts (administration, management, gerencia, gestión) and their etymologies; the limitations of teaching administration; the complexity of a practice marked by the dimensions of science, art and the social game; and the ideological question underlying the great thought factory that the general theory of administration has been since the start of the 19th century. The article reflects upon the need to construct a theory based in practice contextualized in the global south that goes beyond the classic frames of reference and, above all, to transform administration into a problem to be discussed outside of the knowledge that recognizes it as a technical practice.

Se aborda la gestión en el campo social a partir de analizar sus prácticas, el mito racionalista y sus dimensiones ideológicas. Para ello, se discuten los conceptos más utilizados (administración, gerencia, managment, gestión) y sus etimologías; las fuertes limitaciones para su enseñanza; la complejidad de la práctica atravesada por dimensiones de la ciencia, el arte y el juego; y la cuestión ideológica provista por la gran usina de pensamiento que, desde inicios del siglo XIX, conforma la teoría general de la administración. Se reflexiona, además, sobre la necesidad de construir una teoría de esa práctica contextualizada desde el sur y por fuera de sus encuadres clásicos y, sobre todo, de transformar la gestión en un problema a ser discutido por fuera de los conocimientos que la reconocen como una práctica técnica.

Abraham Flexner: trayectoria de vida de un educador / Abraham Flexner: the life trajectory of an educator

RESUMEN Este trabajo se enfoca en la trayectoria de vida de Abraham Flexner, conocido en el campo de la salud por el Informe Flexner, publicado en 1910, considerado como una de las discusiones teóricas más importantes en la historia de la educación médica. Flexner fue ante todo un educador, perteneciente al movimiento progresista de educación en EEUU, encabezado por John Dewey. A lo largo del texto se analiza el momento histórico en que se inicia la conformación del campo de la salud en EEUU, sus actores, los intereses en juego, la constitución de la doxa, el rol de las fundaciones filantrópicas y de la American Medical Association. Las críticas de Flexner en el campo de la educación se centraron en los métodos pedagógicos en los diferentes niveles educativos, siendo especialmente crítico de la universidad, los posgrados y la ausencia de una formación humanista, desplazada por la investigación. La pregunta final del artículo es si los problemas enunciados por Flexner sobre la educación en general y la educación médica en particular entre fines del siglo XIX y principios del siglo XX, tienen aún vigencia en las escuelas de medicina y universidades de los países de América Latina.

ABSTRACT This article centers on the life of Abraham Flexner, widely known in the field of health for the Flexner Report published in 1910, which is considered one of the most important theoretical discussions in the history of medical education. Flexner was first and foremost an educator, belonging to the progressive education movement led by John Dewey in the United States. The text analyzes the historical moment in which the health field began to consolidate in the United States, as well as the actors involved, the interests at play, the construction of doxa, and the role of philanthropic organizations and the American Medical Association. Flexner's critiques in the field of education were primarily focused on pedagogical approaches at different stages of education; he was particularly critical of the university level, postgraduate programs, and the absence of humanistic training, which had been supplanted by research. The article closes by raising the question of whether or not the problems related to education - and medical education in particular - identified by Flexner between the late 19th and early 20th century are still relevant to medical schools and universities in Latin American countries today.

Cuadernos Médico Sociales from Rosario, Argentina, and other Latin American social medicine journals from the 1970s and 1980s. / Los Cuadernos Médico Sociales de Rosario y las revistas de la medicina social latinoamericana entre las décadas de 1970 y 1980.

In the 1970s and 1980s, a series of journals were founded to disseminate ideas from Latin American social medicine in various countries across the continent, during the early stage of a movement that would later become institutionalized in Brazil under the name "collective medicine." In this article, we look at the principal characteristics of those endeavors: Revista Centroamericana de Ciencias de la Salud, Saúde em Debate, Salud Problema, Revista Latinoamericana de Salud and Cuadernos Médico Sociales. We focus in particular on Cuadernos Médico Sociales, published in Rosario, Argentina. We analyze the conditions under which this publication emerged, the editorial processes it followed, and the central role played by Carlos Bloch, its founder and managing editor.

Entre 1970 y 1980, fueron creadas un conjunto de revistas con el objetivo de difundir las ideas de la medicina social latinoamericana en distintos países del continente, en una etapa temprana en la institucionalización de este movimiento que luego se afianzó en Brasil bajo el nombre de "salud colectiva". En este trabajo recorremos las principales características de esos emprendimientos: la Revista Centroamericana de Ciencias de la Salud, Saúde em Debate, Salud Problema, Revista Latinoamericana de Salud y Cuadernos Médico Sociales. En particular, nos focalizamos en los Cuadernos Médico Sociales de Rosario, analizando las condiciones de su surgimiento y los procesos editoriales que marcaron esta publicación, donde fue central la figura de Carlos Bloch como editor e ideólogo de la revista.