The S20 Brazilian Mental Health Report for Building a Just World and a Sustainable Planet: Part I.

This is the first part of two documents prepared by experts for the Brazilian S20 mental health report. These reports outline strategies aimed at addressing the exacerbated mental health challenges arising from a post-pandemic world. Ongoing psychiatric epidemiology research has yielded evidence linking mental health with intricate social determinants, including gender, race/ethnicity, racism, socioeconomic status, social deprivation, and employment, among others. More recently, the focus has expanded to also encompass violence and social oppression. By prioritizing prevention and early intervention, harnessing technology, and fostering community support, we can mitigate the long-term impact of mental disorders emerging in life. Utilizing evidence-based practices and forging partnerships between the health and education sectors, S20 countries can promote health and safety of their student population, thereby paving the way for a more promising future for the next generations. The first document focuses on addressing the mental health concerns of vulnerable populations, catering to the needs of children, youth, and aging populations, assessing the current state of alcohol and drug addictions, scaling up psychosocial interventions in primary care, exploring the potential integration of health and educational systems, and emphasizing the imperative adoption of human rights in mental health policies.

Metapresentiality: a foundational concept for a critical theory of digital health. / Metapresencialidad: concepto fundante de una teoría crítica de la salud digital.

In this text, I propose the concept of "metapresentiality" as a fundamental element for a Critical Theory of Digital Health. First, I present the concepts of technique, technology, and technical object, central to the theories of Álvaro Vieira Pinto and Milton Santos. Secondly, based on Luciano Floridi's philosophy of information, I question the relevance of the dichotomy real-material-concrete vs. digital-virtual-informational as an ontological foundation for concepts of reality, place, and presence, highlighting the notions of virtual reality and extended reality. Thirdly, I introduce an etymological-historical critique of the series presence-telepresence-metapresence, focusing on the emerging notion of meta-presentiality in the form of proto-concept and its eventual formalization as a conceptual foundation for a socio-technical appropriation and technosocial integration of digital technologies. Finally, I discuss Digital Health as a field of knowledge, techniques and practices and evaluate epistemological and pragmatic advantages of metapresentiality as a concept in the fields of computing, education and health.

En este texto, propongo el concepto de "metapresencialidad" como elemento fundante para una teoría crítica de la salud digital. En primer lugar, presento los conceptos de técnica, tecnología y objeto técnico, centrales en las teorías de Álvaro Vieira Pinto y Milton Santos. En segundo lugar, a partir de la filosofía de la información de Luciano Floridi, cuestiono la pertinencia de la dicotomía real-material-concreto versus digital-virtual-informacional como fundamento ontológico de los conceptos de realidad, lugar y presencia, destacando las nociones de realidad virtual y realidad extendida. En tercer lugar, introduzco una crítica etimológica e histórica de la serie presencia-telepresencia-metapresencia, enfocando la noción emergente de metapresencialidad en forma de protoconcepto y su eventual formalización como fundamento conceptual para una apropiación sociotécnica y una integración tecnosocial de las tecnologías digitales. Finalmente, discuto la salud digital como campo de saberes, técnicas y prácticas y evalúo las ventajas epistemológicas y pragmáticas de la metapresencialidad como concepto en los campos de la informática, la educación y la salud.

Revolutionizing the Public Health Workforce-A Policy Brief in Retrospect of the World Congress on Public Health Rome 2020.

Background: The COVID-19 pandemic dramatically illustrates the consequences of inadequate prioritization of the Public Health Workforce (PHW). This Policy Brief introduces a Call for Action following the plenary session entitled "Revolutionising the Public Health Workforce (PHW) as Agents of Change" as part of the 2020 World Congress on Public Health. Policy Options and Recommendations: In order to revolutionize the PHW, five long-term key approaches are proposed: 1. Transforming public health competencies through transdisciplinary education and inter-professional training; 2. Revolutionizing educational systems by shifting the public health paradigm; 3. Linking public health education and work opportunities; 4. Overcoming the paradoxical shortage and overproduction of graduates and 5. Developing adaptable, multisectoral agents of change. Conclusion: Public health education of the future requires a paradigm shift towards a holistic understanding of public health, characterized by transdisciplinary education, inter-professional training and a closer integration of academia, health services, and communities.

[Unpublished work by Ricardo Bruno Mendes Gonçalves]. / Texto inédito de Ricardo Bruno Mendes Gonçalves.

This editorial centers on a previously unpublished work by Ricardo Bruno Mendes Gonçalves, recently published in Salud Colectiva, in which he considers the relationship between epidemiology and medical practice, arriving at a novel interpretation of the health sciences as a foundation for democracy. The text is based on an inaugural lecture delivered on December 16, 1988 as part of a seminar called "Clinical epidemiology: possible scientific field or new medical ideology?" organized by the Department of Preventive Medicine at the Universidade Federal da Bahia, Brazil.

Este editorial se centra en un texto inédito que Salud Colectiva publicó recientemente, en el que Ricardo Bruno Mendes Gonçalves aborda la relación entre la epidemiología y la práctica médica, y realiza una interpretación original de las ciencias de la salud como sustrato de la democracia. Se trata de la conferencia dictada el 16 de diciembre de 1988, en el marco de la apertura del seminario "Epidemiología clínica: ¿campo científico posible o nueva ideología médica?", organizado por el Departamento de Medicina Preventiva, de la Universidade Federal da Bahia, Brasil.

[Syndemic, infodemic, pandemic of COVID-19: Towards a pandemiology of emerging diseases]. / Sindemia, infodemia, pandemia de COVID-19: Hacia una pandemiología de enfermedades emergentes.

As the basis for a theory of the co-occurrence of epidemic and pandemic processes, the article begins with a discussion of the concept of syndemic, created during the HIV/AIDS epidemic to understand the social, behavioral, and cultural components of emerging diseases, as is the case of the current COVID-19 pandemic. Secondly, the notion of infodemic is highlighted, which has great potential to better understand the impacts of the pandemic from approaches that are generally neglected in conventional epidemiological research. Third, in order to illustrate these points, a "micro-archaeological" case study of the infodemic resulting from the COVID-19 pandemic is presented, focusing on the specific situation in Brazil. Then, the correlations between scientific evidence, intervention models, and measures to control the pandemic are comparatively analyzed in different countries, as well as their adoption or rejection in the Brazilian context, which is structured by deep economic inequalities, social inequities, and health inequities.

Como base para una teoría de la coocurrencia de procesos epidémicos y pandémicos, en primer lugar, se introduce el concepto de sindemia, creado en la epidemia de VIH/sida para comprender componentes sociales, conductuales y culturales de enfermedades emergentes, tal como la actual pandemia de COVID-19. En segundo lugar, se destaca la noción de infodemia, que tiene gran potencial para comprender los impactos de la pandemia desde planos que generalmente se descuidan en los enfoques epidemiológicos convencionales. En tercer lugar, como complemento e ilustración, se presenta un estudio de caso "microarqueológico" de la infodemia resultante de la pandemia de COVID-19, centrado en la situación concreta de Brasil. Luego, se analizan las correlaciones entre la evidencia científica, los modelos de intervención y las medidas para controlar la pandemia en varios países y su adopción o rechazo en la realidad brasileña, estructurada sobre profundas desigualdades económicas, inequidades sociales e inequidades en salud.

Urbanization and mental health as a research problem in Latin America (with a focus on Brazil).

PURPOSE OF REVIEW: The basic hypothesis of this paper is that, in Latin America, the nature of the set of variables or determinants regarding the relationships of urbanization (and correlated processes of social change, modernization, acculturation, and economic inclusion) and mental health varies with the political context or historical phase considered. To assess the validity of the hypothesis, I propose a periodization of the economic, political, and social changes that occurred in Latin America in the past decades. RECENT FINDINGS: A brief review of recent studies on social determinants of mental health (with a focus on Brazil), considering research findings by historical context, shows that urbanization-modernization-migration variables were more present in the literature in the decades of 1980 and 1990, whereas social inequity factors (gender, ethnicity/race, and racism) came to be dominant as a research question after the year 2000. SUMMARY: New approaches of the mental health situation of peripheral societies such as those in the Latin American continent have gone beyond the urban environment as a determinant and start to consider social determination processes and political contexts.

Evidence-based medicine: a brief historical analysis of conceptual landmarks and practical goals for care. / Medicina baseada em evidências: breve aporte histórico sobre marcos conceituais e objetivos práticos do cuidado.

Evidence-based medicine (EBM) is intended to improve the efficiency and quality of health services provided to the population and reduce the operational costs of prevention, treatment, and rehabilitation; the objective of EBM is to identify relevant issues and promote the social applicability of conclusions. This article underscores the importance of EBM in modern clinical teaching and social practices from the contributions of Archibald Cochrane and David Sackett to the development and dissemination of this paradigm in care and education during the twentieth century. EBM has helped broaden discussions on the relationships between teaching and medical practice, and has taken on an important role in curriculum reforms and training models and practices in health care.

A medicina baseada em evidências (MBE) pretende aumentar a eficiência e qualidade dos serviços de saúde prestados à população e diminuir os custos operacionais dos processos de prevenção, tratamento e reabilitação. Busca identificar problemas relevantes do paciente e promover a aplicabilidade social das conclusões. O artigo ressalta a importância da MBE para o ensino e para as práticas clínicas sociais da atualidade a partir da contribuição de Archibald Cochrane e David Sackett no desenvolvimento e na difusão desse paradigma assistencial e pedagógico durante o século XX. A MBE tem contribuído para ampliar a discussão sobre as relações entre ensino e prática da medicina, assumindo papel de destaque em reformas curriculares e modelos de formação no cuidado e práticas em saúde.

Translating science into policy: mental health challenges during the COVID-19 pandemic.

Several stressors associated with the coronavirus disease 2019 (COVID-19) are expected to affect the mental health of global populations: the effects of physical distancing, quarantine, and social isolation; the emotional suffering of health and other frontline workers; neuropsychiatric sequelae in those affected by the virus; the impact to families of lives lost to the disease; differential effects for those with severe mental disorders; and the consequences of social and economic deterioration. In this context, we sought: to form a panel of Brazilian experts on child and adolescent health, neurodevelopment, health services, and adult and elderly mental health; and to compile evidence-based interventions to support suggested policy changes in Brazil to mitigate the expected increase in mental health disorders during the pandemic and its mental health consequences. The following actions are recommended: 1) invest in prevention programs for the safe return of students to schools; 2) adopt evidence-based psychosocial interventions to maintain an adequate environment for child and adolescent development; 3) target socially vulnerable populations and those experiencing discrimination; 4) train primary care teams to solve common mental health problems, provide needs-based assessments, and manage long-term, at-home care for older patients; 5) invest in technological advancements (e.g., telemedicine, e-Health, and web-based algorithms) to promote coordinated care; 6) increase access to and literacy in the use of computers and mobile phones, especially among older adults; 7) expand protocols for remote, brief psychotherapy interventions and psychoeducation to manage common mental health problems.

COVID-19 in northeast Brazil: first year of the pandemic and uncertainties to come.

OBJECTIVE: To analyze the epidemic of COVID-19 in northeastern Brazil, one of the regions most affected by the virus. METHODS: The official data for COVID-19, from March 2020 to March 2021 in the states of the Northeast Region (NE), were used. The analysis of capital cities and states for accumulated weekly cases and confirmed deaths was made using the JoinPoint Trend Analysis application. RESULTS: In one year, the Northeast region reported 22.9% of the cases and 21.5% of the deaths in the country due to COVID-19. At the beginning of the pandemic, all states showed a growing number of cases, first in the capitals and then in the interior. Following this wave, decreases are observed in all states and their capitals, but with many still reporting a large number of cases. In the middle of the 2nd semester of 2020 the number of cases begins to increase again simultaneously in states and their capitals-some at explosive speed-especially in late 2020 and early 2021. A similar pattern is observed in deaths, which exceed or approach the peak seen in the first wave. In the first wave, all capitals and northeastern states adopted intense isolation measures. Fortaleza, Recife and Teresina reached the highest isolation index of all capitals, close to 0.60. This index decreases, with a slight growth trend until the end of December. With the exception of Fortaleza and Salvador, the other capitals fell to less than 0.40. CONCLUSION: The Brazilian NE and the country are in increasingly complicated health, social and economic situations. It is necessary to speed up vaccinations and maintain non-pharmacological measures: face masks, social distancing measures and hygiene care, in addition to policies to protect workers who have lost their incomes and to subsidize small business owners.

[Covid-19 in the Northeast of Brazil: from lockdown to the relaxation of social distancing measures]. / Covid-19 no nordeste do Brasil: entre o lockdown e o relaxamento das medidas de distanciamento social.

Even in the period when the Covid-19 pandemic was on the rise in the Northeast of Brazil, the relaxation of social distancing measures was introduced. The scope of the study is to assess, in the light of the epidemiological-sanitary situation in the region, the suitability of relaxation of social distancing measures. Based on the WHO guidelines for relaxation of social distancing, operational indicators were created and analyzed for each guideline in the context of the Northeast. To analyze the behavior of the epidemic, according to selected indicators, Joinpoint trend analysis techniques, heat maps, rate ratios and time trends between capitals and the state interior were compared. The weekly growth peak of the epidemic occurred in May-July 2020 (epidemiological weeks 19 to 31). In most capitals, there was no simultaneous downward trend in the number of cases and deaths in the 14 days prior to flexibilization. In all states the number of tests performed was insufficient. In epidemiological week 24, the state percentages of ICU/Covid-19 bed occupancy were close to or above 70%. The epidemiological situation of the nine Northeastern state capitals analyzed here did not meet criteria and parameters recommended by the World Health Organization for the relaxation of social distancing measures.

Mesmo no período em que a pandemia de Covid-19 encontrava-se em crescimento no Nordeste do Brasil, iniciou-se a adoção de medidas de flexibilização do distanciamento social. O objetivo do estudo é o de avaliar a pertinência das propostas de flexibilização, tomando-se em conta a situação da pandemia em cada local e o momento em que foram adotadas. Tendo como referência as diretrizes da OMS, foram construídos e analisados indicadores operacionais para cada diretriz, no contexto da região Nordeste. Para análise do comportamento da epidemia, conforme indicadores selecionados, foram usadas técnicas de Joinpoint Trend Analysis, mapas de calor, razão de taxas e comparação da tendência temporal entre capitais e interior dos estados. O pico do crescimento semanal ocorreu em maio-julho/2020 (semanas epidemiológicas 19 a 31). Na maioria das capitais não se observou tendência decrescente simultânea do número de casos e óbitos nos 14 dias prévios à flexibilização. Em todos os estados o quantitativo de testes realizados foi insuficiente. Na semana epidemiológica 24 os percentuais estaduais de ocupação de leitos de UTI/Covid-19 foram próximos ou superiores 70%. A situação epidemiológica das nove capitais dos estados do Nordeste, no momento em que a decisão de flexibilização foi tomada, mostra que nenhuma delas atendia aos critérios e parâmetros recomendados pela OMS.

Ethnoepidemiology and mental health: insights from Latin America.

In this essay, I explore methodological as well as theoretical implications of an ethno-epidemiological approach, aiming to integrate research findings in mental health into new conceptual models. With this objective, I first evaluate the roots and uses of the term "ethnoepidemiology" to designate three research strategies for scientific knowledge production: type I (studies of sociocultural risk factors and ethnically defined risk groups); type II (studies of lay models of distribution and occurrence of illness in populations); type III (ethnographic studies of projects and areas of epidemiologic research). As an illustration, selected methodological features of three studies in which I have participated are presented and discussed. I then elaborate upon methodological developments derived from this experience of doing research, generating new models for transcultural transdisciplinary research of mental health practices. Lastly, I comment on some broad implications of studying mental health problems from an integrated ethnographical and epidemiological point of view, in diverse and deeply unequal societies such as those of contemporary Latin America.

En este ensayo, exploro las implicaciones teóricas y metodológicas de un abordaje etnoepidemiológico, que busca integrar hallazgos de investigaciones en salud mental con nuevos modelos conceptuales. Con este propósito, en primer lugar, evalúo las raíces y los usos del término "etnoepidemiología" para designar tres tipos de estrategias de investigación para la producción de conocimiento científico: tipo I (estudios de factores de riesgo socioculturales y grupos de riesgo definidos étnicamente); tipo II (estudios de modelos populares de distribución y ocurrencia de enfermedades en poblaciones); y tipo III (estudios etnográficos de proyectos y líneas de investigación epidemiológica). Como ejemplo, se presentan y discuten características metodológicas seleccionadas de tres estudios en los que he participado. Posteriormente detallo los desarrollos metodológicos derivados de esta experiencia de hacer investigación, generando nuevos modelos para la investigación transcultural y transdisciplinaria de las prácticas en salud mental y, por último, en las conclusiones, comento algunas implicaciones generales del estudio de los problemas de salud mental desde un punto de vista etnográfico y epidemiológico integrado, en sociedades diversas y profundamente desiguales, como las de la América Latina contemporánea.

[Health inequalities: new theoretical perspectives]. / Desigualdades en salud: nuevas perspectivas teóricas.

This article, I intend to articulate the theoretical problem of economic and social inequalities with the issue of the social determination of health. Initially, I provide a summary of Rawls' and Sen's theories of justice and equity as an illustration of the dominant perspective in Northern epistemologies. Second, I discuss applications of this theoretical framework in the literature on social inequalities and the social determination of health-illness-care. Thirdly, I present a semantic matrix proposed for the difference-distinction-inequality-inequity-iniquity series to help reduce the existing terminological confusion. Next, I introduce a synthetic theoretical model about the poverty-inequality dyad, referring to the concepts of social resources, health practices, health services, and health situation/conditions. Finally, oriented by an epistemological perspective from the global South, and taking the current Brazilian situation as a case study, I discuss political implications of the complex contemporary conjuncture, pertinent to the hypothesis that a process of transformation of economic inequalities into new forms of social inequities and health iniquities is currently underway.

En este texto pretendo articular la problemática teórica de las desigualdades económicas y sociales con la determinación social de la salud. Inicialmente presento una síntesis de las teorías de justicia y equidad de Rawls y Sen, que ilustran la perspectiva dominante de las epistemologías del norte. En segundo lugar, discuto aplicaciones de ese marco teórico en la bibliografía sobre desigualdades sociales y determinación social de la salud-enfermedad-cuidado. En tercer lugar, presento una propuesta de matriz semántica para la serie significante diferencia-distinción-desigualdad-inequidad-iniquidad, que contribuye a reducir la confusión terminológica existente. Luego, introduzco un modelo teórico sintético sobre el binomio pobreza-desigualdades, referenciado en los conceptos de recursos sociales, prácticas de salud, servicios de salud y situación-condiciones de salud. Finalmente, desde la perspectiva de las epistemologías del sur global, tomando la coyuntura brasileña actual como caso de estudio, discuto sus implicancias políticas relacionadas con la hipótesis de que está en curso un proceso de transformación de las desigualdades económicas con nuevas formas de inequidades sociales e iniquidades en salud.

Quaternary prevention: a concept relevant to public health? A bibliometric and descriptive content analysis.

According to the World Organization of Family Doctors (WONCA), quaternary prevention (P4) is a recent concept that aims to prevent medical overuse. Thus, this study aimed to measure and map research output on P4 as outline research trends, evaluating its current international status through a bibliometric and descriptive content analysis. We reviewed scientific articles on P4 recorded in PubMed, LILACS, SciELO or CINAHL with the outcomes: publication year, first authors' name and nationality, journals' name, country and ranking, publication language, used methods and main reported subjects. The analysis included 65 articles published in 33 journals of 16 countries between 2003 and 2018 with a peak of publications in 2015. The first authors came from 17 different countries, 23% Brazilian, with Uruguay as the leading nation in scientific production per capita. Q1 or Q2 journals amassed 28% of published papers. Bibliographic research comprised 88% of articles and 38% of all focused on specific examples of medical overuse. P4 represents an ethical and valid approach to prevent iatrogenic events and achieve equal and fair access to health services. Conceptual, geographical, and linguistic elements, as well as WONCA conferences and type of healthcare systems in the authors' country were fundamental factors that affected research output. The available studies are still of limited quality and quantity, with further investigations needed to assess the effective impact of P4 on public health.

COVID-19 in Northeast Brazil: achievements and limitations in the responses of the state governments. / COVID-19 no Nordeste brasileiro: sucessos e limitações nas respostas dos governos dos estados.

The COVID-19 pandemic has been most severe in the poorest regions of Brazil, such as the states of the Northeast Region. The lack of national policies for pandemic control forced state and municipal authorities to implement public health measures. The aim of this study is to show the effect of these measures on the epidemic. The highest incidence of COVID-19 among the nine states in the Northeast was recorded in Sergipe, Paraíba and Ceará. Piauí, Paraíba and Ceará were the states that most tested. Factors associated with transmission included the high proportion of people in informal work. States with international airports played an important role in the entry of the virus and the initial spread, especially Ceará. All states applied social distancing measures, banned public events and closed schools. The response was a significant increase in social distancing, especially in Ceará and Pernambuco, a decline in the reproduction rate (Rt), and a separation of the curve of observed cases versus expected cases if the non-pharmacological interventions had not been implemented in all states. Poverty, inequality, and the high rates of informal work provide clues to the intensity of COVID-19 in the region. On the other hand, the measures taken early by the governments mitigated the effects of the pandemic.

No Brasil, a pandemia da COVID-19 tem sido severa nos estados das regiões mais pobres, como o Nordeste. A falta de políticas nacionais para controle da pandemia levou as autoridades estaduais e municipais a implementarem medidas de saúde pública. O objetivo deste estudo é mostrar o efeito dessas medidas na epidemia. A maior incidência da COVID-19 entre os nove estados do Nordeste foi registrada em Sergipe, Paraíba e Ceará. O Piauí, a Paraíba e Ceará foram os que mais testaram. Muitos estados apresentavam alta proporção de pessoas em trabalho informal. Estados com aeroportos internacionais tiveram importante papel na entrada e disseminação inicial do vírus, em especial o Ceará. Todos os estados aplicaram medidas de distanciamento social, proibição de eventos públicos e fechamento de unidades de ensino. As respostas foram o aumento significativo de distanciamento social, em especial Ceará e Pernambuco, a queda do número de reprodução (Rt) e a separação da curva dos casos observados da curva dos casos esperados sem as intervenções não medicamentosas em todos os estados. A pobreza, a desigualdade e as altas taxas de trabalho informal fornecem pistas do porquê da intensidade da COVID-19 na região. Por outro lado, as medidas de mitigação tomadas precocemente pelos governantes amenizaram os efeitos da pandemia.

Subjects at risk in a transhuman and post-clinical world: Reflections on Saramago's All the Names and the Wachowski Sisters' The Matrix. / El sujeto de los riesgos en un mundo transhumano y posclínico: reflexiones a partir de Todos los nombres de Saramago y de Matrix de las hermanas Wachowski.

The main premise of this paper is that common social discourse, manifested in the Arts & Humanities, has played a crucial role in the construction of technoscientific languages and cosmologies. I explore this argument in relation to recently established scientific disciplines, such as Epidemiology, through the lens of two works of cultural production: Saramago's novel All the Names, and cult movie trilogy The Matrix, written and directed by the Wachowski Sisters. Both are allegories that exemplify a virtual world made possible by technoscience. A parallel is suggested between the first social observatories that encapsulated whole populations for systematic observation (allowing improvement of epidemiological methodology) and the "epidemiological dream" - nearly realized through the introduction of electronic data processing, enhanced by the advancement of modeling and simulation strategies and the organization of immense databases on health, disease, life, and death.

La premisa principal de este texto es que el discurso social común, expresado en las artes y las humanidades, ha sido crucial para el proceso de construcción de lenguajes y cosmologías tecnocientíficas. Se examinaron los fundamentos y las correlaciones de este argumento tomando como referencia disciplinas científicas establecidas de manera reciente, como la epidemiología, con la ayuda de dos obras de arte: la novela Todos los nombres, escrita por Saramago, y la trilogía cinematográfica Matrix, escrita y dirigida por las hermanas Wachowski. Ambas alegorías son ilustrativas del mundo virtual posibilitado por la tecnociencia. La propuesta consiste, entonces, en establecer un paralelo entre los primeros observatorios sociales que encapsularon poblaciones enteras para su observación sistemática (lo que permitió el perfeccionamiento de la metodología epidemiológica) y el "sueño epidemiológico", casi cumplido con la introducción del procesamiento electrónico de información y potenciado ahora por el avance de estrategias de modelado y simulación y por la organización de megabases de datos de salud, enfermedad, vida y muerte.

The impact of the Cabanis reform on medical education in Brazil: an assessment of neo-Foucauldian archeology. / Impacto da Reforma Cabanis no ensino médico do Brasil: ensaio de arqueologia neofoucaultiana.

This text assesses the impact of the Cabanis reform on the formation of the health training model which became hegemonic in Brazil. First, we shall briefly discuss the process of constructing the social, ideological, and institutional framework for healthcare in post-revolutionary France. Next the main elements of the Cabanis reform are introduced, analyzing curricular and pedagogical aspects of the new plan for medical education based on professionalism, disciplines, and expertise that resulted in a system of higher education without universities. This is followed by assessment of the historical process which resulted in the "Francization" of the Brazilian educational system, particularly in higher education and more specifically medical education, producing a model of health training based on colleges, hospitals, classrooms, disciplines, skills, and diplomas.

O ensaio avalia o impacto da Reforma Cabanis na configuração do modelo de formação em saúde que se tornou hegemônico no Brasil. Primeiro, discute o processo de construção social, ideológica e institucional do modelo de assistência à saúde da França pós-revolucionária. Em seguida, introduz os principais elementos da Reforma Cabanis, analisando aspectos curriculares e pedagógicos da nova proposta de ensino médico baseado em profissionalismo, disciplinaridade e especialização que resultou num sistema de ensino superior sem universidades. Depois avalia o processo histórico que resultou no "afrancesamento" do sistema educacional brasileiro, resultando num modelo de formação em saúde baseado em faculdades, hospitais, aulas, disciplinas, especialidades e diplomas.

The impact of the Cabanis reform on the historical formation of the Argentine university and on higher education in health. / El impacto de la reforma Cabanis en la formación histórica de la universidad argentina y en la educación superior en salud.

In this essay, we seek to evaluate the impact of the Cabanis reform on the configuration of the health education model that became hegemonic in Argentina. First, we analyze the restructuring of the French educational system triggered by the revolution of 1789, primarily in its political and institutional dimensions. Second, we briefly discuss the process of the social, ideological and institutional reconstruction of the health system in post-revolutionary France. Third, we introduce the Cabanis reform, a proposal for medical education based on professionalism, disciplinarity and specialization that resulted in a higher education system without universities, looking into its main curricular and pedagogical aspects. Finally, we evaluate the sequence of events and processes that, throughout the 19th century, with strong Cabanisian influence through the Idéologie, shaped both the principal features of teaching health and medicine and the higher education model based on faculties currently predominant in the Argentine Republic.

En este ensayo, proponemos evaluar el impacto de la reforma Cabanis en la configuración del modelo de formación en salud que se hizo hegemónico en Argentina. Primero, analizamos la reestructuración del sistema educacional francés desencadenada por la revolución de 1789, principalmente en sus dimensiones político-institucionales. Segundo, discutimos brevemente el proceso de reconstrucción social, ideológica e institucional del sistema de salud en la Francia postrevolucionaria. Tercero, introducimos la reforma Cabanis, propuesta de enseñanza médica basada en profesionalismo, disciplinariedad y especialización que resultó en un sistema de enseñanza superior sin universidades, e indagamos en torno a sus principales aspectos curriculares y pedagógicos. Finalmente evaluamos la secuencia de eventos y procesos que, durante todo el siglo XIX, con fuerte gravitación cabanisiana a través de la Idéologie, conformaron los rasgos principales tanto de la enseñanza de la salud y de la medicina como del modelo de educación superior basado en facultades que actualmente predomina en la República Argentina.

Metapresencialidade, Saúde Digital e Saúde Coletiva / Metapresencialidad, Salud Digital y Salud Colectiva / Meta-presentiality, Digital Health, and Collective Health

Neste ensaio, apresento reflexões preliminares sobre tecnologias digitais como novas formas de promoção da saúde no mundo contemporâneo. Primeiro, introduzo os conceitos de tecnologia, realidade, presença, realidade virtual e realidade estendida, por meio do realismo crítico. Segundo, discuto o conceito emergente de metapresencialidade como fundamental para apropriação sociotécnica de tecnologias digitais nos campos da Educação e da Saúde. Terceiro, analiso criticamente a noção de Educação a Distância, em contraste com a ideia de espaços metapresenciais de aprendizagem, no contexto de um modelo inovador de Educação Superior. Em quarto lugar, discuto brevemente a Saúde Digital como conjunto de saberes, técnicas e práticas capaz de superar o dualismo "tecnologias duras" vs "tecnologias leves" na saúde. Finalmente, avalio questões epistemológicas próprias do campo da Saúde Coletiva, com vistas a redefinir a telessaúde como cuidado em saúde mediado por metapresencialidade.

In this essay, I present preliminary reflections on digital technologies as new forms of health promotion in the contemporary world. First, I introduce the concepts of technology, reality, presence, virtual reality, and extended reality, through critical realism. Second, I discuss the emerging concept of meta-presentity as fundamental for the socio-technical appropriation of digital technologies in the fields of Education and Health. Third, I critically analyze the notion of Distance Education, in contrast to the idea of meta-presential learning spaces, in the context of an innovative model of Higher Education. Fourthly, I briefly discuss Digital Health as a set of knowledge, techniques, and practices capable of overcoming the dualism of "hard " vs. "soft" technologies in health. Finally, I evaluate epistemological issues specific to the field of Collective Health, to redefine telehealth as health care mediated by meta-presentiality.

En este ensayo presento reflexiones preliminares sobre tecnologías digitales como nuevas formas de promoción de la salud en el mundo contemporáneo. Primero, introduzco los conceptos de tecnología, realidad, presencia, realidad virtual y realidad extendida, a partir del realismo crítico. Segundo, discuto el concepto emergente de metapresencialidad como fundamental para la apropiación sociotécnica de tecnologías digitales en los campos de la educación y de la salud. Tercero, analizo críticamente la noción de Educación a Distancia en contraste con la idea de espacios metapresenciales de aprendizaje, en el contexto de un modelo innovador de educación superior. En cuarto lugar, discuto brevemente la Salud Digital como conjunto de saberes, técnicas y prácticas capaz de superar el dualismo "tecnologías duras" vs "tecnologías blandas" en la salud. Finalmente, evalúo cuestiones epistemológicas propias del campo de la Salud Colectiva, con el objetivo de redefinir la telesalud como cuidado de salud mediado por metapresencialidad.

The current challenges of the fight for a universal right to health in Brazil. / Os desafios atuais da luta pelo direito universal à saúde no Brasil.

Brazil has changed a lot since the enactment of the 1988 Federal Constitution. Although substantial advances have occurred in the health sector, old problems persist and new ones arise. The main goal of ensuring the universal right to health has not been achieved. The 16th National Health Conference will be held in 2019, an opportune moment to analyze the history, the present moment and the announcing trends. This text seeks to contribute to this analysis based on the results of studies on the developing health conditions of the population and the Brazilian health system in the last 30 years. It identifies the strengthening of the private sector and capital in the health sector, to the detriment of the public interest and the SUS. Finally, it discusses the strategies of the struggle for the right to health necessary and possible in the current context.

Desde a promulgação da Constituição federal de 1988, o Brasil mudou muito. Na saúde, embora tenham ocorrido avanços importantes, persistem problemas antigos e novos têm surgido. O objetivo maior de assegurar o direito universal à saúde não foi alcançado. Em 2019, realiza-se a 16ª Conferência Nacional de Saúde, momento oportuno para analisar a história, o momento presente e as tendências que se anunciam. Este texto busca contribuir para essa análise, com base nos resultados de estudos sobre a evolução das condições de saúde da população e do sistema de saúde brasileiro nos últimos 30 anos. Identifica o fortalecimento do setor privado e do capital na área da saúde, em detrimento do interesse público e do SUS. Por fim, discute as estratégias de luta pelo direito à saúde necessárias e possíveis no contexto atual.