[Technology and disciplinary fields: cytotechnicians and implementation of the Pap test in Brazil]. / Tecnologia e campos disciplinares: os citotécnicos e a implementação do teste de Papanicolaou no Brasil.

The implementation of the Pap test as a primary technology in the control of cervical cancer in Brazil was the result of choices, agreements and disputes among certain professional groups, including physicians from various specialisations, pharmacists, biologists, biomedical scientists and cytotechnologists. The first part of the paper describes the process of formulating Brazil's first screening campaigns using the Pap smear, and the subsequent emergence of the profession of cytotechnology, whose practitioners interpret this test. Second, based on questions raised by international historiography in the field of science and technology, we explore in detail how the adoption of the Pap smear transpired within the Brazilian context, focussing on the debates among the various professional groups with an interest in the suitability of the test and on the relationships between the public and private healthcare sectors. We show that the professional career of cytotechnologists and the way in which the Pap smear has been implemented as a central technology for cervical cancer screening in Brazil have been shaped by the conflicting views of this technology held by different disciplines as well as by the relationship between these disciplines and labour market dynamics.

[Research and health care at the Fernandes Figueira Institute: an interview with José Augusto de Britto]. / Pesquisa e cuidado à saúde no Instituto Fernandes Figueira: depoimento de José Augusto de Britto.

This material is the result of an interview with José Augusto Alves de Britto, a physician who served as director of the Fernandes Figueira Institute from 2001 to 2008. It covers different aspects of the history of the institution, such as research development, health care, and transformations in the daily routine there. It is part of a project to document and investigate the history of the Fernandes Figueira Institute, which celebrates its one hundredth anniversary in 2024.

O depoimento resulta de entrevista realizada com José Augusto Alves de Britto, médico pediatra que ocupou o cargo de diretor do Instituto Fernandes Figueira entre 2001 e 2008. O relato do depoente aborda diferentes aspectos da história do instituto, como o desenvolvimento da pesquisa e do cuidado à saúde e transformações no cotidiano institucional. O depoimento faz parte de um projeto que documenta e investiga a história do Instituto Fernandes Figueira, que completa seu centenário em 2024.

[Management in tension: the Brazilian public health surveillance system and its response to the covid-19 pandemic]. / Gerenciamento tensionado: o sistema de vigilância em saúde e a resposta à pandemia da covid-19 no Brasil.

This article addresses the Brazilian government's response to the covid-19 pandemic, particularly the public health surveillance and epidemic intelligence system. It traces the evolution of disease surveillance as a response to the International Health Regulations in the context of global health. Executive orders published in the official gazette, Diário Oficial da União, are analyzed, as well as the actors and groups formed to tackle the pandemic between January 2020 and March 2022. The founding assumption is that epidemic intelligence must be placed at the service of public health. Bureaucratic tension and changes in protagonism among different groups can be observed as these intelligence mechanisms were dismantled.

O artigo aborda a resposta do governo brasileiro à pandemia da covid-19, enfatizando o sistema de vigilância em saúde e de inteligência epidemiológica. Retoma a evolução da vigilância em resposta às normas do Regulamento Sanitário Internacional, no contexto da saúde global. Analisa os atos do Executivo publicados no Diário Oficial da União e se detém nos atores e grupos formados para o enfrentamento da pandemia da covid-19 de janeiro de 2020 até março de 2022. Parte da premissa de que a inteligência epidemiológica deve estar a serviço da saúde pública. Constata-se que certo tensionamento burocrático e a transferência de protagonismo entre grupos marcam o desmonte dos mecanismos de inteligência.

Beyond biomedical classifications: breast cancer experience in Brazil, 1990-2015. / Para além das classificações biomédicas: a experiência do câncer de mama no Brasil, 1990-2015.

The paper analyses illness experiences of breast cancer in women undergoing treatment at the Hospital of Cancer III of the National Institute of Cancer. It argues that part of the interviewed women's experience was constructed from the interaction between family coexistence and the mobilisation of different cultural meanings of the disease and femininity, negotiating senses for biomedical entities. The study results from a qualitative research of ethnographic inspiration that interviewed women undergoing treatment from breast cancer during 2015. It draws on the accounts to discuss the interaction of society with biomedical entities for the significance of cancer in Brazil between the 1990s and 2010s.

Analisa as experiências de adoecimento por câncer de mama de mulheres em tratamento no Hospital do Câncer III do Instituto Nacional de Câncer, Rio de Janeiro. Argumenta que parte da experiência das mulheres entrevistadas foi construída pela interação entre a convivência familiar e a mobilização de diferentes significados culturais da doença e da feminilidade, negociando sentidos para entidades biomédicas. O estudo resulta de uma pesquisa qualitativa de inspiração etnográfica, que entrevistou mulheres em tratamento de câncer de mama ao longo de 2015. Parte dos depoimentos para discutir a interação da sociedade com as entidades biomédicas para a significação do câncer no Brasil entre as décadas de 1990 e 2010.

Im perfect tools for a difficult job: colposcopy, 'colpocytology' and screening for cervical cancer in Brazil.

The quasi-totality of social scientists who studied screening for cervical tumours identified such screening with a single method: the Pap smear (exfoliative cytology). This article explains that this method was not valid everywhere. The history of screening for cervical cancer in Brazil displays an alternative method for detecting cervical malignancies: a direct observation of the cervix with a specific instrument--the colposcope. The development of this method in Brazil in the 1940s and 1950s reflected a complex mixture of professional interests, government policies, and regional, local and charitable initiatives. While the use of colposcopy for cervical tumour screening was phased out in the 1970s and 1980s, the long lifespan and widespread diffusion of this method illuminates the irreducible contingency of specific developments in science, technology and medicine. Seen from the vantage point of Brazil, the Western model for preventing cervical malignancies no longer appears self-evident Alternative choices might have led to the development of different material and visual cultures of medicine, stimulated different patterns of medical specialization and division of medical labour, produced different links between malignancies, women, gynaecologists, epidemiologists and public health experts, and shaped different health policies.

New problems of a new health system: the creation of a national public policy of rare diseases care in Brazil (1990s-2010s). / Nuevos problemas de un nuevo sistema de salud: la creación de una política pública nacional de atención de enfermedades raras en Brasil (1990-2014).

This study discusses actors and institution movements leading to the disclosure in 2014 of Resolution 199 by the Brazilian Ministry of Health, which establishes the National Policy for the Comprehensive Care of Persons with Rare Diseases. Taking as sources the mainstream newspapers, drafts law, and secondary literature on the subject, we begin our analysis in the early 1990s when the first patient associations were created in Brazil - mainly for claiming more funds for research on genetic diseases - and arrive at the late 2010s when negotiations for a national policy are taking place in the National Congress. Resolution 199 is part of an ongoing process and the path towards its disclosure and the complications that followed have given us elements to discuss contemporary aspects of the Brazilian public health. Based on the references of the history of the present time and the social studies of science, we argue that two aspects have been fundamental to creating a national policy: framing different illnesses within the terminology "rare diseases" and the construction of a public perception about the right of health which is guaranteed by the 1988 Brazilian Constitution.

En este trabajo se analizan los movimientos de actores e instituciones que llevaron a la promulgación, en 2014, de la Resolución 199 del Ministerio de Salud de Brasil, que establece la Política Nacional de Atención Integral a las Personas con Enfermedades Raras. Tomando como fuentes los principales periódicos, proyectos de ley y bibliografía secundaria sobre el tema, comenzamos nuestro análisis a principios de la década de 1990 con la creación de las primeras asociaciones de pacientes en Brasil, para reclamar fundamentalmente más fondos para la investigación de enfermedades genéticas, y llegamos a fines de la década de 2010 con las negociaciones para una política nacional. La Resolución 199 es parte de un proceso en curso, en el que el camino hacia la promulgación y las complicaciones posteriores nos dan elementos para discutir aspectos actuales de la salud pública brasileña. Sobre la base de la historia del tiempo presente y los estudios sociales de la ciencia, argumentamos que hay dos aspectos que han sido fundamentales para crear una política nacional: enmarcar diferentes enfermedades en la terminología "enfermedades raras" y la construcción de una percepción pública sobre el derecho a la salud, que se garantiza en la Constitución brasileña de 1988.

Still Controversial: Early Detection and Screening for Breast Cancer in Brazil, 1950-2010s.

Mammographic screening for breast cancer is a widely used public health approach, but is constantly a subject of controversy. Medical and historical research on this topic has been mainly conducted in Western Europe and North America. In Brazil, screening mammography has been an open topic of discussion and a challenge for health care and public health since the 1970s. Effectively, Brazilian public health agencies never implemented a nationwide population-based screening programme for breast cancer, despite the pressures of many specific groups such as advocacy associations and the implementation of local programmes. This article examines the complex process of incorporating mammography as a diagnostic tool and the debates towards implementing screening programmes in Brazil. We argue that debates about screening for breast malignancies, especially those conducted in the late twentieth and early twenty-first centuries, took place in a context of change and uncertainty in the Brazilian health field. These discussions were strongly affected both by tensions between the public and the private health care sectors during the formative period of a new Brazilian health system, and by the growing role of civil society actors. Our study investigates these tensions and their consequences. We use several medical sources that discussed the topic in Brazil, mainly specialised leading oncology journals published between 1950 and 2017, medical congress reports for the same period, books and theses, institutional documents and oral testimonies of health professionals, patients and associations collected in the framework of the 'The History of Cancer' project from the Oswaldo Cruz Foundation and Brazilian National Cancer Institute.

[Medicalization of childbirth: the meanings attributed by the literature on childbirth care in Brazil]. / Medicalização do parto: os sentidos atribuídos pela literatura de assistência ao parto no Brasil.

This study analyzes the meanings attributed to the concept of the medicalization of childbirth from a narrative review of the literature in national journals published between 2000 and 2017. It is based on the more general concept of medicalization - understood as the process by which medicine broadens and consolidates its area of activity in the various sectors of society - and the different formulations of the concept conceived by twentieth-century scholars. Five categories were created that related the medicalization of childbirth with interventions, professional dispute, violation of the rights of pregnant women, the birth scenario, and the impact of the medicalization of society. In the first four categories there is a predominance of meanings that explore the interface between medicalization and humanization, considered two analytical super categories, with a predominance of a critique of the medicalized model. Setting aside this analysis model, the medicalization of childbirth category as a reflection of the medicalization of society focuses on a sense of medicalization of childbirth as part of a broader process involving different actors who are part of the care process, pointing to a possibility of more in-depth analysis in which it considers the complex connection between modern health and society.

Este estudo analisa os sentidos atribuídos ao conceito de medicalização do parto a partir de uma revisão narrativa de literatura em periódicos nacionais publicados entre 2000 e 2017. Parte-se da concepção mais geral sobre medicalização ­ entendida como o processo pelo qual a medicina amplia e consolida a sua área de atuação nos diversos campos da sociedade ­ e das diferentes formulações do conceito concebidas por estudiosos do século XX. Foram construídas cinco categorias que relacionaram medicalização do parto com: intervenções, disputa profissional, violação de direitos das gestantes, cenário do parto e reflexo da medicalização da sociedade. Nas quatro primeiras categorias encontramos um predomínio de sentidos que exploram uma interface entre medicalização e humanização, constituindo-se como duas supercategorias analíticas, com um predomínio de uma crítica ao modelo medicalizado. Fugindo a este modelo de análise, a categoria medicalização do parto como reflexo da medicalização da sociedade se concentra em torno de um sentido de medicalização do parto como parte de um processo mais amplo que envolve diferentes atores que seriam copartícipes no processo de assistência, apontando para uma possibilidade de análise mais aprofundada em que considera a complexa conexão entre saúde e sociedade moderna.

Pesquisa e cuidado à saúde no Instituto Fernandes Figueira: depoimento de José Augusto de Britto / Research and health care at the Fernandes Figueira Institute: an interview with José Augusto de Britto

Resumo O depoimento resulta de entrevista realizada com José Augusto Alves de Britto, médico pediatra que ocupou o cargo de diretor do Instituto Fernandes Figueira entre 2001 e 2008. O relato do depoente aborda diferentes aspectos da história do instituto, como o desenvolvimento da pesquisa e do cuidado à saúde e transformações no cotidiano institucional. O depoimento faz parte de um projeto que documenta e investiga a história do Instituto Fernandes Figueira, que completa seu centenário em 2024.

Abstract This material is the result of an interview with José Augusto Alves de Britto, a physician who served as director of the Fernandes Figueira Institute from 2001 to 2008. It covers different aspects of the history of the institution, such as research development, health care, and transformations in the daily routine there. It is part of a project to document and investigate the history of the Fernandes Figueira Institute, which celebrates its one hundredth anniversary in 2024.

Methods of childbirth preparation: a study of printed matter published in Brazil in the mid-twentieth century. / Métodos de preparação para o parto: um estudo sobre materiais impressos publicados no Brasil em meados do século XX.

The article explores the dissemination of natural childbirth practices through an analysis of the books Parto natural: guia para os futuros pais, written by U.S. obstetrician Frederick Goodrich Jr. in 1950, under the title Natural Childbirth: a manual for expectant parents, and first published in Brazil in 1955, and of Parto natural sem dor, written by Brazilian obstetrician Beutner in 1962. Both books found a place in Brazilian culture and influenced thinking about childbirth and delivery in the field of Brazilian obstetrics and in representations of women. Based on Roger Chartier's contributions and on concepts of medicalization, we conclude that these new practices for childbirth preparation shared the period's prevalent medical views of childbirth and delivery.

Discute-se a difusão das práticas de parto natural por meio da análise dos livros Parto natural: guia para os futuros pais, escrito pelo obstetra americano Frederick Goodrich Jr. em 1950 e publicado no Brasil a partir de 1955, e Parto natural sem dor, escrito pelo obstetra brasileiro George Beutner, em 1962. Ambos tiveram boa entrada na cultura brasileira e influenciaram a forma de pensar o parto e de parir, tanto no âmbito da obstetrícia brasileira como no que concerne às representações das mulheres. A partir das contribuições de Roger Chartier e das concepções sobre medicalização, concluímos que essas novas práticas de preparação do parto compartilhavam as visões médicas sobre o parto e o nascimento predominantes no período.

[A firsthand description of childbirth's pathways into Brazilian health policies: interview with Maria do Carmo Leal and Marcos Dias]. / Os percursos do parto nas políticas de saúde no Brasil por suas testemunhas: entrevista com Maria do Carmo Leal e Marcos Dias.

This interview discusses the pathways that brought childbirth into Brazilian public policies. Maria do Carmo Leal and Marcos Dias are active participants in this journey, in academics as well as activism. In the interview, the participants reflect on the challenges to achieving change in the Brazilian health care model and highlight the importance of women's participation and their movements in reaching this goal.

A entrevista aborda os percursos que colocaram o parto na pauta das políticas públicas brasileiras. Maria do Carmo Leal e Marcos Dias são participantes ativos nesse percurso, tanto no campo acadêmico como no âmbito do ativismo. Na entrevista, os depoentes refletem sobre os desafios enfrentados para alcançar uma mudança no modelo assistencial brasileiro e destacam a importância da participação das mulheres e de seus movimentos no alcance desse objetivo.

[Struggles for the history of health: perspectives on the social sciences in health based on the intellectual trajectory of Luiz Antonio de Castro Santos]. / Lutas pela história da saúde: perspectivas sobre as ciências sociais em saúde a partir da trajetória intelectual de Luiz Antonio de Castro Santos.

This interview discusses the connections between social sciences and health, based on the trajectory of sociologist Luiz Antonio de Castro Santos. Castro Santos was an active participant in the process of integrating these fields, and considers some of the challenges he faced as a way of addressing approaches that were not always devoid of tension. In a conversation rich in facts and processes, Castro Santos describes some of the most important characters and landmarks from a trajectory that contributed to the social sciences and history, and especially to the health sciences.

A entrevista aborda os percursos que ligam as ciências sociais à saúde a partir da trajetória do sociólogo Luiz Antonio de Castro Santos. Participante ativo do processo de integração desses campos, Castro Santos contempla alguns dos desafios enfrentados em sua trajetória profissional como forma de abordar aproximações que nem sempre se revelaram desprovidas de tensões. Conversa rica em fatos e processos, Castro Santos situa alguns dos principais personagens e marcos de uma trajetória que trouxe contribuições tanto para as ciências sociais e a história como, principalmente, para as ciências da saúde.

Cancer in Ceará: shaping a medical and social problem, 1940-1954. / O câncer no Ceará: a conformação de um problema médico-social, 1940-1954.

This article addresses the shaping of cancer as a relevant medical and social problem in the Brazilian state of Ceará from 1940 to 1954. While this disease initially garnered little importance on the local medical and health agenda, and was considered a problem for philanthropy, a group of physicians and allies brought cancer to the public health agenda and led to the Campaign Against Cancer in 1954. This group's ability to unite internal and external allies with a broader reach portrayed cancer as a relevant medical and social problem in Ceará. We demonstrate this new portrayal in medical articles, institutional documents, biographies, newspapers, and other documents produced on and by the characters involved with anticancer activities in Ceará.

Synthetic oxytocin and hastening labor: reflections on the synthesis and early use of oxytocin in Brazilian obstetrics. / Ocitocina sintética e a aceleração do parto: reflexões sobre a síntese e o início do uso da ocitocina em obstetrícia no Brasil.

This article reflects on the medicalization of childbirth, focusing on the development of synthetic oxytocin in 1953. Specifically addressed is the social life of oxytocin; in other words, its synthesis, stabilization, and use in obstetrics to hasten labor. Two Brazilian obstetrics journals of this era were surveyed to analyze the early use of synthetic oxytocin in Brazil in the late 1950s, along with obstetric arguments for or against its use. Notable in this period is the increasingly central role of the obstetrician in childbirth, as well as the recommendation to use different interventions linked together (particularly oxytocin) to shorten labor.

O artigo reflete sobre o processo de medicalização do parto, tendo como foco específico o desenvolvimento da ocitocina sintética em 1953. Investiga a vida social da ocitocina, isto é, sua sintetização, estabilização e uso em obstetrícia para acelerar o trabalho de parto. Por meio do levantamento em dois periódicos brasileiros de obstetrícia da época, é analisado o início do uso da ocitocina sintética no Brasil, a partir do final da década de 1950, e os argumentos dos obstetras acerca da recomendação ou não desse uso. É observada, nesse período, a centralidade cada vez maior do obstetra no parto, bem como a recomendação do uso encadeado de diferentes intervenções ­ com destaque para a ocitocina ­ visando menor tempo de trabalho de parto.

Gerenciamento tensionado: o sistema de vigilância em saúde e a resposta à pandemia da covid-19 no Brasil / Management in tension: the Brazilian public health surveillance system and its response to the covid-19 pandemic

Resumo O artigo aborda a resposta do governo brasileiro à pandemia da covid-19, enfatizando o sistema de vigilância em saúde e de inteligência epidemiológica. Retoma a evolução da vigilância em resposta às normas do Regulamento Sanitário Internacional, no contexto da saúde global. Analisa os atos do Executivo publicados no Diário Oficial da União e se detém nos atores e grupos formados para o enfrentamento da pandemia da covid-19 de janeiro de 2020 até março de 2022. Parte da premissa de que a inteligência epidemiológica deve estar a serviço da saúde pública. Constata-se que certo tensionamento burocrático e a transferência de protagonismo entre grupos marcam o desmonte dos mecanismos de inteligência.

Abstract This article addresses the Brazilian government's response to the covid-19 pandemic, particularly the public health surveillance and epidemic intelligence system. It traces the evolution of disease surveillance as a response to the International Health Regulations in the context of global health. Executive orders published in the official gazette, Diário Oficial da União, are analyzed, as well as the actors and groups formed to tackle the pandemic between January 2020 and March 2022. The founding assumption is that epidemic intelligence must be placed at the service of public health. Bureaucratic tension and changes in protagonism among different groups can be observed as these intelligence mechanisms were dismantled.

The opportunity pill: discourses about the birth control pill in A Gazeta da Farmácia, 1960-1981. / A pílula da oportunidade: discursos sobre as pílulas anticoncepcionais em A Gazeta da Farmácia, 1960-1981.

The pharmacy world was a mandatory crossing point and active player in the establishment of hormonal contraception in Brazil. Through an analysis of articles published in A Gazeta da Farmácia from 1960 to 1981, the study explores little-known aspects of the birth control pill's biography and the construction of its Brazilian market. For pharmacy professionals, oral contraceptives were "opportunity pills" in two senses: they provided profits and they restored the prestige of these professionals within the scientific, clinical-therapeutic, and political realms. The pathways of the pill and the pharmacy world intersected as both wove their biographies under the patronage of industry. Pharmacists and the pill were co-constructed, and each was an important crossing point for the other.

O artigo analisa matérias sobre pílulas anticoncepcionais publicadas em A Gazeta da Farmácia, entre 1960 e 1980, examinando aspectos pouco conhecidos da biografia desses medicamentos e da constituição do seu mercado. Para os profissionais de farmácia, os anticoncepcionais orais se apresentaram como "as pílulas da oportunidade", seja no sentido dos lucros, seja no sentido de resgatar seu prestígio no campo científico, clínico-terapêutico e político. As trajetórias das pílulas anticoncepcionais e do mundo da farmácia se interseccionaram, quando ambos buscavam tecer sua biografia, apadrinhados pela indústria. Farmacêuticos e pílulas se coconstituíram, um sendo importante ponto de passagem para outro.

A Statistical Review of Alternative Zinc and Copper Extraction from Mineral Fertilizers and Industrial By-Products.

Rapid, accurate, and low-cost alternative analytical methods for micronutrient quantification in fertilizers are fundamental in QC. The purpose of this study was to evaluate whether zinc (Zn) and copper (Cu) content in mineral fertilizers and industrial by-products determined by the alternative methods USEPA 3051a, 10% HCl, and 10% H2SO4 are statistically equivalent to the standard method, consisting of hot-plate digestion using concentrated HCl. The commercially marketed Zn and Cu sources in Brazil consisted of oxides, carbonate, and sulfate fertilizers and by-products consisting of galvanizing ash, galvanizing sludge, brass ash, and brass or scrap slag. The contents of sources ranged from 15 to 82% and 10 to 45%, respectively, for Zn and Cu. The Zn and Cu contents refer to the variation of the elements found in the different sources evaluated with the concentrated HCl method as shown in Table 1. A protocol based on the following criteria was used for the statistical analysis assessment of the methods: F-test modified by Graybill, t-test for the mean error, and linear correlation coefficient analysis. In terms of equivalents, 10% HCl extraction was equivalent to the standard method for Zn, and the results of the USEPA 3051a and 10% HCl methods indicated that these methods were equivalents for Cu. Therefore, these methods can be considered viable alternatives to the standard method of determination for Cu and Zn in mineral fertilizers and industrial by-products in future research for their complete validation.

Absorption and metabolization of sex hormones and their transformation into contraceptive technologies: the paths taken by medical thought in Brazil. / Absorção e metabolização dos hormônios sexuais e sua transformação em tecnologias contraceptivas: percursos do pensamento médico no Brasil.

The article analyses knowledge assimilation and the development of clinical and research practices relating to sex hormones among Brazilian gynaecologists. It discusses the paths taken by medical thought from the reception of the hormones to their transformation into contraceptives. Our objective is to comprehend styles of introducing and disseminating medical technologies in the area of reproductive health in Brazil. It uses methods of historical analysis and takes as its source the Anais Brasileiros de Ginecologia, a journal published between 1936 and 1970. From the outset, the accompaniment of scientific breakthroughs in relation to sex hormones and their use to treat diverse female illnesses played a key role in the rapid medical acceptance of hormonal contraception. Scientific and technical questions (side effects, dosages) and the demographic issue formed part of the majority of the debates. Objections from the Catholic Church were considered but did not set the agenda of medical thought on contraceptives. The quest to consolidate gynaecology as a scientific, modern and cosmopolitan area of expertise, along with sanitary and demographic motives that allowed contraceptives to be classed as ethical drugs, are identified as processes underlying the assimilation and metabolization of sex hormones as hormonal contraceptives.