[From psychosomatic medicine to medical psychology: the theoretical and institutional trajectory of Julio de Mello Filho]. / Da medicina psicossomática à psicologia médica: a trajetória teórica e institucional de Julio de Mello Filho.

Studies on the causality of pathologies and the doctor/patient relationship based on psychoanalytic formulations received two denominations in Brazil: psychosomatic medicine and medical psychology. The physician and psychoanalyst Julio de Mello Filho took a leading role in this movement after the psychiatrist and psychoanalyst Danillo Perestrello was incapacitated by illness. This study investigates how the theoretical concepts of the psychosomatic movement were structured and the institutional strategies used to establish this discipline in Brazil. From an epistemological and historical point of view, the initial notion of transforming the hegemonic medical model was seen to lose force, followed by a shift in medical psychology as a field of health psychology.

Os estudos sobre as causalidades das patologias e da relação médico/paciente a partir de formulações psicanalíticas receberam duas denominações no Brasil: medicina psicossomática e psicologia médica. O médico e psicanalista Julio de Mello Filho assumiu o protagonismo dessa proposta a partir da doença incapacitante do psiquiatra e psicanalista Danillo Perestrello. A estruturação da concepção teórica do movimento psicossomático e as estratégias institucionais utilizadas para a consolidação desse campo disciplinar no cenário brasileiro são o objeto deste estudo. Por meio de um referencial epistemológico e histórico, conclui-se que a proposta inicial de transformação do modelo médico hegemônico perde força e observa-se um deslocamento da psicologia médica como um campo da psicologia da saúde.

Science, health, and human rights.

A solid knowledge base is one of the necessary conditions to assure health as a human right. The contemporary source of such knowledge are the sciences at large, which however presents a problem, since the scientific enterprise can - and has been - a source of human rights violations as well. The field of social studies of science (STS) takes an iconoclast approach to the science, providing much needed criticism of its claims of authority. Recently, however, when attacks from multiple sources attempt to undermine perfectly reasonable scientific developments, the STS approach may not provide the adequate tools to deal with such challenge, especially with regard to health issues. This essay explores, with examples, ways in which the critical stance of STS may be compatible with a defense of proper scientific knowledge - in fact, helping to define what that actually means - without falling in the trap of scientism.

Analysis of the application of a deterministic routine for identifying multiple pregnancies on SINASC, Brazil. / Análise da aplicação de uma rotina determinística para a identificação de gestações múltiplas no Sistema de Informações sobre Nascidos Vivos.

OBJECTIVE: to evaluate the application of a deterministic routine for identifying multiple pregnancies on the Brazilian Live Birth Information System (SINASC). METHODS: SINASC data deduplication and linkage with the mortality database (fetal deaths) for Rio de Janeiro state for the period 2007-2008; we used a deterministic routine, using a key based on SINASC maternal and birth information, complemented by manual review. RESULTS: of the 433,874 SINASC records, 9,036 (2.1%) were classified as multiple pregnancy newborns; after implementing the routine, we reclassified 385 records as twins, and 286 as singletons; accuracy of multiple pregnancy information on the SINASC database was high (sensitivity=95.8%; specificity=99.9%); applying the routine without the manual review process increased sensitivity by 4.2%, with no significant change of specificity. CONCLUSION: despite the accuracy of information regarding multiple pregnancy held on SINASC, we suggest the use of this routine as an option for improving classification of twins.

Trying to make sense out of chaos: science, politics and the COVID-19 pandemic.

This essay discusses the proliferation of discourses about the COVID-19 pandemic, presenting the challenges both to science and public policies that such an information overload present, having Collins' sociology of expertise as a theoretical framework.

On health needs: the concept labyrinth.

This study aims to reflect on the intertwining of certain key ideas about what we call "health" within the hegemonic biomedical paradigm: health, disease, health needs, medicalization and medical-industrial complex. This reflection is based on the philosophical contributions of Heller and Wiggins on needs; on the discussion of some authors, especially Canguilhem, about health and illness; and Collins' sociology of expertise. After pointing out some of the conundrums that arise from the conceptual fluidity of the topics abovementioned, we present a path forward, based on Collins' proposals about the role of experts in political arguments, to resituate the discussion on health needs.

Accuracy of probabilistic and deterministic record linkage: the case of tuberculosis.

OBJECTIVE: To analyze the accuracy of deterministic and probabilistic record linkage to identify TB duplicate records, as well as the characteristics of discordant pairs. METHODS: The study analyzed all TB records from 2009 to 2011 in the state of Rio de Janeiro. A deterministic record linkage algorithm was developed using a set of 70 rules, based on the combination of fragments of the key variables with or without modification (Soundex or substring). Each rule was formed by three or more fragments. The probabilistic approach required a cutoff point for the score, above which the links would be automatically classified as belonging to the same individual. The cutoff point was obtained by linkage of the Notifiable Diseases Information System - Tuberculosis database with itself, subsequent manual review and ROC curves and precision-recall. Sensitivity and specificity for accurate analysis were calculated. RESULTS: Accuracy ranged from 87.2% to 95.2% for sensitivity and 99.8% to 99.9% for specificity for probabilistic and deterministic record linkage, respectively. The occurrence of missing values for the key variables and the low percentage of similarity measure for name and date of birth were mainly responsible for the failure to identify records of the same individual with the techniques used. CONCLUSIONS: The two techniques showed a high level of correlation for pair classification. Although deterministic linkage identified more duplicate records than probabilistic linkage, the latter retrieved records not identified by the former. User need and experience should be considered when choosing the best technique to be used. OBJETIVO: Analisar a acurácia das técnicas determinística e probabilística para identificação de registros duplicados de tuberculose, assim como as características dos pares discordantes. MÉTODOS: Foram analisados todos os registros de tuberculose no período de 2009 a 2011 do estado do Rio de Janeiro. Foi desenvolvido algoritmo para relacionamento determinístico, usando conjunto de 70 regras, a partir da combinação de fragmentos das variáveis-chave com ou sem modificações (Soundex ou substring). Cada regra era formada por três ou mais fragmentos. Para a abordagem probabilística, foi necessário estabelecer ponto de corte para o escore, acima do qual os links seriam classificados automaticamente como pertencentes ao mesmo indivíduo. O ponto de corte foi obtido por meio do relacionamento da base de dados Sistema de Informação de Agravos de Notificação - Tuberculose com ela mesma, posterior revisão manual e curvas ROC e precision-recall. Foram calculadas a sensibilidade e especificidade para análise de acurácia. RESULTADOS: A acurácia variou de 87,2% a 95,2% para sensibilidade e 99,8% a 99,9% para especificidade para as técnicas probabilística e determinística, respectivamente. A presença de valores faltantes para as variáveis-chave e o baixo percentual da medida de similaridade para o nome e data de nascimento foram os principais responsáveis pela não identificação dos registros do mesmo indivíduo pelas técnicas utilizadas. CONCLUSÕES: As duas técnicas apresentam alta concordância para a classificação como par. Apesar de a técnica determinística ter identificado mais registros duplicados que a probabilística, a segunda recuperou registros não identificados pela primeira. A necessidade e a experiência do usuário devem ser consideradas para a escolha da técnica a ser utilizada.

[Where Descartes got it right: the implications for science, biomedicine, and public health]. / Os acertos de Descartes: implicações para a ciência, biomedicina e saúde coletiva.

The "received view" of Descartes has shaped the image of a dualist thinker who radically separated mind and body and thus laid the foundations for a "divided modernity". Numerous epithets have been applied to Cartesian thinking, all of which now sound depreciative: mechanicism, determinism, and reductionism, among others. This article contends that Descartes was not the type of dualist that is normally assumed. Based on a rereading of two essential works (Discourse on Method and Metaphysical Meditations) and a dialogue with the new literature on the theme, we contend that overcoming the "received view" of Descartes can shed new light on discussions in (and of) the collective health field and highlight the so-called expanded health paradigm (including aspects beyond the biological or physiological, such as the psychological, social, economic, cultural, and political).

Going open source: some lessons learned from the development of OpenRecLink.

Record linkage is the process of identifying and merging records across different databases belonging to the same entity. The health sector is one of the pioneering areas of record linkage techniques applications. In 1998 we began the development of a software package, called RecLink that implemented probabilistic record linkage techniques. In this article we report the development of a new, open-source version of that program, now named OpenRecLink. The aim of this article is to present the main characteristics of the new version and some of the lessons learned during its development. The new version is a total rewrite of the program, based on three goals: (1) to migrate to a free and open source software (FOSS) platform; (2) to implement a multiplatform version; (3) to implement the support for internationalization. We describe the tools that we adopted, the process of development and some of the problems encountered.

[Evaluation of scientific production in different subareas of Public Health: limits of the current model and contributions to the debate]. / A avaliação da produção científica nas subáreas da Saúde Coletiva: limites do atual modelo e contribuições para o debate.

The aim of this study was to discuss the limits of the quantitative evaluation model for scientific production in Public Health. An analysis of the scientific production of professors from the various subareas of Public Health was performed for 2010-2012. Distributions of the mean annual score for professors were compared according to subareas. The study estimated the likelihood that 60% of the professors in the graduate studies programs scored P50 (Very Good) or higher in their area. Professors of Epidemiology showed a significantly higher median annual score. Graduate studies programs whose faculty included at least 60% of Epidemiology professors and fewer than 10% from the subarea Social and Human Sciences in Health were significantly more likely to achieve a "Very Good" classification. The observed inequalities in scientific production between different subareas of Public Health point to the need to rethink their evaluation in order to avoid reproducing iniquities that have harmful consequences for the field's diversity.

[Scientific output: quality assessment or an accountant's tale?]. / Produção científica: avaliação da qualidade ou ficção contábil?

Quality assessment of scientific output is based extensively (if not exclusively) on quantitative bibliometric indicators, despite mounting criticism. The reaction by the academic community has increased in recent years. After presenting a critical evaluation of this model, the article presents an alternative qualitative model oriented towards removing the excessive stimulus for the unbridled production of articles that make a dubious contribution to science. Criticism of the proposed model is presented and discussed.

Modern epidemiology and its discontents.

The goal of this article is to present a snapshot of an ongoing debate within epidemiology, pitching opposing sides in the struggle to define the path it should follow in the years to come. The debate among epidemiologists in the mid-90s pitted those who defended the idea that epidemiology should necessarily deal with a wide context against those who believed that science and public health are better served by focusing on the individual level. Ian Hacking's concept of styles of reasoning was used as a theoretical tool. The literature was reviewed using a core set of articles as an entry point, seeking articles that cited them, and then back-tracking the citations of the resulting set in the Scopus database. The main arguments are presented according to levels (ontological, epistemological, axiological and pragmatic), in order to show an even deeper disagreement, in the very conception of science and its relation to social issues and public policy.

[Multiple authorship: growth or inflationary bubble?]. / Múltipla autoria: crescimento ou bolha inflacionária?

OBJECTIVE: To analyze the increase in number of authors per article in Brazilian scientific journals on public health. METHODS: Articles published between 1999 and 2010 in six journals on public health and one medical journal (for comparison) from SciELO with Qualis (Capes) classification equal or superior to B-1, were searched on the LILACS database. The evolution of the median number of authors/article and the proportion of articles with more than four authors were evaluated. The association between the the triennium of publication and the presence of four or more authors per paper was estimated through the Mantel-Haenzel odds ratio, adjusted for the type of journal. RESULTS: An increase of the median number of authors and the proportion of articles with more than four authors was observed in all journals, especially in the last triennium. The odds ratio for articles with four or more authors, adjusted for the type of journal, were: second triennium 1.3 (95%CI 1.1;1.4); third triennium 1.5 (95%CI 1.3;1.8), fourth triennium 2.39 (95%CI 2.1;2.8). CONCLUSIONS: Scientific journals on public health have shown an increase in the number of authors per article over the years, regardless of editorial orientation.

[Estimated parameters in linkage between mortality and hospitalization databases according to quality of records on underlying cause of death]. / Estimativas de parâmetros no linkage entre os bancos de mortalidade e de hospitalização, segundo a qualidade do registro da causa básica do óbito.

The purpose of the study was to compare the linkage parameter estimates between hospitalization and mortality databases, calculated separately for the subsets of deaths from ill-defined causes and deaths from known causes. The databases for deaths from known causes and ill-defined causes were linked to a hospital admissions database. Parameters were estimated using two strategies: (1) first name, last name, and day, month, and year of birth, (2) full name and date of birth. In the first strategy, the estimates for the first and last name were at least 97% in both sets. However, the items day, month, and year of birth produced low values in both sets. In the second strategy there was an important difference between the two groups, with much lower values for full name and especially for date of birth in the group of deaths from ill-defined causes. Our results emphasize the need for pilot studies to evaluate possible internal heterogeneity of databases during the planning stage of linkage projects.

Intellectual production in collective health: epistemology and evidence from different traditions.

OBJECTIVE: To evaluate the differences in the patterns of Brazilian scientific production, published in journals that concentrate the largest production from Brazilian postgraduate programs in the area of collective health. METHODS: Based on the distinction between paradigmatic and non-paradigmatic science proposed by Kuhn, the publication of articles in the main collective health journals, related to the respective sub-areas and number of authors per article, was evaluated in the three-year period between 2004 and 2006. Data were collected from the LILACS database and independently categorized by authors into the traditional sub-areas of collective health. RESULTS: Multiple-authored articles were much more frequent among those categorized into the sub-area of epidemiology, whereas single-authored articles were more frequent in the areas of social sciences and humanities in health. In addition, there was a difference in the frequency of publication of these types of articles in various journals, with the total number of articles on epidemiology being higher than the sum of all articles from the other two sub-areas. CONCLUSIONS: The different patterns of authorship found have important implications for the processes that evaluate programs and researchers. This cannot be dismissed, otherwise the long-term sustainability of the multidisciplinary profile, which has characterized collective health in Brazil throughout three decades, will be threatened.