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.

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

RESUMEN 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.

ABSTRACT 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.

[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.

O pensamento político-pedagógico de Juan César García: Piaget-Gramsci-Freire e a formação profissional em Saúde na América Latina / The political and pedagogical thinking of Juan César García: Piaget-GramsciFreire and professional health education in América Latina / El pensamiento político-pedagógico de Juan César García: Piaget-GramsciFreire y la formación profesional en salud en América Latina

Neste artigo pretendo demonstrar a atualidade do pensamento político-pedagógico de Juan César García no contexto contemporâneo. Com esse objetivo, primeiro discuto a "teoria do modo de produção de médicos" proposta por García, inspirado no referencial marxista. Segundo, sistematizo elementos que permitem delinear uma teoria da educação baseada no materialismo-histórico, com forte influência do pensamento gramsciano, formulada por García em contraposição ao que chama de "pedagogia idealista". Terceiro, destaco na sua obra elementos político-pedagógicos que precisariam de melhor contextualização para poder avaliar sua efetiva contribuição para a educação profissional em Saúde. Finalmente, apresento argumentos que valorizam a contribuição de Juan César García para a compreensão da dialética permanência-transformação na relação educação-trabalho, sobretudo o papel das instituições encarregadas da formação de sujeitos críticos, criativos e engajados na luta histórica pela qualidade-equidade em saúde.(AU)

This article aims to demonstrate the political and pedagogical thinking of Juan César García from a contemporary perspective. First, I discuss the theory of the "mode of medical production" proposed by García, inspired by Marxism. Second, I systematize elements that delineate a theory of education based on historical materialism, with a strong influence from Gramscian thought as formulated by García, in contrast to what he calls "idealist pedagogy". Third, I highlight political and pedagogical elements in his work that need better contextualization to assess his real contribution to professional health education. Finally, I present arguments to highlight Juan César García's contribution to the understanding of the permanence-transformation dialectic in education-work relations, focusing on the role of institutions tasked with training critical and creative subjects engaged in the historic struggle for health equity and quality of care.(AU)

En este artículo, pretendo demostrar la actualidad del pensamiento político-pedagógico de Juan César García no contexto contemporáneo. Con ese objetivo, discuto primero la "teoría del modo de producción de médicos" propuesta por García, inspirado en el referencial marxista. Segundo, sistematizo elementos que permiten delinear una teoría de la educación basada en el materialismo-histórico, con fuerte influencia del pensamiento gramsciano, formulada por García en contraposición a lo que llama de "pedagogía idealista". Tercero, destaco en su obra elementos político-pedagógicos que necesitarían mejor contextualización para poder evaluar su efectiva contribución para la educación profesional en salud. Finalmente, presento argumentos que valorizan la contribución de Juan César García para la comprensión de la dialéctica permanencia-transformación en la relación educación-trabajo, principalmente el papel de las instituciones encargadas de la formación de sujetos críticos, creativos y comprometidos en la lucha histórica por la calidad-equidad en salud.(AU)

[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.

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.

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

Resumo 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.

Abstract 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.

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.

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.

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

Resumo 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.

Abstract 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.

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.

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

RESUMEN 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.

ABSTRACT 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.

Covid-19 in northeast Brazil: first year of the pandemic and uncertainties to come / Covid-19 no nordeste do Brasil: primeiro ano de pandemia e incertezas que estão por vir

ABSTRACT 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.

RESUMO OBJETIVO Analisar a epidemia da covid-19 na região Nordeste do Brasil, uma das mais atingidas por essa virose. MÉTODOS Os dados oficiais para covid-19 dos estados do Nordeste são referentes ao período de março de 2020 a março de 2021. A análise para capitais e estados da série do acumulado semanal de casos e de óbitos confirmados foi feita com emprego do aplicativo JoinPoint Trend Analysis. RESULTADOS Em um ano, o Nordeste acumulou 22,9% dos casos e 21,5% dos óbitos do país pela covid-19. No início da pandemia, todos os estados apresentaram um crescimento sustentável de casos, primeiro nas capitais e depois interior. Em seguida, observam-se decréscimos em todos os estados e suas capitais, porém muitos permanecem com números elevados. Em meados do segundo semestre de 2020, o número de casos começa a crescer nos estados e suas capitais, alguns em velocidade explosiva, em especial no final de 2020 e início de 2021. Padrão similar é observado para os óbitos, os quais ultrapassaram ou aproximam-se do teto observado na primeira onda, na qual todas as capitais e estados do Nordeste adotaram intensas medidas de isolamento. Fortaleza, Recife e Teresina atingiram os maiores índices de isolamento de todas as capitais, perto de 0,60. Esse índice decresce, com tendência leve de crescimento até final de dezembro, voltando a decrescer. Com exceção de Fortaleza e Salvador, as demais capitais caíram para menos de 0,40. CONCLUSÃO O Nordeste brasileiro e o país estão em uma situação sanitária, social e econômica cada vez mais complexa. É necessário acelerar o processo de vacinação e manter as medidas não farmacológicas - constante uso de máscaras faciais, medidas de distanciamento e cuidados de higiene -, além de políticas de proteção aos trabalhadores que perderam as suas rendas e subsídios aos pequenos empresários.

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.