Resgate histórico do primeiro programa público de interrupção da gestação por estupro no Brasil / Historical rescue of the first public rape pregnancy program in Brazil

Os autores apresentam a evolução histórica dos caminhos percorridos até a criação do primeiro programa público de interrupção legal da gestação no Brasil. Mencionam o atendimento antes desse programa, que era realizado por poucos, de maneira dissimulada e sem publicidade nem publicações para a preservação das equipes. Mencionam como o Hospital Municipal Dr. Arthur Ribeiro de Saboya foi escolhido para esse desafio. Resgatam a luta das mulheres e dos movimentos feministas, e a criação da portaria que determinava a obrigatoriedade do atendimento para a realização do abortamento legal nos casos de antijuricidade, pela Prefeitura Municipal de São Paulo. Mencionam os difíceis caminhos até a constituição das equipes de atendimento e o desenrolar de uma sequência de fatos históricos, passando pelo início do atendimento imediato às vítimas no sentido de realizar as profilaxias pertinentes, a utilização de aspiração manual intrauterina (AMIU) como técnica principal para atendimento ao abortamento em todas as suas situações, os Fóruns Nacionais de Aborto Legal realizados pelo Cemicamp, Ministério da Saúde e Federação Brasileira das Associações de Ginecologia e Obstetrícia (Febrasgo), entre outros, que culminaram com tudo o que temos hoje em termos de atendimento integral à saúde da mulher, mormente no que tange aos direitos sexuais e reprodutivos, à violência sexual e à interrupção legal da gestação.(AU)

The authors present the historical evolution of the paths traveled until the creation of the First Public Program for Legal Interruption of Pregnancy in Brazil. They mention the care before this program that was carried out by a few, in a covert way and without advertisements or publications for the preservation of the team. Mention as the Municipal Hospital Dr. Arthur Ribeiro de Saboya was chosen for this challenge. They rescued the struggle of women and feminist movements, the creation of the ordinance that determined the mandatory care for the performance of legal abortion in cases of anti-juristy, by the city of São Paulo. They mention the difficult paths to the constitution of care teams and the development of a sequence of historical facts, through the beginning of immediate care to victims in order to perform the relevant prophylaxis, in the use of the AMIU as the main technique for abortion care in all its situations, the National Legal Abortion Forums held by Cemicamp, Ministry of Health and Federação Brasileira das Associações de Ginecologia e Obstetrícia (Febrasgo), among others, which culminated in all that we have today in terms of comprehensive care for women's health, especially with regard to sexual and reproductive rights, sexual violence and legal interruption of pregnancy.(AU)

El Gobierno de las poblaciones: Augusto Orrego Luco y la Cuestión Social en Chile / The Governing of populations: Augusto Orrego Luco and the Social Question in Chile

Partiendo de dos textos fundamentales del médico chileno Augusto Orrego Luco: La cuestión social (1897) y su Discurso de toma de posesión de su cargo de presidente de la Sociedad Médica (1895), se analiza las propuestas que este autor desarrollo sobre el papel de la ciencia en el gobierno de las poblaciones. Se presta atención a conceptos, como el de raza vagabunda en relación con la cuestión social, y racial, en el Chile de finales del siglo XIX y se identifican influencias científicas como el determinismo biológico y la teoría de la degeneración

Based on two essential texts by Chilean doctor Augusto Orrego Luco - La cuestión social (The Social Question, 1897) and his Discurso de toma de posesión de su cargo de presidente de la Sociedad Médica (Speech on taking up his position as president of the Medical Society, 1895) - we analyse this author's proposals regarding the role of science in governing populations. The analysis focuses on concepts such as the vagabond race in relation to the social and racial question in late-19th-century Chile, and identifies scientific influences such as biological determinism and the theory of degeneracy

Uncovering the metaphysics of psychological warfare: The social science behind the Psychological Strategy Board's operations planning, 1951-1953.

In April 1951 president Harry S. Truman established the Psychological Strategy Board to enhance and streamline America's sprawling psychological warfare campaign against the USSR. As soon as the Board's staff began work on improving US psychological operations, they wondered how social science might help them achieve their task. Board Director, Gordon Gray, asked physicist turned research administrator Henry Loomis to do a full review of America's social science research program in support of psychological operations. Loomis willingly accepted the task. This paper documents Loomis's investigation into America's social science research program. It uncovers the critical role that government departments had in the creation of research in the early 1950s and thus highlights that the government official is an important actor in the history of social science and the application of social science to psychological operations at the beginning of the Cold War.

'All the stars were aligned'? The origins of England's National Institute for Health Research.

BACKGROUND: In 2006, the research and development (R&D) activity of England's national healthcare system, the National Health Service, was reformed. A National Institute for Health Research (NIHR) was established within the Department of Health, the first body to manage this activity as an integrated system, unlocking significant increases in government funding. This article investigates how the NIHR came to be set up, and why it took the form it did. Our goal was a better understanding of 'how we got here'. METHODS: We conducted oral history interviews with 38 key witnesses, held a witness seminar, and examined published and unpublished documents. RESULTS: We conclude that the most important forces shaping the origin of NIHR were the growing impact of evidence-based medicine on service policies, the growth of New Public Management ways of thinking, economic policies favouring investment in health R&D and buoyant public funding for healthcare. We note the strong two-way interaction between the health research system and the healthcare system - while beneficial for the use of research, challenges for healthcare (such as stop-go funding) could also produce challenges for health research. CONCLUSIONS: Understanding how and why England came to have a centralised health service research system alongside a long-established funder of biomedical research (the Medical Research Council) helps us interpret the significance of the English health research experience for other countries and helps English policy-makers better understand their present options. Learning lessons from the features of the English health research system calls for an understanding of the processes which shaped it. Firstly, the publicly funded, nationally organised character of healthcare promoted government interest in evidence-based medicine, made research prioritisation simpler and helped promote the implementation of findings. Secondly, the essential role of leadership by a group who valued research for its health impact ensured that new management methods (such as metrics and competitive tendering) were harnessed to patient benefit, rather than as an end in themselves. A policy window of government willingness to invest in R&D for wider economic goals and buoyant funding of the health system were also effectively exploited.

Between politics and prevention: A re-examination of China's schistosomiasis control campaign in the 1950s.

In the 1950s, China is widely regarded as having made great achievements in the control of schistosomiasis, also known as snail fever. Despite the success, efforts to prevent the disease did not fare well during the Reform period (1978-present). Given this, several key questions need to be addressed. Was the schistosomiasis control campaign a real success in the context of political fervor? Would a schistosomiasis control policy be successful only when it returns to the Maoist medical model, as Miriam Gross argues? Did schistosomiasis return as advertised, or was it never eliminated since the 1950s? In this article, I argue that (1) schistosomiasis control is widely regarded as a great success in an ecological sense, but as far as a long-term mechanism of control is concerned, an approach that relies exclusively on strong political intervention and mass participation may not be effective; (2) schistosomiasis control should first focus on the establishment of a sustainable, long-term mechanism, rather than a temporary, assault-style approach to the problem; and (3) from the 1950s to the present, the spread of schistosomiasis does not represent its return, but, rather, the failure of control efforts to eliminate it.

Indigenous health and nursing in Roraima in the 1970s.

OBJECTIVE: To analyze the strategies undertaken by the government to address the health problem in Boa Vista/Roraima. METHOD: A study using the microhistory approach, with documentary sources from journalistic material of the 1970s through the triangulation technique: texts, images and context, with analysis from the perspective of the Social World Theory. RESULTS: It was evidenced that the strategies undertaken by the government occurred in favor of the exploration of isolated areas in Roraima that demanded settlement processes, construction of villages and a highway to enable the interconnection of the state with other regions of Brazil, with a smoke screen symbolic effect produced by nurses on indigenous health. CONCLUSION: There was governmental manipulation, when the symbolic power was unveiled, making it possible to see and believe that nursing needs to guide political issues rather than being ruled.

Indigenous health and nursing in Roraima in the 1970s / Salud de los indígenas y enfermería en Roraima en la década de 1970 / Saúde indígena e enfermagem em Roraima na década de 1970

ABSTRACT Objective: To analyze the strategies undertaken by the government to address the health problem in Boa Vista/Roraima. Method: A study using the microhistory approach, with documentary sources from journalistic material of the 1970s through the triangulation technique: texts, images and context, with analysis from the perspective of the Social World Theory. Results: It was evidenced that the strategies undertaken by the government occurred in favor of the exploration of isolated areas in Roraima that demanded settlement processes, construction of villages and a highway to enable the interconnection of the state with other regions of Brazil, with a smoke screen symbolic effect produced by nurses on indigenous health. Conclusion: There was governmental manipulation, when the symbolic power was unveiled, making it possible to see and believe that nursing needs to guide political issues rather than being ruled.

RESUMEN Objetivo: Analizar las estrategias emprendidas por el gobierno para sanar el problema de la salud en Boa Vista / Roraima. Método: En el estudio de la micro-historia, con fuentes documentales oriundas de materia periodística de la década de 1970, cuando fueron articulados, por medio de la técnica de triangulación, textos, imágenes y contexto, con análisis en la perspectiva de la Teoría del Mundo Social. Resultados: Se evidenció que las estrategias emprendidas oriundas del gobierno ocurrieron en pro de la exploración de áreas aisladas en Roraima que demandaron procesos de poblamiento, construcción de aldeas y de una carretera para viabilizar la interconexión del estado con otras regiones de Brasil, teniendo por cortina de humo el efecto simbólico producido por las enfermeras en la salud indígena. Conclusión: Hubo manipulación gubernamental, cuando el poder simbólico fue desvelado, haciendo ver y creer que la enfermería necesita pautar los asuntos políticos en vez de ser pautada.

RESUMO Objetivo: Analisar as estratégias empreendidas pelo governo para sanar o problema da saúde em Boa Vista/Roraima. Método: Estudo na abordagem da micro-história, com fontes documentais oriundas de matéria jornalística da década de 1970, quando foram articulados, por meio da técnica de triangulação, textos, imagens e contexto, com análise na perspectiva da Teoria do Mundo Social. Resultados: Foi evidenciado que as estratégias empreendidas oriundas do governo ocorreram em prol da exploração de áreas isoladas em Roraima que demandaram processos de povoamento, construção de vilarejos e de uma rodovia para viabilizar a interligação do estado com demais regiões do Brasil, tendo por cortina de fumaça o efeito simbólico produzido pelas enfermeiras na saúde indígena. Conclusão: Houve manipulação governamental, quando o poder simbólico foi desvelado, fazendo ver e crer que a enfermagem precisa pautar os assuntos políticos ao invés de ser pautada.

Ugandan health libraries in the 21st century: key initiatives and challenges.

This article is part of a series in this regular feature which looks at new directions in health science libraries. This paper highlights new initiatives aimed at ensuring health libraries can contribute to the development of Uganda in the 21st century and the challenges facing libraries. It stresses that for libraries to be successful they need to form networks and collaborations for resource sharing; take advantage of the benefits of information technology; computerise their library systems; as well as invest in the development of staff. The paper highlights the main challenge facing the library service as inadequate funding both from government for public-funded health libraries and the private sector (for privately funded health libraries). The paper concludes that, despite the bottlenecks brought about by inadequate funding, Ugandan health libraries have taken positive steps to support health research and education, as well as patient care, not just for Uganda, but for the whole of the East African region. J.M.

History of Asbestos Ban in Hong Kong.

As millions of immigrants moved to Hong Kong (HK) from China in the recent decades, large amount of residential housings were built in the early years and a substantial proportion of those buildings used asbestos-containing materials (ACMs). Since the number of new cases of ARDs diagnosed has increased year by year since 1990's, the remarkable increase of incidences had drawn the attention of the public and most importantly the HK government. It became one of the trigger points leading to asbestos ban in HK history. Comparatively, non-governmental organizations (NGOs), labor unions and patients' self-help organizations demonstrated a more aggressive and proactive attitude than the HK government and have played a key role in the development of asbestos banning policy in HK. After numerous petitions and meetings with the government representatives by those parties in the past decade, the HK government eventually changed its attitude and started to consider terminating the endless threat from asbestos by amending the policy, and the new clause of legislation for banning of all forms of asbestos was enacted on 4 April 2014. Other than the restriction of asbestos use, the compensation system about ARDs has also made some great moves by the effort of those parties as well. Based on the experience we learnt through the years, efforts from different stakeholders including patients' self-help organizations, NGOs, legislative councilors, and media power are absolutely essential to the success of progression and development in today's asbestos banning in HK.

Statutory health insurance in Germany: a health system shaped by 135 years of solidarity, self-governance, and competition.

Bismarck's Health Insurance Act of 1883 established the first social health insurance system in the world. The German statutory health insurance system was built on the defining principles of solidarity and self-governance, and these principles have remained at the core of its continuous development for 135 years. A gradual expansion of population and benefits coverage has led to what is, in 2017, universal health coverage with a generous benefits package. Self-governance was initially applied mainly to the payers (the sickness funds) but was extended in 1913 to cover relations between sickness funds and doctors, which in turn led to the right for insured individuals to freely choose their health-care providers. In 1993, the freedom to choose one's sickness fund was formally introduced, and reforms that encourage competition and a strengthened market orientation have gradually gained importance in the past 25 years; these reforms were designed and implemented to protect the principles of solidarity and self-governance. In 2004, self-governance was strengthened through the establishment of the Federal Joint Committee, a major payer-provider structure given the task of defining uniform rules for access to and distribution of health care, benefits coverage, coordination of care across sectors, quality, and efficiency. Under the oversight of the Federal Joint Committee, payer and provider associations have ensured good access to high-quality health care without substantial shortages or waiting times. Self-governance has, however, led to an oversupply of pharmaceutical products, an excess in the number of inpatient cases and hospital stays, and problems with delivering continuity of care across sectoral boundaries. The German health insurance system is not as cost-effective as in some of Germany's neighbouring countries, which, given present expenditure levels, indicates a need to improve efficiency and value for patients.

From instinct to evidence: the role of data in country decision-making in Chile.

BACKGROUND: The Chilean health system has undergone profound reforms since 1990, while going through political upheaval and facing demographic, health, and economic transformations. The full information requirements to develop an evidence-informed process implied the best possible use of the available data, as well as efforts to improve information systems. OBJECTIVE: To examine, from a historical perspective, the use of evidence during the health sector reforms undertaken in Chile from 1990 to date, and to identify the factors that have both determined improvements in the data and facilitated their use. METHODS: A qualitative methodological approach was followed to review the Chilean experience with data on decision-making. We use as the primary source our first-hand experience as officials of the Ministry of Health (MOH) and the Ministry of Finance before and during the reform period considered. A literature review was also conducted, using documents from official sources, historical accounts, books, policy reports, and articles published in indexed journals reviewing and discussing the reform process, looking for the use of data. RESULTS: The Chilean health-care reform process was intensive in its use and production of information. The MOH conducted several studies on the burden of disease, efficacy of interventions, cost-effectiveness, out-of-pocket payments, fiscal impact, social preferences, and other factors. Policy and prioritization frameworks developed by international agencies strongly influenced the use of data and the study's agenda. CONCLUSIONS: The Chilean example provides evidence that tradition, receptiveness to foreign ideas, and benchmarking with international data determined the use of data, facilitated by the political influence of physicians and, later, other technocrats. Internationally comparable statistics are also shown to play a significant role in the policy debate.

O Projeto Mais Médicos para o Brasil e a construção de mitos: uma leitura bartheana / The More Doctors in Brazil Project and the construction of myths: a Barthean reading / El Proyect "Más Médicos para Brasil" y la construcción de mitos: una lectura bartheana

O Projeto Mais Médicos para o Brasil (PMMB) tenciona prover recursos humanos para o Sistema Único de Saúde por meio da melhoria da infraestrutura da rede de saúde; da ampliação das reformas educacionais dos cursos de Medicina e residência médica; e da provisão de médicos para áreas vulneráveis. A implantação do projeto enfrentou reações contrárias à proposta, envolvendo principalmente as instituições médicas do país. Inspirados no conceito de mito, realizamos uma leitura dos discursos com que o Conselho Federal de Medicina sustentou o debate, por meio da análise do Jornal Medicina durante os primeiros 24 meses da implantação do PMMB. O mito é revelador de como práticas discursivas introduzem no imaginário coletivo alegorias que demarcam espaços ideológicos e permite analisar o processo de disputa social e das condições históricas de formulação e implantação de um programa governamental.

The aim of the More Doctors in Brazil Project (MDBP) is to supply human resources to the Brazilian National Health System by improving the infrastructure of the healthcare network; expanding educational reforms in medical courses and residencies; and supplying physicians to vulnerable areas. The implementation of the MDBP faced strong opposition, especially from Brazilian medical institutions. Inspired by the concept of "myth," the present study conducted a reading of the discourse used by the Brazilian Federal Board of Medicine to support its arguments, by analyzing editions of the Medicina newletter published by the Board in the first 24 months of the project's implementation. The myth reveals how discursive practices introduce allegories into the collective imagery that define ideological spaces and enable an analysis of the process of social dispute and the historical conditions behind the formulation and implementation of a government program.

El objetivo del proyecto "Más Médicos para Brasil" (PMMB) es proporcionar recursos humanos para el Sistema Brasileño de Salud, por medio de la mejora de la infraestructura de la red de salud, de la ampliación de las reformas educativas de los cursos de Medicina y residencia médica y de la provisión de médicos para áreas vulnerables. La implantación del proyecto enfrentó reacciones contrarias a la propuesta, envolviendo principalmente a las instituciones médicas do país. Inspirados en el concepto de mito, realizamos una lectura de los discursos con que el Consejo Federal de Medicina sostuvo el debate, por medio del análisis del Jornal Medicina durante los primeros 24 meses de introducción del PMMB. El mito es un factor revelador de como las prácticas discursivas introducen en el imaginario colectivo alegorías que demarcan espacios ideológicos y permite analizar el proceso de disputa social y de las condiciones históricas de formulación e implantación de un programa gubernamental.

Evolution of the National Schistosomiasis Control Programmes in The People's Republic of China.

Schistosomiasis japonica is caused by the parasitic trematode Schistosoma japonicum. It is endemic in The People's Republic of China and has significant impact on human health and socioeconomic development in certain regions. Over the last six decades, the national control programmes evolved in remarkable ways and brought schistosomiasis japonica largely under control. We describe the history and evolution of schistosomiasis control in The People's Republic of China, with an emphasis on shifts in control strategies that evolved with new insights into the biology of the parasite and its intermediate hosts, and the epidemiology of the disease in the country. We also highlight the achievements in controlling the disease in different socioecological settings, and identify persisting challenges to fully eliminate schistosomiasis japonica from the country. To reach the goal of schistosomiasis elimination, further integration of interventions, multisector collaboration, sensitive and effective surveillance are needed to strengthen.

Waging War on Mosquitoes: Scientific Research and the Formation of Mosquito Brigades in French West Africa, 1899-1920.

While the majority of colonial public health officials in Africa intermittently used measures for mosquito containment, the government of French West Africa made the creation of what were called mosquito brigades into a vital element of urban sanitary policy. The project seemed to offer a chance to curb the impact of mosquito-borne disease on the colonial economy. Yet, despite the full support of sanitary policy on the federal, colonial, and local levels, the government found that conducting a "War on Mosquitoes" was far more difficult than they originally envisioned. The colonial government's mosquito brigades were understaffed and often ran into resistance from both the African and European populations. Above all, the government's urban mosquito control programs failed because their goal of controlling the breeding of mosquitoes lay beyond the limited capabilities of the both local government and the Federation's health and sanitation services. This paper will examine the origins and fate of the French West African mosquito brigades and provide a context for analyzing their atypical place among colonial efforts at malaria prevention.

Breve visión de los principales protagonistas de la Escuela Inglesa de Atención Primaria durante el último medio siglo / A brief overview of English Primary Care in the last half century

El objetivo es hacer un breve repaso de las influencias, el núcleo duro de perfil clínico, la enfermería científica y el presente de la Escuela Inglesa de Atención Primaria durante los últimos sesenta años. Entendemos que la influencia intelectual más profunda fue la de Archie Cochrane. Entre los médicos de familia componentes del núcleo duro destacamos a John Fry (1922- 1994), David Metcalfe y Julian Tudor Hart. Por otra parte, Lisbeth Hockey (1918-2004), doctora en enfermería, fue la responsable durante varios años de la Unidad de Investigación en Cuidados de la Universidad de Edimburgo. Las fuentes de investigación historiográfica de la enfermería inglesa en internet son notables. Finalmente, Trisha Greenhalgh, médica de familia, investigadora y docente en la Universidad de Oxford, está lanzando a la vieja Escuela Inglesa de Atención Primaria hacia la mediana del siglo XXI (AU)

Key hefts, the hard core of clinical profile, scientific nursing and nowadays of the English School of Primary Care in the last sixty years are revisited. We understand that the most profound intellectual influence has been to Archie Cochrane, among family physicians hard core components we include John Fry (1922-1994), David Metcalfe and Julian Tudor Hart. On the other hand, Lisbeth Hockey (1918-2004), PhD in Nursing, was responsible for several years of Nursing Research Unit at the University of Edinburgh. The internet sources of English nursing historical research are very noticeable. Finally, Trisha Greenhalgh, family physician, researcher and Professor at the University of Oxford, is launching the old English School of Primary Care towards the middle of the XXI century (AU)

The Rise and Fall of Universal Salt Iodization in Vietnam: Lessons Learned for Designing Sustainable Food Fortification Programs With a Public Health Impact.

BACKGROUND: In 2005, more than 90% of Vietnamese households were using adequately iodized salt, and urinary iodine concentration among women of reproductive age was in the optimal range. However, household coverage declined thereafter to 45% in 2011, and urinary iodine concentration levels indicated inadequate iodine intake. OBJECTIVE: To review the strengths and weaknesses of the Vietnamese universal salt iodization program from its inception to the current day and to discuss why achievements made by 2005 were not sustained. METHODS: Qualitative review of program documents and semistructured interviews with national stakeholders. RESULTS: National legislation for mandatory salt iodization was revoked in 2005, and the political importance of the program was downgraded with consequential effects on budget, staff, and authority. CONCLUSIONS: The Vietnamese salt iodization program, as it was initially designed and implemented, was unsustainable, as salt iodization was not practiced as an industry norm but as a government-funded activity. An effective and sustainable salt iodization program needs to be reestablished for the long-term elimination of iodine deficiency, building upon lessons learned from the past and programs in neighboring countries. The new program will need to include mandatory legislation, including salt for food processing; industry responsibility for the cost of fortificant; government commitment for enforcement through routine food control systems and monitoring of iodine status through existing health/nutrition assessments; and intersectoral collaboration and management of the program. Many of the lessons would apply equally to universal salt iodization programs in other countries and indeed to food fortification programs in general.