Fifty Years of a National Program for the Treatment of Kidney Failure.

This Viewpoint examines the first 50 years of the US End-Stage Renal Disease (ESRD) program, including technological updates and continuing challenges to update cost and quality.

Llamado a concurso de Enfermeras, 1955: La implementación del Sub-departamento de Enfermería del Servicio Nacional de Salud de Chile / Concurso de Enfermagem, 1955: A implantação do Subdepartamento de Enfermagem, do Serviço Nacional de Saúde do Chile / Call for Nursing contest, 1955: The implementation of the Sub-department of Nursing, of the National Health Service of Chile

The article's purpose is to interpret the primary documentary source entitled "Circulares1955. General Directorate. Calls for Competition" of the Bulletin of the National Health Service,Chile, 1955 from a historiographic perspective. The method used was documentary source analysis, according to Jocelyn Létourneau, which divides the documentary analysis into two mainsteps: the descriptive phase that precedes the reading of the document and a second phase thatallows the observer to deliver a judgment of the documentary source. According to the analysisperformed, the categories that emerged are the Context of Health and Nursing institutionalism,and The Nursing sub-department and the meanings of its implementation. The main conclusions are that the National Health Service organized a health structure of unification and decentralization of health and gave nurses their administrative organization called the Nursing Subdepartment. The documentary source shows how nurses assumed administrative positionsthroughout the country as a product of the symbolic validation of the profession from the stateauthority, giving them power in their professional work and thus protagonism in nationalhealth. (AU)

El objetivo del artículo es interpretar la fuente documental primaria denominada “Circulares 1955.Dirección General. Llamados a Concurso” del Boletín del Servicio Nacional de Salud,Chile, 1955 desde una perspectiva históriografica. El método utilizado fue análisis de fuente documental de acuerdo Jocelyn Létourneau, el cual divide el análisis documental en dos grandes pasos:la fase descriptiva que previa a la lectura del documento; una segunda fase que permite al observador entregar un juicio de la fuente documental. De acuerdo al análisis realizado se obtuvieron lassiguientes categorías: Contexto de la institucionalidad Sanitaria y de Enfermería y El sub-departamento de Enfermería y los signficados de su implementación. Entre las principales conclusiones seencuentran que el Servicio Nacional de Salud organizó una estructura sanitaria de unificación y dedescentralización de la salud, y asimismo otorgó a las enfermeras una orgánica administrativa propia denominada Sub-departamento de Enfermería. La fuente documental manifiesta como las lasenfermeras asumiran cargos de administración a lo largo de todo el país, como producto de la validación símbolica de la profesión desde la autoridad estatal otorgándoles poder en su quehacer profesional y con ello protagonismo en la salud nacional. (AU)

O objectivo do artigo é interpretar a principal fonte documental intitulada "Circulares1955". Dirección General. Llamados a Concurso" do Boletín del Servicio Nacional de Salud, Chile,1955, de uma perspectiva historiográfica. O método utilizado foi a análise da fonte documental,segundo Jocelyn Létourneau, que divide a análise documental em duas etapas principais: a fasedescritiva, antes da leitura do documento; uma segunda fase que permite ao observador fazer umjulgamento da fonte documental. De acordo com a análise, foram obtidas as seguintes categorias:Contexto das instituições de saúde e de enfermagem e O subdepartamento de enfermagem e o significado da sua implementação. Entre as principais conclusões, o Serviço Nacional de Saúde organizou uma estrutura sanitária de unificação e descentralização da saúde, e também deu aos enfermeiros a sua própria organização administrativa chamada Sub-Departamento de Enfermagem. Afonte documental mostra como os enfermeiros assumiram posições administrativas em todo o país,como produto da validação simbólica da profissão pela autoridade estatal, dando-lhes poder no seutrabalho profissional e, assim, um papel de liderança na saúde nacional. (AU)

GLOBAL ENDOCRINOLOGY: Global perspectives in endocrinology: coverage of iodized salt programs and iodine status in 2020.

Iodine deficiency has multiple adverse effects on growth and development. Diets in many countries cannot provide adequate iodine without iodine fortification of salt. In 2020, 124 countries have legislation for mandatory salt iodization and 21 have legislation allowing voluntary iodization. As a result, 88% of the global population uses iodized salt. For population surveys, the urinary iodine concentration (UIC) should be measured and expressed as the median, in µg/L. The quality of available survey data is high: UIC surveys have been done in 152 out of 194 countries in the past 15 years; in 132 countries, the studies were nationally representative. The number of countries with adequate iodine intake has nearly doubled from 67 in 2003 to 118 in 2020. However, 21 countries remain deficient, while 13 countries have excessive intakes, either due to excess groundwater iodine, or over-iodized salt. Iodine programs are reaching the poorest of the poor: of the 15 poorest countries in the world, 10 are iodine sufficient and only 3 (Burundi, Mozambique and Madagascar) remain mild-to-moderately deficient. Nigeria and India have unstable food systems and millions of malnourished children, but both are iodine-sufficient and population coverage with iodized salt is a remarkable 93% in both. Once entrenched, iodine programs are often surprisingly durable even during national crises, for example, war-torn Afghanistan and Yemen are iodine-sufficient. However, the equity of iodized salt programs within countries remains an important issue. In summary, continued support of iodine programs is needed to sustain these remarkable global achievements, and to reach the remaining iodine-deficient countries.

Readings about developmentalist health and interpretations for the Brazilian health reform and public health. / Leituras sobre o sanitarismo desenvolvimentista e interpretações para a reforma sanitária brasileira e a saúde coletiva.

In the Brazilian public health literature, an association has been drawn between the 1970s health reform movement and what has been called developmentalist health. By investigating the discourse of two sanitarians from the developmentalist period - Mario Magalhães da Silveira and Carlos Gentile de Mello - we seek to unpick how their status of "precursors" of the health reform was constructed, analyzing the interfaces between public health, developmentalist thinking, the strategy for the construction of the developmentalist health and the health reform. Without refuting the pioneering nature of the sanitarians' ideas, we argue that the Brazilian Unified Health System, Sistema Único de Saúde, was created not simply in continuation of developmentalist thinking.

Na literatura do campo da saúde coletiva há uma construção que sustenta a associação entre o movimento pela reforma sanitária dos anos 1970 e o que se denominou sanitarismo desenvolvimentista. A partir dos discursos de dois sanitaristas do período desenvolvimentista ­ Mário Magalhães da Silveira e Carlos Gentile de Mello ­, buscou-se reconhecer como se deu a construção desse lugar de "precursor" da reforma sanitária. Foi feita a análise das interfaces entre a saúde coletiva, o pensamento desenvolvimentista, a estratégia de construção do "sanitarista desenvolvimentista" e a reforma sanitária. Sem negar o papel precursor daqueles sanitaristas, argumenta-se que a construção do Sistema Único de Saúde não é uma mera continuidade do pensamento desenvolvimentista.

Leituras sobre o sanitarismo desenvolvimentista e interpretações para a reforma sanitária brasileira e a saúde coletiva / Readings about developmentalist health and interpretations for the Brazilian health reform and public health

Resumo Na literatura do campo da saúde coletiva há uma construção que sustenta a associação entre o movimento pela reforma sanitária dos anos 1970 e o que se denominou sanitarismo desenvolvimentista. A partir dos discursos de dois sanitaristas do período desenvolvimentista - Mário Magalhães da Silveira e Carlos Gentile de Mello -, buscou-se reconhecer como se deu a construção desse lugar de "precursor" da reforma sanitária. Foi feita a análise das interfaces entre a saúde coletiva, o pensamento desenvolvimentista, a estratégia de construção do "sanitarista desenvolvimentista" e a reforma sanitária. Sem negar o papel precursor daqueles sanitaristas, argumenta-se que a construção do Sistema Único de Saúde não é uma mera continuidade do pensamento desenvolvimentista.

Abstract In the Brazilian public health literature, an association has been drawn between the 1970s health reform movement and what has been called developmentalist health. By investigating the discourse of two sanitarians from the developmentalist period - Mario Magalhães da Silveira and Carlos Gentile de Mello - we seek to unpick how their status of "precursors" of the health reform was constructed, analyzing the interfaces between public health, developmentalist thinking, the strategy for the construction of the developmentalist health and the health reform. Without refuting the pioneering nature of the sanitarians' ideas, we argue that the Brazilian Unified Health System, Sistema Único de Saúde, was created not simply in continuation of developmentalist thinking.

[The Amiantus Program in Poland - 20 years of implementation]. / Program Amiantus w Polsce ­ 20 lat realizacji.

BACKGROUND: Despite the ban on the production of asbestos-containing materials, introduced in Poland over 20 years ago, new cases of asbestos-related diseases are still being recorded. Systematic control of respiratory function in people exposed to asbestos dust is, therefore, extremely important due to the biological properties of this mineral. MATERIAL AND METHODS: The Amiantus preventive medical examination program was undertaken in 2000 to implement the legal rights of former employees of asbestos processing plants for this type of examinations. People who have ever been employed in such factories have been authorized to use preventive medical examinations for the rest of their lives. The research is continuous, spread over time and focused, in particular, on the assessment of the respiratory system. RESULTS: Since the beginning of the program, throughout 20 years of its implementation, 8329 people have been examined, including 5199 (62.4%) men for whom a total of 34 454 medical examinations have been carried out. During the program period, the percentage of diagnosed pathologies increased from 8% in 2000 to 25% in 2019. Overall, 2078 asbestos-related diseases were diagnosed among former employees of asbestos processing plants under the Amiantus Program, which accounted for 25% of this group. Among all diseases caused by exposure to asbestos, the most common were: asbestosis (1880 cases - 90.5%), lung cancer (121 cases - 5.8%) and pleural mesothelioma (77 cases - 3.7%). Diseases of pleura in the form of plaques and diffuse pleural thickening were diagnosed in 40% of the examined patients, while radiological pulmonary shadows affected over 65% of former employees of asbestos processing plants. CONCLUSIONS: The Amiantus Program, thanks to the long observation period, enabled monitoring the health of former employees exposed to asbestos, and created a unique opportunity to carry out epidemiological analyzes. These studies allowed the authors to expand their knowledge of the natural history of asbestos-related diseases. Med Pr. 2020;71(5):595-601.

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.

The Gospel of Wealth and the National Health: The Rockefeller Foundation and Social Medicine in Britain's NHS, 1945-60.

This article examines the Rockefeller Foundation's (RF) engagement with the British National Health Service (NHS) between 1945 and 1960. It argues that the organization morally invested in the success of the NHS because, to them, it offered a world-inspiring model for how to provide medical care following the tenets of social medicine. The RF administratively and financially supported two health centers, in Edinburgh and Manchester, to help realize these ambitions. While the development of both centers exposed conflicting understandings of social medicine, these facilities later became important examples when British health centers expanded in number after the mid-1960s. The article also considers how the shift toward more communal forms of general practice provoked unease regarding privacy among patients. However, strategies used by medical professionals to offset these anxieties helped facilitate public acceptance of forms of care that aligned with the communitarian values of social democracy. The connections between American private philanthropy and British state planning show how a routine visit to the doctor in Edinburgh or Manchester in the 1950s was implicated in the broader politics of postwar global health.

From Alma-Ata to Astana: the path of Primary Health Care in Portugal, 1978-2018 and the genesis of Family Medicine. / De Alma-Ata a Astana: o percurso dos Cuidados de Saúde Primários em Portugal,1978-2018 e a génese da Medicina Familiar.

Throughout the twentieth century, the profound changes that have taken place in Medicine can only be wholly explained if observed from a historical perspective, for they have always occurred in response to external influences, some scientific and technological, others of a social nature. Modern Family Medicine is one of the many new disciplines that have developed during medical history, and we critically discuss the last 40 years of primary health care in Portugal, which started in 1971, long before the Alma-Ata Declaration (1978). Along the way, in 2005, the Primary Health Care Reform emerges in Portugal, along with the new family health facilities, which until September 2019, attended about 94 % of Portuguese citizens, i.e., 9,5 million people. At the end of this course, in solidarity and voluntarily, this Reform inspired another one in Brazil, in Rio de Janeiro, in 2009. Finally, we present the challenges pointed out in the 2018 Astana Declaration, among them, the issue of the workforce in primary health care as an essential factor for the performance and sustainability of health systems.

Ao longo século XX, as profundas alterações que ocorreram na Medicina apenas podem ser completamente esclarecidas se forem observadas numa perspectiva histórica, pois elas sempre ocorreram em resposta a influências externas, umas científicas e tecnológicas, outras de ordem social. A moderna Medicina Familiar é uma das muitas disciplinas novas que se desenvolveram durante o curso da história da Medicina e aqui debatemos de forma crítica, os últimos 40 anos dos cuidados primários em saúde em Portugal, começando em 1971, mesmo antes da Declaração de Alma-Ata (1978). Ao longo do percurso, em 2005, surge a Reforma dos Cuidados Primários em Saúde em Portugal e as novas unidades de saúde familiar, que até setembro de 2019 atendiam cerca de 94% dos cidadãos portugueses, ou seja, mais de nove milhões e meio de pessoas. No final dessa trajetória, de forma solidária e voluntária, esta Reforma serviu de inspiração para outra, no Brasil, na cidade do Rio de Janeiro, em 2009. Por fim, apresentamos os desafios apontados na Declaração de Astana de 2018, dentre elas, a questão da força de trabalho nos cuidados de saúde primários, como fator essencial para o desempenho e a sustentabilidade dos sistemas de saúde.

De Alma-Ata a Astana: o percurso dos Cuidados de Saúde Primários em Portugal, 1978-2018 e a génese da Medicina Familiar / From Alma-Ata to Astana: the path of Primary Health Care in Portugal, 1978-2018 and the genesis of Family Medicine

Resumo Ao longo século XX, as profundas alterações que ocorreram na Medicina apenas podem ser completamente esclarecidas se forem observadas numa perspectiva histórica, pois elas sempre ocorreram em resposta a influências externas, umas científicas e tecnológicas, outras de ordem social. A moderna Medicina Familiar é uma das muitas disciplinas novas que se desenvolveram durante o curso da história da Medicina e aqui debatemos de forma crítica, os últimos 40 anos dos cuidados primários em saúde em Portugal, começando em 1971, mesmo antes da Declaração de Alma-Ata (1978). Ao longo do percurso, em 2005, surge a Reforma dos Cuidados Primários em Saúde em Portugal e as novas unidades de saúde familiar, que até setembro de 2019 atendiam cerca de 94% dos cidadãos portugueses, ou seja, mais de nove milhões e meio de pessoas. No final dessa trajetória, de forma solidária e voluntária, esta Reforma serviu de inspiração para outra, no Brasil, na cidade do Rio de Janeiro, em 2009. Por fim, apresentamos os desafios apontados na Declaração de Astana de 2018, dentre elas, a questão da força de trabalho nos cuidados de saúde primários, como fator essencial para o desempenho e a sustentabilidade dos sistemas de saúde.

Abstract Throughout the twentieth century, the profound changes that have taken place in Medicine can only be wholly explained if observed from a historical perspective, for they have always occurred in response to external influences, some scientific and technological, others of a social nature. Modern Family Medicine is one of the many new disciplines that have developed during medical history, and we critically discuss the last 40 years of primary health care in Portugal, which started in 1971, long before the Alma-Ata Declaration (1978). Along the way, in 2005, the Primary Health Care Reform emerges in Portugal, along with the new family health facilities, which until September 2019, attended about 94 % of Portuguese citizens, i.e., 9,5 million people. At the end of this course, in solidarity and voluntarily, this Reform inspired another one in Brazil, in Rio de Janeiro, in 2009. Finally, we present the challenges pointed out in the 2018 Astana Declaration, among them, the issue of the workforce in primary health care as an essential factor for the performance and sustainability of health systems.

Treatment on Trial: Tanzania's National Tuberculosis Program, the International Union against Tuberculosis and Lung Disease, and the Road to DOTS, 1977-1991.

Tanzania's national tuberculosis control program, created in 1977, is credited with having been the main inspiration for the World Health Organization's Directly Observed Treatment, Short-Course (DOTS) strategy for the control of tuberculosis, which was implemented from 1994. The text focuses on what previously took place in Tanzanian tuberculosis control between 1977 and the early 1990s. What was it that the International Union against Tuberculosis and Lung Disease, which was central in the effort, assisted in creating? In what sense was the program innovative? How could a country whose health system was destroyed by a deepening economic crisis in the 1980s become a lighthouse of tuberculosis control? How much consideration was given to the rise of HIV/AIDS that occurred in parallel? The paper proposes answers to these questions, and suggests that we should see the creation of the Tanzanian program as a laboratory of nascent global health.