Services on Demand
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Print version ISSN 1415-790X
Rev. bras. epidemiol. vol.7 n.1 São Paulo Mar. 2004
José da Rocha Carvalheiro
Revista Brasileira de Epidemiologia is publishing nine studies selected by peer review in this March 2004, number 7(1): a Joint Editor carries out, anonymously, the evaluation of ad hoc reviewers, generally three. The articles are on various themes, use a range of methodological procedures and have geographical and institutional origins that cover the academic and health care environment in many regions of Brazil. To maintain the regular standard cited in previous issues, the articles generally result from a group of authors (average of 3.7) and only one has a single author. Another evident feature in this number is the female predominance: of the 33 authors, 23 (70%) are women, and in seven of the nine studies they are the first author.
A study by an author from UFMG (Minas Gerais Federal University) analyzes infant mortality in the State of São Paulo, in 1999, aiming to show the contrast between the underlying cause of death and the set of diseases identified by the "multiple cause" procedure.
Also analyzing one of the components of infant mortality, neonatal mortality, in the city of Campinas (SP), two authors, one from the Municipal Health Department, and another from UNICAMP (Campinas State University), use a case-control design and household sampling technique with two controls per case, to perform their analysis through a multiple logistic regression in a hierarchic model. The study "with pragmatic features", according to the French epidemiological jargon, points out the relationship between outcome (death of newborns), socioeconomic variables, maternal morbidity and health care.
One cross-sectional study that is particularly creative operationally estimates the prevalence of breastfeeding in children under 1 year of age in the city of Ribeirão Preto (SP). The unique methodology has been making its mark in the analysis of the complex relationship between multiple purposes. One of the purposes, the association between university-based researchers and service professionals, is corroborated by the constitution of the team: three teachers from the USP Ribeirão Preto Nursing School and three professionals from the Municipal Health Department. Another purpose is to take advantage of the mothers carrying their children in the line on a National Vaccination Campaign day, for a simplified sampling procedure in a prevalence study. Finally, the prevalence performed on the waiting line of the Campaign is in itself an act that promotes breastfeeding.
Two authors from the Department of Nutrition of Universidade Federal de Pernambuco (Pernambuco Federal University) analyze growth surveillance in children under five years of age followed by health services. By means of a cross-sectional study sample of children followed in the Metropolitan Region of Recife and in the rest of the state, the authors compare the relative adequacy of health care infrastructure with the poor performance in complying with the programs that should be followed.
Two teachers of the Department of Epidemiology of FSP/USP and a science career researcher (PqC VI classification) from the São Paulo State Health Department Butantan Institute analyzed sputum bacilloscopy in inpatients of hospitals specializing in tuberculosis in the State. They aimed to find the associations between the bacilloscopy result and variables linked to individuals, services and especially the reason (clinical or social) for hospitalization, length of stay and reason of discharge.
Another cross-sectional study was carried out in an AIDS treatment reference center in a university hospital in the city of São Paulo (SP). Five teachers from various departments of FSP/USP, associated with another Medical School/USP, analyze anthropometrical data in HIV-positive patients included in HAART therapy. They aimed to estimate the relative frequencies of low-weight, overweight and central obesity, according to the gender of the individuals studied.
The study with the highest number of authors, eight, is an epidemiological investigation on lymphatic filariasis. It was performed on a sample of the urban and rural population of a municipality within the metropolitan region of Recife (Moreno, PE). It is a multiple-phase examination survey, as it includes parasitological tests, oriented by a previous interview survey with a closed questionnaire. Filariasis has a distribution limited to three endemic areas in Brazil and it has been more frequently associated with Recife and its surrounding metropolitan region. The authors aimed to find the boundaries of the area of distribution of filariasis comparing the origin of the cases identified parasitologically to an existing epidemiological structure facilitating transmission. Due to the operational complexity of the study, the number of authors and diversity of institutional links is not surprising: four belong to the FIOCRUZ Research Center (Aggeu Magalhães), in Recife. The others are linked to: the Pernambuco Regional Branch of the Ministry of Health's FUNASA (National Health Foundation); the Instituto Materno Infantil de Pernambuco (Pernambuco Mother-Child Institute); the Centro de Ciências da Saúde da Universidade Federal de Pernambuco (Center of Health Sciences of the Federal University of Pernambuco); and the Health Department of the City of Moreno (PE).
Three teachers of the Universidade Federal de Santa Catarina (Federal University of the State of Santa Catarina), from the Public Health and Production Engineering Post-Graduation programs present an "epidemiological profile" of caries, edentulousness and the utilization of prostheses among the elderly, 60 years and older, in a city in the state of Santa Catarina, Biguaçu. Based on the DMFT rate, the authors point out the poor oral health status of the elderly. This led them to an important conclusion: unlike developed countries where the demographic transition was followed by an expansion in social protection for the elderly, in Brazil's case, social inequalities have led to a dramatic scenario of exclusion.
A study carried out in the city of Ribeirão Preto (SP), by a teacher from USP (São Paulo University) and by a professional of the City Sanitary Surveillance public network has an important feature: it describes the result of an epidemiological investigation "conducted during routine inspections". It analyzes the sanitary conditions of the food sector of the city's supermarket network. This is exactly the most marked feature of the study: service professionals carry out "Research in Health Services" , usually more preached than practiced.
In addition to the traditional News section, in this issue we present a Book Review by Maria da Penha Costa Vasconcellos, a teacher at USP's School of Public Health Post-Graduate Program. She analyzes the book: "Metodologias Participativas para trabalhos de Promoção de Saúde e Cidadania" (Participative Methodologies for Work in Promotion of Health and Citizenship), Vetor Editora Publishers (2002), written by Rosalina Carvalho da Silva, a teacher of the Department of Psychology and Education of Faculdade de Filosofia, Ciências e Letras da USP/ Ribeirão Preto (School of Philosophy, Sciences and Languages of USP Ribeirão Preto). This introduces, in an Epidemiology Journal, an analysis of another way of approaching the qualitative methods that Social Psychology has used to delve into its inherent universe of reflection on subjective, interpersonal issues and on living in society. Our purpose in publishing this Review is to focus on a possibility rarely dealt with in an Epidemiology Journal such as ours that publishes studies that utilize qualitative methodology to check epidemiological reality. The book does not deplete all the fantastic possibilities of epidemiological studies with qualitative methodologies and their analytical triangulation with quantitative methods. By adding the Review to the studies published in this issue, it becomes evident that research in services, performed by health care professionals, frequently uses these participative practices. The very attempt to rescue "medicine based on narratives" that is not opposed to, but complements the hegemonic "evidence-based medicine" is another major reason for opening space in an Epidemiology Journal to theoretical and methodological alternatives. "Evidence" should not be viewed only in its quantitative biases, as is the wish of some of those who quote Lord Kelvin, more than a century later, in his saying that "when you cannot measure, your knowledge is meager and unsatisfactory".
Finally, we have a Special Editorial by Ana Bernarda Ludermir, a Teacher of the Department of Social Medicine of the Federal University of the State of Pernambuco (UFPE) and President of the VI Brazilian Congress of Epidemiology. She does not only promote the motto "Looking Out Over the City" and the topics of the Congress. She does more than that, she invites the readers of RBE to come to Recife this year in June, and participate in what is undoubtedly the most important scientific initiative of Brazilian Epidemiology. She gives the fantastic preliminary assessment of more than three thousand, eight-hundred studies submitted! More than that, she reminds us that the motto of the Congress is a posthumous tribute to Dom Hélder Câmara, Archbishop Emeritus of the cities of Olinda and Recife. In the darkness in which the country was plunged during the military dictatorship, Dom Hélder launched a ray of light: a radio program that with the same motto denounced the repression of the discretionary powers of the time. Ana Bernarda lightens the Special Editorial by mentioning the poetry that the city of Recife conveys, due to its "amphibian" landscape and through the voice of its poets. Remembering the almost epidemiological pearl of one of the greatest Brazilian poets, Manuel Bandeira, while almost overusing the predictive value of hemoptysis in the prognosis of the severity of a case of tuberculosis to replace the heroic measure of a pneumothorax: "in this case, you can only sing an Argentinean tango".
Enjoy your reading.