Editorial
José da Rocha Carvalheiro
The Editor
This issue completes the first year of the Brazilian Journal of Epidemiology. It has been hard, but we have fought to win, with the help of our readers, collaborators and, specially, ad hoc reviewers. We have included a Special Article, the first issue of the section Drawers and Shelves, in addition to six Original Articles.
The Original Articles address several different topics, and they have followed the Journal's publishing policies, through the complex process of peer review. Two of them approach the AIDS epidemic, both from institutions in Rio de Janeiro. In one of them, the authors (UNI-RIO, UERJ and FIOCRUZ) used models to estimate the number of AIDS cases in Brazil, adjusted for reporting delays, and they detected, by means of the Poisson regression model, changes in reporting standards after the introduction of the free distribution of anti-retroviral drugs. In the other one, the authors (UFRJ, UERJ, and FIOCRUZ) have used a logistic regression model to analyze risk factors for HIV infection among injecting drug users in Rio de Janeiro. Another article, submitted by Authors from USP, analyzes the issue of abortion, using data exclusively from hospitalization records of the Sistema Único de Saúde (SUS) network. They have been able to identify some important epidemiological trends related to abortion throughout the State of São Paulo. Another study, also from Rio de Janeiro (UFRJ and UERJ), examined the relationship between being overweight and blood pressure among adolescents within a sample of households in Rio de Janeiro. Last but not least, there are two articles on diabetes. One of them, from the Instituto Nacional de Endocrinologia de Havana, Cuba, studies the relationship between length of breast-feeding and the occurrence of diabetes mellitus among Cuban children. The other one, from the University of Montreal, Canada, and from the Center for Nonlinear Science, in Texas, analyzes the diabetes modeling process, according to the complex adaptive process (fractal processes), thereby restoring the dynamics of the pathologic progression leading to the disease. It suggests an uncommon approach in epidemiological literature, which will most certainly cause controversy.
The Special Article, by Jaime Breilh, from the Centro de Estudios y Asesoria en Salud (CEAS), in Quito, Equator, is based on the lecture the Author delivered at the Brazilian Congress of Epidemiology, held in Rio de Janeiro, in 1998 (EpiRio 98). It examines the contribution of the "new" epidemiology, the so -called Critical Epidemiology, to the debate on society and modernity. The Author, one of the most respected epidemiologists in Latin America, addresses the contribution of the Continent to the theoretical debate on the complexity of hegemony and counter-hegemony in the field of public health and epidemiology. The manner in which he approaches the conflictive relationship between epidemiology and management, is such as proposed by "conservative post modernism", which denies the past (reactive management) and the future (prospective management), and assumes the management of an "endless present" as the only alternative capable of succeeding as effective real activity. In this approach, of a dialectics of the past, present, and future that incorporates the Principle of Determination, lies the foundation of an Epidemiology of Hope and Dignity, that preserves its social object, without rejecting the support techniques from other branches of science.
The section Drawers & Shelves is intended to "rescue" important articles that marked an era because of their theoretical or methodological relevance, or still, due the richness of a factual account. They may be unpublished (drawers), though informally printed, which is a tradition in our area. They will preferably be "classical" articles, of great repercussion, or even precursors that went (almost) unnoticed, always with great potential for creating controversy, which will be the "food" for this section of the Journal (shelves). Suggestions from readers for this section will be welcome.
The first contribution to the section Drawers & Shelves is peculiar. As you will be able to see in the presentation of the guest Editor-José Ruben de Alcântara Bonfim, the opening document has had an extremely limited publishing, practically mimeographed, so to speak. Even though published by the former Fundação SESP of the Ministry of Health, no official record has been found. Neither has it been included in the publication records of the authors. It is therefore, a kind of hybrid between a drawer and a shelf. There are two important aspects that are worth mentioning: one, related to the real work of archeology conducted by the special Editor, José Ruben; the other one, the work in itself. It has been fascinating to follow the work of the special Editor: with a close partnership with Dr. José Esparza, from UNAIDS, in Geneva, it was possible to gain access to the minutes of the World Health Assembly, in which the Brazilians "Maneco" Ferreira and Ernani Braga presented the Economic Value of Health. A very long distance was obstinately covered by the special Editor, until he completed the full Literature Revision, at the end of the work. Finding who the main author was, Paulo de Assis Ribeiro, and the intellectually prominent role he played at IBGE, was a real discovery. It was pleasant to realize that two of this century's most outstanding intellectuals attended the session of the World Health Assembly at which the issue of economics in health was introduced, namely: the sanitarian, Winslow and the economist, Myrdal. Lastly, finding out in the autograph note that one of the authors (Manoel Ferreira) dedicated to Professor Pedreira de Freitas, from whose private library we rescued the copy, his curious personal opinion about his own work": "if your problem is insomnia, here is the medicine". As to the work itself, it is interesting to find out that almost fifty years ago, at the dawning of a new era, after the tragedy of World War II, there was already a concern to measure health and disease from an economic perspective. It is expressed in a "productivist" approach, based on direct and indirect costs of health maintenance and the losses due to disease and premature deaths. Forty years later, in 1993, The World Bank released its ideas of privatizing the most complex health actions, and bundling the more simple basic actions. And introduced a single measure, the disease load, with an important econometric component. In the meantime, several other attempts were made. At least one of them is worth mentioning: that of the National Center for Health Statistics, from the U.S.A., which used household inquiries of referred morbidity to form a synthetic indicator of years of life lost due to disease and death, in addition to other possible indicators of years of life prematurely lost. The work we now publish is an important precursor. We hope it may hold credit for starting a significant debate on such a current issue in the Journal. We made a special effort to update the formulae in the text, originally handwritten. We could not close without quoting from the article, at least one of the highly humorous remarks, so typical of our late and dear Ferreira e Braga: Following the abolition of slavery, the idea of attributing a financial value to man was almost abandoned for a time. Under the former system, at least, a small part of the population was given a value in money and the free man was of less financial value than the slave.
So long after, that theme is haunting us again.
I hope you all enjoy your reading.
Publication Dates
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Publication in this collection
21 July 2005 -
Date of issue
Dec 1998
