Saúde, ciência e desenvolvimento: a emergência da leishmaniose tegumentar americana como desafio médico-sanitário no Amazonas / Health, science and development: the emergence of American cutaneous leishmaniasis as a medical and public health challenge in Amazonas state, Brazil

Resumo O artigo faz análise histórica da emergência da leishmaniose tegumentar americana como objeto do conhecimento e desafio médico-sanitário no Amazonas desde a década de 1970. Fornece visão geral dessa época, as medidas sanitárias e os estudos científicos realizados no contexto de implantação dos principais projetos de desenvolvimento regionais executados em nome da política de integração nacional do governo federal. Utiliza como metodologia a análise documental de leis, produção científica, relatórios de pesquisa, boletins epidemiológicos e jornais. Os resultados da pesquisa mostram que a doença surgiu no Amazonas associando o grande problema de saúde com mudanças político-econômicas e alterações socioambientais.

Abstract The history of the emergence of American cutaneous leishmaniasis in the Brazilian state of Amazonas since the 1970s is analyzed as an object of knowledge and a medical and public health challenge. An overview of the period is provided, including the public health measures and scientific studies undertaken in the context of the execution of large-scale regional developments pursued in the name of national integration by the federal government. The methodology uses documental analysis of laws, the scientific literature, research reports, epidemiological bulletins, and newspapers. The results show that American cutaneous leishmaniasis emerged as a major health problem in Amazonas in close association with the political, economic, and socioenvironmental changes seen in the period.

Saúde dos rios, saúde dos povos e do planeta: um olhar sobre o documentário Saúde! Velho Chico, de Stella Oswaldo Cruz Penido e Eduardo Vilela Thielen / Health of the rivers, health of the peoples and of the Earth: an analysis of the documentary Saúde! Velho Chico, by Stella Oswaldo Cruz Penido e Eduardo Vilela Thielen / Salud de los ríos, salud de los pueblos y de lo planeta: una análisis del documental Saúde! Velho Chico, de Stella Oswaldo Cruz Penido y Eduardo Vilela Thielen

Análise do documentário Saúde! Velho Chico, de Stella Oswaldo Cruz Penido e Eduardo Vilela Thielen, tomando-o como registro, a um só tempo, dos padrões históricos de interação com o Rio São Francisco e de alternativas capazes de construir uma relação mais sinérgica e sustentável com as águas fluviais. O filme contrapõe as metanarrativas do desenvolvimento ­ legitimadoras de intervenções como hidrelétricas, barragens, projetos de irrigação para a agricultura industrial e o controverso projeto de sua transposição ­ a formas de relação estabelecidas pelas diversas populações ribeirinhas, das quais a vida, o corpo e as culturas são construídos em estreita simbiose com o rio.

This review analyzes the documentary Saúde! Velho Chico, scripted and directed by Stella Oswaldo Cruz Penido and Eduardo Vilela Thielen, taking it as a record of the historical patterns of interaction with the Rio São Francisco (São Francisco River) and at the same time of alternatives based on the building of more synergistic and sustainable relationships with river waters. In this sense, the film contrasts the metanarratives of development ­ which legitimize interventions such as hydroelectric dams, irrigation projects for industrial agriculture as well as the controversial transfer of the São Francisco River project ­ with relationships established by the riverside populations, who have a close symbiosis between their life, body and cultures and the river.

Análisis del documental Saúde! Velho Chico, con guión y dirección de Stella Oswaldo Cruz Penido y Eduardo Vilela Thielen, entendido como un registro, al mismo tiempo, de los patrones históricos de interacción con el Rio São Francisco (río San Francisco) y de alternativas capaces de construir una relación más sinérgica y sostenible con las aguas de los ríos. La película contrasta las metanarrativas del desarrollo ­ que legitiman intervenciones como represas hidroeléctricas, proyectos de riego para la agricultura industrial y el controvertido proyecto de transposición del río ­ con formas de relación establecidas por las diversas poblaciones ribereñas, que tienen la vida, el cuerpo y las culturas en estrecha simbiosis con el río.

Evaluación ambinntal estratégica para cuencas pioritarias de los andes Colombiianos: dilemas, desafíos y necesidades / Strategic Environmental Assessment for Priority Basins of the Colombian Andes: Dilemmas, Challenges and Necessities

En Colombia muchos ríos y otros sistemas acuáticos continentales, especialmente en la región Andina (la más poblada del país), sufren varios impactos antropogénicos relacionados con cambios en la cobertura vegetal y el uso y manejo del suelo, que comprometen su calidad y cantidad de agua, y el suministro de otros bienes y servicios ecosistémicos para el futuro. Es necesario que el gobierno colombiano formule nuevas y actualice las políticas, planes o programas, en consulta y cooperación constante con otras instituciones, autoridades civiles y ambientales, e investigadores del país (o del exterior), para alcanzar una corresponsabilidad sobre la gestión sostenible de los ríos en esta región. Esto permitiráimplementar una evaluación más integral de la cuenca y de otros aspectos ribereños, para el uso y manejo del agua dulce, en los actuales, o antes del inicio de nuevos proyectos de desarrollo. La toma de decisión sobre soluciones concertadas se debe integrar desde el nivel más bajo posible, e idealmente con participación de todos los grupos de interés, en un marco de evaluación ambiental estratégica (EAE). En este artículo se plantea una reflexión sobre cómo todos los colombianos y particularmente aquellos de la región Andina, pueden contribuir conjuntamente con el gobierno bajo la visión e implementación de una EAE, para lograr una gestión sostenible, eficaz e integrada, de las cuencas hidrográficas de dicha región y del país en general. Para apoyar la reflexión, se destacan algunos aspectos biofísicos y sociales relativos de la cuenca del río Coello en la zona central del país (departamento del Tolima).

In Colombia many rivers and other inland aquatic systems, especially into the Andean Region (the most populated of the country), suffer several anthropogenic impacts related to land use and land cover compromising their water quality and quantity, and the provision of other goods and ecosystem services for the future. It is imperative that the Colombian government may initiate new and updated policies, plans, programs in constant consultation and cooperation with other institutions, civilian and environmental authorities, and researchers from the country (or elsewhere), to obtain amply responsibility on the sustainable river management, especially in this region. Thus, a more integrative watershed river assessment and related riverine issues are necessaries for the current freshwater use and management, and before that new development projects going to start. Decision making regarding concerted solutions should be carried out at the lowest appropriate level, ideally involving all stakeholders into a strategic environmental assessment framework (SEA). This article discusses several issues about how all Colombians and mainly Andean people, can contribute by working together in partnerships with government under the vision and implementation of a SEA, towards a more effective and integrated sustainable management of river basins in the Andean Region and throughout country. This point-of-view is supported by a biophysical and social vision related to the Coello River Basin in Central Colombia (Department of Tolima).

Calidad de las tesis para obtener el título de médico cirujano, Universidad Nacional de San Antonio Abad del Cusco - Perú, 2000-2009 / Quality of theses for obtaining a medical degree. San Antonio Abad Cusco National University, Peru, 2000-2009

Introducción: El poco conocimiento en investigación de estudiantes de Medicina y el hecho de realizar sus tesis de pregrado en corto tiempo, pone en duda la calidad de las mismas. Objetivo: Determinar la calidad de las tesis para titularse de médico cirujano en la Universidad San Antonio Abad del Cusco (decenio 2000-2009) y evaluar su relación con algunos factores determinados. Material y Método: Estudio descriptivo y relacional. Universo: 284 tesis. Muestra aleatoria-estratificada: 172. Se recolectó la información transversal y retrospectivamente mediante un instrumento válido y confiable, evaluándose la calidad de las tesis (cumplimiento metodológico y pertinencia) y su relación con: año de sustentación, número de investigadores, diseño y área estudiada, utilizando el estadístico chi-cuadrado o alguna de sus correcciones. Resultados: Calidad de tesis: excelente (0%), aceptable (20,3%), no aceptable (79,7%). Se encontró que fue pertinente en 79,7%. Todas las secciones de una tesis, excepto el planteamiento del problema, resultaron "no aceptables" en su mayoría. Las deficiencias metodológicas principalmente fueron relacionadas con: estudio piloto (92,4%), referencias bibliográficas (77,9%), instrumento de medición (74,4%), unidad de estudio (68,6%) y operacionalización de variables (59,3%). No se halló relación al asociar variables, excepto al comparar la calidad de tesis en el bienio 2008-2009 respecto a años anteriores, con cierta mejoría (p-valor < 0,05). Conclusiones: Una de cada cinco tesis fue aceptable, siendo el planteamiento del problema de investigación la sección mejor desarrollada. Las tesis mejoraron su calidad en los dos últimos años del periodo evaluado.

Introduction: Poor knowledge on research shown by medical students, and the fact that they must complete their pre-graduate theses in a short time period, lead to doubts with respect to the quality of such research projects. Objective: To determine the quality of theses in order to obtain a medical degree in San Antonio Abad Cusco National University (from 2000 to 2009), and to establish if there is any factor influencing this. Materials and Method: This is a descriptive study using a relational model. The universe was 284 theses. The stratified and random simple included 172 theses. Data was retrospectively and cross-sectionally collected using a valid and reliable instrument, so their quality was assessed (methodology compliance and appropriateness), and we also reviewed the year theses were presented, the number of involved investigators, as well as the design and topics covered. We used the chi square test and some of its corrections for the analysis. Results: Theses were graded as excellent (0%), acceptable (20,3%), and non- acceptable (79,7%). We found theses were appropriate (79,7%). Most sections of all theses, except the investigational questions, were considered as 'non-acceptable'. Methodology deficiencies were mostly related with the following factors (pilot studies (92,4%), references (77,9%), measuring instruments (74,4%), study units (68,6%), and variable operationalization (59,3%). No relationships were found when variables were associated, except when comparing theses during the 2008-2009 period with respect to previous years, and some improvement was found (p<0,05). Conclusions: One of every five theses was graded as acceptable, and the formulation of the problem to be investigated was the best developed section. There were improvements in quality of theses during the last two years of the study period.

Return on Scientific Investment - RoSI: a PMO dynamical index proposal for scientific projects performance evaluation and management / Retorno sobre o Investimento Científico - RoSI: uma proposta de índice dinâmico PMO para avaliação de desempenho e gestão de projetos científicos

Objective: To propose a measure (index) of expected risks to evaluate and follow up the performance analysis of research projects involving financial and adequate structure parameters for its development. Methods: A ranking of acceptable results regarding research projects with complex variables was used as an index to gauge a project performance. In order to implement this method the ulcer index as the basic model to accommodate the following variables was applied: costs, high impact publication, fund raising, and patent registry. The proposed structured analysis, named here as RoSI (Return on Scientific Investment) comprises a pipeline of analysis to characterize the risk based on a modeling tool that comprises multiple variables interacting in semi-quantitatively environments. Results: This method was tested with data from three different projects in our Institution (projects A, B and C). Different curves reflected the ulcer indexes identifying the project that may have a minor risk (project C) related to development and expected results according to initial or full investment. Conclusion: The results showed that this model contributes significantly to the analysis of risk and planning as well as to the definition of necessary investments that consider contingency actions with benefits to the different stakeholders: the investor or donor, the project manager and the researchers.

Objetivos: Propor um novo índice adaptado de riscos esperados para avaliar, planejar e acompanhar projetos de pesquisa que dependem de financiamento e estrutura adequada para o seu desenvolvimento. Métodos: Uma grade de resultados aceitáveis em relação aos projetos de pesquisa com variáveis complexas foi aplicada como índice para mensurar o desempenho dos projetos. Para sua implementação foram utilizados o índice de ulcer como medida básica para acomodar as seguintes variáveis: custos, fator de impacto de publicação, levantamento de fundos e registro de patentes. Obteve-se uma ferramenta de modelagem aqui denominada "Retorno sobre Investimento Científico" (RoSI) que permitiu mensurar e acompanhar projetos de modo analítico, levando-se em conta o conjunto dos resultados esperados, as respectivas variáveis e suas interações analisadas num ambiente virtual semi-quantitativo. Resultados: O modelo foi testado para avaliação de três projetos da Instituição (projetos A, B, e C). Diferentes curvas refletem os índices de ulcer identificando o projeto de menor risco (projeto C) relacionado ao desenvolvimento e resultados esperados de acordo com o investimento inicial ou total considerado. Conclusão: O modelo contribuiu tanto para a quantificação dos riscos e planejamento, quanto para a definição de investimentos necessários que contemplem ações de contingência, beneficiando os diferentes stakeholders envolvidos: o financiador (investidor ou doador), o gestor e os pesquisadores.