Este artigo traça um perfil histórico das diferentes interpretações da loucura, permitindo vislumbrar a própria história da saúde mental, desde seu caráter mítico inicial até explicações racionais, passando pela tolerância ao diferente até sua caracterização como doença. Na condição de doença mental, passível de tratamento e possível cura, surgem os hospitais psiquiátricos, os quais se tornaram símbolos da exclusão e seqüestro da cidadania. As recorrentes denúncias de violência e desrespeito aos direitos humanos, a partir da década de 1970, impulsionaram a reforma deste modelo de assistência psiquiátrica, pautando-se na desinstitucionalização e no resgate da cidadania e do respeito à singularidade e subjetividade do doente mental. A partir disso, a legislação brasileira passou a garantir os direitos e deveres tanto dos doentes mentais como dos médicos que deles cuidam, garantindo o respeito à dignidade humana em toda sua essência, inclusive no que tange a autonomia do paciente com relação ao tratamento compulsório.

To increase blood safety Brazil introduced screening for anti-HBc among blood donors in 1993. There was a decrease in the hepatitis B virus (HBV) transmission, but this measure identified a great number of HBsAg-negative, anti-HBc-positive Studies have shown an increasing chance of finding HBV-positive subjects among household contacts of hepatitis B virus (HBV) carriers as compared with contacts of HBV-negative individuals (Berris et al. 1973, Kashiwagi et al. 1984, Milas et al. 2000. HBV spread inside families can take place by vertical or horizontal route (Dumpis et al. 2001, Ono-Nita et al. 2004. A surveillance approach recommended by the Center for Disease Control and Prevention (US) and the Brazilian Health Ministry is to screen contacts of HBV carriers in order to identify other carriers and susceptible individuals who could benefit from prophylaxis (CDC 1991). One of the most common ways of identifying HBV carriers takes place during blood donation screening (Hadler et al. 1987.In Brazil, HBV blood donors screening was extended to include analysis of antibodies against the core antigen (anti-HBc) in 1993 (Brasil, Ministério da Saúde). While improving safety, the addition of anti-HBc testing has increased the rejection of donated blood and has uncovered a large number of HBsAg-negative, anti-HBc-positive individuals considered to be unsuitable for blood donation. This serologic profile is quite common in en- demic areas and usually indicates a resolved HBV infection, although HBV DNA can be detected in serum from some of these individuals (Hennig et al. 2002).These HBsAg-negative, anti-HBc-positive blood donors require counseling regarding the implications of these results and whether their relatives and sexual contacts are at increased risk for HBV infection. However there is no such policy in Brazil and it has not yet been determined if the contacts of HBsAg-negative, anti-HBc-positive individuals are at increased risk of HBV exposure (Brasil 2000). It is also not know how long these blood donors remained infective in the past or when they stopped carrying HBV. This raises the question: should the surveillance policy for contacts of HBsAg-positive individuals be broadened to include contacts of HBsAg-negative, anti-HBc-positive individuals? The aim of the present study was to clarify whether contacts of HBsAg-negative, anti-HBc-positive blood donor are at increased risk for HBV infection. MATERIALS AND METHODSA cross-sectional study was designed to compare HBV infection prevalence in contacts of subjects with one of two profiles of HBV markers (HBsAg-positive or only antibodies positive: HBsAg-negative, anti-HBc-positive) identified during blood donation. The study was conducted in Cuiabá, (the largest city of the state of Mato Grosso, Central Brazil) at two institutions: the local public blood bank and the main private one. Both collect blood in Cuiabá and also in other cities of the region.

Supplemental tests using Immunoblot are recommended to improve specificity of anti-HCV by ELISA. In Brazil immunoblot is not officially recommended. Aiming to identify EIA false-positive rate 70 positive EIA anti-HCV blood donors were submitted to 3rd generation immunoblot at Hemocentro of Mato Grosso State where polymerase chain reaction tests are not performed. There were 44 (62.9%) immunoblot-positive, 22 (31.4%) negative and 4 (5.7%) indeterminate. Anti-HCV immunoblot can distinguish blood donors with false-positive ELISA from those who need medical assessment. Our data suggest that immunoblot could be useful in Brazilian blood banks where molecular biology tests are not available.

In order to evaluate the reduction in the cost of testing for antibodies against hepatitis C (EIA) by the pool method, we tested serum samples from a rural population and from patients in a hemodialysis program. Two thirds of the high risk groups were positive. Pooling reduced the reagent use by 80% in the rural population and by 13% in the hemodialysis patients. We conclude that pool testing reduces the cost of anti-HCV detection in low-risk groups.

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