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If the association estimated in our study is causal, our results provide evidence that some hip fracture-related deaths could be prevented by improved patient access to appropriate and timely hospital care in the context of a developing country.

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O ponto de partida deste trabalho é a tentativa de examinar a prática e o saber médico nas suas articulações internas, em contraste com as análises críticas da medicina que usualmente partem de um ponto de vista externo, com uma abordagem sociológica ou econômica. A partir deste referencial, constata-se que a suposta cientificidade da medicina não se sustenta ao analizar-se seus referenciais teóricos, em especial no que diz respeito àepidemiologia, disciplina fundamental na constituição dos objetos da prática médica - as doenças - desconhecida pela maioria dos médicos. Mais ainda, categorias fundamentais do raciocínio clínico nunca são definidas, como se fossem objetos naturais, dados, o que faz com que a razão principal da busca por atenção médica, o sofrimento, seja marginalizado dentro do pensamento médico, e que o paciente seja apagado para que surja a doença. Por fim, a partir da constatação do caráter eminentemente individualizado do exercício da medicina, o que por si só a afasta do paradigma das ciências naturais, defende-se a adoção de uma atitude científica que permita ao médico questionar as bases de sua prática e recuperar o papel do sofrimento como eixo principal do pensamento médico.

Within a common national AIDS policy framework, the degree of involvement and cooperation between public and NGO actors deeply impacts population coverage and program sustainability. Specific processes are required to maintain actor mobilization without isolating AIDS programs.

The gap from admission to surgery may be used as a surrogate of the actual delay from fracture to surgery when studying in-hospital HF mortality.

This paper, the second in a series, reports on a study designed to assess how physicians operate selective mechanisms to sort out relevant and/or reliable information from what is presented to them. Twenty-four professors of internal medicine from two leading medical schools in Rio de Janeiro, Brazil, answered open-ended interviews. The conceptual framework adopted is based on Ludwik Fleck's work (on thought style). The thought style that emerged from this set of interviews can be briefly characterized as a largely intuitive, pragmatic, results-oriented search for relevant (i.e., potentially useful in practice) information, selected from sources with sufficient academic credibility and submitted to a primacy of practical knowledge. However, despite this skepticism, doctors lack resources (i.e. time, as well as knowledge of technical aspects of research, particularly in terms of epidemiology and statistics) to effectively assess the knowledge that is constantly being force-fed to them.

Quality assessment of scientific output is based extensively (if not exclusively) on quantitative bibliometric indicators, despite mounting criticism. The reaction by the academic community has increased in recent years. After presenting a critical evaluation of this model, the article presents an alternative qualitative model oriented towards removing the excessive stimulus for the unbridled production of articles that make a dubious contribution to science. Criticism of the proposed model is presented and discussed.