Esta dissertação investiga a emergência da noção de periculosidade na legislação penal brasileira através da reconstrução das discussões formuladas no âmbito da medicina e do direito. Adotando uma abordagem arqueogenealógica de pesquisa, inspirada na obra de Michel Foucault, busca reconstituir as diferentes problematizações que foram formuladas no Brasil a respeito da imputabilidade penal e seu entorno. Esta dissertação enfoca assimilação das discussões sobre crime e loucura dos autores europeus nos escritos brasileiros das disciplinas da criminologia, medicina legal e psiquiatria realizados desde o período que antecede a aprovação do Código Penal de 1890, passando pelos debates penais centrados na “questão racial” e na “questão social”, até as discussões alimentadas em torno da “defesa social” e seus reflexos no Código Penal de 1940. Conclui que as propostas tanto da criminologia quanto da medicina legal e da psiquiatria para a adoção de uma legislação penal baseada nos princípios da “defesa social” não foram incorporadas neste Código na extensão almejada por seus defensores. / This dissertation investigates the emergency of the periculosity notion in the Brazilian penal legislation throughout the disputations formulated in the ambit of medicine and right. Adopting an archeogenealogical approach of research, inspired on the Michel Foucault’s work, this enquire search to reconstitute the different problematizations formulated in Brazil among the penal responsibility and his nearness. This dissertation focuses the assimilation of the disputations about crime and madness of the European authors in the brazilian writers of the disciplines of criminology, legal medicine and psychiatry realized since the period before the approbation of the Penal Code of 1890, undergoing the penal debates centered in the “racial question” and in the “social question”, up to the disputations nourished among the “social defense” and his reflexes in the Penal Code of 1940. The conclusion of this work is that the propositions as far of the criminology as of the legal medicine and of the psychiatry for the adoption of a penal legislation founder in the principles of the “social defense” were not incorporated in the extension desired by his sponsors.

O presente trabalho analisa diferentes aspectos da perícia médico legal, visando buscar formas efetivas de otimizar seus laudos e aferir melhores resultados na busca da verdade dos fatos na Justiça brasileira. Para tanto, é feita uma análise etimológica e uma breve retrospectiva da história da perícia, como forma de melhor entender e contextualizar suas bases e origens. Após, é analisada a realidade brasileira nesta área, em especial no Estado de São Paulo, mediante a verificação da estrutura dos locais de perícia, bem como da qualidade das intervenções dos poderes legislativo e executivo nesta área. É discutida, ainda, a questão da desvinculação da perícia à Segurança Pública no Brasil, bem como é realizado um breve estudo de direito comparado, em que são focadas as diferenças no tratamento legal da perícia entre o ordenamento jurídico brasileiro e os ordenamentos estrangeiros. / This study analyzes several aspects of forensic expertise, aiming to seek effective ways to optimize the experts reports, consequently benchmarking best results in the search for the truth in investigations carried out in Brazil. Therefore, it was performed an etymological analysis and a brief retrospective of the history of forensic sciences as a way to understand and contextualize its origins and bases. In sequence it was analyzed the Brazilian reality in this field, especially in the State of São Paulo, by means of checking the structure of the locations where the States official examinations are conducted, as well as the quality of the interventions of the government and the parliament in this field. This work also discusses the issue of untying the States official examinations from the Citizen Security authorities in Brazil, as well as performs a brief study of comparative Law, which is focused on the differences related to the legal treatment of forensic sciences on foreign Legal systems compared to the Brazilian Legal system.

La complexité qui traverse l'épidémiologie sociale et la médecine légale du vivant est de celle que l'on cherche à saisir par la variété des observations et par l'intrication de points de vue et d'échelles différentes - l'individu, le groupe, la société. Les méthodes du biomédical sont encore peu adaptées au traitement de la complexité, à sa représentation qui ne soit pas normative, statistique. Il existe un ensemble d'approches non statistiques, " non classiques ", qui puissent traiter simultanément un grand nombre de dimensions et qui permettent de réduire la complexité apparente en dégageant des objets d'étude spécifique. Nous présentons ici les principes et l'utilisation des techniques de reconnaissance de forme dans le cadre de l'épidémiologie sociale, en les appliquant à la recherche d'une typologie de recours aux soins, sur la base des données de la cohorte SIRS. Nous expliquons en quoi ces approches ont leur place, épistémologiquement et techniquement parlant, aux côtés des méthodes expérimentales classiques type essais randomisés contrôlés. Nous exposons également un autre moyen de réduire la complexité des données, tout en en préservant les qualités topologiques. Nous introduisons en médecine légale la notion de dimension intrinsèque, plus petite dimension nécessaire et suffisante à la description des données, et de techniques non linéaires de réduction de la dimension. Nous en appliquons les principes au cas de l'intégration de sources d'information multiples pour l'estimation de l'âge chez les adolescents migrants. Enfin, nous discutons les avantages et limites de ces approches ainsi que les perspectives qu'elles ouvrent à ces deux disciplines complémentaires. / Social epidemiology and clinical legal medicine are hybrid objects that articulate several fields, accounting for social and interpersonal relationships. The complexity that characterizes them both is investigated through different viewpoints, scales and dimensions: the individual scale, the group scale and the society scale. The techniques used in biomedicine are not designed to properly deal with such a complexity, in a non-normative way. A wide range of alternative non-statistical, “non-classical” methods exist that can process simultaneously various dimensions so that we can reduce the apparent complexity of data while discovering scientific objects. Here, we present the principles and the use of clustering techniques, applied to social epidemiology. We applied different clustering techniques on data from the SIRS cohort to build a typology of healthcare utilization in the Paris metropolitan area. From an epistemological and technical viewpoint, we explain why these methods should take place beside other recognized but limited techniques such as randomized controlled trials. We introduce another but complementary kind of complexity reduction technique. The concept of intrinsic dimension is explained – the littlest dimension needed to describe properly data – and nonlinear dimensionality reduction techniques are applied in clinical legal medicine. With these tools, we explore whether the integration of multiple information sources is relevant in age estimation of living migrants. Finally, we discuss the pros and cons of these methods, as well as the opportunities they may create for both fields of social epidemiology and clinical legal medicine.

1. Hintergrund Das Schädel-Hirn-Trauma (SHT) stellt eine der häufigsten Todesursachen und Begleitverletzungen bei nichtnatürlichen Todesfällen dar und ist damit Gegenstand der Routine-Untersuchungen in der Rechtsmedizin. Eine Abschätzung der Überlebenszeit (ÜLZ, d.h. der Zeitraum zwischen der Verletzungsentstehung und dem Todeseintritt) ist für die Chronologie eines Tatablaufs und Überprüfung von Zeugenaussagen / Alibiangaben von großer Bedeutung. Primär werden hierfür postmortal pathomorphologische und klassische histologische Befunde herangezogen. Immunhistochemische Untersuchungen haben bisher kaum Eingang in die Überlebenszeitdiagnostik gefunden, könnten aber zur Konkretisierung der bisher gängigen Methoden beitragen. Häufig untersuchte Proteine im Gehirn sind das S100-Protein (S100) und die Neuronenspezifische Enolase (NSE). Die Spiegel beider Marker werden im klinischen Alltag vielfach zur Abschätzung der Schwere und der Prognose eines SHT im Blut und Liquor gemessen. Immunhistochemisch wurden beide Proteine bisher vor allem auf deren allgemeines Vorhandensein und Verteilung im Zusammenhang mit SHT untersucht. Nur eine Studie beschäftigte sich bisher mit einer möglichen zeitlichen Dynamik. 2. Fragestellungen Folgende Fragen sollten durch vorliegende Arbeit beantwortet werden:  Existiert eine Korrelation zwischen dem Anteil positiv auf S100 gefärbter Gliazellen (Astroglia und Oligodendroglia) und der Überlebenszeit?  Ist eine Korrelation zwischen dem Anteil positiv auf NSE gefärbter Neuronen und der Überlebenszeit möglich?  Welche lokalisationsspezifische Veränderungen in den untersuchten Hirnregionen (Umgebung der Kontusion, Hippocampus, Kleinhirn) in Bezug auf die Überlebenszeit existieren?  Gibt es signifikante Unterschiede zwischen Fall- und Kontrollgruppe? 3. Material und Methoden Für diese Untersuchung wurden Hirngewebeproben aus 57 gerichtlich angeordneten Sektionen verwendet. Davon wiesen 47 ein tödliches SHT und ÜLZ zwischen wenigen Sekunden und 34 Tagen auf. Zehn Fälle mit kardiovaskulären Todesursachen wurden als Kontrolle herangezogen. Die Überlebenszeiten der Fälle mit tödlichem SHT wurden in Übereinstimmung mit bisherigen Studien in folgende Kategorien eingeteilt: Akuter Todeseintritt nach SHT (ÜLZ bis 2 Stunden), subakuter Todeseintritt nach SHT (ÜLZ 2 Stunden bis 4 Tage) und verzögerter Todeseintritt nach SHT (ÜLZ über 4 Tage). Die zur Untersuchung gelangten Proben wurden spätestens 6 Tage nach dem Versterben der Personen entnommen (Mittelwert 2,7 Tage). In allen Fällen wurde die Umgebung der Kontusion, bei 35 dieser Fälle der Hippocampus und bei 31 der Fälle auch das Kleinhirn untersucht. Die verschiedenen Regionen wurden jeweils gesondert für Rinde und Mark bzw. im Hippocampus für Stratum pyramidale und radiatum beurteilt. Die immunhistochemische Färbung auf S100 und NSE wurde mit der indirekten Dextran-Polymer-Methode (DakoCytomation), die Gegenfärbung mit Hämatoxylin nach Mayer durchgeführt. Verwendet wurden ein polyklonaler S100-Kaninchen-Antikörper sowie ein monoklonaler NSE-Maus-Antikörper (beide DakoCytomation). Für die semiquantitative Evaluation wurden gefärbte und ungefärbte Neuronen, Oligodendrozyten sowie Astrozyten in jeweils 20 High Power Fields gezählt. So konnte für jede Region und Zellart ein Prozentsatz positiver Zellen ermittelt werden. Für die statistische Auswertung wurde SPSS Statistics (Version 21, 2012 IBM) und OpenOffice Calc (Version 3.4.1, 2012 Apache Software Foundation) verwendet, es kamen der Mann-Whitney-Wilcoxon-Test (nicht-parametrisch), die Spearman-Korrelation und die Benjamini-Hochberg-Prozedur zum Einsatz. Eine Zustimmung zu dem der Promotionsschrift zugrunde liegendem Forschungsvorhaben wurde durch die Ethik-Kommission der Medizinischen Fakultät der Universität Leipzig erteilt (Nr. 117-12-23012012). 4. Ergebnisse Äußere Einflüsse. Es konnte keine Korrelation zwischen dem Anteil positiver Zellen und der Leichenliegezeit (rs= -0.27 bis 0.15, p = 0.1 bis 0.96) oder dem Geschlecht (p = 0.07 bis 0.98) festgestellt werden. Aufgrund des häufigeren Auftretens verzögerter Todeseintritte bei älteren Personen (rs = 0,33, p < 0.05) konnte keine sinnvolle Korrelation zwischen Alter und Zellpositivität durchgeführt werden. Zellzahlen insgesamt. Zur Qualitätssicherung und zur Vergleichbarkeit mit anderen Studien, wurden die Zellzahlen insgesamt erfasst. Hierbei wurden keine signifikanten Unterschiede in den unterschiedlichen ÜLZ-Kategorien festgestellt. Die Zellzahlen in den SHT-Fällen waren hingegen signifikant niedriger als in den Kontrollfällen. Unterschiede in den Kategorien der Überlebenszeit. Die Anteile S100-positiver Oligodendrozyten waren in Kontusionsumgebung signifikant niedriger in der Gruppe mit subakutem Todeseintritt als in der Gruppe mit akutem Todeseintritt (p < 0,05) sowie der Kontrollgruppe (p < 0,05). Im Hippocampus waren die Anteile S100-positiv gefärbter Oligodendrozyten in der Gruppe der akuten sowie subakuten Todeseintritte niedriger als in der Kontrollgruppe (jeweils p < 0,05). Im Vergleich mit der Kontrollgruppe waren die Anteile NSE-positiver Neuronen sowohl im Hippocampus als auch in der Kontusionsumgebung in der Gruppe der akuten Todeseintritte (jeweils p < 0,05) höher. Die Anteile NSE-positiver Neuronen im Hippocampus sanken in der Gruppe der subakuten im Vergleich zur Gruppe der akuten Todeseintritte ab (p < 0,05). Astrozyten zeigten bei dieser Studie keine signifikanten Unterschiede in ihrem Färbeverhalten in Bezug auf die ÜLZ. Überraschenderweise zeigten sich in den Gruppen mit subakutem und verzögertem Todeseintritt auch S100-positive Neuronen im Hippocampus und der Kontusionsumgebung. Diese Beobachtung konnte in der Akutphase nach Traumatisierung und in der Kontrollgruppe nicht gemacht werden. Im Hippocampus war eher eine diffuse neuroplasmatische, in der Kontusionsumgebung eine eher juxtanukleäre Färbung zu finden. In beiden Regionen war die Verteilung der S100-positiven Neuronen unsystematisch oft in räumlicher Nähe zu S100-positiven Gliazellen zu finden.

No description available.

O panorama das ciências forenses no Brasil poderia ser mais auspicioso. O aumento incontrolável das dissensões sociais e da criminalidade comum, o crescimento de facções do crime organizado, o surgimento de novas modalidades de delitos, os desastres de massa e o incremento de novas tecnologias são fatores que apontam no sentido de uma maior demanda por exames periciais e da crescente complexidade dos trabalhos relacionados com as ciências forenses. Paradoxalmente, a falta de investimentos públicos na área, os baixos salários, a ausência de perspectiva profissional e o acúmulo de serviço são alguns dos fatores que claramente influenciam na queda de qualidade do trabalho técnico. Não se publicam mais obras de Criminalística e Medicina Legal no país. As revistas especializadas são poucas e os cursos de Direito paulatinamente vão destinando cada vez menos espaço para aquelas que, ao lado da formação jurídica específica, deveriam ser as matérias principais na formação do bacharel, especialmente daqueles que militam na área penal. Além disso, e exatamente pela natureza técnica da matéria, poucos são os questionamentos que recaem sobre a cadeia de custódia ou sobre a validade das provas periciais apresentadas pelos organismos públicos encarregados da prevenção e da repressão criminal. Este trabalho pretende apresentar uma breve revisão dos dispositivos que regulamentam a prova pericial no sistema processual penal, recentemente alterados pela Lei n. 11.690, de 09/06/08, a estrutura da polícia científica e os procedimentos periciais de levantamento dos locais de interesse à Justiça Criminal, desde o momento que antecede à perícia até a entrega do relatório técnico, apontando seus limites, deficiências e qualidades. / The overview of forensic sciences in Brazil could be more auspicious. The uncontrollable raise of social disagreements and common criminality, the increase of organized crime factions, the appearance of new forms of crime, mass disasters and improvement of new technologies are factors which leads to a sense of higher demand for expert examinations and an increasing complexity of works related to forensic sciences. Paradoxically, the absence of public investment in the area, the low wages, the lack of professional perspectives and the accrual of workload are some of the factors that clearly influence the decline of quality of technical works. There are few new publications about Criminalistics and Legal Medicine in Brazil. The specialized journals are few and law schools are gradually giving less space for those which, like specific legal matters, should be the main ones in the training of new lawyers, especially those who work with criminal law. Besides that, and exactly because of the technical nature of the matter, few are the questions which fall upon the chain of custody or the validity of the expert evidence shown by the public organisms which are responsible for the criminal prevention and repression. This dissertation intends to present a brief review of the articles that regulate the expert evidence in the criminal procedural law, recently altered by Law nº 11.690 of 09/06/08, and the structure of forensic science and the expert procedures to gather places of interest to the Criminal Justice, from the moment preceding the expertise until the delivery of the technical report, pointing out its limitations, shortcomings and qualities.

O amplo emprego do exame de DNA em ações de investigação de paternidade levou à divulgação maciça de sua eficácia pelos meios de comunicação que acabou por lhe dar uma aura de infalibilidade, colocando em descrédito os métodos analíticos mais antigos. Enfocado pela mídia como técnica suprema, foram omitidas do grande público as limitações existentes quando aplicada à Criminalística, seu alto custo e a complexidade dos processos técnicos exigidos para que sejam auferidos resultados confiáveis. No meio jurídico brasileiro, o tema é ainda discutido de forma superficial, marginalizando os operadores do direito dos conhecimentos técnico-científicos necessários para a interpretação dos resultados probabilísticos oferecidos pelos exames de DNA. Este trabalho procura, de certa forma, diminuir esta lacuna técnico-científica e esclarecer os reais alcances e limitações da aplicação desta técnica nas investigações forenses como auxiliar na elucidação de crimes e na identificação de pessoas. Inicia-se pelo estudo da evolução das técnicas empregadas na Medicina Forense para a identificação humana, discutindo-se a propalada sobrepujança da análise de DNA em relação aos tradicionais exames periciais. É feita uma abordagem sobre o desenvolvimento da Biologia Molecular, principiando-se pelo estudo da estrutura do DNA e pela forma de transmissão da informação genética, para, em seguida, tratar da detecção de polimorfismos presentes nesta molécula propiciadores, em última instância, da obtenção de padrões genéticos indivíduo-específicos que vêm sendo empregados na identificação de suspeitos em casos de crimes sexuais; na identificação de cadáveres de vítimas de crimes ou de grandes catástrofes; e no estabelecimento de vínculo entre suspeitos e locais de crime, entre um local de crime e outro, e entre instrumento lesivo e vítima. Dá-se também grande ênfase à coleta de materiais e as precauções para garantir a cadeia de custódia das amostras que serão estudadas, ressaltando-se ainda aspectos éticos e jurídicos que envolvem a questão da coleta de materiais biológicos de suspeitos à luz do direito brasileiro. São também abordados os procedimentos laboratoriais utilizados para a extração, quantificação, amplificação e detecção do DNA dos materiais analisados, bem como os métodos estatísticos empregados para a correta interpretação dos resultados auferidos e as recomendações existentes para elaboração do laudo pericial e para o necessário controle de qualidade das análises de DNA. São discutidos aspectos atinentes ao uso das informações sobre o DNA, quer em suas repercussões sociais quer como prova na justiça penal, pela abordagem de características de seu contraditório e de seu real valor para a formação da culpabilidade. É ainda apresentado o trabalho pericial realizado no Laboratório de DNA do Instituto de Criminalística de São Paulo e também exposto um estudo estatístico sobre a eficácia técnica das análises realizadas neste laboratório. Conclui-se que a análise de DNA, mesmo sendo uma poderosa ferramenta, está longe de ser uma condição sine qua non em estudos forenses. A prova de DNA deve ser sempre considerada dentro de um conjunto de variadas evidências e o papel do geneticista forense não é o de fazer presunções de culpabilidade ou de inocência, mas o de fornecer informações exatas para melhor aplicação da justiça. / The wide application of the DNA exam in paternity investigation led to the massive divulgation of its efficiency through the communication channels, earning it a reputation of infallible result, and jeopardizing the credit of older analytical methods. While focused by the media as the most supreme technique, several limitations were omitted regarding its use in criminal matters, such as its high cost and the complexity of technical processes demanded for trustworthy results. The theme is still discussed in a superficial way among the Brazilian juridical scenario, which leaves the law related individuals with a lack of technical and scientific knowledge required to the interpretation of results offered by DNA exams. The goal of this report is to, in a way, diminish this technical and scientific gap and clarify the real accomplishments and limitations of this technique, while applied to forensic investigations as an auxiliary alternative to crime solving and people identifying. We begin with the study on the evolution of the techniques applied in Legal Medicine to human identification, discussing the surpass of DNA analysis in relation to other traditional exams. The development of Molecular Biology is featured with basis on the DNA structure and the way the genetic information is transmitted, followed by the polymorphisms detection in this molecule and obtainment of specific genetic patterns which have been used for identifying suspects of sexual crimes; identification of crime and catastrophe victims, and in the establishment of a link between suspects and crime scenes, one crime scene and another, and a wound object and a victim. Great emphasis is given to the collecting of material and precaution used to ensure the custody of samples to be analysed, enhancing the ethic and legal aspects involving the collection of biological material of suspects brought to light as per the Brazilian Law. Laboratory procedures utilized to the extraction, amplifying and detection of DNA analysed material are outlined, and statistics methods applied to the correct interpretation of results and existing recommendations to elaborate the expert report, and to the necessary quality control of DNA analysis. Several aspects referent to the use of information about DNA are discussed, as whether in relation to its social repercussions or as a penal proof, through the characteristics of its contradictory and real value to elaborate culpability. An expert essay formulated at the São Paulo Criminal Institute DNA Laboratory is presented along with a statistics study on the technical efficacy of samples analysis made in that lab. The conclusion is that the DNA analysis, despite being a powerful tool, is far from being a sine qua non condition in forensic studies. The DNA proof must always be considered within an ensemble of various evidences, and the role of the legal genetic expert is not to make presumptions of culpability of innocence, but to provide accurate information to help the applicable law.

Die Arbeit befaßt sich mit den Formen des nicht natürlichen Todes und weiteren rechtsmedizinischen Sachverhalten wie Leichenerscheinungen, Scheintod, Identifizierung von Personen und Leichen, Selbstverstümmelungen und Spuren von Tätern und Opfern in den deutschen Volksmärchen. Rechtsmedizinische Zusammenhänge von Ursache und Wirkung werden nach ihrer Gültigkeit im Märchen hinterfragt. Wie werden beispielsweise Gewaltwirkungen auf äußere Erscheinungsbilder betroffener Märchenfiguren, Tötungsgeschehen und Tatwerkzeuge dargestellt? Inwiefern entsprechen Schilderungen der Tatbestände und ihre Bewertung im Märchen auch historischem Rechtsverständnis? Was unterliegt den epischen Gesetzen des Märchens? Für die rechtsmedizinische Fragestellung nach den Verletzungsspuren am Getöteten, dem Tötungsgeschehen und den Tatwerkzeugen sind die Märchen als Quelle des Volkswissens nur begrenzt verwertbar. Zum Beispiel sind keine Wunden, innere Blutungen oder kleinere Verletzungen nach Gewalteinwirkung beschrieben. Es wurden nahezu alle klassischen Todesarten wie Ertrinken, Vergiften, Verbrennen, Verhungern, Erhängen, Erfrieren, Selbsttötung und Tod durch scharfe und stumpfe Gewalt im Märchen vorgefunden und betreffende Textstellen unter Benutzung der "historisch-geographischen Methode" regional verglichen. Zusammenhänge von Ursache und Wirkung konnten jedoch nicht im Sinne einer rechtsmedizinischen Rekonstruktion des zum Tode führenden Geschehens nach heutigen Maßstäben aufgestellt werden. Das Märchen als Volksüberlieferung kennt keinen historisch konkreten Zeitbezug. Mit der zeitlich und regional variierenden Wiedergabe des Erzählstoffes fließen neue Motive und anderes Wissen mit ein. Daraus ergab sich für die Arbeit eine zurückhaltende Aufstellung von Vergleichen des rechtshistorischen Alltags und der geschilderten Märchenwirklichkeit. Der nicht natürliche Tod konnte bei der rechtsmedizinischen Untersuchung nicht unabhängig von seinem Zusammenhang im Märchen betrachtet werden. Er ist im Märchen oft ein Mittel, entsprechend den Moralvorstellungen Gerechtigkeit herzustellen, aber auch die Protagonisten von ihrem positiven Weg abzubringen. Seine sozialisierende Funktion in der Märchengesellschaft kann nicht übersehen werden. / This thesis reports about the types of the non-natural death and further issues of legal medicine in the German folk tales such as the sure signs of dead bodies, appearently dead people, identification of persons and corpses, mutilation of its own and traces of perpetrators and victims. Do forensic correlations between cause and effect appear in the fairy tales? How do fairy tales describe the violent effects to the concerned figures? outward appearance, the killing event and the tools of crime? How does the facts of the cases? description and their valuation in the fairy tales correspond to the historical comprehension of the rights? The folk tales are only of restricted use as a source of general knowledge for the forensic issue of the injury traces on a dead body, of the killing event or of the tools of crime. For example, there are not described any wounds, internal bleedings or smaller injuries after violence. Nearly all classical causes of non-natural death are found in the fairy tales: drowning, freezing to death, hanging, burning to death, poisoning, dying of starvation, suicid and death by sharp and blunt force. There could not be shown any correlations between cause and effect in the sense of a killing event?s forensic reconstruction after today's standards. The folk tales as an oral tradition are not exactly related to a certain historical period. With each new performance a story was influenced by new motivs or knowledge. For that reason the comparison between fairy tales and historical reality of everyday life is very restrained. The non-natural death as a forensic fact can only be interpretated in ist function in the folk tales. By means of the non-natural death the fairy tales? characters are doing justice corresponding to their moral ideas, but positive figures can also be pushed away from their good ways. The non-natural death? socializing function in the fairy tales? society is evident.

Due to concerns about international differences in treatment effectiveness, many countries are reluctant to extrapolate overseas clinical data to form the basis of guideline recommendations and intervention approval processes. The evidence on which these concerns are based, however, comes from a limited dataset, with few studies directly assessing international differences in treatment effectiveness. This study aims to assess differences in the results of cardiovascular trials between Europe, North America, and Asia using the panoramic meta-analysis approach. All meta-analyses containing randomised control trials for the treatment or prevention of cardiovascular diseases were searched for in The Cochrane Library (2000 to 2008) and Medline (2005-2008). Analysis was then conducted within and over the included meta-analyses by performing pair-wise comparisons of the trial results between Europe and North America, Europe and Asia, and North America and Asia and a universal comparison of all three continents’ trial results together. All analyses were conducted over fatal and non-fatal endpoints. The findings suggested that for both endpoints, interventions performed best in Asian trials. For fatal endpoints, a high proportion of positive trial results were observed for Japan. Further investigation showed that between-continent differences in treatment effect could be explained by between-continent differences in trial quality. However, the types of intervention prone to inter-continental differences could not be identified for fatal or non-fatal endpoints. These findings suggest that those developing guidelines and approving interventions should be cautious when extrapolating overseas data. In particular, this study highlights the importance of taking trial quality into account when extrapolating and interpreting clinical trial data from different regions.

Made available in DSpace on 2016-04-28T14:16:19Z (GMT). No. of bitstreams: 1 Robinson Henriques Alves.pdf: 746447 bytes, checksum: 10c58ac7d4f0f0bf68ceed4e7459e6a2 (MD5) Previous issue date: 2014-03-24 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / The aim of the present study is to analyze the establishment and operation of Legal Medicine chairs in Brazilian medical and law schools in the 19th century. The study focused on the logistics and political features underpinning that process, including the procedures for hiring professors and notions of the Legal Medicine that were taught. In addition, attention was also paid to the ties that bind Europe and Brazil as to the institutionalization of science, with particular emphasis on Portugal s apparent lack of interest in establishing higher education courses in its American colony, as well as on the influence exerted by Legal Medicine on Law. The basic assumption underlying the present study is that the institutionalization of a definite field of knowledge demands explicit recognition of the need of specific training, research practice, divulgation and application of the knowledge thus produced. The study is based on an exploratory and descriptive survey of the literature, which was analyzed according to the epistemological, historiographical and historical approach proper to History of Science. Results show that, by the end of the 19th century, Legal Medicine had established programs for training, research, divulgation and application of its specific knowledge, which allows to infer that it achieved institutionalization as an autonomous field of knowledge / O objetivo do presente estudo foi reunir elementos que permitissem compreender como se instalou e passou a funcionar a cadeira de Medicina Legal nas Faculdades de Medicina e de Direito no Brasil no século XIX, com particular atenção aos aspectos logísticos e políticos da criação das cadeiras, passando pela contratação de professores e pelas ideias acerca de Medicina Legal expostas nos cursos aqui alocados. Procurou se ainda compreender as relações entre a Europa e o Brasil na institucionalização da ciência, dado o notório desinteresse da metrópole portuguesa em criar cursos superiores no Brasil colonial, e a possível influência que a Medicina Legal exerceu sobre o Direito. Partiu-se do pressuposto de que a institucionalização de um ramo do conhecimento implica reconhecer seu ensino, pesquisa, divulgação e aplicação. Trata-se, pois, de uma pesquisa bibliográfica, de caráter exploratório e descritivo, mas com o viés próprio da História da Ciência, qual seja, analisar fatos e documentos sob a perspectiva epistemológica, historiográfica e histórica. O estudo encerra-se com a constatação de que a Medicina Legal, no final do século XIX, mantinha o seu ensino, pesquisa, divulgação e aplicação do conhecimento, do que derivou seu reconhecimento como área de estudo independente e sua consequente institucionalização