Midwives are crucial human resources for health to achieve universal health care

@#Midwives are primarily considered as professionals with expertise in assisting women before, during, and after childbirth. Thus, the competencies for midwifery as defined by the International Confederation of Midwives revolve principally around assessment and provision of care to women and the fetus/newborn/infant during the pre-pregnancy and antenatal periods, labor and birth, postnatal/postpartum periods.1 The availability of skilled midwives in communities has allowed women, especially those who belong to lower income groups, to access professional services around childbirth, as reflected in responses from the National Demographic and Household Survey.2 For instance, while 50% of all women surveyed received antenatal care from a midwife, it is notable that 70% of those who belonged to the lowest wealth quintile were seen by a midwife during the antenatal period. Furthermore, midwives assisted 30% of deliveries reported by respondents, while roughly a little over a third of deliveries for each of the three lowest quintiles were attended by a midwife. Furthermore, in the Philippine setting, midwives are recognized as the first professional point of contact for most members of a community, especially in rural and remote places, as midwives are the ones deployed to manage Barangay Health Stations. Elaborating the scope of the practice of midwifery in relation to the provision of “primary health care services in the community” as stipulated in Republic Act No. 73923, the Board of Midwifery of the Professional Regulation Commission, in a primer for the profession, stated that midwives are expected to, among others, (a) implement government health programs in accordance with policies and guidelines of the Department of Health; (b) supervise barangay health workers; and (c) manage a Barangay Health Station.4 Stated differently, midwives, given the scope of work that they do and the areas where they are deployed, serve as the face and touchpoint of the health sector in our communities. They are the embodiment of the different health policies and programs enacted at the national and local levels through which Filipinos experience, individually and collectively, the drive for better health (or lack thereof ) advanced by different agencies, personalities, and stakeholders. However, as pointed out by Felipe-Dimog et al.5 in this issue of Acta Medica Philippina, midwives, especially those working in the public health sector, may take on roles beyond that contemplated by law. For instance, in the course of my professional practice during which I was deployed briefly in a rural health unit, and worked with an urban health department, I have encountered midwives who were tasked to work as program coordinators (or assistant coordinators), sanitation inspectors, field epidemiologists, and supply managers, among others, because of scarcity in the overall staff complement of health departments. Given their close ties with their areas of assignments, midwives are also expected to be community coordinators, if not organizers. The extent to which midwives are assigned these additional tasks depend on their professional relationship with their immediate supervisor; the level of trust and confidence reposed on them by their superiors; in some instances, their attendance to specific training workshops; as well as the availability of more qualified personnel (or lack thereof ) in the locality. Yet despite all these – placement in remote, if not hardship posts; additional assignments beyond their job description – midwives receive salaries that may not be commensurate after consideration of the job context. Staff midwife positions (i.e., Midwife I to III) in government institutions are remunerated at Salary Grades 9 to 13 (i.e., approximate gross pay of PHP 21,000 to PHP 31,000, based on the fourth tranche of the Salary Standardization Law, but may be lower depending on the income classification of the local government unit6). Additional compensation and benefits under special laws may not always be provided as this will depend on the paying capacity of the employing agency. Furthermore, midwives – especially those who completed the two-year program under the previous policy – also must contend with issues concerning their professional status. I have personally encountered community members who do not consider midwives as professionals in the same league as nurses or physicians, or who view midwives as “assistants” or “subordinates” of nurses and physicians, forgetting that a certain degree of independent practice is allowed each professional licensed by the Republic of the Philippines. Midwives play a crucial role in caring for Filipinos not only around childbirth – this is their primary professional duty – but throughout the lifespan – especially for midwives working in local health departments. Stakeholders must not forget to give due recognition to the value and worth contributed by midwives in shaping the health and well-being of each generation of Filipinos.

O esporte e o ídolo das origens: desvelando a constituição do futsal / The sport and the idol of origins: unveiling the constituition of futsal / El deporte y el ídolo de los orígenes: descubriendo la constitución del futbol sala

Diversas fontes que trabalham com a história do futsal fornecem informações desencontradas e de pouca confiabilidade para os estudiosos da área. Esse trabalho se vale dessas informações e procura, por meio de um debate historiográfico, problematizar a "origem" e a constituição desta prática esportiva ao longo do tempo. O artigo objetiva, primeiramente, discutir o ídolo das origens no futsal, e problematizar o surgimento deste esporte. Na segunda parte, o artigo analisa as transformações na prática desse esporte por meio de mudanças propostas pelas confederações. Conclui-se ser necessária uma desnaturalização e reinterpretação da história do futsal. Este artigo procurou estabelecer novas possibilidades de se pensar a história do futsal e suas relações com a sociedade brasileira.

A lot of sources about history of futsal show diverging and poorly reliable information to students and researchers of this area. This research uses these information and problematizing the "origin" and constitution of this sportive practice over time. This article aims, in the first part, discuss the idol of origins in futsal, and problematizing the appearance of this sport. In the second part, the article analyses the transformation in practice through changes proposed by confederations. In conclusion, it is necessary a denaturation and reinterpretation of history of futsal. This article aims to establish new possibilities to understand the futsal history and its relations with Brazilian society.

Diversas fuentes que trabajan con la historia del futbol sala ofrecen informaciones incongruentes y poco confiables para los estudiosos del área. Este trabajo se apoya en estas informaciones y busca, por medio de un debate historiográfico, problematizar el "origen" y la constitución de la práctica a lo largo del tiempo. El artículo tiene por objetivo, en su primera parte, discutir el ídolo de los orígenes en el futbol sala, y problematizar el surgimiento de este deporte. En la segunda parte, el artículo analiza las transformaciones en la práctica de este deporte por medio de cambios propuestos por las confederaciones. Se concluye que es necesaria una desnaturalización y reinterpretación de la historia del futsal. Este artículo buscó establecer nuevas posibilidades de pensar la historia del futsal y sus relaciones con la sociedad brasileña.

Reform of Professional Education in Physical Therapy in Perspectives of World Confederation for Physical Therapy International Course Accreditation: Case of Capital Medical University School of Rehabilitation Medicine / 中国康复理论与实践

This study described the significance of professional education in physical therapy in Capital Medical University School of Rehabilitation Medicine under the background of the World Confederation for Physical Therapy (WCPT) International Course Accreditation, analyzed the present problems of core curriculum system as well as the inevitable trends of carrying on the education reform of physical therapy, and the continuous reform program of core curriculum system in physical therapy based on the accreditation of the WCPT were suggested. The final purpose was to improve the quality of physical therapy talents substantially in order to achieve the standard of WCPT accreditation.

Design of Rehabilitation Therapy Practice Base Using International Standards / 中国康复理论与实践

@#Objective To focus on how to bring the international teaching methods, assessment methods and indicators of the rehabilitation clinical practice on the basis of the local conditions.Methods By analyzing the problems found in the years of clinical teaching, and combining with research status home and abroad, the clinical teaching standards of WCPT were analyzed, and the design of establishing international standard rehabilitation practical base in local area was proposed. This paper discussed and shared our learning and suggestion in practice.Results This paper solved a series of issues of this clinical practical base, such as positioning, training methods and assess, and broke the traditional teaching mode of emphasizing pedagogical part.Conclusion It is very important to strengthen the skills training, improve the assessment system, and establish multiple assessment ways to clinical skills.

Future perspective on international affairs for Korean doctors

The Korean Medical Association (KMA) has been requested to respond proactively and effectively to local agendas reflecting global perspectives in order to lead our society through the dynamic and fast-changing health care environment, which faces issues such as big data, artificial intelligence, and the increasing health-related impacts of climate change and fine particulate matter. Since the KMA joined the World Medical Association (WMA) in 1949 and the Confederation of Medical Associations in Asia and Oceania (CMAAO) in 1956, the KMA has made continuous progress in international affairs. Based on these achievements, the KMA has recently played important roles, such as the chair of the WMA Finance and Planning Committee, a council member in the WMA, and a council chair in the CMAAO. For the next several decades, the WMA and CMAAO are still expected to be the basic channels for sharing trends and visions, discussing health challenges across borders, and developing powerful initiatives that improve people's health. Maintaining current partnerships with the WMA and CMAAO and strengthening strategic collaboration with promising national medical associations are required to extend the KMA's influence. Training next-generation representatives to build capacity for international relations might also be necessary for the sustainability of international collaboration. Through the KMA's advancements in international affairs, incorporating harmonious perspectives on local, regional, and global agendas, the KMA is fully expected to contribute to addressing health challenges by demonstrating its leadership.

Cursos de obstetrícia em países da América do Sul: caracterização e análise da estrutura curricular / Midwifery programmes in South American countries: characterisation and curricular structure analysis

Introdução: A contribuição das obstetrizes e enfermeiras obstétricas é fundamental para a melhora na assistência à saúde da mulher, especialmente em relação às taxas de mortalidade materna, qualidade, disponibilidade e acessibilidade dos serviços de saúde e redução na quantidade de cesarianas. Daí a importância de conhecer como ocorre a formação desses profissionais. Objetivos: 1. Caracterizar os cursos de Obstetrícia de entrada direta e as instituições de ensino superior que os oferecem, nos países da América do Sul; 2. Analisar o projeto pedagógico dos cursos, especialmente sua estrutura curricular. Método: Estudo documental, descritivo-exploratório. Teve como referencial teórico o ensino por competências, apoiado pelos documentos sobre a educação e a prática profissional de obstetrizes publicados pela Confederação Internacional de Obstetrizes (ICM). Foram incluídos cursos de Obstetrícia de nível superior, de entrada direta, dos países da América do Sul, filiados à ICM em 2017. Cinco estruturas curriculares foram analisadas de acordo com uma matriz de conteúdos baseada no modelo de currículo da ICM. Para cada um deles, foi construída uma ficha com as características básicas do curso. Foi realizada análise quantitativa e qualitativa dos dados. Resultados: Foram localizados 75 cursos, distribuídos em sete países: Argentina (n=9), Brasil (n=1), Chile (n=20), Equador (n=1), Paraguai (n=6), Peru (n=36), Uruguai (n=1) e binacional Argentina e Uruguai (n=1). Entre outros dados, foi apurado que todos os cursos são oferecidos em universidades e exigem uma prova ou curso preparatório para ingresso. A carga horária dos cursos varia de 3.322 a 9.000 horas e a duração é de 8 a 12 semestres, sendo 10 semestres a mais frequente. Majoritariamente, denominam-se Curso de Obstetricia e outorgam o grau de licenciado e o título de Licenciado em Obstetrícia, Matrona/Matrón ou Obstetriz/Obstetra. É grande a heterogeneidade em relação à visão, missão e perfil do egresso. A análise das estruturas curriculares dos cursos mostrou que os conteúdos correspondem às recomendações da ICM, exceto para os módulos relacionados a habilidades básicas em saúde para parteiras, assuntos profissionais da Obstetrícia e atendimento obstétrico para mulheres que precisam se submeter a um aborto. Isto pode refletir um compromisso da educação de obstetrizes para a aquisição das competências essenciais estabelecidas pela ICM. Conclusões: São oferecidos 75 cursos nos sete países estudados e existem muitas diferenças em suas características, em particular, quanto à quantidade e distribuição geográfica dos cursos, duração, carga horária e perfil do egresso. Nas estruturas curriculares analisadas, identificou-se a quase totalidade dos conteúdos curriculares recomendado pela ICM. A principal lacuna nas ementas dos cursos se refere à competência para atenção às mulheres em situação de abortamento.

Introduction: The contribution of midwives and nurse-midwives is essential to achieve an improvement in women's health care, especially regarding quality, availability and accessibility of health services, reduction in the number of caesarean sections and maternal mortality rates. Hence the importance of knowing how the training of these professionals is currently taking place. Aim: 1. Characterise the direct entry Midwifery programmes and the higher education institutions that offer them, in South American countries; 2. Analyse the pedagogical project of the programmes, particularly its curricular structure. Method: Descriptive-exploratory, documentary study. The theoretical reference was based on competency education, supported by the documents of the International Confederation of Midwives (ICM) on education and professional practice of midwives. Were included undergraduate direct entry Midwifery programmes from the South American countries affiliated to the ICM in 2017. Five curricular structures were analysed according to a content matrix based on the ICM curriculum model. Quantitative and qualitative data analysis were performed. Results: 75 programmes were found, distributed in seven countries: Argentina (n = 9), Brazil (n = 1), Chile (n = 20), Ecuador (n = 1), Paraguay = 36), Uruguay (n = 1) and binational Argentina and Uruguay (n = 1). Among other data, it was found that all programmes are offered in universities and require a test or preparatory course for admission. The total number of hours of the programmes varies from 3,322 to 9,000 hours and the duration is 8 to 12 semesters, 10 semesters being the most frequent. They are mainly denominated Curso de Obstetricia and the majority grants the degree of licensee and title of Licenciado em Obstetricia, Matrona/Matrón or Obstetriz/Obstetra. There is great heterogeneity regarding the vision, mission and graduates profile. The analysis of the programmes curricular structures showed a correspondence between the programmes contents and the recommendations of the ICM, except for the modules related to basic health skills for midwives, professional midwifery subjects and obstetric care for women who need to undergo abortion. This may compromise midwifery education for the acquisition of the core competencies established by the ICM. Conclusions: 75 programmes are offered in the seven countries studied and there are many differences in their characteristics, in particular, the quantity and geographical distribution of the programmes, duration, number of hours and graduate profile. Almost all of the curricular contents recommended by the ICM were identified within the analysed curricular structures. The main gap in the programmes syllabuses refers to the competence to provide abortion-related care.

O conceito de federalismo e a idéia de interesse no Brasil do século XIX / The concept of federalism and the notion of interest in 19th century Brazil / Le concept de fédéralisme et l'idée d'intérêt dans le Brésil du XIXe siècle

This article analyzes the formation of the concept of Federalism in 19th century Brazilian political debate. We seek to understand the transition from the concept of Confederation to that of Federalism and the political values that came to be associated with the latter. Based on the methodology of Conceptual History formulated by Reinhart Koselleck, we focus on the continuities and breaks in the issue of decentralization. Analyzing 19th century newspapers and Parliamentary debates, we contend that the notion of Provincial interest is a key aspect for understanding the Federalist thinking formulated in the first half of the 19th century.

Dans cet article, on cherche à comprendre la formation du concept de fédéralisme dans le domaine politique brésilien du XIXe siècle. C'est-à-dire, le passage du concept de confédération vers celui de fédéralisme ainsi que les valeurs politiques qui y seront associés. Suivant la méthodologie de l'Histoire des Concepts proposée par Reinhart Koselleck, on a essayé d'observer les continuités et les discontinuités par rapport au sujet de la décentralisation. D'après l'analyse des journaux et des débats parlementaires de l'époque, on perçoit que l'idée d'intérêt provincial est un aspect fondamental pour comprendre la pensée fédéraliste diffusée pendant la première moitié du XIXe siècle.