COVID-19 in the Americas: the role of collaborating centers in understanding lessons and best practices in pandemic preparedness and response / COVID-19 en la Región de las Américas: papel de los centros colaboradores en la comprensión de las enseñanzas y mejores prácticas en la preparación y respuesta frente a pandemias / COVID-19 nas Américas: o papel dos centros colaboradores para entender as lições e melhores práticas de preparação e resposta a pandemias

ABSTRACT COVID-19 exposed major gaps in global, regional, state, and local responses to public health emergencies. In preparation for the WHA Special Session to consider the benefits of developing an international instrument on pandemic preparedness, the O'Neill Institute in partnership with Foundation for the National Institutes of Health convened 30 of the world's leading authorities on global health law, financing, biomedical science, implementation, and emergency response along with leaders from prominent international organizations. This meeting was followed by regional consultations convened in Latin America-Caribbean, Africa, and Southeast Asia. These high-level expert consultations generated in-depth discussions on weaknesses and persisting gaps in global pandemic preparedness and what a new international agreement might include to address them. Regional intergovernmental organizations like PAHO can work closely with related multilateral development banks to develop financial instruments that can smooth systemic economic disruption; and regional centers of research and manufacturing excellence can offer a strong front line for producing medicines and vaccines rapidly during a pandemic. With our research focused on the regional response to COVID-19 we are able to look at country responses individually and collectively to see how Latin America - Caribbean countries can capitalize and leverage their regional connections to strengthen their pandemic preparedness and response. By identifying existing gaps and examining the responses and approaches taken by PAHO, we can better understand the role of international and regional organizations and their collaborating centers in preparing and responding to pandemics.

RESUMEN La COVID-19 expuso grandes brechas en las respuestas locales, nacionales, regionales y mundiales a las emergencias de salud pública. En preparación para la reunión extraordinaria de la Asamblea Mundial de la Salud para considerar los beneficios de elaborar un instrumento internacional sobre la preparación frente a las pandemias, el Instituto O'Neill, en colaboración con la Fundación para los Institutos Nacionales de Salud, convocó a 30 de las principales autoridades mundiales en materia de derecho, financiamiento, ciencia biomédica, implementación y respuesta a emergencias de salud, así como a líderes de organizaciones internacionales prominentes. A esta reunión le siguieron consultas regionales convocadas en América Latina y el Caribe, África y el sudeste asiático. Estas consultas con expertos de alto nivel generaron debates en profundidad acerca de las debilidades y brechas persistentes en la preparación frente a las pandemias y qué podría incluirse en un nuevo acuerdo internacional sobre cómo abordarlas. Las organizaciones intergubernamentales regionales como la Organización Panamericana de la Salud pueden trabajar en estrecha colaboración con los bancos multilaterales de desarrollo relacionados para elaborar instrumentos financieros que puedan aliviar las perturbaciones económicas sistémicas; y los centros regionales de excelencia en investigación y producción pueden formar una sólida primera línea de acción para producir medicamentos y vacunas rápidamente durante una pandemia. Con esta investigación centrada en la respuesta regional a la COVID-19, podemos analizar las respuestas de los países de forma individual y colectiva para observar la manera en que América Latina y el Caribe pueden capitalizar y aprovechar sus conexiones regionales para fortalecer su preparación y respuesta frente a una pandemia. Al determinar cuáles son las brechas existentes y examinar las respuestas y los enfoques adoptados por la OPS, podemos comprender mejor el papel de las organizaciones regionales e internacionales y sus centros colaboradores en la preparación y respuesta frente a las pandemias.

RESUMO A COVID-19 expôs grandes lacunas nas respostas globais, regionais, estaduais e locais a emergências de saúde pública. Nos preparativos para a Sessão Especial da Assembleia Mundial da Saúde para avaliar os benefícios de desenvolver um instrumento internacional de preparação para pandemias, o Instituto O'Neill, em parceria com a Fundação para os Institutos Nacionais de Saúde, reuniu 30 das principais autoridades mundiais em direito sanitário global, financiamento, ciências biomédicas, implementação e resposta a emergências, além de líderes de organizações internacionais proeminentes. Essa reunião foi seguida por consultas regionais convocadas na América Latina/Caribe, na África e no sudeste da Ásia. Essas consultas com especialistas de alto nível geraram discussões minuciosas sobre os pontos fracos e as lacunas persistentes na preparação global para pandemias e o que poderia ser incluído em um novo acordo internacional para resolvê-los. Organizações intergovernamentais regionais, como a OPAS, podem trabalhar em estreita colaboração com os bancos multilaterais de desenvolvimento para desenvolver instrumentos financeiros capazes de atenuar a ruptura econômica sistêmica; por outro lado, centros regionais de excelência em pesquisa e fabricação podem oferecer uma linha de frente expressiva para a rápida produção de medicamentos e vacinas durante uma pandemia. Usando os dados da nossa pesquisa sobre a resposta regional à COVID-19, podemos analisar as respostas dos países de forma individual e coletiva para avaliar como os países da América Latina e do Caribe podem capitalizar e alavancar suas conexões regionais para fortalecer sua preparação e resposta à pandemia. Ao identificar lacunas existentes e analisar as respostas e abordagens adotadas pela OPAS, podemos compreender melhor o papel das organizações internacionais e regionais e de seus centros colaboradores na preparação e resposta a pandemias.

A proposal on Kuroko leadership: An element of Japan’s global health competency extracted from the experiences of international health cooperation / 国際保健医療

  In the increasingly globalized world, developing global health competency (GHC) education by determining the required core elements for undergraduates is on the rise. A growing number of people from different backgrounds have migrated to Japan. To accommodate their various healthcare needs, potential GHC elements that facilitate Japanese GHC education should be identified. This paper aims to extract some of the key GHC elements required for students in medical and healthcare fields based on the abundant experience of Japan’s international health cooperation and to make recommendations for GHC education in Japan and worldwide.  To date, Japan’s international health cooperation has cultivated a variety of competencies to realize its mission of reducing global health disparities. Japanese GHC elements are the bases of core concepts in healthcare and share commonalities with GHC elements in global communities: Cultural competency, “Go to the People”, respect for diversity, transdisciplinary collaboration, capacity building, independence, people/patient-centered healthcare, and empowerment.   Comprehensive preparation of these elements is found among kabuki kurokos (black robes), people dressed in all black who assist kabuki actors onstage during performances. The black worn by the kurokos means “nothingness”; they should be invisible on stage, so as not to interfere with the performance. Kurokos understand the culture (values, behaviors, etc.) of the lead actors, manage and coordinate stage proceedings to meet the actors’ needs, and help them achieve the best performance by collaborating with other backstage workers.   Kurokos’s empowering leadership competency is akin to the Western concept of servant-leadership, which emphasizes being a servant first and devoting oneself to enabling greater health and independence/autonomy among vulnerable people. Japanese educators can exemplify kuroko values by providing their students with GHC education. Japanese GHC elements can be integrated into worldwide GHC education. Spiritual care is also essential for inclusion in GHC education to develop students’ holistic care competency.

Gerenciamento tensionado: o sistema de vigilância em saúde e a resposta à pandemia da covid-19 no Brasil / Management in tension: the Brazilian public health surveillance system and its response to the covid-19 pandemic

Resumo O artigo aborda a resposta do governo brasileiro à pandemia da covid-19, enfatizando o sistema de vigilância em saúde e de inteligência epidemiológica. Retoma a evolução da vigilância em resposta às normas do Regulamento Sanitário Internacional, no contexto da saúde global. Analisa os atos do Executivo publicados no Diário Oficial da União e se detém nos atores e grupos formados para o enfrentamento da pandemia da covid-19 de janeiro de 2020 até março de 2022. Parte da premissa de que a inteligência epidemiológica deve estar a serviço da saúde pública. Constata-se que certo tensionamento burocrático e a transferência de protagonismo entre grupos marcam o desmonte dos mecanismos de inteligência.

Abstract This article addresses the Brazilian government's response to the covid-19 pandemic, particularly the public health surveillance and epidemic intelligence system. It traces the evolution of disease surveillance as a response to the International Health Regulations in the context of global health. Executive orders published in the official gazette, Diário Oficial da União, are analyzed, as well as the actors and groups formed to tackle the pandemic between January 2020 and March 2022. The founding assumption is that epidemic intelligence must be placed at the service of public health. Bureaucratic tension and changes in protagonism among different groups can be observed as these intelligence mechanisms were dismantled.

Covid-19 na América Latina: desigualdades e capacidades de resposta dos sistemas de saúde a emergências sanitárias / COVID-19 in Latin America: inequalities and response capacity of health systems to health emergencies / COVID-19 en América Latina: desigualdades y capacidad de respuesta de los sistemas de salud ante emergencias de salud

RESUMO Objetivo. Identificar correlações entre a covid-19, características demográficas e socioeconômicas e capacidade dos sistemas de saúde latino-americanos para resposta a emergências sanitárias. Método. Realizou-se um estudo ecológico, utilizando dados secundários de 20 países latino-americanos relativos a incidência, mortalidade, testagem e cobertura vacinal para covid-19 no período de 2020 a 2021, assim como informações demográficas e socioeconômicas. A preparação dos países para responder a emergências sanitárias foi explorada a partir do Relatório Anual de Autoavaliação dos Estados Partes da Organização Mundial da Saúde de 2019 sobre a implementação do Regulamento Sanitário Internacional (RSI). Realizaramse análises estatísticas por meio do teste de correlação de Spearman (rho). Resultados. Observou-se correlação positiva alta do produto interno bruto per capita e do índice de desenvolvimento humano com incidência de covid-19, testagem e cobertura vacinal; e entre proporção da população idosa e cobertura vacinal. Não foram identificadas correlações entre os indicadores da covid-19 e as capacidades prévias de implementação do RSI. Conclusões. A ausência de correlação entre indicadores relativos à covid-19 e a capacidade de implementação do RSI pode estar relacionada a limites dos indicadores utilizados ou da ferramenta de acompanhamento do RSI como instrumento indutor da preparação dos países para enfrentamento de emergências sanitárias. Os resultados sugerem a importância de condicionantes estruturais e a necessidade de estudos longitudinais, comparativos e qualitativos para compreender os fatores que influenciaram a resposta dos países à covid-19.

ABSTRACT Objective. To identify correlations between COVID-19, demographic and socioeconomic characteristics, and the capacity of Latin American health systems to respond to health emergencies. Method. An ecological study was performed using secondary data from 20 Latin American countries regarding incidence, mortality, testing and vaccination coverage for covid-19 from 2020 to 2021 as well as demographic and socioeconomic indicators. The preparedness of countries to respond to health emergencies was explored based on the 2019 State Party Self-Assessment Annual Report on the implementation of the International Health Regulations (IHR). Statistical analyses were performed using the Spearman correlation test (rho). Results. A high positive correlation was noted between gross domestic product per capita and the human development index with the incidence of COVID-19, testing, and vaccination coverage; and between the proportion of elderly population and vaccination coverage. No correlations were identified between the covid-19 indicators and previous IHR implementation capacities. Conclusions. The lack of correlation between indicators related to COVID-19 and the ability to implement the IHR may reflect limitations of the indicators used or of the IHR monitoring tool as an instrument that induces the preparedness of countries to face health emergencies. The results suggest the importance of structural conditioning factors and the need for longitudinal, comparative, and qualitative studies to understand the factors that influenced the response of countries to COVID-19.

RESUMEN Objetivo. Determinar las posibles correlaciones entre la COVID-19, las características demográficas y socioeconómicas, y la capacidad de los sistemas de salud latinoamericanos para responder a emergencias de salud. Método. Se realizó un estudio ecológico con datos secundarios de 20 países latinoamericanos sobre la incidencia, la mortalidad, las pruebas y la cobertura de vacunación relativas a la COVID-19 en el período 2020-2021, y con información demográfica y socioeconómica. Se exploró la preparación de los países para responder a emergencias de salud a partir del Informe Anual de Autoevaluación de los Estados Miembros de la Organización Mundial de la Salud del 2019 sobre la implementación del Reglamento Sanitario Internacional (RSI). Los análisis estadísticos se realizaron con la prueba de correlación (ro) de Spearman. Resultados. Se observó una alta correlación positiva del producto interno bruto per cápita y del índice de desarrollo humano con la incidencia, las pruebas y la cobertura de vacunación respecto a la COVID-19, así como de la proporción de personas mayores en la población con la cobertura de vacunación. No se observó ninguna correlación entre los indicadores de COVID-19 y la capacidad previa de implementación del RSI. Conclusiones. La falta de correlación entre los indicadores relativos a la COVID-19 y la capacidad de implementación del RSI puede deberse a limitaciones de los indicadores utilizados o del mecanismo de seguimiento del RSI como instrumento inductor de la preparación de los países para enfrentar emergencias de salud. Los resultados sugieren la importancia de los factores condicionantes estructurales y la necesidad de realizar estudios longitudinales, comparativos y cualitativos para determinar los factores que influyeron en la respuesta de los países a la COVID-19.

Atividades práticas no processo de formação em Fisioterapia no Brasil e em Portugal: olhar de docentes e gestores / Practical activities on physiotherapy degree courses in Brazil and Portugal through the lens of teachers and course coordinators / Actividades prácticas en el proceso de formación en Fisioterapia en Brasil y en Portugal: la mirada de docentes y gestores

O estudo se propôs a desvelar atividades práticas realizadas no processo de formação profissional em Fisioterapia em cursos de Graduação no Brasil e em Portugal. Estudo de casos múltiplos (Brasil e Portugal) e integrados (cursos de Fisioterapia), com oito gestores (coordenadores/diretores), quatro de cada país, e 12 professores, seis de cada país. Utilizou-se entrevista semiestruturada de gestores e grupo focal de professores, com análise de conteúdo temática. Os resultados apontam para cenários diversificados, evidenciando a existência de práticas nos três níveis de Atenção à Saúde. Outrossim, essas atividades desenvolvidas durante a formação, em ambos os países, assumem uma complexidade crescente, entretanto ocorrem, em maior número, nos níveis secundário e terciário, com predomínio do perfil reabilitador. Portanto, a elucidação dessas práticas pode fomentar aproximações para ações de internacionalização na graduação em dois países de língua portuguesa.(AU)

Abstract The aim of this study was to investigate practical activities on physiotherapy degree courses in Brazil and Portugal. We carried out an integrated (physiotherapy courses) multiple case (Brazil and Portugal) study with eight course coordinators/directors (four in each country) and 12 professors (six in each country). We conducted semi-structured interviews with the coordinators/directors and focus group meetings with the professors, the results of which were analyzed using thematic content analysis. The results point to different training scenarios with practices encompassing all three levels of health care. In both countries the findings reveal the increasing complexity of practices, focusing mainly on secondary and tertiary care and rehabilitation. The elucidation of these practices can therefore help promote the internationalization of degree courses in these two Portuguese-speaking countries.(AU)

Resumen El estudio se propone desvelar actividades prácticas realizadas en el proceso de formación profesional en Fisioterapia en cursos de graduación en Brasil y en Portugal. Estudio de casos múltiples (Brasil y Portugal) e integrados (cursos de Fisioterapia), con ocho gestores (coordinadores/directores), cuatro de cada país, y 12 profesores, seis de cada país. Se utilizó la entrevista semiestructurada para los gestores y el grupo focal para los profesores y el análisis se realizó por contenido temático. Los resultados señalan escenarios diversificados, poniendo en evidencia la existencia de prácticas en los tres niveles de atención de la salud. Por otro lado, esas actividades desarrolladas durante la formación en ambos países asumen una complejidad creciente; sin embargo, ocurren en mayor número en los niveles secundario y terciario con predominio del perfil rehabilitador. Por lo tanto, la aclaración de esas prácticas puede fomentar aproximaciones en dos países de lengua portuguesa para acciones de internacionalización en la graduación.(AU)

Points of entry dynamics: understanding the cross-border threats for Ebola virus disease and COVID-19 in Ghana using a logic model approach

Background. The influx of people across the national borders of Ghana has been of interest and concern in the public health and national security community in recent times due to the low capacity for the prevention and management of epidemics and other public health risks. Although the International Health Regulations (IHR) stipulate core public health capacities for designated border facilities such as international airports, seaports, and ground crossings, contextual factors that influence the attainment of effective public health measures and response capabilities remain understudied. Objective. To assess the relationship between contextual factors and COVID-19 procurement to help strengthen infrastructure resources for points of entry (PoE) public health surveillance functions, thereby eliminating gaps in the design, implementation, monitoring, and evaluation of pandemicrelated interventions in Ghana. Materials and Methods. This study employed a mixed-methods design, where quantitative variables were examined for relationships and effect size interactions using multiple linear regression techniques and the wild bootstrap technique. Country-level data was sourced from multiple publicly available sources using the social-ecological framework, logic model, and IHR capacity monitoring framework. The qualitative portion included triangulation with an expert panel to determine areas of convergence and divergence. Results. The most general findings were that laboratory capacity and KIA testing center positively predicted COVID-19 procurement, and public health response and airline boarding rule negatively predicted COVID-19 procurement. Conclusion. Contextual understanding of the COVID-19 pandemic and Ebola epidemic is vital for strengthening PoE mitigation measures and preventing disease importation.

The World Health Organizations changing goals and expectations concerning malaria, 1948-2019 / As mudanças nos objetivos e expectativas da Organização Mundial da Saúde com relação à malária, 1948-2019

Abstract From its inception, in 1948, the World Health Organization made control of malaria a high priority. Early successes led many to believe that eradication was possible, although there were serious doubts concerning the continent of Africa. As evidence mounted that eradicating malaria was not a simple matter, the malaria eradication programme was downgraded to a unit in 1980. Revived interest in malaria followed the Roll Back Malaria Initiative adopted in 1998. This article presents an historical account of the globally changing ideas on control and elimination of the disease and argues that insufficient attention was paid to strengthening health services and specialized human resources.

Resumo Desde sua origem, em 1948, a Organização Mundial da Saúde priorizou o controle da malária. Os primeiros êxitos induziram à crença na viabilidade da erradicação, apesar de sérias dúvidas quanto ao continente africano. À medida que se somavam comprovações de que a erradicação da malária não seria simples, o projeto com essa finalidade foi rebaixado a uma unidade em 1980. O reavivamento do interesse na malária ocorreu após a iniciativa Roll Back Malaria, criada em 1998. Este artigo apresenta um panorama histórico das mudanças nas ideias, em âmbito global, ligadas ao controle e à eliminação da doença e defende a tese de que a atenção dada ao fortalecimento dos serviços de saúde e a recursos humanos especializados foi insuficiente.

Regional cooperation and health diplomacy in Africa: from intra-colonial exchanges to multilateral health institutions / Cooperação regional e diplomacia sanitária na África: dos intercâmbios intracoloniais às instituições multilaterais de saúde

Abstract Tracing the pathways of cooperation in health in sub-Saharan Africa from hesitant exchanges to institutionalized dimensions from the 1920s to the early 1960s, this article addresses regional dynamics in health diplomacy which have so far been under-researched. The evolution thereof from early beginnings with the League of Nations Health Organization to the Commission for Technical Assistance South of the Sahara and the World Health Organization's Regional Office for Africa, shows how bilateral dimensions were superseded by WHO's multilateral model of regional cooperation in health. Alignments, divergences, and outcomes are explored with respect to the strategies and policies pursued by colonial powers and independent African states regarding inter-regional relations, and their implications for public health and epidemiological interventions.

Resumo Trilhando os caminhos da cooperação sanitária na África subsaariana, de intercâmbios incertos a dimensões institucionalizadas dos anos 1920 até início dos anos 1960, este artigo aborda a dinâmica regional na diplomacia sanitária que, até o momento, carece de pesquisas. A evolução, desde os primórdios da Organização da Saúde da Liga das Nações até a Cooperação Técnica na África Subsaariana e o Escritório Regional da África da OMS, demonstra como dimensões bilaterais foram substituídas pelo modelo multilateral da OMS de cooperação sanitária regional. São analisados alinhamentos, divergências e resultados de estratégias e políticas empregados por potências coloniais e Estados africanos independentes em relações inter-regionais, bem como suas implicações em intervenções epidemiológicas e de saúde pública.

Recomendaciones internacionales y debates locales en torno a la creación de la Escuela de Salud Pública de Buenos Aires, 1958 / International recommendations and local debates about the creation of the Escuela de Salud Pública in Buenos Aires, 1958

Resumen El artículo analiza las condiciones de emergencia de la Escuela de Salud Pública de la Universidad de Buenos Aires hacia fines de los años 1950. Ésta tuvo como objetivo ofrecer formación académica de posgrado a médicos y a otros profesionales en bioestadística, administración sanitaria, dirección de hospitales, epidemiología y ciencias sociales, en el marco de un "Diplomado en Salud Pública". Nuestro trabajo ubica el nacimiento de la institución en el contexto de las recomendaciones y debates que distintas agencias internacionales realizaron sobre la educación médica y la gestión de políticas sanitarias en América Latina. A través de publicaciones, actas de congresos e informes técnicos intentamos reconstruir dichas discusiones y sus ecos en la Argentina de los años 1950.

Abstract This article analyzes the conditions surrounding the emergence of the Escuela de Salud Pública at the Universidad de Buenos Aires in the late 1950s. It was designed to offer postgraduate academic training to doctors and professionals in biostatistics, health administration, hospital management, epidemiology and the social sciences within the framework of a "Diploma in Public Health." This study situates the birth of the institution in the context of the recommendations and debates within various international agencies on medical education and health policy management in Latin America. Examining publications, conference proceedings and technical reports, it seeks to reconstruct these discussions and their echoes throughout Argentina in the 1950s.

SARS-CoV-2 en América Latina y Caribe: Las tres encrucijadas para el pensamiento crítico en salud / SARS-CoV-2 in Latin America and the Caribbean: The three intersections for critical thinking in health

Resumen Pensar la pandemia de SARS-CoV-2 implica el estudio de dimensiones generales y singulares para el devenir histórico de América Latina y Caribe. De lo individual a lo colectivo, de las ciencias biomédicas a las ciencias sociales y la salud colectiva, de los grupos de riesgos a las sociedades excluyentes y las inequidades constitutivas de la herencia colonial, patriarcal, capitalista moderna en el Estado y las sociedades. El objetivo de este artículo es revisar lo que se denomina las tres encrucijadas para el pensamiento crítico latinoamericano en salud. Buscando analizar y reflexionar sobre los presupuestos y lógicas presentes en la respuesta a la emergencia sanitaria en referencia a: 1. La teoría crítica en salud y sus intersecciones con el pensamiento crítico latinoamericano; 2. las implicancias decoloniales de problematizar el Estado y los sistemas de salud pública, y 3. la geopolítica de la seguridad sanitaria global como hoja de ruta del Norte global. Se esbozan aproximaciones en los riesgos de aceleración del capitalismo del desastre post-pandemia y los caminos alternativos de abordaje de las tensiones creativas en la reconstrucción de procesos emancipatorios para la soberanía sanitaria regional y una Salud desde el Sur.

Abstract Thinking about the SARS-CoV-2 pandemic implies the study of general and unique dimensions for the historical evolution of Latin America and the Caribbean. From the individual to the collective, from biomedical sciences to social sciences and collective health, from risk groups to exclusive societies and the inequities constituting the colonial, patriarchal, modern capitalist heritage in the State and societies. The objective of this article is to review what are called the three intersections for Latin American critical health thinking. Seeking to analyze and reflect on the assumptions and logic present in the responses to the health emergency with reference to: 1. Critical health theory and its intersections with Latin American critical thinking; 2. The decolonial implications of problematizing the State and public health systems; and 3. The geopolitics of global health security as a roadmap for the global North. They outline approaches on the risks of capitalism's acceleration of the post-pandemic disaster and the alternative ways of addressing creative tensions in the reconstruction of emancipatory processes for regional health sovereignty and Health from the South.

Outbreak investigation in cargo ship in times of COVID-19 crisis, Port of Santos, Brazil / Investigação de surto em navio de carga em tempo de COVID-19, Porto de Santos, Brasil

ABSTRACT In February 2020, a Chinese cargo ship docked at the Port of Santos with reports of crew members with a feverish and respiratory condition. A team was gathered to verify the existence of suspected cases of COVID-19 inside the vessel and define its clearance. All 25 crew members were interviewed, and no suspected cases were found. The vessel was then cleared for port activities. The investigation resulted from the implementation of the contingency plan to face a public health emergency of international importance and several surveillance entities cooperated.

RESUMO Em fevereiro de 2020, um navio de carga vindo da China atracou no Porto de Santos com relato de tripulantes com quadro febril e respiratório. Uma equipe foi mobilizada para verificar a existência de casos suspeitos de COVID-19 dentro da embarcação e definir a liberação da embarcação no porto. Todos os 25 tripulantes foram entrevistados e não foram encontrados casos suspeitos. Então a embarcação foi liberada para atividades no porto. A investigação resultou da aplicação do plano de contingência diante de uma emergência de saúde pública de importância internacional e houve a colaboração de diversas entidades de vigilância.

Un enfoque bioeticista y de derechos frente a la pandemia / A bioethical and rights-based approach to the pandemic

Lay bioethics is an applied ethic that allows us to face the problems generated by the tension between science and the human being.The current pandemic caused by an unknown infectious agent has highlighted the need for the application of this applied ethic, not located on the laurels of the ethereal or purely intellectual, but rather based in day-to-day reality. Decision-making from all areas of health care requires this fundamental frame of reference; the application of correct precepts in epidemiological, sanitary decisions and political measures cannot and should not be done without this frame of reference; or the result will be catastrophic.

La Bioética laica es en principio una ética aplicada que permite afrontar los problemas generados por la tensión existente entre la ciencia y el ser humano. La actual pandemia causada por un agente infeccioso no conocido ha puesto de relieve la necesidad de la aplicación de esta ética aplicada, no ubicada en los laureles de lo etéreo o puramente intelectual sino más bien asentada en la realidad del día a día. La toma de decisiones desde todos los ámbitos del quehacer sanitario requiere este marco referencial fundamental; aplicación de correctos preceptos en las decisiones epidemiológicas, sanitarias y medidas políticas no puede ni debe hacerse sin este marco referencial; otrora el resultado será catastrófico.(AU)

Declaración de posición del Grupo de la Comisión Lancet de Hipertensión con respecto a la mejora mundial de las normas de exactitud para los dispositivos de medición de la presión arterial / Lancet Commission on Hypertension Group position statement on the global improvement of accuracy standards for devices that measure blood pressure / Posicionamento do Grupo da Lancet Commission on Hypertension sobre a melhoria global dos padrões de acurácia para aparelhos que medem a pressão arterial

Objetivos. El boletín de notas de México correspondiente al 2018 evalúa las oportunidades a disposición de la población infantil y joven mexicana para que puedan desarrollar niveles adecuados de actividad física y sueño, y disminuyan el sedentarismo.Métodos. El boletín es un sistema de vigilancia que recopila los datos obtenidos en las encuestas nacionales, censos, documentos gubernamentales, sitios web, literatura gris y estudios publicados con respecto al análisis de 16 indicadores en 4 categorías: comportamientos diarios, estado físico, entornos y fuentes influyentes, y estrategias e inversión. Los datos fueron cotejados con los puntos de referencia establecidos. A cada indicador se le asignó una calificación entre 1 y 10 (< 6 significa reprobado) o fue marcado como "incompleto" si los datos eran nulos o insuficientes. Resultados. Las calificaciones obtenidas para los comportamientos diarios fueron: actividad física en general: 4; participación en actividades deportivas organizadas: 5; juego activo: 3; modalidades de transporte activas: 5; sueño: 7; y sedentarismo: 3. El estado físico obtuvo un 7. Las calificaciones para los entornos y fuentes influyentes fueron: familiares y pares: "incompleto"; escuela: 3; comunidad y entorno: 4. Para las estrategias e inversión: estrategias gubernamentales: 6; entidades no gubernamentales: 2.Conclusiones. Las bajas calificaciones obtenidas en 11 de los 16 indicadores demuestran que las escuelas, las familias, las comunidades y el gobierno tienen que aunar esfuerzos para mejorar las oportunidades que tiene la población infantil y joven en México para desarrollar niveles de actividad física satisfactorios.(AU)

ABSTRACT The Lancet Commission on Hypertension identified that a key action to address the worldwide burden of high blood pressure (BP) was to improve the quality of BP measurements by using BP devices that have been validated for accuracy. Currently, there are over 3 000 commercially available BP devices, but many do not have published data on accuracy testing according to established scientific standards. This problem is enabled through weak or absent regulations that allow clearance of devices for commercial use without formal validation. In addition, new BP technologies have emerged (e.g. cuffless sensors) for which there is no scientific consensus regarding BP measurement accuracy standards. Altogether, these issues contribute to the widespread availability of clinic and home BP devices with limited or uncertain accuracy, leading to inappropriate hypertension diagnosis, management and drug treatment on a global scale. The most significant problems relating to the accuracy of BP devices can be resolved by the regulatory requirement for mandatory independent validation of BP devices according to the universally-accepted International Organization for Standardization Standard. This is a primary recommendation for which there is an urgent international need. Other key recommendations are development of validation standards specifically for new BP technologies and online lists of accurate devices that are accessible to consumers and health professionals. Recommendations are aligned with WHO policies on medical devices and universal healthcare. Adherence to recommendations would increase the global availability of accurate BP devices and result in better diagnosis and treatment of hypertension, thus decreasing the worldwide burden from high BP.(AU)

RESUMO A Comissão Lancet sobre Hipertensão Arterial identificou que uma iniciativa central para enfrentar a carga mundial da hipertensão arterial seria a melhoria na qualidade da mensuração da pressão arterial pelo uso aparelhos de pressão arterial validados quanto à acurácia. Atualmente, existem mais de 3 000 aparelhos de pressão arterial disponíveis comercialmente; entretanto, muitos não têm dados publicados sobre testes de acurácia realizados de acordo com padrões científicos estabelecidos. Este problema resulta de regulamentação fraca ou inexistente, o que permite a aprovação para uso comercial de dispositivos sem validação formal. Além disso, surgiram novas tecnologias de mensuração da pressão arterial (por exemplo, sensores sem algemas) sem consenso científico quanto aos padrões de acurácia. No conjunto, essas questões contribuem para a oferta generalizada de dispositivos de pressão arterial clínica e domiciliar com acurácia limitada ou incerta, levando a diagnóstico, gerenciamento e tratamento inadequados da hipertensão em escala global. Os problemas mais significativos relacionados com a acurácia dos dispositivos de pressão arterial podem ser resolvidos por regulamentação que imponha a obrigatoriedade de validação independente dos aparelhos de pressão arterial, de acordo com a norma universalmente aceita pela Organização Internacional de Normalização. Esta é uma recomendação fundamental para a qual existe uma necessidade internacional urgente. Outras recomendações essenciais incluem o desenvolvimento de padrões de validação especificamente para novas tecnologias de mensuração da pressão arterial e listas on-line de aparelhos com acurácia adequada que sejam acessíveis aos consumidores e profissionais de saúde. As recomendações estão alinhadas com as políticas da Organização Mundial da Saúde (OMS) sobre dispositivos médicos e atenção universal à saúde. A adesão às recomendações aumentaria a oferta global de dispositivos de pressão arterial com acurácia adequada e resultaria em melhor diagnóstico e tratamento da hipertensão arterial, diminuindo assim a carga mundial dessa doença.(AU)

A formação inicial de Antônio Luis Cavalcanti de Albuquerque de Barros Barreto: uma trajetória rumo à saúde internacional / The early training of Antônio Luis Cavalcanti de Albuquerque de Barros Barreto: an itinerary to the international health

Resumo Analisa a formação do médico Antônio Luis Cavalcanti de Albuquerque de Barros Barreto, com passagens pela Faculdade de Medicina do Rio de Janeiro e pelo Instituto Oswaldo Cruz, bem como sua atuação na divulgação do projeto da Fundação Rockefeller no Brasil. A partir de testamento, relatos orais, tese de doutoramento e notícias de jornais, é possível compreender as especificidades da turma de 1913 do Curso de Aplicação do Instituto Oswaldo Cruz e como seus estudantes estiveram articulados em ações relativas ao projeto de saúde internacional. O texto evidencia que a defesa dos acordos com a Fundação Rockefeller podia causar controvérsias, negociações e concessões em estados onde ela ainda não havia penetrado, como ocorreu em Pernambuco.

Abstract The article analyzes the education and training of the physician Antônio Luis Cavalcanti de Albuquerque de Barros Barreto, who studied at both the Rio de Janeiro Faculty of Medicine and Oswaldo Cruz Institute and who promoted the Rockefeller Foundation's project in Brazil. An examination of a will, oral accounts, Barros Barreto's medical thesis, and newspaper reports reveals characteristics of the class of 1913 at the Oswaldo Cruz Institute Specialization Program and shows how these students engaged in the foundation's international health initiatives. The text demonstrates how the idea of partnering with the foundation fueled controversies, impelled negotiations, and led to concessions in states where the foundation had yet to establish its presence, as in Pernambuco.

Debate teórico sobre salud pública y salud internacional / Theoretical debate on public health and international health

Se presentan teorías, tesis y programas de salud pública de alcance internacional. Se toma 1851 como el año inicial del debate internacional sobre salud, con la Primera Conferencia Sanitaria Internacional efectuada en París. Se enfatiza la importancia de tomar en cuenta el cambiante contexto histórico (1851-2017) en que se estudia el tema. Se discute la diversa nomenclatura en torno a salud internacional, y por lo extenso del asunto, solo se comentan la fragmentación institucional de entidades que intervienen en el asunto, lo concerniente a los programas verticales, sus propósitos, la realidad de Salud para Todos y la Atención Primaria de Salud y la estrategia de acceso y cobertura universal de los servicios de salud, con énfasis en América Latina y Cuba(AU)

This article addresses public health theories, thesis and programs of international scope. As starting year of the international debate on health is taken 1851, when the First International Sanitary Conference was held in Paris. It is emphasized the importance of taking into account the changing over time historical context in which the issue is studied (1851-2017). It is discussed the diverse nomenclature used related to international health, and due to the vastness of this issue, in the article is only commented the institutional fragmentation of the entities involved, the vertical programs, its purposes, the reality of the terms Health for All and Primary Health Care, and the strategy of the health access and universal coverage of health services, with emphasis in Latin America and Cuba(AU)

Curriculum to Learn Social Determinants of Health at Mie University Faculty of Medicine / 医学教育

Health disparity is an emerging issue in our society. It occurs in connection with an aging population, uneven distribution of health sectors or the collapse of medical care systems in rural communities. Accordingly, future health professionals should learn more about social determinants of health (SDH). Mie University Faculty of Medicine has conducted international health electives in Asian and African countries and education about community-based health profession all over the Mie prefecture. Moreover, a lecture entitled “Global Health and Community Medicine” was launched based on the concept that both topics share common aspects of SDH.　In this article, I will report educational programs at Mie University, that provide medical students with opportunities to learn SDH.

The use of circulating cathodic antigen rapid test and serology for diagnosis of active Schistosoma mansoni infection in migrants in Italy, a non-endemic country: a cross sectional study

ABSTRACT Diagnosis of schistosomiasis in migrants coming from endemic areas can be difficult, especially in asymptomatic subjects. Light-intensity disease, in fact, may be missed due to the low sensitivity of the stool microscopy and serologic testing cannot distinguish between a resolved infection and an active infection in patients who have been infected and treated in the past, because specific antibodies can persist despite cure. We describe a cross-sectional study conducted on 82 migrants tested for Schistosoma mansoni on single blood (anti-schistosome antibodies, total IgE) and urine [point-of-care (POC) circulating-cathodic-antigen (CCA) test] samples. A positive POC-CCA test (active infection) resulted in two untreated patients with a positive serology while all patients (n = 66) with a past infection showed a negative POC-CCA test. POC-CCA urine test in combination with serology may be helpful in rapidly differentiate active from past S. mansoni infection in migrants coming from endemic areas.

O Congresso Nacional e as emergências de saúde pública / The Brazilian National Congress and public health emergencies

Resumo Analisou-se a resposta do Legislativo Federal Brasileiro frente a quatro emergências de saúde pública recentes, por meio de análise documental de caráter qualiquantitativo, nos bancos de dados de informação legislativa do Congresso Nacional. Observou-se que a resposta se caracterizou por pronunciamentos (de denúncia, de pedidos de providência, de críticas e de elogios à atuação do Poder Executivo) e pela fiscalização dessa atuação por meio de requerimentos de informação, de convocação de autoridades e de audiências públicas. A produção legislativa, no entanto, foi inexpressiva, restrita à aprovação de proposições de suplementação de recursos orçamentários de iniciativa do Poder Executivo. Poucos projetos de lei de iniciativa de parlamentares trataram matérias periféricas ao problema e não prosperaram. Conclui-se que a insuficiência normativa para a atuação das autoridades sanitárias no enfrentamento de emergências de saúde pública não tem sido suprida pelo Poder Legislativo e terá de sê-lo, provavelmente, por iniciativa do Executivo.

Abstract The response of the Brazilian Legislative Branch to four recent public health emergencies is analyzed through quali-quantitative documentary held in legislative information databases of the National Congress. It was observed that this response was characterized by public statements (of denunciation, requests for action, criticism and praise to the actions of the Executive Branch) and by the overseeing of these activities through information requests, convening authorities and public hearings. The lawmaking, however, was negligible, restricted to the approval of propositions for supplemental budget resources from the Executive Branch initiative. Few bills of parliamentary initiative approached the problem and were approved. We conclude that the inefficient actuation of health authorities in coping with public health emergencies is caused by the neglect of the Legislative Branch, so the Executive Branch should probably overcome the problem.

Strengthening the communicable disease surveillance and response system, Amhara Region, Ethiopia, 2012-2014: Review of a technical cooperation project / 国際保健医療

<p><b>Objectives</b></p><p>  The International Health Regulations (2005) bound the member states of the World Health Organization (WHO) to initiate epidemiological investigations of disease outbreaks and to notify WHO within 24 hours of their detection if the event is deemed to constitute public health emergency of international concern. The Japan International Cooperation Agency started the Amhara Regional Infectious Disease Surveillance Project to strengthen the surveillance and response system in the Amhara Region of Ethiopia in 2008. The objectives of the study were to review the project activities and to share the experiences and lessons learned in 22 districts of the North and South Gondar and West Gojjam Zones from mid-2012 through 2014.</p><p><b>Methods</b></p><p>  We conducted training for district surveillance officers and focal point personnel at health centres (HCs), monitoring visits to district health offices and HCs, held review meetings on surveillance, and provided technical assistance in outbreak investigations. We evaluated the project activities in terms of the timeliness of the surveillance reports submitted by the health facilities, provision of technical assistance in outbreak investigations, and the number of training sessions held for the surveillance personnel.</p><p><b>Results</b></p><p>  The timeliness of submission of surveillance reports had improved to almost 100% at end of 2014 compared with before the review period (about 68%). From the third quarter of 2013, we conducted monitoring visits to 59 HCs every semester. We were involved in 11 outbreak investigations of measles, anthrax, pertussis, neonatal tetanus, and typhoid fever. We held a total of 25 training sessions for district surveillance officers and HC focal points.</p><p><b>Conclusion</b></p><p>  The project successfully strengthened the surveillance and response system. We recommend that the Amhara Regional Health Bureau maintain its commitment to the system in terms of human resources and funding. Training for surveillance officers and focal points should be conducted periodically.</p>

Emerging power for international health development assistance: A case study of the BRIC countries / 中国卫生政策研究

Brazil, Russia, India, China and South Africa are the five BRIC countries which have showed a rapid growth in economic development in recent years especially in international health assistance area, which has gradually become a force that cannot be ignored. This article compares and analyzes the current status and character-istics of the BRIC countries in the field of international health assistance and compares them with the Countries of the Economic Cooperation and Development Organization's Development Assistance Committee ( ECDO-DAC) . It will also summarize the new features, advantages and disadvantages of the health development assistance exerted by the BRICS countries;and ultimately provide suggestions for the future international health development aid policy of China.