Práticas Avançadas de Enfermagem ­ PAE / Advanced Nursing Practices ­ ANP

Trata de nota técnica sobre Práticas Avançadas de Enfermagem (PAE) no Brasil, elaborada por comissão e submetida à aprovação do plenário do Conselho Federal de Enfermagem (Cofen). O documento aborda conceitos, ações, implementação e regulação das práticas avançadas de Enfermagem, expandindo os limites do escopo da atuação do enfermeiro e reforçando a sua prática clínica. (AU)

This is a technical note on Advanced Nursing Practices (ANP) in Brazil, prepared by a committee and submitted for approval by the plenary of the Federal Nursing Council (Cofen). The document addresses concepts, actions, implementation and regulation of advanced nursing practices, expanding the limits of the scope of nurses' work and reinforcing their clinical practice. (AU)

Esta es una nota técnica sobre las Prácticas Avanzadas de Enfermería (PAE) en Brasil, elaborada por un comité y sometida a la aprobación del plenario del Consejo Federal de Enfermería (Cofen). El documento aborda los conceptos, acciones, implementación y reglamentación de las prácticas avanzadas de enfermería, ampliando los límites del ámbito de actuación de las enfermeras y reforzando su práctica clínica. (AU)

Expanding Global Surgery Education in Brazil: Perspectives after the 35th Brazilian Surgical Congress / Expandindo o Ensino de Cirurgia Global no Brasil: Perspectivas após o 35º Congresso Brasileiro de Cirurgia

ABSTRACT The 35th Brazilian Congress of Surgery marked a turning point for surgical education in the country. For the first time, the Brazilian College of Surgeons included Global Surgery on the main congressional agenda, providing a unique opportunity to rethink how surgical skills are taught from a public health perspective. This discussion prompts us to consider why and how Global Surgery education should be expanded in Brazil. Although Brazilian researchers and institutions have contributed to the fields expansion since 2015, Global Surgery education initiatives are still incipient in our country. Relying on successful strategies can be a starting point to promote the area among national surgical practitioners. In this editorial, we discuss potential strategies to expand Global Surgery education opportunities and propose a series of recommendations at the national level.

RESUMO O 35º Congresso Brasileiro de Cirurgia foi marcado por discussões inovadoras para a educação cirúrgica no país. Pela primeira vez, o Colégio Brasileiro de Cirurgiões incluiu a Cirurgia Global na pauta principal do congresso, proporcionando uma oportunidade única de repensar como as habilidades cirúrgicas são ensinadas a partir de uma perspectiva de saúde pública. Essa discussão nos leva a considerar por que e como o ensino da Cirurgia Global deve ser expandido no Brasil. Embora pesquisadores e instituições brasileiras tenham contribuído para a expansão do campo desde 2015, as iniciativas de educação em Cirurgia Global ainda são incipientes em nosso país. Basear-se em estratégias bem-sucedidas pode ser um ponto de partida para promover a área entre os profissionais de cirurgia nacionais. Neste editorial, discutimos potenciais estratégias para expandir as oportunidades de educação em Cirurgia Global e propomos uma série de recomendações a nível nacional.

Health profile and training habits of 42k marathoners, temuco chile / Perfil de salud y hábitos de entrenamiento de maratonistas 42k, temuco chile / Perfil de saúde e hábitos de treinamento de maratonistas de 42k, temuco chile

ABSTRACT Context: participation of runners in marathons increases each year, making them an attractive population to investigate. In Chile, the characteristics of marathoners in decentralized and emerging races, such as the Temuco Araucanía International Marathon (MITA), are not yet known. Objective: to describe health profile, sociodemographic characteristics, and training habits of the 42K runners enrolled in MITA during the years 2017, 2018 and 2019. Methods: Non-probabilistic convenience sample composed of people over 18 years of age, who signed informed consent. The data were obtained through a survey prepared by the authors, and were analyzed with the statistical program Stata 16.0 to describe the group based on the variables of health profile, sociodemographic characteristics and training habits. Results: 135 adult marathoners were included (n=42-2017, n=45-2018, n=48-2019). The mean age was 39.5±9.1 years and 86.6% were men. Fifteen percent self-reported comorbidities, 96.7% were non-smokers, 80% were normal weight, 65% had a high educational level and 87% were workers. Regarding training habits, it is noteworthy that the frequency was 4.9±1 days per week, with a mean duration of 89±1 minutes per session. Finally, 71.9% of the sample reported doing high intensity training. Conclusions: the MITA 42K runners are generally healthy subjects, nonsmokers and without comorbidities; mostly men, normal weight, middle age, with a high educational level and workers. They present a high frequency of weekly training, with an average duration of 90 minutes per session, this being carried out at high intensity by almost 2/3 of the sample. Knowledge of the health profile and training habits of runners is a first step to responsibly generate guidelines that contribute to strengthening the safe practice of this sport. Level of Evidence IV; Descriptive and Cross-Sectional Study.

RESUMEN Introducción: la participación de corredores en maratones aumenta cada año, convirtiéndolos en una población atractiva de investigar. En Chile, aún no se conocen las características de maratonistas de carreras descentralizadas y emergentes, como la Maratón Internacional Temuco Araucanía (MITA). Objetivo: describir el perfil de salud, las características sociodemográficas y los hábitos de entrenamiento de los corredores de 42K, inscriptos en MITA durante los años 2017, 2018 y 2019. Métodos: Muestra no probabilística por conveniencia mayores de 18 años, que firmaron el término de consentimiento informado. Los datos fueron obtenidos a través de la aplicación de una encuesta de elaboración original, analizados con programa estadístico Stata 16.0 para describir al grupo en función de las variables perfil de salud, sociodemográficas y hábitos de entrenamiento. Resultados: Se incluyeron 135 adultos maratonistas (n=42-2017, n=45-2018, n= 48-2019) La edad promedio fue de 39,5±9,1 años y 86,6% fueron hombres. El 15% auto reportó comorbilidades, 96,7% eran no fumadores; 80% eran normopeso, con un 65% de participantes con nivel educacional alto y 87% trabajadores. En cuanto a los hábitos de entrenamiento, se destaca que la frecuencia es de 4,9±1 días por semana, con una duración media de 89±1 minutos por sesión y finalmente, el 71,9% de la muestra reporta realizar entrenamiento de alta intensidad. Conclusiones: los corredores 42K del MITA son en general sujetos sanos, no fumadores y sin comorbilidades; en su mayoría hombres, normopeso, de edad media, con un nivel educacional alto y trabajadores. Presentan una alta frecuencia de entrenamiento semanal, con una duración promedio de 1:30 minutos por sesión, siendo realizada a alta intensidad casi 2/3 de la muestra. El conocimiento del perfil de salud y hábitos de entrenamiento de los corredores, constituye un primer paso para generar, de forma responsable, lineamientos que contribuyan a fortalecer la práctica segura de este deporte. Nivel de Evidencia IV; Estudio Descriptivo y Transversal.

RESUMO Introdução: a participação de corredores em maratonas aumenta a cada ano, tornando-os uma população atrativa para investigação. No Chile, ainda não são conhecidas as características dos maratonistas em corridas descentralizadas e emergentes, como a Maratona Internacional Temuco Araucanía (MITA). Objetivo: descrever o perfil de saúde, características sociodemográficas e hábitos de treinamento dos corredores de 42K inscritos no MITA durante os anos de 2017, 2018 e 2019. Métodos: Amostra não probabilística de conveniência composta por pessoas maiores de 18 anos, que assinaram o termo de consentimento livre e esclarecido. Os dados foram obtidos por meio de um questionário elaborado pelos autores e foram analisados com o programa estatístico Stata 16.0 para descrever o grupo com base nas variáveis de perfil de saúde, características sociodemográficas e hábitos de treinamento. Resultados: foram incluídos 135 maratonistas adultos (n=42-2017, n=45-2018, n=48-2019). A média de idade foi de 39,5±9,1 anos e 86,6% eram homens. Comorbidades autorreferidas 15%, 96,7% não fumantes, 80% eutróficos, 65% com alta escolaridade e 87% trabalhadores. Em relação aos hábitos de treino, destaca-se que a frequência foi de 4,9±1 dias por semana, com duração média de 89±1 minutos por sessão. Por fim, 71,9% da amostra relatou fazer treinamento de alta intensidade. Conclusões: os corredores do MITA 42K são indivíduos geralmente saudáveis, não fumantes e sem comorbidades; em sua maioria homens, eutróficos, de meia idade, com alto nível educacional e trabalhadores. Apresentam uma elevada frequência de treino semanal, com duração média de 90 minutos por sessão, sendo este realizado em alta intensidade por quase 2/3 da amostra. O conhecimento do perfil de saúde e hábitos de treino dos corredores é um primeiro passo para gerar com responsabilidade orientações que contribuam para o fortalecimento da prática segura deste esporte. Nível de Evidência IV; Estudo Descritivo e Transversal.

Cursos en línea abiertos y masivos: oportunidad de aprendizaje sobre salud global en Latinoamérica / Massive open online courses: learning opportunities about global health for Latin American countries

Introducción. Los cursos en línea, masivos y abiertos, brindan la oportunidad de formar profesionales e investigadores en Latinoamérica sobre salud global. Objetivos. Determinar la oferta global de los cursos en línea, masivos y abiertos, sobre salud global y conocer las características de su contenido. Materiales y métodos. Se examinaron las plataformas especializadas en cursos en línea, masivos y abiertos, para recopilar aquellos sobre salud global. La búsqueda no tuvo restricción de tiempo y se realizó por última vez en noviembre de 2021. La estrategia de búsqueda solo incluyó el descriptor "global health". Posteriormente, se obtuvieron las características del curso, su contenido y el dominio abordado de salud global. Estos datos fueron analizados descriptivamente, y se reportaron frecuencias absolutas y relativas. Resultados. La estrategia de búsqueda identificó 4.724 cursos en línea, masivos y abiertos. De ellos, solo 92 estaban relacionados con salud global. La mayoría de estos cursos (n=44; 47,8 %) se ofrecieron mediante la plataforma Coursera. Más de la mitad de los cursos (n=50; 54,4 %) fueron realizados por instituciones de Estados Unidos y en idioma inglés (n=90; 97,8 %). La mayor parte de los cursos se centró en la "globalización de la salud y la asistencia sanitaria" (n=24; 26,1 %), seguido de los dominios "fortalecimiento de capacidades" (n=16; 17,4 %), "carga global de enfermedad" y "determinantes sociales y ambientales de la salud" (n=15; 16,3 %). Conclusiones. Se encontró una importante oferta de cursos en línea, masivos y abiertos, sobre salud global. Estos cursos abordaron las competencias de la salud global que se requieren para los profesionales sanitarios.

Introduction. Massive open online courses provide the opportunity to train health professionals and researchers from Latin America in global health. Objective. To determine the global offer of massive open online courses in global health and the characteristics of their content. Material and methods. We examined massive open online course platforms to compile the global health offerings. The search had no time restriction and was last conducted in November, 2021. The search strategy only included the descriptor "global health". We obtained the characteristics of the courses, their content, and the global health domain covered. These data were analyzed using descriptive statistics, reporting absolute and relative frequencies. Results. Our search strategy identified 4,724 massive open online courses. Of these, only 92 were related to global health. Most of these courses (n=44; 47.8%) were offered through Coursera. More than half (n=50; 54.4%) of the MOOCs were conducted by U.S.A. institutions and in English language (n=90; 97.8%). Most courses focused on "globalization of health and healthcare" (n=24; 26.1%), followed by the domains "capacity building" (n=16; 17.4%), "global burden of disease" and "social and environmental determinants of health" (n=15; 16.3%). Conclusions. We found a high offer of massive open online courses on global health. These courses covered the global health competencies required for health professionals.

The “Dravidian model”: egalitarianism and healthcare reform

Throughout the post-independence period, the state of Tamil Nadu has consistently performed better than most other states in several major healthcare indicators, including infant mortality rate and total fertility rate. At the same time, it has received praise for the deep penetration and robust functioning of its public health system. Tamil Nadu’s achievements in healthcare have been analysed in a number of scholarly studies in the past, and a recent book by Kalaiyarasan A and Vijayabaskar M, titled “The Dravidian Model: Interpreting the Political Economy of Tamil Nadu,” is the latest addition to this literature. The authors argue that the state’s uniqueness in human and social development primarily originates in the egalitarian politics and radical social movements of the early twentieth century which constituted a “Dravidian common-sense” that has since “shaped the development trajectory of the state.” Their arguments on the significance of egalitarian politics in improvements in health and wellbeing receive ample support from existing social sciences literature on health, equity, and justice.

Role of Nurse Leadership to Evaluate the Current Status of Nurses with a View to Invest in Nursing to Secure Global Health An Exploratory Approach

There is an opportunity for nurses to better explain what we do, to break the myths around nursing and to advocate for investment in the profession. This study endeavoured to explore the role of nurse leadership to invest in nursing to secure global health and to identify role of nurse leaders according to their demographic variables. An exploratory sequential mixed method re- search design was selected in this study. Through purposeful sampling, the researcher selected 60 nurse administrators. Data was collected from the nurse administrators in the form of an electronic survey and virtual face-to- face semi structured interview method after obtaining a formal permission. The data collected from them was utilised only for the purpose of the study and was kept confidential. The final analysis summarised the findings that emerged from both quantitative and qualitative data. In the present study there were 50 (83.3%) females and 10 males (16.7 %) and them had nurse administrators 52(86.6%) of experience. The results covered the issues like current status of nurses, ways and benefits to invest in nursing for global health and the role of nurse leaders in investing in nursing for global Health. Nurses are the head honchos and lifeline of health-care organisations but still lack recognition. Concern on this has been expressed by many, but till date no strong visible implementation of laws and policies are seen. Nurses need to take initiation and leadership at higher levels to bring change in the existing scenario and implement the recommendations regarding basic pay and maximum working hours per week..

Condições de saúde autorrelatadas por solicitantes de refúgio no Rio de Janeiro, Brasil, de 2010 a 2017 / Asylum seekers' self-reported health conditions in Rio de Janeiro, Brazil, from 2010 to 2017 / Condiciones de salud autoinformadas por solicitantes de refugio en Río de Janeiro, Brasil, del 2010 al 2017

No Brasil, entre 2011 e 2022, 348.067 pessoas solicitaram o reconhecimento da condição de refugiado no país. Os motivos que resultaram na migração, os riscos durante o trajeto e a transição cultural ao chegar podem estar associados a diferentes problemas de saúde. O objetivo deste estudo foi analisar as condições de saúde autorrelatadas por solicitantes de refúgio no Município do Rio de Janeiro no período de 2010 a 2017. Trata-se de um estudo transversal de dados secundários. Foram coletadas informações preenchidas nos formulários de solicitação de refúgio do Comitê Nacional para os Refugiados (Conare) de 2010 a 2017 e da entrevista social da Cáritas Arquidiocesana do Rio de Janeiro (Cáritas/RJ). Calcularam-se as taxas de prevalência de condições de saúde e respectivos intervalos de 95% de confiança (IC95%) e a razão de chances (RC) e IC95% em um modelo de regressão logística simples segundo variáveis sociodemográficas e de migração. O estudo incluiu 1.509 indivíduos. Na chegada ao Brasil, 620 (41%) relataram ter uma ou mais condições de saúde. As chances de apresentar problemas de saúde foram maiores em pessoas oriundas do Congo (RC = 18,7) e República Democrática do Congo (RC = 9,5), nos indocumentados (RC = 4,4), nas mulheres (RC = 2,1), em pessoas com Ensino Fundamental (RC = 1,9), com idade ≥ 45 anos (RC = 1,8) e entre os que vivem/viveram maritalmente (RC = 1,8 e 2,5, respectivamente). Entre as pessoas que relataram alguma condição de saúde, mais da metade informaram sentir dores (52%). É possível que as dores físicas tenham relação com estresse pós-traumático e outros sofrimentos em saúde mental, que podem se manifestar por meio de sintomas de dores somáticas.

From 2011 to 2022, 348,067 people applied for a refugee status in Brazil. The reasons that resulted in their migration, the risks during their journey, and the cultural transition upon arrival may be associated with different health problems. This study aimed to analyze the self-reported health conditions of asylum seekers in the municipality of Rio de Janeiro from 2010 to 2017. This is a cross-sectional study with secondary data. Data were collected from asylum application forms at the Brazilian National Committee for Refugees (Conare) from 2010 to 2017 and from social interviews in the Archdiocesan Caritas of Rio de Janeiro (Cáritas/RJ). The prevalence rates of health conditions, their respective 95% confidence intervals (95%CI) and odds ratio (OR) were calculated in a simple logistic regression model according to sociodemographic and migration variables. This study included 1,509 individuals. Upon arrival in Brazil, 620 (41%) reported having one or more health conditions. The chances of showing health problems were higher in people from the Congo (OR = 18.7) and the Democratic Republic of the Congo (OR = 9.5), in undocumented individuals (OR = 4.4), women (OR = 2.1), in people with elementary education (OR = 1.9), aged ≥ 45 years (OR = 1.8), and among those who live/lived maritally (OR = 1.8 and 2.5, respectively). Of those who reported a health condition, more than half claimed experiencing pain (52%). Physical pain may be related to post-traumatic stress and other mental health distress, manifesting itself by somatic pain symptoms.

En Brasil, entre el 2011 y el 2022, 348.067 personas solicitaron el reconocimiento de la condición de refugiado en el país. Los motivos que dieron lugar a la migración, los riesgos durante el trayecto y la transición cultural al llegar pueden estar asociados a diferentes problemas de salud. Este estudio tuvo como objetivo analizar las condiciones de salud autoinformadas de los solicitantes de refugio en el municipio de Río de Janeiro en el período del 2010 al 2017. Se trata de un estudio transversal de datos secundarios. Los datos se recopilaron de los formularios de solicitud de asilo del Comité Nacional para Refugiados de Brasil (Conare) del 2010 al 2017 y de la entrevista social de Caritas Arquidiocesana de Río de Janeiro (Cáritas/RJ). Se calcularon las tasas de prevalencia de las condiciones de salud y sus respectivos intervalos de 95% de confianza (IC95%) y la razón de posibilidades (RP) y el IC95% en un modelo de regresión logística simple según variables sociodemográficas y de migración. El estudio incluyó a 1.509 sujetos. A su llegada a Brasil, 620 (41%) informaron tener una o más condiciones de salud. Las posibilidades de presentar problemas de salud fueron mayores en personas procedentes de Congo (RP = 18,7) y República Democrática del Congo (RP = 9,5), en personas indocumentadas (RP = 4,4), mujeres (RP = 2,1), en personas con educación primaria (RP = 1,9), en ≥ 45 años (RP = 1,8), y entre los que viven/han vivido en una relación estable (RP = 1,8 y 2,5, respectivamente). Entre las personas que reportaron alguna condición de salud, más de la mitad relató sentir dolores (52%). Los dolores físicos pueden estar relacionados con el estrés postraumático y otros sufrimientos en salud mental que pueden presentarse mediante síntomas de dolores somáticos.

Acesso equitativo a vacinas: lições aprendidas e perspectivas futuras / Equal access to vaccines: lessons learned and future perspectives

Resumo A vacinação é um componente essencial da atenção primária à saúde e do enfrentamento de emergências em saúde. No entanto, apesar do progresso ocorrido nas últimas décadas, persistem importantes barreiras que resultam na queda de coberturas e disparidades entre os países no acesso a novas vacinas. Neste cenário, a Organização Mundial da Saúde (OMS) lançou, em 2020, a Agenda de Imunização para o decênio 2021-2030 (AI2030). Este artigo tem o objetivo de debater os principais fatores que afetam o acesso às vacinas e as estratégias para promoção da equidade no acesso a elas a nível global e nacional. Tais fatores são multisetoriais e precisam ser considerados em ambos os níveis, destacando-se as barreiras financeiras e geográficas, os desafios de infraestrutura, fatores socioeconômicos e culturais, políticas públicas e governança. O texto aponta a necessidade de remodelação da arquitetura global das cadeias produtivas e dos centros de pesquisa e inovação, criando e/ou fortalecendo as existentes em países de baixa e média renda. Além disso, é necessário estabelecer novos mecanismos e modelos de produção e comercialização de vacinas. As estratégias adotadas para acesso a vacinas e outras tecnologias em saúde estão no centro do debate da agenda de saúde global.

Abstract Vaccination is an essential component of primary health care and coping with health emergencies. However, despite the progress from the last decades, important barriers persist resulting in lower access and disparities between the countries in the access to new vaccines. In this scenario, the World Health Organization (WHO) launched, in 2020, the Immunization Agenda for the 2021-2030 decade (AI2030). This article aims to discuss the main factors that affect access to vaccines and strategies to promote equity in access to them at global and national levels. These factors are multi-sectoral and need to be considered in both levels, with emphasis on financial and geographic barriers, infrastructure challenges, socioeconomic and cultural factors, public policies, and governance. The text points the need to remodel the global architecture of production chains and research and innovation centers, creating and/or strengthening existing ones in low- and middle-income countries. In addition, establishing new mechanisms and models for the production and commercialization of vaccines is necessary. The strategies adopted for accessing vaccines and other health technologies are at the center of the global health agenda debate.

Reescrever saúde global / Rewriting global health

Resumo O conceito de saúde global popularizou-se mesmo com suas origens sendo alvo de um escrutínio crítico: nomeadamente, suas origens na medicina colonial, suas ligações com a proteção do comércio internacional e da exploração capitalista, seus pressupostos orientalistas. Até que ponto o conceito é, ainda, adequado ou proveitoso? Será possível reescrever a saúde global de forma a reconhecer e contrariar as suas múltiplas violências? Reflito sobre a potencialidade do conceito de saúde global a partir de uma ética da escrita que pretende ser analítica (respeitante à sua capacidade para refletir as tensões sociais, a multiplicidade de experiências, as justificações e reivindicações dos atores, a opressão e o potencial não realizado); crítica (respeitante à sua capacidade de identificar a contradição entre aquilo que os arranjos sociais ostensivamente proclamam e o que produzem de facto); e política (respeitante ao seu potencial emancipatório e de reparação das injustiças históricas). Identifico cinco vertentes importantes para um esforço de reescrever o conceito de saúde global: o global como planetário; o global como coletivo; o global como público; o global como periférico; e o global como cotidiano.

Abstract The concept of global health has become popular even though its origins have come under critical scrutiny: namely, its origins in colonial medicine, its links to the protection of international trade and capitalist exploitation and its Orientalist assumptions. To what extent is the concept still adequate or useful? Is it possible to rewrite global health while recognizing and tackling its multiple forms of violence? I reflect on the potentiality of the concept of global health based on an ethics of writing that intends to be analytical (concerning its ability to reflect social tensions, the multiplicity of experiences, the social actors' justifications and claims, the oppression, and the unrealized potential); critical (concerning its ability to identify the contradiction between what social arrangements ostensibly proclaim and what they actually produce); and political (concerning its potential for emancipation and for the reparation of historical injustices). Five important aspects are identified toward rewriting the concept of global health: the global as planetary; the global as collective; the global as public; the global as peripheral; and the global as everyday.

Desafios da Segurança da Saúde Global em tempos de pandemia: O acesso a Equipamentos de Proteção Individual na crise da covid-19 / Global Health Security Challenges in times of pandemic: Access to Personal Protective Equipment in the Covid-19 Crisis

Resumo Este artigo aborda a fragilidade do sistema de Segurança da Saúde Global, enfocando a distribuição de Equipamentos de Proteção Individual (EPI) durante crises sanitárias e tendo como foco e ponto de partida a pandemia de covid-19. A escassez de EPI foi agravada por fatores como alta taxa de transmissão do vírus, falta de treinamento adequado sobre seu uso e descarte, flexibilização das diretrizes de uso prolongado, reutilização do equipamento e restrições à exportação de produtos de saúde. O colapso da cadeia de suprimentos globais de EPI expôs os profissionais de saúde na linha de frente, especialmente em países de baixa e média renda, devido à infraestrutura de saúde inadequada e à disparidade socioeconômica. A falta de ação efetiva para manter e distribuir equitativamente os estoques de EPI existentes exacerbou sua escassez, comprometendo o enfrentamento eficaz à pandemia. Para fortalecer a resiliência dos sistemas de saúde, é necessário desenvolver estratégias para garantir a segurança e equidade na cadeia de suprimentos global de produtos de saúde, por meio de redes interconectadas e redundantes de fornecedores. A colaboração internacional e investimentos em mecanismos multilaterais desempenham um papel crucial na construção de uma Segurança da Saúde Global mais resiliente.

Abstract This article addresses the precariousness of the Global Health Security system, focusing on the distribution of Personal Protective Equipment (PPE) during health crises and taking the COVID-19 pandemic as a departure point and a center. The shortage of PPE was exacerbated by factors such as the high transmission rate of the virus, inadequate training on its use and disposal, flexibility in guidelines regarding prolonged use and reuse of equipment, and restrictions on the export of healthcare products. The collapse of the global PPE supply chain has exposed frontline healthcare workers, especially in low- and middle-income countries, due to inadequate healthcare infrastructure and socioeconomic disparities. The lack of effective action to maintain and equitably distribute existing PPE stocks further exacerbated their shortage, compromising the effective response to the pandemic. To strengthen the resilience of healthcare systems, strategies need to be developed to ensure safety and equity in the global supply chain of healthcare products, with interconnected and redundant networks of suppliers. International collaboration and investments in multilateral mechanisms play a crucial role in building a more resilient Global Health Security.

A captura ideológica dos mecanismos de participação social da OMS na negociação do acordo internacional sobre pandemias / The ideological capture of WHO's social participation mechanisms in the negotiation of the international pandemic agreement

Resumo Este artigo aborda a participação social nas negociações do acordo internacional sobre pandemias, conduzidas no âmbito da Organização Mundial da Saúde (OMS) por um Órgão Intergovernamental de Negociação (OIN). Apresenta resultados de pesquisa realizada por meio de revisão de literatura, pesquisa documental que abarcou mais de cem documentos do OIN, e pesquisa empírica que realizou a análise qualitativa dos conteúdos de 383 vídeos enviados pelo público durante a segunda fase de audiências públicas do OIN. A pesquisa confirma a hipótese de que houve captura ideológica das audiências públicas, entendida como a atuação concertada de indivíduos e organizações que, aproveitando-se de modalidades de participação abertas ao público, por meio de uma atuação massiva em prol de argumentos sem base científica ou inverificáveis, busca distorcer a finalidade das audiências públicas, transformando a consulta sobre o que deveria estar contido no acordo sobre pandemias em um espaço de difusão de sua agenda política. Apresenta, ainda, indícios de atuação concertada da extrema-direita contra o acordo. As conclusões defendem a necessidade de mudanças nesse mecanismo de participação, em prol de uma regulação da saúde global que leve em conta a opinião e os interesses dos seus principais destinatários.

Abstract This article addresses social participation in the negotiations of the international agreement on pandemics, conducted within the World Health Organization (WHO) by an Intergovernmental Negotiating Body (INB). It presents the results of research conducted with a literature review, document research that covered over 100 documents of the INB, and empirical research that carried out a qualitative analysis of the contents of 383 videos sent by the general public during the second phase of public hearings of the INB. The research confirms the hypothesis that there has been an ideological capture of the public hearings, understood as the concerted action of individuals and organizations that, by taking advantage of participation modalities open to the general public, with a massive action in favor of unscientific or unverifiable arguments, have sought to distort the purpose of social participation, turning the public consultation on what should be included in the agreement on pandemics into a space for the dissemination of their political agenda. It also presents evidence of concerted action by far-right groups against the agreement. The conclusions point to the need for changes in this participation mechanism, in favor of a regulation of global health that considers the opinion and interests of its main recipients.

Covid-19 como tema de memória, verdade e justiça: entrevista com Deisy Ventura / Covid-19 as an issue of memory, truth, and justice: an interview with Deisy Ventura

Resumo Entrevista com Deisy Ventura, professora titular da Faculdade de Saúde Pública da Universidade de São Paulo, que discute a dimensão política da pandemia de covid-19 no Brasil. A pesquisadora se tornou uma das principais referências no assunto por seu amplo conhecimento de direito internacional com foco em saúde. Na entrevista, ela apresenta reflexões relacionadas à saúde global, além de discutir a gestão da pandemia no país e suas implicações para os direitos humanos. De acordo com a pesquisadora, houve no Brasil uma política governamental sistemática de disseminação do vírus, e a pandemia deveria ser tratada como uma questão de memória, verdade e justiça.

Abstract This interview with Deisy Ventura, professor at the Faculty of Public Health of the Universidade de São Paulo, discusses the political dimension of the covid-19 pandemic in Brazil. She has become a leading reference on the subject due to her extensive knowledge of international law, with a focus on health. In this interview, Deisy Ventura offers some reflections on global health and discusses the handling of the pandemic in Brazil and its human rights implications. According to Ventura, the Brazilian government had a systematic policy for the spread of the virus, and the pandemic should be treated as a matter of memory, truth, and justice.

Questionário I-SHARE Brasil: adaptação do português de Portugal para o português do Brasil / I-SHARE Brazil questionnaire: adaptation from Portuguese to Brazilian Portuguese

A pandemia de COVID-19 trouxe desafios acrescidos aos já existentes, em termos de acesso aos serviços, respostas adequadas, garantia de direitos, entre outros, para a área da saúde sexual e reprodutiva no Brasil e no mundo. A pesquisa "International Sexual Health and Reproductive Health Survey" (I-SHARE), um estudo global desenvolvido em mais de 40 países, surge da necessidade de investigar essa situação, sendo necessário criar e adaptar instrumentos capazes de captar esta nova realidade mundial. O objetivo do presente artigo é apresentar o processo de adaptação do questionário I-SHARE de português de Portugal para o português do Brasil. A versão brasileira do questionário I-SHARE incluiu 15 grandes blocos de questões relacionadas a COVID-19, violência e saúde sexual e reprodutiva. A adaptação obrigou a acomodar diferenças linguísticas, culturais e institucionais de diferente natureza. O pré-teste, realizado com 10 pessoas, revelou uma boa aceitação, não se tendo verificado dificuldades de compreensão e análise por parte dos/as participantes. Conclui-se que o questionário I-SHARE Brasil, além de ter servido uma pesquisa particular no contexto da pandemia de COVID-19, poderá ser adaptado a outras realidades e estudos futuros no âmbito da saúde sexual e reprodutiva no Brasil.

The COVID-19 pandemic brought increased challenges regarding access to services, adequate responses, guaranteeing rights, among others, for the area of sexual and reproductive health in Brazil and around the world. The "International Sexual Health and Reproductive Health Survey" (I-SHARE), a global study carried out in more than 40 countries, arises from the need to investigate this situation, making it necessary to create and adapt instruments capable of capturing this new global reality. The objective of this article is to present the process of adapting the I-SHARE questionnaire from Portuguese to Brazilian Portuguese. The Brazilian version of the I-SHARE questionnaire included 15 large blocks of questions related to COVID-19, violence and sexual and reproductive health. Adaptation forced to accommodate linguistic, cultural and institutional differences of different nature. The pre-test, carried out with 10 people, revealed good acceptance, with no difficulties in understanding or analyzing on the part of the participants. It is concluded that the I-SHARE Brazil questionnaire, in addition to having served as a particular research in the context of the COVID-19 pandemic, can be adapted to other realities and future studies in the field of sexual and reproductive health in Brazil.

Restricted participation: Drivers, experiences and implications of disability stigma in Ethiopia

Background: Community-based inclusive development (CBID) acknowledges society's critical role in supporting the active participation of persons with disabilities. However, research on how this approach relates to the context-sensitive socially situated barriers of disability stigma is underexplored. Objectives: This study aimed to understand the drivers and experiences of disability stigma in Ethiopia, from the perspective of persons with disabilities engaged in CBID programmes, and to establish how disability stigma acts as a barrier to participation. Methods: An inductive methodological approach guided the research design. Mixed methods were used including a narrative review of disabilities studies literature, 16 semi-structured interviews with persons with disabilities, and a quantitative survey of 970 persons with disabilities across three communities in Ethiopia. Results: Informed by theories of epistemic justice, this study identified specific indicators of meaningful participation and examined how these relate to experiences of disability stigma. The study found that the participation of adults with disabilities in society is restricted across different areas of life. Misconceptions about the causes of disability and social perceptions regarding the capacities of persons with disabilities are found to exacerbate stigma and act as a barrier to participation. Conclusion: Targeted efforts to challenge internalised norms and harmful beliefs within CBID approaches are required to address disadvantages arising from embedded disability stigma. Contribution: This study makes conceptual, empirical and practical contributions that advance insights into the relationship between disability stigma and participation in Ethiopia and the dimensions of epistemic justice relevant to understanding the nature and drivers of disability stigma.

On the brink: The climate and nature crisis and risks of nuclear war

@#The Russian military invasion of Ukraine on February 24, 2022, and Hamas’ terror attack on Israel on October 7, 2023, signaled the beginning of two of the most recent wars to make international headlines. To date, over 110 armed conflicts are taking place: over 45 in the Middle East and North Africa (Cyprus, Egypt, Iraq, Israel, Libya, Morocco, Palestine, Syria, Turkey, Yemen, Western Sahara); over 35 in Africa (Burkina Faso, Cameroon, the Central African Republic, the Democratic Republic of the Congo, Ethiopia, Mali, Mozambique, Nigeria, Senegal, Somalia, South Sudan, Sudan); 21 in Asia (Afghanistan, India, Myanmar, Pakistan, the Philippines); seven in Europe (Russia, Ukraine, Moldova, Georgia, Armenia, Azerbaijan); and six in Latin America (three each in Mexico and Colombia); with two more international armed conflicts (between India and Pakistan, and between India and China) in Asia.1 This list does not even include such problematic situations as those involving China and the South East Asia region. As though these situations of armed violence were not enough, mankind has already passed or is on the verge of passing several climate tipping points – a recent review lists nine Global core tipping elements (and their tipping points) - the Greenland Ice Sheet (collapse); West Antarctic Ice Sheet (collapse); Labrador-Irminger Seas / SPG Convection (collapse); East Antarctic Subglacial Basins (collapse); Amazon Rainforest (dieback); Boreal Permafrost (collapse); Atlantic M.O. Circulation (collapse); Arctic Winter Sea Ice (collapse); and East Antarctic Ice Sheet (collapse); and seven Regional impact tipping elements (and their tipping points) – Low-latitude Coral Reefs (die-off); Boreal Permafrost (abrupt thaw); Barents Sea Ice (abrupt loss); Mountain Glaciers (loss); Sahel and W. African Monsoon (greening); Boreal Forest (southern dieback); and Boreal Forest (northern expansion).2 Closer to home, how can we forget the disaster and devastation wrought by Super Typhoon Haiyan (Yolanda) 10 years ago to date? Whether international or non-international, armed conflicts raise the risk of nuclear war. Russia has already “rehearsed its ability to deliver a ‘massive’ nuclear strike,” conducting “practical launches of ballistic and cruise missiles,” and stationed a first batch of tactical nuclear weapons in Belarus,3 and the possibility of nuclear escalation in Ukraine cannot be overestimated.4 Meanwhile, in a rare public announcement, the U.S. Central Command revealed that an Ohio- class submarine (560 feet long, 18,750 tons submerged and carrying as many as 154 Tomahawk cruise missiles) had arrived in the Middle East on November 5, 2023.5 Indeed, “the danger is great and growing,” as “any use of nuclear weapons would be catastrophic for humanity.”

Design and application of the global health talent competency index system / 中华医院管理杂志

Objective:To establish a global health talent competency index system in China as a scientific basis for improving the global health talent team construction.Methods:Such keywords as global health, competence, global competence and public health talent competence, were used to search for literature published from 2012 to 2022 in the China National Knowledge Infrastructure database. Through literature research and job responsibility analysis and the competency iceberg theory model, the authors established the initial Index set. In October 2022, the expert consultation method was used to identify indexes, with their weight evaluated. Based on the results of expert consultation, a survey questionnaire was developed to evaluate the importance of global health talent competency indexes. A questionnaire survey was conducted in November 2022 through random convenient sampling to select relevant personnel from domestic medical institutions, universities, and pharmaceutical enterprises, and exploratory factor analysis and regression analysis on questionnaire data were made to explore the internal structure, weights and quantitative relationships between indexes of the index system.Results:The global health talent competency index system consisted of 8 level-1 indexes and 28 level-2 indexes. The 8 level-1 indexes were professional accumulation, foreign language communication, international exchange, self-management and growth, influence, achievement drive, globalization literacy, and professionalism. The weights of the level-1 indexes were 0.110, 0.104, 0.153, 0.121, 0.106, 0.171, 0.139, and 0.096, respectively. Knowledge and skill related competencies included professional accumulation and foreign language communication; Behavioral competencies included international communication, self-management and growth, and influence; Personality traits and competencies included internal drive by achievements, global literacy, and professionalism. The regression analysis results showed that all the level-2 indexes, except for creativity, team collaboration, and independent thinking, had a significant predictive effect on their level-1 indexes ( P<0.01). Conclusions:The global health talent competency index system established in this study proves scientific, and practical for the selection, training, and evaluation of global health talents.

The role of the Global Fund to Fight AIDS, Tuberculosis and Malaria in the development of global health and its collaboration with China / 中国血吸虫病防治杂志

The Global Fund to Fight AIDS, Tuberculosis and Malaria (The Global Fund) has become an increasingly active and influential organization in global health during the past two decades. It is now playing an increasingly important role in the prevention and control of major infectious diseases, international financing for health, public procurement market development across the world. The article outlines the basic architecture of the Global Fund, including its overall information, financing mechanism, operational models and key experiences accumulated. Based on previous cooperation, the article analyzes the importance of the long-term partnership between China and the Global Fund, and proposes policy suggestions to achieve more win-win outcomes in the near future.

Health risks of overweight and obesity among children / Монголын Анагаах Ухаан

@#Childhood obesity is, according to the WHO, one of the most serious challenges of the 21st century. More than 100 million children have obesity today. Globally, the prevalence of obesity and overweight tripled in the child and youth populations from the mid-1970s (about 4%) to 2016 (greater than 18%). In 2016, more than 330 million children and adolescents were affected by overweight or obesity globally. It is estimated that by 2030 nearly 30% of all children will be affected by overweight or obesity. For this reason, childhood obesity is a major public health problem worldwide. </br>This study summarizes and reviewed research findings related to childhood obesity and health risks. Overweight and obesity are defined as an abnormal or excessive accumulation of fat that can harm health. Obesity has a multifactorial origin that involves both genetic and environmental factors. Several studies showed that excess body fat increased the risk of multiple comorbidities, such as high blood pressure, coronary heart disease, type 2 diabetes, insulin resistance, and cancer. According to the results of the research, the mother's nutritional status and obesogenic environments have a great influence on childhood obesity. A summary of the results of many studies concluded that childhood obesity is more likely to develop non-communicable diseases in adulthood. The global prevalence of overweight in children aged 5 years or under has increased modestly, but with heterogeneous trends in low and middle-income regions, while the prevalence of obesity in children aged 2–4 years has increased moderately. Overweight or obesity during childhood has important short-term and long-term consequences.@*Conclusion@#In recent decades, the prevalence of obesity in children has increased dramatically. For the successful implementation of activities to prevent overweight and obesity in children, it is necessary to create a supportive environment and to promote health.

Report of Online Conference on Measures against Coronavirus in Japan Organized by President of Subcommittee on Novel Coronavirus Disease Control and Medical Students / 国際保健医療

  An online lifestyle has become typical with the COVID-19 pandemic. Although the number of infected patients in Japan has decreased significantly from its peak, concern remains about the seasonality of the infection and the possibility of variant strains. In this context, 10 medical students and Dr. Shigeru Omi, Chairman of the Subcommittee on Countermeasures against Novel Coronavirus Infections, held an online panel discussion on November 6, 2021.  First, the frailty of Japan’s testing system compared to other countries was highlighted. Although weekly testing for all citizens would be ideal, implementing efficient countermeasures with limited resources was emphasized.  Second, concern exists about other diseases because people are refraining from receiving necessary medical examinations for fear of being infected with COVID-19. Strengthening mass approaches using the media and personal approaches by health care professionals is essential.  Third, much false information exists on social networking sites and is being spread. The importance of suitable individual risk communication was suggested.  Finally, medical students mentioned the loss of experience due to restrictions on school attendance and club activities. Although medical students are treated differently in each country, increasing opportunities to discuss the purpose of medical education and whether online alternatives are possible were highlighted.  This was the first opportunity for a direct discussion between medical students, who have been greatly affected by COVID-19, and Dr. Omi, a policymaker. We hope that more such discussions will be possible, and that people’s opinions will be considered toward a better environment.