Vulnerabilidade social no contexto da pandemia de COVID-19: uma discussão bioética / Social vulnerability in the context of the COVID-19 pandemic: a bioethical discussion / Vulnerabilidad social en el contexto de la pandemia del COVID-19: una discusión bioética

Objetivo: analisar, sob um olhar bioético, a vulnerabilidade social referente à saúde durante o contexto da pandemia de COVID-19. Metodologia: foram incluídas publicações de 1º de janeiro a 31 de dezembro de 2020, revisadas por pares, identificadas nas bases de dados Pubmed, SciELO e LILACS. Foram utilizados para realizar a busca na base Pubmed o termo MESH "COVID-19" conjugado com os termos: "vulnerable population", "population groups", "social determinants of health", "health equity". Os descritores DECS equivalentes em português e em espanhol dos termos MESH foram utilizados na busca nas outras duas bases. Resultados: de um total de 132 artigos, após a aplicação dos critérios de inclusão e exclusão, foram identificados 21 artigos elegíveis. Os temas mais abordados na amostra foram: vulnerabilidades referentes a pessoas idosas, raça, minorias étnicas, condições socioeconômicas precárias, gênero feminino, pessoas com deficiência e condições crônicas de saúde. Observou-se artigos abordando mais de uma temática, integrando aspectos diversos de populações vulneráveis. Com base nos dados encontrados foram feitas análise e discussão com foco em vulnerabilidade como conceito bioético, além de conexões com discriminação e determinação social da saúde. Conclusão: os resultados apontam para a violação de direitos explicitados na Declaração Universal de Bioética e Direitos Humanos. Ao aumentar a disparidade da morbimortalidade por COVID-19 de grupos populacionais já impactados pela determinação social da saúde, constata-se uma violação do direito à saúde, indicando que governos e sociedades falham em respeitar a vulnerabilidade de grupos sociais no contexto pandêmico.

Objective: to analyze, from a bioethical perspective, social vulnerability in relation to health during the context of the COVID-19 pandemic. Methods: The study included peer-reviewed publications from January 1st until December 31st 2020, identified in Pubmed, SciELO and LILACS data basis. Mesh terms were utilized for research in Pubmed as follows: "COVID-19" conjugated with the terms: "vulnerable population", "population groups", "social determinants of health", "health equity". Portuguese and Spanish equivalents DECS terms were used for searching in the other two databases. Results: a total of 132 articles were found. After applied inclusion and exclusion criteria, were 21 eligible articles. The most recurrent themes were: racial, ethnic and social-economics, gender, age, disability and chronic health conditions. Articles addressing more than one theme were observed, integrating different aspects of vulnerable populations. A bioethical discussion with focus in vulnerability based in the data retrieved took place and connections with discrimination and social determinants of health were made. Conclusion: results point to the violation of rights explained in the Universal Declaration of Bioethics and Human Rights. By increasing the disparity in morbidity and mortality from COVID-19 of population groups already impacted by the social determination of health, there is a violation of the right to health, indicating that governments and societies fail to respect the vulnerability of social groups in the pandemic context.

Objetivo: analizar desde un punto de vista bioético, la vulnerabilidad social relacionada con la salud durante el contexto de la pandemia de la COVID-19. Metodología: se incluyeron publicaciones revisadas por pares del 1 de enero al 31 de diciembre de 2020, identificadas en las bases de datos Pubmed, SciELO y LILACS. Se utilizó el término MESH "COVID-19" para buscar en la base de datos Pubmed junto con los términos: "población vulnerable", "grupos de población", "determinantes sociales de la salud", "equidad en salud". Los descriptores DECS equivalentes en portugués y español de los términos MESH fueron utilizados en la búsqueda en las otras bases.Resultados: de un total de 132 artículos, tras aplicar los criterios de inclusión y exclusión, se identificaron 21 artículos. Los temas más discutidos fueron: vulnerabilidades relacionadas con los adultos mayores, raza (énfasis en personas negras), minorías étnicas, condiciones socioeconómicas precarias, género femenino, personas con discapacidad y condiciones crónicas de salud. Se observaron artículos que abordaban más de un tema, integrando diferentes aspectos de las poblaciones vulnerables. A partir de los datos encontrados, se realizó análisis y discusión con foco en la vulnerabilidad como concepto bioético, así como las conexiones con la discriminación y la determinación social de la salud. Conclusión: los resultados apuntan a la violación de los derechos explícitos en la Declaración Universal de Bioética y Derechos Humanos. Al aumentar la disparidad en la morbimortalidad por COVID-19 de grupos poblacionales ya impactados por la determinación social de la salud, se vulnera el derecho a la salud, indicando que los gobiernos y las sociedades no respetan la vulnerabilidad de los grupos sociales ante la pandemia.

Prevenção de quedas na hospitalização: oportunidades educativas na perspectiva dos trabalhadores de Enfermagem* / Preventing falls during hospitalization: educational opportunities from the perspective of Nursing staff / Prevención de caídas durante la hospitalización: oportunidades educativas desde la perspectiva de los trabajadores de Enfermería

Objetivo: descrever as oportunidades educativas identificadas pelos trabalhadores de Enfermagem para prevenir as quedas de pacientes adultos hospitalizados. Método: estudo qualitativo, descritivo, com 21 trabalhadores de Enfermagem de um hospital universitário no sul do Brasil. A coleta de dados ocorreu de março a maio de 2020, com entrevistas semiestruturadas, submetidas à Análise de Conteúdo. Resultados: foram descritas pelos trabalhadores a necessidade de as ações educativas atingirem os envolvidos na prevenção das quedas, emergindo as categorias: Protagonismo do paciente na prevenção das quedas: a educação como estratégia para a percepção do risco; O desafio do envolvimento do familiar/acompanhante como potencializador do cuidado; Dialogicidade na prevenção das quedas: uma reflexão sobre o fazer diário. Conclusão: os trabalhadores identificaram as oportunidades de investimento na educação e na formação, considerando as experiências prévias e o contexto social, criando percursos de aprendizagem, testando novas abordagens para a prevenção de quedas e aprimorando seu papel educativo.

Objective: to describe the educational opportunities identified by Nursing staff to prevent falls in hospitalized adult patients. Method: This is a qualitative, descriptive study with 21 Nursing workers from a university hospital in southern Brazil. Data collection took place from March to May 2020, with semi-structured interviews, submitted to Content Analysis. Results: workers described the need for educational actions to reach those involved in fall prevention, and the following categories emerged: Patient protagonism in fall prevention: education as a strategy for risk perception; The challenge of involving the family member/companion as an enhancer of care; Dialogicity in fall prevention: a reflection on daily practice. Conclusion: workers identified opportunities to invest in education and training, taking into account previous experiences and the social context, creating learning paths, testing new approaches to fall prevention, and improving their educational role.

Objetivo: describir las oportunidades educativas identificadas por los trabajadores de Enfermería para prevenir caídas en pacientes adultos hospitalizados. Método: estudio cualitativo, descriptivo, con 21 trabajadores de Enfermería de un hospital universitario del sur de Brasil. La recolección de datos se realizó de marzo a mayo de 2020, con entrevistas semiestructuradas, sometidas a Análisis de Contenido. Resultados: los trabajadores describieron la necesidad de acciones educativas para llegar a los involucrados en la prevención de caídas, surgiendo las siguientes categorías: Papel del paciente en la prevención de caídas: la educación como estrategia para la percepción del riesgo; El desafío de la participación de la familia/acompañante como potenciador del cuidado; Diálogo en la prevención de caídas: una reflexión sobre la práctica diaria. Conclusión: los trabajadores identificaron oportunidades de inversión en educación y capacitación, considerando experiencias anteriores y el contexto social, creando caminos de aprendizaje, probando nuevos enfoques para prevenir caídas y mejorar su rol educativo.

O racismo institucional na universidade e consequências na vida de estudantes negros: um estudo misto / Institutional racism at the university and consequences in the lives of Black students: a mixed study

Resumo O objetivo do artigo foi analisar como o racismo institucional em uma universidade pública brasileira afeta a vida de estudantes negros e negras. Trata-se de um estudo misto, desenvolvido por meio da aplicação de questionário autoaplicado online a estudantes universitários que se autodeclararam negros. Os dados quantitativos foram analisados por estatística descritiva, análise bivariável por meio do qui-quadrado e regressão logística multinominal. A análise dos dados qualitativos foi feita no Iramuteq. Do total de 125 respondentes, 68 (54,4%) afirmaram ter sofrido racismo pelo menos uma vez dentro da universidade. Percebeu-se que as situações racistas vividas pelas pessoas negras dentro do ambiente universitário colocam em questão a autoconfiança e a motivação do estudante, afetando diretamente a sua saúde mental e seu desempenho no curso. Evidenciou-se a importância dos coletivos para acolhimento e fortalecimento do pertencimento dos estudantes.

Abstract This article aimed to analyze how institutional racism at a Brazilian public university affects the lives of Black students. This mixed study was developed by applying an online self-administered questionnaire to university students who self-declared as Blacks. Quantitative data were analyzed using descriptive statistics, bivariate analysis using chi-square, and multinomial logistic regression. Qualitative data analysis was performed using IRAMUTEQ. Sixty-eight (54.4%) of the 125 respondents claimed to have suffered racism at least once within the university. We noticed that racist situations experienced by Black people within the university environment call into question the student's self-confidence and motivation, directly affecting their mental health and performance in the course. The importance of receptive groups for strengthening students' belonging was highlighted.

Àgô Sankofa: um olhar sobre a trajetória da doença falciforme no Brasil nos últimos 20 anos / Àgô Sankofa: an overview of the progression of sickle cell disease in Brazil in the past two decades

Resumo A doença falciforme (DF) é um caso emblemático de negligência histórica em saúde no Brasil e reflete como o racismo institucional produz iniquidades em saúde. Este artigo fez um percurso histórico até os dias atuais e mostra atraso na implementação de políticas de saúde voltadas para as pessoas com DF, tantas vezes encoberto em (in)ações e omissões do poder público. O descompromisso para a efetivação das recomendações do Ministério da Saúde, a exemplo da triagem neonatal, e a dificuldade de incorporar as tecnologias para a assistência à saúde resultam desse modus nada operandi. Os avanços e retrocessos nas ações programáticas, bem como a pressão constante sobre os diversos entes governamentais, caracterizaram a saga dos últimos 20 anos. O texto disserta sobre as políticas voltadas para as pessoas com DF, apropriando-se da simbologia Sankofa, já que só é possível construir o presente pelo aprendizado dos erros do passado. Assim, reconhecemos essa trajetória e esse momento histórico em que há possibilidade concreta de avançar e concretizar o tão almejado cuidado integral para pessoas com DF. Concluiu-se que há um convite para um novo olhar, em que esperançar seja o disparador das movimentações necessárias para a garantia do direito para as pessoas com DF.

Abstract Sickle cell disease (SCD) is an emblematic case of historical health neglect in Brazil and reflects how institutional racism produces health inequalities. This article engaged in a historical journey of this disease, showing the delayed implementation of health policies for people with sickle cell disease, often concealed in Public Power's (in)actions and omissions. The lack of commitment to implement the recommendations of the Brazilian Ministry of Health, such as neonatal screening, and the difficulty in incorporating technologies for health care result from this modus operandi. The advances and setbacks in programmatic actions and the constant pressure on several governmental entities have characterized the reported saga in the last twenty years. The present text discusses the policies for people with SCD, appropriating the Sankofa symbol, meaning that building the present is only possible by remembering past mistakes. Thus, we recognize this trajectory and this historical moment in which there is a concrete possibility of moving forward and achieving the longed-for comprehensive care for people with SCD. There is an invitation to glance at a new perspective, one in which hope is the trigger for the movements needed to guarantee the rights of people with SCD.

Desnortear, aquilombar e o antimanicolonial: três ideias-força para radicalizar a Reforma Psiquiátrica Brasileira / Bewilderment, aquilombar, and the antimanicolonial: three ideas to radicalize Brazilian Psychiatric Reform

Resumo Este artigo é parte de uma pesquisa que buscou cartografar saberes e fazeres antirracistas em saúde mental por meio do acompanhamento das práticas de três coletivos de profissionais trabalhando na/com a rede de atenção psicossocial na cidade de São Paulo, o que possibilitou caracterizar suas estratégias de intervenção. Buscando contribuir para sua conceitualização, delineamos, por meio da revisão da literatura descolonial, três ideias-força que nos permitem dar corpo à descolonização da Reforma Psiquiátrica: o desnortear, que, em diálogo com Achille Mbembe e Frantz Fanon, nos convida à afirmação da loucura e da negritude - sem, no entanto, estabelecer fixações; o antimanicolonial, que se dá no fomento do exercício livre e contracultural de imaginar diásporas, em relação com as proposições de Édouard Glissant, Paul Gilroy e Lélia Gonzales quanto a uma (des)orientação atlântica na qual elementos da diáspora negra e da América Latina possam ressignificar negritude e desrazão; e o aquilombar, como práxis libertária que tem em sua gênese os quilombos como metáfora viva da radicalização das relações nas diferenças, a partir do quilombismo de Abdias do Nascimento, da quilombagem de Clóvis Moura, do (k)quilombo de Beatriz Nascimento e do devir quilomba de Mariléa de Almeida.

Abstract This article is part of a study aimed to map antiracist knowledge and practices in mental health by monitoring the practices of three collectives of professionals working in/with the psychosocial care network in the city of São Paulo, allowing us to characterize their intervention strategies. To contribute to the conceptualization of this article, through a review of the decolonial literature, three major ideas have been outlined that have allowed us to give substance to the decolonization of Psychiatric Reform: bewilderment, which, in dialogue with Achille Mbembe and Frantz Fanon, invites us to affirm madness and blackness without, however, establishing fixations; the antimanicolonial, which occurs in the promotion of the free and countercultural exercise of imagining diasporas, in light of that proposed by Édouard Glissant, Paul Gilroy, and Lélia Gonzales regarding an Atlantic (de)orientation in which elements of the black diaspora and Latin America can re-signify blackness and unreason; and aquilombar, as a liberatory praxis whose genesis lies in the quilombos as a living metaphor for the radicalisation of relationships in differences, based on Abdias do Nascimento's quilombismo, Clóvis Moura's quilombagem, Beatriz Nascimento's (k)quilombo, and Mariléa de Almeida's devir quilomba.

Racismo e insegurança alimentar: mazelas de uma comunidade quilombola da Amazônia legal brasileira / Racism and food insecurity: misfortunes of a Quilombola community in the Brazilian Legal Amazon

Resumo Este estudo analisou a insegurança alimentar na comunidade quilombola Imbiral Cabeça-Branca, no Maranhão, durante a pandemia da COVID-19. Estudo transversal realizado no último trimestre de 2021, com 25 chefes de família da comunidade. A maioria dos participantes eram mulheres (52,0%), com baixa escolaridade, desempregados (68,0%), e 76,0% recebiam o Auxílio Emergencial federal. A densidade domiciliar média era de quatro pessoas, e as casas eram predominantemente de taipa, sem saneamento básico. A água consumida provinha de poços artesanais, e a maioria das casas tinha acesso à eletricidade. A insegurança alimentar foi identificada em todas as famílias, sendo 12,0% classificadas como Leve, 24,0% Moderada e 64,0% Grave. A forma Grave foi mais comum em lares chefiados por homens solteiros (75%), idosos, pessoas com baixa escolaridade (78,7%) e desempregados (64,7%). A insegurança alimentar na comunidade quilombola, assim como em outras comunidades similares no país, é resultado das condições precárias de vida, desemprego, privação de alimentos e falta de titulação de terras. Esses fatores também contribuem para a perpetuação do racismo institucional e ambiental enfrentado por essas comunidades.

Abstract This study examined food insecurity in the Quilombola community of Imbiral Cabeça-Branca, in Maranhão, Brazil, during the COVID-19 pandemic. A cross-sectional study was conducted in the last quarter of 2021 with 25 household heads from the community. Most participants were women (52.0%) with low schooling and were unemployed (68.0%), and 76.0% received a Federal Emergency Aid. The mean household density was four people, and houses were predominantly made of rammed earth, lacking basic sanitation. The consumed water came from artesian wells, and most houses had electricity. Food insecurity was identified in all households, with 12.0% classified as mild, 24.0% as moderate, and 64.0% as severe. The severe form was more common in households headed by single men (75%), older adults, less-educated individuals (78.7%), and the unemployed (64.7%). Food insecurity in the Quilombola community and other similar communities in the country results from substandard living conditions, unemployment, food deprivation, and lack of land titling. These factors also contribute to the perpetuation of institutional and environmental racism faced by these communities.

Tendência temporal da incompletude do registro da raça/cor nos sistemas de informação em saúde do Brasil, 2009-2018 / Incomplete recording of race/colour in health information systems in Brazil: time trend, 2009-2018

Resumo Propõe-se avaliar a incompletude e a tendência temporal do preenchimento do campo raça/cor das doenças e agravos mais prevalentes na população negra nos Sistemas de Informação em Saúde do Brasil, 2009-2018. Trata-se de estudo ecológico de tendência temporal e múltiplos grupos. Foi adotada a classificação de Romero e Cunha (2006) para análise da incompletude e utilizados dados secundários do Sistema Nacional de Agravos de Notificação, Sistema de Informações Hospitalares e Sistema de Informações sobre Mortalidade do Brasil e regiões brasileiras, calculada a proporção de subnotificação e a tendência temporal, utilizando o modelo de regressão linear simples, com correção Prais-Winsten (p-valor<0,05). Excetuando-se os registros de mortalidade por causas externas (excelente), tuberculose (bom) e mortalidade infantil (regular), todos os registros apresentaram escore ruim. Observou-se tendência decrescente da proporção de incompletude. A análise por região mostrou que as maiores médias de incompletude foram registradas na região Norte (30,5%), Nordeste (33,3%) e Centro-Oeste (33,0%). As regiões Sudeste e Nordeste foram as que mais apresentaram tendência decrescente. Os resultados visam ampliar a visibilidade acerca das implicações do preenchimento do campo raça/cor para a equidade em saúde.

Abstract This ecological study of time trends and multiple groups evaluated incompleteness in the race/colour field of Brazilian health information system records and the related time trend, 2009-2018, for the diseases and disorders most prevalent in the black population. The Romero and Cunha (2006) classification was applied in order to examine incompleteness using secondary data from Brazil's National Notifiable Diseases System, Hospital Information System and Mortality Information System, by administrative regions of Brazil, while percentage underreporting and time trend were calculated using simple linear regression models with Prais-Winsten correction (p-value<0.05). All records scored poorly except those for mortality from external causes (excellent), tuberculosis (good) and infant mortality (fair). An overall downward trend was observed in percentage incompleteness. Analysis by region found highest mean incompleteness in the North (30.5%), Northeast (33.3%) and Midwest (33.0%) regions. The Southeast and Northeast regions showed the strongest downward trends. The findings intended to increase visibility on the implications of the race/color field for health equity.

Uso dos serviços de saúde por pessoas idosas em áreas rurais e urbanas do Brasil / Health services utilization by older adults in rural and urban areas of Brazil

Resumo Objetivo Avaliar o uso dos serviços de saúde por pessoas idosas residentes em áreas urbanas e rurais do Brasil. Método Estudo transversal que analisou dados da Pesquisa Nacional de Saúde 2019, referentes aos moradores idosos (≥60 anos) selecionados nos domicílios, totalizando 22.728 entrevistas (3.300 em área rural e 19.426 em área urbana). Foram estimadas para as áreas rurais e urbanas as prevalências de cadastro na Estratégia Saúde da Família, intervalo de tempo da última consulta médica e odontológica, procura do serviço nas últimas duas semanas, última aferição da pressão arterial e da glicemia e avaliados os fatores associados à utilização dos serviços de saúde médicos e odontológicos nos últimos 12 meses. Resultados A autopercepção da saúde como 'muito boa' ou 'boa' foi maior na área urbana (47,32%), assim como a proporção de pessoas idosas que relataram consulta médica e odontológica nos últimos 12 meses (90,54%). Evidenciou-se menor frequência do acompanhamento da aferição de pressão arterial (81,30%) e da glicemia (45,83%) em áreas rurais. As pessoas idosas que possuem baixa escolaridade, residem em áreas rurais, na região Norte são as que possuem menor chance de utilização dos serviços. Conclusão A população idosa residente em área rural apresenta piores condições de saúde em relação à população residente em área urbana.

Abstract Objective To assess health services utilization by older adults in urban and rural areas of Brazil. Method A cross-sectional study was conducted analyzing data from the 2019 National Health Survey on older adults (≥60 years) selected from households based on 22,728 interviews (3,300 in rural and 19,426 in urban areas). For rural and urban areas, the prevalence of Family Health Strategy enrolment, time since last medical and dental visit, service use in past 2 weeks, and last blood pressure and blood glucose measurements were estimated. Also, the factors associated with medical and dental health services utilization in the past 12 months were explored. Results Self-rated health of "Very good" or "Good" was greater in urban areas (47.32%), as was the proportion of older adults reporting a medical or dental visit within the last 12 months (90.54%). Rates of blood pressure (81.30%) and glucose (45.83%) monitoring were lower in rural areas. Older individuals that had low education, resided in rural areas, and the North region, had a lower likelihood of using health services Conclusion The older population living in rural areas had poorer health status compared with the urban population.

O campo de estudos sobre saúde da população negra no Brasil: uma revisão sistemática das últimas três décadas / The field of studies on the black population health in Brazil: a systematic review of the last three decades

Resumo A saúde da população negra (SPN) pode ser compreendida simultaneamente como campo de estudos, de intervenção social e de domínio cultural. Essa complexa esfera de conhecimento e prática surgiu imbricada com demandas de movimentos sociais e de profissionais, sobretudo de mulheres negras, com a finalidade de enfrentar problemas concretos de saúde pública. Como campo de estudos, ainda é incipiente a produção científica no Brasil. Dado esse contexto, conduzimos esta investigação com o objetivo de demonstrar como tem se estruturado a produção sobre SPN no país nas últimas três décadas. Trata-se de uma revisão sistemática integrativa, que visa a síntese e a análise do conhecimento científico já produzido sobre esse tema. Selecionamos 400 trabalhos publicados entre 1998 e 2020 e analisamos a evolução do volume de produção, seus lócus (estados, instituições, áreas científicas e abrangência territorial), temáticas e metodologias, bem como alguns desses intercruzamentos. Como resultado, encontramos um aumento notório do volume de pesquisas mais recentemente, em um campo interdisciplinar e com maior diversidade temática em relação aos estudos pioneiros. Essa evolução pode apontar um processo de consolidação do campo de estudos sobre saúde e raça no Brasil, ainda que os sinais apresentados sejam ambíguos.

Abstract Black population health (BPH) can be understood, at the same time, as a field of study, of social intervention, and of cultural domain. This complex sphere of knowledge and practice emerged from the demands of social movements, especially those of black women, to face concrete public health problems. As a field of study, scientific production in Brazil is still incipient. Given this context, we conducted this investigation to demonstrate how the production on BPH has been structured in Brazil in the last three decades. This is an integrative systematic review that aims to synthesize and analyze the scientific knowledge already produced on this topic. We selected 400 works among articles, theses, and dissertations published between 1998 and 2020 and analyzed the evolution of the production volume, its locus (states, institutions, scientific areas, and territorial scope of the studies), themes and methodologies, as well as some of these intercrossing. As a result, we found a notable increase in the research volume in recent years, in an interdisciplinary field with wide thematic diversity in relation to pioneer studies. This evolution may point to a process of consolidation of the field of studies on health and race in Brazil, even if the signs presented are ambiguous.

Public health surveillance and the data, information, knowledge, intelligence and wisdom paradigm / Vigilancia de salud pública y el paradigma de datos, información, conocimiento, inteligencia y sabiduría / Vigilância em saúde pública e o paradigma de dados, informações, conhecimento, inteligência e sabedoria

ABSTRACT This article points out deficiencies in present-day definitions of public health surveillance, which include data collection, analysis, interpretation and dissemination, but not public health action. Controlling a public health problem of concern requires a public health response that goes beyond information dissemination. It is undesirable to have public health divided into data generation processes (public health surveillance) and data use processes (public health response), managed by two separate groups (surveillance experts and policy-makers). It is time to rethink the need to modernize the definition of public health surveillance, inspired by the authors' enhanced Data, Information, Knowledge, Intelligence and Wisdom model. Our recommendations include expanding the scope of public health surveillance beyond information dissemination to comprise actionable knowledge (intelligence); mandating surveillance experts to assist policy-makers in making evidence-informed decisions; encouraging surveillance experts to become policy-makers; and incorporating public health literacy training - from data to knowledge to wisdom - into the curricula for all public health professionals. Work on modernizing the scope and definition of public health surveillance will be a good starting point.

RESUMEN En este artículo se señalan las deficiencias de las definiciones actuales de la vigilancia de salud pública, que incluyen la recopilación, el análisis, la interpretación y la difusión de los datos, pero no las medidas de salud pública. El control de un problema de salud pública de interés exige una respuesta de salud pública que vaya más allá de la difusión de información. No es deseable que la salud pública esté dividida por un lado en procesos de generación de datos (vigilancia de salud pública) y por otro en procesos de uso de datos (respuesta de salud pública), gestionados por dos grupos diferentes (expertos en vigilancia y responsables de la formulación de políticas). Ha llegado el momento de replantear la necesidad de modernizar la definición de la vigilancia de salud pública tomando como referencia el modelo mejorado de Datos, Información, Conocimiento, Inteligencia y Sabiduría de los autores. Entre las recomendaciones que se proponen se encuentran las de ampliar el alcance de la vigilancia de salud pública más allá de la difusión de información para que incluya también el conocimiento aplicable (inteligencia); instar a los expertos en vigilancia a que presten ayuda a los responsables de la formulación de políticas en la toma de decisiones basadas en la evidencia; alentar a los expertos en vigilancia a que se conviertan en responsables de la formulación de políticas; e incorporar la formación en conocimientos básicos de salud pública (desde los datos hasta los conocimientos y la sabiduría) en los planes de estudio de todos los profesionales de la salud pública. Un buen punto de partida será trabajar en la modernización del alcance y la definición de la vigilancia de salud pública.

RESUMO Este artigo aponta deficiências nas definições atuais de vigilância em saúde pública, que incluem coleta, análise, interpretação e disseminação de dados, mas não ações de saúde pública. O controle de um problema preocupante de saúde pública exige uma resposta de saúde pública que vá além da disseminação de informações. A saúde pública não deve ser dividida em processos de geração de dados (vigilância em saúde pública) e processos de uso de dados (resposta de saúde pública) gerenciados por dois grupos distintos (especialistas em vigilância e formuladores de políticas). É hora de repensar a necessidade de modernizar a definição de vigilância em saúde pública, inspirada no modelo aprimorado de Dados, Informações, Conhecimento, Inteligência e Sabedoria dos autores. Nossas recomendações incluem: expansão do escopo da vigilância em saúde pública para além da disseminação de informações, de modo a abranger conhecimentos acionáveis (inteligência); obrigatoriedade de que os especialistas em vigilância auxiliem os formuladores de políticas na tomada de decisões baseadas em evidências; incentivo para que os especialistas em vigilância se tornem formuladores de políticas; e incorporação de capacitação em letramento em saúde pública (partindo dos dados para o conhecimento e em seguida para a sabedoria) nos currículos de todos os profissionais de saúde pública. O trabalho de modernizar o escopo e a definição de vigilância em saúde pública será um bom ponto de partida.

Food environment of bus terminals in the Rio de Janeiro metropolitan region / Ambiente alimentar de terminais rodoviários da região metropolitana do Rio de Janeiro

ABSTRACT PURPOSE To describe and analyze the healthiness of formal and informal food establishments in bus terminals of the metropolitan region of the state of Rio de Janeiro. METHOD An audit was conducted in 156 formal and 127 informal food establishments located in 14 bus terminals of the five most populous cities of the metropolitan region of Rio de Janeiro. Proportions of types of establishments and means (95%CI) of food availability indicators in formal and informal settings were calculated. For the formal setting, prices, proportions of accepted payment methods, days and hours of operation, and food categories with displayed advertising were described. RESULTS The healthiness of food establishments in bus terminals was low (less than 36%). On average, ultra-processed food subgroups were 250% more available for purchase than fresh or minimally processed food. Purchasing food at these places was convenient because several forms of payment were available, and the opening hours of the establishments followed the peaks of movement. In addition, 73.3% of the advertising referred to ultra-processed drinks, and the cost-benefit of buying ultra-processed food was better than fresh or minimally processed food. CONCLUSION The food environment of bus terminals in the metropolitan region of Rio de Janeiro promotes unhealthy eating. Regulatory public policies should focus on initiatives to limit the wide availability and advertising of ultra-processed food in spaces of great circulation of people.

RESUMO OBJETIVO Descrever e analisar a saudabilidade dos estabelecimentos com venda formal e informal de alimentos em terminais rodoviários da região metropolitana do Rio de Janeiro. MÉTODOS Realizou-se auditoria em 156 estabelecimentos formais e 127 pontos informais de venda de alimentos localizados em 14 terminais rodoviários das cinco cidades mais populosas da região metropolitana do Rio de Janeiro. Foram calculadas proporções de tipos de estabelecimentos e médias (IC95%) de indicadores de disponibilidade de alimentos nos ambientes formal e informal. Para o ambiente formal, foram descritos preços, proporções das formas de pagamento aceitas, dias e horários de funcionamento e categorias de alimentos com propaganda exposta. RESULTADOS A saudabilidade dos pontos de venda de alimentos nos terminais rodoviários era baixa (inferior a 36%). Em média, estavam disponíveis para compra 250% mais subgrupos de alimentos ultraprocessados do que in natura ou minimamente processados. Adquirir comida nesses locais era conveniente porque diversas formas de pagamento estavam disponíveis e os horários de funcionamento dos estabelecimentos acompanhavam os picos de movimentação. Além disso, 73,3% das propagandas se referiam a bebidas ultraprocessadas e o custo-benefício da compra de alimentos ultraprocessados era melhor que o de alimentos in natura ou minimamente processados. CONCLUSÃO O ambiente alimentar dos terminais rodoviários da região metropolitana do Rio de Janeiro promove uma alimentação não saudável. Políticas públicas de regulação devem se concentrar em iniciativas que limitem a ampla disponibilidade e publicidade de alimentos ultraprocessados nesses espaços de grande circulação de pessoas.

A importância do ensino e aprendizagem de técnicas de primeiros socorros para leigos: revisão integrativa / The importance of teaching and learning first aid techniques for laypersons: integrative review / La importancia de la enseñanza y el aprendizaje de las técnicas de primeros auxilios para los profanos: revisión integradora

Objetivo: analisar, a importância do ensino e aprendizagem sobre técnicas de Primeiros Socorros para leigos. Métodos: revisão integrativa nas bases de dados LILACS, MEDLINE via PUBMED, BDENF, CINAHL, SCOPUS e biblioteca Cochrane, sem recorte de tempo. Os descritores utilizados foram.: "Educação da População", "Educação em saúde", "Primeiros Socorros" e "Emergências", em inglês foram delimitados e cruzados os descritores.: "Population Education", "Health Education", "First aid" e "Emergencies" os operadores booleanos AND e OR. A amostra foi composta por 11 artigos. Resultados: capacitações em primeiros socorros têm um impacto significativo principalmente ao se aplicar questionários pré e pós-intervenções, pois os erros cometidos anteriormente já se transformavam em acertos. Conclusão: as intervenções educativas realizadas em escolas e comunidades levam a propagação de conhecimento e aprendizagem, podendo assim tangenciar a formação de multiplicadores, resultando em uma sociedade informada.

Objective: to analyze, the importance of teaching and learning about First Aid techniques for lay people. Methods: integrative review in the databases LILACS, MEDLINE via PUBMED, BDENF, CINAHL, SCOPUS and Cochrane library, without a time cut. The descriptors used were: "Population Education", "Health Education", "First Aid" and "Emergencies", in English the Boolean operators AND and OR were delimited and crossed the descriptors: "Population Education", "Health Education", "First aid" and "Emergencies". The sample consisted of 11 articles. Results: first aid trainings have a significant impact mainly when applying pre- and post-intervention questionnaires, because the mistakes previously made were already transformed into successes. Conclusion: the educational interventions carried out in schools and communities lead to the propagation of knowledge and learning, thus being able to tangent the formation of multipliers, resulting in an informed society.

Objetivos:analizar, la importancia de la enseñanza y el aprendizaje de las técnicas de Primeros Auxilios para los profanos. Métodos:revisión integradora en las bases de datos LILACS, MEDLINE a través de PUBMED, BDENF, CINAHL, SCOPUS y biblioteca Cochrane, sin corte de tiempo. Los descriptores utilizados fueron: "Population Education", "Health Education", "First Aid" y "Emergencies", en inglés se delimitaron y cruzaron los siguientes descriptores: "Population Education", "Health Education", "First aid" y "Emergencies" los operadores booleanos AND y OR. La muestra estaba compuesta por 11 artículos. Resultados: las formaciones en primeros auxilios tienen un impacto significativo sobre todo cuando se aplican los cuestionarios previos y posteriores a la intervención, ya que los errores cometidos anteriormente se transformaron en aciertos. Conclusión: las intervenciones educativas llevadas a cabo en las escuelas y comunidades conducen a la propagación del conocimiento y el aprendizaje, pudiendo así tangibilizar la formación de multiplicadores, dando lugar a una sociedad informada.

Health management demand among occupational populationat high risk of stroke / 预防医学

Objective @#Objective To investigate the demand for health management and influencing factors among occupational population at high risk of stroke, so as to provide insights into the development of stroke health management strategies among occupational population.@*Methods@#Occupational population aged 40 to 60 years who participated in health examination were sampled from three tertiary hospitals in Luzhou City, Sichuan Province using a quota sampling method in the ratio of 4∶1∶1, from August to December 2020. Participants' blood biochemistry tests and health examination were collected through the examination reports, and the participants at high risk of stroke were screened using the assessment criteria for high-risk of stroke. Participants' general information and demand for health management were collected using questionnaire surveys. In addition, factors affecting the demand for health management were identified using a multivariable logistic regression model. @*Results@#A total of 3 003 people who participated in health examination were investigated, and 1 062 participants met the assessment criteria for high risk of stroke, accounting for 35.36%. There were 1 000 men (94.16%) and 62 women (5.84%), with a mean age of (49.26±4.97) years. There were 414 professional and technical staff (39.50%). There were 709 participants (66.76%) with demand for health management, with the top three in the demand as health checkups (915 participants, accounting for 86.16%), health consultation (601 participants, accounting for 56.60%) and exercise guidance (560 participants, accounting for 52.73%), and 210 participants (19.77%) received health management. Multivariable logistic regression analysis showed that occupational population at high risk of stroke who received health management were more likely to have the demand for health management (OR=2.158, 95%CI: 1.479-3.149). @*Conclusions@#The occupational population at high risk of stroke have the demand for health management. Having received health management may affect the demand for health management among occupational population at high risk of stroke.

Research progress of early screening and clinical prevention services for high-risk population with cardiovascular diseases / 公共卫生与预防医学

Cardiovascular diseases are preventable and controllable, and the disease burden caused by them can be reduced after preventive intervention. Attentions should be paid to the prevention of disease causes. For high-risk population, it is necessary to conduct early screening of cardiovascular diseases, control risk factors, reduce exposure level, prevent and control the occurrence or progression of diseases. Clinical prevention services are to evaluate risk factors of health in clinical sites, which can prevent diseases by personalized intervention measures. Clinical prevention services for high-risk population with cardiovascular diseases are generally at a low level in China. This article reviews the early screening, risk factors and clinical prevention services for high-risk population with cardiovascular diseases.

Helicobacter pylori infection factors and immunological typing in community health examination population / 公共卫生与预防医学

Objective To investigate and analyze the risk factors of Helicobacter pylori (Hp) infection and the immunological classification of Hp-infected people in community health examination population. Methods Among of the 2 475 residents in a community who underwent health examination in Guangyuan First People's Hospital were selected between July 2022 and April 2023. Western blotting was used to detect and type the Hp antibodies. The risk factors of Hp infection in the community residents were analyzed by binary logistic regression analysis, and the results of immunological typing were compared among patients with different upper digestive tract diseases and chronic diseases. Results The Hp infection rate among of the 2 475 residents who underwent physical examination was 35.64% (882/2475), and the positive rates of type I Hp antibody and type II Hp antibody were 23.72% (587/2 475) and 11.92% (295/2 475) , respectively. There were significant differences in Hp infection rates in gender, age, smoking history, and whether or not people had diabetes (P<0.05). Multivariate logistic regression analysis showed that male, age ≥60 years old, drinking history and diabetes were risk factors of Hp infection in the community health examination population (P<0.05). The positive rate of type I Hp antibody in men and patients with coronary heart disease was higher than that in women and patients without coronary heart disease (P<0.05). Conclusion The infection rate of Hp among health examination population in this community is low, mainly type I. Hp infection is affected by gender, age, drinking history and diabetes. There are more males in the population with type I Hp antibody positivity, and the risk may be higher in patients with coronary heart disease. Clinically, it is necessary to take susceptible population as the focus of prevention and treatment, and take targeted monitoring and diagnosis and treatment measures.

Investigation of the population diversity of intermediate host snails and crabs of Paragonimus along Jiulong River, Zhangjiang River and Dongxi River basins in southern Fujian Province / 中国血吸虫病防治杂志

Objective To investigate the population distribution of intermediate host snails and crabs of Paragonimus along the Jiulongjiang River, Zhangjiang River, and Dongxi River basins in Bopingling Mountain, southern Fujian Province, so as to provide baseline data for researches on parasitic disease prevention and control and enlargement of samples in the parasitic resource bank. Methods A total of 23 villages in 8 counties (districts) along the Jiulong River, Zhangjiang River, and Dongxi River basins in Zhangzhou City, Fujian Province were selected as survey sites during the period from November 2020 through March 2023, and snail and freshwater crabs were sampled from 1 to 3 streams and ditches neighboring residential areas in each village. Morphological identification of snails was performed according to the external morphological characteristics of collected snail shells, and the unidentified snail species sampled from the natural foci of paragonimiasis in Yunxiao County were subjected to se-quence analysis of the mitochondrial cytochrome oxidase 1 (CO1) gene. The crab species was identified by observing the morphological characteristics of the terminal segment of the first pleopod of male crabs, and Paragonimus cercariae and metacercariae were detected in collected snails. Results The shells of the unidentified snails sampled from the natural foci of paragonimiasis in Yunxiao County were approximately 50 mm in height and 18 mm in width, thick and solid, long tower cone-shaped, and had 8 to 10 whorls. CO1 gene sequence analysis identified the snail species as Sulcospira hainanensis. A total of 6 freshwater snail species belonging to 5 genera within 3 families, identified 23 survey sites, including Semisulcospira libertina, Paludomus zhangchouensis and S. hainanensis that belonged to the Family Pleurceridae, Tricula fujianensis and T. huaanensis that belonged to the subfamily Triculinae, Family Pomatiopsidae, and Melanoides tuberculata (Family Thiaridae), and 11 species of freshwater crabs belonging to 5 genera within 2 families were identified, including Sinopotamon genus of S. jianglense, S. pinheense, and S. zhangzhouense, Huananpotamon genus of H. planopodum and H. zhangzhouense, Nanhaipotamon genus of N. huaanense and N. longhaiense, and Minpotamon genus of M. nasicum and M. auritum that belonged to the Family Potamidae, and Somanniathelphusa genus of S. huaanensis and S. zhangpuensis (Family Parathelphusidae). In addition, the prevalence of P. westermani cercariae infections was 0.08% (2/2 317) in P. zhangchouensis from Danyan Village in Changtai District and 0.09% (1/1 039) in S. hainanensis from Jinkeng Village in Yunxiao County, and the prevalence of P. westermani metacercariae infections was 25.81% (8/31) in S. jianglense from Danyan Village in Changtai District, and 26.31% (5/19) in S. zhangzhouense from Jinkeng Village in Yunxiao County, respectively. Conclusions There is a population diversity in the intermediate host snails and crabs along the Jiulongjiang River, Zhangjiang River, and Dongxi River basins in Bopingling Mountain, southern Fujian Province, and P. zhangzhouensis and S. hainanensis are, for the first time, confirmed as the first intermediate hosts of P. westermani.

Two-Dimensional Geometric Morphometric Method on Frontal Sinus for Race Estimation: A Lateral Skull Radiograph Study

@#Introduction: Race estimation of unknown individual is essential in forensic investigation. The resiliency of frontal sinus makes it a potential tool for biological profiling, particularly in cases where fragmented skeleton persists. Geometric morphometrics is an efficient way to characterise shape. However, the use of frontal sinus to identify race of Malaysians is yet to be investigated. This research employed a two-dimensional (2D) geometric morphometric to examine the morphological differences of the frontal sinus among the major races in Malaysia. Methods: Lateral skull radiographs which comprising of 453 adult Malaysian (151 Malays, Chinese and Indian respectively) were used. The 2D landmarks of eight were placed on the digitalized radiographs and 2D geometric morphometric analysis was performed using MorphoJ software. Results: Procrustes ANOVA revealed a significantly different frontal sinus shape (p-value < 0.05) between races. Canonical variate analysis showed significantly different frontal sinus morphology (p-value < 0.05) between Malay and Indian as well as Chinese and Indian. Discriminant function analysis with cross-validation demonstrated a 57.4% accuracy rate. Conclusion: This population-specific study based on frontal sinus of Malaysians using the 2D geometric morphometric, though less reliable, sheds new light on the potential applicability of this method for race estimation purpose.

Effectiveness of Tocilizumab in COVID-19 patients with pneumonia: A systematic review

Background and Objective@#COVID-19 contributes significantly to global morbidity and mortality. Age-related comorbidities elevate the risk of severe cases. Studies have recently demonstrated that widely available medications, including tocilizumab (TCZ), can manage severe symptoms. However, its effectiveness is unclear, particularly among the older population. Therefore, this review aimed to evaluate TCZ’s efficacy in managing severe pneumonia in individuals aged 50 and older.@*Methods@#We systematically search several databases and gray literature including Web of Science, CINAHL, Academic Search Complete, PsycINFO, PsycArticles, SocINDEX, CENTRAL/Cochrane Library, PubMed/MEDLINE for original research articles in English across several study designs published in the year 2020-2022. A narrative synthesis was conducted to summarize the evidence. We employed the NIH quality assessment tool for observational cohort studies to evaluate risk of bias. Additionally, we utilized GRADE to appraise the certainty of evidence.@*Results@#Among 539 screened articles, only five studies met the selection criteria. Tocilizumab's impact on severe COVID-19 pneumonia revealed a diverse effect on mortality rate, with 29% in the TCZ group, and 40% in the controls died within 30 days of intubation (OR 0.61; 95% CI, 0.27-1.36). It is also reported that TCZ was not associated with mortality, despite faster decline in pulmonary function and prolonged fever. Hospital mortality in the TCZ group was significantly lower than in the controls, and age over 60 was the only significant risk factor. Moreover, administering TCZ reduced mechanical ventilation needs, with 82% extubated compared to 53% in controls. However, 45% in TCZ group was associated with a higher ventilator-associated pneumonia rate than in the untreated group which was 20% (P < 0.001). Despite this, TCZ-treated patients had shorter hospital stays.@*Conclusions@#The effects of tocilizumab on reducing mortality risk and improving the survival rate of COVID-19 patients with pneumonia remained inconclusive. Yet, the majority of results suggested that giving tocilizumab leads to shorter hospital stays, lowers the requirement for mechanical ventilation, and decreases the likelihood of ICU transfer. Tocilizumab is linked to the incidence of secondary infections; hence, this medication should be closely monitored for side effects.

Epidemiological characteristics of high-risk population for cardiovascular disease of Shanghai residents / 上海预防医学

ObjectiveTo investigate the high-risk detection rate and aggregation of cardiovascular diseases（CVD） in 8 districts of Shanghai and influencing factors， and to provide scientific references for prevention and control of CVD. MethodsBased on the Cardiovascular Disease Screening and Management Program in Shanghai from 2016 to 2021， 104 685 participants aged 35 to 75 in 8 districts of Shanghai were selected for analysis. χ2 test and multivariate logistic regression were used for statistical analysis of the influencing factors of CVD and aggregation of CVD. ResultsThe proportion of high-risk CVD individuals in the population was 19.17%， including the high-risk individuals with hypertension （8.65%）， dyslipidemia （6.33%）， CVD history （5.58%）， and WHO assessed risk ≥20% types （2.69%）， respectively. Old age， overweight and obesity， central obesity， smoking， drinking， farmers， unmarried， and low family income were the risk factors of CVD， while high education level was the protective factor. In the participants， 16 323 people （81.34%） were classified as CVD high-risk groups； The number of aggregation of 1， 2 and ≥3 high risk types of CVD were 16 323（81.34%）， 3 236（16.13%）， 509（2.54%）， respectively. Old age， low education level， low annual family income， farmers， unmarried， smoking， drinking， overweight， obesity and central obesity were associated with the risk of aggregation of high risk types of CVD， and the correlation strength increased with the increase of aggregation types. ConclusionThe prevention and control of CVD in Shanghai should focus on the hypertension， elderly， overweight， obesity， central obesity， smoking， drinking， low educated， low family income， farmers and unmarried people， and targeted intervention measures should be taken to reduce the risk of CVD among residents.