Prevenção, emancipação social e transição paradigmática: uma trajetória interdisciplinar de 40 anos no Brasil sobre acidentes e desastres / Prevención, emancipación social y transición paradigmática: una trayectoria interdisciplinaria de 40 años en Brasil sobre accidentes y desastres / Prevention, social emancipation, and paradigmatic transition: a 40-year interdisciplinary Brazilian trajectory on accidents and disasters

Resumo: O artigo, na forma de ensaio, sistematiza uma trajetória profissional de experiências interdisciplinares e socialmente engajadas em torno da análise e prevenção de acidentes e desastres nos últimos 40 anos. O trabalho acadêmico se desenvolveu principalmente no âmbito da pesquisa e pós-graduação na saúde pública brasileira impulsionado pelo movimento sanitarista e a construção do Sistema Único de Saúde (SUS) em sua busca por democracia, justiça social e sanitária. A base empírica envolveu ações de vigilância em saúde dos trabalhadores e ambiental organizadas em redes protagonizadas pelo SUS em conjunto com universidades, sindicatos, movimentos sociais, organizações não governamentais (ONG) ambientalistas e Ministérios Públicos. Eventos de maior complexidade socioambiental em setores como siderurgia, petroquímico, mineração, agronegócio e energia forjaram a busca por novos referenciais epistêmicos e interdisciplinares que abarcam duas novas justiças: a ambiental e a cognitiva. Este artigo apresenta essa trajetória de contribuições conceituais em três movimentos a partir da década de 1980 até os dias atuais, cada qual correspondendo a um contexto sociopolítico e institucional, para pensar movimentos de transição paradigmática na análise e prevenção de acidentes e desastres numa perspectiva interdisciplinar. Finaliza-se com a sugestão de prevenção abissal e emancipatória para enfrentar diferentes crises da atualidade, como a ambiental, a sanitária, a democrática e a civilizatória.

Resumen: El artículo, en forma de ensayo, sistematiza una trayectoria profesional de experiencias interdisciplinarias y socialmente comprometidas en torno al análisis y la prevención de accidentes y desastres en los últimos 40 años. El trabajo académico se desarrolló principalmente en el ámbito de la investigación y postgrado en Salud Colectiva brasileña, impulsado por el movimiento sanitario y la construcción del Sistema Único de Salud (SUS) en su búsqueda por democracia, justicia social y sanitaria. La base empírica involucró acciones de vigilancia en salud y ambiental de los trabajadores, organizadas en redes protagonizadas por el SUS en conjunto con universidades, sindicatos, movimientos sociales, organizaciones no gubernamentales ambientalistas y Ministerios Públicos. Los acontecimientos de mayor complejidad socioambiental en sectores como la siderurgia, el petroquímico, la minería, el agronegocio y la energía han llevado a la búsqueda de nuevas referencias epistémicas e interdisciplinarias que abarcaron dos nuevas formas de justicia, la ambiental y la cognitiva. El artículo sistematiza esa trayectoria de contribuciones conceptuales en tres movimientos a partir de la década de 1980 hasta los días actuales, cada cual, correspondiendo a un contexto sociopolítico e institucional, para pensar movimientos de transición paradigmática en el análisis y prevención de accidentes y desastres desde una perspectiva interdisciplinaria. Se finaliza con la sugerencia de prevención abisal y una prevención emancipadora para enfrentar diferentes crisis de la actualidad, como la ambiental, la sanitaria, la democrática y la de civilización.

Abstract: The article, in the form of an essay, systematizes a 40-year-long professional trajectory of interdisciplinary and socially engaged experiences around the analysis and prevention of accidents and disasters. This study was mainly developed within the scope of research and postgraduate studies in Public Health in Brazil, driven by the sanitarian movement and the construction of Brazilian Unified National Health System (SUS) in its search for democracy and social and health justices. Its empirical basis involved workers' health and environmental surveillance actions organized in networks led by SUS in conjunction with universities, unions, social movements, environmental nongovernmental organizations (NGO), and Public Prosecutors' Offices. Events of greater socio-environmental complexity in sectors such as steel, petrochemicals, mining, agribusiness, and energy forged the search for new epistemic and interdisciplinary references that encompassed two new justices, i.e., environmental and cognitive. This essay systematizes this trajectory of conceptual contributions in three movements from the 1980s to the present day (each corresponding to a socio-political and institutional context) to reflect on paradigmatic transition movements in the analysis and prevention of accidents and disasters from an interdisciplinary perspective. It ends by suggesting abyssal and emancipatory prevention to face different current crises, including environmental, health, democratic, and civilizing ones.

Ethical-legal dilemmas of nursing practice in emergencies and disasters: a scoping review / Dilemas ético-legales de la práctica de enfermería en emergencias y desastres: revisión del alcance / Dilemas ético-legais da prática de enfermagem em emergências e desastres: revisão de escopo

ABSTRACT Objective: To map the ethical-legal dilemmas related to nursing practice in emergency and disaster situations. Method: A scoping review developed in accordance with the JBI method, whose information sources were accessed in databases, in addition to gray literature. The selection was made by reading the titles, abstracts and descriptors, observing eligibility criteria, including two reviewers and a third in case of discrepancies. After reading, data extraction and content analysis of 17 selected studies were carried out. Results: Thirteen ethical-legal dilemmas were mapped related to professional/functional duty towards the family, lack of personal protective equipment and unsafe conditions at work, preparation and availability for action, skills, limits imposed by victims' religion, obligation to provide care. Conclusion: Professionals, researchers and representatives of the category need to resolve demands that involve acting in emergencies and disasters, (re)cognizing the ethical-legal dilemma, and seeking (re)legal frameworks and observance of the fundamental/ethical principles that govern the profession, in the sense to support decision-making and the development of legally safe practices.

RESUMEN Objetivo: Mapear los dilemas ético-legales relacionados con la práctica de enfermería en situaciones de emergencia y desastre. Método: Revisión de alcance, desarrollada de acuerdo con el método JBI, a cuyas fuentes de información se accedió en bases de datos, además de literatura gris. La selección se realizó mediante lectura de títulos, resúmenes y descriptores, observando criterios de elegibilidad, contando con dos revisores y un tercero en caso de discrepancias. Luego de la lectura, se realizó la extracción de datos y análisis de contenido de 17 publicaciones seleccionadas. Resultados: Fueron mapeados 13 dilemas ético-legales relacionados con el deber profesional/funcional hacia la familia, falta de equipos de protección personal y condiciones inseguras en el trabajo, preparación y disponibilidad para la acción, habilidades, límites impuestos por la religión de las víctimas, obligación de brindar cuidados. Conclusión: Profesionales, investigadores y representantes de la categoría necesitan resolver demandas que involucran actuar en emergencias y desastres, (re)conociendo los dilemas ético-legales y buscando el (re)encuadre legal y el cumplimiento de los principios fundamentales/éticos que rigen la profesión, con el fin de apoyar la toma de decisiones y el desarrollo de prácticas jurídicamente seguras.

RESUMO Objetivo: Mapear os dilemas ético-legais relacionados à prática de Enfermagem em situações de emergências e desastres. Método: Revisão de escopo, desenvolvida em conformidade com o método JBI, cujas fontes de informação foram acessadas em bases de dados, além da literatura cinzenta. A seleção se deu pela leitura dos títulos, resumos e descritores, observando critérios de elegibilidade, contando com dois revisores e um terceiro em caso de divergências. Após a leitura, procedeu-se à extração dos dados e análise de conteúdo de 17 publicações selecionadas. Resultados: Mapearam-se 13 dilemas ético-legais relacionados ao dever profissional/funcional diante da família, falta de equipamento de proteção individual e condição insegura no trabalho, preparação e disponibilidade para atuação, competências, limites impostos pela religião das vítimas, obrigatoriedade em prestar cuidado. Conclusão: Profissionais, pesquisadores e representantes da categoria precisam resolver demandas que envolvem a atuação em emergências e desastres, (re)conhecendo os dilemas ético-legais e buscando (re)enquadramentos legais e observância dos princípios fundamentais/éticos que regem a profissão, no sentido de amparar a tomada de decisão e o desenvolvimento de práticas seguras juridicamente.

¿Sistemas de salud resilientes para países ya resilientes? Los discursos de la pandemia en la era post COVID-19 / Resilient health systems for already resilient countries? Pandemic discourses in the post-COVID-19 era

Resumen El objetivo fue reconstruir y analizar los discursos de la pandemia en la era post-COVID-19. La metodología se basó en una revisión crítica de la literatura científica sobre la pandemia, seleccionándose entre una muestra de los 500 artículos científicos más citados en Google Scholar sobre la pandemia, a 80 artículos de carácter no biomédico, clínico o farmacológico, publicados en revistas indexadas en Scopus o Web of Science. El abordaje teórico se basó en los debates sobre predictibilidad e impredecibilidad, determinación e indeterminación, en las ciencias de la salud y ciencias sociales. Como resultado se identificaron y analizaron seis tesis sobre la pandemia: a) la tesis de la impredecibilidad de las pandemias; b) la tesis negacionista de la pandemia; c) la tesis de la pandemia como falla en los sistemas de predictibilidad; d) la tesis de la prevención de eventos catastróficos con intervenciones puntuales; e) la tesis de la postergación estructural de la atención de predicciones por los países no desarrollados; y f) la tesis ecologista-sanitaria, de previsión de una fase crítica para el planeta y la humanidad. Se concluyó sobre los límites de la resiliencia como centro en la preparación de los sistemas de salud de Latinoamérica en la post-pandemia.

Abstract This study aimed to reconstruct and analyze the discourses of the pandemic in the post-COVID-19 era. The methodology was based on a critical review of the scientific literature on the pandemic, selecting 80 non-biomedical, clinical, or pharmacological articles published in journals indexed in Scopus or Web of Science from a sample of the 500 most cited scientific articles on the pandemic in Google Scholar. The theoretical approach was based on the debates on predictability, unpredictability, determination, and indeterminacy in the health and social sciences. As a result, six theses on the pandemic were identified and analyzed: a) the thesis of the unpredictability of pandemics; b) the thesis of pandemic denial; c) the thesis of the pandemic as a failure in predictability systems; d) the thesis of the prevention of catastrophic events with timely interventions; e) the thesis of the structural postponement of predictive care by non-developed countries; and f) the environmentalist-health thesis, of foreseeing a critical phase for the planet and humanity. We concluded on the limits of resilience as the center in preparing Latin American health systems in the post-pandemic.

A redução de risco de desastres, a agenda dos Objetivos Sustentáveis e os princípios do SUS, no contexto da pandemia de COVID-19 / Disaster risk reduction, the Sustainable Goals agenda and the principles of the SUS, in the context of the COVID-19 pandemic

Resumo O objetivo foi analisar os nexos entre o Marco de Sendai para a Redução do Risco de Desastres, os Objetivos de Desenvolvimento Sustentável (ODS) e os princípios do Sistema Único de Saúde (SUS), no contexto da emergência de saúde pública da pandemia de COVID-19, e suas potenciais implicações para a saúde da população. O estudo é qualitativo, transversal, exploratório, com dados coletados junto a profissionais de saúde com experiência em práticas assistenciais e de gestão de risco de emergências e desastres, e tratados pelo software Iramuteq para análise lexical. O corpus textual foi apresentado através da classificação hierárquica descendente, que originou sete classes aglutinadas em três categorias denominadas: resposta a desastres no contexto do SUS; prevenção de futuros riscos de desastres; e ações de preparação e recuperação a partir do Marco de Sendai e dos ODS. Ressaltou-se aspectos sobre os efeitos diretos e indiretos da pandemia de COVID-19 e os desafios relacionados à redução do risco de desastres preconizados no Marco de Sendai, apontando a necessidade de fortalecer a cultura de segurança e sustentabilidade no âmbito do SUS, o que se coaduna com os ODS, bem como aos determinantes sociais da saúde.

Abstract The aim of this study was to analyze the connections between the Sendai Framework for Disaster Risk Reduction, the Sustainable Development Goals (SDGs), and the principles of Brazil's Unified Health System (SUS) in the context of the public health emergency caused by the COVID-19 pandemic and its potential implications for population health. This qualitative, cross-sectional, exploratory study collected data from health professionals with experience in emergency and disaster risk management and treatment practices, which were then processed using the Iramuteq software for lexical analysis. The textual corpus was presented through a descending hierarchical classification that resulted in seven classes grouped into three categories: disaster response in the context of SUS; prevention of future disaster risks; and preparedness and recovery actions based on the Sendai Framework and the SDGs. The study highlighted aspects related to the direct and indirect effects of the COVID-19 pandemic and the challenges related to disaster risk reduction as advocated by the Sendai Framework, emphasizing the need to strengthen the culture of safety and sustainability within the SUS, which aligns with the ODS and social determinants of health.

Preparación y enfrentamiento a la pandemia de la COVID-19

Los desastres sanitarios han afectado la humanidad desde sus albores. En otras epidemias, las bajas causadas se contabilizan por cientos de miles. La preparación para el enfrentamiento a la epidemia de la COVID-19 en el hospital Militar de Matanzas, "Dr. Mario Muñoz Monroy", comenzó tempranamente. Con el objetivo de analizar esa experiencia, se reflexiona sobre los resultados del enfrentamiento en el año 2020, a partir de los principales aspectos, las coordinaciones con otros organismos, las decisiones tomadas, cambios estructurales y modificaciones de procesos institucionales. Consolidar la superación científica ha sido un pilar permanente, junto con la disciplina, la responsabilidad personal y social de los miembros del colectivo.

Health disasters have affected humanity since its dawn. In other epidemics, the casualties caused number in the hundreds of thousands. The preparation for confronting the COVID-19 epidemic at the Military Hospital of Matanzas, "Dr. Mario Muñoz Monroy", began early. In order to analyze this experience, we reflect on the results of the confrontation in 2020, based on the main aspects, the coordination with other organizations, the decisions made, structural changes and modifications of institutional processes. Consolidating scientific improvement has been a permanent pillar, along with discipline, personal and social responsibility of the members of the collective.

O papel do psicólogo frente a situações de desastres / The psychologist's role in disaster situations / El papel del psicólogo en situaciones de desastre

INTRODUÇÃO: Os desastres são considerados eventos vitimadores que provocam danos psíquicos e sofrimento às pessoas atingidas e esses casos exigem que os psicólogos estejam cada vez mais preparados para atuar nessas circunstâncias. OBJETIVO: investigar a atuação do psicólogo frente a situações de desastres. A pesquisa se configurou como qualitativa com delineamento de pesquisa de campo. METODOLOGIA: Foram participantes cinco psicólogas com especializações na área de desastres e emergências. O instrumento utilizado para atingir os objetivos da pesquisa foi um roteiro de entrevista semiestruturado composto por sete perguntas semiabertas. As entrevistas foram gravadas em áudio, transcritas na íntegra e analisadas por meio da análise de conteúdo. RESULTADOS: De acordo com os temas abordados pelas participantes, a atuação do psicólogo em desastres é dividida em: pré-desastre, durante o desastre e pós-desastre, o que dependerá do tipo de evento e condições apresentadas; as vítimas devem receber apoio integral, buscando minimizar os danos gerados pela tragédia. Ressalta-se que não é necessária uma atuação apenas depois que o desastre já ocorreu, mas há, além disso, toda uma preparação no prédesastre em locais que possuem maior propensão ao acontecimento destes eventos. CONCLUSÃO: O trabalho do profissional da Psicologia no campo dos desastres é de extrema importância para as vítimas, os parentes das vítimas, a comunidade como um todo e até para os profissionais envolvidos, podendo reduzir o estresse agudo, que é gerado a partir da experiência traumática, priorizando que o sujeito recupere sua capacidade cognitiva de agir e sentir a situação.

INTRODUCTION: Disasters are considered victimizing events that cause psychic damage and suffering to the people affected and these cases require psychologists to be increasingly prepared to act in these circumstances. OBJECTIVE: to investigate the role of the psychologist in the face of disaster situations. The research was configured as qualitative with a field research design. METHODOLOGY: Five psychologists with specializations in the area of disasters and emergencies participated. The instrument used to achieve the research objectives was a semi-structured interview guide composed of seven semi-open questions. The interviews were audio recorded, fully transcribed and analyzed using content analysis. RESULTS: According to the topics addressed by the participants, the psychologist's role in disasters is divided into: pre-disaster, during the disaster and post-disaster, which will depend on the type of event and conditions presented; victims must receive full support, seeking to minimize the damage generated by the tragedy. It is noteworthy that it is not necessary to act only after the disaster has already occurred, but there is, in addition, a whole pre-disaster preparation in places that are more prone to the occurrence of these events. CONCLUSION: The work of the Psychology professional in the field of disasters is extremely important for the victims, the victims' relatives, the community as a whole and even for the professionals involved, and can reduce the acute stress, which is generated from the experience trauma, prioritizing the subject to recover his cognitive ability to act and feel the situation.

INTRODUCCIÓN: Los desastres son considerados hechos victimizantes que provocan daño psíquico y sufrimiento a las personas afectadas, y estos casos exigen que los psicólogos estén cada vez más preparados para actuar en estas circunstancias. OBJETIVO: investigar el papel del psicólogo frente a situaciones de desastre. La investigación se configuró como cualitativa con diseño de investigación de campo. METODOLOGÍA: Participaron cinco psicólogos con especializaciones en el área de desastres y emergencias. El instrumento utilizado para lograr los objetivos de la investigación fue un guión de entrevista semiestructurado compuesto por siete preguntas semiabiertas. Las entrevistas fueron grabadas en audio, transcritas en su totalidad y analizadas mediante análisis de contenido. RESULTADOS: De acuerdo a los temas abordados por los participantes, el rol del psicólogo en desastres se divide en: predesastre, durante el desastre y postdesastre, lo que dependerá del tipo de evento y condiciones que se presenten; las víctimas deben recibir todo el apoyo, buscando minimizar los daños causados por la tragedia. Cabe señalar que no es necesario actuar solo después de que ya haya ocurrido el desastre, sino que existe, además, toda una preparación previa al desastre en los lugares más propensos a la ocurrencia de estos eventos. CONCLUSIÓN: La labor del profesional de la Psicología en el campo de los desastres es sumamente importante para las víctimas, los familiares de las víctimas, la comunidad en su conjunto e incluso para los profesionales involucrados, pudiendo disminuir el estrés agudo, que se genera a partir de la experiencia traumática, priorizando que el sujeto recupere su capacidad cognitiva para actuar y sentir la situación.

Indicators of Nurse Leadership in Disaster Management: A Qualitative study

@#Introduction: Nurses play critical roles in disaster management and are required to demonstrate leadership by dealing with disaster events effectively. This study aimed to identify the nurse leadership indicators at each phase of disaster management. Methods: A qualitative descriptive study was conducted in two phases between November 2017 -January 2018 at two regional hospitals and one central hospital in Yogyakarta. The first phase involved semi-structured in-depth interviews with seven emergency nurses, and the second was a focus group discussions with five nurses’ managers or lecturers. Participants were selected using a purposive sampling technique. Data Analyze used a modified version framework method. Results: We found 49 indicators of nurse leadership in disaster management. We grouped indicators into two major groups: common indicators (27 indicators) and specific indicators (22 indicators). Four themes were obtained according to the disaster management phases: nurse leadership in the mitigation phase, the preparedness phase, the response phase, and the recovery/rehabilitation phase. Each theme contains three main sub-themes (3Cs): character, competence, and the central role of the leader. Conclusion: Using the International Council of Nurses (ICN) framework’s disaster phase as a conceptual basis, 49 nurse leadership indicators were identified as potential information for future items candidates of the instrument for measuring nurse leadership in disaster management.

Cross-Sectional Study Protocol on Community Disaster Resilience in Selangor Flood-Prone Communities During Covid-19 Pandemic

@#Introduction: Future floods are expected to increase in frequency and intensity. Communities must arm themselves with information and skills to overcome these disasters and limit their impact. Moreover, the Coronavirus-19 infection doubled as the transmission was thought to occur when evacuation facilities were overrun and crowded. Despite government and agency assistance, the aftermath of a flood disaster leaves victims susceptible to the impacts. Resilience is essential when battling flooding or a pandemic. Thus, this study aims to determine the community disaster resilience score and its associated factors in Selangor flood-prone communities during the COVID-19 Pandemic. Methods: A cross-sectional quantitative survey will be conducted with a sample size of 574 residents living in flood-prone areas. A validated self-administered questionnaire will be distributed in liaison with community leaders using paper and online. The questionnaire includes respondents’ demographic, flood disaster preparedness, general disaster preparedness belief, and community disaster resilience. The associations and predictors between the independent and dependent variables will be examined using bivariate analysis and multiple linear regression with a < 0.05 significance level. Discussion: Insights from this research will help communities better prepare for and recover from disasters. A more robust resilience approach requires focusing on predictors and recruiting those factors to assist health authorities in promoting flood disaster preparedness and resilience practices in the community. Researchers may comprehend the health behaviour of a community to build disaster preparedness and resilience as well as a health intervention.

Application of Sendai Framework for Disaster Risk Reduction in Food Security During Flood Disaster in Malaysia: A Narrative Review

@#Disaster risk reduction (DRR) plays essential roles in ensuring food security to avoid adverse social, economic and financial implications to the disaster victims. This article aims to review existing DRR strategies in food security during flood disasters and recommend strategies that can be adapted into policies in Malaysia according to the Sendai Framework. Sendai Framework provides comprehensive, globally recognized priority themes in DRR while highlighting governmental and stakeholders’ responsibility. A literature review was carried out by searching available published literatures from online databases and selected information used in this review is taken from articles, journals, reports, national reports, news, and thesis regarding the topic from November 2021 to January 2022. This review revealed that DRR strategies of food security during flood disasters in Malaysia lack one out of 14 work areas in four priorities in the Sendai Framework, which is the national-level risk and vulnerability assessment system and tools. This article proposed 19 recommendations to improve eight work areas across all four priority areas to enhance national food security during flood disasters.

Self Efficacy and Nurses’ Disaster Competency in Disaster Preparedness Management

@#Introduction: Natural disasters are catastrophic events with geological, and hydrological origins such as earthquakes, floods, hurricanes, landslides that can cause fatalities, property damage and social environmental disruption. The threat of geological disasters like tsunami and earthquakes as well as the threat of hydrometeorology, such as floods, landslides, hurricanes, and fires normally occur in Indonesia. Nurses have a role to play in educating the public and engaging in the crisis. This research aims to determine the relationship between nurses’ self-efficacy and disaster preparedness management competency. Method: This research is a quantitative study with a cross-sectional approach. The population consisted of nurses who served in the Emergency Room at three disaster referral hospitals in Padang. According to the inclusion criteria, nurses who participated in this study were selected by the purposive sampling method as 1st level disaster nurses, as many as 60 nurses. The data collection was carried out from August to October 2020. Results: This research shows that there was a significant relationship between nurses’ self-efficacy and disaster preparedness management with a p-value of 0.0001 and a strong relationship with a value of r = 0.673. There was a relationship between disaster management competencies and disaster preparedness management with a p-value of 0.0001, the strength of the relationship was moderate with a value of r = 0.473. Conclusion: The nurse is one of the resources responsible for disaster preparedness management in the community. Educating the nurses about disaster preparedness management increases the nurses’ readiness. Nurses can take action in managing the disaster response.

Development of “Moroca” as a Learning Media for Reproductive Health Services in Disaster Situations

@#Introduction: Due to its geographical, geological, and demographic conditions, Indonesia is facing the risks of natural disasters such as floods, landslides, earthquakes, and volcanic eruptions. Midwives as health workers have a strategic role as providers of reproductive health services, including in disaster situations. This study aims to develop learning media for reproductive health services in a disaster situation based on the monopoly game. Methods: The research employed research and development (R&D) design. The development of learning media for reproductive health services in disaster situations is based on the monopoly game, which consists of the following steps: seeing the potential and problems, data collection, product design, validation by experts, product trials, and product revisions. Results: The learning media is named “Moroca” (Monopoli Kesehatan Reproduksi pada Situasi Bencana / Monopoly of Reproductive Health Services in Disaster Situations). Validation was carried out by two experts and the media was declared feasible and valid for use. The product trial was conducted on 22 students of Midwifery Program. The statistical test used the Wilcoxon test. The results of the analysis showed that there was a significant increase in the level of knowledge about reproductive health services in disaster situations among students after using “Moroca”. Conclusion: Learning media is needed to increase the knowledge and skill of the students. Moroca is can be used as one of the alternative media in education for midwifery students.

Management of helicopter medical transport in 36 patients with critical cardiac disease / 中华危重病急救医学

Objective:To summarize the management experience of helicopter medical transport in patients with critical heart disease, so as to provide reference for transport of patients with critical heart disease under the background of major natural disasters.Methods:The clinical and transport data of 36 critically ill cardiac patients in Fuwai Central China Cardiovascular Hospital from 16:30 on July 21 to 19:30 on July 22, 2021 due to historically rare heavy rainstorms were collected. All 36 critically ill cardiac patients were transported by helicopter. The safe transportation was implemented under the measures of quickly forming a transport leadership and coordination group, clarifying responsibilities and division of labor, doing a good job in the pretreatment of the patient's condition, pipeline assessment and mechanical circulation support (MCS) equipment, simulating and practicing the transfer process, improving the safety of the transfer implementation process, and effectively handing over with the target hospital. The gender, age, disease type, MCS, transport and outcome of patients were collected.Results:Thirty-six patients with cardiac critical illness were from adult extracardiac intensive care unit (ICU), adult cardiac care unit (CCU), children's CCU, comprehensive ICU and department of neurology. There were 24 males and 12 females; age (50.93±20.86) years old. There were 12 patients using respirator, 7 patients needing MCS, 2 of whom needed both extracorporeal membrane oxygenation (ECMO) and intra-aortic balloon pump (IABP), and 7 patients with post-cardiac surgery. The total distance of transportation of 36 patients was 1 638.4 km, the transit time was 10.5 hours, one way flight time of helicopter was about 8 minutes, and the average transport time per patient was about 17.5 minutes. The vital signs of 36 patients during transport were basically stable, without complications, and all of them reached the target hospital safely.Conclusion:Under the seamless connection of the rapid establishment of the transfer leadership coordination group, assessment of the patient's condition and pretreatment, the simulation of the transfer process, and the effective handover with the receiving hospital, the use of helicopter for medical transport for critically ill heart patients is feasible and safe, which can buy valuable time for saving patients' lives and further treatment.

Correlations between disaster cognition and professional identity of nurses during post-disaster reconstruction: a cross-sectional study / 中国实用护理杂志

Objective:To investigate the status of clinical nurses′ professional identity and disaster cognition during the post-disaster reconstruction, and to analyze the correlation between the two.Methods:With the convenient sampling method, the 346 nursing staff of the First Affiliated Hospital of Zhengzhou University participated in the disaster reconstruction for the survey, using the general questionnaire, the nurse professional identity scale, the disaster cognition questionnaire for investigation. Pearson correlation was used to analyze the correlation between disaster cognition and professional identity.Results:The disaster cognition during the post-disaster needed to be improved, the choice rate of knowing disaster nursing well was 6.36%-70.23%. Gender had significant statistical significance on the scores of thinking the importance of disaster care training and willingness to join in disaster care continuing education ( t=-2.54 and -2.32, both P<0.05). Position had significant statistical significance on the score of willing to join in the enthusiasm of emergency rescue( F=6.62, P<0.05). Whether have ever participated in disaster training had significant statistical significance on the scores of focusing on the frequency of disasters and understanding the degree of disaster care ( t=5.57, 7.88, both P<0.05). Nurse professional identity level was high during the post-disaster reconstruction, the total score was (121.73 ± 19.75). Whether have ever participated in disaster training had significant statistical significance on the score of professional identity ( t=4.57, P<0.05). And the total score and each dimension score of disaster recognition were positively correlated with the total score and each dimension score of professional identity in nurses ( r values were 0.44-0.53, all P<0.05). Conclusions:The disaster cognition level is still lacking, the professional identity level is high. The disaster cognition affects professional identity levels to a certain extent, so nursing managers should improve the disaster recognition of nursing staff by making targeted strategy, which can not only improve the professional identity levels, but also reserve power for emergency disaster and post-disaster reconstruction reserves.

Analysis on the status quo and influencing factors of disaster preparedness of nursing organization among newly recruited nurses in tertiary grade A hospitals of Zhengzhou city / 中国实用护理杂志

Objective:To investigate the status quo of disaster preparedness of nursing organization among newly recruited nurses in tertiary grade A hospitals of Zhengzhou city and analyze the influencing factors in order to provide theoretical basis for further improving the standardized training program for newly recruited nurses.Methods:This study was a cross-sectional survey. From December 2021 to March 2022, 964 newly recruited nurses from 4 tertiary grade A hospitals of Zhengzhou city were selected as the survey objects by convenient sampling method. The general information questionnaire and Hospital Nursing Department Disaster Preparedness Scale were used to conduct the questionnaire survey. Disordered multiple classification Logistic regression was used to analyze the influencing factors of disaster preparedness of hospital nursing organization.Results:The disaster preparedness score of nursing organization of newly recruited nurses was (37.62 ± 7.57) points. The results of disordered multiple classification Logistic regression showed that the factors influencing the disaster preparedness level of nursing organization of newly recruited nurses were whether they had participated in disaster rescue work and the degree of attention paid by nursing organizations to disaster rescue training (both P<0.05). Conclusions:The disaster preparedness of the nursing organization of newly recruited nurses in tertiary grade A hospitals of Zhengzhou city was at a medium level. Nursing managers should pay attention to the disaster preparedness of newly recruited nurses, develop their core abilities for disaster rescue according to their influencing factors, and incorporate disaster preparedness related contents on the basis of standardized training programs.

Ethics Considerations on Public Management of Disaster Rescue under the Context of Epidemic Prevention and Control / 中国医学伦理学

Natural disasters and epidemics are intertwined, posing a great threat to national health and property security, and hindering economic development. Faced with the complex rescue environment, the contradiction between individual interests and collective interests may escalate, causing ethical dilemmas different from those encountered in conventional medicine. In the context of COVID-19 epidemic prevention and control, how to maximize the coordination of the conflict between individual interests and collective interests, minimize the losses caused by disasters, and maintain social stability is a new topic of ethical research. Based on the ethical principles of public management, this paper explored the ethical conflicts of public management faced by emergency disaster rescue, in the view of providing ethical theoretical support for dealing with the practical difficulties of emergency public health crisis, and promoting the development and progress of disaster medical rescue work.

Vulnerabilidade programática sob a perspectiva de profissionais e pessoas idosas LGBTQIA+: uma revisão de escopo / Programmatic vulnerability from the perspective of LGBTQIA+ professionals and older people: a scoping review

RESUMO A vulnerabilidade programática diz respeito a acesso e utilização dos recursos de saúde, como programas direcionados a prevenção, assistência e reabilitação de saúde. Para a pessoa idosa LGBTQIA+, as questões de vulnerabilidade são ainda mais significativas, uma vez que o referido grupo enfrenta outras questões de cunho social que refletem no preparo dos profissionais ante o atendimento nos serviços de saúde. Objetivou-se mapear a ocorrência da vulnerabilidade programática de pessoas idosas LGBTQIA+. Trata-se de uma revisão de escopo, orientada pelas recomendações JBI mediante o mnemônico P (Idosos LGBTQIA+), C (vulnerabilidade) e C (programas de atenção à saúde). Os documentos foram analisados qualitativamente com suporte do software Interface de R, IRaMuTeQ. Foram identificadas duas categorias temáticas: A construção do cuidado integral: o papel das instituições de saúde e social no desenvolvimento de ações voltadas para as necessidades da pessoa idosa LGBTQIA+; Vulnerabilidade programática: lacunas no cuidado à pessoa idosa pertencente a minorias sexuais. O presente estudou permitiu identificar que as pessoas idosas LGBTQIA+ podem vivenciar situações de vulnerabilidade programática, sobretudo nos serviços de saúde, instituições de longa permanência e nos atendimentos ofertados pelos profissionais de saúde, sob a ótica do estigma e preconceito.

ABSTRACT Programmatic vulnerability concerns access to and use of health resources, such as programs aimed at health prevention, care, and rehabilitation. For LGBTQIA+ older people, vulnerability issues are even more significant, since that group faces other social issues that reflect on the preparation of professionals to provide care in health services. The aim was to map the occurrence of programmatic vulnerability among LGBTQIA+ older people. This is a scoping review, guided by the JBI recommendations using the mnemonic P (LGBTQIA+ older people), C (vulnerability), and C (healthcare programs). The documents were analyzed qualitatively using the R Interface software, IRaMuTeQ. Two thematic categories were identified: The construction of comprehensive care: the role of health and social institutions in developing actions aimed at the needs of LGBTQIA+ older people; Programmatic vulnerability: gaps in care for older people belonging to sexual minorities. This study identified that situations of vulnerability are more evident in health services, long-term care institutions, and in care provided by health professionals, suffering from stigma and prejudice.

A epidemia da dengue no Estado do Rio de Janeiro e as ações assistenciais como estratégia para gestão de risco de desastres: estudo de caso / The dengue epidemic in the state of Rio de Janeiro and assistance actions as a strategy for disaster risk management: a case study

Epidemias de dengue e as estratégias de preparação adequadas para enfrentá-las têm sido um desafio constante. A partir do estudo do modelo assistencial desenvolvido em 2008 no Rio de Janeiro, buscou-se compreender as intervenções que abrandaram seus efeitos, e assim (re)pensar os planos de contingência e outras ações de gestão de risco de desastres. O objetivo geral foi sintetizar evidências a partir do modelo assistencial implementado, para sustentar o desenvolvimento de planos de contingência frente à epidemia de dengue, voltados a atenção à saúde. Com objetivos específicos de: Descrever os desafios para a resposta à epidemia de dengue no estado do Rio de Janeiro. Analisar o modelo assistencial desenvolvido para resposta à epidemia de dengue. Discutir as ações de gestão de risco de desastres, voltadas para a resposta a epidemias de dengue. O método foi Estudo de caso único, e qualitativo e com fontes de evidência de entrevistas semiestruturadas, documentos da imprensa não oficial (jornais) e oficial, documentos administrativos, arquivos através dos TabNet, documentos iconográficos e documentos do acervo da pesquisadora e fontes de informação técnico-científica de bases de dados. Para tratar os dados utilizou-se o software Iramuteq®, análise documental e seleção de estudos por Revisão Sistemática. Epidemias de dengue, na dependência de sua magnitude, das vulnerabilidades socioeconômicas e ambientais, da infestação vetorial, da circulação viral e da capacidade de resposta local, têm potencial para conturbar as rotinas dos serviços de saúde. Os desafios trazem a necessidade de adoção de ações de gestão de risco de desastres, que se desdobram em resiliência social. A análise do modelo assistencial descortinou as ações para a reorganização assistencial, sua possível reprodução em outras epidemias e sua adoção nos planos de contingência, importante ferramenta de planejamento, que congrega os esforços e contribuições dos entes públicos e privados, além da participação popular. A atenção à saúde nas epidemias, parte da organização da rede básica, apoiada por políticas públicas e planos de contingência, protagonizados pelos gestores públicos, construídos com a participação da sociedade e dos diversos setores públicos e privados e conduzidos pelo setor saúde.

Dengue epidemics and adequate preparedness strategies to face them have been a constant challenge. From the study of the care model developed in 2008 in Rio de Janeiro, we sought to understand the interventions that mitigated its effects, and thus (re)think contingency plans and other disaster risk management actions. The general objective was to synthesize evidence from the implemented care model, to support the development of contingency plans against the dengue epidemic, aimed at health care. With specific objectives to: Describe the challenges for the response to the dengue epidemic in the state of Rio de Janeiro. To analyze the care model developed to respond to the dengue epidemic. Discuss disaster risk management actions aimed at responding to dengue epidemics. The method was a single case study, qualitative and with sources of evidence from semi-structured interviews, documents from the unofficial (newspapers) and official press, administrative documents, files through TabNet, iconographic documents from the researcher's collection and sources of information technical-scientific databases. To treat the data, the Iramuteq® software, document analysis and selection of studies by Systematic Review were used. Dengue epidemics, depending on their magnitude, socioeconomic and environmental vulnerabilities, vector infestation, viral circulation and local response capacity, have the potential to disrupt the routines of health services. The challenges bring the need to adopt disaster risk management actions, which result in social resilience. The analysis of the care model revealed actions for care reorganization, its possible reproduction in other epidemics and its adoption in contingency plans, an important planning tool that brings together the efforts and contributions of public and private entities, in addition to popular participation. Health care in epidemics, part of the organization of the basic network, supported by public policies and contingency plans, led by public managers, built with the participation of society and the various public and private sectors and conducted by the health sector.

Las epidemias de dengue y las estrategias adecuadas de preparación para enfrentarlas han sido un desafío constante. A partir del estudio del modelo de atención desarrollado en 2008 en Río de Janeiro, buscamos comprender las intervenciones que mitigaron sus efectos, y así (re)pensar los planes de contingencia y otras acciones de gestión del riesgo de desastres. El objetivo general fue sintetizar evidencias del modelo de atención implementado, para sustentar el desarrollo de planes de contingencia frente a la epidemia de dengue, dirigidos a la atención en salud. Con objetivos específicos: Describir los desafíos para la respuesta a la epidemia de dengue en el estado de Río de Janeiro. Analizar el modelo de atención desarrollado para responder a la epidemia de dengue. Discutir las acciones de gestión del riesgo de desastres destinadas a responder a las epidemias de dengue. El método fue un estudio de caso único, cualitativo y con fuentes de evidencia de entrevistas semiestructuradas, documentos de la prensa no oficial (periódicos) y oficial, documentos administrativos, archivos a través de TabNet, documentos iconográficos y administrativos de la colección del investigador y fuentes de información técnico- bases de datos científicas. Para el tratamiento de los datos se utilizó el software Iramuteq®, análisis de documentos y selección de estudios por Revisión Sistemática. Las epidemias de dengue, dependiendo de su magnitud, vulnerabilidades socioeconómicas y ambientales, infestación de vectores, circulación viral y capacidad de respuesta local, tienen el potencial de perturbar las rutinas de los servicios de salud. Los desafíos traen consigo la necesidad de adoptar acciones de gestión del riesgo de desastres, que resulten en resiliencia social. El análisis del modelo de atención reveló acciones para la reorganización de la atención, su posible reproducción en otras epidemias y su adopción en planes de contingencia, una importante herramienta de planificación que reúne esfuerzos y contribuciones de entidades públicas y privadas, además de la participación popular. La atención en salud en epidemias, parte de la organización de la red básica, sustentada en políticas públicas y planes de contingencia, liderada por gestores públicos, construida con la participación de la sociedad y de los diversos sectores público y privado y conducida por el sector salud.

Terapia ocupacional e trabalho: desafios e perspectivas de uma prática emergente durante e após a pandemia da Covid-19 / Occupational therapy and work: challenges and perspectives of an emerging practice during and after the Covid-19 pandemic

Resumo Este ensaio discute as possibilidades de intervenção da terapia ocupacional no campo do trabalho em período pandêmico, bem como apontar os desafios e perspectivas de atuações pós-pandemia. As intervenções foram discutidas a partir de três estágios: i) preparação pré-pandemia; ii) estratégias de preparação durante a pandemia; iii) recuperação pós-pandemia, considerando os níveis micro, meso e macroestruturais, a partir da perspectiva de uma prática centrada na pessoa e no ambiente de trabalho. A atenção às (in)capacidades laborais e a atuação no processo de retorno ao trabalho foram consideradas as principais intervenções do terapeuta ocupacional, articuladas com os diversos atores, instituições, serviços e entidades de classe, de forma a ampliar as ações e promover uma rede de atenção integrada. As novas configurações do trabalho resultantes da inovação tecnológica ampliaram o diálogo interdisciplinar da terapia ocupacional com o campo do trabalho. Espera-se contribuir com reflexões teóricas para pensar a prática profissional e o fortalecimento desse campo na contemporaneidade.

Abstract This essay discusses the intervention possibilities of occupational therapy in the field of work in the pandemic period, as well as points out the challenges and perspectives of post-pandemic actions. Interventions were discussed from three stages: i) pre-pandemic preparation; ii) pandemic preparedness strategies; iii) post-pandemic recovery, considering the micro, meso and macrostructural levels, from the perspective of a practice centered on the person and the work environment. Attention to work (in)capacities and acting in the process of returning to work were considered the main interventions of the occupational therapist, articulated with the various actors, institutions, services and class entities, in order to expand actions and promote a network integrated care. The new configurations of work resulting from technological innovation have expanded the interdisciplinary dialogue between occupational therapy and the field of work. It is expected to contribute with theoretical reflections about professional practice and the strengthening of this field in contemporary times.

Simulação e cooperação interdisciplinar e interinstitucional: desenvolvimento de competências do estudante de enfermagem em desastres / Simulación y cooperación interdisciplinaria e interinstitucional: desarrollo de competencias del estudiante de enfermería en desastres / Interdisciplinary and interinstitutional simulation and cooperation: development of nursing students competencies in disaster

Resumo Objetivo identificar a importância atribuída à utilização da prática simulada na ação pedagógica do estudante do Curso de Licenciatura em Enfermagem no domínio de desastres e no âmbito interdisciplinar e interinstitucional em Portugal. Métodos estudo enquadrado no paradigma qualitativo, apoiado no raciocínio indutivo e exploratório. Como técnica de coleta de dados, recorreu-se à entrevista semiestruturada, aplicada a coordenadores/diretores dos Cursos de Licenciatura em Enfermagem de escolas públicas e privadas de Portugal. Resultados a metodologia de simulação no domínio de desastres constitui uma estratégia de ensino/aprendizagem, para os estudantes de enfermagem desenvolverem competências nesse âmbito. Este tipo de metodologia de ensino/aprendizagem terá maior vantagem, se realizada em parceria com organizações que intervêm nas operações de proteção e socorro e de âmbito interdisciplinar, uma vez que potencializa a qualidade de prevenção e de resposta de todos os atores envolvidos. Considerações finais e implicações para a prática face à complexidade específica e à imprevisibilidade das situações de desastres, o estabelecimento de parcerias estratégicas de cooperação com organizações com responsabilidade nesse domínio, que promova nos estudantes de enfermagem o desenvolvimento de competências e diminua a visão determinística errada das organizações, relativamente à capacidade de o estudante integrar estas ações, é fundamental.

Resumen Objetivo identificar la importancia atribuida al uso de la práctica simulada en la acción pedagógica del estudiante del Curso de Pregrado en Enfermería en el dominio de los desastres y en el ámbito interdisciplinario e interinstitucional en Portugal. Método s: estudio enmarcado en el paradigma cualitativo, apoyado en el pensamiento inductivo y exploratorio. Como técnica de los datos, se aplicaron entrevistas semiestructuradas a los coordinadores/directores de escuelas de enfermería públicas y privadas de Portugal. Resultados la metodología de simulación en el ámbito de las catástrofes es una estrategia de enseñanza/aprendizaje para que los estudiantes de enfermería desarrollen competencias en este ámbito. Este tipo de metodología de enseñanza/aprendizaje será más ventajosa si se realiza en alianza con organizaciones que intervienen en operaciones de protección y socorro y en un ámbito interdisciplinario, ya que mejora la calidad de la prevención y respuesta de todos los actores involucrados. Consideraciones finales e implicaciones para la práctica dada la complejidad específica e imprevisibilidad de las situaciones de desastre, el establecimiento de alianzas estratégicas de cooperación con organizaciones con responsabilidad en este dominio, lo que promueve el desarrollo de competencias en los estudiantes de enfermería y reduce la visión determinista equivocada de las organizaciones, en cuanto a la capacidad del estudiante para integrar estas acciones, es fundamental.

Abstract Objective to identify the importance attributed to simulated practice use in nursing undergraduate students' pedagogic actions in the field of disasters, in an interdisciplinary and interinstitutional scope in Portugal. Methods a study framed in the qualitative paradigm, supported by inductive and exploratory reasoning. As a data collection technique, semi-structured interviews were applied to coordinators/directors of nursing courses at public and private schools in Portugal. Results simulation methodology in the field of disasters is a teaching/learning strategy for nursing students to develop skills in this area. This type of teaching/learning methodology will have a greater advantage if carried out in partnership with organizations involved in protection and rescue operations and with an interdisciplinary scope, since it enhances prevention quality and response of all actors involved. Final considerations and implications for practice considering the specific complexity and unpredictability of disaster situations, the establishment of strategic cooperation partnerships with organizations with responsibility in this field, which promotes the development of nursing students' skills and reduces the erroneous deterministic view of organizations, regarding the ability of students to integrate these actions, is fundamental.

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

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

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

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