Crise global da atenção primária à saúde / Global crisis in primary health care / Crisis global de la atención primaria

Enquanto no Norte Global se discute uma crise na Atenção Primária à Saúde, a maioria dos países nunca chegou a constituir sistemas de saúde baseados propriamente numa atenção primária robusta. Nesse cenário, o Brasil apresenta uma tendência mais favorável, com conquistas importantes para a atenção primária e a medicina de família e comunidade nos últimos dez anos. Restam desafios a serem superados para que o Sistema Único de Saúde alcance níveis satisfatórios de acesso a seus serviços, com profissionais adequadamente formados e valorizados pela população.

While the Global North is discussing a crisis in primary health care, the majority of countries have never managed to establish health systems based on robust primary care. Brazil presents a more favorable trend, with important achievements for primary care and family practice over the last ten years. There are still challenges to be overcome so that the Unified Health System achieves satisfactory levels of access to its services, with professionals who are properly trained and valued by the public.

Mientras que en el Norte Global se habla de una crisis de la atención primaria, la mayoría de los países nunca han creado realmente sistemas sanitarios basados en una atención primaria robusta. Brasil, muestra una tendencia más favorable, con importantes logros para la atención primaria y la medicina familiar y comunitaria en los últimos diez años. Aún quedan retos por superar para que el Sistema Único de Salud alcance niveles satisfactorios de acceso a sus servicios, con profesionales debidamente formados y valorados por la población.

Práticas Avançadas de Enfermagem ­ PAE / Advanced Nursing Practices ­ ANP

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

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

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

Vacina contra zika: desenvolvimento, agenciamentos e controvérsias sociotécnicas / Zika vaccine: development, assemblages, and sociotechnical controversies

Resumo O ensaio teórico discute as controvérsias sobre o desenvolvimento da vacina contra a zika, evidenciando as negociações que envolvem as escolhas técnico-científicas e os efeitos da definição do "perfil do produto alvo da vacina" (TPP) para uso somente no cenário emergencial. São propostas três perspectivas de análise em diálogo com os Estudos Sociais da Ciência: os fluxos de estabelecimento de normativas pela Organização Mundial da Saúde (OMS), as narrativas publicadas em revistas especializadas e de um grupo de entrevistados. Concluímos que os termos de definição do TPP ajudaram a constituir a política ontológica da OMS, implicando: exposição, responsabilização e culpabilização de mulheres pela prevenção da síndrome congênita da zika; instituição de certas estratégias de vacinação; invisibilização de outros cenários possíveis; maior espaço de aceitação de determinadas plataformas; ampliação das desigualdades globais. Tal política ontológica engendrou uma potente racionalidade emergencial que distinguiu a vacina da necessidade social da vacinação, empurrando a última para a invisibilidade.

Abstract The theoretical essay discusses the controversies about the zika vaccine development, highlighting negotiations which involve technical-scientific choices and the effects of defining the Vaccine Target Product Profile (TPP) for use only in the emergency scenario. Three perspectives of analysis are presented aligned with the Social Studies of Science: the flows of normative establishment provided by the World Health Organization (WHO), the narratives published in specialized journals and the discuss of a group of interviewees. We conclude that the definition terms of TPP supported the establishment of the WHO ontological policy, implying in exposure, accountability and culpability of women for the prevention of Congenital Zika Syndrome; definition of certain vaccination strategies; making other possible scenarios invisible; greater acceptance of certain platforms; widening global inequalities. Such an ontological policy engendered a potent emergency rationality that distinguished the vaccine from the social need for vaccination, pushing the second one towards invisibility.

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

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

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

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

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

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

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

Interconexão entre saúde planetária e resposta ao HIV/aids: uma reflexão sob a ótica do pensamento complexo / Interconnection between planetary health and HIV/AIDS response: a reflection from the perspective of complex thinking

OBJETIVO: Refletir sobre os pontos de interconexão entre saúde planetária e a resposta do mundo ao HIV/aids sob a ótica do pensamento complexo. MÉTODO: Trata-se de ensaio teórico do tipo reflexivo, ancorado no pensamento complexo proposto por Morin e na literatura atual e pertinente sobre saúde planetária e HIV/aids. RESULTADOS: Considerando que os Objetivos do Desenvolvimento Sustentável se interconectam com as atuais discussões sobre a saúde planetária, a reflexão foi tecida a partir dos cinco Ps (isto é, pessoas, planeta, prosperidade, paz e parcerias), os quais tem refletido na resposta do HIV/aids entre as diferentes nações. CONCLUSÃO: As reflexões incitam alguns pontos importantes que envolvem a saúde planetária e o acesso e a adesão ao tratamento, com a finalidade de controlar e erradicar o HIV/aids até 2030. O cuidar da saúde planetária representará o cuidado com todos os seres humanos, em especial aqueles com maior vulnerabilidade, como pessoas vivendo com HIV/aids.

OBJECTIVE: To reflect on the connections between planetary health and the world's response to HIV/AIDS from the perspective of complex thinking. METHOD: This is a theoretical reflective essay anchored in the complex thinking proposed by Morin and in the current and relevant literature on planetary health and HIV/AIDS. RESULTS: Recognizing that the Sustainable Development Goals are linked to current discussions on planetary health, the reflection was woven around the five Ps (i.e., people, planet, prosperity, peace, and partnerships) that are reflected in the response of different nations to HIV/AIDS. CONCLUSION: The reflections raise some important points related to planetary health and access to and treatment adherence, intending to control and eliminate HIV/AIDS by 2030. Caring for planetary health will mean caring for all people, especially those with greater vulnerability, such as people living with HIV/AIDS.

De la bioética de protección a la medicina basada en la evidencia desde una perspectiva transdisciplinar

En el contexto de la bioética se debate con frecuencia el hecho de que, con el desarrollo de la ciencia y la técnica, de las tecnologías de la información y las comunicaciones, y los cambios relacionados con el ecosistema, se hace necesario garantizar el respeto de la vulnerabilidad humana y la integridad personal al aplicar y fomentar el conocimiento científico, la práctica médica y las tecnologías vinculadas (artículo 8 de la Declaración Universal sobre Bioética y Derechos Humanos). Esta vulnerabilidad se protege a través del respeto con equidad y justicia, de los derechos básicos de cada ser humano y al garantizar la integridad personal; esta es la esencia de la bioética de protección y constituye, también, la base principal de la medicina basada en la evidencia, caracterizada por el uso consciente, explícito y juicioso de la evidencia clínica en la práctica diaria para el cuidado del paciente, en aras de ofrecer la mejor atención. Existe una necesidad inmediata de proporcionar beneficios sostenibles a las personas vulnerables en situaciones de enfermedad, por ello es vital mantener un enfoque en la salud pública cubana desde la perspectiva de la bioética de protección y la transdisciplinariedad, sustentada en una medicina basada en la evidencia, en las 3 esferas, en el proceso asistencial, en el proceso pedagógico y en el investigativo; como máximo exponente de la salud global, que tiene como esencia una visión transdisciplinaria, ya que aborda la salud desde la perspectiva del derecho universal a esta y al bienestar social.

In the context of bioethics, the fact that with the development of science and technology, of information and communication technologies, and the changes related to the ecosystem, it is necessary to guarantee respect for vulnerability and personal integrity when applying and promoting scientific knowledge, medical practice and related technologies (article 8 of the Universal Declaration on Bioethics and Human Rights). This vulnerability is protected through respect, with equity and justice, for the basic rights of every human being and by guaranteeing personal integrity; this is the essence of protection bioethics and also constitutes the main basis of evidence-based medicine, characterized by the conscious, explicit and judicious use of clinical evidence in daily practice for patient care, for the sake of to offer the best care. There is an immediate need to provide sustainable benefits to vulnerable people in disease situations, for this reason it is vital to maintain a focus on Cuban public health from the perspective of protective bioethics and transdisciplinarity, supported by evident-based medicine, in the 3 spheres, in the care process, in the pedagogical process and in the investigative process; as the greatest exponent of Global Health, whose essence is a transdisciplinary vision, since it addresses health from the perspective of the universal right to it and to social well-being.

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

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

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

The “Dravidian model”: egalitarianism and healthcare reform

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

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

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

Research on Issues Preventing Japanese Global Health Personnel from Working at International Organizations / 国際保健医療

Objective  There is a growing need to develop human resources with diverse experience, expertise, and a global perspective who can contribute to global rule-making in health. One of the government’s goals is to increase the number of Japanese personnel working for international organizations, but it has not reached the desired level. This study identified the barriers that medical and non-medical professionals have when applying for or working at international organizations, as well as the support measures they expect from the government, to highlight issues and examine employment support measures.Methods  A qualitative and descriptive research was conducted based on semi-structured interviews with 20 physicians, nursing professionals, graduates of public health graduate schools, non-medical professionals, students, etc., who were (1) seeking employment with international organizations, (2) currently employed, and (3) previously employed but left.Results  The following seven themes were highlighted as barriers to applying for or working at an international organization: 〈issues specific to Japanese society and people〉, 〈concerns about a career in global health〉, 〈discrepancy between a career as a healthcare professional and a career in global health〉, 〈need to strengthen skills〉, 〈preparation for competitive examinations〉, 〈importance of WLB〉, 〈issues inherent in international organizations〉. Conclusion  Possible support measures include individual career counseling, seminars on how to survive in international organizations, and seminars for female applicants of child-rearing age, based on the knowledge and experience of current/former employees of international organizations. As for the issues that hinder the dispatch of medical personnel overseas, the first step would be to compare and verify the positive effects that strengthening the overseas dispatch would have on their skills, the workplace environment, and the acceptance of foreign patients. The development and introduction of systems, such as sabbatical and long-term leave, and reinstatement of employment is especially required of global companies and international hospitals.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Reescrever saúde global / Rewriting global health

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

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

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

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

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