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.

Potential financial loss and risk factors for hamstring muscle injuries in elite male Brazilian soccer players: a season-long prospective cohort pilot study.

Purpose: The aim of this pilot study was to analyze the potential financial loss and a range of potential risk factors for hamstring muscle injuries in elite Brazilian soccer. Methods: Thirty-four male players (age: 25 ± 6 years; stature: 180 ± 8 cm; body mass: 78 ± 9 kg; minutes played in matches: 2243 ± 1423 min) from an elite professional soccer club were monitored during a 12-month season. Muscle injury was identified by magnetic resonance imaging and the severity was defined according to the number of days away: minimal (1-3 days), mild (4-7 days), moderate (8-28 days), severe (>28 days). Potential financial loss due to the team's under achievements was determined. Dorsiflexion range of motion, eccentric knee flexor strength and isokinetic tests were performed during the pre-season. Association between dependent variables and the occurrence of injury was evaluated. Results: Nine hamstring muscle injuries with moderate severity were found in 8 athletes. Recovery time was 22 days off the field on average. Potential financial loss was $-43.2 million USD and earnings on merit money was 21%. Previous injury, increased flexor deficit 60°â€…/sec and increased flexor fatigue index 300°/sec were all associated with a greater chance of hamstring muscle injury. Ankle dorsiflexion range of motion was significantly lower in the injured group (35.6 ± 3° vs. 39.1 ± 4.9°; p = 0.017, effect size = -0.74). Conclusion: High financial burden was found in elite Brazilian soccer during one full season. Injured athletes had high hamstring fatigue index, knee flexor strength deficit, ankle range of motion restriction and previous hamstring muscle injury when compared to non-injured athletes. Therefore, preventive approaches in professional soccer players with previous hamstring injuries should be a priority.

'Their opinion counts as far as you let it'- understanding queer migration in Minas Gerais, Brazil.

The literature regarding the life course and queer migration has shown that many gay men and lesbians seek large cities to live their lives away from the prying eyes of their families and build their sexual identity. In the global south, little is known about the effects that sexuality can have on the migratory trajectories of individuals. In that sense, what happens to the lives of those that have never left their hometowns and have had to find ways to experience their sexuality in these places. Therefore, the aim of this paper is to discuss queer migration, the impact on the lives of the individuals that left their hometowns, others that at one point came back and those that never left in the first place. Based on 21 life course interviews with self-identified LGB individuals in small/medium towns in Brazil, this paper shows how aspects such as closeness to family, educational trajectory, financial stability affects the migration trajectories of LGB individuals that live in small/medium cities. The results show that families are an important influence in the decision-making to migrate, to stay or to return to your hometown.

Non-communicable diseases prevention and control by government ministries in Guyana.

Background: Countries of the Caribbean Community signed the Declaration of Port of Spain in 2007 with the vision to stop the epidemic of non-communicable diseases (NCDs). The adoption of the Declaration by member states represented a regional effort, challenging governments, the private sector, and civil society to act together. Multisectoral actions in Guyana aimed at achieving this goal are the focus of this article, demonstrating the work of different actors in addressing the burden of NCDs in the country. Objective: To analyze multisectoral actions developed among five ministries for the implementation of the Declaration of Port of Spain 2007 in Guyana. Methods: This qualitative study was guided by the Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist and conducted in five ministries (Agriculture, Education, Finance, Health, and Trade) in Georgetown, Guyana. The thematic analysis was guided by a framework consisting of four elements: context (why the policy is needed), content (what the policy is mainly about), process (how the policy was brought forward and implemented), and actors (who participates in and influences the formulation and implementation of the policy). The framework considers how these elements interconnect to shape policy development and implementation processes. Findings: Data analysis provided the researchers with insights into possible topic areas and codes for consideration during the analysis, hence a deductive approach to data analysis was used. The results highlighted the importance of coordination among government entities, national and international agencies, private actors, industry players, and civil society. Participants did not mention the use of responsibility metrics but cited mechanisms that facilitated collaboration. Conclusion: The results showed limitations in transforming multisectoral initiatives into intersectoral collaboration to achieve real integration among the different actors involved, considering the actual context and content. Actions could be more effectively implemented with significant outcomes for NCD control in Guyana.

Global landscape of nicotine and tobacco products additives policies.

INTRODUCTION: Product design is a key tobacco industry strategy to recruit consumers and hinder cessation. An important technology in tobacco product design is the use of additives including those that create characterising flavours, that is, flavours that are perceived by taste and or smell by the user. To curb youth use, many countries are implementing policies to limit the use of flavours and other additives in tobacco products. This paper reviews the global landscape of tobacco additives policies including those focusing only on flavouring additives, updating a previous review. METHODS: We gathered additives policy data from available online sources of tobacco control policies including parties' reports to the WHO Framework Convention on Tobacco Control (where WHO refers to World Health Organization), the website Tobacco Control Laws, government websites, searches with the Google search engine and consultations with the WHO to ensure comprehensiveness of the assessment. The policies were classified according to their objective and characteristics: Labelling regulations, sales bans and tobacco product design regulations. We classified and organised the regulations according to their stated intent. RESULTS: We found that 62 countries had tobacco products' additives-related regulations at the regional, national or subnational levels. Most of these regulations focused on flavouring additives especially bans on the selling, importing and manufacturing tobacco products with characterising flavours. CONCLUSIONS: The data demonstrate various global policies addressing additives and/or flavours and a range of definitions of additives and flavours. Establishing common definitions and standards could facilitate cooperation between countries and regions.

Complex Exercises Improve Cognition in People With Parkinson's Disease and Freezing of Gait.

BACKGROUND: Evidence has suggested that cognitive decline may be a risk factor for freezing of gait (FOG) in Parkinson's disease (PD). Complex and challenging exercises have been suggested as potential rehabilitation strategies to decrease FOG severity and improve cognition; however, it is unknown whether improvement in cognition would explain decreased FOG severity following exercise. OBJECTIVE: In this secondary analysis, we evaluated the effects of the adapted resistance training with instability (ARTI-complex and challenging exercises) compared with traditional motor rehabilitation (TMR-without challenging exercises) on cognitive function in people with FOG of PD. We also verified whether cognitive improvement explains the decrease in FOG previously published. METHODS: Participants were randomized to either the experimental group (ARTI, n = 17) or the active control group (TMR, n = 15). Both training groups exercised 3 times a week for 12 weeks (80-90 minute each session). FOG severity (FOG ratio from inertial sensors during a 360° turning-in-place task), frontal lobe function (Frontal Assessment Battery [FAB]), global cognition (Montreal Cognitive Assessment [MoCA]), and attention and psychomotor speed (Digit Symbol Substitution Test [DSST]) were evaluated before and after interventions. RESULTS: Only the ARTI group improved FAB, MoCA, and DSST scores at posttraining. In addition, ARTI was more effective than TMR in improving FAB scores at posttraining. The changes in FAB scores explained the changes in FOG ratio following ARTI (R2 = .43, P < .01). CONCLUSIONS: This pilot study suggests that ARTI, a complex and challenging training, improves cognition in people with FOG of PD. Improvements in frontal lobe function with ARTI help explain decreased FOG severity.

"My Cross to Bear": Mothering in the Context of Intimate Partner Violence Among Pregnant Women in Mexico.

Intimate partner violence (IPV) during pregnancy negatively affects both maternal and infant health, yet gaps remain in understanding factors that maintain violence and/or promote resilience within the context of mothering. Nine focus groups were conducted with pregnant and/or IPV-exposed women (n = 17) and service providers (n = 26) working with these women in Nuevo León, Mexico. Thematic analysis of the focus group data revealed the detrimental impact of cultural norms that prioritize the relationship with women's partners, marriage, and family above women's dignity. Participants also identified ways that values regarding motherhood function as motivation for women to pursue a life without violence.

The Grenada Learning and Memory Scale: Psychometric features and normative data in Caribbean preschool children.

OBJECTIVE: Neuropsychological assessment of preschool children is essential for early detection of delays and referral for intervention prior to school entry. This is especially pertinent in low- and middle-income countries (LMICs), which are disproportionately impacted by micronutrient deficiencies and teratogenic exposures. The Grenada Learning and Memory Scale (GLAMS) was created for use in limited resource settings and includes a shopping list and face-name association test. Here, we present psychometric and normative data for the GLAMS in a Grenadian preschool sample. METHODS: Typically developing children between 36 and 72 months of age, primarily English speaking, were recruited from public preschools in Grenada. Trained Early Childhood Assessors administered the GLAMS and NEPSY-II in schools, homes, and clinics. GLAMS score distributions, reliability, and convergent/divergent validity against NEPSY-II were evaluated. RESULTS: The sample consisted of 400 children (190 males, 210 females). GLAMS internal consistency, inter-rater agreement, and test-retest reliability were acceptable. Principal components analysis revealed two latent factors, aligned with expected verbal/visual memory constructs. A female advantage was observed in verbal memory. Moderate age effects were observed on list learning/recall and small age effects on face-name learning/recall. All GLAMS subtests were correlated with NEPSY-II Sentence Repetition, supporting convergent validity with a measure of verbal working memory. CONCLUSIONS: The GLAMS is a psychometrically sound measure of learning and memory in Grenadian preschool children. Further adaptation and scale-up to global LMICs are recommended.

Unraveling impacts on carbon, water and energy exchange of Pinus plantations in South American temperate ecosystems.

Tree plantations are expanding in southern South America and their effects on ecosystem services, particularly climate regulation, are still not well understood. Here, we used remote sensing techniques and a paired design to analyze ≈33,000 ha of Pinus plantations along a broad geographical and environmental gradient (26-43° South latitude, 54-72° West longitude). Radiation interception, surface temperature, evapotranspiration, and albedo were assessed both in tree plantations stands and in adjacent uncultivated areas. Additionally, the climatic impact of tree plantations was quantified by analyzing changes in atmospheric radiative forcing and its carbon (C) equivalent. Tree plantations intercepted more radiation when replacing steppes, grasslands, and shrublands but not when replacing forests. The control exerted on radiation interception by precipitation decreased in both space and time after tree plantation. Furthermore, evapotranspiration notably increased in tree plantations. The lower albedo of tree plantations compared to uncultivated adjacent areas induces global warming through the biophysical pathway. Thus, the climate benefits of afforestation through C sequestration can be counteracted by 18 to 83 % due to albedo changes. It is necessary to fully consider the biophysical effects and water footprint of tree plantations in public policies that promote them, as well as in international carbon accounting mechanisms.

Sociopolitical, clinical, and ethical challenges of sustainable fracture care in Haiti.

INTRODUCTION: In low- and middle-income countries such as Haiti, musculoskeletal injuries are the leading cause of morbidity and mortality. Untreated injuries can contribute to decreased mobility, leading to disability and reduced productivity for individuals. The accessibility of timely fracture care poses a substantial challenge in Haiti, where socioeconomic instability and recent surges in gang violence exacerbate an already strained healthcare infrastructure. This manuscript delves into the intricate barriers to sustainable fracture care in Haiti, shedding light on the sociopolitical landscape and clinical challenges that influence the delivery of orthopedic services. ETHICAL DISCUSSION: The ethical considerations in providing fracture care in Haiti are multifaceted, including classic medical principles, self-preservation in the face of violence, issues of justice in resource and service allocation, and concerns of nonmaleficence in the context of international volunteers. These ethical dilemmas arise from the complex interplay of limited resources, the dangers posed by the current sociopolitical climate, and the involvement of international aid in a vulnerable healthcare system. CONCLUSION: To address the clinical and ethical conflicts of providing fracture care in Haiti, solutions include education and training of Haitian orthopedic surgeons, capacity building of healthcare facilities, and establishing ethical standards for international volunteers. This comprehensive approach is vital for advancing sustainable fracture care in Haiti and other resource-limited settings.

Epidemiological profile trends and cost of pediatric sickle cell disease in Brazil from 2008 to 2022.

OBJECTIVE: This study aimed to investigate the epidemiological trends of Pediatric Sickle Cell Disease (SCD) in Brazil over the period 2008-2022, with a focus on understanding the incidence, mortality rates, and associated healthcare costs. The study explored potential associations between patient characteristics and the occurrence of crises in pediatric SCD cases. METHODS: A cross-sectional study was conducted, analyzing national annual rates of pediatric SCD hospitalizations using data from the FioCruz platform. Descriptive and inferential analyses, including time series and ARIMA regression, were employed. Economic dimensions were assessed using cost categorization. The study followed STROBE reporting guidelines. RESULTS: Data on 81,942 pediatric SCD hospitalizations were collected, with a predominance of crisis-related cases (74.08 %). Males and children under five years old were most affected. Regional disparities were observed, with the Southwest region recording the highest hospitalization rates. ICU costs were higher for crisis-related hospitalizations. Mortality rates were significantly higher for crisis-related cases (p < 0.001), with ARIMA regression indicating a significant association between hospitalizations for crisis-related cases and mortality. CONCLUSION: This study highlights the significant burden of pediatric SCD in Brazil, particularly crisis-related cases, suggesting a need for focused interventions. By prioritizing early detection, equitable access to healthcare, and evidence-based interventions, Brazil can mitigate the burden of SCD and improve patient outcomes. These findings contribute to informing public health policies and interventions aimed at addressing the challenges of pediatric SCD management in Brazil.

How does participation in Global Value Chains affect embodied carbon emissions in international trade? New insights from cross-country panel data analysis.

Global Value Chains (GVCs) significantly influence international trade and environmental outcomes. Despite the economic benefits of GVCs, their impact on the environment remains under-examined. This study  analyzes the effects of GVC participation (considering forward and backward positions) on total carbon emissions embodied in exports (TEEE) and imports (TEEI). Utilizing panel data from 65 economies spanning 1995 to 2018, we apply input-output matrices and the system generalized method of moments (GMM-SYS) approach. Our results indicate that GVC participation generally is associated with reductions in TEEI and increases in TEEE, with backward participation exerting a more substantial impact. Furthermore, we observed asymmetrical impacts of GVC participation between developed and developing countries. Developed nations tend to reap greater benefits from GVC in terms of diminished CO2 emissions associated with imports, as well as notable CO2 reductions in both exports and imports, particularly when forward participation is the focal point. Conversely, developing countries grapple with heightened environmental burdens stemming from their engagement in backward linkages.

Current challenges for plant biology research in the Global South.

In an attempt to address the large inequities faced by the plant biology communities from the Global South (i.e. countries located around the tropics and the Southern Hemisphere) at international conferences, this Viewpoint is the reflexive thinking arising from the concurrent session titled 'Arabidopsis and its translational research in the Global South' organized at the International Conference of Arabidopsis Research 2023 (ICAR 2023) in Chiba, Japan in June 2023. Here, we highlight the main obstacles plant biology communities in the Global South face in terms of knowledge production, as measured by the unequal production and citation of publications, investigating and advancing local plant genomics and biodiversity, combating disparities in gender and diversity, and current initiatives to break isolation of scientists.

Climate change impacts on dengue transmission areas in Espírito Santo state, Brazil.

Espírito Santo state, in Brazil, is a dengue-endemic region predicted to suffer from an increase in temperature and drought due to climate change, which could affect the areas with active dengue virus transmission. The study objective was modeling climatic factors and climate change effects in zones suitable for dengue virus transmission in Espírito Santo state, Brazil. Data on dengue reports from 2022 were used to determine climatic variables related to spatial distribution. The climate change projections were generated for the 2030s, 2050s, 2070s, and 2090s for three distinct Shared Socioeconomic Pathways: SSP1-2.6, SSP2-4.5 and SSP5-8.5. A maximum entropy algorithm was used to construct the three models and projections, and the results were used to calculate the ensemble mean. Isothermality, the maximum temperature of the warmest month, precipitation of the wettest month, precipitation of the warmest quarter, and annual precipitation impacted the model. Projections indicated a change in areas suitable for dengue virus transmission, varying from -30.44% in the 2070s (SSP1-2.6) to +13.07% in the 2070s (SSP5-8.5) compared to 2022. The coastal regions were consistently suitable in all scenarios. Urbanized and highly populated areas were predicted to persist with active dengue transmission in Espírito Santo state, posing challenges for public health response.

Development of DRIP - drought representation index for CMIP climate model performance, application to Southeast Brazil.

With the escalating impacts of drought events driven by climate change, reducing the uncertainty of drought projections becomes critical for enhancing risk management and adaptation strategies. This study aimed to develop an index for assessing the performance of CMIP6 Global Climate Models in simulating meteorological drought scenarios across regional hydrological systems, intended to provide more reliable information for management purposes. Named the 'Drought Representation Index for CMIP Climate Model Performance' (DRIP), this index evaluates CMIP models' performance to represent drought severity, duration, and return period. DRIP was used to select CMIP models and create an ensemble of the best-performing models (E-DRIP) to improve the reliability of drought projections. E-DRIP was then compared with a general ensemble of available CMIP6 models (E-CMIP). We applied this method in Southeast Brazil, a region known for its climate uncertainties and low predictability; specifically, it was implemented within the Paraíba do Sul River Basin, a nationally strategic watershed in a highly populated and industrialized area, which has recently faced unprecedented drought-related water crises. Results showed that DRIP effectively assessed the individual performance of CMIP models, which exhibited considerable variability, and identified the top-performing models for a multi-model ensemble. Additionally, the E-DRIP ensemble significantly reduced uncertainties in drought projections, achieving an average reduction of 63 % in the study area compared to E-CMIP. Furthermore, the proposed method enables evaluations across any standardized drought index scale, reference period, or threshold, and can be readily adapted to other hydrological systems.

Waste from the food industry: Innovations in biorefineries for sustainable use of resources and generation of value.

Biorefineries have attracted significant attention from the scientific community and various industrial sectors due to their use of unconventional biomass sources to produce biofuels and other value-added compounds. Various agro-industrial residues can be applied in biorefinery systems, making them economically and environmentally attractive. However, the cost, efficiency, and profitability of the process are directly affected by the choice of biomass, pre-treatments, and desired products. In biorefineries, the simultaneous production of different products during processing is a valuable approach. Chemical, physical, biological, or combined treatments can generate numerous compounds of high commercial interest, such as phenolic compounds. These treatments, in addition to modifying the biomass structure, are essential for the process's viability. Over the years, complex treatments with high costs and environmental impacts have been simplified and improved, becoming more specific in generating high-value resources as secondary outputs to the main process (generally related to the release of sugars from lignocelluloses to produce second-generation ethanol). Innovative methods involving microorganisms and enzymes are the most promising in terms of efficiency and lower environmental impact. Biorefineries enable the use of varied raw materials, such as different agro-industrial residues, allowing for more efficient resource utilization and reducing dependence on non-renewable sources. In addition to producing low-carbon biofuels, biorefineries generate a variety of high-value by-products, such as packaging materials, pharmaceuticals, and nutritional ingredients. This not only increases the profitability of biorefineries but also contributes to a circular economy.

A Collaborating Centre for animal health economics in the Americas.

Countries in the Americas play a vital role in global livestock and aquaculture production. With international trade of livestock and aquaculture products becoming an important source of income for countries, there has been an increased interest in using animal health economics for advocacy and allocation of resources. This article discusses the development of a new Collaborating Centre for the Economics of Animal Health and the applications of the Global Burden of Animal Diseases (GBADs) framework in the Americas region. Incentives for the increased use of economics in animal health decision-making and examples from the Americas region are examined. The article then discusses the newly formed World Organisation for Animal Health Collaborating Centre in the Americas region. Finally, it reviews two ongoing case studies that are implementing the GBADs framework in Peru and the United States of America.

Les pays des Amériques jouent un rôle crucial dans la production mondiale d'animaux d'élevage, qu'il s'agisse d'espèces terrestres ou aquatiques. Le commerce international des produits issus de l'élevage et de l'aquaculture étant désormais une source importante de revenus pour les pays, la possibilité d'utiliser les concepts de l'économie de la santé animale à des fins de plaidoyer et d'allocation des ressources suscite un intérêt croissant. Les auteurs abordent la désignation d'un nouveau Centre collaborateur pour l'économie de la santé animale ainsi que les applications du programme " Impact mondial des maladies animales " (GBADs) dans la région des Amériques. Ils examinent les avantages d'une meilleure prise en compte de l'économie dans les prises de décision en matière de santé animale, illustrés par quelques exemples concrets relevés dans la région. Ils décrivent ensuite la création du nouveau Centre collaborateur de l'Organisation mondiale de la santé animale dans la région des Amériques. Enfin, ils présentent deux études de cas menées actuellement concernant la mise en oeuvre du programme GBADs respectivement au Pérou et aux Etats-Unis d'Amérique.

Los países de las Américas desempeñan un papel fundamental en la producción ganadera y acuícola mundial. Dado que el comercio internacional de productos ganaderos y acuícolas se ha convertido en una importante fuente de ingresos para los países, el interés por utilizar la economía de la sanidad animal en favor de la promoción y la asignación de recursos ha ido en aumento. En este artículo se analiza la creación de un nuevo Centro colaborador para la economía de la sanidad animal y las aplicaciones del marco del impacto global de las enfermedades animales (GBADs) en la región de las Américas. Se examinan los incentivos para un mayor uso de la economía en la toma de decisiones sobre sanidad animal, así como ejemplos de la región. A continuación, en el artículo se presenta el recién creado Centro colaborador de la Organización Mundial de Sanidad Animal en la región de las Américas. Por último, se examinan dos estudios de casos en los que se está poniendo en práctica el marco del GBADs en Perú y los Estados Unidos de América.

The Mpox outbreak is a public health emergency of international concern: Implications for mental health and global preparedness.

BACKGROUND: The Mpox, a zoonotic viral disease that has historically affected Central and West Africa, has been declared a Public Health Emergency of International Concern by the World Health Organization. Rapid transmission and recent dissemination in Africa may imply significant challenges to global health, including mental health. METHODS: We reviewed the mental health implications of the Mpox outbreak according to the published literature. We also discussed the psychological effects of the global spreading of this infection and public health preparedness strategies. Key areas of intervention may include the epidemiological surveillance, vaccine development, and mental health strategies. COMMENTS: The Mpox outbreak calls for a robust global preparedness to address potential health emergencies. Strengthening epidemiological surveillance, ensuring equitable vaccine distribution, and building resilient public health infrastructure are crucial. Additionally, addressing mental health consequences may require immediate, intermediate, and long-term strategies, including telepsychiatry, stress management training, and the integration of mental health into primary care.