Cerebral rScO2 Measured by Near-Infrared Spectroscopy (NIRS) During Therapeutic Hypothermia in Neonates with Hypoxic-Ischemic Encephalopathy: A Systematic Review.

INTRODUCTION: Perinatal asphyxia, a leading cause of neonatal mortality and neurological sequelae, necessitates early detection of pathophysiological neurologic changes during hypoxic-ischaemic encephalopathy (HIE). This study aimed to review published data on rScO2 monitoring during hypothermia treatment in neonates with perinatal asphyxia to predict short- and long-term neurological injury. METHODS: A systematic review was performed using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Study identification was performed through a search between November and December 2021 in the electronic databases PubMed, Embase, Lilacs, Scopus, Web of Science, and Cochrane Central Register of Controlled Trials (CENTRAL). The main outcome was short-term (Changes in brain magnetic resonating imaging) and long-term (In neurodevelopment) neurological injury. The study protocol was registered in PROSPERO (International Prospective Register of Systematic Reviews) with CRD42023395438. RESULTS: 380 articles were collected from databases in the initial search. Finally, 15 articles were selected for extraction and analysis of the information. An increase in rScO2 measured by NIRS (Near-infrared spectroscopy) at different moments of treatment predicts neurological injury. However, there exists a wide variability in the methods and outcomes of the studies. CONCLUSION: High rScO2 values were found to predict negative outcomes, with substantial discord among studies. NIRS is proposed as a real-time bedside tool for predicting brain injury in neonates with moderate to severe HIE.

Vasculitis pauciinmune asociada a lupus eritematoso sistémico: a propósito de un caso

Introducción: la poliangeítis microscópica (PAM) hace parte del grupo de vasculitis asociadas a anticuerpos anticitoplasmáticos de neutrófilos (ANCA), cuya presencia de anticuerpos contra mieloperoxidasa (MPO) se observa en la mayoría de los casos (70-95 %), asimismo, el compromiso renal presagia mayores tasas de morbilidad y mortalidad, sin embargo, la coexistencia con lupus eritematoso sistémico (LES) es poco frecuente y con mayor énfasis en la variante de LES del adulto mayor o de inicio tardío. Objetivo: dar a conocer un caso poco común de dos enfermedades autoinmunes, lo cual ha sido reportado como síndrome de superposición y brindar información útil que permita ampliar los diagnósticos diferenciales. Presentación del caso: se presenta el caso de un paciente masculino de 76 años con historia de poliartralgias progresivas en deterioro del estado general, con debut en síndrome confusional agudo, caída de filtrado glomerular, microhematuria y proteinuria casi nefrótica. A la evaluación inicial se encontró anemia y trombocitopenia severa, en perfil inmune ANA 1/320 y complemento consumido, cumpliendo criterios para LES, ANCA reactivo específicamente MPO ANCA (1/320) y sospecha de glomerulonefritis con patrón rápidamente progresivo (GNRP). Dado el contexto clínico, se decidió comenzar con pulsos de metilprednisolona consecutivos, seguidos de prednisolona oral y, como terapia de mantenimiento, se instauró ciclofosfamida. Finalmente, con una biopsia renal se confirmó el diagnóstico de vasculitis sistémica pauciinmune con formación de crescencia celular. La evolución clínica del paciente fue satisfactoria, logrando la estabilización de órganos y la normalización de la función renal, hematopoyética y el estado neurológico. Discusión y conclusión: dado que la presentación clínica de LES es heterogénea, se ha reportado su asociación con vasculitis, las cuales comparten un compromiso común de órganos como articulaciones, piel y riñones. Los hallazgos paraclínicos, como por biopsia, fueron consistentes tanto con PAM como con LES, por lo tanto, se diagnosticó como un caso de superposición. Este caso demuestra el enigma del diagnóstico y la complejidad en el manejo de entidades poco frecuentes, de etiologías inmunológicas superpuestas que ponen en peligro la vida de quien la(s) padece, de no tener un diagnóstico oportuno y un tratamiento temprano.

Introduction: Microscopic polyangiitis (MPA) is part of the group of vasculitis associated with antineutrophil cytoplasmic antibodies (ANCA), whose presence of antibodies against myeloperoxidase (MPO) is observed in most cases (70-95 %), likewise, the renal compromise portends higher rates of morbidity and mortality. However, coexistence with Systemic Lupus Erythematosus (SLE) is infrequent, and with greater emphasis on the older adult or late-onset variant of SLE (1). Purpose: Present a rare case of two autoimmune diseases, which has been reported as overlapping syndrome and provide useful information that allows expanding differential diagnoses. Case report: We present the case of a 76-year-old male patient with a history of progressive polyarthralgias in deteriorating general condition, with debut in acute confusional syndrome, drop in glomerular filtration rate, microhematuria and almost nephrotic proteinuria. At the initial evaluation anemia and severe thrombocytopenia were found, in the immune profile ANA 1/320, complement consumed; fulfilling criteria for SLE, ANCAs reactive specifically MPO ANCA (1/320) and suspected Rapidly Progressive Renal Insufficiency (PRRI). Given the clinical context, it was decided to start consecutive pulses of methylprednisolone followed by oral prednisolone, and cyclophosphamide was established as maintenance therapy. Finally, a renal biopsy confirmed the diagnosis of pauci-immune systemic vasculitis with cell crescent formation. These findings were consistent with both SLE and PAM, thus it was diagnosed as a case of overlap. The clinical evolution of the patient was satisfactory, achieving organ stabilization and normalization of renal function, hematopoietic function, and neurological status. Discussion and conclusion: RPGN associated with ANCA present non-nephrotic proteinuria, glomerular filtration rate drop. The most common is anti-glomerular basement membrane (AMBG) antibodies. Serological detection of antineutrophil cytoplasmic antibodies, PR3 and MPO should be available. Microscopic polyangiitis could be determined by renal biopsy, with the presence of cell growth, absence of immune deposits and MPO ANCA positivity. This case is a diagnostic enigma, and the complexity in the management of rare entities, of immunological etiology, superimposed that endanger the life of those who suffer from it, if they do not have a timely diagnosis and early treatment.

COVID-19 Coinfection with Mycobacterium abscessus in a Patient with Multiple Myeloma.

BACKGROUND: Coronavirus disease (COVID-19) is a worldwide pandemic causing multiple fatalities and morbidities worldwide. We report a case of severe pneumonia causing acute respiratory distress syndrome due to a coinfection with SARS-CoV-2 and Mycobacterium abscessus in an elderly patient with multiple myeloma in Florida, USA. Case Presentation. An 84-year-old male with a medical history significant for multiple myeloma not in remission was sent to the emergency department to rule out COVID-19 infection prior to continuing his chemotherapy sessions. At presentation, he had nonspecific mild symptoms and an unremarkable physical examination. He had significant blood test findings including serum lactate dehydrogenase 373 U/L, high sensitive C-reactive protein 17.40 mg/l, and ferritin 415 ng/ml. Xpert-SARS-CoV-2 was positive. Chest radiograph revealed patchy areas of interstitial infiltrates in mid to lower lung zones. During his hospitalization course, his oxygenation deteriorated, requiring mechanical intubation. Repeat chest radiograph showed worsening bilateral infiltrates. He was started on broad-spectrum antibiotics and eventually weaned off mechanical intubation and extubated. On the 11th day of admission, he was found to be bradycardic and in shock, and he was reintubated. His labs showed worsening inflammatory markers along with kidney dysfunction to the point of requiring renal replacement therapy. He received both convalescent plasma and remdesivir for treatment of COVID-19 pneumonia. Eventually, repeat blood cultures came back positive for the growth of acid-fast beaded bacilli. While awaiting final culture and sensitivity reports, his antibiotics were upgraded to cover possible nocardia infection. Repeat blood and sputum cultures resulted in growth of AFB bacilli Mycobacterium abscessus 1 week after. CONCLUSIONS: This case report highlights the importance of keeping a broad differential and considering multiple coinfections, including atypical ones during this COVID-19 pandemic, such as the one that was discussed above, Mycobacterium abscessus, in order to provide goal-directed therapy.

A Case of Plasmodium falciparum Malaria Treated with Artesunate in a 55-Year-Old Woman on Return to Florida from a Visit to Ghana.

BACKGROUND Malaria is the infection caused by inoculation with the mostly obligate intraerythrocytic protozoa of the genus Plasmodium. Severe malaria manifests as multiple organ dysfunction with high parasitemia counts characterized by coma, stupor, and severe metabolic acidosis. Physicians in the United States do not frequently encounter patients with malaria, and the drugs are only available through the Centers for Disease Control and Prevention, which makes the management of this disease somewhat complicated. In 2019, the marketing of quinine for malaria was discontinued. In May 2020, the US Food and Drug Administration approved the use of intravenous artesunate for the treatment of adults and children with severe malaria. This case report describes a case of Plasmodium falciparum malaria in a 55-year-old woman who returned home to Florida from a visit to Ghana. CASE REPORT A previously healthy 55-year-old woman with no significant past medical history presented to the Emergency Department (ED) of a hospital in south Florida due to cyclic fever for 7 days. The patient's family reported mental status changes since symptom onset. The patient had returned from a 10-day trip to Ghana 18 days prior to admission. On arrival to the ED, the patient appeared lethargic and within hours was in respiratory distress. She was intubated and mechanically ventilated in the ED for acute hypoxemic respiratory failure. A malaria smear was positive with 25% parasitemia, and a diagnosis of severe malaria was made, consistent with P. falciparum infection complicated by multi-organ failure. Infectious disease consultation was obtained and an infusion of intravenous (IV) quinidine and IV doxycycline was emergently started due to the anticipated delay in obtaining artesunate. During the second day of admission, the patient had QTc prolongation, so quinidine was switched to IV artesunate. The parasitemia and acidosis started improving by the third day of therapy. CONCLUSIONS Given that artesunate is more effective, easier to dose, and more tolerable than quinidine, it is now the treatment of choice for severe malaria in the United States.

E-Cigarette or Vaping Product Use-Associated Lung Injury (EVALI) Mimicking COVID-19 Disease.

BACKGROUND: Coronavirus 2 (SARS-CoV-2) is the virus associated with the coronavirus disease (COVID-19) causing a pandemic worldwide in 2020. There are other noninfectious diseases that can present exactly as COVID-19, and the management and approach are completely different, hence the importance of understanding and having a wide differential in patients presenting with similar characteristics. Case Report. A 23-year-old male, with a history of childhood asthma, presented to the Emergency Department in a hospital in south Florida in the USA with complaints of a 2-day duration of subjective fever, chills, dry cough, dyspnea, and myalgia. His vital signs were blood pressure 135/65 mmHg, temperature 39°C, pulse 134 bpm, respiratory rate 22 breaths per minute, and saturation of oxygen 96% in room air. Laboratory analysis was significant for white blood cells 15.3 × 103/µL, ALT 69 U/L, AST 66 U/L, ferritin 375.6 ng/mL, C-reactive protein 27.70 mg/dL, and procalcitonin 1.43 ng/mL. A respiratory pathogen panel (RPP) and a SARS-CoV-2 test were both negative. The patient was given empiric antibiotic treatment and hydroxychloroquine. Two more tests for SARS-CoV-2 were negative, and the patient reported that he smoked marijuana through an e-cigarette. The patient was started on high-dose steroids, and symptoms improved. CONCLUSION: COVID-19 is an emergent lung disease that is affecting the population worldwide; many other noninfectious diseases can mimic its presentations and laboratory characteristics; the importance of having a broad differential diagnosis especially in causing confusion during pandemic times is valuable in the management of patients with such presentations, such as EVALI, and glucocorticoids will be indicated in this circumstances.

Co-Infection with SARS-COV-2 and Parainfluenza in a young adult patient with pneumonia: Case Report.

Coronavirus 2 (SARS-CoV-2) is now considered a pandemic causing Coronavirus disease (COVID-19), multiple fatalities and morbidities which have been associated with it worldwide. We report a severe pneumonia causing acute respiratory distress syndrome due to a coinfection with SARS-COV-2 and Parainfluenza 4 virus in a Hispanic 21 year old male in Florida, USA. The case represents the importance of prompt diagnosis and awareness of the potential co-infection with other respiratory viruses and this novel deadly virus.

[The health system in Venezuela: a patient without medication?] / Sistema de salud en Venezuela: ¿un paciente sin remedio?

The situation in Venezuela is marked by a profound socioeconomic crisis that raises questions concerning its effects on the health system. The study's aim was to analyze the trends and current situation of the Venezuelan health system, with special emphasis on financing. Based on the World Health Organization's Framework for Action to Strengthen Health Systems, five of the system's six basic components were studied, along with the results in terms of coverage and the population's health. Healthcare financing in Venezuela proved to be primarily private, with a high and growing share of out-of-pocket expenditures, one of the highest in the world. The health sector is also assigned low fiscal priority, with a reduced public budget, vulnerable to fluctuations in oil prices. Meanwhile, health services provision and effective access have been jeopardized in recent years due to the decreased availability of physicians, particularly in some specialties, gaps in provision and medical equipment in health centers, and shortage of medical inputs, medicines, and vaccines, among other factors, affecting the population's health, worsening of several indicators. The economy's structural characteristics and socioeconomic dynamics have impacted the Venezuelan health system, aggravating longstanding problems like the system's fragmentation, segmentation, and "privatization", triggering the emergence of new difficulties like shortage of medicines and lack of accountability, among others.

La coyuntura venezolana está marcada por una profunda crisis socioeconómica que genera interrogantes sobre sus efectos en el sistema de salud. El objetivo de este trabajo fue analizar las tendencias y la situación actual del sistema de salud venezolano, con especial énfasis en la financiación. Teniendo por base el marco de acción de la Organización Mundial de la Salud para el fortalecimiento de los sistemas de salud, fueron estudiados cinco de los seis componentes básicos del sistema, así como los resultados en términos de cobertura y salud de la población. El financiamiento de la salud en Venezuela resultó ser primordialmente privado, con un elevado y creciente componente de gasto de bolsillo que se coloca entre los mayores del mundo. Asimismo, el sector salud mostró una baja prioridad fiscal, con un gasto público reducido y vulnerable ante las oscilaciones de los precios del petróleo. Por otro lado, la prestación y el acceso efectivo a los servicios de salud se ha visto comprometido en años recientes, debido -entre otros factores- a la disminución en la disponibilidad de médicos, particularmente para algunas especialidades; fallas en la dotación y equipos médicos de los centros de salud; escasez de insumos médicos, medicamentos y vacunas, afectando la salud de la población que registra algunos retrocesos. Las características estructurales de la economía y la dinámica coyuntural socioeconómica han impactado en el sistema de salud venezolano, profundizando problemas de vieja data como la fragmentación, segmentación y "privatización" del sistema y provocando el surgimiento de nuevas dificultades como escasez de medicamentos, opacidad en la información, entre otros.

A conjuntura venezuelana está caracterizada por uma profunda crise socioeconômica que gera interrogantes sobre os seus efeitos no sistema de saúde. O objetivo deste trabalho foi analisar as tendências e a situação atual do sistema de saúde venezuelano, com especial ênfase no financiamento. Tendo por base o marco de ação da Organização Mundial da Saúde para o fortalecimento dos sistemas de saúde, foram estudados cinco dos seis componentes básicos do sistema, assim como os resultados em termos de cobertura e saúde da população. O financiamento da saúde na Venezuela acabou por ser, sobretudo, privado, com um elevado e crescente componente de despesas diretas que fica entre os maiores do mundo. Além disso, o setor da saúde revelou uma baixa prioridade fiscal, com despesas públicas reduzidas e vulneráveis perante as oscilações dos preços do petróleo. Por outro lado, a prestação e o acesso efetivo aos serviços de saúde foram comprometidos nos anos recentes, devido -entre outros fatores- à redução na disponibilização de médicos, particularmente para algumas especialidades; falhas na dotação e equipes médicas dos centros de saúde; carência de material médico, remédios e vacinas, afetando a saúde da população que registra alguns retrocessos. As características estruturais da economia e a dinâmica conjuntural socioeconómica tem atingido o sistema de saúde venezuelano, aprofundando problemas de longa data como a fragmentação, segmentação e "privatização" do sistema, gerando o surgimento de novas dificuldades como a carência de medicamentos, ausência de transparência na informação, entre outros.

Sistema de salud en Venezuela: ¿un paciente sin remedio? / The health system in Venezuela: a patient without medication? / O sistema de saúde na Venezuela: um paciente sem remédio?

La coyuntura venezolana está marcada por una profunda crisis socioeconómica que genera interrogantes sobre sus efectos en el sistema de salud. El objetivo de este trabajo fue analizar las tendencias y la situación actual del sistema de salud venezolano, con especial énfasis en la financiación. Teniendo por base el marco de acción de la Organización Mundial de la Salud para el fortalecimiento de los sistemas de salud, fueron estudiados cinco de los seis componentes básicos del sistema, así como los resultados en términos de cobertura y salud de la población. El financiamiento de la salud en Venezuela resultó ser primordialmente privado, con un elevado y creciente componente de gasto de bolsillo que se coloca entre los mayores del mundo. Asimismo, el sector salud mostró una baja prioridad fiscal, con un gasto público reducido y vulnerable ante las oscilaciones de los precios del petróleo. Por otro lado, la prestación y el acceso efectivo a los servicios de salud se ha visto comprometido en años recientes, debido -entre otros factores- a la disminución en la disponibilidad de médicos, particularmente para algunas especialidades; fallas en la dotación y equipos médicos de los centros de salud; escasez de insumos médicos, medicamentos y vacunas, afectando la salud de la población que registra algunos retrocesos. Las características estructurales de la economía y la dinámica coyuntural socioeconómica han impactado en el sistema de salud venezolano, profundizando problemas de vieja data como la fragmentación, segmentación y "privatización" del sistema y provocando el surgimiento de nuevas dificultades como escasez de medicamentos, opacidad en la información, entre otros.

The situation in Venezuela is marked by a profound socioeconomic crisis that raises questions concerning its effects on the health system. The study's aim was to analyze the trends and current situation of the Venezuelan health system, with special emphasis on financing. Based on the World Health Organization's Framework for Action to Strengthen Health Systems, five of the system's six basic components were studied, along with the results in terms of coverage and the population's health. Healthcare financing in Venezuela proved to be primarily private, with a high and growing share of out-of-pocket expenditures, one of the highest in the world. The health sector is also assigned low fiscal priority, with a reduced public budget, vulnerable to fluctuations in oil prices. Meanwhile, health services provision and effective access have been jeopardized in recent years due to the decreased availability of physicians, particularly in some specialties, gaps in provision and medical equipment in health centers, and shortage of medical inputs, medicines, and vaccines, among other factors, affecting the population's health, worsening of several indicators. The economy's structural characteristics and socioeconomic dynamics have impacted the Venezuelan health system, aggravating longstanding problems like the system's fragmentation, segmentation, and "privatization", triggering the emergence of new difficulties like shortage of medicines and lack of accountability, among others.

A conjuntura venezuelana está caracterizada por uma profunda crise socioeconômica que gera interrogantes sobre os seus efeitos no sistema de saúde. O objetivo deste trabalho foi analisar as tendências e a situação atual do sistema de saúde venezuelano, com especial ênfase no financiamento. Tendo por base o marco de ação da Organização Mundial da Saúde para o fortalecimento dos sistemas de saúde, foram estudados cinco dos seis componentes básicos do sistema, assim como os resultados em termos de cobertura e saúde da população. O financiamento da saúde na Venezuela acabou por ser, sobretudo, privado, com um elevado e crescente componente de despesas diretas que fica entre os maiores do mundo. Além disso, o setor da saúde revelou uma baixa prioridade fiscal, com despesas públicas reduzidas e vulneráveis perante as oscilações dos preços do petróleo. Por outro lado, a prestação e o acesso efetivo aos serviços de saúde foram comprometidos nos anos recentes, devido -entre outros fatores- à redução na disponibilização de médicos, particularmente para algumas especialidades; falhas na dotação e equipes médicas dos centros de saúde; carência de material médico, remédios e vacinas, afetando a saúde da população que registra alguns retrocessos. As características estruturais da economia e a dinâmica conjuntural socioeconómica tem atingido o sistema de saúde venezuelano, aprofundando problemas de longa data como a fragmentação, segmentação e "privatização" do sistema, gerando o surgimento de novas dificuldades como a carência de medicamentos, ausência de transparência na informação, entre outros.

Fiocruz as an actor in Brazilian foreign relations in the context of the Community of Portuguese-Speaking Countries: an untold story.

Brazilian foreign policy paradigms and changes in the global scenario since the Cold War created conditions for stronger ties between Brazil and Portuguese-speaking African countries. Recently, Brazil took the lead in regional integration processes and in South-South cooperation initiatives. These strategies and Fiocruz's acknowledged technical expertise resulted in its direct involvement in Brazilian foreign public health policy in the Community of Portuguese-Speaking Countries. Fiocruz developed cooperation projects in various areas, sharing its know-how and best practices in the most critical fields in partner countries, consolidating "public health framework cooperation" and contributing to diversifying Brazil's partners and promoting Brazil as a global actor.

Fiocruz as an actor in Brazilian foreign relations in the context of the Community of Portuguese-Speaking Countries: an untold story / A Fiocruz como ator da política externa brasileira no contexto da Comunidade dos Países de Língua Portuguesa: uma história revelada

Brazilian foreign policy paradigms and changes in the global scenario since the Cold War created conditions for stronger ties between Brazil and Portuguese-speaking African countries. Recently, Brazil took the lead in regional integration processes and in South-South cooperation initiatives. These strategies and Fiocruz's acknowledged technical expertise resulted in its direct involvement in Brazilian foreign public health policy in the Community of Portuguese-Speaking Countries. Fiocruz developed cooperation projects in various areas, sharing its know-how and best practices in the most critical fields in partner countries, consolidating "public health framework cooperation" and contributing to diversifying Brazil's partners and promoting Brazil as a global actor.

Os paradigmas da política externa brasileira e as mudanças no cenário global desde a Guerra Fria criaram as condições para aproximação do Brasil com os países africanos de língua portuguesa. Recentemente, o Brasil tomou a liderança nos processos de integração regional e nas iniciativas de cooperação Sul-Sul. Essas estratégias e a reconhecida expertise técnica da Fiocruz abriram espaço para o envolvimento direto da instituição na política externa do Brasil com a Comunidade de Países de Língua Portuguesa na área da saúde. A Fiocruz desenvolveu projetos de cooperação em áreas diversas, compartilhando seu know-how e melhores práticas em áreas prioritárias dos países parceiros, consolidando a "cooperação estruturante em saúde" e contribuindo para a diversificação de parceiros do país e promovendo o Brasil como ator global.

A Fiocruz como ator da política externa brasileira no contexto da Comunidade dos Países de Língua Portuguesa / Fiocruz as an actor in Brazilian foreign relations in the context of the Community of Portuguese-Speaking Countries: an untold story

Os paradigmas da política externa brasileira e as mudanças no cenário global desde a Guerra Fria criaram as condições para aproximação do Brasil com os países africanos de língua portuguesa. Recentemente, o Brasil tomou a liderança nos processos de integração regional e nas iniciativas de cooperação Sul-Sul. Essas estratégias e a reconhecida expertise técnica da Fiocruz abriram espaço para o envolvimento direto da instituição na política externa do Brasil com a Comunidade de Países de Língua Portuguesa na área da saúde. A Fiocruz desenvolveu projetos de cooperação em áreas diversas, compartilhando seu know-how e melhores práticas em áreas prioritárias dos países parceiros, consolidando a “cooperação estruturante em saúde” e contribuindo para a diversificação de parceiros do país e promovendo o Brasil como ator global. (AU)

Situação e financiamento da saúde nos países-membros do Fórum IBAS / Health situation and financing in member countries of IBSA Forum

Visando contribuir à literatura comparada sobre potências emergentes, e sobre o Fórum Índia, Brasil e África do Sul (IBAS) em particular, este trabalho apresenta perspectivas comparativas sucintas sobre questões centrais dos sistemas de saúde desses países. Tomando por base os objetivos fundamentais dos sistemas de saúde estabelecidos no Relatório Mundial da Saúde 2000 da Organização Mundial de Saúde (OMS), este artigo analisa e compara o estado de saúde das populações, a proteção financeira dos sistemas contra riscos à saúde e o financiamento dos sistemas de saúde. O levantamento de dados foi realizado por meio de pesquisa bibliográfica subsidiada por diversos indicadores devidamente tabulados e sistematizados. Conclui-se que os países-membros do IBAS têm perfis de saúde bastante diferentes e que suas populações são afetadas, em maior ou menor medida, pelos gastos catastróficos derivados das despesas com saúde. Em termos de financiamento do sistema, os três países apresentaram crescimento no gasto em saúde em valores per capita entre 2002-2012. Contudo, o gasto público foi inferior ao gasto privado em todos eles e a composição deste último mostra três realidades completamente distintas.

Aiming to contribute to the literature on emerging powers and the India-Brazil-South Africa Forum (IBSA) in particular, this study provides brief comparative perspectives on key issues on those countries' health systems. Based on the fundamental goals of health systems established in the WHO World Health Report 2000, this article analyzes and compares the health status of populations, the financial protection of the systems against health risks, and the health systems financing. Data collection was conducted through literature review subsidized by several indicators that were systematized. In conclusion, the member countries of IBSA Forum have quite different health profiles and their populations are affected, to some extent, by catastrophic spending resulting from health expenses. In terms of system financing, every country experienced growth in per capita health expenditures between 2002 and 2012. However, public spending was lower than private spending in all of them, and the composition of the latter shows three completely distinct realities.

A agenda de cooperação sul-sul em saúde do Fórum IBAS - Índia, Brasil e África do Sul / The South-South Cooperation in Health Cooperation Agenda of the IBAS Forum - India, Brazil and South Africa

O presente trabalho tem por objetivo analisar o processo de formulação da agenda de cooperação bi ou trilateral em saúde do Fórum de Diálogo Índia, Brasil e África do Sul (IBAS) no período 2003- 2013 e seus possíveis desdobramentos. Nesse sentido, foi elaborado um marco analítico que articula diferentes abordagens e enfoques teóricos referidos à cooperação Sul-Sul com ênfase na saúde e questões relacionadas à formulação de agendas e ao processo decisório no âmbito das políticas públicas. Em termos metodológicos, esta pesquisa constitui um estudo de caso descritivo e exploratório que se baseou na aplicação de três técnicas qualitativas para o levantamento de dados (pesquisa bibliográfica, análise documental e entrevistas com informantes-chaves selecionados), que foram contrastados entre sim de modo que as conclusões deste estudo basearam-se na triangulação das três fontes analisadas. Apresentam-se os processos de cooperação bilateral em saúde entre o Brasil e os demais países-membros do IBAS, mostrando que ambos antecederam a criação do Fórum e que houve predomínio de intercâmbio de tecnologias e importação de fármacos (entre Brasil e Índia) e de troca de experiências sobre políticas públicas no combate à AIDS, em ciência, tecnologia e inovação e reformas dos sistemas de saúde (entre Brasil e África do Sul). Esses antecedentes históricos de cooperação bilateral influenciaram, em alguma medida, a definição dos itens que compuseram a agenda de cooperação trilateral em saúde do IBAS, dentre os quais se destacou o tema da epidemia de HIV/AIDS. Observa-se que uma estrutura hierárquica, com os políticos eleitos situados no topo orientou o processo de formulação da agenda de cooperação em saúde do IBAS. Os presidentes e seus chanceleres, por meio das diretrizes da política externa, ainda que com nuances distintas em suas gestões, incidiram indiretamente imprimindo ou restando dinamismo para a cooperação Sul-Sul no IBAS. Evidencia-se ainda um avanço lento e errático na formulação e nos desdobramentos da agenda de cooperação trilateral em saúde. Conclui-se que os dois Grupos de Trabalho (Ciência e Tecnologia e Saúde) envolvidos com a cooperação em saúde do Fórum IBAS apresentaram resultados modestos e desiguais e que vários fatores incidiram no lento desenvolvimento e nos poucos resultados concretos dessa cooperação, entre eles: a pouca coordenação entre as instituições que atuaram no processo; a insuficiência de recursos financeiros e humanos; as frequentes mudanças de atores (ministros, secretários, gestores em geral); o surgimento do BRICS e a ampliação de sua agenda de cooperação em saúde que demonstram uma sobreposição de agendas e levantam questionamentos sobre a importância e singularidade do Fórum IBAS e, particularmente, sobre a manutenção de sua agenda de cooperação em saúde

This study examines the agenda-setting process for bilateral and trilateral health cooperation through the India, Brazil and South Africa Dialogue Forum (IBSA) over the period 2003-2013, and its possible outcomes. In this regard, an analytical framework was developed combining different theoretical approaches to South-South cooperation, emphasising health and issues related to agenda setting and public policy decision making. Methodologically, this exploratory, descriptive case study applied three qualitative data collection techniques (literature review, document analysis and key informant interviews); the resulting data were contrasted so that the study findings reflect a triangulation among all three sources. Bilateral health cooperation processes between Brazil and the other two IBSA Forum member countries are described, showing that both processes predated the IBSA Forum: between Brazil and India, technology exchange and drug imports predominated, while between Brazil and South Africa, public policy exchanges on combating HIV/AIDS, plus science, technology, innovation and health system reforms were more prevalent. To some extent, this historical background of bilateral cooperation influenced the definition of the items on the IBSA trilateral health cooperation agenda, particularly the HIV/AIDS epidemic. A hierarchical structure, with elected politicians at the top, was observed to guide the IBSA health cooperation agenda-setting process. Presidents and their foreign ministers, albeit with different styles and focuses, influenced South-South cooperation in IBSA indirectly through foreign policy guidelines, enhancing or dampening the dynamism of the process. In addition, progress in trilateral health cooperation agenda setting and outcomes is shown to be slow and erratic. It was concluded, firstly, that the two Working Groups (on Health and on Science and Technology) involved with health cooperation through the IBSA Forum have yielded modest, uneven results and, secondly, that a number of factors have influenced the slow development and paucity of concrete results of this cooperation, including inadequate coordination among institutions participating in the process; insufficient financial and human resources; high turnover of actors (ministers, secretaries, managers); emergence of the BRICS and expansion of its health cooperation agenda, resulting in overlapping agendas and raising questions as to the importance and uniqueness of the IBSA Forum, particularly as regards maintaining its health cooperation agenda

A agenda de Cooperação Sul-Sul em Saúde do Fórum IBAS - Índia, Brasil e África do Sul / The agenda for South-South Cooperation in Health IBSA - India, Brazil and South Africa

O presente trabalho tem por objetivo analisar o processo de formulação da agenda de cooperação bi ou trilateral em saúde do Fórum de Diálogo Índia, Brasil e África do Sul (IBAS) no período 2003-2013 e seus possíveis desdobramentos. Nesse sentido, foi elaborado um marco analítico que articula diferentes abordagens e enfoques teóricos referidos à cooperação Sul-Sul com ênfase na saúde e questões relacionadas à formulação de agendas e ao processo decisório no âmbito das políticas públicas. Em termos metodológicos, esta pesquisa constitui um estudo de caso descritivo e exploratório que se baseou na aplicação de três técnicas qualitativas para o levantamento de dados (pesquisa bibliográfica, análise documental e entrevistas com informantes-chaves selecionados), que foram contrastados entre sim de modo que as conclusões deste estudo basearam-se na triangulação das três fontes analisadas. Apresentam-se os processos de cooperação bilateral em saúde entre o Brasil e os demais países-membros do IBAS, mostrando que ambos antecederam a criação do Fórum e que houve predomínio de intercâmbio de tecnologias e importação de fármacos (entre Brasil e Índia) e de troca de experiências sobre políticas públicas no combate à AIDS, em ciência, tecnologia e inovação e reformas dos sistemas de saúde (entre Brasil e África do Sul). Esses antecedentes históricos de cooperação bilateral influenciaram, em alguma medida, a definição dos itens que compuseram a agenda de cooperação trilateral em saúde do IBAS, dentre os quais se destacou o tema da epidemia de HIV/AIDS. Observa-se que uma estrutura hierárquica, com os políticos eleitos situados no topo orientou o processo de formulação da agenda de cooperação em saúde do IBAS...

This study examines the agenda-setting process for bilateral and trilateral health cooperation through the India, Brazil and South Africa Dialogue Forum (IBSA) over the period 2003-2013, and its possible outcomes. In this regard, an analytical framework was developed combining different theoretical approaches to South-South cooperation, emphasising health and issues related to agenda setting and public policy decision making. Methodologically, this exploratory, descriptive case study applied three qualitative data collection techniques (literature review, document analysis and key informant interviews); the resulting data were contrasted so that the study findings reflect a triangulation among all three sources. Bilateral health cooperation processes between Brazil and the other two IBSA Forum member countries are described, showing that both processes predated the IBSA Forum: between Brazil and India, technology exchange and drug imports predominated, while between Brazil and South Africa, public policy exchanges on combating HIV/AIDS, plus science, technology, innovation and health system reforms were more prevalent. To some extent, this historical background of bilateral cooperation influenced the definition of the items on the IBSA trilateral health cooperation agenda, particularly the HIV/AIDS epidemic. A hierarchical structure, with elected politicians at the top, was observed to guide the IBSA health cooperation agenda-setting process...

Regional integration and south–south cooperation in health in Latin America and the Caribbean / Integración regional y cooperación sur-sur en materia de salud en América Latina y el Caribe

This paper analyzes whether south-south cooperation is legitimately a recent practice or merely an improved version of previous regional integration processes in Latin America and the Caribbean. The authors reviewed and systematized the historic development of subregional integration processes in Latin America and the Caribbean and focused on health cooperation in the following contexts: the Central American Integration System, the Andean Community of Nations, the Caribbean Community, the Amazon Cooperation Treaty Organization, the Southern Common Market, and the Union of South American Nations. The study concludes that the conceptual and methodologic foundations of south-south cooperation in health were born from and nurtured by the processes of regional integration in Latin America and the Caribbean. This paper posits that regional political and economic integration initiatives bring potential benefits to the health sector and act as an important mechanism to develop south-south cooperation in this domain. The study recommends furthering this type of research to provide information that will allow national and multilateral agencies, or other stakeholders, to formulate and implement better policies for international health cooperation that target reducing inequities and promoting health and wellbeing for all people.

Este artículo analiza si la cooperación sur-sur constituye legítimamente una práctica reciente o es solo una versión mejorada de los procesos anteriores de integración regional en América Latina y el Caribe. Los autores analizaron y sistematizaron el desarrollo histórico de los procesos de integración subregional en América Latina y el Caribe y se centraron en la cooperación en materia de salud en los siguientes contextos: el Sistema de Integración Centroamericana, la Comunidad Andina de Naciones, la Comunidad del Caribe, la Organización del Tratado de Cooperación Amazónica, el Mercado Común del Sur y la Unión de Naciones Suramericanas. El estudio concluye que las bases conceptuales y metodológicas de la cooperación sur-sur en materia de salud nacieron y se nutrieron de los procesos de integración regional en América Latina y el Caribe. Este artículo postula que las iniciativas regionales de integración política y económica aportan beneficios potenciales al sector de la salud y actúan como un mecanismo importante para desarrollar la cooperación sur-sur en este dominio. El estudio recomienda fomentar este tipo de investigaciones con objeto de proporcionar información que permitirá a los organismos nacionales y multilaterales, o a otros interesados directos, formular e implantar mejoras en las políticas de cooperación internacional en materia de salud que tengan como meta la reducción de las desigualdades y la promoción de la salud y del bienestar de todas las personas.

Regional integration and south-south cooperation in health in Latin America and the Caribbean.

This paper analyzes whether south-south cooperation is legitimately a recent practice or merely an improved version of previous regional integration processes in Latin America and the Caribbean. The authors reviewed and systematized the historic development of subregional integration processes in Latin America and the Caribbean and focused on health cooperation in the following contexts: the Central American Integration System, the Andean Community of Nations, the Caribbean Community, the Amazon Cooperation Treaty Organization, the Southern Common Market, and the Union of South American Nations. The study concludes that the conceptual and methodologic foundations of south-south cooperation in health were born from and nurtured by the processes of regional integration in Latin America and the Caribbean. This paper posits that regional political and economic integration initiatives bring potential benefits to the health sector and act as an important mechanism to develop south-south cooperation in this domain. The study recommends furthering this type of research to provide information that will allow national and multilateral agencies, or other stakeholders, to formulate and implement better policies for international health cooperation that target reducing inequities and promoting health and well-being for all people.