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.

Desafíos del profesional de Enfermería en el nexo salud y cambio climático / Challenges of the Nursing Professional within the Nexus between Health and Climate Change / Desafios para os enfermeiros no nexo entre saúde e mudança climática

La población mundial está enfrentando una de las mayores amenazas para la subsistencia de todas las especies. El cambio climático está afectando la salud de las personas y representa un reto para los profesionales de enfermería, quienes están llamados a trabajar con equipos transdisciplinarios para evaluar el impacto de este fenómeno en la salud humana, la promoción de entornos saludables, la mitigación y adaptación del sector salud, así como en la atención de la población afectada por los eventos climáticos extremos.

La população mundial está enfrentando uma das maiores ameaças à subsistência de todas as espécies. As mudanças climáticas estão afetando a saúde das pessoas e representam um desafio para os profissionais de enfermagem, que são chamados a trabalhar com equipes transdisciplinares para avaliar o impacto deste fenômeno na saúde humana, promover ambientes saudáveis, mitigar e adaptar o setor da saúde, assim como atender a população afetada por eventos climáticos extremos.

The world population is facing one of the greatest threats to the survival of all species. Climate change is affecting people's health and represents a challenge for the Nursing professionals who are called to work in transdisciplinary teams to evaluate the impact of this phenomenon on human health, to promote healthy environments, to mitigate and adapt the health sector, as well as its impact of the population affected by extreme weather events.

Situación epidemiológica de VIH a nivel global y nacional: Puesta al día / Epidemiological situation of HIV at global and national level: update

INTRODUCCIÓN: En las cuatro décadas de la epidemia por VIH, se han observado avances notables que han contribuido a una disminución progresiva en la incidencia de nuevas infecciones y en la mortalidad a nivel mundial. Sin embargo, no ha ocurrido lo mismo en Latinoamérica y en Chile. OBJETIVO: Esta revisión tiene como objetivo conocer la epidemiología actual a nivel global, latinoamericano y chileno. METODOLOGÍA: Se analizaron los informes epidemiológicos oficiales de infección por VIH emitidos por organismos nacionales e internacionales, más los estudios epidemiológicos nacionales. RESULTADOS: Se estima que 39 millones de personas viven con VIH en el mundo; no obstante, la mortalidad y la incidencia de nuevos casos han disminuido de forma notoria durante las últimas dos décadas, asociado a una expansión en al acceso a terapia antirretroviral en forma global. A diferencia del resto del mundo, América Latina presenta una tendencia de alza en las nuevas infecciones y Chile registra un aumento de 35% en nuevos casos durante los últimos 10 años, coincidiendo con un aumento en los flujos de migrantes que ha afectado a la región. Algunas estrategias preventivas como la profilaxis pre exposición se han implementa-do a un ritmo lento, tanto a nivel mundial, como latinoamericano. CONCLUSIONES: La epidemiología del VIH presenta características propias regionales y nacionales. En particular en Chile, diversos factores incluyendo déficit en políticas públicas de prevención y los recientes flujos migratorios han modelado nuestra actual epidemia. El desafío presente debe contemplar los esfuerzos multisectoriales para lograr los objetivos de ONUSIDA en esta década.

BACKGROUND: Over the course of the last four decades of global HIV epidemic, significant improvements have contributed to gradually reduce the frequency of new infections and global mortality rates. However, in Latin America particularly in Chile, new infections continue increasing. AIM: This review aims to comprehend the_epidemiology today on a worldwide, Latin American, and Chilean scale. METHODS: National epidemiology studies and official HIV reports from international and national organizations were reviewed. RESULTS: It is estimated that 39 million people live with HIV worldwide; however, mortality and the incidence of new cases have decreased markedly over the last two decades, associated with an expansion in access to antiretroviral therapy globally. In contrast to the rest of the world, Latin America shows an upward trend in new infections, with Chile registering a 35% increase in new cases over the last 10 years, coinciding with an increase in migratory flows that has occurred throughout the region. Some preventive strategies, such as pre-exposure prophylaxis, have been implemented at a slow pace, both globally and in Latin America. CONCLUSIONS: The epidemiology of HIV has regional and national characteristics. Specifically in Chile, several factors, including deficits in public prevention policies and recent migratory flows, have shaped our current epidemic. The present challenge must contemplate multisectoral efforts to achieve the UNAIDS objectives during this decade.

Development of an online nursing leadership program for global health in the Western Pacific Region

@#<strong>BACKGROUND AND OBJECTIVE</strong><p>Global health highlights the transnational determinants, issues, and possible solutions for improving health outcomes. Addressing global health issues requires population-based approaches coupled with individualized healthcare across settings, including strategies for achieving health equity. Designing and implementing global health solutions requires competent nurse leaders who can facilitate multi-disciplinary collaborations, engage in policy development, and lead advocacies that support the global health agenda. Thus, this paper examined the stakeholder perspectives that informed the development of a leadership program on global health for nurse leaders in the Western Pacific Region (WPR).</p><strong>METHODS</strong><p>The study used a descriptive qualitative approach to generate key recommendations for a context-appropriate, multi-country capacity-building program for nurse leaders on global health. The Analysis Design, Development, Implementation, and Evaluation (ADDIE) model and reflexive approach were employed to guide the development of the training design. Twenty-five nurse leaders from World Health Organization Collaborating Centers (WHO-CC) in the Western Pacific participated. Qualitative data were collected from participant feedback and post-activity sessions throughout program implementation.</p><strong>RESULTS</strong><p>Thematic analysis of stakeholder data revealed that the program (1) capitalized on equipping nurse leaders with the concepts related to global health and developing competencies in leadership, policy engagement, and advocacy; (2) ensured learning strategies by having participants from varied contexts and experiences; and (3) reflected on the strengths and limitations of the use of the online platform.</p><strong>CONCLUSION</strong><p>This paper contributed to the growing literature on global health and programs that support addressing global health issues. The findings underscored the urgent need to capacitate nurses in leadership positions who contribute to addressing emerging issues in global health. The paper recommended improvements in the design and implementation of the Global Health Nursing Leadership Program to engage more nurse leaders across the region and enhance content and delivery.</p>

Research progress on global health competency and its models / 中华预防医学杂志

At present, the research on Global Health Competencies is mainly conducted in the field of the establishment of competency models and application of indicators. This review summarizes the research progress of the Global Health Competency and its models, and focuses on cutting-edge research from the aspects of target audience, purpose, content, classical model, methods and future development. The competency model is suggested to be adjusted and updated according to the practices of different countries and regions. The research and funding of the competency model in the field of public health is suggested to be strengthened, and the global health and diplomacy are suggested to be combined to enrich and improve the competency model. Finally, this review aims to promote Global Health Competencies research in China, especially to improve the global health talent training system and relevant policies in further research.

Research progress on global health competency and its models / 中华预防医学杂志

At present, the research on Global Health Competencies is mainly conducted in the field of the establishment of competency models and application of indicators. This review summarizes the research progress of the Global Health Competency and its models, and focuses on cutting-edge research from the aspects of target audience, purpose, content, classical model, methods and future development. The competency model is suggested to be adjusted and updated according to the practices of different countries and regions. The research and funding of the competency model in the field of public health is suggested to be strengthened, and the global health and diplomacy are suggested to be combined to enrich and improve the competency model. Finally, this review aims to promote Global Health Competencies research in China, especially to improve the global health talent training system and relevant policies in further research.

Governança em rede: um estudo de caso sobre a Rede Global de Bancos de Leite Humano durante a pandemia de covid-19 / Network governance: a case study on the Global Network of Human Milk Banks during the covid-19 pandemic

O estudo investigou a forma de governança praticada pela Rede Global de Bancos de Leite Humano (rBLH-Global), com ênfase no contexto da doação de leite humano durante o início da pandemia de covid-19. Identificou-se que, embora já houvesse indicações anteriores da governança compartilhada, revelou-se que sua abordagem em rede é profundamente influenciada por sua estrutura, princípios compartilhados e relações estabelecidas. Os elementos clássicos de governança, juntamente com as três dimensões do capital social, ofereceram uma fundamentação sólida para analisar essa forma de governança com base nos quatro fatores-chave de eficácia da governança em rede de Provan e Kenis (2008). Dentre os resultados, observou-se que a rBLH-Global demonstra: processos democráticos e descentralizados na formação de diretrizes; padrões uniformes de qualidade e segurança; resiliência e adaptabilidade durante crises; uma estrutura descentralizada; e liderança distribuída. O estudo validou que a rBLH-Global atua sob a forma de governança compartilhada, uma interação altamente horizontalizada entre os membros da rede, enfatizando relações mútuas, interdependência e decisões coletivas. Observou-se que o capital social da Rede permite a eficácia dessa forma adotada mesmo com um grande número de membros. O estudo também destacou percepções de profissionais de saúde e mulheres-mães doadoras de bancos de leite humano de diferentes países membros da rBLH-Global, revelando alto grau de confiança, consenso de objetivos, interdependência em competências e cooperação mútua. Conclui-se que a rBLH-Global, por sua governança compartilhada, prosperou durante os desafios da pandemia. Recomendações futuras incluem ampliar o escopo de análise para outros atores, estudos comparativos e explorar lições aprendidas para futuras crises. A pesquisa destaca a relevância das opiniões de profissionais de saúde e mulheres-mães doadoras para avaliação da governança, sugerindo a complementaridade destas perspectivas em estudos subsequentes.

The study investigated the form of governance practiced by the Global Network of Human Milk Banks (rBLH-Global), with an emphasis on the context of human milk donation during the beginning of the covid-19 pandemic. It was identified that, although there were previous indications of shared governance, it was revealed that its network approach is deeply influenced by its structure, shared principles and established relationships. The classical elements of governance, together with the three dimensions of social capital, provided a solid foundation for analyzing this form of governance based on Provan and Kenis' (2008) four key factors of network governance effectiveness. Among the results, it was observed that rBLH-Global demonstrates: democratic and decentralized processes in the formation of guidelines; uniform quality and safety standards; resilience and adaptability during crises; a decentralized structure; and distributed leadership. The study validated that rBLH-Global operates under shared governance, a highly horizontal interaction between network members, emphasizing mutual relationships, interdependence and collective decisions. It was observed that the social capital of the Network allows the effectiveness of this adopted form even with a large number of members. The study also highlighted perceptions of health professionals and women donors from human milk banks from different member countries of rBLH-Global, revealing a high degree of trust, consensus of objectives, interdependence in skills and mutual cooperation. It is concluded that rBLH-Global, due to its shared governance, prospered during the challenges of the pandemic. Future recommendations include expanding the scope of analysis to other actors, comparative studies, and exploring lessons learned for future crises. The research highlights the relevance of the opinions of health professionals and female donor mothers for evaluating governance, suggesting the complementarity of these perspectives in subsequent studies.

Entre "beiras" e bares: rede de atenção em saúde mental para uso de álcool na tríplice fronteira amazônica / Between edges and bars: mental health care network for alcohol use in the Amazonian triple border

A atenção à saúde mental em países de baixa e média renda é caracterizada pela reduzida prioridade do tema na agenda de saúde pública, escassez de recursos e desigualdades. Estas desigualdades se acentuam em áreas periféricas como fronteiras, que vivenciam maiores dificuldades na provisão de serviços. Na Amazônia, estas dificuldades são acrescidas das especificidades locais, desafiando a produção do cuidado em saúde. Este estudo de caso teve por objetivo analisar a rede de saúde mental para o uso de álcool na tríplice fronteira amazônica a partir do município de Tabatinga (Brasil). As técnicas eleitas foram análise de documentos, entrevistas e elaboração de diário de campo. Realizou-se análise documental das políticas públicas voltadas para atenção em saúde mental e uso de álcool nos três países fronteiriços; entrevistas com profissionais e gestores de saúde da atenção primária de Tabatinga para a caracterização da rede e seus fluxos; e registros em diário de campo. A análise dos dados primários ocorreu em um processo de codificação iterativa que resultou na construção de temas. Os resultados foram interpretados à luz das construções teóricas da psicologia social de Pichon-Rivière e discussões atuais no campo da saúde mental global. Os achados deste estudo apontaram para: convergências dos princípios expressos nas políticas de atenção à saúde mental e uso de álcool nos três países; a existência de uma rica dinâmica transfronteiriça permeada por intercâmbios sociais que se dão no cotidiano de vida da população, mas não se traduzem com a mesma expressividade no campo das relações institucionais de saúde; o uso de álcool como fenômeno fortemente imbricado na dinâmica sociocultural local, fator que influencia a percepção do tema em sua relação com a saúde; o uso de álcool como tema ausente das prioridades da saúde e dos demais setores na região; rede de atenção marcada por desigualdades e insuficiências em termos de dispositivos, recursos humanos, capacitação, articulações intersetoriais; rede que reflete as disputas de diferentes racionalidades em torno da atenção em saúde mental, álcool e outras drogas. Estes resultados indicam particularidades da fronteira amazônica em termos sociais e culturais, que podem auxiliar na construção de políticas e perspectivas de manejo conjunto da atenção à saúde mental no cenário fronteiriço.

Mental healthcare in low and middle-income countries is characterized by its low priority on the public health agenda, scarcity of resources, and inequalities. These disparities are particularly pronounced in peripheral regions like border areas, where service delivery faces significant challenges. In the Amazon region, these challenges are compounded by unique local factors. This case study aimed to examine the mental health network for alcohol use in the Amazonian triple border, specifically focusing on the municipality of Tabatinga in Brazil. The data collection involved analyzing documents, conducting interviews, and producing field notes observations. The document analysis examined the mental health and alcohol policies of the three countries. Interviews with healthcare professionals and managers from Tabatinga's primary healthcare provided insights into the local mental health network and its operations, while field notes offered contextual information. Data analysis was carried out through an iterative coding process. The findings were interpreted in light of Pichon-Rivière's social psychology theoretical framework and ongoing discussions in the global mental health field. The study revealed several key points: alignment of principles outlined in mental health and alcohol policies across the three countries; a vibrant cross-border dynamic characterized by social interactions in daily life that are not reflected in institutional healthcare relationships; the deep integration of alcohol use within local socio-cultural dynamics shaping perceptions of its health implications; alcohol use as a low priority within health and broader regional agendas; an unequal and deficient healthcare network lacking adequate facilities, human resources, training, and intersectoral collaboration; and underlying tensions surrounding different approaches to mental health, alcohol, and substance abuse care within the healthcare system. These findings underscore the social and cultural complexities of the Amazonian border region, offering insights for the development of policies and collaborative management strategies for mental health care in this unique border context.

Desvelando a governança e a sustentabilidade dos sistemas alimentares na era da Sindemia Global: uma abordagem a partir dos Guias Alimentares para Populações / Unveiling the governance and sustainability of food systems in the era of the Global Syndemic: an approach based on the Dietary Guidelines for Populations

Introdução: A sinergia das pandemias de obesidade, desnutrição e mudanças climáticas, conhecida como Sindemia Global (SG), demonstra o papel crítico dos sistemas alimentares nos principais desafios contemporâneos da saúde global. Sua superação requer instrumentos de múltiplo impacto que incidam sobre seus determinantes fundamentais e fatores sistêmicos impulsionadores. Diferentes concepções do problema e propostas de soluções mobilizam conceitos complexos e polissêmicos na disputa por espaço e recursos. O crescente envolvimento de corporações multinacionais nos mecanismos de governança global dos sistemas alimentares suscita debates visto que interesses comerciais são um dos principais fatores sistêmicos impulsionadores da SG. Objetivo: avançar na compreensão dos Guias Alimentares para Populações (GAP) como instrumentos de indução de políticas para que sistemas alimentares sejam social, econômica e ambientalmente sustentáveis e promotores de saúde no contexto da SG. Metodologia: com a combinação de revisão da literatura e pesquisa qualitativa foram elaborados três artigos. O primeiro mobilizou a revisão da literatura, a análise documental e a observação participante para refletir sobre as dinâmicas entre os principais atores do sistema alimentar no enfrentamento da SG, com atenção à relação entre mecanismos de governança econômica global e dos sistemas alimentares. O segundo mobilizou a revisão da literatura para identificar e adaptar um quadro para análise qualitativa da integração da sustentabilidade - em todas as suas dimensões - em GAPs. O terceiro mobilizou o quadro de análise produzido no segundo artigo para comparar a amplitude e a profundidade com que os GAPs de países selecionados trabalham a sustentabilidade à luz dos determinantes fundamentais e fatores sistêmicos impulsionadores da SG. Resultados: Desde a crise econômica de 2008 observa-se maior envolvimento de atores ligados à governança econômica nos mecanismos de governança global sobre sistemas alimentares. Isso torna ainda mais complexa a disputa de concepções sobre os desafios dos sistemas alimentares e as propostas de soluções. Nesse contexto, o quadro adaptado configura-se como uma ferramenta valiosa para pesquisadores, formuladores de políticas e sociedade civil. Ele fornece um método concreto para avaliar se os GAPs abordam adequadamente todas as dimensões da sustentabilidade e maximizam seu potencial como instrumento de política de múltiplos impactos para enfrentar a SG. Esse quadro de análise também pode orientar processos de revisão e formulação de GAPs. O estudo evidenciou que dada a conjuntura marcada pela disputa de narrativas, o aprofundamento da integração da sustentabilidade pode oferecer um marco de referência inequívoco para adoção de medidas estruturais que alterem as condições sistêmicas que permitem que a SG prospere. Sugere também que quanto mais profunda a integração da sustentabilidade em um GAP, menores as margens para que grandes corporações disputem interpretações que favoreçam os interesses comerciais, não o bem comum. Conclusões: Este estudo demonstra que os GAPs, além de ferramentas de educação alimentar e nutricional, são instrumentos cruciais que refletem a perspectiva de um país sobre seu sistema alimentar e têm o potencial de influenciar políticas públicas para a sustentabilidade desses sistemas. No entanto, para cumprir efetivamente esse papel, os GAPs devem abordar de forma ampla e profunda todas as dimensões e subdimensões da sustentabilidade.

Introduction: The synergy of obesity, undernutrition, and climate change pandemics, known as the Global Syndemic (GS), demonstrates the critical role of food systems in the major contemporary challenges of global health. Overcoming it requires multi-impact instruments that address its fundamental determinants and systemic drivers. Different conceptions of the problem and proposed solutions mobilize complex and polysemous concepts in the dispute for space and resources. The growing involvement of multinational corporations in global food system governance mechanisms raises debates as commercial interests are one of the main systemic drivers of the GS. Objective: To advance the understanding of Dietary Guidelines for Populations (DGPs) as policy instruments to induce food systems to be socially, economically, and environmentally sustainable and health-promoting in the context of the GS. Methodology: Combining literature review and qualitative research, three papers were developed. The first mobilized literature review, document analysis, and participant observation to reflect on the dynamics between the main food system actors in addressing the GS, with attention to the relationship between global economic and food system governance mechanisms. The second mobilized literature review to identify and adapt a framework for qualitative analysis of sustainability integration - in all its dimensions - in DGPs. The third mobilized the analysis framework produced in the second paper to compare the breadth and depth with which DGPs from selected countries address sustainability in light of the GS's fundamental determinants and systemic drivers. Results: Since the 2008 economic crisis, there has been greater involvement of actors linked to economic governance in the global governance of food systems. This makes the dispute over conceptions of food system challenges and proposed solutions even more complex. In this context, the adapted framework is a valuable tool for researchers, policymakers, and civil society. It provides a concrete method for assessing whether DGPs adequately address all dimensions of sustainability and maximize their potential as a multiimpact policy instrument to address the GS. This analysis framework can also guide DGP review and formulation processes. The study evidenced that given the conjuncture marked by the dispute of narratives, the deepening of sustainability integration can offer an unequivocal reference framework for adopting structural measures that alter the systemic conditions that allow the GS to thrive. It also suggests that the deeper the integration of sustainability into a DGP, the smaller the margins for multinational corporations to dispute interpretations that favor commercial interests, not the common good. Conclusions: This study demonstrates that DGPs, in addition to food and nutritional education tools, are crucial policy instruments that reflect a country's perspective on its food system and have the potential to influence public policies for the sustainability of these systems. However, to effectively fulfill this role, DGPs must comprehensively and deeply address all dimensions and subdimensions of sustainability.

Relações raciais e branquitude na cooperação humanitária internacional em saúde / Race relations and whiteness in international humanitarian cooperation in health

O debate sobre questões raciais na cooperação humanitária internacional em saúde vem sendo aprofundado especialmente desde 2020, embora sem necessariamente incluir uma perspectiva sobre a branquitude. Esta pesquisa tem como objetivo entender as relações raciais entre profissionais de diferentes perfis na organização Médicos Sem Fronteiras que atuam em projetos médico-humanitários em diversos países. Esses profissionais são categorizados em dois grupos principais: os profissionais móveis internacionais e os profissionais recrutados localmente. A pesquisa concentrou-se nas interações entre esses grupos no continente africano, com foco particular nas relações entre profissionais brancos e negros. Procurou-se compreender essas relações à luz dos conceitos de raça, racismo e branquitude, bem como considerar a persistência de uma perspectiva colonial na área de atuação. A metodologia incluiu observações feitas entre 2010 e 2024 em diversos países, análise de materiais e documentos da organização e entrevistas em profundidade. Conclui-se que o racismo está presente nas dinâmicas do humanitarismo em saúde e que a branquitude desempenha um papel central nesses processos, influenciando tanto aspectos institucionais quanto individuais e contribuindo para as hierarquias de poder organizacional.

The debate on racial issues in international humanitarian cooperation in health has been deepened especially since 2020, although without necessarily including a perspective on whiteness. This research aims to understand race relations between professionals of different profiles in Médecins Sans Frontières, who work on medical-humanitarian projects in various countries. These professionals are categorized into two main groups: internationally mobile staff and locally hired staff. The research focused on the interactions between these groups on the African continent, with a particular focus on relations between Black and White professionals. It sought to understand these relationships in the light of the concepts of race, racism and whiteness, as well as considering the persistence of a colonial perspective in the area. The methodology included observations made between 2010 and 2024 in various countries, analysis of organizational materials and documents, and in-depth interviews. It concludes that racism is present in the dynamics of humanitarianism in health and that whiteness plays a central role in these processes, influencing both institutional and individual aspects and contributing to organizational power hierarchies.

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.

Asociación entre las tendencias de búsqueda en internet con el número de casos confirmados por la viruela símica: estudio multinacional en diez países / Association between internet search trends and the number of confirmed monkeypox cases: a multinational study in ten countries

INTRODUCCIÓN: La viruela símica es una infección zoonótica que se ha distribuido por todo el mundo. La búsqueda de información en internet refleja el interés y concientización de la población acerca de salud. OBJETIVO: Determinar la asociación entre el volumen relativo de búsquedas en internet con el número de casos confirmados por la viruela símica en diez países. MÉTODOS: Se realizó un estudio obser- vacional, analítico, retrospectivo, utilizando la herramienta Google Trends (GT™) para encontrar el volumen relativo búsqueda (VRB) sobre viruela símica desde 01 de enero al 31 de agosto del 2022 usando términos de búsqueda en el idioma oficial de los 10 países con mayor número de casos en dichas fechas, registrado por Our World in Data. Para establecer la relación lineal entre el VRB con los nuevos de casos por día se usó el coeficiente de correlación de Pearson con un nivel de significancia (p ≤ 0,05). RESULTADOS: Se encontró un coeficiente de correlación de Pearson fuerte en Brasil (Rp = 0,562,p = 0,001), y débil en países como Alemania (Rp = 0,281, p = 0,004), Estados Unidos de Norteamérica (Rp = 0,255, p = 0,008), España (Rp = 0,122, p = 0,213), Perú (Rp = 0,120, p = 0,333), Canadá (Rp = 0,116, p = 0,238), Francia (Rp = 0,095, p = 0,335), Reino Unido (Rp = 0,085, p = 0,362), Portugal (Rp = 0,024, p = 0,805) y Países Bajos (Rp = 0,067, p = 0,497). CONCLUSIÓN: Nuestro estudio evidencio que el VRB presento una relación positiva con el número de nuevos casos de viruela símica. Asimismo, se observo un coeficiente de correlación fuerte en Brasil, y en el resto de países fue débil.

BACKGROUND: Smallpox is a zoonotic infection that has been distributed worldwide. The search for information on the Internet reflects the interest and awareness of the population about health. AIM: To determine the correlation between the relative volume of internet searches and the number of confirmed cases of smallpox in ten countries. METHODS: An observational, analytical, retrospective study was conducted using the Google Trends (GT™) tool to find the relative search volume (RSV) on monkeypox from January 1 to August 31, 2022 using search terms in the official language of the 10 countries with the highest number of cases on those dates, as recorded by Our World in Data. To establish the relationship between RSV and new cases per day, Spearman's correlation was used with a significance level (p ≤ 0.05). RESULTS: A. strong Pearson correlation coefficient was found in Brazil (Rp = 0.562, p = 0.001), and weak in countries like Germany (Rp = 0.281, p = 0.004), United States (Rp = 0.255, p = 0.008), Spain (Rp = 0. 122, p = 0.213), Peru (Rp = 0.120, p = 0.333), Canada (Rp = 0.116, p = 0.238), France (Rp = 0.095, p = 0.335), United Kingdom (Rp = 0.085, p = 0.362), Portugal (Rp = 0.024, p = 0.805) and Netherlands (Rp = 0.067, p = 0.497). CONCLUSION: Our study showed that RSV had a positive relationship with the number of new cases of smallpox. Also, a strong correlation coefficient was observed in Brazil, while the rest of the countries showed a weak correlation coefficient.

Odontología sostenible y sustentable / Sustainable dentistry

Introducción: la periodontitis es una enfermedad infecciosa multifactorial asociada a un biofilm de microorganismos patógenos. Objetivo: el objetivo del trabajo fue establecer la prevalencia de Porphyromonas gingivalis en pacientes con periodontitis y relacionarla con la severidad de la enfermedad. Material y métodos: participaron 45 pacientes, sistémicamente saludables, con edades entre 35 y 65 años. El grado de periodontitis se definió según los criterios de Papapanou y colaboradores. Como grupo control, se incluyeron 20 sujetos de ambos sexos sin periodontitis y sin enfermedades sistémicas. Se tomaron muestras de fluido gingival en dos sitios más profundos. Porphyromonas gingivalis se detectó por PCR (reacción en cadena de la polimerasa). Resultados: la frecuencia relativa de periodontitis fue de 13.3% grado I, 46.7% grado II y 40% grado III. El sexo masculino presentó periodontitis grado III 72.2% y grado II 52.3%. El grado I se registró con mayor frecuencia en el sexo femenino, 66.7%. La prevalencia de Porphyromonas gingivalis en la población con periodontitis fue de 44.4%. Se obtuvieron diferencias estadísticamente significativas entre los grados de severidad de periodontitis y la presencia de Porphyromonas gingivalis (p = 0.0002, α = 5%). Conclusión: la periodontitis predominó en el sexo masculino. La prevalencia de Porphyromonas gingivalis en la población con periodontitis crónica fue de 44.4% y su presencia está relacionada con la severidad (AU)

Introduction: periodontitis is a multifactorial infectious disease associated with a biofilm of pathogenic microorganisms. Objective: the objective of the work was to establish the prevalence of Porphyromonas gingivalis in patients with periodontitis and relate it to the severity of the disease. Material and methods: 45 systemically healthy patients, aged between 35 and 65 years old, participated. The degree of periodontitis was defined according to the criteria of Papapanou et al. As a control group, 20 patients of both sexes without periodontitis and without systemic diseases were included. Gingival fluid samples were taken from two deeper sites. Porphyromonas gingivalis was detected by PCR (polymerase chain reaction). Results: the relative frequency of periodontitis was 13.3% grade I, 46.7% grade II and 40% grade III. The male sex presented periodontitis grade III 72.2% and grade II 52.3%. Grade I was recorded more frequently in the female sex, 66.7%. The prevalence of Porphyromonas gingivalis in the population with periodontitis was 44.4%. Statistically significant differences were obtained between the degrees of severity of periodontitis and the presence of Porphyromonas gingivalis (p = 0.0002, α = 5%). Conclusion: periodontitis predominated in males. The prevalence of Porphyromonas gingivalis in the population with chronic periodontitis was 44.4% and its presence is related to severity (AU)

Medicina Integrativa en Chile: Hacia una visión más global de la salud de las personas / Integrative Medicine in Chile: Towards a more global vision of people's health

La Organización Mundial de la Salud ha definido salud como un estado de completo bienestar físico, mental y social, no solo como la ausencia de enfermedad. La medicina integrativa considera la articulación de diferentes prácticas y sistemas médicos, como las terapias mente-cuerpo, las terapias manuales, la medicina energética, los sistemas completos y los estilos de vida saludables, que permite ampliar la comprensión de los procesos de salud y enfermedad, junto con dar herramientas concretas en este abordaje, centrado en la persona más que en la enfermedad. En Chile, el Ministerio de Salud planteó la incorporación de las medicinas alternativas y complementarias a través del decreto 42, reglamentándolas como auxiliares a la atención tradicional, normando las condiciones de los recintos donde se realizan y regulando hasta el momento el ejercicio de la acupuntura, la homeopatía y la naturopatía. Existen múltiples barreras para la implementación de unidades de medicina integrativa, como la percepción de que son costosas, poco efectivas y que muchas veces existe resistencia por parte de los equipos de salud. Para su avance es importante ir incorporando la disciplina en los currículums de las carreras de la salud, el consensuar taxonomías y resultados a evaluar, no perder de vista que el tronco de la atención en salud se encuentra en la atención primaria y generar un mayor desarrollo de la evidencia asociada a su uso, sobre todo a nivel local, incorporando de manera más rutinaria el informar también sobre sus potenciales efectos adversos.

The World Health Organization has defined health as a state of complete physical, mental and social well-being, not just the absence of disease. Integrative medicine considers the articulation of different medical practices and systems such as mind-body therapies, manual therapies, energy medicine, whole systems and healthy lifestyles, allowing focusing on the cause of diseases and giving concrete tools to focus on the person rather than just the disease. In Chile, the Ministry of Health proposed incorporating alternative and complementary medicines through Decree 42, regulating them as auxiliary to traditional care, the conditions of practice for the exercise of acupuncture, homeopathy, and naturopathy. There are multiple barriers to implementing integrative medicine units, such as the perception that they are expensive and ineffective and, frequently, the resistance of health teams. For its advancement, it is essential to gradually incorporate this discipline in health careers curricula, agree on taxonomies and outcomes, and maintain sight that the core of health care is at the primary level. It is also necessary to generate evidence on the use of integrative medicine, especially at the local level, incorporating its practice more routinely and reporting on its potential adverse effects.

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.