A promessa ou possibilidade de passar a existir uma cultura médica de vida saudável na América Latina

Os desafios enfrentados por pacientes e suas famílias para terem acesso a cuidados médicos referentes a condições de saúde crônicas fazem com que os profissionais de saúde responsáveis por seu atendimento médico se sintam, com elevada frequência, impotentes. Às vezes convém atribuir a reponsabilidade por esses desafios a um ou mais grupos específicos, tais como os formuladores de políticas ou o sistema de seguro-saúde. No entanto, as verdadeiras razões desses desafios são bem mais complexas, existindo múltiplos fatores presentes, com interrelação. Torna-se necessário realizar uma análise sistêmica mais ampla, bem como ter uma visão mais abrangente, de forma a integrar o contexto sociocultural, focando particularmente as populações vulneráveis e aquelas precariamente atendidas, incluindo-se os adultos mais idosos, a população de áreas densamente povoadas e os indivíduos com status socioeconômico de nível inferior, assim como os migrantes e as minorias1. Neste contexto, a equidade e a justiça social constituem fundamentos aplicáveis essencialmente em um estado de utopia, mas estes fundamentos são indispensáveis à implementação de mudanças futuras.A justiça social constitui um apelo bastante significativo como conceito, a ser plenamente reconhecido em todas as profissões relacionadas aos cuidados de saúde2. O conceito afirma que todos devem, independentemente das circunstâncias legais, políticas, econômicas ou outras3, ter acesso igual à riqueza, ao bem-estar, aos privilégios e às oportunidades, bem como à saúde. Além disso, esse conceito é dirigido para dimensões que vão além dos princípios do direito civil ou penal e transcendem, entre os indivíduos e a sociedade, a relação cujo propósito é ter e manter uma vida gratificante. Portanto, a justiça social é de aplicação universal, devendo ser relacionada a propósitos sociais em todas as regiões do mundo.Como região, a América Latina tem muitos países e com numerosos pontos em comum. Antes da pandemia do coronavírus de 2019 (COVID-19), existiam desafios significativos com relação à saúde na América Latina, incluindo a escassez de medicamentos, a falta de acesso a alimentos saudáveis ou a cuidados primários, seja para migrantes ou pessoas desabrigadas. De acordo com o Índice de GINI, a América Latina é a região mais injusta do planeta, com 185 milhões de pessoas auferindo uma renda abaixo do limiar de pobreza, o equivalente a 66 milhões de indivíduos em estado de pobreza extrema4. Para superar essas deficiências, as comunidades precariamente atendidas se apoiam mutuamente, trabalhando em projetos locais, bancos de alimentos e organizações religiosas, mas desafios significativos continuam existindo.A abordagem atual, com respeito aos cuidados de saúde para indivíduos fragilmente representados e que vivem em comunidades mal atendidas, não é mais sustentável. O caminho a adotar deve incluir como base a medicina para uma vida saudável (HLM, na sigla em inglês), promovendo em sua essência atividades físicas, boa alimentação, ter um peso corporal mediano e abster-se de fumar. Em nível sistêmico, essa mudança cultural diz respeito ao estabelecimento de políticas e práticas.Apromessa ou possibilidade de ter uma existência gratificante encontra-se aqui, na América Latina. Essa abordagem precisa abraçar o conceito de justiça social para que todos tenham oportunidades semelhantes com relação a ter um estilo de vida saudável, minimizando-se os efeitos deletérios das doenças crônicas.Alternate :The challenges that patients and their families experience to access care for chronic health conditions often make the health professionals responsible for their care feel powerless. At times, it may be convenient to lay the blame for these challenges on a singular group, such as policymakers or the health insurance system. However, the true reasons such challenges exist are much more complex, multifactorial, and interrelated. A broader systemic analysis and broader visio is needed to integrate the sociocultural context and place a particular focus on vulnerable, underserved populations, including older adults, people living in densely populated areas, people with lower socioeconomic status, migrants, and minorities11 Shadmi E, Chen Y, Dourado I, Faran-Perach I, Furler J, Hangoma P, Hanvoravongchai P, Obando C, Petrosyan V, Rao KD, Ruano AL, Shi L, de Souza LE, Spitzer-Shohat S, Sturgiss E, Suphanchaimat R, Uribe MV, Willems S. Health equity and COVID-19: global perspectives. Int J Equity Health 2020;19(1):104.. In this context, equity and social justice are constructs that may only feasible in a Utopia but are essential to effect change moving forward.Social justice as a concept is quite appealing and should be fully embraced by all health care professions22 Arena R, Laddu D, Severin R, Hall G, Bond S, HL-PIVOT Network. Healthy living and social justice: addressing the current syndemic in underserved communities. J Cardiopulm Rehabil Prev 2021;41(3):E5-E6.. The concept professes that all people should have equal access to wealth, well-being, privilege, opportunity, and health regardless of legal, political, economic, or other circumstances33 Braveman PA, Kumanyika S, Fielding J, Laveist T, Borrell LN., Manderscheid R, Troutman A. Health disparities and health equity: the issue is justice. Am J Public Health 2011, 101(Suppl. 1):S149-S155.. Moreover, this concept focuses on dimensions beyond civil or criminal law principles and the relationship between individuals and society to lead fulfilling lives. Therefore, social justice is relatable and universal for all regions in the world.Latin America as a region hosts many countries that share numerous commonalities. Prior to the coronavirus disease 2019 (COVID-19) pandemic, there were significant health related challenges in Latin America, including prescription drug shortages, lack of access to healthy food or primary care for migrants, and homelessness. According to the GINI Index, Latin America is the most inequitable region globally;185 million people's income is below the poverty threshold, of whom 66 million live in extreme poverty44 Garcia PJ, Alarcón A, Bayer A, Buss P, Guerra G, Ribeiro H, Rojas K, Saenz R, Salgado de Snyder N, Solimano G, Torres R, Tobar S, Tuesca R, Vargas G, Atun R. COVID-19 response in Latin America. Am J Trop Med Hyg 2020;103(5): 1765.. While these underserved communities support each other to supplement these shortcomings by working with local movements, food banks, and religious organizations, significant challenges remain. The current approach to health care in underrepresented individuals who live in underserved communities is no longer sustainable. The way forward must include healthy living medicine (HLM) as a foundation, at its core promoting physical activity, good nutrition, average body weight, and not smoking. On a systemic level, this cultural change refers to the establishment of policies and practices. The promise or possibility of being is here in Latin America. This approach needs to embrace the concept of social justice so that all individuals in the population have similar opportunities to embrace a healthy lifestyle and minimize the deleterious effects of chronic disease.

Faculty readiness for a digital education model: A self-assessment from health sciences educators

During the COVID-19 pandemic, the continuity of education across the world is being supported through e-learning. Healthcare programs especially, require continuing patient-centered training to benefit individuals and society. The objective of this study was to assess the faculty members' skills to continue educational services through a digital education model at the beginning of the lockdown. The methodology consisted in a quantitative approach descriptive and cross-sectional design. The instrument was a survey with two sections: (1) self-assessment and (2) self-ranking based on the digital education model. The results for 497 participants indicated higher scores on active learning and web conference digital skills. Evaluation is still a competence required to be reinforced by the faculty to incorporate a full transition into online learning. There seems to be an agreement about faculty readiness to implement different active learning strategies, despite being in a distance education model.Implications for practice:* University leaders welcomed the self-assessment that faculty members performed on digital skills as it allowed them to adapt the training programs and designate staff teams to support the educators once classes restarted.* Educators implementing a digital education model should consider a planned and structured educational solution that is beyond the distance between learners and teachers, but an engaging environment for learning incorporating different technologies and active pedagogies.

Well-being variations on students of health sciences related to their learning opportunities, resources, and daily activities in an online and on-crisis context: a survey-based study.

BACKGROUND: Universities' training process intensely relies on face-to-face education. The COVID-19 pandemic interrupted it and forced them to reinvent their process online. But this crisis seems not to be the last we will face, and we take it as a lesson to prepare for future crises. These critical contexts are especially challenging because they imply changing teaching strategies, and students may not have the technology access or the living conditions to connect as they need. They also lived through a pandemic where the virus and the life changes added stress to their learning process and threatened their well-being. So, this study aims to analyze how well-being variations reported by Health sciences students relate to their learning opportunities, access conditions, and daily activities. METHOD: We surveyed 910 Health sciences students from six different Chilean universities at the end of the first semester of 2020, the first in pandemic conditions. Respondents answered online questionnaires about 1) Remote teaching activities, 2) Learning resources availability, 3) Daily life activities, and 4) Well-being changes. We performed descriptive analysis and Structural Equation Modelling. RESULTS: Live videoconference classes were the most frequent teaching activity; only a third of the students had quiet spaces to study online, and most had to housekeep daily. More than two third reported some well-being deterioration. The structural equation model showed a good fit. CONCLUSION: Results show an online learning scenario that tries to emulate traditional learning focusing on expositive strategies. Most students reported that their well-being deteriorated during the semester, but tutorials, workplace availability, and social support were protective factors.

The training of a new social-responsible generation of health professionals with a patient-centered vision.

The challenges that Latin America faces in health are deeply related to others, such as access to clean water, the right to education, and housing. Health professionals that work in an environment where the population faces constant barriers to accessing care in the public health system or has limited resources to pay for it in a private sector will face an ethical dilemma, the question of how to honor the call to care for patients when there is not enough support system or infrastructure to do so. Within the schools of medicine and health sciences, the question is how to train students to face or resolve these conflicts. The social responsibility approach is a proposal that allows the alignment of education for health professionals and health systems to contribute to the creation of an effective, equitable, and sustainable system. The present article aims to discuss this problem from the importance of training health professionals, ethical and committed to their communities, that have the skills and attitudes to implement a patient-centered vision. The involvement of universities and training institutions of the next generation of health professionals cannot be postponed.

Results and effects of patients who have recovered from COVID-19: identifying the relationship with risk factors and comorbidities.

The number of deaths from COVID-19 is closely associated with multimorbidities. This study aimed to review the clinical and functional conditions of patients who recovered from COVID-19. Additionally, identify the relationship with risk factors and comorbidities. Systemic arterial hypertension (SAH) was more frequently observed in patients with severe COVID-19. Diabetes mellitus (DM) is one of the comorbidities that has contributed the most to the increase in the number of hospitalizations due to complications and the number of deaths due to infection by COVID-19. Obesity has been shown to be a risk factor for hospitalization in patients with COVID-19 under 60 years of age. Most survivors of COVID-19 suffer primarily from muscle fatigue or weakness. In addition, patients who were more seriously ill during their hospital stay have greater impairment of functional capacity, pulmonary diffusion and fatigue symptoms, and are the main target population for long-term recovery interventions. To optimize the post-hospitalization rehabilitation of patients after discharge from COVID-19, the need for multidisciplinary work in rehabilitation, the reinforcement of public policies to ensure equity in access to the public health system and training should be considered of the health team in view of the new demands and realities generated by COVID-19.

Ageist No More: Interprofessional Training for Undergraduate Healthcare Students.

Ageism seeps deep into our society, whether in law, policies, or healthcare practices it segregates individuals based on their age. The aim of this work was to evaluate the impact of an educational strategy in ageist attitudes against older adults in healthcare undergraduate students. A five-week intervention: Healthy environments and self-care for the older adults was implemented. To assess the impact of this strategy in ageist attitudes in participants, a simulated consultation with an older adult was conducted. Participants' perspectives on the experience were collected using an online survey. One hundred and thirty-eight undergraduate students from health programs were included. They highlighted growth in the understanding of the normal aging process and the prejudices that surround aging. During the role-play activity, participants identified communication, empathy, and professionalism as the abilities developed with this strategy and the need to show empathy and avoid prejudice against older adults in their clinical interactions. Educational interventions are a great tool to promote cultural changes, diminish prejudices and misconceptions of ageism in future healthcare professionals.

Using a digital whiteboard for student engagement in distance education.

The COVID-19 pandemic transformed educational processes across different educational levels. As institutions and faculty members effort focused on guaranteeing academic continuity, the challenge was how to translate the learning methodologies applied in the classroom to virtual settings. A digital whiteboard was integrated to synchronous class sessions to complement the educational experience. During these sessions, students and teachers interacted to co-construct ideas and socialize learning. The objective of this study was to assess the impact of introducing a digital whiteboard in student engagement. The quantitative approach integrated student's perception through an online survey with 12 items. The results show that the students enjoyed the dynamic(4.56), students believe that the incorporation of digital whiteboard contributed to understanding abstract concepts(4.83), and perceived the resource contributed for class engagement(4.72). The design of educational projects that incorporate these resources translate to active learning dynamics which foster student engagement.

Current Activities Centered on Healthy Living and Recommendations for the Future: A Position Statement from the HL-PIVOT Network.

We continue to increase our cognizance and recognition of the importance of healthy living (HL) behaviors and HL medicine (HLM) to prevent and treat chronic disease. The continually unfolding events precipitated by the coronavirus disease 2019 (COVID-19) pandemic have further highlighted the importance of HL behaviors, as indicated by the characteristics of those who have been hospitalized and died from this viral infection. There has already been recognition that leading a healthy lifestyle, prior to the COVID-19 pandemic, may have a substantial protective effect in those who become infected with the virus. Now more than ever, HL behaviors and HLM are essential and must be promoted with a renewed vigor across the globe. In response to the rapidly evolving world since the beginning of the COVID-19 pandemic, and the clear need to change lifestyle behaviors to promote human resilience and quality of life, the HL for Pandemic Event Protection (HL-PIVOT) network was established. The 4 major areas of focus for the network are: (1) knowledge discovery and dissemination; (2) education; (3) policy; (4) implementation. This HL-PIVOT network position statement provides a current synopsis of the major focus areas of the network, including leading research in the field of HL behaviors and HLM, examples of best practices in education, policy, and implementation, and recommendations for the future.