Spatial analysis of care for patients undergoing dialysis therapy in the state of Minas Gerais, Brazil, between 2015 and 2019.

OBJECTIVE: To analyze the spatial flow of care for patients undergoing dialysis therapy in the health regions of the State of Minas Gerais. METHODS: Ecological study whose population was patients undergoing dialysis therapy in public, philanthropic institutions or whose treatment was paid for by the Unified Health System in private clinics in partnership, in the State of Minas Gerais. Patients were grouped by health region of residence. The proportions of patients who underwent dialysis were calculated, as well as enrollment on the kidney transplant list in their own region of residence or outside it. Person correlations of these proportions with socioeconomic and care indicators of the health regions were estimated. Spatial exploratory techniques estimated general (Moran's I) and local (LISA) spatial correlation coefficients. RESULTS: Regions with higher GDP had a higher number of nephrologists and a higher proportion of registrations in the region of residence. A cluster of regions with low GDP was identified further to the northeast of the State (also with lower nephrologist ratio values), a cluster with a high proportion of those registered on the transplant list in the center of the State, and a cluster with a low proportion of dialysis in the same region of residence further southeast. CONCLUSION: Regional disparities were evident in relation to the proportion of patients registered on the waiting list for kidney transplantation, the proportion of patients undergoing dialysis in the same region of residence and the proportion of patients registered on the waiting list for kidney transplantation in the same region of residence. residence.

Regional action framework on communication for health: a vision for using communication to improve public health in the Western Pacific Region

Strategic communication is at the heart of public health and more important than ever in the digital age. Using communication strategically requires expertise, skills and resources to plan, implement and evaluate interventions that encourage governments to implement policies that improve people’s lives and well-being, that empower health workers to deliver the best care possible, and that encourage people to take actions that protect and improve their health and that of their family and community. This Regional Action Framework on Communication for Health (C4H) aims to support Member States in implementing the C4H approach. It outlines steps to be taken by WHO and Member States to use C4H to achieve shared public health goals in the Western Pacific.

Regional health innovation strategy for the Western Pacific

The Regional Health Innovation Strategy for the Western Pacific outlines a vision and recommends key actions for governments to leverage health innovations to solve problems, accelerate impact, and shape the future of health and well-being. The implementation of the strategy should be guided by a mission-oriented approach, leverage collective intelligence and actions, focus on learning from the innovation process, and aim for a purposeful impact. In doing so, governments are encouraged to assume leadership in health innovation, create enabling ecosystems for innovation, and foster spaces for learning.

Human land-use changes the diets of sympatric native and invasive mammal species.

The consequences of biological invasions and habitat degradation for native biodiversity depend on how species cope with the individual and synergetic challenges these processes present. To assess the impact of anthropogenic land-use on the food web architecture of an invaded community, we examine the diets of nine native and two highly invasive mammal species at different trophic levels, inhabiting different land-uses across six biogeographic regions in Tasmania, Australia. We use two complementary methods, environmental DNA metabarcoding analysis (eDNA) of faeces and stable isotope analysis (SIA) of nitrogen (N) and carbon (C) in whole blood, to account for the high interindividual and temporal variability in the diets of multiple species simultaneously. eDNA showed regionalisation in the diet of smaller species, with land-use further defining dietary taxa within each region. SIA revealed that bioregion and land-use influence the δ13C values of all carnivore species and omnivores, whereas the δ15N values of these species are influenced only by land-use and not bioregion. Including multiple species showed that native rats are changing their diet in response to the presence of invasive rats, an impact that would have otherwise been attributed to land-use. Our findings demonstrate that human activities and invasive species are moulding the diets of invaded communities, raising questions about the potential impacts that dietary modifications will have on the life-history traits and the evolutionary consequences these modifications might have on the survival of native species. This highlights the urgency of including human activities in ecological studies and the importance of targeting multispecies assemblages to gain a better understanding of synergetic impacts on native biodiversity.

Las consecuencias de invasiones biológicas y degradación de hábitat en la biodiversidad nativa de un lugar dependen de las respuestas de las especies a los desafíos individuales y conjuntos que estos procesos les presentan. En este estudio examinamos la dieta de nueve mamíferos nativos y dos mamíferos altamente invasivos, pertenecientes a diferentes niveles tróficos, y que habitan diferentes usos de suelo en seis regiones bioclimáticas en Tasmania, Australia con el fin de examinar el impacto de diferentes usos de suelo en la estructura de una red trófica en una comunidad invadida. Para ello utilizamos dos métodos complementarios: ADN ambiental (eDNA) en heces y análisis de isótopos estables (SIA) de nitrógeno (N) y carbono (C) en sangre para dar cuenta, respectivamente, de la alta variabilidad interindividual y temporal en la dieta de estos animales. Los resultados de eDNA mostraron una regionalización en la dieta de las especies más pequeñas, y que el uso de suelo define aún más los taxa dietéticos dentro de cada región. El SIA reveló que los valores de δ13C de todas las especies de carnívoros y omnívoros están influenciadas por biorregiones y uso de suelo, mientras que los valores de δ15N de carnívoros y omnívoros sólo son influenciadas por el uso de suelo. Nuestros hallazgos demuestran que las actividades humanas y las especies invasoras están moldeando las dietas en comunidades invadidas generando preguntas sobre los potenciales impactos que las modificaciones dietéticas puedan tener sobre las características de las historias de vida de especies nativas y las consecuencias evolutivas que a su vez estas puedan tener en la sobrevivencia de estas especies. Así, este estudio demuestra la urgencia de incluir actividades humanas en los estudios ecológicos y la importancia de enfocarse en ensamblajes de múltiples especies para obtener un mejor entendimiento de los impactos sinérgicos sobre la biodiversidad nativa.

Mortalidade materno-infantil em um estado nortista brasileiro: coerência e discrepância entre instrumentos de gestão e agenda 2030 / Addressing maternal and child mortality in a northern brazilian state: coherence and discrepancy between management instruments and the 2030 agenda / Abordando la mortalidad materno-infantil en un estado del norte de brasil: coherencia y discrepancia entre los instrumentos de gestión y la agenda 2030

Introdução:As mortes maternas e infantis refletem as condições de vida de uma determinada população e são marcadores importantes de desenvolvimento de uma nação, reduzi-las tornou-se prioridade na Agenda 2030 de desenvolvimento sustentável. Políticas públicas devem ser formuladas, executadas e monitoradas em escalas nacionais, estaduais e locais para melhorar a qualidade de vida e cumprir os compromissos pactuados nacional e internacionalmente.Objetivo:identificar o alinhamento dos indicadores e os resultados alcançados nas metas para redução de mortalidades materna e infantil do Plano de Desenvolvimento Sustentável e Plano Estadual de Saúde do Estado de Rondônia com Agenda 2030.Metodologia:Trata-se de uma pesquisa documental e bibliográficacomanálise crítica de indicadores referentes à redução da mortalidade materno-infantil na Agenda 2030 e respectivos ações e metas alcançadas ou não contempladas no Plano de Desenvolvimento Sustentável de Rondônia (2015-2030) e Planos Estaduais de Saúde (2016-2019 e 2020-2021). Verificou-se os resultados alcançados em relatórios da sociedade civil e anual de gestão.Resultados:Constatou-se que a redução das mortes materna e infantil são destacadas nos planejamentos analisados, contudo a mortalidade infantil contida nos planosconsidera somente as mortes em menores de um ano de vida e há incompletudes nos escopos selecionados para o monitoramento, assim como diferentes indicadores de verificação, dificultando análise das metas pactuadas na Agenda 2030.Conclusões:Os relatóriosdos resultados alcançados apontaram retrocessos para o alcance das metas. Instrumentos de gestão e planejamento são imprescindíveis para nortear ações e estabelecer prioridades, porém para que haja avanços é necessário coerência não somente em metas pactuadas, mas nos indicadores e meios de verificação a fim de corroborar para análise e retroalimentação do planejamento (AU).

Introduction:Maternal and infant deaths reflect the living conditions of a given population and are important markers of a nation's development, reducing them has become a priority in the 2030 Agenda for sustainable development. Public policies must be formulated, implemented and monitored at national, state and local scales to improve the quality of life and meet the commitments agreed nationally and internationally. Objective:To identify the alignment of indicators and the results achieved in the goals for reducing maternal and child mortality of the Sustainable Development Plan and State Health Plan of the State of Rondônia with Agenda 2030. Methodology:This is a documentary and bibliographical research with critical analysis of indicators related to the reduction of maternal and child mortality in the 2030 Agenda and respective actions and goals achieved or not contemplated in the Sustainable Development Plan of Rondônia (2015-2030) and State Health Plans (2016-2019 and 2020-2021). It was verified the results achieved in reports of civil society and annual management. Results:It was found that the reduction of maternal and infant deaths are highlighted in the however the infant mortality contained in the plans considers only deaths in children under one year of age and there are incompleteness in the scopes selected for monitoring, as well as different verification indicators, making it difficult to analyze the goals agreed in the 2030 Agenda. Conclusions:The reports of the achieved results pointed setbacks to the achievement of the goals. Management and planning tools are essential to guide actions and establish priorities, but for there to be progress it is necessary coherence not only in agreed indicators and means of verification in order to corroborate for analysis and feedback of planning (AU).

Introducción: Las muertes maternas e infantiles reflejan las condiciones de vida de una determinada poblacióny son marcadores importantes del desarrollo de una nación, su reducción se ha convertido en prioridad en la Agenda 2030 de desarrollo sostenible. Las políticas públicas deben ser formuladas, ejecutadas y monitoreadas a escala nacional, estatal y local para mejorar la calidad de vida y cumplir con los compromisos pactados a nivel nacional e internacional. Objetivo: Identificar la alineación de los indicadores y los resultados alcanzados en las metas para reducción de mortalidades materna e infantil del Plande Desarrollo Sostenible y Plan Estadual de Salud del Estado de Rondônia com Agenda 2030.Metodología: Se trata de una investigación documental y bibliográfica con análisis crítico de indicadores referentes a la reducción de la mortalidad materno-infantilen la Agenda 2030 y respectivos acciones y metas alcanzadas o no contempladas en el Plan de Desarrollo Sostenible de Rondônia (2015-2030) y Planes Estatales de Salud (2016-2019 y 2020-2021). Se han verificado los resultados obtenidos en informes de la sociedad civil y anual de gestión.Resultados: Se constató que la reducción de las muertes materna e infantil son destacadas en los planeamientos analizados, sin embargo, la mortalidad infantil contenida en los planes considera solamente las muertes en menores de un año de vida y hay incompletudes en los ámbitos seleccionados para el monitoreo, así como diferentes indicadores de verificación, dificultando el análisis de las metas pactadas en laAgenda 2030.Conclusiones: Los informes de los resultados alcanzados apuntaron retrocesos para el alcance de las metas. Instrumentos de gestión y planificación son imprescindibles para orientar acciones y establecer prioridades, pero para que haya avances es necesaria coherencia no solo en metas pactadas, pero en los indicadores y medios de verificación con el fin de corroborar el análisis y retroalimentación de la planificación (AU).

Equity in health and justice: a look at the Brazilian unified health system (SUS) from the perspective of John Rawls

This study addresses the issue of equity in health and justice from the perspective of public health bioethics, describing the Brazilian Unified Health System (SUS), equating legitimate interests for essential goods, such as health. The conception of John Rawls' theory of justice is "justice as fairness" and has a seventeenth century contractualism tenor. Although it was not conceived specifically for health and marked by the "difference principle", it promoted, in the field of health care, the institution of health systems created on the basis of universal access and equity in the distribution of scarce resources. The principles of the Brazilian Unified Health System (SUS) guarantee access to all levels of care, equality in health care, without distinctions or privileges of any kind, integrity in health care, free of charge, community participation and decentralization, regionalization and hierarchization of health actions and services, which gives the SUS a strong Rawlsian bias. The Brazilian model was built on the principle that health is a right of all and a duty of the State, therefore, it is based on the assumption of universal and equal access to health actions and services for its promotion and recovery.

Este estudio aborda el tema equidad en salud y justicia desde la perspectiva de la bioética de la salud pública, describiendo el Sistema Único de Salud (SUS) brasileño, equiparando intereses legítimos por los bienes esenciales, como la salud. La concepción de la teoría de justicia de John Rawls es la "justicia como equidad" y tiene un tenor de contractualismo del siglo XVII. Aunque no fue concebida específicamente para la salud y marcada por el "principio de la diferencia", impulsó, en el ámbito de la atención sanitaria, la institución de sistemas de salud creados sobre la base del acceso universal y la equidad en la distribución de recursos escasos. Los principios del Sistema Único de Salud (SUS) brasileño garantizan el acceso para todos los niveles asistenciales, igualdad en la atención a la salud, sin distinciones ni privilegios de ningún tipo, integridad en la asistencia a la salud, gratuidad, participación comunitaria y una descentralización, regionalización y jerarquización de las acciones y servicios de salud, lo que da al SUS un fuerte sesgo rawlsiano. El modelo brasileño se construyó sobre el principio de que la salud es un derecho de todos y un deber del Estado, por lo tanto, se basa en el supuesto del acceso universal e igualitario a las acciones y servicios de salud para su promoción y recuperación.

Este estudo aborda a questão da equidade em saúde e da justiça sob a perspectiva da bioética da saúde pública, descrevendo o Sistema Único de Saúde (SUS), equiparando interesses legítimos para bens essenciais, como a saúde. A concepção da teoria da justiça de John Rawls é "justiça como equidade" e tem um teor contratualista do século XVII. Embora não tenha sido concebida especificamente para a saúde e marcada pelo "princípio da diferença", ela promoveu, no campo da assistência à saúde, a instituição de sistemas de saúde criados com base no acesso universal e na equidade na distribuição de recursos escassos. Os princípios do Sistema Único de Saúde (SUS) garantem o acesso a todos os níveis de atenção, a igualdade na assistência à saúde, sem distinções ou privilégios de qualquer espécie, a integralidade na assistência à saúde, a gratuidade, a participação da comunidade e a descentralização, regionalização e hierarquização das ações e serviços de saúde, o que confere ao SUS um forte viés rawlsiano. O modelo brasileiro foi construído com base no princípio de que a saúde é um direito de todos e um dever do Estado, portanto, parte do pressuposto do acesso universal e igualitário às ações e serviços de saúde para sua promoção e recuperação.

Eastern Mediterranean Health Journal [2023; Vol.29, Issue 10]

Eastern Mediterranean Health Journal is the official health journal published by the Eastern Mediterranean Regional Office of the World Health Organization. It is a forum for the presentation and promotion of new policies and initiatives in health services; and for the exchange of ideas concepts epidemiological data research findings and other information with special reference to the Eastern Mediterranean Region. It addresses all members of the health profession medical and other health educational institutes interested NGOs WHO Collaborating Centres and individuals within and outside the Region

المجلة الصحية لشرق المتوسط هى المجلة الرسمية التى تصدرعن المكتب الاقليمى لشرق المتوسط بمنظمة الصحة العالمية. وهى منبر لتقديم السياسات والمبادرات الجديدة فى الصحة العامة والخدمات الصحية والترويج لها، و لتبادل الاراء و المفاهيم والمعطيات الوبائية ونتائج الابحاث وغير ذلك من المعلومات، و خاصة ما يتعلق منها باقليم شرق المتوسط. وهى موجهة الى كل اعضاء المهن الصحية، والكليات الطبية وسائر المعاهد التعليمية، و كذا المنظمات غير الحكومية المعنية، والمراكز المتعاونة مع منظمة الصحة العالمية والافراد المهتمين بالصحة فى الاقليم و خارجه

La Revue de Santé de la Méditerranée Orientale est une revue de santé officielle publiée par le Bureau régional de l’Organisation mondiale de la Santé pour la Méditerranée orientale. Elle offre une tribune pour la présentation et la promotion de nouvelles politiques et initiatives dans le domaine de la santé publique et des services de santé ainsi qu’à l’échange d’idées de concepts de données épidémiologiques de résultats de recherches et d’autres informations se rapportant plus particulièrement à la Région de la Méditerranée orientale. Elle s’adresse à tous les professionnels de la santé aux membres des instituts médicaux et autres instituts de formation médico-sanitaire aux ONG Centres collaborateurs de l’OMS et personnes concernés au sein et hors de la Région

Distribución y características de la certificación de los reumatólogos en México / Distribution and characteristics of the certification of rheumatologists in Mexico

Objetivo: Describir la distribución de los reumatólogos de adultos y pediátricos con certificación vigente en México y los factores asociados a esta distribución. Métodos: Se revisaron las bases de datos del Consejo Mexicano de Reumatología y del Colegio Mexicano de Reumatología de 2020. Se calculó la tasa de reumatólogos por cada 100.000 habitantes por estado de la República Mexicana. Para conocer el número de habitantes por estado, se consultaron los resultados del censo de población del Instituto Nacional de Estadística y Geografía de 2020. Se analizó el número de reumatólogos con certificación vigente por estado, edad y sexo. Resultados: En México hay registrados 1.002 reumatólogos de adultos, con una edad promedio de 48,12±13 años. Predominó el género masculino con una relación de 1,18:1. Se identificaron 94 reumatólogos pediatras, con una edad promedio de 42,25±10,4 años, con predominio del género femenino con una relación de 2,2:1. En la Ciudad de México y Jalisco se reportó más de un reumatólogo/100.000 habitantes en la especialidad de adultos y solo en la Ciudad de México en pediátricos. La certificación vigente es de 65 a 70% en promedio y los factores asociados a una mayor prevalencia fueron edad menor, género femenino y ubicación geográfica. Conclusiones: Existe escasez de reumatólogos en México y en el área pediátrica hay regiones desatendidas. Es importante que las políticas de salud apliquen medidas que permitan una regionalización más equilibrada y eficiente de esta especialidad. Aunque la mayoría de los reumatólogos cuentan con certificación vigente, es necesario establecer estrategias esta proporción.(AU)

Objective: Describe the distribution of adult and pediatric rheumatologists with current certification in Mexico and the factors associated with this distribution. Methods: The databases of the Mexican Council of Rheumatology and the Mexican College of Rheumatology for 2020 were reviewed. The rate of rheumatologists per 100,000 inhabitants by state of the Mexican Republic was calculated. To find out the number of inhabitants by state, the results of the 2020 population census of the National Institute of Statistics and Geography were consulted. The number of rheumatologists with current certification by state, age, and sex was analyzed. Results: In Mexico, there are 1002 registered adult rheumatologists with a mean age of 48.12±13 years. The male gender prevailed with a ratio of 1.18:1. Ninety-four pediatric rheumatologists were identified with a mean age of 42.25±10.4 years, with a predominance of the female gender with a ratio of 2.2:1. In Mexico City and Jalisco, more than one rheumatologist/100,000 inhabitants were reported in the specialty of adults and only in Mexico City in pediatrics. The current certification is 65 to 70% on average and the factors associated with a higher prevalence were younger age, female gender and geographic location. Conclusions: There is a shortage of rheumatologists in Mexico and in the pediatric area there are underserved regions. It is important that health policies apply measures that allow a more balanced and efficient regionalization of this specialty. Although most rheumatologists have current certification, it is necessary to establish strategies to increase this proportion.(AU)