Measuring domestic water use: a systematic review of methodologies that measure unmetered water use in low-income settings.

OBJECTIVE: To present a systematic review of methods for measuring domestic water use in settings where water meters cannot be used. METHODS: We systematically searched EMBASE, PubMed, Water Intelligence Online, Water Engineering and Development Center, IEEExplore, Scielo, and Science Direct databases for articles that reported methodologies for measuring water use at the household level where water metering infrastructure was absent or incomplete. A narrative review explored similarities and differences between the included studies and provide recommendations for future research in water use. RESULTS: A total of 21 studies were included in the review. Methods ranged from single-day to 14-consecutive-day visits, and water use recall ranged from 12 h to 7 days. Data were collected using questionnaires, observations or both. Many studies only collected information on water that was carried into the household, and some failed to mention whether water was used outside the home. Water use in the selected studies was found to range from two to 113 l per capita per day. CONCLUSION: No standardised methods for measuring unmetered water use were found, which brings into question the validity and comparability of studies that have measured unmetered water use. In future studies, it will be essential to define all components that make up water use and determine how they will be measured. A pre-study that involves observations and direct measurements during water collection periods (these will have to be determined through questioning) should be used to determine optimal methods for obtaining water use information in a survey. Day-to-day and seasonal variation should be included. A study that investigates water use recall is warranted to further develop standardised methods to measure water use; in the meantime, water use recall should be limited to 24 h or fewer.

Noise level in intensive care units of a public university hospital in Santa Marta (Colombia). / Nivel de ruido en unidades de cuidado intensivo de un hospital público universitario en Santa Marta (Colombia).

OBJECTIVE: To evaluate the noise level in adult, pediatric and neonatal intensive care units of a university hospital in the city of Santa Marta (Colombia). DESIGN: A descriptive, observational, non-interventional study with follow-up over time was carried out. MATERIALS AND METHODS: Continuous sampling was conducted for 20 days for each unit using a type i sound level meter, filter frequency in A weighting and Fast mode. We recorded the maximum values, the 90th percentile as background noise, and the continuous noise level. RESULTS: The mean hourly levels in the adult unit varied between 57.40±1.14-63.47±2.13dBA, with a maximum between 71.55±2.32-77.22±1.94dBA, and a background noise between 53.51±1.16-60.26±2.10dBA; in the pediatric unit the mean hourly levels varied between 57.07±3.07-65.72±2.46dBA, with a maximum of 68.69±3.57-79.06±2.34dBA, and a background noise between 53.33±3.54-61.96±2.85dBA; the neonatal unit in turn presented mean hourly values between 59.54±2.41-65.33±1.77dBA, with a maximum value between 67.20±2.13-77.65±3.74dBA, and a background noise between 55.02±2.03-58.70±1.95dBA. Analysis of variance revealed a significant difference between the hourly values and between the different units, with the time of day exhibiting a greater influence. CONCLUSIONS: The type of unit affects the noise levels in intensive care units, the pediatric unit showing the highest values and the adult unit the lowest values. However, the parameter exerting the greatest influence upon noise level is the time of day, with higher levels in the morning and evening, and lower levels at night and in the early morning.

[Equivalent continuous noise level in neonatal intensive care unit associated to burnout syndrome]. / Nivel continuo equivalente de ruido en la unidad de cuidado intensivo neonatal asociado al síndrome de burnout.

Noise levels in neonatal intensive care units allow the appearance of symptoms associated with burnout such as stress, irritability, fatigue and emotional instability on health care personnel. The aim of this study was to evaluate the equivalent continuous noise levels in the neonatal intensive care unit and compare the results with noise levels associated with the occurrence of burnout syndrome on the care team. Continuous sampling was conducted for 20 days using a type I sound level meter on the unit. The maximum, the ninetieth percentile and the equivalent continuous noise level (Leq) values were recorded. Noise level is reported in the range of 51.4-77.6 decibels A (dBA) with an average of 64 dBA, 100.6 dBA maximum, and average background noise from 57.9 dBA. Noise levels exceed the standards suggested for neonatal intensive care units, are close to maximum values referred for noise exposure in the occupational standards and to noise levels associated with the onset of burnout; thus allowing to infer the probability of occurrence of high levels of noise present in the unit on the development of burnout in caregivers.

[Child health environment in the context of relocating of camp site families to social housing]. / Salud ambiental infantil en el contexto de la reubicación de familias de campamentos a viviendas sociales.

INTRODUCTION: Housing interventions aimed at overcoming poverty can lead to changes in the health status of children by modifying risk factors in their physical and social environment OBJECTIVE: the aim was to identify children's environmental health factors to change with the relocation of families from slums to public housing. SUBJECTS AND METHOD: A cross-sectional study was conducted in children ages 2-8 years old of families relocated to public housing (n=115) who were compared to children residing in slums (n=88) in Santiago, Chile. Family socioeconomic characteristics, indoor environment and neighborhoods were collected. It was included respiratory symptoms, accidents and maternal-child care of children. χ2, Fisher and Mann-Whitney test were used to compare groups. RESULTS: There were differences in households related to pets keeping, presence of humidity/molds in homes, types of fuels, and perceived safety problems in neighborhoods (p<0.05). The families from slums reported higher tenancy of pets (73.8% v/s 32.2%%), humidity/molds in homes (43.,2% v/s 18.3%), use of wood for heating (39.8% v/s 0.0%), compared with families of public housing. Residents of public housing perceived more safety problems in neighborhood, and children have more asthma related symptoms and have lower diversity of accidents in home. CONCLUSION: Among the factors studied, indoor air quality and safety in neighborhoods could be linked to changes from the relocation of families. This reinforces the need to deepen the positive and negative influences of residential mobility of these groups focused on child welfare perspective.

Food insecurity profile according to habits and lifestyles in workers with subsistence jobs, Medellín-Colombia 2016.

Introduction: Although the informal economy absorbs a considerable portion of the population, there is still little evidence that contributes to identify the lifestyles and eating habits that outline food insecurity in workers with subsistence jobs. Objectives: To determine the profile of food insecurity according to habits and lifestyles in workers with subsistence jobs. Methods: Cross-sectional study with primary sources of information, obtained through an assisted survey, to a census of 686 workers in 2016. The results of the nutritional component of a doctoral thesis approved by the Institutional Ethics Committee of the CES University, Medellín, Colombia, are presented. Results: In this working population, 52.6% were 50 years or old; however, 86.1% reported being the main household provider, and 33.3% did not have a permit to work in public areas. Moreover, 56.8% reported being sedentary/little active, and the highest consumption of alcohol and tobacco was recorded in men, who also ate their food alone. Conversely, women considered that mood affected their appetite, and they consumed their food while serving customers and handling money. In general, less than 50.0% of workers had a set time to consume their food. Food insecurity in workers' households was explained by alcohol consumption (prevalence ratio = 1.62; confidence interval = 1.05;2.38) and having exclusive hours to consume food (prevalence ratio = 1.40; confidence interval = 1.00;1.96). Their food insecurity is defined by not consuming alcoholic beverages, considering that their mood affects their appetite, consuming one or two meals a day, without a defined schedule, not having permission to work, presenting moderate/severe food insecurity, and being a woman. Conclusions: The conditions that explain and outline food insecurity in this working population contribute to their socio-environmental and labor vulnerability, however, these conditions can be reversed.

Introducción: Aunque la economía informal ocupe una gran parte de la población, todavía existen pocas evidencias que ayuden a identificar los estilos de vida y hábitos alimentarios que definen la inseguridad alimentaria entre los trabajadores con empleos de subsistencia. Objetivos: Determinar el perfil de inseguridad alimentaria según hábitos y estilos de vida en trabajadores con empleos de subsistencia. Métodos: Estudio transversal con fuentes primarias de información, realizado a través de encuesta asistida, con un censo de 686 trabajadores en 2016. Los resultados del componente nutricional de una tesis doctoral aprobada por el Comité de Ética Institucional de la Universidad CES, en Medellín, Colombia, son presentados. Resultados: De esta población trabajadora, el 52,6% tenía más de 50 años, sin embargo, el 86,1% reportó ser la persona que más aportaba en el hogar y al 33,3% no se le permitía trabajar en los espacios públicos. El 56,8% refirió ser sedentario/poco activo, registrándose el mayor consumo de bebidas alcohólicas y cigarrillos en los hombres, quienes también comían solos. Por su parte, las mujeres consideraban que el estado de ánimo afectaba al apetito y, cuando comían, simultáneamente atendían a los clientes y manejaban dinero. En general, menos del 50,0% tenía un tiempo definido para consumir sus alimentos. Explicaron inseguridad alimentaria en sus hogares, consumo de bebidas alcohólicas (RP = 1,62. IC = 1,05;2,38) e horarios exclusivos para consumir alimentos (RP = 1,40. IC = 1,00;1,96). Perfilan su inseguridad alimentaria no consumir bebidas alcohólicas, considerar que el estado de ánimo afectaba al apetito, consumir una o dos comidas al día, sin horario definido, no tener permiso para trabajar, presentar inseguridad alimentaria moderada/grave y ser mujer. Conclusiones: Las condiciones que explican y perfilan la inseguridad alimentaria de esta población trabajadora contribuyen a configurar su vulnerabilidad socioambiental y laboral, sin embargo, pueden ser revertidas.

[Mental health and environmental health. A prospective view. SESPAS Report 2020]. / Salud mental y salud ambiental. Una visión prospectiva. Informe SESPAS 2020.

Since the dawn of psychiatry, the environment has been an essential factor in the study and understanding of mental illness. Traditionally, the interrelationship between genome and environment has been a central theme in research on the etiopathogenesis of mental health problems and in the very conception of mental health. In its application to psychopathology and mental health, psychiatric enviromics was defined as «the study of environmental conditions and processes that promote mental health or increase the risk of developing mental disorders¼. However, environmental health -at least in Spain and in connection with its powers within the Spanish General Health System- has paid attention to aspects pertaining to risks associated with the physical, chemical and biological pollution of the air, the water and the ground, as well as to its correlation with food pollution. Although environmental risks such as air quality, extreme temperatures, noise, climate change and various environmental toxicants can play a particularly important role, they can hardly be identified as single etiopathogenic elements. This work reviews the recent literature on environmental research and problems of psychiatric morbidity and mortality. Although the results are inconclusive, future lines of research should consider a more agile interdisciplinary collaboration, allowing, on the one hand, a better understanding of mental illness and, on the other hand, to be able to shift from "traditional" environmental health to an environmental health that takes social environmental factors into account and seriously addresses the still little studied concept of "social pollution".

Urban organic community gardening to promote environmental sustainability practices and increase fruit, vegetables and organic food consumption.

OBJECTIVE: To describe the environmental practices of participants in an urban organic community garden at the beginning of their gardening experience and after a period of six months, and to discover their opinion about how this activity influenced the consumption of vegetables, fruits and organic food. METHOD: Interviews using structured questionnaires were conducted twice with 115 city dwellers: when they started in the vegetable garden and about 6 months later. The questionnaire included questions related to environmental practices. The second evaluation also included questions related to the consumption of organic food, vegetables and fruit. RESULTS: This research showed significant behavioural transformation, including positive outcomes in environmental practices such as recycling and trying to persuade friends or family to recycle, compost leftovers or choose to walk/bike to save petrol. In the opinion of the participants, activities in the organic community garden helped to increase consumption of fruits, vegetables and organic food. CONCLUSION: The study results reinforce the hypothesis that an organic community vegetable garden can induce significant, positive behavioural changes among its users. In particular this research suggests horticulture is associated with positive improvements in personal environmental behaviours, awareness of the environment's high social priority and increased consumption of organic food, fruit and vegetables.

[Threats, challenges and opportunities for paediatric environmental health in Europe, Latin America and the Caribbean]. / Amenazas, desafíos y oportunidades para la salud medioambiental pediátrica en Europa, América Latina y el Caribe.

In a world that is increasingly technological and interconnected, but also more violent, overexploited and polluted, Paediatric Environmental Health (PEH) is one of the best contributions to improve global health. Few areas of the planet have a high affinity with common values and interests, such as the European Union (EU), Latin America and the Caribbean (LAC). The investments and actions of the PEH in pre- and postnatal periods during the first two decades of life will generate countless benefits in the health and well-being during the human life span. Detecting, reducing, or eliminating physical, chemical, biological and social pollutants is one of the main missions and actions of the PEH. In this special article, an update review is presented on the threats, challenges and cooperation opportunities in PEH among bio-health professionals and other social sectors involved, from the EU and LAC. New professional profiles, knowledge structures and architectures for engagement emerge. Courageous leaderships, new substantial resources, broad social changes, and the necessary collaboration between the two regions will be required to improve the health of present and future generations.

Cátedra Integración de las Ciencias y la Educación Superior por un Desarrollo Sostenible

La Cátedra Integración de las Ciencias y la Educación Superior por un Desarrollo Sostenible es un equipo dirigido por una institución de la educación superior que se asocia con la UNESCO en un proyecto para lograr avances en el conocimiento y la práctica en un ámbito de prioridad común. La alianza se formaliza mediante un acuerdo entre la directora general de la UNESCO y el rector de la institución que acoge la cátedra. Por su importancia en la Educación Ambiental para el Desarrollo Sostenible como pilar de salud y bienestar humano, quedó constituida recientemente esta cátedra en la Universidad de Ciencias Médicas de Villa Clara. El objetivo de esta comunicación es socializar los antecedentes, constitución y propósitos de la Cátedra UNESCO en la referida universidad.

The Chair Integrating Sciences and Higher Education for Sustainable Development is a team led by a higher education institution that partners with UNESCO on a project to advance knowledge and practice in a common priority area. The alliance is formalized through an agreement between the director general of UNESCO and the rector of the institution that hosts the chair. For its importance in Environmental Education for Sustainable Development As a pillar of health and human well-being, this chair was recently established at Villa Clara University of Medical Sciences. The objective of this research paper is to socialize the background, constitution, and purposes of the UNESCO Chair at the aforementioned university.

Vigilância Popular em Saúde no sul do Brasil: expressões de um território que pulsa / Vigilancia popular en salud en el sur de Brasil: expresiones de un territorio que pulsa / Popular Health Surveillance in southern Brazil: expressions of a pulsating territory

Em todo o território nacional tem sido possível identificar variadas iniciativas de protagonismo popular na perspectiva da promoção e da proteção da vida, em busca de territórios saudáveis e sustentáveis. Este texto objetiva descrever a experiência de um processo histórico, dinâmico e permanente de luta e mobilização social contra a violação de direitos fundamentais por saúde e sustentabilidade ambiental, no Assentamento Santa Rita de Cássia II, em Nova Santa Rita, Rio Grande do Sul, Brasil. Essa experiência pode ser considerada como uma ação de fortalecimento e reinvenção da vigilância em saúde pela população, portanto uma Vigilância Popular em Saúde, transgredindo fronteiras fragmentadoras da hegemonia dos saberes, percorrendo caminhos que priorizam e enfrentam os problemas do seu território vivo, território que pulsa e luta desde sua retomada.(AU)

En todo el territorio nacional ha sido posible identificar variadas iniciativas de protagonismo popular desde la perspectiva de la promoción y protección de la vida, buscando territorios saludables y sostenibles. El objetivo de este texto es describir la experiencia de un proceso histórico, dinámico y permanente de lucha y movilización social contra la violación de derechos fundamentales de salud y sostenibilidad ambiental, en el Asentamiento Santa Rita de Cássia II, en Nova Santa Rita, Rio Grande do Sul, Brasil. Esa experiencia puede considerarse como acción de fortalecimiento y reinvención de la vigilancia en salud por parte de la población; por lo tanto, una Vigilancia Popular en Salud, transgrediendo fronteras de fragmentación de la hegemonía de los saberes, recorriendo caminos que priorizan y enfrentan los problemas de su territorio vivo, territorio que pulsa y lucha desde su retomada.(AU)

Throughout the country it had been identified diverse initiatives of popular protagonism in the perspective of promotion and protection of life, in search of healthy and sustainable territories. This text aims at describing the experience of a historical, dynamic and permanent process of struggle and social mobilization against the violation of fundamental rights for health and environmental sustainability in the Settlement Santa Rita de Cássia II, in Nova Santa Rita, Rio Grande do Sul, Brazil. This experience can be considered as an action of strengthening and reinvention of health surveillance by the population, therefore a Popular Health Surveillance, trespassing the fragmenting frontiers of knowledge hegemony, going through paths that prioritize and face the problems of its living territory, a territory that pulsates and struggles since its resumption.(AU)

La cosmovisión indígena en políticas públicas medioambientales para reducir la contaminación durante la pandemia del coronavirus / coronavirusIndigenous Worldview in Environmental Public Policies to Reduce Pollution during the Coronavirus Pandemic / A cosmovisão indígena nas políticas públicas ambientais de redução da poluição durante a pandemia do coronavírus

Introducción: consecuencia de la pandemia a causa del coronavirus (SARS-CoV-2), desde el 2020 ha aumen-tado la generación de los residuos con riesgo biológico o infeccioso, usados en los protocolos de biosegu-ridad por parte de la ciudadanía en general y el talento humano en salud. Ello generó un alto riesgo para salud y un aumento en el índice de contaminación ambiental y degradación de los recursos naturales, que hasta el momento ha superado las expectativas para su mitigación. Desarrollo: para contrarrestar el impacto del aumento en el índice de contaminación ambiental, se reflexiona sobre la necesidad de buscar acciones medioambientales para mitigar el daño y ampliar el concepto sobre el medio ambiente y la importancia de la interacción y codependencia del ser humano con la naturaleza. Se plantea la idea de retomar elementos conceptuales del conocimiento de las culturas indígenas sobre la visión holística del ambiente, partiendo de una cosmovisión indígena del buen vivir, donde el ambiente y el ser humano se encuentran en constante equilibrio y armonía. Conclusión: se pretende encontrar, desde la cosmovisión indígena, posibles abordajes conceptuales que mitiguen el impacto de la contaminación ambiental a causa del coronavirus, así como la formulación de acciones estratégicas para la adecuada gestión de estos residuos

Introduction: Since 2020, due to the the Coronavirus (SARS-CoV-2) pandemic, there has been an increase in generation of waste with biological or infectious risk used in biosafety protocols by the community and human resources in health, which, in turn, generates a high rate of pollution and environmental degradation of natural resources that has so far exceeded expectations for mitigation.Development: To reduce the impact of this problematic situation, a reflection was made to strengthen the current public policies and implement environmental actions that seek to mitigate the damage, but, above all, to change the concept of the environment and increase awareness about the importance of interac-tion and codependency of human beings with nature. The idea of retaking conceptual elements of the knowledge of indigenous cultures regarding the holistic vision of the environment is proposed, starting from a Quechua worldview of good living, where the environment and the human being are in constant balance and harmony. Conclusions:This study is intended to determine, from the indigenous worldview, the possible conceptual approaches that mitigate the environmental impact, as well as to formulate strategic actions for the adequate management of the resultant waste.

Introdução: como consequência da pandemia causada pelo Coronavírus (SARS-CoV-2), desde 2020 houve um aumento na geração de resíduos com risco biológico ou infeccioso utilizados em protocolos de bios-segurança pelo público em geral e talentos humanos em saúde; o que gerou um alto risco à saúde e um aumento no índice de contaminação ambiental e degradação dos recursos naturais que até agora tem superado as expectativas para sua mitigação. Desenvolvimento: para neutralizar o impacto do aumento do índice de contaminação ambiental, é feita uma reflexão sobre a necessidade de buscar ações ambien-tais para mitigar os danos, e ampliar o conceito de meio ambiente e a importância da interação e code-pendência do ser humano com a natureza. Propõe-se a ideia de retomar elementos conceituais do conhe-cimento das culturas indígenas sobre a visão holística do meio ambiente, partindo de uma cosmovisão indígena do bem viver, onde o meio ambiente e o ser humano estão em constante equilíbrio e harmonia. Conclusão: pretende-se encontrar a partir da visão de mundo indígena, possíveis abordagens conceituais que mitiguem o impacto da contaminação ambiental devido ao coronavírus, bem como a formulação de ações estratégicas para o gerenciamento adequado desses resíduos

Enfermagem no manejo da hipertensão arterial sistêmica na atenção primária: contribuições para a saúde planetária / Nursing in the management of systemic arterial hypertension in primary care: contributions to planetary health

Este estudo objetiva refletir sobre o papel da enfermagem na gestão da Hipertensão Arterial Sistêmica (HAS) na Atenção Primária à Saúde (APS), e como os princípios da saúde planetária influenciam sua redução. Método: Baseado em análise teórica, realizado em junho de 2023, abordou a HAS com embasamento em portarias ministeriais, documentos internacionais e diretrizes. Resultados: Enfermeiros, ao promoverem hábitos saudáveis como dieta equilibrada e exercícios, previnem obesidade, doenças cardiovasculares e outras condições associadas à HAS, reduzindo complicações como problemas renais e cardíacos. A APS e um local que oportuniza fornecer esses cuidados abrangentes aos pacientes com HAS. Esta abordagem não apenas beneficia a saúde individual dos pacientes, mas também promove a saúde do planeta ao reduzir as morbidades, promover pessoas conscientes e, consequentemente, mais saudáveis, e reduzir o uso de recursos médicos e naturais. Conclusão: Assim, a enfermagem na APS desempenha um papel significativo não só na saúde dos pacientes, mas também na conscientização da sustentabilidade ambiental e na promoção do bem-estar individual e, consequentemente, global.(AU)

This study aims to reflect on the role of nursing in the management of Systemic Arterial Hypertension (SAH) in Primary Health Care (PHC), and how the principles of planetary health influence its reduction. Method: Based on theoretical analysis, conducted in June 2023, it addressed SAH with a foundation in ministerial ordinances, international documents, and guidelines. Results: Nurses, by promoting healthy habits such as balanced diet and exercise, prevent obesity, cardiovascular diseases, and other conditions associated with SAH, reducing complications such as renal and cardiac problems. PHC is a setting that enables the provision of comprehensive care to patients with SAH. This approach not only benefits the individual health of patients but also promotes planetary health by reducing morbidities, fostering conscious individuals, and consequently, healthier ones, and reducing the use of medical and natural resources. Conclusion: Thus, nursing in PHC plays a significant role not only in the health of patients but also in raising awareness of environmental sustainability and promoting individual and, consequently, global well-being.(AU)

Este estudio tiene como objetivo reflexionar sobre el papel de la enfermería en la gestión de la Hipertensión Arterial Sistémica (HAS) en la Atención Primaria de Salud (APS), y cómo los principios de la salud planetaria influyen en su reducción. Método: Basado en análisis teórico, realizado en junio de 2023, abordó la HAS con fundamentos en normativas ministeriales, documentos internacionales y directrices. Resultados: Los enfermeros, al promover hábitos saludables como una dieta equilibrada y ejercicio, previenen la obesidad, enfermedades cardiovasculares y otras condiciones asociadas con la HAS, reduciendo complicaciones como problemas renales y cardíacos. La APS es un entorno que permite brindar atención integral a los pacientes con HAS. Este enfoque no solo beneficia la salud individual de los pacientes, sino que también promueve la salud planetaria al reducir morbilidades, fomentar individuos conscientes y, en consecuencia, más saludables, y reducir el uso de recursos médicos y naturales. Conclusión: Por lo tanto, la enfermería en APS juega un papel significativo no solo en la salud de los pacientes, sino también en la concienciación sobre la sostenibilidad ambiental y la promoción del bienestar individual y, en consecuencia, global.(AU)

Inseparability between public health, planetary health and the nursing process: premise for sustainable development / Inseparabilidad entre salud pública, salud planetaria y proceso de enfermería: premisa para el desarrollo sostenible / Indissociabilidade entre saúde pública, saúde planetária e processo de enfermagem: premissa para o desenvolvimento sustentável

ABSTRACT The aim is to conduct theoretical reflection on the inseparability among public health, planetary health and the nursing process in light of complexity thinking, with the aim of contributing to healthy and sustainable development. Study with a theoretical-reflexive approach that accessed bibliographical sources from contemporary authors who defend the inseparability between public health and planetary health and, at the same time, provide theoretical-systemic support to the nursing process, under an inductive critical bias. The nursing process is conceived as a complex phenomenon, which comprises interdependent dynamics, dialogical approaches, critical-reflective perception and prospective leadership. Theoretical reflection on the nursing process and sustainable development raises an expanded, contextualized and interdependent look at the role of nursing professionals in different health contexts, in order not to compromise well-being and environmental health.

RESUMEN El objetivo es realizar una reflexión teórica sobre la inseparabilidad entre la salud pública, la salud planetaria y el proceso de enfermería a la luz del pensamiento de la complejidad, para contribuir con el desarrollo saludable y sostenible. Se trata de un estudio con enfoque teórico-reflexivo que accedió a fuentes bibliográficas de autores contemporáneos que defienden la inseparabilidad entre la salud pública y la salud planetaria y, al mismo tiempo, otorgan apoyo teórico-sistémico al proceso de enfermería, bajo un sesgo inductivo crítico. El proceso de enfermería se concibe como un fenómeno complejo, compuesto por dinámicas interdependientes, enfoques dialógicos, percepción crítico-reflexiva y liderazgo prospectivo. La reflexión teórica sobre el proceso de enfermería y el desarrollo sostenible suscita una mirada ampliada, contextualizada e interdependiente sobre la actuación profesional de enfermería en los diversos contextos de salud, con el fin de no comprometer el bienestar y la salud ambiental.

RESUMO Objetiva-se conduzir reflexão teórica sobre a indissociabilidade entre saúde pública, saúde planetária e processo de enfermagem à luz do pensamento da complexidade, no intuito de contribuir para o desenvolvimento saudável e sustentável. Estudo de abordagem teórico-reflexiva que acessou fontes bibliográficas de autores contemporâneos que defendem a indissociabilidade entre saúde pública e saúde planetária e, paralelamente, conferem sustentação teórico-sistêmica ao processo de enfermagem, sob um viés crítico indutivo. Concebe-se o processo de enfermagem como fenômeno complexo, que compreende uma dinâmica interdependente, abordagens dialógicas, percepção crítico-reflexiva e liderança prospectiva. A reflexão teórica acerca do processo de enfermagem e o desenvolvimento sustentável suscita um olhar ampliado, contextualizado e interdependente sobre a atuação do profissional de enfermagem nos diversos contextos da saúde, a fim de não comprometer o bem-estar e a saúde ambiental.

Desarrollo de la capacidad de comunicar riesgos relacionados con la exposición infantil a fluoruros, a través de una estrategia educativa en línea / Development of the capacity to communicate risks related to childhood exposure to fluorides through an online educational strategy / Capacitação para comunicar os riscos relacionados à exposição infantil a fluoretos por meio de uma estratégia educacional online

Resumen: Los fluoruros son contaminantes presentes con frecuencia y generalmente de forma natural en aguas subterráneas, y afectan a países que dependen de estas aguas para el riego y el consumo humano. La exposición crónica a fluoruros genera diversos efectos a la salud; por lo anterior, esta investigación se basó en la educación y la comunicación de riesgos para contribuir a la resolución del problema de exposición a fluoruros en la población. El objetivo fue desarrollar la capacidad de diseñar programas de comunicación de riesgos del personal involucrado en la respuesta y manejo de los riesgos ambientales para la salud, con énfasis en la exposición a fluoruros. Se diseñó e implementó un curso piloto de formación en línea sobre comunicación de riesgos y exposición a fluoruros. Para el análisis de la percepción de riesgos y conocimientos de los participantes, antes y después del curso, se aplicó un cuestionario y se llevó a cabo un grupo focal. Además, los asistentes realizaron una serie de actividades y diseñaron un programa de comunicación de riesgos con el que se valoró el grado en que se alcanzó la capacidad de desarrollar programas de comunicación de riesgos. Para mejorar el curso piloto se diseñaron y aplicaron dos encuestas de satisfacción y se realizó un análisis FODA (Fortalezas, Oportunidades, Debilidades, Amenazas). Los resultados mostraron un incremento en el nivel de conocimientos y cambios en la percepción de los participantes; en cuanto a la capacidad de diseñar programas de comunicación de riesgos, dos participantes lograron diseñarlo de manera excelente. La experiencia previa, la motivación, el compromiso para aprender y la retroalimentación brindada durante el curso, influyeron en el desarrollo de esta capacidad.

Abstract: Fluorides are contaminants that occur frequently and, generally, naturally in groundwater, affecting countries that depend on these waters for irrigation and human consumption. Chronic exposure to fluorides generates various health effects; therefore, this research was based on education and risk communication to contribute to the resolution of the problem of fluoride exposure in the population. The objective was to develop the capacity to design risk communication programs for personnel involved in the response and management of environmental health risks, with emphasis on fluoride exposure. An online pilot training course on risk communication and fluoride exposure was designed and implemented. For the analysis of the risk perception and knowledge of the participants, before and after the course, a questionnaire was applied and a focus group was conducted. In addition, the participants carried out a series of activities and designed a risk communication program to assess the degree to which the capacity to develop risk communication programs was achieved. To improve the pilot course, two satisfaction surveys were designed and implemented, and a SWOT (Strengths, Weaknesses, Opportunities, and Threats) analysis was conducted. The results showed an increase in the level of knowledge and changes in the participants' perception; regarding the ability to design risk communication programs, two participants were able to design them excellently. Previous experience, motivation, commitment to learn and the feedback provided during the course influenced the development of this ability.

Resumo: Os fluoretos são contaminantes que ocorrem com frequência e, geralmente, de forma natural nas águas subterrâneas, afetando os países que dependem dessas águas para irrigação e consumo humano. A exposição crônica aos fluoretos gera vários efeitos à saúde; portanto, esta pesquisa baseou-se na educação e na comunicação de riscos para contribuir com a solução do problema da exposição ao fluoreto na população. O objetivo foi desenvolver a capacidade de elaborar programas de comunicação de risco para o pessoal envolvido na resposta e no gerenciamento de riscos ambientais à saúde, com ênfase na exposição à fluoretos. Foi elaborado e implementado um curso piloto de treinamento online sobre comunicação de riscos e exposição. Para a análise da percepção de risco e do conhecimento dos participantes antes e depois do curso, foi aplicado um questionário e aplicado um grupo de foco. Além disso, os participantes realizaram uma série de atividades e elaboraram um programa de comunicação de riscos para avaliar até que ponto a capacidade de desenvolver programas de comunicação de riscos foi alcançada. Para aprimorar o curso piloto, foram duas pesquisas de satisfação foram desenvolvidas e implementadas e uma análise FOFA (Forças, Oportunidades, Fraquezas e Ameaças) foi aplicada. Os resultados mostraram um aumento no nível de conhecimento e mudanças nas percepções dos participantes; em termos da capacidade de elaborar programas de comunicação de riscos, dois participantes conseguiram elaborar excelentes programas de comunicação de riscos. A experiência prévia, a motivação, o compromisso com o aprendizado e o feedback fornecido durante o curso influenciaram o desenvolvimento dessa capacidade.

Evolución 2010-2019 de la mortalidad neonatal en la cuenca Matanza Riachuelo. Comparación con Argentina, provincia de Buenos Aires y Ciudad Autónoma de Buenos Aires, 2019 / Evolution of neonatal mortality in the Matanza-Riachuelo River Basin between 2010 and 2019. A comparison of Argentina, the province of Buenos Aires, and the City of Buenos Aires, 2019

Introducción. La tasa de mortalidad neonatal (TMN) es un indicador de condiciones socioeconómicas, ambientales y sanitarias. La cuenca Matanza Riachuelo (CMR) es la más contaminada de Argentina. Objetivo. Analizar la evolución de la mortalidad neonatal (MN) en la CMR entre los años 2010 y 2019, sus características, y compararla con datos globales de Argentina, de la provincia de Buenos Aires (PBA) y de la Ciudad Autónoma de Buenos Aires (CABA) en 2019. Población y métodos. Estudio descriptivo de estadísticas vitales del Ministerio de Salud de la Nación. Resultados. En 2019, la TMN en la CMR fue del 6,4 ‰; en Argentina, del 6,2 ‰; en PBA, del 6 ‰, y en CABA, del 5,1 ‰. El riesgo de MN en la CMR fue mayor que en CABA (RR: 1,32; IC95% 1,08-1,61). Entre 2010 y 2019, disminuyó la TMN en la CMR, en PBA y en Argentina; pero no en CABA. El riesgo de MN por afecciones perinatales en la CMR fue mayor que en CABA (RR: 1,30; IC95% 1,011,67). El riesgo de muerte para nacidos vivos (NV) con muy bajo peso al nacer (MBPN) en la CMR fue mayor que en CABA (RR: 1,70; IC95% 1,33-2,18) y menor que en Argentina (RR: 0,78; IC95% 0,70-0,87). Conclusión. La evolución 2010-2019 de la TMN fue similar en la CMR, en Argentina y en PBA. En 2019 la estructura de causas y el riesgo de MN fueron similares en la CMR, en PBA y en Argentina, con mayor riesgo por afecciones perinatales y de los NV con MBPN. La TMN de NV de MBPN fue menor en la CMR que en Argentina.

Introduction. The neonatal mortality rate (NMR) is an indicator of socioeconomic, environmental, andhealth care conditions. The Matanza-Riachuelo River Basin (MRRB) is the most polluted in Argentina.Objective. To analyze neonatal mortality (NM) in the MRRB between 2010 and 2019 and compare itwith overall data for Argentina, the province of Buenos Aires (PBA), and the City of Buenos Aires (CABA)in 2019.Population and methods. Descriptive study based on vital statistics provided by the Ministry of Health. Results. In 2019, the NMR was 6.4‰ in the MRRB, 6.2‰ in Argentina; 6‰ in PBA; and 5.1‰ in CABA.The risk of NM in the MRRB was higher than in CABA (RR: 1.32, 95% CI: 1.08­1.61). Between 2010and 2019, the NMR decreased in the MRRB, PBA, and Argentina; but not in CABA.The risk of NM due to perinatal conditions in the MRRB was higher than in CABA (RR: 1.30, 95%CI: 1.01­1.67).The risk of death among very low birth weight (VLBW) live births (LBs) in the MRRB was higher than in CABA(RR: 1.70, 95% CI: 1.33­2.18) and lower than in Argentina (RR: 0.78, 95% CI: 0.70­0.87).Conclusion. The evolution of NMR between 2010 and 2019 was similar in the MRRB, Argentina, andPBA. In 2019, the structure of causes and the risk of NM were similar in the MRRB, PBA, and Argentina,with a higher risk due to perinatal conditions and among VLBW LBs. The NMR among VLBW LBs waslower in the MRRB than in Argentina

Anamnesis ambiental como parte de la consulta pediátrica: estudio piloto / Environmental history-taking as part of pediatric consultations: a pilot study

Introducción. La salud ambiental infantil es la rama de la pediatría que estudia la influencia del medioambiente en la salud y la enfermedad de los niños. Las exposiciones ambientales globales representan una seria amenaza para la salud, lo que justifica una mayor investigación y acción. Objetivo. Evaluar la salud ambiental de una muestra de niños que viven en áreas urbanas y rurales de la ciudad de Uruguaiana, Brasil. Población y métodos. Se incluyeron padres/tutores (n = 714) de niños atendidos en el Policlínico Infantil de la Ciudad de Uruguaiana de enero a octubre de 2021, que respondieron la anamnesis ambiental en pediatría (Sociedad Brasileña de Pediatría). Los datos obtenidos se analizaron según la residencia en zona urbana o rural, o el ingreso familiar. Resultados. Al comparar los habitantes de la zona urbana (n = 660) con los de la zona rural (n = 54), verificamos que entre los de la zona rural fue significativamente mayor la actividad con productos químicos (15 % vs. 32,7 %; p = 0,004), vivir cerca de plantación (7,5 % vs. 74,5 %; p <0,001) o con fuente de contaminación (4,8 % vs. 32,7 %; p <0,001), tener perro (62 % vs. 87,3 %; p <0,001), usar plaguicidas (0,6 % vs. 32,7 %; p <0,001) y exposición a contaminación química (2,6 % vs. 18,2 %; p <0,001). En el área urbana predominó la exposición al tránsito de vehículos cerca de la vivienda (85 % vs. 48,1 %; p <0,001), renta media inferior a 3 salarios mínimos (90 %) y baja escolaridad. Conclusión. Realizar la anamnesis ambiental es fundamental para la detección de amenazas ambientales presentes en los lugares donde los niños y adolescentes viven, aprenden, juegan y estudian.

Introduction. Children's environmental health studies the influence of the environment on health and disease in children. Global environmental exposures pose a serious threat to health, warranting further research and action. Objective. To assess the environmental health of a sample of children living in urban and rural areas in Uruguaiana, Brazil. Population and methods. We included parents/legal guardians (n = 714) of children seen at Policlinica Infantil de Uruguaiana between January and October 2021, who completed the environmental history- taking in pediatrics (Brazilian Society of Pediatrics). Collected data were analyzed based on place of residence (urban or rural) or household income. Results. The comparison between inhabitants of the urban area (n = 660) and the rural area (n = 54) established that, among those living in the rural area, activity with chemical substances (15% versus 32.7%; p = 0.004), living near a plantation (7.5% versus 74.5%; p < 0.001) or near a source of contamination (4.8% versus 32.7%; p < 0.001), having a dog (62% versus 87.3%; p < 0.001), using pesticides (0.6% versus 32.7%; p < 0.001), and exposure to chemical contamination (2.6% versus 18.2%; p < 0.001) were significantly higher. In the urban area, exposure to vehicle traffic near the house (85% versus 48.1%; p < 0.001), an average income below 3 minimum wages (90%), and a low level of education predominated. Conclusion. Environmental history-taking is critical for the detection of environmental threats present in the areas where children and adolescents live, learn, play, and study

Exposición a plaguicidas en Latinoamérica. Revisión bibliográfica / Pesticide exposure in Latin America:Bibliographic review

Introducción: Se estima que el uso de plaguicidas en los países de Latinoamérica y el Caribe representa alrededor del 20 % del consumo mundial y que en Centroamérica el consumo per cápita de plaguicidas es mucho mayor que en otras regiones del mundo (1.84 kg por persona/por año). Metodología: Se realizó una búsqueda de artículos, hasta 2023, incluyéndose algunos que fueron publicados en 1978, utilizando las palabras clave y sus combinaciones: plaguicidas, legislación y jurisprudencia, exposición a plaguicidas, uso de plaguicidas, salud ambiental, políticas públicas de salud, América Latina. Resultados: Las publicaciones sobre el uso, marco legal y efectos en la salud de los plaguicidas en América Latina son escasas, por lo que se trabajó sobre la base de 50 artículos, que se consideraron los más relevantes. Conclusión: A pesar de existir diferentes leyes, políticas y tratados, hoy día las estadísticas de prevalencia y regulaciones de uso están lejos de ser satisfactorias, lo que conlleva la necesidad que se determinen intervenciones acertadas y oportunas para minimizar los daños a la salud y al ambiente relacionados con plaguicidas...(AU)

Declaración de la Sociedad Argentina de Pediatría sobre la prevención de enfermedades no transmisibles: la necesidad de fortalecer conocimientos y reforzar estrategias / Statement of the Sociedad Argentina de Pediatría on the prevention of noncommunicable diseases: the need to strengthen knowledge and reinforce strategies

Investigaciones de las últimas décadas revelaron que un ambiente adverso en la etapa de desarrollo puede producir una mayor susceptibilidad hacia fenotipos relacionados con enfermedad cardiovascular, diabetes, hipertensión, trastornos neuroconductuales y otras enfermedades crónicas no transmisibles. Estas enfermedades, cuyo aumento ocurre especialmente en países con alta vulnerabilidad social, provocan muertes prematuras y constituyen la primera causa de muerte en la vida adulta, además de un elevado costo para la salud pública. Consciente de la necesidad de prevenir estas enfermedades desde los primeros mil días de vida, la Sociedad Argentina de Pediatría creó la Subcomisión DOHaD y formuló una declaración para la prevención de enfermedades no transmisibles a la que adhirieron otros países de Latinoamérica. La aplicación de las estrategias declaradas con acciones interdisciplinarias e intersectoriales sostenidas en el tiempo contribuirá a construir salud, a disminuir la carga de enfermedades crónicas no transmisibles y al mayor bienestar y productividad para los pueblos.

Research in recent decades has revealed that an adverse environment in the developmental stage can produce a greater susceptibility to phenotypes related to cardiovascular disease, diabetes, hypertension, or neurobehavioral disorders, among other chronic noncommunicable diseases. These diseases, whose tendency is increasing especially in countries with high social vulnerability, cause premature deaths and constitute the first cause of death in adult life as well as a great cost to public health. Aware of the need to prevent these diseases from the first thousand days of life, the Sociedad Argentina de Pediatría created the DOHaD Committee and formulated a statement for the prevention of NCDs, to which Latin American countries also adhered. We believe that the application of the declared strategies with interdisciplinary and intersectoral actions sustained over time will contribute to building health, reducing the burden of NCDs, and to greater wellbeing and productivity for the people

Boas práticas sobre o gerenciamento de residuos em saúde: uma revisão integrativa / Good practices on health waste management: an integrative review / Buenas prácticas sobre la gestión de los desechos de salud: un examen integrativo

Objetivo: objetivo identificar na literatura científica as boas práticas utilizadas em ambientes hospitalares sobre o processo de gerenciamento de resíduos em saúde. Método: trata-se de uma revisão integrativa, realizada nas bases de dados LILACS, MEDLINE/PubMed, Scopus e Web of Science, em abril de 2022. Utilizaram-se os descritores Waste Management, Medical Waste, Solid Waste Processing, Hospitals, combinados com o operador booleano AND. Foram encontrados 95 artigos e selecionados 12. Resultados: as boas práticas utilizadas pelos profissionais em ambientes hospitalares que auxiliam no processo de gerenciamento de resíduos em saúde foram: implementação de política de gestão sobre resíduos em saúde e presença de orçamento especial para a gestão de resíduos, estabelecimento de subcomitês de descarte em diferentes departamentos para monitorar o descarte de resíduos médicos, presença de comitê de gerenciamento de resíduos de saúde, comitê de proteção contra radiações e de comitê de prevenção e controle de infecção, disponibilização de equipamentos de proteção individual, fichas de informação de gerenciamento de resíduo químico perigoso hospitalar, diretrizes de prevenção e controle de infecção e de instrumentos educativos, além de treinamentos específicos sobre a temática e disponibilização de locais de armazenamento de resíduos separados de resíduos perigosos. Conclusão: a gestão segura dos RSS se mostra cada dia mais muito importante no que diz respeito ao meio ambiente e à saúde pública. Porém, entre os artigos citados percebe-se a implementação de boas práticas mas, de forma incipiente.

Objective: objective: to identify in the scientific literature the good practices used in hospital environments on the process of waste management in health. Method: This is an integrative review, carried out in the LILACS, MEDLINE/PubMed, Scopus and Web of Science databases in April 2022. The descriptors Waste Management, Medical Waste, Solid Waste Processing, Hospitals, combined with the Boolean operator AND were used. 95 articles were found and 12 were selected. Results: the good practices used by professionals in hospital environments that assist in the process of waste management in health were: implementation of management policy on waste in health and presence of special budget for waste management, establishment of disposal subcommittees in different departments to monitor the disposal of medical waste, presence of health waste management committee, radiation protection committee and infection prevention and control committee, provision of personal protection equipment, information sheets for management of hazardous chemical waste in hospital, guidelines for infection prevention and control and educational instruments, besides specific training on the subject and provision of separate waste storage sites for waste from hospital waste dangerous. Conclusion: the safe management of SSR is becoming increasingly important in terms of the environment and public health. However, the articles mentioned include the implementation of good practices, but in a nascent way.

Propósito: identificar en la literatura científica las mejores prácticas utilizadas en los ambientes hospitalarios en el proceso de manejo de residuos en salud. Método: Se trata de una revisión integrada realizada en las bases de datos LILACS, MEDLINE/PubMed, Scopus y Web of Science en abril de 2022. Se utilizaron los descriptores Gestión de Residuos, Residuos Médicos, Procesamiento de Residuos Sólidos, Hospitales, combinados con el operador Y booleano. Se encontraron 95 artículos y se seleccionaron 12. Resultados: las buenas prácticas utilizadas por los profesionales en los entornos hospitalarios que ayudan en el proceso de gestión de los desechos en la salud fueron: aplicación de la política de gestión de los desechos en la salud y presencia de un presupuesto especial para la gestión de los desechos, establecimiento de subcomités de eliminación en diferentes departamentos para supervisar la eliminación de los desechos médicos, presencia de comités de gestión de los desechos sanitarios, comité de protección radiológica y comité de prevención y control de las infecciones, suministro de equipo de protección personal, información sobre la gestión de los desechos químicos peligrosos hospitalarios herramientas educativas, así como capacitación específica sobre el tema y suministro de sitios de almacenamiento de desechos separados para desechos peligrosos. En conclusión, la gestión segura de las denuncias de infecciones de transmisión sexual es cada vez más importante en lo que respecta al medio ambiente y la salud pública. Sin embargo, entre los artículos citados figura la aplicación de buenas prácticas, pero de manera incipiente.

Análisis de interacciones de los actores de la red de conocimiento en salud ambiental del Observatorio Nacional de Salud de Colombia

Introducción: Las interrelaciones positivas y negativas entre el hombre y el medioambiente impactan en la salud general de la población, por esto, la gestión del conocimiento y la transformación social, orientadas a la prevención de la exposición a factores de riesgo ambiental y a la creación de ambientes propicios, deben realizarse a través de acciones multidisciplinares intersectoriales, como el trabajo colaborativo de redes del conocimiento. Objetivo: Describir las interacciones entre los actores de la Red de Conocimiento de Salud Ambiental del Observatorio Nacional de Salud de Colombia (ONS), con el fin de promover, mejorar y fortalecer la colaboración, intercambio de información y planificación conjunta de acciones. Metodología: Estudio descriptivo transversal de análisis de redes sociales mediante herramientas de minería de texto del lenguaje de programación R. Se analizaron las categorías de agua y saneamiento, clima, calidad del aire, radiaciones electromagnéticas e intoxicaciones químicas de un corpus documental de 99 textos de los actores de la red general de conocimiento en salud pública del ONS. Se calcularon medidas de centralidad y prestigio y se graficaron redes dirigidas multicapa con Power BI. Resultados: Los actores con mayor centralidad en la red fueron: Ministerio de Salud y Protección Social, Superintendencia de Salud, Profamilia, universidades de Antioquia y La Salle, ONS, Observatorio de Salud Ambiental de Bogotá, Organización Panamericana de la Salud y Organización Mundial de la Salud. Las cinco categorías analizadas presentaron bajas centralidades de grado, y las categorías de agua y clima mostraron mayor participación de los actores (más nodos e interacciones). Conclusiones: El análisis de redes sociales permitió identificar temas relevantes de salud ambiental entre los actores de la red del ONS, además de actores clave para desarrollar espacios de interacción y gestión del conocimiento. Acorde con las limitaciones del análisis, se sugiere la inclusión de aproximaciones bibliométricas para la actualización de las interacciones de la red.

Introduction: Positive and negative interactions between the human beings and the environment have an impact on the general health of the population. Therefore, it is necessary to use knowledge management and social transformation, in order to limit exposure to environmental risk factors by creating a favorable environment for healthcare. This should be carried out through multidisciplinary and intersectorial actions, such as the collaborative work of knowledge networks. Objective: To describe the interactions between the actors within the Environmental Health Knowledge Network Colombia's National Observatory of Health (ONS acronym in Spanish), in order to promote, improve and strengthen collaboration, information exchange and planning of collaborative actions. Methodology: Cross-sectional descriptive study to analyze social interactions through text mining tools by R, programmer language. Categories analyzed: Water and sanitation, climate, air quality, electromagnetic radiation and chemical poisoning. Data source: a documentary corpus of 99 texts done by actors of Environmental Health Knowledge Network of Colombia's ONS. We calculated centrality and prestige measures. We used Power BI in order to plot multi-layered directed networks. Results: Actors with greatest centrality in the network: Ministry of Health and Social Protection, Health Superintendency, Profamilia, Antioquia and La Salle universities, National Health Observatory, Bogota's Observatory of Environmental Health, the Pan American Health Organization and the World Health Organization. The five categories analyzed provides a low centrality degree, and water and climate categories presented greater participation by actors (more nodes and links). Conclusions: Social interactions analysis provides the identification of relevant environmental health issues in Colombia and key actors in order to develop interaction spaces for knowledge management. The analysis had limitations that suggest the inclusion of bibliometric approaches for updating the interactions within the network.