Desafios da Segurança da Saúde Global em tempos de pandemia: O acesso a Equipamentos de Proteção Individual na crise da covid-19

This article addresses the precariousness of the Global Health Security system, focusing on the distribution of Personal Protective Equipment (PPE) during health crises and taking the COVID-19 pandemic as a departure point and a center. The shortage of PPE was exacerbated by factors such as the high transmission rate of the virus, inadequate training on its use and disposal, flexibility in guidelines regarding prolonged use and reuse of equipment, and restrictions on the export of healthcare products. The collapse of the global PPE supply chain has exposed frontline healthcare workers, especially in low- and middleincome countries, due to inadequate healthcare infrastructure and socioeconomic disparities. The lack of effective action to maintain and equitably distribute existing PPE stocks further exacerbated their shortage, compromising the effective response to the pandemic. To strengthen the resilience of healthcare systems, strategies need to be developed to ensure safety and equity in the global supply chain of healthcare products, with interconnected and redundant networks of suppliers. International collaboration and investments in multilateral mechanisms play a crucial role in building a more resilient Global Health Security.Este artigo aborda a fragilidade do sistema de Segurança da Saúde Global, enfocando a distribuição de Equipamentos de Proteção Individual (EPI) durante crises sanitárias e tendo como foco e ponto de partida a pandemia de covid-19. A escassez de EPI foi agravada por fatores como alta taxa de transmissão do vírus, falta de treinamento adequado sobre seu uso e descarte, flexibilização das diretrizes de uso prolongado, reutilização do equipamento e restrições à exportação de produtos de saúde. O colapso da cadeia de suprimentos globais de EPI expôs os profissionais de saúde na linha de frente, especialmente em países de baixa e média renda, devido à infraestrutura de saúde inadequada e à disparidade socioeconômica. A falta de ação efetiva para manter e distribuir equitativamente os estoques de EPI existentes exacerbou sua escassez, comprometendo o enfrentamento eficaz à pandemia. Para fortalecer a resiliência dos sistemas de saúde, é necessário desenvolver estratégias para garantir a segurança e equidade na cadeia de suprimentos global de produtos de saúde, por meio de redes interconectadas e redundantes de fornecedores. A colaboração internacional e investimentos em mecanismos multilaterais desempenham um papel crucial na construção de uma Segurança da Saúde Global mais resiliente

Clean air matters: an overview of traffic-related air pollution and pregnancy

The right to a healthy pregnancy and to giving birth in a safe environment is source of comprehensive research. Decent birth facilities, respect, and no discrimination are already recognized as fundamental rights, but an accurate look at the outdoor environment is required. Air pollution is a dangerous factor to pregnant women and newborns, many of whom highly exposed to traffic-related atmospheric pollutants in urban areas. Such exposure can lead to low birth weight and long-lasting effects, such as respiratory diseases and premature death. Thus, this commentary, based on the analysis of literature, presents the importance of the exposome concept and of epigenetics in identifying the role of the environment for better health conditions of pregnant women and newborns. In the final considerations, this study proposes the deepening of the subject and the mobilization in this regard, with a human rights-based approach to environmental health and to the increased awareness of pregnant women on the risks of air pollution and its effects on health

Attempts to Replicate the Skills, Attributes and Capabilities Associated with International Mobility in an Online World: A Case Study

In recent years, obstacles to physical mobility, such as the Covid-19 pandemic, have hastened the turn towards online platforms for educational and social activities. Many study abroad programs have had to adapt to such circumstances and embrace virtual environments in the face of limited physical mobility. In this case study, we look at how one multi-university program, the UGPN Academy, was able to expand international student learning efforts despite travel limitations due, in part, to adapting to online communication technologies and environments. Through comparison of surveys administered to participants pre- and post-participation, students reported that having an online community as a source of social support, as well as learning about different experiences during a global pandemic, were two strengths of the program. In addition, students reported becoming more familiar with different online technologies as well as feeling more open to people from diverse backgrounds and international careers. These findings contribute to a further understanding of Internationalisation at Home (IaH) as a useful model that can be extremely valuable in its own right. Although IaH is not a replacement for physical mobility, it may provide its own benefits, such as providing a collaborative, diverse online community as a source of social and professional support, networking and opportunities for international learning experiences for students who are unable to participate in traditional study abroad programs. Diversifying and further integrating such virtual platforms can then be seen as a part of best practices rather than a replacement for traditional modes of international cultural exchange

Aplicação da matriz FPSEEA de saúde ambiental para a macrometrópole paulista: subsídios para o planejamento e gestão socioambiental regional

Ao planejamento da gestão urbana em escalas regionais faz-se necessário incorporar a dimensão ambiental para que as cidades possam enfrentar os desafios decorrentes da reestruturação do espaço pelas dinâmicas econômicas e a adaptação aos efeitos das mudanças climáticas. Nesse contexto, a Macrometrópole Paulista (MMP) apresenta heterogênea divisão funcional socioambiental entre os seus municípios. Essas divisões corroboram com diferentes condições socioambientais nesse conjunto regional que podem ser expressas por indicadores estratégicos que qualifiquem as localidades municipais. Para tal, este trabalho tem como objetivo selecionar indicadores relevantes no contexto da saúde ambiental e da sustentabilidade para os municípios que compõem a Macrometrópole Paulista. Para a seleção dos indicadores foi considerada a matriz de indicadores para a Saúde Ambiental denominada de FPSEEA (Força Motriz-Pressão-Situação-Exposição-Efeito-Ações). Os resultados podem ser vistos como uma nova maneira inovadora de qualificar as condições socioeconômicas, ambientais e de saúde, destacando a importância da escala regional como uma nova unidade territorial a ser explorada na gestão urbana

Bicycle use in Latin American cities: changes over time by socio-economic position

IntroductionWe aimed to examine utilitarian bicycle use among adults from 18 large Latin American cities and its association with socio-economic position (education and income) between 2008 and 2018.MethodsData came from yearly cross-sectional surveys collected by the Development Bank of Latin America (CAF). A total of 77,765 survey respondents with complete data were used to estimate multilevel logistic regression models with city as random intercept and year as random slope.ResultsIndividuals with high education and high-income levels had lower odds of using a bicycle compared with participants with lower education and income levels. These associations, however, changed over time with the odds of bicycle use increasing for all groups, especially among individuals with the highest education and income levels.DiscussionOur results confirm the broadening appeal of bicycling across socio-economic positions in several Latin American cities and reinforce the importance of considering policies aimed at supporting and enhancing bicycle travel for all users

Sociocultural considerations in aging men's health: implications and recommendations for the clinician

http://dx.doi.org/10.1016/j.jomh.2009.07.00

A whisper-game perspective on the family communication of DNA-test results: a retrospective study on the communication process of BRCA1/2-test results between proband and relatives

Objective of this paper is to study how DNA-test result information was communicated and perceived within families. A retrospective descriptive study in 13 probands with a BRCA1/2 unclassified variant, 7 with a pathogenic mutation, 5 with an uninformative result, and in 44, 14, and 12 of their 1st and 2nd degree relatives respectively. We examined differences and correlations between: (a) information actually communicated (b) probands' perception, (c) relatives' perception. The perception consisted of recollections and interpretations of both their own and their relatives' cancer-risks, and heredity-likelihood (i.e. likelihood that cancer is heritable in the family). Differences and low correlations suggested few similarities between the actually communicated information, the probands' and the relatives' perception. More specifically, probands recalled the communicated information differently compared with the actually communicated information (R = .40), and reinterpreted this information differently (R = .30). The relatives' perception was best correlated with the proband's interpretation (R = .08), but this perception differed significantly from their proband's perception. Finally, relatives reinterpreted the information they received from their proband differently (R = .25), and this interpretation was only slightly related with the original message communicated by the genetic-counsellor (R = .15). Unclassified-variants were most frequently misinterpreted by probands and relatives, and had the largest differences between probands' and relatives' perceptions. Like in a children's whisper-game, many errors occur in the transmission of DNA-test result information in families. More attention is required for how probands disseminate information to relatives. Genetic-counsellors may help by supporting the probands in communicating to relatives, e.g. by providing clear summary letters for relatives

Air pollution policies from an urban-oriented perspective: comparing implemented strategies to control vehicular emissions and mobility in São Paulo, New York City and Paris

Objetivo: Este estudo teve por objetivo descrever e analisar as políticas e estratégias de controle da poluição do ar no meio urbano, com vistas a melhorar a qualidade do ar e apto a servir como referência para outras cidades em face de problemas críticos de poluição do ar. Usando os casos de Nova Iorque, São Paulo e Paris, este estudo destaca as diferentes políticas e tendências de gestão previstas nas três cidades, fornecendo uma caracterização destes três centros, descrevendo o período global e legal de desenvolvimento das principais políticas e destacando as principais estratégias implementadas ao longo dos últimos vinte anos. Metodologia: Tendo como abordagem um estudo múltiplo de caso, um primeiro componente fundamental da pesquisa consistiu na caracterização das três cidades, fornecendo dados sobre tendências das médias anuais da poluição do ar no que se refere a níveis de NO2, PM10, PM2.5, Ozônio e SO2 ao longo dos últimos quinze anos, apresentando uma visão geral dos meios de transporte e das frotas de veículos, e descrevendo as principais políticas desenvolvidas nas três cidades. Em seguida, a pesquisa propõe uma categorização das principais estratégias aplicadas, usando as abordagens de gestão da poluição do ar (regulatório, incentivos econômicos e outros) da OECD (Organização para a Cooperação e Desenvolvimento Econômico) para visualizar as escolhas estratégicas empregadas. Então, os resultados são condensados na matriz de análise SWOT e complementada a análise com sugestões de uma abordagem da qualidade do ar com maior inclinação para os direitos humanos. Resultado: Se prazos e contexto local variaram de uma cidade para outra, as três cidades têm um percurso histórico geral semelhante no desenvolvimento de certas políticas em oposição a outras. Níveis totais de poluição atmosférica têm diminuído ao longo dos últimos quinze anos, mas os níveis de poluição do ar continuam acima do que é recomendado nas diretrizes da OMS (Organização Mundial da Saúde). As cidades diferem no desenvolvimento de estratégias. De acordo com os critérios da OECD, se as abordagens reguladoras são uma tendência comum às cidades na redução dos níveis de poluição do ar, elas diferem na forma e até na extensão de seu investimento em mobilidade e transportes públicos e na matriz energética escolhida. Outra descoberta incluiu o desenvolvimento de incentivos econômicos, dados disponíveis e inclusão da indústria automobilística em questões ambientais. Elas têm em comum a capacidade tecnológica para desenvolver combustíveis de energia mais limpa e fomentar meios de transporte não-motorizados. No entanto, as disparidades em opções de transporte, infraestrutura e na distância entre trabalho e residência pareceu ter impacto sobre o uso de veículos privados, em parte devido à dificuldade de acesso da residência a transportes públicos disponíveis, além de opções políticas dos governos locais. Isto é particularmente verdadeiro no que tange a população de renda média, que constitui a grande parcela que faz uso de automóveis próprios, e população de baixa renda. Conclusão: abordagens regulatórias são estratégias historicamente preferidas no controle da poluição do ar, especificamente no caso de episódios de poluição do ar a níveis críticos, mesmo quando a cidade já fomenta sua rede de transporte público. Há melhorias a serem feitas em prol da qualidade dos índices relativos à poluição do ar em cada cidade e também pela melhor compreensão da contribuição e dos impactos das emissões veiculares na qualidade do ar. O foco na tecnologia veicular é uma escolha que só pode ser complementada se mais estratégias de transporte limpo atingirem um número maior de habitantes. Além disso, se é importante o compartilhamento de tecnologia e know-how entre as cidades, isso só pode ser feito se estudos prévios forem realizados localmente e se os moradores estiverem envolvidos no processo de tomada de decisão. Caso contrário, conforme as políticas de poluição do ar forem sendo desenvolvidas, elas correm o risco de fracassar. Para este fim, a abordagem da poluição do ar baseada nos direitos humanos poderia ser uma opção para o progresso das estratégias mais inclusivas no tratamento da qualidade do ar e de seu compartilhamento.Objective: The objective of this study was to describe and analyze urban air pollution control policies and strategies, with the goal of improving air quality and serving as a reference for other cities facing critical air pollution issues. Using the cases of New York City, São Paulo and Paris, this study highlights the different policies and management tendencies practiced in the three cities, by providing a characterization of the three centers, describing the global and legal timeframe of the development of main policies and highlighting major strategies implemented over the last twenty years. Methodology: Using a multi-case study approach, the first component of the research consisted of characterizing the three cities, providing data on air pollution yearly average level trends of NO2, PM10, PM2.5, Ozone and SO2 over the last fifteen years, giving an overview of modes of travel and the local vehicle fleet, and describing the main policies undertaken in the three cities. Then, the study proposed a categorization of the main strategies applied using OECD air pollution management approaches (regulatory, economic incentives and others) to foresee strategic choices employed. Finally, the results were synthesized with a SWOT analysis matrix and complemented with suggestions based on a human-rights approach to air quality. Results: While the timeframe and local context differed from one city to another, in general the three cities followed a similar historical pathway to developing certain policies as opposed to others. Overall levels of atmospheric pollution have decreased over the last fifteen years but air pollution levels continue above WHO recommended guidelines. The cities differ in the development of strategies used. According to OECD criteria, if regulatory approaches to air pollution are commonly used to lower air pollution levels, cities differ in the way and extent to which they have invested in mobility and public transportation and the chosen energy matrix. Another finding included the development of economic incentives, available data and inclusion of the automobile industry into environmental issues. While the three cities do have technological capacity to develop cleaner energy fuels and foster non-motorized modes of transports in common, disparities in transportation options, infrastructure and distance to and from work appeared to have an impact on the use of privately owned vehicles. This is partly due to the lack of available public transportation in residential neighborhoods and local governments political choices. In particular, this impacted low- and middle-income populations the most as they constitute the majority of car owners. Conclusion: Regulatory approaches have historically been the primary tool used to control air pollution. This is especially true when pollution has reached critical levels even when there is widely-used, reliable public transportation. There are some improvements to be made to advance the quality of the data related to air pollution in each city and to better comprehend the effects and long-lasting impacts of vehicular emissions on air quality. Focusing on vehicle technology is a choice that can only be complemented if more integrated clean transportation strategies reach a greater number of city inhabitants. Furthermore, technology and know-how are important factors which must be transferred from one city to another and must take into account past local studies as well as input from local communities. If not, as air pollution policies are being developed, they run the risk of failing. To this end, human-rights based approach to air pollution must be an option to progress towards more inclusive strategies and their replication

An Environmental Health Typology as a Contributor to Sustainable Regional Urban Planning: The Case of the Metropolitan Region of São Paulo (MRSP)

The recognition of metropolitan regions and their growth as a necessary scale of analysis for their integrated management has become a central characteristic of urban planning. The current metropolitan landscape warrants the use of instruments beyond the municipal scale, especially since the economic integration of cities and their development are accentuating urban problems that affect the sustainability of cities. The São Paulo Metropolitan Region (MRSP), one of the world’s megacities, is used as a case study to identify how typologies can contribute to integrated sustainable urban planning and management at the metropolitan level. It applies the territorial analytical typology based on the Driving-Force-Pressure-Situation-Exposure-Effect-Actions (DPSEEA) Environmental Health Matrix to identify the heterogeneity of conditions encountered in large metropolitan regions such as the MRSP. The results show a great variety of environmental and social conditions present in the municipalities of the MRSP that condition the sustainability and health of the urban environment. This typology constitutes a first step to characterize metropolitan regions in socioenvironmental terms using as a conceptual basis a matrix of environmental health indicators, being a precursor in the largest metropolitan region of Brazil