Scientific mapping using bibliometric data network analysis was applied to analyze research works related to lipases and their industrial applications, evaluating the current state of research, challenges, and opportunities in the use of these biocatalysts, based on the evaluation of a large number of publications on the topic, allowing a comprehensive systematic data analysis, which had not yet been conducted in relation to studies specifically covering lipases and their industrial applications. Thus, studies involving lipase enzymes published from 2018 to 2022 were accessed from the Web of Science database. The extracted records result in the analysis of terms of bibliographic compatibility among the articles, co-occurrence of keywords, and co-citation of journals using the VOSviewer algorithm in the construction of bibliometric maps. This systematic review analysis of 357 documents, including original and review articles, revealed studies inspired by lipase enzymes in the research period, showing that the development of research, together with different areas of knowledge, presents good results related to the applications of lipases, due to information synchronization. Furthermore, this review showed the main challenges in lipase applications regarding increased production and operational stability; establishing well-defined evaluation criteria, such as cultivation conditions, activity, biocatalyst stability, type of support and reactor; thermodynamic studies; reuse cycles; and it can assist in defining goals for the development of successful large-scale applications, showing several points for improvement of future studies on lipase enzymes. Enzymes can act as natural catalysts on specific or non-selective substrates, usually under mild temperature, pressure, and pH conditions, and achieve high conversion rates . In thisLipases demonstrate several interesting properties, such as their ability to act at the interface between aqueous and non-aqueous phases, their ability to process all types of glycerides and free fatty acids in transesterification, specificity, high catalytic activity under milder reaction conditions, stability in organic solvents, and activity without cofactors. These properties of lipases demonstrate their good performance when applied in biocatalysis in the most diverse processes . For exaDue to the diversity of catalytic processes involving lipases, a large number of studies have been published proposing improvements in the characteristics and mechanisms of action of these biocatalysts, such as improved stability ,14, immoBibliometric analysis is a quantitative method that uses mathematical and statistical tools to measure the interrelationships and impacts of publications within a given area of research, resulting in a macroscopic view of a large number of academic works. VOSviewer is a program designed to build and visualize bibliometric maps based on network data, considering the strength of the connection between items .The emergence of scientific databases, such as Scopus and Web of Science, made it relatively easy to acquire large volumes of bibliometric data. This phenomenon associated with bibliometric software enables extensive data analysis, motivating academic interest in bibliometric analysis . TherefoThe present study highlights the relationship of study networks involving lipase enzymes, based on a search of the literature in English in the Web of Science (WS) database from 2018 to 2022 to highlight, through scientific mapping, the most researched topics involving lipases. With this, it was possible to identify the challenges related to the scale-up of the process catalyzed by lipases and to show perspectives for future research that seek to increase the production and operational stability of processes enzymatic.Bibliometric analysis is a quantitative method that uses mathematical and statistical tools to measure the interrelationships and impacts of publications within a given area of research, resulting in a macroscopic view of a large number of academic literature works .The data collected for this research was based on WS. The search expressions form the terms “lipase” and “industrial applications” for the topics in this field, which performs word searches in titles, abstracts, and keywords. According to Gonçalves et al. ,25,26, tAccording to Uman , systemaBibliographic coupling measures the proximity between two articles by comparing their references. Therefore, the greater the number of references they share, the greater the similarity between them, which can be theoretical, methodological, or another shared particularity . Figure The articles are indicated by a label and, by default, a circle. Thus, the more citations the document has, the larger the circle in the bibliographic coupling will be. The articles by the authors Chapman et al. , Basso aIn the bibliographic coupling chart, the strength of a link indicates the number of cited references that two publications have in common . Table 1Chandra et al.  and MahfIn this context, from the connection network established among the articles, it is possible to observe the similarity of the research topics developed by these authors, evidenced by the total link strength value shown in bibliographic coupling.Keyword co-occurrence analysis assumes that words often appear together and have a thematic relationship . VOSviewIn order to identify possible topics researched in the last five years, a network was built for the co-occurrence of keywords. From the information extracted from the WS, the minimum number of five occurrences for a keyword was established, resulting in a total of 140 keywords identified for constructing the network graph in VOSviewer, as presented in With the grouping of terms, it was possible to identify the existing relationships among topics in the field of research of enzyme immobilization, studies on enzymatic catalysis, its characteristics, and studies on enzymes from microbial sources . In cluster 2 (in green), the search terms were enzymes, cold-adapted lipases, enzyme identification, and classification. Cluster 3 (dark blue) presented a search set involving nanoparticle stability, in vitro antioxidant stability, transesterification, esterification, and biodiesel. The terms in cluster 4 (in yellow) are related to research on biotechnology, directed evolution of enzymes, stability, and enzyme stability. In cluster 5 (in purple), the researched topics were directed to the production and application of lipases, in which the terms industrial application, biochemical characterization, extracellular lipase, production of lipases, solid-state fermentation, and microbial lipases appear. Cluster 6 (in light blue) contains search terms related to enzyme production, optimization, hydrolysis, fermentation, substrate, purification, alkaline lipases, and microbial lipases.Co-occurrence links present the strength of the relationship between items (link strength), represented by a positive numerical value. Journal of Molecular Catalysis B: Enzymatic; International Journal of Biological Macromolecules; Bioresource Technology; Process Biochemistry; Enzyme and Microbial Technology; Applied Microbiology and Biotechnology; Biotechnology and Applied Biochemistry; and Biotechnology Advances have very dense and highlighted areas on the map, showing a more significant number of citations in these journals in the investigated period. In addition, it is possible to observe on the map that these journals are located close to each other, indicating closely related research fields. The journal co-citation map shows the structure of the researched scientific areas. For the construction of the map, journals with a minimum of ten citations were selected, totaling 429 journals used to construct the co-citation map. Journal of Molecular Catalysis B: Enzymatic; Process Biochemistry, and Enzyme and Microbial Technology hold great relevance for research mainly related to enzyme immobilization. Therefore, it was possible to obtain an overview of the structure of the co-citation map of the journals, to observe the intellectual links among journals, and the impact of this network through the visualization of the density map , which is one of the few liquid lipase formulations for industrial application. A genetically-modified lipase, derived from the lipase of the fungus Thermomyces lanuginosus [In general, soluble enzymes do not present characteristics that allow their application in large-scale continuous processes. With their sensitivity to process conditions, low stability, and difficult reuse at an industrial scale, studies focus on immobilization techniques to improve this performance . When weuginosus ,78, withuginosus ,80. Curruginosus ,82,83.The main goal of immobilization techniques is the protection of enzymes under extreme environmental conditions, including the influence of temperature, pH, and organic solvents during the application processes, allowing enzymatic activity to be maintained even under various reaction conditions since the main function of the support is to stabilize the enzyme structures and, consequently, to preserve enzyme efficacy and storage. Immobilized enzymes are more robust, show higher stability, and are easier to handle compared to their soluble forms. They are also easily recovered/recycled after use ,86,87,88Enzyme immobilization methods include physical adsorption, ionic and covalent bonds, and various techniques such as binding, entrapment, encapsulation, and reticulation. Various organic and inorganic materials or carriers can be used to apply enzyme immobilization techniques ,89. ImmoIn the food industry, for example, studies show that immobilized enzymes are applied in different stages of food and beverage processing, in brewing, meat tenderization, baking, and protein hydrolysis, offering numerous advantages such as stabilization and reuse, which enable cost reduction ,78,91,92Lipase immobilization techniques have been the subject of several studies developed over the years ,96,97,98In the graph generated by the program VOSviewer , it is oGoing deeper into these details, the authors address the relevance of recombinant technology studies with protein engineering, which act in the structural modification of this enzyme ,18, mainModeling and optimization by statistical experimental planning stand out in most of the works with lipase ,31. NoneAmong the observed works, when talking about the bioreactor, there is a range of studies that need to be considered for the effective dynamics of the reaction system, which should be considered for scale-up. Thus, the large amount of biocatalyst is mentioned, in relation to the efficiency of the reaction and the enzymatic activity, as well as the impregnation of the material on the reactor wall in continuous processes or for long periods, the adequate heat and mass transfer, the effective operational control, the combination of the reaction medium with the characteristic of the enzyme, the kinetic model of the reaction, and the amount of water in the medium ,32,47.The works with significant numbers of citations found in the search focus on lipase immobilization processes for application in industrial processes.Within this niche, the application is focused on the biotechnology and bioprocess sectors, which include food, cosmetics, biofuels, and environmental areas, which show the versatility of this enzyme.When observing the topics that comprise the optimization of lipases, studies are found evaluating both the supports for immobilization, fermentative processes of enzyme production, enzymatic purification, biochemical characterization, and the application in reactions in both an organic and inorganic media, reinforcing the breadth of use of this biocatalyst.It is verified that in the case of lipase immobilization techniques, the tests comprise the configuration of support materials, operational stability, and reuse.Kinetic studies are fundamental in this process of transition from laboratory scale to industrial scale. Allied with the computational modeling of these reactions, it allows us to determine and optimize operational parameters, in addition to enabling monitoring of the bioprocess and planning the structure necessary for implementation.Other factors that contribute to the previous topic are the genetic studies at the structural level of lipases, which allows the improvement of their characteristics regarding activity, productivity, thermal stability, reuse, and enantioselectivity.Compatibility studies considering the synergy of free or immobilized enzyme, reactor type, reaction medium, and product are fundamental to performing a combination that allows an efficient process, with high yields, and continuous operation processes.Lipases stand out in different industrial sectors with wide applicability; consequently, the number of research works involving this enzyme covers multiple areas of knowledge. Therefore, the systematic review presented aimed to map the potentiality of this biocatalyst aiming at its industrial application, where the following topics can be highlighted:Thus, the approach of enzyme technology focused on lipases is broad, requiring the combination of knowledge in protein engineering, immobilization, process engineering, and life cycle analysis to both understand the mechanisms that involve this biocatalyst and enable the use on an industrial scale with the least efficiency loss in the processes.


Mixed Methods Appraisal Tool (MMAT), STrengthening the Reporting of OBservational studies in Epidemiology (STROBE), and Standards for Reporting Qualitative Research (SRQR). The qualitative and quantitative findings were grouped into a four-level hierarchical matrix. The epidemiological profile of malaria morbidity, from traditional epidemiology, has been sustained by environmental problems, armed conflict, individual risk behaviors, and low adherence to recommendations from health institutions. However, the qualitative component reveals deeper causes that are less studied, of greater theoretical complexity, and that reflect challenges to design and implement health interventions, such as socioeconomic and political crises, poverty, and the neoliberal orientation in the malaria control policy; the latter reflected in the change in the role of the State, the fragmentation of control actions, the predominance of insurance over social assistance, the privatization of the provision of health services, the individualistic and economistic predominance of health, and low connection with popular tradition and community initiatives. The above confirms the importance of expanding mixed studies as a source of evidence to improve malaria research and control models in Colombia, and to identify the underlying causes of the epidemiological profile.Mixed methods are essential in public health research and malaria control, because they allow grasping part of the complexity and diversity of the factors that determine health-disease. This study analyzes the mixed studies on malaria in Colombia, 1980–2022, through a systematic review in 15 databases and institutional repositories. The methodological quality was assessed with The online version contains supplementary material available at 10.1186/s12889-023-16098-5. Plasmodium vivax and P. falciparum represent about 98% of all Colombian cases, and problems of plasmodial resistance to antimalarials or anophelines to insecticides do not explain their endemicity ) AND ) AND (Colombia), in Scielo with (ab: (mixed methods)) AND ) AND (Colombia) and ScienceDirect with Colombia Title, abstract, keywords: (mixed methods) AND malaria, do not generate results.Specifically in malaria, there are studies with mixed methods that have evaluated strategies for case reporting , health National Strategic Plan for Malaria 2019–2022 from Colombia. In connection with these purposes, the objective of this research was to analyze the mixed studies on malaria in Colombia published in the world scientific literature between 1980–2022, through a broad approach of Cochrane, which one summarize the scientific production in an area, update a field of knowledge, summarize the available evidence, identify the main research topics or gaps in research, define future lines of work, among other aspects [For all the above, it is important to carry out a systematic review in this field in order to synthesize the available evidence in the country and determine its methodological quality; know the main topics addressed; identify ways to articulate quantitative and qualitative evidence on malaria; identify issues with consistent evidence to guide public policy actions; generate hypotheses on aspects not yet explored or explained in qualitative or quantitative research; broaden the understanding of the processes underlying the epidemiological profile of malaria in Colombia; and ultimately, to generate evidence that allows us to complement the actions of  aspects .A systematic review following PRISMA guideline . The revin Spanish Descriptores en Ciencias de la salud) and MeSH , the following search terms were identified: i) for the disease: malaria, Plasmodium, and Paludism; ii) for the method: mixed methods, qualitative, hermeneutic, ethnographies, ethnography, grounded theory, community-based participatory research, community-based research, participatory research, participatory action research, cultural anthropology, ethnopsychology. With these terms, nine search strategies were established and applied in the PubMed, OVID EMCare, Scielo, Science-Direct, Jstor, Web of Science, Campbell Collaboration / Cochrane Library, EMBASE, and HAPI databases . They were complemented with searches for other publications in Google Scholar, Redalyc, and the system of libraries and institutional repositories of the main Colombian universities with research on malaria . It is important to note that the systematic review was limited to Colombia, since the findings of other studies in countries with a similar parasitological situation such as Venezuela, Peru or Brazil, are not comparable in key aspects of this review such as the following: type of system of health, type of disease control program, characteristics of the territory , political and social situation , among other characteristics that may offer disparate results or that they are not applicable to the reality of Colombia. To manage references and eliminate duplicates we use Zotero.We apply four inclusion criteria: include search terms in title, abstract, or keywords ; be a study on malaria as the central outcome; developed in a Colombian population; and that it was original research. In this review we only applied two exclusion criteria: studies executed without a design based on mixed methods , and studies with incomplete information or without data from the two components  of a mixed study on malaria. Two researchers conducted this phase independently and discrepancies were resolved by consensus.Data extraction from the selected manuscript was carried out by extracting the following variables: title, authors, year of publication, study location, number and central characteristics of the study subjects, type of mixed study, data collection instruments, central theme or objective, central results of the quantitative component, categories of the qualitative component and conclusions. Then, qualitative synthesis was conducted. Two researchers also conducted this phase independently and discrepancies were resolved by consensus.Mixed Methods Appraisal Tool (MMAT)" [STrengthening the Reporting of OBservational studies in Epidemiology (STROBE) guidelines were applied for the quantitative component [Standards for Reporting Qualitative Research (SRQR) guidelines were applied for the qualitative component [Two researchers independently guaranteed the reproducibility of the studies' methodological quality assessment . The methodological rigor of the studies was evaluated based on the criteria of the guide " (MMAT)" . Given tomponent , becauseomponent . The supCollected search results, screening, and data extraction process, were made in Excel. The percentage of studies that met each of the methodological quality criteria was determined, and for each study, the percentage of quality criteria met was determined. Because, in the quantitative component, the studies evaluated different units of analysis  and studied heterogeneous subjects, it was not possible to carry out a quantitative synthesis , but rather a qualitative one of the main variables, proportions, and temporal trends in malaria. In the qualitative component, the main categories reported from the studies were analyzed, and for each one, its properties (characteristics of a category that give it meaning) and dimensions  were identified.Once the synthesis of the findings of each component was made, its articulation was carried out through a matrix in which the results were grouped in four levels:The most investigated , called the epidemiological profile of malaria, includes aspects of morbidity, mortality, outbreaks, and knowledge surveys.The second grouped the characteristics of the malaria control program after of the reform to the health system (Law 100 of 1993), giving an account of the impacts of this change on the operation and achievements of the program.In the most profound or structural aspects, the changes in the Colombian health system in the 1990s appear.The base of the hierarchy includes structural and permanent problems from Colombia in the last four decades, such as poverty; economic, social and political crises, and the neoliberal turn in the Colombian economic system.Some approaches of the critical realism were taken to define these levels. Critical realism is an epistemological stance that allows overcoming the limitations of positivism and hermeneutics by making explicit the importance of investigating the simultaneity, interrelation, and superposition of the dimensions of reality : the empirical (observer's perceptions), historical, and transfactual  .n = 91), Redalyc (n = 52), and the system of libraries and institutional repositories of the main Colombian universities (n = 44). Only 491 articles with search terms in title, abstract, or keywords were screened. Of the 153 eligible texts, 94 epidemiological studies (quantitative), ten entomological studies, 9 in vivo or in vitro models, 11 qualitative, and 20 corresponding to other typologies  were excluded. Therefore, only nine investigations that applied mixed methods were included , allowed the identification of 127,679 records, of which 187 were identified in the manual search in Google Scholar . In this sense, most studies did not correctly describe the quality criteria applied in their quantitative component, being bias control the least applied. In the qualitative component, the least applied items were the specification of the type of study and the guarantee of reflexivity Fig. .Fig. 2AsHousing: important characteristics are reported, such as poor material conditions of the floor, ceiling, and walls, as well as the absence of sanitary infrastructure in most of the cases analyzed (greater than 70%) [han 70%) .Families: in this unit stands out the high proportion of poverty , the high risk of greater impoverishment due to the disease, and due to the type of economic activity of its members (primarily people who are paid for each workday), absence of protection mechanisms against malaria  and overcrowding [crowding . The extcrowding .Subjects exposed to malaria: the largest proportion does not attend hospitals because they are far from their homes, the long waiting times, the poor-quality care (friendliness), and delay in diagnosis [iagnosis . There aiagnosis .Malaria control program at the municipal, departmental or national level: the following findings are highlighted: i) the national trends evaluated since 1960 show that mortality has decreased and morbidity has increased, with an underestimation of cases between 15–25%, and with the presence of outbreaks in some years [ii) in the decade 1991–2000, the highest incidence occurred in the Department of Antioquia (one of those that reports the highest proportion of cases in the country), the highest peaks occurred between 1992 and 1995 with 17 municipalities concentrating 75% of all the Department's cases [iii) Antioquia, like the national average, shows a decrease in mortality from 1946 to 2003 [me years ; ii) in 's cases , 35; iii to 2003 , 39, alt to 2003 . After 1 to 2003 .Information related to units of analysis such as housing and families in endemic areas, exposed subjects, and control programs were obtained:However, morbidity trends should be analyzed with caution due to the following problems in data availability: decrease and lack of knowledge over several years of the number of blood samples examined ; underreAdded to the above is a recent study showing a low diagnostic and epidemiological surveillance capacity in some areas. For example, the Rondón study with 25 diagnostic sites in southern Colombia indicates that less than 30% had microscopy stations; approximately half of them performed the diagnosis for malaria, and the rest only took the sample and sent it to a reference laboratory; the Secretariat of Health of the Amazon (Colombia) does not carry out monitoring visits, and only 60% of the diagnostic points participate in quality assurance programs . HoweverIn this component, issues related to the concept of health were found in some exposed subjects from rural areas, socioeconomic characterization of some studied regions, the role of the State, and impacts of the change in Colombia's general health social security system in 1993.Regarding the conceptions of health of some endemic areas' residents, it was mentioned that health is related to biological, psychological, social, and environmental factors. At the same time, the disease is explained in terms of socioeconomic problems reflected in the absence of sewerage, little supply of water and food, among others. Also, nosological systems that group diseases into infectious , behaviors that affect health , pests , and environmental problems  were found , 36.In describing the socioeconomic context, some authors found that migration to urban areas to seek better education and income generates problems of food insecurity . This isIn some testimonies, the importance of having a strong State was also highlighted, even though the reality of the residents of some endemic areas of the Department of Antioquia, mainly in the rural area, shows the low presence of the State, the failure to comply with its responsibilities in security, its inability to control armed groups, low coverage of basic health-care services, problems (and in some cases absence) of road infrastructure, few incentives for agricultural production and low inclusion of social organizations in activities related to managing their health .Finally, various categories were found that account for the negative effects of changes in the Colombian general health social security system at the end of the 1980s and the beginning of the 1990s, from the perspective of key actors such as experts from the Pan American Organization of Health, the National Institute of Health, the departmental and local health secretariats, as well as operational personnel and community leaders. In this sense, it is indicated that since 1993 there have been radical changes in the structure and organization of public health programs and in the functions or responsibilities of territorial entities, which resulted in fewer investments in core public health issues, and loss of the capacity and experience gained in previous decades. Also, significant territorial gaps in planning, allocation of resources, personnel, training, disease monitoring, and intersectoral coordination are outlined .Although the most significant impacts have been recorded since 1993, several authors highlight that the significant changes related to the competencies of territorial entities, particularly the decentralization  that affected public health programs, had been a constant and long-term process in Colombia since 1986, modeled by Laws 12 of 1986, 10 of 1990, 60 of 1993, 715 of 2001, being a milestone Law 100 of 1993 that completely reformed the health system , 38. In Malaria was classified as one of the most critical health problems among the subjects studied. The main symptoms of malaria, the causative agent, the vector, and the prevention methods  are identified. The subjects know that the vector lives and reproduces in stagnant waters, that transmission occurs by mosquito bites, that the tropical climate partly explains the disease's presence, and that the mosquito is found in bushes, near garbage, stagnant water swamps and latrines. Knowledge is often not directly related to practice; many people start self-medicating since no prescription is required in pharmacies , 36.People living in endemic areas go to health services  or traditional healers. They make the initial (symptomatic) diagnosis at home and manage it with medicinal plants, although as the fever progresses, they visit the health center for pharmacological treatment . Most suIn addition to cultural practices and beliefs, the primary socio-ecological dynamics related to malaria include mining, migration, armed conflict, and climatic variations . In addii.Loss of progress made since the Malariology Campaign from 1943 and the Malaria Eradication Service (in Spanish SEM) from 1956, in terms of community education and training, active case detection , operatiii.An economic emphasis of the program , with a prevalence of privatization in disease care and an individualistic view of health .iii.Disarticulation and fragmentation of responsibilities and preventive actions, low integration with local health plans, and little participation of the community and local authorities in control activities .iv.Since 1991, a deterioration in malaria control has been observed, associated with decentralization and the subjection of health policy to market principles, with progressive weakening of State responsibilities, dismantling of installed capacity, loss of know-how and experience acquired, fragmentation of control actions, and the collapse of the information system .v.Reduction of economic resources allocated to the program, subordination of health care to insurance contracts, delayed payments for health service providers, and little clarity on the allocation and administration of resources , 39, 40.vi.Organizational problems since the health secretariats are subject to political influence, with little participation of the personnel and an unstable relationship with institutions of training. Additionally, there is personnel without sufficient technical skills, low salary, corruption in hiring, little horizontal and vertical articulation with other vector control programs, and delays in providing drugs, mosquito nets, and insecticides .Finally, in this component it is highlighted the testimonies of key actors and the documentary research on the negative impacts that the changes in the General Health Social Security System had on the malaria control program in Colombia, highlighting the following events:i.clinical-epidemiological profile of malaria. This level includes the findings of the quantitative component of the studies that show increasing trends in morbidity, the presence of outbreaks, groups with a higher prevalence of the event, and high levels of knowledge about the causes, symptoms, transmission, treatment and prevention of malaria.The first would correspond to the most visible part or to the proximal processes, closest to the clinical-epidemiological outcome, which materialize in the ii.characteristics of the malaria control program after the changes introduced with the health reforms that began in the late 1980s, highlighting the reduction in the program's budget, problems with information systems and surveillance, fragmentation of malaria control actions, among others.The second level shows the iii.The previous characteristics are based on the changes derived from implementing the new social security health law (Law 100 of 1993), whose axes were the economic vision of health, decentralization, privatization, the reduction of social spending, among other neoliberal policies.iv.Finally, all the previous characteristics underlie problems related to the neoliberal economic system, the change in the role of the State, poverty, and the social, economic and political crises that the country has experienced Fig. .The previous results account for proximal, intermediate, and structural processes associated with malaria in Colombia. Using some postulates of critical realism Fig. , the eviFigure It confirms that in malaria research in Colombia, the biomedical studies focused on the parasite, the vector and clinical-epidemiological aspects predominate ;It coincides with previous systematic reviews that demonstrate the low academic-scientific production in qualitative studies and social processes that underlie malaria , 45;This predominance of approaches of traditional epidemiology will not allow progress in the intervention of the malaria in Colombia since its conception of health is limited in theoretical and practical terms .Through 9 search strategies applied in 15 sources, the study found nine mixed studies on malaria in Colombia published between 1986 and 2018 in various topics and units of analysis. This low number of studies accounts for several important aspects:Regarding the last aspect, it is worth noting that, in health philosophy and social epidemiology, this phenomenon has been called the "paradigm in crisis" of classical epidemiology. This phenomenon occurs because their reasoning and methods do not address all levels of reality ; they assume the population only as the sum of individuals , favoring the measurement of biological factors, behavioral factors or external environmental exposures; they do not allow addressing social, historical and cultural aspects of the health-disease process; they generate partial public policy recommendations given the limitations of their ontological, epistemological and methodological foundations; and they have low explanatory power for key outcomes such as morbidity or mortality .The above highlights the importance of articulating the quantitative tradition with qualitative findings that make it possible to overcome some of the limitations mentioned above. In this sense, this systematic review shows the advantages of mixed studies by revealing social, economic, political, cultural, and historical causes, generally not revealed in the hegemonic research on malaria in Colombia. Thus, the advantages of mixed methods materialize, such as capturing part of the complexity and diversity of the factors that determine health disease; enriching the results of traditional epidemiological studies ; improviIn the quantitative and qualitative findings, it was common the reference to homes, families, and socioeconomic context characterized by poverty and its related problems such as migration , food insecurity, barriers to access to health services and the increased risk of becoming ill. This complexity of the social and economic contexts in which the disease occurs has been widely documented for general issues that relate to poverty, malnutrition, and infectious diseases . These aIn this regard, it is essential to clarify that the studies in this review that refer to poverty are not exhaustive or precise in the use of this concept. In this sense, it is important to note that in the study of poverty, there are multiple visions , approaches , definitions , methods , and measurement typologies (univariate or multivariate) demonstrating that this field of study is complex. In the case of malaria in Colombia, it is a subject that has not been rigorously investigated, which should be corrected in subsequent studies .i) social representations, meanings, perceptions, wisdom, experiences, and practices about the health-disease process; ii) nosology, knowledge, beliefs and therapeutic itineraries of the traditional health system; and iii) the meanings of the health-disease process as a material, cultural and spiritual reality [On the other hand, it is essential to note that the social and practical representations that subjects and communities have regarding malaria are part of a broader sociocultural system referred to social constructions on health and its value, and they determine the initial actions against health, disease care, hospital consultation and the type of treatment accessed. The finding from the systematized studies in this research coincides with a previous review on the qualitative studies of malaria in Colombia, in which it is established that, from the perspective of social actors, their conception of the health system revolves around the following categories:  reality . These aIn this regard, it was also found that the knowledge, attitudes, and practices about the causality, transmission, treatment, and prevention of malaria are satisfactory. This finding indirectly reflects the effect of the education, communication, and health information campaigns that different institutions and community groups have carried out on the disease as part of the objectives of control programs since 1957, which has resulted in the incorporation of a part of biomedical knowledge in the communities , 38. TheIn the structural aspects that determine the profile of malaria, multiple testimonies captured in the qualitative component highlight two interrelated factors, the low presence of the State  and the armed conflict derived from this, findings that coincide with that reported in a systematic review of qualitative studies carried out in Colombia . The nexThe results of this research also show that the establishment of neoliberal policies in Colombia, at the end of the 1980s and during the 1990s, negatively affected public health in general and malaria control in particular, because it implied the reduction of the budget, fragmentation of the information system, disarticulation of control actions, reduction of active surveillance of cases, reduction of the diagnostic effort, among other effects derived from the change from a healthcare model to an insurance model, adjusted to the logic of private markets and decentralization. These findings coincide with previous publications that have documented multiple characteristics of neoliberalism in health, highlighting the positioning of the private sector for health care or "privatization of individual health"; the lack of financing of the public sector and the dissemination of the idea of its inefficiency to justify the participation of private health companies; assume the provision of health services as an axis of capitalist accumulation; promote the use of generally expensive technologies that result in the need to accept private capital; outsource hospital processes; give technocratic management to the health system; prioritize economic efficiency mainly by reducing costs and medical personnel; and not addressing issues of health inequities as a priority –57.Despite the fact that some narratives of the qualitative component relate the changes in the health system with the economic model , the evidence on this relationship is not solid or consistent, which requires further investigation. In general, the structural or deep determinants of the epidemiological profile of malaria in Colombia were only captured in the qualitative component, which has limitations in its inference; For this reason, more quantitative and mixed studies are required to analyze these findings in greater detail.This research shows that health education and communication efforts have effectively generated a significant amount of knowledge about the etiology, symptoms, treatment, and prevention of the disease. It also shows that malaria morbidity has not been effectively impacted in the last decades. The epidemiological profile of malaria morbidity, from traditional epidemiology, has been sustained by environmental problems, armed conflict, individual risk behaviors, and low adherence to recommendations from health institutions. However, the qualitative component of the mixed studies reveals deeper causes that are less studied, of greater theoretical complexity, and that reflect greater challenges to design and implement health interventions, such as socioeconomic and political crises, poverty, and the neoliberal orientation in the policy of malaria control; The latter reflected in the change in the role of the State, the fragmentation of control actions, the predominance of insurance over social assistance, the privatization of the provision of health services, an individualistic and economistic predominance of health, low connection with the popular heritage and the social and community initiatives, among others. These characteristics show the importance of expanding mixed studies as a source of evidence to improve malaria research and control models in Colombia and identify the underlying causes of the epidemiological profile. The intervention of the underlying causes is not being included in current control policies, plans, and projects.Additional file 1.


The Science of Nature grants the Arnold Berliner Award to the lead author of an article which represents excellent, original, and—especially—interdisciplinary research. As such, the winning articles clearly reflect the vision of Arnold Berliner (Autrum As every year, r Autrum . Springer Autrum , a 2-yeaI am very proud that, this year, the Editorial Board of our journal has decided to award Cynthia Tedore Fig.  for the On behalf of the Editorial Board, I congratulate Cynthia Tedore, the two co-first authors Mateusz Glenszyk and David Outomuro, and the rest of the team on the award.


Chung Un Lee,  was a pioneer of tropical medicine research in China, serving as the president of Guiyang Medical College, the dean of Peking Union Medical College, the vice president of the Chinese Medical Association, a member of the British Medical Association, and the Far Eastern Tropical Medical Association  Lu, 199. Chung UChung Un Lee, a native of Changzhou, Jiangsu Province, was born in 1894. His father was influenced by the Reform thoughts when he was the magistrate of Shandong and established the first local new-style primary school, where Chung Un Lee studied . In 1908In 1913, Chung Un Lee entered the medical school of the University of Glasgow in the UK . The schIn 1923, Chung Un Lee published the article “A Filarial Survey in British Guiana, 1921” in the Journal of Helminthology, which included a survey visit to the local domicile, and covered ~50% of the Chinese in Georgetown. According to the census returns for 1921, there were 2,722 Chinese in British Guiana, mostly native-born, and the local Chinese were mostly spared from filariasis or elephantiasis. He found through blood tests and a survey of lifestyle habits that the lower incidence of filariasis among the Chinese was attributable to their attention to personal hygiene, with most falling asleep soon after dark and almost all sleeping under mosquito nets, a traditional habit that allowed them to avoid infection. This finding suggested that filariasis is dangerous regardless of race and that there is no racial immunity .In June 1923, Chung Un Lee returned to his homeland and took up an assistant professorship in the Department of Internal Medicine at Peking Union Medical College, from which he started a new medical career. Chung Un Lee pioneered the research of tropical diseases in China and established tropical disease observatories in the epidemic areas in the south. Many scientific studies from the 1920s and 1930s were focused on parasitic diseases, especially filariasis, malaria, schistosomiasis, and kala-azar.Microthrix parvicella infection was high, whereby lymphatic disease is also evident. His study of paraffin sections of a series of mosquitoes collected from Tsing Kiang Pu revealed that a significant proportion of C. pipiens were negative for different stages of pathogen development, and although no larva was found in the rostrum, larvae at different stages of development were found in the pectoral muscles, which provides strong evidence that both C. pipiens and Culex fatigans can serve as effective intermediate hosts for Filaria bancrofti in China. This led to the conclusion that filariasis is carried by human-associated mosquitoes such as Culex spp., and is mainly caused by indoor infection (At the beginning of the 20th century, there was high incidence of filariasis in China, which is typical in southern regions. In 1926, Chung Un Lee started his research on filariasis in China, and in response to the occurrence of filariasis and elephantiasis in the population north of the Yangtze River, Chung Un Lee examined 363 people for microfilament disease, finding that the rate of microfilament disease in people with signs of filarial infection was much higher than in those who were free from filarial disease . He alsonfection . ThroughAnopheles, the vector of malaria, and proposing countermeasures for the epidemic and clinical treatment of malaria. In the Peking Union Medical College Hospital, Chung Un Lee’s team conducted >3,700 experiments in the decade from 1925 to 1935. In 1936, he proposed that two infections, malaria, and relapsing fever, occur after blood transfusion. Based on a study of the occurrence of 54 cases, he found that malaria in most people is the result of direct blood transmission from transfusion donors, thus proposing that blood transfusion is a route for transmitting the pathogen. Accidental transmission of benign tertian malaria or relapsing fever to a person whose health is already compromised by some existing disease is a risk factor for complications, and in malaria-endemic areas, the effects can even be catastrophic, so that the most stringent measures must be used to minimize the incidence of accidental transmission through blood transfusion (Chung Un Lee conducted extensive research on malaria, studying the identification, habits, and control of nsfusion .Plasmodium falciparum or crescents from the blood. Quinine’s strong bitter taste and induction of intoxication symptoms, especially in susceptible individuals, also greatly reduce its value as an antimalarial agent. In addition, the cultivation of quinine-derived cinchona trees is limited to certain regions of the world, and quinine production was monopolized by private companies, which further contributed to unreasonably high drug prices. It is out of these considerations that Chung Un Lee introduced plasmochin, a new synthetic product invented by the Elberfield Pharmaceutical Laboratory in 1925. It belongs to the same class of drugs as quinine, and treatment with a combination of quinine and plasmochin is more effective. In some cases of malaria, in which a decision needs to be made quickly, Chung Un Lee advocated the use of spleen puncture as a diagnostic tool. Even though some so-called irritant measures were applied in some cases, repeated blood examination failed to detect parasites, while after spleen puncture, there was a febrile reaction and parasites were found in peripheral blood (In the 1920s, Chung Un Lee confirmed the value of plasmochin as an antimalarial drug through the treatment history of 8 cases of malaria, 6 cases of benign malaria, and 2 cases of aestivo-autumnal malaria in Beijing. Although the value of quinine and its associated alkaloids is undeniable, in many respects they are not ideal specific drugs. Quinine is more specific for aestivo-autumnal malaria and has little effect on clearing al blood .in vitro could be extended up to two and a half months if the medium was changed frequently. This could be achieved using the small tissue culture method, which prevented bacterial contamination and desiccation of the media. Later, he studied the lethal action of four antimony compounds on schistosomes in vitro: chemically pure, sodium antimony tartrate, Fouadin, and antimony III-pyrocatechin-disulphonate of sodium (Schistosomiasis is also a tropical disease with a high incidence in China, mostly in the Yangtze River basin, which is the hardest hit. Chung Un Lee devised a simple technical method that keeps adult schistosomes alive without difficulty in artificial media for several weeks, or even months if necessary. The viability of the worms varies in different media, which may depend more on the inherent vitality of the parasite than on the nature of the medium . Chung Uf sodium .In the 1930s, kala-azar was widely prevalent in China in the region north of the Yangtze River, with hundreds of thousands of patients. Chung Un Lee proposed that sandflies might be the vector of kala-azar. He used an artificial feeding device  to squeeChung Un Lee’s research confirmed the infection of dogs with kala-azar and that patients could be infected by dogs. He conducted studies on the association of kala-azar in humans with sandflies and dogs, and identified the key factor of dogs in the epidemic of kala-azar. He and Dr Huei-Lan Chung confirmed that humans can be infected by dogs with kala-azar, and pointed out that the infection rate of dogs is much higher than that of humans after the bites of sandflies, thus concluding that dogs are the most important hosts of kala-azar . Based oIn a study of clinical manifestations and therapeutic drugs for kala-azar, Chung Un Lee conducted a clinical study of 394 cases of pathogenically confirmed kala-azar admitted to Peking Union Medical College Hospital, 51 of which were in the early stages. The results of the study showed that children are relatively susceptible to kala-azar, and the superficial lymph glands of children are significantly enlarged in the early stages of the disease. Severe complications may occur in the early stages of kala-azar, with two cases of acute agranulocytosis. Early diagnosis can be difficult since splenomegaly, leucopenia, and globulin precipitation are absent or negative. Early kala-azar must be differentiated from tuberculosis, malaria, typhoid fever, or undulant fever, and the possibility of pathogenesis can be considered when accompanied by a definite, progressive leucopenia-induced fever . In his In 1934, Chung Un Lee compared the efficacy of urea-stibamine and neostibosan in the treatment of kala-azar and suggested that urea-stibamine is more effective, but its toxicity is also more severe . In the In November 1937, Chung Un Lee left Beijing to attend the National Medical College of Guiyang, which was planned by the Ministry of Education to receive medical students affected by the war. On March 1 of the following year, the National Guiyang Medical College was established, and Chung Un Lee was officially appointed its president. Chung Un Lee’s nine years at Guiyang Medical College were also nine significant years for medical education in China .In 1947, Chung Un Lee was appointed president of the Peking Union Medical College, the first Chinese president in its history . He firmChung Un Lee spent his life fighting for the eradication of tropical diseases in China, blazing the trail for research on kala-azar, filariasis, malaria, and schistosomiasis. He made various breakthrough achievements in tropical medicine and laid the foundation for related research in China. Chung Un Lee devoted himself to medical education, serving as the first president of the National Guiyang Medical College, where he proposed the motto of “Sincerity in oneself, loyalty to the group, and respect for the past and the future,” sending a large number of medical experts to China during the war. He served as the president of Peking Union Medical College, was elected as the first academician of Academia Sinica, was a member of the first national committee of the Chinese People’s Political Consultative Conference, and the chairman of the European and American Association. Chung Un Lee was a man who cared about the fate of the motherland and the suffering of the people, always adhering to the spirit of science and the principle of academic primacy, which made him a trailblazer in the research of tropical diseases in China.


Since the beginning of the pandemic in 2019, SARS-CoV-2 virus has undergone numerous mutations and several variants of concern (VOCs) have emerged. Here, we investigated the transmission of SARS-CoV-2 based on the virus sequencing data from the world, USA, and the local area . We examined the changes in prevalence of the WHO designated VOCs Alpha, Delta, and Omicron variants in the world, USA, and Temple, TX for past three years. In addition, the time interval until the emergence of these VOCs in 20 major cities of USA and the local area were compared.The metadata for weekly sequenced cases of VOCs Alpha, Delta, and Omicron for the world and USA were downloaded from GISAID. The local data consisted of 8154 SARS-CoV-2 samples collected from patients of Central Texas VA hospital located in Temple, TX from March 2020 to April 2023. Our local catchment includes rural and urban area. All SARS-CoV-2 positive samples were sequenced regardless of their Cycle Threshold (CT) values. The penetration of VOCs in the USA was determined by the days from the first detection of each variant anywhere in the world until the first date that each variant appeared in each city.The prevalence changes of VOCs were similar across all three of our comparison areas . While Alpha and Delta showed gradual increase, Omicron showed a sharp increase. The fold increase of cases between Alpha to Delta, Delta to Omicron, and Alpha to Omicron were much bigger for Temple, TX than the US or across the world . The penetration of VOCs differed by region and by variants . Overall, the penetration of Alpha and Delta was much slower than Omicron. The penetration of Alpha to major cities took 41 to 419 days, and Delta penetration took 0 to 441 days. However, Omicron was penetrated to all major cities in only 12 to 42 days .Penetration of the VOCs in the USAFigure 1The changes in prevalence of the VOC variants Alpha, Delta, and Omicron in the world, USA and local catchment area and its impact. A. The number of VOCs in the world, USA and Temple, TX region. The number is compounded weekly from the week of March 15, 2020, to April 2, 2023. For the World and USA, data analysis is based on the samples sequenced and uploaded to GISAID database. Arrows indicate first detection date of each variant. B. The total number of sequenced cases for each VOCs in each region. C. The fold increase of the number of variants in the transition between Alpha to Delta, Delta to Omicron, and Alpha to Omicron in three regions.By analyzing regional penetration, our study demonstrates the diverse transmission characteristics of Alpha, Delta, and Omicron variants. While the penetration of new VOCs such as Alpha and Delta was slower during the early years of the pandemic, Omicron spread was much more rapid. Understanding these transmission patterns of SARS-CoV-2 can help public health entities and the federal government better plan initiatives that help protect their citizens.Figure 2Penetration of the VOC variants to major cities in USA. Days were calculated from the first detection date of each variant in the world till its appearance in the city. The red gradients indicate early emergence while blue gradients indicate late arrival. Background map shows 2018 population of the areas.All Authors: No reported disclosures


The intention of the present Special Issue is to focus on the latest research in the musculoskeletal system, with an emphasis on the molecular mechanisms underlying its pathophysiology, as well as innovative diagnostic tools and therapeutic perspectives. The musculoskeletal system is the biggest human organ system, comprising bones, providing support, articular cartilage, allowing joints to slide, ligaments and tendons, connecting all the bones together and muscles, with associated nerves and blood vessels, permitting them to contract and allowing the movement of the human body, which, in turn, underlies the basis of life. The mechanobiology of the musculoskeletal system is based on the strong interconnection between the mechanical forces and the biological cues of molecules, cells, and tissues which are connected in the kinetic chain in which one site alterations affect all the tissues and organs. It means that, when the tendon or ligament is damaged, the released metabolites, cytokines, extracellular vesicles, and other mediators affect the cartilage and bone locally, as well as the surrounding muscles, and even distant tissues due to the instauration of a systemic inflammatory response triggering a chain reaction throughout the body. The management of the pathological processes established at the molecular level requires a multidisciplinary approach based on a holistic view of the entire system in terms of prevention, early diagnosis, and innovative therapeutic approaches. The holistic view of the musculoskeletal system as an interdependent organ system has been highlighted by the authors contributing to the present special issue. For instance, Eldjoudi and co-authors , in theiThe muscle atrophy, fibrosis, and inflammation are the main causes of muscle weakness but also of the surrounding tissue impairment . There aAging represents another leading risk factor for musculoskeletal disorders, considering also the metabolic alterations that occur with aging, that may lead to undernutrition, dysbiosis, and other digestive system-related disorders, which, in turn, can worsen age-related variations, as in a vicious circle ,19. The Furthermore, skeletal muscle is considered the main site for insulin-stimulated glucose uptake and therefore, a primary target for insulin resistance in the human body. In a study by Grunwald et al. , the locRecently, in the perspective of the management of articular cartilage degenerative disorders, a multidisciplinary approach based on the construction of “smart” biomaterials for tissue engineering, able to interact both with the damaged and surrounding tissues, raised increasing attention among the scientific community ,23,24,25Finally, we wish to highlight the contributions to the present SI, focusing on the innovations in the examination and diagnostic tools used in the musculoskeletal disorder evaluation and treatment. For instance, the study by Kamp et al.  evaluateWe express thanks to all the authors who contributed to this Special Issue, who added, through their researches, a small brick to this extensive wall of knowledge regarding the musculoskeletal disorder physiopathology, diagnosis, and therapeutic perspectives, providing new molecular-level insights and inviting the scientific community to further deepen research into the treated aspects.


To map the inclusion of affirmative policies in Postgraduate Nursing courses in Brazil.This is a descriptive, document-based study, carried out with information collected on the Sucupira Platform, via the Coordination for the Improvement of Higher Education Personnel, linked to the Ministry of Education. After data collection, carried out between October 2021 and March 2022, each public notice was read in full, in order to extract the following elements: name of the program; program code; name of the Higher Education Institution; acronym; Federative unit; and number of vacancies for master’s courses.79 institutions in the country were identified, with a final sample of 67 evaluated programs, which were classified into nine types, based on the use of affirmative policy principles in academic and professional master’s degrees.Postgraduate Nursing courses present an imbalance regarding the implementation of affirmative policies in their offers of regular vacancies, as well as in issues of equity in regional access and diversity in the social groups contemplated. During this period, the demand for plurality in public spaces and the discrimination of this part of the population gave rise to discussions on public policies for equal opportunities and on reorientations in the educational system,4.Through historical perception, it was observed that the conservative way of maintaining the privileged classes in the field of educational, social and media resources, recurrent for generations, provided the practice of discriminatory processes in multiple scenarios. Thus, it was understood that discriminatory actions were not composed of isolated factors and events, but composed structured and complex networks of specific conditions that preceded them, such as intersectionality.Based on the requirements of the National Education Plan, which lasts for ten years, and in a constitutional manner, considering art. 214 of the Federal Constitution and Law #13,005/2014, there was the promotion of goals for overcoming educational inequalities and the elaboration of policies for all educational levels, from basic to higher education, which led to a significant expansion of offers vacancies in Federal Institutions of Higher and Technological Education, in addition to enabling forms of integration and democratization of access to public education in the country for subjects conditioned by the harmful conformations already described,6.This was solidified with the enactment of Law n.º 12,711/2012, which promoted the reservation of vacancies in higher education courses at federal institutions, linked to the Ministry of Education (MEC), complemented by Law n.º 13,409/2016, which facilitated the retention of vacancies for low-income students, black, brown, indigenous and people with disabilities, who are part of the Federation Unit where the educational institution is located, according to the records of the Brazilian Institute of Geography and Statistics (IBGE),8.Although the Brazilian population is made up of 47.7% whites and 50.7% blacks, a 2015 study identified that the profile of postgraduate students was composed of 70.86% whites and 27.08% black. With the observation of this inequality, in 2016, Normative Ordinance MEC #13, supported by the Statute of Racial Equality and Law #12.711, designated the expansion of the ethnic and cultural diversities of postgraduate students, from the adoption of AP, giving autonomy to each institution to adhere or not to inclusion of proposals,10, but postgraduate studies present a lack of information in this regard. Therefore, it is pertinent that mechanisms for distributing vacancies aimed at social integration be evidenced, in order to collaborate with the discussion on equity in postgraduate studies, especially in what is in line with the objects of the four-year evaluation report of the Coordination for the Improvement of Higher Education Personnel (CAPES).In reference to the area of Nursing, there are several and diverse studies on the inclusion and follow-up of quota students in undergraduate coursesThus, the present study aims to map the use of affirmative action policies in postgraduate Nursing courses in Brazil.This is a descriptive study, based on documents, with a quantitative approach, carried out with the data obtained from CAPES, linked to MEC..The data set was extracted from the Sucupira platform, a tool designed to collect information on stricto sensu postgraduate programs  nationwide. Annually, the program coordinators are responsible for updating the information on the platform, in order to feed the databases on topics related to postgraduate studies, which serve as a reference for the four-year evaluation and academic transparency. The Sucupira platform is an important tool of the National Postgraduate System (SNPG), which handles the monitoring and evaluation of said programsData selection was carried out between November 2021 and March 2022 on the Sucupira platform, based on information provided by graduate programs in Nursing about academic and professional master’s courses (PM) on the platform, in the year 2021. The collection was guided by a research instrument validated by the authors, composed of the items: adhesion of the Higher Education Institution (HEI) to the affirmative action policy; number of vacancies destined to affirmative actions; and types of affirmative action implemented in graduate programs.Thus, the data was downloaded directly from the Sucupira platform, from which a table was generated, with the following variables: name of the program; program code; HEI name; HEI acronym; Federative unit; and quantitative number of vacancies in the institution’s master’s courses.From the collected data, the mapping, quantification and identification of registered programs in the country were carried out. Then, the information was exported to the Microsoft Excel software, being evaluated by descriptive statistics and presented in graphs and tables, considering, in the presentation of the classifications, the groups benefited by the AP, which are generally qualified, based on on characteristics such as race or ethnicity, gender, social class and disability.The rationale for the discussion on the collected texts included articles indexed in the SciELO, LILACS and BDENF databases, using the descriptors: “public policy”; “Ethnic groups”; “graduate nursing education”; “teaching”; and “social inclusion”.Because it is a descriptive study, supported by secondary data in the public domain, there was no need to file ethical questions by the Research Ethics Committee with Human Beings, however the analysis was carried out with scientific rigor, in view of the production of truthful and meaningful results.A total of 79 institutions were found that offer academic and professional master’s (PM) courses at the postgraduate level in Nursing in Brazil, considering the research outlines. However, one program was excluded for having only a doctoral level record and another 11 for not adhering to AP. Thirty-one programs were identified that did not offer doctoral vacancies, only academic and professional master’s degrees, but offered AP vacancies in their selections, while 36 programs had the same number of vacancies for PM courses and doctoral degrees, but their public notices did not define the number of vacancies offered for AP by academic degree.In this scenario, in order to avoid non-scientific biases, the present work only considered evaluations at the PM level, so the final sample had 67 evaluated programs, allocated in the North, Northeast, Midwest, Southeast and South regions of Brazil.In the study, it was observed that the Southeast Region had the highest number of programs (24), considering the important factors of demographic density and the number of public universities that offer graduate programs in Nursing, followed by the Northeast, with 18 programs, South, with 15, Midwest, with six, and North, with four programs .In view of the specific vacancies for AP made available by graduate programs in Nursing in Brazil, the Southeast Region has the highest number (55 vacancies), followed by the Northeast (49), South (41), Central-West (14) and North (seven vacancies) which shows the lowest number of vacancies, as illustrated in In the same evaluation, graduate programs were separated into nine classes, considering the types of AP available in their PM courses: quilombolas; trans people; deaf; gypsies; migrants and refugees; traditional populations; indigenous; black or brown; and people with disabilities .The highest distribution index observed was AP for blacks (blacks and browns), with a percentage of 28.2%, representing a quantitative of 29 programs, while the second highest percentage found was for people with disabilities (25.2%), as 26 programs adhere to this type of AP, followed by 24.3% of AF for indigenous people, arranged in 25 programs, and 10.7% of AP for quilombolas, present in 11 programs .The lowest rates of offers of AP vacancies were observed for trans people, with 4.9%, distributed in five programs, for representatives of traditional populations (2.9% — three programs), for migrants and refugees (1.9% — two programs) and for deaf and gypsies (1% — one program each) .Considering the regional distribution of the analyzed programs, it was verified that, among the seven states that make up the North Region, only Amazonas and Pará provide seven vacancies for AP in postgraduate courses in Nursing, exclusively for blacks (blacks and browns), for indigenous people and for people with disabilities (PwD) .In the Northeast Region, made up of nine states, eight programs were found  that offer AP vacancies for blacks (blacks and browns), indigenous people and PwD; four  that end offers of AP vacancies for quilombolas and/or for traditional peoples and communities; two  that offer vacancies in AP for transgender people; and one  who joined the AP vacancies for gypsy women .Of the four states in the Midwest Region, three ensure offers of AP vacancies in five postgraduate programs in Nursing , which are aimed at blacks (blacks and browns) and indigenous people, followed by reservations for people with disabilities (made in two states — 33.3% of programs) and for quilombolas (made in one state — 16.7% of programs). Only one of the states in the region, which has a graduate program in the area, does not have vacancies for affirmative action and one of the programs does not describe the number of PA opportunities offered .In the Southeast, comprising four states, 24 graduate programs in Nursing were found. Of the PA vacancies available in the region, the offers cover blacks, indigenous peoples and PwD, granted in the states of São Paulo, Minas Gerais and Rio de Janeiro (in 75% of the programs), and there are vacancies for traditional peoples and communities, for trans people and for refugees in one state (Minas Gerais — 25% of programs). It is important to emphasize that, in the state of São Paulo, which has thirteen postgraduate programs in Nursing, only one provided the full number of vacancies for the PA policy, as shown in In the South Region, the three states offer AP vacancies in their programs, considering black, indigenous and quilombola groups . For trans people, vacancies are offered in two states (Santa Catarina and Rio Grande do Sul — 29.9%) and, for deaf people and PwD, there is access in only one state (Rio Grande do Sul — 9%).,12.The participation of students benefiting from quota policies in academic community spaces has created and revealed stigmas in the social and university environments, since there are narratives about stereotypes of inferiority of those involved, however, in fact, such AP are instruments of historical reparation, resulting from initiatives to suspend methods of social exclusion. Such a negative perception also contributes to the individual identification of the subject, producing barriers to the execution of AP in institutions and the monitoring of admissions to universities.Within the scope of postgraduate studies, APs arise from recent and unique discussions, since each program defines its guidelines and criteria for engagement, including because quota policies are flexible, which does not occur at the undergraduate level. For the most part, the programs promote the admission of candidates, based on regular stages, described in a unified public notice and ordered steps, thus the modalities of admission of wide competition and/or use of the AP are declared in each course. However, these actors are important to reduce access inequalities at the higher level,15.The insertion policies, which have, as an initial conception, the identification of the subjects to be admitted, define the characteristics of those who have integration needs, with the objective of aligning the premises of organization of the inclusion and exclusion practices. Such a determination places men, rich, white and heterosexual individuals as habitual and normal and defines black, poor, PwD, women and gay individuals as unequal and distinct, accustomed to the need for integration. Precisely, valuing movements contrary to these characteristics is important in postgraduate studies, as it can bring many benefits to those involved and to society in general,13,16.With this understanding, it is noted that meritocracy, as opposed to equity, points to a generational debate, based on social beliefs, which emphasize the logic of a Eurocentric educational system, demonstrating organizational differences, which strengthen characteristics that have already been deconstructed at different levels of education,16. Indeed, nursing has a significant representation of self-declared brown and black professionals, which, together, constitute 53.0% of the total number of workers in the area, in addition to indigenous professionals. This data is relevant, as it demonstrates the contingent of students who can potentially seek postgraduate studies through offers of AP vacancies.Currently, there is a promising scenario in Nursing, with regard to racial diversity, which is occasionally beneficial to society. Thus, the fact that a large percentage of nursing professionals identify themselves as brown or black may represent important trends in the diversification and enrichment of postgraduate programs in the area. Thus, postgraduate studies, in addition to being a step forward in the academic and professional training of these individuals, can significantly benefit from the variety of experiences and perspectives they bring,13.These points and the issues of integration and diversity in the academic environment translate into fundamental aspects in the production of relevant and contextualized knowledge, whether it be those who identify as non-binary or other gender identities, which can also bring broader perspectives and approaches to patient care.When analyzing the theme of gender identity in Nursing, it can be seen that this area has traditionally been and mostly female. This predominance can be attributed to several sociocultural factors, including the perception that care and empathy are characteristics often associated with being feminine. However, it is crucial to emphasize the importance of gender diversity in the profession, whether male, since multiplicity, in all its manifestations, enriches the profession, making it more representative of the entire population and allowing for a more open and inclusive exchange of ideas,13,16.Furthermore, it is also essential to recognize and value the contribution of indigenous professionals of different age groups, who can help shape a more balanced workforce. Therefore, as we try to demonstrate here, encouraging gender, ethnicity and age diversity in nursing graduate programs is decisive,18.Considering these facts, it is noted that there is already a plurality in the national distribution of vacancies in the Nursing area, considering the heterogeneity of peoples, communities and groups in situations of social vulnerability, of which blacks, traditional communities, indigenous and PwD are the ones that stand out the most, evidenced by the greater visibility of these segments in postgraduate admission processes, which is in line with notes on representativeness, as signaled in other studies.In Nursing, the training of graduate professionals has shown great relevance in promoting fundamental debates for the construction of Science, in addition to allowing the qualification of professionals and composing a new perception of the autonomy of the nursing worker. In this way, the literature also highlights the social vulnerability in the implementation of postgraduate programs in Brazil, considering that the North and Midwest regions have the lowest concentration of courses, in contrast to the Southeast and Northeast, which have the highest concentration, with graduate studies concentrating the main producers of scientific research,20,21, has minimal rates of AP use when students enter their postgraduate courses, despite the fact that a large portion of the northern population is made up of indigenous populations and traditional communities, which benefit from the Quota Law at universities and in local degree courses.Although there are gaps in the literature on aspects of insertion of AP in postgraduate programs in Nursing in Brazil, from the scenario described in this work, it was possible to identify that the North Region, despite being in a moment of ascension in the field of search.The data also clarified that the Midwest region, which has only four states in its composition, has the second largest territorial extension in Brazil and is the political division with the smallest population, has a small scope of use of AP in its postgraduate courses. -graduation. In turn, the Southeast Region, with four states, has the highest population concentration index in the country — with emphasis on the state of São Paulo, which has the most preponderant economic production in South America and is home to the only mega-metropolis in Brazil: the city of São Paulo —, is a predominantly urban region, with great ethnic, cultural and economic diversity and presents relevant methods of insertion in undergraduate courses, such as the Social Inclusion Program of the University of São Paulo (Inclusp), which reveals the use of measures to expand the access of people in vulnerable situations to the university,22,23,24.The South Region, characterized by having the smallest territorial extension at the national level, for having an influential economy and for being the second most populous division in the country, has three states in its composition, which offer AP vacancies in their programs. In the region, measures for the integration of vulnerable students have been discussed, since graduation, through the guarantee of permanence of these students in courses and the strong presence of interculturality in university spaces,22. This fact was reflected in the last specific public notices, increasing the distance between the regions, in terms of qualification of postgraduate programs. In this sense, it is necessary to consider the importance of such regions becoming protagonists in research on their peculiarities, an important point to raise their grades in national evaluation mechanisms.Historically, the South and Southeast regions have shown the best performances in CAPES assessments, with the North and Northeast regions being marginalized, including in terms of the implementation of public policies, especially at the graduate level,22,25. The expansion of the Quota Law in postgraduate courses in Nursing constitutes important instruments for the insertion and qualification of indigenous professionals, quilombolas, PwD and other actors studied here, improving the debate and increasing the level of research development in each region of the country, according to your specifics.It should be noted that the inclusion processes are relevant to the inclusion of ethnic and multicultural groups in postgraduate spaces, as these initiatives enrich dialogue, as well as reduce inequalities in educationThis study was limited to addressing the master’s programs in Brazil, based on the records of the Sucupira platform and the information provided by the graduate programs themselves, not covering the doctoral level, however. Although these postgraduate levels are stricto sensu, the master’s and doctoral programs differ in terms of objectives, requirements, expected results and duration, so it is opportune to evaluate the academic progress of the AP, depending on the integration and permanence of students in a state of vulnerability, in order to identify the connection between the levels and the barriers demonstrated, related to aspects of access, progression and effective technical and scientific training of students coming from the public in focus in this article, as well as with regard to the organization of programs in monitoring these students.To mitigate these limitations in future studies, it would be useful to expand the research scope, seeking to include doctoral programs and additional sources of information, in addition to the Sucupira platform, to ensure more comprehensive and more accurate views of postgraduate studies in Brazil. Certainly, there is no attempt to generalize graduate programs since the characteristics and requirements of master’s programs may not represent the universe of graduate programs with the necessary accuracy.As for the area of Nursing, this study makes it possible to visualize the result of some systems of entry of groups in a situation of social vulnerability in postgraduate studies — in master’s courses, particularly —, presenting subsidies for making new and better decisions, referring to the methods selection and vacancies. This fact adds value to the discussions on actions of social scope, an item observed by CAPES in the quadrennial evaluation procedures of the PM, being opportune in the constitution of reports on the current condition of the postgraduate programs analyzed here and in their future planning.Additionally, this text points out the importance of discussing the meanings of integration and its processes, aiming, in addition to access, the qualification of programs and the alignment of the mentioned policies. Likewise, problematic situations already identified in graduation are highlighted, such as the question of the permanence of students enrolled in AP, which must be better managed, aiming at obtaining satisfactory results, which is far ahead of the theme of offer of inclusive vacancies that can be the subject of studies, regarding the permanence and continuity of the qualifications of these individuals.When addressing the issue of affirmative action vacancies among the 67 institutions studied here, nine significant classifications were identified, demonstrating that there is a movement towards the implementation of affirmative action policies in academic and professional master’s courses in the country, proving a dynamic with the potential to reduce  the historical limits and barriers experienced by certain minority groups. When investigating the findings on postgraduate courses in Nursing, observing them as specialized spaces to produce knowledge, aimed at health promotion and prevention, and on the constitution of essential and unique epistemological foundations for each region, it was verified the practical difficulties in the implementation of educational policies in Brazil.In this sense, the North and Midwest regions stood out, demonstrating the absence of initiatives to aggregate ethnicities and cultures to the profile of local nursing students, based on exchanges of knowledge and experiences with blacks, browns and indigenous peoples On the other hand, the execution of these actions in the South and Southeast is significant, confirming the logic, in which regions considered peripheral repeat the colonialist movement, regarding the production of knowledge and postgraduate training, therefore the maintenance of the Eurocentric profile is also evident among graduate students, as well as the standardization, already underway, which regulates admission by quotas to undergraduate courses.This mapping also makes it possible, in principle, to identify and discuss possible challenges and obstacles in graduate programs in Nursing, throughout the national territory, highlighting the disparities between regions, as well as the distribution and plurality of types of eligible affirmative actions, which makes it possible to review selection processes and opportunities for advancement, in terms of equitable training and the production of information representative of regional groups, especially those with the protagonism of communities and individuals from each part of Brazil.Moreover, the demand to produce data about and with historically excluded groups and, beyond that, about multiple public policies, which cover different human spaces, contributes to the constitution of an intercultural scientific knowledge, capable of strengthening society, which can be made possible by the insertion and recognition of the role of affirmative action policies in the practice of a more equitable education.


Policy analysis provides multiple methods and tools for generating and transforming policy-relevant information and supporting policy evolution to address emerging social problems. In this study, a bibliometric analysis of a large number of studies on historical policy analysis was performed to provide a comprehensive understanding of the distribution and evolution of policy problems in different fields among countries. The analysis indicates that policy analysis has been a great concern for scholars in recent two decades, and is involved in multiple disciplines, among which the dominant ones are medicine, environment, energy and economy. The major concerns of policy analysts and scholars are human health needs, environmental pressures, energy consumption caused by economic growth and urbanization, and the resulting demand for sustainable development. The multidisciplinary dialog implies the complicated real-world social problems that calls for more endeavors to develop a harmonious society. A global profiling for policy analysis demonstrates that the central policy problems and the corresponding options align with national development, for example, developing countries represented by China are faced with greater environmental pressures after experiencing extensive economic growth, while developed countries such as the USA and the UK pay more attention to the social issues of health and economic transformation. Exploring the differences in policy priorities among countries can provide a new inspiration for further dialog and cooperation on the development of the international community in the future. Social problems are evolving with the rapid development of economy, and the problems mankind is facing and options they choose reflect the developmental demand. Policy is a political action with specific subjects, targets, and strategies in a certain period of time, which primarily aims to create a healthy environment for the development of society Porter, . As for Accordingly, regarding the typology of policy analysis, three categories can be established based on ontology and epistemology Fig.  Bacchi,: (1) PosThe profoundly complex and diversified realistic demands such as equity and sustainability  What core concerns are reflected in the policy analysis and how does these core concerns reflect real-world social problems? (2) How do these core concerns change over time? (3) What are the differences in core concerns among countries and what drives those differences? From an evolutionary perspective, this paper aims to uncover the past and present policy problems of concern and the relevant possible options, thus providing a clue for future policy analysis. The analysis of the evolution and differences in policy problems among countries may provide a view of the development context of different countries and put forward new inspiration and hope for further dialog and cooperation on the development of the international community in the future. Furthermore, another possible key sustainability implication with respect to the core concerns of policy analysis is to provide a reference for exploring the gaps between academic research and policy agenda.www.vosviewer.com)  Core Collection database was used for data retrieval ”. For further discipline analysis, the most cited articles were selected with the quick filtering toolbar of WOS. Consequently, 1287 most cited papers of policy analysis were included in dataset 1. Then co-citation analysis of journals was performed to provide clues for discipline research , followed by medicine-related journals , the journals of energy science , the journals of economy , and then several multidisciplinary journals .For network construction, 1287 most cited papers were screened. The collaboration network of countries was visualized and illustrated, showing that 112 countries have published the most cited policy analysis articles. As for the co-authorship of countries and organizations, 2286 universities were identified, and 193 of them from 59 countries met the criteria of network analysis, among which the universities from the USA , the UK  and China (University of Chinese Academy of Sciences) had the largest number of links and the strongest willingness to cooperate with other organizations ; the red cluster centering policy, such as policy framework, policy systems, and policy implementation; and the yellow cluster mainly concerned with energy  Fig. . SimultaPolicy analysis-related articles mainly involved the fields of medicine, environment, energy, economy and multidiscipline. The publication information in different fields was investigated. First, the volume growth trend over time was traced. Generally, a growing number of articles were published annually. The most obvious growth was found in policy analysis in environment, followed by medicine and energy, and the growth in economy and multidiscipline was relatively stable Fig. . SpecifiA total of 8381 organizations from 177 countries contributed to medical policy analysis. Further investigation showed that universities from the UK , the USA , Canada  and Australia  contributed the most to medical policy analysis with the greatest willingness to collaborate both domestically and internationally. By contrast, Chinese universities, such as Peking University, University of Chinese Academy of Sciences and Zhejiang University, were more prone to domestic collaboration Fig. .Fig. 6PrCo-occurrence analysis of keywords showed that of the 16,719 keywords identified from 7963 retrieved items, 1778 keywords met the threshold. In addition to the three core topics “medicine”, “policy” and “health” , the mortality, prevalence, risk factors as well as prevention of diseases have been the key focus of medical policies. Additionally, the issues of children and adolescents, such as physical activity, overweight and childhood obesity, have also attracted medical scientists and policy analysts. Figure Co-authorship analysis showed that 9060 organizations from 160 countries contributed to environmental policy analysis, among which universities from China played a key role, especially University of Chinese Academy of Sciences, Tsinghua University, Beijing Normal University, North China Electric Power University and Beijing Institute of Technology Fig. . Of the The collaboration network showed that 3668 organizations from 117 countries performed policy analysis in energy. The top five organizations were Tsinghua University, University of Chinese Academy of Sciences, Xiamen University, North China Electric Power University and Beijing Institute of Technology, all of which showed strong willingness to collaborate both domestically and internationally. The network showed that there was complex knowledge interaction and flow in the citation of energy policy analysis Fig. . Of the 1144 organizations from 67 countries were found to contribute almost the same to policy analysis in economy. Hong Kong Polytechnic University, Delft University of Technology, University of Leeds, Rensselaer Polytechnic Institute and University of Sydney had the largest number of publications. Hong Kong Polytechnic University, Delft University of Technology, University of British Columbia, University of Sydney and Rensselaer Polytechnic Institute had the highest collaboration Fig. . Of the In the co-authorship network, universities such as Stanford University, University of Chinese Academy of Sciences, University of Maryland, University of California, Berkeley and University of Cambridge had the most publications and a high collaboration. University of California Irvine had fewer publications but relatively higher link, showing that this university was strongly willing to cooperate with other organizations Fig. . Of the Policy analysis aims to understand what is the governments’ focal point, investigate why and how governments issue policies, evaluate the effects of certain policies  resulting in climate change and environmental degradation remains to be the most threatening and urgent issue, and has attracted attention of governments and the society  hypothesis demonstrates the relationship between environmental quality and economic output, which has been proved by empirical studies  Policy analysis has been a great concern of scholars for many years and has attracted increasing attention year by year, which reflects the value of and actual needs for policy analysis. (2) The world is facing common problems, which requires attention and efforts of the whole world, and a more harmonious social development such as the management of epidemics and complex disease, environmental-friendly development, green energy production and transformation from resource and energy usage-driven economic expansion to sustainable development is on the way. (3) Global profiling for policy analysis demonstrates that the central policy problems align with national development, which inspires further dialog and cooperation on the development of the international community in the future.This study has limitations. First, keywords cannot fully reflect the essential intent of an article although they are the key points of a study. Therefore, using keywords as an element for bibliometric analysis is far from enough. Second, this paper deals with academic research of policy analysis, but whether it is fully consistent with the policy agenda is unexplored. Moreover, we have shown the correlations between different phenomena, but the underlying mechanism remains indefinable.Supplementary information


Considering the development of this study, we selected cases where art therapy played a central role in the educational/therapeutic process. Studied 130-150 cases per year on average, for 25 years (1996-2021), including children and adolescents aged between 2 and 18 years of both sexes, different social backgrounds in terms of housing, culture, and education: education/ clinical art therapy  and non-clinical education/art-therapy.The activities also have components of artistic creation, research, and teaching with students, within the disciplines “Art therapy in institutional contexts” and “Artistic play and experiment in group dynamics”, within the University of Art and Design section Pedagogy of Plastic and Decorative Arts from Cluj-Napoca Romania. The results are published at the international and world congresses to which we were invited together with the practitioners under supervision.The aims of occupational therapy, which include art therapy and play therapy, are to facilitate the use of creative process and symbolic communication, associated with narrative and imitation, to develop new ways of communication, self-expression and seeing things.The making of art or the production of other crafts resembles a situation testThe analysis of the products allows the beneficiaries to attain a certain level of introspection and to “work through” their problems in constructive mannerThe execution of an operation requires sensory, cognitive, and affective intervention;Psychological dimensions, which include the individual’s intrinsic need for self-improvement, for obtaining competence and self-knowledge;The socio-cultural and symbolic dimension of the act;The spiritual dimension, related to the meaning of the occupation for the individual;The temporal dimensions of the occupation (referring to the time or period of time required for recovery).We use materials and techniques that are specific to visual arts , but also traditional ones, specific to tridimensional arts, such as pottery wheels and sculptural modeling. Activities are structured according to the following dimensions:By interacting with these factors, the individual gets to know his own potential and limits, but also those of the environment in which he lives.Image:Image 2:An equidistant trialogue and circular relations between art, religion and science, without any specific supremacy, is created, which can offer from the start the possibility of lasting harmonizations, of informational transfers and professional enhancements that support developments, ennobling the human being through positive reorientations and beneficial recoveries.None Declared


There are errors in the Funding statement. The correct Funding statement is as follows: This work is supported by Fundamental Research Grant Scheme , Ministry of Higher Education of Malaysia , and Faculty Research Grant Scheme (GPF018A-2018), Universiti Malaya . The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.