As an important component of traditional medicine, Traditional Chinese Medicine (TCM) is widely spread and applied in more than 100 countries across the world. The standardization of TCM is very important for the international application of Chinese medicine. In this paper, we have explained and analyzed the standardization situations of TCM in China with the purpose of providing reference for standardization and international development of TCM. WHO Traditional Medicine Strategy: 2014–2023 released by the World Health Organization shows that TCM has spread to more than 100 countries and has grown into an international industry [TCM has been widely applied to prevention and treatment for various diseases from ancient times till now . TCM, a industry .As the country of origin and application of TCM, China has a unique TCM theoretic system and effective treatment methods. In recent years, after the constant transformation of concepts and methods, great breakthroughs and remarkable achievements have been made in terms of standardization of TCM, but some problems remain . In this Several Opinions of the State Council on Supporting and Promoting the Development of Traditional Chinese Medicine, in which “promoting the standardization of TCM” was included.Standardization of TCM, under the principle of “unification, simplification, coordination, and optimization” and by its comprehensive use, refers to developing and applying standards to the various links, processes, and objects of TCM such as medical care, scientific research, education, industry, culture, and management, to promote academic development and propagation of achievement of TCM, to standardize management of TCM, to guarantee the quality and safety of TCM, to promote the modernization and international communication of TCM so as to achieve good economic and social benefits, and to achieve guiding and supporting a series of activities for the purpose of the comprehensive development of TCM . StandarIn the National Work Conference on Traditional Chinese Medicine convened in 2011, Comrade Li Keqiang, a member of Central Politburo Standing Committee of the Communist Party of China and Vice Premier of the State Council, stressed that “the construction for the standardization of TCM should be strengthened.” Twelfth Five-Year Planning Outline for National Economic and Social Development of the People's Republic of China, National Development and Reform Commission has included “promotion of standardization and normalization of TCM” as one of the important tasks. Ministry of Science and Technology took the lead to formulate Traditional Chinese Medicine Innovation Development Planning Outline 2006–2020, in which the standardization of TCM was set as one priority area for being the standard specifications of the international traditional medicine. Standardization Administration of the People's Republic of China will support the TCM as an important field for international breakthrough and arrange almost hundreds of standard items of TCM in the service standard development plan.In theDuring the “Eleventh Five-Year Plan” period, the TCM standard system has been basically established. The system consists of four categories of standards, namely, basic standards, technical standards, management standards, and working standards , and for Classification and Codes of Diseases and ZHENG of Traditional Chinese Medicine (GB/T15657-1995) as China's first national standard for classification of TCM diseases stipulates the classification principles and coding methods of diseases and ZHENG of TCM and has the corresponding computer software, promoting the standardization of TCM clinical diagnosis; Clinic Terminology of Traditional Chinese Medical Diagnosis and Treatment-Diseases (GB/T 16751.1-1997), Clinic Terminology of Traditional Chinese Medical Diagnosis and Treatment-Syndromes (GB/T 16751.2-1997), and Clinic Terminology of Traditional Chinese Medical Diagnosis and Treatment-Therapeutic Methods (GB/T 16751.3-1997) specify the basic terminology of common diseases, syndromes, and therapeutic principles of TCM to improve the medical quality of TCM and the level of scientific management of medical institutions of TCM positive role and Basic Theory Terminology of Traditional Chinese Medicine (GB/T 20348-2006) provides the basic standard for the terminology of TCM theories such as Yin and Yang, five elements, and main and collateral channels, which is of great significance for the inheritance and innovation of TCM and meeting the needs of the teaching, scientific research, health care, management, and foreign exchange of TCM [The formulation of basic and general standards of Traditional Chinese Medicine started with the focus on formulation and revision for basic theoretical terminology, terminology of some subjects of TCM and their classification and codes, and other standards to achieve TCM terminology standardization. Five national standards of TCM have been issued in succession, namely,e of TCM . Criteria of Diagnosis and Therapeutic Effect of Diseases and Syndromes in TCM (ZY/T001.1-94) and Clinical Guidelines for Emergency Treatment of Internal Medicine of Traditional Chinese Medicine (YY228), and TCM academic societies have issued over 50 technical specifications [ Criteria of Diagnosis and Therapeutic Effect of Diseases and Syndromes in TCM is the first industry standard of TCM in China for 9 clinical departments with 406 diseases and syndromes, including internal medicine, surgery, gynecology, and pediatrics, marking that the major progress was made in the standardization of TCM industry in China.The clinical practice of TCM needs not only the guidance of TCM theory but the tools of medical treatment. From the 1980s to 2002, TCM authorities have issued nearly 70 technical standards such asications . Criteri Routine and Technical Operation Regulation of Nursing Care in TCM (ZYYXH/T 1.1-2006~ZYYXH/T 1.18-2006) for nursing care of clinical departments such as internal medicine, surgery, gynecology, and pediatrics, 19 standards for the series of Technical Specification of Health Preservation and Prevention of Chinese Medicine (ZYYXH/T 158-2010~ZYYXH/T 176-2010) with massage on the spine, the whole body, pediatrics and moxibustion, medicinal liquor, acupoint sticking, cupping, and so on to guide and standardize technical operations of TCM health care of care physicians and technicians and make technical operations more standardized and more safe, 1 standard of Classification and Determination of Constitution in TCM (ZYYXH/T 157-2009) as the important reference basis for the clinical practice, to determine the specification and quality evaluation, 10 standards for the series of Standard Specifications for Study and Compilation of Traditional Chinese Medicine Classics (ZYYXH/T 362-2012~ZYYXH/T 371-2012) for proofreading TCM classics, 1 standard of Clinical Guidelines of Chinese Medicine on Sub-Health (ZYYXH/T 2-2006) for clarifying the understanding of subhealth of TCM, common syndromes, and intervention principles of TCM on subhealth to gain the scientific, standardized diagnosis and intervention on subhealth and provide evidences for the feasible health management plan and intervention measures on subhealth [ Guidelines for TCM Diabetes Prevention and Treatment (ZYYXH/T 3.1-2007~ZYYXH/T 3.15-2007) for the course, complications, and merged diseases of diabetes to have detailed and normative prevention and treatment strategy of TCM, achieving the standardized, scientific prevention and treatment of TCM of diabetes [ Guideline for Diagnosis and Treatment of Tumor in TCM (ZYYXH/T 136-2008~ZYYXH/T 156-2008) for the standard of differentiation of syndromes and signs for classification and diagnosis and treatment of TCM of common malignant tumor  established Committee of TCM Standardization Technology with the code of ISO/TC249 (tentatively) . In ISO/ Codes of International Classification of Diseases (ICD-11), WHO has decided to include the traditional medicine, and China has actively participated in the preparation of traditional medicine. All of the works lay an important milestone for the international standardization of TCM and also are the important opportunities for China to regain the initiative in the international standardization.Upon the revision ofSince 1980s, the constant exploration on the standardization of Traditional Chinese Medicine (TCM) has made certain achievements. However, on account of its long-term, arduous, and complex nature, the current TCM standardization still falls behind with the developmental needs of TCM.Since TCM standardization is still in its developing phase and inadequate in publicizing and implementing, a number of TCM practitioners still hold weak consciousness and different cognitions towards TCM standardization, thus resulting in their infirm identity, urgency, and responsibility for carrying out TCM standardization . TherefoPublished standardization at present revealed limited coverage in criteria of TCM, emphasizing the foundation and operation without covering in all areas. The application of the latest industry standards of seven clinical trials of TCM into clinical trials for 11 kinds of gynecology diseases has gained international recognition , which m Clinic Terms of Traditional Chinese Medicine in 1997, it has not yet been revised till now. As a consequence, the lagging update of standards makes them detached with reality and thus unable to truly reflect the current academic level and management requirements of TCM, which hinders the popularization and application of TCM standards [Many of the present standardizations are mainly based on the literatures and lack of evidence-based medicine and clinical evidence, which impede their execution in clinical practice . Moreovetandards .For the present situation, methodology researches of the standard revision need to be improved to reach a redaction method suitable for its own features of TCM, which will perform a positive effect on TCM standardization. the Guidance on Strengthening the Standardization of Traditional Chinese Medicine, under whose direction support system of TCM standardization is bound to receive a much more comprehensive and orderly development.Development of TCM standards is witnessing booming growth, while the progress of related support system is comparatively slow, which is still in its infancy and in need of further refining. So far, the management, implementation, and supervision system of TCM standardization is still incomplete; surveys and feedbacks of its applicability are also imperfect; what is more, it also shows a shortage of talented professionals in such a field . In 2012Most of the present established TCM standards are domestic, with few international ones. So it is important to take full advantage of China's status as a permanent member of international standardization organization as well as its working role in secretariat of TCM technical committee, so as to play an active part in setting development strategies, regulations, and projects of TCM standardization; besides, dominance of TCM international standardization should be seized in order to promote the transformation of TCM standards to international ones . The Medium- and Long-Term Development Plan about the Standardization of Traditional Chinese Medicine (2011–2020) has been published, and we believe, under its direction, there will be a more scientific and orderly development of TCM standardization for the services of people's health.The standardization of TCM is a gradual process, as well as a course of innovation and academic progress. Because of its fundamental, strategic, and global effects in development of TCM, the standardization should be promoted under a comprehensive plan and top design and proceeded with phased and planned steps . The Med


Lean thinking is on the rise in health surveys,particularly internationally, especially in the USA and UK, improving thestructure, process and outcome of care and management actions. However, it is anemerging theme in nursing.  this study showed that the use of lean thinking in the context of health has atransforming effect on care and organizational aspects, promoting advantages interms of quality, safety and efficiency of health care and nursing focused on thepatient. This term wasfirst used by Krafcik and popularized by Womack and Jones, in 1992 with the publicationof the book "the machine that changed the world"-The term, -Despite the origin of lean thinking in the industrial context, its principles have beenused in various scenarios, including health. This universal applicability of the leanconcept is due to the similarity of the production processes of organizations,regardless of their specific nature, which try to plan and execute a series of actionsin a certain sequence and time, to provide value for a customer The introduction of lean thinking in health, or, lean healthcare, occurred in astructured and systematic way in 2006. That year, the Lean Enterprise Academy (LEA), aBritish non-profit, organization dedicated to the study and dissemination of leanthinking, organized the first congress on the implementation of lean principles inhealth services ,-Since then, health organizations have adopted lean thinking as a strategy to providebest care in several countries, including the United States-Thedacare (Wisconsin);Virginia Mason Medical Center (Washington), and Martin Health System (Florida); Sweden-Astrid Lindgren Children's Hospital; United Kingdom - the Bolton Hospitals; andAustralia- the Flinders Medical Centre Lean within the health environment is still little explored in Brazil. During the searchon Google Scholar, in 2014, five Brazilian studies were found: one article and fourdissertations. The studies explore aspects of applicability and benefits of lean in ahospital laundry Lean thinking consists of a systematic approach that enables the identification andelimination of waste in production processes, focusing mainly on aggregate quality anddelivering to the customer only what he considers to be of value Another principle is the elimination of activities that do not generate value, alongwith any waste . Such waste does not allow that the process of care and treatment occurwithout interruption, detours, returns or delays. Thus, with the elimination of theseissues, the efficiency of activities and quality of service simultaneously increase-In the health service, the aspects that the patient values include a better, safer,faster, qualified and decisive care, according to his/her needs, aiming for the fullrecovery of his/her well-being (19). It is a widely diffused model within the quality health assessmentarea Several studies in the international literature about lean in health care aim tocontribute to these scientific publications and innovations addressing this theme,therefore, the present study presents the contributions of this management model basedon the triad of the quality evaluation model in health proposed by Donabedian,-Process corresponds to the set of activities that occurbetween professionals and patients during care delivery and includes both the technicalcomponents of care , as well asinterpersonal relationships ,-Outcome refers to the effects of care on the patient's healthstatus and also includes the customer and staff satisfaction with receiving andproviding care, respectively ,-The three domains or conceptual assessment variables of this model are: structure,process and outcome. Structure is related to the physical and organizational settings,in which care occurs. Attributes included are: material resources , human resources ,and organizational structure In light of the foregoing, the question is: what evidence is available in the scientificliterature regarding the use of lean thinking in health care and nursing? How do leanpractices impact the actions of health care in relation to the structure, process andoutcome dimensions?Thus, the objective was to demonstrate the scientific knowledge about lean thinking inthe health area, emphasizing the impact and contributions to health care andnursing.An integrative literature review was adopted to meet the objective of the study. This isa wider type of revision that includes both experimental and non-experimental research,allowing for the synthesis of multiple published studies and the development of acomprehensive explanation of a specific phenomenon. This method provides foridentification of gaps in current knowledge that need to be understood with thedevelopment of new studies. The steps of this review were: statement of the researchquestion; data collection; data evaluation; analysis and interpretation of data;presentation of results; and conclusions (24-25). Data collection was conducted in February and March of 2015, using: the Latin Americanand Caribbean Health Sciences (LILACS), Publisher Medline (PubMed), Cumulative Index toNursing and Allied Health Literature (CINAHL), Scopus, Web of Science, Emerald and inthe electronic library, Scientific Electronic Library Online (SciELO) databases. Using these syntaxes, the following results were obtained: 26 articles in LILACS, 348articles in PubMed, 181 articles in CINAHL, 567 in Scopus, 174 in Web of Science, 62 inEmerald, and 77 in SciELO, totaling 1,435 publications.The inclusion criteria for articles were: original articles with abstracts availableonline, published from 2006 to 2014, in Portuguese, Spanish or English, that focus onlean thinking-related to health, as well as its contributions to the professional careactions of the area. This timeframe was used due to the fact that lean, in health, beganto have greater visibility from the year 2006 (5). Articles duplicated in more than onedatabase were deleted and only one was used. The final sample consisted of 47 articles, PubMed (seven), CINAHL (seven), Scopus, (20),Web of Science (11), Emerald (2), as described in Data categorization was guided by the triad of a conceptual model for quality assessmentin health, developed by DonabedianBased on the year of publication, an increase in new articles was observed, consideringthe 47 that were selected that were written over the years. The year of 2012 recordedthe highest number of published articles, at 11 (23.4%).Journal of Health Organization and Management with fourarticles (8.5%); and two articles (5.9%) published in each of the following journalsrelated to lean thinking in health: BMC Health Services Research withthree articles (6.4%); Quality & Safety in Health Care;Canadian Journal of Emergency Medical Care; InternationalJournal of Health Care Quality Assurance; Leadership in HealthServices; Quality & Safety in Health Care;Quality Management in Health Care.Regarding publication language, all articles included were published in English, in 37different journals, especially those related to management and quality in health care,such as the Regarding the country of origin of publication, 16 (34%) were submitted from the UnitedStates, seven (14.9%) from the United Kingdom, five (10.6%) from Holland, eight (17%)from Sweden, and two (4.3%) from Canada. Australia, Spain, Italy, Luxembourg, Malaysia,Norway, China accounted for another 14.9%, with one article for each country. Twostudies (4.3%) were conducted in more than one country. No articles were identified fromSouth America.In relation to scenarios where the studies were conducted, the hospital environment washighlighted with 44 articles (93.6%). The most exploited sectors were: emergency rooms,operating rooms, and intensive care units. The other sites studied were primary care,with two articles (4.3%) and one article (2.1%) on both scenarios: hospitals and primarycare.Regarding the type of study, all articles included in the review were derived fromoriginal research; 28 (59.6%) used a quantitative approach, 12 (25.5%) a qualitativeapproach, and seven (14.9%) a mixed approach search. Another aspect analyzed was the profession of the authors. In this regard, of the 47articles, 28 did not specify the professional background of the authors. Of the 19 whoprovided this information, it is emphasized that ten articles had nurse participation,four with the exclusive authorship coming from this profession.The use of lean thinking is on the rise in health research in the global context andappears across multiple care settings. In this sense, it is observed that the articleswere published in different journals which identify heterogeneity in the publication ofthe issue, but a homogeneous distribution of the number of articles published betweenthem.(6.73).Most studies were implemented in the United States, which may be associated with thepioneering of this country in the implementation of lean concepts inhealthWith regard to the scenarios used for conducting these studies, the hospital environmentpredominated, across various units. This demonstrates the applicability of lean at amultiplicity of hospital care facilities. A similar result is described in a previousliterature review on the implementation of lean thinking in healthcareThe incipient participation of nurses as authors on this subject was observed. Thisresult may be associated with the origin of lean thinking in the area of administrationand engineeringRegarding the content of the articles, the results will be discussed according to thecategories of quality assessment from the triad in health.,,,Regarding the physical structure of the places where care is provided, the studieswere implemented in various units, including: chemotherapy-,-,-Regarding the normative, technical and administrative instruments, lean thinkingguides should be standardized and simplified care processes in order to reducebureaucracy and facilitate health care. These changes inspired by lean reduceambiguity at work, a more continuous flow of care, and allows team members to be moreautonomous in the execution of activities and problem solvingIn a study performed in a surgical centerIn another study,,,(36.56).It is highlighted that the use of lean thinking provides economic improvements andpositive impacts on the financial income of healthcare organizations, by increasingthe capacity for patient careAnother attribute of the structure component is human resources. By using lean tooptimize the operating room capacity at a hospital in Luxembourg, it was possible toincrease the number of annual surgeries without any increase in the quantity ofpersonnel. However, this required training and motivation of the hospital staff,which had repercussions on eliminating unnecessary waiting periods and stress beforesurgery and increased the transfer rate of patients in the operating room to otherunits-The lean methodology is anchored in appreciation and respect for people, professionaltraining and instructions on the workplace, enabling the improvement of professionalsinvolved in the care process and optimizing the quality of care and patientsafetyResearch performed in the United States revealed that the ideal professional toconduct a lean transformation in a hospital is the nurse because he has experienceleading multidisciplinary teams and is committed to patient care, and can viewhospital systems from the patient's perspectiveInformation systems, also recognized as a component of structure, bring together aset of data, information, and knowledge to support the planning, development anddecision-making processes of health professionals involved in patient care for thehealth system patientsA study performed in diagnostic support services in a clinical hospital in the UnitedKingdom (UK)Another study performed in an emergency room in SwedenIn addition to allowing the comparison between the current and future state in aparticular care environment, the combination of simulation with lean thinking canmake the flow of care more efficient, reducing the waiting list of patients andassisting in the selection of optimal resources, the process for service managementin hospitals, eliminating or minimizing the use of a trial and error approach,,-,,,For the care process to succeed there must be commitment, involvement and continuedsupport of leaders for the "front line" professionals in the health institutions(8.74).Lean thinking is the assumption that nurses and other professionals working on the"front line" of health services are better able to decide what patients need to havetheir needs met, considering good clinical practiceA study performed in a UK hospital specializing in cardiothoracic care highlightedthe importance of managerial skills as essential strategies to facilitate theimplementation of lean in health care, such as: open dialogue; ability to inspirepeople to approach old problems in new ways; maintaining the enthusiasm of workers;and the development of actions to facilitate and enhance communication amongprofessionals The application of lean principles improves patient care. In a study performed in ahospital emergency room in Canada, for patients with acute coronary syndrome, it waspossible to reduce the time of medical interpretation of the electrocardiogram (ECG),medical evaluation, and administration of acetylsalicylic acid through the use oflean principlesTo achieve these goals some changes were necessary in the process of care for thesepatients, including: a specific ECG room next to the emergency triage was created;nurse triage is now the first contact for the patient in the unit, rather than thesecretary; materials and equipment were relocated to reduce the movement of the nurseand the patient at the time of service; a procedure was established for immediate ECGinterpretation by the doctor; readjustment of risk stratification tools for use bynurses; screening and clarification of the criteria for activation of the flowchartfor care of patients with acute coronary syndrome. The application of lean principlessignificantly improved the performance of early diagnosis and therapeutic targets foremergency cardiac care in this service.,,,,,,,(36.55 to 56); andmanages change and problem-solving using a scientific approach,,In addition to improving the care provided to patients, lean thinking is a methodthat seeks to understand the processes in order to identify and analyze problems andexisting waste,-,,-,-,,-,,,-,-,-,(45.67); Kaizen-,,,-,,,,-,,,,,,Lean uses several tools to improve care processes, among which the following werehighlighted in the articles: value stream mapping,-,,,-,-,-,,-,-,,-,-,-,-,,,,,,,,,,,-,,,,,,,,-,,-,,,(27 to 29.38), increasedpatient satisfaction-,,(27 to 28.41); increased access tocare,,,,,--(41.54), reduction in employee overtime(27.59); early hospital discharge,,All the articles analyzed reported successes and benefits for outcomes when using leanprinciples in health, both in health care and organizational aspects. The main effectsfound were: increased productivity and staff efficiency(28.61). It is essential that there is a continuous learningenvironment to facilitate the implementation of Lean principles. The challenges inimplementing the Lean system are: to maintain the support of health professionals andleaders of hospitals, availability of time, resources and lack of training of leaders /managers with vision in Lean,,,,However, in order for lean systems to improve metrics of care and patient satisfaction,health professionals, hospital managers, and the stakeholders involved will depend onthe team's degree of commitment to lean principles and organizationalcultureThis study enabled us to show that Lean thinking in health is a management model thatimproves the structure, process and outcome, from the care and management actions. Theprinciples of Lean thinking is widespread in various contexts of health, such asemergency, oncology, pharmacy, intensive care unit, radiology, orthopedics, mentalhealth clinics and cardiology services.The main impacts from the application of this thinking in health are increasingproductivity and team efficiency; reduction in waiting time for patient care;standardization of care process, reducing costs, improved teamwork, reduction in thepatient's hospital length; increasing the quality of service provided; increased patientsatisfaction; increasing patient safety and health professionals; and employeesatisfaction.It emphasizes the need for further studies on the applicability of Lean thinking in careenvironments in Brazil due to most publications focus on an international level, mainlyin the United States and the United Kingdom. It is also important to highlight theimportance of new nursing research that specifically objectifies the participation ofthe profession in this context. The participation of nurses in the scientific literaturerelated to this issue is still incipient, even though he has been considered aprofessional able to lead a Lean transformation.


The last thirty years have been characterized by tremendous growth in the number of existing health networks world-wide; yet, little is known about why such networks emerge, what their effects are, and their roles in the governance of health .can mean, and what it should mean, given the constraints and realities. Each partner contributes toward the network by strengthening the capacities of the medical, legal, and/or justice sectors to care for survivors of SGBV, and by building an evidence base for SGBV programming. Partners develop, implement, and evaluate core elements of a multi-sectoral response model that incorporates the overlapping and complementary responsibilities of the health, police and justice, and social service sectors. The ethos of the Africa Regional SGBV Network centers on the conviction that survivors require access to all services, but that it may not be feasible, appropriate, or cost-effective to deliver all services in one location. Through their interventions over the years, network partners have not taken the conventional understanding of a multi-sectoral approach for granted, but have instead allowed other viewpoints and actions to emerge in regard to such an approach. Where necessary, partners have conceived programmatic response to survivors' service needs differently, testing out innovative and, sometimes, daring approaches.The 'Africa Regional Sexual and Gender-Based Violence (SGBV) Network' emerged in the East and Southern African region in 2006. Led and coordinated by the Population Council, this network materialized as a consequence of the landscape of SGBV work in the region. At the time, while discourse and initiatives related to SGBV prevention were not unheard of, far less attention was being given to programmatic response to the service needs of SGBV survivors. With initial funding from the Swedish-Norwegian Regional HIV and AIDS Team for Africa, Embassy of Sweden, Lusaka, Zambia, the Population Council identified a number of implementing partner organizations in East and Southern Africa to facilitate collective action around the issue of responding to the needs of SGBV survivors in the region. Since then, network partner organizations have continued to work on fostering a multi-sectoral response  in their countries and beyond - exploring what such a response means in low-resource settings, what it Africa Regional SGBV Network convened a meeting in Washington, DC, USA. The meeting commemorated the 16 Days of Activism Against Gender Violence and raised awareness of interventions for survivors of SGBV in low-resource contexts. The forum reflected a culmination of efforts from seven years of grounded research and practice-building in the field of SGBV, and brought together network partner organizations from Kenya, South Africa, Swaziland, and Zambia, in addition to policy, practitioner, and researcher audiences from the Washington, DC area.On December 4, 2013, for the first time ever, the This volume of extended abstracts summarizes network partner presentations delivered during the meeting. The presentations centered on each partner's interventions and main results, coupled with the effectiveness of partners' endeavors in responding to the needs of survivors. The notion of 'effectiveness' as employed here draws on Shiffman's  definitichange the world to meet their members' perceptions of what reality should look like [Effectiveness refers to the extent to which networks are able to ook like . We examAfrica Regional SGBV Network have engendered in the East and Southern African region.Accordingly, this collection of extended abstracts highlights the nature of policy consequences that the efforts of the The current volume appears during an exciting time of 'climate change' in SGBV work, where SGBV prevention initiatives in particular are receiving mounting attention in the East and Southern African region. While there is good reason for this near-singular focus on prevention, this volume will remind readers that any supposed dichotomy between 'prevention' and 'response' is artificial, at best. Both are closely interconnected and critical, and work hand in hand with one another. In responding to SGBV, we prevent it - and in preventing SGBV, we respond to it. Furthermore, compared to other parts of the world, SGBV 'prevention' and 'response' alike are in their infancy in East and Southern Africa.Africa Regional SGBV Network is 'changing the world' to meet its members' perceptions of what reality should look like in regard to programmatic response to the needs of survivors in the region.In responding to SGBV, and in bringing about policy consequences (as defined above), the Population Council and its partners are changing the way the world thinks about the critical health and development issue that SGBV represents in East and Southern Africa. Indeed, as each of the extended abstracts in this volume demonstrates, in diverse ways, the


Moststudies were published after 2013 (57%), originating from the United States andUnited Kingdom (77.8%). It was observed the use of social networking among nursingstudents, postgraduate students, mentors and nurses, in undergraduate programmes,hybrid education (blended-learning) and in interprofessional education. The socialnetworking sites used in the teaching and learning process were Facebook (42.8%),Ning (28.5%), Twitter (21.4%) and MySpace (7.1%), by means of audios, videos,quizzes, animations, forums, guidance, support, discussions and research group. few experiences of the use of social networking in nursing education were foundand their contributions show the numerous benefits and difficulties faced,providing resourses for the improvement and revaluation of their use in theteaching and learning process. Web-based social networking are activities resulting in connections and interactionsbetween individuals and groups using a wide variety of tools. These tools include email,blogs, instant messaging, text messages and posts as well as programs that enabledigital information sharing in video, audio or text format. Social networking websitesintegrate these tools in easy to handle formats and allow users to determine how andwith whom they will share their informationThe increase in the use of social networking, evidently, has become a common phenomenonin recent years and generated great impact on the development of forms of interactionand socialization among studentsIn this way, social networking represents an attractive tool for the educational field,because the students are thoroughly familiar with them and willing to establish morefluid communication with the aim to exchange knowledge, information and ideasThe educational use of social networking is growing among academics as a powerful toolsfor teaching and learningTeachers have been engaged in using technology to make learning more personalized,interactive and dynamic, making it easier for students to work with audio, video,interactive games, and more recently, with blogs and social networkingIn short, social networking can be a perfect tool for learning, however, despite theincrease in their use, only few students use them for school purposesHaving knowledge of the possibilities of the use of social networking in teaching andtaking into account the panorama of healthcare education, has social networkingtechnology been used in nursing education? That was the guiding question of this study,with the purpose of knowing the possibilities, ways, successes and failures of their usein this area of study.To identify the use of social networking in nursing education.The integrative literature review was the research method used to achieve the objectiveof this study, since it has as an advantage the possibility of synthesis and analysis ofthe scientific knowledge already produced about the research theme.This research method is characterized by presenting an extensive methodological approachwith regard to the literature reviews, allowing the inclusion of multiple studies withdifferent research designs for the complete understanding of the phenomenon studied.This method combines both data of the theoretical literature and empirical, andincorporate wide range of purposes: definition of concepts, review of theories andevidences, and analysis of methodological problems on a particular subjectThe six steps followed to elaborate the integrative review were: definition of theresearch subject, establishment of the inclusion and exclusion criteria for theliterature search, definition of the information to be extracted from the studies,evaluation of the studies included, interpretation of results and data synthesisThe inclusion criteria for this review were the studies published throughout the periodallowed by the selected databases, aiming at including the largest possible number ofarticles, taking into consideration the contemporaneity of the subject studied.According to the exclusion criteria, it was removed studies addressing the use of socialnetworking with other approaches, such as:- in higher education of other professional groups, elementary education, highschool education and technical education;- in research using social networking as a data collection method andinterviews;- in the approaches on the use of social networking as a security method inschool environments;- in the approaches on the user's safety in the use of social networking;- in the posts and comments from students on social networking;- regarding to the ethical aspects of the use of social networking;- in education focused on the patient and on community;- on the use of other technologies such as Wikis (hypertext), videoconferencing, virtual environments, mobile devices, blogs (websites in theformat of dairy), YouTube, text messaging, Web sites and simulation of virtualreality.The studies were resulting from journals indexed in the databases: Latin American andCaribbean Health Sciences (LILACS), Spanish Bibliographic Index of the Health Sciences(IBECS), Cochrane, Brazilian Nursing Databases (BDENF) Scientific Electronic LibraryOnline (SciELO), Cumulative Index to Nursing and Allied Health Literature (CINAHL),Scopus, PubMed, CAPES Periodicals Portal and Web of Science.A query in the Descriptors of Health Science (MeSH) and in the Medical Subject Headings(MeSH) was performed for the selection of articles, and it was identified and used thedescriptors: social networking and nursing education.Aiming at analyzing any publication related to the theme and in order to expand thestudy sample, the keywords "social networking sites" and "nursing education" were alsoused as search strategy, with the main question and the inclusion and exclusion criteriapreviously established as guidelines to maintain the consistency in the search forarticles and avoid possible bias.In April 2015, therefore, a search using the descriptors and a second research using thekeywords were carried out in all databases .Firstly, it was carried out the reading of the titles and abstracts of the total sample,taking into account the inclusion and exclusion criteria. Thus, of the total of 489articles found, 97 articles were selected.In a second moment, of the 97 articles selected, it was performed the removal of 72duplicate articles, and the sample consisted of 25 articles.In the third moment, it was carried out the reading in full of those 25 articles, and 11articles were removed for not meeting the inclusion and exclusion criteria, thus thefinal sample was composed of 14 articles.For the analysis in full of the selected articles, an instrument of collection andsynthesis of data was used in order to extract, organize and summarize the informationand facilitate the construction of the database.The instrument developed and validated by Ursi and GalvãoIn this integrative review of the 489 articles found, 14 articles met the inclusion andexclusion criteria and composed the sample, as shown in In this integrative review, it was found an article in 2007, two in 2008, two in 2010,one in 2011, three in 2013 and five in 2014.According to the population target of the nursing education, it is emphasized that sevenarticles cite the use of social networking with nursing students (50%), an article waitsfor the approval for its use with postgraduate students in nursing (7.1%), an articlementions the use of social networking by nursing mentors (7.1%), an article uses socialnetworking to newly hired nurses in a neonatal hospital (7.1%) and four articles listthe benefits of its use in nursing education (28.6%).Among the seven studies involving nursing students, it was observed that four wereperformed in undergraduate nursing programmes (57.1%), one was developed in hybrideducation involving nursing students (14.3%) and two addressed the interprofessionaleducation among nursing students and other professionals (28.6%).Regarding the study sites, it was observed that among the articles that used socialnetworking with nursing students, the majority of them (44.5%) were developed in theUnited States of America (USA), with two studies in Minnesota, one in Arizona and oneinvolving eleven universities in the USA. In addition, there was a study developed inMalaysia, one in Queensland, Australia and another one in Glamorgan, United Kingdom.The study involved the use of social networking for mentors in nursing and it wasdeveloped at the University of Nottingham in UK, and the study involving newly hirednurses of a neonatal hospital was also held in London in UK. In this way, the studiesanalyzed were developed in several countries and in total, four studies (44.5%) werecarried out in the US, three (33.3%) in UK, one was performed (11.1%) in Malaysia andone in Australia.Analyzing the authors of the studies in this review, it can be observed that almost halfof publications on the subject in focus were discussed by two authors: Skiba DS (4:28.5%) and Pittenger AL (2: 14.2%).Among the topics covered on the use of social networking with nursing students, it wasobserved that the topics and subjects were very diversified, and thus it was possible tohighlight: information technology and project management, safe administration ofmedications, disparities in the healthcare system in the US, recommendations for theincorporation of social networking in education, diabetes management, critical care andthe practice of ethical and moral behavior.Social networking sites have been used in different ways for nursing education. Sixarticles (60%) used them in teaching of a certain content by means of audios, videos,quizzes, animations, forums, guidance and support; three articles (30%) used them onlyfor the discussion after the transmission of the content and 1 (10%) in the formation ofa research group.According to the types of social networking used in the articles included in thisreview, it is noticed that 6 (42.8%) involved the social network Facebook, 4 (28.5%)used Ning, 3 (21.4%) used Twitter and 1 (7.1%) mentioned the benefits of MySpace.Regarding the studies that addressed other approaches on the use of social networkingwith nursing students, it was observed that two described social networking as tools tobe used in nursing education, a study reported the benefits of using social networking(Facebook and MySpace) to the educators and two others mentioned the benefits to thestudents.The tools used in nursing education were posts, explanations, study groups, academicadvising, connection between students, access to external resources, opportunity forreflection, flexibility, collaboration and feedback.Among the results and benefits cited with the use of Facebook and MySpace, it ishighlighted as benefits for the educators the possibility to learn through socialnetworking, interact with students, work in network with other professionals andestablish interaction and connection without leaving the house in times of financialcrisis.Regarding the students, the social network Facebook allows a better interaction with andamong students, can be used in academic discussions, allows to connect and interact witha wider audience, helps students in the exploration of their professional identity andin the improvement of their social and cognitive skills, allows a social support,increases the time dedicated by the student to learning, can be used in deeperapproaches, helping students to develop their ability to think critically andanalytically. Additionally, Facebook can also be used in research groups and, finally,it can be considered as a novel method for guiding and supporting learning. Besides thebenefits resulting from the use of Facebook, it was also mentioned the difficulties incommunicating complex ideas and the possible increasing lack of attention, which cancause procrastination.With respect to the social network Twitter, it was mentioned that it presents a quickway to communicate with students, facilitates virtual discussion, encourages sociallearning with changes in the dynamics of the classroom, facilitates active, interactiveand reflective learning, enables students to feel as part of the community, allowsstudents to reflect on their own learning and their experiences, sharing them withteachers and other students. However, the use of 140 characters as allowed by thissocial network was considered as a limitation by the participants, who had norestriction of time or space, however, at this time, they have mentioned it in relationto the number of characters.Regarding the social network Ning, it was verified visibility and effectiveness inintegrating interprofesional education, with the addition of knowledge through thecontribution of students of other regions and, consequently, increased understanding ofthe content addressed. It also allows social interaction and active learning, besidesthe perception of improvement of the quality of the discussion with the presence ofteachers in the social networking. Furthermore, Ning is a less expensive way ofinterprofessional education, involving various occupational categories separated due totime and space. It should be added the fact that it is feasible for companies infinancial terms, with regards to the education of workers, because there is no need torelease these workers from the work shift. However, it was not considered easy to handlefor almost half of the study participants.In a study, it was analyzed the form of control by the teachers, on social networking,demonstrating the educator's performance in three different situations. The groupwithout guidance of the teacher failed to achieve the objectives proposed, the groupthat was completely controlled by the teacher only reached the academic proposal and thegroup headed by the educator showed more interaction, discussion, collaboration andemotion transmission, when compared to the other groups.It was also performed the analysis of the teacher's participation at two differenttimes: in a synchronous moment, in which teachers and students were connected in theclassroom, and in an asynchronous moment. There were difficulties in both moments. Inthe synchronous moment, students and teachers were not able to follow the same steps;and in the asynchronous moment, students showed the need of the presence of theteacher.On the basis of the recommendations of the studies included in this review, it wasobserved the need for the safe and proper use of social networking as teaching tools,since they are tools that represent a platform for learning, however, teachers are theones who should plan the scope of an accurate result in the knowledge. Furthermore,educators need to know this kind of learning, addressing the formative and summativeevaluation and should decide how to promote the interaction with their students,exceeding the physical space of the universities and reaching the cyber spaces of theirchoices.-Social networking can provide many opportunities to innovate the teaching and learningprocess and lead to a reflection on the choice of the methods for assessment of the useof these tools-,,It is important to highlight that some studies were conducted in order to provide tostudents freedom to choose the way of interaction, providing, along with socialnetworking , other communication platforms such as Moodle,blogs and forums. Moreover, students gave priority to the access through social network,in relation to the other methods already known in the academic environment,In addition, it was observed that not all students had, previously, an account in socialnetworkingIt is emphasized the need and importance of the presence of the teacher, both in thesynchronous or asynchronous moments, in the use of social networkingOther considerations were addressed in the studies analyzed, such as the importance ofsafety and ethics in the use of social networking-,,The types of interaction were used in various ways, with the students, between students,between students and former students, between students of different professions, betweenstudents and teachers, between students and experts, between students and professionals,with other audience, showing the possibilty to eliminate the barriers of time andspace-,The benefits of using various social networking in nursing education are immense, bothfor the students and educators, which includes the interaction, integration andconnection among students, socialization with teachers, work in network, discussions,social support, reflection and sharing their own learning and experience, possibility ofinterprofessional education and achievement of an active, interactive and a reflectivelearning,,Besides allowing interaction with a wider audience, social networking helps students toexplore their professional identity, enhancing their social and cognitive skills,--Social networking is a subject of study that is still beginning to gain space and theanalysis of the articles can also identify the difficulties encountered in the use ofeach social network ,The recommendations and gaps of the studies show that more research must still becarried out to better understand the use of social networking by students and understandtheir immersion in online discussions groupsThe limitation of this study is related to the small number of internationalpublications found and absence of national publications, which may be related to thekeywords used. The social media descriptor, defined in MeSH as a platform that offersthe ability and tools to create and publish information accessed through the Internet,was not used in this study because of the lack of articles employing this descriptor inthe searches carried out.The results of this study show that social network sites used in the process of teachingand learning were Facebook, Ning, Twitter and MySpace, showing the various contributionsof their use for the area of education in nursing, such as the benefits to the students,educators, professionals and institutions, besides the tools and the way to use them inthe process of teaching and learning.It was observed that social networking was used to transmit various contents in thenursing field, demonstrating completeness in the transmission and discussion of simpleand complex issues, depending on the form of action, control and participation of theteacher. It is also worth mentioning its use in the face-to-face education, distancelearning and hybrid education, both the professional and interprofessional learning,proving to be able to be used in many contexts and in many ways, either for thetransmission of content, discussions or interaction, depending on the objectivesproposed by educators.The difficulties encountered in the use of each social network, as well as theirspecificities, contribute to the improvement of the techniques and evaluation of theirindication in teaching. Further studies are still required, according to therecommendations and gaps identified in this review, especially in relation to theunderstanding of the use of social network by students and ways of assessing thesetools.


This Corrigendum is issued because the Department of Psychology, and the NeuroMi – Milan Center for Neuroscience are part of, and belong to, the same institution, namely the University of Milano-Bicocca, Milan, Italy. They are not two different institutions, as we erroneously stated in the original manuscript: that erroneous statement may affect the funding of our institutions. Accordingly, Dr. Bolognini and Dr. Vallar have 2 (not 3) affiliations: University of Milano-Bicocca, and IRCCS Istituto Auxologico Italiano, Milan, Italy. We state that the correction and the revised information do not affect the scientific validity of the results.NB, CR, and GV have contributed equally to all stages of this work.The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.


We note with profound sadness the unexpected death of Alan J. Magill, MD, FASTMH, immediate past-president of the American Society of Tropical Medicine and Hygiene (ASTMH), on September 19, 2015 outside Seattle.Alan was president of our Society in 2014. He served with distinction, bringing to this elected position his characteristic enthusiasm, optimism, and focus. A noteworthy feature of his presidential year was the Ebola outbreak in Africa; he led efforts by the Society to address this horrific epidemic, including support for urgent scientific work and communication, and the need to respect the human rights aspects of the epidemic. He was greatly interested in the future of the Society, in particular its attention to its core missions of sharing scientific evidence, informing health policy, fostering career development, recognizing excellence, and advocating for investment in tropical medicine research. His efforts allowed us to move noticeably closer to the Society's vision of a world free of tropical infectious diseases.Alan was the director of the Malaria Program of the Bill & Melinda Gates Foundation. Under his leadership the Foundation made great strides in its ambitious goal to eradicate malaria. Although there is a long way to go, we have clearly turned the tide on malaria and we have Alan to thank as one of the leading engineers of this success story. More broadly, he was an enthusiastic educator about infectious diseases, and a global leader in the fight against them.Hunter's Tropical Medicine and Emerging Infectious Diseases, a leading textbook; serving as coeditor for CDC Health Information for International Travel (the Yellow Book), the leading resource for travel medicine information in the United States; and authorship of numerous scientific papers and book chapters on malaria, leishmaniasis, travel medicine, and other topics in infectious diseases and military medicine.Following his medical training, Alan served with distinction for 26 years in the U.S. Army Medical Corps, with a focus on clinical infectious diseases and research. His activities included clinical work in Germany, leading the Parasitology group at the U.S. Naval Medical Research Unit No. 6 Peru, directing research efforts to identify important impacts of malaria and leishmaniasis in U.S. military campaigns, and leadership in infectious diseases research at the Walter Reed Army Institute of Research. He was then a program leader at the Defense Advanced Research Projects Agency before moving to the Bill & Melinda Gates Foundation. Among Alan's many accomplishments were leading multiple research efforts at the U.S. Department of Defense, including the development of multiple diagnostics and treatments for malaria and leishmaniasis; discovery of a novel parasitic disease, viscerotropic leishmaniasis; serving as lead editor on the ninth edition of Alan's passion, good humor, intellect, and drive will be greatly missed by the ASTMH. His impacts were huge, with broad contributions on tropical infectious diseases and travel medicine over many years; mentoring generations of clinicians, soldiers, and scientists; and leadership of enormous efforts to control and eradicate malaria and other infectious diseases. For our Society, Alan brought focus to our mission and vision. His contributions and sprit live on as we work to fulfill his goal of a world free of malaria and other serious tropical infections.


Creative and Sensitive, involving 17 ostomized subjects and family members at amunicipal outpatient clinic. The ethical aspects were complied with. Acharacterization form was used, as well as Creativity and Sensitivity Dynamics:"speaking map", "body-knowledge" and "calendar". Critical Discourse Analysis wasapplied. the health needs and care demands of the ostomized patients and their familymembers, in their multiple dimensions, were constituted in the home and community,outpatient and social context, implying new orientations for nursing care. Theunveiling of the data brought elements that constituted guidelines, in amacrosociological approach, to achieve the expanded integrality of nursing care.the ostomized clients are unique in their genre/peculiar from Latin sui generis,calling for strategies that respond to and distinguish their specificities.Elaborating a Public Health Policy that improves and reorganizes the care demands,taking into account these individual biopsychosocial and spiritual aspects, is apossible and irrevocable target in the attempt to achieve better conditions ofhealth and wellbeing. Adding up to the definition, the term process means reflexive activityintended to achieve knowledge on something. Thus, as part of the nurse's modes ofaction, based on the valuation of culture, it could characterize a clinical nursing carepractice.The guidelines for a comprehensive care program to ostomized patients and their family,proposed in this articles, are considered here as a process-based technology in amacrosociological approach. Social technology is understood as a set of applied arts andsocial techniques to support social work, serving as a tool of social inclusion andimprovement of quality of life. Hence, it comprises a replicable product, technique ormethod, developed in the interaction with the community, and represents and effectivesolution of social transformation. Addingpractice..In view of the social group studies, the stoma is a surgical derivation of viscera to the skin at a different point from thenatural excretion orifice. In this surgery, the colon or part of the urinary system is linked to the abdominal wall, communicating them withthe outside with a view to the elimination of feces and/or urine. Thus, the stomapatients starts to use a collector bag stuck to the abdomen to protect theskin..The social repercussions in health for stoma patients and their family start when thestoma needs to be installed and there are difficulties to accept this new situation.There exists evidence that the diagnosis and installation of the stoma influence thelives of the patients and the people they relate with. The clients suffer a biologicalrupture and are confronted with different changes in their life process, ranging fromthe change in the gastrointestinal physiology, when they lose control of theirsphincters, from self-esteem to altered body image, acknowledging their body asdysfunctional. Hence, the stoma alters not only the biological system, but also affectsthe individuals emotional and physiologically, impairing their social relationships.Therefore, they feel stigmatized as they suffer surgical complications in thepostoperative phase and face problems in the experience of their sexuality. In functionof the anatomical change of their body, the way of life of patients living with a stomafor elimination changes. These transformations, in turn, condition the patient's family,affect, professional and social life, entailing the need for family support and aprofessional care structure with a view to faster and more effectiverehabilitation..Based on the observations in the Group of Ostomized Patients that served as the researchscenario, it could be evidenced that, in daily nursing care, the support granted toostomized subjects' problem, in its multiple dimensions, privileges the restoration andmaintenance of the physical body damaged by the surgical derivation. This care model,which remains rooted in the biomedical perspective, does not highlight the multipleSocial Determinants of Health (SDH) that strongly influence the course of life of stomaclients and their families, such as social, economical, cultural, ethnic/racial,psychological and behavioral factors that, as a whole, determine and condition themaintenance of health and the occurrence of diseases. In that perspective, thedifferences in health conditions among human groups may not be justified by biologicalfactors but, on the opposite, the differences in health conditions seem to result fromsocially constructed habits and behaviors and, mainly, from factors beyond theindividual or group's direct control.As social human beings, stoma patients and their relatives are subject to these SDH,linked to their life and health conditions, inherent in the family system with anelimination stoma. Therefore, they need to be unveiled with a view to investing in the"causes of the causes" of the health problems and their developments, facing thedifficulties in life with the surgical derivation, entailing the possibility to achievethe integrality of care. The emergence of a specific program to consolidate theorganization of a support network and the operation of a health care process for thisgroup, in the singular space, should be considered. In that sense, the goal was: todescribe the care needs and demands that mark that discursive practices of ostomizedclients and their families, and to discuss guidelines for a comprehensive care programto ostomized clients and their family, organized by macrosociological categories.. Paying attention to the public policies in force in care to stoma clientsand their families can serve as an important tool to assert the rights and duties of SUSusers, managers and health professionals.Concerning the public policies for stoma patients, these have gradually advanced tosupport best practices in the Unified Health System (SUS). In search of alignment withinternational studies, the lack of research that directly focuses on health policies forthe social group being assessed could be observed. One North American study on theDevelopment of a Self-Management Program for Stoma Care is highlighted, which emergesfrom the stoma patients' quality of life recommendations/suggestions, considering theimpact of the surgical derivation on physical, psychological, social and spiritualaspects. Paying. The discussion on the social relationships and their repercussions forhealth serves as the theoretical background to study the achievement of care integralityin view of the contemporary order of capital that alienates and thingifies the relationsbetween the social being and the Social Determinants of Health in the model by Dahlgrenand Whitehead, coping with inequities in health at the different degrees ofgovernability: the general, the private and the singular, as well as the problematizing pedagogy in health, mediating the dialoguewith stoma clients and their relatives.Qualitative field research developed through the Creative and Sensitive Method (CSM) asthe data production axis for the construction, analysis and validation of the researchresults. The dihitehead, copingsingular, as welelatives.The participants were 11 ostomized clients, being seven adults and four elderly; and sixfamily members, being four adults and two elderly, involved in and affected by the stomaproblem in their daily life, totaling 17 subjects. The participants were distributed infour distinct groups of data production, consisting of different family systems, in viewof the criterion that groups should contain between six and eight members at most. Theparticipants were identified using alphanumerical codes, in the order in which the datawere produced, described as follows: researcher/group coordinator (C), research aids (A)and ostomized patients (O). The family members were identified according to the numberattributed to their ostomized patient . Each group was also identified forthe sake of a better organization of the data production and analysis: G1, G2, G3 andG4.Plataforma Brasil, in compliance with National Health CouncilResolution 466/12, Ministry of Health, and approved on November 27th 2012,Opinion 155.748, CAAE 07399512.2.0000.5238. To develop the research, the following stepswere implemented: request for authorization to access the place of study, entry in thescenario and start of the data production process, based on the random collection ofpotential subjects, which took place at the place of study between December/2012 andMarch/2013, where individual interviews were held to collect the participants'characteristics, after they had accepted to participate in the research by signing theInformed Consent Form (ICF). In that sense, during other meetings, three types ofCreativity and Sensitivity Dynamics (CSD) were developed with each group ofparticipants, called "Spoken Map", "Body-Knowledge" and "Calendar", in that order.The research scenario was a Group of Ostomized Patients at a municipal outpatient cliniclocated in Campos dos Goytacazes, RJ. The project was registered on theThe CSD "Spoken Map", rooted in the social space, was conducted as follows: on a sheetof paper, each participant (ostomized client and family member) should freely drawand/or write the places/routes taken to attend to their needs after the stoma, outlininglimits and challenges they face along this route. The central theme of the CSD"Body-Knowledge" was "the care demands, what they need to take care and what they do",where each group participant manifested the place the maintenance care for the stomaclient's body and the relative's body occupied on the silhouette of four physicalbodies, two females and two males, drawn on a sheet of brown paper for the participantsto frame. The CSD "Calendar" served to synthesize the data production: on a sheet ofpaper, the subjects should develop an individual artistic production linked to thecentral theme about what the ostomized client (or relative) needs to feel complete andtaken care of. The participants were offered several magazines, scissors, glue, coloredand ballpoint pens..The group discussions were audio recorded electronically. Next, the artistic productionswere organized and digitalized. The combination of the data developed with all thetechniques made up the textual corpus of the research production report, subject tofloating reading to apprehend the main ideas and apply the Critical Discourse Analysis(CDA), triangulating the data that emerged.Among the 17 research participants, 11 were ostomized, with a predominance of ostomized(7), colostomized (9) women. On average, the surgical derivation had been installed for113 months. Ages ranged from young adults to elder elderly. The majority (6) wasmarried, had finished secondary education (4), was evangelical (5) and Catholic (5) andgained a mean family income of one minimum wage (6). The six participating relatives hadthe following degree of family relationship: husband (2), cousin (1), aunt (1), sister(1) and wife (1). The majority (5) started the monitoring in the preoperative phase ofthe ostomy, were female (4), between 34 and 67 years of age. The marital situation ofmost of them was married (3), being (1) divorced and (2) single, with unfinished primaryeducation (3), evangelical (3) and Catholic (3). A family income between one and threeminimum wages was predominant (3).start of the whole newlife (O1). The causes of the adult and elderly, colostomized or ileostomizedresearch subjects' permanent or temporary stoma included reports of tumors, polyps,Firearm Perforation (FP), ulcerative rectocolitis, Chron disease and medical errors,such as inappropriate diagnosis and intestinal abscess due to tubal infection, caused byan examination done wrongly.The research participants used language as a form of social practice. The health needs,care demands and borderline situations, in their multiple dimensions, which marked theirdiscursive practice, were constituted in the domestic and community, outpatient andsocial context, one influencing the other, implying new orientations for nursing care.The stoma clients had different causes underlying the installation of the stoma, whichthey called "surgery of life" , being the eat and accomplish dreams, cultivate hope and be optimisticabout the future in view of the new condition of being ostomized , despite difficultiesto accept it: ... a good environment for our daily care, healthy eating, calmplace... for you to take care of yourself... People's love, the kindness of ourrelatives... (O4).The participating stoma patients highlighted that, to feel complete and truly taken careof, they need to I had to buy the box of bag and stomahesive I bought it, because I left thehospital, look, I didn't do it through X, I did it through a privatehospital... (O11). This bag, one possesses one quality and the otheranother, you see? (F4). It's the quality of the bag...(F3). ... for us ostomized patients it would be good to have like... a placejust for us, you see, mainly a bathroom... (O4).The needs and demands of the stoma patient's physical body include the needs and demandsrelated to the maintenance of the stoma, with particular attention for theparticularities of elderly stoma patients; basic hygiene and esthetic care: use ofadjuvant and accessory equipment that attends to their specificity . The quality of the material offered in the market is a constant concern,as what best adapts to the user is not always considered, from the perspective of hiswellbeing and comfort, but what corresponds to the interests of the economic system: ......then I also mentioned the good, because a good diet is extremely important always,despite our restrictions because of the stoma, right?! (O11).Care with meals also stands out because of some adaptations and dietary restrictions theclients go through because of the stoma. The knowledge gained from experience in thisgroups helps to test foods, identifying foods that help to neutralize odors or producestrong smells, foods that soften the feces or provoke intestinal constipation and othersthat produce increased flatulence. In addition, the location of the stoma, the baselinedisease and comorbidities are factors inherent in the diet to be followed: ... I am unable to sit still, work occupies the mind when youoccupy the mind, often I even forget that I use the bag (O1). ...contact with nature, contact with people and with the human being created byGod... (O4).As regards the access to professionals and support networks, besides the family as animportant core of support and care, the networks that take care of the body image and spirit (church) stood out in their respective social spaces.Concerning the socio-interactive needs, the family constitution, leisure and work wereemphasized. The latter serves as a form of social acknowledgement, besides constitutingan escape line from different kinds of problems deriving from the presence of the stoma.The availability of technology, such as the mobile phone, also favors the socialinteraction: ... because in society the laws refer to the rights of citizens, and whichshould be respects, and because it's also difficult for us to get safety and healthcare... (F1).The need to have their rights guaranteed is also highlighted as a matter of citizenship:Some needs and demands of the family members are similar to those of the stoma patients.Besides basic care for health maintenance, the relatives exhibit dynamics characteristicof everyone living with people who present some kind of impairment or who truly serve ascaregivers. In turn, they suffer the social consequences it implies. The thematicsynthesis of the groups highlighted important aspects for the relatives' physical andpsychospiritual health: waking up early, use of sunscreen, use of sunglasses andprescription glasses, going to the gym, exercising and stretching, healthy eatinghabits, water intake, sleep and rest, hygiene and bodily esthetics, creation andmaintenance of bonds at work, with neighbors, friends and family, need for a healthy andcalm mind and spiritual and religious support, such as going to church frequently,reading the bible and praying. In the inter-discourse produced, the care needs anddemands inherent in the relatives' health deserve attention and inclusion in a nursingprocess, with a view to achieving the integrality of health care. The family systemneeds to be balanced to jointly cope with the limitations imposed on the wellbeing ofostomized patients and their family members.In this social group's discursive practice, borderline situations also emerged as afrontier/problem/challenge for the family system's life and health dynamics, as follows:fragmented social networks, contradictions/conflicts in the search for a healthierlifestyle, general environmental conditions and unbalanced/maladjusted/disorganizedhousing conditions and their influence on self-care, unfavorable socioeconomicconditions, alienation from work and its consequences and demands for human life, lackof professional care or its instability, particularities of elderly stoma patients -vulnerability to repercussions of the stoma, the social environment of the stoma patientand its influence on the psychological aspect and how it promotes social practice.Particular attention should be paid to the difficulty to accept his physical conditionin the social sphere, the production of foods and its influence on the behavior of theintestinal elimination stoma. These elements were taken into account in the planning ofthe macrosociological approach guidelines, with a view to better conditions of healthand wellbeing, considering the need to achieve integral health care.. In that perspective, care for a user is an effort towards a complete,holistic and therefore integral approach of each person with health needs who, for acertain period in his life needs nursing care.The integrality of health care needs to be addressed in different dimensions to beachieved as fully as possible in health care. Further approximation betweenprofessionals and users is needed, so that the needs of individuals and groups start toguide the actions, breaking with the vertical imposition of conducts. In tha. They involve a process of measuring the health shortage in a population,in the form of losses in a certain health profile. Assessing them implies constructing ahealth or disease profile. The need grows as the health deficit increases.These needs, characteristic of the human condition, as "needs for food, shelter,reproduction and health, besides autonomy and freedom" and the respective demands,"products of the social relations and linked to lacks" are social and historicallydetermined. They iUnderstanding that these needs can be captured in the microspace of care, from amacrosociological perspective, producing care demands in health and nursing, thesedemands need to guarantee, in their modus operandi, the possibility to see the client asa whole, in constant interaction with the dynamic environment, allowing the client tofeel complete and truly taken care of. The elements of the macrosociological dimensions that permeate the life of human beings are fundamental to achievehealth and wellbeing. All health needs and care demands included in the macrodimensionneed to be considered to plan actions each professional needs to perform with the userswho need care. Therefore, a retun to the microspace of care is needed to supportprofessional attitudes coherent with the specific health needs of each social group andeach human being.The abovementioned dimensions go beyond the health needs of the people without this kindof surgical derivation. The family system of the ostomized patients is graduallyaffected and their members are involved in the existential movement of these dimensions,assuming responsibilities to offer the support needed in the context of this new stateof being a family. As a result of this imposed condition, the family gains new healthneeds and care demands that accompany the therapeutic itinerary of their ostomizedrelative, beyond what existed before the ostomy.. Thus, to devise the organization of a Comprehensive Health Care Programfor Ostomized People and Families in the Outpatient Context, these subjects need to bevalued as protagonists of care, sociocultural beings with specific demands, and situatethem as active participants in the health care process. Therefore, it is important toinvest in guidelines organized according to macrosociological dimensions, as discussednext.Considering health as the synergy of different factors and the subjects as abiopsychosocial and spiritual complex, the current public policies aim to welcome themin their context and take precedence through autonomy, physical and moral integrity.Therefore, the basic intent is to comply with the doctrinarian principles of the SUSregarding universal access to services, integrality and equality in health care. TheNational Humanization Policy is highlighted, concerning its emphasis on the social needsand interests of the different actors involved in health. Its political actions,therefore, are based on the challenges of constructing and expanding the spaces ofexchange among these actors, in the advance from a new ethics that moves and sustainsthe institutional support function. Thus, User participation in health conferences and councils needs to be encouraged, developedin the context of the SUS, besides user satisfaction research with a view to improvingthe service offered/shared. Investments are needed in the integration of the outpatientclinic with the health service network, from the perspective of interdisciplinarity,adding other types of services that go beyond the traditional concept of health, in viewof the need to work with the intersectoral approach in the contemporary world,guaranteeing referral and counter-referral.Concerning the biological and psychological-affective dimension, the physical andsocioemotional particularities of body maintenance of intestinal and urinary stoma usersare highlighted: change of (drainable and closed) collector bad, maintenance of closedcollector bag, daily maintenance of drainable collector bag for urostomy,self-irrigation, use of adjuvants , prevention of late complications , use of accessories (belt and adhesive tape), sun bath and equipment protectionduring common bath, with a view to reaching a healthy skin around the stoma, color,shape, size, protrusion, moisture, mucous integrity - with normal characteristics of astoma, effluent control, pain relief, self-esteem, safety, autonomy, comfort, wellbeing,happiness, satisfactory sexual activity, self-concept, congruent daily activity,increased life expectancy, among others. The increased availability of collector bagsand adjuvants that attend to the emerging singularities of clients in the SUS contextshould be highlighted.In the esthetic dimension, as a form of physical human beauty, the supply of estheticcourses and treatment options for stoma patients should be taken into account, with aview to contributing to the maintenance of their self-esteem and well-being, mainlyfocused on women. In the socioeconomic and professional field, financial counseling inthe family system is relevant, besides encouraging the effective participation of healthprofessionals, stoma clients and their relatives in the Association of Ostomized People.The promotion of professional courses for ostomized people should be considered, with aview to facilitating their (re)insertion in the job market, paying attention to thelimits and possibilities to assume certain functions that may diverge due to theirhealth condition.The need emerged to promote a healthy outpatient and home environment, covering theaspects of hygiene, temperature, ventilation, lighting, color therapy and aromatherapy.In the technological dimension, the personal needs related to SUS are considered, suchas the need to promote technological participation. In addition, the professional needsare considered with a view to achieving a health work process with individual andcollective care, aiming to maximize and control health care involving clients with atemporary elimination stoma and their relatives, concerning the care and support neededfor reconstructive surgery; individual and collective care for the relatives of stomapatients, so as to include them in care for their ostomized relative and also to receivecare; the implementation of consults by different professionals: nurses, physicians,social workers, psychologists and nutritionists, for support and adjustment of thedisequilibria due to the confection of the stoma in the different dimensions of thelives of clients with intestinal/urinary stoma and their family members; identificationand monitoring of late complications; implementation of home visits to understand thehome context and family dynamics and dialogued orientations on self-care; besides themanagement of material, staff and physical structure, inherent in the functioning of theoutpatient clinic and the development of activities promoted by health professionalsworking at the service and registered users.In the cultural dimension, the development of playful and sociocultural activities ishighlighted, such as games, sports, music, drama appropriate to the physical, social andmental capacity of each participant. Also, the educational field comprises: dialogical,group-based and individual education in health for the problematization of borderlinesituations, experienced in the concrete reality of the people involved in the careprocess deriving from the installation of the stoma, with a view to achieving self-careand permanent education for the health professionals involved. In addition, thedevelopment of interdisciplinary field studies is highlighted, in response to theproblems that emerge in this social group and the dissemination of the knowledgeproduced. The religious-spiritual need strongly emerged in the statements of theostomized participants and their relatives, evidencing the health care demand thatguarantees respect for these subjects' religiosity and/or spirituality..When considering the implementation of these guidelines, organized according to themacrosociological dimensions mentioned, the interdisciplinary perspective of healthneeds to be adopted. This is a common thematic point that acts as an integrator andmediator in the circulation of disciplinary discourse, in which reciprocity, mutualenrichment and a trend towards the horizontalization of the power relations between thefields coexist, overcoming the disciplinarity and fragmentation of knowledge andtherefore relating it with the reality and the problems of modern life, in search ofcare for the integrality of human beings..In the field of interdisciplinarity, the team's efforts will be directed at thesituation inherent to each health service. Different professionals with aparticular/specific background will adopt distinct perspectives in function of a commonobjective, which does not mean the juxtaposition of knowledge, nor the annulment of thespecificity of each field. This nevertheless implies awareness of the limits andpotentialities of each knowledge field with a view to opening towards collectiveaction.With a view to the appropriate functioning of a Comprehensive Health Care Program forOstomized People and Families, a physical structure should be provided that is relevantto the activities to be developed, with qualified and quantitatively sufficient staff,according to the number of registered users, printed material and/or the computerizationof health care, collectors and protective and safety equipment for stoma patients, aswell as fixed and daily consumption material for professional actions. It is importantto invest in communication media like mobile phones and the internet, in view of theirrole in a globalized world where information is multiplied exponentially. The healthprofessionals need to recover for the sake of continuing changes in daily practice,encouraging evidence-based practice and scientific research. This technology is alsorelevant for communication among health care networks, with a view to takingresponsibility for the users' referral and counter-referral and for administrativeactivities.. In that interval, the nurses advise the patients about care for the stoma,meals, hygiene, preparing them for self-care and the return to daily activities.Concerning the nurses' specific actions in the program, the nursing consultation ishighlighted, involving the implementation of the five phases of the nursing process andcontinuing education, including training and educational programs. In professionalnursing practice, the nurses are considered essential in the rehabilitation process ofostomized patients, as they are present since the diagnosis of the stoma. In tha. This precaution will influence the organization of the stomal therapyservice, the planning and implementation of care that will guarantee the specificitiesrequired to manage this social group's quality of life.It is important to consider the particularities of elderly patients concerning thechanges characteristic of the aging process: anatomic-physiological, cognitive,functional and psychosocial. This p. In line with Brazilian studies, international research has identifiedcoping experiences of stoma patients in the course of their lives, as physical,psychological, social and spiritual aspects are affected. Hence, they need adjustmentsto maintain their quality of life, which is a possible target with the help of health services and nurses,whether specialists or not, despite the presence of the stoma.The nurses are responsible for devising health action strategies that transcend thedisease focus, with a view to promoting means to help the elimination stoma users tomake decisions, express feelings and help them to cope with the changes in their bodyimage for the sake of survival. In lin of life, which he stoma.The operation of health care, the commodification of care and the lack of effectiveapplication of basic concepts in the execution of humanized, comprehensive, technicalwork that is faithful to the SUS principles negatively affect the problem-solvingability of the borderline situations the people experience in the context they live in.Thus, investments are needed in the organization of a health service network thatmaintains a flow in line with the peculiar needs of a certain social group, with a viewto achieving health in a broad sense. Achieving this comprehensive state of health,often considered utopic and revolutionary, which is dynamic in the course of daily life,represents an emerging challenge not only for the SUS users, but also for the healthprofessionals and their managers, wherever they are. Nevertheless, it is not considereda naïve objective, but feasible when practicing and devising health from amacrosociological perspective, with a distinguished professional attitude, based onsensitive listening to the users' health needs and promotion of articulation andeffective integration with the different spaces: general, particular and singular.In the development context of this research in health and nursing, challenges and limitsemerged in the conception phase of a singular project, and mainly in the data productionphase, where difficulties occurred to capture the subjects and maintain the groupsconstituted to develop the CSD, although the reliability criteria were complied with,related to the saturation of the data: empirical, theoretical and categorical. Theresults discussed here are not enclosed in their construction, in view of the concept ofknowledge as inexhaustible, unfinished and incomplete, besides the complexity derivingfrom the multiple changes the elimination ostomy causes in the lives of the peopleinvolved. Through these results, it was verified that the health needs of stoma patientsand their relatives, as well as the borderline situations this social group isconfronted with, are captured in the microspace of their social relationship, producingcare demands in health and nursing. Imprinting a macrosociological perspective on thesedemands, based on the subjects' multiple voices in their singular space, through theprofessional's sensitive and qualified listening, is the route to achieve the expandedintegrality of care.


Dr. Victor Abertondo and Dr. Michael Lee are not included in the author byline. They should be listed as the thirteenth and fourteenth authors respectively and are both affiliated with the Department of Agronomy, Iowa State University, Ames, Iowa, United States of America. The contributions of Dr. Victor Abertondo are as follows: Conceived and designed the experiments, performed the experiments, and analyzed the data. The contributions of Dr. Michael Lee are as follows: Conceived and designed the experiments, performed the experiments, analyzed the data, contributed reagents/materials/analysis tools, and wrote the manuscript.


It is hard to estimate the value of vaccines. They have contributed substantially to the reduction of burden from communicable diseases and associated mortality. Each year, three million lives are saved, thanks to vaccination , 2. In dJournal of Market Access and Health Policy is dedicated to vaccines and consists of a series of seven articles that present undeniable and robust evidence on benefits of vaccination from an economic perspective. We consider it extremely important to highlight these benefits in order to retain public trust in vaccination and to keep and strengthen the reliability of immunisation policies and programmes. All the seven articles give a broad overview of several aspects related to immunisation:They depict the impact of vaccination on economic growth, sustainability, and efficiency of healthcare systems. It has been shown that economic growth is driven by improved health –6. VacciThey show the true economic and societal value of vaccination. There are several intangible gains provided by vaccination that are ignored by traditional economic analyses. These include outcome-related productivity gains , behaviour-related productivity gains (influence on fertility and consumption choices), and community externalities  among others , 12.They also discuss short- and long-term benefits that can be obtained with vaccination in the context of relatively low levels of investments. Several examples demonstrate that, apart from commonly recognisable long-term gains, vaccines are also able to provide short-term benefits, which result in rapid returns on investments –18.Finally, they give ideas on actions that need to be taken by governments, international agencies, and other stakeholders, such as the medical community, in order to make benefits of vaccination programmes fully recognised and appreciated.This special issue of the The present series constitutes a comprehensive source of information on the benefits of vaccines and depicts the usefulness of vaccines from different angles and perspectives. They help realise the broad spectrum of benefits that add to health, and of the economic and societal gains of immunisation. Conveying this message to the patients and authorities, thereby ensuring increased awareness of the true value of vaccination, is of great importance in today's world in Europe where vaccine's hesitancy and underuse may lead to severe outbreaks, as recently observed in Germany, with measles outbreaks, and in Spain, where one case of diphtheria was registered for the first time since 1987. Promoting and strengthening the role of vaccines is in line with a document recently published by the Council of the European Union (Mondher Toumi, Editor-in-ChiefFaculty of Medicine, Public Health DepartmentResearch Unit EA 3279, University Aix-MarseilleMarseille, FranceWalter RicciardiEuropean Public Health AssociationDepartment of Public HealthCatholic University of the Sacred HeartRome, Italy


Philosophical Transactions of the Royal Society as a stand-alone issue in 1981. We do this from the broader perspective of the study of infectious disease dynamics, rather than the specific perspective of the dynamics of insect pathogens. We argue that their 1981 paper fits seamlessly in the systematic study of infectious disease dynamics that was initiated by the authors in 1978, combining effective use of simple mathematical models, firmly rooted in biology, with observable or empirically measurable ingredients and quantities, and promoting extensive capacity building. This systematic approach, taking ecology and biology rather than applied mathematics as the motivation for advance, proved essential for the maturation of the field, and culminated in their landmark textbook of 1991. This commentary was written to celebrate the 350th anniversary of the journal Philosophical Transactions of the Royal Society.We discuss the context, content and importance of the paper ‘The population dynamics of microparasites and their invertebrate hosts’, by R. M. Anderson and R. M. May, published in the  In 1766, Daniel Bernoulli, working on a mathematical analysis of the benefits of smallpox inoculation, wrote ‘in a matter which so closely concerns the well-being of the human race, no decision shall be made without all knowledge which a little analysis and calculation can provide’ )