After the outbreak of COVID-19, the international community has been faced with various problems it has brought to cities. A large number of research projects and corresponding management measures were launched globally, trying to reduce the impact of COVID-19 on society. Among them, exploring how to maintain the health of residents by managing and updating the design of urban streets is one of the important issues regarding urban sustainability in the post-epidemic era.This study uses bibliometric analysis techniques to obtain an overview of the knowledge structure of 898 Chinese urban streets and residents' health relationship studies from the China National Knowledge Infrastructure (CNKI) database for two periods (1999–2019 and 2020–2022). Five aspects were analyzed in terms of the keyword domain co-occurrence network, topic evolution path, emergent terms, hierarchical clustering, and confusion matrix.The findings revealed that studies focused on six broad themes: community residents, health surveys, health education, COVID-19, healthy city, and public health. Based on these findings, the paper compares and discusses research priorities before and after the outbreak and highlights areas for further research and attention. Historically, cities have been at the center of pandemics, and public health crises have played a significant role in the evolution of urban planning and design concepts and technologies . As contIn the urban spatial structure, the street is the most important public space in the city, which spreads like a human vascular vein . The manThere is no doubt that the relationship between urban streets and residents' health in China will emerge in the research of different professional disciplines. The street, as an administrative and statistical unit, can be used in the research of health management, disease investigation, and analysis, especially during the epidemic period; it will be considered as the “first line of defense for epidemic prevention and control” . At the In this context, this study aims to review research on the relationship between urban streets and residents' health in China from 1999–2019 to 2020–2022. Specific objectives were to identify key topic areas, discuss how they have changed over time, and generate references that highlight influential literature. Through comparison, this study also emphasizes lessons to be learned from the epidemic and makes recommendations for areas that are relatively underdeveloped and require further research. This study provides a detailed systematic review of specific issues, emphasizing the relevance of various topics. The research findings can be used to understand better the current knowledge structure related to the subject, provide critical resources for reference and obtain more information for interested researchers and decision-makers, and then identify potential research differences.The bibliometric analysis summarizes large quantities of bibliometric data to present the state of the intellectual structure and emerging trends of a research topic or field. The analytical process is a combination of quantitative and qualitative assessment and interpretation –15. ThisTo make the analyzed data more comprehensive and reliable, the China National Knowledge Infrastructure (CNKI) databases was used as the data retrieval source. The database is listed as the main journal articles access database in Oxford LibGuides and Harvard Library's Chinese Studies, and CNKI is also the largest digital library in China, which includes most Chinese academic publications –21. The In this study, the Dissimilarity Matrix was constructed as follows . FirstlyAccording to the above, the paper sorts out the literature focus and research fields in these two periods, then discuss the research trend, the main topic areas of research, and the results of the analysis of the evolution path of the research topic.As seen in The study of the relationship between urban streets and residents' health in China, as a cross-cutting research theme, mainly involves the following disciplines during 1999–2019: public health and preventive medicine, clinical medicine, society, politics, urban and rural planning and municipalities, urban economy, and environment (in order of the percentage of literature by discipline); during 2020–2022, it mainly involves public health and preventive medicine, the urban and rural planning and municipality, urban economy, society, politics, etc. There is a clear shift on the proportion of literature by various disciplines and particularly with a significant increase in urban and rural planning and municipalities, and urban economy between 2020 and 2022.Valid keywords were extracted from 688 articles, and a total of 1,575 keywords were obtained. Valid keywords were extracted from 210 papers, and a total of 677 keywords were obtained. In this study, a time-zone diagram of the theme evolution was analyzed by COOC, and Burst Detection was performed by CiteSpace, which is based on the temporal dimension to determine (grasp) the research evolution paths, evolution characteristics, and frontier research trends of the research theme over different periods. During 1999–2009, the emergent terms with high salience and centrality were humanization, urban public space, and urban community sports. The emergent terms in this period indicate that research on the relationship between urban streets and residents' health in China has focused on the humanization of spaces, the development of community sports, and the education and management of residents' health. Residents' daily hygienic behavior is the critical normative content of health education through the production and distribution of promotional materials , explaining to residents about the prevention and treatment of chronic diseases, and guiding them to look at hygiene bulletin boards, hygiene wall posters, etc., and regularly carrying out thematic hygiene knowledge competitions and health consultation activities . Along wDuring 2010–2015, urban streets, community construction, population aging, and landscape design were the emergent terms with high emergence and centrality. Based on the SD method, Gou and Wang  evaluateDuring 2016–2019, only the words of social organization, elderly service facilities, urban design, community governance, accessibility, built environment, and optimization strategy emerged. Luo and Fu , based oThe context of the study theme at this time is the emergence of new types of research evidence as cities enter a phase of stock renewal and a new phase of centralized data generation for all types of urban data. Big data and open data constitute the new urban data environment, making the research results more scientific and overcoming the limitations of static, scale, and granularity trade-offs in traditional methods. However, numerous researchers are at the stage of analyzing the data and exploring the relationship between variables, and the evaluation of how to make the research results serve in the actual street space update and the effects after use is relatively weak. On the other hand, the equity of the study also needs to be concerned, as most of the studies focus on first-tier cities with good economic environments and infrastructure, and more levels of cities are needed as research subjects.The thematic evolution trends of this research area in the period of 2020–2022 are shown in The clustering tree diagram  and confThe second subcategory contains only township (street) and women of reproductive age. The third subcategory is from survey analysis to health status. In these two categories, streets appear as administrative services and statistical units. The research focuses on the reproductive health and health knowledge of married women of childbearing age , 40, as Integrating and analyzing the results of these three categories mentioned above, it was obtained that the literature is dominated by studies focusing on community residents, health surveys, and health education. In other words, research questions related to urban public health are relatively under-explored. An important issue that can be noted from this analysis is the diversity of groups targeted for study in health survey research , which brings insight into public health research from an urban planning and urban design perspective (there is a homogeneity of research groups). The change in the content of health education requires a diversification of the means of communication and the timeliness of acceptance by residents throughout the process.The clustering tree diagram  and the The second subcategory contained only psychological health and COVID-19, and He et al.  concludeIn the third and fourth subcategories, from street space to older people health, Yu et al.  proposedOn the other hand, Yu et al.  discusseIn the fifth subcategory, from landscape to street design, Li and Yang  propose During this period, research related to COVID-19, healthy city, and public health topics were more prominent. Among them, the healthy street is a new model for street development and a new direction for street design in the context of healthy city and stock planning, and it provides physical, psychological, and social dimensions of health services for residents. During a pandemic, the combination of administrative and geospatial attributes of streets is more evident, and the epidemic policies at different stages influence when and where residents go out and have a subtle impact on their daily life behaviors, for example, online food delivery services , communiOn the other hand, for this topic, searches in two databases, web of science and ScienceDirect, found that travel restrictions imposed during the pandemic increased the risk of alienation and associated stress and anxiety issues. At a time when most residents want to maintain their physical and mental health by accessing parks and street green spaces –64, it iAnother important issue reflected by the pandemic is the vulnerability of cities to supply chain disruptions, especially those related to the food supply, mainly due to restrictions on movement in pandemic prevention policies that block the food transportation chain from farms to markets and to residents' homes, which is undoubtedly a huge blow to low-income groups and the unemployed . Lal 7272 and LaFrom before to after COVID-19, the theme extended from the focus on the health of community residents and the sustainable development of healthy streets to re-examine the allocation of street space and refined management, focusing on women and vulnerable groups , this has accumulated more experiences and rich research directions for exploring the relationship between street space and residents' health such as building more humane streets and improving spatial compatibility; adhering to the orientation of healthy street planning and design, and refining the design of street facilities; using flexible thinking to manage street space in multiple dimensions and pluralistic participation in governance (civil society groups); continuing to pay more attention to women and disadvantaged groups; applying urban multi-source data to improve the information and technology of street governance, etc. The impact of COVID-19 has left cities operating in an environment with extreme uncertainty. Such a result is a challenge to the socio-economic, public health, and social stability, leaving governments with difficult trade-offs. City managers and researchers have explored different perspectives on how to control the spread of pandemics in urban spaces to safeguard sustainable urban development and health equity for residents; among them, the street is the most basic research unit. Although human society has been affected by COVID-19, the relationship between street space and residents' health should also follow the objective laws of urban, economic, and social development. A paradigm shift in governance from planning concepts and design tools to the policy of management is needed, rather than relying on a temporary and campaign approach to deal with the relationship between the two when a public health event occurs, and such shift must become a regular and continuous spatial governance effort.The purpose of this study is to provide an overview of existing research on the relationship between street and resident health in urban China before and after the onset of COVID-19, to identify major topic areas, and to highlight under-researched areas. In an analysis of 688 papers published from 1999 to 2019, it was found that research relating to this topic can be summarized into three major themes: community residents, health surveys, and health education. And from 2020 to 2022, themes of COVID-19, healthy city, and public health were dominated, and the research relating to this topic is enriching and growing.COVID-19 once again reveals how pandemics change the spatial structure of cities and social relations in space, reshaping space and social relations during the pandemic, which also created new spatial inequalities. Hence, executable policy of health is depending on political will and state budgeting . When stOverall, the pandemic has had a subtle impact on the relationship between streets and the health of China's residents. Now that 3 years have passed since the pandemic, it is the appropriate time to take stock of the lessons learned in order to improve the ability of cities to cope with the pandemic and to maintain sustainable and healthy urban development. First, because the streets have different orientations in the research of different disciplines, but they are interrelated, so the theoretical framework, research methods and research paradigms of the research are diverse. Second, at different times, the integration of urban streets and residents' health is different, and the correlation between the resources of each element within this complex system has not been sufficiently studied. Third, the shift of the study from relevance exploration to the causality of the research content, makes the findings more convincing. Fourth, there have been researchers who have conducted quantitative research through experimental methods, using technical equipment and virtual experiments, but the complex diversity of the city itself makes the research results remain some uncertainties.The research on the relationship between urban streets and residents' health is influenced by multiple factors such as urban economy, politics, society, science and technology, public health, etc. The research should be based on the actual situation of urban development, with more links to administrative management, public health, pathology, and other disciplines to strengthen the relationship, distinguish the problem under study and discern its characteristics. In the process of problem analysis, it is important to avoid the reduction of interdisciplinary cross-research opportunities due to the lack of knowledge on related research contents in different disciplines, which is one of the reasons why it is difficult to implement research and obtain appropriate results. Moreover, some research results, because it takes a certain period of time to execute on the ground, are less effective, and it is an issue worthy of attention on how to promote the implementation of research results. Therefore, when conducting research on the relationship between urban streets and residents' health, it is necessary to integrate the interrelationship between research elements, go beyond the traditional research from the perspective of the research object itself, and break the research paradigm of “current situation - problem - countermeasure”.However, this study has its limitations. Evidently, bibliometric analysis is a valid method to provide an overview of the research field, identify major subject areas, and explore the evolution of themes and concepts. Yet, this study only provides a systematic review of the literature in China, and relevant research literature from other countries should be examined to better understand the impact of pandemics in providing more specific policy recommendations. In addition, most of the articles that this study analyzed are peer-reviewed. Evidence reported in the gray literature should also be considered in future studies to ensure better coverage of real-world impacts and policy-focused reporting, which will improve the coverage and breadth of study results where limitations can be reduced and reflect the needs of the real world.The datasets presented in this study can be found in online repositories. The names of the repository/repositories and accession number(s) can be found in the article/supplementary material.LM and K-HW: conceptualization, methodology, and writing—review and editing. LM: writing—original draft, software, formal analysis, data curation, and visualization. Both authors have read and agreed to the published version of the manuscript.


The main objective of this paper is to analyze the Brazilian Ministry of Health (MoH) efforts in the management of medical equipment, with a specific approach for lung ventilators in the pandemic scenario of COVID-19.The methodology included a review of the normative framework and literature on technological management and research on the database of the Ministry of Health.As a promoter for acquiring medical equipment, the MoH role is highlighted and added to this competence; its function as the coordinator of the National Policy on Health Technology Management (PNGTS). According to the PNGTS the MoH has to support health managers in the implementing, monitoring, and maintaining health technologies. The scenario of lung ventilators in the pandemic was discussed, with research to verify demands, offers, installed capacity, and investments. In less than one year, the Ministry of Health acquired several pulmonary ventilators, 8.55 times greater than the annual averages of equipment acquired from 2016 to 2019. So far, there is still no maintenance plans or strategy of management for that equipment, especially in a post-pandemic scenario. Conclusion: It is possible to conclude that the Ministry of Health needs to improve health technology management systems. On the scale of the Policy, it is necessary to commit to permanent and long-term actions to ensure sustainability and reduce the technological vulnerabilities of the SUS. The Brazilian Ministry of Health (MoH) has historically made efforts to adapt its installed infrastructures through investments based on Programs to Strengthen the Unified Health System (SUS). One of the MoH financial efforts is "Action 8535—Structuring of Specialized Health Care Units" , which iThrough these investments to public and private non-profit institutions, linked to SUS, the MoH substantially fosters the market for medical-hospital equipment with more than US$ 140 million per year, intended exclusively to purchase medical-hospital equipment and materials permanents . In 2018The MoH's first formal initiative on medical-hospital equipment management was in1990. The MoH created the Dental-Medical-Hospital Equipment Program (PROEQUIPO). This program aimed to contribute so that the health system had, at all levels , dental-medical-hospital equipment addressed to international technical standards regarding safety and quality and qualified human resources to manage this entire installed park.This initiative hoped to avoid operators' and patients' risks, wasted financial resources, and early scrapping of equipment .i)the creation of a specialization course in the area of management and maintenance of medical equipment for professionals of different levels of education ;ii)the development and internalization of international technical standards for the certification and improvement of the quality of the manufacture of electromedical equipment;iii)the creation of electromedical equipment testing laboratories for certification procedures;iv)the reformulation of the standard on hospital construction , which later originated the Ministerial Order MoH nº 1884/1994;v)the development of technical manuals to guide health professionals in the areas of safety, planning, and dimensioning of hospital environments;vi)the development of standards and ordinances by the Ministry of Health to improve the quality and safety of medical equipment;vii)and the mandatory registration of medical equipment and articles sold in the country .Between 1992 and 1996, the Program allowed:In January 1997, the MoH published the operative manual for the SUS Reorganization and Reinforcement Project (REFORSUS). The World Bank—WB financed the Project to recover the country's health network infrastructure by purchasing medical equipment, renovation, expansion, and conclusion of health institutions infrastructure, and actions to improve the management of services. These initiatives resulted in a considerable increase in the value of the technological park of SUS healthcare establishments, which in 2015 arrived at the level of 63,626 institutions involving around 17.5 million dollars in investments .Within the scope of REFORSUS, MoH carried out several actions and initiatives to prepare SUS technical staff in the management of health technologies. In 2002 the MoH made a public call to finance a distance learning project related to the training of national human resources on medical and hospital equipment management. This action was named the Medical- Hospital Equipment Maintenance Management (GEMA).In mid-2001, the Brazilian National Health Surveillance Agency (Anvisa) instituted the Sentinela Network intending to be an active observatory of the performance and safety of regularly used health products: medicines, IVD, orthoses, prostheses, equipment, and medical- hospital materials, sanitizing, blood and its components. Among its specific objectives, the following stand out: i) obtain quality information on adverse events and technical complaints related to products under surveillance in the post-use / post-marketing period—VIGIPOS, to support decision-making by the National Surveillance System Sanitary (SNVS); ii) contribute to the improvement of risk management in health services; iii) develop and support studies of interests to the Brazilian Public Health System . The intIn 2007, the Support System for the Elaboration of Health Investment Projects (SOMASUS) was created, which is a computerized system with free access, developed by the Executive Secretariat of the MoH, to assist states, municipalities, and institutions of the SUS in the elaboration of infrastructure investment projects in a more qualified way. The information provided by SOMASUS includes layouts of the environments of health establishments, their respective technical characteristics, and comprehensive content to support dimensioning, acquisition, installation, and operation of medical assistance equipment. The development of SOMASUS was based on the premise that establishing standards is essential for planning health investments. Therefore, the available content is based on the parameters from SUS care coverage, ministerial ordinances, technical standards, and Anvisa collegiate directive resolutions .In early 2008, Ordinance nº 375/GM/MS was published, which instituted the National Program for Qualification, Production, and Innovation in Equipment and Materials for Use in Health at the Industrial Health Complex. The General Coordination of Equipment and Materials in Health (CGMES) within the structure of the Department of the Industrial Health Complex(DECIIS) of the Secretariat of Science, Technology and Strategic Inputs (SCTIE) .In May 2019, through Decree nº 9,795, DECIIS and, consequently, CGEMS were extinguished . In thisAlready in 2010, the National Health Technology Management Policy (PNGTS) was published, which is the guiding instrument for the actors involved in the management of the assessment, incorporation, dissemination, management of the use and withdrawal of technologies in the Unified Health System. PNGTS establishes that it is up to the MoH to support managers in the implementation of technologies and in their monitoring and maintenance after incorporation .In 2011, the MoH instituted the Health Network Quality Improvement and Training Project , with an intervention proposal to support the organization of regionalized health care networks in Brazil. It was a cooperation between the World Bank and the Ministry of Health, which aims to add to the ongoing efforts to consolidate SUS. There has been a quantitative and qualitative leap in providing health technologies to the population in recent years. This new reality has demanded from health managers an increasing effort to train professionals to manage medical-assistance equipment to optimize the use of public resources and expand the population's access to this equipment .Also, in 2011, Law 12,401 was published, and it provides rules for therapeutic assistance and the incorporation of health technology within the scope of SUS. Decree nº 7,646 provides for the National Commission for the Incorporation of Technologies in the Unified Health System (CONITEC) and the administrative process for incorporating exclusion and altering health technologies SUS .In 2013, through Ordinance GM/MS nº 3134, the National List of Equipment and Permanent Materials financed by SUS (RENEM) was created to manage the financeable items for SUS and standardize their nomenclatures, allowing their effective management. RENEM items are made available to register project proposals according to the type of Health Care Establishment and their respective environments, organized by the Equipment and Materials Information and Management System (SIGEM) .At the end of 2014, Ordinance nº 2,531/GM/MS was published, which redefined the guidelines and criteria for defining the list of strategic products for SUS and the establishment of Partnerships for Productive Development (PDP) .We carried out a literature search for normative account and survey of descriptive and exploratory data on the management of medical and hospital equipment within the scope of the MoH: i) National Register of Health Establishments (CNES) of the Department of Informatics of SUS (DATASUS), ii) and the System of Management of Equipment and Permanent Financeable Materials for SUS (SIGEM) of the National Health Fund (FNS). CNES provides information on the registration of Health Establishments regarding the physical area, human resources, equipment, and outpatient and hospital services. SIGEM, on the other hand, is the system that makes the information on financial equipment available to SUS. Data search was also carried out in the Federal Government's Integrated Financial Administration System (SIAFI), an accounting system to carry out all the processing, control, and financial, patrimonial, and accounting executions of the Brazilian federal government. Finally, we consulted the database on the ANVISA website to obtain information on the health records of lung ventilators.https://covid.saude.gov.br/, containing information on the pandemic's Brazilian response. The original search was carried out between March 2020 and December 2020.We also made consultations in the MoH website database dedicated to coronavirus data, In addition to research of an applied nature with a qualitative and quantitative approach, it is considered the authors' practical experiences in managing medical-hospital equipment and the health industrial complex.The lung ventilator is a device used in cases of respiratory failure, with the function of pumping oxygen-enriched air into the lungs. In the SIGEM there is the item with the nomenclature Pressometric and Volumetric Lung Ventilator with a suggested value: US$ 11.440,7749 .In consultation with SIGEM, in March 2020, approvals for decentralized purchases of lung ventilators in the last four years were verified, Table Checking the approval data in the last year, 2019, we can see that 76% of the approved items have specification and value  suggested by the Ministry of Health, which indicates that the settings definitions are mostly standardized.In consultation with the National Register of Health Establishments (CNES-DATASUS)  in MarchIn a consultation carried out March 2020), 60 records of volumetric lung ventilators were found on the Anvisa website [20, 60 reIn the paper entitled "Study of Medical-Assistance Equipment, Orthotics, Prosthetics, and Special Materials in the Unified Health System (SUS) in Brazil," published in March 2019, the authors intended to consolidate the strategic and priority products in a single list through the analyses of computerized databases, publications, and consultations with the technical and final areas of the Ministry of Health. In addition to crossing the information with the previous publications on the list of strategic products, assistance demands, incidences and ABC curve, judicialization, and recent incorporation in SUS. The study considered all the criteria with the same relevance and without weighting. The lung ventilator appeared in four out of five possible criteria, showing its relevance to the services and the health system . The lunWith the establishment of a pandemic of international importance due to the new human coronavirus, MoH took measures to deal with the public health emergency, mainly to provide the historical care demand for lung ventilators.Interministerial efforts through a workgroup coordinated by the Special Secretariat for Productivity and Employment of the Ministry of Economic (MoE), with broad support and participations from the business community, the productive sector, and financial agents gathered energy to supply the necessary demand of SUS in lung ventilators. Highlighting that this happened almost a year after the extinction of CGEMS and DECIIS within the MoH, remembering that one of its competencies was coordinating activities for qualification, productions, and innovation in medical and hospital equipment.In addition to the extinction of DECIIS, the MoH extinguished the Executive Group for the Industrial Health Complex—GECIS. This Forum, coordinated by the MoH, was a formal representation of fourteen bodies or entities of the Federal Public Administration, involving the decision-making nucleus of national development policy , national development and regulation agencies and ST&I institutions. With this Forum, the SUS National Directorate began to coordinate, in an unprecedented way, a priority policy for industrial, technological, and innovation development, placing itself as an instance of articulation of the economic, industrial, and technological area to meet the imperatives of SUS .Productive escalation: First, MoH specified the demand and criteria for ventilatory therapy for patients affected by COVID-19. Then, the MoH stimulated partnerships for large-scale product developments, arrangements for the production of critical components, and all the logistics necessary for the national companies that produce lung ventilators to make an exponential leap in their production to supply the centralized acquisition of MoH. Table a) More Maintenance Initiative Lung Ventilators: The Initiative + maintenance was carried out through a voluntary network to maintain unused lung ventilators, estimated at 3,000 lungs ventilators. The voluntary network was formed by the National Service for Industrial Learning (SENAI), ArcelorMittal, BMW Group, Fiat Chrysler Automóveis (FCA), Globo Comunicação e Participações, Ford, Oswaldo Cruz Foundation, General Motors, Honda, Hyundai Motor Brazil, Votorantim Institute, Technological Research Institute (IPT) and POLI-USP, Jaguar Land Rover, Mercedes-Benz do Brazil, Moto Honda, Petrobras, Renault, Scania, Todos pela Saúde (Itaú), Toyota, Troller, Usiminas, Vale, Volkswagen do Brazil and Volvo do Brazil. Supported by the Ministry of Health, the Ministry of Economy, the Brazilian Agency for Industrial Development (ABDI), and the Brazilian Association of Clinical Engineering (ABEClin). It had 40 points to receive the equipment. It involved more than 500 engineers and trained technical volunteers. More than 2,500 lung ventilators were recovered [b) ecovered , 24.Among the actions carried out by the interministerial group to supply the care demand for lung ventilators, the following stand out:Regarding the national lung ventilator manufacturers, it is essential to register the investments and government subsidies that allowed the country to have the productive capacity to respond to the health emergency. Among those manufacturers, we highlight the history of KTK Takaoka, specifically the young medical student Kentaro Takaoka, who, with subsidies from USP's Institute of Technological Research (IPT). He set up a plant in the building of the Clinical Hospital of the Faculty of Medicine. He developed reduced dimensions equipment capable of performing controlled artificial ventilation, winning in 2005 Finep (Brazilian Innovation Agency) Inventor Innovator trophy .Also, there was support for the Magnamed company, founded in 2005. This company was one of the first companies invested by the Center for Innovation, Entrepreneurship, and Technology (Criatec), in 2014 it received from BNDES, through PSI—Innovation (Investment Support Program), credit for a new lung ventilator development project and in 2015 support from FINEP—Innovation and Research.As Marcelo Miterhof, an economist at BNDES, points out, “if today we have a company capable of manufacturing high-tech equipment in Brazil, it is not luck or chance. It is a collective effort of Brazilian society. That started with the Technological Institute of Aeronautics (ITA), passed through USP's laboratories, received funding from FAPESP research, gained scale with investment funds from BNDES and FINEP, obtained subsidized credit from BNDES-PSI, and now it will help Brazil to face the pandemic, strengthening the SUS” .It is worth mentioning Anvisa's actions and efforts with the issuance of instruments and transitory flexibility applicable to the confrontation of COVID-19. Specific resolutions have been published to address lung ventilators. Such efforts have contributed to expanding the availability of lung ventilators with accurate health records. In June 2020, 70 records of pressure and volume lung ventilators were located.In consultation with CNES, in December 2020, the installed capacity of lung ventilators in SUS also increased considerably, from 43,758 units in USE in SUS to 60,089, Table The pandemic of the new coronavirus highlighted the weaknesses in the databases for managing health technologies in the Ministry of Health. As demonstrated, there have historically been efforts for management systems for technology investments, appropriately for the decentralization of resources with a view of the institution's acquisitions. However, there are still no tools to assist the management of these post-acquisition technologies. CNES data, at the beginning of the pandemic, suggested that about 3,000 lung ventilators were out of use, and it is not possible to identify the reasons for this equipment not being in use. It should be noted that the MoH systems do not have standardization of item nomenclature; they are not interoperable and connected, which makes data collection and management difficult.The management of technologies involves, in addition to other system and infrastructure resources, trained human resources in operation and maintenance of this equipment in health establishments. The annual demand in recent years, through the approval of investment proposals from the Ministry of Health, averaged 1,800 lung ventilators per year. Given the massive centralized purchases, about 15,000 lung ventilators, efforts to adapt the management of these technologies in health services are imperative.The analysis of the technical specifications of the lung ventilators approved in 2019, about 76% with the same specification, indicates opportunities for using government purchasing powers through possible centralized purchases with the possibility of more significant advantage and economy, especially to establish maintenance clauses and post-investment data.In less than a year, the Ministry of Health acquired several lung ventilators, 8.55 times greater than the annual average of equipment acquired from 2016 to 2019. It should be noted that, to date, there has been no maintenance or management plan or strategy for this equipment, especially in a post-pandemic scenario. It should be noted that according to PNGTS, it is up to the MoH to support managers in the implementation of technologies and in their monitoring and maintenances after incorporation.Technology management lacks interoperable data and systems for its implementation. Data fragmentation, absence of technology databases compromises public policies and weakens the performance of health services.Furthermore, the articulation of public policies that combine efforts to ensure the population's access to the SUS is crucial. The interruption of the activities of the Industrial Health Complex, especially of the GECIS meetings, in the year preceding the pandemic, demonstrates the fragility of the continuity of government efforts in the medium and long term for national productive development, with a reduction in the dependencies of the international market.Therefore, based on the themes discussed here, it is possible to conclude that the Ministry of Health needs to improve health technology management systems. On the scale of the Policy, it is necessary to commit to permanent and long-term actions to ensure sustainability and reduce the technological vulnerabilities of the SUS.


In this sense, despite the relevance of the growth of female participation in the medical career, little is discussed about the distribution between genders of the main surgical medical specialties in the country.  discuss the process of feminization in surgical specialties in Brazil over the last few years, tracing a distribution profile of these specialties.  this is a retrospective and cross-sectional study with secondary data from the Censuses of Medical Demography in Brazil in the years 2011, 2013, 2015, 2018, 2020 and 2023, including the surgical specialties: Urology, Orthopedics and Traumatology, Thoracic Surgery, Neurosurgery, Digestive System Surgery, Cardiovascular Surgery, Hand Surgery, General Surgery, Head and Neck Surgery, Vascular Surgery, Plastic Surgery, Ophthalmology, Coloproctology, Otorhinolaryngology, Pediatric Surgery, and Gynecology and Obstetrics. males prevails in numbers, among the surgical specialties, however, with a lower growth rate compared to females. Specialties such as urology, orthopedics and traumatology and neurosurgery are mostly male, while gynecology and obstetrics are female.  it is evident that female participation in the surgical medical field has increased significantly over the last few years.  The same effect is seen in Latin America, where during the years 1960 to 1990, the number of economically active women tripled, growing from 18 to 57 million,,,A large part of this female workforce is concentrated in some sectors of activity, including domestic, administrative, teaching, and health. When it comes specifically to Brazilian medicine, despite men still comprising the majority of the active medical class, female participation has seen a slow and gradual increase over the last few decades, marked by the increase in the number of university graduates,,-,-This change marks a process of feminization of medicine in the country, especially when analyzing younger age groups at the base of the doctors’ population pyramidIn this sense, despite the relevance of the topic on female participation in the medical career, no current research was found in the literature that debated the distribution between sexes of the main surgical medical specialties in the country. Therefore, the objective of this work is to discuss the feminization process in surgical specialties in Brazil over the last few years, outlining a distribution profile of these specialties.We conducted a retrospective, cross-sectional study with secondary data, which includes evaluating sociodemographic characteristics of doctors in Brazil according to the number of professional records, gender, and distribution in medical and surgical specialties.The secondary data used correspond to the Medical Demography Censuses in Brazil from the years 2011, 2013, 2015, 2018, 2020, and 2023.We considered the number of specialists the most suitable variable for mapping population characteristics, such as sex and age, as it disregards secondary medical records, that is, those registered with more than one Regional Council of Medicine (CRM) for practicing in more than one Federation Unit. We obtained specialist data from the Medical Demography Censuses, by crossing information from medical specialty societies, the National Medical Residency Commission (CNRM) of the Ministry of Health, and the Regional Medical Councils, as there is no unified database in the countryWe included the following medical specialties: Urology, Orthopedics and Traumatology, Thoracic Surgery, Neurosurgery, Digestive System Surgery, Cardiovascular Surgery, Hand Surgery, General Surgery, Head and Neck Surgery, Vascular Surgery, Plastic Surgery, Ophthalmology, Coloproctology, Otorhinolaryngology, Pediatric Surgery, and Gynecology and Obstetrics.We present the data in raw numbers, percentages, and by the male-female ratio (MFR), which constitutes descriptive statistics, calculated from the number of males divided by the number of females in the same surgical specialty. Values less than 1 indicate a predominance of females in relation to males, while values greater than 1 indicate male predominance. In turn, a ratio equal to 1 indicates equality between the groups. We tabulated and organized the obtained data in Microsoft Office Word and Microsoft Office Excel, both in the 2016 version.To demonstrate the temporal distribution of the percentage of male and female specialists, we created maps with pie charts using the QGIS 3.22 software. The country’s demographic and cartographic data were obtained from the Brazilian Institute of Geography and Statistics (IBGE), comprising data available in the Medical Demography Censuses in Brazil for the years 2011, 2013, 2015, 2018, 2020, and 2023.Since we extracted the data from public domain documents, submission to the Ethics in Research Committee was not necessary.Regarding the total number of specialist doctors, males remain with significant numbers, totaling, in 2023, 96,836 doctors, as opposed to 45,921 female physicians. At the same time, the growth rate in the number of female specialists increased by 114%, in contrast to the 77% growth for male doctors .Certain specialties remain predominantly male, such as urology, followed by orthopedics and traumatology and neurosurgery . On the The biggest drop in the MFR was in the urology sector, falling from 84.61 (2011) to 33.04 (2023), followed by thoracic surgery, from 14.34 to 7.02, and orthopedics and traumatology, varying from 19.2 to 12.47 .--As occurred in other professional classes, Brazilian medicine is undergoing a change in the distribution between the sexes, the effect of a movement in favor of equal rights and a reduction in inequalities and discrimination in the work environmentth century that the first female medical students graduated in Brazil,th century, men made up 77.7% of the medical profession. This male expressiveness lasted until the 60s, when it reached 87%. Following the opening of more medical schools and the significant fight for rights, female participation increased from 15.8% in 1970 to 48.6% in 2022,,It was only at the end of the 19-,,Despite the reduction in sex discrepancy over recent years, surgical specialties are still predominantly male. This same scenario is found in the United Kingdom and the United States, as men represent 73% and 61% of practicing surgeons, respectively. Among the surgical specialties studied, urology and orthopedics and traumatology were the specialties marked by the numerical superiority of men, despite the significant reduction in the discrepancy between sexes. Studies indicate that these surgical areas are, historically, demarcated by gender discrimination and psychological harassment, which, although often unrecognized, prevent women from entering them,,--When asked about the reasons, among other factors listed, the precarious maternity policy and work relations in educational institutions and hospitals, as well as the restricted guidance and mentoring on the part of teaching superiors and the salary difference are important causes of dissatisfaction and low adherence of women in surgical and academic careers-,,Another critical point strictly related to sex discrimination refers to female surgeons being repeatedly questioned about their professional and social skills, which is reflected in the limited number of women taking on leadership and coordination positions in surgical areas-,,,,Conversely, surgical specialties focused on women’s health or that simultaneously have an associated clinical career, such as gynecology and obstetrics, otorhinolaryngology, and pediatric surgery, have a greater female participation and, therefore, display the lowest MFR rates. This is due to more valued and respected maternity policies, more flexible work routines and hours, in addition to more harmonious and balanced working relationships with superiors-,,-,,In fact, when analyzing the years studied, there was a significant increase in women in surgical specialties, especially due to the fight for labor rights and the deconstruction of cultural paradigms and social stereotypesAs limitations of the study, it is worth mentioning that a single data source - the Medical Demographic Census - can contribute to a smaller sample number of data and, therefore, mischaracterize the numerical reality of the proportion between men and women in surgical specialties in Brazil. Furthermore, it is not possible to know what is the main dedication or composition of the journey of doctors who have degrees in more than one specialty, which may not reflect reality.Female participation in the medical and surgical field has increased significantly over recent years, with a greater proportion of growth and participation in certain specialties. Although this great advance has been demonstrated, educational measures related to coexistence in the workplace and labor rights are still necessary, in search of a greater increase in the surgical training of women, aiming at equal participation between men and women in this field.


Although gender inequities in surgery are well recognized in the international literature, the panel portrayed how distant we are from the desired equity in our country. In addition, the session emphasized the need to broaden the debate and identify the mechanisms for greater inclusion and maintenance of women in the surgical career. In this editorial, we provide a historical overview of gender disparities in the Brazilian surgical ecosystem, highlight the contributing factors to a reduced number of female surgeons, and how the structure of medical societies may influence the rise of women to leadership positions. Accordingly, we discuss the benefits of gender diversity for surgeons, patients, and institutions. Furthermore, we analyze the representation of women in the Brazilian College of Surgeons since its foundation and in the scientific sessions at the conference, demonstrating that more initiatives are required to encourage female representation in the college. Finally, we propose a series of recommendations to foster engagement and contribute to the prosperity of women surgeons in Brazil.In September 2021, the 34 The panel was moderated by Dr. Maria Cristina Araujo Maya, professor of general surgery at the State University of Rio de Janeiro, and featured three speakers from different generations: Dr. Elizabeth Gomes dos Santos, general secretary and president of the Commission of Women Surgeons and of the Residency Committee of the Brazilian College of Surgeons (Colégio Brasileiro de Cirurgiões - CBC); Dr. Fernanda Lage Lima Dantas, professor at the Federal University of Acre, member of the Commission of Women Surgeons and full member of the CBC; and Dr. Flavia Yung Ju, plastic surgeon, full member of the CBC and preceptor of the Brazilian Institute of Plastic Surgery. On the panel, the three speakers addressed the low representation of women in the surgical area, the challenges they face, and the factors that contribute to maintaining the status quo. Although the existence of gender inequities in surgery is recognized in the international literature, this panel portrayed how far we are from the desired equity in our country. In addition, it was clear the need to broaden the discussion, identifying means for greater inclusion and retention of women in the surgical careers. Finally, it is still necessary to fight prejudice and to reaffirm the benefits of diversity for surgeons of both genders and for patients, as well as to find ways for medical societies to contribute to the prosperity of female surgeons in Brazil.In September 2021, the 34Women who choose a surgical career have faced historical challenges for generations. Until 1879, women were not accepted in medical schools in Brazil, a paradigm broken by Dr. Rita Lobato Freitas, the first physician in the country to graduate from the Bahia Faculty of Medicine, in 1887. Gradually, the percentage of women studying medicine increased, reaching 50% of the total number of medical students in 1993, and becoming the majority in 2009,Several factors contribute to a reduced number of women opting for a surgical career. Among the reasons mentioned by the conference speakers, two were recognized by a study carried out with Brazilian female doctors as the main challenges: the balance between personal and professional life and the workloadDuring the panel, the guests also discussed how the structure of medical societies influences the rise of women to leadership positions,,8.12.  Men and women differ in their experiences and values, which influence both interests and prioritiesth Brazilian Congress of Surgery, only 21% (95/455) of the speakers were women  through mandatory institutional courses on diversity, equity, and inclusion for medical students, resident physicians, and practicing physicians, as well as other health professionals; Strengthen institutional notification and response mechanisms in cases of gender discrimination and moral and sexual harassment; Promote equal mentoring and career planning programs with counseling, guidance, and emotional and professional support;Implement family planning initiatives during graduation and residency, providing information on contraceptive methods, fertility, and assisted reproduction, as well as compatible maternity and paternity leave, flexible hours, and day care in workplaces, with adequate facilities for breastfeeding, among others; Promote gender diversity when selecting speakers, moderators, and members of congress organizing committees, to achieve greater equity during the event, including also other genders and ethnic minorities; Develop a diverse and inclusive organizational culture in the context of medical societies in different areas of expertise.th congress, the CBC was innovative by enabling protagonism to women surgeons and diversity with the “Panel discussion: Women in Surgery”. More measures like these will be needed to allow the Congress and the College to become more inclusive environments. Incorporating diversity and equity as institutional values enable the inclusion of different perspectives and leadership styles that benefit patients, surgeons, and organizations. Thus, medical societies can and should be spokespersons for these changes, as well as agents that promote women’s prosperity in surgery.  The Brazilian Congress of Surgery is one of the main spaces to promote scientific discoveries, generate debates, and communicate discoveries in the surgical area. Therefore, the event selects which people and ideas are considered relevant to medical-scientific development. In its 34


Water quality criteria (WQC) for the protection of aquatic organisms mainly focus on the maximum threshold values of the pollutants that do not have harmful effects on aquatic organisms. The WQC value is the result obtained based on scientific experiments in the laboratory and data fitting extrapolation and is the limit of the threshold value of pollutants or other harmful factors in the water environment. Until now, many studies have been carried out on WQC for the protection of aquatic organisms internationally, and several countries have also issued their own relevant technical guidelines. Thus, the WQC method for the protection of aquatic organisms has been basically formed, with species sensitivity distribution (SSD) as the main method and the assessment factor (AF) as the auxiliary method. In addition, in terms of the case studies on WQC, many scholars have conducted relevant case studies on various pollutants. At the national level, several countries have also released WQC values for typical pollutants. This study systematically discusses the general situation, theoretical methodology and research progress of WQC for the protection of aquatic organisms, and deeply analyzes the key scientific issues that need to be considered in the research of WQC. Furthermore, combined with the specific characteristics of the emerging pollutants, some new ideas and directions for future WQC research for the protection of aquatic organisms are also proposed. Water quality criteria (WQC) refers to the maximum concentration or level at which pollutants or environmental factors in water environments do not have harmful effects on human health or water ecosystems ,2,3. WQCCurrently, the two mainstream WQC research systems internationally are based on those of the United States and the European Union (EU). The United States puts forward the toxicity percentage ranking method, which is a two-value criteria system . It poinVarious relevant factors are comprehensively considered in the derivation process of WQC, and the determination of criteria values is influenced by many water environmental factors, such as water hardness, temperature, pH and dissolved organic matter, and so on ,15,16,17Based on the mentioned above, the main purpose of the present study is to systematically summarize and integrate the current technical methods of WQC, deeply analyze the key issues and technical systems of WQC research methods and summarize the current case studies of WQC. Finally, some new ideas of the derivation method of WQC for emerging pollutants are also explored and prospected.The pioneering study on WQC began in the early 20th century. The United States was the earliest country to conduct WQC research. The development process of water quality standards is presented in the form of a series of WQC papers, reports, and monographs. Additionally, the United States finally issued its national water quality guideline for the protection of aquatic organisms in 1985. In addition, the European Union, the Netherlands, Canada, Australia and New Zealand, Japan, China, and other countries have also formulated their own relevant technical guidelines for WQC and established their own WQC and ecological risk assessment research systems. With the deepening of WQC research, many countries have revised, improved, and updated their guidelines in recent years .For example, the technical guidance of the United States was issued in 1985 [Technical Guidance Document for Risk Assessment” (TGD) in 2003 [The European Union promulgated the Water Framework Directive (WFD) in 2000, which played an important role in developing and promoting the setting of water environmental quality standards. The WFD is a legal framework designed to protect freshwater and marine ecosystems from the adverse effects of pollutants and to protect human health. The European Union (EU) uses environmental risk assessment technology to derive the predicted no-effect concentration (PNEC) of pollutants as water quality protective objectives for environmental management and issued the “ in 2003 . In 2004 in 2003 . This isGuidance Document for Aquatic Effects Assessment in 1995 to evaluate the hazardous effect of pollutants on water environments [A protocol for the derivation of water quality guidelines for the protection of aquatic life” [Australian and New Zealand guidelines for fresh and marine water quality” in 2000 [the Guidance document on deriving environmental risk limits in 2001 [Environmental Quality Standards for Water Pollution in 1971 [In addition to the two mainstream countries of the United States and the European Union, some other countries and organizations have also conducted relevant research on WQC. For example, the Organization for Economic Cooperation and Development (OECD) issued the ronments . In 1999ic life” , which wic life” . The Aus in 2000 , which w in 2000 . The Nat in 2001 , which w in 2001 . The Min in 1971 , which w in 1971 .Technical guideline for deriving WQC for freshwater organisms”, which was first released by the Ministry of Ecology and Environment in 2017 [The research on WQC in China started relatively late, dating back to the 1980s. The initial research was only the collection and collation of relative references and data and integrated the research methods of WQC in different countries and organizations. Subsequently, on the basis of a large number of theoretical explorations and WQC case studies, some monographs and books related to WQC were published one after another ,5,39. Th in 2017 . It is a in 2017 , which iThere are many key steps involved in the extrapolation of WQC for the protection of aquatic organisms. In general, the factors affecting WQC mainly include the reliability of basic data, standardization of toxicity data and the scientificity of statistical analysis methods. All these elements play a very important role in the study of WQC.Firstly, in terms of species selection, the selection of regional native species is crucial for WQC. Many studies have shown that, for the same pollutant, biota differences will lead to the ultimate difference in the WQC value of the pollutant, which further highlights the importance of site-specific or native species ,42,43. T5, which is the concentration at which 5% of species are at risk [Secondly, in terms of WQC derivation methods, the derivation system based on the SSD method and supplemented by the assessment factor (AF) method has been basically formed in the world at present. The main steps of WQC derivation mainly include data collection, data screening and evaluation, and WQC derivation . The bas at risk ,45,46. I at risk  only use at risk , the SSDThe SSD method is an international mainstream method used to establish ecological environment criteria. Model selection is the core and key of this method. When building SSD models, the commonly used derivation methods according to the amount of toxicity data include the normal distribution model, logistic distribution model, etc., and the mainstream trend is to use the best-fit curve to derive the final WQC value ,48,49. SThirdly, in terms of the description and value of the WQC for specific pollutants, the double-value criteria system is mainly used internationally at present. The United States, Canada, China, and other countries adopt double-value criteria. Double-value criteria generally refer to long-term criteria and short-term criteria (or chronic criteria and acute criteria). Long-term criteria (chronic criteria) are designed to protect aquatic life  from the negative effects caused by the indefinite long-term effects of pollutants. In contrast, short-term criteria are designed to protect aquatic organisms from serious negative effects (such as death) caused by short-term effects. Some countries and organizations also use single-value criteria such as the European Union . There aIn recent years, great progress has been made in international research focusing on WQC. Many scholars have carried out a large number of WQC case studies of typical pollutants and published a series of research papers, monographs, etc. These studies not only summarized and explored the theoretical methodology of WQC for the protection of aquatic organisms but also provided case studies on WQC, including conventional pollutants, some physical and chemical parameters of water bodies, and new emerging pollutants ,39,45,52At the same time, the countries and organizations studying WQC were screened, and it was found that China and the United States were significantly ahead of other countries in terms of the number of publications on WQC, with 284 and 134 publications . In China, the Chinese research academy of environmental sciences published the most articles, and its secondary institution, the state key laboratory of environmental criteria and risk assessment, contributed more than 118 articles. The top five countries in terms of the number of articles issued were China, the United States, Canada, the United Kingdom, and Italy. Additionally, the number of WQC articles issued by these five countries accounted for 60% of all the published articles .In terms of the WQC values of toxic substances published at the national level, some countries have also published WQC for the protection of aquatic organisms for some toxic substances at the national level. For example, since the release of the guidelines for WQC in the United States, a number of WQC for toxic substances have been published, and the WQC are updated almost every 2–3 years in combination with the latest research. EPA’s compilation of nationally recommended WQC is presented as a summary table containing recommended WQC for the protection of aquatic life and human health in surface waters. These criteria are published pursuant to the Clean Water Act and provide guidance for states and tribes to use to establish water quality standards and ultimately provide a basis for controlling discharges or releases of pollutants. At present, the latest WQC published by the US EPA contains 186 indicators ,22, inclIn addition to the United States, Australia and New Zealand , Canada The acquisition of toxicity data is the key issue of WQC research. Different types of pollutants have different influencing factors in the study of WQC. For example, the toxic effect of organic matter on organisms is relatively complex, so the endpoint of the toxic effect of organic pollutants on organisms should be clarified in the WQC study, and then the criteria are deduced. The toxic effects of heavy metals are greatly influenced by environmental factors. Another problem encountered in WQC studies is the lack of data on the toxicity of the selected pollutants. The toxicity data could not meet the requirements of fitting the SSD curve, nor could they meet the requirements of the AF method. However, when environmental management is in urgent need, it is necessary to predict the toxicity data of pollutants by means of model prediction. Model prediction includes the following levels. First, how to use laboratory experiments to predict actual toxicity effects in the field? The Biotic Ligand Models (BLM) approach can be used. The BLM is a mechanistic approach that greatly improves our ability to generate site-specific ambient water quality criteria for metals in the natural environment . Water eEmerging pollutants refer to the pollutants produced in production, construction or other activities, which are caused by human activities, that clearly exist but have not been regulated by laws, regulations and standards and harm the living and ecological environment. With the continuous detection of emerging pollutants in the environment, they are gradually receiving widespread attention ,73,74. TCompared with conventional pollutants, emerging pollutants have the following differences. Taking EDC as an example, first, the dose–response relationship of conventional pollutants generally follows the principle of “low dose, low toxicity”, and its toxicity value has a certain threshold. While for EDCs, it is also toxic at low doses, with the characteristics of “low dose, high toxicity”. In addition, EDCs may exhibit certain biological effects, including delayed and multigenerational effects, and may exhibit non-monotonic dose–response relationships ,76. SecoFurthermore, in terms of WQC values, when deriving WQC for conventional pollutants, double criteria values, such as short-term criteria values and long-term criteria values, are generally formulated. Nonetheless, EDCs in a short time exposure generally will not cause serious toxicity on aquatic organisms, while, under trace concentrations, will have irreversible toxicity effects on aquatic organisms. The acute-to-chronic ratio of EDCs is generally large; the largest may reach 10,000 or 100,000 times. Therefore, it is recommended to use single-value criteria when deriving WQC for EDCs, and only the values obtained from chronic toxicity are used to derive the long-term criteria value. In addition, it is also important to establish an effective correlation between toxic effects and endpoints . Many efIn addition, a non-monotonic dose–effect relationship may appear in both in vitro and short-term in vivo studies of the EDCs, but it might not be able to widely predict the toxicity endpoint in long-term in vivo studies. In the absence of the toxicity threshold of EDCs, probabilistic methods should be used to predict the threshold, which is also a new idea for the future study of WQC of emerging pollutants.


Pregnancy, childbirth, and the postpartum period are phases commonly associated with joy and hope. Even though it may be an unplanned event for many women, pregnancy usually develops without complications most of the times: mother and newborn child start together—and well—a new phase of their lives. This does not mean that the good outcome was achieved without a significant number of women experiencing discomfort, stress, anxiety, fear, or even some sadness. These are conditions that, although not desirable, tend to be present during pregnancy, childbirth, and the postpartum period. However, for some women, this is a period of great anguish, suffering, and risk. Risk of intimate partner violence, of mistreatment in health facilities, of developing physical or psychological sequelae, and risk of dying.A maternal death is an individual, family, and social tragedy. Because it is preventable in the absolute majority of times it occurs, there is no male equivalent, and it disproportionately affects certain groups of women, maternal mortality exceeds the boundaries of clinical obstetrics and reflects broader societal issues.Homo sapiens, lies the biological basis of pregnancy and childbirth. This includes, for instance, the shape of the pelvis and the complex endocrinology of parturition. The innate characteristics and potential of the species favored the development, over time, of the current human culture and society. Culture and society are the origin of the guiding principles of social organization, the legal and political structure, and the mode of production of the economy. In this context, human interaction with the planet has produced environmental degradation, with consequences that include the increasing concentration of particulate matter in the atmosphere and the acceleration of global warming. The latter, besides being responsible for the melting of ice glaciers and the rise of the sea level, is associated with a greater frequency and intensity of extreme climate events, including heat waves or drought or severe storms and heavy rain. These events affect maternal health and have been associated with an increased maternal and perinatal morbidity and mortality.Considered as causes of complications of pregnancy, intrinsic or extrinsic etiological agents  do not act in isolation on women to produce complications. The etiological agents act under the influence of several other factors, in a complex and multifactorial process known as the health-disease process . Over thH. sapiens, their culture and society, and the environment are super determinants of the whole health-disease process, thus originating the so-called primary determinants of health. Education, income, ethnicity and gender issues affect the risk of a woman dying during pregnancy, childbirth, and postpartum/postabortion period. Women of color, those living on the outskirts of large cities or in rural areas, those with little access to education or income, are the women experiencing the highest maternal mortality.Together, the innate characteristics of Given the broad determinants of maternal mortality and the complex health-disease process, maternal mortality has long ceased to be “just” a health indicator and became a social development indicator. Hence its inclusion as a progress indicator of two successive global initiatives, the Millennium Development Goals (2000–2015) and the Sustainable Development Goals (2016–2030). Both initiatives, promoted by the United Nations (UN), seek to encourage the governments of the signatory countries to implement programs to promote social development and eliminate extreme poverty.The World Health Organization (WHO) estimates that in the early 1990s there were ∼ 500,000 maternal deaths per year worldwide. According to the UN health agency, the annual number of maternal deaths around the world would be just over 450,000 deaths in 2000 and 295,000 in 2017. The global maternal mortality ratio in 2000 and 2017 was estimated at 342 and 211 maternal deaths per 100,000 live births, respectively. In Brazil, the maternal mortality ratio in 2000 was estimated by the WHO at 69 deaths per 100,000 live births, and, in 2017, 60 deaths per 100,000 live births. The WHO estimated for 2017 a total of 1,700 maternal deaths in Brazil, with the lifetime risk of 1 maternal death for 940 women.Considering the evolution of the maternal mortality ratio in Brazil since 1990, the most substantial reduction took place in the last decade of the 20th century. This reduction of maternal mortality has been partially and ecologically attributed to a greater access to primary health care during pregnancy , greater coordination between the different levels of the health system, and improvements in emergency services. These advances occurred in the context of greater economic stability and the implementation of the Unified Health System (SUS) in Brazil, which occurred in the beginning of the 1990s. In the 2000s, the rate of reduction in the maternal mortality ratio decreased and started to tend to stability, suggesting the need for more intense social transformations as well as greater gains in efficiency and quality in the health system.Although there is no shortcut to reduce maternal mortality—social development is necessary for substantial and sustainable gains—the health sector cannot be exempted from its central role in tackling maternal mortality. The reduction in maternal mortality occurs over a long journey, which can be divided into stages. According to the theory of obstetric transition , Brazil Maternal mortality is a difficult puzzle to solve. However, progress made in the last few decades is encouraging. In Brazil, the major obstacle is to advance the quest for social justice, particularly from an ethnic and gender perspective, expanding women's access to education and income, with special emphasis on women of color. In addition, it is essential to make a leap in the quality and effectiveness in public health services. The provision of women-centered, timely, appropriate and respectful quality care guided by the best scientific evidence should be the major goal of all maternity and women's health services. For this, the state needs to strengthen the public sector health system, and the society needs to exercise its primary role of defense and social control of the public health system.


The year 2022 has been a year of significant advancements in disaster and emergency medicine. The global community, in the previous years, has faced numerous challenges, from the COVID-19 pandemic to an increase in natural disasters  protocols in Munich, Germany, reveals that the location of out-of-hospital cardiac arrest (OHCA) does not significantly affect the return of spontaneous circulation incidence, although patients in public spaces have a higher chance of being admitted to the hospital with spontaneous circulation. The study also highlights the overall low levels of bystander CPR and bystander use of automated external defibrillators, emphasizing the importance of public education and training to improve the chain of survival.Another significant aspect of disaster and emergency medicine is the management of patients in challenging environments. Two articles in this Research Topic address the intricacies of providing medical care during transportation. Wang et al. present a national retrospective study on trauma treatment and incidence, providing valuable data to inform healthcare prevention and management strategies in the country. By analyzing over 4.5 million trauma patients from two national-level databases, the authors offer insights into the demographic characteristics, trauma causes, injury degrees, disease burden, and mortality rates. This valuable information can serve as a foundation for informed decision-making, resource allocation, trauma prevention, and trauma management.The Research Topic also delves into the epidemiology of trauma in China. Lamberti-Castronuovo et al. discuss the key role of health diplomacy in overcoming the crisis, demonstrating the importance of intersectoral cooperation and collaboration between different areas of expertise. By conducting a retrospective observational case study with qualitative methodology, the authors analyze the changes made to human resources, health service delivery, and logistics in response to the pandemic. Their findings underscore the importance of intersectoral collaboration in overcoming pandemic-related challenges and preparing for future disasters.The interconnectedness and multidisciplinary nature of disaster and emergency medicine are further emphasized through the articles exploring the challenges posed by the COVID-19 pandemic. This Research Topic showcases the breadth and depth of disaster and emergency medicine research in 2022, demonstrating the crucial role of intersectoral collaboration, adaptation to changing environments, and effective resource allocation. As we continue to face complex challenges in public health, military medicine, trauma care, and cardiac arrest management, it is essential to draw upon the valuable insights provided by these studies to advance our understanding and enhance our response capabilities.Robinson et al., climate change is having and will continue to have a significant impact on public health, particularly in the context of emergency medicine. The increasing frequency and severity of extreme weather events call for the development of adaptive strategies. These strategies should focus on enhancing our capacity to respond to emergencies, especially in resource-limited countries where the consequences of extreme weather events are more severe, and response capabilities are often constrained (The diverse range of issues addressed in this Research Topic highlights the interconnectedness and multidisciplinary nature of disaster and emergency medicine. As underscored by strained .Lamberti-Castronuovo et al., the COVID-19 pandemic showcased the importance of intersectoral cooperation in overcoming the challenges posed by a global health crisis. However, such collaboration cannot be improvised in the wake of an emergency. Instead, it requires an ongoing relationship between the actors potentially involved in the response, fostering a culture of preparedness and resilience.Public health, by definition, is multidisciplinary and multisectoral. The contributing articles in this Research Topic demonstrate the indispensable nature of collaboration between different sectors and areas of expertise in emergency disaster response. As highlighted by In conclusion, this Research Topic underlines the ever-evolving nature of disaster and emergency medicine and the need for collaboration, innovation, and preparedness to address the emerging challenges. The findings and insights from these contributions will undoubtedly contribute to the ongoing efforts to improve the practice of disaster and emergency medicine and enhance our capacity to respond to the pressing issues of our time. As researchers, practitioners, and policymakers continue to work together in this multidisciplinary field, we can expect further advancements that will ultimately benefit the health and wellbeing of communities worldwide.SO conceptualized the Research Topic, drafted the manuscript, ensuring that it adhered to the journal guidelines and provided a comprehensive overview of the Research Topic, revised the manuscript based on feedback, ensuring its clarity and coherence, and solely responsible for the content of this editorial and approves its submission to the journal.


Stroke is a major health concern globally, ranking as the second-leading cause of death and the third-leading cause of death and disability combined. The economic impact of stroke is also significant, with an estimated global cost exceeding US$721 billion, equivalent to 0.66% of the global GDP . These fThis opinion article presents an analysis of the current state of stroke research in China, focusing on the four major clinical medicine journals, namely the New England Journal of Medicine (NEJM), The Lancet, the Journal of the American Medical Association (JAMA), and the British Medical Journal (BMJ). In addition, Frontiers in Neurology was also used as a reference. We also examine the factors driving progress in stroke research in China and discuss possible future directions for stroke research in the country.China has made significant progress in stroke prevention, treatment, and rehabilitation in recent years , 6. The As the population of China continues to age and risk factors for stroke, such as diabetes and hypertension, remain poorly controlled and on the rise, the incidence of stroke is reaching a period of high prevalence , 14. ThiIt is important to note that stroke research in China has predominantly focused on ischemic stroke, with particular emphasis on acute-phase rescue and treatment during hospitalization. Societal organizations such as the Chinese Stroke Association and the National Health Commission Stroke Prevention and Control Committee have made significant efforts toward stroke prevention, post-discharge rehabilitation, and secondary prevention for the past decade , 15, 16.Our study focused on stroke-related research published between 2020 and 2021 in the Science Citation Index Expanded (SCIE) database. A total of 9,113 articles and review articles were identified using the search terms “stroke”. Of these, Chinese scholars contributed 2,351 publications, accounting for 25.8% of the total, and ranking second globally after the United States . Capital Medical University ranked first among research institutions worldwide with 428 publications. However, the average number of citations per article by Chinese scholars was only 90% of the global average (6.18/6.93), suggesting the need for further improvement in the quality of stroke-related research conducted by Chinese scholars.As an example, Frontiers in Neurology published a total of 4,220 papers, including articles and reviews, between 2021 and 2022, according to the SCIE database. Of these, 673 (15.9%) were related to stroke research, with China contributing to nearly one-third of these papers (31.6%). Four highly representative articles (most cited articles in SCIE database) from these stroke-related studies include a review by Li et al. , which aIn conclusion, China has made significant strides in the field of stroke research, driven primarily by its economic growth, talent development, and demographic advantages. While there has been a notable increase in the number of studies published in top journals, the overall quality of research still falls behind that of developed countries. Moving forward, the government must invest more resources in stroke-related research, particularly in the areas of hemorrhagic stroke and rehabilitation. By doing so, Chinese scholars can make further contributions to the field of stroke research and improve the overall health of the global population.W-JT had full access to all the data in the study and took responsibility for the integrity of the data and the data analysis accuracy, study concept and design, acquisition of data, analysis and interpretation of data, drafting of the manuscript, critical revision of the manuscript for important intellectual content, and study supervision.


Wood is a widely used building material. It is characterized by a high strength-to-weight ratio, predictable fire behavior, good performance in seismic zones, and it is easy to use in the construction of prefabricated buildings. In addition, wood reduces energy consumption during construction and reduces a building’s overall environmental impact, has lower embedded energy compared to steel and concrete, and has a positive effect on a building’s carbon footprint . The useFor multi-story floors, glulam-concrete composite beams (GCC) have been used for years, in which bending tensile forces are mainly carried by laminated wood, and compressive forces by concrete. Compared to typical glulam beams, GCC beams are characterized by, among other things, better load-bearing capacity, flexural strength and stiffness, better sound insulation, and greater thermal mass . Du et aThe permanent preservation of the form and safety of wooden constructions is ensured not only by the structural elements with adequate load-bearing capacity and strength but also by the properties of connectors and connections of individual components. Among the most common connectors in wooden constructions are dowel-type fasteners, which include screws, dowels, and bolts. According to Johanides et al. ,6, in orAn important aspect of current research is numerical modeling, which is an excellent tool for understanding the behavior of joints in wood constructions ,6. The nAn innovative solution for connecting light timber-framed roof elements has been proposed by Islam et al. . The apeThe safety of wood construction relies on proper construction technique, the quality of the engineered wood, and fire resistance. The fire safety of the structure is one of the basic requirements to be met when designing, constructing, and using a wooden house. For this reason, flame retardants are used for wood and wood-based materials, which are designed to, among other things, reduce the spread of fire, weight loss, and the rate of heat release. However, the use of flame retardants affects the mechanical properties of the wood. Grześkowiak et al.  determinOne of the research directions presented in this Special Issue is the possibility of using wood by-products from primary wood processing in the production of wood-based and insulation materials for the wider construction industry. In the sawmill industry, during the primary processing of wood raw material, in addition to losses due to desorption changes, material losses of up to 50% of the wood raw material originally intended for production are also generated . These l2. The decrease in the bond quality of plywood glued with resin with the addition of different bark species is due to its chemical composition, which can affect the resin curing process and lower the pH of the adhesive mixture. The consequence of this can be the occurrence of resin pre-curing and a decrease in the strength of the adhesive bond. In addition, spruce bark causes a decrease in the elastic modulus of plywood and its bending strength, especially in the perpendicular direction. However, the presence of lignin as well as tannins in the bark contributed to a favorable reduction in formaldehyde emissions, which was clearly observed for birch, beech, maple, and pine bark. Only in the case of spruce bark was a deterioration in the hygienic quality of the plywood produced.The bark has a unique chemical composition and contains numerous organic compounds such as tannins, lignin, cellulose, catechins, gallocatechins, flavonoids, and proanthocyanidins ,13,14. FBy-products from the wood industry have also become a source of fillers that can be used in the production of polymer-based composites. Dukarska et al.  showed tThe current technological and social trends require the construction sector to implement the principles of sustainable development. An important element of this concept is the principle of wooden construction based mainly on wood and wood-based materials, which counteracts climate change by storing carbon dioxide in wood and reducing the consumption of high-emission materials such as concrete and steel. The introduction of new and innovative solutions improves the energy efficiency of buildings, their functionality, and reduces their negative impact on the natural environment. The works presented in this Special Issue exemplify the current directions of research in modern wooden construction in accordance with the concept of sustainable development.


A negative impact on mental health of Ukrainian people who will survive the war is very likely.Those who leave are exposed to the trauma of leaving behind home, relatives, friends, job, habits, i.e., most of what they had built in their life, and to the unpleasant feeling of knowing nothing of what they will go through.Mutual support and nurture problem-solving strategies, including favoring family reunion, restoring people dignity and control over the environment, help children recover a more positive social reality, are major protective factors in buffering the impact of war, displacement and related trauma.By November 2022, Italy had hosted more than 170.000 Ukrainian refugees. The National Service intervention, coordinated by the Civil Protection Department, has developed a Plan for the reception and assistance of the population from Ukraine to uniform the response to the emergency on the national territory. The plan has focused on two aspects: humanitarian assistance and reception. The network for reception is composed of the CAS - Extraordinary Reception Centers and the SAI - Integration Reception System. The Plan also provides measures related to health care and education to ensure mandatory vaccination requirements and the access to the school system for unaccompanied foreign minors. As to plans aimed to address mental health issues, the right to care is guaranteed, but several issues can be identified that limit the impact of the national policies on the needs of this population.None Declared


The Fourth Industrial Revolution profoundly changed social institutions, industries, individuals, and ultimately the current society. The potential to improve the quality of life and generate economic benefits is one of the major promises of the Fourth Industrial Revolution, and some of the most significant opportunities can be found in nanotechnology, quantum technology, and artificial intelligence (AI). At the same time, the development and deployment of technology raise a range of ethical and social issues globally. These include (1) potential labor market disruptions, (2) biases inherent in the technology itself, (2) the emergence of new moral dilemmas, (3) societies torn apart by falling trust, (4) growing inequality due to the digital divide, and (5) growing threats to data privacy, security, and reliability , the efficiency of economic systems and competitiveness countries in general.Therefore, one of the factors for effective digital modernization of society, as well as any process of change, can be the stimulation of skills of current workforce. In this regard, the issue of human development in the context of labor productivity growth during digitalization is very relevant and in high demand for scholarship and practice. Currently, companies are facing a number of problems related to human capital and its efficiency  shows that the productivity of almost 60% of children will be half of what they could achieve; at the same time, there are many positive examples of human resource transformation, for example, in Singapore, the Republic of Korea, and Ireland : (1) management and organization theory, (2) institutional economics, (3) market and firm theory, (4) behavioral dogmas of the organization, (5) various applied methodologies and methodologies for measuring and systematizing HCR, (6) business process human resources, and (7) strategic and collective human capital. When using the polyparadigm nature of the study of management research, it is important to consider the many paradigms of management research. The proposed study analyzes the polyparadigm of strategies .LDGOS–is the level of development of the government's online service, rated in points (1–100) and calculated by WIPO; data from some countries for 2020 and 2022 were not taken into account due to lack of data (no data). The highest score in 2021 was occupied by the USA (94.7), and the lowest–by Germany (73.5). One can assume that the digitalization of government's online services actively influences the development of human capital and strategies for its management.PI–is the prosperity index, rated in points (1–100) and calculated by the Legatum Institute Foundation; data is contained in The Legatum Prosperity Index™ 2019: Creating the Pathways from Poverty to Prosperity Report and reflects the achievements of the countries of the world in terms of their wellbeing and prosperity. PI practically did not change for the considered countries in 2020–2021. This index can also be taken into account in modern personnel strategies for managing human capital.IEF–is the index of economic freedom, rated in points (1–100) and calculated by the Heritage Foundation; data is contained in Country Rankings of Economic Freedom 2020 and reflects the rule of law, the degree of bureaucratization of public administration, the effectiveness of regulation, and the openness of markets. In 2022, Germany had the highest IEF (76.1), and Russia–the lowest (56.1). IEF can also be considered in new personnel management strategies.HIC–is the human inequality coefficient calculated by the United Nations (UNDP); data is contained in the Human Development Report 2019. It reflects the degree of social justice in education, employment, career development, performance, and pay (in %). In 2021, the USA had the highest HIC (10.6), and Germany–the lowest (6.2). The index can be integrated into modern strategies.phw-is the productivity per capita (GDP per hour worked) per hour (USD). It is calculated by the OECD and shows the cost of goods produced by one worker per 1 h of work. This index can be taken into account in digital HR management strategies. Unfortunately, there is no information about GDPphw in Russia today; in the USA, the index is 71.1 USD.GDPThe novelty of the proposed research is characterized, first, by the specification of the conceptual dogmas of human capital administration in the context of digitalization and, second, by the assumption of the interdisciplinarity of the digitalization phenomenon. We tested the skills of current workforce methodology, which is based on the calculations of the World Economic Forum  and reflects the level of education and training, labor force qualifications, and digital skills of the population.Strategic management originated in the early 80s of the 20th century at the enterprises of Western Europe. Strategic management of skills of current workforce involves managing the formation of competitive labor potential, taking into account current and future transformations of the external and internal environment, which allows the organization to survive, develop, and achieve short-term and long-term goals. The reorganization of the labor supply market and the development of digital platforms are transforming employment mechanisms; in this connection, further, we will highlight the main current personnel strategies.phw; PI) are related to the behavioral dogmas of the organization and methodologies for measuring and systematizing HCR. For example, when calculating the profitability of a business and the cost of an hour using modeling methods for 50 production employees who directly provide services to customers , the full salary per hour will be 330 rubles, and the profitability of the business will be 59%. In the considered strategy, recruitment is carried out according to strict criteria; wages are calculated depending on the length of service.The main strategy is the concept of profitability of human capital management in the context of digitalization of economic systems Hamburg, . This stThe advantage of the strategy of profitability of human resource management in the context of the digitalization of national economic systems is the focus on flexible management of personnel training. The classical methods of managing human potential based on the development of skills no longer meet the requirements of the modern labor market, according to the concept developed by I. Hamburg . The demIn addition, corporate learning extends beyond a single company, with massive open online courses and social learning becoming especially popular. These trends are producing new types of corporate training and co-working spaces.phw; IEF) converge on a multidimensional typology of HCR resources: management and organization theory, behavioral dogmas of the organization, HCR systematization, and strategic and collective human capital. For example, when transferring employees to a remote work format, eliminating rental fees, and introducing automation everywhere, business profits can increase up to 10%. Financial rewards in an organization using a liquidation strategy are gradually increased based on merit, and staff skills are constantly improved as needed. The liquidation strategy in the context of the digitalization of economies in the field of human capital management includes the automation of the functions of the personnel department, which is an important advantage of the concept. Automation includes, on the one hand, the introduction of digital workplaces and, on the other hand, technologies that change the methods of work and interaction between employees  converge on the management, the theory of behavioral dogmas of the organization, and strategic and collective human capital. At present, one can state the formation of an innovative direction in management based on the management of human potential, a dynamic network organizational structure focused on the cultivation and management of self-managed working groups. The spread of remote work contributes to the acquisition of skills for online management of virtual departments and well-coordinated work in a multicultural environment, which also implements an entrepreneurial strategy. The advantage of this strategy is that it is implemented in conditions of a high degree of financial risk and limited resources and involves mobile decision-making. Personnel awards that meet personal needs are awarded on a competitive basis, with an emphasis on entrepreneurial strategy and teamwork. In contrast to the liquidation strategy, the entrepreneurial concept is focused on the use of digital platforms that allow economic activity to be regulated in such a way that most of the duties performed by full-time employees can be transferred to a private company.The next relevant concept of human resources management in the context of the digitalization of national economic systems is an entrepreneurial strategy (Malik and Sanders, The anti-crisis strategy for the transformation of human resources management in the context of the digitalization of national economies is aimed at preventing the bankruptcy of an organization Mendy, . The polIn the human resource management system, the concept in the context of the digitization of national economies is focused on low risks and sustainable growth, and long-term planning is the dynamic growth strategy of Knice et al. . PolyparAny strategy for the development and control of human potential accumulates the conditions and safety of work, methodological aspects of conflict resolution, methods for assessing and adapting personnel, a code of corporate ethics, a personnel reserve, a system of incentives and remuneration, as well as a development concept. The modernization of human potential in the context of the digitalization of the economy should be based on a competency-based approach while taking into account the new conditions; digital competencies will be a priority.As a result, we provide a detailed outlook on the cumulative challenges associated with intra-entrepreneurship, the sustainability of HRM management, and the digital transformation facing modern organizations. The researchers considered a sustainable approach to personnel management, which focuses on the synthesis of internal and external factors in the context of achieving positive results not only for a particular institution but also for the socio-economic segment and the environment. There is a strong necessity to examine cases related to the role of HRM in creating a corporate image and optimal development of institutions, as well as in increasing employee engagement, satisfaction, productivity, and wellbeing. The study discusses the new opportunities provided by digitalization and mobile communications in the field of intellectual capital, which make employees the focus of an organization to create sustainable, highly competitive advantages, which is the practical significance of the study.Research design: LK. Research: VK, PK, and LB. Literature review: PK and LB. Writing: LK and VK. All authors contributed to the article and approved the submitted version.