This study analyzes the productive structure of Portugal in the period 2013–2017, using indicators of localization and specialization applied to 308 Portuguese local authorities. From an empirical approach using a threshold model, the following indicators are used: (i) localization quotient; (ii) specialization coefficient; (iii) Theil entropy index; (iv) rate of industrialization; and (v) the density of establishments by business size. The selected period 2013–2017 is due to the available data concerning firms located per local authority, and the choice of threshold model is justified through the possibility of assessing the non-linear effects of specialization and diversification on productivity, considering, in simultaneous terms, different regimes per business size. Estimation of the threshold model identified a positive, statistically significant relation between industrialization and productivity. Similarly, the terms of interaction between exports and diversification, and between the former and higher education institutions, shows a catalyzing effect of productivity. In addition, the most specialized micro-firms affect productivity significantly and positively, while the least specialized have the opposite effect. Small, less specialized companies have a significant and negative effect on productivity, contrasting with less specialized, medium-sized companies, which affect productivity positively. For large firms, the impact on productivity is negative for both high and low levels of specialization, reinforcing the need to fill existing gaps in strategic diversification, as well as the vertical and horizontal integration of the activities of production chains with high value added. The relation between spatial concentration and sector specialization, which began to be studied in the field of regional science, in recent years has emerged in the field of entrepreneurship and innovation, with it being a well-established fact that business undertakings are susceptible to geographical concentration ,2,3, togIn the literature on this topic, the concept of industrial district formulated by Marshall  and BecaIndustrialization greatly improved productivity , which hAiming to advance knowledge about the relation between industrialization and productivity, using the Sales Index database, this study uses indicators of localization and specialization applied to all 308 local authorities in Portugal, intending to make a generic analysis of the dynamics of their production structure in the period 2013–2017. More specifically, a threshold model is estimated, in order to test the effect of industrialization on productivity as well as other research hypotheses arising from the literature review.In this vein, the current study uses a concept of entropy operationalized through the Theil Index, developing an economics approach focused on the analysis of both spatial and sectoral determinants of productivity. This approach aims to assess the non-linear effects of specialization and diversification on productivity, considering, in simultaneous terms, different regimes per business size. Toward this empirical application, we contribute to advancing the existent knowledge on determinants of productivity, using an Entropy index and also unveiling distinct signals and significances of the determinants studied in different specialization regimes.To achieve the objectives proposed, the following sections present firstly a literature review, originating in industrial districts and moving toward the cluster approach, and resulting in the research hypotheses. This is followed by the empirical approach, namely the methodology, and presentation, analysis, and discussion of the results. The study ends with the conclusion, limitations, and implications.Principles of Economics by Marshall  see .p value of 0.003, indicating that H0: single threshold model; H1: double threshold model) is highly significant with a bootstrap p value of 0.000  and 0.023 (Th-22)  see .The results of the fixed effects regression and threshold effect are presented in The F statistic of 3.06, for a level of significance of 5% with the null hypothesis of all The parameters displayed in It is worth pointing out that the rate of industrialization , which can contribute to reinforcing productivity and competitiveness, following a sustainable logic of strategic diversification of sectors of economic activity and considering the spatial heterogeneity of the European regional chessboard.


December, 2019, marked the third re-emergence in the 21st century of the zoonotic coronavirus (CoV), named severe acute respiratory syndrome corona virus 2 (SARS-CoV-2), crossing species to infect humans. The outbreak of the 2019 novel coronavirus disease (COVID-19), which started in China in the city of Wuhan likely from a wet market of live animals, has caused a rapid increase in the number of infections and deaths across Chinese borders, and has become a serious public and global health threat.The emergence and re-emergence of zoonotic diseases is not new, and over the past three decades the onset of outbreaks of infectious diseases emerging from animal reservoirs to infect humans has increased. For example, Ebola virus, highly pathogenic avian influenza (HPAI) viruses, and the coronaviruses severe acute respiratory syndrome (SARS) coronavirus and Middle East respiratory syndrome (MERS) coronavirus.Vet Res in 2005, show that at least 75% of emerging infectious diseases are zoonotic and originate from wildlife. Prevention activities are difficult to implement because events causing the emerge or re-emerge of zoonoses are complex and affected by multiple factors, such as genetic evolution, demographic changes, environmental conditions, or climate changes affecting the ecosystem.The size of the issue is significant, as epidemiological data by Blancou and colleagues from the University of Athens Medical School , reported in The unforeseeable onset and rapid dissemination of zoonotic outbreaks means public health systems need to be able to quickly identify early signs of such threats and react promptly. The fact that the beginning of the nCoV-2019 outbreak was observed by at least one physician, as reported by The Guardian on February 2, but not perceived as an urgent threat at the level of decision makers, demonstrates the essential need to identify what could be done better—before new diseases emerge—therefore preventing future outbreaks or, at least, reducing their impact.To reach this aim, the following steps are crucial: first, the understanding of the causes of disease emergence, the ecology of the agents involved, and their animal hosts; second, the creation of a network able to merge the contributions of different expertise, and work together holistically. At present, the main players of the network are in place , but they act separately; for example, veterinarians are not connected with occupational physicians, and in turn they are not in contact with general practitioners who are at the frontline of the disease. Therefore, in the current system, a cohesive network able to receive and act on early warnings at different levels is missing.The One Health approach is an example of how separate efforts can be aligned to work together effectively. The concept of One Health recognises the interdependence of human health, animal health, and environmental health, and aims to achieve better public health outcomes through the understanding and prevention of risks that originate at the interface between humans, animals, and their environments. Such approach implies a multidisciplinary effort in the implementation of programmes, policies, and research, where multiple sectors communicate and work together, with the common goal of helping disease prediction, prevention, and preparedness.Three major international organisations, WHO, the UN Food and Agriculture Organization (FAO), and the World Organisation for Animal Health (OIE), have started to put this vision into practice by consolidating a formal partnership to combat human-animal-environment health risks, strengthening their joint action in May, 2018. A year later, as a result of this partnership, they released a guide  that provides principles and best practices to assist countries in achieving sustainable and functional collaboration at the human-animal-environment interface.This effort should be repeated both at the academic and public health level. Rare examples are the University of Washington's Center for One Health Research  or the Global Health department at Harvard University , which has recently promoted the cross-education of its practitioners by collaborations with veterinaries. In public health, interestingly, the US Centers for Disease Control and Prevention is following One Heath strategies against some zoonoses. An example is the response to the Rift Valley Fever (RVF) Virus outbreak in East Africa in 1997. Most of the human infections resulted from direct or indirect contact with the blood or organs of infected animals. To break the chain of transmission, CDC researchers developed a vaccine to vaccinate animals against RVF, therefore preventing its transmission to humans.The Lancet in January. Those occupational categories deserve attention as groups at particular risk of zoonotic exposure. In public health departments the collaboration between hygienists, occupational physicians, general practitioners, and veterinarians could provide a push to implement monitoring activities, where the health of workers, animals, and the general population are jointly monitored.Another key area where the One Health approach is needed is monitoring and surveillance. Some professions have greater exposure to zoonotic risks than others—eg, farmers or butchers. Nearly half of the first patients affected by COVID-19 were working at the wet market where the virus originated, according to the first clinical characterisation provided by Chen and colleagues from The University of Hong Kong–Shenzhen Hospital , and published by The recent outbreak of the coronavirus infection is a particularly severe example of how close interactions between the health of humans, animals, and the environment can lead to a deadly epidemic. Now it is time to embrace One Health as a framework for public health action against zoonoses, as suggested by the tripartite  zoonotic guide. Governments must prioritise strategies to introduce the One Health approach in education and training programmes and in their public health systems, both at the national and international level. The timely recognition of the interconnection between humans, animals, and environment, intrinsic in the One Health approach, is a key prerequisite for understanding and managing the future of global health threats.EClinicalMedicine


The data were collected between March and April2020, using a form structured into: background, scope, challenges andpotentials of health/nursing professionals and recommendations for thefuture.the challenges and the need for investments in the health and nursingworkforce to achieve the Sustainable Development Goals were evidenced. Thereport of the High Level Commission on health Employment and Economic Growthpresents important recommendations, also introduced in the Triple ImpactReport and in the Strategic Directions for Nursing and Midwifery, convergingto the goals of the Nursing Now campaign, stimulating a profile of nurseswith technical, political and leadership skills, engaged in healthpolicy-making, and the effectiveness of their practice is clear to theentire society.Nursing Now campaign may be a condition forachieving its goals. This reality reveals evidence that global health willnot be ensured without strengthening Nursing first.knowledge about the dynamics of the factors that converged to the developmentof the  Contradictorily, despite this numerical relevance, the estimatedglobal shortage of nurses is about nine million by 2030.In 2020, Nursing, with approximately 27.9 million professionals, represents 59% ofall health professionals worldwide, constituting the majority group in the healtharea. Contranurses is used in this article to designate all members of thenursing team, in accordance with the documents of the World Health Organization(WHO) analyzed in this study. The use of the term Nursing, in turn,designates both the profession and the academic discipline.It should be highlighted that, for the sake of standardization, the termnd World Health Assembly, which recognized 2020 as theInternational Year of Nurses and Midwives, not only to honor the 200thanniversary of the birth of Florence Nightingale, but to reaffirm and grantvisibility to the daily contribution of Nursing to the health and well-being ofpeople. Therefore, WHO underlines that nurses are fundamental to achieving thegoal of leaving no one behind, in a global context of seeking toimplement the Sustainable Development Goals (SDG) by 2030. Among the strategies toachieve the SDG, universal health coverage and access, so that everyone is entitledto health services(-), requires not only the strengthening and qualification of nursingeducation, as investments for the continuation of these workers in professionalpractice.As a historical milestone, it is important, initially, to highlight WHO’s72fpeople. Therefrvices-, requir.Thus, the vital contribution of Nursing to the achievement of global and Braziliangoals related to the priorities on the global health agenda is recognized, includinguniversal access, mental health and non-communicable diseases, emergencypreparedness and response and patient safety, always focusing on people-centeredcare,5.(-), as occurs in the context of COVID-19.Despite its representativeness and the acknowledged relevance of its work, however,Nursing is still invisible and undervalued in many aspects, especially in healthpolicy-making. Hence, in addition to the recognition and valuation of its numericalimportance, it is essential to value high-quality Nursing for leadership, policy anddecision-making, participation in decision-making processes, and action ranging fromplanning to care provided to specific population groups, including the fight againstpandemics-8, asNursing Nowcampaign was launched, implemented in collaboration between the InternationalCouncil of nurses (ICN) and WHO, with the support of the Burdett Trust for Nursing,a coalition of nurses and other health advocates.In this perspective, it is imperative to invest in the qualification of nurses toprepare them to cope with health problems worldwide, so that their contributions andpotentials are properly understood. Among the manifestations of the recognition ofNursing as a key profession for health and for the achievement of universal healthcoverage and access, on February 27, 2018, the global dvocates., Triple Impact Report and Global Strategic Directions for Nursing and Midwifery(2016-2020).The global campaign was based on evidence from key documents that demonstrate therelevance of Nursing to global health: Report of the High-Level Commission on HealthEmployment and Economic Growth-working for Health and Growth, Triplet Report and Glo16-2020).NursingNow campaign, to be met between 2018 and 2020, are: 1) Increaseinvestments in the improvement of teaching, professional development, standards,regulations, and the terms and employment conditions of nurses; (2) Increase andimprove the dissemination of effective and innovative approaches in the field ofnursing; 3) Intensify the influence of nurses and midwives in global and Brazilianhealth policies, as part of broader efforts to ensure that human resources forhealth are more engaged in decision-making processes; (4) Enhance leadershippositions occupied by nurses, and multiply opportunities for development at alllevels; and (5) Provide an expanded evidence base for the decision-makers andpolicy-makers about where Nursing can have the greatest impact, what prevents nursesfrom reaching their full potential, and how to deal with these obstacles.In this context, it is worth noting that the goals of the Nursing Now campaign sets relevant and challengingobjectives, emphasizing the fundamental importance of Nursing leadership for theachievement of local, Brazilian and global health targets. It is based on theassumption that health agendas will not be successful without nurses in leadershippositions, in the different spaces for health policy-making and decision-making, andwho perform their functions with greater effectiveness. Thus, at least 75% ofcountries should have a Chief Nursing Officer as part of their most qualified teamsin health management and policies. Therefore, greater investments in the training ofnurses with political and “policy” skills is fundamental.Therefore, the Nursing Now campaign also seeks to demonstratethe individual and collective value of Nursing, supporting research that documentsthe visibility and socioeconomic impact of Nursing on the healthcare quality andcosts. It aims to reset the boundaries of practice, valuing the philosophicalassumptions of the nursing discipline and the social mission of theprofession. Thus, the campaign has been implemented in 123 countries, withdecentralized goals, but which align with the global objectives of the campaign ineach nation involved.In this context, the ofession. Thus, involved.NursingNow campaign, the objective in this article is to identify the guidingaxes of the documents that grounded the Nursing Now campaign and relate therecommendations in those documents with the campaign goals.This being a unique moment for global Nursing and in view of the importance ofunderstanding the creation and implementation context of the , based on the analysis of documents that encouraged the creation andimplementation of the Nursing Now campaign. The identification ofthe documents was based on the reading of the seminal document that officialized thelaunch of the global campaign.Descriptive and documentary research, based Nursing Nowcampaign, aiming at an in-depth understanding of its contributions and importancefor the creation and implementation of the campaign.In this process, it was essential to recover historical materials that referred tothe political and health scenario, at the time of the preparation of the documentsthat motivated the planning and development of the Nursing Nowcampaign constituted the scope of analysis, namely: Report of the High-LevelCommission on health Employment and Economic Growth-working for Health andGrowth; Triple Impact: How developing nursing will improve health, promotegender equality and support economic growth; Strategic Directions for Nursing and Midwifery - 2016-2020.Therefore, three official reports that promoted the dGrowth; Triplec growth; Strate016-2020.These historical documents were accessed from the official websites of the UN, WHOand ICN. Together, these documents establish the campaign, justifying the need for aspecific movement to value Nursing as a means of effective investment instrengthening health systems and improving the health conditions of the population,around the globe.Three independent researchers repeatedly read these reports and individuallycompleted a data collection script they had prepared in advance. In case ofdisagreement between the analyses, the material could be analyzed by a fourthresearcher. That was not necessary though. The script consisted of the topics:background, scope, challenges and potential of health/nursing professionals’ work,as well as recommendations for the future.Nursing Nowcampaign. After completing each topic in the script, for each analyzed report, thecomparative analysis of the data started. Thus, for example, a synthesis of thetopic “recommendations for the future” could be elaborated among the documents(reports). In the next step, the recommendations of the reports that structured thecampaign (guiding axes) were identified, relating them to each of theNursing Now campaign goals. The data collection script made it easier to synthesize in order to describe the dataand identify the guiding axes that promoted the The research data were collected between March and April 2020. Being officialdocuments in the public domain, collected through online access, registration orapproval of the research by an Ethics Committee for Research involving human beingswas deemed unnecessary.(-) that grounded and motivated the Nursing Now campaign, have beendetailed below.The information collected in the analysis process, based on the documents-12 thIn In In Therefore, the data support that each goal of the Nursing Now campaign is based oncomplementary evidence in the seminal documents analyzed for the overallstrengthening of nursing. and, specifically, targets for the advancement of globalhealth(-). Thus, the Report of the High Level Commission on Health Employment andEconomic Growth presents a global diagnosis of the health workforce conditions. Withthe participation of an ICN representative in the Commission, this document presentsimportant recommendations that were also introduced in the Triple ImpactReport and in the Strategic Directions for Nursing and Midwifery.The three documents analyzed in this article emphasize the challenge imposed on theinternational community to invest in the health and Nursing workforce as a conditionfor achieving different SDG and, splhealth-12. Tc Growth presenttReport and in , understanding Nursing not as a cost to institutions, but as aninvestment. This necessary demonstration implies, however, facing the challenge ofopposing arguments that support the thesis of this investment, knowing beforehandthat two priorities of health managers are always at the top of the list: costreduction without changing the quality of care and improvement of patient outcomeswhile maintaining reasonable costs. In this negotiation, the assertiveness of nurse leaders’ argumentsneeds to be based on the best evidence on the effectiveness of Nursing work, throughevidence deriving from comparative analyses between similar conditions ofperformance, with and without nurses, proving the added value of this workforce inthe health indicators of the patients under their care.It should be taken into account that the objectives of the Nursing Now campaign andthe recommendations evidenced in the documents studied, are interconnected, whichalso mobilizes and enables their analysis and discussion in an interrelated way. Thefundamental issue of achieving universal health access and coverage by 2030, in viewof the implementation of the SDG, demonstrates and implies the need to make visibleand disseminate the relevance of Nursing, demonstrating its socioeconomicvalue, undersvestment,15. Tle costs. In thi(-).In addition, the defense will be convincing if the nurse leader demonstrates to thehealth manager the value of Nursing in achieving health outcomes in economic terms.In the same perspective of budget containment, nurses who ensure the patient’s safereturn of the patient successfully develop the alternative of a shorter hospitalstay-19.In this perspective, it should be emphasized that nurses need to be attentive tocapitalize in favor of Nursing on all these initiatives and successfulinterventions, ensuring that these records, in economic value, are computed in thoseorganizations as cost savings resulting from nursing work, without loss of qualityand ensuring care continuity at the primary level, preventing readmissions andensuring the return of the health system user to society and work..The first goal of the Nursing Now campaign recommends investments in the improvementof teaching, professional development, standards, regulations and employmentconditions of nurses. It is directly related to Recommendations 1, 2, 3, 4, 5, 6, 7,8 and 9 of the Report of the High Level Commission on Health Employment and EconomicGrowth as well as Recommendation 4 of the Triple Impact Report and Thematic Area 1of the Strategic Directions for Nursing and Midwifery. Therefore, mostrecommendations of the High Level Commission on Health Employment and EconomicGrowth were related to this campaign goal. In this sense, for the sake ofinvestments in professional development and employment conditions, it is essentialto invest in job creation, in the provision and organization of health services. Inthe meantime, it is paramount to invest in the Nursing workforce, fundamentally inhigh-quality, modern, dynamic and relevant teaching, which is attractive to futurenurses, avoiding, as early as in the education process, possible drop-outmovements., with prepared and sufficient teachers who acknowledge Nursingeducation as a challenge, with relevant curricula and sufficientclinical and management experiences and training. An education that guaranteesBrazilian and international recognition of its competence and quality, ensuringrights in possible immigration processes, with preparation focused on the healthneeds of the populations, the most vulnerable groups and areas, centered on people,but also with skills to act in situations of humanitarian crises, particularlyconsidering the workers’ rights and requirements of protection and security. It isimportant for this education to present the students, future nurses, with how theyshould act as leaders, providing role models, broadening horizons and opportunities,as well as the prestige of Nursing, in such a way that future generations will beable to advocate for improvements in services, policies, and opportunities forconstant training as a pre-condition for self-confidence, quality improvements,security, and stimulus to action, as well as the creation and implementation ofpositive changes in the outcomes of the population’s health and well-being.Thus, the goal is teaching based on evidence of the best and most modern practicesfor learning, with pIn addition, plans should be supported to increase the number of trained and employednurses around the world, ensuring the appropriate training and motivation of thisworkforce for work at all health levels and services. Among the recommendations, theunique importance of Nursing work in situations of humanitarian crises and thechallenge that is imposed on countries in cases of international migration of nursesare highlighted. Still within the scope of this first goals, for the advancement ofnursing education, it is relevant to value quality and continued educationthroughout working life, exploring the power of information and communicationtechnologies, based on the recognition of gender equality rights and aiming tomaximize women’s economic participation in the job market.. Despite different possible problems, Nursing practice at the regional,Brazilian and international level may share the competencies of its workers,requiring continuing development, which implies the recognition and valuation ofnursing with lifelong experience and the strengthening of clinical leaders,highlighting that good leaders create other leaders. Achieving this objective will only be possible when enhancing fundingand fiscal resources, as well as through local, regional and internationalintersectoral collaboration and partnerships.In this sense and strongly articulated to the necessary investment in high-qualityeducation, motivating and mobilizing future nurses, health systems need to beresponsive, with the necessary perspective of attractive jobs, not only to welcomeyoung newly qualified nursing workers, but to ensure their permanence and motivationfor the practice of the profession. Therefore, jobs and openings need to createdthat are recognized as decent, with salaries that permit fulfilling nurses’ basicneeds, whose work organization is also decent, fair, appropriate, and compatible interms of sufficiency, quality and value of human resources, and materials andequipment essential for their performance. Despit leaders. Achievincrease and improve the dissemination of effectiveand innovative practices in nursing and is related to Recommendation 10of the Report of the High Level Commission on Health Employment and Economic Growth,with Recommendations 5 and 6 of the Triple Impact Report and with Thematic Area 4 ofthe Strategic Directions. In this perspective, the documents highlight the relevanceof research development with robust evidence that underpins the dissemination ofeffective and innovative Nursing practices. Therefore, research on the impact ofNursing on health service access, quality and costs is suggested, as well as toincrease the gender equality and improve the countries’ economic conditions.Expanded efforts are needed to disseminate the evidence in formats that better reachthe service professionals, as well as the policy makers.Campaign goal 2 aims to The traditional mode of responsibility the researcher complies with by merelypublishing results in journals is outdated, given its insufficiency due to lack ofcapillarity and the characteristics of the postmodern society in the digital age:direct methods need to be explored to increase the quality and speed of scientificdissemination and translation of knowledge.. They also focus on the importance of Nursing and its work throughinterprofessional collaborations, as well as investment in search of scientificevidence that strengthens the development of the Nursing workforce. For this,“breaking silences” is needed, rupturing walls that sometimes Nursing itself has built in a siegeprocess, conquering other health professionals, politicians, legislators and healthleaders as allies for the work of nurses, so that they are allowed to freely usetheir full potential and competence, not only in a technical, but essentially in apolitical perspective.The third goal advocates nurses and midwives’ greater influence in global andBrazilian health policies, as part of broader efforts to ensure that human healthresources are involved in decision-making processes and is related to Recommendation1 of the Triple Impact Report and thematic areas 3 and 4 of the Strategic Directionsfor Nursing and Midwifery. The recommendations reinforce the need to strengthen theprofile of Nursing, making it central to health policies. They as needed, ruptur. If, for various reasons, investments in leadership are needed, at alllevels and modalities of nursing education, ranging from undergraduate topostgraduate education, in addition to continuing education courses on specifictopics, the aging of the nursing workforce and the imminent vacancies in leadershipneed to be considered, which need to be filled by prepared young talents.Goal 4 reinforces the need for more nurses in leadership positions and moredevelopment opportunities at all levels and relates to Recommendations 1 and 3 ofthe Triple Impact Report and thematic area 2 of the Strategic Directions for Nursingand Midwifery. Leadership is central in the discussions about the contributions ofNursing to more effective health policies that meet the health needs of individualsand communities: leadership of the professional team, leadership in defense ofgender equality with equal wages and opportunities, leadership to exercise the fullpotential of nursing, leadership for active participation in the processes ofestablishing health policies and health decision-making. Thus, the goal is thestrengthening of nursing leadership, enabling more efficient and effectivemanagement and governance environments. Nursing leaders should devote time andeffort to improve the social capital of the workplace in favor of their team, aimingat positive deployments of this investment. If, fo. Nevertheless, training and empowerment initiatives for leaders at thefront line of services are needed, as well as many other forms of development of leadership and themeanings of engagement, empowerment and job satisfaction(-). Goal 4 drives nurses to appropriate the right and duty to emphasizetheir participation in leadership positions and to create opportunities to ensurethe development of professionals and the profession at all levels.Efforts are urgently needed to enhance the prospection of candidates for leadershipposts and concern with other determining factors, such as that generation Y nursesconsider or reject leadership roles. Neverte needed, as welsfaction-25. Gper day, sevendays per week, it is responsible for pointing out feasible routesand strategies to solve problems and achieve the goals the team that outlined,representing the profession with her participation and vision. In this context, thisobjective synthesizes much of the other four objectives, reinforcing the need forreliable evidence to strengthen the political mobilization of Nursing, culminatingin better indicators of health, economic development and gender equality.Finally, goal 5 seeks to provide an expanded evidence base for decision makers andpolicy makers on how and when nursing can have the greatest impact and what preventsnurses from reaching their potential to manage these obstacles. It is directlyrelated to Recommendations 2 and 3 of the High Level Commission on Health Employmentand Economic Growth, Recommendation 5 of the Triple Impact Report and thematic area4 of the Strategic Directions for Nursing and Midwifery. That explains the relevanceof seeking evidence as to how and when the purposes of political activity aresuccessful, ensuring greater and better participation of nursing leaderships inhealth policy-making, health planning and interventions, as well as in situations offrustration and failure, knowing what obstacles remain to be overcome in order toensure this intended and necessary political activity; as the most presentprofession in the entire health system, 24 hours The analysis of these interrelations reveals that the objectives of the campaignidealize a nurse profile with technical and political skills to make the differencein any work environment, with leadership and health policy-making competencies,scientific evidence of the effectiveness of its practice being disseminated to theentire society.The limitations of this research are related to the ability of abstraction themethodology used can grant to the research problem because, being a documentary,descriptive research, other analyses of how the narrative about the topics in thedata analysis process may complement and deepen possibilities to better understandthe possible impact of the Nursing Now campaign, based on its connections with thefactors signaled in the documents that fostered its existence and development.Furthermore, the incipient nature of research on the theme results in limitedexplorations of contextual factors that may be involved in the development of thecampaign goals.At this unique moment for global Nursing, this article was able to demonstrate theaspects embodied in the documents that converged to the planning, launch anddevelopment of the Nursing Now campaign, thus revealing the foundations thatvalidate the campaign goals. Therefore, this study points to a complex process,based on evidence published by respected organizations, that the challenges forglobal health and its socioeconomic implications require that Nursing isacknowledged, equipped and valued to meet the current and future health demands ofhumanity, in different contexts.It should be emphasized, however, that this research did not aim to analyze theimplications of the terminologies international entities use concerning universalhealth coverage or access. Therefore, other theoretical and methodologicalapproaches are due for this purpose.In addition, the investments made now, advocating for changes and actions expectedand explained in the Nursing Now campaign goals, will revert, of course, indeployments of the campaign with short, medium and long-term results. To achievethis success Nursing, Health Systems and the society that receives health caredeserve, it is necessary that each of us, who practice nursing today, arecontinuously mobilized in favor of this cause and that we are all collaborators toachieve the objectives of the Nursing Now campaign.


In 2020, ~1.8 million Americans are expected to be newly diagnosed with cancer, with approximately 70% of cases diagnosed over the age of 65. Cancer can have a ripple effect, impacting not just patients themselves, but their family caregivers. This presentation will provide an overview of the estimates of the number of family caregivers caring for individuals with cancer in the US, focusing on older patients, from several population-based data sources: Caregiving in the US 2020, the Health Information National Trends Survey , the Behavioral Risk Factors Surveillance System , and the National Health and Aging Trends (NHATS) Survey. The presentation will compare features of the data sources to give a comprehensive picture of the state of cancer caregiving. In addition, the presentation will highlight what is known about the experiences of cancer caregivers, including caregiving characteristics, burden, unmet needs, and ideas for improving support for family caregivers.


The prevalence of leprosy has been declining steadily throughout the world since the 1980s as a result of multidrug therapy.Characteristically, leprosy evolves in a chronic, indolent form, with polymorphous lesions and in an oligosymptomatic form. Virchowian forms are even more indolent and diffuse infiltration can make diagnosis difficult. Lepromas, although asymptomatic, are often the reason for seeking medical care, and may generate diagnostic confusion with other papulonodular dermatoses such as granuloma annulare, dermatofibroma and sarcoidosis, among others.As Virchowians are the most bacilliferous, all strategies for identification and early treatments are valuable. In this manuscript, the dermoscopic findings of the lepromas are described.Male, 54 years old, brown, with asymptomatic nodular lesions throughout the integument one year ago. At examination, multiple normochromic papules of fibromatous consistency were found, associated with diffuse infiltration of the skin and diffuse loss of hair on the body . These nM. leprae, with consequent multiplication and bacillary spread through the haematogenic pathway.Individuals that evolve to the virchowian pole, such as this case, present humoral immune response, with high production of antibodies against the PGL-1 antigen, but these antibodies are ineffective in the elimination of Dermoscopy, in addition to being of great importance in the diagnosis of cutaneous tumors, is currently used in the detection and diagnosis of other non-tumoral skin diseases, such as inflammatory and infectious dermatoses, in order to reinforce clinical suspicion and differential diagnosis.The dermoscopic description of the lesions of some clinical forms of leprosy can be found in the literature, such as the histoid and tuberculoid forms.Its yellowing color in the dermoscopic examination is due to the intense xanthomization of the lepromes (Virchow cells), which is less evident in other lesions such as granuloma annular, sarcoidosis and xanthogranuloma,In anatomopathological examination of the leproma, there is an epidermal rectification, probably due to the accumulation of macrophages grouped in the superficial and deep dermis, with clear cytoplasm and vacuolated aspect. These vacuoles, in the coloration of fite-Faraco, contain a large quantity of bacilli; forming globes.The diagnosis of leprosy, however, is clinical, so that dermatoscopic aspects, as well as laboratory tests, anatomopathological and specific staining help in cases of greater clinical difficulty. Treatment with the diagnosis should be done promptly, as well as investigation of communicators, in order to reduce the transmission of the bacillus and controlling the incidence of new cases of the disease in the country.None declared.Anna Carolina Miola: Approval of the final version of the manuscript; elaboration and writing of the manuscript; obtaining, analysis, and interpretation of the data; critical review of the literature; critical review of the manuscript.Natalia Parenti Bicudo: Approval of the final version of the manuscript; obtaining, analysis, and interpretation of the data; critical review of the manuscript.Giuliane Minami Tsutsui: Approval of the final version of the manuscript; intellectual participation in the propaedeutic and/or therapeutic conduct of the studied cases, critical review of the manuscript.Helio Amante Miot: Approval of the final version of the manuscript; elaboration and writing of the manuscript; critical review of the literature; critical review of the manuscript.None declared.


Violence against women in the Republic of North Macedonia is the most common form of human rights violation, and women's safety is thus a high-priority public health problem. There have been significant achievements in the area of policy development: legislation harmonization for human rights protection, prevention of violence against women, protocols for the treatment and support of female victims, especially those with disabilities, and further collaboration and coordination between different sectors. In practice, there is still a need to establish a system of institutions for effective prevention, protection, gathering of evidence, and support of women victims of gender-based violence in addition to the prosecution of perpetrators. Policies for the improvement of women's safety should be considered as a priority and undertaken at an individual, relationship, community, and society level. Women's safety is a global public health problem , and “GlViolence has a negative effect on women's physical, mental, sexual, and reproductive health . EvidencViolence against women in the Republic of North Macedonia (further in the text Macedonia) is the most common form of human rights violation against women, and it has a negative impact on health, causing injuries, death, as well as psychological trauma . Women'sPublic health and human rights approaches have been applied to analyze the magnitude, burden, and risk factors of violence against women in Macedonia and to give actionable recommendations for policy interventions for the purpose of prevention. The public health approach is a science-based, multi-disciplinary approach for understanding and preventing violence, with coordinated action to be undertaken by different sectors .In Macedonia, due to inappropriate evidence of violence and a lack of systematic follow-up of the victims of violence, within health, social, educational, and other institutions in the country, it is not possible to give an objective assessment of the burden of violence against women .The official data from the police showed that, in 2004, there were 2,434 complaints of domestic violence of which 1,000 victims were wives, 460 parents, and 175 were children and other family members  in big families with members spanning several generations. In most of the cases, violence was linked to alcohol abuse. Centers for social work have provided services to 409 victims of family violence in 2004 and 2005, and 85 victims of violence were accommodated in the four shelter centers in Skopje, Kochani, Bitola, and Strumica  in 2000 showed that 61.5% of the interviewed women reported psychological violence, 23.9% physical violence, and 5% sexual violence .An intimate partner was identified by women as the most frequent perpetrator in 43.9% of reported violence against women in the community injury survey conducted on a sample of 1,000 households in Macedonia in 2008 .The Global School-Based Student Health Survey has shown that “overall 10.0% of students aged 13–15 years had been bullied on 1 and more days during the past 30 days, while 8.6% of students seriously considered attempting suicide during the past 12 months; male students (6.8%) were less likely than female students (10.5%) to seriously consider attempting suicide”  is 59.4%, whereby psychological violence is most common (58.2%) followed by physical violence (23.7). Almost every second woman in Bosnia and Herzegovina (47.2%) has experienced at least one form of violence since age of 15, mostly psychological (41.9%) and physical (24.3). Data obtained from a study conducted in Serbia in 2010 show that the overall prevalence of violence against women is 54.2%, with psychological violence at 48.7% and physical violence at 21.6% .The official number of violent deaths in females in Macedonia has decreased; homicides have gone down from 12 in 2007 to 9 in 2017 and suicides from 45 in 2007 to 32 in 2017, and this is almost three times lower than in males . Twenty-Evidence suggests that certain characteristics in women, such as sexual orientation, disability status, or ethnicity, and some contextual factors, such as humanitarian crises, including conflict and post-conflict situations, may increase women's vulnerability to violence  and may The main risk factors for violence against women in Macedonia, as stated by the perpetrators, are poor economic status of perpetrator, low education, unemployment, exposure to domestic violence against their mothers, harmful use of alcohol (every fourth perpetrator), unequal gender norms, including attitudes accepting violence, and a sense of entitlement over women . The vioThe main risk factors for victims of intimate partner violence as reported by the women are low levels of education, lack of employment for the woman, exposure to mothers being abused by a partner, experienced child abuse, and attitudes accepting violence, male privilege, and women's subordinate status , 18.The State response in addressing the problem of violence against women was in line with the resolution WHA67.15 from May 2014  and the The Government has been undertaking evidence-based policy interventions that are in line with WHO key recommendations , 22 at aThe Republic of North Macedonia is a signatory of the international acts from the United Nations (UN), the Council of Europe (CoE), and the European Union (EU) for the protection of human rights and prevention of discrimination, torture, and maltreatment, which are incorporated in the national legislation . The mosThe existing national legislative provisions are, to a great extent, in compliance with the principle of gender equality and the international instruments on the protection of women's human rights. Macedonia ratified the CEDAW Convention on January 18th, 1994, and the Optional Protocol to the same Convention and made no reservations .The Constitution  stipulatCitizens shall be equal in the Constitution and the laws: Criminal Code ; Law on In 2003 and 2004, the State made amendments on the actual Family Law  and Law The Annual Report of the Helsinki Committee for 2012 shows that there were serious violations to the freedoms and rights of citizens as well as drastic violations to the principle of rule of law and the legal state; this was not only in the form of systemic problems in the functioning of the bodies and institutions but also in the form of the abuse of their competencies .Violence prevention was set as priority in the collaboration between the Ministry of Health and the World Health Organization (WHO) since 2004 in Biennial collaborative agreements. The WHO National focal point for violence and injury control and prevention was appointed by the Minister of Health in 2003, thus starting the collaboration with the WHO organizing the national conference against violence against women on November 25th, 2003.The Department for Violence and Injury Control and Prevention was established within the Institute of Public Health in 2004 as a lead agency for violence prevention in the health sector, and it was later in 2012 inaugurated as the Safe Community Affiliate Support Center.The first shelter center was opened in 2004 in Skopje for the protection of victims of domestic violence. The process was followed by the opening of five more centers in the country and a national SOS line financed by the Government. Training of social workers and health professionals was also conducted .In the institutional framework, the sector for equal opportunities was established within the Ministry of Labor and Social Policy for the improvement of the status of women. There is also the national commission on equal opportunities for women and men, which was established in 2006 as a regular parliamentary commission .The Governmental National Coordination Body for Domestic Violence Prevention was established with Government approval in 2009, and it includes representatives from the Ministries of Health, Labor and Social Policy, the Interior, Education, Justice, the Institute of Public Health, as well as other non-governmental organizations, WHO and other stakeholders responsible for the implementation of the National Strategy for protection against domestic violence 2008–2011 .The Joint UN Program “Strengthening National Capacities to Prevent Domestic Violence” started in December 2008 and finished in August 2012, and it provided technical and financial assistance to the National Coordination Body in the implementation of the National Strategy for protection from domestic violence. UN agencies UNDP, UNFPA, WHO, UNICEF, and UNIFEM have worked together with the national partners: Ministries of Labor and Social Policy, the Interior, Justice, Health, Education, and Science, providing funding of 2,458,000 US dollars from the Government of the Netherlands, 958,000 US dollars from the UN Trust Fund, and a further 43,000 US dollars from UN agencies. A total of 70,000 US dollars in kind have also been provided by Government of the Republic of Macedonia .Specific national policies for domestic violence prevention have been developed to address violence against women, and annual action plans have also been prepared for implementation: a National Strategy for Protection Against Domestic Violence 2008–2011  was implProtocols against child abuse and neglect, sexual abuse, and pedophilia have been prepared as well . The JoiIn the context of the recent ratification of the European Council Istanbul Convention, the Government opened three multi-sectoral sexual assault referral centers in the hospitals in Tetovo, Kumanovo, and the University Obstetrics and Gynecology Clinic in Skopje for psychosocial and legal support as well as for the safety and security of the victims of sexual violence, applying a standard operating procedure. In the next 5 years, the Government will open seven more centers .The First Family Center established in 2013 in Skopje as a specialized counseling center for support and prevention against domestic violence is an example of good cooperation between the civil sector, local government, and business sector, providing free, confidential, and high-quality counseling and psychotherapy services for victims and perpetrators of domestic violence .The WHO Training Education Advancing Collaboration in Health Violence and Injury Prevention modular training curriculum on violence prevention and control has been completed by 2,390 health professionals and 60 university professors within the period 2009–2012. Training was financially supported by WHO within the UN Joint Program mentioned above. Two hundred twenty doctors were trained in 1 day workshops for evidence of violence and web register in Skopje in 2012 .Guidelines for referral mechanisms for professionals were prepared in 2010 and 2-day capacity-building workshops for the implementation of the Joint Protocol for domestic violence prevention were organized in eight municipalities in the period 2011–2012, and these were supported by the UN Joint Program. A total of 200 professionals from different sectors were trained: health workers, social workers, policemen, teachers, municipal staff, etc.Three 1-day capacity-building workshops for the protocol for intersectoral collaboration for domestic violence prevention were organized in 2015, and 90 doctors, nurses, social workers, and other workers were trained.In 2016, the Ministry of Health, in cooperation with NGO HERA, UNFPA, the Center for Family Medicine, and the Institute for Public Health, accredited a training package for gender-based violence with nine modules for 2-day training for health professionals. Over 200 medical professionals have completed this training, while 40 primary health care physicians completed a 2-day training program for gender-based violence in persons with disabilities in 2019.Despite the progress made in violence control and prevention and safety promotion, further efforts and a more strategic approach are needed in the years ahead , especiaThe future key challenges in the prevention of violence against women in Macedonia in the near future will be to implement the legislation for the prevention of domestic violence as well as the recommendations of the WHO World Report on Violence and Health  through Advocacy and empowerment counseling interventions, education, and home visitation are promising in the prevention or reduction of intimate partner violence against women .A multisectoral integrated approach is required for gender-based violence reduction at both the legislative and community level, dealing with common risk factors as well as the cultural and societal influences behind perpetrator behavior and victim response.Overall strengthening of the main functions, and especially the development of violence-prevention policies and legislation and establishing strong monitoring, will add significant value to the integrated system for the prevention of violence against women while including health in all policies.There are achievements in policy development for the prevention of violence against women as well as capacity-building and multisectoral collaboration between governmental, civil society, and international organizations with legislative and institutional changes. But there is still a need for the Government to provide resources and undertake measures and activities to respond to cultural change in social systems and to improve efficiency and effectiveness of legal mechanisms for the protection of women. Policies for the improvement of women's safety should be considered as a priority and should be undertaken at the individual, relationship, community, and society level.The author confirms being the sole contributor of this work and has approved it for publication.The author declares that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.


Painful conditions, particularly due to head pain, spinal disease, and neuropathic pain, are highly prevalent in modern society, resulting in a significant impact on the individual due to the disability of the condition and the direct cost of associated treatments. Additionally, indirect costs to society result from the loss of work productivity of the individual due to pain. For musculoskeletal pain alone, the related costs in the USA are estimated at $215 billion, of which 41% are from direct medical care, and the remaining are indirect costs associated with the condition [In this Special Issue of Brain Sciences, the included manuscripts have explored several causes of pain and disability, their diagnosis, and treatment. Cantone et al. evaluated the disability that can result from mucopolysaccharidosis related cervical myelopathy . The aut


Despite good intentions, training programs targeting hospital managers are only effective if grounded on the best practices. These training programs must be sustainable and continuously be monitored and updated.4Hospital managers and administrators are the key motivators for the success of each inpatient healthcare institution.IJHPM entitled “Capacity Building to Improve Hospital Managers’ Performance in West Asia. ”5 This letter outlines the training and development program, targeting public hospital managers in Iran, initiated in 2016 by the Iranian Ministry of Health and Medical Education (MoHME) in collaboration with the World Health Organization (WHO). The purpose of this program is to empower public hospital managers, and to build capacity for improving their performance and productivity. Despite its efforts, the letter did not provide a comprehensive historical overview of the program. The letter also did not adequately acknowledge the intellectual property right of the project owners. There was no reference to the project owners responsible for delivering these training programs. Further, the title of the letter did not represent its content, which mainly covered Iran’s experience not the West Asia region.The present letter is a critique and a response to a letter recently published at the The history of health managers’ professional development initiatives in Iran dates back to nearly two decades ago, in 1999, when some health managers participated in international training courses. 6 and WHO confirmed the proper implementation of this program.7 The tailored course entailed 28 days of training in 7 modules over a period of 8 months. This course was implemented in 7 management training centers in Iran. This successful experience in Iran, motivated the WHO to implement this course for health managers in Iraq and Afghanistan, which was held in the National Public Health Management Center in Tabriz, Iran. The WHO has supported the capacity building program since the starting point of the program, and in addition, involved in monitoring and evaluation of the training courses. In Iran, as a developing country, it will be important to continue conducting health management training, and also to justify the large investments in training programs, through rigorous assessment of their contribution to the capacity development of individuals, organizations, and health systems. To accomplish this important objective, the Health Managers Development and Training Supreme Institute, affiliated with the MoHME, was established in 2017, to organize and lead the professionalism, managers training, and management development in national and international health systems.Notwithstanding these academic events, with the beginning of the Health Transformation Plan in Iran in 2014, the need for managerial skills improvement in hospital managers was deeply felt. In 2015, a training assessment for hospital managers was done to identify their needs for inclusion in the planning, implementation, and evaluation of educational courses. Based on this assessment results, approximately 75% of the participants obtained low scores, and the qualitative analysis demonstrated their training needs. Consequently, the Hospital Managers Development Program was designed, and then started by the Hospital Management and Clinical Services Excellency Office in collaboration with Management Development and Administration Reform Center of MoHME, WHO country office of Iran, International Federation of Hospitals, and Iran University of Medical Sciences, Tehran, Iran. Also, International Relation Department of MoHME supported and facilitated the Hospital Managers Development Program initiative. In less than two years, all of the 600 public hospitals managers were trained in leadership and management skills,Not applicable.Authors declare that they have no competing interests.All authors developed this letter and agreed upon the final manuscript.1Department of Health Policy, Economics and Management, School of Management and Medical Education, Shahid Beheshti University of Medical Sciences, Tehran, Iran. 2Advisor to Secretariat of High Council for Health and Food Security, Ministry of Health and Medical Education, Tehran, Iran. 3Secretariat of the High Council for Health and Food Security, Ministry of Health and Medical Education, Tehran, Iran. 4School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran. 5Health Managers Development Institute, Ministry of Health and Medical Education, Tehran, Iran. 6Health Management Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran.


COPHELA , a collaborative project between the European Union (EU) and Latin America, will produce on-line courses for the master degree in pharmacy. The program runs from 2019 through 2021. It is funded by the Erasmus+ program of the Education, Audio-visual and Culture Executive Agency (EACEA) of the European Commission. The partners are EU and Latin American universities. These are accompanied by associated partners from EU and Latin American universities, as well as from governmental and non-governmental organizations, such as pharmacy chambers and educational associations. The project is coordinated by the University of Granada, Spain (first author of this paper). It will produce distance learning master degree courses in a dozen fields of specialized pharmaceutical science education and practice, ranging from patient care to industrial pharmacy. This paper describes the design of the project and is intended to evoke constructive comments. It also represents a call for the recruitment of additional associated partners.  In light of the evolving situation in pharmacy specialization in Latin America, the COPHELA project proposes to produce distant learning tools for master degrees in pharmacy specialization. These will be published in Spanish, Portuguese and/or English, and will be available primarily for the Latin American market but also in the EU.PHARMINE (Pharmacy Education in Europe) ,2, and tPHAR-QA  ,4, andPHAR-IN  ,6.This COPHELA project is a follow-on to three previous EU-funded projects: The competences for fundamental and specialized pharmacy practice The education and training tools necessary to produce the competences cited previously in (1) above, andThe harmonization of competences, and the education and training tools necessary, in the EU member states.All three projects centered on:The purpose of the three previous projects was to adapt pharmacy education in the EU to the on-going evolution in practice. For example, community and hospital pharmacies are moving towards patient care activities, such as therapeutic monitoring, intervention in public health campaigns (vaccination and other), medicinal treatment of long-term ailments, and interpretation of clinical biological results, etc. There is also a substantial transformation in industrial pharmacy in research and development, production, etc. This accompanies the shift in therapeutics from small chemical drug molecules to large protein biosimilars. The development of the generic drug market with the consequential changes in marketing, regulatory affairs, etc., is another example of the evolution in practice. COPHELA looks at the paradigms and technology required to extend to Latin America the principles behind the three EU PHARMINE projects. It aims at creating master degree courses in specialized pharmaceutical sciences to meet the challenges of the changing face of pharmacy. Below, we examine the characteristics of pharmacy practice in the EU and Latin America, and how specialized education and training can provide possibilities for adaptation in the changing world.Workplace. A hospital pharmacist can be defined as a pharmacist working in a hospital pharmacy -and this independently of the education and training s/he has followed. An industrial pharmacist can be defined as a pharmacist working for a drug company. In both cases –hospital and industrial – this attribute is independent of the following three attributes.Specific pharmaceutical activities. This concerns the definitions of the practice of community and hospital pharmacy . Such definitions involve pharmaceutical acts like formulation of specific forms of drugs or deliverance of specific drug treatments. The practitioners’ perceptions of such acts have been described in detail [n detail ,8,9.Laws and directives. The definition of attribute 2 –pharmacy practice –is established through laws and directives from national associations and/or chambers, and, in the case of the EU, by directives drafted by the European Commission and approved by the European Parliament. It should be noted that a directive is an act that requires a given country to achieve a result without dictating the means of achieving that result. Thus hospital pharmacy in Spain and Portugal are governed by associations and chambers [chambers ,11, and chambers ,13. At tchambers  defines chambers ,16,17,18chambers ,20. The Education and training. This attribute concerns the education and training for fundamental practice and for specialized practice in hospital and industrial pharmacy. As an example, in Spain and Portugal, hospital pharmacy practice is taught in specific hospital pharmacy specialization courses [ courses ,22. Conc courses .The attributes of pharmacy practice, with examples from the EU and Latin America, are:Below, are the paradigms and methodology to achieve these aims. Evidence of collaboration between the EU and Latin America in the form of student and/or staff exchange, joint projects in education and training and/or research, etc.Present and future development of specialization in pharmacy practice in the fields of patient care, research in pharmaceutical science and/or education, etc.Development of IT capacity in teaching.Interaction with national and international governmental departments , pharmacy chambers and associations, etc.The first stage in the elaboration of the COPHELA project was to constitute a core team of 10 partners (authors of this paper) who replied to the following criteria:EACEA/EU projects are separated into “workpackages” (WPs) that group the activities of the project. WPs function independently but rely on the results of other WPs. The target group and the ultimate beneficiaries of the COPHELA project are the populations of the Latin American countries. Benefit will come in various forms. Firstly, there will be an improvement in the healthcare of the Latin American population, following the amelioration of pharmaceutical care, based on the upgrade of pharmaceutical specialization in community and hospital pharmacies. Secondly, the Latin American pharmaceutical industry will benefit by providing employees with the tools required for future changes in the industry, such as the change from a chemistry-based industry producing small molecules to a biotechnology-based industry producing large therapeutic proteins.There are several potential issues. Firstly, they involve shortcomings in the performance of the partners and their capacity to produce, evaluate and accredit satisfactory courses. in the time given. Appropriate expedient measures to counter such deficiencies are based on the capacity of the auditing to detect and suggest solutions, and a satisfactory interaction with EACEA and project partners.Secondly, problems could arise in the accreditation of courses by bodies external to the project such as government health and education authorities, and thus, in the long-term use of COPHELA material post-2021, the official date of the closure of the project. The main purpose of COPHELA accreditation is recognition. The project in its present form has 44 partners and associated partners in the EU and Latin America. The fact that all the COPHELA universities and other institutions have contacts with the accreditation authorities in their different countries should ensure that such problems can be resolved. Thirdly, in parallel to accreditation, problems could arise concerning intellectual property and ownership of the material produced given that in the EU and in Latin America the economics of the education and training of pharmacists vary greatly. This ranges from the situation in state-owned universities where such education and training are without charge, to that in private universities with a fee system. Here, solutions will be found on the basis of interactions between the project partners and associated partners, and the relevant partners in the healthcare system of the country concerned. Ownership will be guaranteed by the commitments and conventions on a joint project. Intellectual property rights will be ensured through Creative Commons Licenses .COPHELA is a collaborative project between the EU and Latin America aimed at improving specialization education in pharmacy. Its ambition is to improve not only the competences of target groups, such as university staff and students, and pharmaceutical professionals, but also the wellbeing and prosperity of the general public through better patient care, and better drugs, with a modernized pharmaceutical industry capable of providing the latter. The purpose of this manuscript is to request comments on project design and recruit potential research partners.


Late life depression (LLD), a common mental disorder, has become an increasingly acute public health concern with a quickly expanding geriatric population worldwide. To our knowledge, however, the incidence of LLD in northern cities in China has not been empirically investigated, and many elderly people with depressive moods and mild depressive symptoms have not been given sufficient attention.This is a multi-stage and prospective study. The first stage is a cross-sectional study, investigating the epidemiological characteristics of LLD in northern China and exploring the biological, psychological, and social risk factors for developing LLD based on a set of questionnaires from 6,800 community-residing elderly adults. The second stage involves statistical analysis, by constructing a risk factor model for LLD and analyzing their direct and indirect functional routes on the basis of structural equation modeling. The third stage is an experimental study a total of 60 elderly patients with LLD and their principle caregivers will be randomly assigned to control and trial groups. The trial group patients and caregivers will undergo supportive psychosocial, drug treatment, and health education (PDH) intervention, whereas the control group patients and caregivers will be treated routinely . At the end of the intervention, depressive symptoms, quality of life, and the social and cognitive functioning of the patients in the two groups will be respectively assessed at a baseline and after 6, 9, and 12 months post-intervention by employing scales and questionnaires to analyze the effectiveness of the supportive PDH intervention measures in comparison with TAR. Ultimately, a supportive PDH intervention and health management model will be obtained by combining PDH intervention with mental health institutions, community health services, and aging families as the main line.This study will provide strong and suitable evidence for enhancing the integrated supportive PDH intervention and health management model of LLD patients among community-dwelling residents.This study has been approved by the Ethics and Research Committee of the First Affiliated Hospital of China Medical University . Late life depression (LLD) is complex, burdensome, and difficult to treat. Specifically, it refers to elderly people who, for the first time in their lives, meet criteria for major depressive disorder (MDD) or display clinically significant depressive symptoms such as functional disability, cognitive decline, increased risk of medical comorbidity , and even suicide in severe cases –4. MeanwEvidence shows that successful antidepressant treatment is one of the most effective ways of reducing disability, preventing morbidity, and improving quality of life (QOL) in older patients . HoweverIn Western countries in the 1970s, health management, an important topic in the field of healthcare, developed rapidly and was successfully implemented for chronic conditions such as hypertension, diabetes mellitus, and chronic obstructive pulmonary disease –22. By cAccording to literature review and analysis, we found that there are four main deficiencies of the existing research. First, due to a large elderly population base, rapid aging growth, uneven distribution of mental health resources, and insufficient public attention to the mental health of the elderly, under-recognition and under-treatment of depression appears to be severe in Liaoning which ranked first among 19 provinces and cities in terms of the proportion of the elderly population aged 65 and above in 2016. Second, research on interventions for LLD is limited. Previous studies have been mostly based on pharmacotherapy, psychosocial intervention, health education, or a combination of any two of these, but none, to our knowledge, have been conducted combining all aspects together. Third, research on the risk factors of LLD has been limited, and the methods used have not been sufficiently systematic. Previous studies were limited to investigating risk factors –26, but This study is designed to comprehensively assess the overall community mental health resources available to LLD patients, along with the prevalence, risk factors, and prevention and treatment status of LLD in Liaoning. By exploring and constructing the integration of psychosocial interventions, medical care, and health education with psychiatric hospitals, community health services (CHS), and aging families, this study can provide a reference for the practice of supportive intervention and health management, as well as guidance for formulating health policies in Liaoning. The aims of this study are as follows:Analyze the epidemiological characteristics of LLD in Liaoning province.Construct a risk factor model for LLD in Liaoning.Conduct supportive psychosocial, drug treatment, and health education (PDH) interventions alongside treatment as routine (TAR) in a trial group and control group, respectively, to compare their effectiveness with regard to patients and their caregivers.Establish a supportive PDH intervention and health management (SIHM) model for elderly patients with depression according to the local economic level, mental health resources, and demographics of Liaoning.Team members of the preliminary investigation will consist of six graduate students studying psychiatry, two clinical psychiatrists with experience in the fields of mental health, geriatrics, and medical psychology, and five CHS staff members from Liaoning province. Before implementing the questionnaire survey, graduate students and CHS staff will undergo unified training, to explain the specific purpose, content, significance, procedures, and principles of the investigation. Further, the team members will learn the definitions and scoring criteria of each item in the questionnaires and scales, communication skills for interacting with elderly patients and their caregivers, and possible problems and solutions that might be encountered. After sampling according to inclusion and exclusion criteria, the psychiatrists, accompanied by other team members, will enter selected communities, ask permission from community leaders, and complete the investigation in public activity areas or at elderly residences accompanied by the arranged community staff.In addition, team members of the intervention will comprise graduate students in psychiatry, one clinical psychiatrist, and one psychologist employed to supervise and guide the intervention process. After team members work out a detailed intervention plan according to the purpose of the project and the characteristics of the research objects, the research team will organize experts in psychiatry, psychotherapeutics, social medicine, and geriatrics to review and approve the plan. Afterwards, the plan will be revised and improved based on expert advice before implementation. Then, in the course of carrying out the plan, the intervention team members will record any problems with the intervention process and immediately report back to the project leader for revisions before further implementation. The goal of such cycles is to ensure the effectiveness of the intervention.In order to ensure the quality of the preliminary investigation of this project, we formulated the following measures. First, there will be unified training for researchers before data collection to reduce bias caused by differences among researchers. Second, when carrying out the questionnaire, the environment will be as quiet as possible, so as to facilitate the emotional stability of the research subjects and avoid adverse effects from the internal and external environment. Third, when collecting the questionnaires after completion, missing items will be promptly identified (without violating the principle of voluntariness) to ensure the accuracy and integrity of the survey data. Finally, data obtained from the survey will be input into statistical software for analysis by two investigators working together. At the same time, before statistical processing, SPSS descriptive statistics will be used to verify the recorded data, and errors will be corrected.Similarly, the following three measures were developed to ensure the quality of the intervention. First, members of the intervention team will regularly report the concrete content of the intervention measures and the implementation process to the project leader and clinical psychiatrists. Second, a clinical psychiatrist will be invited to evaluate, guide, and correct the accuracy of the intervention measures and methods, along with any problems with the intervention and suitable solutions. Third, contingency plans will be developed and imparted to researchers in case of any emergencies while executing intervention measures.This is a multi-stage and prospective study. It includes the following three stages:The first stage is a cross-sectional study, based on the baseline information from 6,800 community-dwelling elderly adults collected through a set of questionnaires. The aim of the first stage is to investigate the epidemiological characteristics of LLD in northern China, and to explore the biological, psychological, and social risk factors for developing LLD.The second stage involves statistical analysis, with the aim of constructing a risk factor model for LLD and analyzing direct and indirect functional routes on the basis of structural equation modeling (SEM).The third stage is an experimental study, comprising a 6-month supportive intervention period and a 6-month follow-up period. In order to ensure the participation of the subjects in this study and improve the effectiveness of the interventions, a total of 60 elderly patients with depression and their principle caregivers will be randomly and equally assigned to trial and control groups.Trial group patients and caregivers will undergo supportive PDH interventions, and control group patients and caregivers will receive TAR. Subsequently, depressive symptoms, QOL, and the social and cognitive functioning of the patients in the two groups will be respectively assessed at a baseline and after 6, 9, and 12 months post-intervention by using scales and questionnaires to analyze the effectiveness of the supportive PDH intervention measures. Ultimately, an SIHM model will be constructed by combining PDH intervention with mental health institutions, CHS, and aging families as the main line.We plan to enroll the participants between December 2019 and December 2022. The goal is to recruit 6,800 community-residing elderly adults to complete the baseline investigation. Then, 60 LLD patients who meet more strict criteria, along with their principle caregivers, will receive 6 months of supportive PDH intervention followed by a 6-month follow-up period. The inclusion and exclusion criteria for all the respondents, patients with LLD, and caregivers are listed in The 6800 community-residing elderly adults will be screened and enrolled by the investigators according to the inclusion and exclusion criteria. To ensure the balance and representativeness of sample sources, we intend to adopt a multi-stage sampling method. At the first stage, four cites will be randomly selected in Liaoning province by randomized sortition. At the second stage, one district and one township will be randomly selected from each selected city. At the third stage, one urban community and one village community will be randomly selected from each selected district/township. At the fourth stage, elderly residents will be selected from each selected urban community and village community with a convenient sampling method.The 60 community-residing elderly adults with LLD and their principle caregivers will be allocated to trial and control groups. In addition, we will ensure that there are no statistical differences between the two groups in term of the degree of depression, drug treatment programs, knowledge of mental health, geographic distribution, and other aspects before carrying out the interventions. The trial group of 30 elderly patients and their principle caregivers will receive the same content and frequency of individualized and group intervention for 6 months. By contrast, the 30 elderly patients in the control group and their principle caregivers will receive TAR, which are suitable for all MDD patients as routine. During this period, except for any additional treatment for comorbid physical diseases or short-lasting benzodiazepines for severe insomnia, other antipsychotic medications, systematic psychotherapy, and long-lasting benzodiazepines will not be allowed. The detailed content, forms, and methods of the supportive PDH intervention are listed in Considering that Shenyang, the capital of Liaoning, has the second-largest elderly population in the province, a multi-stage sampling method will be applied during this phase as well. At the first stage, one district and one township will be randomly selected by randomized sortition in Shenyang. At the second stage, one urban community and one village community will be randomly selected from each selected district/township. At the third stage, with the help of local community health workers, 60 elderly patients with LLD who meet the inclusion criteria will be selected from each selected urban community and village community with a convenient sampling method.In addition, the 60 elderly patients in the trial and control groups will receive clinical visits at the baseline and after 6, 9, and 12 months post-intervention using scales and questionnaires. The primary treatment and intervention outcome evaluation index shows the change in the total Geriatric Depression Scale (GDS) score. A secondary index includes the change in the total Older People Quality Of Life (OPQOL) score, the 36-item short-form (SF-36) from the Medical Outcomes Study (MOS), the Social Disability Screening Schedule (SDSS), the Family APGAR Scale, the Montreal Cognitive Assessment (MoCA), the Knowledge-Attitude-Practice (KAP) for LLD, the General Self-Efficacy Scale (GSES), and the Irritational Beliefs Scale (IBS). That is, the effectiveness of the supportive PDH intervention will be comprehensively evaluated in terms of depressive symptoms, QOL, and social, family, and cognitive functioning. See At screening, the trained investigators will examine, gather, and record participant eligibility. The Chinese version of MINI  will be Finally, to evaluate the effectiveness of supportive PDH intervention, follow-up data regarding improvements in depressive symptoms, QOL, and social, family, and cognitive functioning will be assessed and acquired using other standardized Chinese scales and questionnaires, respectively –31.The primary goals of this study are to analyze the epidemiological characteristics and construct a risk model for LLD in Liaoning. The study design for this part is a cross-sectional study. Wang et al. reported the prevalence of MDD in elderly Chinese at 2.8%, where the ratio of urban to rural was 1.4:1 . That isGiven that 10% of the data are missing, a total of 6,800 elderly residents  should be included.The secondary goals of this study are to conduct and evaluate integrated supportive PDH interventions and TAR for the objects in the trial group and control group, respectively. The study design for this part is an experimental study, and the sample size can be determined by the change in the value of the mean and standard deviation of the depression score of elderly patients before and after intervention in a previous study . That isGiven that 20% of the data are missing, each group should have a sample size of 30 LLD patients. Meanwhile, to facilitate the compliance of patients in the later intervention stages, and to ensure the effectiveness of the intervention, each patient’s primary caregiver will be required to accompany the participant. In the later stages, we will further revise the sample size according to the preliminary experimental results from the intervention study.The participants, method, assessment time, and data collection administrators are listed in The statistical analyses will be performed by employing the SPSS statistical package, version 20.0 , and all evaluations of significance will be determined based on two-sided tests using the 0.05 level of statistical significance. In addition, missing values will be replaced by the column mean/median in this study. The details of the analytic approach are as follows.Demographic and clinical characteristics, lifestyle patterns, medical history, history of alcohol and drug abuse or dependence, family history of mental illness, self-knowledge and treatment attitude, and the self-efficacy levels and depressive symptoms of the subjects will be described by frequency distribution, percentage, arithmetic mean, and standard deviation.t-test, Mann–Whitney U-test, and the chi-squared test, as appropriate.Comparison of the above variables between patients with or without LLD will be made using the independent-sample Correlation analysis, logistic regression (for binary variables), and multiple linear regression (ANCOVA for continuous variables) will be used to determine whether the variables can enter SEM, and to test the direct and indirect pathways among these hypothesized determinants.Amos version 22.0 statistical software will be used for SEM of the risk factors for LLD.GDS, SDSS, SF-36, OPQOL, Family APGAR, GSES, IBS, MoCA, and the related KAP for LLD in the elderly will be used as evaluation indices, and analysis of variance (ANOVA) will be applied to compare the results of the control and the trial groups before and after intervention.Regression analysis will be used to analyze the influence of various factors on the effectiveness of the supportive PDH intervention.This study [approval no. (2019) 2019-312-2] was approved by the Ethics and Research Committee of the First Affiliated Hospital of China Medical University, which verified that the study will be performed in accordance with all ethical standards set forth by the committee.Participants will be assured of the confidential nature of the study, and written informed consent will be obtained. All data collection will be anonymous and in accordance with the provision of Chinese law regulating patient autonomy, rights, and responsibilities in the field of clinical information and documentation.Based on an analysis of the current clinical report results, there are many basic studies and investigations of the pathogenic factors of LLD. Investigations mainly focus on three groups of variables. First, researchers study the correlation between the characteristics , 35 bio, 37 per–40  and a grant from the Major Project of the Science and Technology Ministry in China (2017YFC0820200).The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.


The 11th International Retroviral Nucleocapsid and Assembly Symposium was held August 15–17, 2019, on the campus of Northeastern University. The meeting consisted of 40 oral presentations and a poster session while providing a stimulating environment to advance our understanding of retroviral assembly and replication and promoting interactions between young scientists and prominent researchers. The presentations covered a range of topics related to retroviral replication and assembly, including biophysical and structural studies, the roles of Gag, NC, RNA, and membranes in retroviral replication and assembly, interactions with cellular factors, virus assembly and budding, and therapeutic strategies. As an outcome of the meeting, this Special Issue was organized. Due to the pandemic, deadlines for the Special Issue were extended, and the issue was completed in October 2020.The eleven manuscripts published as part of this Special Issue reflect the breadth of topics covered by the symposium, ranging from fundamental biophysical studies of the molecular interactions involved in retroviral replication and assembly to the characterization of complex cellular interactions involved in these processes. Studies of molecular biophysics and biochemistry included a study of the dimerization of the Rous Sarcoma Virus genomic RNA , compari