Nevertheless, although the area of trench and lakes only occupies 1.67–3.16% of the total area of land, its ecological value accounts for an astonishing 23.80–50.70% of the total ESV. At the district level, the primary decline in eco-system services value was noted in the Chongming District in the north and Pudong New Area in the east of Shanghai. However, due to the overall planning of the city and the advantages of its resource endowment, Qingpu District and its surrounding areas in western Shanghai have witnessed improvements in terms of the values of hydrological adjustment, water supply, and environmental purification. This study presents a deeper and more comprehensive understanding of issues regarding ESV in rapidly urbanized areas, thereby providing an important reference for decision-makers regarding the rational layout of cities, sustainable use of land, and management of natural ecosystems.Land resources are foundational for human survival and development. In contrast, land use/land cover (LULC) dynamics drive considerable changes in ecosystem services. Recently, China witnessed a new stage of rapid urbanization. Therefore, investigating the relationships between ecosystem services value (ESV) and LULC in these areas is highly relevant. Based on the data of land use and socioeconomic development in Shanghai from 2000 to 2020, we adopted a land use/land cover dynamics analysis method and established the ESV per unit area at the city scale, discussed the impact of LULC on ESV spatially and quantitatively, and tested the research process based on the sensitivity analysis of the ESV coefficient. The results show that from 2000 to 2020, the LULC pattern in Shanghai rapidly changed. In particular, the area of cultivated land has shrunk by 123.96 thousand hm The ecosystem is composed of plants, animals, microbial communities, and the abiotic environment. The ecosystem itself and the services provided by its species are the conditions and processes needed to meet and sustain human production and life. These provide a wide range of direct and indirect services for human survival and contribute significantly to improving human well-being ,2,3,4,5.From an economic perspective, measuring the impact of LULC on various ecosystems is an effective way to assess the environmental costs and benefits of different land-use plans and decisions. Based on the evaluation model of ecosystem services value established by Costanza et al., scholars from home and abroad have conducted extensive empirical studies ,38,39. MCompared with other parts of the world, LULC dynamics in China are substantially more complicated. With the rapid development of China’s economy and its increasing urbanization, land resources in China have undergone huge conversions and occupations, resulting in a drastic transformation of land-use types and areas, which have significantly impacted the value of regional ecosystem services ,51,52,53There are many studies have been conducted regarding LULC in China, including its dynamics in urbanized areas ,71,72,73In the 20 years from 2000 to 2020, Shanghai’s economy grew more than 15 times. Simultaneously, Shanghai’s rapid development has also been accompanied by resource consumption, environmental deterioration, and transformation of land use patterns. From this perspective, land use/land cover in Shanghai has significantly changed, both temporally and spatially, which needs special attention. In recent years, documents emphasizing the optimization of the systematic structure and balanced development of the city, strengthening urban land use, and promoting the coordinated development of industrial layout, spatial structure, and ecological environment have been issued, such as the Shanghai City Master Plan (2017–2035), Shanghai Land Use Master Plan (2010–2030), and other documents have been issued. In this study, we derived the multi-period LULC monitoring dataset of China from Landsat MSS, TM/ETM, and Landsat 8 satellite remote sensing data and combined it with relevant statistical data. Based on this, we selected the representative city of Shanghai to study LULC and its influence on ESV. The degree of land-use dynamics, ecosystem services value, contribution rate, coefficient of sensitivity, and other indicators were used to objectively reflect the influence of LULC on ESV in Shanghai from 2000 to 2020. The purpose of this study is to provide a deeper and more comprehensive understanding of the issues related to ESV in rapidly urbanized coastal areas, thus providing theoretical and methodological support for promoting the sustainable development of land resources and social economy in Shanghai. Specifically, our study aims to answer three main questions: (1) How did the LULC dynamics occur in Shanghai from 2000 to 2020? In this regard, we will analyse and discuss the specific changes of the LULC dynamics in Shanghai; (2) How did the total and individual ESV change in response to the LULC dynamics during this period? This is the key issue of this study, and we will try to explore and reveal the impact relationship between them; (3) Regarding LULC dynamics, what management strategies should Shanghai adopt? In summary, this study aims to address these issues and assumes that LULC dynamics play a key role in the degradation of natural ecosystem services over time.2. Situated in a humid subtropical region, Shanghai has a typical subtropical monsoon climate. It features four distinct seasons, and is rainy and hot during the same period . As the economic, financial, and commercial centre of China, Shanghai is a region that boasts the strongest comprehensive and economic strengths in China. In 2020, the GDP of Shanghai was 3870.058 billion yuan, ranking first among the cities in China . In recent decades, Shanghai has undergone intensive land use dynamics owing to rapid urbanization, which has aroused public and academic attention on the need to study changes in ESV caused by LULC in Shanghai. As shown in Based on the National Resources and Environment Database and Landsat remote sensing image data of the United States as the main information source, the Chinese Academy of Sciences (CAS) established the national 1:10 scale multi-period LULC dataset, namely the China Land Use and Cover Change (CNLUCC) through artificial visual interpretation, and adopted a conical projection of Albers positive axis equi-area double standard parallels as the data projection system. In this study, the data used to analyze the impact of LULC on ESV in Shanghai are based on five land-use maps generated by the Institute of Geographic Sciences and Natural Resources Research, CAS, which are from 2000, 2005, 2010, 2015, and 2020. In this study, Landsat Thematic Mapper (TM), Enhanced Thematic Mapper Plus (ETM+) remote sensing image data were mainly used for remote sensing interpretation of data from 2000, 2005, and 2010, while Landsat 8 remote sensing image data were used for updating the LULC data from 2015 and 2020.2), and the consumer price index (CPI) used in ecosystem services value calculations were obtained from the Shanghai Statistical Yearbook (2001–2021) and the China Statistical Yearbook (2001–2021).Based on the national standard stipulated in China’s Land Use Classification in 2017 (GB/T 21010-2017), land use types in Shanghai, after comprehensive consideration of the characteristics of its land resources, were classified as cultivated land, forest land, grassland, trench and lakes, wetland pits, and construction land in ArcGIS10.2, which can highlight the characteristic land-use types of coastal areas . Based oLand use dynamic degree (LUDD) describes the change rate of land use in a certain period. The comprehensive LUDD is often used to measure the change rate of land use over an entire area, whereas the individual LUDD is used to calculate the change rate of a certain land type. The calculation method for LUDD is as follows: the ratio of the total area transformed from one land type to another to the initial area of the land type transformed in a certain period . The laribLU is the final value of land type i in period m, iaLU is the initial value of land type i in period m, while ib’LU is the final value of land type i in period n, ia’LU is the initial value of land type i in period n, and mnM is the ratio of the change in period m to that of period n. iLUDD is the dynamic degree, and T is the study period, the unit of which is set as year in this study; hence, the iLUDD in the formula represents the average annual change rate of a certain land type, and the comprehensive LUDD equals the sum of iLUDD.In the formula above, 2) in Shanghai from 2000 to 2020 were used to estimate the economic value of food crops (yuan hm−2) in Shanghai. The ecosystem services value equivalent factor is used to represent the relative contribution rate of the potential ecosystem services value. Without considering human input, the economic value provided by natural ecosystems is approximately 1/7 of the economic value produced by existing food crops per unit area [−2) was modified. To make the raw data comparable, the CPI was used to adjust the ecosystem services value of different years to the level based on data from the year 2000  and the sown area of food crops  of each land use type in Shanghai can be obtained as shown in Based on the ecosystem services value coefficient determined by Costanza et al. and combined with the equivalent conversion method of Chinese ecosystem value proposed by Xie et al. ,60,61, tiA refers to the area of land use type i, and ijV represents the value per unit area produced by ecological services j of land use type i. m refers to the sum of all land use types, and n represents the sum of all ecosystem service categories.Based on existing studies, in the formula for calculating ecosystem services value, ESV represents the total value of the regional ecosystem services. iCR is the ratio of the value of ecosystem service i to the total value of ecosystem services, whereas jCR equals the ratio of the value of ecosystem type j to the total value of ecosystem services.To facilitate the analysis of changes in ecosystem services value and the comparison of ESV in different regions, this study, based on the research of traditional calculation methods of ESV conducted by Zhang et al. ,77, intrVi1 and Vi2 represent the ESV per unit area produced by land use type i before and after adjustment, respectively, while ESV1 and ESV2 represent the total ESV before and after adjustment, respectively. If the ESV is inelastic relative to V, then CS < 1, meaning that the ESV is insensitive to the ESV coefficient. Conversely, if ESV is elastic relative to V, then CS > 1, indicating that ESV is sensitive to the ESV coefficient. As CS increases, its ESV becomes more dependent on the ESV coefficient, indicating that the accuracy of the ESV coefficient matters.The coefficient of sensitivity is a type of elastic coefficient, which is used to show the dependence of ecosystem service value on the ESV coefficient. That is, the degree of change in ESV is caused by a 1.0% change in the ESV coefficient ,79. In tFrom 2000 to 2020, the main types of land use in Shanghai were cultivated land, trench, lakes, and construction land, and the sum of the three areas in the five years accounted for over 90% of the total area of Shanghai, as shown in 2 of cultivated land. Meanwhile, the net increase in construction land ranked first, reaching 141,260 hm2. The increase in construction land is approximately equal to the decrease in cultivated land, forest land, trench, and lakes, as shown in From 2000 to 2020, Shanghai witnessed rapidly changing LULC patterns and a significant decline in the area of cultivated land, trench, and lakes, with a net decrease of 123,960 hmIn the Shanghai Main Functional Area Planning issued by the Shanghai government, the development strategy for the vast area in the west and south of the city is divided into new areas, whose development focus is intensive and efficient, with improved functions, a friendly environment, a harmonious society, and the integration of urban and rural areas. In other words, the increase in lakes in Shanghai is probably due to the promotion of relevant policies. This study will further explain this point.Ecosystem services values of Shanghai in 2000, 2005, 2010, 2015, and 2020 were 11,458.78 million yuan, 10,269.72 million yuan, 10,539.58 million yuan, 11,148.40 million yuan, and 10,320.38 million yuan , respectThe change in ESV caused by LULC can also be analyzed from the perspective of conversion between various land use types . First, Meanwhile, the shift from wetland pits to trench and lakes contributed to increasing the ESV of the entire city from 2000 to 2020, especially from 2005 to 2010. Similarly, by virtue of the ecological civilization construction strategy advocated by the Chinese government in recent years, the shift from construction land to other land use types greatly facilitated the increase in ESV in 2015–2020. During this period, Shanghai conducted a large number of ecological restoration and environmental protection projects, such as the development of the Chongming ecological island, construction of the Huangpu Riverside greenway. Efforts have also been made to further develop the Shanghai Jiuduansha Wetland National Nature Reserve, Shanghai Chongming Dongtan National Nature Reserve, and other regional projects related to ecological environmental protection. Therefore, great strides have been made regarding ecological restoration and environmental protection in Shanghai in recent years, controlling the scale and mode of urban construction to a certain extent, especially adjusting, and optimizing the structure of urban land use, and controlling wetland pit contraction.According to For the convenience of analysis, we selected seven districts: Huangpu, Xuhui, Changning, Jing’an, Putuo, Hongkou, and Yangpu as the city center. In general, choosing the seven districts west of the Huangpu River as the core area was based on the geographical characteristics and historical evolution of Shanghai. After the signing of the Treaty of Nanjing between China and Britain in 1842, Shanghai officially opened as one of the five trade ports. Since the 1990s, large-scale renovation of infrastructure has been performed, rendering this region one of the most prosperous areas in Asia, which is also the core area of Shanghai.The calculation results for the total ESV based on the analysis of each district in Shanghai are shown in The rate of change of the ecosystem services value in Shanghai from 2000 to 2020 is shown in 2. It is rich in natural resources that can provide high values for hydrological adjustment, water supply, and environmental purification. Qingpu District and its surrounding Jiading District, Jinshan District, Songjiang District, and Fengxian District are all classified as new urbanized areas in the Shanghai Main Functional Area Planning issued by the Shanghai Government. The development strategy for this area is intensive and efficient, with improved functions, a friendly environment, a harmonious society, and the integration of urban and rural areas. Therefore, the increase in the ESV of Qingpu District also benefits from the support of relevant policies.It should be noted that, located in the lower reaches of Taihu Lake and the upper reaches of the Huangpu River, Qingpu District boasts 1817 rivers, stretching 2155 km, and 21 lakes, covering a total area of 59.3 kmBy adjusting the ESV coefficient per unit area of each land use type by ±50.0%, the CSs of ESV in Shanghai in the corresponding years can be obtained through calculation . We can Existing studies clearly show that in large cities such as Shanghai, the most evident temporal and spatial change in land use type can be attributed to the expansion of construction land and diminishing natural vegetation . Based oTo a large extent, the change in land-use type from 2000 to 2020 in Shanghai has led to a decrease in the overall urban ecosystem service supply, especially regarding the reduction in the value of biodiversity (−407.65 million yuan). In fact, similar situations have been witnessed worldwide ,88,89. AIn fact, the policy is also an important factor that affects the change of urban LULC and leads to the difference of ESV. For example, in the Shanghai Main Functional Area Planning issued by the Shanghai Government, the development strategy for the vast area in the west and south of the city is divided into new areas, whose development focus is intensive and efficient, with improved functions, a friendly environment, a harmonious society, and the integration of urban and rural areas. In other words, the increase in lakes in Shanghai is probably due to the promotion of relevant policies, this change of LULC in turn led to the improvement of ESV in Qingpu District. Overall, while working to improve urban economic development and adjust the structure of urban land use, decision-makers and administrators should recognize the relationship between different land use types and the ecosystem services provided by them, which contribute to the rational layout of cities, sustainable use of land, and management of natural ecosystems.Based on the land use classification (GB/T 21010-2017) and relevant calculation rules of ESV and combined with the characteristics of land types in Shanghai, this study focused on the land use types that can highlight the characteristics of the study region, such as cultivated land, forestland, grassland, trench and lakes, wetland pits, and construction land. Construction land with ESV equivalent to less than 0 was excluded from this study. However, considering the expanding area for construction land in Shanghai year by year in recent years, it can be known that the actual loss of ESV in Shanghai may be higher than the research results, which is comparable to previous research results . MeanwhiAccording to the rule that the value of an equivalent factor is equal to 1/7 of the market value of grain output per unit area in the same year, the value change caused by different prices in different periods of time is eliminated by using the CPI index to revise the ESV coefficient of land use types in Shanghai, which makes the calculated results closer to the actual ESV and improves the accuracy and comparability of value evaluation, thus properly preserving and developing the traditional methods. In general, this study selected Shanghai as a representative city to consider land use/land cover and its influence mechanism on ecosystem services value, and used TM remote sensing image data and relevant statistical data to objectively indicate the impact of LULC on ESV in Shanghai from 2000 to 2020 through indicators such as dynamic degree of land use, ESV and its contribution rate, and CS. It provides theoretical and methodological support for promoting the sustainable development of land resources and the social economy in Shanghai by enhancing a deeper and more comprehensive understanding of issues related to ESV in rapidly urbanized areas, thus providing an important reference for decision-making regarding the rational layout of cities, sustainable use of land, and management of natural ecosystems.Since its reform and ’opening up’, China has made remarkable achievements in economic and social development. With rapid economic growth and urban development, capital, labor force, land, and other traditional elements continue to gather in cities for urban development in all aspects, rendering an increasingly limited use of urban land and thus enhancing the impact of land use change on the ecosystem. Based on existing research results and the characteristics of LULC and ESV in Shanghai, this study comprehensively considered the actual situation of the city, calculated the equivalent factor of ESV in Shanghai, and then measured the ESV and its changes in Shanghai from 2000 to 2020.2, while the construction land has expanded by 141.26 thousand hm2, which led to a decline in ESV of the entire city, especially regarding hydrological adjustment and biodiversity, which were reflected in the declining trend of the value generated by various ecosystem services. In particular, the contribution of wetland pits to the overall ecosystem of Shanghai cannot be ignored, and trench and lakes are essential for improving ecosystem services: although the area of trench and lakes only occupies 1.67–3.16% of the total area of land, its ecological value accounts for an astonishing 23.80–50.70% of the total ESV. As such, they cannot be ignored despite the small fraction they occupy in the entire area. In the future planning of land use in Shanghai, we should heed to the ecological service function of land types, such as trench, lakes, and wetlands pits, and clarify the key role they play in maintaining the balance and healthy development of urban ecosystems. At the district level, barring Chongming District, the value of water supply has increased in all other districts, especially Qingpu District (+118.65 million yuan) in the west of the city. Meanwhile, the main reason for the decrease of ecosystem services value from 2000 to 2020 was the decrease of ecosystem services value in Chongming District in the north and Pudong New Area in the east, which experienced the most severe loss of ESV. However, by virtue of the overall planning of the city and the advantage of its resource endowment, the value of hydrological adjustment in Qingpu District has risen significantly (+1011.45 million yuan) and that of environmental purification has also increased (+30.87 million yuan). We believe that the scale of urbanization and industrialization should be set and controlled in terms of time and space to prevent the pollution and destruction of wetland pits, trench, and lakes during urban development. However, the results of the sensitivity analysis demonstrate that ESV is inelastic to the ecosystem services value coefficient (V), which is consistent with the realities of Shanghai, indicating the reliability of the ESV coefficient determined in this study.As a representative of China’s rapid urbanization, Shanghai has undergone significant changes in land use structure during the process of urban expansion, which is mainly reflected in the encroachment of the expanding construction land on cultivated land, forest land, trench, and lakes, as well as other land types. The LULC pattern in Shanghai rapidly changed from 2000 to 2020, in particular, the area of cultivated land has shrunk by 123.96 thousand hm


The rapid spread of the COVID-19 pandemic in early 2020 has impacted the politics, economy and society of countries around the world. The public health diplomacy system through which developed countries in Europe and America used to provide vertical one-way assistance to developing countries faces huge challenges. How emerging economies can cooperate to fight the pandemic on the basis of mutual trust and mutual benefit has become an urgent issue. In this paper, we examine the impact of political mutual trust on the effectiveness of pandemic prevention and control from the perspective of establishing strategic partnerships between emerging economies. Furthermore, taking into account the huge differences between emerging economies, this paper explores institutional distance, cultural distance, and geographical distance—the adjustment effect of the control effect. Studies have shown that the improvement of political mutual trust is conducive to the formation of a community of shared futures between countries and has a positive effect on curbing the spread of the pandemic. The increase of the three-dimensional distance of institutions, culture, and geography will weaken the effect of establishing strategic partners for pandemic prevention and control. This paper explores a new model of horizontal international cooperation among emerging economies, and provides a reference for emerging economies to deal with common globalization issues in the future. Since the beginning of 2020, the rapid spread of COVID-19 has brought a great impact on the world's politics, economics, and society. Different from the major public security incidents for human beings, in the face of this COVID-19 pandemic, there are huge differences in the prevention and control strategies of the world's major economies. U.S. states have introduced different pandemic prevention policies, such as issuing stay-at-home orders, closing schools and public places, canceling public events, and others  increased in real terms by 4.9% in 2020, well above the average annual growth rate of 2% between 2017 and 2019, and Canada's per capita COVID-19 spending was as high as $602 . AccordiInternational cooperation is critical in addressing global health and public health security concerns, and is key to the response to the COVID-19 pandemic . The essPrevious studies have explored how to prevent and control the spread of the epidemic from multiple perspectives, including public health management , clinicaThe unique urgency and uncertainty of major public emergencies have not only impacted the global public health system, but also provided opportunities for countries to cooperate. This paper takes into account the large number and wide distribution of emerging economies and the huge institutional and cultural differences between countries, which may lead to differences in their stressors, responses, and priorities . These dStrategic cooperative partnership between countries means mutual trust, more channels of interaction and institutions established to solve problems at the governmental and non-governmental levels. In the face of global crises and challenges, countries can transcend bilateral issues, seek common ground while reserving differences, and seek international cooperation for common solutions . TherefoH1: Establishing cooperative partnership plays a positive role in pandemic prevention and control.The dimensions of differences between countries are diverse, and the institutions, cultures, and geographical distances between countries may have an impact on the international cooperation carried out under the partnership, which in turn makes the establishment of strategic partnerships have different influences on the effect of pandemic prevention and control.Institutions include formal institutions  and informal institutions  , and insOn the one hand, the existence of institutional distance makes it difficult for countries to reach consensus on divergent issues, which may increase political tensions and make international cooperation in prevention and control more difficult . Mutual H2: Institutional distance negatively regulates the positive effect of establishing strategic partners on pandemic prevention and control.There are cultural differences between different countries , and culH3: Cultural distance negatively regulates the positive effect of establishing strategic partnerships for pandemic prevention and control.The difficulty of national cooperation is increased by increasing geographical distance, which is challenging to interrupt the rapid spread of COVID-19 around the world. On the one hand, geographic distance is a negative factor affecting state relations and is also seen as a proxy for transportation and communication costs , which nH4: Geographical distance negatively regulates the positive effect of establishing strategic partners on pandemic prevention and control.There is not yet a consistent definition of the concept of emerging economies, and a common practice is to classify countries other than developed as emerging economies , 46. FirWe collected China's strategic partnership with 164 emerging economies in 2019, and cross-sectional data on the pandemic, economy, population, and medical care of these countries in 2020. We mainly considered two aspects. One is the availability of data. In 2020, the COVID-19 virus spread widely around the world and was identified by the World Health Organization as a public health emergency of international concern. In addition, some indicator statistics in the World Health Organization and World Bank databases are only updated to 2020. Second, the impact of close strategic partnership on the effectiveness of COVID-19 prevention and control has a lag. The data for each indicator used in this article is taken from the Johns Hopkins University Coronavirus Resource Center, the website of the Chinese Ministry of Foreign Affairs, the public data of the Hofstede team, the CEPII database, the World Bank, the World Health Organization, and the United Nations Comtrade Database.The number of confirmed cases is one of the important indicators to reflect the effectiveness of a country's pandemic prevention and control . The fewThe independent variable of this paper is the strategic partnership, which is measured by the closeness of the bilateral partnership. The value is 0 for unestablished partnerships, one for partnerships, two for comprehensive partnerships, three for strategic partnerships, and four for comprehensive strategic partnerships. The higher the value, the stronger the partnership.IkCH represents the index value of the k-th institutional dimension of China, Ikj represents the index value of the k-th institutional dimension of emerging economies j, and Vk represents the variance of the index value of the k-th institutional dimension. The data of each institutional dimension comes from six aspects of the Worldwide Governance Indicators (WGI) provided by the World Bank . The second is cultural distance, which reflects the degree of cultural difference between China and emerging economies. The cultural distance between China and various emerging economies is measured according to the cultural distance measurement index proposed by Kogut and Singh . One can obtain a score for each cultural dimension of the economy by entering a country's name. The third is geographical distance, which reflects the geographical proximity between China and emerging economies, measured by the straight-line distance between Beijing, the capital of China, and the capitals of emerging economies.There are three moderator variables in this paper. The first is institutional distance, which reflects the institutional environment differences between China and emerging economies. The measurement method refers to the formula of Kogut and Singh , that isnd Singh . That isIn this paper, five variables are included as control variables from the three aspects of economy, population, and medical care. The first is the closeness of bilateral economic ties, which is measured by the total import and export trade between China and emerging economies; the second is the level of national economic development, which is measured by the GDP per capita of emerging economies; the third is the age structure of the country's population, which is measured by the proportion of the population aged 65 and over to the total population; the fourth is the health status of the national population, which is measured by the incidence of tuberculosis per 100,000 people; the fifth is the national medical and health level, which is measured by the coverage of health services in the infectious diseases index.The variable definitions and measurement methods in this paper are shown in Descriptive statistics and correlations of the variables are shown in In order to test the impact of strategic partnership on the effect of pandemic prevention and control (H1), we employ the following linear estimation model.Furthermore, in order to study whether different institutional environments, cultural backgrounds and geographic distances between the two countries have different effects on epidemic prevention and control, we expand model (2), (3) and (4) on the basis of model (1), and explore the moderating effect of institutional ,cultural and geographic distances, respectively:Among these, the independent variable lnincidence  represents the effect of pandemic prevention and control. The independent variable lnrelationship  represents the closeness of the bilateral partnership. lnid, lncd, and lngd are three moderator variables, which are geographic distance, cultural distance, and institutional distance. CV represents the set of control variables that affect the impact of pandemic prevention and control, including lntrade, lngdp_per, lnelderly, lntuberculosis, and lnsci_infectious, and ε represents the random disturbance term.p < 0.05), which suggests that the closer the partnership between China and emerging economies, the lower the incidence of COVID-19 in emerging economies. Therefore, the establishment of strategic partnerships will help emerging economies to achieve better pandemic prevention and control effects. Hypothesis 1 is supported.Hypothesis 1 of this paper is that the establishment of strategic partnership is conducive to improving the effect of pandemic prevention and control, and the incidence of COVID-19 is used as a reverse indicator to measure that effect. p < 0.05), indicating that the estimated result is still robust. In addition, in the subsequent moderating effects test  to replace the original incidence (lnincidence), thereby measuring the effectiveness of pandemic prevention and control, and use the number of visits (lnvisit) between state leaders as the proxy variable of the partnership (lnrelationship), while other variables remain unchanged. It can be seen from cts test , after t*lnid is significantly positive , the coefficient of lnrelationship*lncd is significantly positive , and the coefficient of lnrelationship*lngd is also significantly positive . The signs of the three interaction terms are all opposite to the independent variable, indicating that institutional, cultural, and geographical distance have negative moderating effects on the relationship between the establishment of strategic partnerships and pandemic prevention and control in emerging economies. When the institutional, cultural, and geographical distances between countries are relatively far, the positive impacts of establishing strategic partnerships on prevention and control in emerging economies will be weakened. Thus, hypotheses 2, 3, and 4 of this paper are supported.Hypotheses 2, 3, and 4 in this paper respectively assume that the positive effect of establishing strategic partnerships on COVID-19 prevention and control may be influenced by differences of institutional, cultural, and geographical distance. In this paper, we constructed the interaction terms of one independent variable (lnrelationship) and three moderator variables . Moreover, in this paper, we have constructed the independent variable lnrelationship and the interaction terms of the three moderator variables. Model (5), (6) and (7), respectively incorporate moderator variables and interaction terms based on model (2), to investigate the effect of differences in multiple distances on the impact of establishing strategic partnerships for pandemic prevention and control. From the regression results in In this paper, we find that the establishment of strategic partners is positively correlated with the effectiveness of pandemic prevention and control. There are three main reasons for this. First, close partnerships between countries reduce the likelihood of public health securitization. Securitization occurs when a threatening issue is sufficiently prominent to allow authorities to take approaches that they deem most appropriate to deal with the issue . The strFrom the perspective of different dimensions in distance, we find that multiple distances—institutional, cultural, geographical—have negative moderating effects on the relationship between the establishment of strategic partnerships and the effect of prevention and control. It is not surprising that these multiple distances have significant moderating effects. On the one hand, despite the many similarities among countries during the pandemic, measures to deal with the spread of COVID-19 and priorities in prevention and control may differ due to differences in countries' geographical locations, cultures, and institutions , which wIn this paper, we have examined the impact of strategic partnerships among emerging economies on the effectiveness of COVID-19 prevention and control. We have studied the relationship between incidence and strategic partnership among 165 emerging economies. The results indicate that a good relationship in political cooperation is of great importance for countries to work together to fight the pandemic and slow down the spread of the virus. On this basis, we further examine the adjustment mechanisms of institutional, cultural, and geographical distance between emerging economies on this driving effect, and the results show that all three distances will weaken this driving effect.Based on the above research conclusions, we put forward the following suggestions for the urgent needs of pandemic prevention and control:(1) Political mutual trust and strategic mutual trust are the cornerstones of cooperation among countries. We should take the joint prevention and control of the pandemic situation as an opportunity to promote coordination and cooperation among countries. By establishing a solid foundation of political mutual trust among countries, such as strategic partnership and high-level leaders' visits for exchange, strengthening cooperation based on the purpose of mutual benefit and win-win, adhering to the principles of openness, tolerance and seeking common ground while reserving differences, and promoting pragmatic cooperation on major issues of difference.(2) Governments should establish high-level systems and mechanisms, explore effective anti-pandemic cooperation mechanisms and extend them widely. Countries can try to establish bilateral cooperation first, then gradually move toward multilateral cooperation, regional cooperation, and global cooperation, and improve the global system for the governance of public health safety.(3) Governments should also promote multi-level collaboration among non-governmental organizations in various countries. They should strengthen the cultural exchange mechanism, carry out non-governmental cultural exchange activities, enhance cultural identity, and promote people's communication. In terms of cooperation on scientific research, universities and research institutions are encouraged to conduct academic exchanges and project cooperation, establish a joint training mechanism for medical talent, and accelerate the research and development of vaccines and anti-pandemic drugs. Countries should give full play to the role of enterprises. Whether it is the supply and transportation of materials for prevention and control or the production of vaccines, enterprises need to participate. Enterprises need to build pandemic bases for the production of prevention-related material such as masks, vaccines, and protective clothing in local areas, thereby reducing the shortage of these materials caused by insufficient production capacity and inefficient transportation.The development of today's world is inseparable from emerging economies. According to IMF statistics, emerging economies have contributed nearly 50% of world economic growth in the past 10 years. A global multi-polarization system is taking shape. It is foreseeable that the official development assistance from developed countries to developing countries will gradually weaken, and emerging economies need to further strengthen open cooperation in the fields of politics, economy, science and technology, get rid of excessive dependence on developed countries, and improve their international voice.The original contributions presented in the study are included in the article/supplementary material, further inquiries can be directed to the corresponding author.All authors listed have made a substantial, direct, and intellectual contribution to the work and approved it for publication.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.All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.


In October 2014, the Pan American Health Organization/World Health Organization (PAHO/WHO) and its Member States adopted the Strategy for Universal Access to Health and Universal Health Coverage, which defines universal access as the absence of geographical, economic, sociocultural, organizational, or gender barriers; and health coverage as the capacity of the health system to serve the needs of the population, including the availability of infrastructure, human resources, health technologies (including medicines) and financing. The Universal health strategy advocated for a robust health system, supported by motivated, well-distributed health personnel with an appropriate set of skills, to provide quality services based on the needs of the populationIn September 2017, PAHO and its Member States approved the Strategy on Human Resources for Universal Access to Health and Universal Health Coverage. The lines of action of the Strategy are: strengthen and consolidate governance and leadership; to develop conditions and capacities to expand access to health and health coverage, with equity and quality; and to partner with the education sector to respond to the needs of health systems in transformation toward universal healthIn September 2018, the Plan of Action for Women’s, Children’s, and Adolescents’ Health 2018-2030 was approved by PAHO/WHO Member States. The plan calls for the promotion of universal and equitable access for women, children, and adolescents to quality and comprehensive health services. Proposed actions under this objective include the development and implementation of comprehensive adolescent-responsive care, and systematic analysis and addressing of the barriers faced by adolescents in conditions of vulnerability in accessing health services.Since 2020, the COVID-19 pandemic has impacted health services and health outcomes in the Americas, particularly in vulnerable populations and highlighted the inextricable connections between health, the economy, the environment, and social protection policies and mechanisms.Given the impact of COVID-19 in the region, advancing, and implementing a primary health care (PHC) approach is urgently needed now more than ever. Within this context, PAHO and Global Affairs Canada initiated a project in 2021 focused on interventions to strengthen the first level of care to ensure the continuity of priority health programs, planning for the recovery of health systems over the mid-to longer term. Its actions will contribute to increasing access to and coverage of sexual and reproductive and maternal health services for women and adolescent girls by identifying and overcoming barriers to address their health needs through the provision of gender responsive, culturally sensitive, people centered, comprehensive, and quality interventions focused on the life-course approach. A sub-project is targeting the role of nurses in the improvement of health of adolescents in conditions of vulnerability.curricula and identification of content related to adolescent health in undergraduate nursing courses was conducted. Among the results found was the need to improve the capacity of the faculty and the identification of themes related to adolescent health that need be incorporated into the training of nurses, such as behavior (decision and attitude), gender identity and sexual orientation, bullying and cyberbullying, use of digital technologies, violence in relationships, parenthood in adolescence, and pubertal delay.With the collaboration of the schools of nursing of the Universidad Nacional de Colombia - Colombia, Universidad de Guayaquil - Ecuador, and Universidad Nacional Mayor de San Marcos - Perú, an analysis of Adolescence is an important stage of human development, in which adolescents, neither old children nor young adults, deal with physical, hormonal, sexual, emotional, cognitive, moral and relationship factors. Although they are generally considered a healthy group, the incidence of preventable or treatable health conditions and the barriers of access are identified as important issues affecting their healthSince 2020, this group has been affected by the direct effects of COVID-19, but also in their daily lives, with the interruption of critical health services, including mental health and sexual and reproductive health services, the disruption of education and reduced social environment and exchanges, the loss of family income, and increased exposure to violenceGiven the insertion and role of nurses in health services and systems, strengthening the nursing workforce involves prioritizing policies that focus on actions in the areas of education, employment, leadership and maximizing the contributions of nurses in service delivery, as recommended in the WHO Global Strategic Directions for Nursing and Midwifery 2021-2025The investment in nursing professionals, in their various spheres of action and decision-making, will respond to problems such as shortages, inequitable distribution, and insufficient qualification, with a specific impact on populations in vulnerable conditions.Salud integral de los y las adolescentes”, available in the Virtual Campus of Public Health, and the realization of webinar series, workshops and other capacity building activities focused on the training needs identified. Additionally, analysis of policies related to adolescent health, participation of nurses in leadership positions, advocation for expanding the role of nurses in school health and primary health care and disseminating nursing practices on adolescent health will be conducted. This special issue of this journal is one of the achievements of this project.The Pan American Health Organization in order to overcome the need to update the knowledge of faculty and nurses in regard to adolescent health is planning several activities in the next years, such as the promotion of the course “It is expected that the articles published here will assist in the dissemination of best practices and roles of nurses in different countries, especially those countries in the project such as Bolivia, Ecuador, Colombia, Guyana, Honduras, Perú, and generate subsidies for governments, policy makers, educational institutions, professional associations, and researchers to support effective actions related to adolescent health.


New media has gradually become the mainstream media that college students rely on, and new media has also brought about subversive changes and has become an essential medium for college students to receive and disseminate information, such as learning, interpersonal communication, and entertainment. Young college students have become the most enthusiastic recipients and users of new media. College students need to have the ability to recognize, understand, and criticize new media. New media literacy has become the basic quality that every college student living in modern society must have. This paper takes 826 college students as the research object with deep neural network (DNN), and then analyzes their media selection tendency, media usage time, positive influence, and the relationship with new media literacy. The formation of good new media literacy has a positive effect and influence on the work and study after the university, making it the main force of the media society. The media is the medium of dissemination of information –3. It reWith the development of the Internet, new media has been updated and upgraded. So far, considering different research perspectives and levels, the definition of new media in academia has not been unified. New media is a relative concept. New media can be regarded as the product of new technologies. The latest technologies such as digitalization, multimedia, and network are all necessary conditions for the emergence of new media. After the birth of new media, the form of media communication has undergone earth-shaking changes, such as subway reading, large screens in office buildings, and so on, all of which have transplanted the communication content of traditional media into a new communication space.New media can be divided into four types , 5: mobiMedia literacy  is the aNew media literacy is divided into functional access and critical access . Each diWith the continuous development of new media technology, new media is no longer concentrated in a few elite groups, and the general public has become the main user group of new media, which has also brought earth-shaking changes to the media industry. At this time, individuals play the roles of information transmitters and producers, and the connotation of new media literacy should be further enriched and improved.When people use new media correctly and efficiently, new media can better serve people's work and life. With new media to actively participate in social interaction, constantly improve yourself in social interaction, and gradually enhance the awareness of concentric circles, responsibility awareness, civilized online awareness, and network security awareness. In general, new media literacy mainly includes the ability to acquire and understand, to think and question, to participate and create, and to use and produce.Sun Yat-sen University first opened a new media literacy course for college students on the MOOC platform in 2014. The course has successfully completed 12 rounds, each of which is divided into 9-week lesson plans, focusing on the Internet revolution and its impact, future journalism and future audiences, and online public opinion. The course outline displayed on the official MOOC .


Formerly Professor of Psychiatry, University College London, and Director of the Division of Psychiatry, University College London, UKProfessor Michael King, who died on 10 September 2021 aged 71, made numerous important contributions in primary care psychiatry, including risk prediction and the evaluation of complex interventions for mental disorders. However, his research interests went much further than this. Always curious and with an insatiable intellectual appetite, he was an academic polymath, often drawing on approaches from other fields and applying them to psychiatric research. He was particularly fascinated by subjects that were difficult to study, such as improving mental health at the end of life for people with cancer, the role of spiritual beliefs in mental well-being, and the mental health and stigma experienced by people from sexual minorities. Michael was a brilliant methodologist and a prolific researcher, producing almost 800 peer-reviewed publications, attracting over £45 million in grant income and supervising 30 PhD students over the course of his career. He was also tremendously generous and effective in supporting the development of junior clinical and non-clinical academics, many of whom are leaders in their fields today.Michael believed that visibility was key in addressing homophobia in society and, as an out gay man, he was also a courageous advocate for the rights of LGBT people, drawing on the scientific evidence to make his case. In the 1990s he was instrumental in changing how the cause of death was recorded for victims of AIDS, to mitigate the associated stigma without compromising the collection of accurate statistics. His research into male victims of sexual violence influenced the current legal definition of male rape. He was often called as an expert witness in cases of child custody involving lesbian and gay parents. He also gave expert evidence to the Church of England Synod on same-sex marriage and the ordination of LGBT ministers. In 2001, with Annie Bartlett, he co-founded the Royal College of Psychiatrists’ LGBT special interest group (now the Rainbow SIG). Michael contributed hugely to the work of this group, presenting at numerous conferences and providing wise counsel to the College on relevant, often contentious, matters of policy. He was able to remain calm, even when seriously provoked, always presenting his arguments in an empathic, open and assured way. At the time of his death, he remained the foremost expert in LGB mental health in the UK and an international leader in this area. He also weathered a number of attacks on his reputation as a consequence of his courage in speaking up for sexual minorities. Although he was not someone who sought accolades or prizes, he was honoured to be invited to give the prestigious Beattie Smith lecture at the University of Melbourne in 2017, in recognition of his immense contribution to this field.Michael was one of two brothers born in Christchurch, New Zealand on 10 February 1950, to Bruce, a farmer, and Patricia King. He completed his medical studies at the University of Auckland in 1976 before moving to the UK to train in family practice. In 1981 he began his training in psychiatry at the Maudsley Hospital, remaining firmly invested not just in psychiatry but in medicine and primary care throughout his career. He was awarded Membership and Fellowship of the medical Royal Colleges of all three specialties. He trained in psychiatric epidemiology at the General Practice Research Unit of the Institute of Psychiatry and gained both an MD (University of Auckland 1986) and PhD (University of London 1989) prior to his appointment as senior lecturer in the Department of Academic Psychiatry at the Royal Free Hospital School of Medicine in London. He became the Head of Department in 1995 while he was still only a Reader and, under his energetic and inspiring leadership, the Department rapidly expanded. Later, when the Medical School became part of University College London (UCL), he became Director of the UCL Division of Psychiatry, a role he retained until 2014.As an adult, Michael learnt Spanish, French and German and developed a number of long-standing international collaborations, particularly in South America, Europe, India and Australasia. He was also an excellent clinician, setting up the psychosexual service at Camden and Islington NHS Foundation Trust for which he was the consultant psychiatrist for 30 years.www.ntmpatientcare.uk). Michael is survived by Irwin, two nieces and a nephew. He is very much missed by his family and by his many friends and colleagues across the world.Michael met his life partner, Professor Irwin Nazareth, in 1984 at the Gay Medical Association. They celebrated their civil partnership in 2006 and married in 2017. In 2019 he contracted a rare non-tuberculous mycobacterium (NTM) infection, later found to be connected to the extremely rare lung condition pleuroparenchymal fibroelastosis, from which he died. As was typical of his approach to life, finding that no patient support group existed, he established one, NTM Patient Care UK (


The purpose of this article is to highlight the history of Hospital Agios Dimitrios, the General Hospital of Thessaloniki. During the early 20th century, many refugees settled in the Greek city of Thessaloniki. To address the growing public health needs of the city’s inhabitants, the Greek government established a health agency to offer medical care and respond to infectious disease outbreaks and epidemics. This initiative resulted in the construction or renovation of various hospitals. The Hospital Agios Dimitrios in Thessaloniki was completed in 1903. Its innovative architecture includes kiosks and wards designed to provide better ventilation and prevent the transmission of infectious diseases. This article highlights the history of Hospital Agios Dimitrios, the General Hospital of Thessaloniki. Thessaloniki has great historical and strategic importance in Greece and is the capital of the geographic region of Macedonia. It has been home to thousands of refugees who fled to Greece during conflicts in the nineteenth and twentieth centuries . To addrHistory of ThessalonikiThe history of Thessaloniki dates back to 316 BC, during the reign of Κing Cassander of Macedonia 350-297 BC), who was appointed regent by King Philip III (359-317 BC). After the death of Philip III, Cassander settled in Macedonia and married princess Thessalonike (352-295 BC), daughter of King Philip II (382 BC-336 BC) and half-sister of Alexander the Great (356-323 BC), with the aim to become king of Macedonia ,5. Κing 0-297 BC,Thessaloniki became a junction connecting the Adriatic Sea with the Hellespont and Asia Minor, allowing it to quickly develop into one of the most wealthy and populous cities in the region Figure . In 168 During the Byzantine era in 330 AD, around the time that Constantine the Great (272-337 AD) founded Constantinople, cities such as Thessaloniki began strengthening their commercial, military, and economic influence to maintain their roles as important crossroads between the West and the East ,8. AfterIn the aftermath of the Balkan Wars, Thessaloniki received a large wave of refugees from Serbia, Russia, the Caucasus, Bulgaria, and Anatolia . ThousanThessaloniki again served as an important strategic location during World War I (1914-1918), with British, French, and Serbian troops relying on its harbor for shipping supplies . After RNewcomers who settled in Thessaloniki were attracted to its multiculturalism, housing, and employment opportunities. Several Muslim neighborhoods comprising approximately 9,000 properties had been deserted after the Treaty of Lausanne on July 24, 1923. During the first months after the Asia Minor Catastrophe (August 1922 - May 1923) about 117,000 refugees from Thrace and Asia Minor arrived in the city . By 1932Other hospitals in the regionAs early as the 17th century, the Turkish chronographer and traveler Evliya Çelebi 1611-1682) mentioned the existence of a Greek Hospital in the city of Thessaloniki . By the 11-1682 mAfter the turn of the 20th century, several more hospitals were built in Greece, including the Jewish Hirsch Hospital (1908), Hagia Sophia Russian Hospital (1910), Hospital for Special Diseases or "Smallpox House" (1912), Hospital for Venereal and Skin Diseases (1917), and Sanatorium of Asvestochori (1920). Another notable facility, Red Cross Hospital (1919), is still operating today as the Georgios Gennimatas General Hospital of Thessaloniki ,18.Agios Dimitrios HospitalGureba Hastahanesi) was inaugurated [2), was later converted to a Municipal Hospital (Belediye) and renamed Hamidiye Belediyesi in honor of Sultan Abdul Hamid II (1876-1909) [Agios Dimitrios Hospital was built in an area that the Greek community used for the burial of the dead . Construugurated   .In 1929, the daughter of famous Greek architect Lysandros Kaftantzoglou, Eleni Zografou 1872-1937) , electric room, massage room, disinfectant room, baths and cold showers, laboratory, restaurant, kitchen, and laundry. The second floor included a men's operating room with 25 beds, two women's operating rooms with five beds each, two men's ward rooms with 15 beds each, a women's ward with 20 beds, a tuberculosis room with five beds, two ophthalmology wards with five beds each, and doctors' offices and dormitories. An adjoining room housed the furnaces for sterilization of tools, cotton, and bandages, as well as machines for sterilizing the water and heating patients' clothes .Adelfato (Brotherhood), an administrative council appointed by the Central Administration of Macedonia. Adelfato was chaired by the mayor, and its members were elected by the Municipal Council. Over the next several years, a radiology laboratory, a department of pathology and ophthalmology, and a tuberculosis clinic were established, and the number of beds increased to 200 [After the liberation of the city in 1912, the Hellenic Municipal Hospital of Thessaloniki was managed by the d to 200 .During World War II (1939-1945), the hospital supported the Greek army, which used much of the main hospital building as medical and storage facilities . The hosAdrias after a poorly regulated firing. The shell destroyed part of the patients' wards and seriously injured doctors, nurses, and patients. All the windows of the hospital were broken, and the machines of the chemistry were destroyed [On January 20, 1949, the hospital was bombed by the destroyer In 1971, the hospital became the property of the state as a Legal Entity under Public Law, and it was officially renamed the Hospital Agios Dimitrios in honor of the patron and protector of the city, Saint Demetrius ,16,19. ISince 1980, the following departments have been added: audiometry, electroencephalography, nystagmography, neurochemistry, hematology and blood banking, and neuroradiology. The kitchen building was also expanded to increase the size of the restaurant and food storage. A prefabricated building was delivered to the hospital to accommodate more outpatient treatment and administrative services . In 1982In the 1990s, doctors' locker rooms and gynecology offices were added to the ground floor, and a pathology clinic, kitchen, and new lavatories to the second floor. A new building was constructed to house the outpatient clinics, administration offices, library, and amphitheater. Outpatient clinics for autoimmune diseases, diabetes, lipidemia, headache, rheumatology, and fatigue testing also were added. Since the 2000s, social work, community outreach, breast health and mammography, sleep and apnea, orthopedics, pulmonary health, and diode laser services have been established .Thessaloniki has been a strategically important city from the time of Philip II until World War II. Under the rule of its many conquerors, the city also has been a major refugee settlement and multicultural center in the region. Overcrowding in the city has led to many disease outbreaks, such as malaria, tuberculosis, dysentery, and typhoid. Yet, until 1917, Thessaloniki had no organized public health policy. Soon after Eleftherios Venizelos established the Ministry of Health, the construction of hospital structures began. Hospital Agios Dimitrios in Thessaloniki, which was first erected in the 1850s and completed around 1902, was originally intended as a burial ground. The building has undergone numerous renovations in the last century and now serves as one of the most important public hospitals in the city.


To estimate the temporal trend of the incidence rates of accidents with venomous animals in children and adolescents in Brazil.Sistema de Informação de Agravos de Notificação – SINAN). The time series of incidence rates of accidents with venomous animals were stratified by age group (children aged 0 to 9 years and adolescents aged 10 to 19 years), Brazilian macro-regions , and type of accident . For trend analysis, the Prais-Winsten model and the Annual Percent Change (APC) were used.An ecological time-series study was carried out between 2007 and 2019. Data were obtained from the Brazilian Information System on Diseases of Compulsory Declaration (The time series of the incidence rate of accidents with venomous animals in children and adolescents from the North, Northeast, Midwest, and Southeast macro-regions and in children from the South region showed an upward trend. The average annual incidence rates were higher in the age group of 10 to 19 years, except for the South macro-region. Accidents with scorpions, snakes, and spiders, in this order, were the most frequent; the trends in the time series stratified by type of animal varied according to the geographic macro-region.There was an upward trend in the incidence rate of accidents with venomous animals in children and adolescents in Brazil, except for adolescents in the South macro-region of the country. In Brazil, accidents involving venomous animals are compulsory notification events since 2010, and those caused by snakes, scorpions, spiders, and caterpillars are of priority interest for the epidemiological surveillance system. Overall, these accidents are more serious in children than in adults, considering that the amount of injected venom is independent of the victim's age and the unbound fraction concentration in organs is higher in the pediatric population.Accidents with venomous animals are those caused by animals that produce toxic substances and provide specific mechanisms for inoculation. This type of accident is frequent and represents a serious public health issue in tropical countries.Bothrops genus are the most frequent among snakebites in Brazil. The North and Midwest macro-regions, especially rural areas, account for the highest incidences. Most accidents are clinically classified as mild; however, the delay in medical assistance and in the beginning of serum therapy can increase the fatality rate. Conversely, accidents caused by scorpions are predominantly urban, and an increase in cases in the states of the Northeast and Southeast macro-regions has been observed in recent years. Most cases present a benign clinical course; nevertheless, in the pediatric age group, there is a greater risk for severe clinical manifestations, especially when the accident is caused by the species T. serrulatus.Regarding accidents with snakes, those by snakes from the Loxosceles (brown spider), Phoneutria (Brazilian wandering spider) and Latrodectus (black widow). The occurrence of accidents with each type of spider varies according to geography and time of the year. In turn, accidents with caterpillars, which are more common in the South and Southeast macro-regions of the country, occur in urban areas, with the exception of lonomic accidents, which are more frequent in rural areas. The severity of the accident is associated with the amount and intensity of contact with the caterpillars, factors that are worthy of attention when dealing with pediatric patients.As for spider bites, there are three genera of spiders in Brazil that cause severe symptoms:  Thus, periodic epidemiological studies are necessary to know their temporal characteristics and assist in decision-making when developing control and prevention strategies aimed at risk areas and groups. Specifically, ecological time-series studies are an important tool for formulating explanatory hypotheses at the population and regional level, and contribute to the improvement and effectiveness of care. In this context, the objective of this study was to estimate the temporal trend of the incidence rates of accidents with venomous animals in children and adolescents in Brazil.In a large and heterogeneous country such as Brazil, regional and temporal variations are expected in the occurrence of accidents with venomous animals. The environmental and habitat transformations of these animals, which result from irregular deforestation, population migration, socioeconomic changes, and diverse climate changes, potentially modify the incidence rates of these accidents.Sistema de Informação de Agravos de Notificação – SINAN), and the population of each macro-region, according to age group, was obtained from the Brazilian Institute of Geography and Statistics (IBGE).An ecological time-series study on the incidence of accidents with venomous animals was carried out in children and adolescents residing in Brazilian macro-regions, from 2007 to 2019. All data were obtained from official secondary sources of the Brazilian Ministry of Health, which can be accessed on publicly available websites. Data on reported cases of accidents with venomous animals were obtained from the Brazilian Information System on Diseases of Compulsory Declaration , Brazilian macro-regions  and type of accident . Incidence rates were estimated by dividing the number of cases by the number of the population and multiplied by 100 thousand, according to the stratification of interest. The base 10 logarithmic transformation of the incidence was considered as the dependent variable (log[y]) and the centralized-year, as the independent variable (x). Subsequently, the annual percent change (APC) of the incidence and its respective 95% confidence intervals (95%CI) were estimated. The trend was considered statistically significant when zero was not contained in the 95%CI of APC; in this case, the positive APC value represented an upward trend, and the negative APC value, a downward trend. When zero was contained in the 95%CI of APC, the trend was considered stationary. All analyses were performed using the R software version 3.6.3.For trend analysis, the Prais-Winsten model was used. this study did not require evaluation by the Research Ethics Committee, as it used secondary, anonymized, and publicly available data.According to Resolution No. 466 of 2012, of the National Health Council of the Brazilian Ministry of Health,Between 2007 and 2019, 597,447 cases of accidents with venomous animals were reported in Brazil in children and adolescents. During this period, there was a 122.5% increase in the annual number of records, from 31,926 cases in 2007 to 71,048 cases in 2019. As for the age group, 55% of the victims aged between 10 and 19 years. Regarding the geographic distribution, 36% of the cases were from the Northeast; 32.5% from the Southeast; 16% from the South; 10.4% from the North; and 5.1% from the Midwest of the country.Of the total number of cases in which the involved animal was known , 51% were caused by scorpions; 16.2% by snakes; 14.4% by spiders; 3.3% by caterpillars; and 15% by other animals. The average annual incidence rates of accidents with venomous animals and the trend analysis, according to macro-region and age group, can be observed in Regarding snakebites, the North macro-region had the highest incidence rates in both age groups analyzed. The average annual incidence rate was higher in the age group of 10 to 19 years in all Brazilian macro-regions. The time series of the North and Northeast were stationary, whereas those of the Southeast and South showed a downward trend in the incidence of this type of accident; in the Midwest, a mixed pattern was observed .As for accidents with spiders, the average annual incidence rate during the study period was higher in the age group of 10 to 19 years, except in the South macro-region. The units of analysis showed an upward trend, with the exception of the South macro-region, in the age group of 10 to 19 years, whose time series was stationary. The average annual incidence rate was significantly higher in the South macro-region .Finally, the average annual incidence rate of accidents with caterpillars was higher in the age group of 0 to 9 years in all macro-regions. North, Northeast, and Midwest showed an upward trend, whereas in the Southeast and South stationary time series were observed. The average annual incidence rate was higher in the South macro-region for both age groups .The present study verified an upward trend in the incidence rate of accidents with venomous animals in children and adolescents in Brazil, except for adolescents in the South macro-region. The average annual incidence rates were higher in the age group of 10 to 19 years, except for the South macro-region. Accidents with scorpions, snakes, and spiders, in this order, were the most frequent in this population; incidence and distribution rates varied according to the geographic area of the country. In addition, stationary time series and those with a downward trend were verified, such as those observed in accidents with snakes, which reinforces the idea that, in fact, there is an increase in the number of accidents with venomous animals, especially those caused by scorpions.In Brazil, there has been a progressive improvement in the registration of diseases of compulsory notification in recent decades. Thus, the gradual increase in the incidence rate of accidents with venomous animals during the analyzed period may reflect the increase in notifications by epidemiological surveillance services, without necessarily having had a real increase in the number of cases in the population of children and teenagers. Nevertheless, the environmental imbalance with extensive areas of irregular deforestation and the acceleration of the urbanization process, which several Brazilian cities have undergone in recent decades, are factors that may be related to the increase in the number of cases. During this period, the constant numerical increase in cases caused by all animal species was attributed to several factors, including the increase in the human population, the gradual improvement of the epidemiological surveillance system, and, probably, environmental and socioeconomic factors differently affecting the incidence of accidents per each zoological group and region..A previous study on accidents with venomous animals in the Brazilian population, which analyzed the period from 2001 to 2012, showed that most accidents were caused by scorpions, snakes, and spiders, whose occurrence showed great regional variations., by analyzing the period from 2003 to 2012, had already found a stationary trend in the historical series for the country altogether.Regarding snakebites, the estimated trends were stationary or downward in children and adolescents residing in Brazilian macro-regions. Matos et al. However, in the present study, this indicator showed to be increasing in the North, Northeast, and Midwest macro-regions, which raises an alert for the possible emerging nature of this type of accident, already evidenced in other countries.The highest incidence rates of accidents with caterpillars have been traditionally found in the South and Southeast of Brazil.As limitations of this study, the authors highlight the use of secondary data, which involves the quality of records and is directly associated with the organization of health services in each location. About 86% of the reports of snakebites and 90% of the reports of spider bites presented ignored and/or unfilled information in the field concerning the genus of the involved animal, considering the age group of 0 to 19 years, in the period from 2007 to 2019, which made the analysis unfeasible. This is an essential piece of information to support preventive and health promotion actions, considering that there are specificities in the habits of different types of animals, in addition to providing indications that help in the therapeutic conduct according to the region where the accident occurred. which may contribute to the increase in notifications, at the expense of snakebites, for example, which are more common in rural regions and away from urban centers and their health services.Another point worth reflecting on is the more urban nature of most scorpion accidents, Finally, the stratification of the data also allowed the authors to use the crude incidence rates of accidents with venomous animals rather than the standardized incidence rate.It is also worth mentioning that, although ecological studies are useful to formulate hypotheses, it is necessary to point out the main limitation of this study design: the ecological bias, which consists of attributing inferences about individuals based on aggregated data from groups. In this study, the authors carefully used smaller units of analysis, stratifying the study population according to age group and Brazilian macro-region. Thus, it is believed that the groups became more homogeneous in relation to exposures, contributing to the minimization of this type of bias. the present study used data from the entire national territory, collected over a long period. In view of the vast geographic area and population size of Brazil, an ecological approach potentially and quickly identifies the existence of vulnerable groups, which require priority actions.Conversely, unlike other Brazilian studies that analyzed specific locations,Although there is an upward trend in the incidence of accidents by venomous animals in children and adolescents in most regions of Brazil, these diseases can be prevented through educational actions and health policies aimed at protecting this population. Furthermore, the improvement of strategies to ensure diagnosis and institution of early treatment is necessary to reduce the severity and, consequently, the number of fatal outcomes associated with these diseases. Within this context, the authors believe that this study contributed with updated and substantiated information about accidents by venomous animals in children and adolescents in Brazil.


People living with HIV/AIDS not only suffer in terms of physical and/or psychological health, but also frequently experience violations of human rights and fundamental freedoms. Although there are international treaties and a regulatory framework that legally protects people with HIV/AIDS, it is essential to determine the effectiveness of the regulatory framework in Colombia. Therefore, our main goal was to examine the legislation on HIV/AIDS in Colombia with the purpose of understanding the decrees and laws, and describing the main obstacles and barriers that people with HIV/AIDS encounter. For this purpose, we employed the method of legal interpretation and reviewed the legal regulations on HIV/AIDS, as well as the judgments of guardianship of the Constitutional Court. It is verified that there is a specific regulation on HIV/AIDS, specifically decree 559 of 19,991, decree 1543 of 1997, Law 599 of 2000, Law 972 of 2005, and Law 1220 of 2008. Although at the legislative level Colombia shows an evolution in the norm, patients with HIV/AIDS continue to be victims of human rights violations. As a result, and through the analysis of tutela judgments, it was found that the Constitutional Court recognized the violation of rights and ordered the necessary measures to be taken to guarantee the human rights and fundamental freedoms of the defendants. The human immunodeficiency virus (HIV) attacks the immune system and, if left untreated, can cause acquired immune deficiency syndrome (AIDS). Despite the fact that there is no cure, in the case that a person who contracts HIV will have it chronically, both adequate medical care and adherence to treatment are essential for people to have long, healthy lives, and to prevent the development of AIDS .According to the most recent data from the Joint United Nations Program on HIV/AIDS, in Colombia in 2020, 180,000 people were living with HIV/AIDS . HoweverUNAIDS proposed the global goal of “90-90-90” for 2020, i.e., that 90% of people living with HIV should have been diagnosed, 90% of those diagnosed should receive treatment, and 90% of those receiving treatment should have achieved viral suppression . HoweverAs well as physical health problems, such as well-known opportunistic diseases  and psycTherefore, the legal framework for HIV/AIDS is supported by general international instruments pertaining to the protection and guarantee of human rights and fundamental freedoms. The international instruments that recognize and guarantee the fundamental rights of all people are as follows: The Universal Declaration of Human Rights of 1948 , InternaFurthermore, the legal framework is supported by specific international guidelines for HIV/AIDS. Some of the most important guidelines, in chronological order, are as follows: The Declaration of Helsinki of the World Medical Association of 1964 , ProgramIn accordance with the various binding instruments, Colombia, among other countries, must respect, protect, and comply with the following. First, they must respect human rights norms, and thus must not directly or indirectly violate the fundamental rights of people living with HIV/AIDS. Second, they must protect and adopt the necessary measures to prevent the human rights and fundamental freedoms of people living with HIV/AIDS from violation violated. Third, they must comply with the established norms, and develop and implement all necessary legislative, financial, administrative, and judicial measures.Despite the existence of international treaties and specific guidelines, no previous study has examined the effectiveness of the regulatory framework designed to legally protect people with HIV/AIDS in Colombia. Therefore, the main objective of this research is to examine the legislation on HIV/AIDS in Colombia. The specific objectives are to (1) analyze the decrees and laws on HIV/AIDS, and (2) describe the main obstacles faced by people with HIV/AIDS according to the tutela rulings of the Colombian Constitutional Court.We use the method of legal interpretation in this study, since it is the most appropriate method for analyzing and interpreting the law according to our particular objectives . It is iThe materials in this study were decrees and laws pertaining specifically to HIV/AIDS in Colombia, in addition to the five most recent tutela judgments by the Constitutional Court. First, we examined the laws that establish rights and guarantees for people with HIV, as well as the Criminal Legislation on HIV/AIDS in Colombia. Next, we searched for and analyzed tutela judgments related to the violation of rights of patients with HIV. The judgments were obtained from the website of the Constitutional Court of Colombia. All these study activities were carried out in April and May 2022.Decree 559 of 1991 was the first legal document regulating the management of HIV/AIDS . This deDecree 559 was repealed with the introduction of Decree 1543 of 1997 , a new lDecree 1543 of 1997  compriseLaw 972 of 2005 is the first law in Colombia governing the adoption of regulations to improve the state care of populations suffering from ruinous or catastrophic diseases, especially HIV/AIDS . Law 972HIV/AIDS has also been considered under criminal legislation in Colombia. In Law 599 of 2000 , in the Following this initial law, another new law that reformed the Penal Code, Law 1220 of 2008, was introduced . The purSince records began on the website of the Constitutional Court in 1992, more than 500 tutela rulings directly or indirectly related to HIV/AIDS have been issued. In these rulings, whether fundamental rights have been violated is verified, such as discrimination in the workplace, military or place of learning due to having HIV/AIDS. Whether rights to the disability pension, health, liberty, privacy  or a decent life have been violated is also verified, for both Colombian citizens and foreigners.In the following, the five most recent Constitutional Court tutela judgments on HIV/AIDS are analyzed to understand the judicial obstacles faced by HIV/AIDS patients in Colombia.Judgment T-077 of 2022 . One manJudgment T-415 of 2021 . A foreiJudgment T-229 of 2021 . A couplJudgment T-221 of 2021 . A womanJudgment T-031 of 2021 . A man wPeople with HIV/AIDS not only suffer poor physical and/or psychological health, but are also victims of violations of human rights and fundamental freedoms. Although international treaties with the force of law have been ratified in Colombia ,13,14,15After analyzing the legislation on legal assets protected by two decrees ,32, the First, it is necessary to discuss the factors that led to the introduction of these rules. Decree 559 of 1991 was the first legal document regulating the management of HIV/AIDS in Colombia . The devSecond, to understand the evolution of the regulations, it is necessary to highlight differences in the decrees ,32. The Third, it is important to discuss laws that have modified the Penal Code in relation to HIV/AIDS. Although Law 599 of 2000  stipulatDespite the rights established in relation to regulatory norms in Colombia, people with HIV/AIDS still encounter obstacles and barriers that violate their fundamental rights. An example of this can be seen in the tutela rulings reviewed and resolved by the Constitutional Court ,39,40,41This research had some limitations. First, the results of the analysis of law and sentencing cannot be generalized to all people with HIV/AIDS in Colombia. Second, only the five most recent Constitutional Court rulings regarding HIV/AIDS cases were analyzed. Therefore, further investigations are recommended, in which the judgments of guardianship on HIV/AIDS should be systematically analyzed from a historical perspective, including rights violations as well as the final results of all sentences passed by the Constitutional Court.HIV/AIDS is a pandemic that, despite beginning several decades ago, continues to spread and cause chronic disease, which sometimes leads to death and human rights violations of infected people. The International Conventions and Treaties on fundamental rights have been essential for establishing, promulgating, and modifying regulatory norms on HIV/AIDS. The specific decrees and laws guaranteeing the rights and duties of people with HIV/AIDS have been very important to improve the quality of life of these people, and represent progress toward addressing the obstacles and barriers that they encounter in various spheres of life. In addition, these regulations provide legal certainty and protect human rights and fundamental freedoms. Although the legal framework formally guarantees the rights of people with HIV/AIDS in Colombia, this population still suffers violations of protected rights. Among the violated rights, the following stand out: The right to health and life, the right to non-discrimination, the right to human dignity, and the right to privacy, as well as due process. The violation of these rights is confirmed in the tutela judgments analyzed, since the Constitutional Court concluded the violation of these rights and expressed the obligation to take the necessary measures to restore the violated rights. Moreover, it is important to highlight the role of the Colombian Constitutional Court, which has not only established rights through tutela rulings, but also declared an article stating that specific punishment of HIV transmission is unconstitutional. In short, despite the fact that the regulatory framework on HIV/AIDS in Colombia is adequate and guarantees the fundamental rights of those affected, infected people still suffer violations of their human rights and fundamental freedoms.