Retos éticos y jurídicos de la restauración de la naturaleza: enfoque One Health y protección de la biodiversidad

En el siglo XXI, nos encontramos en un momento crucial donde la salud y el bienestar de las personas están intrínsecamente ligados a la preservación del medio ambiente y a la sostenibilidad de nuestro planeta. Cada vez más, comprendemos que no podemos separar el cuidado de nuestra salud de la salud del ecosistema en el que vivimos. Surge así la necesidad imperante de abordar la interrelación entre la salud humana, el cambio climático y la conservación de la biodiversidad. Este enfoque holístico nos exige replantear nuestros conceptos y prácticas en el ámbito de la salud pública, reconociendo que la promoción del bienestar individual y colectivo está estrechamente vinculada con la protección y preservación del entorno natural que nos rodea. Es necesario adoptar una perspectiva integradora y multidimensional en el ámbito de la salud, que abarque desde las dimensiones individuales hasta las colectivas, desde lo biológico hasta lo ambiental, y desde lo local hasta lo global.

La promoción de la salud y prevención de enfermedades son muy abordadas desde el campo de estudio e intervención de la enfermería comunitaria, la cual es considerada como una importante disciplina con la que se puede generar una aplicación integral de los cuidados y favorecer a las personas, las familias y las comunidades que pueden alcanzar a ser beneficiadas. De acuerdo a lo indicado, es importante señalar que el presente estudio se desarrolló con el objetivo de analizar la promoción de la salud y prevención de enfermedades desde la enfermería comunitaria. La metodología de investigación utilizada fue de enfoque cualitativo con un tipo de investigación documental, fundamentada en el desarrollo de la modalidad de revisiones bibliográficas, con las que se trabajó desde un método analítico-descriptivo de investigaciones actualizadas. En torno a los resultados, se encontró que desde la enfermería comunitaria se participa en la atención primaria en salud, por lo que los profesionales del cuidado pueden trabajar precisamente para la promoción de salud y prevención de enfermedades. Sien embargo, existen múltiples desafíos en la aplicación de la enfermería comunitaria, porque en los diferentes países de la región de Latinoamérica, continúan existiendo la falta de control en las políticas públicas implementadas por los Estados y Sistemas de Salud para la promoción de la salud y prevención de enfermedades en las zonas más precarias y marginales. En conclusión, es urgente aplicar la enfermería comunitaria para promover la salud y prevenir enfermedades en los diversos contextos sociales, principalmente en las comunidades más vulnerables.

Este ensayo académico sobre el sistema de salud de Cuba resultó de un trabajo presentado en la carrera de Sistemas de Salud del Doctorado en Salud Pública de la Universidad de Ciencias Empresariales y Sociales. Cuba es un país ubicado en Centroamérica, en el Mar Caribe y su capital es Habana. Su Constitución lo define como un Estado socialista de derecho y justicia social, independiente y soberano organizado como una república unitaria e indivisible y regido por el Partido Comunista de Cuba. Su Sistema de Salud es público, universal y gratuito, depende del Ministerio de Salud y es financiado prácticamente en un 100% por el Estado. El Médico de Familia y la Enfermera de Familia fueron creados en 1984, donde el equipo se encarga de la atención de 150 a 180 familias, además, entre 15 y 20 consultorios conforman un grupo de. Trabajo Básico (GBT), integrado por otros profesionales de la salud que se encargan de implementar el programa en su comunidad y organizar el trabajo en función de las necesidades de la población de su zona. Su esencia es garantizar la promoción de la salud, la prevención de enfermedades, el restablecimiento de la salud, la rehabilitación social de los pacientes y la asistencia social. El Sistema Nacional de Salud tiene características humanistas y solidarias a través de la cooperación internacional de Cuba, donde 164 países ya se han beneficiado de la ayuda de sus profesionales. En materia de enfermedades no transmisibles, el SNS enfrenta grandes problemas y apuesta por fortalecer su sistema de salud con enfoque en control a través de políticas públicas que protejan a su población.

Se aborda la problemática de salud en los adolescentes de Santa Catarina Yecahuizotl, en la alcaldía Tláhuac. El objetivo principal fue identificar los principales problemas de salud mental y física y desarrollar estrategias de intervención efectivas para su prevención. Para ello, se realizó un diagnóstico de los determinantes de salud utilizando estadísticas oficiales, mapeo de factores protectores y de riesgo a través de un recorrido en la comunidad y un análisis de datos epidemiológicos. Mediante grupos focales con personal de salud y habitantes, se identificó la prevalencia de estrés, ansiedad y obesidad, entre otros padecimientos. Asimismo, se identificaron los recursos en salud con los que cuenta la comunidad. De esta manera, se diseñó una intervención que incluye un evento de dos días con actividades educativas, lúdicas y prácticas saludables. Estas actividades son promovidas de forma constante en la comunidad por el Centro de Salud Dr. Xuan Zenteno Cuevas/Santa Catarina Yecahuizotl. La intervención se alinea con los objetivos de la psicología de la salud de la OMS y los PRONACES, enfocándose en la promoción de la salud mental y la prevención de enfermedades. Los resultados esperados son un impacto positivo en la salud y el bienestar de la comunidad. Se concluye que la participación comunitaria y la colaboración con el personal sanitario del Centro de Salud son fundamentales para el éxito de la intervención, promoviendo un bienestar integral y sostenible en la comunidad.

Las reformas en los sistemas de salud que se han impulsado en los diferentes países, tanto europeos como americanos y latinoamericanos, están enfocadas a lograr mayor equidad, eficiencia, efectividad, economía y calidad en la provisión de los servicios. Estas reformas involucran la introducción de los mecanismos del mercado como reguladores de la prestación de los servicios, y si bien se han obtenido avances positivos, también se han creado nuevos problemas y han surgido nuevas barreras en la accesibilidad y equidad de los servicios y el desarrollo de las acciones de salud pública. Esto se relaciona, entre otros factores, con la fragmentación de responsabilidades, el interés de lucro del sector privado, las políticas de contratación entre las aseguradoras y las prestadoras de servicios. Frente a este problemática se plantea una estrategia de asociación, a manera de partnership a escala municipal, aplicable al desarrollo de programas de promoción de la salud y prevención de enfermedad, que permita poner los sectores a trabajar mancomunadamente, como socios para desarrollar y recuperar las acciones de salud pública en el ámbito municipal, lo que genera un impacto positivo e importante en la salud de la comunidad.

From theory to practice: Analyzing factors that foster the successful implementation of the one health approach for enhancing health security in Cameroon

Polycyclic Aromatic Hydrocarbons in Carcinogenesis

The 2015 New York City Legionnaires' Disease Outbreak: A Case Study on a History-Making Outbreak.

Global Health Security Implementation: Expanding the Evidence Base.

Entre las acciones para la promoción de la salud y prevención de enfermedades, el ejercicio físico adecuado tiene un papel relevante ya que ha estado asociada a la salud de las personas desde la antigüedad, la relevancia del ejercicio físico como factor para mejorar la salud abarca todas las edades. Las recomendaciones de actividad física para que las personas cuiden de su salud son variadas, pero se presentan algunas que tienen aprobación de las diferentes entidades internacionales expertas como la OMS. Dichas recomendaciones se enfatizan ya que los efectos beneficiosos no solo en el proceso de envejecimiento han sido ampliamente estudiados en los últimos años. Por lo tanto, los especialistas en ciencias del deporte y las autoridades sanitarias recomiendan que toda persona incluya en su vida cotidiana, ya sea en el hogar, en el trabajo o en la comunidad, una actividad física regular para recuperar o mantener la salud. En este artículo se abordan algunas definiciones de activad física, con la finalidad presentar también su clasificación, además de presentar propuestas de prescripción en diferentes edades y con condiciones de salud particulares, al igual que resaltar los beneficios que se tienen al realizar actividad física regular.

Este estudio analiza el impacto del uso de dos aplicaciones móviles, Google Fit y Headspace, en la promoción de hábitos de vida saludables y la prevención de enfermedades en estudiantes de la carrera de Administración del Instituto Superior Tecnológico General Eloy Alfaro. La investigación se fundamenta en la creciente importancia de las tecnologías móviles como herramientas para fomentar el bienestar físico y mental en contextos educativos. Se aplicaron encuestas estructuradas para recopilar datos sobre la frecuencia de uso de ambas aplicaciones, el nivel de satisfacción de los usuarios y su percepción respecto al cambio de conductas relacionadas con la salud. Los resultados obtenidos evidencian que Google Fit ha contribuido significativamente a la mejora de la actividad física diaria, mientras que Headspace ha sido valorada positivamente por su aporte en la reducción del estrés y la mejora del bienestar emocional. Sin embargo, también se identificaron limitaciones en cuanto a la continuidad del uso y la necesidad de personalización de las funciones. Se concluye que estas herramientas pueden desempeñar un papel complementario en la promoción de la salud, aunque se requiere un análisis más profundo de su impacto a largo plazo. Finalmente, se proponen líneas de investigación futuras y recomendaciones para el diseño de aplicaciones más eficaces y adaptadas a las necesidades estudiantiles.

BackgroundThe USAID Preparedness and Response (P&R) project’s publication on Multisectoral Coordination that Works identified five dimensions most critical to creating effective and sustainable One Health platforms: political commitment, institutional structure, management and coordination capacity, technical and financial resources, and joint planning and implementation. This case study describes Tanzania experience in using these dimensions to establish a functional One Health platform. The main objective of this case study was to document the process of institutionalizing the One Health approach in Tanzania.MethodsAn analysis of the process used to establish and institutionalize the MCM in Tanzania through addressing the five dimensions mentioned above was conducted between August 2018 and January 2019. Progress activity reports, annual reports and minutes of meetings and consultations regarding the establishment of the Tanzania national One Health platform were examined. Relevant One Health publications were studied as reference material.ResultsThis case study illustrates the time and level of effort required of multiple partners to build a functional multi-sectoral coordinating mechanism (MCM). Key facilitating factors were identified and the importance of involving policy and decision makers at all stages of the process to facilitate policy decisions and the institutionalization process was underscored. The need for molding the implementation process using lessons learnt along the way -- “sailing the ship as it was being built” -- is demonstrated.ConclusionsTanzania now has a functioning and institutionalized MCM with a sound institutional structure and capacity to prevent, detect early and respond to health events. The path to its establishment required the patient commitment of a core group of One Health champions and stakeholders along the way to examine carefully and iteratively how best to structure productive multisectoral coordination in the country. The five dimensions identified by the Preparedness and Response project may provide useful guidance to other countries working to establish functional MCM.

Despite difficult challenges during responses to the terrorist attacks of September 11, 2001, Hurricane Katrina, and the 2009 Pandemic Influenza A/H1N1 and severe acute respiratory syndrome outbreaks, no North American emergency to date has overwhelmed intensive care unit (ICU) services on a widespread basis since the modern development of the field of critical care. However, planners have recognized that in a future public health emergency we may not be so fortunate. To deal with very large emergencies involving many patients whose survival depends on immediate access to intensive care, an international Task Force for Mass Critical Care proposed recommendations in January 2007 to extend critical care resources for the adult population, referred to as the Emergency Mass Critical Care (EMCC) approach (1–5). The EMCC approach triples critical care capabilities for a period of up to 10 days in a very large public health emergency by focusing on immediately life-saving interventions, while delaying or forgoing less urgent care. Crisis standards of care in a large public health emergency would attempt to optimize population outcomes, rather than use unlimited efforts to maximize survival of each individual. Available resources would be substituted or adapted for equivalent or nearly equivalent unavailable resources. Resources would be conserved, reused, and reallocated to those patients most likely to benefit from them. Modest increases in stockpiles and major changes in the organization of care would be essential. While planners in the field acknowledge that mass critical care is a reasonable concept, we lack evidence that such an approach is feasible. However, failure to begin operational planning for mass critical care guarantees a failed response. As public health emergency planners begin to consider the EMCC framework, it is urgent that pediatric implications be detailed for integration into these developing plans. This supplement represents the discussions of a multidisciplinary panel convened by the Oak Ridge Institute for Science and Education (supported financially by the Centers for Disease Control and Prevention), and provides guidance for pediatric EMCC (PEMCC). Work of the PEMCC Task Force was directed by a 17-member Steering Committee selected on the basis of their expertise and experience, and included representatives from the Task Force for Mass Critical Care, World Federation of Pediatric Intensive and Critical Care Societies, American Academy of Pediatrics, American College of Critical Care Medicine, American College of Emergency Medicine, Royal College of Physicians (Canada), and National Commission on Children and Disasters, as well as several unaffiliated disaster preparedness experts. This Steering Committee led development of all manuscripts and selected individuals for the PEMCC Task Force. The full PEMCC Task Force comprised 44 experts from fields including bioethics, pediatric critical care, pediatric trauma and surgery, neonatology, obstetrics, general pediatrics, emergency medicine, pediatric emergency medicine, disaster preparedness and response, emergency medical services (EMS), infectious diseases, toxicology, military medicine, nursing (including critical care nursing), pharmacy, veterinary medicine, information sciences, public health law, maternal and child public health, and local, state, and federal government emergency planning and response agencies. Priority topics were organized on the basis of MEDLINE and Ovid database literature searches, bibliographies, state and federal government planning documents, after-action reports of recent medical responses to catastrophes, and through participation in local, state, and federal government working groups on hospital and disaster preparedness. Where evidence was available, it was utilized in formulating recommendations. Where evidence was lacking, recommendations represent expert opinion. Wherever possible, recommendations are consistent with and easily integrated into prior recommendations of the adult Task Force for Mass Critical Care. The Steering Committee produced draft outlines by synthesizing information obtained in the evidence-gathering process and convened October 6–7, 2009, to review and revise each outline. Eight draft manuscripts were subsequently developed from the revised outlines. The full PEMCC Task Force convened March 29–30, 2010, to present and discuss the draft manuscripts. Feedback on each manuscript was compiled and the Steering Committee modified the draft documents to reflect this input, in addition to updating the manuscripts based on the most current medical literature. The Steering Committee revised the manuscripts from March to October, 2010, working primarily via email and conference calls. New versions were electronically transmitted to all Task Force members to obtain concurrence with manuscript revisions. All authors and reviewers completed disclosure statements; there were no conflicts of interest. The authors were given complete autonomy by the Oak Ridge Institute for Science. The views expressed in these summaries are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention. Based on the recognition of the special needs of children during disasters and extensive discussion, the following recommendations are made by the PEMCC Task Force. These recommendations are described in detail in nine subsequent articles. Readers should refer to individual articles for all recommendations rather than those highlighted in this executive summary. Treatment and Triage Recommendations for PEMCC (p. S109) PEMCC in Pediatric Hospitals. These recommendations provide the basis for hospitals to prepare for PEMCC: Every hospital with a pediatric ICU or neonatal ICU should plan and prepare to provide PEMCC, and should do so in coordination with regional health planning efforts. Hospitals with ICUs should plan and prepare to provide PEMCC every day of the response for a total critically ill patient census at least double the pediatric ICU bed capacity and at least triple usual ICU capability. Hospitals should prepare to deliver PEMCC for 10 days without sufficient external assistance. Care should be coordinated with the emergency department for triage and transfer of patients to/from ICUs. All communities should develop a graded response plan for events across the spectrum from multiple casualties to catastrophic critical care events. To optimize medication availability and safe administration, the Task Force suggests that modified processes of care should be considered before an event, such as the following: rules for medication substitutions and restrictions; safe dose and frequency reduction; conversions from parenteral to oral/enteral administration; shelf-life extension; and use of length-based weight estimations. PEMCC for pediatric patients ideally should occur in hospitals or similarly designed and equipped structures with experience in providing critical care to pediatric patients. Principles for staffing models should include the following: strategies to achieve and maintain adequate staffing levels; patient care assignments for the unit should be managed by the most experienced clinician available; and assignments should be based on staff abilities and experience, with delegation of some duties and efforts to reduce care variability and complications. PEMCC in Nonpediatric Hospitals All hospitals must plan to care for children in their proportion to the population or for those affected by the mass casualty event. To facilitate such planning, nonpediatric hospitals should include a pediatrician or pediatric medical liaison in those committees responsible for disaster planning, appeals, and determining when crisis standards of care should be implemented. During a disaster, it may be more efficient to transfer skilled pediatric critical care teams to nonpediatric centers to support those facilities in providing care to critically ill pediatric patients. Nonpediatric hospitals may not have the pediatric equipment needed to sustain critically ill patients; therefore, these teams may need to take their own equipment. Establish referral network for pediatrics consultation or transfers to support hospitals that do not normally receive pediatric patients. Nonpediatric hospitals should preidentify hospital staff with experience in care of pediatric patients and create key positions in which these individuals would serve. The Task Force was unable to recommend a protocol for allocating scarce pediatric critical care resources (tertiary triage) during PEMCC. However, they suggest that: Resources should be allocated on the basis of need, benefit, the conservation of resources, and finally lottery or queuing. Younger children should not be discriminated against based on age alone. While a validated pediatric scoring system is being developed, tertiary triage should be based on expert opinion and conducted by triage teams, including experienced trauma surgeons and/or intensivists, using their best medical judgment as is the current standard of practice. The Task Force recommends that the American Academy of Pediatrics and the Institute of Medicine, bodies with subject-matter expertise and necessary positioning, develop a set of research priorities for disaster pediatric medicine such that the evidence base can be established to facilitate the development of necessary tools (i.e., decision matrices). Supplies and Equipment for PEMCC (p. S120) This chapter focuses on strategies and paradigms for purchasing and stockpiling equipment that will be necessary in PEMCC. This includes specific equipment (not including personal protective equipment, which is beyond the scope of this chapter) and supply lists necessary to triple pediatric ICU capacity for up to 10 days for a scenario in which the surge includes patients across all ages, and another scenario in which most patients are from a single age group. Recommendations include the deployment of mechanical ventilators including specifications (see p. 128 for further details), ventilation ancillary equipment (including equipment that could be disinfected or sterilized between patient uses in a pandemic situation), other options for assisted ventilation and nonconventional ventilation, suggestions for a ventilator inventory, equipment for hemodynamic management, and supplies for sedation, analgesic, antimicrobials, and nutrition. Additional equipment and supply recommendations necessary for various types of pediatric hospitals to prepare for disasters have been provided by the New York City Department of Health and Mental Hygiene's Pediatric Hospital Disaster Toolkit (http://www.nyc.gov/html/doh/html/bhpp/bhpp-focus-ped-toolkit.shtml); the toolkit has been positively viewed and is an additional resource that should be considered. Neonatal and Pediatric Regionalized Systems in PEMCC (p. S128) This chapter outlines the present system of care in the United States and Canada, and the systems likely to be available for providing mass critical care. Topics discussed in this manuscript include: gaps between anticipated needs and existing resources, changes in functioning of regional systems necessary for PEMCC, protocols for patient transfer, agreements with healthcare institutions that primarily provide adult care, just-in-time training of healthcare workers, transport systems for patients, and allocating staff to other healthcare facilities. Recommendations are provided for operational planning integrated across jurisdictions necessary to implement PEMCC. All preparations for mass critical care for the general population must include pediatric aspects. For this to occur, pediatric experts must be involved in all aspects of emergency and disaster planning. States and Regions. States and regions should: Facilitate PEMCC by providing legal protections for those involved in PEMCC. Reaffirm ethical norms in PEMCC. Ensure that all hospitals are prepared to provide care for children in a mass casualty scenario, including a level or scope of care beyond what they might ordinarily provide during normal operating conditions. Plan to share scarce resources with neighboring states and ensure effective public-private collaboration to meet the needs of a pediatric patient surge and optimize pediatric critical care capacity in a mass casualty event. Develop pediatric-specific performance criteria to hold regional systems accountable for PEMCC preparations and responses. Perform vulnerability analyses to estimate anticipated pediatric mass critical care needs, including especially vulnerable populations. Inventories of functional resources (space, equipment, supplies, and staff) for mass critical care must be performed at every hospital with an ICU. State information systems must be developed to track critical care needs and resources in real time during public health emergencies. Integrate operational plans for mass critical care and triage allocation (rationing) across all jurisdictional levels and all response agencies, and integrated with all aspects of emergency preparedness planning. Define regional mechanisms to direct the distribution of patients and resources in a public health emergency. Federal. Action at the federal level should include: Plans for federal involvement are consistent with state plans for mass critical care and triage allocation (rationing). Federal expertise and guidance to promote consistency in informing state laws and regulations regarding mass critical care and triage allocation (rationing) in public health emergencies. Federal incentives, specific readiness requirements, readiness, and performance measures germane to pediatric care capabilities and capacity to ensure that all states prepare sufficiently for mass critical care and triage allocation (rationing). Federal support for research on best practices ahead of time, as well as real-time surveillance, epidemiologic research, and clinical trials during a public health emergency, which will result in better evidence-based practices at the level of regional systems of care, and better clinical care. Education in a PEMCC setting (p. S135) Prospective and just-in-time training modules for pediatric critical care providers and the public are discussed within this article. Recommended topics for skilled clinicians, particularly those who do not typically treat pediatric patients, include: training in pediatric triage, administration of EMCC coordination and planning, and training in use of nonstandard equipment. As part of comprehensive emergency preparation, educational needs should be identified and addressed. Practitioners should work to maintain their basic pediatric care levels pertinent to their job, and contemplate whether additional training might benefit them in preparation for potential mass critical care events. If they are likely to be involved in a PEMCC response, they should seek out additional proactive training. Hospitals should: identify team leaders and pediatric care providers and encourage them to receive additional training and stay current in the management of critically ill children; identify just-in-time resources that could be used in times of need, and contemplate how they could best implement those resources, particularly if infrastructure, such as internet access, is compromised; and, if they do not have pediatric critical care capabilities, establish a relationship with a regional children's hospital to look for potential educational and training collaboration and offer these courses to their hospital staff. Regional pediatric critical care centers should: maintain an active educational role in both self-education in management of critically ill children and in regional education in their usual referral network; identify potential local hospitals that could help with surge capacity and ensure that those hospitals are receiving necessary training to manage potential surge patients; and work to develop just-in-time resources for remote assistance in training, such as telemedicine or telephone consultation. State/federal/professional societies should fund and develop additional training courses for pediatric mass critical care, both proactive courses and for development, evaluation, and distribution of just-in-time training modules. PEMCC: The role of community preparedness in conserving critical care resources (p. S141) This section of the supplement addresses the role of the wider community in preparing for disasters and PEMCC. Community preparedness reduces extraneous use of hospital resources and conserves scarce critical care resources by delivering population-based care in the community by utilizing the following: citizens, hotlines/healthlines, EMS/9-1-1, alternate care facilities, pediatric-specific agencies and organizations (i.e., schools, daycares, after-school programs), and integration with a health emergency operations center linked to community incident command systems. The Task Force recommends the following actions by pediatric leadership (those who represent, care for, and advocate for children): Actively promote programs to ensure, before and during a crisis, an informed citizenry and the education of children and families in the Centers for Disease Control and Prevention guidelines on community mitigation strategies. Advocate for a community level of preparedness that leads to empowered self-awareness, knowledge of the information that best prepares the public to provide basic lifesaving information and self-care, and builds physical and mental health resilience. Advocate for the establishment of permanent national- and state-level call systems and disease- and child-specific healthlines as crucial adjuncts during public health emergencies. Advocate for 9-1-1 telephone triage with pre-established criteria and protocols for the proper use and safety of EMS and EMS-sanctioned transportation during pandemics. Work with community planners to identify the logistic support necessary for establishing and operating alternate care facilities, and identify and create protocol-driven, patient management objectives based on assumptions about the types of patients that would be managed in such facilities. Advocate for creative operational concepts that provide guidance and protocols sensitive to the needs of the pediatric population. Legal Considerations during PEMCC events (p. S152) Liability is a significant concern for healthcare practitioners and facilities during PEMCC. While many of the legal issues associated with providing PEMCC are not unique within the context of disaster health care, the scope of parens patriae power of state, principles of informed consent, and security should be considered in PEMCC planning and response efforts since parents and legal guardians may be unavailable to participate in decision making during disasters. This article describes the legal considerations inherent in planning for and responding to catastrophic emergencies and makes recommendations for PEMCC legal preparedness. To address gaps in existing liability protections for public health and PEMCC emergency responses, the Task Force recommends strengthening several areas of legal preparedness. As outlined in the Institute of Medicine crisis standards of care guidance (6): Necessary legal protections must be provided for healthcare practitioners and institutions that implement crisis standards of care plans. Unless comprehensive, national liability protections are implemented, state governments must link existing health practitioner and entity liability protections to crisis standards of care. Courts and other adjudicators should consider whether adherence to the Institute of Medicine guidance provides evidence of meeting the standard of care and "the legal effect of changing standards of care during emergencies" in medical malpractice claims. In addition to the Institute of Medicine recommendations, the following suggestions should be considered for PEMCC preparedness: PEMCC disaster protocols should be properly vetted and accepted; when providing pediatric mass critical care, practitioners who follow such accepted and vetted protocols in good faith should be protected from civil liability (5–7). PEMCC protocols should be included in state disaster plans. Health facilities should ensure that their pediatric disaster plans are consistent with state plans and, to the extent possible, with neighboring health facilities. Facilities that care for pediatric patients should develop specific informed consent and security protocols to incorporate into their disaster plans. Facilities that do not normally care for pediatric patients or that do not routinely provide care for critically ill pediatric patients should also consider incorporating such planning or partnering with other facilities that provide such care in the event that pediatric patients arrive at their facilities during emergencies. PEMCC: Focus on family-centered care (p. S157) Family-centered care (FCC) is especially a concern and challenge in PEMCC. This article addresses the tension between offering FCC and effective disaster treatment/triage. It offers a list of practical suggestions for incorporating FCC principles into each of the following healthcare settings during a disaster, including a PEMCC event: EMS transport, emergency departments, pediatric ICUs, general pediatric wards, and alternative sites. Disaster and PEMCC responses must incorporate FCC principles to the extent possible in a variety of healthcare settings. Family-Centered Care in EMS Care of Children. Practical suggestions have been developed for EMS professionals planning for and responding to mass casualty/pandemic events that involve children. These include encouraging families, local pediatricians, and local groups (champions) to engage in every stage of planning and preparation for disasters. FCC in Emergency Departments and ICUs in a Mass Event. Overcrowding, panic, security concerns, staff stress, and separation of families during triage make practicing FCC an imperative and demanding task. The fundamental precepts of FCC, such as attention to the as a of and of the health of the critical to the of disaster The following are some recommendations for emergency department professionals as they plan and to the needs of children and their families in a mass event: possible, EMS and emergency should a to with the child during the triage and This may providing care for parents in addition to children. The local triage and tools should for a and should a of including at least date of and should be obtained as and as possible, and if necessary to the National for and Children an by the government to with families in a mass Mental health professionals in triage and emergency of children should be available on the In the pediatric and of a liaison such as a child or nursing to and general information of to families could reduce on the and skilled medical to the acute needs of critically or patients. FCC in should include a for children with families and proper for children. The Task Force also recommends planning for FCC during PEMCC at alternative and a medical strategies to establishing of when families are and and families, including those with and in PEMCC (p. The specific is ethical issues unique to children in disasters to their and It that children should be not in proportion to existing resources, to their proportion of the general population or those affected by the event. While the ethical principles of triage the for and the lack of a validated pediatric scoring system on expert opinion. The article the to individuals between and of capacity for children should be based on their proportion of the population, or in proportion to those or likely to be affected by the mass critical care event, rather than in proportion to existing standards are to be resources should be allocated on the basis of medical need, medical benefit, and the conservation of resources. the of a validated pediatric the recommends the use of expert opinion. lists are to the Resources should not be allocated based on the complete or on or to in this is essential. The of PEMCC in the developing (p. care in developing is as well as the that can be for offering mass critical care in developed during disasters. in scarce resource and routinely make difficult allocation This article and recommendations for providing the most good with resources through with existing healthcare and using available resources to The of pediatric critical care should include "the of the child with a or in without for the and including emergency, and intensive to disasters in developing have to take into the available resources and (i.e., to provide special needs care that as a of immediate lifesaving The response in these needs to be to the stage of development of the health services and resources. In the must be on care, and basic emergency care, in care should without care resources. in preparing for a pandemic in a developing from public health and and developing strategies for community and mitigation strategies. care strategies must on using the United Health guidelines and for of and of and assistance is provided to during through provided by the Health of 2007 and the Regional emergency response capabilities and their through the Regional with international such as for government (Canada), Department for and will the deployment of scarce resources. are many issues to PEMCC that are such as of triage and decision making and research priorities that need to be addressed. institutions need to make use of these recommendations as guidelines to their readiness and in preparation for PEMCC. The Pediatric Emergency Mass Critical Care Task Force the American Academy of Pediatrics and Disaster for their review and to this

IntroductionZoonoses are a major global health threat, especially in low-income countries, due to their prevalence and emergence. Repeated outbreaks emphasize the need for integrated, multisectoral surveillance. While the One Health approach is essential, its implementation faces major barriers. Tools like JEE and OH-EpiCap help assess and improve these systems. This study aims to assess the functioning and effectiveness of regional One Health platforms in Guinea.MethodsA cross-sectional study was conducted across the eight administrative regions of Guinea to evaluate the performance of regional One Health (OH) platforms. Data were collected through structured interviews with 160 stakeholders involved in zoonotic disease surveillance, preparedness, and response. The evaluation focused on several key components: coordination; case recording and disease detection; epidemic preparedness and response; mobilization of material resources; stakeholder training; and financing mechanisms. Regional performance was assessed using the standardized evaluation tool developed by the Africa CDC. A comparative analysis was performed using radar charts to identify performance gaps between regions and to highlight disparities in the implementation of the One Health approach.ResultsThe overall One Health performance score in Guinea was 41%, indicating a limited level of implementation at the national scale. None of the eight assessed regions reached the 60% performance threshold. Indicator-level analysis revealed significant heterogeneity across regions. Conakry demonstrated strong performance in the domain of legislation (89%), whereas all regions exhibited weak capacities in the mobilization of material resources (9%), highlighting a major cross-cutting challenge. Regional performance scores varied considerably, with particularly low levels observed in Labé, Kindia, and Faranah (33%), underscoring major disparities in the implementation of the One Health framework.ConclusionThis study identified critical gaps in the performance of Guinea's One Health platforms, notably in resource mobilization and regional disparities. Strengthening local capacities, harmonizing practices, and improving multi-sectoral coordination are essential. Using the Africa CDC assessment tool revealed actionable insights to inform policy and investment. These findings emphasize the urgent need to reinforce One Health implementation amid persistent zoonotic threats in the country.

The operational and policy complexity of civil-military relations (CMR) during public health emergencies, especially those involving militaries from outside the state concerned, is addressed in several guiding international documents. Generally,...