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ABSTRACT Objective: To analyze how clinical simulation impacts nursing students’ proficiency in clinical evaluation, decision-making, therapeutic communication, and reporting of dengue fever with warning signs within a primary health care context. Methods: Third-term nursing undergraduates participated in the activity, which involved a standardized patient, a 45-year-old female with persistent vomiting, fever, and abdominal pain after a trip to an endemic dengue area. A structured checklist was used to assess their performance in terms of diagnostic suspicion, anamnesis, physical examination, tourniquet test, recognition of severity signs, completion of the reporting formulary, patient referral decisions, and communication with the patient. The actor received detailed instructions to ensure realism and standardization. This project followed ethical tenets and was approved by the Research Ethics Board. Results: Students showed high engagement, with improvements in their logical reasoning, confidence in approaching patients, and communication. Most of them correctly identified dengue fever suspicion, although they had difficulties recognizing the warning signs, which enriched the debriefing and promoted reflection on decision-making. Conclusion: Clinical simulation is a powerful tool for teaching dengue fever and integrating theory and practice. Thus, it provides significant learning and strengthens the education of better-prepared nurses for qualified performance in primary healthcare.

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ABSTRACT This paper examines the fitness industry as a by-product of neoliberal ideology, using "The New Way of the World: On Neoliberal Society" as a conceptual framework. Neoliberalism, as articulated by Dardot and Laval, extends beyond economic policy to shape governance and human behavior by embedding market-driven rationality into everyday life. The fitness industry, with its emphasis on individual responsibility for health and self-optimization, exemplifies core neoliberal tenets. It fosters the notion of the "entrepreneurial self," wherein success or failure is attributed to personal merit, thereby marginalizing collective health initiatives. The proliferation of fitness influencers further reinforces this paradigm, often disseminating misinformation and promoting unrealistic ideals of health and fitness. We argue that the commodification of health within the fitness industry aligns with neoliberalism's foundational principles: competitiveness, self-regulation, and the erosion of collective structures. In response, we advocate for a shift toward health frameworks rooted in inclusivity, equity, and shared responsibility, challenging the individualistic ethos embedded in current fitness discourse. Reimagining health policy through a lens of solidarity offers a pathway to dismantling neoliberal rationality and fostering a more democratic and equitable health system.

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ABSTRACT The present study examines the development of medical science during the COVID-19 pandemic in light of Ernst Mayr's critique of Thomas Kuhn's philosophy of scientific revolutions. Kuhn's model, which emphasizes paradigm shifts and disruptive changes in scientific practice, contrasts with the evolutionary and cumulative nature of biological sciences, as argued by Mayr. Revisiting Mayr's critique, we question the applicability of Kuhn's model to the COVID-19 pandemic by using vaccine development as a case study. We argue that the rapid advancements in vaccine technology, particularly mRNA-based vaccines, are better understood as the outcome of multiple independent micro-revolutions in scientific fields, such as genetics, pharmacology, and molecular biology. These disciplines have advanced steadily over decades, facilitating the accelerated response to the pandemic. Consequently, the rapid, effective, and game-changing development and implementation of mRNA vaccines represented a major breakthrough in medical science; their trajectory diverged from Kuhn's concepts of scientific revolution and normal science. Through this analysis, we propose rethinking of medical epistemology – one that acknowledges the asynchronous yet non-disruptive progress of the medical sciences. Such a framework not only provides a more accurate understanding of scientific evolution but also offers a valuable tool for addressing societal challenges, such as vaccine hesitancy and public trust in science.

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ABSTRACT This essay examines human enhancement drugs – particularly anabolic-androgenic steroids – through the lens of public health theory from the Global South. It critiques prohibitionist policies, which criminalize users while disregarding social determinants, as well as extreme relativism, which reduces consumption to individual autonomy alone. In contrast, harm reduction emerges as an evidence-based, user-centered approach that rejects criminalization, upholds human rights, and provides contextualized health responses. By reframing anabolic-androgenic steroids as human enhancement drugs, the analysis promotes a less moralistic perspective shifting the focus from individual behavior to broader societal pressures. Allied with Global South public health frameworks, harm reduction addresses the health needs of people who use drugs, prioritizing societal transformation over punishment.

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ABSTRACT This essay presents a political-philosophical reflection on the need to reconstruct health practices in order to make them more effective and sensitive in identifying and responding to the needs of diverse individuals and populations. To this end, it draws on the experience of health sector reforms in Brazil and the development of the Brazilian Public Health System, focusing in particular on the relevance of three conceptual constructs associated with this process: comprehensiveness, vulnerability, and care. Inspired by philosophical hermeneutics (Gadamer, Ricoeur), the discussion emphasizes the importance of a broader and more integrated understanding of health needs; the use of social markers of difference as indicators of vulnerabilities that require differentiated responses from health services and policies; and the value of a dialogical approach to health practices that is existentially sensitive and informed by multiple forms of knowledge, enabling productive integration of technical efficacy with practical success.

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ABSTRACT Lactation induction is the process of stimulating milk production when pregnancy has not occurred, but there is still a desire to breastfeed. Initially designed for adoptive mothers and mothers through surrogacy, the protocol does not explore other uses, such as in cases of LGBTQIA+ families, in which breastfeeding may also be a significant symbol in the transition to parenthood. Thus, we seek to explore the complexities of the use of lactation protocols by cisgender women couples who have chosen co-lactate. This article is based on qualitative research conducted through semi-structured interviews with women in São Paulo and Rio de Janeiro, Brazil, between June and October 2024. Seven women participated: three couples and one non-gestational mother. From this analysis, two analytical categories emerged: the first addresses the sources of information used by the participants, highlighting the key role of information networks built through the internet and the notable absence of healthcare professionals as references in this process. The second category discusses the participants’ experiences with the induction protocol, highlighting the challenges of balancing their routines with the protocol’s demands and the importance of healthcare professionals who act as positive deviants from the hegemonic model of care. We propose a reflection within the field of healthcare on its onto-epistemological assumptions, suggesting the right to opacity as a guiding principle in the construction of healthcare practices, acknowledging that it is not necessary to understand the other – or their life logics – in order to form a care alliance that goes beyond rigid, standardized protocols.

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ABSTRACT Background Artificial Intelligence is increasingly embedded in stroke care, yet clear guidance on the competencies required for its safe and ethical use in vascular neurology is lacking. Objective To map the literature on Artificial Intelligence applications across the stroke care continuum and to synthesize the technical, ethical-legal, and humanistic competencies needed for Artificial Intelligence-augmented clinical practice. Data sources PubMed/MEDLINE, Embase, Scopus, Google Scholar, and targeted gray literature from professional and regulatory bodies. Eligibility criteria Peer-reviewed studies, reviews, and consensus statements or guidance documents addressing Artificial Intelligence in stroke care or related ethicallegal and humanistic competencies. Case reports, exclusively preclinical studies, and non-scholarly publications were excluded. Methods A scoping review was conducted according to PRISMA-ScR and JBI guidance, with independent screening and narrative thematic synthesis. Results From 1,426 records, 74 studies were included. Validated Artificial Intelligence applications were identified in hyperacute imaging (e.g., automated ASPECTS and large-vessel occlusion detection), prognostication, complication prediction, and rehabilitation monitoring, with improvements in speed and precision. Key gaps included limited external validation, insufficient bias assessment, and weak implementation governance. Three competency domains emerged: technical (data literacy and model evaluation), ethical-legal (accountability, privacy and equity), and humanistic (empathy, communicationand shared decision-making). We propose “clinical-Artificial Intelligence correlation” as a core competency integrating algorithmic outputs with clinical judgment. Conclusion Artificial Intelligence can enhance stroke care when combined with rigorous clinical oversight and strong ethical and humanistic foundations. Registration: 10.17605/OSF.IO/G4W9J

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ABSTRACT Causal inference and its graphical representation using directed acyclic graphs provide invaluable tools for calculating effects and handling confounding in medicine. However, since biological systems involve complex dynamics characterized by numerous feedback loops, practitioners need to abstract out the inner workings of cycles in order to reason with a causal framework. This text presents a step beyond linear causality, toward a language that can adequately capture the circular complexities underlying human health. The most fundamental homeostatic mechanisms are inherently cyclic, including sleep-wake states, hormonal regulation, hemodynamics, respiration, blood cell production, eating, and digesting. In fact, numerous medical interventions aim to restore harmonious activity within such systems, reversing dysfunctional states by appropriately modifying certain elements. These include sleep hygiene, synchronized cardioversion, mechanical ventilation, glycemic periodic control with insulin. This study describes medical contexts using cyclic graphs, covering interventions such as control of hormonal cycles in reproductive medicine. Health practitioners can benefit from this enriched perspective, which parsimoniously describes the fundamental behavior of disease processes.

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ABSTRACT This essay draws on a qualitative study that explored the understandings of employees responsible for planning, preparing, and distributing meals in three food assistance services in downtown São Paulo (Brazil) regarding food provision for people experiencing homelessness. In that study, 12 semi-structured interviews and materials from in-depth fieldwork conducted between December 2022 and December 2023 were analyzed using thematic content analysis. We revisited the previously identified themes through the lens of Enrique Dussel's Philosophy of Liberation, particularly the concepts of Totality, Exteriority, and Dignity, and explored how institutional food practices mediate recognition, autonomy, belonging, and humanity in contexts of social vulnerability. We examined how service workers construct interpretations that shape everyday food practices and how their positions within broader power relations influence daily routines. We also considered the perceptions of belonging, identity, and pleasure associated with the food provided, as well as different conceptions of autonomy within these institutional contexts. The debate centers on the tension between recognizing the human dignity of a group that society often treats as "non-human" and the practices that either reinforce or challenge this treatment. Drawing on Dussel's framework, we argue that food provision simultaneously challenges and reinforces the boundaries of Exteriority, thereby shedding light on the ethical and political dimensions of food as a social and cultural act.

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ABSTRACT In the aftermath of the COVID-19 pandemic, telemedicine has evolved from a contingency-based alternative into a structural pillar of healthcare delivery, increasingly being integrated with artificial intelligence. Algorithms for triage, clinical decision support, remote monitoring, and generative language models now actively participate in medical care. This integration is more than just functional; it reorganizes the foundational aspects of medicine—ontological, ethical, and epistemological—by redefining what qualifies as valid knowledge, who has legitimate authority, and how care is organized when an algorithmic agent facilitates the clinical interaction. This article critically examines the emergence of the patient-clinician-algorithm triad in telemedicine, and analyzes its implications for autonomy, informed consent, epistemic trust, privacy, justice, responsibility, and the phenomenology of care. It argues that the future of medicine will not be human or algorithmic but human-algorithmic, provided clinical judgment, explainability, and moral responsibility remain central.