Revista Panamericana De Salud Publica-pan American Journal of Public Health最新文献

The Manual for Surveillance of Events Supposedly Attributable to Vaccination or Immunization in the Region of the Americas represented one of the first steps toward building the regional system for surveillance of events supposedly attributable to vaccination or immunization (ESAVIs) and adverse events of special interest (AESIs). This manual establishes that, after notification and investigation of an event, a national committee of experts should classify the event in accordance with the World Health Organization (WHO) causality classification. The Pan American Committee for Safe Vaccination (COPAVASE) was created in response to the introduction of the new COVID-19 vaccines to support causality analysis of complex regional ESAVI cases and to advise the Pan American Health Organization (PAHO) on strategies for developing safety information and implementing risk mitigation measures. As part of this work, two strategic planning exercises were carried out, one with Committee members and PAHO staff and another that included national authorities and committee members, who contributed ideas on how to strengthen the work both at the regional level and in countries' surveillance systems.Suggested areas of work included definition of clear guidelines, development of model terms of reference and case presentation guidelines, training, and strategies to ensure committee sustainability.With the strategies identified, PAHO expects to be able to continue strengthening national safe vaccination committees as key institutions for maintaining public trust.

In May 2024, the Pan American Health Organization issued alerts of increased numbers of cases of Oropouche fever in non-Amazonian regions in Latin America. Following this, an association between Oropouche fever and Guillain-Barré syndrome was reported in three patients in Santiago de Cuba, Cuba. Neurological manifestations have rarely been described in relation to Oropouche virus infection. Previously, encephalitis and meningoencephalitis have been associated with Oropouche virus infection, but now the virus seems also to be associated with Guillain-Barré syndrome. In this article we describe the main factors that could underlie the increased incidence of Oropouche fever and its neurological complications. Oropouche virus should be recognized as a potential pathogen in cases of fever associated with neurological symptoms (meningitis, meningoencephalitis, and Guillain-Barré syndrome). Medical professionals and health systems need to be aware of these complications and the importance of early diagnosis and preparedness, especially during large outbreaks or in patients living in or coming from endemic regions.

Objective: To analyze a community of practice, the Global Alliance for Nursing and Midwifery (GANM), and illustrate the evolution and sustainability of a virtual community of practice aimed at enhancing knowledge acquisition and dissemination.

Methods: Retrospective content analysis of data gathered from the online tracking of GANM's community activities, engagement data, and platform logistics was conducted and analyzed.

Results: The GANM hosts a diverse community of over 4 300 members from 160 countries. Members benefit from opportunities for knowledge sharing, access to evidence-based tools and materials, and the ability to engage in a creative space for asking questions, discussing current issues, networking, and forming collaborative professional relationships. The discussion forum is frequently used for disseminating new information about evidence-based practice and announcing educational opportunities.

Conclusions: Through a wide variety of activities, the GANM engages a diverse community and provides an opportunity for nurses, midwives, and allied healthcare professionals around the world to network, engage in discussions, and build collective knowledge. The development of future communities of practice can be guided by existing evidence and the GANM's collective experiences, to maintain and enhance community engagement and prevent dormancy.

Objective: To identify barriers to and facilitators of access to perinatal mental health services among pregnant adolescents and young mothers in Belize.

Methods: This was an exploratory descriptive qualitative study using focus group discussions conducted in August 2023. The study sample was selected through purposeful sampling. Participants included pregnant adolescents, adolescent mothers and young mothers from rural and urban areas in three regions of the country (Southern, Northern, and Western). The data were analyzed using thematic analysis and the results were organized into themes.

Results: The barriers and facilitators identified fell into four themes. The first theme was individual factors and showed that respondents had good knowledge about mental health problems and a desire to seek mental health services. However, awareness about their availability was limited. The second theme was health systems and highlighted a lack of trust and confidence in health care providers, as well as limited access to mental health services due to insufficient human resources, long waiting times, and transportation costs. The third theme was stigma about teenage pregnancy and mental health issues. The fourth theme was social support, with both family and peer group support identified as facilitators for help-seeking among the respondents.

Conclusion: This study highlights important barriers to using mental health services for pregnant adolescents and young mothers in Belize. These include stigma, lack of awareness of mental health services, and limited access to them. Implementing targeted strategies to address the barriers are recommended to improve provision and uptake of mental health services among the study population.

Objectives: Congenital anomalies are an important cause of infant morbidity and mortality in Brazil. The aim of this study was to describe the prevalence of and main outcomes related to these anomalies in Brazil.

Methods: This descriptive study was carried out using data from the Brazilian Information System on Live Births (known as Sinasc) and the Brazilian Mortality Information System (known as SIM) for births occurring from 2010 to 2022.

Results: During this period, 37 126 352 live births were registered in Sinasc, and 309 140 live births were reported with congenital anomalies, accounting for approximately 1% of all births, and representing about 24 000 per year (prevalence: 83/10 000 live births). Limb defects were the most prevalent anomaly, occurring in 26/10 000 live births, followed by heart defects (11/10 000) and oral clefts (7/10 000). A higher prevalence of congenital anomalies was found among infants born prematurely (202/10 000), with Apgar scores ≤7 at 1 minute after birth (216/10 000) and at 5 minutes (540/10 000), and among those with low birth weight - that is, < 2 500 g - (250/10 000). A higher prevalence of congenital anomalies was observed among low birthweight infants born to mothers aged ≥35 years (115/10 000), or with a history of ≥2 miscarriages (109/10 000) or in multiple pregnancies (>120/10 000). During this period, 23 798 fetal deaths (6% of all fetal deaths) and 103 642 infant deaths (22% of all infant deaths) due to congenital anomalies were registered. The fetal mortality rate due to congenital anomalies was <1/1 000, while the infant mortality rate was 3/1 000. Neural tube defects were the main cause of fetal death from a congenital anomaly (3 975/23 798, 17%), and heart defects were the main cause of infant death (40 955/103 642, 40%).

Conclusions: These findings highlight the importance of improving surveillance for congenital anomalies in Brazil, as well as reinforcing the need for preventing these anomalies and ensuring that assistance is provided to those who are affected.

In October 2024, the Pan American Health Organization (PAHO) formally integrated surgical, intensive, and emergency care into its health agenda. This followed important events, including the June 2024 endorsement of the Strategy on Integrated Emergency, Critical and Operative Care 2025-2030 by the PAHO Executive Committee. This strategy builds on the 2015 World Health Assembly (WHA) Resolution 68.15, which recognized surgery as essential to universal health coverage, and the 2023 WHA Resolution 76.2, which called for standardized emergency preparedness and response. With 365 million Latin Americans lacking access to essential surgical services, the need for a regional action plan is urgent. Ecuador, the first country in Latin America to develop a national surgical, obstetric, and anesthesia plan (NSOAP), highlighted the need for integrated surgical care to address health disparities in the region. While PAHO's formal integration is commendable, its success will rely on sustained political engagement, financial commitment, and robust monitoring. This article outlines the foundations for this strategy, the mechanisms required for successful implementation, and the role of PAHO and its Member States in strengthening surgical systems as a public health priority. By focusing on vulnerable groups and leveraging collaboration, this initiative can reduce health inequities across the Americas, reinforcing universal health coverage and access to safe, timely, and affordable surgical care.

The establishment of a biobank in the Caribbean represents a vital opportunity to enhance biomedical research and tackle health issues in the area. The Caribbean's unique genetic diversity, shaped by migration and environmental factors, underscores a well-managed biobank's potential impact on global health, especially for underrepresented groups. This paper examines biobanking's potential in the Caribbean, focusing on precision medicine, public health improvements and regional scientific self-sufficiency. It analyzes successful models such as the UK Biobank, the All of Us Research Program at the United States' National Institutes of Health, and Human Heredity and Health in Africa (known as H3Africa), hosted at the University of Cape Town, pinpointing key lessons on data-sharing, ethical governance and infrastructure that could be applied to the Caribbean context. The UK Biobank and H3Africa are relevant examples due to their contributions to large-scale data and health research in diverse populations. The UK Biobank project is a large-scale study with deep genetic and phenotypic data from about 500 000 participants in the United Kingdom. It offers unprecedented insights into health data through extensive follow up and collection of genome-wide genotype data. H3Africa focuses on genomics research that addresses health disparities among African populations, which parallels the Caribbean's challenges. Its ethical governance and community engagement focus are crucial for Caribbean biobank development. This article highlights the challenges of developing biobanks, including ensuring sufficient sample storage and data security, and the need for strong governance. It recommends solutions that involve regional collaboration, stakeholder engagement and increased investment in infrastructure. Establishing a Caribbean biobank with equitable data-sharing principles can significantly enhance global genomic data sets and ensure that the benefits of precision medicine reach the Caribbean. This study promotes a strategic, ethical and inclusive approach to biobanking for long-term success.

Objective: To evaluate the system for Health Surveillance of Populations Exposed to Chemical Substances (Vigipeq) in Brazil from 2011 to 2021.

Methods: Qualitative attributes (simplicity; acceptability, or engagement of individuals and institutions in surveillance; flexibility; and utility, or achievement of system objectives) were assessed using a semi-structured and anonymous questionnaire completed by representatives of environmental health surveillance agencies in capital cities. Quantitative attributes, including sensitivity (case detection), representativeness (generation of accurate information about events in terms of time, place, and person), and positive predictive value (PPV, true events of contaminated areas and exposed populations), were derived from the Health Surveillance Information System for Populations Exposed to Contaminated Soil. Data on exogenous intoxications were sourced from the Brazilian Notifiable Diseases Information System.

Results: Between 2011 and 2021, 16 029 cases of exogenous intoxication and 17 753 contaminated or potentially contaminated areas were recorded in Brazil. According to the questionnaire responses, Vigipeq was considered complex, inflexible, and had low acceptability. However, its sensitivity to detect exposures was high. The PPVs for identifying contaminated areas as well as exposed and potentially exposed populations were low. The system demonstrated utility in achieving its objectives.

Conclusions: Vigipeq is a useful tool but requires improvements in its operational aspects and in the application of the data it generates. Monitoring of environmental health surveillance actions can be optimized by establishing performance indicators and implementing tools to support forecasting and intervention in future events.

Objectives: This study had two objectives: first, to estimate trends in affordability of sugar-sweetened beverages and nonessential energy-dense foods from 2010 to 2022 in Mexico, both nationally and by household income level. The second was to simulate the effects of different tax increases for these foods and beverages to observe how much their affordability would change compared with the current scenario.

Methods: We used the 2010 to 2022 rounds of the Mexican National Survey of Household Income and Expenditures. The affordability ratio was estimated as the proportion of monthly income required to purchase 16 L of sugar-sweetened beverages and 2.8 kg of nonessential energy-dense foods, amounts that reflect median monthly consumption per household. Trends in the affordability ratio and its components (e.g. income and costs) are reported. Additionally, different tax increases were simulated for 2014-2022.

Results: Nationally and among low-income households, the affordability of these foods and beverages did not show significant changes before and after the implementation of the taxes on these introduced in 2014. The simulation scenarios showed that a tax of 3 pesos/L for sugar-sweetened beverages and 32% for nonessential energy-dense foods would be effective in reducing affordability at all income levels.

Conclusions: Current taxes are not high enough to significantly reduce the affordability of these foods and beverages. For low-income households, increases in income were greater than the increases in prices, thus sugar-sweetened beverages and nonessential energy-dense foods did not become less affordable, even after taxes were introduced in 2014. Tax rates would need to increase significantly to reduce affordability, and they should be adjusted for economic growth to compensate for increases in household income.