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

Objective: Given that vector control represents the primary strategy for preventing these diseases, the objective of this systematic review is to ascertain the efficacy of chemical interventions in reducing their burden.

Methods: The PRISMA guidelines were followed to search for experimental studies published between 1987 and 2024 in English, Portuguese, and Spanish. Medline, Embase, WOS-Core Collection, Scopus, Lilacs, Cochrane Library, and Biological Science Database were consulted to identify studies using incidence or prevalence as outcome variables of interest.

Results: Of the 2 232 references initially retrieved, 8 articles were included in the review. All studies used entomological indices along with disease burden indices to measure intervention impact. Three studies evaluated the use of insecticide-impregnated curtains alone, one combined those with residual insecticide treatment in dwellings, one evaluated the use of insecticide-impregnated school uniforms, and the remaining three evaluated household insecticide application. Only four of the eight articles showed some level of efficacy of chemical interventions in reducing dengue prevalence or incidence.

Conclusion: The chemical interventions under examination did not result in a notable reduction in the burden of these diseases within the population, which would appear contradictory given the prominent role of chemical interventions in vector-borne disease control programs.

Objectives: To develop a generalizable extraction, transform, and load (ETL) process and workflow for prospective harmonization of data from active cohort studies being conducted in different geographic locations across the Region of the Americas.

Methods: This study harmonized and merged data from two active prospective cohort studies, the Living in Full Health (LIFE) project in Jamaica and the Cancer Prevention Project of Philadelphia (CAP3) in the United States. The RedCAP data collection platform was leveraged in harmonizing and pooling baseline prospective cohort data that was collected from June 2019 to December 2024.

Results: The merged data from this harmonization methodology displayed good coverage on the mapped variables. Seventeen of 23 (74%) of the questionnaire forms harmonized greater than 50% of the variables. Statistical tests on the age-adjusted prevalence of health conditions demonstrated regional differences that could be used to investigate disease hypotheses in the Black Diaspora.

Conclusion: This study developed a successful data harmonization process that can guide similar projects. Active data harmonization is a useful strategy that can reduce costs and leverage resources required to conduct multi-site cohort studies, while fostering data sharing and collaborative research across the Region of the Americas.

Objectives: To estimate cervical cancer screening (CCS) coverage rates and assess the spatial distribution and clustering between departments and municipalities in Bolivia.

Methods: Standardized CCS coverage rates were calculated using the direct standardization method. The global Moran's I test was used to investigate the existence of spatial autocorrelation of CCS coverage, and the Getis-Ord Gi* was used to identify the spatial clustering of municipalities with high (hot spot) or low (cold spot) coverage.

Results: Overall coverage was low. Around 14% of women aged 20-69 years were screened in Bolivia in 2022. Large geographical inequities in CCS coverage rates were identified both between departments and between municipalities. At the municipal level, CCS showed large differences, ranging from 59% to below 1%. Hot spots were identified in northwestern and southeastern Bolivia; specifically, in Pando, Chuquisaca, and Tarija departments. Cold spots were identified in Beni and Santa Cruz departments.

Conclusions: Bolivia is still a long way from achieving the World Health Organization target of 70% screening coverage. The present results indicate where the screening program must be reinforced to improve the responsiveness of Bolivia's health system to women's reproductive health needs.

"South-South" partnerships forged between institutions in resource-constrained settings, usually in low- and middle-income countries, provide innovative frameworks for resource, knowledge, and expertise exchanges to address public health challenges in regions sharing similar contexts. Population-based cancer registries (PBCRs) and surveillance systems in low- and middle-income countries are essential for cancer control, yet they are scarce. In response, the authors formed a South-South Colombian-Mexican partnership to implement the first PBCR in Tijuana, northwestern Mexico, and an integrated pediatric cancer real-time clinical outcomes monitoring system, replicated from Colombia's successful model, VIGICANCER. The newly established team assessed local needs in Mexico, adapted VIGICANCER protocols to the local context, and conducted training. In 2017, BajaREG was inaugurated in Tijuana, and, in 2018, joined the newly launched Mexican National Cancer Registry Network. In 2020, the Pediatric and Adolescent Cancer Registry Surveillance System (PACARSS) was integrated into BajaREG. Between 2018 and 2024, BajaREG registered 8 231 adult and 268 pediatric cases. PACARSS currently collects population-level data on pediatric cancer clinical outcomes in Tijuana. Despite multiple challenges, including the COVID-19 pandemic, stakeholder engagement enabled success. The authors showcase how locally tailored South-South partnerships can capitalize on collaborations and facilitate the implementation of sustainable PBCRs and surveillance systems in regions sharing similar challenges, resources, and health care systems.

Objective: To investigate whether the quality and quantity of genomic DNA harnessed from existing formalin-fixed paraffin-embedded (FFPE) breast cancer biopsy tissue samples in the public health system of Trinidad and Tobago (T&T) were sufficient for downstream genetic testing and to investigate the occurrence of the common breast cancer susceptibility gene 1 (BRCA1) mutation, BRCA1-185delAG, in these samples.

Methods: Genomic DNA was extracted from 67 FFPE samples using a standard protocol (Qiagen). Samples were genotyped using polymerase chain reaction (PCR) and Sanger sequencing.

Results: The genomic DNA was highly fragmented in the 250-500 bp range. The quality and quantity only allowed testing of one variant. This study successfully genotyped 34 of 67 FFPE breast cancer tissue biopsy samples for the BRCA1-185delAG mutation. This mutation was not detected in the 34 samples.

Conclusion: Existing FFPE cancer tissue biopsies in the public health system in T&T are of limited utility for genetic testing. The absence of the BRCA1-185delAG mutation in the limited number of breast cancer samples tested does not preclude its existence in this population. Further investigations are needed to determine the extent of clinically relevant breast cancer-associated mutations in this population.

Cardiovascular diseases remain the leading cause of premature morbidity and mortality globally, with hypertension as their main modifiable risk factor. In Latin America and the Caribbean, hypertension affects more than 30% of adults, yet control rates remain alarmingly low. The HEARTS in the Americas Initiative, led by the Pan American Health Organization, promotes a model of team-based care to enhance risk management for hypertension and cardiovascular diseases within primary health care. Team-based care leverages the skills of diverse health professionals, including nurses, pharmacists and community health workers, to optimize resource allocation, task-sharing and care delivery. Evidence underscores the effectiveness of team-based care in improving blood pressure control, reducing hospitalizations and enhancing quality of life through strategies such as periodic follow up and medication titration. Despite its benefits, implementing team-based care faces cultural and systemic barriers. This special report outlines a policy framework to scale team-based care across the Region of the Americas, ensuring equitable access to high-quality, cost-effective prevention and care for cardiovascular diseases.

In 2021, Brazil began implementing the 11th Revision of the International Classification of Diseases (ICD-11), with completion scheduled for 2027. ICD-11 represents a technological and conceptual leap, offering new opportunities for epidemiological analysis and health management. However, it also imposes challenges for interoperability and preservation of historical data series, making its implementation more complex. Given Brazil's vast territory and considering the existing health information systems, the implementation will be phased, focusing on five priority areas: publication, translation, and use of ICD-11 in Brazil; information technology infrastructure; data comparability and quality; capacity building; and promotion and dissemination. The present article aims to provide an overview of the current state of ICD-11 implementation in the country, the steps already taken and future perspectives. The implementation follows the guidelines established by the World Health Organization's Implementation Guide and Technical Note No. 91/2024 issued by Brazil's Ministry of Health. These documents address procedures such as the update of health information systems as well as areas deserving special attention, such as the diversity of regional contexts across the country and the scale of change involved in updating international classifications, with the goal of ensuring safety and effectiveness, preserving time series, and enabling swift adaptation. The process represents another public health milestone in Brazil, while simultaneously promoting the modernization and enhancement of vital statistics information systems, reinforcing Brazil's role in advancing global public health.

Plasma-derived medicinal products (PDMPs) are essential medicines required for the treatment of congenital, rare, and acquired diseases. At present, the market dynamics of these products have led to high dependence on a few producing countries, causing shortages, stockouts, and problems related to access in general. To help solve this problem, this document proposes a value model for PDMPs from a public health perspective, and considers the prospects, visions, and challenges to implementation in Colombia, as a case study. These proposals seek to contribute to the development of strategic independence in plasma, while promoting equitable access to PDMPs in the Region of the Americas. They are the result of a series of discussions and semi-structured interviews with national and international stakeholders from different public and private sectors, and with leaders of the National University of Colombia and the International Plasma and Fractionation Association (IPFA). It is hoped that these proposals will serve as an example for other countries in the Region to include this issue in their public policy agenda.

Objective: To describe and systematize experiences and lessons learned in the implementation of a Pan American Health Organization (PAHO) technical cooperation strategy in countries at high risk of importation and spread of measles and rubella, with the following objectives: monitoring the progress of vaccination coverage through microplanning, strengthening risk analysis and epidemiological surveillance, and providing a rapid response to outbreaks of vaccine-preventable diseases.

Methods: Cross-sectional descriptive study of the interventions carried out by PAHO, with the support of seven epidemiologists who were trained and sent to nine countries in the Region between August and December 2023. The collected data were consolidated and analyzed along four strategic lines: vaccination, epidemiological surveillance, risk analysis, and preparedness for a rapid response to outbreaks. Information was collected through a questionnaire that included qualitative and quantitative data, following up on the work plan of the epidemiologists deployed in the Region.

Results: The results of the activities were analyzed on the four strategic lines, using training tools and methodologies to establish intervention plans in the countries visited.

Conclusions: The support of the group of consultants in the high-risk countries made an important contribution to strengthening different components of the national immunization program in each country.

In today's digital age, health data is increasingly coveted, and having legal rules to protect it is not enough to prevent its incorrect, imprudent, or improper use. Breaches of confidentiality, intrusions, and unrestricted access to personal data and sensitive data are a challenge for Latin American and Caribbean countries. This is due to the coexistence of diverse social actors, unspecific regulatory frameworks, data management aimed at reducing IT risks, inequalities in access, and technological-financial gaps, which can be analyzed from a governance perspective. This further demonstrates the region's inability to achieve an equitable distribution of the resources needed to implement policies that guarantee respect for human rights. It is, therefore, imperative to harmonize development objectives with initiatives to protect confidentiality and prevent data leaks, in order to improve the reputation of institutions in terms of credibility and trust, and to enhance the sustainability of systems that focus on people rather than data.