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

Objective: To map the reasons why individuals oppose or refuse organ and tissue donation, from an international perspective.

Methods: A scoping review was conducted from May 2022 to February 2024 using a three-stage search strategy across five databases and Google Scholar. Data analysis involved categorizing information based on similarities and populations studied.

Results: The analysis included 92 articles and national reports. The data collected were classified into two categories. Category 1 included the reasons why individuals oppose deceased donation: lack of knowledge about the donation process, 22 (16.5%); religious beliefs, 21 (15.8%); fear of mutilation or damage to body integrity, 17 (12.8%); conflicts with health care professionals during hospitalization or distrust of professionals or the organ donation process, 11 (8.3%); and unknown reasons, 11 (8.3%). Category 2 included the reasons why individuals refuse to donate a deceased relative's organs and tissues after the family interview for deceased donation: previous written or verbal expression by the potential donor, 42 (10.1%); fear of mutilation or damage to body integrity, 41 (9.9%); conflicts with health care professionals during hospitalization or distrust of professionals or the organ donation process, 38 (9.2%); religious beliefs, 37 (8.9%); and individual motivations, 36 (8.7%).

Conclusions: This scoping review found that there were two main categories of reasons behind being opposed to or declining organ and tissue donation, with 23 subcategories. By mapping these reasons across international contexts, these findings provide insights for future research and can be used to inform the development of educational initiatives on organ and tissue donation.

The performance of health systems is related to ensuring the right to health, an important component of human rights that includes the right to health protection. Regulatory action by the state aims to reduce risks to health and thus help improve health system performance, particularly with respect to the principles of comprehensiveness and equity. The aim of this article is to discuss resilience from the perspective of national regulatory agencies - especially when they are faced with public health emergencies (PHEs) - and their contribution to health system resilience, taking as a model the work of the Brazilian Health Regulatory Agency (ANVISA). In the context of PHEs, health regulators have been improving their practices and working on several fronts. Regulatory agencies have used specific regulatory instruments to speed up access to effective and safe products for responding to pandemics, to ensure the quality of care, and to communicate with the public. ANVISA specifically has brought new areas of action under its purview, such as overseeing the development of mechanical ventilators. It is crucial to recognize the interdependence between improving response capacity and improving performance in dealing with PHEs. Examples include the fast-track approval of COVID-19 vaccines, which allowed more rapid vaccination; cooperation among regulatory agencies; and, in the case of Brazil, work by ANVISA to strengthen the role of the country's Unified Health System (SUS) and the right to health in the face of disinformation and denialism.

Objective: Evaluate the differences in the dengue case fatality rate among the different subregions of the Americas in the period 2014-2023 and explore their relationship with the human development index (HDI) in each subregion.

Methods: Longitudinal ecological study based on open-access data from each country, grouped into the corresponding subregions to calculate the different indicators. In addition, a linear regression was performed between the mean case fatality rate in each region and the weighted regional HDI.

Results: There are large differences in dengue lethality by subregion and considerable variability by year. These differences in lethality are not directly correlated with the incidence recorded in each region. The regional HDI shows a close relationship with lethality: a higher HDI is generally associated with a lower case fatality rate.

Conclusions: The observed differences in lethality and their relationship with subregional development levels indicate that a broad and multifactorial perspective should be taken when designing a dengue control strategy.

Objective: To describe the process of restructuring the National Expert Committee and its impact on the causality assessment of events supposedly attributable to vaccination or immunization (ESAVI) in the context of vaccine safety monitoring during the COVID-19 pandemic, 2020-2023.

Method: A report was prepared on the experience of creating and operating Mexico's National Expert Committee during the aforementioned period.

Results: During the 2020-2023 period, 1293 severe ESAVIs were reported after COVID-19 vaccination; after 98.6% (1275) of them had been assessed and classified, 10 specialized subcommittees were formed.

Conclusions: Restructuring of the committee, assessment of adverse events with a series of prior steps, and use of the World Health Organization's causality assessment tool made it possible to generate scientific documents to validate vaccine safety and maintain trust in vaccination.

Objetivo: To document the historical facts and the challenges faced in the Region of the Americas in achieving and sustaining measles, rubella, and congenital rubella syndrome (CRS) elimination between 2013 and 2023.

Method: Special report with a narrative description of the main achievements, challenges, and lessons learned during the period, and an analysis of vaccination coverage, surveillance indicators, and measles outbreaks using data from the Pan American Health Organization and the United Nations Children's Fund, among others.

Results: Between 2003 and 2016, regional vaccination coverage with the first dose of the measles, rubella, and mumps vaccine was between 92% and 94%; after 2017 there was a marked decline due to lower coverage levels in the most populous countries. The regional reporting rate of suspected cases remained at the expected level, with differences in each subregion. Between 2017 and 2023, measles outbreaks tested the strengths and weaknesses in the quality of each country's response. Starting in 2020, the COVID-19 pandemic had a negative impact on both vaccination coverage and the quality of epidemiological surveillance.

Conclusions: The elimination of measles in 2016 and rubella in 2015 were major achievements in the Region of the Americas. Between 2017 and 2020, the main challenge was to address measles outbreaks that caused the re-establishment of endemic transmission in two countries. Between 2020 and 2023, the main challenge was to tackle the negative impact of the COVID-19 pandemic on declining vaccination coverage and surveillance indicators.

Objective: To describe the experiences of the National Advisory Commission on Serious Events Supposedly Attributable to Vaccination or Immunization (ESAVI) implemented in Ecuador for the period 2020-2023.

Methods: A report analyzing the implementation, operations, and results of the National Advisory Commission on Serious ESAVI in Ecuador was prepared. A quantitative analysis of vaccination records was carried out, as well as a qualitative analysis based on expert interviews, reflecting the direct experiences and operational challenges faced by the members of the Commission.

Results: Implementation of the Commission has allowed for the systematic recording and analysis of serious ESAVIs. Of 256 reported cases, 139 were analyzed: 59% were considered coincident events; 16.6%, unclassifiable; 6.5%, indeterminate; 5%, stress-related; 3.6% as events related to a programmatic error; and 9.4% as vaccine-related, which included allergic reactions, Guillain-Barré syndrome, and thrombosis, among others. The experts highlighted the need to improve staff training and technology infrastructure, and noted that the Commission played a crucial role in monitoring vaccine safety, as well as in increasing public confidence in vaccination processes.

Conclusions: The National Advisory Commission has played an essential role in vaccine safety surveillance in Ecuador by ensuring reporting, causality analysis, and investigation of serious ESAVIs. Challenges were identified and will need to be addressed to maintain public trust in immunization programs.

Data sharing increasingly underpins collaborative research to address complex regional and global public health problems. Advances in analytic tools, including machine learning, have expanded the potential benefits derived from large global repositories of open data. Participating in open data collaboratives offers opportunities for Caribbean researchers to advance the health of the region's population through shared data-driven science and policy. However, ethical challenges complicate these efforts. Here we discuss fundamental challenges that threaten to impede progress if not strategically addressed, including power dynamics among funders and researchers in high-income countries and Caribbean stakeholders; research and health equity; threats to privacy; and risk of stigma. These challenges may be exacerbated by resource and infrastructure limitations often seen in small island developing states (SIDS) and low- and middle-income countries. We propose a framework for Safeguarding Health And Research data sharing by promoting Equity (SHARE) for Caribbean researchers and communities participating in shared data science. Using the SHARE framework can support regionally relevant and culturally responsive work already underway in the region and further develop capacity for intentional sharing and (re)use of Caribbean health data.

Measles and rubella have long been recognized as priorities for disease prevention because of their devastating consequences for child health; hence, all World Health Organization (WHO) regions currently have a goal to eliminate measles and four out of six WHO regions have a goal to eliminate rubella. Significant global progress has been made in the twenty-first century, with more than 40% of countries in the world verified by a Regional Verification Commission as having eliminated measles and more than 50% of countries having sustained rubella elimination. Making further progress will require addressing fundamental gaps in health systems, a particular challenge in the current global context where many countries face multiple barriers to both sustaining and achieving measles and rubella elimination. These challenges require a strategic shift toward a holistic approach that embeds immunization at the center of primary health care at all levels, which will have broad benefits beyond preventing measles and rubella. Progress will be supported through technological innovations such as microarray patch vaccines. Whether this holistic approach will be more effective than vertical initiatives at achieving measles and rubella elimination remains to be seen. Measles is so infectious and its immediate impact so visible on individuals and health systems that any weaknesses in global or national strategy are immediately evident. The tools exist to prevent every death from measles and every case of congenital rubella syndrome. Countries and partners - at all levels - share accountability for ensuring children are protected from these entirely preventable diseases.