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

Objective: Analyze the impact of the COVID-19 pandemic on influenza vaccination coverage in some countries in the Americas.

Methods: This descriptive ecological study included Argentina, Chile, and Uruguay and analyzed information on influenza vaccination coverage in the countries during 2018-2023. The study reports annual estimates of influenza vaccination coverage expressed as a percentage of the population. The sources used were those reported by the Pan American Health Organization/World Health Organization and the ministries of health of the countries studied.

Results: Comparatively, vaccination coverage rates according to risk groups among Argentina, Chile, and Uruguay show a downward trend without reaching optimal vaccination coverage for 2018 to 2023. Increased vaccination rates were reported in 2020 for all age and risk groups, except in Uruguay for children under 5 years of age. Among pregnant women, Argentina reported higher coverage in 2020 with 77%, Chile 90% (2018), and Uruguay 55% (2020). Among health workers, all three countries reached their highest coverage in 2020 (100%) but reported a decrease for 2022.

Conclusion: The studied countries have observed a decrease in post-COVID-19 influenza vaccination coverage. Therefore, they are working to achieve optimal coverage, not only in influenza risk groups but across the entire population. Data on influenza vaccination coverage are limited in some cases. The availability of new vaccines can provide greater immunogenicity, efficacy, and effectiveness. However, they represent a challenge for the Expanded Program on Immunization, which requires cost-effectiveness studies to evaluate new vaccines while experiencing restricted national budgets.

Objective: Chronic noncommunicable diseases are the leading cause of death and disability worldwide, with devastating effects on household economies and national growth. The objective of this research is to investigate the knowledge and application of clinical practice guidelines in primary care in Argentina, and to identify barriers and facilitators in the use of evidence-based practices for diagnosis, access, and adherence to noncommunicable disease prevention and control.

Methods: Descriptive quantitative-qualitative study. In the quantitative phase, a survey of trained professionals was conducted in 2020 and 2021. In the qualitative phase, semi-structured interviews were conducted with health professionals and managers between July and December 2021.

Results: The response rate was 29%. Among professionals with a care function, 81% reported knowledge of the guidelines (the most well-known were those for hypertension and diabetes), although the implementation rate varied. A full 83% considered their content clear, 70% found the guidelines appropriate for the setting, and 60% cited the scarcity of resources as an obstacle. The interviews revealed that the guidelines are not frequently followed and the existence of barriers to their implementation, such as organizational culture, lack of leadership, resistance to change, and the heterogeneity of teams. Facilitating factors included a comprehensive perspective and trainings.

Conclusions: The existence of guidelines is not sufficient to modify practices in health teams, since, while they are known, their adoption is limited. Interdisciplinary work and continuous in-service training tailored to the context are key facilitators. Local strategies, incentives, and specific resources need to be introduced in primary health care for effective implementation of the guidelines.

Objective: Identify the factors associated with lack of maternal and child vaccination during the 2024-2025 pertussis outbreak in Mexico.

Methods: Retrospective multicenter study in 20 hospitals across 10 states. Maternal Tdap vaccination (tetanus, diphtheria, and acellular pertussis vaccine) and compliance with the childhood vaccination schedule at 2, 4, 6, and 18 months were recorded. Both ^χ²/Fisher and Mann-Whitney tests were performed, in addition to logistical regressions to estimate aOR (CI 95%).

Results: Tdap coverage in pregnancy was 35.7%. Maternal age was associated with a higher likelihood of vaccination (aOR 1.62 for every 5 years; 95% CI 1.07-2.47), while mothers ≤21 years of age had a lower likelihood (aOR 0.22; CI 95% 0.05-0.91). Education ≥ secondary increased coverage (aOR 12.51; CI 95% 1.48-106.03). In 99 evaluated children, 56.6% had an incomplete vaccination schedule, and maternal age ≥31 years was related to lower adherence (aOR 0.38; CI 95% 0.15-0.95).

Conclusions: In this multicenter cohort from the 2024-2025 outbreak, low Tdap coverage in pregnancy and a high proportion of incomplete childhood vaccination were observed. Maternal vaccination was associated with older age and education, while young mothers had lower coverage. In children, adherence was lower with mothers ≥31 years. These findings underscore the need to strengthen prenatal vaccination strategies as a public health priority. It is also essential to consolidate adherence to the hexavalent childhood schedule and its boosters to reduce morbidity and mortality from pertussis in infants and prevent future outbreaks.

Objectives: Drug use disorders - preventable and treatable conditions - are a challenging and growing public health threat in the Region of the Americas. This study aims to provide a comprehensive analysis of the levels and trends of the burden of these disorders across countries in the Americas.

Methods: This study analyzed morbidity, mortality and disease burden from drug use disorders, including opioid, cocaine, amphetamine, cannabis and other drug use disorders, across 38 countries in the Americas from 2000 to 2021. Using estimates from the Global Burden of Disease Study in 2021, trends were assessed using the average annual percentage change, estimated through regression analysis.

Results: In 2021, 17.7 million (95% uncertainty interval [UI]: 15.9 to 19.9 million) people in the Americas were living with these disorders, mainly opioid use disorders (42.7%) and cannabis use disorders (31.5%). Drug use disorders accounted for 77 717 deaths (95% UI: 70 414 to 86 270) or 6.9 deaths (95% UI: 6.3 to 7.6) per 100 000 population, which was higher than the global estimates. Rates of age-standardized disability-adjusted life years from drug use disorders increased annually by 4.95%, reaching 695.36 years (95% UI: 583.45 to 807.69) per 100 000 population, higher than the global estimate. The burden of these disorders was consistently higher among male young adults. Regionwide in 2021, 145 515 (95% UI: 132 710 to 159 080) all-cause deaths (1.6%, 95% UI: 1.4 to 1.7% of total deaths) were attributed to drug use, primarily deaths from opioid use disorders, cirrhosis and liver cancer.

Conclusions: Drug use disorders are a major and growing public health challenge in the Americas, driven mainly by opioid use disorders in young adults and the rise in these disorders among women. Urgent, evidence-based responses are needed that target high-risk populations, expand treatment and harm reduction, and strengthen data systems. Tailored strategies informed by national contexts and global frameworks can reduce avoidable deaths and improve population health.

Objective: Identify the social determinants of therapeutic adherence among users of the primary health care system's cardiovascular health program (PSCV).

Method: Cross-sectional observational-descriptive study in two family health centers (CESFAM) in Valparaíso, Chile from March to June 2024. A total of 364 users over 18 years of age from the PSCV, selected through proportional stratified sampling, were surveyed. To identify the factors that influence therapeutic adherence, an ad hoc scale was designed that integrates the Morisky-Green-Levine-MMAS-4 test, the dimensions of the Rosenstock, Janz, and Becker health belief model, and the Dahlgren and Whitehead social determinants model. Descriptive statistics and chi-square tests were used to identify significant associations between adherence and individual, social, and structural factors.

Results: It was found that 65.1% of the individuals surveyed exhibited low therapeutic adherence, and 58.2% low pharmacological adherence. Adherence was significantly associated with personal characteristics (age), lifestyle factors (knowledge about their disease, motivation, adherence to medical monitoring and diet, low stress), support networks (family support), and living conditions (access and quality of care in the CESFAM, user satisfaction, and physical and economic barriers).

Conclusions: The findings show the multidimensional influence of social and structural factors on adherence, emphasizing the centrality of the primary care level in managing cardiovascular diseases. Using a people-centered and territorial approach, implementation of strategies that include health education, psychosocial support, and the elimination of access barriers could improve therapeutic adherence.

Objective: Using Mexico as a case study, identify barriers and opportunities and formulate recommendations to strengthen management of type 1 diabetes mellitus (T1DM) in primary health care (PHC), with potential for implementation in other countries of the Region of the Americas.

Methods: A two-stage exploratory qualitative study was conducted. The first stage consisted of a scoping review (2010-2020) of the PubMed, LILACS, and SCIELO databases for reports of successful comprehensive care practices for T1DM, classified into four domains: physical health, emotional health, functional, and social. The second stage consisted of semi-structured interviews with the chief executives of 12 civil society organizations (CSOs) in Mexico, to analyze their strategies for intervention, education, and linkage with public policies.

Results: The scoping review yielded 12 studies, highlighting continuous glucose monitoring, diabetes education, and psychosocial support as key elements. CSOs in Mexico have developed innovative interventions, despite facing barriers such as a lack of basic supplies, nonstandard protocols, and reliance on external funding. Their interventions have had a relevant impact on improving self-care, access to technologies, and emotional support.

Conclusions: The care of patients with T1DM in PHC settings requires a distinct model that combines sustained access to supplies, continuing education, and emotional support. The findings of this study can be used to outline a model adaptable to other countries of the Region of the Americas, based on coordination between the public sector and civil society to improve equity, continuity, and quality of care.

Objective: To estimate the association of social determinants, the urban environment, and public policies with the occurrence and evolution over time of homicides in Santiago de Cali, Colombia (2015-2024), to inform decision-making in public health and territorial planning.

Methods: A mixed-methods approach was used. First, an ecological analysis of 2,264 neighborhood units using multivariable logistic regression evaluated the association between homicides and variables such as the multidimensional poverty index (MPI), unemployment, education, liquor-licensed establishments, and presence of state institutions between 2019 and 2024. Second, an interrupted time series (ITS) model and an autoregressive integrated moving average with exogenous variables (ARIMAX) time-series analysis were applied to analyze the effect of four municipal policies on the monthly homicide rate between 2010 and 2024.

Results: The MPI (odds ratio [OR]:1.45; p < 0.001), unemployment (OR: 1.30; p = 0.005), and density of liquor-licensed establishments (OR: 1.18; p = 0.027) were associated with a higher likelihood of homicides. Educational attainment had a protective effect (OR: 0.78; p = 0.006). A ban on male pillion riders on motorcycles reduced the homicide rate by 19% (incidence rate ratio [IRR]: 0.81; p = 0.005), whereas Casas de Justicia community justice centers led to a sustained -1.2 % monthly decline (p = 0.004).

Conclusions: Homicidal violence in Cali is conditioned by structural inequalities and responds to specific municipal interventions. Policies can have immediate or sustained impacts. These findings allow for targeted resource allocation to critically affected territories, strengthening of community justice, and planning of intersectoral interventions on health, public safety, and development.

Objective: To determine the prevalence of hypertension control and its associated risk factors among adult patients using the HEARTS in the Americas treatment protocol.

Methods: A cross-sectional, interviewer-administered survey was conducted among adult hypertensive patients in North-Central Trinidad over a four-month period. Anthropometric and blood pressure measurements, and factors associated with hypertension control - alcohol use, smoking status, physical activity, nutrition, and treatment adherence - were assessed.

Results: Data from 287 respondents (M 107, F 180) were analyzed, with a response rate of 89.7%. The overall proportion of patients with optimally controlled blood pressure was 52.3% (95% CI [46.5, 58.0]), with a systolic and diastolic blood pressure (mean ± SD) of 139.6 ± 18.1 mmHg and 81.9 ± 10.6 mmHg, respectively; 54% of participants were on Step 1 of the HEARTS protocol (n = 155). Blood pressure control was associated with incomes of greater than TTD 10 000 per month (adjusted odds ratio [aOR] 3.536; 95% CI [1.255, 9.957]; p = 0.017). Being overweight (aOR 0.459; 95% CI [0.229, 0.920]; p = 0.028) was associated with lower odds of having optimally controlled blood pressure.

Conclusions: In North-Central Trinidad, over half of hypertensive patients achieved optimal blood pressure control under the HEARTS in the Americas protocol, the highest rate reported locally. Continued efforts should focus on strengthening adherence and monitoring to sustain and enhance hypertension control outcomes.

Objectives: Physical activity, fitness and nutrition influence health trajectories from childhood to adulthood and are linked to the risk of chronic diseases. Despite the urgency of prevention, there is a lack of longitudinal data about these health indicators among children in Puerto Rico. This 3-year study (2013-2016) followed 46 children from ages 7 to 9 years to assess their physical activity, fitness, nutrition and self-efficacy over time, and to explore the interrelationships among these indicators.

Methods: Physical activity was measured using accelerometers, fitness via the FitnessGram assessment protocol, nutrition through 3-day dietary recall and self-efficacy with a questionnaire. Statistical analyses included repeated measures of analysis of variance, logistic regression and Spearman's correlations.

Results: Throughout the study, most participants failed to meet the physical activity guidelines for Americans, with girls being consistently less active and having higher percentages of body fat than boys. Fitness levels declined over time, particularly muscular strength and endurance. Self-efficacy was positively associated with muscular fitness and body composition. Despite caloric intake falling within general age-appropriate recommendations, the low levels of physical activity suggest there may be an imbalance between energy intake and expenditure.

Conclusions: Early sex disparities in physical activity and fitness, coupled with low self-efficacy and high levels of sedentary time, underscore the urgent need for public health initiatives and school-based interventions that promote active lifestyles, improve nutrition and build self-efficacy, especially among girls. Schools are uniquely positioned to implement evidence-based strategies that can foster healthier behaviors and reduce long-term health risks among youth.

Objective: To summarize the knowledge available in Latin America about clinical coordination (CC) between levels of care, the knowledge of primary care (PC) providers about cancer diagnosis, associated factors, and interventions for the improvement thereof.

Methods: A scoping review was conducted in the MEDLINE, LILACS, and SciELO databases. After reviewing titles, abstracts, and full texts, data on study characteristics and main results were extracted and synthesized in accordance with the conceptual framework of CC.

Results: Of 4,937 records identified, 20 were included, mostly from Brazil and Mexico, covering breast, cervical, and oral cancer. Very few studies analyzed CC in cancer diagnosis; those that did reported issues in both management coordination and clinical information. Additionally, limited knowledge of signs and symptoms that should prompt diagnostic suspicion and limited adherence to clinical practice guidelines were identified among PC providers. No interventions to improve CC were identified. Studies of those aimed at improving diagnostic suspicion did not assess intermediate outcomes, although a reduction in time to diagnosis was demonstrated.

Conclusions: There is a significant knowledge gap in Latin America regarding CC in cancer diagnosis, and few interventions to improve diagnostic capacity in the PC setting. Strengthening PC and improving CC is essential to reducing diagnostic delays that contribute to cancer mortality in fragmented health systems, such as those of Latin America, which entails significant challenges for research in the region.