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

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.

Honduras has historically faced significant limitations to scientific development, with research spending below 0.1% of the gross domestic product and a university system focused almost exclusively on teaching. However, between 2007 and 2012, the Teasdale-Corti project (a joint undertaking of Canada and Honduras) marked a turning point by establishing the first academic master's degree in infectious and zoonotic diseases, a biomedical research laboratory, an ethics committee, and biosafety training programs. This process laid the groundwork for the creation of the Microbiology Research Institute. Over the last decade, these initiatives have trained numerous researchers, consolidated research groups in priority infectious diseases, and led to over 170 publications in indexed journals, representing about 12% of the scientific output of the National Autonomous University of Honduras. Likewise, the advent of the assistant researcher role allowed for a significant increase in academic output. Comparison with other Central American countries reveals a marked lag compared to Costa Rica and Panama, mainly explained by the low level of investment in research. Conversely, factors such as international collaboration, local leadership, and institutional integration have been decisive in sustaining progress. The Honduran experience demonstrates that, even in contexts of vulnerability, it is possible to build scientific capacities by combining a strategic vision, sustainable partnerships, and institutional commitment. Nevertheless, these achievements are still fragile and require future consolidation.

Background: HEARTS is the regional strategy led by the Pan American Health Organization to strengthen hypertension and diabetes control in primary health care. This report summarizes formative and process evidence from the ANDES trial in Puno, Peru, and its alignment with HEARTS implementation.

Methods: We assessed 414 health facilities using an adapted World Health Organization Service Availability and Readiness Assessment (SARA-NCD), conducted 55 semi-structured interviews with health professionals, and applied the Hill-Bone adherence scale to 204 hypertensive patients.

Results: Facility readiness was 28% for hypertension and 29% for diabetes. Lower-level facilities - posts and basic health centers - showed markedly lower readiness (OR = 0.20 for hypertension; OR = 0.03 for diabetes). Provider interviews identified limited prioritization of hypertension, weak supply chains, and insufficient training. Mean adherence score was 48.3 ± 4.0 (medication 31.6 ± 3.5; appointment-keeping 5.98 ± 1.27; salt reduction 10.67 ± 1.18).

Conclusions: Findings reveal major readiness gaps and systemic barriers to hypertension and diabetes management in high-altitude Andean regions. Community health worker-supported interventions such as ANDES can facilitate adoption of HEARTS strategies in resource-limited primary care settings.

This opinion paper summarizes the strategy applied toward malaria elimination in Suriname and highlights its relevance and feasibility for implementation in similar Amazon rainforest settings. The country implemented a strategy in both stable and nonstable communities, which included robust surveillance, maximizing access to early diagnosis and treatment, retreatment strategies, and ample distribution of insecticide-treated nets. Decades of sustained community engagement further contributed to the sustainability of these efforts. The authors believe similar strategies could be effectively adapted and applied elsewhere in Amazon regions.

Objective: To analyze the factors associated with access to cardiometabolic disease screening in older adults in the Peruvian Amazon.

Method: A secondary analysis study using data from 310 older adults in the AMAZON FRAIL study. Sociodemographic, social, functional, and clinical variables were evaluated using bivariate analysis and Poisson regression.

Results: Of the 310 individuals included in the study, the majority (82.47%, n = 254) were between 60 and 79 years old, and 61.15% (n = 192) were women. A total of 48.71% (n = 151) had never had their blood pressure measured, and 69.03% (n = 214) had not been screened for diabetes. Multivariate analysis revealed that factors associated with a higher likelihood of participating in screenings included: being male; having previously undergone diabetes screening; having a history of hypertension; and presenting cognitive decline. In addition, diabetes screening was associated with: living alone; having a prior history of hospitalizations; having social support; having diabetes; having previously undergone blood pressure screening; exhibiting impaired physical performance; and depression.

Conclusions: Sociodemographic, clinical, and functional factors influence access to blood pressure and diabetes screening in older adults in the Peruvian Amazon, highlighting the need to implement comprehensive strategies.