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

Objective: To evaluate the implementation of care pathways for systemic arterial hypertension (SAH) and type 2 diabetes (T2DM) at the primary health care level in two regions of Northeastern Brazil.

Methods: A descriptive, cross-sectional, before-and-after analysis was conducted, involving the identification of barriers to implementation, situational diagnosis, development of an implementation plan, health team training, and implementation assessment through a self-administered questionnaire. The following clinical indicators were evaluated: proportion of individuals with stratified cardiovascular risk among the total number of patients; proportion of individuals with SAH or T2DM who achieved blood pressure and glycemic control; and percentage of patients diagnosed with SAH or T2DM.

Results: Implementation began in January 2023 in the 1st Health Region of Mata Atlântica (1RSPB, state of Paraíba) and in June 2023 in the 7th Metropolitan Health Region (7RSRN, state of Rio Grande do Norte). The final assessment occurred in December 2023. In the 1RSPB, increases were noted in the percentages of cardiovascular risk stratification (0 to 36%, P < 0.001), blood pressure control (33.4% to 62.6%, P < 0.001), and glycemic control (26.7% to 77.9%, P < 0.001). In the 7RSRN, cardiovascular risk stratification increased from 0 to 17.4%. Changes in the percentages of patients with controlled SAH (47.9% to 48.4%, P = 0.72) and T2DM (59.2% to 57.3%, P = 0.41) were not statistically significant.

Conclusion: The implementation of HTN and T2DM care pathways was feasible, with greater improvements observed in the healthcare network with lower baseline control levels and longer implementation duration.

Objective: To describe HEARTS Initiative implementation in Mendoza, Argentina, focusing on governance, adaptations, and lessons from scaling a standardized hypertension care model across the provincial public health system.

Methods: This descriptive case study analyzed HEARTS introduction and scale-up in Mendoza from 2022 to 2024. Data sources included ministerial resolutions, technical planning documents, and health system monitoring data. Implementation was examined using a five-stage framework (assess, develop, introduce, expand-early, expand-mature), analyzing actors, facilitators, barriers, and adaptations.

Results: In 2022, Mendoza's Ministry of Health issued a provincial ministerial resolution formally designating HEARTS as the standard hypertension care model for all public health services. This enabled province-wide procurement of validated blood pressure devices, formulary revision prioritizing first-line antihypertensives, and training of nearly 4 000 health workers. HEARTS indicators were incorporated into the provincial digital information system for routine monitoring. By 2024, 36 046 adults were receiving antihypertensive medication through the provincial public system, and 12 617 adults aged 20-64 years met active follow-up criteria (at least one visit and documented medication dispensation in the previous 12 months), representing a 40% increase since 2022. These data suggest approximately 15% of the estimated 243 584 adults with hypertension relying exclusively on public services are now under documented treatment and follow-up.

Conclusions: Mendoza demonstrates that binding policy mandates coupled with standardized protocols, centralized procurement, unified information systems, and workforce training can institutionalize HEARTS in decentralized federal health systems. These findings are relevant for other Argentine provinces and subnational health systems in the Americas seeking to strengthen hypertension control through primary care.

Objective: To investigate nurses' contribution to tackling chronic noncommunicable diseases (NCDs) in primary health care (PHC) settings in Brazil.

Methods: Ecological study using secondary data from the Primary Care Health Information System (Sistema de Informação em Saúde para a Atenção Básica, SISAB) and the National Register of Health Establishments (Cadastro Nacional de Estabelecimentos de Saúde, CNES) concerning nursing consultations for six groups of NCDs: chronic respiratory diseases, diabetes mellitus, hypertension, cardiovascular risk screening, and breast and cervical cancer screening. Rates per 100,000 population and average productivity per nurse were calculated for the macroregions of Brazil.

Results: In 2023, PHC nurses provided more than 30 million consultations related to NCDs. The highest rates were observed in the Northeast (for hypertension and diabetes) and in the South (for cancer screening). Nationwide, the average productivity was 314.8 consultations per nurse, with the highest number of nurses per 100,000 population seen in the South (58.6) and Northeast (51.0) regions.

Conclusion: Nursing plays a strategic role in providing NCD management in PHC settings. Our findings suggest a strong contribution by nurses to coverage and screening of chronic diseases, but with marked regional inequalities. This reiterates the importance of investing in clinical protocols, infrastructure, and continuous training to expand equitable access to quality health care.

Objective: To analyze the sociodemographic and socioeconomic characteristics associated with varying levels of functional dependence among older adults, considering the diverse patterns of aging in Latin America.

Methods: National surveys between 2018 and 2023 that used the Washington Group scale to measure disability were reviewed. Three levels of functional dependence (moderate, severe, and total) were defined, and sociodemographic characteristics such as sex, age, education, living arrangements, and socioeconomic status were analyzed, comparing countries with different stages of aging. The sample comprised adults 60 years and older from Bolivia, Chile, Colombia, the Dominican Republic, Ecuador, Guatemala, and Mexico (N = 199 663).

Results: The results show remarkable variability in the prevalence of functional dependence. Severe dependence is related to advanced age, low socioeconomic status, low education, and certain living arrangements. People with less education and in extended or single-person households tend to show higher levels of dependence. Mobility and cognitive impairment were the most prevalent types of disability, especially in countries with advanced aging.

Conclusions: Aging in Latin America is uneven, with educational and socioeconomic status influencing the functional dependence of older adults. Public policies must be tailored to local realities to address health, infrastructure, and care challenges in a comprehensive and equitable manner.

Objectives: To map and synthesize the available evidence on screening strategies for sexually transmitted infections (STIs) in non-pregnant, asymptomatic people in the most vulnerable populations.

Methods: This is a quick scoping review, based on the guidelines of the Joanna Briggs Institute (JBI). It includes studies published between January 2022 and March 2025, identified in the PubMed, Embase, and Virtual Health Library databases, and technical documents retrieved through a manual search. The selection followed previously defined eligibility criteria and the synthesis was descriptive and narrative.

Results: Fifteen studies were included, among them clinical guidelines, observational studies, and systematic reviews, with a predominance of publications from the United States and Australia. The evidence indicates that regular screening for chlamydia, gonorrhea, syphilis, hepatitis B and C, and the human immunodeficiency virus (HIV) is recommended in populations vulnerable to STIs, such as men who have sex with men, sex workers, people taking HIV pre-exposure prophylaxis (PrEP), people deprived of their liberty, and people living with HIV/AIDS (Acquired Immune Deficiency Syndrome). The frequency varies according to the risk profile and anatomical site. Strategies such as opt-out screening and the use of rapid tests at points of care were highlighted, although gaps remain in their large-scale implementation.

Conclusion: Screening for STIs in asymptomatic and non-pregnant populations is a relevant public health strategy, especially in the most vulnerable population groups. The findings support the discussions needed to update national guidelines and formulate evidence-informed policies, underlining the need for integrated strategies to increase access to early diagnosis and overcome health inequalities.

Objective: To describe the process and initial program outcomes of integrating perinatal mental health into maternal and child health services in Belize.

Methods: This was an exploratory study using both qualitative and quantitative methods. The qualitative data was extracted from project reports that described the process involved in the integration of mental health into primary health care facilities. The quantitative data was collected through a retrospective review of records of patients screened for perinatal mental health in 16 primary health care facilities from July to December 2024.

Results: The results were organized into two sections. The first comprised the process for integrating perinatal mental health into maternal health services, which included training of primary maternal health care providers, development of Standard Operating Procedures on the use of the Edinburgh Postnatal Depression Scale (EPDS) as a screening tool and for referral protocols, and supportive supervision and monitoring. The second was the program outcomes, which included 485 pregnant women and adolescents who were screened and of whom 162 (33.4%) had an EPDS score of 12 or greater. All 23 (26.1%) adolescents and 139 (35.0%) adults with a positive screening were referred for mental health evaluation. Of those referred, only 59 (36.4%) were evaluated, and 27 (45.8%) were diagnosed with a mental health disorder. Of the 27 diagnosed, 19 (32.2%) were confirmed to be experiencing a depressive episode, the rate of which was significantly higher among adolescents: 5 (62.5%) compared with 14 (27.5%) adults (P < .05).

Conclusion: The findings of this exploratory study indicate that within the existing health system in Belize, the integration of perinatal mental health into maternal health care at the primary health care level is feasible and essential, particularly for identifying high-risk groups such as adolescents. It is imperative to improve uptake of mental health referrals for evaluation and treatment after screening.