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

Objectives: To analyze clinical risk models using epidemiological surveillance and hospital data (2022-2024) in Cali, Colombia to identify drivers of respiratory failure in patients hospitalized with severe acute respiratory infection.

Methods: A cross-sectional analytical study was conducted using secondary data from notification file 348, which is part of the Colombian National Public Health Surveillance System. A total of 2 354 hospitalized cases of severe acute respiratory infection were analyzed after quality control and exclusion of inconsistent records. Bivariate and multivariable analyses were performed using chi-squared tests and generalized linear models, respectively, to determine the factors associated with respiratory failure (outcome variable).

Results: Among all cases, 7.3% had respiratory failure. Not having health insurance and having a high multidimensional poverty index score were significantly associated with respiratory failure (both p<0.05). Co-morbidities such as asthma (p<0.01), chronic obstructive pulmonary disease (p<0.01), heart disease (p<0.05), and cancer (p<0.05) also significantly increased the risk of respiratory failure. Sepsis was the only complication significantly associated with the outcome (p<0.01). The final model had good sensitivity (81.9%) and several high-risk profiles were identified.

Conclusions: The study highlights the relevance of co-morbidities and social vulnerability in the development of respiratory failure among cases of severe acute respiratory infection. These findings support the implementation of clinical audit tools and targeted risk management strategies to improve timely care and reduce adverse outcomes in high-risk populations.

Objective: This paper explores vaccination policies for health care workers (HCWs) in effect in all 35 Pan American Health Organization (PAHO) countries plus the British territory of Anguilla to highlight strengths and challenges within the region and inform relevant policies and interventions.

Methods: Data were collected in two phases. Phase 1 (March-September 2021) was conducted as part of a global survey examining characteristics of national vaccination policies for HCWs. The questions addressed policy enforcement, antigens included in policies, funding, vaccination monitoring, and emergency vaccination plans. Respondents were representatives from 21 countries. In Phase 2 (March-August 2023), 15 country representatives who did not respond to the initial survey completed an amended, web-based version of the original questionnaire.

Results: Of the 36 countries, 15 (42%) reported having a national HCW vaccination policy, and 3 (8%) planned to introduce one within 5 years. Among those with policies, 80% integrated them into occupational health regulations. All policies covered influenza and hepatitis B, while many also included tetanus, measles, rubella, diphtheria, and COVID-19. Over half of respondents had emergency vaccination mechanisms, and 44% reported national monitoring systems. Ten countries had comprehensive vaccination policies for HCWs.

Conclusions: To strengthen HCW vaccination policy in the Americas, future efforts should support countries in developing tailored national policies, expanding antigen coverage-especially for outbreak-prone diseases-and investing in strong monitoring systems. Additionally, scaling up behavioral research, enhancing communication strategies, and institutionalizing emergency mechanisms will be critical for addressing vaccine hesitancy and ensuring both pandemic preparedness and routine care continuity.

Objective: To describe training needs and analyze perceived barriers to accessing virtual training among health professionals with technical and managerial roles in the National Integrated Health System of El Salvador.

Method: This research analyzes a survey on training needs conducted by the El Salvador node of the Virtual Campus of Public Health of the Pan American Health Organization. The entire population (100%) registered as managers and technical personnel were included. Professionals with more than 20% missing data for variables of interest were excluded. The analysis made use of proportions, ratios, and an ordinal logistic regression model, along with artificial intelligence and QDA Miner Lite^® for content analysis of open-ended questions.

Results: A total of 519 records were analyzed: 68% (95% CI: 63.7-71.9%) were women and 37.8% (95% CI: 33.6-42.1) were between 30 to 39 years of age; 79.0% (95% CI: 73.4-83.5%) of managers identified topics of institutional interest and 96.1% (95% CI: 92.5-98.1%) of technical personnel reported taking courses that include topics related to their profession. The barriers associated with completing a course were time constraints (proportional odds ration [OR]: (13.11; 95% CI: 7.3-24.4) and being female (OR: 95% CI: 1.1-2.5).

Conclusion: Training needs for managers were most frequently reported in the areas of management and administration; for technical personnel, training needs were mainly in the area of specialized care. Being female and time constraints were factors associated with completing online training programs.

Objectives: To analyze the sodium content of packaged foods and beverages sold in Argentina in 2024, evaluate changes since 2022, and assess compliance with national regulations and the Updated Pan American Health Organization (PAHO) Regional Sodium Reduction Targets.

Methods: A cross-sectional survey was conducted using nutrition label data from 3 915 products collected in April-May 2024 in Buenos Aires supermarkets. Two chains were selected among the six major retailers covering 80% of the national market. Sodium levels were compared against limits established by the National Sodium Reduction Law (866 products) and PAHO regional targets (2 630 products). The 2024 data were compared with a 2022 sample of 3 665 products collected using the same methodology.

Results: Categories with the highest median sodium content included meat and fish condiments (4 417 mg/100 g), appetizers (1 873 mg/100 g), luncheon meat and sausages (1 050 mg/100 g), hard cheese (900 mg/100 g), and dressings (788 mg/100 g). Significant sodium reductions occurred in 11 of 66 categories (16.7%) between 2022 and 2024, including condiments (-9 083 mg/100 g) and bread (-167 mg/100 g). Compliance with the National Law was high; only 5.8% of products exceeded limits, mainly hamburger buns (27.8%) and mayonnaise (22%). Compared to the PAHO targets, 44.5% of products exceeded the 2022 thresholds and 52.5% the 2025 thresholds, with the highest noncompliance in fresh pasta (94.3%) and savory snacks (68-77%).

Conclusion: Updating the National Sodium Reduction Law and strengthening policies are essential to further reduce sodium intake and improve health.

Objective: This study uses a modeling framework to assess the potential impact of implementing the World Health Organization (WHO) REPLACE strategy to reduce the intake of industrially produced trans-fatty acids (IP-TFAs) on cardiovascular disease (CVD) in Costa Rica.

Methods: The TFA Macrosimulation Model was used to estimate reductions in CVD mortality under three regulatory scenarios: (1) setting IP-TFA limits at 2% in oils and fats and 5% in other foods; (2) applying a uniform 2% IP-TFA limit across all foods; and (3) implementing a complete ban on partially hydrogenated oils (PHOs).

Results: The model estimates that enforcing a 2% IP-TFA limit across all foods could prevent or delay approximately 128 deaths annually (3.0% of CVD mortality), while a full PHO ban could avert about 215 deaths per year (5.0% of CVD mortality). Economically, the PHO ban could yield annual savings of approximately US$2.1 million by reducing productivity losses associated with premature mortality.

Conclusion: Implementing the WHO REPLACE strategy has the potential to substantially reduce CVD mortality, while also improving the population's health and economic productivity. These findings offer strong evidence to advocate for regulatory actions in Costa Rica and other nations across the Americas region to eliminate IP-TFAs from the food supply.

Objective: To evaluate the effectiveness of the strategy implemented by Casa Masantonio for the treatment of tuberculosis and to analyze the associated factors in vulnerable populations in the City of Buenos Aires between 2019 and 2023.

Methods: A retrospective cohort study (2019-2023) was conducted using data from the National Health Surveillance System. We compared treatment success among patients at Casa Masantonio (n=145) with the usual treatment strategies in the Buenos Aires Metropolitan Area (n=17 965). Sociodemographic, clinical, and treatment variables were analyzed. Crude and adjusted risk ratios (RR) were estimated by Poisson regression.

Results: The success rate was significantly higher in Casa Masantonio (93.8%) compared to the general population (70.2%) (RRa 1.48; CI 95%: 1.24-1.74), and loss to follow-up was substantially lower (2.1% vs. 19.9%). Likewise, mortality was lower at Casa Masantonio (4.1% vs. 9.7%); RRa 0.40; CI 95%: 0.16-0.82). This center served a highly vulnerable population, 55% homeless and 77% with problematic substance use.

Conclusion: The results highlight the effectiveness of a comprehensive, person-centered approach adapted to the social and health conditions of each patient. This model not only improves clinical outcomes but also demonstrates that in order to achieve success in the treatment of diseases such as tuberculosis, it is essential to integrate social, territorial, and community support.

Objectives: To explore the early stages of the International Classification of Diseases 11th Revision (ICD-11) implementation in Argentina and Mexico, focusing on mortality coding, to identify essential elements and key considerations for successful adoption.

Methods: Qualitative analysis was conducted using case studies from Argentina and Mexico. Data were collected through interviews, workshops, and document analysis to uncover opportunities, challenges, and strategic decisions in ICD-11 implementation.

Results: Key findings highlight the critical role of comprehensive system assessments, strategic partnerships, financial planning, technological readiness, targeted training initiatives, and structured evaluation mechanisms. Both countries emphasized the importance of tailored strategies aligned with their unique contexts and highlighted the need for collaboration across sectors and the establishment of national task forces. Challenges included navigating the complexities of integrating ICD-11 within existing systems and enhancing interoperability through accelerated development of tools and establishment of expert networks.

Conclusions: Tailored strategies are essential for integrating ICD-11 into national health information systems. Greater collaboration, establishment of national task forces, and clear monitoring frameworks are crucial for successful implementation. Guided by digital health and health informatics expertise, countries can overcome challenges and align with broader health care objectives, thereby ultimately enhancing global health outcomes through effective ICD-11 adoption. By learning from early adopters such as Argentina and Mexico, other countries can better prepare for their own transitions to ICD-11.