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

Objective: To search the literature for evidence on community participation and empowerment practices in primary health care in Latin America.

Methods: Scoping review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) checklist. The review was conducted in March 2024. The Scientific Electronic Library Online (SciELO), Latin American and Caribbean Health Sciences Literature (LILACS), and MEDLINE (via PubMed) databases were searched. The results obtained across all databases were exported to the Mendeley^® platform and presented descriptively.

Results: Thirteen studies, conducted in Brazil, Chile, Colombia, and Mexico, were selected. Community participation and empowerment practices were identified in two main settings: institutional and social. In the institutional setting, the importance of training health care professionals and establishing educational groups for the overall population was emphasized. In the social setting, the importance of home visits and community activities was emphasized.

Conclusions: Institutional practices for community participation and empowerment have great potential to improve population health and well-being. However, challenges such as a lack of resources, staff training, and community engagement must be addressed. A comprehensive approach that combines actions at the institutional, community, and individual levels is needed to achieve a sustainable impact on community empowerment.

International ethical standards for research involving persons who have diminished decision-making capacity allow for delegation of the decision to participate in research to a representative who can act as a surrogate decision-maker. However, this approach has been questioned by the Convention on the Rights of Persons with Disabilities (CRPD), according to which all persons with disabilities, regardless of their mental or neurological condition, always have universal legal capacity to make decisions. The incompatibility between ethical standards and the CRPD is clear and impacts the conduct of research involving people with mental disabilities, which is essential for the improvement of their health and well-being. This article advances a proposal that seeks to reconcile the CRPD with ethical standards for informed consent processes in research and provides practical recommendations, especially for Latin American countries that still face challenges in implementing the CRPD in the research field.

Objective: To evaluate diagnostic accuracy of polymerase chain reaction (PCR) in detecting mpox infection in humans by pooling the estimates of sensitivity and specificity across different study settings.

Methods: A systematic search was conducted in PubMed, Cochrane database, Scopus, and Google Scholar. Studies that evaluated the diagnostic accuracy of PCR test for the detection of monkeypox virus providing the sensitivity and specificity values and the total number of samples were included. The sensitivity and specificity values of PCR test were pooled for all the included studies. The meta-analysis was conducted in accordance with PRISMA guidelines using the metadta package in STATA software. A summary receiver operating characteristic (SROC) curve and forest plot were generated. The protocol was registered in PROSPERO (CRD-NIHR) database with Reference ID CRD42024590183.

Results: Twelve studies were included for meta-analysis. The pooled sensitivity and specificity estimate across all the studies using a random effects model was 0.99 (95% CI [0.95, 1.00]) and 1 (95% CI [0.96, 1.00]), respectively. The SROC curve confirmed high diagnostic accuracy of PCR. The quality assessment of diagnostic accuracy studies (QUADAS) tool depicted low risk of bias.

Conclusions: This systematic review and meta-analysis is the first study in the scientific literature to provide a pooling for diagnostic accuracy for PCR test for mpox and confirms it as an accurate tool in detecting the infection in humans.

Objective: This study evaluated the association between serologically confirmed prior dengue infection and the subsequent risk of virologically confirmed dengue, severe dengue, dengue hospitalization, dengue-related death and all-cause mortality.

Methods: A systematic review and meta-analysis were conducted following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. PubMed, CINAHL, MEDLINE, the Cochrane Library and Web of Science were searched for reports of phase III randomized controlled trials of vaccine efficacy that had data about the placebo group and information about prior infections and were published between January 1994 and March 2024. Random-effects models were used to calculate combined odds ratios (ORs), and heterogeneity was assessed.

Results: Four studies from three phase III trials were included. Participants with prior infection had a lower likelihood of developing virologically confirmed dengue during follow up (OR: 0.85, 95% confidence interval [CI]: 0.75 to 0.98, P = 0.024) and the same risk of dengue hospitalization as those without prior infection (OR: 1.18, 95% CI: 0.92 to 1.53, P = 0.198). However, they had a higher rate of severe dengue (OR: 2.91, 95% CI: 1.23 to 6.87, P = 0.015). No dengue-related deaths occurred during follow up. There were no statistically significant differences in all-cause mortality between individuals with and without prior dengue (OR: 1.74, 95% CI: 0.21 to 14.08, P = 0.76).

Conclusions: Prior dengue infection significantly reduced the risk of virologically confirmed dengue and increased the risk of severe dengue, but had no significant effect on dengue hospitalization, dengue-related death or all-cause mortality during follow up. These findings suggest the need to reconsider prior infection as an independent risk factor.

On September 29, 2023, the Republic of Ecuador convened a meeting to address surgical system strengthening and urge political leaders to invest in surgical infrastructure. The meeting included experts in health diplomacy, innovative financing, implementation strategy and national surgical plans. The event occurred in parallel with the Sixtieth Directing Council of the Pan American Health Organization, Seventy-fifth session of the World Health Organization Regional Committee for the Americas. The meeting centered around four major areas: (i) building surgical capacity as a means to develop universal health care and emergency preparedness; (ii) developing policies and strategies for strengthening surgical systems; (iii) developing models for financing, sustaining, and improving surgical systems in low- and middle-income countries; and (iv) evaluating implementation strategies for funding these endeavors. National surgical plans represent a critical opportunity to build resilient health care systems by establishing comprehensive and sustainable policies. This article highlights the key messages from the event, which focused on Latin America, to inform the broader global health community.

Objective: To assess the sensitivity and specificity of the modified criteria for case definition of congenital syphilis implemented in 2017, which excluded treatment of the sexual partner as a necessary condition for adequate maternal treatment.

Methods: This retrospective cohort study involved epidemiological monitoring of 503 children born in 2018 and living in Porto Alegre, Brazil: 412, including miscarriages and stillbirths, had been reported as congenital syphilis cases; 91, who had been exposed to syphilis during pregnancy, were no longer considered cases after partner treatment was excluded as a criterion for adequate maternal treatment. The study involved observation of treatment at birth, laboratory follow-up with non-treponemal tests up to age 18 months or treponemal tests after age 18 months, and symptom-based screening for cohort closure.

Results: A total of 286 cases and 126 non-cases were identified using the criteria for reportable cases. Among those exposed but who did not meet the criteria for reportable cases, three cases and 88 non-cases were identified (p < 0.001). Considering the current case definition of congenital syphilis for reporting purposes, the sensitivity was 98.9% (95%CI: 97.0 to 99.7), and the specificity, 41.0% (95%CI: 34.4 to 48.0). The monitoring strategy for case closure had a sensitivity of 69.4% (95%CI: 64.7 to 73.8) and a specificity of 96.7% (95%CI: 90.7 to 99.3).

Conclusion: The current case definition of congenital syphilis case for reporting purposes proved sensitive, but less specific. We suggest that it be reviewed in light of the possibility of missing true-positive diagnoses.

Objective: To stratify areas at risk of measles transmission in the state of Rio de Janeiro, using the risk assessment tool developed by the World Health Organization and Centers for Disease Control and Prevention, with adaptations to the regional context.

Methods: This ecological study used municipalities of Rio de Janeiro state as the units of analysis. The overall risk of measles transmission was evaluated based on the scores of indicators grouped into four categories: vaccination, threat assessment, quality of health care services, and living conditions. After summing and normalizing the scores for each category, weights were assigned to obtain the risk index. The 20%, 60%, and 90% centiles were used to establish cut-off points, classifying municipalities as low risk, medium risk, high risk, and very high risk. To evaluate the performance of the measles transmission risk index, a spatial overlay was performed with the cases reported in the epidemic period 2018-2020.

Results: A progressive increase in incidence rates of measles cases was observed across municipalities, corresponding to escalating transmission risk in different strata. About 97% of measles cases occurred in municipalities classified as high or very high risk, primarily located in the state's metropolitan region.

Conclusion: Given the potential risk of measles transmission during the post-elimination period, our findings reinforce the importance of developing and implementing tools to identify priority areas for surveillance. The spatial overlay indicated the method's effectiveness in identifying vulnerabilities associated with transmission other than low vaccine coverage, such as precarious living conditions and poor quality of health care services.

This article aims to analyze and contextualize the training of nurses at the postgraduate level, and to present strategic orientations to expand their doctoral education in Latin America and the Caribbean. This paper presents strategies to advance the potential of nurses' contribution to health systems and the development of scientific competencies through postgraduate studies-at the doctoral level-with emphasis on cooperation and internationalization, training aligned with the health needs of the population, transfer of knowledge to practice and sustainability of actions. Nurses are well positioned to act as researchers, faculty members and leaders, and to contribute to the development of more effective strategies for future actions and policies that are required by health systems. However, investment and commitment from different key stakeholders will be needed to transform nursing education.

Objectives: To assess the frequency of symptoms in patients with Oropouche fever and compare them with those observed in patients with dengue and other arboviral diseases.

Methods: A systematic review was conducted following the MOOSE and PRISMA reporting guidelines. The review included studies on acute clinical manifestations in patients with Oropouche fever. Searches were conducted in PubMed, Virtual Health Library, Cochrane Library, and Google Scholar up to September 2024. The symptoms of Oropouche fever were compared to those of dengue and other arboviral diseases. Certainty of evidence was assessed using the GRADE approach.

Results: A total of 23 studies covering 3648 patients with Oropouche fever were included. The most frequent symptoms in patients with Oropouche virus infection were fever (97%) and headache (86%). There was no difference in frequency of fever or headache between patients with Oropouche and dengue. However, odynophagia (28%) and abdominal pain (15%) were more frequent in Oropouche than in dengue, with odds ratios (ORs) of 3.20 and 2.50, respectively. Myalgia (69%) and arthralgia (57%) were less frequent in Oropouche fever than in dengue.

Conclusions: Fever and headache are common in Oropouche virus infection, but do not help discriminate it from dengue. However, odynophagia and abdominal pain are more frequent in patients with Oropouche fever, while myalgia, arthralgia, and rash are more prevalent in dengue. These findings may aid in differential diagnosis in areas of arboviral co-circulation. Further studies on the recurrence and duration of symptoms are needed to improve diagnostic strategies.