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

Objective: To determine the excess mortality associated with the November 2023 extreme heat wave in Rio de Janeiro, Brazil, with temperatures reaching 42°C.

Methods: Using the excess heat factor (EHF) to characterize the heat wave, this study identified elevated excess mortality across various disease categories, including symptoms and abnormal clinical findings, nervous system disorders, mental health conditions, and genitourinary diseases, diverging from typical heat-related mortality patterns.

Results: This event resulted in an estimated excess mortality of 1 392 individuals in a short period, disproportionately affecting older adults and women, with a significant number of deaths occurring at home. The findings underscore the complexity of heat wave impacts and highlight gaps in health care access, risk perception, and clinical management.

Conclusions: Heat waves are increasingly recognized as a significant public health threat, exacerbated by climate change, with profound impacts on morbidity and mortality. The study emphasizes the urgent need for comprehensive heat alert and response systems, intersectoral action plans, and public education to mitigate the effects of extreme heat. Furthermore, it calls for adaptive strategies in urban planning, housing, and public health policies to address the growing frequency and intensity of heat waves in the context of climate change. As Brazil faces escalating challenges from rising temperatures, particularly in urban centers, coordinated multisectoral efforts are essential to protect vulnerable populations and reduce heat-related mortality in the future.

Objective: To describe the energy and sodium content of foods reported in the 2018-2019 National Household Income and Expenditure Survey of Costa Rica, classified using the NOVA system, by urban/rural residence and income quintiles.

Methods: Descriptive study in which records of food purchases from the 2018-2019 National Household Income and Expenditure Survey were converted to energy and sodium content by means of food composition tables. Foods were classified into the four NOVA groups and analyzed according to urban/rural residence and income quintiles.

Results: Of the 737 foods analyzed, 52% were processed or ultra-processed (14% in group 3 and 38% in group 4). The remaining 48% corresponded to unprocessed or minimally processed foods and processed culinary ingredients (groups 1 and 2). Of the total energy consumed (2 302 kcal per person per day [kcal/p/d]), approximately 26% came from groups 3 and 4. Overall energy consumption was higher in urban areas (2252 kcal/p/d versus 2422 kcal/p/d in rural areas). Group 4 food consumption was higher in urban areas (21.3% versus 14.0%, respectively). Group 2 contributed 2.53 g/p/d of sodium, followed by group 4 with 0.84 g/p/d.

Conclusions: Processed culinary ingredients and ultra-processed foods are the main sources of dietary sodium in Costa Rica, indicating the need for public policies to prevent chronic noncommunicable diseases associated with excessive sodium consumption. The pattern of energy consumption in Costa Rica is stable, the main source being unprocessed and minimally processed foods, led by cereals, grains, and pastas. However, processed and ultra-processed foods contribute at least a quarter of caloric intake.

This study critically analyzes the effects of social protection policies on tuberculosis treatment and discusses perspectives for the implementation of comprehensive, sustainable care in Latin America. Based on the theory of social determinants of health, this article offers theory and reflection on the effects of social inequalities on adherence to treatment, showing that financial support, food security, and access to transportation are fundamental elements in reducing the impact of the disease on individuals and communities. In addition, the worsening of tuberculosis control indicators due to the COVID-19 pandemic is contextualized, highlighting the interruption of essential services, increased underreporting, and compromised treatment coverage. Latin American countries show progress in the implementation of social protection programs, but structural challenges such as poor intersectoral integration, unstable funding for public policies, and bureaucratic barriers to implementation limit their effectiveness in controlling tuberculosis. Furthermore, dependence on external government resources sometimes reveals the fragility of policies in contexts of political and economic instability. It follows that social protection must be a key pillar in the response to tuberculosis in Latin America, through permanent, intersectoral, sustainable actions. This proposal could help to support the goals of the End TB Strategy and those of the 2030 Agenda for Sustainable Development. The elimination of tuberculosis in the region depends on strengthening primary care, political and social commitment, and the adoption of strategies aligned with global targets for equity and sustainable development.

Public health surveillance is essential to protect the health of the population and address health inequities. The World Health Organization (WHO) Guidelines on Ethical Issues in Public Health Surveillance is a comprehensive international ethical framework that provides specific guidance on surveillance work and its challenges. This article illustrates this publication's relevance in guiding surveillance in four areas prioritized by the Pan American Health Organization: 1) monitoring health inequalities and their determinants; 2) controlling noncommunicable diseases and their risk factors; 3) eliminating communicable diseases; and 4) preparing for and responding to public health emergencies. While advances have been made in the integration of ethics into public health surveillance, this article presents several challenges that urgently need to be addressed in the Region of the Americas.

Neglected tropical diseases affect more than one billion people worldwide, over 55 million of whom are in the Region of the Americas. These conditions can cause long-term disability and death, and disproportionately affect populations living in poverty. It is well known that adopting the gender perspective and incorporating intersectionality in the development of health programs can help reduce inequities. Based on this idea, this article suggests specific actions for the mainstreaming of gender and intersectionality. These actions include the collection of disaggregated data, the implementation of affirmative actions and inclusive communication, intersectional gender analysis, capacity building for health care providers, mental health and stigma management, and the implementation of a human rights-based approach. Adoption of the gender perspective with an intersectional approach is not only advisable but essential to achieving comprehensive person- and community-centered health care. Integration must occur from the strategic level through to the local level, to elucidate and tackle the barriers that people face in accessing health care as a result of their axes of identity. Community participation should be encouraged and capacity built both within health services and in communities themselves.

Ambulatory care-sensitive conditions are those for which effective primary health care services could prevent hospitalizations or mitigate severe complications. Hospital admissions for these conditions have been used to measure the effectiveness of primary health care. We review and compare lists of these conditions developed by national and international health entities to explore their applicability to diverse health care systems, the conditions included and the methodological challenges of making cross-country comparisons. While ambulatory care-sensitive conditions can provide a framework for assessing the performance of health care systems, the relevance of specific conditions or lists depends on the local epidemiological context. Countries have developed lists to address their specific context and priorities, for example, with Brazil focusing on infectious diseases and the United Kingdom emphasizing chronic conditions. We explore case studies of how analyses of these conditions can inform policy aimed at improving the effectiveness and accessibility of primary health care, provide evidence about the prevalence and sociodemographic heterogeneity of these conditions, and how they can be used for cross-country comparisons. The findings underscore the importance of developing context-specific lists of ambulatory care-sensitive conditions when evaluating the performance of primary health care services, promoting informed policy decisions and guiding resource allocation in health care systems. Standardized data collection and coding practices are required to enable meaningful cross-country comparisons and to ensure the effective use of these conditions as a tool to assess and monitor health system performance.

Objective: Describe and examine the use of the digital telehealth strategy in primary health care (PHC) facilities in Chile, describe its implementation in the country, and analyze its impact on demand management within the Chilean health system.

Methods: A cross-sectional descriptive observational study was conducted in 320 PHC facilities in the telehealth system. All requests for care registered on the platform were analyzed using anonymized data from the panel of telehealth indicators. Studied variables included: volume of requests, distribution by sex and age, variability in demand, percentage of requests resolved remotely, and waiting times according to clinical priority level. A descriptive analysis of frequencies and proportions was performed, and an estimate was made of the impact of telehealth in terms of reducing in-person visits.

Results: Between January 2021 and December 2024, 5 037 145 requests from 1 292 942 individuals were received on the telehealth platform, with a higher participation of women (64.4%). The predominant age group was 25 to 65 years (49.8%). Demand was highest in October and November; February and December were the least active months. A total of 23.45% of users enrolled in PHC used telehealth services at least once. Of the total number of requests, 28.4% were handled remotely, 62.7% required in-person attention, and 6.4% were closed for administrative reasons. Waiting times for high-priority requests averaged eight days, which is above the recommended standard of 24 to 48 hours.

Conclusions: Telehealth has proven to be an effective strategy for demand management in PHC, with high adoption among working-age adults. However, challenges remain in terms of managing high-priority requests and ensuring equity of digital access for older adults. It is recommended to strengthen the integration of high-quality telemedicine services and to improve response times based on clinical urgency in order to optimize the strategy's impact on access to health care.

Objective: To analyze the distance between the place of residence and the location of maternal deaths in Brazil from 2018 to 2023, taking into account territorial, ethnic-racial, and regional inequalities.

Methods: An ecological study was conducted using data from Brazil's Mortality Information System (SIM) and the Live Birth Information System (Sinasc). Distances between the municipalities of residence and those where maternal deaths occurred were calculated using the Open Source Routing Machine (OSRM) API. The maternal mortality ratio (MMR), defined as the number of maternal deaths per 100 000 live births, was estimated according to distance intervals, race/skin color, age group, pandemic period, and municipal population size.

Results: A total of 10 911 maternal deaths were recorded in Brazil during the study period. The majority (56.7%) occurred without inter-municipal travel. Travel distances greater than 500 km were more frequent among indigenous women and women under 20 years of age. In these cases, the MMR was higher, reaching 772.5 deaths per 100 000 live births during the COVID-19 pandemic (2020 and 2021). Among indigenous women, the average travel distance was the highest across all groups, reaching 533 km in 2020 and 2021. Municipalities with fewer than 50 000 inhabitants accounted for 58.2% of inter-municipal travel.

Conclusions: Travel distances were longer in contexts of greater social and territorial vulnerability, such as among indigenous women and residents of less populated areas. The findings underscore the need for public policies that address territorial inequalities and expand geographic access to ensure safe and timely obstetric care.

Objective: To characterize the workforce that performs public health actions related to the essential public health functions.

Methods: Exploratory study with a qualitative approach; municipalities selected according to administrative criteria; purposive sampling, with at least 20 people in four departments. Occupations were defined based on stakeholder mapping and organizational charts of institutions. Data were collected in Google Forms^® and face-to-face workshops, and were processed in Excel^® and SPSS^®.

Results: Within the different phases of the policy cycle, priority was placed on following sub-functions: in "Evaluation", strengthening information systems, surveillance, emergency preparedness, and promoting evidence-based research; in "Policy development", leadership and governance, with the participation of vulnerable groups; in "Resource allocation", the need to improve the competencies and distribution of health personnel, and to guarantee access to medicines and sustainable financing; and in "Access", prevention and early detection of diseases, with a comprehensive approach to the social determinants of health. A concentration of professionals in capital cities and a need to improve working conditions were identified.

Conclusions: The essential public health functions strengthen stewardship in health and improve access, equity, and quality of life in Colombia. Priority sub-functions were identified in each phase of the policy cycle, particularly in the "Access" component. Given the diversity of occupations, it is necessary to formally recognize and coordinate these profiles. The findings offer guidance on public health education and support strategic planning and the formulation of comprehensive public policies.

Objective: Describe strategies and lessons learned in preparedness for, response to, and stabilization of numerous outbreaks of imported measles cases in Colombia in 2018 and 2019, in the post-elimination era.

Methods: Case study with a mixed methodological approach, using information from the National Public Health Surveillance System, event-based surveillance, laboratory surveillance, and vaccination reports for 2018 and 2019. Semi-structured interviews were conducted with key professionals in epidemiological surveillance, laboratory analysis, and vaccination. The interviews were transcribed, followed by discourse analysis and a synthesis of opinions.

Results: Outbreaks were investigated within the framework of the incident management system, with optimization of notification, investigation, and transmission containment in the territory. The inclusion of real-time polymerase chain reaction virus detection tests reduced the time required for diagnosis, with a positive predictive value of 98%. In addition, vaccination of migrants and "zero-dose" vaccination helped reduce transmission.

Conclusions: The national risk management system for outbreaks, epidemics, and events of public health interest led by the National Institute of Health designed care routes in hospitals, modified the diagnostic algorithm, and established barrier-free vaccination. This led to an efficient response that controlled the spread of measles in the Region and maintained elimination status.