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

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.

Objective: To evaluate the level of trust in vaccines and to analyze the factors that determine their acceptance in adults residing in the Dominican Republic.

Methods: A cross-sectional study was conducted between January and April 2023 with 949 participants selected through face-to-face and online surveys. A non-probabilistic snowball sampling was used, with recruitment at the Dr. Hugo Mendoza Pediatric Hospital. A structured questionnaire was administered that included demographic variables, information sources, a vaccine trust index, and determinants of acceptance. Descriptive and regression analyses were performed to identify associations between variables.

Results: A favorable attitude towards vaccination was observed. The average score on the index was 86.9, with 89.8% of participants expressing strong trust. Pediatricians were the most reliable source of information, especially among young and middle-aged adults. Regression analysis showed a positive association between age and rating on the index (β = 0.116; CI 95%: 0.017-0.218); and negative associations with male sex(β = -3.985; 95% CI: -6.992 to -0.921) and university-level education (β = -1.870; CI 95%: -3.632 to -0.107). Although the perceived risk of preventable disease is high, concerns about side effects persist, possibly linked to misinformation.

Conclusions: Despite the high acceptance of vaccines, barriers such as lack of vaccination reminders and fear of adverse effects persist. Strengthening communication and training health professionals could increase trust in and adherence to vaccination programs, especially in certain groups.

Objective: To provide more accurate population estimates to support the operation of Bolivia's immunization program.

Methods: This cross-sectional ecological study calculated population estimates using geospatial covariates extracted from Meta Data for Good and WorldPop satellite imagery, and validated them with the results of a microcensus conducted in five Bolivian municipalities.

Results: Of the 6077 buildings identified in satellite images, 4505 residential buildings were found to be occupied. Of these, 3087 (68.52%) agreed to participate in the survey. A total of 17 617 people were expected and 13 397 were enumerated. Field enumeration identified fewer people under 30 years of age and more people over 60 years of age than expected. The Meta images provided excellent matches when analyzing population estimates by sex. Meta matched best with enumeration in rural areas, and WorldPop matched best with enumeration in urban areas.

Conclusions: This study demonstrates that combining geospatial analysis with microcensus validation can significantly improve health planning, enabling equitable resource distribution and more effective immunization coverage.

Civil registration and vital statistics (CRVS) systems are essential to guarantee the right to identity. They also generate key information for the planning and evaluation of health and social policies.This article aims to document the efforts made in Mexico to modernize and link vital statistics and the Civil Registry through innovative digital strategies, highlighting the implementation of the electronic birth certificate. Using a case study methodology, this special report describes the implementation of the electronic birth certificate and its regulatory and operational evolution. Finally, we analyze the results achieved so far in terms of the timeliness of the records.The integration and use of the electronic birth certificate in the 32 states has been successful, as evidenced by the high coverage and efficiency in birth registration. Its implementation has streamlined the birth registration process, improved data quality, optimized public policy planning, and facilitated compliance with international health and human rights obligations.The digitization of birth registration in Mexico represents a significant step forward in the digital transformation of the Civil Registry and vital statistics system, and in guaranteeing the right to identity.