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

Objective: The objective of this study was to develop an evidence map on the strategies for preventing and controlling Aedes aegypti infestation and related viral infections.

Methods: The evidence map was created according to the methodology of the Latin American and Caribbean Center on Health Sciences Information (BIREME). Publication searches were performed in MEDLINE/PubMed and the Virtual Health Library, filtered for systematic reviews (SRs) only. The methodological quality of the SR was accessed using the AMSTAR2 tool, and Tableau software was used to construct the evidence map.

Results: A total of 44 SRs on the prevention and control of A. aegypti infestation and related viral infections (dengue, chikungunya, Zika, and yellow fever viruses) were included in the map. The evidence map indicates 130 associations between 59 interventions and 18 outcomes. The reported interventions were categorized into 10 groups, including community/educational actions, use of repellents, immunization, individual protection, diagnostics, biological and chemical control of the vector, epidemiological surveillance, environmental actions, and combined interventions. The described outcomes were grouped as mosquito infestation, behavior change, prevention and control, immunological response, safety, and epidemiological surveillance.

Conclusion: The elaborated map highlighted strong evidence supporting the effectiveness of vaccination, DEET repellents, community participation, chemical control of the vector, and combined housing interventions in protecting against the vector and transmitted viruses. Nonetheless, several evidence gaps remain in the knowledge of how to best prevent and control the vector and its related viral infections, underscoring the need for high-quality SRs and primary studies.

Objective: To integrate and analyze health and public safety data from the state of Rio Grande do Norte, located in Brazil's Northeast region, regarding violence against girls and women.

Methods: Individual-level data related to incidents of violence against girls and women in Rio Grande do Norte between 2019 and 2021 were obtained for linkage from two health information systems (the Notifiable Health Conditions Information System, Sinan; and the Mortality Information System, SIM) and from police reports. A deterministic linkage algorithm was developed in Stata, using matching rules based on key variables available in the different databases.

Results: A total of 43 626 girls and women were identified as victims of violence during the study period. Of these, 83.5% were detected in police records, 16.5% in Sinan, and only 0.4% appeared in both systems. Health services captured proportionally more cases of violence against children and adolescents aged 0 to 19 years, as well as cases of physical and sexual violence. Police records included a higher number of psychological violence cases involving adult victims. Among the fatalities, the group identified exclusively in Sinan exhibited more deaths from external causes related to violence.

Conclusions: The lack of integration across systems conceals the true scale of violence against girls and women. Policies aimed at data integration, coupled with efforts to address underreporting, are essential for the development of effective interventions to promote a life free from violence.

Evidence-based program registries (EBPRs) are essential tools in prevention science, providing structured evaluations of intervention effectiveness to guide policymakers and practitioners. While established registries such as Blueprints for Healthy Youth Development and Xchange have been instrumental in cataloging evidence-based programs, Latin America has lacked a region-specific repository tailored to its unique prevention challenges. Evidencia Viva was developed to address this gap by systematically assessing and classifying substance use prevention programs implemented and evaluated in Latin America. The initiative draws from established EBPR models, employing rigorous inclusion criteria and a multidisciplinary expert review process to evaluate intervention efficacy. Programs are categorized into five tiers, ranging from beneficial to potentially harmful, ensuring that decision-makers have access to transparent and reliable information. The registry's initial assessments include interventions from Brazil, Chile, Colombia, Guatemala, Mexico, Peru, and Uruguay, highlighting both effective and ineffective programs. Notably, programs like Unplugged and Keepin' It REAL have demonstrated positive impacts, while others, such as PROERD (the Brazilian adaptation of DARE) and #Tamojunto, have shown limited or even negative effects. Despite its potential to strengthen evidence-based prevention in the region, Evidencia Viva faces challenges, including the limited number of rigorously evaluated programs, disparities in research capacity across Latin American countries, and the need for sustained funding to ensure long-term viability. Evidencia Viva contributes to the accessibility and dissemination of validated interventions, supporting informed policymaking and more effective substance use prevention strategies. However, ensuring its sustainability will require continued investment in research capacity, funding, and regional collaboration.

Objective: Evaluate the feasibility of integrating the guidelines of the Pan American Health Organization (PAHO) on violence against women into the university curriculum of health personnel in Latin America by identifying barriers, facilitators, and opportunities.

Methods: An exploratory qualitative study was conducted through a narrative review of the literature and of the medical and nursing curricula of Latin American universities, as well as semi-structured interviews with 37 experts on university curricula from 13 Latin American countries. Data were analyzed by thematic coding and triangulation.

Results: Facilitators include political commitment in the Region, academic interest in incorporating gender issues, and experiences of successful partial integration that can serve as examples for other Latin American countries. Barriers include institutional resistance, limited preparation of teaching staff, and the overload of current curricula. Highlighted opportunities include the development of pilot workshops, regional collaboration, and the use of innovative methodologies such as hands-on simulations and clinical case-based learning.

Conclusion: The integration of PAHO guidelines and content on violence against women is feasible, but requires strategies adapted to local realities such as institutional awareness-raising, teacher training, and regional collaboration. This study provides preliminary evidence to guide educational policies and strengthen training in the prevention and management of gender-based violence in Latin America.

Objective: Although the benefits of vaccination are well established, a minority of health workers (HWs) are vaccine hesitant. Understanding vaccine hesitancy among HWs is crucial for providing them the information and skills they need to promote vaccine acceptance and informed decision-making among the populations they serve. This study aimed to evaluate differences in vaccine hesitancy and attitudes towards vaccines among HWs in the Caribbean between 2021 and 2024.

Methods: Two cross-sectional Internet surveys were conducted among HWs in the Caribbean. The first survey was administered early in the COVID-19 pandemic, before COVID-19 vaccines were widely available in the region (April-May 2021). The second survey took place in the post-pandemic era when COVID-19 vaccines were easily obtainable and after countries and the Pan American Health Organization (PAHO) implemented interventions to address vaccine hesitancy (January-March 2024).

Results: Caribbean HWs' attitudes toward all vaccines were relatively more positive in 2024 than in 2021. Notably, the rate of COVID-19 vaccine hesitancy decreased from 26% in 2021 to 5% in 2024, with the largest reductions observed among allied health professionals, the youngest respondents, and nursing professionals. Respondents' sentiments about vaccines in general and perceptions of vaccines' effectiveness and safety were also more favorable in the second survey.

Conclusions: Improvements in HWs' attitudes and reduced vaccine hesitancy are likely due to multiple, interactive contextual factors, including increased knowledge about COVID-19 and its vaccine, scientific evidence of vaccine effectiveness, personal experience, and increased health education efforts. While this study did not evaluate specific interventions, findings suggest that well-designed and context-sensitive strategies may contribute to supporting vaccine acceptance among HWs.

Objective: Cross-cultural adaptation into Brazilian Portuguese of the five-stage Edmonton Obesity Staging System (EOSS), which classifies the severity of obesity according to morbidities and health risks.

Methods: The following steps were taken: (1) translation and synthesis; (2) semantic analysis by a committee of subject experts and linguists; (3) construction of complementary content and validation by a panel of experts, in two rounds; (4) back-translation and submission to the original author; (5) semantic evaluation by health professionals; and (6) pre-testing on a sample of people with obesity. Semantic analysis and complementary content validation were verified by 80% minimum concordance.

Results: The tool maintained semantic, idiomatic, conceptual, and cultural equivalence with the original version. The semantic evaluation showed adequate understanding by the target audience, with over 80% concordance.

Conclusion: The version of the EOSS adapted for Brazil has proved to be a robust and useful tool for assessing obesity in the Brazilian context. It meets rigorous methodological standards, indicating its use in research and clinical practice as an important tool for assessing people with obesity.

Objective: To analyze Brazil's national policies and regulations related to pediatric hematology-oncology nursing in Brazil and identify key areas for improvement.

Methods: Using the READ approach, relevant policies and regulations were systematically examined. The method consists of four phases: readying materials, extracting data, analyzing data, and distilling findings. Qualitative analysis used both inductive and deductive approaches to identify themes.

Results: The review included 25 documents: 11 regulatory, 11 governmental (including one national and two state plans), and three educational documents. Two main themes emerged: nursing-related regulations and national plans. Although Brazil has a strong nursing regulatory framework, responsive policies and regulations are needed to address the changing pediatric hematology-oncology landscape. Key areas for improvement include training more registered nurses, updating graduate programs to address early cancer signs in children, improving staffing and skill mix, enhancing nursing competencies, implementing continuing professional development requirements, and ensuring availability of resources. Recommendations highlight the roles of nursing regulations, governmental bodies, nursing associations, pediatric hematology-oncology centers, and nurses.

Conclusions: Nurses are vital to health care systems and it is important to harness their full potential. We need a strong national strategy and effective regulations to recognize the contributions of nurses and meet the evolving needs of pediatric hematology-oncology patients in Brazil.

Objective: To analyze the applicability of the World Health Organization's WHO Guideline on self-care interventions for health and well-being in selected Latin American and Caribbean countries.

Methods: Countries prioritized by the Pan American Health Organization for technical cooperation in reproductive health were selected: Argentina, Bolivia (Plurinational State of), Chile, Colombia, Ecuador, Guyana, Honduras, Peru, and Uruguay. An exhaustive search was conducted for documents considered to be clinical practice guidelines on family planning, as well as other guidelines on related topics. Two simultaneous strategies were employed: a systematic search of published and indexed literature, and a gray literature search).

Results: The applicability of each recommendation on self-care for reproductive health is described for each country in a "traffic light" table, where green means "implemented", yellow means "in the implementation process", and red means "not implemented".

Conclusions: Favorable frameworks exist for interventions that promote the implementation of self-care strategies for sexual and reproductive health. The least developed thematic areas in the selected countries are: eliminating unsafe abortion and promoting sexual health. Only three countries in the Region of the Americas (Argentina, Colombia, and Uruguay) have laws that guarantee legal abortion and facilitate access to safe abortion. Although most countries in the Region do not guarantee the rights of transgender people, all countries except Guyana and Honduras provide hormones for them.

Objective: To assess the prevalence and factors associated with physical abuse against children in Guyana.

Methods: This study utilized nationally representative data from the Multiple Indicator Cluster Survey conducted in Guyana in 2019. The percentage of children who endured physical abuse was the primary outcome studied. Logistic regression was used to assess the association between the exposure variables and the outcome. The slope index of inequality (SII) and the concentration index (CIX) were calculated to assess inequalities in child physical abuse.

Results: In Guyana, 53.1% and 4.4% of children endured moderate and severe physical abuse, respectively. Children aged 24 months or older (adjusted odds ratio [AOR] 2.29; 95% CI [1.33, 3.95]), living in the Interior (AOR 2.42; 95% CI [1.20, 4.87]), in households headed by females (AOR 2.32; 95% CI [1.47, 3.65]), whose mothers ever consumed alcohol (AOR 2.41; 95% CI [1.53, 3.79]) or had positive attitudes toward child physical abuse (AOR 4.37; 95% CI [2.07, 9.23]) were at higher risk of experiencing moderate physical abuse. The risk of severe physical abuse increased among children whose mothers had a positive attitude toward child physical punishment and decreased according to the mother's level of education. Important disparities were observed between boys and girls according to maternal education and geographic regions.

Conclusions: Children in Guyana who endured moderate physical abuse exceed 50% of the country's child population. Guyana needs to enact legislation that prohibits child physical abuse. Stringent enforcement is necessary to ensure Guyanese children do not continue to experience physical abuse.