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Este artículo se propone a analizar y contextualizar la formación de enfermeras y enfermeros a nivel de posgrado, y presentar orientaciones estratégicas para ampliar su formación doctoral en América Latina y el Caribe. En esta comunicación se presentan estrategias para avanzar el potencial de la contribución del personal de enfermería a los sistemas de salud y el desarrollo de competencias científicas por medio de los estudios de posgrado -nivel doctorado-, con hincapié en la cooperación e internacionalización, la formación alineada con las necesidades de salud de la población, la transferencia de conocimientos a la práctica y la sostenibilidad de las acciones. El personal de enfermería está bien posicionado para actuar como investigadores, docentes y líderes, y para contribuir a la elaboración de estrategias más eficaces para las futuras acciones y políticas que requieren los sistemas de salud. Sin embargo, será necesaria la inversión y el compromiso de diferentes actores clave para transformar la formación de enfermería.

Objetivos. Evaluar la frecuencia de los síntomas en pacientes con oropouche y compararlos con los observados en el dengue y otras arbovirosis. Métodos. Se realizó una revisión sistemática basada en MOOSE y PRISMA; se incluyeron estudios sobre manifestaciones clínicas agudas en pacientes con oropouche. La búsqueda incluyó las bases de datos PubMed, Biblioteca Virtual en Salud, Cochrane Library y Google Scholar hasta septiembre de 2024. Se compararon los síntomas del oropouche con los del dengue y otras arbovirosis, y se valoró la certeza con el enfoque GRADE. Resultados. Se incluyeron 23 estudios con 3 648 pacientes con oropouche. Los síntomas más frecuentes en pacientes con oropouche fueron fiebre (97%) y cefaleas (86%). No hubo diferencias en la frecuencia de fiebre ni cefaleas entre pacientes con oropouche y dengue. Sin embargo, la odinofagia (28%) y el dolor abdominal (15%) fueron más frecuentes en el oropouche que en el dengue (OR 3,20 y 2,50, respectivamente). Las mialgias (69%) y las artralgias (57%) fueron menos frecuentes en los pacientes con oropouche en comparación con el dengue. Conclusiones. La fiebre y las cefaleas son frecuentes en la fiebre de Oropouche, pero no ayudan a diferenciarlo del dengue. En cambio, la odinofagia y el dolor abdominal son más frecuentes en los pacientes con oropouche, mientras que las mialgias, las artralgias y el exantema prevalecen más en el dengue. Estos hallazgos pueden ayudar en el diagnóstico diferencial en áreas de cocirculación arboviral. Se requieren estudios adicionales sobre la recurrencia y la duración de los síntomas para mejorar las estrategias diagnósticas.

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.

Objective. To examine maternal mortality in Panama, analyzing its direct obstetric deaths, indirect obstetric deaths, and contributory conditions. Methods. This cohort study used publicly available data from the National Institute of Statistics and Census to present a 25-year retrospective analysis of maternal deaths in the Republic of Panama from 1998 to 2022. Public data were sourced from the National Institute of Statistics and Census website of Panama. Relevant codes from the International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD) were used. The maternal mortality ratio (MMR) was defined as the number of maternal deaths per 100 000 live births. Trendline reliability with R2 was performed to analyze the data. Results. A total of 1 026 maternal deaths occurred in Panama from 1998 through 2022, of which 61.2% were attributed to direct obstetric causes; 23.9%, indirect obstetric causes; 13.6%, contributory conditions; and 1.4% were unknown or undetermined. The average MMR was 60.1. The trendline reliability resulted in R2 = 0.1 (y = –0.5147x + 1094.7), which is not statistically significant but meets the 2030 Sustainable Development Goals. The specific primary causes of direct obstetric deaths were: 12.9% due to postpartum hemorrhage (ICD O72); 9.2%, eclampsia (ICD O15); 6.7%, puerperal sepsis (ICD O85); and 6.3%, pre-eclampsia (ICD O14). For indirect obstetric deaths, the primary causes were: 14.9% due to other maternal diseases classifiable elsewhere but complicating pregnancy, childbirth, and the puerperium (ICD O99); and 7.3%, maternal infectious and parasitic diseases classifiable elsewhere but complicating pregnancy, childbirth, and the puerperium (ICD O98). Conclusions. The findings of this study confirmed that there were substantially more direct obstetric causes (61.2%) than indirect obstetric causes (23.9%), contributory causes (13.6%), or unknown/undetermined causes (1.4%) of maternal mortality, despite being highly preventable. Although Panama is right on track to fulfill the target of 70 MMR by 2030, these results highlight the lack of health care access due to the absence of obstetrician-gynecologists per 100 000 population in indigenous comarcas, where 30.8% of the maternal mortalities occur. Furthermore, the health system in Panama is not immune to pandemics and crises. From 1998 to 2022, there were 5 years when the MMR in Panama exceeded 70: 2001, 2002, 2006, 2011, and 2020. These findings also underscore the dichotomy between statistics and health policy. While the trendline reliability was insignificant (R2 = 0.1), the MMR satisfies requirements for the 2030 Sustainable Development Goals. Future studies should consider factors related to indirect obstetrics and contributory causes of deaths, health care access, COVID-19, cesarean section and natural birth, age, economic income, prenatal and postpartum care, as well as the quality of private and public health facilities in the Americas.

La educación continua de los equipos de salud es imprescindible para garantizar resultados que tengan un efecto positivo en la salud de la comunidad. En el 2019, a través del Ministerio de Salud Pública y Asistencia Social (MISPAS), República Dominicana inició la implementación de la iniciativa HEARTS de la Organización Panamericana de la Salud (OPS). De esta manera, se alineó con las mejores prácticas mundiales para la prevención y el manejo de la hipertensión y las enfermedades cardiovasculares (ECV), y así reducir las tasas de mortalidad debida a esta enfermedad no transmisible (ENT). De hecho, la hipertensión es la principal causa de ECV, y la ECV es la ENT responsable de más muertes en el mundo. El personal médico pasante de República Dominicana tiene la enorme labor de diagnosticar y tratar de manera oportuna a las personas con presión arterial alta y diversos factores de riesgo cardiovascular. Por lo tanto, la capacitación y formación de los estudiantes de pregrado previo a ejercer funciones como médicos pasantes, representa una prioridad en el sistema de salud del país. La iniciativa HEARTS ha producido una serie de cursos virtuales de alta calidad, gratuitos y disponibles todo el año en la plataforma del Campus Virtual de Salud Pública de la OPS. Estos cursos constituyen una oportunidad singular para que las escuelas de medicina adheridas a la Asociación Dominicana de Facultades y Escuelas de Medicina (ADOFEM), a través de un acuerdo con el MISPAS, utilicen el e-learning como herramienta innovadora y poderosa de entrenamiento de los miembros del equipo de salud.

Objective. To determine the prevalence of HIV in women with (pre)cancerous cervical lesions in Suriname and their retention in care. Methods. A retrospective population study including all women diagnosed with (pre)invasive cervical intraepithelial neoplasia (CIN I to III or cervical cancer) in the only pathology department, during 2010–2020. The HIV test coverage and the HIV positivity ratio were determined through matching pathology data with the national HIV test database. The relation between retention in HIV care up to 2022 and different covariates was determined through Kaplan–Meier survival analysis and log-rank tests. Results. There were 2 901 (1 395 CIN I, 396 CIN II, 444 CIN III, and 666 cervical cancer) diagnoses of (pre)invasive cervical neoplasia. An overall HIV test coverage of 57.5% and a positivity ratio of 5.8% were found, with no difference among the (pre)cancer stages. The undiagnosed prevalence (women not previously known HIV-positive at cervical diagnosis) was 1.6% and 2.9% among precancer and cancer diagnoses, respectively. The median time in care of women with cervical cancer was 8 months for those not on antiretroviral therapy (ART) and 4 years for those starting ART. Among women with precancer stages this was 5 and 10 years, respectively (p < 0.05). Conclusions. HIV testing, followed by treatment initiation when found HIV-positive, should be prioritized in women diagnosed with cervical neoplasia. This will enhance the individual clinical outcomes and facilitate the control of the HIV epidemic in Suriname.

Objetivo. Sistematizar evidências sobre o efeito de intervenções mundiais para a redução do consumo e/ou venda de bebidas alcoólicas. Método. Mapa de evidências que, a partir de buscas em nove bases bibliográficas, incluiu 182 estudos de revisões sistemáticas com ou sem metanálises, revisões de intervenções e revisões de revisões. Os estudos avaliaram o efeito de intervenções - agrupadas em conjuntos abrangentes de ações: comunicação para mudança de comportamento; ambientes promotores da saúde e mudanças dos sistemas - sobre dois desfechos de interesse: redução de consumo e redução da compra e/ou venda de álcool. Resultados. Foram registradas 207 associações entre diferentes intervenções e desfechos, com destaque para intervenções de comunicação para mudança de comportamento (81,64%) e para o desfecho de redução de consumo (98,55%). A maioria das associações apresentou efeito positivo (40,58%), inconclusivo (28,99%) ou potencialmente positivo (26,57%). Das intervenções com resultado positivo ou potencialmente positivo, destacam-se o monopólio de vendas de bebidas alcoólicas pelo governo, controle de densidade de pontos de venda, cobrança de preço mínimo por unidade, advertências sanitárias em rótulo de bebidas alcoólicas e múltiplas intervenções integradas. Conclusão. Espera-se que o presente mapa auxilie formuladores de políticas públicas e profissionais de saúde na adaptação de experiências para seus contextos de atuação, estimulando ações intersetoriais para reduzir o consumo de álcool.

Objective. To identify challenges that may raise pathogens’ resistance to antimicrobial drugs by exploring the private market for antimicrobials in two selected mining and frontier areas of Guyana. Methods. The private sector supply was mapped by approaching all authorized pharmacies and informal outlets, e.g., street vendors and grocery stores, around the two selected towns. Interviews were conducted with a) sellers on the availability of drugs, expiration dates, prices, and main producers; and b) customers on purchased drugs, diagnoses, and prescriptions received before purchasing drugs, and intention to complete the treatment. The information collected was described, and the determinants of the self-reported intention of customers to complete the whole treatment were identified. Results. From the perspective of the supply of antimicrobials, essential medicines faced low and insecure availability, and prescriptions frequently deviated from diagnoses. From the perspective of the demand for antimicrobials, one-third of purchased antibiotics had a high potential for antimicrobial resistance as per the World Health Organization AWaRe classification. A high price reduced the self-reported intention to complete the treatment among those who had a prescription, while buying the medication in a licensed pharmacy increased such intention. Conclusions. In Guyana, there persists a need to establish and revise policies addressing both supply and demand, such as restricting the sale of antimicrobials to licensed pharmacies and upon prescription, improving prescription practices while reducing the financial burden to patients, guaranteeing access to first-line treatment drugs, and instructing patients on appropriate use of antimicrobials. Revising such policies is an essential step to contain antimicrobial resistance in the analyzed areas and across Guyana.

Objetivo. Identificar las capacidades tecnológicas y describir la apropiación de uso en una comunidad de mujeres de una zona en condiciones de vulnerabilidad de Colombia. Método. Estudio transversal observacional realizado en la subregión de Urabá (Colombia). Se realizó una encuesta a 1 478 mujeres de entre 18 y 49 años en centros de atención primaria en salud acerca de sus capacidades tecnológicas, experiencia con el uso de la información alojada en la red y apropiación de la tecnología. Resultados. El acceso y uso de las tecnologías de la información y la comunicación (TIC) variaban según la edad, el nivel educativo y el estrato socioeconómico, con diferencias en preferencias en cuanto a la información y el consumo crítico de esta. Conclusión. En este estudio, las mujeres en nuestro estudio enfrentan múltiples barreras de acceso para el uso apropiado de las TIC para la promoción de la salud. La apropiación de estas herramientas en Colombia, específicamente en la subregión de Urabá, es un desafío complejo que requiere un enfoque integral y multidimensional.

Objetivo. A partir de revisão da literatura, elaborar um mapa das evidências disponíveis sobre as formas de tratamento da chikungunya. Métodos. Em maio de 2022, realizou-se uma busca bibliográfica sobre chikungunya nas bases de dados PubMed e Biblioteca Virtual em Saúde. Para elaboração do mapa de evidências, os estudos que faziam menção à febre chikungunya foram selecionados e caracterizados quanto ao tipo de intervenção, ao desfecho e à direção do efeito (positivo, negativo, potencial positivo ou potencial negativo, inconclusivo, sem efeito), conforme metodologia preconizada pelo Centro Latino-Americano e do Caribe de Informação em Ciências da Saúde (BIREME). Resultados. Foram incluídos 15 estudos (revisões sistemáticas, ensaios clínicos controlados e revisões narrativas) com intervenções farmacológicas e não farmacológicas. Todas as intervenções tiveram foco na mitigação dos sintomas; nenhum estudo investigou especificamente o combate ao vírus. Apenas um estudo de intervenções farmacológicas relatou efeito positivo, com monoterapia de hidroxicloroquina e terapia combinada de metotrexato mais sulfassalazina e hidroxicloroquina para redução e alívio da dor ocasionada pela artrite pós-chikungunya. O único estudo a relatar efeito negativo descreveu o uso de cloroquina para artralgia pós-chikungunya. Entre as intervenções não farmacológicas, registraram-se efeitos positivos para estimulação transcraniana por corrente contínua, exercícios com bandas elásticas e método Pilates, principalmente para alívio da dor e melhora da função articular. Conclusão. Embora a revisão não tenha identificado nenhum tratamento que combata o vírus diretamente após a instalação da doença, o mapa de evidências sugere que é possível tratar os sintomas e as sequelas da chikungunya com terapias farmacológicas e não farmacológicas.

The World Health Organization Global Hearts initiative (HEARTS) and technical package aim to improve the primary health care management of hypertension and other risk factors for cardiovascular disease at the population level. This study describes the first HEARTS implementation pilot project in Guatemala’s Ministry of Health (MOH) primary health care system. This pilot began in April 2022 in six primary health care facilities in three rural indigenous municipalities. The project consisted of HEARTS-aligned strategies adapted to enhance program sustainability in Guatemala. Outcomes were defined using the Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) framework. The primary reach outcome was treatment count, defined as the absolute number of patients per month receiving medication treatment for hypertension. The primary effectiveness outcomes were mean systolic blood pressure (BP), mean diastolic BP, and proportion of patients with BP control (

Objetivo. Describir la metodología de la búsqueda intencionada y reclasificación de muertes maternas (BIRMM), que permite identificar y corregir la clasificación errónea y el subregistro de defunciones maternas. Métodos. Se utiliza la metodología BIRMM, desarrollada inicialmente en México en el 2003 y difundida en otros países de América Latina a partir del 2012. La BIRMM consta de cuatro componentes clave: i) reclasificación de muertes maternas confirmadas; ii) identificación e investigación de casos sospechosos de muerte materna; iii) confronta con otras fuentes de información; y iv) publicación de resultados y análisis estadístico de la mortalidad materna. Resultados. La aplicación de la BIRMM permite identificar y analizar las muertes maternas en comités de mortalidad materna, lo que ha facilitado la implementación de planes de respuesta efectivos, contribuyendo a una reducción sostenida de la mortalidad materna en los países. Conclusiones. La metodología BIRMM es una herramienta efectiva para corregir el subregistro y la mala clasificación de muertes maternas, lo que permite una mejor vigilancia y respuesta a este problema. Su adopción y ejecución rutinaria son esenciales para mejorar la calidad de la información sobre mortalidad materna y reducir las muertes maternas en la Región de las Américas. La sostenibilidad de esta metodología depende del compromiso institucional y la voluntad política en los países.

Objetivo. Identificar e sintetizar evidências sobre efetividade e custo-efetividade da metodologia Aedes com Wolbachia para redução dos casos de arboviroses. Método. Revisão sistemática rápida, com busca realizada em fevereiro de 2022 em cinco portais de busca e bases de dados bibliográficas online. As etapas de seleção foram conduzidas por dois revisores, com resolução de conflitos por um terceiro. A extração dos dados foi feita por um revisor e conferida posteriormente por outro. Os critérios de inclusão foram estudos com descrição de custo-efetividade e efetividade da metodologia Aedes com Wolbachia, a partir de intervenções em campo, publicados nos idiomas português, inglês e espanhol, sem restrição de data de publicação. Resultados. Foram incluídos quatro estudos, sendo um ensaio randomizado em cluster, dois quase- experimental e um antes-depois, publicados entre 2019 e 2021 em quatro países. Os estudos encontrados tiveram resultados efetivos em alguns dos desfechos avaliados, como na diminuição da incidência de casos de dengue, Zika e chikungunya. Apesar de não terem sido identificados estudos experimentais abordando custo-efetividade da estratégia Aedes com Wolbachia, alguns estudos de modelagem demonstraram um potencial custo-benefício desta estratégia. Conclusão. Considerando os resultados apresentados, conclui-se que a Wolbachia apresenta potencial para ser uma estratégia economicamente efetiva e que leva à redução da incidência de casos de dengue, Zika e chikungunya. Apesar disso, não é possível, todavia, recomendar a estratégia como política pública, pois ainda são necessários mais estudos de grande porte e de alta qualidade metodológica para subsidiar a tomada de decisão política.

Objective. To determine the prevalence and causes of vision loss and calculate the effective cataract surgery coverage (eCSC) in adults aged 60 years and older in Latin America and the Caribbean in 2020. Methods. The International Agency for the Prevention of Blindness Vision Atlas and the Rapid Assessment of Avoidable Blindness databases were used as data source. The collected data were used to estimate the prevalence and causes of vision loss in people aged 60 years and older, and to determine the eCSC. Results. The overall prevalence of moderate to severe vision impairment (MSVI) and blindness in Latin America and the Caribbean were 14.14% and 2.94%, respectively. Tropical Latin America was the subregion with the highest prevalence of blindness (3.89%) while Southern Latin America had the lowest (0.96%). For both MSVI and blindness, cataract was the main cause of vision loss. The eCSC rates showed great variation, ranging from 4.0% in Guatemala to 75.2% in Suriname. Conclusions. The prevalence of vision loss in adults aged 60 years and older in Latin America and the Caribbean was higher than previous estimates on younger groups. Cataract was the main cause of blindness, and the eCSC indicates that the outcomes from cataract surgery should be improved. Specific actions associated with improving access, integrating eye assessment with primary care programs, expanding the use of telemedicine, and improving data quality should be taken by public health authorities aiming to address vision loss in this group.

La Región de las Américas ha experimentado históricamente desigualdades sociales enraizadas en el colonialismo, las cuales se reflejan y reproducen en el ámbito de la salud. La incursión de la pandemia de COVID-19 afectó a toda la Región, pero golpeó con mayor fuerza a los grupos socialmente más desaventajados, y agravó las inequidades en salud. Bajo la premisa que las pandemias no son fenómenos socialmente neutrales, en este informe especial se analizan los impactos desiguales de la pandemia desde distintas perspectivas –histórica, epidemiológica, política, social, económica, ambiental y poblacional. Se ofrecen aquí reflexiones críticas sobre las implicaciones negativas de las desigualdades para el bienestar, no solo de las poblaciones más afectadas, sino de la sociedad en su conjunto. Se concluye con recomendaciones estratégicas para progresar hacia la equidad en salud en el escenario pospandémico. Se destaca la importancia de avanzar en la madurez de los sistemas de información para el monitoreo de la equidad en salud, la resiliencia de los sistemas de salud, y la implementación de políticas y prácticas explícitas dirigidas a eliminar las inequidades en salud. Se espera que todo lo anterior allane el camino hacia la prosperidad y el desarrollo sostenible en la Región.

Objectives. To summarize available data on unit costs for human immunodeficiency virus (HIV) testing, prevention, and care interventions in Latin America and the Caribbean. Methods. We conducted a systematic literature review of costing studies published between 2012 and 2024, and selected those reporting empirically measured costing data. The available data were categorized according to predefined intervention categories and compared by time and place. We also explored variations in unit costs by intervention type. Results. Of 1 746 studies identified, 22 met the inclusion criteria, which provided 103 unique unit cost estimates from nine countries. About 50% of the included studies were published between 2019 and 2021. Antiretroviral therapy services had the most cost data available (39% of unit costs), followed by inpatient care (27%) and HIV testing (24%). Considerable cost variations were observed both within and between interventions. Conclusions. Our analysis underscores the need for accurate and reliable cost data to support HIV budgeting and decision-making efforts. We identified several gaps in the availability of cost data and emphasize the importance of presenting results more effectively by incorporating key contextual variables. Given the challenges of shrinking budgets and sustainability risks, robust evidence is indispensable to inform priority setting and budget allocation for HIV services.

Objective. To evaluate whether use of a culturally adapted mobile application (app) for adolescents with type 1 diabetes is associated with improved metabolic control. Methods. The Dominican Republic’s National Institute of Diabetes, Endocrinology, and Nutrition and the Learning to Live clinic recruited 23 pediatric participants for the study. Blood tests were performed before and after use of the app for a period of 3 months. Based on the user profile, participants were encouraged to use the app’s bolus insulin calculator after each meal. The app included a list of regionally and culturally specific foods, color-coded to indicate a high glycemic index (GI) as red; medium GI as yellow; and low GI as green. The color-coding was designed to assist participants in making healthier eating choices. Results. There were statistically significant improvements in lipid profile. Mean high-density lipoprotein values rose to acceptable levels, while low-density lipoproteins and triglyceride levels fell to the recommended values. The overall quality of life increased, although glycated hemoglobin levels showed no statistically significant changes. Conclusion. The findings of this study suggest that using this culturally tailored app can help young patients with type 1 diabetes to improve metabolic health.

Objetivo. Analizar la implementación de los grupos relacionados por el diagnóstico (GRD) en Chile con miras a optimizar la distribución de los recursos públicos. Método. Se utilizó un análisis narrativo cronológico de los principales hitos, complementado por simulaciones de aplicación de los GRD mediante competencia emulada y análisis de conglomerados para fines evaluativos. Resultados. En el año 2001 se introdujeron los GRD en Chile, en un contexto académico. El Fondo Nacional de Salud (FONASA) comenzó a utilizarlos en el sector privado y, con un piloto, en el sector público en el 2015. Tras casi dos décadas de avances, en el 2020 se instaló el programa GRD como mecanismo de pago para los hospitales públicos desde el FONASA. Sin embargo, la pandemia de COVID-19 enlenteció su desarrollo. En el 2022 se retomó la aplicación y, tras evaluar el programa, se evidenció que los conglomerados de hospitales predefinidos para el pago diferenciado por GRD no lograron diferenciar grupos homogéneos. En el 2023 se reformó el programa y se aumentaron los recursos financieros, se definió un solo conglomerado y una tasa base, y se reconoció una mayor complejidad hospitalaria que la de años previos. Además, se agregaron tres hospitales al programa, con un total de 68. Conclusiones. La experiencia muestra que es posible dar continuidad a una política pública de financiamiento de la salud para lograr una mayor eficiencia y equidad en el sistema de salud, sobre la base de la existencia de instituciones robustas que persistan en su desarrollo y mejoramiento continuo.

Objectives To describe the development, implementation, and results of a training course designed to equip health professionals from the Pan American Health Organization region with the knowledge and tools needed to adapt health systems to current climate realities Methods The Pan American climate resilient health systems course was a 9-week live-virtual course in MarchApril 2023, which was delivered through Zoom and offered in English, Spanish, and French. All lectures were delivered by local and regional climate and health experts. The curricular foundation of this initiative was the Global Consortium on Climate and Health Education core competencies for health professionals. Participants completed pre- and post-course surveys Results A total of 1212 participants attended at least one of the nine sessions and 489 (from 66 countries) attended at least six sessions. Of these, 291 participants completed both the pre- and post-course surveys which were used in the analysis. Longitudinal survey results suggested an improvement in participants climate and health communication, an increased frequency of incorporating climate knowledge in professional practice, and improved confidence in engaging in climate initiatives. At the same time, many participants expressed a need for additional training Conclusions The results indicate that live-virtual courses have the potential to empower health professionals to contribute to climate resilience efforts by: increasing their communication skills; changing their professional practice; increasing their ability to lead climate and health activities; and preparing them to assess vulnerability and adaptation in health systems, measure and monitor environmental sustainability, and apply a health equity lens.

El estudio de costos catastróficos que experimentan las personas afectadas por tuberculosis realizado en Colombia durante la pandemia de COVID-19 trajo consigo la oportunidad de implementar encuestas telefónicas como medio para la recopilación de información. Lo anterior se constituye como una innovación metodológica en los estándares establecidos por la Organización Mundial de la Salud (OMS) que, para este tipo de estudios, suelen tener base en el empleo de encuestas cara a cara con los pacientes que acuden a las instalaciones de salud. El diseño del estudio, sus objetivos y metodología fueron adaptados del manual práctico para la realización de encuestas de costos de la tuberculosis de la OMS. Se seleccionaron 1 065 personas afectadas por tuberculosis como participantes del estudio, a quienes se les administró de manera telefónica el cuestionario estándar adaptado al contexto colombiano. Fue posible obtener datos estructurados sobre los costos directos e indirectos que enfrentan los pacientes con tuberculosis y sus familias; de manera general, se observó que todas las variables de recopilación alcanzaron una completitud mayor a 80%, con un tiempo promedio de encuesta de 40 minutos y una tasa de rechazo de 8%. La metodología de encuestas telefónicas desarrollada para determinar la línea base del estudio de costos catastróficos en Colombia resultó innovadora por el formato telefónico, que mantiene los estándares de información requerida para permitir estimaciones comparables a nivel internacional, y es un medio útil en la generación de resultados estandarizados en eventos en los cuales existe limitación para la realización de encuestas cara a cara.

Objetivo. Apresentar a experiência de um serviço de resposta rápida para apoiar a tomada de decisão em saúde. Método São descritos os processos e resultados de um serviço de produção de revisões rápidas e mapas de evidências para apoiar a tomada de decisão no âmbito da Política Nacional de Promoção da Saúde, bem como a percepção dos autores sobre o processo de trabalho. Resultados O serviço de resposta rápida teve início em 2020. Até dezembro de 2023, foram produzidas 54 revisões rápidas e cinco mapas de evidências, abrangendo nove temáticas de Promoção da Saúde. Estes produtos foram desenvolvidos em quatorze etapas por uma equipe composta por coordenador, supervisoras, revisores e bibliotecária. O desenvolvimento das respostas rápidas se configurou um processo de tradução do conhecimento e envolveu a interação contínua entre as equipes demandantes e de produção. O estabelecimento de comunicação efetiva foi um fator crítico para que os produtos fossem entregues em tempo oportuno e alinhados às necessidades dos tomadores de decisão e seus apoiadores. Conclusão Os serviços de resposta rápida podem contribuir para melhorar o uso de evidências na tomada de decisão nas políticas e sistemas de saúde.

Objectives. This paper describes and analyzes embedded implementation research and the empirical processes of planning for utilization, strategies to promote utilization and the sustainability of utilization of results from research led by decision-makers in Latin America and the Caribbean. Methods. This qualitative, descriptive and interpretive study is based on the findings from semistructured interviews with members of teams working under the Embedding Research for the Sustainable Development Goals initiative (2018–2019) as well as their responses to a self-assessment follow-up questionnaire 1 year after the project was completed. Results. Altogether 13 teams from 11 countries participated in the Initiative. Nine teams had a core team composed of a decision-maker as the principal investigator assisted by a researcher as co-principal investigator. Four teams included more than one co-principal investigator; and in five teams, the originally assigned principal investigator was replaced. There was an interesting relationship between the expected utilization of research results, the utilization strategies, the sustainability of research uptake and the teams’ collaboration modalities. When decision-makers and co-principal investigators were active participants, the intention to use the results and strategies for utilization were clearly oriented to improve implementation. In teams with basically a formal collaboration between the two principals, plans for utilization were unclear or focused on producing academic knowledge. The participation of implementers below the rank of principal investigator decision-maker may be relevant. Conclusions. Embedded implementation research is an innovative tool that may foster the utilization of research and strengthen health programs and services. Considering the internal dynamics of such research teams will enhance planning and strategies for research utilization as well as the sustainability of practical and actionable findings.

This Special Report aims to outline the development process of the first National Clinical and Policy guidelines on Intimate Partner Violence and Sexual Violence in Trinidad and Tobago and to support the implementation of quality standards for survivors. The study used an implementation science approach to identify key evidence-based practice recommendations from guidance documents on health care for women who are subjected to violence and from relevant national legislation, policy, and practices. The process engaged stakeholders in discussions on the appropriateness, implementation, and use of these recommendations in the context of local health care delivery. Multidisciplinary teams of frontline health workers were consulted in groups in each of the five Regional Health Authorities. Interviews were held with senior government stakeholders responsible for health policy and with representatives of four civil society agencies. Participants provided recommendations to integrate quality standards into routine practice. These were incorporated into the guidelines, which include human rights principles and pathways of care for identifying violence, providing psychosocial and clinical care, safety planning, referrals, care during emergencies, and prevention of intimate partner violence and sexual violence. The guidelines were approved by the Ministry of Health of Trinidad and Tobago on 15 August 2022. Training of trainers has been undertaken to support implementation.

Objectives. To (i) ascertain stakeholders’ perceptions of the contextual factors and resources necessary to successfully implement the AMORE platform, a tool that provides accessibility assessments for health care services, considering factors such travel time and traffic conditions, and (ii) identify potential barriers to and facilitators for enhancing spatial accessibility to health care services within the Colombian urban context. Methods. In this qualitative study, semi-structured interviews were conducted with a purposive sample of seven key stakeholders. The sample was drawn from individuals involved in development of policies in Colombia, service providers, and users, among others, who had expertise in the field. Interviews were conducted until saturation was reached. Results. The participants had positive views on the appearance of the AMORE platform, highlighting its user-friendly visualization. Suggestions were made about the variables used in the dashboard, the implementation of the platform, potential usage areas, and barriers and facilitators to implementation and use. Barriers included economic, political, and personnel challenges, while facilitators included creating a minimum viable product at a low cost and building interinstitutional and international cooperation. Conclusions. Innovations such as the AMORE platform have the potential to support decision-making processes across various sectors, including public policies and internal processes within private organizations, academia, and the community. However, implementing such a tool has financial, contextual and environmental challenges. The study identified key factors that were considered prerequisites for successfully implementing the AMORE platform in Colombian cities.

Los medicamentos son bienes especiales que cubren necesidades de salud de la población. En las últimas décadas, la industria farmacéutica modificó su estrategia de investigación y desarrollo, y migró su interés desde la exploración de fármacos destinados a enfermedades crónicas padecidas por gran parte de la población hacia la búsqueda de medicamentos para pocas personas que tienen enfermedades raras. Esta falta de masividad en los consumidores se traduce en una oferta selectiva de pocos productos dirigidos a ciertas patologías que tienen un precio muy elevado, lo cual hace difícil tanto el acceso de los pacientes como el brindar cobertura desde los financiadores de la salud. En este artículo se recorre la temática de los medicamentos de alto precio y se incorpora al debate el contexto sanitario, cultural, jurídico, político y económico que la rodea. Se hace hincapié en las diferencias existentes entre los distintos fármacos en términos de eficacia para cambiar el curso natural de las enfermedades para los cuales son indicados, en la construcción del precio al cual estos medicamentos se venden en el mercado, en las consecuencias que tiene ese precio para los financiadores de la salud, y en la relación costo-oportunidad de tener que pagar por ellos en desmedro de otros recursos considerados esenciales. Por último, se reflexiona sobre los derechos legítimos de cada individuo a reclamar el acceso a medicamentos de alto precio por considerarlos fundamentales para recuperar su salud, y de cómo garantizar esa cobertura puede afectar los derechos colectivos de la población, y se aportan ejemplos concretos que ilustran esta situación.

This article analyzes the state of social participation in health in the Region of the Americas, framing it within the regional context and commitments assumed by the Member States of the Pan American Health Organization. It aims to provide regional input to the discussion of a resolution on social participation for universal health coverage, health, and well-being at the 77th World Health Assembly in 2024. In the Americas, social participation has evolved from a utilitarian approach to a fundamental aspect of health system governance, enshrined within legal frameworks and recognized as a citizen’s right. Regional resolutions emphasize inclusive policies and intersectoral action to tackle health inequities, meanwhile the World Health Organization handbook on social participation underscores the need for inclusive governance mechanisms and addressing power imbalances. Informed by Member States’ recommendations and scientific literature, the article emphasizes the importance of addressing power imbalances, strengthening legal frameworks, and enhancing capacities of governments and populations. It stresses adapting social participation mechanisms to diverse cultural contexts and ensuring meaningful community involvement in decision-making. Finally, the article advocates for a comprehensive approach to social participation grounded in principles of equity, democracy, and human rights; and fundamentally as an essential component of the primary health care approach. It calls for integrating social participation into health system governance, policy dialogues, capacity- building, and evaluation to ensure effective participatory processes.

Objetivo. Evaluar la implementación de estrategias de la iniciativa HEARTS en una comunidad de la República Bolivariana de Venezuela. Métodos. Estudio cuasiexperimental, con la evaluación de la cascada de cuidado, factores impulsores e índices de madurez y desempeño cuatro meses después de la implementación de la iniciativa HEARTS en la comunidad La Marroquina en 52 pacientes con hipertensión (HTA). Los datos se procesaron en el programa SPSS® versión 25.0. Se aplicaron las pruebas t-Student y de ji cuadrado para determinar la significancia estadística. Resultados. Completaron los cuatro meses de seguimiento 50 pacientes, 63,5% con baja escolaridad y estrato socioeconómico bajo o muy bajo. Al inicio, 11,5% estaba controlado, y 40,4% inició con monoterapia. Al cuarto mes, 100% de las personas hipertensas recibieron el diagnóstico, 92% recibió tratamiento y 52% alcanzó la meta de control de HTA. El 72% recibía terapia combinada. De las personas hipertensas, 70% mantenía cifras de presión arterial

Objectives. To evaluate the structure and operation of national immunization technical advisory groups (NITAGs) in Latin America and the Caribbean and to make recommendations for improvement. Methods. A convenience sample of six current and eight former NITAG members representing 12 countries in the region were invited in 2022 to answer a web-based questionnaire on NITAG structure, organization, and procedures. The questionnaire used indicators similar to those in the Joint Reporting Form on Immunization. Participants were also asked about the role their NITAGs played in coronavirus disease 2019 (COVID-19) immunization policies. Results. Brazil, Dominican Republic, and Venezuela (Bolivarian Republic of) reported not having an active NITAG. The nine active NITAGs are structured and organized according to World Health Organization and Pan American Health Organization recommendations, with variations between countries. Most NITAGs include representatives of the five recommended medical specialties with the participation of additional members possible. Only Bolivia (Plurinational State of) and Mexico have no explicit policy for managing members' potential conflicts of interest. All NITAGs have an exclusively technical advisory role and generally meet once a quarter. Usually, NITAGs are asked by health ministries to analyze issues and make recommendations. All NITAGs, except for Perus, actively participated in supporting decision-making for immunization policy on COVID-19. Conclusions. NITAGs have successfully supported vaccine policy-making through evidence-based recommendations. However, improvement in their structure, operation, and transparency is needed to help them keep up with the rapidly evolving field of immunization. Research on the impact of NITAGs is important to support the development of recommendations for improvement.

Objective. To compare the adequacy, agreement, and acceptability of Papanicolaou testing (cytology) for cervical cancer screening using self-collected samples compared to physician-collected samples in Grenada in the Caribbean. Furthermore, the study identifies the human papillomavirus (HPV) genotypes present among asymptomatic women testing positive for HPV, the etiologic cause of cervical cancer. Methods. Participants were divided into two groups and two cervical samples were collected from the women in each group: a self-collected sample and a physician-collected sample. Cervical specimens were tested for cytology and HPV. HPV genotyping was performed on positive specimens. Results. Self-collected samples were adequate and in agreement with physician-collected samples, showing no difference between the two sampling methods. Oncogenic high-risk HPV genotypes were identified in cervical samples which were positive for atypical squamous cells and low-grade squamous intraepithelial lesions. The high-risk HPV genotypes found, notably HPV 45 and 53, differed from those most commonly reported. Although the commonly reported high-risk genotypes HPV 16 and 18 were found, so were 31, 33, 35, 52, 66, 68, and 82. Conclusions. Using self-collection facilitated the discovery of unexpected HPV genotypes among asymptomatic women in Grenada. These findings add new information to the literature regarding cervical cancer and neoplasia screening and HPV genotypes in the Caribbean. This genotype information may impact surveillance of women with low-grade lesions, HPV vaccine selection, and possibly further vaccine research. Research regarding HPV in Caribbean pathology samples of cervical neoplasia and cancer is needed.

Objetivo. Calcular o indicador de consumo de álcool per capita (APC) para o Brasil utilizando dados nacionais (APC Brasil), com vistas a estabelecê-lo como padrão ouro para o país em substituição ao indicador anteriormente calculado pela Organização Mundial da Saúde (OMS) com base em dados internacionais. Métodos. Foram selecionadas, no Brasil, as fontes públicas de dados necessárias para a composição do cálculo do APC registrado e definida a concentração alcoólica por categoria de bebida. Para as variáveis APC turista e APC não registrado, indisponíveis no Brasil, foram usadas as estimativas da Organização das Nações Unidas (ONU) e da OMS. O indicador APC Brasil foi calculado e comparado ao indicador produzido pela OMS por meio de análise das medianas para o período de 2005 a 2020. Resultados. O indicador de consumo de álcool nacional foi de 9,2 litros per capita em 2005, chegando a 9,8 em 2020. Já o indicador da OMS mostrou, para 2005, um consumo de 8,4 litros per capita, com queda até 2016 e leve aumento para 7,8 em 2020. Conclusão. O APC Brasil foi calculado com base em fontes nacionais e mostrou tendência distinta em relação ao indicador da OMS, que se mostrou em queda. A disponibilização transparente e regular desse indicador por canais governamentais permitirá o seu monitoramento, possibilitando a elaboração de políticas para o enfrentamento do consumo do álcool no país.

Objective. To estimate the national and regional population attributable fraction (PAF) and potential number of preventable anemia cases for three nutritional risk factors (iron, red blood cell folate [RBCF], and vitamin B12 deficiencies) among women of childbearing age in Belize. Methods. A national probability-based household and micronutrient survey capturing sociodemographic and health information was conducted among 937 nonpregnant Belizean women aged 15–49 years. Blood samples were collected to determine hemoglobin, ferritin, alpha-1-glycoprotein (AGP), RBCF, and vitamin B12 status. All analyses used sample weights and design variables to reflect a complex sample survey. Logistic regression was used to determine adjusted prevalence risk (aPR) ratios, which were then used to estimate national and regional PAF for anemia. Results. The overall prevalence of anemia (hemoglobin

El desarrollo de la salud pública en América Latina durante el siglo XX combinó, desde el principio, el marco de la medicina social sobre los orígenes sociales, políticos y ambientales de la enfermedad con los aportes del trabajo de campo de la antropología médica. A pesar de la hegemonía del modelo médico, el surgimiento del marco de la medicina preventiva legitimó aún más la participación de los científicos sociales en el estudio de la multicausalidad de la enfermedad. Sin embargo, las limitaciones que trajo consigo la falta de contextualización histórica y política del modelo de la medicina preventiva dieron paso al movimiento latinoamericano de medicina social, basado en el materialismo histórico, y al desarrollo tanto de la epidemiología crítica como de la antropología médica crítica.

Objetivo. Identificar los países que tienen legislación relacionada con la declaración obligatoria de alergenos alimentarios, alimentos irradiados y transgénicos en el etiquetado nutricional de alimentos envasados. Métodos. Estudio exploratorio en el cual se revisaron los reglamentos sanitarios o normas técnicas de los alimentos de los países de América Latina con el fin de recopilar información sobre la declaración de alergenos, trazas de alergenos, alimentos irradiados y transgénicos. La búsqueda de la información se realizó a través de páginas gubernamentales de los países. Los resultados se presentan de manera descriptiva y narrativa. Resultados. De los 19 países revisados, 89% declara alergenos en su etiquetado nutricional, 76% incorpora la declaración de trazas en su legislación de manera explícita y 82% sigue las recomendaciones del Codex Alimentarius con algunas modificaciones en las categorías de alimentos. Conclusiones. La declaración de alergenos como medida de seguridad alimentaria, así como avanzar en mejorar la rotulación de trazas de alergenos y la disponibilidad universal de epinefrina son los desafíos pendientes de la Región.

Objetivo. Descrever o padrão temporal e espacial e identificar os fatores associados a incidência de HIV/AIDS entre jovens no Brasil. Método. Estudo ecológico que incluiu jovens brasileiros de 15 a 24 anos notificados com HIV/AIDS de 2001 a 2021. Utilizou-se o método joinpoint para a análise temporal. Aglomerados espaciais foram detectados pelos métodos Bayesiano, autocorrelação espacial, Getis-Ord Gi* e Varredura Scan. Quatro modelos de regressão não espacial e espacial foram usados para identificar fatores associados ao desfecho. Todas as análises estatísticas consideraram p < 0,05. Resultados. No Brasil, a incidência média foi de 12,29 por 100 000 habitantes, com aumento de 7,3% ao ano no período 2007-2014 e posterior decréscimo de 3,4% em 2014-2021. Observou-se padrão Alto/Alto e hotspots, principalmente em municípios do Sul, Sudeste, Centro-Oeste e Norte. O cluster primário localizou-se em 572 municípios do Rio Grande do Sul e Santa Catarina e os maiores riscos relativos em Manaus (Amazonas) e Rondonópolis (Mato Grosso). A taxa de analfabetismo (β = -0,08), Índice de GINI (β = -3,74) e Cobertura da Estratégia de Saúde da Família (β = -0,70) apresentaram relação negativa com o desfecho. Em contrapartida, o Índice Firjan de Desenvolvimento Municipal (β = 2,37), o Índice de Vulnerabilidade Social (β = 6,30), o percentual de pessoas que recebem o Bolsa Família (β = 0,04) e renda per capita (β = 0,008) apresentaram associação positiva. Conclusão. Houve tendência de aumento da incidência de HIV/AIDS até 2014 com posterior declínio até 2021. Aglomerados de altas taxas concentraram-se, especialmente, em municípios das regiões Norte, Sul, Sudeste e Centro-Oeste. Indicadores de vulnerabilidade socioeconômica influenciam o desfecho positivamente ou negativamente, dependendo do território investigado.

Objective. To assess changes in reproductive, maternal, newborn, child, and adolescent health (RMNCAH) in Haiti from August 2018 to September 2021, before and during the COVID-19 pandemic. Methods. A retrospective study using surveillance data from the Haitian Unique Health Information System, examining two periods: pre- and peri-COVID-19 pandemic. Health indicators at the national level in the two periods were compared using two-sample t-tests for proportions, and average absolute monthly changes were calculated using variance-weighted regression. Results. There was a statistically significant decline in the proportion of most of the indicators assessed from the pre- to the peri-COVID-19 pandemic period. However, the most affected indicators were the proportions of pregnant women with four antenatal care visits, with five antenatal care visits or more, and those who received a second dose of tetanus vaccine, which decreased by over 4 percentage points during the two periods. Likewise, the proportions of children who received diphtheria, tetanus, and pertussis (DTaP), BCG, polio, pentavalent, and rotavirus vaccines also all declined by over 8 percentage points. In contrast, pneumococcal conjugate vaccine increased by over 4 percentage points. A statistically significant decrease was also observed in the average absolute monthly changes of several reproductive and child health indicators assessed. Conclusions. The COVID-19 pandemic may have contributed to the decline observed in several RMNCAH indicators in Haiti. However, the role played by the sociopolitical crisis and control exercised by armed groups over the population in the last three years cannot be ruled out.

Objective. To document tobacco industry strategies to influence regulation of new and emerging tobacco and nicotine products (NETNPs) in Latin America and the Caribbean. Methods. We analyzed industry websites, advocacy reports, news media and government documents related to NETNPs, focusing on electronic cigarettes and heated tobacco products. We also conducted a survey of leading health advocates. We applied the policy dystopia model to analyze industry action and argument- based strategies on NETNP regulations. Results. Industry actors engaged in four instrumental strategies to influence NETNP regulation – coalition management, information management, direct involvement in and access to the policy process, and litigation. Their actions included: lobbying key policy-makers, academics and vaping associations; providing grants to media groups to disseminate favorable NETNP information; participating in public consultations; presenting at public hearings; inserting industry-inspired language into draft NETNP legislation; and filing lawsuits to challenge NETNP bans. The industry disseminated its so-called harm reduction argument through large/influential countries (e.g., Argentina, Brazil, and Mexico). Industry discursive strategies claimed NETNPs were less harmful, provided safer alternatives, and should be regulated as so-called harm reduction products or have fewer restrictions on their sale and use than those currently in place. Conclusion. Our analysis provides a better understanding of industry strategies to undermine tobacco and nicotine control. To help counter industry efforts, health advocates should proactively strengthen government capacities and alert policy-makers to industry attempts to create new regulatory categories (so-called reduced-risk products), provide misleading information of government authorizations of NETNPs, and co-opt so-called harm-reduction messages that serve the industry’s agenda.

Objetivo. Los trastornos mentales, neurológicos y por consumo de sustancias psicoactivas (MNS) tienen una prevalencia alta y existe una brecha para su atención en Colombia. El Programa de acción para superar las brechas en salud mental (mhGAP, por su sigla en inglés) de la Organización Mundial de la Salud (OMS) tiene varios componentes. Uno de ellos es la Guía de intervención mhGAP 2.0, orientada a la mejora de la atención primaria en salud; se trata de una guía para la evaluación y el manejo de trastornos MNS a partir de protocolos de toma de decisiones clínicas. Se planteó como objetivo determinar las barreras que se pueden presentar en el proceso de implementación del programa. Métodos. Se realizó un estudio cualitativo con enfoque de análisis de contenido que se desarrolló en tres fases: i) preparación, organización y presentación del estudio; ii) codificación abierta, categorización y abstracción de los contenidos; y iii) análisis de información. El estudio incluyó la entrevista semiestructurada a 21 personas involucradas en la prestación de servicios en salud mental en Chocó (Colombia): cinco profesionales de medicina, siete de enfermería y tres de psicología, además seis profesionales que trabajaban en el área administrativa de las secretarías de salud del departamento. Se exploraron las percepciones de las partes interesadas, que eran el personal asistencial y el personal administrativo del sector salud en el departamento del Chocó. Se realizaron preguntas abiertas para explorar las experiencias con el proceso y las barreras identificadas en la práctica. Resultados. Se identificaron cuatro categorías temáticas diferentes: intersectorialidad, viejos desafíos, posibilidades e idoneidad de herramientas. Conclusiones. Se construyó un modelo teórico sobre las barreras de implementación para el Programa de mhGAP desde las percepciones de las partes interesadas. El control de las barreras se percibe como un camino posible para generar un aporte significativo para la salud poblacional.

Introducción. Los trastornos hipertensivos durante el embarazo son una causa importante de morbilidad grave, muerte y discapacidad a largo plazo. El tratamiento farmacológico adecuado es uno de los pilares de la gestión de estos trastornos. Objetivos. Sintetizar las recomendaciones desarrolladas por la Organización Mundial de la Salud (OMS) con el fin de mejorar la calidad del cuidado y los desenlaces en salud de las mujeres embarazadas con trastornos hipertensivos y abordar aspectos sobre su implementación. Métodos. Se llevó a cabo una síntesis de las recomendaciones de dos guías de la OMS (Tratamiento farmacológico de la hipertensión severa en el embarazo y Tratamiento farmacológico de la hipertensión no severa en el embarazo). Las guías elaboradas por la OMS siguen los métodos de elaboración de las guías GRADE (Grading of Recommendations Assessment Development and Evaluation) del Manual para el Desarrollo de Guías de la OMS. Adicionalmente, se realizó una búsqueda sistemática en PubMed, Lilacs, Health Systems Evidence, Epistemonikos y literatura gris de estudios desarrollados en las Américas con el fin de identificar barreras, facilitadores y estrategias de implementación, así como para identificar indicadores. Resultados. Se formularon cuatro recomendaciones dirigidas a las mujeres con trastornos hipertensivos. Se identificaron barreras y facilitadores para la implementación, y se crearon indicadores de adherencia y resultado. Conclusiones. Las recomendaciones formuladas buscan orientar sobre cómo enfocar el tratamiento farmacológico de la hipertensión en el embarazo, con consideraciones para su implementación en América Latina y el Caribe.

Objetivo. Describir la legislación vigente respecto a historia clínica electrónica (HCE) y telesalud de los países latinoamericanos y analizar el tratamiento de la confidencialidad y el secreto profesional. Métodos. Entre marzo y septiembre de 2022, se realizó un relevamiento de la reglamentación vigente en los 21 países latinoamericanos en estudio, en dos niveles: i) la existencia de legislación respecto a la HCE y la telesalud, y ii) el tratamiento de la confidencialidad y el secreto profesional en la HCE y la telesalud. Se confeccionó una ficha de extracción de datos por país. Se recolectaron datos a partir de fuentes on-line oficiales. Se analizó cualitativamente la información y se sintetizó en forma de tablas cuando fue posible. Resultados. El uso de la HCE está reglamentado legalmente en 16 países. Para el caso de telesalud, son 19 países los que cuentan con legislación en referencia a esta herramienta. Todos los países analizados resguardan la confidencialidad y el secreto profesional a través de reglamentaciones. Sin embargo, en el contexto de telesalud se mencionan en 11 países, en tanto en el contexto de la HCE, solo en 9 países. Conclusiones. Desde el inicio del segundo milenio América Latina ha avanzado respecto a la legislación de herramientas digitales en la atención en salud como la HCE y la telesalud. Se observa a su vez un interés por las cuestiones éticas relacionadas con el uso de la HCE y la telesalud, en particular de la confidencialidad y secreto profesional, aunque dichos aspectos deben ser fortalecidos en la salud digital.

Objective. Basic and translational research in pediatric cancer are essential to improve patient care. To critically assess the developments achieved in these areas in Latin America, we systematically reviewed information published between 2013 and 2023. Methods. Studies of basic and translational research performed by investigators in Latin America evaluating pediatric malignant solid and central nervous system tumors were retrieved from PubMed. Original articles published in English between 2013 and 2023 were included. Collaborations among Latin American authors or among Latin American authors working with researchers from other continents were also included. Studies were excluded if they focused only on adults or on basic research in tumor biology not specifically related to the tumor types analyzed in this review. Results. A total of 550 articles were retrieved, but after removal of duplicates, 514 articles were included in the analysis, the majority of which were authored by researchers affiliated with institutions in Argentina, Brazil and Mexico. These countries also had the highest number of collaborations on original articles published with authors from Europe and North America. Argentina had the highest number of collaborations on original publications, with coauthors from Brazil and Uruguay. The median impact factor of the 244 journals in which articles were published was 3.5. The most commonly studied tumors were osteosarcomas, neuroblastomas and medulloblastomas; the most commonly studied areas were molecular analysis, tumor cell biology and biomarkers. Conclusions. In Latin America, research in pediatric oncology is on the agenda, despite a notable disparity in publication rates and frequency of collaboration between countries. There is a need to strengthen scientific collaboration within Latin America and with countries from other continents to promote research and to develop novel treatment strategies that reflect the local needs of children in Latin America who have solid tumors and brain cancer.

Objective. To create and validate criteria for prioritizing problems related to policies and management of the health workforce. Methods. This methodological study was divided into three stages. First, the criteria were elaborated by means of a systematized literature review. Second, the criteria were evaluated online by a committee of judges comprised of eight specialists. In the third stage, an evaluation was carried out by the target audience in a hybrid workshop. The participants evaluated the material using the Suitability Assessment of Materials instrument, adapted for the research. Results. Three prioritization criteria (relevance, window of opportunity and acceptability) and a scoring scale were developed based on the literature review. In the evaluation by the committee of judges, the approval percentage of the criteria and prioritization method was 84%. Modifications were made based on suggestions in relation to the material presented to the specialists. In the pre-test stage, the approval percentage varied by item, with six of them reaching a maximum approval of 100% (corresponding to approximately 46% of the items), four reaching 92% and three achieving 83% each, indicating positive results. Conclusions. The developed criteria were considered valid for use in the context of policies and management in the area of human resources for health.

This report provides a summary of childhood cancer and the efforts made in the Dominican Republic to address child and adolescent cancer in line with the World Health Organization’s Global Initiative for Childhood Cancer. Information was obtained by review of recent local and international literature on pediatric oncology. As a result of the Global Initiative, a meeting was held by the Council of Ministers of Health of Central America to support the development of national pediatric cancer plans for each country. The objectives of these plans are to improve overall survival and quality of care for children with cancer through early detection, diagnosis, and treatment. In the Dominican Republic, several steps have been taken in the past 5 years to enhance diagnosis and care of children with cancer. For example, the National Committee of Childhood Cancer, headed by the Ministry of Public Health and including relevant stakeholders, was established to develop the national childhood cancer plan. In addition, a campaign was launched to raise awareness of childhood cancer, and the first early detection manual and public policy on child and adolescent cancer were published. A government initiative has been working to improve the hospital infrastructure and expand the pediatric cancer center, and a national course on early detection of pediatric cancers has been held. In 2023, the National Strategic Childhood Cancer Plan 2023–2030 was launched in the Dominican Republic. The plan will help policy-makers, implementers, researchers, and advocates enhance diagnosis and care of children with cancer.

Objetivo. Avaliar a cobertura vacinal e as taxas de abandono da vacina tríplice viral nas macrorregiões brasileiras. Métodos. Este estudo ecológico, com abordagem espaço-temporal, utilizou dados do Programa Nacional de Imunizações e do Sistema de Informação sobre Nascidos Vivos. Estimou-se a variação anual (2014 a 2021) da cobertura vacinal e da taxa de abandono da vacina tríplice viral em crianças de 12 meses e 15 meses de idade nos 5 570 municípios brasileiros. A análise estatística foi realizada para o conjunto de municípios de cada macrorregião brasileira usando a técnica de varredura espaço-temporal, considerando o modelo probabilístico de Poisson e a hipótese de que os municípios com menores coberturas vacinais ou altas taxa de abandono formariam aglomerados (clusters) espaço-temporais. Resultados. De 2014 a 2021, 38,3% e 12,9% dos municípios alcançaram cobertura da vacina tríplice viral ≥ 95,0% na primeira e segunda doses, respectivamente; 53,6% dos municípios tiveram alta taxa de abandono (20,0% a 49,9%) e 37,2% tiveram altíssima taxa de abandono. O Nordeste apresentou os clusters primários para baixa cobertura da primeira (2018 a 2021) e da segunda doses (2020 a 2021) da vacina tríplice viral com maiores riscos relativos (RR) em relação aos demais clusters primários. O RR para alta taxa de abandono foi elevado em todas as macrorregiões brasileiras (1,57 a 26,23). Conclusões. Em algumas macrorregiões, a taxa de abandono era alta desde 2014, sinalizando risco de ressurgimento do sarampo. Por sua vez, a análise espaço-temporal indicou mais baixas coberturas vacinais em 2020, sugerindo influência da pandemia de covid-19.

Objetivo. Avaliar a implementação de estratégia do “Plano de Ação: Estratégia de Vacinação nas Fronteiras – Agenda 2022” do Ministério da Saúde nas 33 cidades gêmeas e avaliar o incremento das coberturas vacinais (CV) brasileiras. Métodos. Ensaio clínico comunitário, do tipo antes e depois. Analisou-se a realização da estratégia, bem como comparadas as CV pré e pós-intervenção em dois tempos: P1 (pré-intervenção) e P2 (pós-intervenção). Análises estatísticas sobre a CV, no P1 e P2, foram calculados os valores de média entres os municípios, desvio padrão e diferença entre as coberturas dos dois períodos. Resultados. Observou-se integração entre as equipes de Atenção Primária à Saúde (APS), Vigilância, Imunização e Distrito Sanitário Especial Indígena (DSEI), porém com dificuldades, como aquelas inerentes ao fluxo migratório. Ressalta-se que o fluxo imigratório é um dos desafios no contexto da imunização, APS e DSEI, entretanto, a esta dificuldade soma-se a polarização entre os serviços (imunização, APS e DISEI), ocasionando um desafio para a integração dos setores. Em relação à análise das CV, após a realização das oficinas, foram totalizadas 50 977 doses aplicadas na população geral nas 33 cidades-gêmeas do Brasil. Houve incremento das coberturas vacinais de crianças de até um ano de idade nos locais avaliados após a intervenção, o que pode ser importante para aumentar as CV no Brasil. Conclusão. Houve incremento das coberturas vacinais das crianças até um ano de idade nos locais avaliados após a intervenção e isso influenciou no aumento das CV no Brasil.

Objetivo. Identificar las tendencias de mortalidad por accidentes de tránsito en motocicleta en Colombia entre los años 2008 y 2021. Métodos. Se realizó un estudio observacional y descriptivo de tendencias de la mortalidad por accidentes de tránsito en motocicleta a partir de los registros oficiales de defunciones entre 2008 y 2021. Se efectuó un análisis de regresión Jointpoint Poisson para detectar los puntos de inflexión en las tasas de mortalidad específicas por edad, sexo y área de residencia. Resultados. Se identificaron 28 200 muertes por accidentes de tránsito en motocicleta en todo el período; fallecieron 24 271 hombres y 3 929 mujeres. El 74,1% de las defunciones ocurrió en el área urbana y el 25,9% en el área rural. En esta área se observó una tendencia creciente en la mortalidad en adultos jóvenes de ambos sexos a lo largo de todo el período. Lo mismo ocurrió en hombres de más de 65 años. En el área urbana, se identificó una tendencia al aumento de la mortalidad en las edades entre 45 a 64 años para ambos sexos durante todo el período. Solo se detectó un punto de inflexión en el año 2015, que mostró una disminución en la tendencia, en mujeres adolescentes. Conclusión. La tendencia en la mortalidad por accidentes de tránsito en motocicleta en Colombia se mantuvo en aumento durante todo el período (2008-2021) tanto en áreas rurales para adultos jóvenes como en áreas urbanas para personas de mediana edad.

Objetivo. 1) Describir la carga de la enfermedad renal crónica en países de América Latina entre 1990 y 2019 y, 2) estimar la correlación entre los años de vida saludables perdidos (AVISA) con el índice sociodemográfico y el índice de acceso y calidad de salud. Métodos. Análisis secundario y ecológico, basado en el Estudio de la Carga Global de Enfermedades, Lesiones y Factores de Riesgo 2019. Se reportaron las tasas estandarizadas de mortalidad, años perdidos por muertes prematuras (APMP), años de vida ajustados por discapacidad (AVAD) y AVISA por enfermedad renal crónica para 1990, 2005 y 2019. La información se desagregó por países, sexo, grupos etarios y subcausas. Resultados. Entre 1990 y 2019, la carga de la enfermedad renal crónica aumentó considerablemente en los países de América Latina, convirtiéndose en una de las principales causas de mortalidad y de AVISA. La tasa estandarizada de AVISA por enfermedad renal crónica se debió, en gran medida, al peso de las muertes prematuras más que a la discapacidad. En 2019, Nicaragua, El Salvador, México y Guatemala se destacaron por tener las tasas estandarizadas de mortalidad por enfermedad renal crónica y de AVISA más elevadas, mientras que Uruguay presentó las más bajas. Conclusiones. La enfermedad renal crónica es una epidemia invisibilizada que representa una carga excesiva, en mortalidad y AVISA, para los países de América Latina. Es indispensable aunar esfuerzos regionales para enfrentar la enfermedad, además de impulsar acciones locales que atiendan las particularidades de cada país.

Objective. To examine sociodemographic differences in the awareness, understanding, use and effect of nutrition labels among Mexican and Chilean youth. Methods. Online surveys among youth (10-17 years) were obtained in 2019 (n=2631). Participants reported their awareness, understanding, and use of their country-specific nutrition facts tables (NFT) and front-of-pack labels (FOPL) (Chile: warning labels [WLs]; Mexico: guideline daily amounts [GDA]). Additionally, participants reported their perceived healthfulness of a sweetened fruit drink after viewing one of six versions of it with different FOPL (no-label control, Health Star Rating, WLs, GDAs, Traffic Light, or Nutri-Score) during an experimental task. Results. Higher self-reported nutrition knowledge was associated with higher NFT and FOPL awareness, understanding, and use, except for WL use. WLs were the most effective FOPL in decreasing the perceived healthfulness of the sweetened fruit drink compared to a no-label condition and other FOP labels. In Chile, the effect of GDA differed by income adequacy, while in Mexico Nutri-Score differed by age. Conclusions. Results suggest that nutrition label awareness, use, understanding, and impact differ across demographics, favoring higher income and nutrition knowledge. Despite this, WLs are likely to have a positive impact on nutrition-related knowledge and behaviors among Mexican and Chilean youth, independently of their socio-demographic groups.