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Escaño GJ, Pridemore WA. Population-Level Alcohol Consumption and Homicide Rates in Latin America: A Fixed Effects Panel Analysis, 1961-2019. Br J Criminol 2024; 64:656-674. [PMID: 38638838 PMCID: PMC11022986 DOI: 10.1093/bjc/azad056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/20/2024]
Abstract
Latin America and the Caribbean (LAC) possesses 8 per cent of the global population but approximately one-third of global homicides. The region also exhibits high per capita alcohol consumption, risky drinking patterns and a heterogeneous mix of beverage preferences. Despite this, LAC violence receives limited attention in the English-language literature and there are no studies of the population-level alcohol-homicide association in the region. We examined the effects on total, male and female homicide rates of total and beverage-specific alcohol consumption (22 nations, 1961-2019) and of risky drinking patterns (20 nations, 2005 and 2010). We collected homicide and alcohol data from the World Health Organization. Panel fixed effects models showed (1) per capita total and wine consumption were positively associated with total, male and female homicide rates, though effects were much stronger for males, (2) per capita beer consumption was positively associated with total and male homicide rates, (3) per capita spirits consumption was not associated with homicide rates, and (4) nations with riskier drinking patterns had higher total, male and female homicide rates than those with less risky drinking patterns.
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Affiliation(s)
- Guillermo J Escaño
- University at Albany, State University of New York, School of Criminal Justice, 135 Western Avenue, Albany, NY 12222, USA
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2
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Evans-Gilbert T, Figueroa JP, Bonvehí P, Melgar M, Stecher D, Kfouri R, Munoz G, Bansie R, Valenzuela R, Verne E, Salas D, Jennifer Sanwogou N. Establishing priorities to strengthen National Immunization Technical Advisory Groups in Latin America and the Caribbean. Vaccine 2024; 42:2310-2316. [PMID: 38438288 DOI: 10.1016/j.vaccine.2024.02.082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 02/23/2024] [Accepted: 02/26/2024] [Indexed: 03/06/2024]
Abstract
Following the COVID-19 pandemic, the Americas faced a significant decline in vaccination coverage as well as increased vaccine hesitancy. The objective of this paper is to summarize the challenges and opportunities outlined by the National Immunization Technical Advisory Groups (NITAGs) in Latin America and the Caribbean (LAC) and prioritize targeted interventions. The exploratory survey included open-ended questions on two primary components: challenges, and opportunities. Free-text comments presented by each NITAG were collated and classified using indicators and sub-indicators of the NITAG Maturity Assessment Tool (NMAT). Opportunities were classified thematically, and priority actions were generated from the responses. All 21 NITAGs in LAC, representing 40 countries, 76 % of which have been active for over a decade, responded to the survey. The most common challenges were establishment and composition (62 %), integration into policymaking (62 %), resources and secretariat (52 %), and stakeholder recognition (48 %). The distribution of responses was seen across the whole sample and did not suggest a more pronounced need in relation to year of establishment. Opportunities included maximizing the Regional NITAG Network of the Americas (RNA) to facilitate collaboration, information sharing, visibility, and communication; existing global, regional, and systemic analyses; the World Health Organization/Pan American Health Organization (WHO/PAHO) templates for standard operating procedures; twinning programs with mature NITAGs; and NITAGs in governance structures. Action plans were outlined to formalize the establishment of NITAGs and broaden their composition; strengthen decision-making and access to data resources; and enhance the credibility of evidence-based recommendations and their uptake by policymakers and the public. NITAG challenges are not unique to LAC. NITAGs have outlined a short-term prioritized action plan which is critical to enhancing NITAG value and importance in countries.
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Affiliation(s)
- Tracy Evans-Gilbert
- Department of Child and Adolescent Health, University of the West Indies, Kingston, Jamaica.
| | - J Peter Figueroa
- Department of Community Health and Psychiatry, The University of the West Indies, Mona, Kingston, Jamaica.
| | - Pablo Bonvehí
- Center for Medical Education and Clinical Research, Av. Las Heras 2929, 1425 Buenos Aires, Argentina.
| | - Mario Melgar
- Hospital Roosevelt, Ciudad de Guatemala 01011, Guatemala.
| | - Daniel Stecher
- Hospital de Clínicas José de San Martín, Facultad de Medicina, Universidad de Buenos Aires, Paraguay 2155, C1121 ABG Buenos Aires, Argentina.
| | - Renato Kfouri
- Immunization Department, Brasilian Society of Pediatrics, R. Santa Clara, 292 - Copacabana, Rio de Janeiro, RJ 22041-012, Brazil.
| | - Greta Munoz
- Hospital Pediátrico Baca Ortiz, S/N y D.M., Avenida 6 de Diciembre & Av. Cristóbal Colón, Quito, Ecuador.
| | - Rakesh Bansie
- Academic Hospital Paramaribo, RRP8+PQ7, Flustraat, Paramaribo, Suriname.
| | | | - Eduardo Verne
- Hospital Nacional Cayetano Heredia, Av. Honorio Delgado 262, San Martín de Porres 15102, Peru.
| | - Daniel Salas
- Pan American Health Organization/World Health Organization, 525 23 Street NW, Washington, DC 20037, USA.
| | - N Jennifer Sanwogou
- Pan American Health Organization/World Health Organization, 525 23 Street NW, Washington, DC 20037, USA.
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Nigenda G, Serván-Mori E. Human resources for health and maternal mortality in Latin America and the Caribbean over the last three decades: a systemic-perspective reflections. Int J Equity Health 2024; 23:67. [PMID: 38561759 PMCID: PMC10983735 DOI: 10.1186/s12939-024-02154-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Accepted: 03/18/2024] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND The role of human resources for health in the operation of health systems is crucial. However, training and incorporating them into institutions is a complex process due to the continuous misalignment between the supply and demand of health personnel. Taking the case of the Latin American and Caribbean region countries, this comment discusses the relationship between the availability of human resources for health and the maternal mortality ratio for the period 1990-2021. It proposes the need to resume planning exercises from a systemic perspective that involves all areas of government and the private sector linked to the training and employment of health workers. MAIN TEXT We used secondary data from a global source to show patterns in the relationship between these two aspects and identify gaps in the Latin American and Caribbean regions. The results show enormous heterogeneity in the response of regional health systems to the challenge of maternal mortality in the region. Although most countries articulated specific programs to achieve the reduction committed by all countries through the Millennium Development Goals, not all had the same capacity to reduce it, and practically none met the target. In addition, in the English Caribbean countries, we found significant increases in the number of health personnel that do not explain the increases in the maternal mortality rate during the period. CONCLUSIONS The great lesson from the data shown is that some countries could articulate responses to the problem using available resources through effective strategies, considering the specific needs of their populations. Although variations in maternal mortality rate cannot be explained solely through the provision of health personnel, it is important to consider that it is critical to find new modalities on how human resources for health could integrate and create synergies with other resources to increase systems capacity to deliver care according to conditions in each country.
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Affiliation(s)
- Gustavo Nigenda
- Faculty of Nursing and Obstetrics, National Autonomous University of Mexico, Mexico City, Mexico
| | - Edson Serván-Mori
- Center for Health Systems Research, National Institute of Public Health of Mexico, Universidad Av. 655, Cuernavaca, Morelos, Mexico.
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Reichenberger V, Corona AP, Ramos VD, Shakespeare T, Hameed S, Penn-Kekana L, Kuper H. Access to primary healthcare services for adults with disabilities in Latin America and the Caribbean: a review and meta-synthesis of qualitative studies. Disabil Rehabil 2024:1-10. [PMID: 38433528 DOI: 10.1080/09638288.2024.2320268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 02/14/2024] [Indexed: 03/05/2024]
Abstract
PURPOSE This review and meta-synthesis of qualitative studies aims to provide an overview of qualitative evidence on primary healthcare access of people with disability in Latin America and the Caribbean, as well as to identify barriers that exist in this region. METHODS Six databases were searched for studies from 2000 to 2022. 34 qualitative studies were identified. RESULTS Barriers exist on both demand and supply sides. The thematic synthesis process generated three broad overarching analytical themes, which authors have related to Levesque et al.'s aspects of "ability to perceive," "availability, accommodation and ability to reach" and "appropriateness and ability to engage." Access to information and health literacy are compromised due to a lack of tailored health education materials. Barriers in the urban environment, including inadequate transportation, and insufficient healthcare facility accessibility create challenges for people with disabilities to reach healthcare facilities independently. Attitudinal barriers contribute to suboptimal care experiences. CONCLUSION People with disabilities face several barriers in accessing healthcare. Lack of healthcare provider training, inappropriate urban infrastructure, lack of accessible transport and inaccessibility in healthcare centers are barriers that need to be addressed. With these actions, people with disabilities will be closer to having their rights met.
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Affiliation(s)
- Veronika Reichenberger
- International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, London, UK
| | - Ana Paula Corona
- Department of Hearing and Speech Sciences, Multidisciplinary Institute of Rehabilitation and Health, Federal University of Bahia, Salvador, Brazil
| | - Vinicius Delgado Ramos
- Instituto de Medicina Fisica e Reabilitacao, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Tom Shakespeare
- International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, London, UK
| | - Shaffa Hameed
- International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, London, UK
| | - Loveday Penn-Kekana
- Epidemiology and Public Health, Maternal and Neonatal Health Group, London School of Hygiene & Tropical Medicine, London, UK
| | - Hannah Kuper
- International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, London, UK
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Mancilla V, Jimenez NR, Bishop NS, Flores M, Herbst-Kralovetz MM. The Vaginal Microbiota, Human Papillomavirus Infection, and Cervical Carcinogenesis: A Systematic Review in the Latina Population. J Epidemiol Glob Health 2024:10.1007/s44197-024-00201-z. [PMID: 38407720 DOI: 10.1007/s44197-024-00201-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 01/24/2024] [Indexed: 02/27/2024] Open
Abstract
BACKGROUND Latina women experience disproportionately higher rates of HPV infection, persistence, and progression to cervical dysplasia and cancer compared to other racial-ethnic groups. This systematic review explores the relationship between the cervicovaginal microbiome and human papillomavirus infection, cervical dysplasia, and cervical cancer in Latinas. METHODS The review abides by the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. PubMed, EMBASE, and Scopus databases were searched from January 2000 through November 11, 2022. The review included observational studies reporting on the cervicovaginal microbiota in premenopausal Latina women with human papillomavirus infection, cervical dysplasia, and cervical cancer. RESULTS Twenty-five articles were eligible for final inclusion (N = 131,183). Forty-two unique bacteria were reported in the cervicovaginal microbiome of Latinas. Seven bacteria: Lactobacillus crispatus, Lactobacillus iners, Chlamydia trachomatis, Prevotella spp., Prevotella amnii, Fusobacterium spp. and Sneathia spp. were enriched across multiple stages of cervical carcinogenesis in Latinas. Therefore, the total number of reported bacteria includes four bacteria associated with the healthy state, 16 bacteria enriched in human papillomavirus outcomes, 24 unique bacteria associated with abnormal cytology/dysplasia, and five bacteria associated with cervical cancer. Furthermore, three studies reported significantly higher alpha and beta diversity in Latinas with cervical dysplasia and cancer compared to controls. Lactobacillus depletion and an increased abundance of L. iners in Latinas compared to non-Latinas, regardless of human papillomavirus status or lesions, were observed. CONCLUSIONS The identification of 42 unique bacteria and their enrichment in cervical carcinogenesis can guide future cervicovaginal microbiome research to better inform cervical cancer prevention strategies in Latinas.
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Affiliation(s)
- Vianney Mancilla
- Department of Basic Medical Sciences, University of Arizona College of Medicine-Phoenix, 425 N. 5th Street, Phoenix, AZ, 85004-2157, USA
| | - Nicole R Jimenez
- Department of Obstetrics and Gynecology, University of Arizona College of Medicine-Phoenix, 425 N. 5th Street, Phoenix, AZ, 85004-2157, USA
| | - Naomi S Bishop
- Associate Librarian, University of Arizona Health Sciences, University of Arizona College of Medicine-Phoenix, 475 N. 5th Street, Phoenix, AZ, 85004, USA
| | - Melissa Flores
- Department of Psychology, University of Arizona, 1200 E University Boulevard, Tucson, AZ, 85721, USA
| | - Melissa M Herbst-Kralovetz
- Department of Basic Medical Sciences, University of Arizona College of Medicine-Phoenix, 425 N. 5th Street, Phoenix, AZ, 85004-2157, USA.
- Department of Obstetrics and Gynecology, University of Arizona College of Medicine-Phoenix, 425 N. 5th Street, Phoenix, AZ, 85004-2157, USA.
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Villalobos Dintrans P, Oliveira D, Stampini M. Human Resources for Care in Latin America and the Caribbean: Current Needs and Future Demands. J Am Med Dir Assoc 2024; 25:232-236. [PMID: 37813366 DOI: 10.1016/j.jamda.2023.08.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 05/09/2023] [Accepted: 08/24/2023] [Indexed: 10/11/2023]
Abstract
OBJECTIVES To estimate the current gap and the necessary supply of human resources for care (HRC) for older people experiencing severe care dependence in Latin America and the Caribbean (LAC). DESIGN Simulation study using previous estimations of severe care dependence for LAC countries. SETTING AND PARTICIPANTS Older people (aged 65+) experiencing severe care dependence in 26 countries of LAC. METHODS We calculated the current gap and the necessary supply of HRC in 2020, 2035, and 2050 assuming a mix of complementary human resources, in line with regional standards for long-term care (LTC) schemes, and differing levels of care coverage. RESULTS Considering 100% coverage of LTC services for the population aged 65+ experiencing severe care dependence, the region will need almost 5 million people working full-time in the sector. This figure is expected to increase to more than 14 million by 2050. Nurse assistants and nurses will be the professional profiles in highest demand. In addition, the region requires 2 million rehabilitation professionals in 2020, and this figure will increase to more than 6 million in 2050. CONCLUSIONS AND IMPLICATIONS The rapid aging process in LAC will bring several challenges and opportunities to the region. Countries should start designing strategies to reduce the current gaps of HRC to meet older people's care needs in the coming years, in terms of both quantity and competencies, to help ensure that their human rights are met.
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Affiliation(s)
- Pablo Villalobos Dintrans
- Programa Centro Salud Pública, Facultad de Ciencias Médicas, Universidad de Santiago, Santiago, Chile; Millennium Institute for Care Research (MICARE), Santiago, Chile.
| | - Déborah Oliveira
- Millennium Institute for Care Research (MICARE), Santiago, Chile; Facultad de Enfermería, Universidad Andrés Bello, Viña del Mar, Chile
| | - Marco Stampini
- División de Protección Social y Salud, Inter-American Development Bank, Washington, DC, USA
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Vargas V, Darrow J. Pharmaceutical Innovation in Latin America and the Caribbean. J Law Med Ethics 2023; 51:148-162. [PMID: 38156355 DOI: 10.1017/jme.2023.120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2023]
Abstract
This study assesses Latin America and Caribbean countries' capacity to innovate new pharmaceuticals, defined as developing new drugs and vaccines, repurposing existing drugs, and inventing around patents to produce new drug variations. Vaccine innovation includes reengineering existing vaccines, developing new manufacturing methods, and the clinical development of unapproved vaccine candidates initiated elsewhere.
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Affiliation(s)
- Verónica Vargas
- HARVARD UNIVERSITY, CAMBRIDGE, MA, USA AND UNIVERSITY ALBERTO HURTADO, CHILE
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Rama M, Vargas V. INTRODUCTION: Rethinking Pharmaceutical Policies in Latin America and the Caribbean: An Overview. J Law Med Ethics 2023; 51:6-16. [PMID: 38156348 DOI: 10.1017/jme.2023.135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2023]
Abstract
The demographic and epidemiological transitions are driving pharmaceutical expenditures up in Latin American and the Caribbean, with much of the cost falling on households. The domestic development and manufacturing of bio-similars could make medicines more affordable.
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Williams CR, Valeria Bahamondes M, Gómez Ponce de León R, da Costa Machado H, Bahamondes L, Caffe S, Serruya SJ. Analysing the context and characteristics of legal abortion and comprehensive post-abortion care among adolescents aged 10-14 in a network of sentinel centres in Latin America: a retrospective cross-sectional study, 2016-2020. Sex Reprod Health Matters 2023; 31:2175442. [PMID: 36919908 PMCID: PMC10026806 DOI: 10.1080/26410397.2023.2175442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2023] Open
Abstract
Pregnancy-related complications are a substantial source of morbidity and mortality among adolescents in low- and middle-income countries. While the youngest adolescents (those aged 10-14) are considered to be at particularly high risk of adverse outcomes, there is little empirical data available on their sexual and reproductive health. Using a unique dataset of clinical records drawn from a regional network of sentinel centres providing legal abortion and comprehensive post-abortion care in 12 Latin American and Caribbean countries, we described the population of adolescents aged 10-14 seeking legal abortion and post-abortion care and calculated institutional rates of complications, using older adolescents (aged 15-19) and young adults (aged 20-24) as comparator groups. We also assessed the quality of care provided as compared to WHO recommendations. Nearly 17% (89 out of 533) of young adolescents sought care when they were already at 15 or more weeks' gestation. Young adolescents were at higher risk of pre-procedure and intra-operative complications than older adolescents and young adults, though the trend is less clear for the most severe complications. In general, the quality of care provided by centres in the network was aligned with WHO recommendations for safe abortion and comprehensive post-abortion care. Taken together, these findings provide insight into the challenges facing the global health community in assuring the sexual and reproductive health and rights of the youngest adolescents, and outline avenues for future research, advocacy, and evidence-based policymaking.
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Affiliation(s)
- Caitlin R Williams
- PhD Candidate, Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - M Valeria Bahamondes
- International Consultant, Latin American Center for Perinatology/Women's Health and Reproductive Health of the Pan American Health Organization (CLAP/WR-PAHO/WHO), Montevideo, Uruguay
| | - Rodolfo Gómez Ponce de León
- Regional Reproductive Health Advisor, Latin American Center for Perinatology/Women's Health and Reproductive Health Pan American Health Organization (CLAP/WR-PAHO/WHO), Montevideo, Uruguay
| | - Helymar da Costa Machado
- Statistician, Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas - UNICAMP, Cidade Universitária, Rua Alexander Fleming 101, Campinas, SP 13083-881, Brazil
| | - Luis Bahamondes
- Professor of Gynaecology, Human Reproduction Unit, Department of Obstetrics and Gynecology, School of Medicine, Universidade Estadual de Campinas (UNICAMP), Campinas, Brazil
| | - Sonja Caffe
- Regional Adolescent Health Advisor, Pan American Health Organization/World Health Organization, Washington, DC, USA
| | - Suzanne Jacob Serruya
- Director, Latin American Center for Perinatology/Women's Health and Reproductive Health of the Pan American Health Organization (CLAP/WR-PAHO/WHO), Montevideo, Uruguay
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Loaiza JR, Gittens RA, Zapata R, Armien B, González-Santamaría J, Laporta GZ, Franco L. The bibliometric landscape of infectious disease research in Panama (1990-2019). Dialogues Health 2023; 2:100117. [PMID: 38515494 PMCID: PMC10953851 DOI: 10.1016/j.dialog.2023.100117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 02/11/2023] [Accepted: 02/20/2023] [Indexed: 03/23/2024]
Abstract
Background This work aims to analyze the landscape of scientific publications on subjects related to One Health and infectious diseases in Panama. The research questions are: How does the One Health research landscape look like in Panama? Are historical research efforts aligned with the One Health concept? What infectious diseases have received more attention from the local scientific community since 1990? Methods Boolean searches on the Web of Science, SCOPUS and PubMed were undertaken to evaluate the main trends of publications related to One Health and infectious disease research in the country of Panama, between 1990 and 2019. Results 4546 publications were identified since 1990, including 3564 peer-reviewed articles interconnected with One Health related descriptors, and 211 articles focused particularly on infectious diseases. A pattern of exponential growth in the number of publications with various contributions from Panamanian institutions was observed. The rate of multidisciplinary research was moderate, whereas those of interinstitutional and intersectoral research ranged from low to very low. Research efforts have centered largely on protozoan, neglected and arthropod-borne diseases with a strong emphasis on malaria, Chagas and leishmaniasis. Conclusion Panama has scientific capabilities on One Health to tackle future infectious disease threats, but the official collaboration schemes and strategic investment to develop further competencies need to be conciliated with modern times, aka the pandemics era. The main proposition here, addressed to the government of Panama, is to launch a One Health regional center to promote multidisciplinary, interinstitutional and intersectoral research activities in Panama and beyond.
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Affiliation(s)
- Jose R. Loaiza
- Instituto de Investigaciones Científicas y Servicios de Alta Tecnología (INDICASAT AIP), Panama
- Programa Centroamericano de Maestría en Entomología, Universidad de Panamá, Panama
- Smithsonian Tropical Research Institute, Apartado 0843-03092, Panama City, Panama
| | - Rolando A. Gittens
- Instituto de Investigaciones Científicas y Servicios de Alta Tecnología (INDICASAT AIP), Panama
| | - Robinson Zapata
- Secretaria Nacional de Ciencia, Tecnología e Innovación de Panamá, Panama
| | - Blas Armien
- Grupo de Biología Celular y Molecular de Arbovirus, Instituto Conmemorativo Gorgas de Estudios de la Salud, Panama
| | - José González-Santamaría
- Grupo de Biología Celular y Molecular de Arbovirus, Instituto Conmemorativo Gorgas de Estudios de la Salud, Panama
| | - Gabriel Z. Laporta
- Graduate Research and Innovation Program, Centro Universitario FMABC, Santo André, SP, Brazil
| | - Leticia Franco
- Health Emergencies Department, Pan American Health Organization, Washington, DC, United States of America
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Acre VN, Küng SA, Arce C, Yapu A, Iriondo D, Morales M. Reach, experience, and acceptability of an abortion self-care intervention in Bolivia: a mixed-methods evaluation. Sex Reprod Health Matters 2023; 31:2139888. [PMID: 36867125 PMCID: PMC9987779 DOI: 10.1080/26410397.2022.2139888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/04/2023] Open
Abstract
In 2018, Ipas Bolivia launched an abortion self-care (ASC) community intervention with the goal of increasing access to supportive, well-informed abortion support provided by community agents (CAs). Between September 2019 and July 2020, Ipas conducted a mixed-methods evaluation to assess the reach, outcomes, and acceptability of the intervention. We used logbook data maintained by CAs to capture demographic characteristics and ASC outcomes of people supported. We also conducted in-depth interviews with 25 women who had received support and 22 CAs who had provided support. 530 people accessed ASC support through the intervention, most of whom were young, single, educated women accessing abortion in the first trimester. Among the 302 people who self-managed their abortions, 99% reported having a successful abortion. No women reported adverse events. All women interviewed expressed satisfaction with the support provided by the CA and, in particular, with the information, lack of judgement, and respect they felt from CAs. CAs spoke highly about their experience and viewed their participation as a way to increase people's ability to exercise their reproductive rights. Obstacles included experiences of stigma, fears of legal repercussions, and difficulties dispelling misconceptions around abortion. Legal restrictions and abortion stigma continue to complicate access to safe abortion, and findings from this evaluation highlight important avenues for the effectiveness and expansion of ASC interventions, including legal support to people who have abortions and those who provide abortion support, building capacity of people as informed buyers, and ensuring that interventions reach rural and other often under-served people.
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Affiliation(s)
- Valerie N Acre
- Senior Research, Monitoring and Evaluation Advisor, Ipas, Chapel Hill, NC, USA. Correspondence:
| | | | | | - Adela Yapu
- Program Manager, Ipas Bolivia, La Paz, Bolivia
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Medina-Ranilla J, Espinoza-Pajuelo L, Mazzoni A, Roberti J, García-Elorrio E, Leslie HH, García PJ. A systematic review of population and patient perspectives and experiences as measured in Latin American and Caribbean surveys. Health Policy Plan 2023; 38:1225-1241. [PMID: 37803966 DOI: 10.1093/heapol/czad083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 07/20/2023] [Accepted: 09/11/2023] [Indexed: 10/08/2023] Open
Abstract
High-quality health systems must provide accessible, people-centred care to both improve health and maintain population trust in health services. Furthermore, accurate measurement of population perspectives is vital to hold health systems accountable and to inform improvement efforts. To describe the current state of such measures in Latin America and the Caribbean (LAC), we conducted a systematic review of facility and population-based assessments that included patient-reported experience and satisfaction measures. Five databases were searched for publications on quantitative surveys assessing healthcare quality in Spanish- or Portuguese-speaking LAC countries, focusing on the domains of processes of care and quality impacts. We included articles published since 2011 with a national sampling frame or inclusion of multiple subnational regions. We tabulated and described these articles, identifying, classifying and summarizing the items used to assess healthcare quality into the domains mentioned earlier. Of the 5584 publications reviewed, 58 articles met our inclusion criteria. Most studies were cross-sectional (95%), assessed all levels of healthcare (57%) and were secondary analyses of existing surveys (86%). The articles yielded 33 unique surveys spanning 12 LAC countries; only eight of them are regularly administered surveys. The most common quality domains assessed were satisfaction (in 33 out of 58 articles, 57%), evidence-based/effective care (34%), waiting times (33%), clear communication (33%) and ease of use (31%). Items and reported ratings varied widely among instruments used, time points and geographical settings. Assessment of patient-reported quality measures through population- and facility-based surveys is present but heterogeneous in LAC countries. Satisfaction was measured frequently, although its use in accountability or informing quality improvement is limited. Measurement of healthcare quality in LAC needs to be more systematic, regular, comprehensive and to be led collaboratively by researchers, governments and policymakers to enable comparison of results across countries and to effectively inform policy implementation.
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Affiliation(s)
- Jesús Medina-Ranilla
- School of Public Health and Administration, Epidemiology, STD and HIV Unit, Cayetano Heredia University (UPCH), Honorio Delgado Av. 430, San Martín de Porres, Lima 150135, Peru
| | - Laura Espinoza-Pajuelo
- School of Public Health and Administration, Epidemiology, STD and HIV Unit, Cayetano Heredia University (UPCH), Honorio Delgado Av. 430, San Martín de Porres, Lima 150135, Peru
| | - Agustina Mazzoni
- Health Care Quality and Patient Safety Department, Institute for Clinical Effectiveness and Health Policy (IECS), Dr. Emilio Ravignani 2024, Buenos Aires C1414CPV, Argentina
| | - Javier Roberti
- Health Care Quality and Patient Safety Department, Institute for Clinical Effectiveness and Health Policy (IECS), Dr. Emilio Ravignani 2024, Buenos Aires C1414CPV, Argentina
| | - Ezequiel García-Elorrio
- Health Care Quality and Patient Safety Department, Institute for Clinical Effectiveness and Health Policy (IECS), Dr. Emilio Ravignani 2024, Buenos Aires C1414CPV, Argentina
| | - Hannah Hogan Leslie
- Division of Prevention Science, Department of Medicine, University of California, San Francisco, 550 16th St., Floor 4, San Francisco, CA 94143, United States
| | - Patricia Jannet García
- School of Public Health and Administration, Epidemiology, STD and HIV Unit, Cayetano Heredia University (UPCH), Honorio Delgado Av. 430, San Martín de Porres, Lima 150135, Peru
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Grondona SI, Lima ML, Massone HE, Miglioranza KSB. Pesticides in aquifers from Latin America and the Caribbean. Sci Total Environ 2023; 901:165992. [PMID: 37536597 DOI: 10.1016/j.scitotenv.2023.165992] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 07/30/2023] [Accepted: 07/31/2023] [Indexed: 08/05/2023]
Abstract
In Latin America and the Caribbean (LAC), agriculture is the primary consumer of water and the biggest user of pesticides worldwide. Given that groundwater is a crucial resource in this region, a systematic review was conducted to evaluate the current state of knowledge on the presence of pesticides in aquifers. The review examined 48 research papers published between 1998 and 2020, and found that only six countries in the region have information on pesticides in groundwater. A total of 70 agrochemicals were detected, encompassing legacy pesticides, herbicides, insecticides, fungicides, and metabolites. Herbicides, including the widely used atrazine and glyphosate, were the most commonly detected current-use pesticides. These herbicides are being gradually banned or restricted due to their potentially harmful effects on the environment. Factors that contribute to the presence of these contaminants in aquifers include preferential flows, seasonal variations in rainfall, aquifer type, unsaturated zone thickness, and land use and management practices. Researchers noted that analysis of these contaminants is often beyond the economic or methodological scope, and analytical capacity in the region is generally limited. Based on the findings of this review, there is a clear need for groundwater pesticide monitoring in the region to reduce health risks to humans and ecosystems.
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Affiliation(s)
- Sebastian Iván Grondona
- Instituto de Geología de Costas y del Cuaternario, Universidad Nacional de Mar del Plata-Comisión de Investigaciones Científicas Bs. As. Mar del Plata, Argentina, Funes 3350, 7600 Mar del Plata, Argentina; Laboratorio de Ecotoxicología y Contaminación Ambiental (ECoA), Instituto de Investigaciones Marinas y Costeras (IIMyC), Universidad Nacional de Mar del Plata-CONICET, Funes 3350, 7600 Mar del Plata, Argentina.
| | - María Lourdes Lima
- Instituto de Geología de Costas y del Cuaternario, Universidad Nacional de Mar del Plata-Comisión de Investigaciones Científicas Bs. As. Mar del Plata, Argentina, Funes 3350, 7600 Mar del Plata, Argentina
| | - Héctor Enrique Massone
- Instituto de Geología de Costas y del Cuaternario, Universidad Nacional de Mar del Plata-Comisión de Investigaciones Científicas Bs. As. Mar del Plata, Argentina, Funes 3350, 7600 Mar del Plata, Argentina
| | - Karina Silvia Beatriz Miglioranza
- Laboratorio de Ecotoxicología y Contaminación Ambiental (ECoA), Instituto de Investigaciones Marinas y Costeras (IIMyC), Universidad Nacional de Mar del Plata-CONICET, Funes 3350, 7600 Mar del Plata, Argentina
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14
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Blanco E, Algranti E, Cifuentes LA, López-Carrillo L, Mora AM, Rodríguez-Guzmán J, Rodríguez-Villamizar LA, Veiga LHS, Canelo-Aybar C, Nieto-Gutierrez W, Feliu A, Espina C, Ferreccio C. Latin America and the Caribbean Code Against cancer 1st edition: Environment, occupation, and cancer. Cancer Epidemiol 2023; 86 Suppl 1:102381. [PMID: 37852723 DOI: 10.1016/j.canep.2023.102381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 03/21/2023] [Accepted: 03/25/2023] [Indexed: 10/20/2023]
Abstract
Within the framework of the Latin America and Caribbean region (LAC) Code Against Cancer 1st edition, the current work presents recommendations to reduce exposure to environmental and occupational carcinogenic agents relevant for LAC. Using the methodology established by the International Agency for Research on Cancer (IARC) in the World Code Against Cancer Framework and experience from developing the European Code Against Cancer 4th edition, a working group of LAC cancer-prevention experts reviewed the list of Group I IARC carcinogenic agents, identified prevalent environmental and occupational exposures in the region, and proposed evidence-based cancer prevention recommendations suited to the epidemiological, socioeconomic, and cultural conditions of LAC countries. Two sets of recommendations were drafted: those targeting the general public and a second set for policymakers. Outdoor and indoor air pollution, ultra-violet radiation and occupational exposures to silica dust, asbestos, benzene, diesel, and welding fumes were identified as prevalent carcinogens in LAC and as agents that could be reduced or eliminated to prevent cancers. Recommendations for additional risk factors were not included due to insufficient data of their attributable burden in LAC (sunbeds, radon, aflatoxin), or lack of a clear preventive action to be taken by the individual (arsenic in drinking water, medical radiation), or lack of evidence of carcinogenicity effect (bisphenol A, phthalates, and pesticides). A broad consensus was reached on environmental and occupational carcinogenic exposures present throughout the LAC region and on individual-level and public policy-level recommendations to reduce or eliminate these exposures. Key educational content for the dissemination of these recommendations was also developed as part of LAC Code Against Cancer 1st Edition.
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Affiliation(s)
- Estela Blanco
- Centro de Investigación en Sociedad y Salud y Nucleo Milenio SocioMed, Universidad Mayor, Badajoz 130, Oficina 1305, Las Condes, Santiago 7550000, Chile; Departamento de Salud Pública, Facultad de Medicina, Pontificia Universidad Católica de Chile, Avenida Libertador Bernardo O'Higgins 340, Región Metropolitana, Postal/Zip Code: 8331150, Santiago, Chile
| | | | - Luis Abdon Cifuentes
- Departamento de Ingeniería, Pontificia Universidad Católica de Chile, Avenida Libertador Bernardo O'Higgins 340, Región Metropolitana, Postal/Zip Code: 8331150, Santiago, Chile
| | - Lizbeth López-Carrillo
- Instituto Nacional de Salud Pública, Avenida Universidad 655, Santa María Ahuacatitlán, Cuernavaca, Morelos 62100, Mexico
| | - Ana M Mora
- Center for Environmental Research and Community Health (CERCH), School of Public Health, University of California, 1995 University Avenue, Suite 265, Berkeley, CA 94720-7392, USA
| | | | - Laura Andrea Rodríguez-Villamizar
- Escuela de Medicina, Facultad de Salud, Universidad Industrial de Santander, Cra. 32 #29-31, Bucaramanga, Santander 680002, Colombia
| | - Lene H S Veiga
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, 9609 Medical Center Drive, MSC 9776, Bethesda 20892, MD, USA
| | - Carlos Canelo-Aybar
- Department of Clinical Epidemiology and Public Health, Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain
| | - Wendy Nieto-Gutierrez
- Department of Clinical Epidemiology and Public Health, Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain
| | - Ariadna Feliu
- International Agency for Research on Cancer (IARC/WHO), Environment and Lifestyle Epidemiology Branch, 25 avenue Tony Garnier CS 90627, CEDEX 0769366, Lyon, France
| | - Carolina Espina
- International Agency for Research on Cancer (IARC/WHO), Environment and Lifestyle Epidemiology Branch, 25 avenue Tony Garnier CS 90627, CEDEX 0769366, Lyon, France
| | - Catterina Ferreccio
- Departamento de Salud Pública, Facultad de Medicina, Pontificia Universidad Católica de Chile, Avenida Libertador Bernardo O'Higgins 340, Región Metropolitana, Postal/Zip Code: 8331150, Santiago, Chile; Advanced Center for Chronic Diseases ACCDIS, Santiago, Chile.
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15
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Feliu A, Finck C, Lemos M, Bahena Botello A, de Albuquerque Melo Nogueira F, Bonvecchio Arenas A, Garcés-Palacio IC, Jurberg C, Pesce K, Espina C. Latin America and the Caribbean Code Against Cancer 1st edition: Building capacity on cancer prevention to primary healthcare professionals. Cancer Epidemiol 2023; 86 Suppl 1:102400. [PMID: 37852724 DOI: 10.1016/j.canep.2023.102400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 05/11/2023] [Accepted: 06/15/2023] [Indexed: 10/20/2023]
Abstract
INTRODUCTION Every year 1.5 million new cancer cases are diagnosed in Latin America and the Caribbean (LAC). Of these, about 40 % could be prevented. Health illiteracy has been identified as a main barrier for cancer prevention. Primary healthcare professionals (HCP) are key in cancer prevention as they are the first entry point of the population into the healthcare system. The LAC Code Against Cancer 1st edition aims to improve health literacy and awareness of cancer prevention in the LAC population, through building capacity of primary HCP. METHODS The definition and development of the learning objectives, curriculum, structure, and evaluation of an online learning program for primary HCP was led by a dedicated group of experts from the LAC Code Against Cancer project. A pedagogical guideline and a template to ensure harmonization across topics were produced to guide the program development. Two rounds of internal revisions and an editorial process were performed. RESULTS An online competency-based microlearning program for primary HCP was produced, taking the LAC Code Against Cancer as a basis. The competences addressed in the curriculum are core knowledge, communication skills, decision-making and applying knowledge to real-world situations. A comprehensive evaluation to assess acquisition of these competences, based on the Miller's Pyramid, was designed with three data collection points: a) immediately before, to assess baseline knowledge and skills; b) immediately after, to determine acquired competences; and c) at 3-6 months follow-up, to assess performance in daily practice. The e-learning will be freely available in the Virtual Campus for Public Health of the Pan American Health Organization in Spanish, English, and Portuguese. CONCLUSION Primary HCP, perceived as trustworthy sources of information, are key actors to increase the population's awareness and literacy on cancer prevention. Building capacity of these professionals has the potential to increase dissemination and impact of the LAC Code Against Cancer by prompting communication with the public and offering personalized actionable preventive messages through counselling.
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Affiliation(s)
- Ariadna Feliu
- International Agency for Research on Cancer (IARC/WHO), Environment and Lifestyle Epidemiology Branch, 25 avenue Tony Garnier CS 90627, Lyon CEDEX 07 69366, France.
| | - Carolyn Finck
- Departamento de Psicología, Universidad de los Andes, Cra 1 Nr 18A-12, Bogotá, Colombia
| | - Mariantonia Lemos
- Universidad EAFIT, Escuela de Artes y Humanidades, Carrera 49 #7 sur 50, Medellín, Colombia
| | - Arlette Bahena Botello
- Escuela de Salud Pública, Instituto Nacional de Salud Pública, Universidad 655 Colonia Santa María Ahuacatitlán, Cerrada Los Pinos y Caminera, Cuernavaca, Morelos, Mexico
| | - Fernanda de Albuquerque Melo Nogueira
- Instituto Nacional do Câncer José Alencar Gomes da Silva, Coordenação de Prevenção e Controle do Câncer, Área Técnica Ambiente, Trabalho e Câncer, Rua Marqueês de Pombal, 125, 5o andar, Centro, Rio de Janeiro CEP: 20230-240, Brazil
| | - Anabelle Bonvecchio Arenas
- Centro de Investigación en Nutrición y Salud (CINyS), Instituto Nacional de Salud Pública, Universidad No. 655 Colonia Santa María Ahuacatitlán, Cerrada Los Pinos y Caminera, Cuernavaca, Morelos, Mexico
| | - Isabel C Garcés-Palacio
- Grupo de Epidemiología, Facultad Nacional de Salud Pública, Universidad de Antioquia UdeA, Calle 70 No. 52-21, Medellín, Colombia
| | - Claudia Jurberg
- Fundação Carlos Chagas Filho de Amparo à Pesquisa do Estado do Rio de Janeiro, Av. Erasmo Braga 118 - 6º andar, Rio de Janeiro, Brazil
| | - Karina Pesce
- Diagnostico e Intervencionismo mamario del Hospital Italiano de Buenos Aires Argentina, Peron 4190. Capital Federal, Argentina
| | - Carolina Espina
- International Agency for Research on Cancer (IARC/WHO), Environment and Lifestyle Epidemiology Branch, 25 avenue Tony Garnier CS 90627, Lyon CEDEX 07 69366, France
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16
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Lemos M, Restrepo J, Espina C, Feliu A, Ferreccio C, Garcés-Palacio IC, Jurberg C, de Albuquerque Melo F, Cornejo-Ovalle M, Arrossi S, Murillo R, Acosta Pérez E, Venegas G, Finck C. Latin America and the Caribbean Code Against Cancer 1st edition: Formative research on the comprehension and persuasiveness of the recommendations by the general population. Cancer Epidemiol 2023; 86 Suppl 1:102456. [PMID: 37852727 DOI: 10.1016/j.canep.2023.102456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 09/13/2023] [Accepted: 09/20/2023] [Indexed: 10/20/2023]
Abstract
BACKGROUND Cancer prevention is the most efficient and cost-effective strategy in cancer control. One prevention strategy is giving credible, clear, and evidence-based recommendations to the individual; however, it is key that these messages are accepted and understood properly by the public. This study aimed to pilot the draft recommendations developed as part of the Latin America and the Caribbean (LAC) Code Against Cancer 1st edition, in terms of comprehension and persuasion of each message. METHODS A mixed method two-wave study, in which two versions of the messages were presented to the general population in five LAC countries. We used an ad-hoc questionnaire and interviews that followed the cognitive-pretesting methodology. RESULTS Findings suggest that the messages were generally well understood, especially in Spanish speaking countries, and that the messages were generally more understandable than persuasive. We adapted and revised the recommendations based on the findings of the first Wave and held a second iteration in the Spanish speaking countries. We observed a better understanding of most messages in Wave 2. CONCLUSION The LAC Code Against Cancer is a valuable tool of well understood messages for the public, with concrete actions everyone can take to prevent cancer. Further research should assess particularities of the region for further efficient dissemination of these important health messages, identify key messages for certain population groups and future interventions that strengthen health literacy in rural and less educated populations to increase behavior change.
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Affiliation(s)
- Mariantonia Lemos
- Escuela de Artes y Humanidades, Universidad EAFIT, Medellín, Colombia
| | - Julia Restrepo
- Escuela de Artes y Humanidades, Universidad EAFIT, Medellín, Colombia
| | - Carolina Espina
- International Agency for Research on Cancer (IARC/WHO), Environment and Lifestyle Epidemiology Branch, 25 avenue Tony Garnier CS 90627, 69366 CEDEX 07 Lyon, France
| | - Ariadna Feliu
- International Agency for Research on Cancer (IARC/WHO), Environment and Lifestyle Epidemiology Branch, 25 avenue Tony Garnier CS 90627, 69366 CEDEX 07 Lyon, France
| | - Catterina Ferreccio
- Facultad de Medicina, Departamento de Salud Pública, Pontificia Universidad Católica de Chile, Santiago, Chile. Advanced Center for Chronic Diseases (ACCDiS), Santiago, Chile
| | | | - Claudia Jurberg
- Oswaldo Cruz Institute, Oswaldo Cruz Foundation and Carlos Chagas Filho Foundation for Research Support of Rio de Janeiro State (FAPERJ), Rio de Janeiro, Brazil
| | | | | | - Silvina Arrossi
- Centre for the Study of State and Society, National Council for Scientific and Technical Research, Buenos Aires, Argentina
| | - Raúl Murillo
- Centro Javeriano de Oncología - Hospital Universitario San Ignacio - Facultad de Medicina - Pontificia Universidad Javeriana, Bogotá, Colombia
| | | | - Gino Venegas
- Clínica Angloamericana Lima-Peru - Facultad de medicina, Universidad de Piura, Lima, Peru
| | - Carolyn Finck
- Departamento de Psicología Universidad de los Andes, Bogotá, Colombia.
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Baena A, Paolino M, Villarreal-Garza C, Torres G, Delgado L, Ruiz R, Canelo-Aybar C, Song Y, Feliu A, Maza M, Jeronimo J, Espina C, Almonte M. Latin America and the Caribbean Code Against Cancer 1st Edition: Medical interventions including hormone replacement therapy and cancer screening. Cancer Epidemiol 2023; 86 Suppl 1:102446. [PMID: 37852728 DOI: 10.1016/j.canep.2023.102446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 08/04/2023] [Accepted: 08/17/2023] [Indexed: 10/20/2023]
Abstract
Prostate, breast, colorectal, cervical, and lung cancers are the leading cause of cancer in Latin America and the Caribbean (LAC) accounting for nearly 50% of cancer cases and cancer deaths in the region. Following the IARC Code Against Cancer methodology, a group of Latin American experts evaluated the evidence on several medical interventions to reduce cancer incidence and mortality considering the cancer burden in the region. A recommendation to limit the use of HRT was issued based on the risk associated to develop breast, endometrial, and ovarian cancer and on growing concerns related to the over-the-counter and without prescription sales, which in turn bias estimations on current use in LAC. In alignment with WHO breast and cervical cancer initiatives, biennial screening by clinical breast examination (performed by trained health professionals) from the age of 40 years and biennial screening by mammography from the age of 50 years to 74, as well as cervical screening by HPV testing (either self-sampling or provider-sampling) every 5-10 years for women aged 30-64 years, were recommended. The steadily increasing rates of colorectal cancer in LAC also led to recommend colorectal screening by occult blood testing every two years or by endoscopic examination of the colorectum every 10 years for both men and women aged 50-74 years. After evaluating the evidence, the experts decided not to issue recommendations for prostate and lung cancer screening; while there was insufficient evidence on prostate cancer mortality reduction by prostate-specific antigen (PSA) testing, there was evidence of mortality reduction by low-dose computed tomography (LDCT) targeting high-risk individuals (mainly heavy and/or long-term smokers) but not individuals with average risk to whom recommendations of this Code are directed. Finally, the group of experts adapted the gathered evidence to develop a competency-based online microlearning program for building cancer prevention capacity of primary care health professionals.
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Affiliation(s)
- Armando Baena
- Early Detection, Prevention & Infections Branch, International Agency for Research on Cancer (IARC/WHO), Lyon, France.
| | - Melisa Paolino
- Centro de Estudios de Estado y Sociedad / Consejo Nacional de Investigaciones Científicas y Técnicas, Buenos Aires, Argentina
| | - Cynthia Villarreal-Garza
- Centro de Cáncer de Mama, Hospital Zambrano Hellion - TecSalud, Tecnológico de Monterrey, Monterrey, Mexico
| | - Gabriela Torres
- Centro de Investigación en Salud Poblacional, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, Mexico
| | - Lucia Delgado
- Escuela de Graduados, Facultad de Medicina, Universidad de la República, Montevideo, Uruguay
| | - Rossana Ruiz
- Instituto Nacional de Enfermedades Neoplásicas, Lima, Peru
| | - Carlos Canelo-Aybar
- Department of Clinical Epidemiology and Public Health, Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain
| | - Yang Song
- Department of Clinical Epidemiology and Public Health, Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain
| | - Ariadna Feliu
- International Agency for Research on Cancer (IARC/WHO), Environment and Lifestyle Epidemiology Branch, 25 avenue Tony Garnier CS 90627, 69366 CEDEX 07 Lyon, France
| | - Mauricio Maza
- Department of Noncommunicable Diseases and Mental Health, Unit of Noncommunicable Diseases, Violence, and Injury Prevention, Pan American Health Organization, Washington, DC, USA
| | - Jose Jeronimo
- Division of Cancer Epidemiology and Genetics, Department of Health and Human Services, National Cancer Institute, National Institutes of Health, Bethesda, USA
| | - Carolina Espina
- International Agency for Research on Cancer (IARC/WHO), Environment and Lifestyle Epidemiology Branch, 25 avenue Tony Garnier CS 90627, 69366 CEDEX 07 Lyon, France
| | - Maribel Almonte
- Early Detection, Prevention & Infections Branch, International Agency for Research on Cancer (IARC/WHO), Lyon, France
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Espina C, Feliu A, Maza M, Almonte M, Ferreccio C, Finck C, Herrero R, Dommarco JR, de Almeida LM, Arrossi S, García PJ, Garmendia ML, Mohar A, Murillo R, Santamaría J, Tortolero-Luna G, Cazap E, Gabriel OO, Paonessa D, Zoss JW, Luciani S, Carvalho A, Schüz J. Latin America and the Caribbean Code Against Cancer 1st Edition: 17 cancer prevention recommendations to the public and to policy-makers (World Code Against Cancer Framework). Cancer Epidemiol 2023; 86 Suppl 1:102402. [PMID: 37852725 DOI: 10.1016/j.canep.2023.102402] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 06/02/2023] [Accepted: 06/15/2023] [Indexed: 10/20/2023]
Abstract
Preventable risk factors are responsible of at least 40% of cases and almost 45% of all cancer deaths worldwide. Cancer is already the leading cause of death in almost half of the Latin American and the Caribbean countries constituting a public health problem. Cost-effective measures to reduce exposures through primary prevention and screening of certain types of cancers are critical in the fight against cancer but need to be tailored to the local needs and scenarios. The Latin America and the Caribbean (LAC) Code Against Cancer, 1st edition, consists of 17 evidence-based recommendations for the general public, based on the most recent solid evidence on lifestyle, environmental, occupational, and infectious risk factors, and medical interventions. Each recommendation is accompanied by recommendations for policymakers to guide governments establishing the infrastructure needed to enable the public adopting the recommendations. The LAC Code Against Cancer has been developed in a collaborative effort by a large number of experts from the region, under the umbrella strategy and authoritative methodology of the World Code Against Cancer Framework. The Code is a structured instrument ideal for cancer prevention and control that aims to raise awareness and educate the public, while building capacity and competencies to policymakers, health professionals, stakeholders, to contribute to reduce the burden of cancer in LAC.
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Affiliation(s)
- Carolina Espina
- International Agency for Research on Cancer (IARC/WHO), Environment and Lifestyle Epidemiology Branch, 25 avenue Tony Garnier CS 90627, 69366 CEDEX 07 Lyon, France.
| | - Ariadna Feliu
- International Agency for Research on Cancer (IARC/WHO), Environment and Lifestyle Epidemiology Branch, 25 avenue Tony Garnier CS 90627, 69366 CEDEX 07 Lyon, France
| | - Mauricio Maza
- Pan American Health Organization (PAHO), Cancer Prevention and Control, Washington, DC 20037, United States
| | - Maribel Almonte
- World Health Organization (WHO), Department of Sexual and Reproductive Health and Research, Geneva, Switzerland
| | - Catterina Ferreccio
- Departamento de Salud Pública, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile; Advanced Center for Chronic Diseases ACCDIS, Santiago, Chile
| | - Carolyn Finck
- Departamento de Psicología, Universidad de los Andes, Bogotá, Colombia
| | - Rolando Herrero
- Agencia Costarricense de Investigaciones Biomédicas, Fundación INCIENSA, Costa Rica
| | | | - Liz Maria de Almeida
- National Cancer Institute of Brazil (INCA), Prevention and Surveillance, Rio de Janeiro, Brazil
| | - Silvina Arrossi
- Centro de Estudios de Estado y Sociedad (CEDES), Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Buenos Aires, Argentina
| | | | | | - Alejandro Mohar
- Instituto Nacional de Cancerología, Instituto de Investigaciones Biomédicas (UNAM), Tlalpan, Mexico
| | - Raúl Murillo
- Centro Javeriano de Oncología, Hospital Universitario San Ignacio, Bogotá, Colombia
| | | | | | - Eduardo Cazap
- Sociedad Latinoamercia y del Caribe de Oncología Médica (SLACOM), Red de Institutos e Instituciones Nacionales de Cáncer (RINC-SLACOM), Buenos Aires, Argentina
| | - Owen O Gabriel
- Owen King EU Hospital, Department of Oncology, Saint Lucia
| | - Diego Paonessa
- Asociación Latina e Ibérica Contra el Cáncer (ALICC), Buenos Aires, Argentina
| | - J Walter Zoss
- Red de Institutos e Instituciones Nacionales de Cáncer (RINC-SLACOM), Rio de Janeiro, Brazil
| | - Silvana Luciani
- Pan American Health Organization (PAHO), Cancer Prevention and Control, Washington, DC 20037, United States
| | - Andre Carvalho
- International Agency for Research on Cancer (IARC/WHO), Environment and Lifestyle Epidemiology Branch, 25 avenue Tony Garnier CS 90627, 69366 CEDEX 07 Lyon, France
| | - Joachim Schüz
- International Agency for Research on Cancer (IARC/WHO), Environment and Lifestyle Epidemiology Branch, 25 avenue Tony Garnier CS 90627, 69366 CEDEX 07 Lyon, France
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19
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Mujica OJ, Sanhueza A, Carvajal-Velez L, Vidaletti LP, Costa JC, Barros AJD, Victora CG. Recent trends in maternal and child health inequalities in Latin America and the Caribbean: analysis of repeated national surveys. Int J Equity Health 2023; 22:125. [PMID: 37393277 PMCID: PMC10314462 DOI: 10.1186/s12939-023-01932-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 06/07/2023] [Indexed: 07/03/2023] Open
Abstract
BACKGROUND Although most Latin American and the Caribbean (LAC) countries made important progress in maternal and child health indicators from the 1990s up to 2010, little is known about such progress in the last decade. This study aims at documenting progress for each country as a whole, and to assess how within-country socioeconomic inequalities are evolving over time. METHODS We identified LAC countries for which a national survey was available between 2011-2015 and a second comparable survey in 2018-2020. These included Argentina, Costa Rica, Cuba, the Dominican Republic, Guyana, Honduras, Peru, and Suriname. The 16 surveys included in the analysis collected nationally representative data on 221,989 women and 152,983 children using multistage sampling. Twelve health-related outcomes were studied, seven of which related to intervention coverage: the composite coverage index, demand for family planning satisfied with modern methods, antenatal care (four or more visits and eight or more visits), skilled attendant at birth, postnatal care for the mother and full immunization coverage. Five additional impact indicators were also investigated: stunting prevalence among under-five children, tobacco use by women, adolescent fertility rate, and under-five and neonatal mortality rates. For each of these indicators, average annual relative change rates were calculated between the baseline and endline national level estimates, and changes in socioeconomic inequalities over time were assessed using the slope index of inequality. RESULTS Progress over time and the magnitude of inequalities varied according to country and indicator. For countries and indicators where baseline levels were high, as Argentina, Costa Rica and Cuba, progress was slow and inequalities small for most indicators. Countries that still have room for improvements, such as Guyana, Honduras, Peru and Suriname, showed faster progress for some but not all indicators, although also had wider inequalities. Among the countries studied, Peru was the top performer in terms of increasing coverage and reducing inequalities over time, followed by Honduras. Declines in family planning and immunization coverage were observed in some countries, and the widest inequalities were present for adolescent fertility and antenatal care coverage with eight or more visits. CONCLUSIONS Although LAC countries are well placed in terms of current levels of health indicators compared to most low- and middle-income countries, important inequalities remain, and reversals are being observed in some areas. More targeted efforts and actions are needed in order to leave no one behind. Monitoring progress with an equity lens is essential, but this will require further investment in conducting surveys routinely.
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Affiliation(s)
- Oscar J Mujica
- Pan American Health Organization (PAHO), 525 23Rd Street NW, Washington, DC, 20037, USA.
| | - Antonio Sanhueza
- Pan American Health Organization (PAHO), 525 23Rd Street NW, Washington, DC, 20037, USA
| | - Liliana Carvajal-Velez
- United Nations International Children Emergency Fund (UNICEF), New York City, USA
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Luis Paulo Vidaletti
- International Center for Equity in Health (ICEH), Federal University of Pelotas, Pelotas, Brazil
| | - Janaína C Costa
- International Center for Equity in Health (ICEH), Federal University of Pelotas, Pelotas, Brazil
| | - Aluísio J D Barros
- International Center for Equity in Health (ICEH), Federal University of Pelotas, Pelotas, Brazil
| | - Cesar G Victora
- International Center for Equity in Health (ICEH), Federal University of Pelotas, Pelotas, Brazil
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Luz PM, Deshpande V, Kazemian P, Scott JA, Shebl FM, Spaeth H, Pimenta C, Stern M, Pereira G, Struchiner CJ, Grinsztejn B, Veloso VG, Freedberg KA. Impact of pre-exposure prophylaxis uptake among gay, bisexual, and other men who have sex with men in urban centers in Brazil: a modeling study. BMC Public Health 2023; 23:1128. [PMID: 37308858 PMCID: PMC10262537 DOI: 10.1186/s12889-023-15994-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Accepted: 05/23/2023] [Indexed: 06/14/2023] Open
Abstract
BACKGROUND Men who have sex with men (MSM) in Brazil remain disproportionately affected by HIV. We estimated the potential incidence reduction by five years with increased uptake of publicly-funded, daily, oral tenofovir/emtricitabine (TDF/FTC) for HIV pre-exposure prophylaxis (PrEP) among MSM using the Cost Effectiveness of Preventing AIDS Complications microsimulation model. We used national data, local studies, and literature to inform model parameters for three cities: Rio de Janeiro, Salvador, and Manaus. RESULTS In Rio de Janero, a PrEP intervention achieving 10% uptake within 60 months would decrease incidence by 2.3% whereas achieving 60% uptake within 24 months would decrease incidence by 29.7%; results were similar for Salvador and Manaus. In sensitivity analyses, decreasing mean age at PrEP initiation from 33 to 21 years increased incidence reduction by 34%; a discontinuation rate of 25% per year decreased it by 12%. CONCLUSION Targeting PrEP to young MSM and minimizing discontinuation could substantially increase PrEP's impact.
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Affiliation(s)
- Paula M Luz
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Avenida Brasil 4365, Rio de Janeiro, 21040-360, Brazil.
| | - Vijeta Deshpande
- Medical Practice Evaluation Center, Massachusetts General Hospital, 100 Cambridge Street, Suite 1684, Boston, MA, 02114, USA
| | - Pooyan Kazemian
- Department of Operations, Weatherhead School of Management, Case Western Reserve University, 11119 Bellflower Road, Cleveland, OH, 44106, USA
| | - Justine A Scott
- Medical Practice Evaluation Center, Massachusetts General Hospital, 100 Cambridge Street, Suite 1684, Boston, MA, 02114, USA
| | - Fatma M Shebl
- Medical Practice Evaluation Center, Massachusetts General Hospital, 100 Cambridge Street, Suite 1684, Boston, MA, 02114, USA
| | - Hailey Spaeth
- Medical Practice Evaluation Center, Massachusetts General Hospital, 100 Cambridge Street, Suite 1684, Boston, MA, 02114, USA
| | - Cristina Pimenta
- Ministry of Health of Brazil, SRTVN Quadra 701, Lote D, Edifício PO700, 5º Andar, Brasília/DFBrasilia, 70719-040, Brazil
| | - Madeline Stern
- Medical Practice Evaluation Center, Massachusetts General Hospital, 100 Cambridge Street, Suite 1684, Boston, MA, 02114, USA
| | - Gerson Pereira
- Ministry of Health of Brazil, SRTVN Quadra 701, Lote D, Edifício PO700, 5º Andar, Brasília/DFBrasilia, 70719-040, Brazil
| | | | - Beatriz Grinsztejn
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Avenida Brasil 4365, Rio de Janeiro, 21040-360, Brazil
| | - Valdilea G Veloso
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Avenida Brasil 4365, Rio de Janeiro, 21040-360, Brazil
| | - Kenneth A Freedberg
- Medical Practice Evaluation Center, Massachusetts General Hospital, 100 Cambridge Street, Suite 1684, Boston, MA, 02114, USA
- Harvard Medical School, 25 Shattuck Street, Boston, MA, 02115, USA
- Harvard University Center for AIDS Research, Harvard Medical School, 42 Church Street, Cambridge, MA, 02138, USA
- Division of General Internal Medicine, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA
- Division of Infectious Diseases, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA
- Department of Health Policy and Management, Harvard School of Public Health, 677 Huntington Ave, Boston, MA, 02115, USA
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López-Cortés A, Esperón P, Martínez MF, Redal MA, Lazarowski A, Varela NM, Lares-Asseff I, Quiñones LA. Editorial: Pharmacogenetics and pharmacogenomics in Latin America: ethnic variability, new insights in advances and perspectives: a RELIVAF-CYTED initiative, Volume II. Front Pharmacol 2023; 14:1211712. [PMID: 37205907 PMCID: PMC10189108 DOI: 10.3389/fphar.2023.1211712] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 04/26/2023] [Indexed: 05/21/2023] Open
Affiliation(s)
- Andrés López-Cortés
- Cancer Research Group (CRG), Faculty of Medicine, Universidad de Las Américas, Quito, Ecuador
- Latin American Network for the Implementation and Validation of Clinical Pharmacogenomics Guidelines (RELIVAF-CYTED), Santiago, Chile
| | - Patricia Esperón
- Latin American Network for the Implementation and Validation of Clinical Pharmacogenomics Guidelines (RELIVAF-CYTED), Santiago, Chile
- Molecular Genetics Laboratory, Clinical Biochemistry Department, School of Chemistry, Universidad de la República, Montevideo, Uruguay
| | - Matías F. Martínez
- Latin American Network for the Implementation and Validation of Clinical Pharmacogenomics Guidelines (RELIVAF-CYTED), Santiago, Chile
- Laboratory of Chemical Carcinogenesis and Pharmacogenetics, Department of Basic-Clinical Oncology (DOBC), Faculty of Medicine, University of Chile, Santiago, Chile
- Department of Pharmaceutical Science and Technology, Faculty of Chemical and Pharmaceutical Sciences, University of Chile, Santiago, Chile
| | - María A. Redal
- Latin American Network for the Implementation and Validation of Clinical Pharmacogenomics Guidelines (RELIVAF-CYTED), Santiago, Chile
- Genetic Division, Department of Medicine, Faculty of Medicine, Hospital de Clínicas José de San Martín, Buenos Aires University, Buenos Aires, Argentina
- Clinical Biochemistry Department, Faculty of Pharmacy and Biochemistry, Institute for Research in Physiopathology and Clinical Biochemistry (INFIBIOC), Hospital de Clínicas José de San Martín, University of Buenos Aires, Buenos Aires, Argentina
| | - Alberto Lazarowski
- Latin American Network for the Implementation and Validation of Clinical Pharmacogenomics Guidelines (RELIVAF-CYTED), Santiago, Chile
- Clinical Biochemistry Department, Faculty of Pharmacy and Biochemistry, Institute for Research in Physiopathology and Clinical Biochemistry (INFIBIOC), Hospital de Clínicas José de San Martín, University of Buenos Aires, Buenos Aires, Argentina
| | - Nelson M. Varela
- Latin American Network for the Implementation and Validation of Clinical Pharmacogenomics Guidelines (RELIVAF-CYTED), Santiago, Chile
- Laboratory of Chemical Carcinogenesis and Pharmacogenetics, Department of Basic-Clinical Oncology (DOBC), Faculty of Medicine, University of Chile, Santiago, Chile
| | - Ismael Lares-Asseff
- Latin American Network for the Implementation and Validation of Clinical Pharmacogenomics Guidelines (RELIVAF-CYTED), Santiago, Chile
- Academy of Genomics and Laboratory of Pharmacogenomics and Molecular Biomedicine, Instituto Politécnico Nacional, CIIDIR-Unidad Durango, Durango, Mexico
| | - Luis A. Quiñones
- Latin American Network for the Implementation and Validation of Clinical Pharmacogenomics Guidelines (RELIVAF-CYTED), Santiago, Chile
- Laboratory of Chemical Carcinogenesis and Pharmacogenetics, Department of Basic-Clinical Oncology (DOBC), Faculty of Medicine, University of Chile, Santiago, Chile
- Department of Pharmaceutical Science and Technology, Faculty of Chemical and Pharmaceutical Sciences, University of Chile, Santiago, Chile
- *Correspondence: Luis A. Quiñones,
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Costa JC, Mujica OJ, Gatica-Domínguez G, del Pino S, Carvajal L, Sanhueza A, Caffe S, Victora CG, Barros AJ. Inequalities in the health, nutrition, and wellbeing of Afrodescendant women and children: A cross-sectional analysis of ten Latin American and Caribbean countries. Lancet Reg Health Am 2022; 15:100345. [PMID: 36405302 PMCID: PMC9669334 DOI: 10.1016/j.lana.2022.100345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
BACKGROUND Afrodescendants are systematically affected by discrimination in the Americas and few multi-country studies addressed ethnic inequalities in health and wellbeing in the region. We aimed to investigate gaps in coverage of key health outcomes and socioeconomic inequalities between Afrodescendants and non-Afrodescendants populations in Latin American and Caribbean countries. METHODS Using national household surveys (2011-2019) from ten countries, we analyzed absolute inequalities between Afrodescendants and a comparison group that includes non-Afrodescendants and non-Indigenous individuals (henceforth non-Afrodescendants) across 17 indicators in the continuum of reproductive, maternal, newborn, child, and adolescent health. These include indicators of family planning, antenatal care, delivery assistance, child nutrition, immunization coverage, child protection, access to improved water, sanitation and hygiene, adolescent fertility, and early childhood mortality. Inequalities between country-specific subgroups of Afrodescendants were also explored. The slope index of inequality was used to assess wealth-based inequalities within each ethnic group. FINDINGS Afrodescendants represented from 2·8% (Honduras) to 59·1% (Brazil) of the national samples. Of the 128 combinations of country and indicators with data, Afrodescendants fared worse in 78 (of which 33 were significant) and performed better in 50 (15 significant). More systematic disadvantages for Afrodescendants were found for demand for family planning satisfied, early marriage, and household handwashing and sanitation facilities. In contrast, Afrodescendants tended to present lower c-section rates and lower stunting prevalence. Honduras was the only country where Afrodescendants performed better than non-Afrodescendants in several indicators. Wealth gaps among Afrodescendants were wider than those observed for non-Afrodescendants for most indicators and across all countries. INTERPRETATION Gaps in health outcomes between Afrodescendants and non-Afrodescendants were observed in most countries, with more frequent disadvantages for the former although, in many cases, the gaps were reversed. Wealth inequalities within Afrodescendants tended to be wider than for non-Afrodescendants. FUNDING Pan American Health Organization, Bill and Melinda Gates Foundation, and the Wellcome Trust.
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Affiliation(s)
- Janaína Calu Costa
- International Center for Equity in Health, Federal University of Pelotas, Brazil
| | | | | | | | - Liliana Carvajal
- Division of Data, Analytics, Planning and Monitoring, Data and Analytics Section, UNICEF, New York, USA
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | | | - Sonja Caffe
- Pan American Health Organization, Washington D.C., USA
| | - Cesar G. Victora
- International Center for Equity in Health, Federal University of Pelotas, Brazil
| | - Aluísio J.D. Barros
- International Center for Equity in Health, Federal University of Pelotas, Brazil
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Husaini DC, Reneau K, Balam D. Air pollution and public health in Latin America and the Caribbean (LAC): a systematic review with meta-analysis. Beni Suef Univ J Basic Appl Sci 2022; 11:122. [PMID: 36196224 DOI: 10.1186/s43088-022-00305-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 09/19/2022] [Indexed: 11/26/2022] Open
Abstract
Background Over the years, air pollution has garnered increased attention from researchers who continue to provide studies and suggestive data that prove there is an ever-increasing risk of air pollution on the health of humans, terrestrial, and aquatic animals. A measurement involved in the quantity of certain traceable particles within the air, namely: Particulate Matter (PM) 2.5 and 10, ozone (O3), Nitrogen dioxide (NO2), sulfur dioxide (SO2), and carbon monoxide (CO) emissions, all converted to Air Quality Index. Most studies are predominantly from developed nations with limited research conducted in developing nations such as those in Latin America and the Caribbean. Main body In this systematic review, we examined the impact of air pollution on public health. A database search produced 1,118 studies, of which four were selected for a quantitative meta-analysis that explored hazard ratios concerning exposure to elevated levels of PM2.5. The meta-analysis results show that exposure to PM2.5 increases the risk of an adverse health event by as much as 2% five days after exposure. Results also indicated a consensus on the negative impacts of air pollution on public health. The results also suggest that more can be done within the region to combat or at the very least minimize the impact of air pollution to public health. Conclusion The pooled data from the studies reviewed show that there is an increased risk of an adverse health event on the day of exposure to PM2.5 and every subsequent day after exposure. A pattern exists between hospitalization and air pollution due to increased susceptibility to respiratory infections and asthma development. Combating the harmful effects of air pollution should be a top priority in Latin America and the Caribbean.
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Cabella W, Velázquez C. Abortion Legalization in Uruguay: Effects on Adolescent Fertility. Stud Fam Plann 2022; 53:491-514. [PMID: 35767463 DOI: 10.1111/sifp.12204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
The Latin American and Caribbean adolescent fertility rates are among the highest in the world: about 1.7 million children are born to teen mothers every year, and most of them are declared unintended pregnancies. The region also has the highest rate of unintended pregnancy of any world region, and nearly half of such pregnancies end in abortion. However, fewer than 18 percent of the region's women live in countries where abortion is broadly legal. This paper estimates the causal effect of abortion legalization on adolescent fertility in Uruguay using official data on legal abortions provided after the 2012 reform. We employed a difference-in-differences strategy, classifying states by whether they are responsive or unresponsive to the reform. The results suggest that abortion reform had a negative impact on the adolescent birth rate by 2.5-2.8 births per thousand adolescents aged 15-19 (a 4 percent decrease from the preintervention average). Additionally, we exploited variation in reform implementation intensity through the estimation of fixed-effect linear regression models and found consistent results. Our findings are robust to controlling for a concurrent large-scale program of contraceptive implants. We conclude that legislation aimed at enhancing rights and reducing avoidable deaths and complications from unsafe abortions may also have spillover effects that help reduce adolescent fertility.
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Affiliation(s)
- Wanda Cabella
- Programa de Población, Facultad de Ciencias Sociales, Universidad de la República del Uruguay, Montevideo, 11200, Uruguay
| | - Cecilia Velázquez
- Centre for Distributive, Labor, and Social Studies (CEDLAS-UNLP, Argentina), National Council of Scientific and Technical Research (CONICET, Argentina), CP(1900) La Plata, Buenos Aires, Argentina and Centre for Economic Research (CINVE, Uruguay), Montevideo, 11200, Uruguay
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Sanhueza A, Carvajal L, Cueva DA, Caffe S, Camacho AV, Berroterán MA, Horowitz D, Gordillo-Tobar A, Mujica OJ. The Every Woman Every Child initiative: supporting countries in Latin America and the Caribbean to reduce social inequalities in health. Int J Equity Health 2022; 21:83. [PMID: 35701816 PMCID: PMC9196148 DOI: 10.1186/s12939-022-01682-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 05/26/2022] [Indexed: 11/25/2022] Open
Abstract
The Every Woman Every Child Latin America and the Caribbean (EWEC-LAC) initiative was established in 2017 as a regional inter-agency mechanism. EWEC-LAC coordinates the regional implementation of the Global Strategy for Women’s, Children’s and Adolescents’ Health in Latin America and the Caribbean (LAC), including adaptation to region specific needs, to end preventable deaths, ensure health and well-being and expand enabling environments for the health and well-being of women, children and adolescents. To advance the equitable achievement of these objectives, EWEC-LAC’s three working groups collectively support LAC countries in measuring and monitoring social inequalities in health, advocating for their reduction, and designing and implementing equity-oriented strategies, policies and interventions. This support for data-driven advocacy, capacity building, and policy and program solutions toward closing current gaps ensures that no one is left behind. Members of EWEC-LAC include PAHO, UNAIDS, UNFPA, UNICEF, UN WOMEN, the World Bank, the Inter-American Development Bank, USAID, LAC Regional Neonatal Alliance, and the LAC Regional Task Force for the Reduction of Maternal Mortality. To date, EWEC-LAC has developed and collected innovative tools and resources and begun to engage with countries to utilize them to reduce equity gaps. These resources include a framework for the measurement of social inequalities in health, data use and advocacy tools including a data dashboard to visualize trends in social inequalities in health in LAC countries, a methodology for setting targets for the reduction of inequalities, and a compendium of tools, instruments and methods to identify and address social inequalities in health. EWEC-LAC has also engaged regionally to emphasize the importance of recognizing these inequalities at social and political levels, and advocated for the reduction of these gaps. Attention to closing health equity gaps is ever more critical in the face of the COVID-19 pandemic which has exploited existing vulnerabilities. More equitable health systems will be better prepared to confront future health shocks.
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Affiliation(s)
- Antonio Sanhueza
- Department of Evidence and Intelligence for Action in Health, Pan American Health Organization, PAHO/WHO, Washington, DC, USA.
| | - Liliana Carvajal
- Division of Data Analytics Planning and Monitoring, Data and Analytics Section, UNICEF, NY, New York, USA.,Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | | | - Sonja Caffe
- Family, Promotion and Life Course Department, Pan American Health Organization, PAHO/WHO, Washington, DC, USA
| | - Alma Virginia Camacho
- United Nations Population Fund, Regional Office for Latin American and the Caribbean (UNFPA LACRO), Panama City, Panama
| | - María Alejandra Berroterán
- Communications Officer, Regional Office for Latin American and the Caribbean, UNICEF, Panama City, Panama
| | - Deborah Horowitz
- Bureau for Latin America and the Caribbean, United States Agency for International Development, Washington, DC, USA
| | | | - Oscar J Mujica
- Department of Evidence and Intelligence for Action in Health, Pan American Health Organization, PAHO/WHO, Washington, DC, USA
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Cohorts Consortium of Latin America and the Caribbean (CC-LAC). Derivation, internal validation, and recalibration of a cardiovascular risk score for Latin America and the Caribbean (Globorisk-LAC): A pooled analysis of cohort studies. Lancet Reg Health Am 2022; 9:None. [PMID: 35711683 DOI: 10.1016/j.lana.2022.100258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Background Risk stratification is a cornerstone of cardiovascular disease (CVD) prevention and a main strategy proposed to achieve global goals of reducing premature CVD deaths. There are no cardiovascular risk scores based on data from Latin America and the Caribbean (LAC) and it is unknown how well risk scores based on European and North American cohorts represent true risk among LAC populations. Methods We developed a CVD (including coronary heart disease and stroke) risk score for fatal/non-fatal events using pooled data from 9 prospective cohorts with 21,378 participants and 1,202 events. We developed laboratory-based (systolic blood pressure, total cholesterol, diabetes, and smoking), and office-based (body mass index replaced total cholesterol and diabetes) models. We used Cox proportional hazards and held back a subset of participants to internally validate our models by estimating Harrell's C-statistic and calibration slopes. Findings The C-statistic for the laboratory-based model was 72% (70-74%), the calibration slope was 0.994 (0.934-1.055) among men and 0.852 (0.761-0.942) among women; for the office-based model the C-statistic was 71% (69-72%) and the calibration slope was 1.028 (0.980-1.076) among men and 0.811 (0.663-0.958) among women. In the pooled sample, using a 20% risk threshold, the laboratory-based model had sensitivity of 21.9% and specificity of 94.2%. Lowering the threshold to 10% increased sensitivity to 52.3% and reduced specificity to 78.7%. Interpretation The cardiovascular risk score herein developed had adequate discrimination and calibration. The Globorisk-LAC would be more appropriate for LAC than the current global or regional risk scores. This work provides a tool to strengthen risk-based cardiovascular prevention in LAC. Funding Wellcome Trust (214185/Z/18/Z).
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Brettler JW, Arcila GPG, Aumala T, Best A, Campbell NR, Cyr S, Gamarra A, Jaffe MG, la Rosa MJD, Maldonado J, Ojeda CN, Haughton M, Malcolm T, Perez V, Rodriguez G, Rosende A, González YV, Wood PW, Zúñiga E, Ordunez P. Drivers and scorecards to improve hypertension control in primary care practice: Recommendations from the HEARTS in the Americas Innovation Group. Lancet Reg Health Am 2022; 9:None. [PMID: 35711685 PMCID: PMC9121401 DOI: 10.1016/j.lana.2022.100223] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Background Cardiovascular disease (CVD) is the leading cause of morbidity and mortality in the Americas, and hypertension is the most significant modifiable risk factor. However, hypertension control rates remain low, and CVD mortality is stagnant or rising after decades of continuing reduction. In 2016, the World Health Organization (WHO) launched the HEARTS technical package to improve hypertension control. The Pan American Health Organization (PAHO) designed the HEARTS in the Americas Initiative to improve CVD risk management, emphasizing hypertension control, to date implemented in 21 countries. Methods To advance implementation, an interdisciplinary group of practitioners was engaged to select the key evidence-based drivers of hypertension control and to design a comprehensive scorecard to monitor their implementation at primary care health facilities (PHC). The group studied high-performing health systems that achieve high hypertension control through quality improvement programs focusing on specific process measures, with regular feedback to providers at health facilities. Findings The final selected eight drivers were categorized into five main domains: (1) diagnosis (blood pressure measurement accuracy and CVD risk evaluation); (2) treatment (standardized treatment protocol and treatment intensification); (3) continuity of care and follow-up; (4) delivery system (team-based care, medication refill), and (5) system for performance evaluation. The drivers and recommendations were then translated into process measures, resulting in two interconnected scorecards integrated into the HEARTS in the Americas monitoring and evaluation system. Interpretation Focus on these key hypertension drivers and resulting scorecards, will guide the quality improvement process to achieve population control goals at the participating health centers in HEARTS implementing countries. Funding No funding to declare.
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Affiliation(s)
- Jeffrey W Brettler
- Southern California Permanente Medical Group, Los Angeles, CA, USA.,Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA, USA
| | - Gloria P Giraldo Arcila
- Department of Non-Communicable Diseases and Mental Health. Pan American Health Organization (PAHO), Washington, DC, USA
| | - Teresa Aumala
- Primary Health Care Center, Ministry of Health, Centro de Salud Conocoto, Quito, Ecuador
| | - Allana Best
- Ministry of Health, Park Street, Port of Spain, Trinidad and Tobago
| | - Norm Rc Campbell
- Department of Medicine, Physiology and Pharmacology and Community Health Sciences, Libin Cardiovascular Institute of Alberta, Calgary, AB, Canada
| | - Shana Cyr
- Ministry of Health, Wellness & Elderly Affairs, Sir Stanislaus James Building, Waterfront, Castries, Saint Lucia
| | - Angelo Gamarra
- Department of Non-Communicable Diseases and Mental Health. Pan American Health Organization (PAHO), Washington, DC, USA
| | - Marc G Jaffe
- Department of Endocrinology, The Permanente Medical Group, Kaiser San Francisco Medical Center, San Francisco, CA, USA
| | - Mirna Jimenez De la Rosa
- School of Public Health, Faculty of Health Sciences, Universidad Autónoma de Santo Domingo, Dominican Republic.,Oficina Escuela de Salud Pública, Ciudad Universitaria, Universidad Autónoma de Santo Domingo, Distrito Nacional, Dominican Republic
| | | | - Carolina Neira Ojeda
- Department of Noncommunicable Diseases, Ministry of Health, Santiago de Chile, Chile
| | | | - Taraleen Malcolm
- Pan American Health Organization (PAHO), Port of Spain, Trinidad and Tobago
| | - Vivian Perez
- Pan American Health Organization,(PAHO), Lima, Peru
| | - Gonzalo Rodriguez
- Pan American Health Organization, (PAHO), Ciudad Autónoma de Buenos Aires, Buenos Aires, Argentina
| | - Andres Rosende
- Department of Non-Communicable Diseases and Mental Health. Pan American Health Organization (PAHO), Washington, DC, USA
| | - Yamilé Valdés González
- National Technical Advisory Committee on Hypertension, University Hospital "General Calixto García", Havana, Cuba
| | - Peter W Wood
- Department of Medicine, Division of General Internal Medicine, University of Alberta, Edmonton, AB, Canada
| | - Eric Zúñiga
- Health Services Antofagasta, Servicio de Salud Antofagasta, Universidad de Antofagasta, Antofagasta, Chile
| | - Pedro Ordunez
- Department of Non-Communicable Diseases and Mental Health. Pan American Health Organization (PAHO), Washington, DC, USA
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Orona-Návar C, García-Morales R, Loge FJ, Mahlknecht J, Aguilar-Hernández I, Ornelas-Soto N. Microplastics in Latin America and the Caribbean: A review on current status and perspectives. J Environ Manage 2022; 309:114698. [PMID: 35183939 DOI: 10.1016/j.jenvman.2022.114698] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 01/21/2022] [Accepted: 02/07/2022] [Indexed: 06/14/2023]
Abstract
A literature review was carried out to analyze the current status of microplastic research in Latin America and the Caribbean (LAC). Specifically, this work focused on publications pertaining to (1) occurrence and distribution of microplastics in the environment, including water, sediments, and soil and (2) the environmental impact of MPs, particularly their presence and effects on aquatic and terrestrial organisms. The review included peer-reviewed articles from Scopus, Science Direct, Web of Science, Google Scholar and two iberoamerican open access databases (Redalyc and SciELO). It was found that LAC has only contributed to 5% of the global scientific output on microplastics, and overall the highest contributor within the region was Brazil (52%), followed by Chile (16%) and Mexico (13%). An additional section analyzing the barriers to conducting microplastic research in LAC and their exacerbation by the current COVID-19 pandemic was included to provide additional context behind the relatively low scientific production and improve recommendations encouraging research in this region.
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Affiliation(s)
- Carolina Orona-Návar
- Tecnologico de Monterrey, Escuela de Ingeniería y Ciencias, Ave. Eugenio Garza Sada 2501, Monterrey, N.L., 64849, Mexico
| | - Raul García-Morales
- Tecnologico de Monterrey, Escuela de Ingeniería y Ciencias, Ave. Eugenio Garza Sada 2501, Monterrey, N.L., 64849, Mexico; Centro de Nanociencias y Nanotecnología, Universidad Nacional Autónoma de México, Carretera Tijuana-Ensenada Km. 107, C.P. 22860, Ensenada, B.C., Mexico
| | - Frank J Loge
- Department of Civil and Environmental Engineering, University of California Davis, One Shields Avenue, Davis, CA, 95616, USA
| | - Jürgen Mahlknecht
- Tecnologico de Monterrey, Escuela de Ingeniería y Ciencias, Ave. Eugenio Garza Sada 2501, Monterrey, N.L., 64849, Mexico
| | - Iris Aguilar-Hernández
- Tecnologico de Monterrey, Escuela de Ingeniería y Ciencias, Ave. Eugenio Garza Sada 2501, Monterrey, N.L., 64849, Mexico.
| | - Nancy Ornelas-Soto
- Tecnologico de Monterrey, Escuela de Ingeniería y Ciencias, Ave. Eugenio Garza Sada 2501, Monterrey, N.L., 64849, Mexico.
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Varallyay NI, Kennedy C, Bennett SC, Peters DH. Strategies to promote evidence use for health programme improvement: learning from the experiences of embedded implementation research teams in Latin America and the Caribbean. Health Res Policy Syst 2022; 20:38. [PMID: 35392931 PMCID: PMC8991468 DOI: 10.1186/s12961-022-00834-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 03/06/2022] [Indexed: 11/24/2022] Open
Abstract
Background To achieve global health targets, innovative approaches are needed to strengthen the implementation of efficacious interventions. New approaches in implementation research that bring together health system decision-makers alongside researchers to collaboratively design, produce and apply research evidence are gaining traction. Embedded implementation research (EIR) approaches led by decision-maker principal investigators (DM PIs) appear promising in this regard. Our aim is to describe the strategies study teams employ in the post-research phase of EIR to promote evidence-informed programme or policy improvement. Methods We conducted a prospective, comparative case study of an EIR initiative in Bolivia, Colombia and Dominican Republic. Guided by a conceptual framework on EIR, we used semi-structured key informant interviews (n = 51) and document reviews (n = 20) to examine three decision-maker-led study teams (“cases”). Focusing on three processes (communication/dissemination, stakeholder engagement with evidence, integrating evidence in decision-making) and the main outcome (enacting improvements), we used thematic analysis to identify associated strategies and enabling or hindering factors. Results Across cases, we observed diverse strategies, shaped substantially by whether the DM PI was positioned to lead the response to study findings within their sphere of work. We found two primary change pathways: (1) DM PIs implement remedial measures directly, and (2) DM PIs seek to influence other stakeholders to respond to study findings. Throughout the post-research phase, EIR teams adapted research use strategies based on the evolving context. Conclusions EIR led by well-positioned DM PIs can facilitate impactful research translation efforts. We draw lessons around the importance of (1) understanding DM PI positionality, (2) ongoing assessment of the evolving context and stakeholders and (3) iterative adaptation to dynamic, uncertain circumstances. Findings may guide EIR practitioners in planning and conducting fit-for-purpose and context-sensitive strategies to advance the use of evidence for programme improvement. Supplementary Information The online version contains supplementary material available at 10.1186/s12961-022-00834-1.
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Affiliation(s)
- N Ilona Varallyay
- Health Systems Program, Department of International Health, Johns Hopkins School of Public Health, 615 N Wolfe St, Baltimore, MD, 21205, United States of America.
| | - Caitlin Kennedy
- Social and Behavioral Interventions Program, Department of International Health, Johns Hopkins School of Public Health, 615 N Wolfe St, Baltimore, MD, 21205, United States of America
| | - Sara C Bennett
- Health Systems Program, Department of International Health, Johns Hopkins School of Public Health, 615 N Wolfe St, Baltimore, MD, 21205, United States of America
| | - David H Peters
- Department of International Health, Johns Hopkins School of Public Health, 615 N Wolfe St, Baltimore, MD, 21205, United States of America
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Torres-Roman JS, Ronceros-Cardenas L, Valcarcel B, Bazalar-Palacios J, Ybaseta-Medina J, Carioli G, La Vecchia C, Alvarez CS. Cervical cancer mortality among young women in Latin America and the Caribbean: trend analysis from 1997 to 2030. BMC Public Health 2022; 22:113. [PMID: 35034604 PMCID: PMC8761303 DOI: 10.1186/s12889-021-12413-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 12/08/2021] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Cervical cancer continues to show a high burden among young women worldwide, particularly in low- and middle-income countries. Limited data is available describing cervical cancer mortality among young women in Latin America and the Caribbean (LAC). The purpose of this study was to examine the mortality trends of cervical cancer among young women in LAC and predict mortality rates to 2030. METHODS Deaths from cervical cancer were obtained from the World Health Organization mortality database. Age-standardized mortality rates per 100,000 women-years were estimated in women aged 20-44 years using the world standard population for 16 countries (and territories) in LAC from 1997 to 2017. We estimated the average mortality rates for the last 4 years (2014-2017). Joinpoint regression models were used to identify significant changes in mortality trends. Nordpred method was used for the prediction of the mortality rates to 2030. RESULTS Between 2014 and 2017, Paraguay and Venezuela had the highest mortality rates of cervical cancer, whereas Puerto Rico had the lowest rates. Overall, most of the LAC countries showed downward trends of cervical cancer mortality over the entire period. Significant decreases were observed in Chile (Average annual percent change [AAPC]: - 2.4%), Colombia (AAPC: - 2.0%), Cuba (AAPC: - 3.6%), El Salvador (AAPC: - 3.1%), Mexico (AAPC: - 3.9%), Nicaragua (AAPC: - 1.7%), Panama (AAPC: - 1.7%), and Peru (AAPC: - 2.2%). In contrast, Brazil (AAPC: + 0.8%) and Paraguay (AAPC: + 3.7%) showed significant upward trends. By 2030, mortality rates are not predicted to further decrease in some LAC countries, including Argentina, Paraguay, and Venezuela. CONCLUSIONS Mortality trends of cervical cancer among young women have large variability in LAC countries. Cervical cancer screening programs have a high priority for the region. Primary and secondary prevention in the community are necessary to accelerate a reduction of cervical cancer mortality by 2030.
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Affiliation(s)
- J Smith Torres-Roman
- Universidad Científica del Sur, Lima, Peru. .,Latin American Network for Cancer Research (LAN-CANCER), Lima, Peru.
| | | | - Bryan Valcarcel
- Latin American Network for Cancer Research (LAN-CANCER), Lima, Peru
| | - Janina Bazalar-Palacios
- Latin American Network for Cancer Research (LAN-CANCER), Lima, Peru.,Universidad Católica Los Ángeles de Chimbote, Instituto de Investigación, Chimbote, Peru
| | | | - Greta Carioli
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, 20133, Milan, Italy
| | - Carlo La Vecchia
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, 20133, Milan, Italy
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31
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Faria CGF, de Matos UMA, Llado-Medina L, Pereira-Sanchez V, Freire R, Nardi AE. Understanding and addressing COVID-19 vaccine hesitancy in low and middle income countries and in people with severe mental illness: Overview and recommendations for Latin America and the Caribbean. Front Psychiatry 2022; 13:910410. [PMID: 36177216 PMCID: PMC9513790 DOI: 10.3389/fpsyt.2022.910410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 08/22/2022] [Indexed: 11/22/2022] Open
Abstract
Despite the speedy development of vaccines for COVID-19, their rollout has posed a major public health challenge, as vaccine hesitancy (VH) and refusal are high. Addressing vaccine hesitancy is a multifactorial and context-dependent challenge. This perspective focuses on VH in the world region of Latin America and the Caribbean (LAC) and includes people suffering from severe mental illness, therefore covering populations and subpopulations often neglected in scientific literature. We present an overview of VH in LAC countries, discussing its global and historical context. Vaccine uptake has shown to widely vary across different subregions of LAC. Current data points to a possible correlation between societal polarization and vaccination, especially in countries going through political crises such as Brazil, Colombia, and Venezuela. Poor accessibility remains an additional important factor decreasing vaccination rollout in LAC countries and even further, in the whole Global South. Regarding patients with severe mental illness in LAC, and worldwide, it is paramount to include them in priority groups for immunization and monitor their vaccination coverage through public health indicators.
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Affiliation(s)
- Clara Gitahy Falcão Faria
- Laboratory of Panic and Respiration, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
| | | | | | - Victor Pereira-Sanchez
- Department of Psychiatry, Columbia University, New York, NY, United States.,Division of Translational Epidemiology and Mental Health Equity, New York State Psychiatric Institute, New York, NY, United States.,Department of Child and Adolescent Psychiatry, New York University Grossman School of Medicine, New York, NY, United States.,Department of Psychiatry, Amoud University, Borama, Somalia
| | - Rafael Freire
- Laboratory of Panic and Respiration, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil.,Department of Psychiatry and Center for Neuroscience Studies, Queen's University, Kingston, ON, Canada
| | - Antonio Egidio Nardi
- Laboratory of Panic and Respiration, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
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32
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Liebermann E, Van Devanter N, Frías Gúzman N, Hammer MJ, Ompad D. Dominican Provider Attitudes Towards HPV Testing for Cervical Cancer Screening and, Current Challenges to Cervical Cancer Prevention in the Dominican Republic: a Mixed Methods Study. J Cancer Educ 2021; 36:1170-1185. [PMID: 32307667 PMCID: PMC7572473 DOI: 10.1007/s13187-020-01746-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Creating effective programs for cervical cancer prevention is essential to avoid premature deaths from cervical cancer. The Dominican Republic has persistently high rates of cervical cancer, despite the availability of Pap smear screening. This study explored Dominican provider attitudes towards human papillomavirus (HPV) testing and current challenges to effective cervical cancer prevention. In this Consolidated Framework for Implementation Research (CFIR)-driven mixed methods study, we conducted in-depth interviews (N = 21) and surveys (N = 202) with Dominican providers in Santo Domingo and Monte Plata provinces regarding their perspectives on barriers to cervical cancer prevention and their knowledge and attitudes towards HPV testing as an alternative to Pap smear. Providers believed the main barrier to cervical cancer prevention was lack of cervical cancer awareness and resulting inadequate population screening coverage. Providers felt that Pap smear was widely available to women in the Dominican Republic and were unsure how a change to HPV testing for screening would address gaps in current cervical cancer screening programs. A subset of providers felt HPV testing offered important advantages for early detection of cervical cancer and were in favor of more widespread use. Cost of the HPV test and target age for screening with HPV testing were the main barriers to acceptability. Providers had limited knowledge of HPV testing as a screening test. The group was divided in terms of the potential impact of a change in screening test in addressing barriers to cervical cancer prevention in the Dominican Republic. Findings may inform interventions to disseminate global evidence-based recommendations for cervical cancer screening.
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Affiliation(s)
- Erica Liebermann
- New York University Rory Meyers College of Nursing, 433 First Avenue, 6th floor, New York, NY, 10010, USA.
| | - Nancy Van Devanter
- New York University Rory Meyers College of Nursing, 433 First Avenue, 6th floor, New York, NY, 10010, USA
| | - Natalia Frías Gúzman
- Instituto Nacional de Cáncer Rosa Emilia Sánchez Pérez de Tavares (INCART), Avenida Correa y Cidrón, 10103, Santo Domingo, Dominican Republic
| | - Marilyn J Hammer
- Dana-Farber Cancer Institute, 450 Brookline Avenue, LW523, Boston, MA, 02215, USA
| | - Danielle Ompad
- New York University College of Global Public Health, 715 Broadway, Rm 1011, New York, NY, 10003, USA
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Rodríguez F, Rüland J. Cooperative counter-hegemony, interregionalism and 'diminished multilateralism': the Belt and Road Initiative and China's relations with Latin America and the Caribbean (LAC). J Int Relat Dev (Ljubl) 2021; 25:476-496. [PMID: 34803480 PMCID: PMC8595274 DOI: 10.1057/s41268-021-00248-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
This article examines the institutional rationale of China's Belt and Road Initiative for Sino-Latin American interregionalism and global multilateralism. Applying Pedersen's ideational-institutional realism approach and research on interregionalism, we provide a more nuanced analysis than mainstream realist theorising dominating research on China's foreign policies. We argue that China's interregional relations with Latin America and the Caribbean (LAC) entail a cooperative strategy to counter US hegemony in its own 'backyard'. At a cognitive level, we show that the worldviews of Chinese foreign policy elites are informed by the tenets of realism. At an institutional level, interregionalism serves as a soft balancing device. In the power dimension, China uses cooperative relations with LAC to create soft power, enhancing access to raw materials, and promoting Chinese values, worldviews, and policies to the region. Hence, China-LAC interregionalism qualifies as 'diminished multilateralism', a pragmatic variant of multilateralism that favours particularistic interests while hampering collective problem solving.
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Affiliation(s)
- Fabricio Rodríguez
- Institute of Sociology, Friedrich Schiller University Jena, Jena, Germany
| | - Jürgen Rüland
- Department of Political Science, University of Freiburg, Freiburg, Germany
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Rodriguez-Morales AJ, Franco OH. Public trust, misinformation and COVID-19 vaccination willingness in Latin America and the Caribbean: today's key challenges. Lancet Reg Health Am 2021; 3:100073. [PMID: 34522914 PMCID: PMC8432286 DOI: 10.1016/j.lana.2021.100073] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 08/25/2021] [Indexed: 11/24/2022]
Affiliation(s)
- Alfonso J Rodriguez-Morales
- Grupo de Investigación Biomedicina, Faculty of Medicine, Fundación Universitaria Autónoma de las Américas, Pereira, Risaralda, Colombia.,Master of Clinical Epidemiology and Biostatistics, Universidad Científica del Sur, Lima, Perú.,School of Medicine, Universidad Privada Franz Tamayo (UNIFRANZ), Cochabamba, Bolivia
| | - Oscar H Franco
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Mittelstrasse 43, 3012, Bern, Switzerland
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Pradilla G, Lamberty G, Hamhaber J. Hydromorphological and socio-cultural assessment of urban rivers to promote nature-based solutions in Jarabacoa, Dominican Republic. Ambio 2021; 50:1414-1430. [PMID: 34061346 PMCID: PMC8249590 DOI: 10.1007/s13280-021-01565-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 11/05/2020] [Accepted: 04/22/2021] [Indexed: 06/12/2023]
Abstract
In Latin America and the Caribbean, river restoration projects are increasing, but many lack strategic planning and monitoring. We tested the applicability of a rapid visual social-ecological stream assessment method for restoration planning, complemented by a citizen survey on perceptions and uses of blue and green infrastructure. We applied the method at three urban streams in Jarabacoa (Dominican Republic) to identify and prioritize preferred areas for nature-based solutions. The method provides spatially explicit information for strategic river restoration planning, and its efficiency makes it suitable for use in data-poor contexts. It identifies well-preserved, moderately altered, and critically impaired areas regarding their hydromorphological and socio-cultural conditions, as well as demands on green and blue infrastructure. The transferability of the method can be improved by defining reference states for assessing the hydromorphology of tropical rivers, refining socio-cultural parameters to better address river services and widespread urban challenges, and balancing trade-offs between ecological and social restoration goals.
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Affiliation(s)
- Gonzalo Pradilla
- Institute of Applied Geosciences, Technische Universität Darmstadt, Schnittspahnstrasse 9, 64287 Darmstadt, Germany
| | - Georg Lamberty
- Faculty of Spatial Development and Infrastructure Systems, Cologne University of Applied Sciences, Robertstrasse 2, 53111 Cologne, Germany
| | - Johannes Hamhaber
- Faculty of Spatial Development and Infrastructure Systems, Cologne University of Applied Sciences, Robertstrasse 2, 53111 Cologne, Germany
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36
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Liebermann E, Hammer MJ, Gúzman NF, Van Devanter N, Ompad D. Dominican Provider Practices for Cervical Cancer Screening in Santo Domingo and Monte Plata Provinces. J Cancer Educ 2021; 36:693-701. [PMID: 31953801 PMCID: PMC9743805 DOI: 10.1007/s13187-020-01690-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Cervical cancer is the second leading cause of cancer death for women in the Dominican Republic. Pap smear screening in the Dominican Republic has not achieved adequate reduction in cervical cancer mortality. The purpose of this study was to examine Dominican provider practices for cervical cancer screening and the use of national or international screening guidelines. We surveyed 101 gynecology specialists, 50 non-specialists, and 51 obstetrics-gynecology residents in the Santo Domingo and Monte Plata provinces of the Dominican Republic regarding their cervical cancer screening practices and use of guidelines. Bivariate (chi-square) analyses were conducted to compare screening practices by demographic and practice characteristics. The majority of providers followed WHO guidelines (62.9%) and/or Dominican national norms (59.4%). The majority (87%) of providers use time since first sexual activity as the basis for screening initiation; 96% advise screening every 6-12 months. The most commonly used screening test is the conventional Pap smear. Colposcopy was recommended most often for all abnormal Pap results. Dominican providers report they follow national and/or international cervical cancer screening guidelines. They do not follow age-based screening guidelines, nor have they adopted an extended interval for screening and continue to recommend screening at least annually. A culture of early and frequent screening has consequences in terms of cost, high demand for follow-up services, and reduced capacity to reach the populations at highest risk. Early screening also may challenge the acceptability of adopting alternative screening technologies such as HPV testing.
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Affiliation(s)
- Erica Liebermann
- New York University Rory Meyers College of Nursing, 433 First Avenue, 6th floor, New York, NY, 10010, USA.
| | - Marilyn J Hammer
- Phyllis F. Cantor Center for Research in Nursing and Patient Care Services, Dana-Farber Cancer Institute, 450 Brookline Avenue, LW523, Boston, MA, 02215, USA
| | - Natalia Frías Gúzman
- Instituto Nacional de Cáncer Rosa Emilia Sánchez Pérez de Tavares (INCART), Avenida Correa y Cidrón, 10103, Santo Domingo, Dominican Republic
| | - Nancy Van Devanter
- New York University Rory Meyers College of Nursing, 433 First Avenue, Rm 670, New York, NY, 10010, USA
| | - Danielle Ompad
- New York University College of Global Public Health, 715 Broadway, Rm 1011, New York, NY, 10003, USA
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37
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Varallyay NI, Bennett SC, Kennedy C, Ghaffar A, Peters DH. How does embedded implementation research work? Examining core features through qualitative case studies in Latin America and the Caribbean. Health Policy Plan 2021; 35:ii98-ii111. [PMID: 33156937 PMCID: PMC7646734 DOI: 10.1093/heapol/czaa126] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/03/2020] [Indexed: 01/04/2023] Open
Abstract
Innovative strategies are needed to improve the delivery of evidence-informed health interventions. Embedded implementation research (EIR) seeks to enhance the generation and use of evidence for programme improvement through four core features: (1) central involvement of programme/policy decision-makers in the research cycle; (2) collaborative research partnerships; (3) positioning research within programme processes and (4) research focused on implementation. This paper examines how these features influence evidence-to-action processes and explores how they are operationalized, their effects and supporting conditions needed. We used a qualitative, comparative case study approach, drawing on document analysis and semi-structured interviews across multiple informant groups, to examine three EIR projects in Bolivia, Colombia and the Dominican Republic. Our findings are presented according to the four core EIR features. The central involvement of decision-makers in EIR was enhanced by decision-maker authority over the programme studied, professional networks and critical reflection. Strong research-practice partnerships were facilitated by commitment, a clear and shared purpose and representation of diverse perspectives. Evidence around positioning research within programme processes was less conclusive; however, as all three cases made significant advances in research use and programme improvement, this feature of EIR may be less critical than others, depending on specific circumstances. Finally, a research focus on implementation demanded proactive engagement by decision-makers in conceptualizing the research and identifying opportunities for direct action by decision-makers. As the EIR approach is a novel approach in these low-resource settings, key supports are needed to build capacity of health sector stakeholders and create an enabling environment through system-level strategies. Key implications for such supports include: promoting EIR and creating incentives for decision-makers to engage in it, establishing structures or mechanisms to facilitate decision-maker involvement, allocating funds for EIR, and developing guidance for EIR practitioners.
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Affiliation(s)
- N Ilona Varallyay
- Department of International Health, Johns Hopkins School
of Public Health, 615 N Wolfe St, Baltimore, MD 21205, United States
- Corresponding author. Malabia 1970, Buenos Aires CABA 1414,
Argentina. E-mail:
| | - Sara C Bennett
- Department of International Health, Johns Hopkins School
of Public Health, 615 N Wolfe St, Baltimore, MD 21205, United States
| | - Caitlin Kennedy
- Social and Behavioral Interventions Program, Department of
International Health, Johns Hopkins School of Public Health, 615 N Wolfe St,
Baltimore, MD 21205, United States
| | - Abdul Ghaffar
- The Alliance for Health Policy and Systems Research at the
World Health Organization, 20 avenue Appia, 1211 Geneva, Switzerland
| | - David H Peters
- Department of International Health, Johns Hopkins School
of Public Health, 615 N Wolfe St, Baltimore, MD 21205, United States
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Küng SA, Ochoa B, Ortiz Avendano GA, Martínez López C, Zaragoza M, Padilla Zuniga K. Factors affecting the persistent use of sharp curettage for abortion in public hospitals in Mexico. ACTA ACUST UNITED AC 2021; 17:17455065211029763. [PMID: 34263683 PMCID: PMC8287640 DOI: 10.1177/17455065211029763] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Objectives: Dilation and curettage is an outdated abortion procedure no longer recommended by the World Health Organization. However, use of dilation and curettage remains high in some countries, including Mexico. We aim to understand the factors that contribute to persistent use of dilation and curettage in Mexico. Methods: We conducted a mixed-methods study in two phases: (1) secondary quantitative data analysis from 40 Ipas-supported public hospitals in Mexico and (2) 28 in-depth interviews in 9 Ipas-affiliated hospitals with doctors, nurses, and hospital administrators. Results: Among our sample, 41% of abortions less than 13 weeks performed in 2019 were treated with dilation and curettage, while this increased to 67% of abortions at or above 13 weeks. Only 18% of induced abortions were performed with dilation and curettage compared to 44% of post-abortion care procedures. The main factor identified as determining use of dilation and curettage in in-depth interviews was availability of abortion supplies, both in terms of cleaning, storage, and maintenance of supplies and in the budgeting and procurement of supplies. Other factors included confidence in the efficacy of other methods, attitudes toward different methods, skill and training, and perceived benefits to patients. Conclusion: Ensuring supplies for recommended abortion methods are available is a key lever for any intervention aimed at reducing dilation and curettage use. However, as the doctor performing the abortion decides which method to use, individual factors such as lack of skill and mistrust in other procedures can become a particularly obstinate barrier to recommended method use. Localizing decision-making power in the hands of doctors is problematic in that it places the doctor’s preference above that of the person receiving the abortion. It is important to look deeply at the power structures that contribute to doctor-oriented models of abortion care.
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Affiliation(s)
| | - Beatriz Ochoa
- Ipas Central America and Mexico, Mexico City, Mexico
| | | | | | - Mara Zaragoza
- Ipas Central America and Mexico, Mexico City, Mexico
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Küng SA, Saavedra-Avendano B, Vélez EA, Piñeros MCM, Metcalfe GMF, Darney BG. Factors Associated with Support for Adolescent Access to Contraception Among Mexican Catholic Parents. J Relig Health 2021; 60:1600-1612. [PMID: 33550424 PMCID: PMC8137468 DOI: 10.1007/s10943-021-01186-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 01/16/2021] [Indexed: 06/12/2023]
Abstract
We used a nationally representative survey of 2186 Mexican Catholic parents to assess two outcomes: support for adolescent access to modern contraception and whether adolescents unaccompanied by an adult should have access to contraceptive methods. A majority (85%) of Mexican Catholic parents support adolescent access to modern contraceptive methods, but there was less support (28%) for access to contraception unaccompanied. Further, our results show strong support (92%) for sex education in schools. Parents who believe that good Catholics can use contraception had higher odds of support for adolescent access and unaccompanied access to modern contraception. Mexican Catholic parents support adolescent access to modern contraception, but support for unaccompanied access to contraception is lower. This may reflect an interest in being involved, and not necessarily opposition to contraceptive use. Measures of Catholicism that focus on behaviors may better explain opinions about adolescent access to contraception.
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Affiliation(s)
| | | | | | | | | | - Blair G Darney
- Department of Obstetrics and Gynecology, Oregon Health and Science University, Portland, OR, USA
- OHSU-PSU School of Public Health, Portland, OR, USA
- Instituto Nacional de Salud Pública (INSP), Centro de Investigacion en Salud Poblacional (CISP), Cuernavaca, Mexico
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Post L, Ohiomoba RO, Maras A, Watts SJ, Moss CB, Murphy RL, Ison MG, Achenbach CJ, Resnick D, Singh LN, White J, Chaudhury AS, Boctor MJ, Welch SB, Oehmke JF. Latin America and the Caribbean SARS-CoV-2 Surveillance: Longitudinal Trend Analysis. JMIR Public Health Surveill 2021; 7:e25728. [PMID: 33852413 PMCID: PMC8083950 DOI: 10.2196/25728] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 12/11/2020] [Accepted: 04/09/2021] [Indexed: 02/06/2023] Open
Abstract
Background The COVID-19 pandemic has placed unprecedented stress on economies, food systems, and health care resources in Latin America and the Caribbean (LAC). Existing surveillance provides a proxy of the COVID-19 caseload and mortalities; however, these measures make it difficult to identify the dynamics of the pandemic and places where outbreaks are likely to occur. Moreover, existing surveillance techniques have failed to measure the dynamics of the pandemic. Objective This study aimed to provide additional surveillance metrics for COVID-19 transmission to track changes in the speed, acceleration, jerk, and persistence in the transmission of the pandemic more accurately than existing metrics. Methods Through a longitudinal trend analysis, we extracted COVID-19 data over 45 days from public health registries. We used an empirical difference equation to monitor the daily number of cases in the LAC as a function of the prior number of cases, the level of testing, and weekly shift variables based on a dynamic panel model that was estimated using the generalized method of moments approach by implementing the Arellano–Bond estimator in R. COVID-19 transmission rates were tracked for the LAC between September 30 and October 6, 2020, and between October 7 and 13, 2020. Results The LAC saw a reduction in the speed, acceleration, and jerk for the week of October 13, 2020, compared to the week of October 6, 2020, accompanied by reductions in new cases and the 7-day moving average. For the week of October 6, 2020, Belize reported the highest acceleration and jerk, at 1.7 and 1.8, respectively, which is particularly concerning, given its high mortality rate. The Bahamas also had a high acceleration at 1.5. In total, 11 countries had a positive acceleration during the week of October 6, 2020, whereas only 6 countries had a positive acceleration for the week of October 13, 2020. The TAC displayed an overall positive trend, with a speed of 10.40, acceleration of 0.27, and jerk of –0.31, all of which decreased in the subsequent week to 9.04, –0.81, and –0.03, respectively. Conclusions Metrics such as new cases, cumulative cases, deaths, and 7-day moving averages provide a static view of the pandemic but fail to identify where and the speed at which SARS-CoV-2 infects new individuals, the rate of acceleration or deceleration of the pandemic, and weekly comparison of the rate of acceleration of the pandemic indicate impending explosive growth or control of the pandemic. Enhanced surveillance will inform policymakers and leaders in the LAC about COVID-19 outbreaks.
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Affiliation(s)
- Lori Post
- Buehler Center for Health Policy and Economics, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Ramael O Ohiomoba
- Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Ashley Maras
- Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Sean J Watts
- Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Charles B Moss
- Institute of Food and Agricultural Sciences, University of Florida, Gainsville, FL, United States
| | - Robert Leo Murphy
- Institute of Global Health, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Michael G Ison
- Divison of Infectious Disease, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Chad J Achenbach
- Divison of Infectious Disease, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Danielle Resnick
- International Food Policy Research Institute, Washington DC, DC, United States
| | - Lauren Nadya Singh
- Buehler Center for Health Policy and Economics, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Janine White
- Buehler Center for Health Policy and Economics, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Azraa S Chaudhury
- Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Michael J Boctor
- Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Sarah B Welch
- Buehler Center for Health Policy and Economics, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - James Francis Oehmke
- Buehler Center for Health Policy and Economics, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
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Pinchoff J, Silva M, Spielman K, Hutchinson P. Use of effective lids reduces presence of mosquito larvae in household water storage containers in urban and peri-urban Zika risk areas of Guatemala, Honduras, and El Salvador. Parasit Vectors 2021; 14:167. [PMID: 33741050 PMCID: PMC7977570 DOI: 10.1186/s13071-021-04668-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 03/04/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In 2015, an outbreak of Zika virus spread across Latin America and the Caribbean (LAC). Public health programs promoted vector control behaviors, including covering water storage containers with lids. Such approaches disrupt Zika transmission by eliminating the habitats of the Aedes aegypti mosquito, which breeds in stagnant water. METHODS A quantitative household survey and observation checklist with trained enumerators were undertaken between August and October 2018 in selected urban/peri-urban USAID implementation communities in El Salvador, Guatemala, and Honduras. The survey included questions regarding knowledge, attitudes, and practices related to Zika virus. An accompanying checklist was implemented to observe water storage containers, including for short-term and long-term water use. The characteristics of these containers were tabulated, including the presence of a lid. The lids were examined for key features to determine their potential effectiveness to prevent mosquito breeding: fully covering and sealing the container, not having holes, and not having water on them (potentially creating a secondary breeding site). Multivariate logistic regression was used to estimate the effectiveness of lid types and characteristics on the presence of larvae. RESULTS Overall, in adjusted models, using an effective lid versus no lid was associated with a 94% decrease in odds of larval presence in long-term water storage containers (odds ratio = 0.06; 95% confidence interval [0.029, 0.152]); however, similar impacts were not observed for washbasins in the adjusted models. Models adjusted for household wealth, receiving a visit from a vector control technician, scrubbing the container in the last 7 days, and perception of more mosquitoes around. CONCLUSIONS Effective lids, if made available and coupled with complementary behavioral messaging, may reduce transmission of Zika and other Aedes mosquito-borne diseases in the LAC region.
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Giraldo GP, Joseph KT, Angell SY, Campbell NRC, Connell K, DiPette DJ, Escobar MC, Valdés-Gonzalez Y, Jaffe MG, Malcolm T, Maldonado J, Lopez-Jaramillo P, Olsen MH, Ordunez P. Mapping stages, barriers and facilitators to the implementation of HEARTS in the Americas initiative in 12 countries: A qualitative study. J Clin Hypertens (Greenwich) 2021; 23:755-765. [PMID: 33738969 PMCID: PMC8678790 DOI: 10.1111/jch.14157] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 12/10/2020] [Accepted: 12/13/2020] [Indexed: 12/24/2022]
Abstract
The World Health Organization (WHO) Global Hearts Initiative offers technical packages to reduce the burden of cardiovascular diseases through population-wide and targeted health services interventions. The Pan American Health Organization (PAHO) has led implementation of the HEARTS in the Americas Initiative since 2016. The authors mapped the developmental stages, barriers, and facilitators to implementation among the 371 primary health care centers in the participating 12 countries. The authors used the qualitative method of document review to examine cumulative country reports, technical meeting notes, and reports to regional stakeholders. Common implementation barriers include segmentation of health systems, overcoming health care professionals' scope of practice legal restrictions, and lack of health information systems limiting operational evaluation and quality improvement mechanisms. Main implementation facilitators include political support from ministries of health and leading scientific societies, PAHO's role as a regional catalyst to implementation, stakeholder endorsement demonstrated by incorporating HEARTS into official documents, and having a health system oriented to primary health care. Key lessons include the need for political commitment and cultivating on-the-ground leadership to initiate a shift in hypertension care delivery, accompanied by specific progress in the development of standardized treatment protocols and a set of high-quality medicines. By systematizing an implementation strategy to ease integration of interventions into delivery processes, the program strengthened technical leadership and ensured sustainability. These study findings will aid the regional approach by providing a staged planning model that incorporates lessons learned. A systematic approach to implementation will enhance equity, efficiency, scale-up, and sustainability, and ultimately improve population hypertension control.
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Affiliation(s)
- Gloria P Giraldo
- Department of Non-Communicable Diseases and Mental Health, Pan American Health Organization, Washington, DC, USA
| | - Kristy T Joseph
- Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Sonia Y Angell
- College of Physicians and Surgeons of Columbia University, New York, NY, USA
| | - Norm R C Campbell
- Department of Medicine, Physiology and Pharmacology and Community Health Sciences, O'Brien Institute for Public Health and Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, AL, Canada
| | | | | | | | | | | | - Taraleen Malcolm
- Pan American Health Organization, Port of Spain, Trinidad and Tobago
| | | | - Patricio Lopez-Jaramillo
- Lancet Commission on Hypertension Group, London, UK.,University of Santander, Bucaramanga, Colombia
| | - Michaels Hecht Olsen
- Lancet Commission on Hypertension Group, London, UK.,Holbaek Hospital, Holbaek, Denmark.,University of Southern Denmark, Odense, Denmark
| | - Pedro Ordunez
- Department of Non-Communicable Diseases and Mental Health, Pan American Health Organization, Washington, DC, USA
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Fontecha G, Sánchez A, Ortiz B. Publication Trends in Neglected Tropical Diseases of Latin America and the Caribbean: A Bibliometric Analysis. Pathogens 2021; 10:pathogens10030356. [PMID: 33802834 PMCID: PMC8002643 DOI: 10.3390/pathogens10030356] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 03/12/2021] [Accepted: 03/12/2021] [Indexed: 01/05/2023] Open
Abstract
(1) Background: Neglected tropical diseases (NTDs) have been overlooked on the global health agenda and in the priorities of national systems in low- and middle-income countries (LMICs). In 2012, the Sustainable Development Goals (SDGs) were created to ensure healthy lives and promoting well-being for all. This roadmap set out to accelerate work to overcome the global impact of NTDs. Almost a decade has passed since NTDs were re-launched as a global priority. Investment in research and development, as well as the production of scientific literature on NTDs, is expected to have increased significantly. (2) Methods: A bibliometric analysis of the scientific production of Latin America and the Caribbean (LAC) was carried out in relation to 19 endemic NTDs. These data were compared with the scientific production in malaria, tuberculosis, and HIV/AIDS. The database available from Thomson Reuters Web of Science (WoS) was used. In addition, the average annual growth percentage was calculated for each disease. (3) Results: In the last decade, the NTDs with the highest number of publications in the world were dengue and leishmaniasis. The United States was the most prolific country in the world in 15 out of 19 NTDs analyzed. In the LAC region, Brazil was the largest contributor for 16 of the 19 NTDs analyzed. Arboviral diseases showed the highest average annual growth. The number of publications for malaria, tuberculosis and HIV/AIDS was considerably higher than for NTDs. The contribution of most LAC countries, especially those considered to be LMICs, is inadequate and does not reflect the relevance of NTDs for the public health of the population. (4) Conclusions: This is the first bibliometric analysis to assess the trend of scientific documents on endemic NTDs in LAC. Our results could be used by decision makers both to strengthen investment policies in research and development in NTDs.
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Affiliation(s)
- Gustavo Fontecha
- Microbiology Research Institute, Universidad Nacional Autónoma de Honduras, J1 Building, 4th fl, Tegucigalpa 11101, Honduras;
- Correspondence: ; Tel.: +504-3393-5443
| | - Ana Sánchez
- Department Health Sciences, Brock University, 500 Glenridge Avenue, St. Catharines, ON L2S 3A1, Canada;
| | - Bryan Ortiz
- Microbiology Research Institute, Universidad Nacional Autónoma de Honduras, J1 Building, 4th fl, Tegucigalpa 11101, Honduras;
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Rodríguez-Labrada R, Martins AC, Magaña JJ, Vazquez-Mojena Y, Medrano-Montero J, Fernandez-Ruíz J, Cisneros B, Teive H, McFarland KN, Saraiva-Pereira ML, Cerecedo-Zapata CM, Gomez CM, Ashizawa T, Velázquez-Pérez L, Jardim LB. Founder Effects of Spinocerebellar Ataxias in the American Continents and the Caribbean. Cerebellum 2021; 19:446-458. [PMID: 32086717 DOI: 10.1007/s12311-020-01109-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Spinocerebellar ataxias (SCAs) comprise a heterogeneous group of autosomal dominant disorders. The relative frequency of the different SCA subtypes varies broadly among different geographical and ethnic groups as result of genetic drifts. This review aims to provide an update regarding SCA founders in the American continents and the Caribbean as well as to discuss characteristics of these populations. Clusters of SCAs were detected in Eastern regions of Cuba for SCA2, in South Brazil for SCA3/MJD, and in Southeast regions of Mexico for SCA7. Prevalence rates were obtained and reached 154 (municipality of Báguano, Cuba), 166 (General Câmara, Brazil), and 423 (Tlaltetela, Mexico) patients/100,000 for SCA2, SCA3/MJD, and SCA7, respectively. In contrast, the scattered families with spinocerebellar ataxia type 10 (SCA10) reported all over North and South Americas have been associated to a common Native American ancestry that may have risen in East Asia and migrated to Americas 10,000 to 20,000 years ago. The comprehensive review showed that for each of these SCAs corresponded at least the development of one study group with a large production of scientific evidence often generalizable to all carriers of these conditions. Clusters of SCA populations in the American continents and the Caribbean provide unusual opportunity to gain insights into clinical and genetic characteristics of these disorders. Furthermore, the presence of large populations of patients living close to study centers can favor the development of meaningful clinical trials, which will impact on therapies and on quality of life of SCA carriers worldwide.
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Affiliation(s)
| | - Ana Carolina Martins
- Programa de Pós-Graduação em Genética e Biologia Molecular, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, 91540-070, Brazil
| | - Jonathan J Magaña
- Department of Genetics, Laboratory of Genomic Medicine, National Rehabilitation Institute (INR-LGII), 14389, Mexico City, Mexico
| | - Yaimeé Vazquez-Mojena
- Centre for the Research and Rehabilitation of Hereditary Ataxias, 80100, Holguín, Cuba
| | | | - Juan Fernandez-Ruíz
- Departamento de Fisiología, Facultad de Medicina, Universidad Nacional Autonoma de Mexico, 04510, Mexico City, Mexico
| | - Bulmaro Cisneros
- Department of Genetics and Molecular Biology, Center of Research and Advanced Studies (CINVESTAV-IPN), 07360, Mexico City, Mexico
| | - Helio Teive
- Movement Disorders Unit, Neurology Service, Internal Medicine Department, Hospital de Clínicas Federal University of Paraná, Curitiba, PR, 80240-440, Brazil
| | | | - Maria Luiza Saraiva-Pereira
- Programa de Pós-Graduação em Genética e Biologia Molecular, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, 91540-070, Brazil
- Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS, 90035-903, Brazil
- Departamento de Bioquímica, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, 90035-903, Brazil
| | - César M Cerecedo-Zapata
- Department of Genetics, Laboratory of Genomic Medicine, National Rehabilitation Institute (INR-LGII), 14389, Mexico City, Mexico
- Rehabilitation and Social Inclusion Center of Veracruz (CRIS-DIF), Xalapa, 91070, Veracruz, Mexico
| | | | - Tetsuo Ashizawa
- Program of Neuroscience, Houston Methodist Research Institute, Houston, TX, 77030, USA
| | - Luis Velázquez-Pérez
- Centre for the Research and Rehabilitation of Hereditary Ataxias, 80100, Holguín, Cuba.
- Cuban Academy of Sciences, 10100, La Havana, Cuba.
| | - Laura Bannach Jardim
- Programa de Pós-Graduação em Genética e Biologia Molecular, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, 91540-070, Brazil
- Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS, 90035-903, Brazil
- Departamento de Medicina Interna, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, 90035-903, Brazil
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Llau AF, Williams ML, Tejada CE. National vaccine coverage trends and funding in Latin America and the Caribbean. Vaccine 2020; 39:317-323. [PMID: 33288342 DOI: 10.1016/j.vaccine.2020.11.059] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Revised: 11/20/2020] [Accepted: 11/23/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND From 2006 to 2011 nearly 174,000 deaths were prevented in Latin America and the Caribbean through vaccination of children under five, which is widely attributed to the Expanded Program on Immunization (EPI). Despite near global adoption of EPI recommendations, vaccination coverage shows substantial variation across world regions. Causes for low immunizations within regions are multifaceted and include vaccination program costs. To date, publications regarding vaccine coverage across Latin America and the Caribbean are not readily available. This study aimed to: (1) compare vaccine coverage trends across nations within the region; and (2) assess whether national immunization program expenditures are correlated with vaccine coverage. METHODS Coverage for nine vaccines were collected by nation using publicly available data from WHO. National immunization program expenditures for each country were collected from the World Bank Index. The proportion of countries achieving 90% coverage in the years 2013 and 2017 for each vaccine were compared. Pearson correlation coefficients were calculated to measure the relationship between financing variables and DTP3 coverage for 2017. RESULTS In 2017, fewer Latin American and Caribbean nations were able to achieve 90% vaccine coverage for five vaccines compared to 2013. Mostly weak to moderate positive relationships were found between national immunization program expenditures and DTP3 coverage for 2017. Excluding Haiti, a weak negative relationship was found between total government expenditure on vaccines per infant and DTP3 coverage for 2017. Countries across Latin America and the Caribbean were largely self-reliant in funding vaccine expenditures. CONCLUSIONS Fewer countries across Latin America and the Caribbean are currently achieving optimum national vaccine coverage and weak to moderate relationships between routine immunization and vaccine expenditures and coverage were observed. Additional factors contributing to national vaccine coverage should be concomitantly examined to implement strategies which optimize delivery of childhood immunizations.
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Affiliation(s)
- Anthoni F Llau
- Florida International University, Robert Stempel College of Public Health and Social Work, Global Health Consortium, United States.
| | - Mark L Williams
- Fay W. Boozman College of Public Health at the University of Arkansas for Medical Sciences (UAMS), United States
| | - Carlos Espinal Tejada
- Florida International University, Robert Stempel College of Public Health and Social Work, Global Health Consortium, United States
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Bolaño-Ortiz TR, Camargo-Caicedo Y, Puliafito SE, Ruggeri MF, Bolaño-Diaz S, Pascual-Flores R, Saturno J, Ibarra-Espinosa S, Mayol-Bracero OL, Torres-Delgado E, Cereceda-Balic F. Spread of SARS-CoV-2 through Latin America and the Caribbean region: A look from its economic conditions, climate and air pollution indicators. Environ Res 2020; 191:109938. [PMID: 32858479 PMCID: PMC7361092 DOI: 10.1016/j.envres.2020.109938] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Revised: 07/03/2020] [Accepted: 07/10/2020] [Indexed: 05/17/2023]
Abstract
We have evaluated the spread of SARS-CoV-2 through Latin America and the Caribbean (LAC) region by means of a correlation between climate and air pollution indicators, namely, average temperature, minimum temperature, maximum temperature, rainfall, average relative humidity, wind speed, and air pollution indicators PM10, PM2.5, and NO2 with the COVID-19 daily new cases and deaths. The study focuses in the following LAC cities: Mexico City (Mexico), Santo Domingo (Dominican Republic), San Juan (Puerto Rico), Bogotá (Colombia), Guayaquil (Ecuador), Manaus (Brazil), Lima (Perú), Santiago (Chile), São Paulo (Brazil) and Buenos Aires (Argentina). The results show that average temperature, minimum temperature, and air quality were significantly associated with the spread of COVID-19 in LAC. Additionally, humidity, wind speed and rainfall showed a significant relationship with daily cases, total cases and mortality for various cities. Income inequality and poverty levels were also considered as a variable for qualitative analysis. Our findings suggest that and income inequality and poverty levels in the cities analyzed were related to the spread of COVID-19 positive and negative, respectively. These results might help decision-makers to design future strategies to tackle the spread of COVID-19 in LAC and around the world.
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Affiliation(s)
- Tomás R Bolaño-Ortiz
- Mendoza Regional Faculty - National Technological University (FRM-UTN), 273 Coronel Rodríguez St., 5500, Mendoza, Argentina; National Scientific and Technical Research Council (CONICET), Mendoza, Argentina.
| | - Yiniva Camargo-Caicedo
- Environmental Systems Modeling Research Group (GIMSA), University of Magdalena, Santa Marta, Colombia
| | - Salvador Enrique Puliafito
- Mendoza Regional Faculty - National Technological University (FRM-UTN), 273 Coronel Rodríguez St., 5500, Mendoza, Argentina; National Scientific and Technical Research Council (CONICET), Mendoza, Argentina
| | - María Florencia Ruggeri
- Centre for Environmental Technologies (CETAM), Universidad Técnica Federico Santa María (UTFSM), Av. España 1680, Valparaíso, Chile
| | - Sindy Bolaño-Diaz
- Environmental Systems Modeling Research Group (GIMSA), University of Magdalena, Santa Marta, Colombia
| | - Romina Pascual-Flores
- Mendoza Regional Faculty - National Technological University (FRM-UTN), 273 Coronel Rodríguez St., 5500, Mendoza, Argentina; National Scientific and Technical Research Council (CONICET), Mendoza, Argentina
| | | | | | - Olga L Mayol-Bracero
- Department of Environmental Science, University of Puerto Rico, San Juan, PR, USA
| | - Elvis Torres-Delgado
- Department of Environmental Science, University of Puerto Rico, San Juan, PR, USA
| | - Francisco Cereceda-Balic
- Centre for Environmental Technologies (CETAM), Universidad Técnica Federico Santa María (UTFSM), Av. España 1680, Valparaíso, Chile; Department of Chemistry, Universidad Técnica Federico Santa María (UTFSM), Av. España 1680, Valparaíso, Chile
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Adeleye BN, Gershon O, Ogundipe A, Owolabi O, Ogunrinola I, Adediran O. Comparative investigation of the growth-poverty-inequality trilemma in Sub-Saharan Africa and Latin American and Caribbean Countries. Heliyon 2020; 6:e05631. [PMID: 33313434 PMCID: PMC7721624 DOI: 10.1016/j.heliyon.2020.e05631] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 09/18/2020] [Accepted: 11/26/2020] [Indexed: 11/06/2022] Open
Abstract
To "end poverty in all its forms everywhere" and "reduce inequality within and among countries", this study aligns with the 2030 Sustainable Development Goals 1 and 10. It uniquely contributes to the growth-poverty-inequality discourse by using per capita consumption expenditure growth (poverty), Gini index (inequality) and GDP growth (economic growth). It is a comparative analysis of 58 Sub-Saharan Africa (SSA) and Latin American (LAC) countries (from 2000 to 2015) to determine whether economic growth reduces the incidence of poverty and if its interaction with income inequality enhances or alters its impact on poverty. Consistent findings from a multi-analytical approach using pooled ordinary least squares, fixed effects and system GMM reveal that: (1) economic growth exhibit poverty-reduction properties; (2) the growth rate of inequality intensifies poverty, (3) inequality aggravates the impact of growth on poverty, and (4) the growth-poverty-inequality trilemma differs across income groups and regional samples. Furthermore, this study submits that the interaction of income inequality dampens the positive impact of economic growth on the incidence of poverty and supports the argument that the extent of inequality lessens the effect of inclusiveness. Hence, income inequality is a crucial determinant of poverty. Policy implications are discussed.
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Affiliation(s)
- Bosede Ngozi Adeleye
- Department of Economics and Development Studies, Covenant University, Nigeria
- Centre for Economic Policy and Development Research (CEPDeR), Covenant University, Nigeria
- Regional Centre of Expertise (RCE), Ogun, Nigeria
| | - Obindah Gershon
- Department of Economics and Development Studies, Covenant University, Nigeria
- Centre for Economic Policy and Development Research (CEPDeR), Covenant University, Nigeria
| | - Adeyemi Ogundipe
- Department of Economics and Development Studies, Covenant University, Nigeria
- Centre for Economic Policy and Development Research (CEPDeR), Covenant University, Nigeria
| | - Oluwarotimi Owolabi
- Department of Economics and Development Studies, Covenant University, Nigeria
| | - Ifeoluwa Ogunrinola
- Department of Economics and Development Studies, Covenant University, Nigeria
- Centre for Economic Policy and Development Research (CEPDeR), Covenant University, Nigeria
| | - Oluwasogo Adediran
- Department of Economics and Development Studies, Covenant University, Nigeria
- Centre for Economic Policy and Development Research (CEPDeR), Covenant University, Nigeria
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Conde K, Peltzer RI, Pantani D, Pinsky I, Cremonte M. Alcohol industry, corporate social responsibility and country features in Latin America. Drug Alcohol Rev 2020; 40:423-430. [PMID: 33156567 DOI: 10.1111/dar.13208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 10/14/2020] [Accepted: 10/15/2020] [Indexed: 11/30/2022]
Abstract
INTRODUCTION AND AIMS Research on corporate behaviour can contribute to the understanding of the possible adverse impacts of alcohol-industry corporate social responsibility (CSR) initiatives and their potential influence on policymaking. This study explores the association between alcohol-industry CSR activities and selected country features in Latin America and the Caribbean. DESIGN AND METHODS Nine health experts evaluated 148 CSR activities using a standardised protocol; activities were classified into the categories risk management CSR (rmCSR), that is, to avoid/rectify externalities (n = 67), and strategic CSR, that is, to fulfill philanthropic responsibilities (n = 81). We evaluated the associations, separately, between the number of rmCSR and of strategic CSR actions in each country with threats from public health measures (specifically, the level of research into alcohol consumption and harms, the existence of an alcohol surveillance system and the number of governmental alcohol policy actions) and per capita alcohol consumption; we adjusted by economic indices (country income level and the gross domestic product) and population size. RESULTS Multivariate analyses showed that the higher the level of alcohol research within a country and its per capita consumption, the more likely rmSCR activities were to occur, independently of the country's economic development or population. DISCUSSION AND CONCLUSIONS Results suggest rmSCR actions could be implemented as a way to preserve markets by counteracting scientific evidence about alcohol related harms. This evidence could serve as a starting point to future research, contributing to the understanding of alcohol industry behaviour and the advancement of effective public policies.
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Affiliation(s)
- Karina Conde
- Institute of Basic, Applied and Technologic Psychology, National Scientific and Technical Research Council, National University of Mar del Plata, Mar del Plata, Argentina
| | - Raquel Inés Peltzer
- Institute of Basic, Applied and Technologic Psychology, National Scientific and Technical Research Council, National University of Mar del Plata, Mar del Plata, Argentina
| | - Daniela Pantani
- Department of Preventive Medicine, Universidade Federal de Sao Paulo, Sao Paulo, Brazil
| | - Ilana Pinsky
- School of Public Health, City University of New York, New York, USA
| | - Mariana Cremonte
- Institute of Basic, Applied and Technologic Psychology, National Scientific and Technical Research Council, National University of Mar del Plata, Mar del Plata, Argentina
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Vryzas Z, Ramwell C, Sans C. Pesticide prioritization approaches and limitations in environmental monitoring studies: From Europe to Latin America and the Caribbean. Environ Int 2020; 143:105917. [PMID: 32619916 DOI: 10.1016/j.envint.2020.105917] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 06/12/2020] [Accepted: 06/12/2020] [Indexed: 06/11/2023]
Abstract
Assessment and management of issues related to pesticide residues, such as environmental fate, monitoring and toxicity, are complex and, in many cases, require costly studies. The early establishment of a priority list of pesticides that should be monitored and assigned to a restricted-use policy is an important issue of post-registration Risk Assessment (RA). Various pesticide registration approaches have been adopted by different countries with those from Europe and the USA being the most popular, constituting the major prototypes for registration approaches in other countries. Adoption of pesticide registration and monitoring systems developed in Europe or USA by Latin American and Caribbean countries may underestimate factors affecting the environmental fate and toxicity of pesticides in their own countries. Incentive for this short review was the activities undertaken during the three KNOWPEC workshops held in Costa Rica, Argentina and Bolivia where European pesticide experts met Latin American experience in the form of Costa Rica's exceptional environmental conditions and ecology, Argentina's and Uruguay's soyisation and Bolivia's contrasting climate and agricultural zones. During the parallel activities of the workshop - including scientific presentations, field trips, interviews and meetings among European partners and pesticide stakeholders in Latin America, - the whole pesticide chain (import-export, trade, application, plant protection-efficacy, residues, monitoring, remediation and risk) was studied and clarified. Recently-published chemical prioritization studies were reviewed to consider their use as a tool to support risk assessments. Differences in regional practices are highlighted as regards to the establishment of RA or prioritization strategy in European and Latin American regimes. General guidance of establishing a cost-effective pesticide monitoring scheme in water bodies of Latin America and the Caribbean (LAC) is also proposed. Moreover, we summarize the most important factors that should be taken into consideration for prioritization approaches and categorization used in pesticide environmental monitoring studies. Consideration of current RA approaches and limitations, and pesticide prioritization exercises highlighted in this Commentary could assist in the management of pesticides in Latin America and Caribbean.
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Affiliation(s)
- Zisis Vryzas
- Laboratory of Agricultural Pharmacology and Ecotoxicology, Faculty of Agricultural Development, Democritus University of Thrace, 68200 Orestias, Greece.
| | | | - Carmen Sans
- Chemical Engineering and Analytical Chemistry Department, Faculty of Chemistry, Universitat de Barcelona, Martí i Franquès, 1, 08028 Barcelona, Spain
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Liebermann E, Devanter NV, Frías Gúzman N, Ompad D, Shirazian T, Healton C. Parent-Level Barriers and Facilitators to HPV Vaccine Implementation in Santo Domingo, Dominican Republic. J Community Health 2020; 45:1061-1066. [PMID: 32394119 PMCID: PMC10626339 DOI: 10.1007/s10900-020-00830-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Cervical cancer is the second leading cause of cancer death for women in the Dominican Republic. Vaccination against human papillomavirus (HPV) could reduce mortality from cervical cancer globally by as much as 90%. The purpose of our study was to explore multi-level barriers and facilitators to implementation of a national HPV vaccine program in the Dominican Republic; this article focuses on parent-level barriers and facilitators. In this qualitative study, we conducted six focus groups (N = 64) with parents of school-age children in the Santo Domingo area of the Dominican Republic, representing diverse socioeconomic groups and geographic settings. Thematic content analysis, using inductive and deductive approaches, was done following transcription and translation of audio-recordings from focus group discussions. Among this group of parents in the Santo Domingo area, facilitators to vaccine uptake were favorable attitudes towards vaccines in general and concern about cervical cancer as a health issue. Barriers found were low to moderate knowledge of HPV and cervical cancer, especially in the rural and suburban groups, and cost and lack of public awareness of the vaccine. This study identified key barriers and facilitators to HPV vaccine implementation in the Dominican Republic. Health messaging, incorporating specialist providers as opinion leaders, will need to be tailored to broad audiences with varying levels of information and awareness, anticipating misinformation and concerns, and will need to emphasize HPV vaccine as a method to prevent cancer.
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Affiliation(s)
- Erica Liebermann
- New York University Rory Meyers College of Nursing, 433 First Avenue, 6th floor, New York, NY, 10010, USA.
| | - Nancy Van Devanter
- New York University Rory Meyers College of Nursing, 433 First Avenue, Rm 670, New York, NY, 10010, USA
| | - Natalia Frías Gúzman
- Instituto Nacional de Cáncer Rosa Emilia Sánchez Pérez de Tavares (INCART), Avenida Correa y Cidrón, Santo Domingo, 10103, Dominican Republic
| | - Danielle Ompad
- New York University College of Global Public Health, 715 Broadway, Rm 1011, New York, NY, 10003, USA
| | - Taraneh Shirazian
- New York University College of Global Public Health, 207 E 84th Street, 206, New York, NY, 10028, USA
| | - Cheryl Healton
- New York University College of Global Public Health, 665 Broadway, New York, NY, 10012, USA
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