Perspectives for Primary Health Care public policy in South America. / Perspectivas para las políticas públicas de Atención Primaria en Salud en Suramérica.

We aim to conduct a comparative analysis of the implementation of PHC in nine South American countries. Three dimensions were highlighted from documentary sources: political commitment, leadership, and governance; care model; and engagement of communities and other stakeholders. The results indicate a formal commitment that places PHC at the center of efforts to achieve universal access. The following can be observed: revitalization processes in public subsystems, based on guaranteeing preventive, promotional, curative and rehabilitation actions; PHC as gatekeeper; emphasis on family and community; assigned population and territory; multidisciplinary teams; and, in some cases, the accent on interculturality expressed in the concept of "buen vivir" (good living). The PHC revitalization processes were affected by political changes. Between progress and setbacks, the segmentation of coverage was not overcome. The current moment seeks to recover more inclusive and broad public policies in the context of the return of the progressive and democratic fields. The dissemination of country experiences can contribute to the development of a comprehensive, integrated, and quality approach to PHC in the Region.

El objetivo es realizar un análisis comparativo de la implementación de la APS en nueve países de Suramérica. A partir de fuentes documentales fueron destacadas tres dimensiones: compromiso político, liderazgo y gobernanza; modelo de atención; involucramiento de comunidades y otros actores. Los resultados indican la existencia de compromiso formal que localiza la APS en el centro de los esfuerzos para lograr el acceso universal. Se observan procesos de revitalización en los subsistemas públicos, basados en la garantía de acciones preventivas, promocionales, de cura y rehabilitación; puerta de entrada; enfoque familiar y comunitario; población y territorio adscriptos; equipos multiprofesionales, y, en algunos casos, énfasis en la interculturalidad expresada en la concepción de "buen vivir". Los procesos de revitalización de la APS fueron afectados por cambios políticos. Entre avances y retrocesos, no se logró superar la segmentación de cobertura. El momento actual es de rescate de políticas públicas más inclusivas y amplias, en el contexto de recomposición de los campos progresistas y democráticos. Difundir experiencias de los países puede contribuir para el desarrollo de un enfoque de APS integral, integrada y de calidad en la Región.

Impact of rotavirus vaccination on diarrheal disease burden of children in South America.

INTRODUCTION: Rotavirus is a leading cause of severe diarrheal disease and death in children under five years of age worldwide. Vaccination is one of the most important public health interventions to reduce this significant burden. AREAS COVERED: This literature review examined vaccination coverage, hospitalization rate, mortality, genotypic distribution, immunogenicity, cost-effectiveness, and risk versus benefit of rotavirus vaccination in children in South America. Nine out of twelve countries in South America currently include a rotavirus vaccine in their national immunization program with coverage rates in 2022 above 90%. EXPERT OPINION: Introduction of the rotavirus vaccination has led to a marked reduction in hospitalizations and deaths from diarrheal diseases in children under 5 years, particularly infants under 1 year, in several South American countries. In Brazil, hospitalizations decreased by 59% and deaths by 21% (30-38% in infants). In Peru, hospitalizations in infants fell by 46% and deaths by 37% (56% in infants). Overall, data suggest that rotavirus vaccination has reduced rotavirus deaths by 15-50% in various South American countries. There is some evidence that immunity wanes after the age of 1-year old. Ongoing surveillance of vaccine coverage and changes in morbidity and mortality is important to maximize protection against this disease.

Potentially toxic trace elements in the muscle of coastal South American fish: Implications for human consumption and health risk assessment.

Micropogonias furnieri and Urophycis brasiliensis are two coastal demersal fish species distributed in the southwestern Atlantic Ocean. Considering that many coastal areas in the southwestern Atlantic Ocean suffer from anthropogenic pressure, the aim of this study was to assess the level of potentially toxic trace elements (Ag, Al, As, Cd, Co, Cr, Cu, Fe, Hg, Mn, Mo, Ni, Pb, Se, Sr, V and Zn) in the muscle of coastal species, and evaluated the human health risk related to the consumption of muscle. Mercury, inorganic As (Asi), V, and Se showed a higher contribution to the total THQ. Considering two possible scenarios, Asi represents 1 % or 5 % of the total As, the total THQ was <1 for general population and of some health concerns for fishermen population (Total THQ > 1; 5 % Asi). Consequently these results show the importance of quantifying As species in muscle to generate more reliable risk estimates for human health.

Estimated Loss of Productivity Attributed to Cardiovascular Diseases in South America. / Estimativa de Produtividade Perdida Atribuída a Doenças Cardiovasculares na América do Sul.

BACKGROUND: Cardiovascular diseases (CVD) have significant health and economic burdens. In South America, the loss of productivity related to these diseases has not yet been well explored. OBJECTIVE: Estimate the potentially productive years of life lost (PPYLL) and loss of productivity related to premature mortality associated with CVD in South America, in 2019. METHODS: Mortality data available from the 2019 Global Burden of Disease Study were used to estimate the burden of disease attributable to CVD. For monetary calculations of productivity loss, a proxy of the human capital approach was used. Data were stratified by sex, in working age groups. RESULTS: The total number of deaths due to CVD in South America in 2019 was 754,324, and the total number of PPYLL was 2,040,973. The total permanent loss of productivity was approximately US$ 3.7 billion and US$ 7.8 billion in purchasing power parity, equivalent to 0.11% of the gross domestic product. The cost per death was US$ 22,904, and the ratio between men and women for the cost per death was 1.45. The variation in scenarios indicates that the estimates are robust, even with important differences between countries. CONCLUSIONS: CVD impose a significant economic burden on countries in South America. The characterization of this burden can support governments in the allocation of resources for the planning and execution of health policies and interventions in promotion, prevention, and recovery.

FUNDAMENTO: As doenças cardiovasculares (DCV) têm ônus sanitário e econômico significativos. Na América do Sul (AS), a perda de produtividade relacionada a estas enfermidades ainda não foi bem explorada. OBJETIVO: Estimar os anos de vida produtiva perdidos (AVPP) e a perda de produtividade relacionados a mortalidade prematura associada as DCV na AS, em 2019. MÉTODOS: Empregou-se dados de mortalidade disponíveis no Global Burden of Disease Study 2019 na estimativa da carga de doença atribuível a DCV. Para os cálculos monetários da perda da produtividade usou-se uma proxy da abordagem de capital humano. Estratificou-se por sexo, nas faixas etárias de trabalho. RESULTADOS: O número total de mortes por DCV na AS no ano de 2019 foi de 754.324 e os AVPP foram 2.040.973. A perda permanente de produtividade total foi de aproximadamente US$ 3,7 bilhões e US$ 7,8 bilhões em paridade do poder de compra, equivalente a 0,11% do produto interno bruto. O custo por morte foi de US$ 22.904, e a razão desse custo por óbito, entre homens e mulheres foi 1,45. A variação dos cenários aponta robustez nas estimativas, mesmo com diferenças importantes entre os países. CONCLUSÕES: As DCV impõem um ônus econômico significativo a este bloco de países. A caracterização deste fardo pode amparar os governos na alocação de recursos destinados ao planejamento e execução de políticas e intervenções sanitárias, sejam de promoção, prevenção ou recuperação.

Exploring the Landscape of Intracranial Aneurysms in South America: A Comprehensive Narrative Review Intracranial Aneurysms in South America.

Exploring the landscape of intracranial aneurysms in South America unravels a complex interplay of epidemiological factors, clinical manifestations, and therapeutic challenges. The study methodically conducts a comprehensive literature review spanning the years 2003 to 2023, focusing on English-language articles obtained from diverse databases to elucidate the multifaceted nature of intracranial aneurysms in the region. Results and discussions categorize outcomes into positive domains, emphasizing successful treatments, favorable recoveries, and high survival rates, while also shedding light on negative aspects such as residual aneurysms and complications. The research illuminates significant gaps in pathological typing of intracranial aneurysms and exposes challenges in healthcare accessibility, notably the disparities in neurosurgical resources. Management challenges, including constrained infrastructure access, a neurosurgeon shortage, and gender disparities, are underscored. Transitioning to future prospects, the study advocates for strategic interventions, proposing expanded neurosurgical training, multidisciplinary approaches, improved funding, enhanced access to care, and fostering international collaborations. The study concludes by emphasizing the pivotal role of collaborative efforts, intensified training programs, and global partnerships in propelling intracranial aneurysm management forward in South America, ultimately contributing to enhanced patient outcomes across the region.

Toxicity assessment of a tebuconazole-based fungicide on the embryo-larval development of the common south American toad Rhinella arenarum.

Agrochemicals cause diverse effects on aquatic communities, and amphibian species are particularly threatened due the high susceptibility to contamination. Present study evaluates the toxicity of a widely used fungicide tebuconazole (Trigal®) by the assessment of mortality and developmental alterations at acute, subchronic, and chronic exposure during the embryo-larval development of the South American toad Rhinella arenarum. Also, the sensitivity of the different embryonic stages was evaluated with 24-h pulse exposure treatments. The results demonstrated that larvae were more sensitive than embryos at acute exposure (LC50-24 and 96 h = 74.62, 31.92 mg/L and 24.27, 16.81 mg/L for embryos and larvae, respectively). Nevertheless, embryos toxicity increased significantly achieving a sensitivity very similar to larvae at chronic exposure (LC50-168 and 504 h = 13.31, 4.35 mg/L and 14.47, 6.83 mg/L for embryos and larvae, respectively). Embryos exhibited several sublethal effects from 5 mg/L at 96 h onwards, such as delayed development, reduce body size, edemas, tail/axial flexures, weakness, and absence of movements. The teratogenic index at 96 h was 10.13, indicating the severe teratogenic potential of the fungicide. 24-h pulse exposure treatments showed an increased sensitivity in intermediate stages as S.11, S.18, S20, and S.23 (NOEC-96 h = 100, 200, 75, and 20 mg/L, respectively), while stage S.25 was the most sensitive to the fungicide (NOEC-96 h = 5 mg/L). About metamorphic process, tebuconazole caused an acceleration of metamorphosis at the lowest concentration (0.001 mg/L), but also an increase in mortality and in addition, significant differences in the weight in all treatments. The results obtained throughout this work indicate that tebuconazole cause several adverse effects in Rhinella arenarum embryo-larval development.

Analysis of spatial differences in global regional human development index under planetary pressure and decomposition study of driving factors.

To urge nations worldwide to implement robust measures for enhancing human development and mitigating the pressures exerted on the planet by human activities in pursuit of sustainable development, this study encompasses 154 countries globally, using the seven major regions as focal points. Leveraging the Planetary Pressure Adjusted Human Development Index (PHDI) proposed by the United Nations Development Programme on December 15, 2020, as a metric for human development levels, this paper aims to standardize and internationally compare human development data from 1990 to 2021. Subsequently, employing the Theil index, the study assesses the global human development status across the seven regions to analyze spatial disparities in PHDI. Lastly, a comprehensive Generalized Diese Index Method (GDIM) is constructed to accurately reflect absolute and latent factors, dissecting the driving forces impacting global PHDI. The study explores critical pathways for high-quality human development within the harmonious coexistence between humanity and nature. It validates the robustness of GDIM results through a stepwise regression. Research findings indicate varying levels of PHDI development across regions, with a distinct spatial hierarchy evolving: higher human development levels in Europe and Eastern Europe, favorable levels in North and South America, similar levels in Oceania and Asia, and significant improvement potential in Africa. As globalization progresses, overall differences in PHDI gradually decrease; however, disparities persist between and within regions. Economic, technological, and per capita welfare effects consistently positively drive PHDI. In contrast, environmental pressure effects, social effects, per capita value-added effects, and output carbon intensity effects consistently exert hostile driving forces. Population size effects on PHDI show a fluctuating trend. Moreover, in terms of cumulative contribution values, the top three contributors to driving forces are economic, technological, and per capita welfare effects.

Health Science Research at a Regional Level: Insights From South America Comment on "The Roles of Regional Organisations in Strengthening Health Research Systems in Africa: Activities, Gaps, and Future Perspectives".

The article seeks to shed light on the role of regional organizations in strengthening health research systems in Africa, how they operate and how they work, as well as debts and future challenges. As can be observed also in South America, the continued strengthening of health research requires strategic thinking about the roles, comparative advantages, and capacity of regional organizations to facilitate the flourishing of health research systems. Health research is a strategic field for the transformation of socio-health inequalities on the one hand and the reduction of regional asymmetries on the other. Thus, regional organizations represent key actors in strengthening health research systems and the regional research agenda reinforces its sovereign condition in the autonomous definition of relevant topics and financing. In this process, integration mechanisms face a great challenge, as shown by the recent pandemic, not only in Africa but also in South America.

Clusters of rare disorders and congenital anomalies in South America

[ABSTRACT]. Objective. To map geographic clusters of rare disorders and congenital anomalies reported in South America. Methods. Qualitative systematic review conducted in Medline/PubMed, Lilacs, and Scielo electronic data- bases to identify studies meeting eligibility criteria. The strategy resulted in 1 672 unique articles, from which 164 were selected for full reading by a pair of reviewers. Results. Fifty-five articles reported at least one cluster of genetic disorders or congenital anomalies in South American territory. From these papers, 122 clusters were identified, of which half (61) were related to autoso- mal recessive disorders. Sixty-five (53.3%) of the clusters were located in Brazil. Conclusions. The results of the review reinforce that rare diseases and congenital anomalies can occur in a non-random way in space, which is discussed in the perspective of the complex history of formation, social organization, and genetic structure of the South American population. Mapping clusters in population medical genetics can be an important public health tool, given that such places concentrate cases of rare diseases that frequently require multiprofessional, specialized care. Therefore, these results can support important agendas in public health related to rare diseases and congenital anomalies, such as health promotion and surveillance.

[RESUMEN]. Objetivo. Trazar los conglomerados geográficos de los trastornos y las malformaciones congénitas poco frecuentes notificados en América del Sur. Métodos. Se realizó una revisión sistemática cualitativa en las bases de datos electrónicas Medline/PubMed, Lilacs y Scielo para encontrar los estudios que cumplieran con los criterios de selección. Se encontraron 1672 artículos originales, de los que se seleccionaron 164 para su lectura completa por un par de revisores. Resultados. En 55 artículos se informó de al menos un conglomerado de trastornos genéticos o malforma- ciones congénitas en América del Sur. A partir de estos artículos, se encontraron 122 conglomerados, de los cuales la mitad (61) se asociaron con trastornos autosómicos recesivos. Sesenta y cinco (53,3%) de los conglomerados se ubicaron en Brasil. Conclusiones. Los resultados de la revisión confirman que las enfermedades raras y las malformaciones congénitas pueden presentarse de una forma no aleatoria en el espacio, lo que se comenta desde la per- spectiva de la complejidad histórica del proceso de formación, organización social y estructura genética de la población de América del Sur. Definir geográficamente los conglomerados en la genética médica pobla- cional puede ser una importante herramienta de salud pública, ya que en esos lugares se concentran casos de enfermedades raras que suelen requerir una atención especializada y multidisciplinaria. Por lo tanto, estos resultados pueden servir de apoyo a importantes programas de salud pública relacionados con las enferme- dades raras y las malformaciones congénitas como, por ejemplo, la promoción de la salud y la vigilancia.

[RESUMO]. Objetivo. Mapear agrupamentos geográficos de doenças raras e anomalias congênitas relatados na América do Sul. Métodos. Revisão sistemática qualitativa realizada nas bases de dados eletrônicos Medline/PubMed, Lilacs e Scielo para identificar estudos que atendessem aos critérios de elegibilidade. A estratégia resultou em 1.672 artigos únicos, dos quais 164 foram selecionados para leitura completa por uma dupla de revisores. Resultados. Cinquenta e cinco artigos relataram pelo menos um agrupamento de distúrbios genéticos ou anomalias congênitas no território sul-americano. A partir desses artigos, foram identificados 122 agrupamen- tos, dos quais metade (61) estava relacionada a doenças autossômicas recessivas. Sessenta e cinco (53,3%) dos agrupamentos estavam localizados no Brasil. Conclusões. Os resultados da revisão reforçam a observação de que doenças raras e anomalias congênitas podem ocorrer de forma não aleatória no espaço, o que é discutido na perspectiva da complexa história de formação, organização social e estrutura genética da população sul-americana. O mapeamento de agrupa- mentos em genética médica populacional pode ser uma importante ferramenta de saúde pública, visto que esses locais concentram casos de doenças raras que frequentemente requerem atendimento multiprofissional especializado. Portanto, esses resultados podem apoiar importantes agendas de saúde pública relacionadas a doenças raras e anomalias congênitas, como a vigilância e a promoção da saúde.

Alterações climáticas e sua repercussão sobre a saúde humana em países da América do Sul / Climate change and its impact on human health in South America

Nas últimas duas décadas as mudanças climáticas têm se intensificado, causado danos ao meio ambiente e aos indivíduos que nele habitam. Várias ações do ser humano têm contribuído para que cada vez mais essas mudanças climáticas sejam mais presentes e intensas. O aumento das desigualdades e vulnerabilidades sociais, o desmatamento, os incêndios florestais voluntários, a degradação do solo e a poluição ambiental aliados à variabilidade climática global da temperatura da água do mar podem potencialmente levar a eventos climáticos extremos, potencializando os efeitos negativos sobre a saúde. Neste trabalho é apresentado um resumo do relatório do Lancet Countdown South America, fruto da colaboração acadêmica multidisciplinar de instituições de ensino e agências sul-americanas de saúde de 12 países (Argentina, Bolívia, Brasil, Colômbia, Chile, Equador, Guiana, Paraguai, Peru, Uruguai, Venezuela e Suriname) publicado por Hartinger e cols. (2023). Este estudo é uma alerta, pois nele são publicados os resultados do levantamento sobre mudanças climáticas e seus efeitos sobre a saúde humana no continente sul-americano. Conhecê-las é o primeiro passo para que políticas de saúde pública sejam instituídas, e, preferencialmente, de modo preventivo.

Climate change has intensified in the last two decades, damaging the environment and those who inhabit it. Human activity has increased the prevalence and intensity of these changes. Increased social inequality and vulnerability, deforestation, intentional forest fires, soil degradation, and environmental pollution, when associated with sea temperature variability, can lead to extreme weather events, increasing negative health effects. This report summarizes Lancet Countdown South America (Hartinger et al. 2023), the result of multidisciplinary collaboration between education institutions and South American health agencies from 12 countries: Argentina, Bolivia, Brazil, Colombia, Chile, Ecuador, Guyana, Paraguay, Peru, Uruguay, Venezuela and Suriname. This should be considered a wake-up call because it contains the results of a climate change survey and its effects on human health in South America. Knowing these effects is the first step toward appropriate, preferably preventive, public health policies.

Cost of lost productivity from acute respiratory infections in South America

[ABSTRACT]. Objectives. To estimate the burden of permanent productivity losses caused by acute respiratory infections in South American countries in 2019. Methods. Mortality data from the Global Burden of Disease Study 2019 were analyzed to estimate the burden of disease attributable to acute respiratory infections. An approach based on the human capital method was used to estimate the cost of permanent productivity losses associated with respiratory diseases. To calculate this cost, the sum of the years of productive life lost for each death was multiplied by the proportion in the work- force and the employment rate, and then by the annual minimum wage or purchasing power parity in United States dollars (US$) for each country in the economically active age groups. Separate calculations were done for men and women. Results. The total number of deaths from acute respiratory infections in 2019 was 30 684 and the years of productive life lost were 465 211 years. The total cost of permanent productivity loss was about US$ 835 mil- lion based on annual minimum wage and US$ 2 billion in purchasing power parity, representing 0.024% of the region’s gross domestic product. The cost per death was US$ 33 226. The cost of productivity losses differed substantially between countries and by sex. Conclusion. Acute respiratory infections impose a significant economic burden on South America in terms of health and productivity. Characterization of the economic costs of these infections can support governments in the allocation of resources to develop policies and interventions to reduce the burden of acute respiratory infections.

[RESUMEN]. Objetivos. Estimar la carga de la pérdida permanente de productividad causada por infecciones respiratorias agudas en países sudamericanos en el 2019. Métodos. Se analizaron los datos de mortalidad del estudio sobre carga mundial de enfermedad del 2019 para estimar la carga de enfermedad atribuible a las infecciones respiratorias agudas. Se empleó un enfoque basado en el método del capital humano para estimar el costo de las pérdidas permanentes de productividad relacionadas con las enfermedades respiratorias. Para ello, la suma de los años perdidos de vida productiva por cada muerte se multiplicó por la proporción de la fuerza de trabajo y la tasa de empleo y, a continuación, por el salario mínimo anual o la paridad del poder adquisitivo en dólares estadounidenses en los grupos etarios económicamente activos de cada país. Se realizaron cálculos separados para hombres y mujeres. Resultados. El número total de muertes por infecciones respiratorias agudas en el 2019 fue de 30 684 y se perdieron 465 211 años de vida productiva. El costo total de la pérdida permanente de productividad fue de aproximadamente US$ 835 millones según el salario mínimo anual y de US$ 2000 millones en cuanto a la paridad de poder adquisitivo, lo que representa el 0,024% del producto interno bruto de la región. El costo por muerte fue de US$ 33 226. El costo de la pérdida de productividad difirió sustancialmente entre los países y según el sexo. Conclusión. Las infecciones respiratorias agudas suponen una carga económica significativa para América del Sur en términos de salud y productividad. La caracterización de los costos económicos de estas infecciones puede ayudar a los gobiernos en la asignación de recursos para elaborar políticas e intervenciones que permitan reducir la carga de las infecciones respiratorias agudas.

[RESUMO]. Objetivos. Estimar a carga de perdas permanentes de produtividade causadas por infecções respiratórias agudas em países da América do Sul em 2019. Métodos. Dados de mortalidade do estudo Carga Global de Doença 2019 foram analisados para estimar a carga de doença atribuível a infecções respiratórias agudas. Utilizou-se uma abordagem baseada no método do capital humano para estimar o custo das perdas permanentes de produtividade associadas às doenças respiratórias. Para calcular esse custo, a soma dos anos de vida produtiva perdidos devido a cada morte foi multiplicada pela proporção da força de trabalho e da taxa de emprego. Em seguida, esse valor foi multiplicado pelo salário mínimo anual ou pela paridade do poder de compra, em dólares dos Estados Unidos (US$), de cada país nas faixas etárias economicamente ativas. Foram feitos cálculos separados para homens e mulheres. Resultados. O número total de mortes por infecções respiratórias agudas em 2019 foi de 30 684, com 465 211 anos de vida produtiva perdidos. O custo total da perda permanente de produtividade foi de cerca de US$ 835 milhões com base no salário mínimo anual e US$ 2 bilhões em paridade de poder de compra, o que representa 0,024% do produto interno bruto da região. O custo por morte foi US$ 33 226. O custo da perda de produtividade diferiu substancialmente entre os países e por sexo. Conclusão. As infecções respiratórias agudas impõem uma carga econômica significativa à América do Sul em termos de saúde e produtividade. A caracterização dos custos econômicos dessas infecções pode fundamentar as decisões de alocação de recursos tomadas pelos governos para desenvolver políticas e intervenções com o intuito de reduzir a carga das infecções respiratórias agudas.

A legal assessment of private land conservation in South America.

Privately protected areas (PPAs) are a potentially innovative conservation tool. Legal recognition is necessary for their success, especially where there are institutional challenges to nature conservation, such as in South America. Although PPAs have increased in South America since the early 2000s, there is a critical information gap pertaining to their legal frameworks. We analyzed the level of landowner commitment to and governmental support for PPAs across countries in South America that officially recognize PPAs. We analyzed the legal framework governing PPAs and reviewed literature on them. This process was done in English and Spanish. The information we gathered was validated by 16 conservation experts from 10 South American countries. Because Peru is 1 of only 2 South American countries where local communities create and manage PPAs, we studied Peruvian PPAs in more detail by examining official creation documents and interviewing 13 local conservation professionals. We found inadequate minimum duration of PPAs and vague guidelines for conducting economic activities within them and a lack of governmental support (e.g., financial and technical support) for PPAs. Support was limited to the exemption from rural property taxes, which are relatively low compared with countries outside South America. In Peru, PPAs run by individuals and communities needed different legal frameworks because they were created with different objectives and had different sizes and duration of commitments. The prompt improvement of legal frameworks across South America is necessary for PPAs to achieve their aim of being places for enduring nature conservation in the region.

Una revisión legal de la conservación voluntaria entierras privadas de América del Sur Resumen Las áreas protegidas privadas (APP) son una herramienta de conservación con potencial innovador. Para ser exitosas, las APP necesitan reconocimiento legal, especialmente cuando existen obstáculos institucionales para la conservación de la naturaleza, como sucede en América del Sur. Aunque las APP han aumentado en esta zona desde principios de la década del 2000, existe un vacío de información con respecto a sus marcos legales. Analizamos el nivel de compromiso de los terratenientes y el apoyo gubernamental hacia las APP en los países de América del Sur que reconocen de forma oficial las APP. Analizamos el encuadre legal que rige a las APP y revisamos la literatura existente sobre ellas; realizamos este proceso en inglés y en español. Dieciséis expertos de la conservación de diez países sudamericanos validaron la información recopilada. Ya que Perú es uno de los dos países de la zona en donde las comunidades locales crean y manejan las APP, nos enfocamos en sus APP y examinamos a detalle los documentos oficiales de creación y entrevistamos a 13 profesionales de la conservación locales. Encontramos una duración mínima inadecuada de las APP y directrices vagas para la realización de actividades dentro de ellas, así como una falta de apoyo gubernamental (p. ej.: apoyo económico y técnico). Este apoyo se limitaba a la exención de los impuestos sobre la propiedad rural, los cuales son relativamente bajos en comparación con los países fuera de América del Sur. En Perú, las APP a cargo de individuos y comunidades necesitaban diferentes encuadres legales porque fueron creados con diferentes objetivos y tenían diferentes tamaños y plazos para los compromisos. Se necesita una rápida mejora de los marcos legales en América del Sur para que las APP logren el objetivo de ser sitios para que perdure la conservación de la naturaleza en la región.

Mushroom Production in the Southern Cone of South America: Bioeconomy, Sustainable Development and Its Current Bloom.

A Sustainable Development Goals (SDGs) based analysis is presented here for business development of the production of edible and medicinal mushrooms using agro-wastes in the Southern Cone of South America. This circular economy approach using edible and medicinal mushroom production on lignocellulosic residues is discussed by analysing both its advantages and drawbacks. Among its main benefits, it is notable that mushroom cultivation using lignocellulosic residues promotes innovation aimed at environmental sustainability, facilitating diversification of the labour supply and the transfer of science to the socio-cultural sphere, which also increases the availability of healthy foods. However, there are some bottlenecks in the process, such as the continuous supply chain of substrates for fungal growth, the lack of equipment and infrastructure for the implementation of cultivation systems in extreme habitats, as well as authorization requirements and other limitations related to a non-fungiphilic culture society. Therefore, this chapter tries to provide key tools for establishing sustainable guidelines for the procurement of local healthy food and other products derived from mushroom cultivation using agricultural residues in the region, which might bloom due to an SDGs-based circular economy approach.

Exploring the impact of economic growth on environmental pollution in South American countries: how does renewable energy and globalization matter?

Most emerging economies and the South American Countries are no exception to the negative consequences of trade-off between economic growth and environmental sustainability decisions. This study draws strength from the United Nations Sustainable Development Goals (UN-SDGs-7, 11, 12, and 13). Therefore, this study examines the environmental nexus between economic growth, globalization, renewable, and non-renewable energy, in South America from 1995 to 2020. We deployed the pooled mean group (PMG), mean group (MG), and dynamic fixed effects (DFE). Cross-sectional dependence, panel unit root, and cointegration tests were performed. Finally, we used the Dumitrescu and Hurlin test of causality to determine the long-run association between variables. The finding indicates that while environmental pollution increases with increasing economic growth, it decreases with increasing renewable energy both in the short and long term. Whereas economic globalization positively affects environmental pollution in the long term, social globalization and the moderation effect between political globalization and renewable energy improves environmental quality in the long run. Finally, a bidirectional causality was found between economic growth and environmental pollution, with a unidirectional causality running from economic, political, and social globalization, renewable, and non-renewable energy to environmental pollution. Given these findings, we discussed potential policy measures.

Perda de Produtividade Atribuída a Neoplasias na América do Sul / Lost Productivity Attributed to Neoplasms in South America / Pérdida de Productividad Atribuida a Neoplasias en América del Sur

Introdução: A carga da doença tem sido empregada em estimativas do impacto das neoplasias, mas a perda de produtividade em razão dessas enfermidades ainda não foi tão explorada. Objetivo: Estimar os anos de vida produtiva perdidos (AVPP) e a perda de produtividade por conta da mortalidade prematura relacionada ao câncer em países da América do Sul em 2019. Método: Dados de mortalidade disponíveis no Global Burden of Disease (GBD) Study 2019 foram usados para estimar a carga de doença atribuível a neoplasias. A perda de produtividade em termos monetários foi calculada usando um proxy da abordagem do capital humano (ACH). Os cálculos foram realizados por sexo, nas faixas etárias de trabalho. Resultados: O total de óbitos foi de 192.240 e o de AVPP, 2.463.155. A perda total de produtividade permanente foi de US$ 4,4 bilhões e US$ 9,4 bilhões em purchasing power parity (PPP) ­ 0,13% do produto interno bruto (PIB) da região. O custo total por morte foi de US$ 23.617. Houve diferenças significativas entre os países, mas a variação dos cenários mostra robustez das estimativas. Conclusão: O câncer impõe um ônus econômico significativo à América do Sul tanto em termos de saúde quanto de produtividade. Sua caracterização pode subsidiar os governos na alocação de recursos destinados ao planejamento de políticas e execução de intervenções de saúde

Introduction: The burden of the disease has been utilized in estimates of the impact of neoplasms, but the loss of productivity due to these diseases has not yet been explored. Objective: To estimate the years of productivity life lost (YPLL) and lost productivity due to premature cancer-related mortality in South American countries in 2019. Method: Mortality data available from Global Burden of Disease (GBD) Study 2019 was analyzed to estimate the burden attributable to neoplasms. The productivity loss in monetary terms was estimated using a proxy of the human capital approach (HCA). Calculations were performed by sex, in working age groups. Results: The total deaths and YPLL reached 192,240 and 2.463.155, respectively. The total permanent productivity loss was around US$ 4.4 billion and US$ 9.4 billion in purchasing power parity (PPP) ­ 0.13% of the continent's gross domestic product (GDP). Total cost per death was US$23,617. There were significant differences among countries, but the variation of scenarios shows robustness of the estimates. Conclusion: Cancer imposes a significant economic burden on South American, both in terms of health and productivity. Its characterization can help governments to allocate resources for policies planning and health interventions.

Introducción: Se ha utilizado la carga de enfermedad en las estimaciones del impacto de las neoplasias, pero aún no se ha explorado la pérdida de productividad por estas enfermedades. Objetivo: Estimar los años de vida productiva perdidos (AVPP) y la pérdida de productividad debido a la mortalidad prematura relacionada con el cáncer en los países de la América del Sur en 2019. Método: Datos de mortalidad disponibles del Global Burden of Disease (GBD) Study 2019 fueron utilizado para estimar la carga de enfermedad atribuible a las neoplasias. La pérdida de productividad en términos monetarios se calculó utilizando un proxy de enfoque de capital humano (ACH). Los cálculos se realizaron por sexo, en los grupos de edad laboral. Resultados: El número total de muertes fue de 192.240 y de AVPP, 2.463.155. La pérdida total de productividad permanente fue del orden de US$ 4.400 millones y US$ 9.400 millones en purchasing power parity (PPP) ­ 0,13% del producto interior bruto (PIB) de la región. El costo total por muerte fue de $23,617. Hubo diferencias significativas entre países, pero la variación de escenarios muestra la robustez de las estimaciones. Conclusión: El cáncer impone una carga económica significativa a América del Sur, tanto en términos de salud como de productividad. Su caracterización puede apoyar a los gobiernos en la asignación de recursos para la planificación de políticas y ejecución de intervenciones en salud.

Assessment of cerebrospinal fluid analysis and short-term survival outcomes in South American camelids: A retrospective study of 54 cases (2005-2021).

BACKGROUND: Cerebrospinal fluid (CSF) is commonly analyzed in South American camelids with suspected neurologic disease because of ease of collection and characteristic findings associated with certain diseases. OBJECTIVES: To assess CSF findings associated with short-term survival or non-survival in South American camelids in which neurologic disease was a differential diagnosis based on history and physical examination. ANIMALS: Twenty-one llamas and 33 alpacas that underwent CSF analysis at the University of Missouri Veterinary Health Center. METHODS: Retrospective study. Medical records of camelids that underwent CSF analysis between January 2005 and September 2021 were studied. Short-term survival was defined as survival to discharge from the Veterinary Health Center. A Fisher's exact test was used to compare species, CSF results, and survival. RESULTS: Odds of survival were 3.9 times higher in camelids with a total nucleated cell count (TNCC) <3 cells/µL (P = .04). No significant association was found between survival and total protein concentration (TPC; P = .15) or percentage of eosinophils (P = 1.0). No significant correlation was found between species and increased TNCC (P = .63), TPC (P = .55), or percentage of eosinophils (P = .30). Among camelids diagnosed with Paralephostrongylus tenuis infestation, odds of survival were 4.95 times higher in alpacas (P = .05). CONCLUSIONS: Cerebrospinal fluid TNCC ≥3 cells/µL is associated with decreased odds of short-term survival in South American camelids.

Controle do câncer do colo do útero na atenção primária à saúde em países sul-americanos: revisão sistemática

[RESUMO]. Objetivo. Descrever as estratégias para prevenção e controle do câncer do colo do útero (CCU) na atenção primária à saúde (APS) na América do Sul. Métodos. Revisão de literatura em duas etapas: revisão documental em sites governamentais de Argentina, Bolívia, Brasil, Chile, Colômbia, Equador, Paraguai, Peru, Uruguai e Venezuela; e revisão sistemática da literatura nas bases LILACS, MEDLINE, Scopus, SciELO e Science Direct. Resultados. Foram incluídos 21 documentos institucionais (planos, guias de prática e diretrizes nacionais) e 25 artigos. Todos os países tinham taxas elevadas de morbimortalidade por CCU. Predominou o rastreamento oportunístico na APS, embora os documentos disponíveis sinalizassem intenções e estratégias para diagnóstico precoce e acompanhamento longitudinal dos casos suspeitos e confirmados, preferencialmente na rede pública. Todos os países adotavam uma concepção abrangente de APS, embora o processo de implementação estivesse em estágios heterogêneos e predominassem a focalização e a seletividade. Destaca- se pior acesso ao rastreamento para mulheres de regiões rurais ou remotas e para povos originários. A indisponibilidade de serviços de APS próximos às residências/comunidade foi uma importante barreira para o rastreamento do CCU. Conclusões. A fragmentação dos sistemas de saúde e a segmentação na oferta de serviços são obstáculos para a prevenção e o controle do CCU na América do Sul. São necessários programas organizados de rastreamento do CCU e a incorporação de busca ativa para realização do Papanicolaou via APS. A interculturalidade nas práticas e a formulação de políticas numa perspectiva interseccional são fundamentais para superar as iniquidades no controle do CCU nos países sul-americanos.

[ABSTRACT]. Objective. To describe cervical cancer (CC) prevention and control strategies in the primary care setting in South America. Method. Two review steps were performed: review of documents published in governmental websites in Argentina, Bolivia, Brazil, Chile, Colombia, Ecuador, Paraguay, Peru, Uruguay, and Venezuela; and systematic review of the literature available in LILACS, MEDLINE, Scopus, SciELO, and Science Direct databases. Results. Twenty-one institutional documents (plans, practice guides, and national guidelines) and 25 journal articles were included. All countries had high CC morbidity and mortality rates. Screening in primary healthcare (PHC) was mostly opportunistic, although the institutional documents indicated an intention and strategies for early diagnosis and longitudinal follow-up of suspected and confirmed cases, preferably within the public healthcare system. All countries adopted a broad view of PHC, although the stage of PHC implementation was heterogeneous in different countries, with predominance of selective PHC. Access to screening was more difficult for women from rural or remote areas and for indigenous populations. The unavailability of PHC close to households/communities was an important barrier for CC screening. Conclusions. The fragmentation of healthcare systems and the selective provision of services are barriers for the prevention and control of CC in South America. Organized CC screening programs and active search for Papanicolaou testing in primary care are needed. Intercultural practices and intersectional public policies are essential to overcome the inequities in CC control in South American countries.

[RESUMEN]. Objetivo. Describir las estrategias de prevención y control del cáncer cervicouterino (CCU) en los servicios de atención primaria de salud (APS) de América del Sur. Métodos. Revisión bibliográfica en dos etapas, a saber, revisión documental en sitios web gubernamentales de Argentina, Bolivia, Brasil, Chile, Colombia, Ecuador, Paraguay, Perú, Uruguay y Venezuela, y revisión sistemática en las bases de datos LILACS, MEDLINE, Scopus, SciELO y Science Direct. Resultados. Se incluyeron 21 documentos institucionales (planes, guías de práctica y directrices nacionales) y 25 artículos. Todos los países tenían altas tasas de morbilidad y mortalidad por CCU. En los servicios de APS predominó el tamizaje oportunista, aunque los documentos disponibles señalaran intenciones y estrategias de diagnóstico precoz y seguimiento longitudinal de los casos sospechosos y confirmados, particularmente en la red pública. Todos los países adoptaron un concepto integral de APS, aunque el proceso de aplicación se encontrara en fases heterogéneas y predominaran la focalización y la selectividad. Cabe destacar que las mujeres de las zonas rurales o remotas y de los pueblos indígenas registran el peor grado de acceso al tamizaje. La falta de servicios de APS cerca de las residencias o las comunidades fue una barrera importante para el tamizaje del CCU. Conclusiones. La fragmentación de los sistemas de salud y la segmentación en la oferta de servicios son obstáculos para la prevención y el control del CCU en América del Sur. Se necesitan programas organizados de tamizaje del CCU e incorporación de la búsqueda activa para realizar la prueba de Papanicolaou en los servicios de APS. La interculturalidad en las prácticas y la formulación de políticas desde una perspectiva intersectorial son esenciales para superar las inequidades en el control del CCU en los países suramericanos.

Volcano: Between Structural Vulnerabilities and Collective Defence of Honor in Communities Surrounding an Open Dumpsite.

This study analyzes the dynamics in which structural vulnerabilities are shaped and expressed in the day-to-day lives of people making a living from a garbage dump in Argentina. It is a mixed methods case study, qualitative driven with a collaborative cycle (2016-2021). The study is embedded in medical anthropology, social epidemiology and Latin America Social Medicine, with the focus on the ways people respond to inequalities locally. The findings contribute to the field of health disparities in three directions: 1) the description of patterns of segregation in South America peripheries, shedding light on cumulative disadvantages and multiple exposures; 2) the experience of living enmeshed in places with strong stigmas, revising the ways this source of discrimination become social suffering; and 3) the detection of the impact of collective action and social capital in providing material and symbolic resources for restoring dignity and honour that challenge depreciated status.

DOSIMETRY IN DIGITAL BREAST TOMOSYNTHESIS: COST-EFFICIENT APPROACH FOR THE SOUTH AMERICAN PERSPECTIVES.

The measurement of air kerma in air (Kair) to estimate average glandular dose (AGD) received during digital breast tomosynthesis (DBT) studies is sometimes a difficult task. In this work, a novel methodology was implemented to measure Kair and half-value layer while the X-ray tube is rotating. A low economic cost support (LCS) was built to place aluminium sheets and a calibrated dosemeter. Three Fujifilm Innovality equipment were used and two dosemeters calibrated on W-Al energies. Validation of the new methodology was made against standard scheme and it was applied to estimate AGD for 300 patients and 7 phantoms. Validation analysis was satisfactory. The difference in the AGD calculated with the LCS and DICOM Header was lower than ±10%. AGD values ranged from 0.77 to 2.11 mGy and 0.85 to 2.15 mGy for phantoms and patients, respectively. The novel methodology has a potential use for DBT equipment without stationary mode.