[Managing conflicts of interest in tobacco control: situation in the AmericasManejo de conflitos de interesse no controle do tabaco: situação nas Américas]. / Manejo de conflictos de interés en control del tabaco: situación en las Américas.

This special report describes the methodology for calculating the indicator for the adoption of effective mechanisms to counter interference by the tobacco industry and those who work to further its interests, as established in the Strategy and Plan of Action to Strengthen Tobacco Control in the Region of the Americas 2018-2022; the report also presents the status of adoption of these mechanisms in the countries of the Region as of 2019, and progress since 2016. It was found that, as of 2019, of the 35 Pan American Health Organization (PAHO) Member States 13 had regulations establishing specific measures for managing conflicts of interest for government officials and employees with responsibility for tobacco control policies; seven had implemented related but nonspecific measures; and 14 had not implemented any measure. Although there has been progress since 2016, efforts must be redoubled to reach the target of 20 Member States having mechanisms for the identification and management of conflicts of interest, as established in the Strategy and Plan of Action. It should be noted that having regulations on the subject does not fulfill, nor by any means fully meet, all the obligations arising from Article 5.3 of the World Health Organization Framework Convention on Tobacco Control. The PAHO Secretariat, in response to requests by Member States, developed the methodology for calculation of the indicator and systematized the findings that are presented.

Este relatório especial descreve tanto a metodologia de cálculo do indicador sobre a adoção de mecanismos eficazes para evitar a interferência da indústria do tabaco ou daqueles que defendem seus interesses, estabelecida na "Estratégia e plano de ação para fortalecer o controle do tabagismo na Região das Américas 2018-2022", quanto a situação da adoção desses mecanismos nos países da Região para o ano de 2019, e seu progresso desde 2016. Constatou-se que, até 2019, dos 35 Estados Membros da Organização Pan-Americana da Saúde (OPAS), 13 possuíam regulamentações que estabelecem medidas específicas para o manejo de conflitos de interesse para funcionários públicos responsáveis por políticas de controle do tabaco. Da mesma forma, 7 haviam implementado medidas relacionadas, mas não específicas, e 14 não haviam implementado nenhuma medida. Embora haja avanços em relação a 2016, os esforços devem ser redobrados para atingir a meta estabelecida na estratégia e no plano de ação de 20 Estados Membros com mecanismos de identificação e gestão de conflitos de interesse. Vale destacar que ter regulamentação sobre o tema não esgota, muito menos conclui, o cumprimento de todas as obrigações que emanam do artigo 5.3 da Convenção-Quadro da Organização Mundial da Saúde para o Controle do Tabaco. A Secretaria da OPAS, em cumprimento ao que foi solicitado pelos Estados Membros, desenvolveu a metodologia para o cálculo do indicador e sistematizou os resultados aqui apresentados.

Lessons learned from fostering tobacco taxes in the Americas and implications for other health taxes.

During the past decade progress has been made from a public health perspective in advancing tobacco taxation policies in the World Health Organization's Region of the Americas, and there are important lessons to be learned from this experience. This report aims to systematize and distill the key lessons learned, both by documenting progress and paving the way toward a comprehensive approach to taxing other health-harming products, particularly those considered to be drivers of the noncommunicable disease epidemic, such as alcohol and sugar-sweetened beverages. A thorough review of publications and institutional documents was undertaken and discussions were held with experts about the experiences of the past decade. Broadly, the lessons can be characterized according to the main mechanisms that have fostered progress. These are the robust, consistent and standardized monitoring of tobacco taxes that has enabled comparisons between countries and across time; the setting of tax policy within a framework of multisectoral policy coherence; and the development of guidelines and the generation of independent evidence to support tobacco taxes and tackle harmful industry interference. Currently, progress in these areas is lagging for taxes on alcohol and sugar-sweetened beverages. Applying the lessons learned from the extensive experience with tobacco taxation can help advance progress in taxes on alcohol and sugar-sweetened beverages and capture the potential synergies to be gained from building a comprehensive approach. Although more work is needed in developing and implementing taxation policies across all three products, the findings from this report can assist in strengthening their public health objectives to tackle noncommunicable diseases and improve population health.

Desde una perspectiva de salud pública, en los últimos diez años se ha avanzado en la formulación de políticas de aplicación de impuestos al tabaco en la Región de las Américas de la Organización Mundial de la Salud, y se pueden extraer importantes enseñanzas de esta experiencia. Este informe tiene como objetivo sistematizar y extraer las enseñanzas clave, tanto al documentar el progreso como al allanar el camino hacia un enfoque integral para gravar otros productos dañinos para la salud, particularmente los que se considera que están impulsando la epidemia de las enfermedades no transmisibles, como las bebidas alcohólicas y las bebidas azucaradas. Se llevó a cabo una revisión exhaustiva de las publicaciones y los documentos institucionales, y se celebraron debates con expertos sobre las experiencias del último decenio. En términos generales, las enseñanzas pueden caracterizarse según los principales mecanismos que han fomentado el progreso. Estos mecanismos son: un seguimiento sólido, sistemático y estandarizado de los impuestos al tabaco que ha permitido realizar comparaciones entre países y períodos; el establecimiento de políticas fiscales en un marco de coherencia de las políticas multisectoriales; y la formulación de pautas y obtención de evidencia independiente para apoyar los impuestos sobre el tabaco y hacer frente a la interferencia nociva de la industria. Actualmente, el progreso en estas áreas está rezagado en el caso de los impuestos sobre las bebidas alcohólicas y las bebidas azucaradas. La aplicación de las enseñanzas obtenidas en la amplia experiencia con la tributación del tabaco puede contribuir a avanzar en los impuestos sobre las bebidas alcohólicas y las bebidas azucaradas, así como a las posibles sinergias que se obtendrán de la elaboración de un enfoque integral. Aunque es necesario seguir trabajando más en la formulación y ejecución de políticas tributarias para los tres productos, los hallazgos de este informe pueden contribuir a fortalecer los objetivos de salud pública para abordar las enfermedades no transmisibles y mejorar la salud de la población.

Na última década, sob a perspectiva da saúde pública, houve progresso no avanço das políticas de tributação do tabaco na Região das Américas da Organização Mundial da Saúde, e há lições importantes a serem aprendidas com essa experiência. Este relatório visa a sistematizar e sintetizar as principais lições aprendidas, documentando o progresso e abrindo o caminho para uma abordagem integral de tributação de outros produtos prejudiciais à saúde, especialmente produtos considerados fatores impulsionadores da epidemia de doenças não transmissíveis, como o álcool e as bebidas açucaradas. Realizou-se uma revisão completa de publicações e documentos institucionais e discussões com especialistas sobre as experiências da última década. De modo geral, as lições podem ser caracterizadas segundo os principais mecanismos que promoveram o progresso. São eles: o monitoramento robusto, consistente e padronizado dos impostos sobre o tabaco, o que permitiu fazer comparações entre países e ao longo do tempo; a criação de políticas fiscais em um marco de coerência multissetorial nas políticas; e o desenvolvimento de diretrizes e a geração de evidências independentes para apoiar os impostos sobre o tabaco e combater a interferência nociva da indústria tabagista. Atualmente, o progresso nessas áreas está atrasado em termos de impostos sobre o álcool e as bebidas açucaradas. A aplicação das lições aprendidas com a vasta experiência obtida com a tributação do tabaco pode ajudar a avançar nos impostos sobre o álcool e as bebidas açucaradas e capturar as potenciais sinergias obtidas com a elaboração de uma abordagem integral. Embora seja preciso mais trabalho para desenvolver e implementar políticas de tributação para os três produtos, os achados deste relatório podem ajudar a fortalecer os objetivos de saúde pública de combater as doenças não transmissíveis e melhorar a saúde da população.

Advances in tobacco control in the Region of the Americas, 2020.

This report describes the current status of the tobacco control measures contained in the Strategy and Plan of Action to Strengthen Tobacco Control in the Region of the Americas 2018-2022 (Pan American Health Organization) and the advances made in its application, identifying achievements from 2016 to 2020 and challenges that still need to be addressed in order to reach the expected goals. This analysis relied on data from the World Health Organization (WHO) Report on the Global Tobacco Epidemic from 2015, 2017, and 2019, and national regulations were analyzed to determine their consistency with WHO criteria. Significant progress has been made in implementation of the WHO Framework Convention on Tobacco Control in the Americas. By 2020, most countries had regulations on 100% smoke-free environments in indoor public places, workplaces, and public transport, and large graphic health warnings on tobacco packaging. The number of countries that ban tobacco advertising, promotion, and sponsorship and that tax tobacco at the minimum level recommended by WHO has doubled since 2016. However, the 2022 targets have not yet been reached for any of these measures or for ratification of the relevant international agreements. Although progress has been made in the Region, it has not been uniform. Unless the pace of application of the tobacco control measures contained in the Strategy and Plan of Action accelerates, it is unlikely that its targets will be met. Tobacco industry interference remains one of the main challenges.

Se describe el estado actual y los avances en la aplicación de las medidas de control del tabaco contenidas en la Estrategia y Plan de Acción para Fortalecer el Control del Tabaco en la Región de las Américas 2018-2022 y se identifican los logros alcanzados entre los años 2016 y 2020 y los retos que aún se deben enfrentar para cumplir las metas previstas. Para ello se utilizaron los datos del Informe de la Organización Mundial de la Salud (OMS) sobre la Epidemia Mundial de Tabaquismo de los años 2015, 2017 y 2019, así como las normativas nacionales para determinar su consistencia con los criterios de la OMS. Se constatan importantes avances en la aplicación del Convenio Marco de la OMS para el Control del Tabaco en las Américas. Al 2020, la mayoría de los países contaban con normativas sobre ambientes 100% libres de humo en lugares cerrados públicos y de trabajo, y el transporte público, y advertencias sanitarias gráficas grandes en los paquetes de tabaco. Desde el 2016 se duplicó el número de países que prohíben la publicidad, la promoción y el patrocinio del tabaco y que aplican impuestos al tabaco al nivel mínimo recomendado por la OMS. Sin embargo, aún no se ha alcanzado la meta prevista al 2022 para ninguna de esas medidas ni para la ratificación de los tratados internacionales en el tema. Aunque se ha avanzado en la Región, el avance no ha sido uniforme, y a menos que el ritmo de aplicación de las medidas de control del tabaco contenidas en la Estrategia y Plan de Acción se acelere, es poco probable que se logren las metas establecidas. La interferencia de la industria tabacalera se mantiene como uno de los principales retos.

Este artigo descreve a situação atual e o progresso na implementação das medidas para o controle do tabagismo prescritas na Estratégia e plano de ação para fortalecer o controle do tabagismo na Região das Américas 2018-2022, reconhece as conquistas realizadas no período entre 2016 e 2020, e identifica os desafios a serem enfrentados para alcançar as metas planejadas. A análise se baseou em dados obtidos do Relatório da OMS sobre a Epidemia Global do Tabaco, publicado em 2015, 2017 e 2019, e em regulamentações nacionais para determinar o cumprimento dos critérios da OMS. Observam-se avanços na implementação da Convenção-Quadro da OMS para o Controle do Tabaco nas Américas. Em 2020, a maior parte dos países dispunha de regulamentações para ambientes 100% livres da fumaça do tabaco em locais públicos fechados, locais fechados de trabalho e meios de transporte público, e advertências sanitárias com ilustrações gráficas grandes nas embalagens dos produtos de tabaco. O número de países que proíbem publicidade, promoção e patrocínio do tabaco e adotaram impostos sobre os produtos do tabaco no padrão mínimo recomendado pela OMS dobrou desde 2016. No entanto, as metas planejadas para 2022 ainda não foram atingidas ­ tanto em relação a estas medidas quanto à ratificação dos respectivos tratados internacionais. Apesar dos avanços, o progresso na Região não é uniforme. Se as medidas para o controle do tabaco prescritas na Estratégia e plano de ação não forem implementadas em um ritmo acelerado, as metas dificilmente serão alcançadas. A interferência da indústria do tabaco continua sendo um dos maiores desafios.

Taxation of novel and emerging nicotine and tobacco products (HTPs, ENDS, and ENNDS) globally and in Latin America.

This article provides a snapshot of the market structure and regulatory approaches around novel and emerging tobacco and nicotine products, both globally and in Latin America, with a focus on excise taxation. Using data from leading market research companies, the WHO Report on the Global Tobacco Epidemic 2021, and country laws and decrees, the article analyses the evolution and market structure of heated tobacco products (HTPs), electronic nicotine delivery systems (ENDS), and electronic non-nicotine delivery systems (ENNDS). This is followed by a summary review of regulatory approaches adopted by countries toward these products, with a particular focus on excise tax policies currently implemented. Based on the well-established knowledge about tobacco taxation best practices and on WHO's recent recommendations on the taxation of novel and emerging tobacco and nicotine products, the authors then discuss possible elements of a good tax policy approach for countries to consider.

En este artículo se presenta una sinopsis de la estructura del mercado y los enfoques regulatorios de los productos nuevos y emergentes de nicotina y tabaco, tanto en América Latina como a nivel mundial, con especial atención a los impuestos selectivos al consumo. Mediante datos de las principales empresas de investigación de mercado, el Informe OMS sobre la epidemia mundial de tabaquismo del 2021 y las leyes y los decretos de los países, en este artículo se analizan la evolución y la estructura del mercado de los productos de tabaco calentado (PTC), los sistemas electrónicos de administración de nicotina (SEAN) y los sistemas electrónicos sin nicotina (SESN). Además, se resumen los enfoques regulatorios adoptados por los países en lo relativo a estos productos, prestando particular interés a las políticas que se aplican actualmente con respecto al impuesto selectivo al consumo. Sobre la base de conocimientos bien consolidados sobre las mejores prácticas de tributación del tabaco y las recientes recomendaciones de la OMS sobre la tributación de los productos nuevos y emergentes de nicotina y tabaco, los autores presentan a consideración de los países los posibles elementos de un enfoque para abordar la política tributaria de forma satisfactoria.

Este artigo fornece um retrato da estrutura de mercado e das abordagens regulatórias dos produtos novos e emergentes de tabaco e nicotina, tanto globalmente quanto na América Latina, com foco na tributação sobre o consumo. Utilizando dados das principais empresas de pesquisa de mercado, do Relatório da OMS sobre a Epidemia Global do Tabaco 2021 e de leis e decretos dos países, o artigo analisa a evolução e a estrutura do mercado de produtos de tabaco aquecido (HTPs, sigla do inglês heated tobacco products), sistemas eletrônicos de liberação de nicotina (ENDS, sigla do inglês electronic nicotine delivery system) e sistemas eletrônicos sem nicotina (ENNDS, sigla do inglês electronic non-nicotine delivery system). Segue-se uma breve revisão das abordagens regulatórias adotadas pelos países em relação a esses produtos, com enfoque especial nas políticas tributárias sobre o consumo atualmente implementadas. A seguir, os autores discutem possíveis elementos de uma abordagem adequada de política tributária a serem considerados pelos países, com base no conhecimento já bem estabelecido sobre as melhores práticas de tributação do tabaco e nas recentes recomendações da OMS para a tributação de produtos novos e emergentes de tabaco e nicotina.

Towards a smoke-free world? South America became the first 100% smoke-free subregion in the Americas.

Almost 20 years after the launching by the Pan American Health Organization of its "Smoke-Free Americas" initiative in 2001, in December 2020, South America became the first subregion in the Americas to accomplish 100% smoke-free environments in line with Article 8 of the World Health Organization Framework Convention on Tobacco Control (FCTC). Some of these countries adopted legal measures that are more robust than others, including in their laws specific outdoor places in the smoking ban (like Argentina and Uruguay) and/or novel nicotine and tobacco products under their scope (like Ecuador and Paraguay). The 10 countries took different paths to adopt this public health measure, either through executive or legislative measures or a combination of both. A few countries, like Argentina, Brazil, and Venezuela, started at the subnational level and then moved on to the national level, similar to the rest of the countries. For achieving this milestone, an adequate context was crucial: the broad ratification of the FCTC and the relevance given to the human right to health, civil society efforts, commitments made by intergovernmental bodies, media and communication strategies, and the development of scientific evidence. Countries faced obstacles, including the well-known interference of the tobacco industry, which among other strategies used litigation; however, courts and judges upheld comprehensive legal measures on smoke-free environments. The process by which South America achieved this milestone represents a role model for other subregions of the Americas and the world.

Casi 20 años después del lanzamiento de la iniciativa "América libre de humo" de la Organización Panamericana de la Salud en el año 2001, en diciembre del 2020, América del Sur se convirtió en la primera subregión de la Región de las Américas en lograr que 100% de los entornos sean libres de humo, en consonancia con el Artículo 8 del Convenio Marco para el Control del Tabaco de la Organización Mundial de la Salud (CMCT). Algunos de países de la subregión adoptaron medidas legales más sólidas e incluyeron en su legislación la prohibición de fumar en lugares al aire libre concretos (como Argentina y Uruguay) o de introducir nuevos productos de nicotina y tabaco en su alcance jurídico (como Ecuador y Paraguay). Los diez países tomaron diferentes caminos para adoptar esta medida de salud pública, ya fuera mediante disposiciones ejecutivas, legislativas o una combinación de ambas. Algunos países, como Argentina, Brasil y Venezuela, empezaron a nivel subnacional y luego, de un modo similar al del resto de países, pasaron al nivel nacional.Para lograr este hito fue crucial un contexto adecuado: una amplia ratificación del CMCT y la relevancia dada al derecho humano a la salud, los esfuerzos de la sociedad civil, los compromisos asumidos por los órganos intergubernamentales, los medios y las estrategias de comunicación, y el progreso de la evidencia científica. Los países se enfrentaron a obstáculos, entre ellos la conocida interferencia de la industria tabacalera, que entre otras estrategias empleó el uso de litigios; sin embargo, distintos tribunales y jueces respaldaron medidas legales integrales de ambientes libres de humo de tabaco.El proceso mediante el cual América del Sur ha logrado este objetivo representa un modelo a seguir para otras subregiones de las Región de las Américas y el mundo.

Em dezembro de 2020, quase 20 anos depois do lançamento da iniciativa "Américas sem Fumo" pela Organização Pan-Americana da Saúde, em 2001, a América do Sul tornou-se a primeira sub-região das Américas a alcançar ambientes 100% livres de fumaça de tabaco, em conformidade com o Artigo 8 da Convenção-Quadro para o Controle do Tabaco da Organização Mundial da Saúde (CQCT). Alguns desses países adotaram medidas legais mais robustas que outros, com a inclusão da proibição de fumar em determinados locais ao ar livre (como Argentina e Uruguai) e/ou de novos produtos de nicotina e tabaco no escopo de suas leis (como Equador e Paraguai). Os dez países seguiram caminhos diferentes ao adotarem essa medida de saúde pública, por meio de medidas executivas ou legislativas ou ainda por uma combinação de ambas. Alguns países, como Argentina, Brasil e Venezuela, começaram no âmbito subnacional e depois passaram ao âmbito nacional, de maneira semelhante aos demais países.Para alcançar esse marco, foi crucial ter um contexto adequado: a ampla ratificação da CQCT, bem como a importância dada ao direito humano à saúde, os esforços da sociedade civil, os compromissos assumidos por organismos intergovernamentais, as estratégias de mídia e comunicação e o desenvolvimento de evidências científicas. Os países enfrentaram obstáculos, incluindo a conhecida interferência da indústria do tabaco, que, entre outras estratégias, recorreu ao litígio; entretanto, os tribunais e juízes mantiveram medidas legais abrangentes sobre ambientes livres de fumo.O processo pelo qual a América do Sul alcançou esse marco constitui um exemplo para outras sub-regiões das Américas e para o mundo.

The case for investment in tobacco control: lessons from four countries in the Americas.

Objective: To synthesize learnings from four national tobacco control investment cases conducted in the Americas (Colombia, Costa Rica, El Salvador, Suriname) under the World Health Organization Framework Convention on Tobacco Control (WHO FCTC) 2030 project, to describe results and how national health authorities have used the cases, and to discuss implications for the role of investment cases in advancing tobacco control. Methods: We draw on findings from four national investment cases that included 1) a cost-of-illness analysis calculating the health and economic burden of tobacco use, 2) a return-on-investment analysis of implementing key tobacco control demand reduction measures, and 3) a subsidiary analysis of one tobacco control topic of national interest (e.g., equity implications of cigarette taxation). Co-authors reported how cases have been used to advance tobacco control. Results: In Colombia, Costa Rica, El Salvador, and Suriname, tobacco use causes social and economic losses equivalent to between 1.0 to 1.8 percent of GDP. Across these countries, implementing WHO FCTC demand reduction measures would save an average of 11 400 lives per year over the next 15 years. Benefits of the measures would far outweigh the costs of implementation and enforcement. Governments are using the cases to advance tobacco control, including to improve tobacco control laws and their enforcement, strengthen tobacco taxation, prioritize tobacco control planning, coordinate a multisectoral response, and engage political leaders. Conclusions: National investment cases can help to strengthen tobacco control in countries, including by increasing public and political support for implementation of the WHO FCTC and by informing effective planning, legislation, coordination and financing.

Automated, flow-based chemiluminescence microarray immunoassay for the rapid multiplex detection of IgG antibodies to SARS-CoV-2 in human serum and plasma (CoVRapid CL-MIA).

In the face of the COVID-19 pandemic, the need for rapid serological tests that allow multiplexing emerged, as antibody seropositivity can instruct about individual immunity after an infection with SARS-CoV-2 or after vaccination. As many commercial antibody tests are either time-consuming or tend to produce false negative or false positive results when only one antigen is considered, we developed an automated, flow-based chemiluminescence microarray immunoassay (CL-MIA) that allows for the detection of IgG antibodies to SARS-CoV-2 receptor-binding domain (RBD), spike protein (S1 fragment), and nucleocapsid protein (N) in human serum and plasma in less than 8 min. The CoVRapid CL-MIA was tested with a set of 65 SARS-CoV-2 serology positive or negative samples, resulting in 100% diagnostic specificity and 100% diagnostic sensitivity, thus even outcompeting commercial tests run on the same sample set. Additionally, the prospect of future quantitative assessments (i.e., quantifying the level of antibodies) was demonstrated. Due to the fully automated process, the test can easily be operated in hospitals, medical practices, or vaccination centers, offering a valuable tool for COVID-19 serosurveillance. Graphical abstract.

[Advances in tobacco control in the Region of the Americas, 2020Avanços no controle do tabagismo na Região das Américas 2020]. / Avances en el control del tabaco en la Región de las Américas 2020.

This report describes the current status of the tobacco control measures contained in the Strategy and Plan of Action to Strengthen Tobacco Control in the Region of the Americas 2018-2022 (Pan American Health Organization) and the advances made in its application, identifying achievements from 2016 to 2020 and challenges that still need to be addressed in order to reach the expected goals. This analysis relied on data from the World Health Organization (WHO) Report on the Global Tobacco Epidemic from 2015, 2017, and 2019, and national regulations were analyzed to determine their consistency with WHO criteria. Significant progress has been made in implementation of the WHO Framework Convention on Tobacco Control in the Americas. By 2020, most countries had regulations on 100% smoke-free environments in indoor public places, workplaces, and public transport, and large graphic health warnings on tobacco packaging. The number of countries that ban tobacco advertising, promotion, and sponsorship and that tax tobacco at the minimum level recommended by WHO has doubled since 2016. However, the 2022 targets have not yet been reached for any of these measures or for ratification of the relevant international agreements. Although progress has been made in the Region, it has not been uniform. Unless the pace of application of the tobacco control measures contained in the Strategy and Plan of Action accelerates, it is unlikely that its targets will be met. Tobacco industry interference remains one of the main challenges.

Este artigo descreve a situação atual e o progresso na implementação das medidas para o controle do tabagismo prescritas na Estratégia e plano de ação para fortalecer o controle do tabagismo na Região das Américas 2018-2022, reconhece as conquistas realizadas no período entre 2016 e 2020, e identifica os desafios a serem enfrentados para alcançar as metas planejadas. A análise se baseou em dados obtidos do Relatório da OMS sobre a Epidemia Global do Tabaco, publicado em 2015, 2017 e 2019, e em regulamentações nacionais para determinar o cumprimento dos critérios da OMS. Observam-se avanços na implementação da Convenção-Quadro da OMS para o Controle do Tabaco nas Américas. Em 2020, a maior parte dos países dispunha de regulamentações para ambientes 100% livres da fumaça do tabaco em locais públicos fechados, locais fechados de trabalho e meios de transporte público, e advertências sanitárias com ilustrações gráficas grandes nas embalagens dos produtos de tabaco. O número de países que proíbem publicidade, promoção e patrocínio do tabaco e adotaram impostos sobre os produtos do tabaco no padrão mínimo recomendado pela OMS dobrou desde 2016. No entanto, as metas planejadas para 2022 ainda não foram atingidas ­ tanto em relação a estas medidas quanto à ratificação dos respectivos tratados internacionais. Apesar dos avanços, o progresso na Região não é uniforme. Se as medidas para o controle do tabaco prescritas na Estratégia e plano de ação não forem implementadas em um ritmo acelerado, as metas dificilmente serão alcançadas. A interferência da indústria do tabaco continua sendo um dos maiores desafios.

[Excise taxes on sugar-sweetened beverages in Latin America and the CaribbeanImposto especial de consumo sobre bebidas açucaradas na América Latina e no Caribe]. / Impuestos selectivos al consumo de bebidas azucaradas en América Latina y el Caribe.

OBJECTIVE: To characterize the design of excise taxes on sugar-sweetened beverages (SSBs) in Latin America and the Caribbean and assess opportunities to increase their impact on SSB consumption and health. METHODS: A comprehensive search and review of the legislation in effect as of March 2019, collected through existing Pan American Health Organization and World Health Organization monitoring tools, secondary sources, and surveying ministries of finance. The analysis focused on the type of products taxed, and the structure and base of these excise taxes. RESULTS: Out of the 33 countries analyzed, 21 apply excise taxes on SSBs. Seven countries also apply excise taxes on bottled water and at least four include sugar-sweetened milk drinks. Ten of these excise taxes are ad valorem with some tax bases set early in the value chain, seven are amount-specific, and four have either a combined or mixed structure. Three countries apply excise taxes based on sugar concentration. CONCLUSIONS: While the number of countries applying excise taxes on SSBs is promising, there is great heterogeneity in design in terms of structure, tax base, and products taxed. Existing excise taxes could be further leveraged to improve their impact on SSB consumption and health by including all categories of SSBs, excluding bottled water, and relying more on amount-specific taxes regularly adjusted for inflation and possibly based on sugar concentration. All countries would benefit from additional guidance. Future research should aim to address this gap.

OBJETIVO: Caracterizar o modelo dos impostos especiais de consumo sobre bebidas açucaradas na América Latina e no Caribe e avaliar oportunidades para aumentar o impacto desses impostos no consumo de bebidas açucaradas e na saúde. MÉTODOS: Realizou-se uma pesquisa ampla e a análise de legislações vigentes em março de 2019, com informações obtidas por meio de instrumentos de monitoramento da Organização Pan-Americana da Saúde (OPAS) e da Organização Mundial da Saúde (OMS) já existentes, fontes secundárias e levantamento junto aos ministérios da Fazenda. A análise centrou-se no tipo de produtos tributados e na estrutura e base desses impostos especiais de consumo. RESULTADOS: Dos 33 países analisados, 21 aplicam impostos especiais de consumo sobre bebidas açucaradas. Em sete países os impostos especiais de consumo incidem também sobre água engarrafada e, em pelo menos quatro, incluem bebidas lácteas açucaradas. Dez desses tributos especiais são ad valorem com algumas bases tributárias estabelecidas no início da cadeia de valor, sete são de tipo específico e quatro têm uma estrutura combinada ou mista. Em três países os impostos especiais são estabelecidos com base na concentração de açúcares do produto. CONCLUSÕES: Apesar do número promissor de países com impostos especiais de consumo sobre bebidas açucaradas, verifica-se grande heterogeneidade nos modelos de tributação em termos de estrutura, base tributária e produtos tributados. Os impostos especiais de consumo vigentes poderiam ser mais bem aproveitados para aumentar o impacto no consumo de bebidas açucaradas e na saúde: incluir todas as categorias de bebidas açucaradas, excluir água engarrafada e recorrer mais a impostos de tipo específico com a correção periódica pela inflação e, possivelmente, com base na concentração de açúcares do produto. Todos os países se beneficiariam em receber mais orientação. Pesquisas futuras devem ter como objetivo abordar essa lacuna.

Excise taxes on sugar-sweetened beverages in Latin America and the Caribbean.

OBJECTIVE: To characterize the design of excise taxes on sugar-sweetened beverages (SSBs) in Latin America and the Caribbean and assess opportunities to increase their impact on SSB consumption and health. METHODS: A comprehensive search and review of the legislation in effect as of March 2019, collected through existing Pan American Health Organization and World Health Organization monitoring tools, secondary sources, and surveying ministries of finance. The analysis focused on the type of products taxed, and the structure and base of these excise taxes. RESULTS: Out of the 33 countries analyzed, 21 apply excise taxes on SSBs. Seven countries also apply excise taxes on bottled water and at least four include sugar-sweetened milk drinks. Ten of these excise taxes are ad valorem with some tax bases set early in the value chain, seven are amount-specific, and four have either a combined or mixed structure. Three countries apply excise taxes based on sugar concentration. CONCLUSIONS: While the number of countries applying excise taxes on SSBs is promising, there is great heterogeneity in design in terms of structure, tax base, and products taxed. Existing excise taxes could be further leveraged to improve their impact on SSB consumption and health by including all categories of SSBs, excluding bottled water, and relying more on amount-specific taxes regularly adjusted for inflation and possibly based on sugar concentration. All countries would benefit from additional guidance. Future research should aim to address this gap.

[Ten years of the WHO Framework Convention on Tobacco Control: progress in the Americas]. / Diez años del Convenio Marco de la OMS para el Control del Tabaco: avances en las Américas.

The objective of this article is to analyze the progress made in the Americas in the implementation of the World Health Organization Framework Convention on Tobacco Control (FCTC) after its tenth anniversary of entry into force. At the time of the analysis, 30 of the 35 countries of the Americas are Parties to the FCTC. While progress has been made in implementing the measures contained in the FCTC, the level of implementation has not been homogeneous either across mandates or across countries. Forty percent of Parties to the Convention in the Americas are yet to implement any of the measures at their highest level of implementation according to the WHO classification. It is crucial that the countries of the Americas continue to progress towards the full implementation of the FCTC progressively. In these efforts, it is important to take into account that FCTC measures such as those related to smoke-free environments and adoption of effective health warnings are basic public health measures, which are almost entirely within the competence of health authorities and therefore susceptible to be implemented in a prompt fashion in all countries of the region.

Generating revenue by raising tobacco taxes in Latin America and the Caribbean.

OBJECTIVE: The objective of this study was to determine if raising tobacco taxes in the Latin America and Caribbean (LAC) region will generate extra tax revenue, even at outer edges of the sensitivity analysis, with relatively high price elasticities of demand for cigarettes. METHODS: A model of the cigarette market in 31 LAC countries was developed using cigarette tax, price, and retail sales data for 2014. It was then assumed that all countries increased the excise tax by 50% per pack. The model incorporated 12 studies from the LAC region that estimate the price elasticity of demand for cigarettes to quantify the expected impact of this tax increase on sales and tax revenues. RESULTS: The tax increase would raise cigarette prices by an average of 28% across the region. The volume of cigarette sales would decrease by 7% (confidence interval (CI): 3-11). Cigarette tax revenue would increase by 32% (CI: 27-37), representing an extra US$ 7 050 million (CI: 5 984-8 086) in revenue. Almost all countries showed increases in tax revenue, even at outer edges of the sensitivity analysis. CONCLUSIONS: These findings confirm that the expected benefits of raising tobacco taxes are robust across the LAC region. Countries in the region should have confidence that raising tobacco tax rates will generate extra tax revenues.

The role of intravenous immunoglobulin in autoimmune diseases with dermatological implications.

Intravenous immunoglobulin (IVIG) therapy has emerged as a promising treatment option for various dermatological autoimmune diseases due to its immunomodulatory potential and low incidence of severe side effects. Despite its widespread use, the mechanism of action of IVIG in treating autoimmune diseases remains a topic of debate. IVIG is derived from the plasma fractionation of a large pool of donors, primarily consisting of the IgG isotype. Its main mechanisms of action involve neutralizing circulating autoantibodies via the F(ab')2 portion, inhibiting complement-mediated tissue destruction, and reducing the half-life of circulating autoantibodies through the Fc portion. This paper explores the growing utilization of IVIG as an off-label therapy in dermatological autoimmune or immune-mediated diseases, including autoimmune bullous disease (AIBS), dermatomyositis (DM), lupus erythematosus (LE), systemic sclerosis, scleromyxedema, Stevens-Johnson Syndrome (SJS), toxic epidermal necrolysis (TEN), pyoderma gangrenosum (PG), and necrobiotic xanthogranuloma (NXG). In this context, the sole large prospective, randomized trial was the 2022 ProDERM study, which demonstrate efficacy of IVIG in improving cutaneous manifestations among 95 DM patients compared to the placebo group. Moreover, although considered off-label, the use of IVIG is regarded as the first-line therapy for patients with scleromyxedema. As a first line of therapy, IVIg is only approved for Kawasaki Disease (KD) in the setting of vasculitis. The treatment in all other indications is mostly considered as adjuvant therapy only after failure of immunosuppressive therapy or in the presence of contraindications.

Increasing dietary fiber intake for type 2 diabetes mellitus management: A systematic review.

BACKGROUND: Type 2 diabetes is a chronic, non-communicable disease with a substantial global impact, affecting a significant number of individuals. Its etiology is closely tied to imbalanced dietary practices and sedentary lifestyles. Conversely, increasing die-tary fiber (DF) intake has consistently demonstrated health benefits in numerous studies, including improvements in glycemic control and weight management. AIM: To investigate the efficacy of DF interventions in the management of type 2 diabetes mellitus (T2DM). METHODS: A systematic literature review was conducted to explore the association between DF intake and the management of T2DM. Following the inclusion and exclusion criteria, a total of 26 studies were included in this review. RESULTS: The main strategies implied to increased DF intake were: High DF diet plus acarbose (2 studies); DF supplements (14 studies); and high DF diets (10 studies). Overall, most studies indicated that increased DF intake resulted in im-provements in glycemic control and weight management in T2DM patients. CONCLUSION: DF represents a valuable strategy in the treatment of type 2 diabetes, improving health outcomes. DF intake offers the potential to improve quality of life and reduce complications and mortality associated with diabetes. Likewise, through supplements or enriched foods, DF contributes significantly to the control of several markers such as HbA1c, blood glucose, triglycerides, low-density lipoprotein, and body weight.

Anorectal melanoma: systematic review of the current literature of an aggressive type of melanoma.

Anorectal melanoma (ARM) is a rare malignancy often associated with a poor prognosis due to its late diagnosis and aggressive biological behavior. This review aims to comprehensively investigate ARM's diagnosis, management, and treatment, emphasizing its clinical characteristics, laboratory findings, and implications for patient prognosis. A systematic literature search was conducted in PubMed, Embase, and Cochrane CENTRAL databases from inception to 1 July 2024. This review synthesizes existing literature to provide a comprehensive understanding of this rare primary malignancy. A total of 110 articles reporting on 166 patients were included. Gender data were available for 131 cases, comprising 67 females (51.1%) and 64 males (48.9%). The median age was 66 years. The overall median time to diagnosis was 4 months for anal melanoma, 3 months for rectal melanoma, and 4 months for anorectal junction melanoma. The clinical presentation was nodular in 98.2% of cases. Pre-diagnosis symptoms included bleeding in 84.9% of cases, mucous elimination (6%), pain (68.7%), tenesmus (16.9%), and changes in bowel movements (28.5%). Overall survival (OS) was reported in 82 cases, with a median OS of 11 months: 11 months for anal melanoma, 7 months for rectal melanoma, and 12 months for anorectal junction melanoma. ARM is a rare and aggressive melanoma subtype often diagnosed at an advanced stage, leading to a poor prognosis. A female predominance was observed, consistent with other mucosal melanomas. Anal melanoma exhibited better progression-free survival, and OS compared to rectal and anorectal junction melanoma.

Knowledge and use of extrinsic feedback characteristics: A survey of current practice among Brazilian physical therapists.

OBJECTIVES: This study aimed to identify the knowledge about the different characteristics of and the use of extrinsic feedback (EF) by Brazilian physical therapists. METHODS: This is a cross-sectional study, and we used an internet-based survey with questions about knowledge and application of extrinsic feedback in clinical practice. We analyzed the responses in relation to the best available evidence on motor control and learning. We recruited Brazilian registered physical therapists from different regions in Brazil. Participants' demographics and survey responses were analyzed using descriptive statistics. RESULTS: Two hundred and forty-six Brazilian physical therapists participated in the study. Most participants affirmed not knowing the definition of EF (55.69%), confirmed using some form of EF in their clinical practice (86.59%), and reported using it in 50% to 90% of their patients (26.42%). Brazilian physical therapists reported using mainly summary feedback (69.10%) with external focus of attention (63.41%). Participants reported using concurrent feedback (82.83%) and delivered it after every exercise repetition (63.82%). Most participants (43.09%) did not assess learning retention. Answers were similar regardless of education level or time from graduation. CONCLUSIONS: The results of this survey suggest that Brazilian physical therapists do not have sufficient knowledge about the different characteristics of EF; however, they do consider EF useful and use it for most of their patients. Brazilian physical therapists adopted adequate content characteristics of EF but not adequate use of timing characteristics of EF.

Comparing taxes on alcoholic beverages in the Region of the Americas.

BACKGROUND AND AIMS: Excise taxes represent one of the most cost-effective policies to reduce the harmful use of alcohol. Existing information about their design is limited and no standardized metric has been used to compare tax levels in the Region of the Americas. This study aimed to compare alcohol excise tax policies throughout the Americas, compare tax levels and consider opportunities to improve the impact of excise taxes on alcohol consumption and health. DESIGN AND SETTING: Descriptive analysis using a method developed by the Pan American Health Organization and adapted from the World Health Organization's tobacco tax monitoring. Data were collected by surveying ministries of finance and reviewing tax legislation in effect as of November 2020 in the Region of the Americas. MEASUREMENTS: Tax policy design indicators, taxes as a percentage of the retail price of the most-sold brand of beer, wine and spirits, including a weighted average indicator across beverage types, and tax levels per standard drink (10 g ethanol) in international dollars at purchasing power parity. FINDINGS: Thirty-three countries in the Americas (94%) apply excise taxes on alcoholic beverages, with Argentina and Uruguay not applying them to wine. There is significant heterogeneity in excise tax design across countries and beverage types. Only a third of amount-specific excise taxes are regularly adjusted to avoid erosion. Regional median excise taxes represent the highest share of the price for spirits (21.4%) and the lowest for wine (11.0%). The regional median consumption-weighted average excise tax share across all beverage types is 12.0%. Excise tax shares are generally higher in Latin America than in the Caribbean and Canada. Excise tax levels per standard drink are generally lower for spirits than for other beverages. CONCLUSIONS: Alcohol excise tax policies vary significantly across the Americas, often reflecting national consumption patterns. To maximize their public health impact, tax rates could be increased and tax designs improved, particularly to ensure higher tax burdens on high-strength drinks.