Neglected Infectious Diseases Safety Program — delivering community benefits while minimizing harm: Experiences and lessons learned from the Americas

Neglected infectious diseases (NIDs) affect more than 1 billion people globally, causing serious long-term health effects on the most vulnerable populations. In 2020 the World Health Assembly endorsed a global road map 2021–2030 for tackling neglected tropical diseases that sets targets and milestones as well as cross-cutting targets aligned with the Sustainable Development Goals. To treat infected persons and reduce disease transmission, the World Health Organization (WHO) advocates for a rapid impact intervention: preventive chemotherapy (PC). PC is the administration of safe and effective treatment to a defined population at regular time intervals, regardless of infection status. In the Americas, more than 100 million people suffer from one or more NIDs. Of the people at risk of NIDs in Latin America and the Caribbean, many are receiving safe and effective treatment through mass administration of medications for five diseases: lymphatic filariasis, onchocerciasis, blinding trachoma, soil-transmitted helminthiasis (STH), and schistosomiasis. These medications are donated, while others are procured through the Strategic Fund of the Pan American Health Organization (PAHO) or through the Global Fund to Fight AIDS, Tuberculosis and Malaria. Safety should be assured at every step of the process, from the manufacture of the drugs and assuring their quality and regulatory standards, to shipment and management of drugs in the supply chain, to their administration in the community. A critical condition to success when implementing PC is to “do no harm” while delivering the health services, which relies largely on careful planning, communication, training, monitoring and prompt investigation of serious adverse events (SAEs), and supervision at all levels. In 2021 WHO updated the guidelines and developed training modules for community drug distributors, health workers, and other front-line workers and partners. The modules address key aspects of drug safety, which include management, storage, and packaging of medicines; safe administration of medicines to ensure safety and prevent choking; identification, management, and reporting of adverse events (AEs); and effective communication with communities and health staff. The Fred Hollows Foundation and IZUMI Foundation funded PAHO to implement a two-year project to strengthen safety in administration of medications to eliminate NIDs in the countries of the Americas. Planning and tailoring the educational materials to train different audiences were conducted as a joint effort with the participation of partners from RTI international, Task Force for Global Health, and The Fred Hollows Foundation. This report describes the experience and lessons learned for strengthening regional and national capacities to plan, prepare, and monitor the safe administration of medicines for treatment of NIDs in the endemic countries of the Americas.

Orientaciones para el autocuidado de la diabetes, versión 2024. Módulo 2: Actividad física

La actividad física regular es un factor de protección fundamental para prevenir y controlar enfermedades no transmisibles como la diabetes. También favorece la salud mental, ya que previene el deterioro cognitivo, la depresión y la ansiedad, y contribuye al bienestar general. Por último, como aumenta la sensibilidad a la insulina, ayuda a reducir el nivel de glucosa en la sangre y a disminuir las condiciones que agravan la diabetes y sus complicaciones. Gracias a que también fortalece el corazón, mejora la circulación de las piernas, hace descender la presión arterial y los niveles de colesterol, la actividad física también es imprescindible para prevenir las principales complicaciones de la diabetes, que son la retinopatía, la enfermedad renal crónica y las lesiones en los pies (pie diabético). Otro de los beneficios es la posibilidad de mantener un peso saludable. Por esa razón, si una persona tiene sobrepeso u obesidad, la actividad física, junto con una alimentación saludable, puede contribuir a reducir el peso y la grasa del abdomen (circunferencia abdominal). Este módulo describe un elemento clave en el cuidado de la diabetes, que es la actividad física. Está dirigido a las personas que conviven con la enfermedad, a sus familias y a sus cuidadores. Su propósito es contribuir al autocuidado mediante la entrega de algunas recomendaciones básicas para incorporar la actividad física como parte de la vida cotidiana de las personas con diabetes. Estas recomendaciones no reemplazan las indicaciones del médico o del equipo de salud, pero pueden servir de ayuda para mejorar el automanejo de la diabetes y también para prevenir sus complicaciones.

Orientaciones para el autocuidado de la diabetes. Módulo 2: Actividad física / Diabetes Self-Care Guidelines Module 2: Physical Activity

EL presente módulo describe un elemento clave en el cuidado de la diabetes, que es la actividad física. Está dirigido a las personas que conviven con la enfermedad, a sus familias y a sus cuidadores. Su propósito es contribuir al autocuidado mediante la entrega de algunas recomendaciones básicas para incorporar la actividad física como parte de la vida cotidiana de las personas con diabetes. Estas recomendaciones no reemplazan las indicaciones del médico o del equipo de salud, pero pueden servir de ayuda para mejorar el automanejo de la diabetes y también para prevenir sus complicaciones

Non-communicable diseases prevention and control by government ministries in Guyana.

Background: Countries of the Caribbean Community signed the Declaration of Port of Spain in 2007 with the vision to stop the epidemic of non-communicable diseases (NCDs). The adoption of the Declaration by member states represented a regional effort, challenging governments, the private sector, and civil society to act together. Multisectoral actions in Guyana aimed at achieving this goal are the focus of this article, demonstrating the work of different actors in addressing the burden of NCDs in the country. Objective: To analyze multisectoral actions developed among five ministries for the implementation of the Declaration of Port of Spain 2007 in Guyana. Methods: This qualitative study was guided by the Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist and conducted in five ministries (Agriculture, Education, Finance, Health, and Trade) in Georgetown, Guyana. The thematic analysis was guided by a framework consisting of four elements: context (why the policy is needed), content (what the policy is mainly about), process (how the policy was brought forward and implemented), and actors (who participates in and influences the formulation and implementation of the policy). The framework considers how these elements interconnect to shape policy development and implementation processes. Findings: Data analysis provided the researchers with insights into possible topic areas and codes for consideration during the analysis, hence a deductive approach to data analysis was used. The results highlighted the importance of coordination among government entities, national and international agencies, private actors, industry players, and civil society. Participants did not mention the use of responsibility metrics but cited mechanisms that facilitated collaboration. Conclusion: The results showed limitations in transforming multisectoral initiatives into intersectoral collaboration to achieve real integration among the different actors involved, considering the actual context and content. Actions could be more effectively implemented with significant outcomes for NCD control in Guyana.

Alcohol tax indicators in the Region of the Americas

The harmful use of alcohol is one of the leading risk factors for population health. It is linked with over 200 health conditions, including noncommunicable diseases (NCDs) and mental health conditions, maternal and child health, infectious diseases, and injuries. This psychoactive substance caused 5.5% of all deaths and 6.7% of all disability-adjusted life years in the Region of the Americas in 2016. It also causes a significant social burden and imposes substantial direct treatment costs and indirect economic costs that represent a serious threat to economic and social development. This impact is recognized by target 3.5 of the Sustainable Development Goals aiming to “strengthen the prevention and treatment of substance abuse, including narcotic drug abuse and harmful use of alcohol”. The amount and frequency of alcohol consumed by an individual is determined, in large part, by the affordability of alcoholic beverages. Such affordability depends on the real price of alcoholic beverages, the price of other goods and services, and consumers’ incomes. Thus, there is strong health and economic rationale for the use of fiscal policies targeting alcoholic beverages. The World Health Organization (WHO) recommends reducing the harmful use of alcohol through increased excise taxes on alcoholic beverages as part of the WHO Global strategy to reduce the harmful use of alcohol, and the Pan American Health Organization (PAHO) Plan of Action to Reduce the Harmful Use of Alcohol. It is also part of the WHO recommended most cost-effective, evidence-based policies to prevent and control NCDs, and it is highlighted as one of five high-impact strategies of the SAFER technical package. Although 33 out of the 35 PAHO Member States apply excise taxes on alcoholic beverages, there is great heterogeneity in their design and rates, and most could be further leveraged to improve their impact on alcohol consumption and health. PAHO is committed to providing Member States with accurate, relevant, and internationally comparable information that they can use to guide the development of policy and to evaluate the impact of measures to prevent the harmful use of alcohol. Developing a tax share indicator is necessary to monitor taxes on alcoholic beverages, enable standardized comparisons across countries and over time, establish best practices in tax design, and provide a powerful tool for advocacy. Since 2016, the Department of Noncommunicable Diseases and Mental Health (NMH) at PAHO has been working on developing standardized and comparable indicators of the share of indirect taxes in the price of alcoholic beverages. Building on this experience and the WHO methodology for monitoring tobacco taxes, this brochure presents the results of pioneering tax share and complementary price and tax policy indicators for alcoholic beverages—including beer, wine, and spirits—in 30 PAHO Member States. This brochure is a tool for data dissemination to the different sectors involved in alcohol taxation in the Region of the Americas and, likewise, to help countries in designing, planning, and evaluating alcohol taxes to reduce the harmful use of alcohol.

Striving toward health equity in the Americas

The Americas is the region where the largest socioeconomical disparities are found, as well as health inequities between countries and within countries among minority and excluded population groups. These health inequities are refl ected in diff erences in life expectancy; health at the start of life and over the life course; burden of infectious as well as noncommunicable diseases; health behaviors such as smoking, alcohol and drug use; and accidents, violence, and confl ict. Low-income groups, informal workers, lower educational level population, indigenous peoples, people of African descent, and other groups in situations of vulnerability in the Americas are at an enormous disadvantage and face considerable health inequities, reflected in higher rates of both communicable and noncommunicable diseases and maternal and infant mortality. PAHO has committed to work toward reducing health inequities, refl ected in its Policy on Ethnicity and Health, the Strategy and Plan of Action on Health Promotion within the context of the Sustainable Development Goals 2019–2030, and the Policy for Recovering Progress toward the Sustainable Development Goals with Equity through Action on the Social Determinants of Health and Intersectoral Work.

Meeting with PAHO/WHO Collaborating Centres in Canada as part of the official visit of Dr. Jarbas Barbosa da Silva Jr. Summary report. 9 April 2024, Ottawa, Canada

The meeting with PAHO/WHO Collaborating Centres in Canada as part of the Official Visit of Dr. Jarbas Barbosa da Silva Jr (Ottawa, Canada, 9 April 2024) represented a significant step in the technical cooperation in the region of the Americas, focusing on enhancing cooperation and resilience in health systems. Discussions centered on strategic pandemic response, regulatory capacity building, particularly in pharmaceuticals, and leveraging PAHO/WHO as an information hub. Key topics included Digital Transformation, One Health, and the Elimination Initiative for communicable diseases, emphasizing ethical use of artificial intelligence, generation of evidence, innovation, and tailored strategies. The meeting highlighted the need for innovative health workforce development, transparent algorithms for equity, and integrating new priorities for stronger health systems and outcomes. The commitment to technical cooperation and support for Member States aims to address various health challenges and promote universal health coverage. PAHO/WHO express its appreciation to the efforts and commitment of the twenty-eight PAHO/WHO Collaborating Centres in Canada (May 2024).

Conjunto de herramientas del promotor para que la epilepsia sea una prioridad en la Región de las Américas

La Caja de herramientas del promotor para que la epilepsia sea una prioridad en región de las Américas fue desarrollada para ayudar a individuos y organizaciones a identificar oportunidades que permitan la plena participación de las personas con epilepsia en la comunidad. Fue desarrollado para las organizaciones que buscan orientación, ideas o inspiración a medida que desarrollan proyectos de promoción de la epilepsia. La caja de herramientas está dirigida a las organizaciones de la sociedad civil que trabajan en toda la Región de las Américas y ha sido inspirada por las necesidades y experiencias de las personas con epilepsia. Los diversos módulos y temas abordados pueden ser utilizados como una guía paso a paso para orientar en el proceso de planificación de la incidencia, o como una referencia independiente o un conjunto de recursos que pueden ser utilizados cuando se encuentra un problema u oportunidad en el contexto de la política existente sobre epilepsia, la legislación o el acceso a la atención. No pretende ser una guía independiente sobre cómo llevar a cabo la promoción. En su lugar, proporciona pistas clave para la reflexión y el debate, indicaciones básicas para la incidencia (la teoría) y herramientas esenciales para ayudar a la sociedad civil a trabajar de forma lógica a través de las distintas etapas de un ciclo de planificación de la incidencia. Pretende ser versátil y útil para diversos públicos. Ha sido desarrollado conjuntamente por la Organización Panamericana de la Salud y la Oficina Internacional para la Epilepsia (IBE en inglés) con aportaciones de partes interesadas clave, incluidas personas con epilepsia y sus familias, y con proveedores de atención sanitaria de la Región. A través de una evaluación inicial de las necesidades, las partes interesadas aportaron sus puntos de vista sobre los recursos de los que disponían actualmente, las mejores prácticas que querían compartir, las áreas en las que buscaban apoyo y las oportunidades de apoyo o colaboración adicionales.

Advocate’s toolkit for making epilepsy a priority in the Americas

The Advocate’s Toolkit for Making Epilepsy a Priority in the Americas was developed to help individuals and organizations to identify opportunities that provides full participation of people with epilepsy in the community. It was developed for organizations looking for guidance, ideas, or inspiration as they develop advocacy projects around epilepsy. The toolkit is aimed at civil society organizations working across the Region of the Americas and has been heavily influenced by the needs and experiences of people with epilepsy. The various modules and topics addressed in this toolkit can be used both as a step-by-step guide to lead in the advocacy planning process, or as a reference or set of stand-alone resources that can be used when encountering a problem or opportunity in the context of existing epilepsy policy, legislation, or access to care. It is not meant as a stand-alone guide on how to conduct advocacy activities. Instead, it provides key prompts for reflection and discussion, basic advocacy pointers (the theory), and essential tools to help civil society to work logically through the various stages of an advocacy planning cycle. It is meant to be versatile and useful to a variety of audiences. It recognises that stigma is a major barrier preventing social inclusion and access to health care and treatment for people with epilepsy. Civil society can use the guidance, evidence, and templates to promote epilepsy as a public health priority in their local community or at the national, and regional levels. The toolkit was co-developed by the Pan American Health Organization and the International Bureau for Epilepsy (IBE) with important input from key stakeholders, including persons with epilepsy and their families, and with healthcare providers from the Region. It includes input from others with a connection to epilepsy either personally or through an organization. Through an initial needs assessment, stakeholders provided their perspectives on resources that were currently available to them, best practices they wanted to share, areas where they were seeking support, and opportunities for additional support or collaboration. This toolkit was developed based on that input as well as on feedback on initial drafts. The toolkit can be used as a companion document to support implementation of the WHO Intersectoral Global Action Plan on Epilepsy and Other Neurological Disorders (IGAP) which recognises that epilepsy is treatable, medication can be made affordable and basic epilepsy care can be provided at the primary care level for all people. All countries across the Americas have ratified IGAP and the UN SDG’s and can use this toolkit to plan their advocacy. The toolkit is full of resources, ideas, and guidance for addressing and dismantling stigma and for monitoring and evaluating progress towards implementation of the IGAP.

Viver a vida. Guia de implementação para a prevenção do suicídio nos países

Mais de 700.000 pessoas perdem suas vidas para o suicídio a cada ano. A Organização Mundial da Saúde (OMS) defende que os países ajam na prevenção do suicídio, idealmente por meio de uma estratégia nacional de prevenção do suicídio. Os governos e as comunidades podem excercer seus papéis na contribuição para a prevenção do suicídio implementando o guia VIVER A VIDA - uma abordagem da OMS para a prevenção do suicídio, a fim de que os países possam desenvolver uma estratégia nacional de prevenção. O guia destina-se a todos os países, que possuem ou não, uma estratégia nacional de prevenção do suicídio; pontos focais nacionais ou locais para prevenção do suicídio e partes interessadas da comunidade com interesse ou que já estejam envolvidas na implementação de atividades de prevenção do suicídio. Este guia serve como um catalisador para que os governos tomem medidas baseadas em evidências. Permite aos países proteger as vidas de pessoas que se encontram em situação de sofrimento intolerável e em risco de suicídio, apresentando uma abordagem multissetorial de prevenção, uma vez que todos nós temos a responsabilidade de trabalhar juntos para prevenir o suicídio.

The gender gap in outpatient care for non-communicable diseases in Mexico between 2006 and 2022.

BACKGROUND: Equitable health service utilization is key to health systems' optimal performance and universal health coverage. The evidence shows that men and women use health services differently. However, current analyses have failed to explore these differences in depth and investigate how such gender disparities vary by service type. This study examined the gender gap in the use of outpatient health services by Mexican adults with non-communicable diseases (NCDs) from 2006 to 2022. METHODS: A cross-sectional population-based analysis of data drawn from National Health and Nutrition Surveys of 2006, 2011-12, 2020, 2021, and 2022 was performed. Information was gathered from 300,878 Mexican adults aged 20 years and older who either had some form of public health insurance or were uninsured. We assessed the use of outpatient health services provided by qualified personnel for adults who reported having experienced an NCD and seeking outpatient care in the 2 weeks before the survey. Outpatient service utilization was disaggregated into four categories: non-use, use of public health services from providers not corresponding to the user's health insurance, use of public health services from providers not corresponding to the user's health insurance, and use of private services. This study reported the mean percentages (with 95% confidence intervals [95% CIs]) for each sociodemographic covariate associated with service utilization, disaggregated by gender. The percentages were reported for each survey year, the entire study period, the types of service use, and the reasons for non-use, according to the type of health problem. The gender gap in health service utilization was calculated using predictive margins by gender, type of disease, and survey year, and adjusted through a multinomial logistic regression model. RESULTS: Overall, we found that women were less likely to fall within the "non-use" category than men during the entire study period (21.8% vs. 27.8%, P < 0.001). However, when taking into account the estimated gender gap measured by incremental probability and comparing health needs caused by NCDs against other conditions, compared with women, men had a 7.4% lower incremental likelihood of falling within the non-use category (P < 0.001), were 10.8% more likely to use services from providers corresponding to their health insurance (P < 0.001), and showed a 12% lower incremental probability of using private services (P < 0.001). Except for the gap in private service utilization, which tended to shrink, the others remained stable throughout the period analyzed. CONCLUSION: Over 16 years of outpatient service utilization by Mexican adults requiring care for NCDs has been characterized by the existence of gender inequalities. Women are more likely either not to receive care or resort to using private outpatient services, often resulting in catastrophic out-of-pocket expenses for them and their families. Such inequalities are exacerbated by the segmented structure of the Mexican health system, which provides health insurance conditional on formal employment participation. These findings should be considered as a key factor in reorienting NCD health policies and programs from a gender perspective.

[A brief overview of the 2030 Agenda, noncommunicable diseases and the challenges of leaving no one behind]. / Um breve panorama sobre a Agenda 2030, as doenças crônicas não transmissíveis e os desafios de não deixar ninguém para trás.

This essay provides a theoretical reflection on the challenges of meeting the Sustainable Development Goals of the 2030 Agenda, considering its motto of "leave no one behind". To exemplify these challenges, we discuss noncommunicable diseases (NCDs), one of the main issues on the global health agenda before the COVID-19 pandemic, and the political and economic dimensions that determine their presence and global spread. After a brief overview of NCDs, the text seeks to answer three questions: In "Leaving no one behind?" we list some themes to reflect on how and who has historically been left behind, delving a little deeper into the examples in "Who has been left behind in the world?" and "Who has been left behind in Brazil?". Using data from the most relevant and recent literature on the subject, we discuss the challenges and some ways to leave no one behind in a world where the mean of production has historically made some social groups vulnerable, especially black and Indigenous populations. In our final remarks, we draw inspiration from the Sankofa ideogram to remember that the answers to the sustainable development we seek may lie somewhere in our most primordial and traditional past. And that it is necessary to invest on building new paths from different worldviews and approaches to epistemology on the other side of the abyssal line.

Este ensaio traz uma reflexão teórica sobre os desafios para alcançar as metas dos Objetivos do Desenvolvimento Sustentável da Agenda 2030, considerando seu lema de "não deixar ninguém para trás". Para exemplificar esses desafios, apresenta-se como pano de fundo as doenças crônicas não transmissíveis (DCNT), um dos principais temas da agenda da saúde global antes da pandemia de COVID-19, discutindo as dimensões políticas e econômicas que determinam sua presença e avanço global. Após um breve panorama sobre as DCNT, busca-se responder a três perguntas: em "Sem deixar ninguém para trás?", elencamos alguns temas para refletir sobre como e quem tem ficado historicamente para trás, aprofundando um pouco mais os exemplos ao adentrar em "Quem tem ficado para trás no mundo?" e "Quem tem ficado para trás no Brasil?". A partir de dados da literatura mais relevante e recente sobre o tema, apresentamos os desafios e alguns caminhos para não deixar ninguém para trás em um mundo em que o modo de produção tem historicamente vulnerabilizado alguns grupos sociais, com destaque para a população negra e a população indígena. Trazemos nas considerações finais a inspiração do ideograma Sankofa para lembrar que as respostas para o desenvolvimento sustentável que buscamos podem estar em algum lugar de nosso passado mais originário e tradicional, e que é preciso apostar na construção de novos caminhos a partir de outras epistemologias e cosmovisões presentes do outro lado da linha abissal.

Este ensayo aporta una reflexión teórica acerca de los desafíos para lograr las metas de los Objetivos de Desarrollo Sostenible de la Agenda 2030, teniendo en cuenta su lema "no dejar a nadie atrás". Para ejemplificar estos desafíos, tomamos como telón de fondo las enfermedades crónicas no transmisibles (ECNT), uno de los principales temas de la agenda de salud global antes de la pandemia de COVID-19, discutiendo las dimensiones políticas y económicas que determinan su presencia y avance global. Después de un breve panorama de las ECNT, el texto busca responder tres preguntas: En "¿Sin dejar a nadie atrás?" enumeramos algunos temas para reflexionar sobre cómo y quién ha quedado históricamente atrás, profundizando un poco más los ejemplos al centrarse en "¿Quién ha quedado atrás en el mundo?" y "¿Quién ha quedado atrás en Brasil?". Con base en datos de la literatura más relevante y reciente sobre el tema, presentamos los desafíos y algunas maneras de no dejar a nadie atrás en un mundo en el que el modo de producción ha vulnerabilizado históricamente a algunos grupos sociales, con énfasis en la población negra y en la población indígena. En nuestras consideraciones finales, nos inspiramos en el ideograma de Sankofa para recordar que las respuestas al desarrollo sostenible que buscamos pueden estar en algún lugar de nuestro pasado más original y tradicional. Y es necesario apostar por la construcción de nuevos caminos basados en otras epistemologías y cosmovisiones presentes al otro lado de la línea abisal.

Alcohol use disorder in people with infectious and chronic diseases and mental disorders: Brazil, 2015. / Transtornos relacionados ao uso de álcool entre pessoas com doenças infecciosas, crônicas e mentais: Brasil, 2015.

The study aimed to estimate the prevalence of alcohol use disorder (AUD) and associated factors in Brazilian adults that reported chronic noncommunicable diseases (NCDs), mental disorders (MDs), and infectious diseases (IDs). This was a secondary analysis of the 3rd National Survey on Drug Use by the Brazilian Population in which the principal outcome was presence of AUD. Prevalence of AUD was estimated for three subgroups: individuals that reported NCDs, MDs, and IDs. Factors associated with AUD in each group were analyzed using logistic regression models. Of the 15,645 adults interviewed, 30.5% (95%CI: 29.4-31.5) reported NCDs, 17.6% (95%CI: 16.5-18.7) MDs, and 1.6% (95%CI: 1.2-1.9) IDs. Considering comorbidities, the analytical sample was 6,612. No statistically significant difference was found in the prevalence of AUD between individuals with NCDs (7.5% [95%CI: 6.1- 8.7]), MDs (8.4% [95%CI: 6.7-10.2]), and IDs (12.4% [95%CI: 7.0-17.8]). The main factors associated with AUD in all the groups were male sex and young adult age. Considering the high prevalence of AUD in all the groups, systematic screening of AUD is necessary in health services that treat NCDs, MDs, and IDs.

O objetivo do artigo é estimar a prevalência de transtornos relacionados ao uso de álcool (TRA) e fatores associados entre indivíduos da população brasileira que reportaram doenças crônicas não-transmissíveis (DCNT), transtornos mentais (TM) e doenças infeciosas (DI). Análise secundária do III Levantamento Nacional sobre o Uso de Drogas pela População Brasileira, cujo desfecho principal foi a presença de TRA. A prevalência de TRA foi estimada para três subgrupos: indivíduos que reportaram DCNT, TM e DI. Os fatores associados a TRA dentro de cada grupo foram analisados utilizando modelos de regressão logística. Dos 15.645 adultos entrevistados, 30,5% (IC95%: 29,4-31,5) reportaram DCNT, 17,6% (IC95%: 16,5-18,7) TM e 1,6% (IC95%: 1,2-1,9) DI. Considerando as comorbidades, a amostra analítica foi de 6.612. Não foi encontrada diferença estatisticamente significativa na prevalência de TRA entre indivíduos com DCNT (7,5% [IC95% 6,1-8,7]), TM (8,4% [IC95% 6,7-10,2]) e DI (12,4% [IC95% 7,0-17,8]). Os principais fatores associados a TRA, em todos os grupos, foram ser do sexo masculino e jovem. Considerando a alta prevalência de TRA em todos os grupos é necessário seu rastreio sistemático em serviços de saúde que atendam DCNT, TM e DI.

Association between food insecurity and chronic noncommunicable diseases in Brazil: a systematic review.

OBJECTIVE: To analyze the association of food insecurity (FI) with chronic noncommunicable diseases (NCDs) in the Brazilian context. METHODS: The review protocol was registered with the International Prospective Register of Systematic Reviews (PROSPERO). The searches were conducted in LILACS and PubMed databases (September/2022). Observational studies carried out in the Brazilian population published since 2003 were included, in which: (1) the association of FI with NCDs was analyzed; and (2) the Brazilian Food Insecurity Scale was used. Studies on pregnant women and those that associated FI with cancer, sexually transmitted infections, and musculoskeletal and respiratory diseases were excluded. The studies were subjected to methodological quality assessment. RESULTS: A total of 27 cross-sectional studies were included; nine used secondary data from national surveys, and the others used primary data. An association between FI and overweight and obesity in different age groups was verified in the studies. CONCLUSION: The included articles did not produce evidence on other NCDs of interest to health in Brazil such as diabetes and high blood pressure. However, they corroborate the already-known relationship between obesity and FI. Studies on the topic, with a longitudinal design, should be encouraged.

Effects of air pollution on global health: evidence from the global burden of disease study in the BRICS countries.

PURPOSE: Considering the dynamic influence of environmental, social, economic, and political factors in the emergence and growth of the BRICS countries (Brazil, Russia, India, China, and South Africa) over the years and pre-existing differences, the adverse effects of air pollution on the health and well-being of the people have remained major areas of academic inquiry and policy interventions. The present study examines the global trend of deaths and Disability Adjusted Life Years (DALYs) attributable to air pollution with particular reference to the BRICS countries for the period 1990 to 2019. METHODS: This study has used the global burden of disease estimates by using different rounds of the Global Burden of Disease (GBD) study report published by the Institute of Health Metrics Evaluation. This study has calculated the cause of death and DALYs due to environmental risk factors (i.e. Air pollution). Data analysis has been done by using the standard formula for the calculation of death (mortality) rate and DALYs rate. Similarly, we calculated the age and gender-wise death and DALYs rate by using the appropriate numerator and denominator. RESULTS: The study discovered a significant shift in disease patterns over this period, as communicable diseases like respiratory infections and tuberculosis were replaced by non-communicable diseases such as ischemic heart disease (17.2 million), chronic obstructive pulmonary disease (14.59 million), and stroke (17.02 million) as the primary causes of air pollution-related deaths in 2019 at the global level. Additionally, the study identified a worrying increase in deaths linked to neonatal disorders and respiratory infections caused by ambient particulate matter pollution in South Africa, India, and Brazil. The impact of air pollution on public health is evident across different age groups and genders, with people aged 50-69 years, those aged 70 and above, and children under 5 years being more vulnerable. Furthermore, the male population is disproportionately affected by communicable and noncommunicable diseases caused by air pollution. CONCLUSION: The study highlights the need for policymakers to implement evidence-based interventions to tackle this global health problem. The interventions should aim to reduce the emerging crisis of non-communicable diseases related to air pollution, particularly among vulnerable age groups and the male population, ultimately improving public health outcomes.

Leading causes of death and disease burden in the Americas: Noncommunicable diseases and external causes. Executive summary

The health status of its population is a key determinant of a country’s social and economic development. Understanding disease morbidity, mortality, disability, and the related impact on life expectancy is a fundamental pillar for building resilient health systems and more equitable societies. Such knowledge informs strategic planning and optimal resource allocation to effectively address health challenges, making health systems more responsive to the needs of the populations they serve. This is the executive summary of the report Leading causes of death and disease burden in the Americas: Noncommunicable diseases and external causes, which presents an in-depth analysis on life expectancy and mortality in the Americas, exploring the burden of disease throughout the life course. It focuses on noncommunicable diseases (NCDs), encompassing mental and substance use disorders, neurological conditions, and external causes during the period 2000–2019. Despite a trend to overall increased life expectancy, NCDs and external causes remain a major challenge to social and economic development in the Region of the Americas, requiring public health solutions, health systems innovations, and political interventions to bring about the required changes. Rapidly aging populations and related demographic shifts, increasing disease burdens, and widening gaps in equity demand accelerated actions to tackle NCDs and mental health conditions. This report provides evidence urgently needed for decisive actions, so that the Sustainable Development Goals can be achieved by the countries of the Americas.

Guide de prise en charge nutritionnelle pour le cancer de l’enfant

Le « Guide de prise en charge nutritionnelle our le cancer de l'enfant » vise à fournir au nutritionniste un guide des procédures techniques de prise en charge nutritionnelle des enfants et adolescents atteints de cancer, dans le but d'améliorer la qualité des soins aux différents niveaux de soins. Élaborer des lignes directrices claires et bien définies, basées sur les preuves disponibles. Applicables aux enfants et adolescents atteints de cancer. Flexibles et adaptables à chaque patient. Adéquat et accessible au lieu d’application.

Estrategia de Cooperación Técnica con el País: Ecuador 2024-2028

La Organización se complace en suscribir con el Gobierno de Ecuador la Estrategia de Cooperación con el País (ECP) para el período 2024-2028. En virtud de su mandato, condición jurídica independiente y en coordinación con el Sistema de las Naciones Unidas, la OPS colabora con los gobiernos nacionales sobre la base de planes de trabajo bienales (PTBs) y presupuestos elaborados y acordados conjuntamente, los cuales son los principales instrumentos de rendición de cuentas entre la OPS y sus Estados Miembros y la base de los esfuerzos de movilización de recursos financieros y humanos de la OPS. La presente es una apuesta estratégica a mediano plazo para articular las acciones del plan de trabajo de la Organización con las iniciativas y políticas en salud adelantadas por el Estado ecuatoriano, así como las del nivel regional y mundial en apoyo al cumplimiento de los compromisos de la agenda sanitaria internacional.

Strengthening care for noncommunicable diseases in the Americas

Noncommunicable diseases (NCDs), such as cardiovascular diseases, cancer, respiratory diseases and diabetes, account for 81% of lives lost in the Americas. An estimated 240 million adults in the Region live with at least one NCD, requiring access to continuous support, delivered through Primary Health Care. Successful implementation of NCD policies and interventions can result in significant cost savings, alleviating the economic burden on healthcare systems, individuals, and society, while effective NCD management at the Primary Health Care level reduces premature deaths and disabilities. Strengthening integration of NCDs into Primary Health Care represents a key milestone in a country’s health system response to the Sustainable Development Agenda, with the aim of leaving no-one behind.

Risk Factors for Chronic Non-Communicable Diseases of Long-Haul Truck Drivers during the COVID-19 Pandemic: An Integrative Review.

Long-haul truck drivers are responsible for transporting goods valued at millions of dollars of the world economy, and may have their health affected by living and working conditions. This study analyzed and synthesized scientific findings about risk factors for the development of chronic non-communicable diseases in long-haul truck drivers. An integrative literature review was conducted. We identified 23 studies that met the inclusion criteria and evaluated the health of 7363 drivers. The biological risk factors identified were age, gender, race/ethnicity, genetics, and comorbidities, and were considered to be non-modifiable for chronic diseases. The behavioral risks considered to be modifiable were sedentary lifestyle, smoking, alcohol consumption, overweight, diet, stress, anxiety, and unfavorable socioeconomic conditions. Environmental risks involved working conditions such as the following: number of working hours per day, week, and month; time away from home; risk of musculoskeletal injury; and opportunities for rest, hours of sleep, and access to health services. The results were presented in two categories: (1) biological, behavioral, and environmental risks, and (2) general recommendations to promote physical, cognitive, and emotional health. Macro-structural changes are needed to reorganize work and rest, improve access to health services to control modifiable risk factors, and to support behavioral and environmental changes to reduce chronic non-communicable diseases and deaths.