Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 259
Rev Panam Salud Publica ; 46: e41, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35677216


Objectives: To estimate inequalities in demand for family planning satisfied with modern methods among women in Latin America and the Caribbean, with an emphasis on Brazil and Mexico, and to calculate the scenario for recovery of modern contraceptive coverage by expanding access to long-acting contraceptives (LARC) after the COVID-19 pandemic. Methods: National health surveys from 2006 to 2018 were used to estimate the demand for family planning satisfied with modern methods and how it was affected by the COVID-19 pandemic. The scenario included three variables: coverage, health outcomes, and costs. Considering coverage, United Nations Population Fund data were used to estimate the impact of COVID-19 on access to contraception in Latin America and the Caribbean. Health outcomes were assessed with the Impact 2 tool. Direct investment was used to evaluate cost-effectiveness. Results: Substantial inequalities were found in the use of modern contraceptive methods before the pandemic. We showed the potential cost-effectiveness of avoiding maternal deaths by introducing LARCs. Conclusions: In the scenario predicted for Brazil and Mexico, the costs of modern family planning and averted disability-adjusted life years are modest. Governments in Latin America and the Caribbean should consider promoting LARCs as a highly efficient and cost-effective intervention.

World Neurosurg ; 2022 Jun 17.
Artigo em Inglês | MEDLINE | ID: mdl-35724879


OBJECTIVES: Determine the bibliometric characteristics of scientific articles that address the subject of neurosurgery in Latin America and the Caribbean (LAC). METHODS: A bibliographic search of original articles published in the Web of Science database up to 2021 was performed, without language restrictions. The terms included in the search strategy were Neurosurgery, neurosurgical procedures and neurological surgical procedure. Articles according to the inclusion criteria in the Rayyan application were included. Subsequently, a quantitative bibliometric analysis was carried out with the bibliometrix package in R and VOSviewer. RESULTS: 882 articles published in 271 journals were identified. The first publication was in 2006, the highest number of publications was in 2021, the annual percentage growth rate was 25.9 and the average number of citations per document was 11.2. The author with the highest number of publications was TEIXEIRA MJ (41 articles) and the University of Sao Paulo had the highest number of articles on this topic. World neurosurgery was the journal with the most publications (120 articles) and the study by CARNEY N (2017) was the most cited (1175 citations). The country of the corresponding authors with the most publications and the greatest number of total citations was Brazil. NEUROSURGERY, SURGERY and MANAGEMENT were the most used keywords; however, in the most recent articles SIMULATION and DEEP BRAIN STIMULATION were used. CONCLUSIONS: In the last decade, there has been an increase in articles on Neurosurgery in LAC. Scientific production in neurosurgery must continue to increase in order to promote evidence-based medicine.

Mar Pollut Bull ; 180: 113818, 2022 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-35696895


The effects of marine litter pose ecological, economic and optional value threats to the countries and territories on the margins of the Atlantic Basin. As the abundance of transboundary marine litter increases, this in turn has triggered the development of marine litter policy action plans and inter-regional collaboration. The OSPAR Commission and Cartagena Convention of North-East Atlantic (NEA) and the Wider Caribbean Region (WCR) respectively, have established a memorandum of understanding to facilitate collaboration for enhanced marine litter management. In light of this development, this paper conducts a scoping review of management measures of marine litter within these regions as well as a coherence analysis between their regional action plans (RAPs). The analysis uses a proactive framework based on a modified categorization by Chen (2015) and Williams and Rangel-Buitrago (2019) for comparatively analyse management measures. The analytical categorizations include legislation and enforcement measures, prevention, removal, monitoring, research, information management and exchange and education and outreach. Although specific approaches differed among the regions depending upon geographical and individual situations, each categorization included detailed management activities except for prevention in NEA and removal in the WCR. The comparative analysis demonstrates that there are opportunities for inter-regional cooperation, knowledge sharing and overall enhanced and informed marine litter management.

Plásticos , Resíduos , Região do Caribe , Monitoramento Ambiental , Políticas , Resíduos/análise
Rev Panam Salud Publica ; 46: e21, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35509645


Objective: To estimate the point prevalence and likely ranges of pregnancy-induced hypertension, pre-eclampsia, gestational diabetes, low birth weight and preterm delivery in Latin America and the Caribbean, and evaluate the heterogeneity of the estimates. Methods: We conducted a systematic review and meta-analysis of observational studies reporting the prevalence of maternal and perinatal adverse outcomes in populations in Latin American and the Caribbean published between 2000 and 2019 in English, Spanish, or Portuguese. We searched PubMed, Embase, and LILACS. We estimated the point prevalence and evaluated overall heterogeneity and, in sub-group analyses, heterogeneity by study design and level of bias. Results: Of 1087 records retrieved, 50 articles were included in the review: two on hypertensive disorders of pregnancy, 14 on pre-eclampsia, six on gestational diabetes, nine on low birth weight and 19 on preterm birth. No meta-analysis for hypertensive disorders of pregnancy could be done because of the small number of studies. Point prevalence estimates and 95% confidence intervals (CIs) for pre-eclampsia, gestational diabetes, low birth weight, and preterm birth were: 6.6% (95% CI: 4.9%, 8.6%), 8.5% (95% CI: 3.9%, 14.7%), 8.5% (95% CI: 7.2%, 9.8%), and 10.0% (95% CI: 8.0%, 12.0%), respectively. We observed substantial heterogeneity overall and by study design. No major differences in estimates were observed by level of bias. Conclusions: The results of this study provide updated estimates of some of the most prevalent adverse pregnancy and perinatal outcomes in Latin America and the Caribbean. They highlight that important heterogeneity exists in prevalence estimates, which may reflect the diversity of populations in the region.

Rev Panam Salud Publica ; 46: e42, 2022.
Artigo em Espanhol | MEDLINE | ID: mdl-35520021


Objective: To map research protocols, publications, and collaborations on coronavirus disease 2019 (COVID-19) developed in Latin America and the Caribbean (LAC). Methods: Included were research protocols registered in international platforms and research publications containing populations, data, or authors from LAC. The source of information for protocols was primarily the International Clinical Trial Registry Platform (ICTRP) of the World Health Organization; for publications, specific electronic databases and repositories pertaining to COVID-19 were used. The search for publications was conducted up to 11 November; the search for protocols, up to 30 November 2020 (both dates inclusive). Data was extracted from protocols using standardized variables from the ICTRP, and from publications following pre-established criteria. Results: Among the protocols, 63.0% were therapeutic studies, 10% focused on prevention, and 45% were collaborative; 64% of the protocols received no funding from industry; 23% of the publications were not peer-reviewed and 23% were collaborative in nature. The most frequent study designs were systematic reviews and cross-sectional studies; 47.1% of studies were conducted in health facilities and 22% in community settings; 38.0% focused on diagnosis and 27.9% on prognosis. A qualitative synthesis was performed by line of care and approach strategies. Conclusions: There was an increase in the number of collaborative research studies relative to earlier studies and in protocols not funded by industry. The proposed research agenda was covered in large part as the pandemic unfolded.

Objetivo: Mapear protocolos de pesquisa, publicações e colaborações sobre a doença causada pelo coronavírus 2019 (COVID-19, na sigla em inglês) desenvolvidos na América Latina e no Caribe (ALC). Métodos: Foram incluídos protocolos registrados em plataformas internacionais e publicações de pesquisas que consideraram população, dados e autores da ALC. A fonte de informação para os protocolos foi principalmente a Plataforma Internacional de Registros de Ensaios Clínicos (ICTRP, na sigla em inglês) da Organização Mundial da Saúde. Para as publicações, foram utilizadas bases de dados eletrônicas e repositórios específicos sobre COVID-19. As publicações foram pesquisadas até 11 de novembro, e os protocolos, até 30 de novembro de 2020 (inclusive). As informações dos protocolos foram extraídas de acordo com variáveis padronizadas da plataforma ICTRP e das publicações, segundo critérios pré-estabelecidos. Resultados: Dos protocolos, 63% eram estudos sobre terapias, 10% sobre prevenção e 45% eram colaborativos. Em relação ao financiamento, 64% dos protocolos não vieram da indústria. Em relação às publicações, 23% eram sem revisão por pares e 23% eram colaborativas. Os delineamentos mais frequentes foram revisões sistemáticas e estudos transversais; 47,1% foram realizados em serviços de saúde e 22% no âmbito comunitário; 38,0% focaram no diagnóstico e 27,9% no prognóstico. Realizou-se uma síntese qualitativa segundo a linha de cuidado e as estratégias de abordagem. Conclusões: Observou-se um aumento no número de pesquisas colaborativas (em comparação com estudos anteriores) e de protocolos não financiados pela indústria. A agenda de pesquisa proposta foi coberta, em grande parte, à medida que a pandemia progredia.

Artigo em Inglês | MEDLINE | ID: mdl-35565089


Caribbean women experience a cervical cancer incidence rate that is three times higher than that among their North American counterparts. In this study, we performed a needs assessment of the knowledge and awareness of HPV, HPV vaccination, and cervical cancer and receipt of cervical cancer screening among an indigenous Caribbean community. We purposively recruited individuals aged ≥18 from a community health care clinic (n = 58) to complete a 57-item structured interview including items on demographics, cancer history, knowledge and awareness of HPV, HPV vaccines, cervical cancer, and cervical cancer screening. Participants' mean age was 47.1 years (SD: 14.4). Most were female (74.1%), were married/partnered (51.7%), had primary education (63.8%), and identified as Kalinago (72.4%). Whereas 79.5% had heard of cervical cancer, few had heard of HPV (19.6%) or the HPV vaccine (21.8%). Among those who knew someone with cancer, 90.9% had heard of the HPV vaccine, compared with only 9.1% of those who did not know anyone with cancer (p = 0.02). Access to HPV vaccination is an immediate, cost-effective cancer prevention priority for reducing the disproportionate burden of HPV-related cancers, particularly cervical cancer, in the Caribbean. We recommend culturally targeted education interventions to improve knowledge about HPV vaccination and the link between HPV and cervical cancer.

Conhecimentos, Atitudes e Prática em Saúde , Infecções por Papillomavirus , Vacinas contra Papillomavirus , Neoplasias do Colo do Útero , Vacinação , Adulto , Região do Caribe/epidemiologia , Detecção Precoce de Câncer , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Infecções por Papillomavirus/complicações , Infecções por Papillomavirus/epidemiologia , Infecções por Papillomavirus/prevenção & controle , Vacinas contra Papillomavirus/uso terapêutico , Aceitação pelo Paciente de Cuidados de Saúde , Neoplasias do Colo do Útero/epidemiologia , Neoplasias do Colo do Útero/prevenção & controle
Transbound Emerg Dis ; 2022 May 16.
Artigo em Inglês | MEDLINE | ID: mdl-35578793


Viruses pose a major threat to animal health worldwide, causing significant mortalities and morbidities in livestock, companion animals and wildlife, with adverse implications on human health, livelihoods, food safety and security, regional/national economies and biodiversity. The Greater and Lesser Antilles consist of a cluster of islands between the North and South Americas and is habitat to a wide variety of animal species. This review is the first to put together decades of information on different viruses circulating in companion animals, livestock and wildlife from the Caribbean islands of Greater and Lesser Antilles. Although animal viral diseases have been documented in the Caribbean region since the 1940s, we found that studies on different animal viruses are limited, inconsistent and scattered. Furthermore, a significant number of the reports were based on serological assays, yielding preliminary data. The available information was assessed to identify knowledge gaps and limitations, and accordingly, recommendations were made, with the overall goal to improve animal health and production, and combat zoonoses in the region.

Rev Panam Salud Publica ; 46: e18, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35432501


Objective: To establish whether there was any difference in disease stage in patients with screening-detected colorectal cancer (CRC) in a Caribbean country. Methods: The mode of presentation (elective vs. emergent), method of diagnosis (screening vs. symptomatic), and disease stage were retrospectively compared in all consecutive patients who had resections for CRC over a five-year period. Early CRC was defined as disease that could be completely resected with no involvement of adjacent organs, lymph nodes, or distant sites. Locally advanced CRC was disease that involved contiguous organs without distant metastases that was still amenable to curative resection. Results: There were 97 patients at a mean age of 64.9 ± 12.2 years treated for CRC, and only 21 (21.6%) had their diagnoses made through screening. Significantly more screening-detected lesions were early-stage CRCs (21.7% vs. 9.3%; p < 0.001). At the time of diagnosis, patients who did not have screening-detected lesions had a greater proportion of locally advanced (42.3% vs. 0) and metastatic (26.8% vs. 0) CRC. Those who did not have screening-detected lesions had a greater incidence of emergency presentations at diagnosis (26.8% vs. 0). Conclusions: The incidence of screening-detected CRC in this Caribbean nation was low. Consequently, most patients presented with locally advanced or metastatic CRC, for which there is less opportunity to achieve a cure. Significantly more screening-detected lesions were early-stage CRCs. It is time for policymakers to develop a national CRC screening program.

P R Health Sci J ; 41(1): 22-28, 2022 03 17.
Artigo em Inglês | MEDLINE | ID: mdl-35438891


OBJECTIVE: The objective of this study was to determine cut-off points that can be used to differentiate measures of empathy, which would then be classified as high, medium, or low. To do so, we used data from students from 7 medical schools in Colombia, El Salvador, and the Dominican Republic, after determining the psychometric properties of the 3-dimensional model of empathy in the Jefferson Scale of Empathy, S-version (for medical students). MATERIALS AND METHODS: This non-experimental descriptive study had a sample that consisted of 6291 students. The structure and factor invariance were analyzed by country and sex. A hierarchical cluster analysis and a bifactorial analysis of variance were applied. RESULTS: The measure of empathy was reliable on the global scale (α = .82; ω = .88). A confirmatory factor analysis showed that the original model was replicable and adjusted to the data (comparative fit index [CFI] = .90; goodness of fit index = .94), while the multigroup analysis allowed to assume an invariant factor structure by country and gender (ΔCFI < .01). Tables were constructed with cut off points for empathy and its dimensions. DISCUSSION AND CONCLUSION: Our study solves the problem of comparing the scores and the levels of empathy observed in the medical students at different schools of medicine, making said comparisons within and between countries and between genders. The instrument used has adequate psychometric properties and the cut-off values obtained allow the classifying of people with lower or higher levels of empathy.

Estudantes de Medicina , República Dominicana , Empatia , Feminino , Humanos , Masculino , Psicometria , Reprodutibilidade dos Testes , Inquéritos e Questionários
Front Endocrinol (Lausanne) ; 13: 841675, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35282460


Introduction: Diabetes mellitus is a chronic noncommunicable disease associated with death and major disability, with increasing prevalence in low- and middle-income countries. There is limited population-based data about diabetes in Haiti. The objective of this study was to assess the prevalence of diabetes and associated factors among adults in Port-au-Prince, Haiti using a population-based cohort. Methods: This study analyzes cross-sectional enrollment data from the population-based Haiti Cardiovascular Disease Cohort Study, conducted using multistage sampling with global positioning system waypoints in census blocks in the metropolitan area of Port-au-Prince, Haiti. A total of 3,005 adults ≥18 years old were enrolled from March 2019 to August 2021. We collected socio-demographic data, health-related behaviors, and clinical data using standardized questionnaires. Diabetes was defined as any of the following criteria: enrollment fasting glucose value ≥ 126 mg/dL or non-fasting glucose ≥ 200 mg/dL, patient self-report of taking diabetes medications, or study physician diagnosis of diabetes based on clinical evaluation. Results: Among 2985 (99.3%) with complete diabetes data, median age was 40 years, 58.1% were female, and 17.2% were obese. The prevalence of diabetes was 5.4% crude, and 5.2% age standardized. In unadjusted analysis, older age, higher body mass index (BMI), low physical activity, low education were associated with a higher odds of diabetes. After multivariable logistic regression, older age [60+ vs 18-29, Odds Ratio (OR)17.7, 95% CI 6.6 to 47.9] and higher BMI (obese vs normal/underweight, OR 2.7, 95% CI 1.7 to 4.4) remained statistically significantly associated with higher odds of diabetes. Conclusion: The prevalence of diabetes was relatively low among adults in Port-au-Prince, but much higher among certain groups (participants who were older and obese). The Haitian health system should be strengthened to prevent, diagnose, and treat diabetes among high-risk groups.

Doenças Cardiovasculares , Diabetes Mellitus , Adolescente , Adulto , Doenças Cardiovasculares/epidemiologia , Estudos de Coortes , Estudos Transversais , Diabetes Mellitus/epidemiologia , Feminino , Haiti/epidemiologia , Humanos
MEDICC Rev ; 24(1): 59-69, 2022 Jan 31.
Artigo em Inglês | MEDLINE | ID: mdl-35157640


INTRODUCTION: Carbapenem-resistant Acinetobacter baumannii is a complex health problem, causing difficulties in clinical-therapeutic management worldwide. It is of particular concern in Latin America, the Caribbean and China, where it is an emerging health problem. Carbapenemases produced by these organisms inactivate carbapenem antibiotics. Monitoring circulating genotypes' geographic dispersion contributes to more effective control measures. However, exhaustive studies on carbapenem-resistant A. baumannii are scarce. OBJECTIVES: Study the production of carbapenemases in clinical isolates of A. baumannii resistant to carbapenem antibiotics and the geographic distribution of the sequences circulating in China, Latin America and the Caribbean. DATA ACQUISITION: We followed PRISMA indications. We carried out a systematic search in Pubmed, BVS and CKNI on papers on A. baumannii and carbapenemases published during 2015-2020 in English, Spanish and Chinese, and selected 29 cross-sectional studies that met the search criteria. Studies were evaluated using JBI Critical Appraisal tools, and quantitative data were collated for meta-analysis using the Metaprop library in Stata15. DEVELOPMENT: OXA-type carbapenemases were detected in all studies; among A. baumannii resistant to carbapenem antibiotics, predominant types were OXA-23, OXA-24, OXA-54 and OXA-72; metallobetalactamases were identified less frequently than OXA carbapenemases. Only one clinical isolate producer of Class A carbapenemases (KPC) was identified in Colombia. In total, 41 sequence types were identified; in Latin America and the Caribbean the most common types were: ST79, ST25, ST1 and ST15; in China, the sequences ST195, ST208, ST191, ST368 and ST369 were the most prevalent. ST2 was found in both regions. CONCLUSIONS: The most prevalent carbapenemases and sequence types vary by region, indicating different ancestral strains. Microbiological surveillance, antibiotic use optimization, adequate infection treatment and timely control strategies are essential for carbapenem-resistant A. baumannii prevention and control in geographies such as Latin America, the Caribbean and China where such resistance is an emerging health problem.

Infecções por Acinetobacter , Acinetobacter baumannii , Infecções por Acinetobacter/tratamento farmacológico , Infecções por Acinetobacter/epidemiologia , Antibacterianos/farmacologia , Antibacterianos/uso terapêutico , China/epidemiologia , Estudos Transversais , Cuba , Humanos , América Latina/epidemiologia , Testes de Sensibilidade Microbiana
J Clin Hypertens (Greenwich) ; 24(3): 237-245, 2022 03.
Artigo em Inglês | MEDLINE | ID: mdl-35129266


Hypertension in pregnancy is a key driver of mortality and morbidity among Haitian women. HIV infection and treatment may worsen hypertension and increase cardiovascular disease risk. The authors examined blood pressure and hypertension patterns among 1965 women (2306 pregnancies ending in live births) in a prevention of maternal-to-child transmission (PMTCT) program in Port-au-Prince, Haiti, between 2007 and 2017. Hypertension was defined as blood pressure ≥140/90 mm Hg on two consecutive visits. Latent class analysis assessed trajectories of mean arterial pressure (MAP) and multinomial ordinal logistic regression examined factors associated with higher trajectories. Between 2007-2009 and 2013-2016, hypertension at PMTCT entry increased from 1.3% to 3.8% (p = .005), while incidence at any time during PMTCT follow-up increased from 5.0 to 16.1 per 100 person-years (p < .001). Hypertension detected ≤20 weeks and > 20 weeks of gestation (possible gestational hypertension) increased from 1.1% to 3.5% (p = .003) and from 2.3% to 6.9% (p < .001), respectively. Five MAP trajectories ranged from low-stable to high-increasing. In multivariable analysis controlling for history of antiretroviral therapy, age, parity, and weight, program entry in more recent years was associated with greater odds of higher MAP trajectory (adjusted odds ratio for 2013-2016 vs. 2007-2009 = 3.1, 95% confidence interval: 1.7-5.6). The increasing prevalence and incidence of hypertension highlight a need for screening and management prior to PMTCT entry and during follow-up. In a population with limited access to chronic disease care, and where many deliveries occur outside of a clinical setting, the period of PMTCT follow-up represents an opportunity to diagnose and initiate management of preexisting and pregnancy-related hypertension.

Infecções por HIV , Hipertensão Induzida pela Gravidez , Pressão Sanguínea/fisiologia , Feminino , Infecções por HIV/complicações , Infecções por HIV/tratamento farmacológico , Infecções por HIV/epidemiologia , Haiti/epidemiologia , Humanos , Hipertensão Induzida pela Gravidez/diagnóstico , Hipertensão Induzida pela Gravidez/epidemiologia , Gravidez , Gestantes
Mar Pollut Bull ; 174: 113291, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-35090276


The Wider Caribbean (WC) comprises numerous diverse developing states and territories including Small Island Developing States (SIDS). In particular, the Eastern part of the WC with its 16 SIDS receives a disproportionate amount of marine litter. Addressing this serious and urgent environmental problem requires scientific evidence to support and inform policy formation and decision making. Yet, as this study demonstrates, marine scientific research on the issue of marine litter in the Caribbean SIDS is predominantly undertaken by extra-regional scientists and organisations which might weaken the science-policy transfer to develop suitable and tailor-made solutions. The view point paper highlights issues and the problems associated with parachute science for the Caribbean SIDS before offering a series of potential policy-ready response options to address the identified challenges.

Poluentes da Água/análise , Região do Caribe , Índias Ocidentais
Hypertension ; 79(1): 283-290, 2022 01.
Artigo em Inglês | MEDLINE | ID: mdl-34878898


Cardiovascular disease is the leading cause of death in lower-income countries including Haiti. Environmental lead exposure is associated with high blood pressure and cardiovascular mortality in high-income countries but has not been systematically measured and evaluated as a potential modifiable cardiovascular risk factor in lower-income countries where 6.5 billion people reside. We hypothesized lead exposure is high in urban Haiti and associated with higher blood pressure levels. Blood lead levels were measured in 2504 participants ≥18 years enrolled in a longitudinal population-based cohort study in Port-au-Prince. Lead screening was conducted using LeadCare II (detection limit ≥3.3 µg/dL). Levels below detection were imputed by dividing the level of detection by √2. Associations between lead (quartiles) and systolic blood pressure and diastolic blood pressure were assessed, adjusting for age, sex, obesity, smoking, alcohol, physical activity, income, and antihypertensive medication use. The median age of participants was 40 years and 60.1% were female. The geometric mean blood lead level was 4.73µg/dL, 71.1% had a detectable lead level and 42.3% had a blood lead level ≥5 µg/dL. After multivariable adjustment, lead levels in quartile four (≥6.5 µg/dL) compared with quartile 1 (<3.4 µg/dL) were associated with 2.42 mm Hg (95% CI, 0.36-4.49) higher systolic blood pressure and 1.96 mm Hg (95% CI, 0.56-3.37) higher diastolic blood pressure. In conclusion, widespread environmental lead exposure is evident in urban Haiti, with higher lead levels associated with higher systolic and diastolic blood pressure. Lead is a current and potentially modifiable pollutant in lower-income countries that warrants urgent public health remediation. Registration: URL:; Unique identifier: NCT03892265.

Pressão Sanguínea/fisiologia , Exposição Ambiental/efeitos adversos , Hipertensão/etiologia , Chumbo/sangue , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Haiti , Humanos , Hipertensão/sangue , Hipertensão/fisiopatologia , Masculino , Pessoa de Meia-Idade , Pobreza , Adulto Jovem
Rev Panam Salud Publica ; 46: e28, 2022.
Artigo em Espanhol | MEDLINE | ID: mdl-35495553


Objective: Identify approaches to water safety and quality in documents describing school feeding programs in Latin American and Caribbean (LAC) countries. Methods: Descriptive, cross-sectional, exploratory study of documents on school feeding in LAC countries and territories. A documentary analysis was carried out and four initial categories were determined: "water for consumption", "water for hygiene", "water for food preparation", and "local/family agriculture", according to the use of water in school feeding programs. Documents were identified in 2018 and 2019 on the official websites of LAC countries and territories, the United Nations Food and Agriculture Organization, and the World Food Programme. Absolute and relative frequencies were obtained for quantitative data; thematic content analysis was applied to qualitative data. Results: Of the 114 documents analyzed, 29 were eligible. In the categories "water for consumption", "water for hygiene" and "water for food preparation", the only characteristic attributed to water was that it be potable. In the category "local/family farming", no approaches were found that addressed water for irrigation. Conclusion: The documents address water, but do not focus on its safety and quality. Governments and local authorities should review their documents and ensure that their approaches are mutually coherent and based on intersectoral support and dialogue to achieve the targets of the Sustainable Development Goals.

Objetivo: Identificar as abordagens sobre a inocuidade e qualidade da água em documentos que descrevem os programas de alimentação escolar nos países da América Latina e do Caribe (ALC). Métodos: Estudo descritivo, transversal e exploratório de documentos sobre alimentação escolar nos países e territórios da ALC. Foi realizada uma análise documental e, a priori, foram determinadas quatro categorias: "água para consumo", "água para higiene", "água para preparo" e "agricultura local/familiar", conforme o uso da água na alimentação escolar. Os documentos foram pesquisados durante 2018-2019 nos sites oficiais dos países e territórios da ALC, da Organização das Nações Unidas para a Alimentação e a Agricultura e do Programa Mundial de Alimentos. Foram obtidas as frequências absolutas e relativas dos dados quantitativos e, para os dados qualitativos, aplicou-se a análise de conteúdo do tipo temática. Resultados: Foram analisados 114 documentos, dos quais 29 eram elegíveis. As abordagens das categorias "água para consumo", "água para higiene" e "água para preparo" somente atribuíram à água a característica de ser potável. Na categoria "agricultura local/familiar" não foram encontradas abordagens sobre água para irrigação. Conclusão: Os documentos abordam a água, mas não focam em sua inocuidade e qualidade. Os governos e autoridades locais devem revisar seus documentos e garantir a unanimidade de abordagens com base no apoio e no diálogo intersetorial, a fim de alcançar as metas dos Objetivos de Desenvolvimento Sustentável.

Child Adolesc Psychiatry Ment Health ; 15(1): 82, 2021 Dec 30.
Artigo em Inglês | MEDLINE | ID: mdl-34969383


Internationally, there is a wealth of research suggesting that many children and young people experience mental health problems. However, the evidence from low- and middle-income countries and developing nations is generally limited. This scoping review aimed to add to the body of evidence by providing an overview of the available research literature on children and young people's (CYP's) mental health in the English-speaking Caribbean region. Seven key online academic databases and grey literature sources were searched until January 2021. Records were screened against predefined criteria and suitable articles retrieved. Relevant information was then charted and summarized. All stages of the review were informed by expert consultations. Ninety-six articles from 7901 records met the inclusion criteria. Most of the studies were conducted in Jamaica, Trinidad and Tobago and Barbados while fewer studies reported findings from St Lucia, The Bahamas and St Kitts and Nevis. Research funding was not frequently reported, and participants were predominantly recruited in education settings. There was a substantial focus on depressive symptoms and behaviour problems. Little or no research was available for younger children (< 12), complex clinical cases or commonly under-represented groups. Four unique interventions were identified of which one intervention showed no significant impact on CYP. Among the commonly used outcome measures only the Jamaican Youth Checklist (teacher-reported), Beck Depression Inventory-II, Brief Screen for Depression, Trinidad and Tobago Youth Survey and Minnesota Multiphasic Personality Inventory had evidence for psychometric validity within this population. We discuss future directions, implications and recommendations for research, practice, policy and training.

Rev Panam Salud Publica ; 45: e140, 2021.
Artigo em Espanhol | MEDLINE | ID: mdl-34737772


OBJECTIVE: Describe the perceptions of key actors regarding the disruption of health services for populations that ceased to be prioritized because of the COVID-19 pandemic-pregnant women, newborn, children, adolescents, and women-in countries of Latin America and the Caribbean (LAC) during the first stage of the pandemic. METHODS: In this cross-sectional study, a 35-question survey was administered to key actors in 19 LAC countries between July and September 2020. The respondents were asked for their personal perceptions regarding the situation of social and health services in their country before and during the pandemic. They were also asked for a projection of the situation during the post-pandemic period. RESULTS: In the 691 responses received, the main perception was that coverage in the services analyzed had been high before the pandemic, although their quality was not as highly rated. Both the coverage and quality of services were thought to have declined for adolescents and women. The majority of respondents predicted that all services will continue to function at lower than usual coverage levels for another three months (53.1%) and another 12 months (41.3%). Guaranteeing coverage and access to health services was considered the main policy challenge going forward. The next most needed initiatives noted were financing for actions to support women, children, and adolescents, and protection against violence and promotion of measures to combat it. CONCLUSIONS: Although the pandemic has struck all countries, its effect on the delivery of services in the populations analyzed differs from country to country and according to the types of service. It is essential to invest in national information systems that will make it possible to monitor the different services and identify the populations that need to be prioritized.

OBJETIVOS: Descrever a percepção de atores-chave na interrupção dos serviços de saúde para populações não priorizadas na pandemia ­ grávidas, recém-nascidos, crianças, adolescentes e mulheres ­ em países da América Latina e do Caribe (ALC) durante a primeira fase da pandemia de COVID-19. MÉTODOS: Estudo transversal. Foi realizada uma pesquisa com atores relevantes de 19 países da ALC entre julho e setembro de 2020, com 35 perguntas sobre a percepção pessoal do estado dos serviços sociais e de saúde em seus países antes e durante a pandemia, bem como uma projeção para depois dela. RESULTADOS: Nas 691 respostas, predominou a percepção de que a cobertura dos serviços analisados era alta antes da pandemia, embora a qualidade fosse vista como mais baixa. Notou-se uma redução na cobertura e na qualidade dos serviços a adolescentes e mulheres. A maioria estimou que todos os serviços seguiriam com uma menor cobertura tanto em 3 como em 12 meses (53,1% e 41,3%, respectivamente). Garantir a cobertura e o acesso aos serviços de saúde é o principal desafio político para o futuro, seguido do financiamento de iniciativas para mulheres, crianças e adolescentes, e da proteção e promoção contra a violência. CONCLUSÕES: Embora a pandemia tenha afetado todos os países, o abalo na provisão de serviços para as populações analisadas é heterogêneo entre os países e os tipos de serviço. É preciso investir em sistemas de informação nacionais que permitam monitorar os distintos serviços e identificar as populações que não foram priorizadas.

Rev Panam Salud Publica ; 45: e111, 2021.
Artigo em Espanhol | MEDLINE | ID: mdl-34815734


OBJECTIVE: Characterize the content of communication products for COVID-19 prevention promoted by governments in Latin America and the Caribbean (LAC) for the general public. METHODS: A descriptive, cross-cutting, and exploratory study of the communication products for COVID-19 prevention published up to 28 February 2021 on official websites of the ministries of health of the 47 countries and territories of LAC. Quantitative and qualitative methods based on the dimensions recommended by the World Health Organization (WHO) were employed, together with a social determinants of health (SDH) approach. The content analysis technique and investigator triangulation were used to improve internal validity. RESULTS: 3 253 information products were analyzed. In 47 countries and territories in LAC at least one product included a WHO recommendation; and in 46 at least one category or subcategory related to intermediate SDHs was addressed. Regarding structural SDHs, a gender approach was used in at least one product in only four countries, and an indigenous language in only seven countries. In 35 countries, at least one product was found to have erroneous information and in 13 countries the infodemic was not addressed. CONCLUSIONS: A substantial number of communication products for COVID-19 prevention were found, but they lacked an adequate diversity approach and comprehensive health approach, and they showed gaps and communication errors. The countries should review their health communication policies in the context of the pandemic.

OBJETIVO: Caracterizar o conteúdo dos produtos de comunicação dirigidos à população em geral, para a prevenção da COVID-19, promovidos pelos governos da América Latina e do Caribe (ALC). MÉTODOS: Estudo descritivo, transversal e exploratório dos produtos de comunicação publicados até 28 de fevereiro de 2021 nos sites oficiais dos ministérios da Saúde de 47 países e territórios da ALC para a prevenção da COVID-19. Foram utilizados métodos quantitativos e qualitativos com base nas dimensões recomendadas pela Organização Mundial da Saúde (OMS) e enfoque nos determinantes sociais da saúde (DSS). Foram utilizadas as técnicas de análise de conteúdo e triangulação de investigador. RESULTADOS: Foram analisados 3 253 produtos de informação. Nos 47 países e territórios da ALC, pelo menos um produto incluiu alguma recomendação da OMS, e em 46, foram abordadas algumas das categorias e subcategorias relacionadas aos DSS intermediários. Dos DSS estruturais, foram utilizados enfoque de gênero e alguma língua indígena em pelo menos um produto de apenas 4 e 7 países, respectivamente. Em 35 países foi encontrado pelo menos um produto com informações errôneas, e em 13 não foi abordada a infodemia. CONCLUSÕES: Foi encontrado um número considerável de produtos de comunicação para a prevenção da COVID-19; entretanto, eles não refletiam uma abordagem adequada à diversidade e à saúde integral, e apresentavam lacunas e erros de comunicação. Os países devem revisar suas políticas de comunicação em saúde no contexto da pandemia.

Rev Panam Salud Publica ; 45: e104, 2021.
Artigo em Espanhol | MEDLINE | ID: mdl-34703457


Achieving health equity and addressing the social determinants of health are critical to attaining the health and health-related targets of the 2030 Agenda for Sustainable Development and its Sustainable Development Goals. Frameworks for health, including the Sustainable Health Agenda for the Americas 2018 - 2030, emphasize reduction of health inequities and "leaving no one behind" in national sustainable development. Health equity includes advancing universal health and the primary health care approach, with equitable access for all people to timely, quality, comprehensive, people- and community-centered services that do not cause impoverishment. Equally important, and a hallmark of good governance, is accountability for such advances. Governments have primary responsibility for reducing health inequities and must be held accountable for their policies and performance. Civil society has been recognized as a key partner in advancing sustainable and equitable national development. Effective accountability mechanisms should include civic engagement. The Healthy Caribbean Coalition (HCC), the only Caribbean regional alliance of civil society organizations working to prevent and control noncommunicable diseases-a major health priority fueled by inequities-has played a significant role in holding governments accountable for advancing health equity. This case study examines factors contributing to the success of the HCC, highlighting work under its five strategic pillars- accountability, advocacy, capacity development, communication, and sustainability-as well as challenges, lessons learned, and considerations for greater effectiveness.

Conquistar a equidade em saúde e abordar os determinantes sociais da saúde são essenciais para atingir as metas de saúde e as relacionadas à saúde da Agenda 2030 para o Desenvolvimento Sustentável e seus Objetivos de Desenvolvimento Sustentável. As estruturas para a saúde, incluindo a Agenda de Saúde Sustentável para as Américas 2018-2030, enfatizam a redução das iniquidades em saúde "sem deixar ninguém para trás", quando se trata do desenvolvimento sustentável nacional. A equidade em saúde inclui impulsionar a saúde universal e a abordagem da atenção primária à saúde, habilitando o acesso equitativo por todas as pessoas a serviços oportunos, de qualidade, integrais, centrados no atendimento às pessoas e às comunidades de maneira a não causar o empobrecimento. A questão da responsabilidade por tais avanços é igualmente importante, e é um selo de distinção de boa gestão. Os governos são os principais responsáveis pela redução das iniquidades em saúde e precisam ser responsabilizados por suas políticas e por seu desempenho. Reconheceu-se que a sociedade civil desempenha um papel essencial na promoção do desenvolvimento nacional sustentável e equitativo. Para que sejam eficazes, os mecanismos de responsabilização devem incluir a participação cívica. A Coalizão do Caribe Saudável (HCC), a única aliança de organizações da sociedade civil que trabalha na prevenção e no controle de doenças não transmissíveis na região do Caribe ­ uma grande prioridade de saúde movida pelas iniquidades ­ tem desempenhado uma função significativa na responsabilização dos governos pelo avanço da equidade em saúde. Este estudo examina os fatores que contribuem para o sucesso da HCC e destaca o trabalho da perspectiva dos cinco pilares estratégicos ­ responsabilidade, promoção de causa, desenvolvimento das capacidades, comunicação e sustentabilidade ­, bem como os desafios, as lições aprendidas e as considerações para que se torne ainda mais eficaz.

Rev Panam Salud Publica ; 45: e115, 2021.
Artigo em Espanhol | MEDLINE | ID: mdl-34621303


OBJECTIVE: Analyze cohabitation patterns in the population over 60 years of age living in private households in 23 countries in Latin America and the Caribbean. METHODS: Cross-sectional study based on the most recently available census microdata from the Integrated Public Use Microdata Series (IPUMS, International), corresponding mainly to the 2010 census. Average number of household members, age distribution, and family relationships were calculated and compared for each country and by sex. The average number of household members was compared, by country and by sex, in relation to level of schooling and marital status. RESULTS: The average number of people that older people live with differs between countries, ranging from two or less in countries such as Argentina, Puerto Rico, and Uruguay, to four or more in countries such as Honduras and Nicaragua. This difference depends on a greater or lesser presence of young adults, children, and other family members in the household. The number of household members declines with a higher level of schooling, except in Cuba and Puerto Rico, where no differences are observed. In general, older women live in households with fewer people than men, although this is not the case for unmarried or divorced people. CONCLUSIONS: In the Region, it is common for older persons to live with children and other family members. The differences between countries and by educational level show that the family plays an important role in social protection of the elderly in less developed countries and in the least educated groups.

OBJETIVO: Analisar os padrões de convivência da população de 60 anos ou mais que reside em moradias particulares em 23 países da América Latina e do Caribe. MÉTODOS: Estudo transversal realizado com base nos microdados censitários mais recentes disponíveis no Integrated Public Use Microdata Series (IPUMS)-International, na maior parte correspondente à etapa censitária de 2010. O número médio de coabitantes, sua distribuição por idade e as relações de parentesco estabelecidas entre eles foram calculados e comparados para cada país e por sexo. A média de coabitantes em função do nível de escolaridade e do estado civil foi comparada por país e por sexo. RESULTADOS: A média do número de pessoas com quem os idosos convivem difere entre países. Oscila entre 2 pessoas em países como Argentina, Porto Rico e Uruguai e 4 ou mais pessoas em países como Honduras e Nicarágua. Essa diferença resulta da maior ou menor presença de jovens, filhos e outros familiares em casa. Quanto maior o nível de escolaridade, menor o número de coabitantes, exceto em Cuba e em Porto Rico, onde não são observadas diferenças. Em geral, as mulheres idosas vivem em moradias com menos pessoas que os homens, embora não seja o caso das pessoas solteiras ou divorciadas. CONCLUSÕES: A convivência com filhos e outros familiares é habitual na Região. As diferenças entre países e por nível educacional mostram que a família desempenha um papel importante na proteção social da velhice nos países menos desenvolvidos e nos grupos menos escolarizados.