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1.
Artigo em Inglês | PAHO-IRIS | ID: phr-51069

RESUMO

[ABSTRACT]. Caribbean countries are experiencing social, epidemiological, and demographic transitions shaped by the growing elderly population and the rise of noncommunicable diseases (NCDs)—now responsible for 78% of all deaths. These circumstances demand rethinking the model of care to improve health outcomes and build more sustainable health systems with new orientations in policy, service delivery, organization, training, technology, and financing. Policy must be aimed towards healthy living, leveraging interventions that ensure healthy aging. The health system must proactively structure interventions to reduce the incidence of new NCD cases and to prevent related complications. Interventions should be focused on optimizing the individual’s capacity, functional ability, and autonomy within adapted environments, as well as with the necessary preventive, long-term care, self-care, community care, and health system support.


[RESUMEN]. Los países del Caribe están experimentando transiciones sociales, epidemiológicas y demográficas como resultado del envejecimiento de la población y el aumento de la prevalencia de las enfermedades no transmisibles (ENT), que en la actualidad causan el 78% de todas las defunciones. Estas circunstancias exigen replantear el modelo de atención para mejorar los resultados de salud y establecer sistemas de salud más sostenibles mediante nuevos enfoques en políticas, prestación de servicios, organización, capacitación, tecnología y financiamiento. Las políticas deben tener como propósito procurar una vida saludable, aprovechando las intervenciones que garanticen el envejecimiento saludable. El sistema de salud debe ser proactivo, estructurando las intervenciones para reducir la incidencia de nuevos casos de ENT y para prevenir las complicaciones relacionadas. Las intervenciones deben centrarse en optimizar la capacidad funcional, la autonomía y el desenvolvimiento general de la persona dentro de un entorno adaptado y con el apoyo necesario del sistema de salud en materia de atención preventiva, cuidados a largo plazo, de autocuidado y de atención en la comunidad.


[RESUMO]. Os países do Caribe estão passando por transições sociais, epidemiológicas e demográficas configuradas pela população de idosos cada vez maior e a ascensão das doenças não transmissíveis (DNTs), já responsáveis por 78% de todas as mortes. Essas circunstâncias exigem repensar o modelo de atenção para melhorar os desfechos de saúde e construir sistemas de saúde mais sustentáveis, com novas orientações de política, prestação de serviços, organização, treinamento, tecnologia e financiamento. As políticas devem ser orientadas para a vida saudável, alavancando intervenções que asseguram o envelhecimento saudável. O sistema de saúde deve estruturar proativamente intervenções para reduzir a incidência de novos casos de DNT e a prevenir as complicações relacionadas. As intervenções devem se concentrar na otimização da capacidade do indivíduo, das habilidades funcionais e da autonomia dentro de ambientes adaptados, e também nas ações preventivas a para assistência de longa duração, no autocuidado, na atenção na comunidade e no apoio pelos sistemas de saúde.


Assuntos
Sistemas de Saúde , Envelhecimento , Doenças não Transmissíveis , Aruba , Curaçao , Sistemas de Saúde , Envelhecimento , Doenças não Transmissíveis , Sistemas de Saúde , Envelhecimento , Doenças não Transmissíveis , Curaçao
2.
PLoS One ; 13(4): e0196630, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29709007

RESUMO

BACKGROUND: Chikungunya virus (CHIKV) emerged in Aruba for the first time in 2014. We studied the clinical presentation of acute CHIKV infection and the contribution of serologic and molecular assays to its diagnosis. In a cohort of confirmed CHIKV cases, we analysed the frequency, duration and predictors of post-chikungunya chronic polyarthralgia (pCHIK-CPA), defined as joint pains lasting longer than 6 weeks or longer than 1 year. METHODOLOGY: Patient sera obtained within 10 days of symptom onset were tested for CHIKV, using an indirect immunofluorescence test for the detection of CHIKV-specific Immunoglobulin M (IgM) and post-hoc, by reverse-transcription polymerase chain reaction (RT-PCR). CHIKV was isolated from selected samples and genotyped. For confirmed CHIKV cases, clinical data from chart review were complemented by a Telephone survey, conducted 18-24 months after diagnosis. When joint pain was reported, the duration, presence of inflammatory signs, type and number of joints affected, were recorded. Joint involvement was scored according to the 2010 'American College of Rheumatology/ European League Against Rheumatism' criteria for seronegative rheumatoid arthritis (ACR-score). Risk factors for pCHIK-CPA were identified by logistic regression. PRINCIPAL FINDINGS: Acute CHIKV infection was diagnosed in 269 of 498 sera, by detection of IgM (n = 105), by RT-PCR (n = 59), or by both methods (n = 105). Asian genotype was confirmed in 7 samples. Clinical data were complete for 171 of 248 (69.0%) patients, aged 15 years or older (median 49.4 [35.0-59.6]). The female-to-male ratio was 2.2. The main acute symptoms were arthralgia (94%), fever (85%), myalgia (85%), headache (73%) and rash (63%). In patients with arthralgia (n = 160), pCHIK-CPA longer than 6 weeks was reported by 44% and longer than 1 year by 26% of cases. Inflammatory signs, stiffness, edema and redness were frequent (71%, 39% and 21%, respectively). Joints involved were knees (66%), ankles (50%), fingers (52%), feet (46%), shoulders (36%), elbows (34%), wrists (35%), hips (31%), toes (28.1%) and spine (28.1%). Independent predictors of pCHIK-CPA longer than 1 year were female gender (OR 5.9, 95%-CI [2.1-19.6]); high ACR-score (7.4, [2.7-23.3]), and detection of CHIKV-RNA in serum beyond 7 days of symptom onset (6.4, [1.4-34.1]. CONCLUSIONS: We identified 269 CHIKV patients after the first outbreak of Asian genotype CHIKV in Aruba in 2014-2015. RT-PCR yielded 59 (28%) additional CHIKV diagnoses compared to IgM antibody detection alone. Arthralgia, fever and skin rash were the dominant acute phase symptoms. pCHIK-CPA longer than 1 year affected 26% of cases and was predicted by female gender, high ACR-score and CHIKV-RNA detection beyond 7 days of symptom onset.


Assuntos
Artralgia/virologia , Febre de Chikungunya/complicações , Vírus Chikungunya/genética , Adolescente , Adulto , Anticorpos Antivirais/sangue , Artralgia/complicações , Artralgia/epidemiologia , Aruba , Febre de Chikungunya/epidemiologia , Doença Crônica , Estudos de Coortes , Feminino , Técnica Indireta de Fluorescência para Anticorpo , Genótipo , Humanos , Imunoglobulina G/sangue , Articulações/patologia , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Inquéritos e Questionários , Resultado do Tratamento , Adulto Jovem
5.
Ginebra; Organización Mundial de la Salud; 2017. (WHO/CCU/17.01/ARUBA).
em Espanhol | WHO IRIS | ID: who-255631
7.
Willemstad, Curaçao; PAHO; 2012.
em Inglês | PAHO-IRIS | ID: phr2-10084

RESUMO

[Introduction]. Dengue is the most important mosquito-borne viral disease in the world. Repeated epidemics of dengue and severe dengue affect millions of individuals each year in tropical and subtropical areas of the world, including Central and South America and the Caribbean. Following the end of the Aedes aegypti eradication campaign in the 1960s for the control of Yellow Fever the efforts to control this vector were not maintained. As a result all areas that were formerly free of this vector were re-infested, which permitted the introduction and spread of Dengue when it was reintroduced into the region in the 1970’s (PAHO 1997). Over the last 35 years dengue fever has spread throughout the Caribbean and Latin America with cyclical outbreaks (Figure 1). The last major outbreak occurred in 2010 with 1,662,296 cases reported and 1,193 deaths...


Assuntos
Aruba , Dengue , Doenças Transmissíveis
8.
Willemstad, Curaçao; PAHO; 2012.
em Inglês | PAHO-IRIS | ID: phr4-10084

RESUMO

[Introduction]. Dengue is the most important mosquito-borne viral disease in the world. Repeated epidemics of dengue and severe dengue affect millions of individuals each year in tropical and subtropical areas of the world, including Central and South America and the Caribbean. Following the end of the Aedes aegypti eradication campaign in the 1960s for the control of Yellow Fever the efforts to control this vector were not maintained. As a result all areas that were formerly free of this vector were re-infested, which permitted the introduction and spread of Dengue when it was reintroduced into the region in the 1970’s (PAHO 1997). Over the last 35 years dengue fever has spread throughout the Caribbean and Latin America with cyclical outbreaks (Figure 1). The last major outbreak occurred in 2010 with 1,662,296 cases reported and 1,193 deaths...


Assuntos
Aruba , Dengue , Doenças Transmissíveis
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