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1.
Artículo en Inglés | MEDLINE | ID: mdl-38248534

RESUMEN

Artisanal and small-scale mining is characterized by excessive exposure to physical, chemical, ergonomic, psychosocial and biological hazards. There is a high burden of tuberculosis (TB), human immunodeficiency virus (HIV) infections and silicosis among artisanal and small-scale miners (ASMs). The aim of this project report is to describe lessons learned from strategies implemented to reach ASMs with screening services for TB, HIV and silicosis in Zimbabwe through the Kunda-Nqob'i TB (KNTB) project supported by the United States Agency for International Development (USAID). The intervention package for screening ASMs for TB, HIV and silicosis included service provision through two occupational health clinics at two provincial hospitals and a mobile workplace-based screening (WBS) facility at the mining sites. From 1 October 2020 to 30 September 2023, 10,668 ASMs were screened, with a high number of cases of silicosis (21%) and TB (7.4%). There was a high burden of HIV (30%) in ASMs attending the occupational health clinics. The two occupational health clinics screened 3453 ASMs, while the mobile WBS activities screened 7215 ASMs during the period. A total of 370 healthcare workers (doctors/clinical officers, nurses, environmental health technicians and district tuberculosis and Leprosy control officers) were trained on TB and the fundamental diagnostic principles of silicosis. The KNTB project has been successful in reaching out to many ASMs operating in remote and hard-to-reach mining areas. The KNTB project has brought to light the positive health-seeking behavior of ASMs operating in remote areas. The project has brought to the fore the effectiveness of multi-stakeholder engagement and collaboration in reaching out to ASMs in remote areas with health screening services. There is a high burden of TB, HIV and silicosis in ASMs. Screening for TB, HIV and silicosis using workplace-based screening and occupational health clinics is an effective strategy and should be rolled out to all areas with high artisanal and small-scale mining activity.


Asunto(s)
Infecciones por VIH , Silicosis , Tuberculosis , Estados Unidos , Humanos , VIH , Zimbabwe/epidemiología , United States Agency for International Development , Silicosis/diagnóstico , Silicosis/epidemiología , Tuberculosis/diagnóstico , Tuberculosis/epidemiología , Infecciones por VIH/diagnóstico , Infecciones por VIH/epidemiología
2.
s.l; CONETEC; 8 nov. 2023.
No convencional en Español | BRISA/RedTESA | ID: biblio-1523088

RESUMEN

INTRODUCCIÓN: El tumor desmoplásico de células redondas es un tumor mesenquimal que surge de la superficie peritoneal. 1 Es considerado un sarcoma de partes blandas que suele afectar principalmente al sexo masculino con una elevada prevalencia en niños y adultos jóvenes. 1,2 En Argentina se desconoce su incidencia, pero es considerado una neoplasia poco frecuente. La tasa de incidencia ajustada por edad en los Estados Unidos se estima en 0,3 casos/millón de habitantes.3 Su principal característica diagnóstica es una traslocación recíproca del gen t(11;22) (p13;q11 o q12), que provoca la fusión del gen del sarcoma de Ewing y el cromosoma 22 del tumor de Wilms. 1 Las manifestaciones clínicas iniciales suelen ser inespecíficas y están relacionadas con el tamaño, la ubicación y la velocidad de progresión de la enfermedad.1,2 Suele presentarse como una masa abdominal palpable con dolor y otros síntomas gastrointestinales asociados. Las masas tumorales pueden causar síntomas de compresión, como obstrucción intestinal y uronefrosis. En casos avanzados puede existir carcinomatosis peritoneal con o sin ascitis, o compromiso metastásico en ganglios linfáticos, hígado y pulmones. TECNOLOGÍA: El temsirolimus es un inhibidor selectivo de la molécula denominada mTOR (diana de la rapamicina en las células de mamífero).6,7 Además de regular las proteínas del ciclo celular, mTOR regula la traducción de los factores inducibles por la hipoxia, HIF-1 y HIF-2 alfa. Estos factores regulan la capacidad de los tumores de adaptarse a entornos hipóxicos y de producir el factor de crecimiento del endotelio vascular (VEGF). Por tanto, el efecto antitumoral del temsirolimus podría derivar también en parte de su capacidad de deprimir los niveles de HIF y VEGF en el tumor o en el microentorno tumoral y reducir así el desarrollo de vasos. OBJETIVO: El objetivo del presente informe es evaluar rápidamente los parámetros de eficacia, seguridad, costos y recomendaciones disponibles acerca del empleo de temsirolimus (Torisel®) en personas con diagnóstico de tumor desmoplásico de células redondas avanzado. MÉTODOS: Se realizó una búsqueda bibliográfica en las principales bases de datos tales como PUBMED, LILACS, BRISA, COCHRANE, SCIELO, EMBASE, TRIPDATABASE como así también en sociedades científicas, agencias reguladoras, financiadores de salud y agencias de evaluación de tecnologías sanitarias. Se priorizó la inclusión de revisiones sistemáticas, ensayos clínicos controlados aleatorizados, evaluación de tecnología sanitaria y guías de práctica clínica de alta calidad metodológica. RECOMENDACIONES No se hallaron guías de práctica clínica actualizadas en Argentina y en el Mundo que recomienden la tecnología en la indicación evaluada. Las guías actualizadas de la Red Nacional de Centros para el Tratamiento Integral del cáncer de los Estados Unidos (NCCN, su sigla del inglés National Comprehensive Cáncer Network) no mencionan el uso de temsirolimus dentro de las opciones terapéuticas para el tratamiento de los tumores desmoplásicos de células redondas avanzados.4 Un consenso de expertos estadounidenses sobre la temática publicado en 2020 no menciona el uso de temsirolimus dentro de las opciones de tratamento. CONCLUSIONES No se hallaron ensayos clínicos publicados que hayan evaluado la eficacia y seguridad de la utilización de temsirolimus (Torisel®) en personas con diagnóstico de tumor desmoplásico de células redondas avanzado. La evidencia que sustentaría el uso del fármaco en la indicación mencionada proviene de una series de casos retrospectiva. El mismo incluyo cinco personas progresadas a distintos tratamientos y cirugías, que utilizaron temsirolimus asociada a vinorelbina y ciclofosfamida. El estudio reportó una mediana de libre de progresión de 8,5 meses sobre tres personas, y eventos adversos serios como la fatiga, neutropenia grado 3-4, mucositis y fallo renal. Un estudio en curso, sin resultados publicados y que incluye la tecnología en la indicación evaluada, ha detenido la inclusión de personas debido a que no se cumplió su objetivo de eficacia pre-especificado. Su comercialización en la indicación evaluada no se encuentra autorizada por la agencia regulatoria de los Estados Unidos y de Europa. No se hallaron guías de práctica clínica actualizadas en Argentina y en el Mundo que recomienden la tecnología en la indicación evaluada. No se hallaron evaluaciones económicas publicadas para Argentina y el Mundo, donde el precio de adquisición internacional de referencia relevado para un vial de 25mg/ml es de USD 1.213 (ARS 443.352 noviembre/23).


Asunto(s)
Humanos , Tumor Desmoplásico de Células Pequeñas Redondas/tratamiento farmacológico , Serina-Treonina Quinasas TOR/administración & dosificación , Inhibidores mTOR/administración & dosificación , Argentina , Eficacia , Análisis Costo-Beneficio
3.
Glob Health Sci Pract ; 11(3)2023 Jun 21.
Artículo en Inglés | MEDLINE | ID: mdl-37348934

RESUMEN

INTRODUCTION: Locally led and owned development is considered the best practice for international aid. As an implementing agency for the U.S. President's Emergency Plan for AIDS Relief (PEPFAR), the U.S. Agency for International Development (USAID) supported the goal of transitioning 70% of its portfolio funding directly to local organizations by 2020, including partner country governments. However, limited evidence or evaluation exists on how such a transition can help achieve HIV-related health outcomes. METHODS: We evaluated monitoring, evaluation, and reporting performance; calculated indicators; and quality of service across the HIV/AIDS treatment cascade for local and international partners in the USAID/PEPFAR portfolio implementing similar programs during the U.S. Government fiscal years (FY) 2019 to 2020 (October 1, 2018-September 30, 2020). We compared results aggregated globally, by country, and across individual partners. RESULTS: Globally, local partners met a lower proportion of their treatment targets than international partners and did not meet targets for pre-exposure prophylaxis or voluntary medical male circumcision in FY2020. However, local partners exceeded targets in programs supporting orphans, vulnerable children, and key populations affected by HIV/AIDS. Local partners also had testing positivity, linkage rates, and viral load suppression that were equivalent to or higher than that of international partners. Based on available assessments, local partners displayed quality of service delivery comparable to international partners. CONCLUSION: Local partners faced challenges, including unfamiliarity with USAID funding, increasing targets across several indicators, and the syndemics of HIV/AIDS and COVID-19. A higher percentage of targets and funding led South African local partners to yield an outsized effect on global percent target achievement. While these findings should be interpreted cautiously due to limited sample size and short time horizon, they are a key first step in evaluating the local partner transition support of the long-term goal of sustained epidemic control of HIV/AIDS.


Asunto(s)
Síndrome de Inmunodeficiencia Adquirida , COVID-19 , Infecciones por VIH , Niño , Estados Unidos , Humanos , Masculino , Infecciones por VIH/tratamiento farmacológico , United States Agency for International Development , Cooperación Internacional
5.
J Acquir Immune Defic Syndr ; 93(4): 261-271, 2023 08 01.
Artículo en Inglés | MEDLINE | ID: mdl-36989134

RESUMEN

INTRODUCTION: The COVID-19 pandemic has disrupted access to critical health services, resulting in diminished gains in HIV epidemic control. This review assesses the magnitude of the impact that the COVID-19 pandemic has had on HIV services for adolescents. METHODS: PEPFAR Monitoring, Evaluation, and Reporting programmatic data were analyzed from across 16 USAID-supported adolescent care and treatment programs for fiscal year 2020 (FY20; October 2019-September 2020). Descriptive statistics were used to calculate absolute number and percent change between the pre-COVID-19 (Quarters 1-2; October 2019-March 2020) and COVID-19 periods (Quarters 3-4; April 2020-September 2020) for clinical cascade indicators. All analyses were conducted in Microsoft Excel. RESULTS: The number of HIV tests conducted during COVID-19 decreased by 21.4% compared with pre-COVID-19, with a subsequent 28% decrease in adolescents identified living with HIV. The rate of proxy linkage to antiretroviral therapy increased between periods, from 86.9% to 90.4%. There was a 25.9% decrease in treatment initiations among adolescents during COVID-19. During FY20, viral load coverage rates for adolescents dropped from 81.6% in FY20Q1 to 76.5% in FY20Q4, whereas the rates of viral load suppression for adolescents increased from 76.1% in FY20Q1 to 80.5% in FY20Q4. CONCLUSION: There was a substantial decrease in case-finding, treatment initiations, and viral load coverage rates for adolescents supported in USAID/PEPFAR programs during the COVID-19 pandemic. Additional health systems adaptations and strategies are required to ensure adolescents have continued access to HIV services during pandemic disruptions.


Asunto(s)
COVID-19 , Infecciones por VIH , Estados Unidos/epidemiología , Humanos , Adolescente , Infecciones por VIH/tratamiento farmacológico , Infecciones por VIH/epidemiología , COVID-19/epidemiología , Pandemias , United States Agency for International Development , Servicios de Salud
6.
Terminología | DeCS - Descriptores en Ciencias de la Salud | ID: 052918

RESUMEN

An independent Federal agency established in 1961 as the focal point for economic matters affecting U.S. relations with developing countries.


Agencia Federal de los Estados Unidos independiente establecida en 1961 como el punto focal para las materias económicas que afectan las relaciones de los EEUU con los países en desarrollo.


Órgão independente do governo federal dos EUA estabelecido em 1961 responsável por programas de assistência econômica e humanitária em todo o mundo.

7.
s.l; CONETEC; 5 dic. 2022.
No convencional en Español | BRISA/RedTESA | ID: biblio-1417089

RESUMEN

INTRODUÇÃO: Tecovirimat se dirige e inhibe la actividad de la proteína VP37 del ortopoxvirus (codificada y altamente conservada en todos los miembros del género ortopoxvirus) y bloquea su interacción con Rab9 GTPasa celular y TIP47, lo que evita la formación de viriones envueltos capaces de diseminarse a otras células.8 Originalmente aprobado para el tratamiento de la viruela, se administra por vía oral o intravenosa. La dosis por vía oral comprende 600 mg (3 cápsulas) cada 12 hs por 14 días para personas entre 40 kg a 120 kg de peso corporal, mientras que es de 600 mg tres veces al día por 14 días para personas con más de 120 kg. La infusión intravenosa es de 200 mg cada 12 hs por 14 días para personas de entre 35 kg a 120 kg, y de 300 mg cada 12 hs por 14 días para personas con más de 120 kg. La Administración de Alimentos y Medicamentos (FDA, su sigla del inglés Food and Drug Administration) de los Estados Unidos aprobó en 2018 la comercialización de tecovirimat (TPOXX®) para el tratamiento de la viruela, y amplió su indicación para viruela símica en Mayo del 2022. La Agencia Europea de Medicamentos (EMA, su sigla del inglés European Medicines Agency) y Reino Unido ha autorizado tecovirimat (SIGA®) en Junio y Julio del 2022 para el tratamiento de viruela símica bajo uso compasivo y con vigilancia adicional. OBJETIVO: El objetivo del presente informe es evaluar parámetros de eficacia, seguridad, conveniencia y recomendaciones disponibles acerca del empleo de tecovirimat para el tratamiento de personas con viruela símica en Argentina. MÉTODOS: Teniendo en cuenta la velocidad con la que la información relacionada a la epidemia aparece y se modifica, se desarrollará un protocolo sustentado en proyectos que resume activamente la evidencia científica a medida que la misma se hace disponible. Desarrollaremos una síntesis de evidencia viva, dado el contexto actual de producción de la evidencia y necesidad actualizada de información de calidad para la toma de decisiones en salud.13,14 Con este fin se utilizará la plataforma L-ove de Epistemonikos (https://app.iloveevidence.com/topics) para identificar revisiones sistemáticas "vivas". Se seleccionarán aquellas con una calidad metodológica apropiada evaluada a través de la herramienta AMSTAR-2, y que a su vez llevaran un proceso de actualización frecuente. De cada una de las revisiones sistemáticas vivas identificadas se extractarán los efectos de la intervención sobre los desenlaces priorizados como importantes o críticos y la certeza en dichos efectos. Para la priorización de los desenlaces se adoptará una perspectiva desde el paciente considerando sus potenciales preferencias. La selección se realizará por consenso entre los autores y supervisores del informe considerando los protocolos de ensayos clínicos registrados y publicados, y las cohortes de pacientes con viruela símica. Se seleccionaron "mortalidad", "hospitalización", "mejoría clínica" (tiempo hasta la mejoría subjetiva, aparición de nuevas lesiones, todas las lesiones con costra y una capa de piel sana), "eventos adversos graves" como desenlaces críticos e importantes. Adicionalmente, se extractarán datos relacionados con efectos de subgrupo potencialmente relevantes para la toma de decisión, con especial énfasis en el tiempo de evolución, la severidad de la enfermedad y el estado inmunológico. Para confeccionar las conclusiones en el efecto de las intervenciones evaluadas sobre los desenlaces priorizados, utilizamos lineamientos publicados, específicamente desarrollados a tal fin. RESULTADOS: Se identificaron 3 ensayos clínicos aleatorizados (ECA) que incluyeron 572 voluntarios sanos (no se incluyeron pacientes con viruela símica), en los que se administró tecovirimat en comparación con el mejor estándar de atención y 3 ensayos clínicos no aleatorizados (ECNA) con 588 pacientes con viruela símica en los que se administró tecovirimat (estudios de una sola rama). CONCLUSIONES: El cuerpo de la evidencia muestra que existe incertidumbre (certeza muy baja ⨁◯◯◯) en relación al efecto del uso de tecovirimat sobre mortalidad, la hospitalización, el desarrollo de secuelas, la mejoría clínica, la aparición de nuevas lesiones, y la resolución de las lesiones. Sin embargo, podría incrementar el riesgo de eventos adversos graves (⨁⨁◯◯ certeza Baja). La tecnología no está autorizada para su comercialización por la Administración Nacional de Medicamentos, Alimentos y Tecnología Médica de nuestro país al momento de la fecha de realización del presente informe, mientras que al precio de referencia internacional relevado la tecnología tendría un costo elevado. Se estima que tecovirimat cumple criterios para ser utilizado en el marco del uso de emergencia monitoreado de intervenciones no registradas y experimentales (MEURI). No se identificaron guías de práctica clínica de adecuada calidad metodológica actualizadas que mencionen la tecnología en la indicación evaluada.


Asunto(s)
Humanos , Antivirales/uso terapéutico , Viruela del Mono/tratamiento farmacológico , Argentina , Eficacia , Análisis Costo-Beneficio
8.
BMC Health Serv Res ; 22(1): 1307, 2022 Nov 02.
Artículo en Inglés | MEDLINE | ID: mdl-36324131

RESUMEN

BACKGROUND: In collaboration with its partners, the Ethiopian government has been implementing standard Emergency Obstetric and Neonatal Care Services (CEmONC) since 2010. However, limited studies documented the lessons learned from such programs on the availability of CEmONC signal functions. This study investigated the availability of CEmONC signal functions and described lessons learned from Transform Health support in Developing Regional State in Ethiopia. METHOD: At baseline, we conducted a cross-sectional study covering 15 public hospitals in four developing regions of Ethiopia (Somali, Afar, Beneshangul Gumz, and Gambella). Then, clinical mentorship was introduced in ten selected hospitals. This was followed by reviewing the clinical mentorship program report implemented in all regions. We used the tool adapted from an Averting Maternal Death and Disability tools to collect data through face-to-face interviews. We also reviewed maternal and neonatal records. We then descriptively analyzed the data and presented the findings using text, tables, and graphs. RESULT: At baseline, six out of the 15 hospitals performed all the nine CEmONC signal functions, and one-third of the signal functions were performed in all hospitals. Cesarean Section service was available in eleven hospitals, while blood transfusion was available in ten hospitals. The least performed signal functions were blood transfusion, Cesarean Section, manual removal of placenta, removal of retained product of conceptus, and parenteral anticonvulsants. After implementing the clinical mentorship program, all CEmONC signal functions were available in all hospitals selected for the mentorship program except for Abala Hospital; the number of Cesarean Sections increased by 7.25% at the last quarter of 2021compared to the third quarter of 20,219; and the number of women referred for blood transfusions and further management of obstetric complications decreased by 96.67% at the last quarter of 2021 compared to the third quarter of 20,219. However, the number of women with post-cesarean Section surgical site infection, obstetric complications, facility maternal deaths, neonatal deaths, and stillbirths have not been changed. CONCLUSION: The availability of CEmONC signal functions in the supported hospitals did not change the occurrence of maternal death and stillbirth. This indicates the need for investigating underlying and proximal factors that contributed to maternal death and stillbirth in the Developing Regional State of Ethiopia. In addition, there is also the need to assess the quality of the CEmONC services in the supported hospitals, institutionalize reviews, surveillance, and response mechanism for maternal and perinatal or neonatal deaths and near misses.


Asunto(s)
Cesárea , Muerte Materna , Recién Nacido , Estados Unidos , Femenino , Embarazo , Humanos , Etiopía/epidemiología , Mortinato , Estudios Transversales , United States Agency for International Development
9.
BMJ Open ; 12(10): e065351, 2022 10 11.
Artículo en Inglés | MEDLINE | ID: mdl-36220324

RESUMEN

OBJECTIVE: A dimensional shift in the health service delivery in the primary healthcare setting is required to raise maternal and child well-being. This study aimed to evaluate the effect of US Agency for International Development-funded obstetric ultrasound service on maternal and perinatal health outcomes at Ethiopia's primary healthcare facilities. DESIGN: We employed a quasi-experimental study design. SETTING: The study was conducted in primary health centres located in four regions of Ethiopia. PARTICIPANTS: We used 2 years' data of 1568 mothers from 13 intervention and 13 control primary health centres. Data were obtained from Vscan, antenatal care (ANC), delivery and postnatal care registers. INTERVENTION: Use of portable obstetric ultrasound service during pregnancy. OUTCOME MEASURES: The primary outcome variables include complete four ANC visits, referral during ANC, delivery in a health facility and having postnatal care and continuum of care. The secondary outcome variable was perinatal death. RESULTS: With the kernel matching approach, we have found that having four or more ANC visits was decreased after the intervention (average treatment effect (ATE): -0.20; 95% CI: -0.23 to -0.09), and the rest of the indicators, including referral during ANC (ATE: 0.01; 95% CI: 0.15 to 0.34), institutional delivery (ATE: 0.24; 95% CI: 0.15 to 0.34) and postnatal care (ATE: 0.26; 95% CI: 0.10 to 0.37), were significantly raised because of the intervention. Similarly, we have found that perinatal death dropped considerably due to the intervention. CONCLUSION: The findings show a consistent increase in maternal health service use because of the introduction of obstetric ultrasound services at the primary health centre level. Furthermore, early detection of complications and following referral for specialty care were found to be high. The consistent rise in maternal health service use indicators calls for additional trial to test the effect of obstetric ultrasound service in other locations of the country. Furthermore, evaluating the predictive values, sensitivity and specificity of the obstetric ultrasound service is important.


Asunto(s)
Servicios de Salud Materna , Muerte Perinatal , Atención Prenatal , Ultrasonografía Prenatal , Parto Obstétrico , Etiopía , Femenino , Instituciones de Salud , Humanos , Evaluación de Resultado en la Atención de Salud , Embarazo , Atención Prenatal/métodos , Atención Primaria de Salud , Puntaje de Propensión , Estados Unidos , United States Agency for International Development
10.
Reprod Health ; 19(Suppl 1): 86, 2022 Jun 13.
Artículo en Inglés | MEDLINE | ID: mdl-35698145

RESUMEN

BACKGROUND: Evidence suggests that supportive male engagement in health care services, including family planning, remains low in many countries, despite known benefits for female partners. In 2017-2018, the United States Agency for International Development Transform: Primary Health Care Project conducted a participatory gender analysis, collecting relevant data to better understand Ethiopian men's lack of support for the uptake of family planning services. METHODS: Qualitative data were collected through 96 unique participatory group discussions with community members via a semistructured discussion guide and participatory activity; data were disaggregated by sex, age, and marital status. In-depth interviews (91) conducted with service providers, health system managers, and health extension workers used semistructured guides. Discussants and interviewees were selected purposefully, drawn from 16 rural woredas in four project regions: Amhara; Oromia; Tigray; and Southern Nations, Nationalities, and Peoples' Region. Data collectors took notes and transcribed audio recordings. The research team deductively and inductively coded transcripts to develop preliminary findings later validated by key technical project staff and stakeholders. RESULTS: Findings reinforce existing knowledge on the dominant role of men in health care-related decision making in rural Ethiopia, although such decision making is not always unilateral in practice. Barriers at the societal level impede men's support for family planning; these include norms, values, and beliefs around childbearing; religious beliefs rooted in scriptural narratives; and perceived adverse health impacts of family planning. Lack of efforts to engage men in health care facilities, as well as the perception that health care facilities do not meet men's needs, highlight systems-level barriers to men's use of family planning services. CONCLUSIONS: Findings indicate several opportunities for stakeholders to increase men's support for family planning in rural Ethiopia, including systems-wide approaches to shape decision making, social and behavior change communication efforts, and additional research and assessment of men's experiences in accessing health care services.


Evidence suggests that in instances where men participate when their partners access health care services, their partners experience positive health benefits. Regardless, men tend not to participate. During 2017­2018, the United States Agency for International Development Transform: Primary Health Care Project conducted research to identify gender-related issues that hinder the delivery of primary health care services in Ethiopia. The research team conducted 96 group discussions with male and female community members, as well as 91 in-depth interviews with health care service providers, health system managers, and health extension workers. Participants were specifically selected from 16 rural districts, or woredas, in four regions where the project is active. The researchers then categorized information in the resulting transcripts by common themes, and the data analysis team met to draw out the main findings. Later, a meeting was held with key project staff and stakeholders in Addis Ababa to verify the findings. Findings reinforce existing knowledge on the dominant role of men in health care­related decision making for households in rural Ethiopia, although women often play an important role as well. The research also identified widespread male opposition to family planning due to norms, desires, and societal perceptions around childbearing; religious beliefs; and concerns about the perceived health risks of family planning methods. Further, findings showed that the promotion of family planning methods and services do not explicitly target men, and men believe that current services do not respond to their needs. Respondents suggested opportunities for stakeholders to mitigate these barriers.


Asunto(s)
Servicios de Planificación Familiar , United States Agency for International Development , Etiopía , Femenino , Humanos , Masculino , Hombres , Atención Primaria de Salud , Investigación Cualitativa , Población Rural , Estados Unidos
11.
Popul Health Metr ; 20(1): 2, 2022 01 06.
Artículo en Inglés | MEDLINE | ID: mdl-34986844

RESUMEN

BACKGROUND: Significant levels of funding have been provided to low- and middle-income countries for development assistance for health, with most funds coming through direct bilateral investment led by the USA and the UK. Direct attribution of impact to large-scale programs funded by donors remains elusive due the difficulty of knowing what would have happened without those programs, and the lack of detailed contextual information to support causal interpretation of changes. METHODS: This study uses the synthetic control analysis method to estimate the impact of one donor's funding (United States Agency for International Development, USAID) on under-five mortality across several low- and middle-income countries that received above average levels of USAID funding for maternal and child health programs between 2000 and 2016. RESULTS: In the study period (2000-16), countries with above average USAID funding had an under-five mortality rate lower than the synthetic control by an average of 29 deaths per 1000 live births (year-to-year range of - 2 to - 38). This finding was consistent with several sensitivity analyses. CONCLUSIONS: The synthetic control method is a valuable addition to the range of approaches for quantifying the impact of large-scale health programs in low- and middle-income countries. The findings suggest that adequately funded donor programs (in this case USAID) help countries to reduce child mortality to significantly lower rates than would have occurred without those investments.


Asunto(s)
Mortalidad del Niño , Administración Financiera , Niño , Salud Infantil , Países en Desarrollo , Humanos , Estados Unidos/epidemiología , United States Agency for International Development
12.
BMC Public Health ; 21(1): 2194, 2021 11 30.
Artículo en Inglés | MEDLINE | ID: mdl-34847909

RESUMEN

BACKGROUND: Patient interruption of antiretroviral therapy (ART) continues to limit HIV programs' progress toward epidemic control. Multiple factors have been associated with client interruption in treatment (IIT)- including age, gender, CD4 count, and education level. In this paper, we explore the factors associated with IIT in people living with HIV (PLHIV) in United States Agency for International Development (USAID)-supported facilities under the U.S. President's Emergency Plan for AIDS Relief (PEPFAR) program in Nigeria. METHODS: We conducted cross-sectional analyses on data obtained from Nigeria's National Data Repository (NDR), representing a summarized record of 573 630 ART clients that received care at 484 PEPFAR/USAID-supported facilities in 16 states from 2000-2020. IIT was defined as no clinical contact for 28 days or more after the last expected clinical contact. Univariate and multivariate logistic regression models were computed to explore the factors associated with IIT. The variables included in the analysis were sex, age group, zone, facility level, regimen line, multi-month dispensing (MMD), and viral load category. RESULTS: Of the 573 630 clients analysed in this study, 32% have been recorded as having interrupted treatment. Of the clients investigated, 66% were female (32% had interrupted treatment), 39% were aged 25-34 at their last ART pick-up date (with 32% of them interrupted treatment), 59% received care at secondary level facilities (37% interrupted treatment) and 38% were last receiving between three- to five-month MMD (with 10% of these interrupted treatment). Those less likely to interrupt ART were males (aOR = 0.91), clients on six-month MMD (aOR = 0.01), adults on 2nd line regimen (aOR = 0.09), and paediatrics on salvage regimen (aOR = 0.02). Clients most likely to interrupt ART were located in the South West Zone (aOR = 1.99), received treatment at a tertiary level (aOR = 12.34) or secondary level facilities (aOR = 4.01), and had no viral load (VL) on record (aOR =10.02). Age group was not significantly associated with IIT. CONCLUSIONS: Sex, zone, facility level, regimen line, MMD, and VL were significantly associated with IIT. MMD of three months and longer (especially six months) had better retention on ART than those on shorter MMD. Not having a VL on record was associated with a considerable risk of IIT.


Asunto(s)
Fármacos Anti-VIH , Infecciones por VIH , Adulto , Fármacos Anti-VIH/uso terapéutico , Niño , Estudios Transversales , Femenino , Infecciones por VIH/tratamiento farmacológico , Infecciones por VIH/epidemiología , Humanos , Masculino , Nigeria/epidemiología , Estudios Retrospectivos , Estados Unidos/epidemiología , United States Agency for International Development
13.
Am J Trop Med Hyg ; 105(6): 1476-1482, 2021 Oct 20.
Artículo en Inglés | MEDLINE | ID: mdl-34670193

RESUMEN

Countries across West Africa began reporting COVID-19 cases in February 2020. By March, the pandemic began disrupting activities to control and eliminate neglected tropical diseases (NTDs) as health ministries ramped up COVID-19-related policies and prevention measures. This was followed by interim guidance from the WHO in April 2020 to temporarily pause mass drug administration (MDA) and community-based surveys for NTDs. While the pandemic was quickly evolving worldwide, in most of West Africa, governments and health ministries took quick action to implement mitigation measures to slow the spread. The U.S. Agency for International Development's (USAID) Act to End NTDs | West program (Act | West) began liaising with national NTD programs in April 2020 to pave a path toward the eventual resumption of activities. This process consisted of first collecting and analyzing COVID-19 epidemiological data, policies, and standard operating procedures across the program's 11 countries. The program then developed an NTD activity restart matrix that compiled essential considerations to restart activities. By December 2020, all 11 countries in Act | West safely restarted MDA and certain surveys to monitor NTD prevalence or intervention impact. Preliminary results show satisfactory MDA program coverage, meaning that enough people are taking the medicine to keep countries on track toward achieving their NTD disease control and elimination goals, and community perceptions have remained positive. The purpose of this article is to share the lessons and best practices that have emerged from the adoption of strategies to limit the spread of the novel coronavirus during MDA and other program activities.


Asunto(s)
Antiinfecciosos/uso terapéutico , COVID-19/epidemiología , Administración Masiva de Medicamentos , Programas Nacionales de Salud/organización & administración , Enfermedades Desatendidas/terapia , SARS-CoV-2 , África Occidental , Antiinfecciosos/administración & dosificación , Humanos , Programas Nacionales de Salud/normas , Guías de Práctica Clínica como Asunto , Factores de Riesgo , Factores de Tiempo , Clima Tropical , Estados Unidos , United States Agency for International Development
14.
East. Mediterr. health j ; 27(7): 672-678, 2021-07.
Artículo en Inglés | WHO IRIS | ID: who-353198

RESUMEN

Background: Pakistan and USAID have invested in improving the contraceptive supply chain data and commodity security. In 2011, the first digital contraceptive logistics management information system (cLMIS) was launched, enabling supply chain data visibility from the federal level to health facilities. The system has built-in modules on forecasting and supply planning, inventory management, consumption reporting, business intelligence tools, automatic email and SMS alerts. Using these features, policy-makers and health managers annually forecast needs, and procure contraceptives accordingly. Aims: The objective of this research was to understand the existing technological platforms for family planning (FP) supply chain data visibility and the potential impact on contraceptive commodity security. Methods: The authors reviewed available published and grey literature papers on contraceptives and supplies in Pakistan. We extracted data from the cLMIS, evaluated indicators including reporting compliance, reported stock-out rates, and contraceptive performance. The analysis was validated by reviewing supply chain and FP indicators, such as average monthly consumption, months of stock, and couple years of protection. Results: The cLMIS has resulted in improved distribution, early warning and accountability at the lowest tiers in the FP supply chain in the public sector. At the facility level, FP commodity availability increased from 40% in 2009 to 84% in 2018. Conclusion: Contraceptive supply chain has seen significant growth over the past decade to meet expanding reproductive health evidence to inform strategic decisions; cLMIS is a prime contributor to improvements registered in FP stock availability at public sector facilities.


Asunto(s)
Servicios de Planificación Familiar , Anticoncepción , Dispositivos Anticonceptivos , Anticonceptivos , Sistemas de Información Administrativa , Salud Pública , Tecnología , United States Agency for International Development , Salud Reproductiva , Sistemas en Línea
15.
Artículo en Español | PAHO-IRIS | ID: phr-54166

RESUMEN

[RESUMEN]. Este informe describe el proceso de ampliación progresiva de las cuentas de salud para medir los gastos nacionales en salud, desde los primeros intentos de la Asociación Médica Estadounidense en 1926 hasta la actualidad. Se mencionan los hitos en la creación del Sistema de Cuentas de Salud , desde los antecedentes económicos y las acciones iniciales de unos cuantos países y organizaciones a la necesidad de un conjunto de normas de contabilidad para los sistemas de atención de salud y, por último, la consolidación con el Sistema de Cuentas de Salud del 2011. Varias organizaciones internacionales, como la Organización Mundial de la Salud, la Organización para la Cooperación y el Desarrollo Económicos, Eurostat, el Banco Mundial y la Agencia de los Estados Unidos para el Desarrollo Internacional, han sido fundamentales para ampliar los ejercicios nacionales de cuentas de salud y asegurar que estén normalizados, sean comparables y se institucionalicen. Las acciones nacionales para realizar un seguimiento de los gastos en salud no solo han enriquecido los resultados colectivos, sino que se han convertido en un componente importante del liderazgo mundial, al fundamentar las políticas en todo el mundo. Más de 100 países han creado cuentas de salud de conformidad con la norma mundial, y han logrado una mejor comprensión del gasto en salud y de los flujos financieros. Estos resultados son clave para vigilar los avances relativos a las iniciativas nacionales y mundiales, como los Objetivos de Desarrollo Sostenible y la cobertura universal de salud. Todavía quedan retos por delante, como la institucionalización y la calidad de los resultados. También se necesita responsabilidad social para mejorar las fuentes de datos, y aumentar la producción y eluso de las cuentas de salud.


[ABSTRACT]. This report traces the progressive expansion of health accounts (HA) to measure national health expenditures, from the first attempts in 1926 by the American Medical Association to the present day. Milestones in the development of A System of Health Accounts (SHA) are covered, from the economic background to initial efforts by a few countries and organizations, to the need for a set of accounting standards for health care systems, and finally, to consolidation with SHA 2011. International organizations, such as the World Health Organization, Organization for Economic Cooperation and Development, Eurostat, the World Bank, and the United States Agency for International Development have been critical to expanding national HA exercises and ensuring that these are standardized, comparable, and become institutionalized. National efforts to track health expenditures have not only enriched collective results, but have become an important component of global leadership, informing policy the world over. More than 100 countries have created HA under the global standard and have gained a better understanding of health spending and financial flows. These results are key for monitoring progress toward national and global initiatives, such as the Sustainable Development Goals and Universal Health Coverage. Challenges remain to be tackled, among them institutionalization and quality of results. Social responsibility for improving data sources and expanding the generation and usability of health accounts are also needed.


[RESUMO]. Este informe traça a progressiva expansão das contas da saúde para mensurar os gastos nacionais em saúde, das primeiras tentativas em 1926 pela Associação Americana de Medicina aos dias de hoje. Os marcos do desenvolvimento de um sistema de contas da saúde (SHA) são apresentados: dos antecedentes econômicos, esforços iniciais por parte de alguns países e organizações e necessidade de estabelecer um conjunto de normas contábeis para os sistemas de saúde à consolidação do sistema de contas da saúde (SHA) 2011. As organizações internacionais, como Organização Mundial da Saúde, Organização para a Cooperação e Desenvolvimento Econômico, Eurostat, Banco Mundial e Agência dos Estados Unidos para o Desenvolvimento Internacional, têm sido peças fundamentais para expandir os exercícios de contas nacionais da saúde e assegurar sua padronização, equivalência e institucionalização. Os esforços nacionais para monitorar os gastos em saúde não apenas melhoram os resultados coletivos, mas também são um importante componente de liderança global, servindo de base para políticas no mundo todo. Mais de 100 países criaram contas da saúde segundo o padrão global e têm agora um melhor entendimento do gasto em saúde e fluxos financeiros. Esses resultados são essenciais para monitorar o progresso rumo às iniciativas nacionais e globais, como os Objetivos de Desenvolvimento Sustentável e a cobertura universal de saúde. Existem ainda desafios a serem vencidos, como institucionalização e qualidade dos resultados. Também é preciso responsabilidade social para melhorar as fontes de dados e expandir a geração e a usabilidade das contas da saúde.


Asunto(s)
Gastos en Salud , Economía y Organizaciones para la Atención de la Salud , Planificación en Salud , Estrategias de Salud Globales , Gastos en Salud , Economía y Organizaciones para la Atención de la Salud , Planificación en Salud , Estrategias de Salud Globales , Gastos en Salud , Economía y Organizaciones para la Atención de la Salud , Planificación en Salud , Estrategias de Salud Globales
16.
Cad Saude Publica ; 37(4): e00061820, 2021.
Artículo en Inglés, Portugués | MEDLINE | ID: mdl-34008735

RESUMEN

The Brazilian legislation does not provide for a periodic review of the registration of pesticides and, even nowadays, products banned in other countries are still used. Based on the pesticide active substances registered in the country, the present study investigated the international regulatory situation in the following member countries: Organization for Economic Co-operation and Development (OECD), European Community, and the BRICS (Brazil, Russia, India, China, and South Africa). Moreover, we sought to relate the main chronic effects to human health and the environment of the most commercialized pesticide active substances in Brazil in lists of classification of carcinogenic potential (US Environmental Protection Agency - USEPA and International Agency for Research on Cancer - IARC), endocrine disruption, and candidates for substitution, both from the European Community. A total of 399 pesticide active substances registered in Brazil for agricultural use were identified, excluding microbiological and biological control agents. Of these, the percentage of unauthorized pesticide active substances according to countries is as follows: 85.7% in Iceland; 84.7% in Norway; 54.5% in Switzerland; 52.6% in India; 45.6% in Turkey; 44.4% in Israel; 43.4% in New Zealand; 42.4% in Japan; 41.5% in the European Community; 39.6% in Canada; 38.6% in China; 35.8% in Chile; 31.6% in Mexico; 28.6% in Australia; and 25.6% in the United States. 120 pesticide active substances were related to damage to health and the environment. Considering the pesticide active substances for which commercialization data are available in the country, 67.2% of this volume is associated with at least one serious chronic damage assessed in this study. The results of the present study indicate the need for promoting transparency of international databases, regarding the motivations of the respective regulatory decisions and the Brazilian regulatory bodies to reevaluate the registration of obsolete products and to strengthen public policies related to the reduction of the use of pesticides.


A legislação brasileira não prevê revisão periódica do registro dos agrotóxicos e, ainda hoje, são utilizados produtos proibidos em outros países. Partindo dos ingredientes ativos de agrotóxicos registrados no país, o presente estudo investigou a situação regulatória internacional nos países-membros da Organização para a Cooperação e Desenvolvimento Econômico (OCDE), da Comunidade Europeia e BRICS. Também se buscou relacionar os principais efeitos crônicos à saúde humana e ao meio ambiente dos ingredientes ativos de agrotóxicos mais comercializados no Brasil, em listas de classificação de potencial cancerígeno (Agência de Proteção Ambiental dos Estados Unidos - USEPA e Agência Internacional de Pesquisa em Câncer - IARC), desregulação endócrina e candidatos para substituição (estes dois últimos da Comunidade Europeia). Foram identificados 399 ingredientes ativos de agrotóxicos registrados no Brasil para uso agrícola, excluindo-se os microbiológicos e agentes biológicos de controle. Destes, não têm autorização 85,7% na Islândia, 84,7% na Noruega, 54,5% na Suíça, 52,6% na Índia, 45,6% na Turquia, 44,4% em Israel, 43,4% na Nova Zelândia, 42,4% no Japão, 41,5% na Comunidade Europeia, 39,6% no Canadá, 38,6% na China, 35,8% no Chile, 31,6% no México, 28,6% na Austrália e 25,6% nos Estados Unidos. Foram relacionados a danos à saúde e ao ambiente 120 ingredientes ativos de agrotóxicos. Considerando os ingredientes ativos de agrotóxicos para os quais estão disponíveis dados de comercialização no país, 67,2% deste volume está associado a pelo menos um dano crônico grave avaliado neste estudo. Os resultados do presente estudo indicam a necessidade de promover a transparência das bases de dados internacionais, no que tange às motivações para as respectivas decisões regulatórias e os órgãos reguladores brasileiros reavaliarem o registro de produtos obsoletos, fortalecendo políticas públicas relacionadas à redução do uso de agrotóxicos.


La legislación brasileña no prevé una revisión periódica del registro de los pesticidas e incluso hoy se utilizan productos prohibidos en otros países. Partiendo de los ingredientes activos de pesticidas registrados en el país, el presente estudio investigó la situación regulatoria internacional en los siguientes países-miembros: Organización para la Cooperación y Desarrollo Económico (OCDE), Comunidad Europea, y BRICS. También se buscó relacionar los principales efectos crónicos para la salud humana y en el medio ambiente de los ingredientes activos de pesticidas más comercializados en Brasil en listas de clasificación con potencial cancerígeno (Agencia de Protección Ambiental de Estados Unidos - USEPA e Agencia Internacional de Investigación sobre el Cáncer - IARC), desregulación endocrina y candidatos para sustitución, ambos de la Comunidad Europea. Se identificaron 399 ingredientes activos de pesticidas registrados en Brasil para uso agrícola, excluyéndose los microbiológicos y agentes biológicos de control. De estos, no tienen autorización en Islandia 85,7%, Noruega 84,7%, Suiza 54,5%, India 52,6%, Turquía 45,6%, Israel 44,4%, Nueva Zelanda 43,4%, Japón 42,4%, Comunidad Europea 41,5%, Canadá 39,6%, China 38,6%, Chile 35,8%, México 31,6%, Australia 28,6% y Estados Unidos 25,6%. 120 ingredientes activos de pesticidas estuvieron relacionados con daños en la salud y medioambiente. Considerando los ingredientes activos de pesticidas para los cuales están disponibles datos de comercialización en el país, un 67,2% de este volumen está asociado a por lo menos una enfermedad crónica grave evaluada en ese estudio. Los resultados del presente estudio indican la necesidad de promover la transparencia de las bases de datos internacionales, en lo que respecta a las motivaciones de las respectivas decisiones regulatorias, con el fin de que los órganos reguladores brasileños reevalúen el registro de productos obsoletos, así como para fortalecer políticas públicas relacionadas con la reducción del uso de pesticidas.


Asunto(s)
Plaguicidas , Brasil , Canadá , Chile , China , Ambiente , Humanos , India , Japón , México , Plaguicidas/toxicidad , Estados Unidos
17.
PLoS One ; 16(4): e0249994, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33857244

RESUMEN

In 2017-2018, a group of international development funding agencies launched the Crops to End Hunger initiative to modernize public plant breeding in lower-income countries. To inform that initiative, USAID asked the International Food Policy Research Institute and the United States Department of Agriculture's Economic Research Service to estimate the impacts of faster productivity growth for 20 food crops on income and other indicators in 106 countries in developing regions in 2030. We first estimated the value of production in 2015 for each crop using data from FAO. We then used the IMPACT and GLOBE economic models to estimate changes in the value of production and changes in economy-wide income under scenarios of faster crop productivity growth, assuming that increased investment will raise annual rates of yield growth by 25% above baseline growth rates over the period 2015-2030. We found that faster productivity growth in rice, wheat and maize increased economy-wide income in the selected countries in 2030 by 59 billion USD, 27 billion USD and 21 billion USD respectively, followed by banana and yams with increases of 9 billion USD each. While these amounts represent small shares of total GDP, they are 2-15 times current public R&D spending on food crops in developing countries. Income increased most in South Asia and Sub-Saharan Africa. Faster productivity growth in rice and wheat reduced the population at risk of hunger by 11 million people and 6 million people respectively, followed by plantain and cassava with reductions of about 2 million people each. Changes in adequacy ratios were relatively large for carbohydrates (already in surplus) and relatively small for micronutrients. In general, we found that impacts of faster productivity growth vary widely across crops, regions and outcome indicators, highlighting the importance of identifying the potentially diverse objectives of different decision makers and recognizing possible tradeoffs between objectives.


Asunto(s)
Productos Agrícolas , Modelos Económicos , Producción de Cultivos , Países en Desarrollo , Abastecimiento de Alimentos , Humanos , Oryza/crecimiento & desarrollo , Triticum/crecimiento & desarrollo , Estados Unidos , United States Agency for International Development
18.
Cad. Saúde Pública (Online) ; 37(4): e00061820, 2021. tab, graf
Artículo en Portugués | LILACS | ID: biblio-1249421

RESUMEN

A legislação brasileira não prevê revisão periódica do registro dos agrotóxicos e, ainda hoje, são utilizados produtos proibidos em outros países. Partindo dos ingredientes ativos de agrotóxicos registrados no país, o presente estudo investigou a situação regulatória internacional nos países-membros da Organização para a Cooperação e Desenvolvimento Econômico (OCDE), da Comunidade Europeia e BRICS. Também se buscou relacionar os principais efeitos crônicos à saúde humana e ao meio ambiente dos ingredientes ativos de agrotóxicos mais comercializados no Brasil, em listas de classificação de potencial cancerígeno (Agência de Proteção Ambiental dos Estados Unidos - USEPA e Agência Internacional de Pesquisa em Câncer - IARC), desregulação endócrina e candidatos para substituição (estes dois últimos da Comunidade Europeia). Foram identificados 399 ingredientes ativos de agrotóxicos registrados no Brasil para uso agrícola, excluindo-se os microbiológicos e agentes biológicos de controle. Destes, não têm autorização 85,7% na Islândia, 84,7% na Noruega, 54,5% na Suíça, 52,6% na Índia, 45,6% na Turquia, 44,4% em Israel, 43,4% na Nova Zelândia, 42,4% no Japão, 41,5% na Comunidade Europeia, 39,6% no Canadá, 38,6% na China, 35,8% no Chile, 31,6% no México, 28,6% na Austrália e 25,6% nos Estados Unidos. Foram relacionados a danos à saúde e ao ambiente 120 ingredientes ativos de agrotóxicos. Considerando os ingredientes ativos de agrotóxicos para os quais estão disponíveis dados de comercialização no país, 67,2% deste volume está associado a pelo menos um dano crônico grave avaliado neste estudo. Os resultados do presente estudo indicam a necessidade de promover a transparência das bases de dados internacionais, no que tange às motivações para as respectivas decisões regulatórias e os órgãos reguladores brasileiros reavaliarem o registro de produtos obsoletos, fortalecendo políticas públicas relacionadas à redução do uso de agrotóxicos.


La legislación brasileña no prevé una revisión periódica del registro de los pesticidas e incluso hoy se utilizan productos prohibidos en otros países. Partiendo de los ingredientes activos de pesticidas registrados en el país, el presente estudio investigó la situación regulatoria internacional en los siguientes países-miembros: Organización para la Cooperación y Desarrollo Económico (OCDE), Comunidad Europea, y BRICS. También se buscó relacionar los principales efectos crónicos para la salud humana y en el medio ambiente de los ingredientes activos de pesticidas más comercializados en Brasil en listas de clasificación con potencial cancerígeno (Agencia de Protección Ambiental de Estados Unidos - USEPA e Agencia Internacional de Investigación sobre el Cáncer - IARC), desregulación endocrina y candidatos para sustitución, ambos de la Comunidad Europea. Se identificaron 399 ingredientes activos de pesticidas registrados en Brasil para uso agrícola, excluyéndose los microbiológicos y agentes biológicos de control. De estos, no tienen autorización en Islandia 85,7%, Noruega 84,7%, Suiza 54,5%, India 52,6%, Turquía 45,6%, Israel 44,4%, Nueva Zelanda 43,4%, Japón 42,4%, Comunidad Europea 41,5%, Canadá 39,6%, China 38,6%, Chile 35,8%, México 31,6%, Australia 28,6% y Estados Unidos 25,6%. 120 ingredientes activos de pesticidas estuvieron relacionados con daños en la salud y medioambiente. Considerando los ingredientes activos de pesticidas para los cuales están disponibles datos de comercialización en el país, un 67,2% de este volumen está asociado a por lo menos una enfermedad crónica grave evaluada en ese estudio. Los resultados del presente estudio indican la necesidad de promover la transparencia de las bases de datos internacionales, en lo que respecta a las motivaciones de las respectivas decisiones regulatorias, con el fin de que los órganos reguladores brasileños reevalúen el registro de productos obsoletos, así como para fortalecer políticas públicas relacionadas con la reducción del uso de pesticidas.


The Brazilian legislation does not provide for a periodic review of the registration of pesticides and, even nowadays, products banned in other countries are still used. Based on the pesticide active substances registered in the country, the present study investigated the international regulatory situation in the following member countries: Organization for Economic Co-operation and Development (OECD), European Community, and the BRICS (Brazil, Russia, India, China, and South Africa). Moreover, we sought to relate the main chronic effects to human health and the environment of the most commercialized pesticide active substances in Brazil in lists of classification of carcinogenic potential (US Environmental Protection Agency - USEPA and International Agency for Research on Cancer - IARC), endocrine disruption, and candidates for substitution, both from the European Community. A total of 399 pesticide active substances registered in Brazil for agricultural use were identified, excluding microbiological and biological control agents. Of these, the percentage of unauthorized pesticide active substances according to countries is as follows: 85.7% in Iceland; 84.7% in Norway; 54.5% in Switzerland; 52.6% in India; 45.6% in Turkey; 44.4% in Israel; 43.4% in New Zealand; 42.4% in Japan; 41.5% in the European Community; 39.6% in Canada; 38.6% in China; 35.8% in Chile; 31.6% in Mexico; 28.6% in Australia; and 25.6% in the United States. 120 pesticide active substances were related to damage to health and the environment. Considering the pesticide active substances for which commercialization data are available in the country, 67.2% of this volume is associated with at least one serious chronic damage assessed in this study. The results of the present study indicate the need for promoting transparency of international databases, regarding the motivations of the respective regulatory decisions and the Brazilian regulatory bodies to reevaluate the registration of obsolete products and to strengthen public policies related to the reduction of the use of pesticides.


Asunto(s)
Humanos , Plaguicidas/toxicidad , Estados Unidos , Brasil , Canadá , Chile , China , Ambiente , India , Japón , México
19.
BMC Fam Pract ; 21(1): 252, 2020 12 04.
Artículo en Inglés | MEDLINE | ID: mdl-33276728

RESUMEN

BACKGROUND: Primary health care (PHC) in Ethiopia serves as the main entry point for preventive, promotive and curative health services. The district health office is responsible for the planning, implementation and evaluation of all district health activities. In addition, district health offices manage service delivery facilities working on provision of PHC - primary hospitals, health centers and health posts. As the leader of the health care system tier, district health management must ensure direction, alignment and commitment within teams and organizations and make sure that achievements are consistent with the vision, values and strategy of the organization. USAID Transform: Primary Health Care provides diverse support to improve district health manager competencies including in-service trainings followed by planning and implementation of performance improvement projects and on-the-job mentoring and support. METHODS: This study was conducted to compare district level capacity and performances between leadership, management and governance (LMG) and non-LMG districts. Project outcome monitoring data that shows the performance of districts was collected from 284 districts from January to December 2019. The study was carried out using a comparative-cross sectional study design, which assessed and compared district health office level indicators. Districts were classified into two categories: LMG and non-LMG districts. The study compared data from 94 LMG and 190 non-LMG districts. Propensity score matching was used to control the effect of differences between LMG and non-LMG districts. RESULTS: Results of the independent samples t-test revealed that LMG districts scored better average performances of 61.8 ± 121.45 standard deviation (SD) compared to non-LMG districts 56.89 ± 110.39 SD, with t (282243) = - 3.407317 and p < 0.001, two-tailed. The difference of 4.9 percentage unit in the average performance indicated a statistically significant difference between the LMG and non-LMG districts. CONCLUSION: District level leadership development program contributes to improving district capacity, structure and management practices, and quality of care.


Asunto(s)
Liderazgo , United States Agency for International Development , Estudios Transversales , Atención a la Salud , Humanos , Atención Primaria de Salud , Estados Unidos
20.
s.l; s.n; dic. 2020.
No convencional en Español | BRISA/RedTESA | ID: biblio-1281033

RESUMEN

INTRODUCCIÓN: En el mundo mueren más de 8 millones de personas a causa del tabaquismo, donde más de 7 millones se deben al consumo directo del tabaco, representando un 12% de la mortalidad a nivel global (1,2). En la Región de las Américas, la mortalidad atribuida específicamente al tabaco es del 16%, superando el millón de muertes al año (3). Mientras que en Chile, el tabaquismo es responsable directamente del 18,5% de las muertes anuales, superando los 16.500 decesos cada año (4). El tercer informe mundial de la Organización Mundial de la Salud (OMS) sobre tendencias en el consumo de tabaco 2000-2025, muestra que la prevalencia en mayores de 15 años ha disminuido en el periodo (2). Por su parte, el número de hombres consumidores de tabaco iba en aumento hasta el 2018, tendencia que logró revertirse el 2019, con proyecciones a continuar disminuyendo hacia el 2025. La reducción de la prevalencia y el quiebre de tendencia en los hombres sería, según la OMS, efecto de las acciones que los gobiernos han tomado para proteger a las personas contra el tabaco, en el contexto del Convenio Marco de la OMS para el Control del Tabaco (CMCT OMS) (2,5). OBJETIVO DE ESTA SÍNTESIS: Informar la toma de decisiones sobre el efecto que tiene el consumo de cigarrillos mentolados sobre la dependencia al tabaco y los riesgos o daños a la salud en población fumadora, comparado con fumar cigarrillos no mentolados. Se presentan los principales hallazgos encontrados en la evidencia recopilada, además de algunas consideraciones sobre la implementación relacionadas a la intervención estudiada. RESULTADOS DE LA BÚSQUEDA: Se realizó una búsqueda de Revisiones Sistemáticas (RS) que evaluaran el efecto de fumar productos de tabaco con aditivos o saborizantes sobre la adicción y riesgos a la salud de los consumidores de tabaco. Se incluyeron RS publicadas en todos los idiomas y sin restricción de año de publicación. Se excluyeron revisiones que analizan el efecto de cigarrillos electrónicos, de dispositivos de administración electrónica de nicotina o del tipo pipas de agua. Se excluyeron también los estudios que no evalúan los efectos de los aditivos o saborizantes en la adicción o en daños y riesgos a la salud de los fumadores. La búsqueda arrojó 58 RS después de eliminar por duplicados. Los títulos y resúmenes fueron revisados por dos investigadoras de manera independiente, discutiendo la resolución de cada disenso. Se seleccionaron 8 RS para análisis de texto completo. De éstas, se excluyeron 5 por no responder a la pregunta de investigación. Si bien fue una búsqueda exhaustiva, se complementó con una matriz de evidencia, para identificar estudios relevantes que podrían no haberse encontrado en las bases utilizadas. RESULTADOS DE LOS HALLAZGOS: Hallazgo 1. Dependencia en Adolescentes: Adolescentes fumadores de cigarrillos mentolados tendrían una mayor dependencia a la nicotina que los adolescentes fumadores de no mentolados. Hallazgo 2. Dependencia en Adultos: En fumadores adultos no hay claridad sobre la asociación entre el uso de mentol y la dependencia o adicción a la nicotina. Hallazgo 3: Riesgo o daño a la salud, Mortalidad: El riesgo de morir por cualquier causa, cáncer de pulmón, cánceres relacionados con el tabaquismo o enfermedades cardiovasculares, no es mayor en aquellos que consumen cigarrillo con tabaco con mentol en comparación con aquellos que no lo añaden. Hallazgo 4: Riesgo o daño a la salud, incidencia de cáncer relacionado con el tabaco. El consumo de cigarrillo de tabaco con mentol parece tener una asociación con el desarrollo de cáncer de pulmón u otros cánceres asociados al tabaquismo, similar al consumo de cigarrillos de tabaco sin mentol. CONSIDERACIONES DE IMPLEMENTACIÓN: Consideraciones de Aplicabilidad: La evidencia presentada en esta síntesis corresponde principalmente a estudios realizados en Estados Unidos, con un par en Canadá y Nueva Zelanda. Por lo que se debe interpretar con precaución la extrapolación de estos hallazgos a la realidad local. Sin embargo, algunos datos de Chile Libre de Tabaco del 2015 indican que los fumadores adolescentes (< 18 años) representan el grupo de mayor consumo de cigarrillos mentolados y que inician con mentol en una mucho mayor proporción que los adultos. Este es uno de los grupos que podría verse más atraído por el consumo de cigarrillos mentolados, promoviendo su iniciación, consolidando su consumo habitual o profundizando la dependencia. Consideraciones Económicas: No se identificaron estudios de costos, costo efectividad, costo beneficio o impacto económico relacionados con los efectos que pudiera tener el uso de aditivos como el mentol en los productos de tabaco. Consideraciones de Equidad: En algunos de los estudios analizados es posible observar una gradiente socioeconómica con respecto al uso y efectos de cigarrillos mentolados, así como diferencias de género. Estudios realizados en Estados Unidos, muestran que poblaciones de bajos ingresos, asociadas a determinadas etnias o razas (afroamericanos o hispanos), tenían una mayor preferencia por consumir cigarrillos mentolados que los fumadores de raza blanca. Además, los afroamericanos y los hipanos presentaban una mayor asociación con dependencia a la nicotina que los blancos. Por su parte, las mujeres tienden a fumar más cigarrillos mentolados que los hombres (22,27). Respecto a los daños en salud, no se observaron diferencias entre por sexo o color de piel una vez que se ajustaban los resultados por cantidad de consumo y otras potenciales variables confusoras, ni en el grupo que fumana tabaco con mentol como el que no añadía mentol (13,30­42). Consideraciones de Monitoreo y Evaluación: La evidencia encontrada para esta síntesis es de baja o muy baja certeza en la evidencia. Se requieren más estudios a nivel nacional e internacional que permitan asignar aleatoriamente la exposición al cigarrillo mentolado o saborizado, en un grupo de intervención y un grupo control. De esta manera, aislar el efecto del aditivo y reducir el sesgo que pueden implicar las diferencias en las características de los participantes, entre otras variables confusoras. Desarrollar mayor evidencia a nivel local es fundamental para informar de manera adecuada decisiones que apunten a regular o prohibir el contenido de aditivos en los productos de tabaco, fortaleciendo así el conjunto de políticas y medidas que Chile ya ha aplicado en el marco del control del tabaco para proteger a la población.


Asunto(s)
Humanos , Tabaco/efectos de los fármacos , Uso de Tabaco , Aromatizantes , Mentol , Evaluación de la Tecnología Biomédica , Evaluación en Salud
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